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Integrated Management

of Childhood Illness

(IMCI)

A STRATEGY,AN APPROACH

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IMCI as a Strategy

Management of common childhood illnessis done in an integrated manner

Includes preventive interventions Adjusts curative interventions to the

capacity and functions of the health system(evidence based-syndromic approach)

Involves the family members and thecommunity in the health care process

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IMCI Objectives:

1. To reduce global mortality and

morbidity associated with the

major causes of diseases in

children such as pneumonia,diarrhea,

dengue fever, malaria, measles and

malnutrition.

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IMCI- Objectives:

2.To contribute to healthy

growth and development of

children.

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Why IMCI?

Overlap of conditions

Diagnostic tools are minimal or non-

existent

Drugs and equpment are scarce

Health workers have few opportunities to

practice complicated clinical procedures

Relies on history and signs and symptoms

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Components of IMCI

Improvements in the case-management skills ofhealth workers

-*Standard guidelines

- *Training (pre-service, in-service training)

- *Follow- up after training

Improvements in the overall health system

Improvements in family and community healthcare practices

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Target Age for IMCI Strategy

Young infants

1 week up to 2 months

Older children

2 months up to 5 years old

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IMCI in the Philippines

Pre-Implementation Phase (1995-1997)

Adaptation of the IMCI generic protocol

Conduct of model courses (basic 11-day &facilitators course)

Early Implementation Phase (1997-1999)Pilot implementation in Saranggani and

Zamboanga del Norte

Review & re-planning

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IMCI in the Philippines

Expansion Phase (1999 to present)

IMCI Training of health workers (basic 11-day,

facilitators and follow-up training)Accreditation of hospitals for in-patient

practicum (initially1 hospital per region)

Training on family and community IMCI

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Expnasion phase contd

Integration of IMCI in the pre-servicecurriculum

Revision of IMCI materialsTo include care for development in the counsel

the mother module

New treatment protocol for malaria management

Inclusion of Zinc in diarrhea management

Use of reformulated ORS

Redefinition of signs for dengue hemorrhagicfever

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IMCI IN THE Pre-service

Curriculum WHY?

IMCI clinical guidelines define the most

essential knowledge and skills needed toeffectively manage sick children

Children account for 30-70% of all patients in

the outpatient clinics

Students have rare opportunities to develop

essential outpatient skills

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Principles of Integrated Care

All sick children must beexamined for general danger

signs. -NOT ABLE TO DRINK OR BREASTFEED

-VOMITS EVERYTHING

-CONVULSIONS

-ABNORMALLY SLEEPY OR DIFFICULT TOAWAKEN

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All sick children must be

routinely assessed for:

Major Symptoms

Cough/difficulty breathing

Diarrhea

Fever

Ear Problem

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Allsick childrenshouldbe

routinely assessed for: Nutrition, Vit A Supplementation and

Immunization status and

Potential feeding problems andcheck other problems

Only limited number of carefully-selected

clinical signs

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Principles...

Classification(s) rather than a diagnosis

Address most, but not all, of the major reasons a

sick child is brought to a clinic Use limited number of essential drugs and

encourage active participation of caretakers in

the treatment of children

Counseling of caretakers about home

management

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Methods in Managing Childhood

Illnesses Assess the patient

Classify the disease

Treat the patient

Counsel the patient

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Assess the patient

Take patients history to get information

about disease condition

Done by asking and observing the patients

condition exploring possible causes

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Classify the Disease

A thorough assessment

Supported with laboratory results for

classification of illnesses and confirmationof the disease, which are:

1) Mild

2) Moderate3) Severe

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Treat the patient

A curative method of treating the disease

Varies on the condition of the patient

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Counsel the patient

Provide health education to clients

promoting health & avoiding risk of

infection important for parents/caregivers especially

who lack knowledge on health practices &

risks factors that contribute to diseaseailments

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Color-coded system used in

IMCI Green mild classification home care

management

Yellow moderate classification manage

at the RHU

Pink severe classification urgent referral

in hospital

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IMCI Case Management Process

Outpatient health facility

Assessment

Classification and identification of treatment

Referral, home treatment (feeding & fluids) or counseling of thechilds caretaker

When to return immediately; Follow-up care

Referral health facility Emergency triage assessment and treatment (ETAT)

Diagnosis, treatment and monitoring & follow-up of patient

Appropriate home management Teaching the mother or caretakers how to give oral drugs and treat

local infections at home

Counseling mother or caretaker about food

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Practice questions

1. Target ages for IMCI strategy

2. Classification of the disease, color coding used,and its equivalent management approaches used

3. Major symptoms assessed in all sick children

4. Methods of managing childhood illness

5. How do you assess the patient?

6. How do you classify the disease?7. How is the patient treated?

8. How do you counsel the patient?