***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To estimate the impact of the Integrated Management of Childhood Illness ( IMCI ) strategy on  early-childhood mortality  , we evaluated a  malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets ( ITNs ) . METHODS We conducted a before- and -after intervention study that included a nonr and omized comparison group . We used the preceding birth technique to measure early-childhood mortality ( risk of dying before age 30 months ) , and we used health facility surveys and household surveys to measure process indicators . RESULTS Most process indicators improved in the area covered by the intervention . Notably , because ITNs were also promoted in the comparison area children 's ITN use increased by about 20 percentage points in both areas . Regarding early-childhood mortality , the trend from baseline ( 1999 - 2001 ) to follow-up ( 2002 - 2004 ) for the intervention area ( 13.0 % decrease ; P < .001 ) was 14.1 % ( P < .001 ) lower than was the trend for the comparison area ( 1.3 % increase ; P = .46 ) . CONCLUSIONS Mortality decreased in the intervention area after IMCI and ITN promotion .  ITN use increased similarly in both study areas , so the mortality impact of ITNs in the 2 areas might have canceled each other out . Thus , the mortality reduction could have been primarily attributable to IMCI 's effect on health care quality and care-seeking Objective To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practice s and on  neonatal and infant morbidity .  Design Cluster r and omised trial . Setting Haryana , India . Participants 29 667 births in nine intervention clusters and 30 813 births in nine control clusters . Main outcome measures The pre-specified outcome was the effect on treatment seeking practice s. Post hoc exploratory analyses assessed morbidity , hospital admission , post-neonatal infant care , and nutritional status outcomes . Interventions The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers , improved case management of sick children , and strengthening of health systems . Outcomes were ascertained through interviews with r and omly selected caregivers : 6204 , 3073 , and 2045 in intervention clusters and 6163 , 3048 , and 2017 in control clusters at ages 29 days , 6 months , and 12 months , respectively . Results In the intervention cluster , treatment was sought more often from an appropriate provider for severe neonatal illness ( risk ratio 1.76 , 95 % confidence interval 1.38 to 2.24 ) , for local neonatal infection ( 4.86 , 3.80 to 6.21 ) , and for diarrhoea at 6 months ( 1.96 , 1.38 to 2.79 ) and 12 months ( 1.22 , 1.06 to 1.42 ) and pneumonia at 6 months ( 2.09 , 1.31 to 3.33 ) and 12 months ( 1.44 , 1.00 to 2.08 ) . Intervention mothers reported fewer episodes of severe neonatal illness ( risk ratio 0.82 , 0.67 to 0.99 ) and lower prevalence of diarrhoea ( 0.71 , 0.60 to 0.83 ) and pneumonia ( 0.73 , 0.52 to 1.04 ) in the two weeks preceding the 6 month interview and of diarrhoea ( 0.63 , 0.49 to 0.80 ) and pneumonia ( 0.60 , 0.46 to 0.78 ) in the two weeks preceding the 12 month interview . Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life ( risk ratio 3.19 , 2.67 to 3.81 ) . Conclusion Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity , a likely explanation for the reduction in mortality observed following implementation of the programme in this study . Trial registration Clinical trials NCT00474981 ; ICMR Clinical Trial Registry CTRI/2009/091/000715 To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses ( IMCI ) strategy , a r and omized trial was implemented . All 28 government health centers in a Southern Brazil city were paired according to baseline nutritional indicators . One center from each pair was r and omly selected and its doctors received 20-h training in nutrition counseling .  Thirty-three doctors were included and 12 - 13 patients < 18 mo of age from each doctor were recruited . The study included testing the knowledge of doctors , observing consultations and visiting the children at home 8 , 45 and 180 d after the initial consultation . Maternal knowledge , practice s and adherence to nutritional recommendations were assessed , and anthropometric measurements were taken . Day-long dietary intake was evaluated on a sub sample of children . Doctors in the intervention group had better knowledge of child nutrition and improved assessment and counseling practice s. Maternal recall of recommendations was higher in the intervention than in the control group , as was satisfaction with the consultation . Reported use of recommended foods was also increased . Daily fat intake was higher in the intervention than in the control group ; mean daily intakes of energy and zinc also tended to improve . Children 12 mo of age or older had improved weight gain and a positive but nonsignificant improvement in length .  