Diagnosis and management of febrile children using the WHO/UNICEF guidelines for IMCI in Dhaka, Bangladesh

• Published in: Bulletin of the World Health Organization 2001-01, Vol.79 (12), p.1096-1105
• Main Authors: FACTOR, S. H, SCHILLINGER, J. A, PERKINS, B, BLACK, R. E, SCHWARTZ, B, KALTER, H. D, SAHA, S, BEGUM, H, HOSSAIN, A, HOSSAIN, M, DEWITT, V, HANIF, M, KHAN, N
• Format: Article
• Language: English
• Subjects: Antibiotic prophylaxis/utilization; Bacteremia/diagnosis; Bacteremia/drug therapy; Bacterial diseases; Bacterial Infections - complications; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Bangladesh; Biological and medical sciences; Care and treatment; Case Management; Child; Child Health Services - standards; Child, Preschool; Delivery of health care, Integrated; Diagnosis, Differential; Dysentery/diagnosis; Dysentery/drug therapy; Evaluation studies; Fever - diagnosis; Fever - drug therapy; Fever - etiology; General aspects; Guidelines; Health Policy & Services; Humans; Infant; Infectious diseases; Malaria/diagnosis; Medical sciences; Meningitis, Bacterial/diagnosis; Meningitis, Bacterial/drug therapy; Otitis media/diagnosis; Otitis media/drug therapy; Pneumonia, Bacterial/diagnosis; Pneumonia, Bacterial/drug therapy; Practice guidelines (Medicine); Practice Guidelines as Topic; Sick children; Skin diseases, Infectious/diagnosis; Skin diseases, Infectious/drug therapy; United Nations; Urinary tract infections/diagnosis; Urinary tract infections/drug therapy; World Health Organization
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862001001200005

To determine whether the fever module in the WHO/UNICEF guidelines for the integrated management of childhood illness (IMCI) identifies children with bacterial infections in an area of low malaria prevalence. Physicians assessed a systematic sample of 669 sick children aged 2-59 months who presented to the outpatient department of Dhaka Shishu Hospital, Bangladesh. Had IMCI guidelines been used to evaluate the children, 78% of those with bacterial infections would have received antibiotics: the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%) and urinary tract infection (83%); and 50% or less of children with bacteraemia (50%), dysentery (48%), and skin infections (30%). The current fever module identified only one additional case of meningitis. Children with bacteraemia were more likely to be febrile, feel hot, and have a history of fever than those with dysentery and skin infections. Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current IMCI module. In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections, but improvements in the fever module are possible.