Commed IMCI

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IMCI STRATEGY

Integrated Management of

Childhood Illness



Figure 1: Distribution of 11.6 million deaths among

children less than 5 years old in all developing

countries,1995

Perinatal

18%Other

32%

Malnutrition

54%

Malaria

5%

Acute

Respiratory

Infections

( ARI )

19%

Diarrhoea

19%

Measles

7%

• * Approximately 70%of all childhood deaths

are associated with one

or more of these 5

conditions

• Based on data taken from The Global Burden of Diaease 1996 ,edited by Murray CJL and Lopez AD, and Epidemiologic evidence for a potentiating effect of malnutrition on child mortality, Pelletler DL, Frongillo EA andHablcht JP, AMJ Public Health 1993;83:1130-1133



Integrated management of childhood

illness (IMCI) Objectives

• To reduce significantly global mortality and

morbidity associated with the major causesof disease in children

• To contribute to healthy growth anddevelopment of children



Integrated Management of Childhood

Illness (IMCI) Components

• Improving case management skills of health workers

─ standard guidelines

─ training (pre- and in- service)

─ Follow-up after training

• Improving the health system to deliver IMCI

─ essential drug supply and management

─ organization of work in health facilities

─ management and supervision

• Improving family and community practices



Integrated Management of

Childhood Illness (IMCI)

Birth 1 week 2 months 5 years

Pregnancy

IMCI case management guidelines



For many sick children a single diagnosis may

not be apparent or appropriate

Presenting complaint

Cough and/or fast breathing

Lethargy or unconsciousness

Measles

“Very sick” young infant

Possible cause or associated condition

Pneumonia

Severe anemia

P. falciparum malaria

Celebral malaria

Meningitis

Severe dehydration

Very severe pneumonia

Pneumonia

DiarrheaEar infection

Pneumonia

Meningitis

Sepsis



Integrated management of childhood illness (IMCI)

as a key strategy for improving child health

Nutrition ImmunizationManagement of

sick children

Other disease

prevention

Promotion of growth and

development

Integrated management of Childhood illness (IMCI)



Figure 4: Interventions currently included in the IMCI strategy

Promotion of growthPrevention of disease

Community/home based

interventions to improve nutrition

-insecticide – impregnated bednets

Home

Health -Vaccination

services -Complementary feeding andbreastfeeding counseling

-Micronutrient supplementation

Response to sickness(“curative care”)

-Early case management

-Appropriate care seeking

-Compliance with treatment

-Case management of: ARI,

Diarrhea,measles,malaria,

Malnutrition, other serious

infection.

-Complementary feeding andbreastfeeding counseling

-Iron treatment

-Antihelminthic treatment



IMCI Brings it All Together

Case management

Guidelines and training

for individual diseases

Integrated casemanagement guidelinestraining and follow-up

HealthWorkerskills

Health education

activities for

individual diseases

Interventions toimprove family andcommunity practices

Family andcommunity

Drug supply and management

District management of health services

Health system reform

Healthsystem



Many programmes benefit from the IMCI strategy

Programme What IMCI offers

ARI and CDD Integrated case management

EPI Less missed opportunities

Malaria control Improved care of childhood malariaPromotion of bednets

Maternal health Opportunity to discuss mother’s health

and provide services

Nutrition Locally adapted feeding guidelines

Nutrition and breastfeeding

counseling

Essential drugs Drug policies for childhood diseases

Standard treatment guidelines



Benefits of Integrated Management of

Childhood Illness (IMCI) The IMCI strategy:

• Addresses major health problems

• Responds to demand• Is likely to have a major impact on health

status

• Promotes prevention as well as cure

• is cost-effective

• Promotes cost saving

• Improves equity



THE INTEGRATED CASE MANAGEMENT PROCESS

OUTPATIENT HEALTH FACILITY

Check for DANGER SIGNS

• Convulsions

• Abnormally sleepy or difficult to awaken• Unable to drink/breastfeed

• Vomits everything

Assess MAIN SYMPTOMS

• Cough/difficulty breathing

• Diarrhea• Fever

• Ear problems

Assess NUTRITION, IMMUNIZATION and VITAMIN A SUPPLEMENTATION STATUS and POTENTIAL

FEEDING PROBLEMS



Check for OTHER PROBLEMS

CLASSIFY CONDITIONS andIDENTIFY TREATMENT ACTIONS

According to color-coded treatment

Treatment at outpatient health facility

OUTPATIENT HEALTH FACILITY

• Treat local infection• Give oral drugs

•Advise and teach caretaker• follow-up

Home management

HOME

Caretaker is counselled on:• Home treatment(s)• Feeding and fluids• When to return

Immediately•

Follow-up

Urgent referral

OUTPATIENTHEALTH FACILITY

• Pre-referral treatments• Advise parents• Refer child

REFERRAL FACILITY • Emergency Triage and

Treatment (ETAT)• Diagnosis• Treatment

• Monitoring and follow-

up



IMCI Key Family Practices

1. Breast feed infants exclusively for at least six (6)months.

2. Starting at six (6) months of age, feed children with

freshly prepared energy and nutrient rich

complementary foods, while continuing to

breastfeed up to two (2) years or longer.

3. Ensure that children receive adequate amount of

micro-nutrients ( Vitamin A and Iron, in particular ),

either in their diet or through supplementation.



