2009

MOU on 'Tele-consultation on child health' initiative with multiple partners in Egypt signed at EMRO 11 February 2009 
 

16 December 2009 --- Evaluation of IMCI paediatric teaching at the Faculty of Medicine of the University of Gezira (FMUG), Sudan, 7 – 10 December 2009	| Français |
The four-day evaluation was carried out by an external team with international and national members. The activity had the objectives to: a) assess whether IMCI paediatric teaching, introduced at FMUG in 2002, improved student competencies in managing under-five children; b) make recommendations to further strengthen the teaching programme, and c) build national capacity for these evaluations. As an intermediate step, the evaluation also aimed to assess the quality of teaching resulting from the introduction of IMCI in paediatrics teaching. The methodology was based on the standard methodology described in the Guide to the Evaluation of IMCI Pre-service Education, developed by the Regional Office and expected to be published early in 2010.  The overall environment at FUMG was found to be highly supportive to IMCI. Teaching of the IMCI approach had been endorsed formally at all levels and included not only in paediatric clerkship but also in ‘system courses’ over the various semesters. All teaching staff at the department had been trained in IMCI—giving a reasonable staff to student ratio of 1:14 during clinical teaching. All the materials used were consistent with the national IMCI guidelines. In such a community-oriented institution keen to introduce public health approaches, there was close collaboration between the paediatrics and community medicine departments, which had jointly defined complementary learning objectives for the respective teaching programmes, so as to be able to cover all IMCI tasks—from assessment to identification of treatment and counselling—and age groups (young infant and older children). 13% of the total paediatric teaching time was assigned to IMCI, including a lecture and 5 clinical OPD sessions. IMCI-related items had been included in the examination matrix of the department, with 8.8% of the total marks assigned to IMCI. Reference materials—e.g. IMCI chart booklet—were procured for free by the MOH and lent to students, to be returned at the end of the rotation, this representing an important constraint. Student and teaching staff attitudes toward IMCI were very positive, with students greatly appreciating the clinical sessions, as also seen in previous evaluations in other medical schools in different countries. The student knowledge test—a test of average difficulty—and clinical skill test—including children with moderate and severe conditions—helped identify areas requiring strengthening in teaching. Students had difficulty in applying knowledge to given case scenarios, were relatively comfortable in assessing sick children but had difficulty in ‘integrating’ the different components of the IMCI algorithm. Main recommendations included adding practical teaching sessions to better prepare students for the clinical sessions with actual patients, ensuring supervised clinical practice utilizing also primary health care centres, addressing the (sustainability) issue of provision of the IMCI chart booklet and other materials to students and improving student ability to integrate the different components of the IMCI algorithm. This was the 4th evaluation of a medical school—as part of IMCI pre-service education—supported by the Regional Office after those conducted at the paediatrics departments of  the universities of Alexandria and Mansoura, in Egypt, and Khartoum, in Sudan.
Inter-country orientation and planning workshops on the global community health workers package on child care Cairo, Egypt, 23 - 26 November 2009	| Français |
The four-day workshop, the first of its kind to be conducted globally, aimed to orient participants to a new set of training materials and tools for community health workers jointly developed by WHO and UNICEF and develop plans of action to strengthen community IMCI (Integrated Management of Child Health), in order to increase access to quality child care through community health workers. Community approaches are seen to play a significant role in achieving MDG#4 on under-five mortality reduction, especially in countries in which population access to care is limited.  It was attended by 21 participants of ministries of health of 4 countries in the Region (Afghanistan, Egypt, Sudan and Yemen), UNICEF country office staff (Egypt) and WHO staff from HQ, the Regional Office and the four country offices. The four countries were selected as they had shown interest in the topic and either had started or were planning to start CHW-based community child care. In the specific case of Egypt, the interest was on promoting newborn and child care in the community rather than case management, which is carried out at health facilities by qualified health providers. The materials subject of the orientation were “Caring for the sick child in the community” and “Caring for the newborn at home”. Among the main recommendations were the need to adapt the training materials and methodology for cadres of health providers with low or no literacy and carefully plan and monitor for health system and community support elements, considered essential for any community intervention of this type. Issues included among others policies on which services and medicines CHWs would be allowed to deliver, availability of medicines and supplies (job aids, recording forms, registers, etc.), feedback and motivation schemes by the health system and community. Information on the workshop is available here.
