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Integrated Management of Childhood Illness

•Child Health: Global Profile

•IMCI Rationale, objectives,components

•Principles of integrated care

•IMCI Case Management Process



•Children in low-middle

income countries 10xmore likely to diebefore reaching 5thbirthday

•More than 50countries had childhood

mortality rates over 100per 1,000 live births

http://images.google.com.ph/imgres?imgurl=http://k53.pbase.com/u44/bvcuma/upload/28410064.sickchildrs.jpg&imgrefurl=http://www.pbase.com/bvcuma/image/28410064&h=640&w=480&sz=99&hl=tl&start=10&tbnid=4t6vyLRWoLha-M:&tbnh=137&tbnw=103&prev=/images?q=sick+child&gbv=2&svnum=10&hl=tl



•7 in 10 ten deaths

are due to ARI ,diarrhea, measles,malaria or

malnutrition

•Major contributors

to child deathsthrough the year2020



Study of 163 countries,

SAVE THE CHILDREN, 2001

53 million women give birth each

year without professional help

Global child death rates have been

reduced by 14% over the past decade

Eight babies in the first month of their

lives die every minute world-wide



Causes of Death in Children

Under-

nutrition

53%



• Many sickchildren poorly

assessed• Improperly

treated

• Parents poorly

advised

Health Care : First –Level Facility



*scarce supplyof drugs and

equipment

•minimal/

non-existentdiagnostic support



• Few opportunities

for MD to practicecomplicated

procedures•Reliance on history

of signs andsymptoms



WHO/UNICEF/DOHRegional Child Survival Strategy

and

Assessment of Philippine Situation



•Infant andyoung child

feeding

Lack of accessto safe water &

sanitation

Underlying Factors



High fertility, poor birth spacing



Community and environment



•Lack of access

to basic socialservices

•Inadequate carefor women



Reasons for an IMCI Strategy

•Most children have more

than one condition at one

time

• Illnesses are interrelated

• Illnesses should not be

only tested, but alsoprevented



• Poor quality of care at all levels

• Vertical delivery mechanisms

characterized by low efficiency

http://www.alertnet.org/thenews/photoalbum/?download=/images/0468238.jpg



http://www.niehs.nih.gov/research/supported/centers/prevention/images/children.jpg



Objectives

•Reduce illness,

disability and

death from

common

childhoodillnesses



To promote improved growth and

development amongunder-5 children



An evidence- based syndromic approach canbe used to determine the:

Health

problem/sSeverity of

the condition

Actions



Improving the health system

to deliver IMCI

IMCI Components

Improving case management

skills of health workers



Improving family and

community practices



Principles of Integrated Care

IMCI guidelines

address most, but

not all, of themajor reasons a

sick child is

brought to a

clinic.



A combination of

individual signs

leads to a child’sclassification/s

rather than a

diagnosis



Counseling of caretakers anessential component



IMCI management use a limitednumber of essential drugs



All sick children must be examined for “general danger signs” -- immediatereferral or hospital admission



All sick children must beroutinely assessed for:

2 mos.-5 yrs. Old:

(cough/difficult breathing,diarrhea, fever, ear problem)

1 week-2 mos:

(bacterial infection and diarrhea)



Nutritional, immunization status,feeding problems , care for

development and other problems



Only a limited number of carefully-

selected clinical signs are used

(sensitivity and specificity

to detect disease)



A combination of individual signsleads to a child’s classification/s

rather than a diagnosis;

classifications are color-coded

http://images.google.com.ph/imgres?imgurl=http://www.impact-malaria.com/FR/EPS/Formations_et_cours_internationaux/Formation_de_la_Liverpool_School_LSTMH/cours_liverpool/Unit_3/images/sick-child.jpg&imgrefurl=http://www.impact-malaria.com/FR/EPS/Formations_et_cours_internationaux/Formation_de_la_Liverpool_School_LSTMH/cours_liverpool/Unit_3/3_intro.html&h=334&w=250&sz=24&hl=tl&start=11&tbnid=LEKNvG7hADvMJM:&tbnh=119&tbnw=89&prev=/images?q=sick+child+&gbv=2&svnum=10&hl=tl



