IMPLEMENTATION OF INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI) GUIDELINE AND ITS BARRIERS IN PUBLIC HEALTH FACILITIES OF GAMO ZONE, SOUTH ETHIOPIA, 2023: INSTITUTIONAL BASED MIXED CROSS SECTIONAL STUDY

Abstract

Introduction: The Integrated Management of Neonatal and Childhood Illness (IMNCI) is a comprehensive approach to children's health that prioritizes the overall well-being of the child. Ethiopia is a country with high under-five mortality rates, and about 75% of mortality is caused by IMNCI target diseases. Despite this, IMNCI guideline implementation is low at the country level and unknown in the study area. Also, the barriers to IMNCI have not yet been adequately assessed. Objective: to assess the implementation of the IMNCI guideline and its barriers in the public health facilities of the Gamo zone, South Ethiopia region, 2023. Method: A facility-based mixed cross-sectional study was conducted in May 2023. From 57 health centers in the Gamo Zone, 17 were selected randomly. A total of 572 samples were taken from 2679 cases. Then the total sample was allocated proportionally to each selected health center based on their under-five case flow. Finally, data was collected by document review of the IMNCI register book using a systematic random sampling method. Two IMNCI-trained data collectors and one supervisor were recruited for quantitative data, while the principal investigator collected qualitative data. Data was coded, entered, and cleaned using Epi Data version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were used to determine the level of IMNCI implementation. While qualitative data was collected through in-depth interviews with key informants of the study, it was also transcribed, coded, and thematically analyzed. Result: The proportion of IMNCI implementation in the study area was 63.3%. 446 (78%) cases were correctly classified, and 86 (15%) were incorrectly classified. Similarly, 385 (67.3%) cases were correctly treated, whereas 187 (32.7%) cases were not correctly treated. 477 (783.4%) cases took counseling, while 95 (16.6%) cases did not. Only 125 (21.9%) were appointed correctly. The possible identified barriers to IMNCI implementation were a shortage of trained staff, a shortage of supply and equipment, a physical layout problem, staff negligence and turnover, and the nature of the guidelines. Conclusion and recommendation: The IMNCI implementation was low in the study area compared to WHO standards. So from the federal government to the facility level, responsible bodies and local NGOs should emphasize the solution to the identified barriers.