NON-PARTICIPATORY OBSERVATION OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS PRACTICES AT SELECTED BASIC HEALTH UNITS OF DISTRICT ABBOTTABAD, KP, PAKISTAN: A QUALITATIVE HERMENEUTIC STUDY

Authors

  • Saidul Abrar Department of Community Medicine, Gajju Khan Medical College Swabi
  • Assad Hafeez WHO country office, Kuwait
  • Muhammad Naseem Khan Department of Population Medicine, Qatar University-Qatar
  • Sana Rahim Al-Sayed Children Hospital Mardan
  • Yasir Ali Department of Community Medicine, Makran Medical College Turbat
  • Rubina Bibi Department of Community Medicine, Women Medical College Abbottabad

DOI:

https://doi.org/10.55519/JAMC-03-10839

Keywords:

IMCI, dIMCI, Qualitative, Non-Participatory Observation, Hermeneutics, Pakistan

Abstract

Background: It was in 1995 when a strategy was devised with the intent to reduce under-five mortality in countries having a prevalence of child mortality above 40/1000 live births. This strategy is called “integrated management of childhood illness” (IMCI). Improvement in the skills of healthcare workers (HCWs) depends on the IMCI training received by them. To make IMCI training more effective and scale up, a global technical consultation committee in Geneva recommended implementing an innovative training approach in 2014: the distance learning IMCI (dIMCI). This study was conducted to observe qualitatively the practices of IMCI-trained HCWs at their respective workplaces. Methods: This qualitative hermeneutic study was conducted through non-probability criterion sampling in the district Abbottabad of Pakistan on all 26 basic health units trained in IMCI (either standard or distance learning) from December 9, 2019, to March 9, 2020. Data collection was done by qualitatively observing consultations and interactions of caretakers of under-five children at basic health units. Inductive thematic analysis was used. This qualitative exploration was underpinned by Hans Georg Gadamer’s philosophy of hermeneutics. Results: Four themes emerged from the observation notes. These themes are gratification after consultation, altercation for medication, non-observance of protocol, and methodical consultation. Conclusion: Improvement in the skills of HCWs in the form of IMCI training, either through distance learning or the common eleven-day standard method, can improve caretakers’ satisfaction. However, awareness at the community level is needed for better compliance.

References

WHO. Children: improving survival and well-being 2020. [Internet]. [cited 2020 Dec 11]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/children-reducing-mortality

WHO. Deliver now for women plus children 2005. [Internet]. [cited 2020 Dec 12]. Available from: https://www.who.int/pmnch/activities/dn_fs_childmortality.pdf

WHO. Towards a Grand Convergencefor Child Survival and Health 2016. [Internet]. [cited 2020 Dec 12]. Available from: https://www.who.int/publications/i/item/towards-a-grand-convergence-for-child-survival-and-health

Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 1997;75(Suppl 1):7–24.

Boschi-Pinto C, Labadie G, Dilip TR, Oliphant N, Dalglish SL, Aboubaker S, et al. Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on. BMJ Open 2018;8(7):e019079.

Bryce J, Victora CG, Habicht JP, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Health Policy Plan 2005;20(Suppl 1):i5–17.

WHO. Child health and development 2014. [Internet]. [cited 2019 April 13]. Available from: http://www.emro.who.int/child-health/imci-strategy/three-components

WHO. IMCI Distance Learning Course:Implementation – Introduction and Roll Out 2014. [Internet]. World Health Organization. [cited 2017 Feb 23]. Available from: https://apps.who.int/iris/bitstream/handle/10665/104772/9789241506823_Introduction_roll-out_eng.pdf?sequence=14

ChiCTR. Trial Search 2019. [Internet]. [cited 2020 December 14]. Available from: http://www.chictr.org.cn/searchprojen.aspx?title=&officialname=&subjectid=&secondaryid=&applier=&studyleader=&ethicalcommitteesanction=&sponsor=&studyailment=&studyailmentcode=&studytype=0&studystage=0&studydesign=0&minstudyexecutetime=&maxstudyexecutetime=&recruitmentstatus=0&gender=0&agreetosign=&secsponsor=&regno=1900027201&regstatus=0&country=&province=&city=&institution=&institutionlevel=&measure=&intercode=&sourceofspends=&createyear=0&isuploadrf=&whetherpublic=&btngo=btn&verifycode=&page=1

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19(6):349–57.

Gadamer H. Gadamer Truth and Method. 2nd ed. London UK: Continuum Group; 2006.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77–101.

Fleming V, Gaidys U, Robb Y. Hermeneutic research in nursing: developing a Gadamerian-based research method. Nurs Inq 2003;10(2):113–20.

Shaamekhi HR, Jafarabadi MA, Alizadeh M. Demographic determinants of self-medication in the population covered by health centers in Tabriz. Health Promot Perspect 2019;9(3):181–90.

Sridhar SB, Shariff A, Dallah L, Anas D, Ayman M, Rao PG. Assessment of Nature, Reasons, and Consequences of Self-medication Practice among General Population of Ras Al-Khaimah, UAE. Int J Appl Basic Med Res 2018;8(1):3–8.

Horumpende PG, Said SH, Mazuguni FS, Antony ML, Kumburu HH, Sonda TB, et al. Prevalence, determinants and knowledge of antibacterial self-medication: A cross sectional study in North-eastern Tanzania. PLoS One 2018;13(10):e0206623.

Kassie AD, Bifftu BB, Mekonnen HS. Self-medication practice and associated factors among adult household members in Meket district, Northeast Ethiopia, 2017. BMC Pharmacol Toxicol 2018;19(1):15.

Getachew T, Abebe SM, Yitayal M, Persson L, Berhanu D. Assessing the quality of care in sick child services at health facilities in Ethiopia. BMC Health Serv Res 2020;20(1):574.

Reñosa MD, Bärnighausen K, Dalglish SL, Tallo VL, Landicho-Guevarra J, Demonteverde MP, et al. "The staff are not motivated anymore": Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI) program in the Philippines. BMC Health Serv Res 2021;21(1):270.

Simon B, Kazaura M. Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study. Patient Prefer Adherence 2020;14:1445–53.

Okunola OA. Patterns of Self-medication Practices by Caregivers to Under-five Children in South-Western Nigeria. Child Care Pract 2020;10:1–11.

Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ 1998;317(7159):637–42.

Cole A. GPs feel pressurised to prescribe unnecessary antibiotics, survey finds. BMJ 2014;349:g5238.

Atif M, Azeem M, Rehan Sarwar M, Malik I, Ahmad W, Hassan F, et al. Evaluation of prescription errors and prescribing indicators in the private practices in Bahawalpur, Pakistan. J Chin Med Assoc 2018;81(5):444–9.

Edward A, Dam K, Chege J, Ghee AE, Zare H, Chhorvann C. Measuring pediatric quality of care in rural clinics—a multi-country assessment—Cambodia, Guatemala, Zambia and Kenya. Int J Qual Health Care 2016;28(5):586–93.

Krüger C, Heinzel-Gutenbrunner M, Ali M. Adherence to the integrated management of childhood illness guidelines in Namibia, Kenya, Tanzania and Uganda: evidence from the national service provision assessment surveys. BMC Health Serv Res 2017;17(1):822.

Additional Files

Published

2023-08-10

Most read articles by the same author(s)