The Integrated Management of Childhood Illness (IMCI) strategy was adopted in Burundi in 2003. Our aim was to evaluate to what extent the malnutrition component of the IMCI guidelines is implemented at health facilities level. We carried out direct observations of curative outpatient consultations for children aged 6–59 months in 90 health centres selected randomly. We considered both the child and the health worker (HW) as units of analysis and used bivariate analysis to explore characteristics of HWs associated with tasks systematically or never performed. A total of 514 consultations carried out by 145 HWs were observed. Among the 250 children under two years, less than 30% were asked questions on breastfeeding. None of them had all seven nutrition-related questions asked to their caregivers and none of the 200 children over the age of two years had all five nutrition-related questions asked to their caregivers. Only 13 cases (3%) had all of the six examinations/tasks (weight, height/length, mid-upper arm circumference, oedema, filling in and discussing the growth curve and calculating the weight for height z-score) performed as part of their care. 393 cases (76%) reported that they had not being given any nutrition advice. With regards to HWs, among 99 of them who had received children under two, only 21 (21.2%)[14.2–30.5%) systematically asked the question regarding ‘ongoing breastfeeding’. Only 56 (38.6%)[31–46.9%] weighed or discussed the weight taken prior the consultation for each child they reviewed, only 38 (26.2%)[19.6–34.1%] measured the height/length or discussed it for each child reviewed and 23 (15.9%)[10.7–22.8%] performed (systematically?) the WHZ-score. More than 50% never gave nutrition advices to any child reviewed. HWs who daily manage severe acute malnutrition were the most likely to systematically ask the question regarding ‘ongoing breastfeeding’ and to perform a ‘weight examination’. Those who had not received supervision visit on the topic of malnutrition predominantly never performed a ‘weight examination’. The ‘height/length’ examination’ was predominantly performed by female HWs and those who have ‘contract with the government. This study has found poor compliance by HWs to IMCI in Burundi. This indicates that a substantial proportion of children do not receive early and appropriate care, especially that pertaining to malnutrition. This alarming situation calls for strong action by actors committed to child health in the country. Clinical Trials.gov Identifier: NCT02721160; March 2016 (retrospectively registered).

中文翻译：

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解决常规护理中儿童的营养不良问题：如何在布隆迪卫生中心一级实施儿童疾病综合管理战略？

2003 年，布隆迪通过了儿童疾病综合管理 (IMCI) 战略。我们的目的是评估 IMCI 指南中的营养不良部分在卫生设施层面的实施程度。我们在随机选择的 90 个保健中心对 6-59 个月儿童的治疗性门诊咨询进行了直接观察。我们将儿童和卫生工作者 (HW) 视为分析单位，并使用双变量分析来探索与系统或从未执行的任务相关的 HW 的特征。共有 145 个 HW 进行了 514 次咨询。在 250 名两岁以下儿童中，不到 30% 被问及有关母乳喂养的问题。他们中没有一个人向他们的照顾者询问了所有七个与营养相关的问题，并且在 200 名两岁以上的儿童中没有一个人向他们的照顾者询问了所有五个与营养相关的问题。只有 13 例 (3%) 将所有六项检查/任务（体重、身高/长度、中上臂围、水肿、填写和讨论生长曲线以及计算身高 z 分数的体重）作为一部分进行他们的照顾。393 例 (76%) 报告说他们没有得到任何营养建议。关于 HW，在接受过两岁以下儿童的 99 人中，只有 21 人（21.2%）[14.2-30.5%）系统地询问了有关“持续母乳喂养”的问题。只有 56 (38.6%)[31–46.9%] 称重或讨论了他们审查的每个孩子在咨询前的体重，只有 38 (26.2%)[19.6–34. 1%] 测量了每个孩子的身高/长度或对其进行了讨论，并且 23 (15.9%) [10.7–22.8%] 进行了（系统地？）WHZ 评分。超过 50% 的人从未向任何接受过审查的儿童提供营养建议。每天处理严重急性营养不良的 HW 最有可能系统地询问有关“持续母乳喂养”的问题并进行“体重检查”。那些没有接受关于营养不良主题的监督访问的人大多从未进行过“体重检查”。“身高/身长”检查主要由女性 HW 和“与政府签订合同”的人进行。这项研究发现布隆迪的 HW 对 IMCI 的依从性较差。这表明很大一部分儿童没有得到早期和适当的护理，尤其是与营养不良有关的护理。这种令人震惊的情况要求该国致力于儿童健康的行为者采取强有力的行动。Clinical Trials.gov 标识符：NCT02721160；2016 年 3 月（追溯注册）。