Table 5.
Adherence to clinical assessment by IMCI chart
| IMCI chart | Task: Questions to address to the mother or examinations to perform | Baseline | Control arm | Intervention arm | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | % | 95%CI | N | % | 95%CI | N | % | 95%CI | |||||
| Danger signs b | Ask if the child is able to drink/breastfeed | 686 | 15.9 | 9.2 | 26.1 | 1343 | 28.7 | 20.4 | 38.8 | 695 | 94.5 | 75.1 | 99.0 |
| Ask if the child vomits everything | 686 | 15.7 | 8.6 | 27.0 | 1342 | 40.8 | 33.0 | 49.0 | 695 | 95.8 | 81.2 | 99.2 | |
| Ask about recent convulsions a | 686 | 23.6 | 15.0 | 35.1 | 1342 | 33.1 | 23.3 | 44.6 | 695 | 95.3 | 90.3 | 97.7 | |
| Adherence index (3 tasks) | 686 | 18.4 | 12.0 | 24.9 | 1343 | 34.2 | 25.5 | 42.9 | 695 | 95.2 | 90.0 | 99.9 | |
| Cough/difficult breathing | Ask about cough a | 686 | 94.8 | 90.4 | 97.2 | 1342 | 94.3 | 87.2 | 97.6 | 695 | 99.4 | 97.4 | 99.9 |
| Ask about difficult breathing a | 686 | 2.8 | 1.6 | 4.8 | 1295 | 7.9 | 3.1 | 18.6 | 605 | 11.4 | 4.0 | 28.5 | |
| Ask for duration (if cough/difficult breathing) | 188 | 93.1 | 85.4 | 96.9 | 450 | 82.2 | 74.4 | 88.1 | 324 | 96.9 | 87.5 | 99.3 | |
| Count number of breaths per minute (if cough/difficult breathing) | 317 | 54.9 | 40.6 | 68.4 | 554 | 44.8 | 34.0 | 56.1 | 340 | 88.5 | 79.2 | 94.0 | |
| Look for chest indrawing (if cough/difficult breathing) | 318 | 47.8 | 37.5 | 58.2 | 554 | 41.2 | 28.9 | 54.7 | 340 | 82.4 | 75.0 | 87.9 | |
| Listen for stridor or “wheeze” breathing (if cough/difficult breathing) | 318 | 27.0 | 17.9 | 38.7 | 554 | 17.2 | 10.8 | 26.1 | 339 | 51.6 | 18.8 | 83.1 | |
| Adherence index (2 to 6 tasks) | 686 | 48.3 | 44.4 | 52.2 | 1342 | 50.0 | 45.8 | 54.3 | 695 | 67.8 | 55.0 | 80.7 | |
| Diarrhoea c | Ask about diarrhoea a | 686 | 94.8 | 87.4 | 97.9 | 1343 | 92.3 | 85.1 | 96.2 | 695 | 98.7 | 94.8 | 99.7 |
| Ask for duration (if diarrhoea) | 152 | 92.1 | 86.2 | 95.6 | 340 | 87.1 | 80.0 | 91.9 | 178 | 96.6 | 90.5 | 98.9 | |
| Ask for blood in the stool (if diarrhoea) a | 151 | 53.0 | 45.3 | 60.5 | 346 | 58.4 | 45.3 | 70.4 | 178 | 89.9 | 81.3 | 94.8 | |
| Offer water to the child (if diarrhoea) | 151 | 9.9 | 3.1 | 27.5 | 347 | 6.6 | 3.6 | 11.8 | 178 | 41.6 | 21.7 | 64.6 | |
| Pinch the skin of the abdomen (if diarrhoea) | 98 | 46.9 | 35.0 | 59.3 | 285 | 47.0 | 26.1 | 69.0 | 172 | 76.7 | 65.7 | 85.0 | |
| Adherence index (1 to 5 tasks) | 686 | 86.2 | 81.3 | 91.2 | 1343 | 82.1 | 74.9 | 89.2 | 695 | 93.8 | 91.6 | 96.1 | |
| Fever or history of fever d | Ask about current fever a | 686 | 88.2 | 72.7 | 95.4 | 1343 | 96.9 | 92.1 | 98.8 | 694 | 100.0 | – | – |
| Ask about history of fever a | 686 | 23.5 | 14.0 | 36.6 | 1319 | 75.1 | 51.2 | 89.7 | 654 | 72.9 | 42.8 | 90.6 | |
| Ask for duration (if fever) | 543 | 91.7 | 87.0 | 94.8 | 1027 | 88.4 | 84.5 | 91.4 | 575 | 96.7 | 95.0 | 97.8 | |
| Ask if the child had fever every day (if fever > 7 days) | 8 | 25.0 | 2.8 | 79.5 | 10 | 40.0 | 13.6 | 73.9 | 4 | 75.0 | 17.4 | 97.7 | |