IMCI Case Management Process

Classify

Assess

Identify Treatment

Treat/Refer

Counsel

Follow-Up

Classify

Identify Treatment

Treat/Refer

Counsel

Assess

Follow-Up

Assess

Identify Treatment



Check for General Danger SignsConvulsions

Lethargy/unconsciousnessInability to drink/breastfeed Vomiting

Assess Main SymptomsCough/difficulty breathingDiarrheaFeverEar Problems

Assess Nutrition , Immunizationstatus , Care for Development

and Other Problems



Classify conditions/identify treatment actions

Pre-referral TreatmentAdvise Parents

Refer Child

Urgent

Referral

OUT-PATIENTHEALTH FACILITY

REFERRAL

FACILITY

Emergency Triage

& Treatment (ETAT)

Diagnosis

TreatmentMonitoring &

Follow-up



OUT-PATIENTHEALTH FACILITY

Treatment at OP Health Facility

•Treat Local Infections

• Give oral drugs

• Advise/teach caretaker • Follow-Up

OUT-PATIENT HEALTH FACILITY

Treatment at OP Health Facility



HOMECaretaker is counseled on:

Home treatment

Feeding & fluids

When to return

immediately

Follow-up

Home Management



Vertical” health programmes and an

individual health worker

Separate

disease specificclinical

guidelines & trg.

materials

National

programmesconduct disease

specific trg.

courses

“Integration” of clinical guidelines

by the health

worker



IMCI and an Individual Health Worker

Integrated

clinicalguidelines &

trg. materials

National

programmescollaborate in

integrated training

courses

Integratedclinical case

management

For many sick children a single diagnosis



For many sick children a single diagnosis

may not be apparent or appropriate

Presenting complaint

Cough and/or fast breathing

Lethargy/

unconsciousness

Measles rash

“Very sick” young infant

Possible cause/associated condition

Pneumonia, Severe anemia,P. falcifarum malaria

Cerebral malaria , Meningitis,Severe dehydration,Very severePneumonia

Pneumonia, Diarrhea,

Ear Infection

Pneumonia , Meningitis,Sepsis



Interventions included in IMCI guideline

for first-level health workers

Conditions covered bycase mgt. Interventions

Preventiveinterventions

Generic

Version

ARI, Diarrhea, Dehydration,

Persistent Diarrhea,

Dysentery,

Meningitis, Sepsis,

Malaria, Measles,

Anemia, Malnutrition, Ear

Infection

Immunizations

during sick child

visits, Nutrition

counseling,

Breastfeeding

support, Vit. A

supplementation

Using the

IMCI

Adaptation

Guide

HIV/AIDS,

Dengue Hemorrhagic

Fever, Wheeze,

Sore Throat

Periodic

Deworming



Mgt.of sickchildren NutritionImmunization

Other Disease

prevention

Growth &

Devt.

IMCI as a key strategy

For improving child health



IMCI Vision

All Filipino children have access and equity to

quality health care services supported with

empowered families and communities capable of

sustained actions that will ensure a child friendly

environment conducive to development of the full

potential of the child by 2025.



“ Lo, children are anheritage of theLORD..” Psalm 127: 3a

“..And the King shallanswer and say untothem, Verily I say

unto you, Inasmuchas ye have done itunto one of the leastof these my

brethren, ye havedone it unto me.” Matthew 25:40



R



Resources

• WHO. Department of Child and Adolescent Health andDevelopment. Model Chapter for Textbooks –IMCI , 2001

•news.bbc.co.uk/olmedia/1535000/images/_153685.

September, 2001

•DOH Report presented during IMCI National Program

Implementation Review, December 2006

•http://www.who.int/child_adolescent_health/

•topics/prevention_care/child/imci/en/index.html

•http://www.google.images.com

•http://greenhealthinformation.com/wp-content/pic/healthy_children.jpg•http://web.ivenue.com/standrewlutheranchurch/images/children.jpg

•http://www.ibiblio.org/obl/docs/yearbooks/images/Photo-RC010.gif

•https://reader009.{domain}/reader009/html5/0407/5ac8be101a86d/5ac8be282c

http://www.who.int/child_adolescent_health/topics/prevention_care/child/imci/en/index.html


http://www.google.images.com/

http://web.ivenue.com/standrewlutheranchurch/images/children.jpg

http://www.ibiblio.org/obl/docs/yearbooks/images/Photo-RC010.gif




http://web.ivenue.com/standrewlutheranchurch/images/children.jpg

http://www.google.images.com/




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