The effect of an automated integrated management of childhood illness guideline on the training of professional nurses in the Western Cape, South Africa

Abstract

Background: Reducing under-five mortality rates is a global priority. Although under-five mortality has decreased in South Africa, it is still unacceptably high. The implementation of the Integrated Management of Childhood Illness (IMCI) guideline is a key World Health Organization intervention aimed at reducing under-five mortality. Most primary care consultations are with professional nurses and they are usually trained in IMCI in a year-long primary healthcare diploma, which qualifies them to be a clinical nurse practitioner. This study aimed to evaluate the effect on training outcomes of introducing an automated IMCI guideline. Methods: Thirty professional nurses enrolled for the diploma course were purposively allocated in a quasi-experimental design to train with either paper-based or automated versions of the guideline. Their knowledge of IMCI was evaluated before and after the initial 12 hours of classroom teaching. Data on assessment, classification and management of children was extracted from the medical records of their consultations during supervised clinical training. Results: Both groups improved their knowledge of IMCI, but were not significantly different at the end of classroom teaching. Nurses in the automated group performed significantly better in use of the IMCI guideline (p < 0.05): checking immunisations (68% vs. 93%), making a complete assessment (62% vs 100%), prescribing correct medication (50% vs 85%) and correct dose (42% vs 85%). Conclusion: Use of automated IMCI guidelines showed potential for improved training outcomes. The potential for improved quality of care and clinical outcomes needs to be further studied along with a cost–benefit analysis. (Full text available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2015; DOI: 10.1080/20786190.2014.995914