MPH, Faculty of Haelth Sciences, University of the Witwatersrand, 2009 / The Integrated Management of Childhood Illness (IMCI) strategy was introduced in Zimbabwe in 1996 to integrate vertical child health care programmes. It has since expanded to cover over 300 first level health facilities out of 897 in 23 districts out of a total of 59 districts in the country. This survey was conducted to measure the quality of care delivered to sick children aged 2 months up to 5 years at first level health facilities implementing IMCI. The management of sick children was observed for 226 children aged 2 months up to 5 years who were brought to primary level health facilities. 226 interviews with child caretakers were conducted, all children included in the survey were re-examined by an experienced IMCI practitioner to ascertain the classification (diagnosis) of child’s illness and the appropriate treatment needed. Finally facilities, services and supplies were assessed in the 35 facilities visited. Seventy one percent of cases were children under 2 years old. The majority of caretakers (88%) were mothers of the sick children. All children were systematically checked for the four main symptoms, 80% of children were checked for general danger signs. About 70% of cases classified as having pneumonia received correct treatment for pneumonia. Almost 50% of cases observed received correct treatment for malaria. Half of the children observed (50%) received their 1st dose at the facility. Just less than half (48%) of the children who needed vaccines left the health facilities with all the needed vaccines. Eighty five percent of caretakers were advised on drug treatment. As a result of the advice received, almost two third (65%) of the caretakers who had been prescribed an antibiotic/antimalarial were able to correctly describe how to give the antibiotic to the iv child. The large majority of caretakers (78%) were satisfied with the health services provided. Over half (54%) of facilities visited had at least 60% of health workers trained in IMCI; 88% of children were managed by health workers who had been trained in IMCI. Drugs were available with the exception with oral rehydration salts (ORS) or sugar salt solution (SSS). Most facilities had supplies and equipment for vaccination, and most had other basic supplies and materials; IMCI chart booklets were found in 91% of facilities. Health facilities which received at least one supervisory visit that included observation of -case management in the last 6 months was only 11% indicating that supervision is not carried out on a regular basis. The management of sick children seen by providers trained in IMCI followed a systematic approach in most cases but there is room for further improvement. Drugs were used rationally. Key supportive elements of the health system were in place in the facilities visited with the exception of regular supervision. However only 38% needing urgent referral were identified and prescribed urgent referral. Weaknesses were also observed in the management of diarrhea, fever and in counseling the caretaker. Only 15% of caretakers were given or shown the mothers card as a job aid and only 23% of caretakers were told on when to return immediately. The IMCI strategy has the potential to act as a powerful channel to improve the quality of services. As the survey was unable to determine reasons for poor performance observed, further research is required to investigate the factors leading to poor health worker performance.

Doctor Scientiae / Neuroblastoma is the most common extracranial solid tumor in childhood. The survival rates of patients with neuroblastoma, especially those in the high-risk category, are still low despite varied therapies. The detailed understanding of the molecular mechanisms underlying the pathogenesis of neuroblastoma is essential to develop better therapeutics and improve the poor survival rates. This study provides a multi-omic analysis of neuroblastoma datasets from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) neuroblastoma project and the Gene Expression Omnibus (GEO) data portals to better understand the molecular mechanisms of neuroblastoma.

Published Article / The aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training.

Numerous findings have suggested that the increased prevalence of childhood illnesses such as cancer, infection, and allergy may be due to environmental exposures. One such cause may be maternal smoking or passive smoke exposure. Known immunotoxicants in cigarette smoke and environmental pollution include polycyclic aromatic hydrocarbons such as 1,2:5,6 Dibenzanthracene (DBA). The objective of these studies was to evaluate the immunosuppressive effects of DBA on various stages of immune system development. Adult mice were administered DBA daily in corn oil at dose levels of 158, 500, 1580, and 5000 µglkg S.C. for 28 days. Immunosuppression was not observed at levels less than 5000 µgkg in the following immune parameters: NK cell activity, anti-CD3 antibody-mediated proliferation and mixed-leukocyte response. In contrast, holistic assays such as the PFC response to the T-dependent antigen, sRBC and the delayed type hypersensitivity response were significantly suppressed at dose levels of 500 µglkg and greater. Mice exposed to DBA in utero and through lactation showed neither immunosuppressive nor sex differences among the immune parameters tested when evaluated at weaning, postnatal day (PND) 21, or when evaluated at sexual maturity (PND 42). Transference of DBA metabolites from mother to pup is suggested by HPLC analysis of milk extracted from PND 8 pups. In contrast, juvenile mice administered DBA beginning on PND 21 at dose levels from 0.25 to 2500 µgkg for 28 days demonstrated a dose-dependent suppression (43-79%) of the PFC assay, statistically significant at or above the 2.5 µglkg dose level. Neither immunosuppressive nor sex differences were observed among the various other immune parameters evaluated. Collectively, these studies indicate that the juvenile life stage in B6C3F1 mice is the most vulnerable to DBA-induced immunotoxicity with a 200-fold enhancement in immunosuppression of the PFC response as compared to adult mice. These studies provide insight into how environmental contaminants, such as DBA, may impact children's health.

