Validation of WHO-IMNCI algorithm for jaundice in 0-2 months aged infants

Abstract

Background: For effective management of these major childhood illnesses, WHO and UNICEF have developed the “Integrated Management of Neonatal and Childhood Illness” (IMNCI) Strategy. Present study is to evaluate the utility of the WHO/UNICEF algorithm for Integrated Management of Neonatal and Childhood Illness (IMNCI) for jaundice up to 2 months of age.

Methods: Present study is Prospective observational comparative study. Total of 150 subjects were taken from Emergency and Outpatient Department of Pediatrics. The treatment steps were identified as according to the ‘Assess and Classify’ module of IMNCI algorithm. All relevant investigations were performed, using appropriate methods. Blood sugar was done in all recruited children and serum bilirubin levels were done in all infants presented with jaundice. Based on this detailed clinical evaluation and relevant investigations, final diagnosis were made and therapies were given. These diagnosis and treatments were considered as the ‘Gold Standard’ for comparison.

Results: There were 150 young infants, of whom 81(54%) were male and 69(46%) were female infants. Total of 73 infants were admitted, 12 from OPD and 61 from Emergency. 77 infants were sent home after initial management in hospital. Severe jaundice was present in 12 infants according to IMNCI and 6 infants according to Gold Standard in 0-2 months of age. The predictive utility of algorithm for the diagnosis of severe jaundice with a sensitivity of 100%, specificity of 75%, positive predictive value of 50% and negative predictive value of 100% in 0-2 months of age group.

Conclusion: Algorithm performed well in identifying severe jaundice with the sensitivity of 100% and specificity of 95%.