Health Providers' Counselling of Caregivers in the Integrated Management of Childhood Illness (IMCI) Programme in Uganda

Background: IMCI was launched in Uganda in June 1995 and has so far been implemented in most districts. However, reports indicate that counselling is poorly performed and that health providers find IMCI counselling the most difficult component to implement.
Objectives: The study was carried out to assess IMCI-trained health providers' counselling of caregivers and to determine factors that facilitate or constrain counselling.
Methods: A cross-sectional study utilizing quantitative and qualitative methods was carried out in 2000 in 19 health units in Mukono District. The study involved 37 health providers in 161 IMCI counselling sessions.
Results: Health providers performed well in assessing the child's problem (85%); listening (100%); use of simple language (95%); use of kind tone of voice (99%); showing interest in caregivers (99%); giving feeding advice (76%); and giving advice on return immediately (78%), for follow up (75%), and for immunization (97%). Performance was poor in praising the caregivers (43%); asking feeding questions (65%); explaining feeding problems (50%); explaining health problems (62%); advising on fluid intake (44%); advising on medication (61%), and using mothers' cards (44%). Most health providers (99%) did not address caregivers' health problems. Cadre of health provider, IMCI experience, number of supervisory visits and praise of health provider were independent predictors of using mothers' cards, advising on medication, inviting questions from caregivers, and advising on fluid intake respectively. Twelve percent of the children were referred but most health facilities did not have drugs to treat the children before referring them.
Conclusions: The performance of health providers was good in 9 out of 20 IMCI counselling items, and cadre of health provider, IMCI experience, number of supervisory visits and praise of health provider were associated with IMCI counselling. Improvements in IMCI counselling could be achieved through emphasis on use of IMCI job aids; strengthening support supervision and providing positive feedback to health providers. The issue of availability of pre-referral drugs should be addressed by ensuring that these drugs are part of the essential drug kit. Finally, health providers should be trained and encouraged to address the health of the caregivers as well.

Keywords
Child, preschool; infant; health-provider; caregiver; counselling; IMCI-counselling; Uganda