IMCI Review Center Slides 2010

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Transcript of IMCI Review Center Slides 2010

IMCI Is simply the umbrella program through which all community health intervention can be delivered to children under 5 years of age

Brief History of IMCI 1992 1ST developed by: UNICEF (United Nations Children s Emergency fund) and WHO AIM: To prevent or early detection and TX of the leading cause of childhood death; reduce childhood mortality and morbidity by improving family and community practices for home management of illness, and improving case management of skills of health workers in the bigger health system 1995 IMCI introduced in the Phil. As a strategy to reduce child death and promote growth and development 19970 - implementation started with a memorandum agreement bet. ADPCN & APSOM Ass. Of Phil,. School of Midwifery in April 2002

GOALS To reduce the Infant and under-five mortality rate by at least one third in 2010 To reduce the Infant and under-5 mortality rate by at least two thirds in 2015

How does IMCI accomplish This Goals ? Adopting an integrated approach to child health and development in the national health policy; Adapting standard IMCI clinical guidelines to the country s needs, available drugs, policies and to the local foods and language used by the population; Upgrading care in local clinics by training health workers in the new methods to examine and treat children, and to effectively counsel parents Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available; Strengthening care in hospitals for those children too sick to be treated in outpatient clinic; Developing support mechanism within communities for preventing disease, for helping families to care for sick children, and for getting children to clinic or hospital when needed

Why is IMCI better than Singlecondition Approaches? Children brought for medical treatment in the health facility are often suffering from more than one condition, thus making a single diagnosis impossible. The IMCI takes into account the combined Tx of the major childhood illnesses. Emphasizing prevention of disease through Immunization and improved nutrition

onditions Overlap (other prob.) elies on history and signs & symptoms quipment & Drugs are scarcebility of Health workers to practice complicated clinical procedures are few inimal or non-existent Diagnostic nontools

COMPONENTS OF IMCI upgrading the case management and counseling skills of health care providers

strengthening the health care system for effective management of childhood illnesses improving the family and communityhealth practices related to childhood and nutrition

Benefits of IMCI and Who Will benefit From it?C cost-effective of intervention-gainful and profitable interventions for investors H High Impact on health status of children L- low-cost and promotes cost-savingof resources D demands of children answered-IMCI focuses on the major causes of illness and death of children: ARI, malnutrition, measles, malaria, dengue R responsive to major child health problems E equity of access to health care improved N not only curative, but preventive as well

Other Benefits: Promotes accurate identification of childhood illness in outpatient settings Ensure appropriate combined treatment for all major illness Strengthens the counseling of caretakers and provision of preventive services Speed up referral of severely ill children Promotion of appropriate care-seeking behavior in the home setting, improved nutrition and preventive care, and the correct implementation of prescribed care

Focus of IMCI in the Philippines PD2M3P - PNEUMONIA D - DENGUE D - DIARRHEA M - MALARIA M - MEASLES M - MALNUTRITION

AGE CATEGORIES OF IMCI CHILDREN AGE 2 MONTHS UP TO 5 YEARS YOUNG INFANTS AGED 1 WEEK UP TO MONTHS

ASSESS the childby checking first the danger signs (or possible bacterial infection in a young infant) asking questions about common conditions examining the child checking nutrition and immunization status Includes checking the child for other problems

CLASSIFY A CHILDS ILLNESS USING COLOR-CODED TRIANGLE SYSTEMUrgent pre-referral treatment and referral(PINK)

Specific medical treatment

and advice (YELLOW)Simple advice on home management (GREEN)

E L E M E N T S O F I M C I

yIDENTIFY specific treatments for the childy If requires urgent referral, give essential treatment before the patient is transferred y If the child requires treatment at home, develop an integrated plan for the child and give the 1st dose of drugs in the clinic y If a child should be immunized , give immunization

E L E M E N T S O F I M C I

y Provide practical TREATMENT instructionsy Teaching the caretaker on oral drug administration y How to feed and give oral fluids during illness y How to treat local infections at home y Ask the caretaker to return for follow up on a specific date y Teach the caretaker on how to recognize signs that indicate that the child should be return immediately to the health facility

Elements of IMCI Assess feeding, including breastfeeding practices. COUNSEL to solve any feeding problem found. Then counsel the mother about her own health When a child is brought back to the clinic as requested, GIVE FOLLOW UP CARE and if necessary, reassess the child for new problems

Check for General Danger Signs

Inability to drink or breastfeed Convulsions Lethargy or unconsciousnessAbnormally sleepy or difficult to awaken

Vomiting everything taken.

