IMPACT OF IMCI HEALTH WORKER TRAINING ON ROUTINELY COLLECTED

							IMPACT OF IMCI HEALTH WORKER TRAINING ON ROUTINELY COLLECTED CHILD
HEALTH INDICATORS IN NORTHEAST-BRAZIL

João Amaral, Alvaro Leite, Antonio Cunha, Cesar Victora

Contact
Antonio Jose Ledo Alves da Cunha
Professor of Paediatrics & Director, Institute of Paediatrics
Federal University of Rio de Janeiro
Rua Rodrigo de Brito 46 apt. 503
Botafogo
Rio de Janeiro - RJ
22280-100
Brazil

Telephone +55 21 2541-2075
Email address acunha@hucff.ufrj.br

ABSTRACT

The Integrated Management of Childhood Illness (IMCI) is a global strategy including
improvements in case-management at health facilities, strengthening health systems support
and improving key family and community practices relevant to child health. In Brazil, IMCI was
introduced in 1997, being largely restricted to training health workers in case-management.
We analyse the impact of IMCI on infant mortality in three states in North-eastern Brazil, by
comparing three groups of municipalities: 23 with strong clinical IMCI implementation, 216
with partial implementation, and 204 without IMCI, over the period 1998 to 2002. Two sources
of mortality data are used: vital registration of deaths and births, and the community health
workers’ (CHW) demographic surveillance system. The latter resulted in a larger number of
deaths being reported, and on more stable mortality rates over time than the former. Infant
mortality rates (IMR) declined rapidly according to both sources on information, during the
study period. After adjustment for confounding factors, there was no association between
clinical IMCI implementation and infant mortality measured through either information system.
The negative findings from the Brazil evaluation show that IMCI clinical training, in the
absence of the other two components of IMCI, and particularly in areas with infant mortality
around or below 50 per thousand, is unlikely to lead to a measurable impact on mortality.