Determinants of the Implementation of Integrated Management of Childhood Illness (IMCI) by Midwives in Primary Health Care A Literature Review
DOI:
https://doi.org/10.21070/midwiferia.v12i2.1822Keywords:
IMCI, Primary Health Care, Child Health Services, healthcare workers, implementation determinantsAbstract
Introduction: Integrated Management of Childhood Illness (IMCI) is a strategy developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to improve child healthcare quality and reduce morbidity and mortality among children under five years of age. However, IMCI implementation in primary healthcare settings remains influenced by various individual, organizational, resource-related, operational, and health system factors. This literature review aimed to identify and synthesize the determinants influencing IMCI implementation.
Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Literature searches were conducted in Google Scholar, PubMed, Scopus, and ScienceDirect using keywords related to IMCI implementation and determinants. A total of 86 records were identified, with 72 records remaining after duplicate removal. Following title, abstract, and full-text screening, 34 articles met the eligibility criteria and were included in the review. Study selection was conducted by the primary reviewer and reviewed with research supervisors, with disagreements resolved through discussion and consensus. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Twenty-eight studies were appraised and classified as high quality, while six non-primary research articles were excluded from JBI assessment.
Result: Five determinant categories were identified: individual healthcare worker factors, organizational factors, resource availability factors, health system factors, and operational factors. Knowledge, IMCI training, clinical competence, supervision, leadership support, medicine availability, policy support, financing, workload, and digital health technologies were identified as key determinants.
Conclusion: Strengthening these factors may improve IMCI implementation, service quality, and child health outcomes.
References
[1] C. Boschi-Pinto et al., “Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on,” BMJ Open, vol. 8, no. 7, pp. 1–9, 2018, doi: 10.1136/bmjopen-2017-019079. DOI: https://doi.org/10.1136/bmjopen-2017-019079
[2] T. Wahyudi, E. K. Utomo, F. N. Sani, S. Lastianingsih, P. Azali, and D. Agustinaningrum, “Integrated Management Chilhood Illness (IMCI) in Primary Health Care: Literature Review,” Sci. Technol., vol. 1, no. 1, pp. 77–79, 2021, doi: 10.47701/icohetech.v1i1.1090.
[3] R. Rahmah and Y. Astuti, “The implementation of integrated management of children illness in primary health community in yogyakarta, indonesia,” Open Access Maced. J. Med. Sci., vol. 9, no. T4, pp. 315–318, 2021, doi: 10.3889/oamjms.2021.5808. DOI: https://doi.org/10.3889/oamjms.2021.5808
[4] D. O. Amalia and E. N. Hadi, “Determinants of an integrated management of childhood illness program implementation in Indonesia,” BKM Public Heal. Community Med., vol. 39, no. 03, p. e6974, 2023, doi: 10.22146/bkm.v39i03.6974. DOI: https://doi.org/10.22146/bkm.v39i03.6974
[5] M. Abayneh, T. Gebremedhin, E. Dellie, C. T. Tsehay, and A. Atnafu, “Improving the Assessment and Classification of Sick Children according to the Integrated Management of Childhood Illness (IMCI) Protocol at Sanja Primary Hospital, Northwest Ethiopia: A Pre-Post Interventional Study,” Int. J. Pediatr. (United Kingdom), vol. 2020, no. 2020, p. 12, 2020, doi: 10.1155/2020/2501932. DOI: https://doi.org/10.1155/2020/2501932
[6] A. A. Belete, Y. Agumas, A. K. Tsehay, and H. M. Ayele, “Utilization of the Integrated Management of Newborn and Childhood Illness (IMNCI) protocol and associated factors among health care workers in health centers of South Gondar Zone, Northwest Ethiopia: an institution-based mixed study,” Front. Heal. Serv., vol. 4, no. April, pp. 1–10, 2024, doi: 10.3389/frhs.2024.1364661. DOI: https://doi.org/10.3389/frhs.2024.1364661
[7] E. D. Carter et al., “Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries,” BMC Health Serv. Res., vol. 24, no. 1, 2024, doi: 10.1186/s12913-024-11772-9. DOI: https://doi.org/10.1186/s12913-024-11772-9