Inter-country training on the facilitator guide on the orientation and planning workshop for IMCI pre-service education, Cairo, Egypt, 25-30 July 2009 3 August 2009	| Français |
This three-day training course aimed at building capacity in countries in the region in the use of the "Facilitator Guide on the Practical Orientation and Planning Workshop for IMCI Pre-service Education". It also served as an opportunity to finalize the Guide. It was attended by 19 participants, including senior teaching staff of 8 academic institutions of 5 countries in the Region (Egypt, Jordan, Pakistan, Sudan and Yemen), staff of ministries of health, UNICEF and WHO staff at HQ, Regional and country level. During the workshop, in addition to the Guide, other elements of the Regional package for IMCI pre-service education were used, such as the e-lectures on the "Management of the Sick Child Age 2 months up to 5 years", "Management of the Sick Young Infant up to 2 months" and "IMCI strategy", and the module on "IMCI Pre-service Education - Paediatric Teaching Sessions", describing in detail learning objectives and other elements of lesson plans. The training course was followed by a three-day "Practical Orientation and Planning Workshop for IMCI Pre-service Education" for 18 teaching staff of 5 medical schools of Egypt, for the facilitators to apply the skills learned during the training course. This national workshop brought to 20 the total number of medical schools in Egypt which have taken steps to introduce IMCI into their paediatric teaching programmes. All the above materials of the IMCI Pre-service Education package developed by the Regional Office, including also the "Guide on the Evaluation of IMCI Pre-service Education" and the "IMCI question Bank" for student assessment, are expected to be ready in their final format before the end of the year.
IMCI country focus: Egypt 3 August 2009	| Français |
Egypt is the "IMCI country focus" of this month. This series highlights information on IMCI implementation in countries in the Region which is available on this website, to help users find country-specific information quickly. Egypt is getting close to have staff trained in IMCI in all facilities in the country and is on track to achieve MDG#4 on reduction of under-five mortality by 2015 (based on 1990-2007 data trends). All medical schools but one have started introducing IMCI into their teaching programmes.   Statistics: Trends in under-five mortality, Egypt Causes of death in children under-five, Egypt MDG report, Egypt (2nd country report, March 2005)   Strategy on Integrated Management of Child Health (IMCI): Egypt IMCI guidelines, Rev. 2008 IMCI implementation in Egypt: coverage and key events IMCI Annual Reports Planning for IMCI implementation at district level: a capacity building workshop Follow-up visits after IMCI training, Egypt Health Facility Survey on Outpatient Child Care (IMCI) Services Dr Gezairy's visit to IMCI-implementing areas in Egypt IMCI pre-service education: Schools involved in IMCI pre-service education in Egypt Evaluation of IMCI Pre-service Education, Mansoura, Egypt First national IMCI pre-service education workshop for medical and nursing schools  Child health policy initiative: Child health policy initiative: Child health situation analysis report, Egypt Tele-consultation on child health: Initiative on 'Tele-consultation on child health' Research: Research findings of the WHO EMRO Paediatric Insecticide Study Group on organophosphate / carbamate poisoning in children Research findings of the WHO EMRO Paediatric Hydrocarbon Study Group on hydrocarbon (kerosene) poisoning in children
Sudan expands IMCI community interventions 19 July 2009	| Français |
IMCI in Sudan is moving forward with its community component interventions to promote selected key family practices on child care. The main focus is on the use of community health promoters (CHPs), a cadre of volunteers based in the community. Covering 10-15 households each, a CHP usually visits each household one to two times a month. She is expected to make an assessment of the key child care family practices for that household first. If any child below five years of age is ill in the household (e.g. with fever, cough or difficult breathing, diarrhoea, etc.), the CHP focuses her advice to the mother on whether to take the child to the health facility―if any of the signs for care-seeking is present―and what  home care to provide. If no child is ill, the CHP delivers messages related to one of the selected key family practices, changing family practice as a topic next visit. CHPs also hold health education sessions in the community. Trained core teams have been established in the states to decentralize the intervention. To date, the intervention has been introduced in 126 communities, with 2418 CHPs trained. Partnerships have been established with some community-based organizations to accelerate the pace of expansion. Revised approaches have been proposed to address such key issues as sustainability―related to the high drop out rates of the volunteers, CHP motivation, community ownership, improving household visit procedures and expanding the scope of CHPs to make the intervention more effective. Another community intervention, started in July 2009, is targeting basic school teachers and their pupils as promoting agents in their own communities. The introduction of IMCI into the pre-service teaching programmes of community medicine in medical schools in Sudan is another effort to produce community-oriented doctors with good counselling skills to further promote key family practices.
