Providers’ Concerns About 2018 IMNCI Revised Guidelines and Recommendations for Future Revision
| Category | Provider Concern | Recommendations |
|---|---|---|
| Day 2 follow-up | Many caregivers bringing infants on day 2 to receive second dose of gentamycin tended to bypass consultation rooms and went directly to the injection rooms. Therefore, the SYIs missed the mandatory day 2 assessment. Partners felt that the day 2 assessment of the SYI was critical to ensure quality service provision. | Health providers to educate caregivers to return SYIs on day 2 for review before the second dose of gentamycin is administered. |
| Day 4 follow-up | Fewer caregivers returned their SYIs for review on day 4 because they felt their infants’ condition had improved, despite the guidelines requiring caregivers to bring back SYIs for review. | Health providers to educate caregivers on the need to return SYIs on day 4 for review to document whether the SYI’s condition is improving, has remained the same, or is deteriorating. |
| Assessment | The National IMNCI Chart Booklet lists 18 signs to be used in assessment of SYIs with PSBI, compared to 7 signs for assessment of SYIs in the PSBI section. | Revise the national IMNCI and PSBI materials to harmonize the signs and symptoms for assessment of SYIs. |
| Classification | The National IMNCI Chart Booklet lists 11 signs for critical illness, compared to 6 signs under critical illness in the PSBI section. | Revise the national IMNCI and PSBI materials to harmonize the signs and symptoms for classification of critical illness in infants presenting with PSBI. |
| Fast breathing | The National IMNCI Chart Booklet lumps together all infants aged 0–59 days with signs of fast breathing, compared to the PSBI section that makes a distinction between fast breathing in infants aged 0–6 days and infants aged 7–59 days. | Revise the national IMNCI and PSBI materials to distinguish fast breathing between infants aged 0–6 days and aged 7–59 days. Infants aged 0–6 days with fast breathing need to be referred for inpatient treatment. If referral is declined, treat as outpatient with oral amoxycillin daily for 7 days. Infants aged 7–59 days with fast breathing need to be treated in outpatient settings. Review on day 4 is mandatory for both groups. |
| Temperature | The National IMNCI Chart Booklet indicates temperature for fever as “Fever 37.5°C or above or feels hot,” compared to the PSBI section that indicate temperature for fever as “38°C” or more. | Revise the national IMNCI and PSBI materials to harmonize the value of temperature/fever. |
Abbreviations: IMNCI, integrated management of newborn and childhood illnesses; PSBI, possible serious bacterial infection; SYI, sick young infant.