Implementation of the strategy of integrated management of childhood illnesses [Aplicación de la estrategia de Atención Integral de Enfermedades Prevalentes de la Infancia en Ecuador]

Abstract

Introduction: the strategy of Integrated Management of Childhood Illnesses (IMCI) developed by the World health Organization and the UNICEF is aimed at reducing infant mortality and at promoting the rational use of antibiotics. Objective: to evaluate the performance of the above-mentioned strategy for children with acute respiratory infections in Ecuador, in terms of diagnosis and treatment, particularly antibiotic therapy. Methods: the medical histories of patients aged two months to five-years old, who had been diagnosed with ARI and treated at 2 primary health care centers in urban or rural areas in the period of July 2010 through June 2011, were checked. Data about the characteristics of the patients, the diagnosis and the treatment followed were retrospectively collected. Results: in both primary health centers and in most of the medical records, information about the lines of treatment and administration of antibiotics was missing. Data collected on 1 063 patients revealed that over-prescription of antibiotics occurred more frequently in health centers located in rural areas (6.5 %). Conclusion: future research should focus on identifying the causes of failure in the IMCI implementation. The inaccessibility to health centers may be an example of associated causes, especially in rural areas. The contextualization of the IMCI strategy may be needed to improve child health, to promote the rational use of antibiotics and to reduce the spread of antimicrobial resistance.