An evaluation of the use of the human immuno-deficiency virus portion of the integrated management of childhood illness algorithm by nurses in selected primary health care clinics in KwaZulu-Natal

Abstract

The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested.