1 IMCI. Features of IMCI… not necessarily dependent on the use of sophisticated and expensive...

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IMCIIMCI

Features of IMCI…Features of IMCI…

not necessarily dependent on the use of sophisticated and expensive technologies

a more integrated approach to managing sick children

move beyond addressing single diseases to addressing the overall health and well-being of the child

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careful and systematic assessment of common symptoms and specific clinical signs to guide rational and effective actions

integrates management of most common childhood problems (pneumonia, diarrhea, measles, malaria, dengue hemorrhagic fever, malnutrition and anemia, ear problems)

includes preventive interventions

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adjusts curative interventions to the capacity and functions of the health system (evidence-based syndromic approach)

involves family members and the community in the health care process

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Objectives of IMCIObjectives of IMCI

(1) reduce deaths and the frequency and severity of illness and disability; and

(2) contribute to improved growth and development

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IMCI ComponentsIMCI Components

1. Improving case management skills of health workers

◦ standard guidelines◦ training (pre-service/in-service)◦ follow-up after training◦ role of private providers

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2. Improving the health system to deliver IMCI

◦ essential drug supply and management◦ organization of work in health facilities◦ management and supervision◦ referral system

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3. Improving family and community practices

◦ for physical growth and mental development

◦ for disease prevention◦ for appropriate home care◦ for seeking care

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-For physical growth and mental development Breastfeeding Complementary feeding Micronutrient supplementation Psychosocial stimulation

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3. Improving family and community practices - For disease prevention

immunizationhandwashingsanitary disposal of fecesuse of insecticide-treated bednetsdengue prevention and control

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- For appropriate home care continue feeding increase fluid intake appropriate home treatment

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- For seeking care

Follow health workers adviceWhen to seek carePrenatal consultationPostnatal (postpartum) consultation

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The Integrated Case Management ProcessThe Integrated Case Management Process

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Treatment•treat local infection

•give oral drugs•advise and teach

caretaker•follow up

Outpatient Health Facility

Home

Caretaker is counselled on:

•home treatment•feeding &fluids•when to return

•immediately•follow-up

•check for danger signs•assess main symptoms

•assess nutrition and Immunization status and potential feeding problems

•Check for other problems•classify conditions and

• identify treatment actions


Urgent referral•pre-referral treatment

•advise parents•refer child


•emergency triage &treatment

•Diagnosis & treatment•monitoring & ff-up

Referral facility

Target Groups Target Groups

Sick young infant◦1 week up to 2 months

Sick young children◦2 months up to 5 years

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Assessing the Sick ChildAssessing the Sick Child

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General Danger Signs

• lethargy or unconsciousness• inability to drink or breastfeed

• vomiting

• convulsions

Checking the Main Checking the Main SymptomsSymptoms

- cough and difficult breathing - diarrhea - fever - ear problem

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1. Cough or difficult breathing 3 clinical signs

◦ Respiratory rate◦ Lower chest wall indrawing◦ Stridor

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2. Diarrhea Dehydration

◦ General condition◦ Sunken eyes◦ Thirst◦ Skin elasticity

Persistent diarrhea Dysentery

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3. Fever Stiff neck Risk of malaria and other endemic

infections, e.g. dengue hemorrhagic fever

Runny nose Measles Duration of fever (e.g. typhoid

fever)

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4. Ear problems Tender swelling behind the ear Ear pain Ear discharge or pus (acute or

chronic)

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Checking Nutritional Status, Checking Nutritional Status, Feeding, Immunization StatusFeeding, Immunization Status

Malnutrition ◦visible severe wasting◦edema of both feet◦weight for age

Anemia◦palmar pallor

Feeding and breastfeeding Immunization status

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Assessing Other ProblemsAssessing Other Problems

Meningitis Sepsis Tuberculosis Conjunctivitis Others: also mother’s (caretaker’s) own

health

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IMCI Essential Drugs and IMCI Essential Drugs and SupplySupply

Appropriate antibiotics Quinine Vitamin A Paracetamol Oral antimalarial Tetracycline eye ointment ORS Mebendazole or albendazole Iron Vaccines Gentian violet

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Overall Case Management ProcessOverall Case Management Process

Outpatient 1 - assessment 2 - classification and identification of treatment 3 - referral, treatment or counseling of the child’s caretaker (depending on the classification

identified 4 - follow-up careReferral Health Facility 1 - emergency triage assessment and treatment 2 - diagnosis, treatment and monitoring of patient progress

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SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS

For all sick children age 1 week up to 5 years who are brought to a first-level health facility

ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems.

CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the child’s main symptomsand his or her nutrition or feeding status.

IF URGENT REFERRAL is needed and possible IF NO URGENT REFERRAL isneeded or possible

IDENTIFY URGENTPRE-REFERRAL TREATMENT(S)needed for the child’s classifications..

IDENTIFY TREATMENT needed for the child’s classifications: Identify specific medical treatments and/or advice.

TREAT THE CHILD: Give urgent pre-referral treatment (s) needed.

TREAT THE CHILD: Give the first dose of oral drugs in the clinicand/or advise the child’s caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If needed, give immunizations.

REFER THE CHILD: Explain to the child’s caretaker the need for referral. Calm the caretaker’s fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital.

COUNSEL THE MOTHER: Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a health facility. Counsel the mother about her own health.

FOLLOW-UP care: Give follow-up care when the child returns to the clinic and,if necessary, reassess the child for new problems.

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Summary of the Integrated case Summary of the Integrated case Management ProcessManagement Process

For all sick children age 1 week up to 5 years who are brought to a first-level health facility

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Summary of the Integrated case Summary of the Integrated case Management ProcessManagement Process

ASSESS the Child: Check for danger signs (or possible bacterial

infection). Ask about main

symptoms. If a main symptom is

reported, assess further. Check nutrition and immunization status.

Check for other problems

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Summary of the Integrated Case Summary of the Integrated Case Management ProcessManagement Process

Classify the child’s illness: Use a color-coded triage system to classify the child’s main symptoms and his or her nutrition or feeding status.

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IF URGENT

REFERRALis needed and

possible

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IDENTIFY URGENT PRE-REFERRAL TREATMENT(S)Needed prior to

referral of the child according to classification

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TREAT THE CHILD:Give urgent pre-referral treatment(s) needed.

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REFER THE CHILD:Explain to the child’s

caretaker the need for referral.

Calm the caretaker’s fears and help resolve any problems. Write a referral note.

Give instructions and supplies needed to care for the child on the way to the hospital

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IF NO URGENT REFERRAL

is needed or possible

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IDENTIFY TREATMENT

needed for the child’s

classifications: identify specific

medical treatments and/or

advice

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TREAT THE CHILD:Give the first dose of

oral drugs in the clinic and/or advice the child’s caretaker.

Teach the caretaker how to give oral drugs and how to treat local infections at home.

If needed, give immunizations.

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COUNSEL THE MOTHER:

Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present.

Advise about feeding and fluids during illness and about when to return to a healthy facility.

Counsel the mother about her own health.

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FOLLOW-UP CARE:Give follow-up care when the child returns to the clinic and, if necessary, re-asses the child for new problems.

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SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS

FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic

ASK THE CHILD’S AGE

IF the child is from 1 week up to 2 monthsIF the child is from 2 months up to 5 years

USE THE CHART:œASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT

USE THE CHART:œASSESS AND CLASSIFY THE SICK CHILDTREAT THE CHILDCOUNSEL THE MOTHER

1 IMCI. Features of IMCI… not necessarily dependent on the use of sophisticated and expensive...

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