Introduction The Integrated Management of Childhood Illness (IMCI) is a multicomponent health system strengthening initiative widely adopted in Sub-Saharan Africa to improve poor child health outcomes. Implementation and subsequent evaluation have largely centered on the clinical management component. This study examines the clinical component in tandem with the facility improvement component, while capturing aspects of the community component over a ten year period. Methods The study utilizes a modified Donabedian quality measurement model where expected outcomes are a function of the process and structural components of healthcare quality which corresponds respectively to the clinical management and facility improvement components of the IMCI strategy. The data source is the Demographic Health Survey-Services Provision Assessment on Kenya for years 1999, 2004 and 2010 and it consists of a sample of 3,884 children and their caretakers seeking care at 1,523 health facilities. Bivariate analyses examine the change in health quality indicators and the quality indices (aggregated quality indicators) over time. Then negative binomial models assess the effect of the process and structural quality indices on the Caretaker Perceived Quality of Care (CPQoC) over time. Results Since IMCI implementation in Kenya, the clinical management and facility improvement indicators have not followed a pattern of consistent improvement while the quality indices increased consistently over time. The technical aspects of care have a higher effect on the CPQoC than the structural aspects and some of the interpersonal aspects of care were statistically significant. Privately managed facilities showed the highest impact while access to care had no impact on the CPQoC. Conclusion The findings underscore the importance of clinical management while recognizing the importance of the facility and community components of the IMCI. Revising the strategy to encourage implementation of all components with increased emphasis on the community components as well as ownership from national governments can improve child health outcomes in the region. / 1 / Felicia Aurora Osenkor Amoah

No description available.

O presente estudo teve como objetivo descrever e apreender as contribuições da estratégia atenção integrada às doenças prevalentes na infância (AIDPI) para o acolhimento realizado por profissionais de enfermagem às crianças menores de cinco anos de idade em uma unidade de saúde da família (USF). Trata-se de um estudo descritivo com abordagem qualitativa em saúde, realizado em uma USF da cidade de Ribeirão Preto, SP. Os dados foram coletados em duas etapas, através de observação participante. A primeira etapa ocorreu durante uma experiência de educação permanente (EP) com a equipe de saúde da família, enfocando o acolhimento realizado na unidade e a AIDPI, com dados registrados em diário de campo. A segunda etapa ocorreu durante a implantação de uma estratégia de acolhimento embasada em aspectos da AIDPI, realizada por profissionais de enfermagem, sendo os dados sobre o acolhimento a 30 crianças registrados em roteiro e diário de campo. Durante as discussões da EP, emergiram questões relacionadas à demanda espontânea, à maneira como a equipe lida com essa demanda, ao acolhimento, ao resgate dos espaços coletivos de ação e à necessidade de capacitação dos profissionais para o acolhimento. Visando atender à demanda da população infantil por atendimentos não-agendados, buscou-se, durante a EP, estruturar o acolhimento às crianças menores de cinco anos de idade, através de aspectos da AIDPI, após a apresentação dessa estratégia à equipe, enfocando o trabalho dos profissionais de enfermagem. Com o intuito de apreender o processo de implantação desse acolhimento, os dados coletados na segunda etapa foram descritos e explorados segundo três temas: comunicação e atitudes promotoras de vínculo; anamnese e avaliação clínica; e resolutividade. Os profissionais de enfermagem demonstraram atitude de escuta comprometida e preocupação com a continuidade do processo de trabalho na equipe. Forneceram orientações claras ao cuidador, embora algumas estratégias de comunicação tenham sido pouco utilizadas. Revelou-se uma maior atuação da enfermagem na avaliação da criança. No entanto, a utilização do gráfico de crescimento e o levantamento de hábitos de saúde e questões alimentares necessitam ser mais bem explorados. Foram identificadas situações prioritárias e outros problemas além da queixa inicial, agilizando as ações. As principais dificuldades relacionaram-se à inadequação do espaço físico e à continuidade desse acolhimento qualificado pela AIDPI no cotidiano do serviço. Considera-se que a experiência contribuiu para um trabalho em equipe contínuo, que promoveu o manejo adequado dos casos e organizou o atendimento às crianças que chegam ao serviço para atendimento não agendado. Apontamos a necessidade da incorporação da EP na filosofia de trabalho da unidade, como forma de contribuir para o aprimoramento e continuidade desse acolhimento, no processo de trabalho cotidiano e com a saída e inclusão de membros na equipe. / This study aimed to describe and learn about the contributions of the Integrated Management of Childhood Illness (IMCI) strategy to the welcoming of children under five years old in a Family Health Unit (FHU) by nursing professionals. This is a descriptive health study with a qualitative approach, carried out in a FHU in Ribeirão Preto, São Paulo, Brazil. Data were collected in two stages through participant observation. The first stage occurred during a permanent education (PE) experience with the family health team, which focused on the welcoming performed in the unit and the IMCI. Data about this stage were recorded in a field diary. The second stage occurred during the implementation of a welcoming strategy based on IMCI aspects, performed by nursing professionals. Data about the welcoming of 30 children were recorded in a script and field diary. During PE discussions, some questions emerged related to the spontaneous demand, to the ways the team dealt with this demand, the welcoming, the rescuing of collective spaces of action and to the need to train professionals for welcoming. With a view to attending to the infant population?s demands for non-scheduled care, during PE, we tried to structure the welcoming of children under five years old according to IMCI aspects, after presenting this strategy to the team, with a focus on nursing professionals? work. In order to apprehend the implementation of this welcoming, data collected data in the second stage were described and explored according to three themes: communication and bond-promoting attitudes; medical history taking and clinical assessment; and problem solving capacity. The nursing professionals listened attentively and demonstrated concern regarding the continuity of the work process in the team. They provided clear orientation to caregivers, although some communication strategies were underused. It was demonstrated that nurses are more active in child assessment. However, the use of the growth chart and surveys of health and eating habits should be better explored. Besides initial complaints, priority situations and other problems were identified, streamlining actions. The main difficulties were related to inadequate physical space and the continuity of this welcoming qualified by IMCI in routine care. The experience contributed to continuous team work, promoted adequate case management and organized the attendance of non-scheduled demands. Permanent education needs to be incorporated into the units work philosophy, as a way to contribute to the improvement and continuity of this welcoming in the daily work process and in view of the turnover of team members.

