Abstract
The Integrated Management of Childhood Illnesses (IMCI) strategy, d'E7veloped by the World Health Organisation (WHO) and the United Nations Children's Fund (Unicef) to improve child survival, was implemented in South AfriCa In 1996. The c1inicai component aims to improve the case management skills of health, workers through the use of a set of guidelines embedded in an algorithm. This evaluation study sought to assess the accuracy of the use of the algorithm by IMCI-trained nurses in public sector clinics in KwaZulu-Natal Province. Eight nurses were selected through a two-phase sampling strategy. They were assessed for a total of 72 consultations, using the original WHO checklist tool and a revised checklist. The findings confirmed an earlier WHO/Unicef/KwaZulu-Natal Department of Health (DoH) evaluation that the level of performance was generally poor. The algorithm is designed for dealing with children who present with multiple problems, given the prevalence of HIV in the region, but most nurses only assessed the presenting problem. On average, only six out of ten key tasks were conducted. Fever, and ear and nutritional problems were poorly handled. Inadequate support for the use of the algorithm in the work setting, due to the incomplete implementation of other IMCI components, could account for the poor accuracy of the use of the IMCI algorithm.