IMPACT OF IMCI HEALTH WORKER TRAINING ON ROUTINELY COLLECTED
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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 firstname.lastname@example.org 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.