Abstract:
The Integrated Management of Neonatal and Childhood Illnesses guidelines (IMNCI) has
improved efficiency and quality of services for children. IMNCI recognizes that often, sick
children present with more than one illness which contribute to childhood deaths if not
appropriately assessed, classified and treated. For this reason, sick children should be
managed by an integrated approach so as to deal with the main causes of childhood deaths.
However, low adherence has been an important reason for failure to achieve the goal of
substantially decreasing childhood deaths. Moreover, the IMNCI adherence level in Kenya
(34%) is below the WHO recommended level (68%), furthermore, there is no data on
adherence in Isiolo County. This study assessed health care workers adherence to the
IMNCI guidelines in management of children below 5 years in Isiolo County. A cross
sectional analytical study design was adopted. Twelve (12) health facilities were
conveniently selected and the number of participants determined proportionate to the
population of health care workers in each public health facility. A total of 190 Health care
workers were systematically selected by picking the first participant randomly and the rest
at 4th interval. A structured questionnaire and Key Informant Interview were utilized in
data collection. Data was uploaded in Excel spreadsheet 2013 and analysed using Statistical
Package for Social Sciences version 27. Chi square test was used to establish relationship
between study variables and a P value <0.05 was considered statistically significant. Binary
logistic regression and Adjusted Odds Ratio (AOR) with 95% Confidence Interval was
used to quantify associations. Results: The overall adherence to the IMNCI guideline was
47.7%, the under 5 caseloads >20 (AOR=3.8; 95% C1 (1.450-10.056) and frequent
supervision (AOR=8.4; 95% CI (3.257-21.679) were significantly associated with
adherence. In conclusion; the adherence level to the IMNCI guideline in Isiolo County was
low and health system factors, that is, under 5 caseloads >20 and frequent supervision were
found to influence adherence. Qualitative insights from the informant highlighted the
importance of IMNCI and areas of improvement. Recommendation; support supervision
should be strengthened to improve adherence.
