Implementing a checklist to strengthen IMCI-based assessment of childhood illnesses in an urban primary care setting in Delhi: a quality improvement initiative

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BACKGROUND: Children presenting to the outpatient department (OPD) with common complaints may have other underlying conditions. The Integrated Management of Childhood Illness (IMCI) provides a comprehensive assessment for this. This study aimed to strengthen IMCI-based assessment by using a checklist by doctors among children aged 2 months to 5 years attending an urban primary health centre in Delhi through a quality improvement initiative. METHODS: A baseline assessment with process mapping and root cause analysis was conducted to identify gaps in the existing system. Age-specific child health assessment checklists were introduced to standardise evaluation of danger signs, common conditions and malnutrition. This was implemented through two 6-week Plan-Do-Study-Act (PDSA) cycles. In addition, a dedicated paediatric OPD room, improved anthropometry and availability of essential supplies were established. RESULTS: After the first PDSA cycle, complete assessment improved to 18.3%, and danger sign evaluation increased to 88.3%. By the second cycle, complete assessment reached 50%; danger sign assessment rose to 97.2%. Screening for cough improved from 86.8% to 100%, fever from 64.2% to 91.7%, diarrhoea from 13.2% to 94.5% and ear problems from 3.8% to 88.9%. Assessment for malnutrition increased from 23.1% to 94.4%, haemoglobin testing from 25% to 69.4%, and documentation of immunisation from 1.9% to 83.3%. However, there were concerns regarding sustainability, such as additional time required for consultation and irregular supplies. CONCLUSION: The intervention improved IMCI-based assessment, highlighting the value of simple, context-appropriate strategies while underscoring the requirement for continued implementation in resource-constrained primary care settings.