Thur04 IMCI Manual

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C-IMCICommunity-Integrated Management

of Childhood Illness: a tool for theimplementation of the second element

Presented by Alfonso Rosales



Introduction

• History of C-IMCI

• Community IMCI as a complement to

Health facility IMCI

• C-IMCI Manual Adaptation to Country / Region / Community

Assess and Classify Treatment and Procedures



History

The HH/C IMCI Timeline:The HH/C IMCI Timeline:

1992

WHO/UNICEF

LAUNCHES IMCI

1992-1997

Early efforts focus on

Health worker skills and

system improvements

Santo Domingo

Meeting recog.

Importance of

HH/C-IMCI

Sept. „97

Oct. „97

UNICEF Meetings

with PVO particip

produces mandatefor HH/C IMCI

IAWG estab with

UNICEF leadership

to develop HH/C-

IMCI guidelines

Feb. „98

1998-99

CORE IMCI WG

dedicates focus on

HH/C IMCIagenda

CORE Mtg. at

PAHO

acknowledging role

of PVOs inadvancing HH/C

IMCI

Feb. „99

Durban Mtg consensus on

16 key practices and role

of HH/C IMCI in

promoting them

Jun. „00



Community

• WHO/UNICEF IMCI Clinic Setting

Health Care Workers

Full Algorithm

• COMMUNITY LEVEL Limited, if any access to health care facility

Home based visits Community Health Workers

Simplified Algorithm / Limited Training Time



C-IMCI Manual

I. Materials

• Assess and Classify

• Treatment and Procedures• Child Health Recording Form

• Flow Charts

II. Adaptation

• Country / Community



For WHOM?

•CChildren age 2

months to 5 years



Topics

• Danger Signs

• Cough or Difficult Breathing

• Diarrhoea• Malaria: High or Low

• Fever or No Malaria

• Ear Infections

• Malnutrition

• Breastfeeding

• Preventive Activities: Vaccinations & Vitamin A



C-IMCI Manual contents:• Section 1: Assess and Classify

• Section 2: Home Care Treatment and

Follow up Guidelines



Training Methodology

1. Reflection

2. Definition

3. How to Recognize

4. Skill Development

5. How to Evaluate /Management of RecordingForm

6. What to do after evaluation:What to do

How to do a referral



Check for DANGER SIGNS Convulsions

Lethargy/ unconsciousness

Inability to drink / breastfeed

Vomiting

Assess MAIN SYMPTOMS

Cough / dificulty breathing

Diarrhea

Malnutrition

Other problems

Assess IMMUNIZATION status and

vitamin A supplementation

Classify Conditions and Identify

Treatment Actions

Urgent Referral

Referral

Home Treatment



HOW TO RECOGNIZE DIARRHOEA AND DEHYDRATION

CHECK FOR DIARRHEA AND DEHYDRATION

ASK:Does the child have DIARRHEA?

If YES, continue with Ask and Look,

ASK:Is there blood in the stool?

For how long does the child have diarrhea?

LOOK:Look at the child‟s general condition. Is the child very sleepy or unconscious?

Offer the child fluid. Is the child: not able to drink or drinking poorly? Drinking

eagerly, thirsty?

Look for sunken eyes

Pinch the skin of the abdomen. Does it go back slowly (longer than 2 seconds)?



LOOK: AT THE CHILD‟S GENERAL CONDITION

There are two general danger signs that you would like to check when evaluating achild with diarrhea, these are: very sleepy or unconscious. Please refer to chapter 3 fora review of these two signs.

A child has the sign restless and irritable if the child is restless and irritable all thetime or every time he is touched or handled. If an infant or child is calm whenbreastfeeding but again restless and irritable when he stops breastfeeding, he has thesign “restless and irritable”. Many children are upset just because they are in the clinic.Usually these children can be consoled and calmed. They have not the sign “restless

and irritable”.

LOOK: OFFER THE CHILD SOMETHING TO DRINK

Ask the mother to offer the child some water in a cup or spoon. Watch the child drink.

A child is not able to drink if he is not able to take fluid in his mouth and swallow it.

For example, a child may not be able to drink because he is lethargic or unconscious. Orthe child may not be able to suck or swallow.

A child is drinking poorly if the child is weak and cannot drink without help.

A child has the sign drinking eagerly, thirsty if it is clear that the child wants todrink. Look to see if the child reaches out for the cup or spoon when you offer herwater. When the water is taken away, see if the child is unhappy because she wants to

drink more.