| Ask if urine are dark or not abundant (if fever) | 544 | 10.9 | 6.8 | 16.9 | 1081 | 19.8 | 13.9 | 27.5 | 581 | 81.2 | 67.8 | 89.9 | |
| Ask about abnormal bleeding (if fever) | 544 | 6.3 | 3.0 | 12.4 | 1081 | 14.7 | 7.5 | 26.8 | 581 | 75.7 | 59.0 | 87.1 | |
| Ask about history of measles in the past 3 months (if fever) | 544 | 10.9 | 6.4 | 17.8 | 1081 | 17.7 | 13.2 | 23.2 | 581 | 65.8 | 29.7 | 89.7 | |
| Take the temperature (if fever) | 544 | 99.8 | 98.4 | 99.9 | 1082 | 99.1 | 98.5 | 99.4 | 586 | 99.7 | 98.9 | 99.9 | |
| Perform a RDT (if fever) | 544 | 74.3 | 53.8 | 87.7 | 1082 | 86.7 | 79.5 | 91.6 | 584 | 93.7 | 88.6 | 96.6 | |
| Look for neck stiffness (if fever) | 544 | 16.2 | 7.6 | 31.3 | 1081 | 23.0 | 15.2 | 33.3 | 582 | 47.6 | 37.8 | 57.6 | |
| Take the pulse (if fever) | 544 | 2.4 | 0.5 | 9.9 | 1075 | 8.2 | 2.7 | 22.3 | 582 | 1.6 | 0.4 | 5.6 | |
| Look for cold hands or feet (if fever) | 544 | 1.3 | 0.4 | 4.5 | 1078 | 1.2 | 0.5 | 2.7 | 578 | 33.7 | 11.0 | 67.7 | |
| Look for jaundice or redness in the eyes (if fever) | 544 | 82.5 | 70.8 | 90.2 | 1081 | 83.0 | 73.3 | 89.6 | 584 | 94.0 | 86.9 | 97.4 | |
| Look for general rash (if fever) | 544 | 14.9 | 7.4 | 27.6 | 1082 | 14.1 | 9.3 | 20.6 | 583 | 34.3 | 21.0 | 50.6 | |
| Adherence index (2 to 14 tasks) | 686 | 40.3 | 38.1 | 42.5 | 1343 | 52.5 | 47.8 | 57.2 | 694 | 71.5 | 65.6 | 77.4 | |
| Anaemia | Look for palmar pallor | 686 | 59.9 | 44.2 | 73.8 | 1341 | 51.5 | 42.6 | 60.4 | 692 | 92.2 | 78.4 | 97.5 |
| Nutritional status e | Measure height | 686 | 88.3 | 61.8 | 97.3 | 1343 | 90.4 | 79.1 | 95.9 | 695 | 99.6 | 98.9 | 99.8 |
| Weigh the child | 686 | 98.5 | 94.3 | 99.6 | 1343 | 98.4 | 93.7 | 99.6 | 695 | 99.1 | 97.5 | 99.7 | |
| Measure MUAC | 686 | 84.3 | 70.4 | 92.3 | 1342 | 86.1 | 82.2 | 89.2 | 692 | 88.4 | 83.5 | 92.1 | |
| Look for feet oedema | 686 | 23.5 | 14.3 | 36.1 | 1342 | 35.1 | 22.8 | 49.8 | 692 | 86.6 | 55.0 | 97.1 | |
| Offer RUTF (if age > 5 months & MUAC < 115 mm & no danger sign or severe classification) | 17 | 0.0 | – | – | 34 | 8.8 | 1.9 | 32.8 | 16 | 43.8 | 20.3 | 70.4 | |
| Adherence index (4 to 5 tasks) | 686 | 73.2 | 64.5 | 81.9 | 1343 | 77.1 | 71.6 | 82.5 | 695 | 93.2 | 87.3 | 99.1 | |
a Or reported by the caretakers spontaneously when the consultation started or when asked the reason for consulting; b Tasks recommended by the IMCI guidelines but not observable during consultations: Observe if the child convulses, observe if the child is lethargic/unconscious; c Tasks recommended by the IMCI guidelines but not observable during consultations: Observe if the child is lethargic/unconscious (if diarrhoea), observe if the child is restless/irritated (if diarrhoea), look for sunken eyes (if diarrhoea); d Tasks recommended by the IMCI guidelines but not observable during consultations: Look for running nose (if fever); e Tasks recommended by the IMCI guidelines but not observable during consultations: Look for severe and visible weight loss