More than 10 million children die each year worldwide before the age of five. Among these deaths, more than 70% are the result of preventable or easily treatable diseases eg: acute respiratory tract infection (ARI), diarrhoea, malaria, measles and malnutrition. More than 99% of these deaths occur in developing countries. The World Health Organisation (WHO) has launched specific disease control programs for diagnosis and treatment of diseases like diarrhoea, ARI, and Expanded Program of Immunisation (EPI) (to prevent vaccine preventable diseases). Many developing countries have reduced child mortality rate dramatically after introduction of those vertical programs. However children who are most likely to die invariably have multiple problems; this challenges health workers who are faced with seriously ill children.
To address this, in 1992 WHO and UNICEF jointly launched the global strategy of Integrated Management of Childhood Illness (IMCI). The goal was to reduce childhood morbidity and mortality in the developing world by targeting the five major diseases: ARI, malnutrition, measles, malaria and diarrhoea. IMCI addresses childhood illness on three levels: improving the health system, improving health worker’s performance, and improving family and community practices. While IMCI has mostly focused on the delivery of primary health care, it is increasingly recognized that for primary care to result in an optimal reduction in child mortality, effective first-referral level services, such as that which can be delivered in rural district or provincial referral hospitals, is also necessary.
The importance of hospital care for children
On the basis of IMCI guidelines, 10-20% of sick children seen in primary care will need referral to the first-referral level hospitals. These are the children who are most seriously ill, who will need prompt and good quality care management for their survival. In these hospitals nurses, medical assistants, or non-specialist doctors provide most of the care for seriously ill children.
Observational evidence suggested there is considerable scope for improving the quality of hospital care for severely ill children in many developing countries. Inadequate triage and assessment, poor treatment and insufficient monitoring may adversely affect the outcome of a significant proportion of hospitalised children, and result in unnecessary suffering or avoidable death for many children each year. In other settings over-hospitalization, over-diagnosis of severe illness and over-medication has adverse consequences for health outcomes and in wasted health expenditure.