Nutrition-counseling training  improved doctors ' performances , maternal practice s and the diets and weight gain of children . The r and omized design with blind outcome evaluation strongly supports a causal link . These results should be replicated in other setting Physician behavior and caregiver retention of nutrition advice were examined as potential mediating factors in the success of a nutrition counseling efficacy trial in Pelotas , Brazil , which reduced growth faltering in children 12 - 24 mo old . After pair-matching on socioeconomic status and nutrition indicators , municipal health centers were r and omly assigned to an intervention group , in which physicians were trained with an IMCI-derived ( Integrated Management of Childhood Illness ) nutrition counseling protocol , or to a control group , without continuing education in nutrition . In a sub study of the larger trial , direct observation of consultations , followed by home interviews with mothers , provided data on physician counseling behavior and mothers ' retention of nutrition advice . Trained providers were more likely to engage in nutrition counseling ( P < 0.013 ) and to deliver more extensive advice ( P < 0.02 ) . They also used communication skills design ed to improve rapport and ensure that mothers understood the advice ( P < 0.01 ) . Mothers who received advice from trained providers had high rates of recalling the messages on specific foods ( 95 vs.27 % ; P < 0.01 ) and feeding practice and food preparation recommendations ( 90 vs. 20 % ; P < 0.01 ) , whereas the proportions of the messages recalled on breast-feeding ( 60 % vs. 30 % ) did not differ significantly ( P < 0.20 ) . The training course contained several elements that may explain why intervention group mothers were better able to recall nutrition advice . These include locally appropriate messages , tools for assessing individual problems , and counseling skills BACKGROUND The Integrated Management of Childhood Illness ( IMCI ) strategy is design ed to address major causes of child mortality at the levels of community , health facility , and health system . We assessed the effectiveness of facility-based IMCI in rural Tanzania . METHODS We compared two districts with facility-based IMCI and two neighbouring comparison districts without IMCI , from 1997 to 2002 , in a non-r and omised study . We assessed quality of  case-management for children 's illness , drug and vaccine availability , and supervision involving case-management , through a health-facility survey in 2000 . Household surveys were used to assess child-health indicators in 1999 and 2002 . Survival of children was tracked through demographic surveillance over a predefined 2-year period from mid 2000 . Further information on context ual factors was gathered through interviews and record review . The economic cost of health care for children in IMCI and comparison districts was estimated through interviews and record review at national , district , facility , and household levels . FINDINGS During the IMCI phase-in period , mortality rates in children under 5 years old were almost identical in IMCI and comparison districts . Over the next 2 years , the mortality rate was 13 % lower in IMCI than in comparison districts ( 95 % CI -7 to 30 or 5 to 21 , depending on how adjustment is made for district-level clustering ) , with a rate difference of 3.8 fewer deaths per 1000 child-years . Context ual factors , such as use of mosquito nets , all favoured the comparison districts . Costs of children 's health care with IMCI were similar to or lower than those for case-management without IMCI . INTERPRETATION Our findings indicate that facility-based IMCI is good value for money , and support widespread implementation in the context of health-sector reform , basket funding , good facility access , and high utilisation of health facilities Background Poverty , lack of female empowerment , and lack of education are major risk factors for childhood illness worldwide . Microcredit programs , by offering small loans to poor individuals , attempt to address the first two of these risk factors , poverty and gender disparity . They provide clients , usually women , with a means to invest in their businesses and support their families . This study investigates the health effects of also addressing the remaining risk factor , lack of knowledge about important health issues , through r and omization of members of a microcredit organization to receive a health education module based on the World Health Organization 's Integrated Management of Childhood Illness ( IMCI ) community intervention . Methods Baseline data were collected in February 2007 from clients of a microcredit organization in Pucallpa , Peru ( n = 1,855 ) and their children ( n = 598 ) . Loan groups , consisting of 15 to 20 clients , were then r and omly assigned to receive a health education intervention involving eight monthly 30-minute sessions given