O presente estudo teve como objetivo descrever e apreender as contribuições da estratégia atenção integrada às doenças prevalentes na infância (AIDPI) para o acolhimento realizado por profissionais de enfermagem às crianças menores de cinco anos de idade em uma unidade de saúde da família (USF). Trata-se de um estudo descritivo com abordagem qualitativa em saúde, realizado em uma USF da cidade de Ribeirão Preto, SP. Os dados foram coletados em duas etapas, através de observação participante. A primeira etapa ocorreu durante uma experiência de educação permanente (EP) com a equipe de saúde da família, enfocando o acolhimento realizado na unidade e a AIDPI, com dados registrados em diário de campo. A segunda etapa ocorreu durante a implantação de uma estratégia de acolhimento embasada em aspectos da AIDPI, realizada por profissionais de enfermagem, sendo os dados sobre o acolhimento a 30 crianças registrados em roteiro e diário de campo. Durante as discussões da EP, emergiram questões relacionadas à demanda espontânea, à maneira como a equipe lida com essa demanda, ao acolhimento, ao resgate dos espaços coletivos de ação e à necessidade de capacitação dos profissionais para o acolhimento. Visando atender à demanda da população infantil por atendimentos não-agendados, buscou-se, durante a EP, estruturar o acolhimento às crianças menores de cinco anos de idade, através de aspectos da AIDPI, após a apresentação dessa estratégia à equipe, enfocando o trabalho dos profissionais de enfermagem. Com o intuito de apreender o processo de implantação desse acolhimento, os dados coletados na segunda etapa foram descritos e explorados segundo três temas: comunicação e atitudes promotoras de vínculo; anamnese e avaliação clínica; e resolutividade. Os profissionais de enfermagem demonstraram atitude de escuta comprometida e preocupação com a continuidade do processo de trabalho na equipe. Forneceram orientações claras ao cuidador, embora algumas estratégias de comunicação tenham sido pouco utilizadas. Revelou-se uma maior atuação da enfermagem na avaliação da criança. No entanto, a utilização do gráfico de crescimento e o levantamento de hábitos de saúde e questões alimentares necessitam ser mais bem explorados. Foram identificadas situações prioritárias e outros problemas além da queixa inicial, agilizando as ações. As principais dificuldades relacionaram-se à inadequação do espaço físico e à continuidade desse acolhimento qualificado pela AIDPI no cotidiano do serviço. Considera-se que a experiência contribuiu para um trabalho em equipe contínuo, que promoveu o manejo adequado dos casos e organizou o atendimento às crianças que chegam ao serviço para atendimento não agendado. Apontamos a necessidade da incorporação da EP na filosofia de trabalho da unidade, como forma de contribuir para o aprimoramento e continuidade desse acolhimento, no processo de trabalho cotidiano e com a saída e inclusão de membros na equipe. / This study aimed to describe and learn about the contributions of the Integrated Management of Childhood Illness (IMCI) strategy to the welcoming of children under five years old in a Family Health Unit (FHU) by nursing professionals. This is a descriptive health study with a qualitative approach, carried out in a FHU in Ribeirão Preto, São Paulo, Brazil. Data were collected in two stages through participant observation. The first stage occurred during a permanent education (PE) experience with the family health team, which focused on the welcoming performed in the unit and the IMCI. Data about this stage were recorded in a field diary. The second stage occurred during the implementation of a welcoming strategy based on IMCI aspects, performed by nursing professionals. Data about the welcoming of 30 children were recorded in a script and field diary. During PE discussions, some questions emerged related to the spontaneous demand, to the ways the team dealt with this demand, the welcoming, the rescuing of collective spaces of action and to the need to train professionals for welcoming. With a view to attending to the infant population?s demands for non-scheduled care, during PE, we tried to structure the welcoming of children under five years old according to IMCI aspects, after presenting this strategy to the team, with a focus on nursing professionals? work. In order to apprehend the implementation of this welcoming, data collected data in the second stage were described and explored according to three themes: communication and bond-promoting attitudes; medical history taking and clinical assessment; and problem solving capacity. The nursing professionals listened attentively and demonstrated concern regarding the continuity of the work process in the team. They provided clear orientation to caregivers, although some communication strategies were underused. It was demonstrated that nurses are more active in child assessment. However, the use of the growth chart and surveys of health and eating habits should be better explored. Besides initial complaints, priority situations and other problems were identified, streamlining actions. The main difficulties were related to inadequate physical space and the continuity of this welcoming qualified by IMCI in routine care. The experience contributed to continuous team work, promoted adequate case management and organized the attendance of non-scheduled demands. Permanent education needs to be incorporated into the units work philosophy, as a way to contribute to the improvement and continuity of this welcoming in the daily work process and in view of the turnover of team members.

