Abstract

Background:
IMNCI, devised by World Health Organization (WHO) focuses on well-being of child by addressing major causes (over 80%) of under-5 morbidity and mortality such as pneumonia, diarrhea, measles, malaria and malnutrition. In Pakistan, 50% of Burden of Disease is due to communicable, reproductive, maternal, and child health illnesses. With 65% of population living in rural areas lacking access to specialist care, ChildLife Foundation, via public-private partnership, provides 24/7 audio-visual consults for pediatric patients through telemedicine in 300 government hospitals.

Objective:
The study aimed to access outcome of IMNCI cases via telemedicine in primary and secondary health centers across Pakistan.

Methodology: a retrospective study conducted from January 2024 to March 2024. Data was collected from electronic medical records of children diagnosed with IMNCI disease who received secondary opinion from specialist-level physicians through ChildLife Foundation (CLF) telemedicine satellite centers (TMSCs) in three cities. The tele consultations included virtual rounds, system checks, and observations through fiber optic/VSAT screens with high-definition cameras. Physicians connected to the nurses for audio calls through IP phones on both sides.

Results: A total of 99,129 tele-consultations were conducted, with 62% (n=61,804) related to IMNCI diseases. Pneumonia was the most common diagnosis (59%, n=36,607), followed by gastroenteritis (33%, n=20,177), malaria (5%, n=3,131), and measles (1%, n=661). In 40% of consultations (n=39,344), physicians corrected the triage category, recommending advanced treatments like bubble CPAP for pneumonia (8%, n=2,959) and IV fluids for gastroenteritis (37%, n=7,447). Additionally, 57% (n=35,228) of IMNCI cases were referred to district hospitals for further care.

Conclusion: Nearly half of the children seen at district-level hospitals were diagnosed with IMNCI-related illnesses, highlighting the significant burden. Specialist consultations via telemedicine improved diagnostic accuracy and treatment, enabling mid-level healthcare providers to follow IMNCI guidelines. This approach demonstrated the potential of telemedicine to enhance health care, improving childhood illness management.

Key words: Integrated management of neonatal and childhood illness, ChildLife foundation, telemedicine satellite centers