In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries

Opiyo, Newton; English, Mike

Severe illness remains a leading cause of newborn and child deaths in low-income countries (LICs) (Liu 2012; Seale 2014). Major conditions contributing to severe illness include sepsis, pneumonia, meningitis and diarrhoea (Liu 2012; Seale 2014). Early recognition of severe illness with prevention of cardiorespiratory arrest through resuscitation represents a critical step towards reducing mortality and long-term disability in seriously ill newborns and children. However, the clinical diagnosis of severe illness can be difficult, as signs are often non-specific and deteriorate rapidly. Gove 1999; Molyneux 2006) . This course is specifically aimed at low-income countries and is intended to improve prompt identification and institution of life-saving emergency treatment for very ill children. The more general CDD and ARI programmes were developed by the WHO in 1980, in recognition of high childhood mortality due to diarrhoea/dehydration and pneumonia among very ill neonates and children; they focus on case management training rather than life support (Forsberg 2007; Pio 2003) . Although these courses concentrate on community-based or out-patient-based management, with good evidence for their success (Sazawal 2001), they also include guidance on management of very severe illness. These disease-specific training approaches were incorporated into the broader package of the IMCI strategy. Here the particular focus for management of the very ill child is the decision to provide prereferral care and referral to hospital. In addition to this, the WHO has developed a specific five-day course on hospital management of severe malnutrition (WHO 2002) .