[8] K. Kilov et al., “Integrated Management of Childhood Illnesses (IMCI): A mixed-methods study on implementation, knowledge and resource availability in Malawi,” BMJ Paediatr. Open, vol. 5, no. 1, 2021, doi: 10.1136/bmjpo-2021-001044. DOI: https://doi.org/10.1136/bmjpo-2021-001044
[9] A. Bernasconi, M. Landi, C. S. Yah, and M. A. B. van der Sande, “Information and Communication Technology to Enhance the Implementation of the Integrated Management of Childhood Illness: A Systematic Review and Meta-Analysis,” Mayo Clin. Proc. Digit. Heal., vol. 2, no. 3, pp. 438–452, 2024, doi: 10.1016/j.mcpdig.2024.06.005. DOI: https://doi.org/10.1016/j.mcpdig.2024.06.005
[10] C. Jensen and N. H. McKerrow, “The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa,” BMC Pediatr., vol. 22, no. 1, pp. 1–10, 2022, doi: 10.1186/s12887-022-03147-y. DOI: https://doi.org/10.1186/s12887-022-03147-y
[11] M. D. Reñosa, S. Dalglish, K. Bärnighausen, and S. McMahon, “Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review,” Glob. Health Action, vol. 13, no. 1, 2020, doi: 10.1080/16549716.2020.1732669. DOI: https://doi.org/10.1080/16549716.2020.1732669
[12] R. K. Subedi et al., “Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes,” BMC Pediatr., vol. 23, no. Suppl 1, pp. 1–19, 2024, doi: 10.1186/s12887-023-03889-3. DOI: https://doi.org/10.1186/s12887-023-03889-3
[13] K. M. Lubis and F. Widyaningsih, “The Factors Associated with the Implementation of Integrated Management of Sick Children (IMCI) by Health Workers,” J. Kesmas Gizi, vol. 8, no. 1, pp. 298–306, 2025, doi: 10.35451/cc03w272. DOI: https://doi.org/10.35451/cc03w272
[14] A. Kiplagat, R. Musto, D. Mwizamholya, and D. Morona, “Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania,” BMC Public Health, vol. 14, no. 1, pp. 1–10, 2014, doi: 10.1186/1471-2458-14-277. DOI: https://doi.org/10.1186/1471-2458-14-277
[15] D. M. Amachree and C. Eleke, “Adherence and Implementation-related Challenges of Integrated Management of Childhood Illness Guidelines among Nurses at Health Centers in Port Harcourt, Nigeria,” Int. J. Med. Heal. Dev., vol. 27, no. 3, pp. 244–250, 2022, doi: 10.4103/ijmh.IJMH_35_21. DOI: https://doi.org/10.4103/ijmh.IJMH_35_21
[16] J. Pinto, Y. Peristiowati, Y. Puspitasari, I. Indasah, A. Pinto, and O. M. G. M. Gusmão, “The Implementation of Integrated Management of Childhood Illness (IMCI) in Sick Children from 2 Months up to 5 Years Age Old with Diarrhea in Community Health Center,” J. Community Engagem. Heal., vol. 6, no. 2, pp. 100–105, 2023, doi: 10.30994/jceh.v6i2.533. DOI: https://doi.org/10.30994/jceh.v6i2.533
[17] D. W. Daka, M. A. Wordofa, D. Berhanu, L. Å. Persson, and M. Woldie, “Quality of sick child management by health extension workers: role of a complex improvement intervention,” BMC Health Serv. Res., vol. 23, no. 1, pp. 1–17, 2023, doi: 10.1186/s12913-023-09131-1. DOI: https://doi.org/10.1186/s12913-023-09131-1
[18] A. M. García Sierra and J. A. Ocampo Cañas, “Integrated management of childhood illnesses implementation-related factors at 18 colombian cities,” BMC Public Health, vol. 20, no. 1, pp. 1–10, 2020, doi: 10.1186/s12889-020-09216-0. DOI: https://doi.org/10.1186/s12889-020-09216-0
[19] R. Curran et al., “Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa,” BMC Pediatr., vol. 21, no. 1, pp. 1–12, 2021, doi: 10.1186/s12887-021-02512-7. DOI: https://doi.org/10.1186/s12887-021-02512-7
[20] A. E. Rahman, S. Mhajabin, D. Dockrell, H. Nair, S. El Arifeen, and H. Campbell, “Correction to: Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh (BMC Health Serv Res, (2021), 21, (6,” BMC Health Serv. Res., vol. 21, no. 1, pp. 1–13, 2021, doi: 10.1186/s12913-021-06898-z. DOI: https://doi.org/10.1186/s12913-021-06898-z
[21] F. A. Huda, K. Mathewos, H. R. Mahmood, O. Faruk, L. R. Hirschhorn, and A. Binagwaho, “Examining the implementation of facility-based integrated management of childhood illness and insecticide treated nets in Bangladesh: lessons learned through implementation research,” BMC Pediatr., vol. 23, no. Suppl 1, pp. 1–15, 2024, doi: 10.1186/s12887-023-04389-0. DOI: https://doi.org/10.1186/s12887-023-04389-0