ASK: is the child able to drink or breastfeed? A child has this sign if he/she is too weak to drink and is not able to suck or swallow when offered a drink If you are not sure about the mother s answer, ask her to offer the child a drink. Look to see the child s response Breastfeeding children may have difficulty sucking when their nose is blocked , clear it first

ASK: Does thechild vomit everything?A child who is not able to hold on anything down at all has the sign vomits everything

A child with ANY of the Danger Signs has a serious problem and needs URGENT referral to the hospitaly ASK: Has the child had convulsions? y Use the term for convulsions like fits , spasm , or jerkymovements which the mother understands

y LOOK: See if the child is abnormally sleepy or difficult to

awakeny An abnormally sleepy child is drowsy and does not show interest in what is happening around him/her y He does not look at his mother or watch your face when you talk y He may stare blankly and does not notice what is going on around him y He does not respond when she is touched, shaken or spoken to

I. Cough or Difficulty in breathingAssess for general danger signs. This child may havepneumonia or another severe respiratory infection. After checking for danger signs, it is essential to ask the child s caretaker about this main symptom.

Clinical Assessment

Three key clinical signs are used to assess a sick child with cough or difficult breathing:1. Respiratory rate, which distinguishes children who have

pneumonia from those who do not; pneumonia; and

2. Lower chest wall indrawing, which indicates severe 3. Stridor, which indicates those with severe pneumonia who

require hospital admission.

Cough or Difficulty in breathingStridor is a harsh noise made when the child inhales(breathes in). Children who have stridor when calm have a substantial risk of obstruction and should be referred.

Wheezing is heard when the child exhales (breathesout). This is not stridor. A wheezing sound is most often associated with asthma. In some cases, especially when a child has wheezing when exhaling, the final decision on presence or absence of fast breathing can be made after a test with a rapid acting bronchodilator (if available).

Cough or Difficulty in breathingLower chest wall indrawing: inward movement of thebony structure of the chest wall with inspiration, is a useful indicator of severe pneumonia. It is more specific than intercostal indrawing, which concerns the soft tissue between the ribs without involvement of the bony structure of the chest wall. Chest indrawing should only be considered present if it is consistently present in a calm child. Agitation, a blocked nose or breastfeeding can all cause temporary chest indrawing.

Cough or Difficulty in breathingIf The Child is :2 weeks to 2 months 2 to 12 months

Fast Breathing is :60 or more per minute 50 or more per minute 40 or more per minute

12 months t o 5 years old

THE INTEGRATED CASE MANAGEMENT PROCESS OUT PATIENT HEALTH FACILITY Check for DANGER SIGNConvulsions Abnormality sleepy or difficult to awaken Unable to drink / breastfeed Vomits everything

Asses MAIN SYMPTOMSCough / difficulty breathing ,chestindrawing Diarrhea Fever Ear Problem

Asses NUTRITION,ANEMIA, IMMUNIZATION, and VITAMIN A SUPPLEMENTATION STATUS and POTENTIAL FEEDING PROBLEM Check for OTHER PROBLEMS CLASSIFY CONDITIONS and IDENTIFY TREATMENT ACTIONAccording to color-coded treatment

Urgent ReferralOUTPATIENT HEALTH FACILITY Pre-referral treatment Advise parents Refer child REFERRAL FACILITY Emergency Triage and Treatment (ETAT) Diagnosis Treatment Monitoring and follow-up

Treatment in outpatient facilityOUTPATIENT HEALTH FACILITY Treat local infection Give oral drugs Advise and teach caretaker Follow-up

Home ManagementHOME Caretaker counseled on: Home treatments Feeding and Fluids When to return immediately Follow-up

COUGH OR DIFFICULTY IN BREATHING

SIGN

CLASSIFY

TREATMENT Give the 1st dose of an appropriate antibiotic Give Vitamin A If chest indrawing and wheeze,go directly to treat wheezing Treat child to prevent the lowering of his or her blood sugar level Refer the child URGENTLY to a hospita