BACKGROUND: Ethiopia adopted a new strategy called integrated community case management to address common childhood illness (ICCM). This strategy has been introduced in some rural districts of Bale zone. It has multiple functions, involving assessment of sick children at community health post levels. Despite this, the efficacy of this strategy has not been investigated. Aim: This study aimed to assess the level of ICCM service utilisation and factors influencing this at health posts in Agarfa district. METHODS: Cross sectional and phenomenological methodologies were employed in this study. Data were collected from 401 mothers using questionnaires and 29 participants using in-depth interviews. Quantitative data were analysed using both descriptive and inferential statistical approaches. Thematic analysis was used for the qualitative data. RESULT: The utilsation of ICCM services is limited among caregivers in rural communities. There is a range of factors responsible for the limited utilisation. Examples of these include absence of health extension workers at health posts, caregivers’ negative perception of ICCM service, socio-cultural factors, level of education and household finance. The most common childhood illnesses noted were diarrhoea, followed by fever and cough. Caregivers seek help from HEWs at health posts two or more days after idenfying signs and symptoms of these illnesses. CONCLUSION: Behavioural messages to address prevailing negative attitudes and socio-economic barriers to accessing health care would help improve uptake of ICCM services / Health Studies / M.A. (Public Health)

Ethiopia adopted a new strategy called integrated community case management to address common childhood illness (ICCM). This strategy has been introduced in some rural districts of Bale zone. It has multiple functions, involving assessment of sick children at community health post levels. Despite this, the efficacy of this strategy has not been investigated. Aim: This study aimed to assess the level of ICCM service utilisation and factors influencing this at health posts in Agarfa district. METHODS: Cross sectional and phenomenological methodologies were employed in this study. Data were collected from 401 mothers using questionnaires and 29 participants using in-depth interviews. Quantitative data were analysed using both descriptive and inferential statistical approaches. Thematic analysis was used for the qualitative data. RESULT: The utilsation of ICCM services is limited among caregivers in rural communities. There is a range of factors responsible for the limited utilisation. Examples of these include absence of health extension workers at health posts, caregivers’ negative perception of ICCM service, socio-cultural factors, level of education and household finance. The most common childhood illnesses noted were diarrhoea, followed by fever and cough. Caregivers seek help from HEWs at health posts two or more days after idenfying signs and symptoms of these illnesses. CONCLUSION: Behavioural messages to address prevailing negative attitudes and socio-economic barriers to accessing health care would help improve uptake of ICCM services / Health Studies / M. A. (Public Health)