Evidence-based Estimates of the Expected Duration of Initial Consultations for Sick Children in Low- and Middle-income Countries Using the Integrated Management of Childhood Illness Clinical Algorithm

BackgroundLittle is known about the time required for primary care consultations, particularly those involving sick children in low- and middle-income countries (LMICs). This paper begins to fill that gap by providing evidence-based estimates of the time needed for initial visits with under-five infants and children at public or not-for-profit facilities in LMICs that use the Integrated Management of Childhood Illness (IMCI) clinical algorithm. The estimates are evidence-based and case-mix adjusted. MethodsThe expected duration of IMCI consultations in any given setting is a function of the health issues presented by patients less than 5 years old, the kind and number of tasks health workers must perform to care for such patients, and the time required to complete those tasks. Determining the time needed to complete tasks with no minimum duration requires, in addition to tabulations of health issues and lists of tasks to be performed, information on rates of task performance and the mean observed duration of consultations. All this information was located, first, by searching MEDLINE, the database of the International Network for Rational Use of Medicines, the websites of the WHO and its regional offices, GOOGLE, and GOOGLE SCHOLAR using search terms such as Integrated Management of Childhood Illness, observational, prospective, classification, clinical signs, health facility survey, validity, algorithm, and chart booklet. Additional information was found by reviewing work that cited a qualified study and, conversely, material included in the bibliographies of qualified studies. ResultsEstimates of the expected mean duration of initial consultations were constructed for 39 patient populations in 22 countries. The mean ranges from 17.1 to 20.5 minutes in the infant populations and from 15.5 to 26.4 minutes in the child populations. The shortest consultations range from 16.1 to 16.7 minutes in the infant populations and from 11.0 to 17.4 minutes in the child populations. The 98th percentile of expected durations ranges from 21.5 to 25.7 minutes in the infant populations and from 22.5 to 35.2 minutes in the child populations. ConclusionsIMCI consultations with infants and children presenting for the first time with a new concern require considerably more time than previously recognized. This suggests that the personnel costs of providing appropriate IMCI services may be substantial. It also confirms that the quality of most IMCI consultations is low.