Primary Care Physicians’ Adherence To IMCI Guidelines , Ismailia , Egypt

Hanan Abbas Abdo, Mohammed Hany Kamel, Norhan Seif


Introduction:  The health of children under five remains worrying in developing countries. Between 1990 and 2015, WHO and UNIC EF, have designed a strategy known as Integrated Management of Childhood Illness (IMCI). It includes a set of clinical guidelines designed for use in resource-limited countries by health care workers. The factors involved in a physician's adherence to guidelines include, lack of familiarity, characteristics of the health care practice setting, physician perception of guidelines' usefulness, and incentives. Aim: is  To improve physician adherence to IMCI guidelines. Methodology: a direct observation checklist was used to assess physician adherence to IMCI guidelines at child encounter, while another questionnaire was used to assess physician perception of IMCI at Primary care setting. Results: physicians’ performance and adherence to IMCI protocol was; 100% of physicians achieved accepted performance in both classification & treatment, 86.1% had accepted performance in evaluation of cases but 0% achieved accepted performance in communication; and so the total performance (overall adherence) accepted in only 41.7% of physicians. Conclusion: family physicians should be required to undergo frequent IMCI training with special attention to communication tips, Post training follow up conducted to determine the gap in training, providing practice manual of IMCI protocol as well as ensuring available equipments of IMCI guidelines in the PHCU.


IMCI, physician adherence, guidelines, factors affecting adherence

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World health report (1999), making a difference. Geneva, World Health Organization. Report of the Division of Child Health and Development (1996-1998). Geneva, World Health Organization.

Chessare JB (1998). Teaching clinical decision-making to pediatric residents in an era of managed care. Pediatrics, 101 (4 Pt), 762-766.

Grilli R, Penna A, Zola P, Liberati A. (1996) Physicians' view of practice guidelines. A survey of Italian physicians. Soc Sci Med; 43:1283-1287.

Oxman AD, Sackett DL, Guyatt GH. (1993) Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA; 270:2093- 2095.

Guyatt GH, Sackett DL, Cook DJ. (1993) Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA; 270:2598-2601.

Jaeschke R, Guyatt G, Sackett DL. (1994) Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence- Based Medicine Working Group. JAMA; 271:389-391.

Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V. (1994) Users' guides to the medical literature. IV. How to use an article about harm. Evidence-Based Medicine Working Group. JAMA; 271:1615-1619.

Laupacis A, Wells G, Richardson WS, Tugwell P. (1994) Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA; 272:234-237.

Cohen SJ, Halvorson HW, Gosselink CA (1996). Changing physician behavior to improve disease prevention. Prev Med; 23:284-291.

McColl A, Smith H, White P, Field J. (1998) General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey. BMJ; 316:361-365.

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. (1999) Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA; 282:1458-1465.

Dahlberg K. (2000) Reasons physicians do not follow clinical practice guidelines. JAMA; 283:1686

Oxman AD, Thomson MA, Davis DA, Haynes RB. (1995) No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ; 153:1423-1431.

Lin, Y.S., Tavrow, P. (2000) Assessing Health Worker Performance of IMCI in Kenya. Quality Assurance Project..

Parimi, N., Pereira, P., Prabhakar, P. (2004) Caregivers' Practices, Knowledge, and Beliefs of Antibiotics in Pediatric Upper Respiratory Tract Infections in Trinidad and Tobago: A Cross-Sectional Study, PubMed Central.

BALBON (2009) adherence to IMCI-ARI protocol by public health workers in Zamboanga city. ADZU-SOM RESEARCHES/MPH/2009

Pichel, J.R. (1998) Health Workers’ Diagnosis and Management of Patients with ARI Based on the ARI Case Management Chart, Ateneo de Zamboanga Medical School Foundation, Zamboanga City.

Healthcare Administration Section, Use of Clinical Practice Guidelines, Adherence by Physicians with Clinical Practice Guidelines (2008).

Evaluation report of the Integrated Management of Childhood Illness (IMCI) strategy in the District of Kirehe, Eastern Province in Rwanda, November 2008.

Mullei K, Wafula F, Goodman C (2008) A Case Study of Integrated Management of Childhood Illness (IMCI) Implementation in Kenya. Kenya, Nairobi.

Sabra M. Ahmed (2012). Assessment of Health Services Provided for Children by Rural Health Units of Assiut Governorate. Journal of American Science (2013) ;9(2)

S.E. Arifeen, Bryce J, Gouws E, et al.(2004) Quality of care for under-fives in first-level health facilities in one district of Bangladesh. Bulletin of the World Health Organization | April 2005, 83 (4).

Pasumbal, E.D., Tiu, D.M., Peña, A.C. (2004) The Utilization of the Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community Acquired Pneumonia Among Internists at St. Luke’s Medical Center

Hermida J, Nicholas D, Blumenfeld D, et al. (1994) Comparative Validity of Three Methods for Assessment of the Quality of Primary Health Care: Guatemala Field Study. 1994.



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