The Integrated Management ofChildhood Illness (IMCI) strategy isthe primary child-care approach ofchoice for South Africa.
IMCI trainingwas introduced into South Africa in1996 by WHO and UNICEF. Since then8695 health workers have been trainedin IMCI – mainly primary health carenurse practitioners, but also primarycare doctors and paediatricians. Thebasic 11-day course comprisesclassroom activities, assessingchildren both in an outpatient settingand paediatric ward.
A compact 4-day course has been developed fordoctors and is being taught in somemedical schools. IMCI has been verywell received by nurse practitionerand doctor alike in empowering themto make easy, evidence-baseddecisions in the management of sickchildren at first contact level. Howevermany doctors continue to work withchildren without knowledge of IMCI.Thus, the purpose of this review istwo-fold:•Firstly, many doctors working inhospitals receive referrals fromclinic-based IMCI nurse practi-tioners. Doctors need to beinformed what an IMCI classi-fication means. For example,children are commonly referredwith a classification of “
Severe Pneumonia or Very Severe Disease
”. What does this mean?How should the doctor managethis child?•Secondly, this review introducessome of the basic IMCI skills. Anunderstanding of these skills couldbe helpful for doctors working withsick children in general practice,clinics, community health centresor in an outpatient setting. However,to become a skilled IMCIpractitioner, it is essential for adoctor to attend an IMCI course.
The IMCI approach
IMCI focuses on illnesses that causethe majority of deaths in childrenunder-6 years, many of which arepreventable or readily treatable usingsimple interventions: These arepneumonia, diarrhoea, meningitis,malaria, malnutrition, anemia and HIV/AIDS. This is called a “child survival”approach. Other important aspects ofchild health are also addressed suchas ear infections, the sick young infant(under 2 months), breast-feeding andfeeding assessment.Doctors attending a 4-day IMCIcourse work from two maindocuments: Firstly, a short textbookcalled IMCI: A Handbook for MedicalPractitioners.
The second is a deskreference, used by all nurses anddoctors practicing IMCI, called theChart Booklet.
These were developedby WHO and adapted to the SouthAfrican setting. The Chart Bookletcontains all the information needed toconduct a comprehensive primarychild-care consultation and is availableon the website . The key informationin the Chart Booklet has beensummarized into Table I of this review.Table I is designed as an easyreference on the wall of theconsultation room. The rest of thisreview revolves around the informationin Table I.As can be seen in Table I, the IMCIpractitioner asks pertinent questions,examines the child and will then
these signs. Depending on thesigns present, one or often more
are made. Classificationis similar to a diagnosis but is context-specific: For example, in a primarycare setting, a classification of
is made in afeverish child with neck stiffness. Onlywhen this child is referred to hospitalwhere a lumbar puncture can beperformed and the cerebro-spinal fluid
SA Fam Pract 2005;47(8)
A review of IntegratedManagement of ChildhoodIllness (IMCI)
MBChB, MFamMed, DipMid COG(SA)uMgungundlovu Health District, KwaZulu-Natal.
IMCI, case management, sick children, pneumonia, diarrhoea, fever,malnutrition, anemia, HIV/AIDS, sick young infant, feeding assessment.
Dr. Kerry T, District Medical Manager, uMgungundlovu Health District, KwaZulu-Natal.PO Box 21741, Mayors Walk, Pietermaritzburg, 3208, Tel:033 3426675, Fax:033 3943235, e-mail: firstname.lastname@example.org
(SA Fam Pract 2005;47(8): 32-38)