IMCI country focus: Sudan 19 July 2009	| Français |
This is the first news of a new series, "IMCI country focus", highlighting information on IMCI implementation in countries in the Region which is available on this website. This helps users find country-specific information quickly. The focus of this news is on Sudan. IMCI implementation in Sudan: coverage and key events Sudan IMCI guidelines Schools involved in IMCI pre-service education in Sudan IMCI community component update, Sudan MDG report, Sudan Trends in under-five mortality, Sudan Causes of deaths in children under-five, Sudan Health Facility Survey on the Quality of Outpatient Child Health Services, Sudan Dr H. Gezairy, WHO Regional Director of the Eastern Mediterranean Region, visits IMCI-implementing sites in Sudan, February 2007 First national training course on counselling on infant and young child feeding held in Sudan
Evaluation of IMCI pre-service education, Mansoura, Egypt 2 July 2009	| Français |
The four-day evaluation was carried out at the Department of Paediatrics, Faculty of Medicine, University of Mansoura, Egypt, from 8 to 11 June, to assess whether the introduction of IMCI in the department's teaching programme had led to competent students in managing sick children with common health problems according to the IMCI guidelines and make recommendations to further strengthen the teaching programme. This was the 3rd evaluation of a medical school in the Region—as part of IMCI pre-service education—after those carried out at the paediatric departments of the universities of Alexandria, Egypt, and Khartoum, Sudan, in 2006.
Inter-country training on evaluation of IMCI pre-service education, Mansoura, Egypt 2 July 2009	| Français |
The three-day training brought together 15 participants from 5 countries in the Region (Egypt, Islamic Republic of Iran, Morocco, Pakistan and Sudan), including senior professors of paediatrics from 7 universities, staff from ministries of health and WHO country offices. Based on the Guide on the Evaluation of IMCI Pre-service Education developed by the Regional Office, it aimed to build capacity in the Region in evaluating IMCI pre-service education. The number of teaching institutions in the Region which have introduced IMCI into their teaching programmes, especially paediatrics, has been increasing over the years, raising the need to evaluate the teaching process and student outcomes in these institutions. The training methodology included presentations, video-demonstrations, group discussions and much practice in using the evaluation qualitative and quantitative instruments, from interviews to focus group discussions, visits to teaching sites, MCQ tests and observation of case management, and computerized data entry and analysis. The topics covered ranged from developing the evaluation schedule to assessing the supportive environment at national and institutional level, from assessing the teaching process and methodology to assessing teaching staff and student attitudes, student knowledge and skills, from entering data and analyzing the results to presenting the findings. Training was followed by an evaluation of the teaching programme at the paediatric department of Mansoura University, Egypt, which served as further training to practise and reinforce the newly acquired evaluation skills. More information is available here.
Progress toward MDG 4 in the Eastern Mediterranean Region 22 June 2009	| Français |
An estimated 1.2 million deaths occurred in children under-5 in the Eastern Mediterranean Region in 2007, a 26% decline from the 1990 level. Four countries (Egypt, Morocco, Oman and Tunisia) are close to achieving MDG 4, having reduced their under-5 mortality rate by 60% or more during the same period; many others are on track to achieve the goal by 2015 if current trends continue. Of concern are 6 out of 8 countries, most plagued by conflict, in which the under-5 mortality rate has decreased by less than a third in the 17-year period and remains high, namely Afghanistan, Djibouti, Iraq, Pakistan, Somalia and Sudan. Close to a million deaths occurred among under-5 children in these countries in 2007, almost 80% of all under-5 deaths in the Region. The challenge of achieving MDG 4 in these countries is substantial. Detailed information on mortality rates and trends by country, based on the World Health Statistics, WHO, 2009, is presented in tables and illustrated with graphs in the section on "Data and statistics: Under five mortality and its causes".
