IMCI Workshop

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Transcript of IMCI Workshop

IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI is a strategy for reducing mortality and morbidity associated with major causes of childhood illness. IMCI was initiated jointly in 1992 by DOH, WHO and UNICEF. IMCI has already been introduced in more than 75 countries around the world.

Primarily, there are two objectives of IMCI: 1. To significantly reduce global mortality and morbidity associated with the major causes of disease in children 2. To contribute a healthy growth and development of children.

Three major components of IMCI:

1. Improving case management skills of health workers

2. Improving the health system to deliver IMCI

3. Improving family and community health practices

I. II. III. IV. V. VI.

Assess the child or young infant Classify the illness Identify the treatment Treat the child/Refer Counsel the mother Give follow-up care

I. Assess the child or young infant Assess the child means taking a history and doing physical examination.

II. Classify the illness Classify the Illness means taking a decision on the severity of the illness Classifications are not specific disease diagnoses. Instead, they are categories that are used to determine treatment For effectively manage childhood illness, a colorcoded system has been utilized which represents: green yellow pink

II. Classify the illnessColor Presentation Green Yellow Pink Classification of Disease Mild Moderate Severe Level of Management Home Care Management at the RHU Urgent Referral

III. Identify Treatment The chart recommends appropriate treatment for each classification When using this process, selecting a classification on the chart is sufficient to allow you to identify treatment

IV. Treat the child Treat the child means giving treatment in the health center prescribing drugs or other treatments to be given at home teaching the mother how to carry out the treatments.

V. Counsel the mother Counsel the mother includes assessing how the child is fed telling the mother about the foods and fluids to give the child Telling the mother when to bring the child back to the health center.

VI. Give follow-up care Specific instructions for conducting each follow-up visit

OUT-PATIENT HEALTH FACILITY Check for GENERAL DANGER SIGNS Convulsions (during this illness) Lethargy/unconsciousness Inability to drink or breastfeed Vomiting Assess MAIN SYMPTOMS Coughing/difficulty of breathing Diarrhea Fever Ear Problems Urgent Referral OUT-PATIENT HEALTH FACILITY Pre-referral treatment Advise parents Refer child Assess NUTRITION AND IMMUNIZATION STATUS and POTENTIAL FEEDING PROBLEMS Home Management Check for OTHER PROBLEMS CLASSIFY CONDITION AND IDENTIFY TREATMENT ACTIONS According to color-coded treatment HOME Caretaker is counseled on: Refer child Home treatments Feeding and fluids When to return immediately Follow-up

REFERRAL FACILITY Emergency Triage and treatment (ETAT) Diagnosis Treatment Monitoring and Follow-up

Treatment at Out-Patient OUT-PATIENT HEALTH FACILITY Treat local infection Give oral drugs Advise and teach caretakers Follow-up

Steps: 1. ASK THE MOTHER WHAT S THE CHILD PROBLEMS ARE a. Greet the mother appropriately and ask her to sit with her child b. Using good communication skills, ask the mother what the child s problems are and record them on the Recording Form c. Determine if this is an initial visit or follow up visit.

2. CHECK FOR GENERAL DANGER SIGNS

a. The child is not able to drink or breastfeed

b. The child vomits everything

c. The child has had convulsion (during this illness)

d. The child is abnormally sleepy or difficult to awaken

Exercises: Case 1 Mutya is 15 months old. She weighs 8.5 kg. Her temperature is 35.5C. The health worker asked, What are the child s problems? The mother said, Mutya has been coughing for 4 days, and she is not eating well. This is Mutya s initial visit for this problem. The health worker checked Mutya for general danger signs. He asked, Is Mutya able to drink or Breastfeed? The mother said No. Mutya does not want to breastfeed. The health worker gave Mutya some water. She was too weak to lift her head. She was not able to drink from a cup. Next, he asked the mother, Is she vomiting? The mother said No. Then he asked, Has she had convulsions? The mother said No. The health worker looked to see if Mutya was abnormally sleepy or difficult to awaken . When the health worker and the mother were talking, Mutya watched them and looked around the room. She was not abnormally sleepy or difficult to awaken.

