Adherence to the Use of Integrated Management of Neonatal and Childhood Illnesses (Imnci) Protocol among Health Workers in Ashiedu-Keteke and Ablekuma Submetros, Accra

Abstract

Introduction: In Ghana, one in every twelve children dies before their fifth birthday despite the implementation of the IMNCI protocol since 1998. Studies to investigate this in Ghana have focused on specific aspects such as laboratory test and management of malaria with limited attention paid to assessing health workers’ knowledge and adherence to the three focal areas in the IMNCI strategy. Objectives: This study assessed knowledge and adherence as well as factors associated with the use of the Integrated Management of Childhood and Neonatal Illness (IMNCI) protocol among health workers caring for children under five years in Ashiedu-Keteke and Ablekuma Sub metropolis in the Greater Accra Region. Methods: A health facility-based cross-sectional quantitative survey using a self-administered questionnaire was employed. Data was collected from 300 randomly sampled health workers who directly provide child healthcare in four public health facilities in the Ashiedu-Keteke and Ablekuma sub-metropolis of the Greater Accra region. Descriptive statistics, chi-square and logistic regression analyses performed at a confidence level of 95% and a P<0.05 was considered as statistically significant. Results: Findings suggest that 56.7% of the respondents had a low level of knowledge on IMNCI. Adherence to the IMNCI protocol was also low (58.7%). Factors associated with adherence to the use of the IMNCI protocol were age, the location of health facility, and level of knowledge on IMNCI. Health workers aged 18-29 were less likely to adhere to the protocol compared to those aged above 40 (AOR: 0.07; 95% CI: 0.01 - 0.28). Respondents who worked at Ussher Polyclinic were less likely to adhere to the protocol than those working at Princess Marie Louis Children’s Hospital (AOR: 0.14; 95% CI: 0.05 – 0.39). Health workers who had high level of knowledge on IMNCI protocol were more likely to adhere than those who had low knowledge (AOR: 2.70; 95% CI: 1.51 – 4.84). Conclusion: This study has revealed that both knowledge on, and adherence to, the protocol IMNCI among healthcare workers caring for children under five in the study area are low. If quality healthcare delivery to children under five years in the health facilities studied is to be ensured, it is important that healthcare providers not only become aware and knowledgeable about the IMNCI protocol but also adhere to the protocol in the delivery of healthcare to children. Routine in-service training of healthcare providers on the IMNCI protocol could improve both improve both knowledge on, and adherence to, the protocol IMNCI.