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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Abstract

FACTOR, S.H. et al. Diagnosis and management of febrile children using the WHO/UNICEF guidelines for IMCI in Dhaka, Bangladesh. Bull World Health Organ [online]. 2001, vol.79, n.12, pp. 1096-1105. ISSN 0042-9686.  http://dx.doi.org/10.1590/S0042-96862001001200005.

OBJECTIVE: 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. METHODS: Physicians assessed a systematic sample of 669 sick children aged 2-59 months who presented to the outpatient department of Dhaka Shishu Hospital, Bangladesh. FINDINGS: 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. CONCLUSIONS: 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.

Keywords : Fever [drug therapy]; Bacterial infections [diagnosis]; Bacterial infections [drug therapy]; Meningitis, Bacterial [diagnosis]; Meningitis, Bacterial [drug therapy]; Pneumonia, Bacterial [diagnosis]; Pneumonia, Bacterial [drug therapy]; Otitis media [diagnosis]; Otitis media [drug therapy]; Urinary tract infections [diagnosis]; Urinary tract infections [drug therapy]; Bacteremia [diagnosis]; Bacteremia [drug therapy]; Dysentery [diagnosis]; Dysentery [drug therapy]; Skin diseases, Infectious [diagnosis]; Skin diseases, Infectious [drug therapy]; Malaria [diagnosis]; Antibiotic prophylaxis [utilization]; Child; Delivery of health care, Integrated; Guidelines; Evaluation studies; Bangladesh.

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