Answer the following: a. Write Mutya s name, age, weight, and temperature in the spaces provided on top of the line form. b. Write Mutya s problem on the line after the question Ask: What are the child s problems? c. Tick ( ) whether this is the initial or follow-up visit. d. Does Mutya have general danger signs? If yes, circle the signs on the Recording Form. Then tick( ) yes or no after the question, General danger signs present?

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Child s Name:_____Age:_____ Weight______kg. Temperature_______ ASK:What are the child s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) ClassifyCHECK FOR DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN General Danger Signs Present? YES___NO___

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Child s Name:_____Age:_____ Weight______kg. Temperature_______ ASK:What are the child s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) ClassifyCHECK FOR DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN General Danger Signs Present? YES_ __NO___

Case 2: Nilo is 4 years old. He weighs 10 kg. His temperature is 38 C. The health worker asked about the child s problems. Nilo s parents said, he is coughing and has ear pain. This is the initial visit for this problem. The health worker asked, Is your child able to drink? The parents answered, Yes. Does Nilo vomit everything? he asked. The parent said No. The health worker asked, Has he had convulsions? they said No. The health worker looked at Nilo, the child was not abnormally sleepy or difficult to awaken.

Answer the following: a. Write Nilo s name, age, weight, and temperature in the spaces provided on top of the line form. b. Write Nilo s problem on the line after the question Ask: What are the child s problems? c. Tick whether this is the initial or follow-up visit. d. Does Nilo have general danger signs? If yes, circle the signs on the Recording Form. Then tick yes or no after the question, General danger signs present?

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Child s Name:_____Age:_____ Weight______kg. Temperature_______ ASK:What are the child s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) ClassifyCHECK FOR DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN General Danger Signs Present? YES___NO__ _

3. ASSESS AND CLASSIFY COUGH OR DIFFICULT BREATHING A child with cough or difficult breathing may have pneumonia or another severe respiratory infection Pneumonia is an infection of the lungs. Both bacteria and viruses can cause pneumonia In developing countries, pneumonia is often due to bacteria. The most common is Streptococcus pnuemoniae.

3.1 Assess cough and difficult breathing A child with cough or difficult breathing is assessed for: a. How long the child has had cough or difficult breathing b. Fast breathing-consider fast breathing if: 2mos-12mos. - 50 breaths/min. or more 12mos.-5yrs. - 40 breaths/min. or more c. Chest indrawing d. Stridor in calm child

3.2 Classify Cough or difficult breathingAny general danger signs or Chest indrawing or Stridor in calm child Fast breathing No sign of pneumonia or very severe diseaseSEVERE PNEUMONIA OR VERY SEVERE DISEASE PNEUMONIA NO PNEUMONIA COUGH OR COLD

Exercises: Case 1 Lupita is 8 months old. She weighs 6kg. Her temperature is 39C. Her father told the worker, Lupita has had cough for 3 days. She is having trouble breathing. She is very weak. The health worker said, You have done the right thing to bring your child today. I will examine her now. The health worker checked for general danger signs. The mother said, Lupita will not breastfeed. She will not take any other drinks I offer her. Lupita does not vomit everything and not had convulsions. Lupita is abnormally sleepy. She did not look at the health worker or her parents when they talked. The health worker counted 55 breaths/min. He saw chest indrawing. He decided Lupita had stridor because he heard a harsh noise when she breathed in.

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Child s Name:________________Age:_____ Weight______kg. Temperature_______ ASK:What are the child s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify CHECK FOR DANGER SIGNS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN General Danger Signs Present? YES___NO___

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING For how long? ______days

YES____ NO____

Count the breaths in one minute ____breaths per minute. Fast breathing? Look for chest indrawing Look and listen for stridor

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Child s Name:________________Age:_____ Weight______kg. Temperature_______ ASK:What are the child s problems?______________Initial Visit_______follow-up visit__________ A