4. Dispose of feces, including children’s feces safely; and

wash hands after defecation, before preparing meals andbefore feeding children.

5. Take children as scheduled to complete a full course of

immunizations (BCG, OPV, DPT and Measles) beforetheir first birthday.

6. Protect children in malaria-endemic areas by ensuring that

they sleep under insecticide-treated bednets.



7. Promote mental and social development by responding to a

child’s needs for care and through talking, playing, and

providing a stimulating environment.

8. Continue to feed and offer more fluids including breast

milk when they are sick.

9. Give sick children appropriate home treatment for

infections.



10. Recognize when sick children need treatment outside the

home and seek care from appropriate providers.

11. Follow the health worker’s advice about treatment,

follow-up and referral.

12. Ensure that every pregnant woman has adequate

antenatal care.



GLOBAL UPDATES

• Antibiotic treatment of severe and non-

severe pneumonia

• Low osmorality ORS and antibiotictreatment for bloody diarrhoea

• Treatment of ear infections

• Infant feeding

• Treatment of helminthiasis



ANTIBIOTIC TREATMENT OF

SEVERE ANDNON-SEVERE PNEUMONIA



NON-SEVERE PNEUMONIA

• In low HIV prevalent countries three days of antibiotictherapy (oral amoxicillin and cotrimoxazole) should beused in children 2 months up up 5 years

• Where antimicrobial resistance to cotrimoxazole ishigh oral amoxicillin is the better choice

• Oral amixicillin should be used twice daily at a dose of 25 mg/kg per dose.



SEVERE PNEUMONIA

• Children with wheeze and fast breathing and/orlower chest indrawing should be given a trial of

rapid-acting inhaled bronchodilator before theyare classified as pneumonia and prescribedantibiotics.

• Where referral is difficult and injection is notavailable, oral amoxicillin could be given tochildren with severe pneumonia.



VERY SEVERE PNEUMONIA

• Injectable ampicillin plus injection

gentamicin is a better choice than injectable

chloramphenicol for very severe pneumoniain children 2-59 months of age



LOW OSMOLARITY

AND ANTIBIOTICTREATMENT FOR

BLOODY DIARRHEA



LOW OSMOLARITY ORS

• Countries should now use and manufacture

the low osmolarity ORS for all children

with diarrhoea but keep the same label toavoid confusion.



TREATMENT OF

BLOODY DIARRHOEA• Ciprofloxacin is the most appropriate drug

in place of nalidixic acid which leads to

rapid development of resistance.Ciprofloxacin is given in a dose of 15

mg/kg two times per day for three days by

mouth.



ZINC IN THE MANAGEMENT

OF DIARRHOEA

• Along with increased fluids and continued

feeding, all children with diarrhoea should

be given zinc supplementation for 10-14

days.



TREATMENT OF

FEVER/MALARIA• Artemether-Lumefantrine (CoartemTM)

• Artesunate (3 days) plus Amodiaquine

• Artesunate (3 days) plus SP in areas where SP efficacyremains high

• SP plus amodiaquine in areas where efficacy of bothamodiaquine and SP remain high.This is mainly limitedto countries in West Africa.\



TREATMENT OF EAR

INFECTIONSOral amoxicillin is a better choice for the

management of acute ear infection in

countries where antimicrobial resistance toco-trimoxazole is high. Chronic ear

infection should be treated with topical

quinolone ear drops for at least two weeksin addition to dry ear-wicking.



INFANT FEEDING

EXCLUSIVE BREASTFEEDING



EXCLUSIVE BREASTFEEDING

up to 6 months (180 days) of age

• Breastfeed as often as the child wants, day and night, atleast 8 times in 24 hours.

• Breastfeed when the child shows signs of

hunger:beginning to fuss, sucking fingers, or movingthe lips.

• Do not give other foods or fluids

• Only if the child is older than 4 months, and-appearshungry after breastfeeding, And-is not gaining weightadequately, add complementary foods (listed under 6

months up to 23 months). Give 1 or 2 tablespoons of these foods 1 or 2 times per day after breastfeeding.



COMPLEMENTARY FEEDING

6 MONTHS UP TO 23 MONTHS

• Breastfeed as often as the child wants

• Give adequate servings of complementary foods: 3times per day if breastfed, with 1-2 nutritious snacks, asdesired, from 9 to 23 months.

• Give foods 5 times per day if not breastfed with 1 or 2cups of milk.

• Give small chewable items to eat with fingers. Let thechild try to feed self, but provide help.



MANAGEMENT OF SEVERE

MALNUTRITION WHERE

REFERRAL IS NOT POSSIBLE

• Where a child is classified as having severe

malnutrition and referral is not possible, the

IMCI guideline should be adapted to

include management at first-level facilities.



HIV AND INFANT FEEDING• In areas where HIV is a public health problem all

women should be encouraged to receive HIV testing andcounselling.

• If a mother is HIV-infected and replacement feeding isacceptable, feasible, affordable, sustainable and safe forher and her infant, avoidance of all breastfeeding isrecommended. Otherwise, exclusive breastfeeding isrecommended during the first months of life.

• The child of an HIV-infected mother who is not beingbreastfed should receive complementary foods as

recommended above.



TREATMENT FOR

HELMINTHIASIS• Helminth Infestations in children

below 24 months

• Albendazole and mebendazole can be

safely used in children 12 months orolder.



THANK YOU……..

Commed IMCI

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