integrated management on childhood imci report

8/2/2019 Integrated Management on Childhood Imci Report

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INTEGRATED MANAGEMENT ON

CHILDHOOD ILLNESSES(IMCI)Presented by:Vernalin B. Terrado, RN

AileenMitch

Presented to:Prescilla Vidal


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INTEGRATED MANAGEMENT ONCHILDHOOD ILLNESSES


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INTRODUCTION


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IMCI

IMCI is an integrated approach to child healththat focuses on the well-being of the whole child.

IMCI aims to reduce death, illness and disability,and to promote improved growth anddevelopment among children under five years of

age. IMCI has already been introduced in more than

75 countries around the world.


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AIMS:

1. Improve skills of health providers

2. Speed up the referral of sick children

3. Promote appropriate health-seekingbehaviours

4. Emphasize disease prevention through

immunisation and improved nutrition


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5 major killers of children:

Diarrhea

Acute RespiratoryInfections(Pneumonia)

Measles

Malaria

Malnutrition


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Inequities of Child Health

World Analysts say that this Global Burden of Disease indicate that theseconditions will continue to be major contributors to child deaths through the year2020 unless significantly greater efforts are made to control them.

A. Infant and childhood mortality are sensitive indicators of

inequity and poverty1. children who are most commonly and severely ill, who are

malnourished and who are most likely to die of their illness are those of the most vulnerable and underprivileged populations of low-income countries;

2. even within middle-income and so-called industrialized countries, there are often neglected geographical areas where childhood mortality remains high;

3. millions of children are often caught in the vicious cycle of poverty and ill health. poverty leads to ill health and ill health breeds poverty.


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B. Quality of care is another important indicator of inequities in child health. Everyday, millions of parents

seek health care for their sick children, taking them to hospitals, health centers, pharmacists, doctors, and traditional healers.

1. Surveys reveal that many sick children are not properly assessed and treated by these health providers, and that their parents are poorly counseled;

2. At 1st level health facilities in low-income countries, diagnostic supports e.g. x-ray & laboratory services are minimal or non-existent, and drugs and equipment are often scarce;

3. Limited supplies and equipment, combined with an

irregular flow of patients, leave doctors at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs & symptoms to determine a source of management that makes the best use of available resources.


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Figure 1. Proportion of Global Burden of Selected Diseases Borne by Children Under

5 Years (Estimated, Year 2000)

ARI

Children 0-4years

All Ogther AgeGroups

Malaria

Children 0-4years


Diarrhoea

Children 0-4years


Measles

Children 0-4years


And so, the IMCI strategy, using the case management method targets children

less than 5 years oldthe age group that bears the highest burden of deaths from

common childhood diseases.


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World Analysts say that this Global Burden of

Disease indicate that these conditions willcontinue to be major contributors to childdeaths through the year 2020 unlesssignificantly greater efforts are made to controlthem


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How Can this Situation be Reversed ?

How Can we Provide Quality Care to Sick Children ?

Experience and evidence show that improvements in child

health are not necessarily dependent on the use ofsophisticated and expensive technologies bur rather oneffective strategies that are based on a :(1)holistic approach,(2) are available to the majority of those in need, and(3) which take into account the capacity and structure of health

systems as well as traditions and beliefs in the community.


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IMCI PRINCIPLES


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Principles of Integrated Care:All sick children MUST be examined for general danger signswhich indicate the need for immediate referral or admission to ahospital.

All sick children MUST be routinely assessed for major symptoms(for children age 2 months up to 5 years: cough or difficult breathing,diarrhea, fever, ear problems; for young infants are 1 week up to 2months: bacterial infections and diarrhea). They must also beroutinely assessed for nutritional and immunization status,feeding problems, and other potential problems.

Only a limited number of carefully-selected clinical signsare used, based on evidence of their sensitivity and specificity todetect disease.(These signs were selected considering the conditions andrealities of first level health facilities).


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A combination of individual signs lead to a childs

classification(s) rather than a diagnosis.Classification(s) indicate the severity of condition(s).They call for specific actions based on whether thechild: (a) should be urgently referred to another

level of care,

(b) requires specific treatments (such asantibiotics or anti-malarialtreatment), or

(c) may be safely managed at home.