Assess for

Diarrhea:

Does child havestools with more

water in them

than usual (ask

mother)

If YES,

Is the child:

Sleepy or unconscious? YES NO

Not able to drink or breastfeed? YES NO

Sunken eyes? YES NO

Pinch skin: skin goes back very

slowly (longer than 2 seconds) YES NO

Blood in the stool YES NO

Is the child:

Irritable or restless YES NO

And

Drinks eagerly, thirsty YES NO

If YES to any question,

Diarrhea with severe dehydration

Advise caretaker to give frequent sips

of ORS on the way

Continue breastfeeding

Urgent referral to

nearest hospital or clinic

If YES to both questions,

Diarrhea with dehydration

Refer to Outpatient Clinic

If NO to one or both questions,

Diarrhea with

no signs of dehydration

See Guidelines for

Home Care

Child Health Recording Form: DIARRHOEA



DIARRHOEA

WHAT TO DO AFTER EVALUATION:

DEFINE WHAT TO DO AND HOW TO DO A REFERRAL

If the child is very sleepy, unconscious, irritable, or he IS NOT ableto drink or drinks eagerly, thirsty; or she has sunken eyes; or when

you pinch the skin of the abdomen, the skin goes back slowly; or has

blood in the stool; complete the rest of the assessment immediately.

This child has a severe problem. There must be no delays in his orher treatment. The child needs to be REFERRED immediately to the

nearest clinic or hospital.

If the child is NOT very sleepy, unconscious, irritable, or he IS able

to drink normally, and he does not drinks eagerly, he is not thirsty;

or she has NOT sunken eyes, or when you pinch the skin of the

abdomen, the skin goes back immediately; then the child has no

signs of dehydration. This child can be treated at home. Instead, give

the mother advice about good home care.



REFERRAL OF A CHILD: DIARRHEA

1. Explain to the mother or caretaker the need for referral, and get

her agreement to take the child. If you suspect that she does not

want to take the child, find out why. Possible reasons are:

2. Calm the mother’s fears and help her resolve any problem. For

example:

3. Write a referral note for the mother to take with her to thehospital. Tell her to give it to the health worker there. Write:

4. Give the mother any supplies and instructions needed to care for

her child on the way to the hospital



Treatment / Procedures

• Summary of illness with treatment for each problem(i.e. ear infection, breast problem)

• Specifics for each treatment

• Procedures (step-by-step)

• How to teach mother

• Specific Dosages (adapt to MOH)



NO

DEHYDRATION

MILD

DEHYDRATION

SEVERE

DEHYDRATION

Increase Fluids YES YES YES

Continue Feeding YES YES YES

Give Rehydration

Solution

NO YES YES

Teach Mother How

to Make

Rehydration Fluid

YES YES YES

Referral

NO

Home Care

YES

Outpatient

YES

Urgent

SUMMARY:

TREATMENT COURSE FOR DIARRHOEA



Wash your hands with soap and clean water

Take a half-liter container, and clean it. (A soda bottle is

approximately 1 Liter.)

Put a half-liter of water into the container.

Then put a “pinch” of salt (using three fingers to make a “pinch”)

Put a “fistful” of sugar. Stir the water with a clean spoon so that there is no remaining

sediment.

Taste the prepared solution. Correctly prepared solution tastes like

tears.

The solution can be left at room temperature for up to 6 hours.However, if the solution has been left at room temperature for longer

than this, it should be discarded and new home-based ORS should be

prepared.

Procedure 2: How to Prepare Home-Based Oral

Rehydration Solution



Supplemental Flowchart

Diagrams



Flowchart Diagram

• One health topic

• Limited amount of signs to assess

• Limited wordage• Visual: Picture per assessment

• Color Coded

Urgent ReferralOutpatient Referral

Home Treatment



Does the child have cough or difficulty breathing?

Look / Ask What to Do

Chest

Indrawing

Strange

Sounds

Fast

Breathing

If YES to anyquestion,

PNEUMONIA

Advise caretaker to keep child warm

Advise caretaker to keep feeding child

Fill out a referral note

Refer URGENTLY to Hospital

If there are NO signs

of pneumonia or

very severe disease,

COMMON COLDSoothe the throat and relieve the cough with a safe remedy.

Advise caretaker to increase liquids.

Advice mother when to return immediately.

Follow up in 5 days if no improvement

Advise caretaker not to give any drugs to the child

Fast Breathing is:

50 breaths or more per minute in a child 2 months up to 12 months.

Thur04 IMCI Manual

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