Integrated Management for Childhood Illness (Imci)

8/3/2019 Integrated Management for Childhood Illness (Imci)

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INTEGRATED MANAGEMENT FORCHILDHOOD ILLNESS (IMCI)Prepared by:

Jeanne Keith M. Patulan


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Inequities of Child Health

World Analysts say that this Glo bal Burden ofDisease indicate that these conditions will continue

to be major contributors to child deaths through the year 2020 unless significantly greater efforts aremade to control them.

A. Infant and childhood mortality are sensitiveindicators of inequity and poverty

1. children who are most commonly and severely ill,who are malnourished and who are most likely todie of their illness are those of the most vulnerableand underprivileged populations of low-incomecountries;


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2. even within middle-income and so-calledindustrialized countries, there are oftenneglected geographical areas where childhood

mortality remains high; 3. millions of children are often caught in thevicious cycle of poverty and ill health. povertyleads to ill health and ill health breeds poverty.


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B. Qualityofcare is another important indicatorof inequities in child health. Everyday, millionsof parents seek health care for their sickchildren, taking them to hospitals, healthcenters, pharmacists, doctors, and traditional

healers. 1. Surveys reveal that many sick children are

not properly assessed and treated by thesehealth pro viders, and that their parents are

poorly counseled; 2. At 1st level health facilities in low-incomecountries, diagnostic supports e.g. x-ray &laboratory services are minimal or non-existent,and drugs and equipment are often scarce;


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3. Limited supplies and equipment, combined

with an irregular flow of patients, leave doctorsat this level with few opportunities to practicecomplicated clinical procedures. Instead, theyoften rely on history and signs & symptoms to

determine a source of management that makesthe best use ofavailable resources.


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The Integrated Case ManagementProcess The IMCI process can be used by doctors, nurses

and other health care professionals who see sickinfants and children age 1 aged 1 week to 5 years.It is a case management process for a first level facility such as clinic, health center, or the

outpatient department ofthe hospital.


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The IMCI guidelines describe how to care for achild who is brought to the clinic with an illnessfor a scheduled follow up visit to check thechilds progress. The guidelines giveinstructions on how to routinely assess a childfor general danger signs (or possible bacterialinfection in y oung infant), common illnesses,malnutrition and anemia, and to look for otherpro blems. In addition to the treatment, theguidelines incorporate basic activities for illnessproblem.


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Three Components of IMCI

1. Upgrading the case management and

counseling skills ofhealth care providers.2. Strengthening the health system for effectivemanagement ofchildhood illnesses.

3. Improving the family community practices

related to child health and nutrition.


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The complete IMCI case managementprocess involves the following

elements:

ASSESS a child by checking first foe dangersigns (or possible bacterial infection on a younginfant), asking questions about commonconditions, examining the child and checking the

nutrition and immunization status. Assessmentincludes checking the child for other problems.


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CLASSIFY a childs illness using the color coded triage system. Because many childrenhave more than one condition, each illness is

classified acc

ording t

owhether it requires Urgent pre referral treatment and referral

(PINK)

Specific medical treatment and advice

(YELLOW) Simple advice or home management (GREEN)


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After classif ying all conditions, IDENTIFYspecific treatments for the child. If the childrequires urgent referral, give essential treatment

before the patient is transferred. If the child

needs treatment at home, develop an integratedtreatment plan for the child, and give the firstdose pf drugs in the clinic. If a child should beimmunized, give immunization.


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Pro vide practical TREATMENT instructions,including teaching the caretaker how to give oraldrugs, how to feed and give fluids during theillness, and how to treat local infections at home.

Ask the caretaker to return for follow up on aspecific date, and teach her how to recognizesigns that indicate that the child should returnimmediately to the health facility.


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Assess feeding, including breast feedingpractices. COUNSEL to solve any feedingproblem found. Then, Counsel the mother about

her own health. When a childs brought back to the clinic, GIVE

FOLLOW UP CARE and , ifnecessary, reassessthe child for new problems.


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The Principles of Integrated CareThe IMCI guidelines are based on the followingprinciples:

All sick must be examined for general dangersigns, which indicate a need for immediate referral

or admission to the hospital.1. All the sick children must be routinely assessed for

major symptoms. For children aged 2 months to 5 years; cough,

difficulty of breathing, diarrhea, fever, and ear

problem; and For children aged 1 week to 2 months, bacterialinfection and diarrhea.They must be routinely assessed for nutrition

and immunization status, feeding problems, andother potential problems.


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2. Only for a limited number of carefully selected clinical signs are used, based on theevidence of their sensitivity and specificity to

detect a disease. These signs were selectedconsidering the conditions and realities of first level health facilities.

3. A combination of individual signs leads to a

childs classification/s rather than a diagnosis.the classifications are color coded.


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4. The IMCI guidelines address most, but not all,of the major reason a sick child Is brought tothe clinic.

5. IMCI management procedures use limitednumber of essential drugs and encourageactive participation of caretakers in thetreatment ofchildren.

6. An essential component ofthe IMCI guidelinesis counseling of caretakers about homemanagement, including counseling aboutfeeding, fluids and when to return to a healthfacility.

Integrated Management for Childhood Illness (Imci)

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