Integrated Management of Childhood Illness

•Child Health: Global Profile• IMCI Rationale, objectives, components •Principles of integrated care• IMCI Case Management Process

• Children in low-middle income countries 10x more likely to die before reaching 5th birthday

• More than 50 countries had childhood mortality rates over 100 per 1,000 live births

•7 in 10 ten deaths are due to ARI , diarrhea, measles, malaria or malnutrition

•Major contributors to child deaths through the year 2020

Study of 163 countries, SAVE THE CHILDREN, 2001

53 million women give birth each year without professional help

Global child death rates have been reduced by 14% over the past decade

Eight babies in the first month of their lives die every minute world-wide

Causes of Death in Children

Under-nutritio

n53%

• Many sick children poorly assessed

• Improperly treated

• Parents poorly advised

Health Care : First –Level Facility

*scarce supply of drugs and equipment

•minimal/non-existent

diagnostic support

• Few opportunities for MD to practice

complicated procedures

•Reliance on history of signs and symptoms

WHO/UNICEF/DOHRegional Child Survival Strategy

and

Assessment of Philippine Situation

• Infant and young child

feeding

Lack of access to safe water &

sanitation

Underlying Factors

High fertility, poor birth spacing

Community and environment

•Lack of access to basic social

services

•Inadequate care for women

Reasons for an IMCI Strategy

• Most children have more than one condition at one time

• Illnesses are interrelated

• Illnesses should not be only tested, but also prevented

• Poor quality of care at all levels

• Vertical delivery mechanisms characterized by low efficiency

Objectives

•Reduce illness, disability and death from common childhood illnesses

To promote improved growth and development among

under-5 children

An evidence- based syndromic approach can be used to determine

the:

Health problem/s

Severity of the condition

Actions

Improving the health system to deliver IMCI

IMCI Components

Improving case management skills of health workers

Improving family and community practices

Principles of Integrated Care

IMCI guidelines address most, but

not all, of the major reasons a

sick child is brought to a

clinic.

A combination of individual signs

leads to a child’s classification/s rather than a

diagnosis

Counseling of caretakers an essential component

IMCI management use a limited number of essential drugs

All sick children must be examined for “general danger signs” -- immediate

referral or hospital admission

All sick children must be routinely assessed for:

2 mos.-5 yrs. Old: (cough/difficult breathing, diarrhea, fever, ear problem) 1 week-2 mos: (bacterial infection and diarrhea)

Nutritional, immunization status, feeding problems , care for

development and other problems

Only a limited number of carefully-selected clinical signs are used

(sensitivity and specificity to detect disease)

A combination of individual signs leads to a child’s classification/s

rather than a diagnosis; classifications are color-coded

IMCI Case Management Process

Classify

Assess

Identify Treatment

Treat/Refer

Counsel

Follow-Up

Classify

Identify Treatment

Treat/Refer

Counsel

Assess

Follow-Up

Assess

Identify Treatment

Check for General Danger SignsConvulsionsLethargy/unconsciousnessInability to drink/breastfeedVomiting

Assess Main SymptomsCough/difficulty breathingDiarrheaFeverEar Problems

Assess Nutrition , Immunization status , Care for Development and Other Problems

Classify conditions/identify treatment actions

Pre-referral Treatment Advise Parents

Refer Child

Urgent Referral

OUT-PATIENT HEALTH FACILITY

REFERRAL FACILITY

Emergency Triage & Treatment (ETAT)DiagnosisTreatmentMonitoring &Follow-up

OUT-PATIENT HEALTH FACILITY

Treatment at OP Health Facility

•Treat Local Infections• Give oral drugs• Advise/teach caretaker• Follow-Up

OUT-PATIENT HEALTH FACILITY

Treatment at OP Health Facility

HOME

Caretaker is counseled on:

Home treatment

Feeding & fluids

When to return immediately

Follow-up

Home Management

Vertical” health programmes and an individual health worker

Separate disease specific clinical guidelines & trg. materials

National programmes

conduct disease specific trg.

courses

“Integration” of clinical guidelines

by the health worker

IMCI and an Individual Health Worker

Integrated clinical guidelines & trg. materials

National programmes collaborate in integrated training courses

Integrated clinical casemanagement

For many sick children a single diagnosis

may not be apparent or appropriate Presenting complaint

Cough and/or fast breathing

Lethargy/ unconsciousness

Measles rash

“Very sick” young infant

Possible cause/ associated condition

Pneumonia, Severe anemia, P. falcifarum malaria

Cerebral malaria , Meningitis, Severe dehydration,Very severe Pneumonia

Pneumonia, Diarrhea, Ear Infection

Pneumonia , Meningitis, Sepsis

Interventions included in IMCI guideline for first-level health workers

Conditions covered by case mgt. Interventions

Preventive interventions

Generic Version

ARI, Diarrhea, Dehydration, Persistent Diarrhea, Dysentery,Meningitis, Sepsis,Malaria, Measles,Anemia, Malnutrition, Ear Infection

Immunizations during sick child visits, Nutrition counseling, Breastfeeding support, Vit. A supplementation

Using the IMCI Adaptation Guide

HIV/AIDS,Dengue Hemorrhagic Fever, Wheeze, Sore Throat

Periodic Deworming

Mgt.of sick children

Nutrition Immunization Other Disease

preventionGrowth &

Devt.

IMCI as a key strategyFor improving child health

IMCI Vision

All Filipino children have access and equity to quality health care services supported with empowered families and communities capable of sustained actions that will ensure a child friendly environment conducive to development of the full potential of the child by 2025.

“ Lo, children are an heritage of the LORD..” Psalm 127: 3a

“..And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.” Matthew 25:40

Resources

• WHO. Department of Child and Adolescent Health and Development. Model Chapter for Textbooks –IMCI , 2001

• news.bbc.co.uk/olmedia/1535000/images/_153685.

September, 2001

• DOH Report presented during IMCI National Program Implementation Review, December 2006

• http://www.who.int/child_adolescent_health/• topics/prevention_care/child/imci/en/index.html

• http://www.google.images.com

• http://greenhealthinformation.com/wp-content/pic/healthy_children.jpg• http://web.ivenue.com/standrewlutheranchurch/images/children.jpg• http://www.ibiblio.org/obl/docs/yearbooks/images/Photo-RC010.gif• http://hamilton.co.nz/images/1151.jpg