Report on initial follow up visit to health workers trained in IMCI complementary course in Zambia November 10-18 1997.

This trip report pertains to a consultant visit during November 10-18 1997 to Zambia. The aim was to evaluate health workers performance as a follow-up at 4-6 weeks to a complementary course on integrated management of childhood illnesses (IMCI). The evaluation included observation of the assessment and treatment of children aged 2-5 years by the health workers. An evaluation form allowed identification of correct and incorrect procedures. The reviewer explained after the client left from the visit but before the client left the premises areas that were missed and other feedback. Feedback was given to the patient before final departure from the facility. Chipata district was better equipped for implementation of IMCI than Lundazi or Chama districts. Facilities varied by site. Chipata district was different in having an IMCI trained officer on staff. First line drugs with the exception of nalidixic acid and erythromycin were generally available in all districts. Second line drugs such as Fansidar and amoxycillin were more available in Chipata than in Lundazi and Chama. The follow-up visits included 16 out of 17 health centers. 14 health centers had firmly begun implementation of IMCI. Lumezi and Kanyanga health centers in Lundazi district were not implementing IMCI. The reason was that health workers were assigned to the main in-patient wards. Health workers performed well in asking about general danger signs. All health workers counted breaths in a full minute and all but one looked for chest indrawing. Workers explained to mothers how antibiotics should be taken. Two health workers did not ask about symptoms for diarrhea and 4 health workers from the standard course missed asking about the main symptoms for diarrhea. Only 1 worker missed asking about the main symptom of fever. Four workers missed looking for visible severe wasting and edema. 50% left out feeding assessments.