Imci Lecture.1 Ppt
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Integrated Management of Childhood Illnesses
DefinitionThis is an innovative approach which was started in 1995 by WHO and UNICEF with the aim of introducing a comprehensive and timely management of the 5 most common causes of ill health and death among under-fives.These illnesses are:Pneumonia MeaslesDiarrhea MalnutritionMalaria
Reasons for Developing IMCI Strategy:Curative CareAspect of NutritionImmunizationDisease preventionHealth promotion
Objectives:To reduce death, frequency and severity of illness and disability.Contribute to improved growth and development
Components of IMCIImprovement of health worker skills. This takes the form of training in the case management of sick children. In the Philippines, the DOH has trained facilitators and provincial Health management teams on the case management training for health workers.
Components of IMCI2. Improvement of Health Systems- The IMCI strategy requires that the health system is strengthened to support the strategy in the following ways.
Ensuring the availability of essential drugs & supplies
Organization of the hospital emergency area to support rapid evaluation & management of sick children
Training of health workers in Emergency Triage Assessment and Treatment (ETAT)
Adherence to National policies for standard of care.Availing job aides in critical area
Components of IMCI
3. Improvement of Family and Community Practices
Family & Community PracticesA. Growth Promotion & DevelopmentExclusive breastfeeding for 6 monthsAppropriate complementary feeding from 6 mos. While continuing BF up to 2 years
A. Growth Promotion & DevelopmentAdequate micronutrients through diet or supplementation.Promote mental and psychosocial development.
B. Disease PreventionProper disposal of feces, hand washing etc.Adequate rest and sleep under treated mosquito netsPrevention of HIV/AIDSPrevent child Abuse/neglect & taking appropriate action.
C. Home ManagementContinue to feed & offer more food & fluids when child is sick.Give child appropriate home treatment for infections.Take appropriate actions to prevent and manage child injuries & accidents.
D. Care Seeking and Compliance
Take child to complete full course of immunization before 1st birthday.Recognize when child needs treatment outside home and take to H.C.
D. Care Seeking & ComplianceFollow Health Workers advice about treatment, follow-up & referral.Mothers class attendance & Tetanus Toxoid vaccination during pregnancy.Active participation of men in childcare & reproductive health activities
Principles of Integrated CareAll sick children must be examined for general danger signsAll sick children must be routinely assessed for major symptomsOnly a limited number of carefully selected clinical signs are used.A combination of individual signs lead to a childs classification(s) rather than diagnosis.
Principles of Integrated Care5. IMCI guidelines address most but not all of the major reasons a sick child is brought to a clinic.6. IMCI management procedures use a limited number of essential drugs and encourage active participation of caretakers in the treatment of children.7. An essential component of the IMCI guidelines is the counseling about feeding, fluids and when to return to a health facility.
Assessment Using IMCI StrategyIn IMCI we assess children for a number of things:Assessment Checklist divided into four:First Part History taking Second Part General Danger Signs
Assessment Using IMCI StrategyAssessment Checklist divided into four:Third Part Main symptoms Cough or Difficult breathing Diarrhea Fever Ear problems
Assessment Checklist Fourth Part:Nutritional StatusImmunization StatusOther Problems
History TakingBasically the asking part we cannot ask the child so we will ask the mother, significant other, or primary caregiver. Basic communication that you have to consider:Listen carefully to what the primary caregiver says.Use words the primary caregiver understandsGive the primary caregiver time to answer the questions.Ask additional questions when the primary caregiver is not sure about the answer.
Things to ask the Mother or the Primary CaregiverAsking for General Danger Signs:1. Is the child not able to drink or breastfeed2. Does the child vomits everything?3. Has the child had convulsions?Then ask about Main Symptoms:For Pneumonia:Does the child have cough or difficult breathing? If yes for how long?For Diarrheal diseases:1. Does the child have diarrhea? If yes, for how long? And is there blood in the stool?
For diseases with fever:Does the child have fever? If yes since when?For how long does the child had fever?If more than seven days, has fever been present everyday?For Malarial risk:Does the child live in malaria area?Has the child visited a malaria in past 4 weeks? If yes to either, obtain a blood smear. For Measles:1. Has the child had measles within the last 3 months?