by the organization 's loan officers at monthly loan group meetings . In February 2008 , follow-up data were collected , and included assessment s of sociodemographic information , knowledge of child health issues , and child health status ( including child height , weight , and blood hemoglobin levels ) . To explore the effects of treatment ( i.e. , participation in the health education sessions ) on the key outcome variables , multivariate regressions were implemented using ordinary least squares . Results Individuals in the IMCI treatment arm demonstrated more knowledge about a variety of issues related to child health , but there were no changes in anthropometric measures or reported child health status . Conclusions Microcredit clients r and omized to an IMCI educational intervention showed greater knowledge about child health , but no differences in child health outcomes compared to controls . These results imply that the intervention did not have sufficient intensity to change behavior , or that microcredit organizations may not be an appropriate setting for the administration of child health educational interventions of this type . Trial Registration This study is registered with Clinical Trials.gov , NCT01047033 Background Pneumonia is a leading cause of death among children under five years of age . The Integrated Management of Childhood Illness strategy can improve the quality of care for pneumonia and other common illnesses in developing countries , but adherence to these guidelines could be improved . We evaluated an intervention in Benin to support health worker adherence to the guidelines after training , focusing on pneumonia case management . Methods We conducted a r and omized trial . After a health facility survey in 1999 to assess health care quality before Integrated Management of Childhood Illness training , health workers received training plus either study supports ( job aids , non-financial incentives and supervision of workers and supervisors ) or " usual " supports . Follow-up surveys were conducted in 2001 , 2002 and 2004 . Outcomes were indicators of health care quality for Integrated Management-defined pneumonia . Further analyses included a graphical pathway analysis and multivariable logistic regression modelling to identify factors influencing case-management quality . Results We observed 301 consultations of children with non-severe pneumonia that were performed by 128 health workers in 88 public and private health facilities . Although outcomes improved in both intervention and control groups , we found no statistically significant difference between groups . However , training proceeded slowly , and low- quality care from untrained health workers diluted intervention effects . Per- protocol analyses suggested that health workers with training plus study supports performed better than those with training plus usual supports ( 20.4 and 19.2 percentage-point improvements for recommended treatment [ p = 0.08 ] and " recommended or adequate " treatment [ p = 0.01 ] , respectively ) . Both groups tended to perform better than untrained health workers . Analyses of treatment errors revealed that incomplete assessment and difficulties processing clinical findings led to missed pneumonia diagnoses , and missed diagnoses led to inadequate treatment . Increased supervision frequency was associated with better care ( odds ratio for recommended treatment = 2.1 [ 95 % confidence interval : 1.1 - 3.9 ] per additional supervisory visit ) . Conclusion Integrated Management of Childhood Illness training was useful , but insufficient , to achieve high- quality pneumonia case management . Our study supports led to additional improvements , although large gaps in performance still remained . A simple graphical pathway analysis can identify specific , common errors that health workers make in the case-management process ; this information could be used to target quality improvement activities , such as supervision ( Clinical Trials.gov number N 
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Therefore , we do not know whether IMCI impacts exclusive breast feeding .
Implementing the integrated management of childhood illness strategy may reduce child mortality , and packages that include interventions for the neonatal period may reduce infant mortality .
IMCI may have little or no effect on nutritional status and probably has little or no effect on vaccine coverage .
Maternal care seeking behavior may be more appropriate with IMCI , but study results have been mixed , providing evidence of very low certainty about whether IMCI has effects on adherence to exclusive breast feeding .
Key messages This review shows that use of the World Health Organization IMCI strategy may led to fewer deaths among children from birth to five years of age .
This review showed that use of IMCI : • may lead to fewer deaths among children from birth to five years of age