Background: Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI)\nguidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income\ncountries, child mortality remains high in many settings. One possible explanation of the continued high mortality\nburden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of\nchildren with severe illness in the Democratic Republic of the Congo (DRC).\nMethods: One thousand one hundred eighty under-five clinical visits were observed across a regionally\nrepresentative sample of 321 facilities in the DRC. Based on a detailed list of disease symptoms observed, patients\nwith severe febrile disease (including malaria), severe pneumonia, and severe dehydration were identified. For all\nthree disease categories, treatments were then compared to recommended case management following IMCI\nguidelines.\nResults: Out of 1180 under-five consultations observed, 332 patients (28%) had signs of severe febrile disease, 189\npatients (16%) had signs of severe pneumonia, and 19 patients (2%) had signs of severe dehydration. Overall,\nproviders gave the IMCI-recommended treatment in 42% of cases of these three severe diseases. Less than 15% of\nchildren with severe disease were recommended to receive in-patient care either in the facility they visited or in a\nhigher-level facility.\nConclusions: These results suggest that adherence to IMCI protocols for severe disease remains remarkably low in\nthe DRC. There is a critical need to identify and implement effective approaches for improving the quality of care\nfor severely ill children in settings with high child mortality.
Loading....