For Ear problems:1. Does the child have an Ear problem?2. Is there ear pain?3. Is there ear discharge? If yes, for how long?
General Danger SignsLethargic or unconscious An unconscious child is likely to be seriously ill. A lethargic child, who is awake but does not take any notice of his or her surroundings or does not respond normally to sounds or movement, may also be very sick.
General Danger SignsHistory of Convulsions or convulsing now- The child has had convulsions during the present illness. Convulsions may be the result of fever. In this instance, they do little harm beyond frightening the mother.
General Danger SignsVomiting everything The child vomits everything. The vomiting itself may be a sign of serious illness, but it is also important to note because such a child will not be able to take medication or fluids for rehydration
General Danger SignsNot able to drink or breastfeed The child is unable to drink or breastfeed. A child may be unable to drink either because he is too weak or because he cannot swallow. Do not rely completely on the mothers evidence for this, but observe while she tries to breastfeed or to give the child something to drink
If a child has one or more of these signs, he/she must be considered seriously ill and will almost always need referral. In order to start treatment for severe illnesses without delay, the child should be quickly assessed for the most important causes of serious illness and death- acute respiratory infection (ARI), diarrhea, and fever (especially associated with malaria and measles). A rapid assessment of nutritional status is also essential, as malnutrition is another main cause of death.
Assessment of Main SymptomsGeneral Physical ExaminationFor danger signs:1.See if the child is abnormally sleepy or difficult to awaken.For Pneumonia:Count the breath in one minute. (calm child)RR of 60 bpm for 0-2 months is normalRR of 50 bpm for 2 months-1 year is normalRR of 40bpm for 1-5 years is normalLook for chest indrawing (calm Child)Look and listen for stridor or wheezingCheck the respiratory rate of the child
Assessment of Main SymptomsFor Diarrheal diseases: Offer the child Abnormally sleepy or difficult to awaken? Restless and irritable?Look for sunken eyes.Offer the child fluid. Is the child:Not able to drink or drinking poorlyDrinking eagerly, thirsty?Pinch the skin of the abdomen. Does it go back:Very slowly (longer than 2 seconds)Slowly
Assessment of Main SymptomsFor diseases with fever:Feels hotTemperature (37.5C or above)For Malarial risk:Look or feel for stiff neckLook for runny noseChills
Assessment of Main SymptomsFor Measles: Generalized rashOne of these: cough, runny nose, or red eyesLook for mouth ulcers. Are they deep and extensive?Look for pus draining from the eye.Look for clouding of the cornea
Assessment of Main SymptomsFor Ear problems:Look for pus draining from the earFeel for tender swelling behind the ear.For Malnutrition:Look for visible severe wasting.Look for edema of both feet.Look for palmar pallor?Severe palmar pallorSome palmar pallorDetermine weight for age.Very low
Main Symptom: CoughCount the breath in one minute. (calm child)RR of 60 bpm for 0-2 months is normalRR of 50 bpm for 2 months-1 year is normalRR of 40bpm for 1-5 years is normalLook for chest indrawing (calm Child)Look and listen for stridor or wheezing
Child with Chest Indrawing
Main Symptom: DiarrheaAbnormally sleepy or difficult to awaken.Restless and irritableLook for sunken eyesOffer the child fluid. Is the child:Not able to drink or drinking poorly?Drinking eagerly, thirsty?Pinch the skin of the abdomen. Does it go back:Very slowly (longer than two seconds)Slowly?
For Diseases with FeverFeels hotTemperature 37.5 and aboveFor Malarial RiskLook or feel for stiff neckLook for runny nose.Chills
For Measles:Generalized Rash and One of these: cough, runny nose, or red eyesLook for mouth ulcers. Are they deep and extensive?Look for pus draining from the eye.Look for clouding of the cornea.For Ear problems:Look for pus draining from the ear.Feel for tender swelling behind the ear
For Malnutrition:Look for visible wastingLook for edema of both feetLook for palmar pallor Severe palmar pallor? Some palmar pallor? Determine weight for age. Very low?
Main Symptom: CoughCount the breath in one minute. (cal