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PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents
  1. Sandy Picken1,
  2. Juliet Hannington1,
  3. Lara Fairall1,2,
  4. Tanya Doherty1,3,
  5. Eric Bateman1,
  6. Mark Richards4,
  7. Camilla Wattrus1,
  8. Ruth Cornick1,2
  1. 1 Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
  2. 2 Department of Medicine, University of Cape Town, Mowbray, South Africa
  3. 3 South African Medical Research Council, Cape Town, South Africa
  4. 4 Department of Paediatrics and Child Health, Somerset Hospital, University of Cape Town, Green Point, South Africa
  1. Correspondence to Dr Sandy Picken; sandy.picken{at}


Pioneering strategies like WHO’s Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.

  • public health
  • child health
  • health systems
  • paediatrics
  • practice guidelines as topic

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  • Handling editor Seye Abimbola

  • Contributors SP wrote the first draft of the paper. All authors contributed intellectual content, edited the manuscript and approved the final version for submission.

  • Funding Development of the PACK Child Guide was funded by a grant from The Children’s Hospital Trust. Additional funding was provided by the University of Cape Town Lung Institute. TD’s time was supported by the South African Medical Research Council. PACK receives no funding from the pharmaceutical industry.

  • Competing interests We have read and understood BMJ policy on declaration of interests and declare that SP, LF, EB, CW and RC are employees of the KTU. JH is an ex-employee of the KTU. TD is an employee of the South African Medical Research Council. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann La Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All of EB’s fees and clinical trials are for work outside the submitted work. EB is also a Member of Global Initiative for Asthma Board and Science Committee. Since August 2015, the KTU and BMJ have been engaged in a non-profit partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ co-fund core positions, including a PACK Global Development Director, based in the UK, and receive no profits from the partnership. This paper forms part of a Collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary health care as envisaged in the Declaration of Alma Ata, during its 40th anniversary. Each paper in this collection has been peer reviewed.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data is available.