Validation of an Integrated Management of Childhood Illness Algorithm for Managing Common Skin Conditions in Fiji/Validation D'un Algorithme De Gestion Integree Des Maladies Infantiles Pour la Prise En Charge Des Maladies De Peau Courantes Aux Iles Fidji/Validacion De Un Algoritmo De la Atencion Integrada a Las Enfermedades Prevalentes De la Infancia Para Manejar Enfermedades Cutaneas Comunes En Fiji
2009; World Health Organization; Volume: 87; Issue: 3 Linguagem: Inglês
ISSN
1564-0604
AutoresAndrew C. Steer, Lisi Tikoduadua, Emmalita M. Manalac, Samantha Colquhoun, Jonathan R. Carapetis, Carolyn Maclennan,
Tópico(s)Child and Adolescent Health
ResumoUne traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facita una traduccionn al espanal. Introduction The Integrated Management of Childhood Illness (IMCI) is an evidence-based, cost-effective and comprehensive child health strategy developed by WHO and the United Nations Children's Fund (UNICEF) for middle- and low-income countries. (1) The strategy aims to reduce child morbidity and mortality and to enhance child growth and development in these countries. IMCI has been shown to improve the quality of care and to increase the utilization of health facilities. (2) The core of the IMCI strategy is the application of clinical guidelines for the integrated case management of sick children aged 5 years and under at first-level health facilities. The IMCI guidelines have been individually adapted for conditions in more than 100 countries since they were launched in 1996. (1) The WHO/UNICEF Regional Child Survival Strategy for the Western Pacific highlights the importance of IMCI in delivering essential child survival interventions. (3) The Fiji Ministry of Health adopted the IMCI strategy as a pilot project in three subdivisions of the Central Division of Fiji (Suva, Rewa and Serua Namosi) in 2003. Following a review of the pilot project in 2004, the IMCI strategy was implemented across the country. The review in 2004 also showed that health workers with IMCI training consistently identified skin conditions as a problem that the existing algorithm did not address. Skin conditions, in particular impetigo and scabies, are common in Fiji. One study on Taveuni Island, a northern island, found that of 258 children aged 5 to 15 years, 84 (33%) had evidence of scabies infestation. (4) In a study of 3462 primary-school children in the Central Division of Fiji in 2006, 1259 children (36%) had impetigo and 640 (18%) had scabies, with prevalence as high as 80% for impetigo and 40% for scabies in some areas (A Steer, unpublished data). Scabies is often not identified as a health problem by parents; the condition is so common that consultation is not sought except when skin lesions worsen. In a recent cross-sectional survey of 773 infants and their parents attending maternal and child health-care clinics, 162 (21%) parents reported that their child had infected scabies, but the actual number of cases of infected scabies diagnosed by a medical practitioner at the same visit was 509 (66%), (F Russell, personal communication). Scabies and impetigo in tropical and subtropical countries are more than just nuisance problems in children, and skin diseases are among the most common reasons for attending child health clinics worldwide. (5) Scabies is a neglected disease (6) and lesions are often secondarily infected by bacteria, most commonly Staphylococcus aureus and Streptococcus pyogenes. In studies of invasive S. aureus and S. pyogenes infections in Australian aborigines, impetigo is associated with up to 37% of cases. (7,8) Such findings are also likely to apply to Fiji, where invasive infections with S. pyagenes have a higher incidence than in developed countries and carry a high case-fatality rate. (9) Impetigo caused by S. pyogenes can also lead to acute post-streptococcal glomerulonephritis and may play a role in the pathogenesis of acute rheumatic fever. (10) An algorithm for the identification and management of skin conditions was developed by the Fiji IMCI pilot review panel that included WHO consultants, Fiji Ministry of Health staff, nursing representatives and selected Fijian paediatricians. We are not aware of an IMCI algorithm for the treatment of common childhood skin conditions in any other setting. The IMCI skin algorithm focuses on the most common skin conditions among children in Fiji, including impetigo, scabies, infected scabies and tinea (ringworm) infection (Box 1, Table 1). The algorithm also guides primary health-care workers in the identification of serious skin conditions that require prompt referral, such as extensive cellulitis and orbital and periorbital cellulitis. …
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