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IMCI Lecture

The IMCI (Integrated Management of Childhood Illness) is a WHO/UNICEF strategy to reduce child mortality. It provides guidelines for health workers on assessing, classifying, and treating the major childhood illnesses through an integrated approach. The case management process involves assessing the child for general danger signs and specific symptoms, classifying the illness as red, yellow, or green based on severity, identifying the appropriate treatment, counseling the mother, and providing follow-up care. IMCI aims to effectively manage pneumonia, diarrhea, malaria, measles, malnutrition and other conditions that cause the majority of under-5 deaths through this standardized process.

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Romana Latowed
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79 views

IMCI Lecture

The IMCI (Integrated Management of Childhood Illness) is a WHO/UNICEF strategy to reduce child mortality. It provides guidelines for health workers on assessing, classifying, and treating the major childhood illnesses through an integrated approach. The case management process involves assessing the child for general danger signs and specific symptoms, classifying the illness as red, yellow, or green based on severity, identifying the appropriate treatment, counseling the mother, and providing follow-up care. IMCI aims to effectively manage pneumonia, diarrhea, malaria, measles, malnutrition and other conditions that cause the majority of under-5 deaths through this standardized process.

Uploaded by

Romana Latowed
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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IMCI

Integrated Management
of Childhood Illness
WHAT IS IMCI?
 A strategy for reducing mortality and morbidity
associated with major causes of childhood illness

 A joint WHO/UNICEF initiative since 1992

 Currently focused on first level health facilities

 Comes as a generic guidelines for management


which have been adapted to each country
INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESS

INTRODUCTION

Pneumonia, diarrhea, dengue hemorrhagic fever, malaria, measles and


malnutrition cause more than 70% of the deaths in children under 5 years
of age. All these are preventable diseases in which when managed and
treated early could have prevented these deaths.

There are feasible and effective ways that health worker in health centers
can care for children with these illnesses and prevent most of these deaths.
There are feasible and effective ways that health worker in health centers
can care for children with these illnesses and prevent most of these deaths.
WHO and UNICEF used updated technical findings to describe
management of these illnesses in a set of integrated guidelines for each
illness. They then developed this protocol to teach the integrated case
management process to health worker who see sick children and know
which problems are most important to treat. Therefore, effective case
management needs to consider all of a child’s symptoms.
 For those children who can be treated at home,
caregivers are taught how to provide treatment and
when to seek care for their children.
 The guidelines also identify actions to prevent
illness through the immunization of sick children,
supplementation of micronutrients, promotion of
breastfeeding, and counseling of mothers to solve
feeding problems.
 It is also an important factor to teach families when
to seek care for a sick child as part of the case
management process.
 This approach, which combines steps to manage
and prevent several different conditions, is
comprehensive and systematic.
DISTRIBUTION OF 11.6 MILLION DEATHS
AMONG CHILDREN LESS THAN 5 YRS OLD
IN ALL DEVELOPING COUNTRIES, 1995

 MALNUTRITION 54%
 Others 32%
 ACUTE RESPIRATORY INFECTIONS (ARI) 19 %
 DIARRHEA 19%
 Perinatal 18%
 MEASLES 7%
 MALARIA 5%
OBJECTIVES OF IMCI
To reduce significantly global morbidity and
mortality associated with the major causes of
illnesses in children

To contribute to healthy growth and


development of children
THE CASE MANAGEMENT PROCESS

is used to assess and classify two age groups :


age 1 week up to 2
2 months up to 5 years

And how to use the process shown on the chart


will help us to identify signs of serious disease
such pneumonia, diarrhea, malaria, measles, DHF,
meningitis, malnutrition and anemia.
THE CASE MANAGEMENT PROCESS

The charts describes the following steps;


1. Assess the child or young infant
2. Classify the illness
3. Identify the treatment
4. Treat the child
5. Counsel the mother
6. Give follow up care
THE CLASSIFICATION TABLE

The classification tables on the assess


and classify have 3 ROWS.

COLOR of the row helps to IDENTIFY


RAPIDLY whether the child has a
SERIOUS DISEASE requiring URGENT
ATTENTION. 
Each row is colored either

PINK – means the child has a severe classification and needs


urgent attention and referral or admission for inpatient care.

YELLOW – means the child needs a specific medical treatment


such as an appropriate antibiotic, an oral anti-malarial or other
treatment; also teaches the mother how to give oral drugs or to
treat local infections at home. The health worker teaches the
mother how to care for her child at home and when she should
return.

GREEN – not given a specific medical treatment such as


antibiotics or other treatments. The health worker teaches the
mother how to care for her child at home. Always start at the
top of the classification table. If the child has signs from more
than 1 row always select the more serious classification.
WHY NOT USE THE PROCESS FOR
CHILDREN AGE 5 YEARS OR MORE?
 The case management process is designed for children < 5yrs of
age, although much of the advise on treatment of pneumonia,
diarrhea, malaria, measles and malnutrition, is also applicable
to older children, the ASSESSMENT AND CLASSIFICATION
of older children would differ.