Yemen accelerates IMCI implementation 22 June 2009	| Français |
The Ministry of Public Health and Population provided a big boost to IMCI implementation in 2008, introducing the strategy in 54 new districts and 653 health facilities, thus reaching in total more than half of PHC facilities in the country. This is the highest IMCI implementation level per year ever accomplished in Yemen since the IMCI strategy was pilot-tested in 3 districts in the country in 2002. The number of PHC mobile teams, including IMCI care and established in 2007 on a trial basis to increase access of underserved populations to quality health services, also increased to 670 in 64 districts. While under-five mortality remains high, data recently released by WHO suggest that the under-five mortality rate has decreased by 42% between 1990 and 2007. Infectious diseases such as pneumonia and diarrhoeal diseases remain leading causes of death in young children in Yemen: accelerating the implementation of existing cost-effective interventions under the IMCI strategy and introduction of IMCI into pre-service education would help the country move closer to its Millennium Development Goal 4 set for 2015 and provide more hopes to its young children. For more information on IMCI implementation in Yemen click here.
"National Health Facility Survey on the Quality of Outpatient Primary Child Health Care Services", Morocco, October – December 2007 26 March 2009	| Français |
The report on the “National Health Facility Survey on the Quality of Outpatient Primary Child Health Care Services" (IMCI Health facility Survey) conducted in Morocco at the end of 2007 is now available on this website, together with the survey instruments and adapted guidelines. Conducted after seven years of expanded implementation of the Integrated Management of Child Health (IMCI) strategy in the country, the survey had the main objective to collect quantitative and qualitative information to assess the quality of outpatient health care services, including both the clinical and health system support components, provided by IMCI-trained staff to sick children below 5 years old at health centres. The survey report provides a wealth of information, critically analyzed, useful to inform planning. It contains a set of few recommendations to improve the quality of primary child care services in the country. The recommendations concern the utilization of primary health care services, improving the policy on medicines to provide equitable access to medicines for children and developing a national child health policy and scaling up IMCI implementation as part of the commitment to Millennium Development Goal 4 on reducing child mortality. The role of IMCI pre-service education is also highlighted.
IMCI Annual Report, Egypt, 2007 19 March 2009	| Français |
The IMCI Annual Reports developed by the General Administration for Childhood Illness Programmes team of the Ministry of Health of Egypt are now available on-line on our website. These reports represent an outstanding example of how implementation of a child health strategy can be thoroughly documented and data can be collected and analyzed critically to inform planning. The reports provide detailed information on the child health situation in the country and ministry interventions, with focus on the progress of implementation of the IMCI strategy. Data on performance of health services at primary health care level, often illustrated with graphs, are mostly derived from the IMCI follow-up system, which gathers information on a standard set of indicators on child health services at that level. The data are presented by national and governorate level, with detailed analysis and comparisons with previous years.
MOU on 'Tele-consultation on child health' initiative with multiple partners in Egypt signed at EMRO 11 February 2009	| Français |
A Memorandum of Understanding on a joint initiative on 'Tele-consultation on child health' was signed at EMRO on 10 February 2009 between WHO/EMRO, the United Nations Development Programme (UNDP), the Faculty of Medicine of Alexandria University (AU), the Egypt Ministry of Communication and Information Technology (MCIT) and Ministry of Health and Population (MOHP). The initiative aims at improving the performance of health care providers working in remote areas in Egypt (Siwa district in Matrouh governorate) by tele-consultations and other e-health techniques, as part of continued medical education. It also aims at strengthening the medical educational process at Alexandria University to enhance student knowledge and skills acquisition by e-learning, based on e-resources of the EMRO pre-service education initiative on Integrated Management of Child Health (IMCI). The duration of this pilot project is one year. Senior teaching medical staff of different specialties of the Paediatric Department of Alexandria Faculty of Medicine—already a partner in the EMRO IMCI pre-service education initiative for many years—will be conducting tele-consultations on specific clinical cases by videoconferences regularly and on an emergency basis to guide health provider practice in Siwa. The IMCI guidelines will be the reference for children under-five. The initiative will also provide the health providers with access by video-conferences to the scientific meetings regularly conducted by the Paediatric Department. The Child and Adolescent Health unit (CAH) of EMRO will provide technical support to the initiative, which will be financially managed by UNDP. MCIT will provide technical and equipment support for tele-consultations and e-learning facilities, while MOHP will implement and monitor the agreed plan for its health providers and facilities.