[22] R. Setiaasih, D. K. Sunjaya, Y. Sofiatin, I. Afriandi, L. Hilfi, and D. M. D. Herawati, “Readiness of health posts for primary health care integration in Indonesia: a mixed-methods study,” BMC Public Health, vol. 25, no. 1, 2025, doi: 10.1186/s12889-025-22520-x. DOI: https://doi.org/10.1186/s12889-025-22520-x
[23] H. Fekadu, W. Mekonnen, A. Adugna, H. Kloos, and D. Hailemariam, “Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study,” BMC Health Serv. Res., vol. 24, no. 1, pp. 1–14, 2024, doi: 10.1186/s12913-024-11074-0. DOI: https://doi.org/10.1186/s12913-024-11074-0
[24] L. Tshivhase, M. M. Madumo, and I. Govender, “Challenges facing professional nurses implementinthe integrated management of childhood illness programme in rural primary health care clinics, Limpopo Province, South Africa,” South African Fam. Pract., vol. 62, no. 1, pp. 1–6, 2020, doi: 10.4102/safp.v62i1.5060. DOI: https://doi.org/10.4102/safp.v62i1.5060
[25] M. Mekie et al., “Utilization of integrated community-based case management of childhood illness and associated factors in Ethiopia: a systematic review and meta-analysis,” Ital. J. Pediatr., vol. 50, no. 1, pp. 1–12, 2024, doi: 10.1186/s13052-024-01702-0. DOI: https://doi.org/10.1186/s13052-024-01702-0
[26] S. Sarrassat, J. J. Lewis, A. S. Some, S. Somda, S. Cousens, and K. Blanchet, “An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial,” BMC Health Serv. Res., vol. 21, no. 1, pp. 1–19, 2021, doi: 10.1186/s12913-021-06317-3. DOI: https://doi.org/10.1186/s12913-021-06317-3
[27] T. Schmitz et al., “Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: An observational study,” BMJ Open, vol. 12, no. 7, pp. 1–11, 2022, doi: 10.1136/bmjopen-2021-055315. DOI: https://doi.org/10.1136/bmjopen-2021-055315
[28] M. J. Morikawa, “Unresolved issues in implementing integrated management of childhood illness (IMCI) approach,” Int. J. Heal. Policy Manag., vol. 10, no. 5, pp. 293–294, 2021, doi: 10.34172/ijhpm.2020.89. DOI: https://doi.org/10.34172/ijhpm.2020.89
[29] F. Beynon et al., “The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms,” Glob. Health Action, vol. 17, no. 1, 2024, doi: 10.1080/16549716.2024.2326253. DOI: https://doi.org/10.1080/16549716.2024.2326253
[30] F. Haryanti, I. S. Laksanawati, E. Arguni, S. A. Widyaningsih, N. A. Ainun, and N. Rastiwi, “Evaluation of the Implementation of Integrated Management of Childhood Illness in Special Region of Yogyakarta Province, Indonesia,” Open Access Maced. J. Med. Sci., vol. 10, no. B, pp. 570–575, 2022, doi: 10.3889/oamjms.2022.8670. DOI: https://doi.org/10.3889/oamjms.2022.8670
[31] L. Drown et al., “Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study,” BMC Pediatr., vol. 23, no. Suppl 1, pp. 1–14, 2024, doi: 10.1186/s12887-023-04388-1. DOI: https://doi.org/10.1186/s12887-023-04388-1
[32] World Health Organization, Operational framework for building climate resilient and low carbon health systems. 2023. [Online]. Available: https://iris.who.int/bitstream/handle/10665/373837/9789240081888-eng.pdf
[33] K. McCullough, L. Andrew, A. Genoni, M. Dunham, L. Whitehead, and D. Porock, “An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review,” Res. Nurs. Heal., vol. 46, no. 1, pp. 159–176, 2023, doi: 10.1002/nur.22291. DOI: https://doi.org/10.1002/nur.22291
[34] D. O. Amalia and S. Sabarinah, “Fishbone Diagram Analysis in the Implementation of Integrated Management of Childhood Illness (IMCI) in Indonesia,” J. Aisyah J. Ilmu Kesehat., vol. 8, no. 1, pp. 397–404, 2023, doi: 10.30604/jika.v8i1.1672. DOI: https://doi.org/10.30604/jika.v8i1.1672
[35] J. V. Riri, A. Silumbwe, C. Mweemba, and J. M. Zulu, “Facilitators and barriers to implementation of integrated community case management of childhood illness: a qualitative case study of Kapiri Mposhi District,” BMC Health Serv. Res., vol. 22, no. 1, pp. 1–11, 2022, doi: 10.1186/s12913-022-07867-w. DOI: https://doi.org/10.1186/s12913-022-07867-w
[36] S. Carai and M. W. Weber, “Primary health care for children - evidence for prevention,” BMC Pediatr., vol. 21, no. Suppl 1, pp. 1–2, 2021, doi: 10.1186/s12887-021-02787-w. DOI: https://doi.org/10.1186/s12887-021-02787-w
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