 For example, the cut off rate for determining fast breathing
would be different because normal breathing rates are slower in
older children. Chest indrawing is not a reliable sign of severe
pneumonia as children get older and the bones of the chest
become more firm.
 In addition, certain treatment recommendations or advice
to mothers on feeding would differ for >5yrs old. The drug
dosing tables only apply to children up to 5yrs old. The
feeding advice for older children may differ and they may
have different feeding problems.

 Because of differences in the clinical signs of older and


younger children who have these illnesses, the assessment
and classification process using these clinical signs is not
recommended for older children.
WHY NOT USE THIS PROCESS FOR
YOUNG INFANTS AGE < 1 WEEK OLD?
 The process on young infant chart is designed for
infants age 1 week up to 2 months.

 It greatly differs from older infants and young


children.

 In the first week of life, newborn infants are often


sick from conditions related to labor and delivery.
Their conditions require special treatment.
IDENTIFICATION AND
PROVISION OF TREATMENT
Curative component adapted to address the most
common life-threatening conditions in each country
• Rehydration (diarrhea, DHF)
• Antibiotics (pneumonia, “severe disease”)
• Antimalarial treatment
• Vitamin A (measles, severe malnutrition)
PROMOTIVE AND PREVENTIVE
ELEMENTS

• Reducing missed opportunities for immunization


(vaccination given if needed)

• Breastfeeding and other nutritional counseling Vitamin


A and iron supplementation

• Treatment of helminth infections


The Integrated Case
Management Process 
Learning Objectives

At the end of the session, the students will be


able to:

1) Describe the overall case management


process

2) State in order the steps in the management


process
Overall Case Management Process
Outpatient
1 - assessment
2 - classification and identification of treatment
3 - referral, treatment or counseling of the child’s
(depending on the classification identified)
4 - follow-up care

Referral Health Facility


1 - emergency triage assessment and treatment
2 - diagnosis, treatment and monitoring of patient’s
progress
Assess the Sick Young Infant , Age up t
o 2 Months
 
• NAME OF THE INFANT
• AGE
• WEIGHT
• TEMPERATURE
• INFANT’S PROBLEMS
• INITIAL OR FOLLOW UP VISIT 
Assess the Sick Young Infant , Age up t
o 2 Months
 
• Check for possible bacterial infection
• Check for the presence of Jaundice
• Check for diarrhea
• Check for feeding problem or low weight
• Check for immunization
• Assess other problems
Assess the Sick Child, Age 2 months up
to 5 years
 
• NAME OF THE CHILD
• AGE
• WEIGHT
• TEMPERATURE
• CHILD’S PROBLEMS
• INITIAL OR FOLLOW UP VISIT
Assess the Sick Child, Age 2 months u
p to 5 years
 
Check for general danger signs for all sick
children:
1- Unable to drink or breastfeed
2-Vomits every thing
3- Has the child had convulsions?
4- Unconscious, lethargic
5- Is the child convulsing now
Check General Danger Signs 

CHECK for GENERAL DANGER SIGNS in ALL SICK Children

ASK THE MOTHER WHAT THE CHILD’S PROBLEMS ARE? 


 Determine if this is an Initial or Follow Up visit for this problem
• If Follow Up visit, use the follow up instruction on TREAT THE CHILD CHART
• If Initial visit, assess the child as follows:
CHECK FOR GENERAL DANGER SIGNS
ASK and check ·Is the child able to drink or breast-feed?
·Does the child vomit every thing?
·Has he had convulsions? (during present illness)

LOOK
·See if the child is lethargic or unconscious
·See if the child is convulsing now 
Assess the Sick Child, Age 2 months u
p to 5 years
 

Assess major four symptoms: 


• 1-Cough or difficult breathing
• 2-Diarrhoea
• 3-Fever
• 4-Ear problems

Check for
• Nutrition
• immunization,
• vitamin A supplementation and
• feeding problems
Classification the illness 

The classification tables on the assess and classify have 3 ROWS .

COLOR of the row helps to IDENTIFYRAPIDLY whether the child has a


SERIOUSDISEASE requiring URGENT ATTENTION.

Each row is colored either


Red – means the child has a severe classification and needs urgent attention and
referral or admission for inpatient care

YELLOW – means the child needs a specific medical treatment such as an


appropriate antibiotic, an oral anti-malarial or other treatment.

– also teaches the mother how to give oral drugs or to treat local
infections at home

GREEN – not given a specific medical treatment such as antibiotics or other


treatments. The health worker teaches the mother how to care for her
child at home.
 RED – A CLASSIFICATION THAT NEEDS URGENT REFERRAL AFTER FIRST
DOSE OF APPROPRIATE ANTIBIOTIC

YELLOW – A CLASSIFICATION THAT NEEDS TREAMENT AT HOME AND


 
HEALTH EDUCATION

  GREEN – A CLASSIFICATION THAT NEEDS HEALTH EDUCATION


SUMMARY OF THE INTEGRATED
CASE MANAGEMENT PROCESS

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