IMCI

Integrated Management Of Childhood

Illnesses

By.
Kabahuma Hanifah
Namutebi A Mariam

Facilitator : Dr. OYELLA SHEILA

Outline
• Introduction to IMCI
• Causes of childhood mortality
• Explain the meaning and purpose of integrated case management
• Describe the main steps in the IMCI strategy.
• Implementation of IMCI.
Introduction
The mortality rate of children less than 5 years old has decreased by
over a quarter since 1990, but the reduction has not been evenly
distributed throughout the world.
Children in low-to-middle-income countries are ten times more likely
to die before 5 years of age than children living in the industrialized
world (UNICEF, 2009).
Millennium Development Goal 4 has been a powerful drive for
improvement, but 37 countries still had childhood mortality rates over
100 per 1000 live births, 36 of these being in Africa.
 SDGs
• Target is by 2030, to end preventable deaths of newborns and children under 5
years of age.

• With all countries aiming to reduce neonatal mortality to at least as low as 12

deaths per 1000 live births and under five mortality to at least low as 25 deaths
per 1000 live births.

• In Africa, the majority of these deaths are due to acute respiratory infections
(mostly pneumonia), malaria, diarrhea, measles, and malnutrition, and often to a
combination of these conditions (WHO, 2010).
In addition, neonatal problems constitute a major share of these deaths.

• Many sick children present with symptoms and signs related to more than one of
these conditions
In Africa, the majority of these deaths are due to acute respiratory
infections (mostly pneumonia), malaria, diarrhea, measles, and
malnutrition, and often to a combination of these conditions (WHO,
2010).
In addition, neonatal problems constitute a major share of these
deaths.
Many sick children present with symptoms and signs related to more
than one of these conditions
• This overlap means that a single diagnosis may also be complicated by the need to
combine therapy for several conditions.

• In 1995 WHO and UNICEF developed a strategy known as Integrated Management

of Childhood Illness (IMCI). IMCI integrates case management of the most common
childhood problems, especially the most important causes of death

• Although the major reason for its development resulted from curative care needs,
the strategy also addresses aspects of nutrition, immunization and other elements
of disease prevention and health promotion. It focuses on first-level health
facilities in low-income countries with health workers with limited training.

• Diagnosis relies on history and clinical signs to determine management within the
context of limited resources
• Global under five mortality declined from 59% (93 deaths per 1000 live
birth) in the 1990 to 39% in 2018, Despite the progress improving infant
survival remains a matter of urgency - UNICEF. The sub Saharan African
still has the highest rates at 78/1000 live births with Mali leading
(100/1000) in second position world wide next to Afghanistan. 1 in 13
dies before 5th b.d

• According to the world bank collection of dev’t indicators in 2015;

Uganda’s infant mortality rate was 37.7/1000 live births and leading
causes were communicable diseases including HIV, TB, malaria, diarrhea
and RTI,
Factors associated with mortality

• Poorest households
• Rural areas
• Low rates of maternal education

• Mortality also varies by country depending on the prevalence of HIV

and malaria
• Children die from more than one condition at once
Definition
IMCI is an integrated approach to child health that focuses on the well-
being of the whole child.

A strategy for reducing mortality and morbidity associated with major

causes of childhood illness.

It includes both curative and preventive elements

AIMS
The IMCI strategy consists of three main components:
• Improvements in the case-management skills of health staff.
• Improvements in the functioning of the overall health system.
• Improvements in family and community health care practices.
• It is a case management process for a first-level facility, such as a clinic,
health center or an outpatient department of a hospital.
• The IMCI process can be used by all doctors, nurses and other health
professionals who see young infants and children less than five years old.
IMCI process

• List of conditions to check in children and infants

• Assess and treat children for all conditions that are present
• Standardized algorithms guide the management and decision to
transfer to higher care
Steps in IMCI
Step 1 : Assess
• Good communication
• Screen for general danger signs.
• Specific questions about the most common conditions affecting a
child's health (diarrhea, pneumonia, fever, )
• If the answers are positive, focused physical exam to identify life-
threatening illness
• Evaluation of the child's nutrition and immunization status.
• Look out for other health problems.
Cont.
Step 2: Classify
Based on the results of the assessment classify a child's illness using a
specially developed colour-coded triage system.
Because many children have more than one condition, each condition is
classified according to whether it requires:
• Urgent pre-referral treatment and referral, or
• Specific medical treatment and advice, or
• Simple advice on home management
Step 3: Identify treatment
After classifying all the conditions present, identify specific treatments for the
sick child or the sick young infant.
• If a child requires urgent referral, essential treatment to be given before
referral is identified.
• If a child needs specific treatment , a treatment plan is developed, and the
drugs to be administered at the clinic are identified. The content of the
advice to be given to the mother is decided on.
• If no serious conditions have been found, the mother should be correctly
advised on the appropriate actions to be taken for care of the child at home
Step 4: Treat
carry out the necessary procedures relevant to the child's conditions.
• Give pre-referral treatment for sick children being referred;
• Give the first dose of relevant drugs to the children who are in need of
specific treatment, and teaches the mother how to give oral drugs, how
to feed and give fluids during illness, and how to treat local infections at
home;
• Provide advice on the home management of sick children at home;
• If needed, ask the mother or other caregiver to return with the child for
follow-up on a specific date.
Step 5 : Counsel
• If the follow-up care is indicated teach the mother when to return to
the clinic.
• Also teach the mother how to recognize signs indicating that the child
should be brought back to the clinic immediately.
• When indicated, assess feeding, including breastfeeding practice, and
provides counselling to solve any feeding problems found.
• counsel the mother about her own health.
Step 6: Follow up
• Some children need to be seen more than once for a current episode
of illness.
• The IMCI case management process helps to identify those children
who require additional follow-up visits.
• When such children are brought back to the clinic,
• give appropriate follow-up care, as indicated in IMCI guidelines, and if
necessary, reassess the child for any new problems
IMCI PROCESS: for the sick child (2months -
5years)
IMCI process: sick infant (0 to 2months)
Implementation of IMCI
• Adopting an integrated approach to child health and development in
the national health policy.
• Adapting the 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 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 an outpatient clinic.
• Developing support mechanisms within communities for preventing
disease, for helping families to care for sick children, and for getting
children to clinics or hospitals when needed.
N.B; IMCI has already been introduced in more than 75 countries
around the world UG inclusive.
Refferences
• Principles of medicine in Africa,4th edition.
• 2017 Revised IMNCI Chart booklet M.O.H,Uganda
• WHO-IMCI