Assessment of Implementation of Integrated Management of Childhood Illnesses in Primary Health Care Centers/ Baghdad 2021


  • Zainab Qais Said Al-Sabbagh M. B. Ch. B., C. A. B. M. S. Family medicine. AlRusafa Health Directorate / Iraq
  • Samir Hameed Wannas M. B. Ch. B., F. I. C. M. S. Hematopathology. Al-Rusafa Health Directorate/Iraq
  • Zina Salah Najeeb Al-Omer B.Sc. Pharmacy. Master’s in clinical laboratory science. Ph.D. Degree of science in pharmacy/ clinical laboratory science. Al-Rusafa Health Directorate/ Iraq
  • Zaid Wajih Awad Hasan M. B. Ch. B. Iraq - FETP Graduate – High Diploma in Field Epidemiology General Directorate of Public Health/ Iraq


IMCI, Baghdad, PHCCs, Under-five deaths


Background: Every year some 12 million children in developing countries die before they reach
their fifth birthday. Seven in ten of these deaths are due to acute respiratory infections (mostly
pneumonia), diarrhea, measles, malaria, or malnutrition. The IMCI was developed in response to
many global under-five deaths in low- and middle-income countries in the 1990s. This study aimed
to assess the compliance of health workers to the guiding booklet of IMCI in the management of
Methods: A cross-sectional study was conducted in the four primary healthcare centers (PHCCs)
in Baghdad for 5 months. A total of 223 children aged between 2 months to 5 years who attended
the selected four PHCCs in their initial visit were recruited. A structured questionnaire was
designed for this study, including information about the recruited children and assessment criteria
of the IMCI guiding booklet for case management.
Results: The assessment of the 6 domains of IMCI guidelines were as follows: high/perfect scores
were detected in 86.6% for cough/difficulty breathing, 100% for diarrhea, 37.6% for fever, 100%
for ear problems, 78.5% for throat problems, while weak score was detected in 71.8% for anemia
and malnutrition. Out of the 223 children, 182 (81.6%) received treatment, antibiotics were
prescribed for 99 (44.4%) of them, and (88.9%) of these cases received antibiotics according to the
IMCI guidelines. In most of the cases (94.5%) treatment administration was explained to the
patient's relative and 59.9% were asked if they understood how to administer it.
Conclusions: Adherence of physicians to IMCI guidelines regarding cough/difficulty breathing,
diarrhea, ear problems, and throat problems was high, while it was low in terms of fever and
anemia/malnutrition. We recommend the installation of an internal audit system with clear criteria
to allow evaluation of PHCCs and their employees' performance at regular intervals.


Abebe AM, Kassaw MW, Mengistu FA. Assessment of factors affecting the

implementation of integrated management of neonatal and childhood illness for treatment of underfive children by health professionals in health care facilities in Yifat Cluster in North Shewa Zone,

Amhara Region, Ethiopia. International Journal of Pediatrics. 2019;2019.

Unit. WHO Chad. Integrated Management of Childhood Illness. [28 May, 2020].

Tulloch J. Integrated approach to child health in developing countries. The Lancet. 1999;354:


Gera T, Shah D, Garner P, Richardson M, Sachdev HS. Integrated management of childhood

illness (IMCI) strategy for children under five. Cochrane Database of Systematic Reviews.


Nguyen DTK, Leung KK, McIntyre L, Ghali WA, Sauve R. Does integrated management of

childhood illness (IMCI) training improve the skills of health workers? A systematic review and

meta-analysis. PloS one. 2013;8(6): e66030.

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.

Abdulrahman A, Saleem AM. Implementation of Integrated Management of Childhood

Illness Strategies in Al Hadbaa Primary Health Care Center in Mosul City. Annals of the College

of Medicine, Mosul. 2019;41(1):75-80.

Masadeh MM, Alzoubi KH, Al-Azzam SI, Al-Agedi HS, Abu Rashid BE, Mukattash TL.

Public awareness regarding children's vaccination in Jordan. Human vaccines &

immunotherapeutics. 2014;10(6):1762-6.

Legesse E, Dechasa W. An assessment of child immunization coverage and its determinants

in Sinana District, Southeast Ethiopia. BMC Pediatrics. 2015; 15:1-14.

Centre WHOM. Iraq scales up efforts to improve maternal and child health in line with

Dubai Declaration commitments. [29 May 2020.].

Organization WH. Child and adolescent health and development: progress report 2006-

: highlights. 2008.

Nicholas D, Thomas L, Jacek S, Emmy M, Elizeus K, Brendan F, et al. Why first-level

health care workers fail to follow guidelines for managing severe disease in children in the Coast

Region, the United Republic of Tanzania. Bull World Health Organ. 2009;87(99):107.

Drobac PC, Basinga P, Condo J, Farmer PE, Finnegan KE, Hamon JK, et al.

Comprehensive and integrated district health systems strengthening: the Rwanda Population

Health Implementation and Training (PHIT) Partnership. BMC Health Services Research. 2013;


Tawfiq W A AHA-HETAK. Integrated management of childhood illnesses: the situation in

Iraq. Al-Nahrain University College of Medicine. 2009.

Leung A, Prince T, Society CP, Nutrition, Committee G. Oral rehydration therapy and early

refeeding in the management of childhood gastroenteritis. Pediatrics & Child Health.