IMCIIMCIUniversity of LiverpoolUniversity of Liverpool

LSTMLSTM

MSc Infectious Disease and Tropical MSc Infectious Disease and Tropical MedicineMedicine

Dr. Wail BajhmoumDr. Wail Bajhmoum

INTEGRATED MANAGEMENT OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSCHILDHOOD ILLNESS

OutlineOutline

Background and Brief HistoryBackground and Brief History..

DefinitionDefinition . .

Objectives and GoalsObjectives and Goals..

OutlineOutline

StrategyStrategy..

THE CASE MANAGEMENT THE CASE MANAGEMENT PROCESSPROCESS..

ExamplesExamples..

BackgroundBackground

* * Each year more than 10 million children in Each year more than 10 million children in low-and middle-income countries die low-and middle-income countries die before they reach their fifth birthdaybefore they reach their fifth birthday . .

* * Seven in ten of these deaths are due to Seven in ten of these deaths are due to just five conditionsjust five conditions::

* *pneumonia (19%)pneumonia (19%)

* * diarrhea (19%)diarrhea (19%)

* * malaria (5%)malaria (5%)

* * measles (7%)measles (7%)

* * malnutrition (54%)malnutrition (54%)

BackgroundBackground

IMCI was first developed in 1992 by IMCI was first developed in 1992 by UNICEF and the World Health UNICEF and the World Health Organization (WHO)Organization (WHO)

DefinitionDefinition

* *IMCI is an integrated approach to IMCI is an integrated approach to child health that focuses on the well-child health that focuses on the well-being of the whole childbeing of the whole child . .

* *IMCI includes both preventive and IMCI includes both preventive and curative elementscurative elements..

* *IMCI is designed for use in IMCI is designed for use in outpatient clinical settings with outpatient clinical settings with limited diagnostic tools and limited diagnostic tools and medicationsmedications..

ie. rural areas- specifically in ie. rural areas- specifically in developing countriesdeveloping countries

Objectives and GoalsObjectives and Goals

11 . .Reducing mortalityReducing mortality..

22 . .Reducing the incidence and seriousness Reducing the incidence and seriousness of illnesses and health problems of illnesses and health problems. .

33 . .Improving growth and development Improving growth and development during the first five years of a child’s lifeduring the first five years of a child’s life..

StrategyStrategy..

**Improving case management skills of Improving case management skills of health-care staffhealth-care staff..

**Improving overall health systemsImproving overall health systems..

**Improving family and community Improving family and community health practiceshealth practices..

THE CASE MANAGEMENT THE CASE MANAGEMENT PROCESSPROCESS

11 – – assessmentassessment

22 - - classification and identification of classification and identification of treatmenttreatment..

33 - - referral, treatment or counseling of the referral, treatment or counseling of the child’s caretakerchild’s caretaker..

44 - - follow-up carefollow-up care..

Fever With RashesFever With Rashes

For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask

about cough or difficult breathing, diarrhoea and thenASK: DOES THE CHILD HAVE FEVER?

If NO

If YES

Does the child have fever?( by history or feels hot or temperature 37.5 C** or above)

IF YES:Decide the Malaria Risk: high or low

THEN ASK: LOOK AND FEEL:œFor how long? œLook or feel for stiff neck.œIf more than 7 days, has œLook for runny nose.fever been present every day? Look for signs of MEASLESœHas the child had measles withinthe last 3 months? œGeneralized rash andœOne of these: cough, runny nose, or red eyes.

If the child has measles now or œLook for mouth ulcers.within the last 3 months: Are they deep and extensive?œLook for pus draining from the eye.œLook for clouding of the cornea.

CLASSIFY the child’s illness using the colour-coded classification tables for fever.

Then ASK about the next main symptom: ear problem, and CHECK for malnutrition and anaemia,immunization status and for other problems.

Is it effectiveIs it effective!? !?

The Multi-Countries Evaluation of (IMCI)

includes studies of the effectiveness, cost,

and impact of the IMCI strategy in Bangladesh, Brazil, Peru, Tanzania, and Uganda.

*MCE conclude : more detailed descriptions of methodological and analytic approaches developed to address specific issues need to be provided.

*The MCE will continue these and other methodological challenges in future articles

Thank youThank you