IMCI approach in tertiary hospitals, India.

Objective: This study was conducted to compare physicians' diagnosis with Integrated Management of Childhood Illness (IMCI) algorithm generated diagnosis in hospitalized children aged 2-59 months.

Methods: Recruited were patients aged 2-59 months admitted with one or more IMCI danger signs. IMCI and physician's diagnosis were noted and compared.

Results: In 222 included subjects, mean duration of illness was 9.4 (SD: 16.5) days. Among those with cough or difficult breathing, 44 (19.8%) and 66 (29.7%) were diagnosed as either severe pneumonia or mild to moderate pneumonia by physicians and IMCI algorithm, respectively (p= 0.015). Among 146 presenting as fever, 140 (95.9%) were diagnosed as very severe febrile disease by the IMCI algorithm, whereas physicians diagnosed these as either malaria in 10/146 (6.7%), pyogenic meningitis in 47/146 (32.2%), sepsis in 31/146 (21.3%), tuberculous meningitis in 17/146 (11.6%), encephalitis in 5/146 (3.4%), measles in 3/146 (2.1%) or others in 24/146 (16.4%).

Conclusion: As there was a low concordance between physician and IMCI algorithmic diagnosis of pneumonia (Kappa value= 0.74, 95% CI: (0.64-0.84)) and since very severe febrile disease is not a diagnosis made by the physicians, the IMCI algorithms have to be refined for appropriate management of these conditions.