Integrated Management

of Childhood Illness
(IMCI)

A STRATEGY,
AN APPROACH
IMCI as a Strategy…
 Management of common childhood illness
is done in an integrated manner
 Includes preventive interventions
 Adjusts curative interventions to the
capacity and functions of the health system
(evidence based-syndromic approach)
 Involves the family members and the
community in the health care process
 IMCI – Objectives:

1. To reduce global mortality and

morbidity associated with the
major causes of diseases in
children such as pneumonia,diarrhea,
dengue fever, malaria, measles and
malnutrition.
 IMCI- Objectives:

2.To contribute to healthy

growth and development of
children.
Why IMCI?
 Overlap of conditions
 Diagnostic tools are minimal or non-
existent
 Drugs and equpment are scarce
 Health workers have few opportunities to
practice complicated clinical procedures
 Relies on history and signs and symptoms
 Components of IMCI
 Improvements in the case-management skills of
health workers
- *Standard guidelines
- *Training (pre-service, in-service training)
- *Follow- up after training

 Improvements in the overall health system

 Improvements in family and community health

care practices
Target Age for IMCI Strategy
 Young infants –
– 1 week up to 2 months

 Older children –
– 2 months up to 5 years old
 IMCI in the Philippines
 Pre-Implementation Phase – (1995-1997)
– Adaptation of the IMCI generic protocol
– Conduct of model courses (basic 11-day &
facilitators course)

 Early Implementation Phase – (1997-1999)

– Pilot implementation in Saranggani and
Zamboanga del Norte
– Review & re-planning
IMCI in the Philippines
 Expansion Phase – (1999 to present)
– IMCI Training of health workers (basic 11-day,
facilitators and follow-up training)
– Accreditation of hospitals for in-patient
practicum (initially1 hospital per region)
– Training on family and community IMCI
 Expnasion phase cont’d…
 Integration of IMCI in the pre-service
curriculum
 Revision of IMCI materials
– To include care for development in the counsel
the mother module
– New treatment protocol for malaria management
– Inclusion of Zinc in diarrhea management
– Use of reformulated ORS
– Redefinition of signs for dengue hemorrhagic
fever
 IMCI IN THE Pre-service
Curriculum
 WHY?
– IMCI clinical guidelines define the most
essential knowledge and skills needed to
effectively manage sick children
– Children account for 30-70% of all patients in
the outpatient clinics
– Students have rare opportunities to develop
essential outpatient skills
Principles of Integrated Care

 All sick children must be

examined for “general danger
signs”.
 -NOT ABLE TO DRINK OR BREASTFEED
 -VOMITS EVERYTHING
 -CONVULSIONS
 -ABNORMALLY SLEEPY OR DIFFICULT TO
AWAKEN

All sick children must be
routinely assessed for:

 Major Symptoms
Cough/difficulty breathing
Diarrhea
Fever
Ear Problem
All sick children should be
routinely assessed for:
 Nutrition, Vit A Supplementation and
Immunization status and
 Potential feeding problems and
check other problems

Only limited number of carefully-selected

clinical signs
 Principles...

 Classification(s) rather than a diagnosis

 Address most, but not all, of the major reasons a

sick child is brought to a clinic
 Use limited number of essential drugs and
encourage active participation of caretakers in the
treatment of children
 Counseling of caretakers about home
management
Methods in Managing Childhood
Illnesses
 Assess the patient
 Classify the disease
 Treat the patient
 Counsel the patient
Assess the patient
 Take patient’s history to get information
about disease condition

 Done by asking and observing the patient’s

condition exploring possible causes
Classify the Disease
 A thorough assessment
 Supported with laboratory results for
classification of illnesses and confirmation
of the disease, which are:
1) Mild
2) Moderate
3) Severe
Treat the patient
 A curative method of treating the disease

 Varies on the condition of the patient

Counsel the patient
 Provide health education to clients
promoting health & avoiding risk of
infection
 important for parents/caregivers especially
who lack knowledge on health practices &
risks factors that contribute to disease
ailments
 Color-coded system used in
IMCI
 Green – mild classification – home care
management
 Yellow – moderate classification – manage
at the RHU
 Pink – severe classification – urgent referral
in hospital
 IMCI Case Management Process

 Outpatient health facility

• Assessment
• Classification and identification of treatment
• Referral, home treatment (feeding & fluids) or counseling of the
child’s caretaker
• When to return immediately; Follow-up care
 Referral health facility
• Emergency triage assessment and treatment (ETAT)
• Diagnosis, treatment and monitoring & follow-up of patient
 Appropriate home management
• Teaching the mother or caretakers how to give oral drugs and treat
local infections at home
• Counseling mother or caretaker about food
Practice questions
1. Target ages for IMCI strategy
2. Classification of the disease, color coding used,
and its equivalent management approaches used
3. Major symptoms assessed in all sick children
4. Methods of managing childhood illness
5. How do you assess the patient?
6. How do you classify the disease?
7. How is the patient treated?
8. How do you counsel the patient?