The classifications are colour coded:pink - suggests hospital referral or admission,yellow - indicates initiation of treatment, andgreen - calls for home treatment.


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The IMCI Approach addresses most, but not all, of

the major reasons a sick child is brought to a clinic.A child returning with chronic problems or lesscommon illnesses may require special care. TheIMCI guidelines do not describe the management oftrauma or other acute emergencies due to accidents

or injuries. IMCI management procedures use a limitednumber of essential drugs and encourage activeparticipation of caretakers in the treatment ofchildren.

An essential component of the IMCI guidelinesis the counselling of caretakers about homemanagement, including counselling aboutfeeding, fluids and when to return to a health

facility.


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The IMCI Case Management ProcessOUT PATIENT HEALTH FACILITY

Check for DANGER SIGNS

Convulsions

Lethargy/Unconsciousness

Inability to drink/breastfeed

Vomiting

Assess MAIN SYMPTOMS

Cough / difficulty breathing

Diarrhea Fever

Ear Problems

Assess NUTRITION and IMMUNIZATION STATUS

And POTENTIAL FEEDING PROBLEMS

Check for OTHER PROBLEMS

CLASSIFY CONDITIONS andIDENTIFY TREATMENT ACTIONS

According to colour-coded treatment

PINKUrgent Referral

YELLOWTreatment at Outpatient Health Facility

GREENHome Management

OUTPATIENTHEALTH

FACILITY

Pre-referral treatments

Advise Parents Refer Child

REFERRAL FACILITY

Emergency Triage &

Treatment (ETAT)

Diagnosis

Treatment

Monitoring & Follow-up

OUTPATIENT

HEALTH FACILITY

Treat Local Infections

Give Oral Drugs

Advise & Teach Caretakers

Follow-up

HOME

Caretakers is counselled on:

Home treatment(s) Feeding & Fluids

When to return immediately

Follow-up


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First Steps

1. Triage: Age, Name, Weight and Temp

2. Greet the mother and ask what the childs problems

are :3. Determine if this is an initial or follow up visit:

Initial visit 1st visit for this episode of an illness orproblem

Follow-up visit- the child has been seen a few daysago for the same illness

- if the childs condition improved, still the same oris getting better


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. 4. Decide which age group the child is in:

Age 1 week up to 2 months, use the chart: ASSESS,CLASSIFY AND TREAT THE SICK YOUNG INFANT

Age 2 months up to 5 years, use the chart: ASSESSAND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5

YEARS


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General Danger signs Check ALL sick children for general danger signs

Signs of severe illness that can occur in all

serious illnesses, whatever the cause Children with danger signs will need:

Urgent referral to hospital

Lifesaving treatment


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Check for general danger signs:

Child is not able to drink or breastfeed

o too weak to drink and is not able to suck or swallow whenoffered a drink or

o Breast-feed

o if not sure: ask mother to offer child a drink of clean water orbreast milk

o A child may have difficulty sucking when his nose is blocked. Ifthe nose is blocked, clean it.

Child vomits everythingo a child is not able to hold anything down at all

o if in doubt, offer the child water


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Child has had convulsions(during this illness)o arms and legs stiffen because muscles are contracting

o the child may lose consciousness or not be able to respond tospoken directions or

o handling, even if eyes are open

o fits or spasms or jerky movements

Note: Shiver is not convulsion. There is no loss ofconsciousness. Child is lethargic or unconscious

(abnormally sleepy or difficult to awaken)o

drowsy and does not show interest in what is happening

around himo stare blankly and appear no to notice what is going on around

him

o does not respond when touched, shaken or spoken to.


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4 MAIN SYMTPOMS

Cough or difficult breathing

DiarrheaEar pain

Fever


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CLASSIFY THE ILLNESS

I M C I ColorCoding

Needs urgent attentionand referral or admissionfor in-patient care.This is a severeclassification

Child needs an appropriateantibiotic, an oral anti-

malarial or othertreatment which can be

given in health center

Does not need specificmedication / treatmentsuch as antibiotic. Can bemanage at home by mother


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integrated management on childhood imci report

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