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electronic Integrated Management of Childhood Illnesses (eIMCI)

Challenge

One in every 11 children dies before their 5th birthday and 44% of all under-five deaths occur within the first month of life. Seven in ten of these deaths are due to five childhood diseases occurring singly or in combination: acute respiratory infections, diarrhea, measles, malaria and malnutrition.

Developing countries, including Pakistan, are the major contributors to the global under-five mortality burden, and reducing under five mortality has been a challenge due to: inadequate assessment of sick and malnourished children; lack of parental counseling; unavailability of diagnostic services; equipment and supplies.

It is estimated that two thirds of child deaths globally can be prevented by using available and affordable interventions. WHO and United Nations Children’s Fund (UNICEF) developed the Integrated Management of Childhood Illnesses (IMCI) guidelineĀ  in 1992 which aims to improve coverage of essential child health interventions by improving the case management skills of health workers, strengthening the primary health system for managing sick children, diagnosis for malnutrition and other life-threatening illnesses, and promoting better family and community healthcare practices. However, implementation of IMCI guidelines is suboptimal because of a lack of understanding and planning, lack of supervision, and paucity of logistical support (including case-management forms and paper-based reporting tools).

Our Approach

IRD Pakistan partnered with Indus Hospital to pilot the electronic Integrated Management of Childhood Illnesses (eIMCI) tool in Karachi and Muzaffargarh to enroll and screen children for the major diseases that contribute to child mortality. eIMCI allows health workers to screen for co-morbidities in addition to the presenting complaints.

eIMCI incorporates an Android-based decision support system combined with an open-source case-based medical record system. eIMCI application includes both comprehensive and community modules with added features including: decision support systems (DSS), color coding for danger signs, electronic referrals, SMS reminders for FHWs and parents for upcoming visits and immunization, real-time reporting for both personnel and supervisors including activity tracking, and QR code based identification.

In order to meet the needs of Pakistanā€™s epidemiological environment, we have adapted the IMCI model in order to provide holistic care in both rural and low income communities. This adapted version incorporates additional diseases such as dengue, urinary tract infection and tuberculosis, which are not part of the standard IMCI guidelines, but do contribute to child morbidity and mortality in Pakistan.

Impact

Over the span of three years, more than 50,000 screenings have been conducted with parents and children being linked to appropriate care. In addition, we are planning to expand the eIMCI program in District Tharparkar, Sindh Pakistan.