Background WHO and UNICEF launched the Integrated Management of Childhood Illness (IMCI) strategy in the
mid-1990s to reduce deaths from diarrhoea, pneumonia, malaria, measles, and malnutrition in children younger
than 5 years. We assessed the eff ect of IMCI on health and nutrition of children younger than 5 years in Bangladesh.
Methods In this cluster randomised trial, 20 fi rst-level government health facilities in the Matlab subdistrict of
Bangladesh and their catchment areas (total population about 350 000) were paired and randomly assigned to either
IMCI (intervention; ten clusters) or usual services (comparison; ten clusters). All three components of IMCI?healthworker
training, health-systems improvements, and family and community activities?were implemented beginning
in February, 2002. Assessment included household and health facility surveys tracking intermediate outputs and
outcomes, and nutrition and mortality changes in intervention and comparison areas. Primary endpoint was mortality
in children aged between 7 days and 59 months. Analysis was by intention to treat. This study is registered, number
Findings The yearly rate of mortality reduction in children younger than 5 years (excluding deaths in fi rst week of life)
was similar in IMCI and comparison areas (8?6 vs 7?8 ). In the last 2 years of the study, the mortality rate was
13?4 lower in IMCI than in comparison areas (95 CI ?14?2 to 34?3), corresponding to 4?2 fewer deaths per
1000 livebirths (95 CI ?4?1 to 12?4; p=0?30). Implementation of IMCI led to improved health-worker skills,
health-system support, and family and community practices, translating into increased care-seeking for illnesses. In
IMCI areas, more children younger than 6 months were exclusively breastfed (76 vs 65 , diff erence of diff erences
10?1 , 95 CI 2?65?17?62), and prevalence of stunting in children aged 24?59 months decreased more rapidly
(diff erence of diff erences ?7?33, 95 CI ?13?83 to ?0?83) than in comparison areas.
Interpretation IMCI was associated with positive changes in all input, output, and outcome indicators, including
increased exclusive breastfeeding and decreased stunting. However, IMCI implementation had no eff ect on mortality
within the timeframe of the assessment.
Funding Bill Melinda Gates Foundation, WHO?s Department of Child and Adolescent Health and Development,
and US Agency for International Development.