Integrated Management of Childhood Illness (ICMI) is the leading protocol designed to decrease under 5 mortality globally (WHO) – although its potential impact is threatened by quality of care.
Magge and colleagues report the outcome of a nurse mentorship programme— Mentorship and Enhanced supervision at Health Centres (MESH) in two rural districts (21 rural health centres) in Rwanda. The detail of the intervention is described in the paper. This was a pre post study with outcome assessed through a validated index of key ICMI assessments recorded at baseline and 12 months. The index is effectively a checklist of good clinical assessment/care including items like ability to drink, presence of severe vomiting, convulsions, difficulty breathing, weight, presence of oedema and suchlike. The index increased significantly in both districts. The impact was positive across multiple health care outcomes—number of children seen by ICMI trained nurses increased from 83.2 to 100%, use of ICMI case recording forms increased from 65.9 to 97.1%, correct classification from 56 to 91.5% and correct treatment from 78.3 to 98.2%.
The data is impressive and goes to the heart of what can be achieved through a well thought out quality improvement initiative with an initial analysis of the issues, ‘package’ intervention, comprehensive assessment of the feasibility and success of the intervention, efforts to attain sustainability and longer term impact on health outcomes.

–@RMBeatie50