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IMCI ORIENTATION

PURPOSE OF TRAINING COURSE
This training course is designed to teach the case management process to doctors, nurses and other health workers who see sick children and infants. It is a case management process for a first – level facility such as a health center or an outpatient department of a hospital. The course uses the word “health center” throughout to mean any such setting.

You will learn to manage sick children according to the case management charts, including: 1. Assessing signs and symptoms of illness, nutritional, vitamin A supplementation & immunization status. 2. Classifying the illness 3. Identifying treatments for the child’s classifications and deciding if a child needs to be referred. 4. Giving important pre-referral treatments ( such as a first dose of an antibiotic, Vitamin A, quinine injection, and treatment to prevent low blood sugar ) and referring the child.

Continuation :
5. Providing treatments in the health center, such as oral rehydration therapy, vitamin A, and immunization. 6. Teaching the mother to give specific treatment at home, such as an oral antibiotic or antimalarial. 7. Counselling the mother about feeding and when to return. 8. When a child comes for scheduled follow-up, reassessing the problem and providing appropriate care.

INTRODUCTION
 Pneumonia, diarrhea, dengue hemorrhagic fever, malaria, measles and malnutrition cause more than 70% of deaths in children under 5 years of age. There are feasible and effective ways that health workers 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, instead of separate guidelines for each illness.

Ten countries that early lead in implementing IMCI:
1. 2. 3. 4. 5. 6. BOLIVIA DOMINICAN REPUBLIC EQUADOR INDONESIA NEPAL PERU

7. PHILIPPINES
8. TANZANIA 9. UGANDA 10. ZAMBIA

HOW IMCI STARTED?
1995 – IMCI was developed by WHO – UNICEF to all developing countries. 1997 – IMCI was brought to the Philippines thru the Department of Health – Region I, III,X, XI (funded by United States Agency for International Development (USAID) ) 2001 - Integration of IMCI to Nursing & Midwifery Curriculum (attended by the Academe from different Nursing & Midwifery schools)

Participating Agencies
 DOH – Lead Agency  Commission on Higher Education Department (CHED)  Association of Deans of Philippines College of Nursing (ADPCN)  Association of Philippine School of Midwifery (APSOM)  Philippine Regulation Commission (PRC)

YEAR 2001
Educational Institution : Pilot Schools (Initial)

1. Nursing Education
MINDANAO - San Pedro Colleges, Davao City VISAYAS - St. Paul College, Iloilo City NCR - University of Sto. Tomas, Manila Baliuag University, Baliuag, Bulacan

YEAR 2001
Educational Institution : Pilot Schools (Initial) 2. Midwifery Education

NCR -World Citi Colleges, Quezon City Saint Joseph College, Cavite City University of the Visayas Tecarro College

YEAR 2004
Expansion Schools (additional) held in Subic, Zambales

1. UERM, Manila 2. Benguet University 3. Bicol University 4. Palawan University

IMCI
Integrated Management Of Childhood Illness

What is I.M.C.I.?
 is an integrated approach to child’ s health that focuses on the well-being of the whole child. aims to reduce death, illness and disability, and to promote improved growth and development among children under (5)five years of age . it includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

BASIC COMPONENTS / ADVANTAGES OF IMCI
1. Improving the case management skills of health workers and health facilities. 2. Improving the health care system. 3. Improving the family and community healthcare practices.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
The case management process is presented on a series of charts which show the sequence of steps and provide information for performing them. The charts describe the following steps:

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
1. Assess the child or young infant
 taking a history and doing a physical examination.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
2. Classify the illness - making a decision on the severity of the illness.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
3. Identify treatment  the charts recommend appropriate treatment for each classification.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
4. Treat the child
 giving treatment in health center, prescribing drugs or other treatments to be given at home, and also teaching the mother how to carry out the treatments.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
5. Counsel the mother

 includes assessing how the child is fed and telling her
about the foods and fluids to give the child and when to bring back to the health center.

SIX ( 6 ) STEPS IN CASE MANAGEMENT PROCESS
6. Give follow- up care

 describe what to do when a child returns to the health center by arrangement for a
follow-up visit.

AGE BRACKET:
1. Age 1 week up to 2 months ( Sick young infant )
2. Age 2 months up to 5 years ( Sick child )

I. ASSESS & CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
LEARNING OBJECTIVES:
This module will describe and allow you to practice the following skills:

LEARNING OBJECTIVES:

1. Asking the mother about the child’s problem.
- Greet the mother appropriately and ask her to
sit with her child.

- To use good communication skills:
    listen carefully to what the mother tells you use words the mother understands give the mother time to answer the questions ask additional questions when the mother is not sure about her answer

- Determine if this is an initial or follow-up visit for this problem

LEARNING OBJECTIVES:
2. Checking for general danger signs Greet the mother appropriately and ask her to sit with her child. 3. Asking the mother about the four main symptoms:
    cough or difficult breathing diarrhea fever ear problem

LEARNING OBJECTIVES:
4. When a main symptom is present:
 assessing the child further for signs related to the main symptom  classifying the illness according to the signs which are present or absent

5. Checking for signs of malnutrition and
anemia and classifying the child’s nutritional status.

LEARNING OBJECTIVES:
6. Checking the child’s immunization status
and deciding if the child needs any immunizations today. 7. Checking the child’s Vitamin A status and deciding if the child needs Vitamin A

8. Assessing any other problems

FOUR ( 4 ) MAIN SYMPTOMS:

1. COUGH OR DIFFICULT BREATHING : PNEUMONIA Any general danger sign Fast breathing Chest indrawing Stridor

FOUR ( 4 ) MAIN SYMPTOMS:
2. DIARRHEA : DEHYDRATION ACUTE & PERSISTENT DIARRHEA DYSENTERY CHOLERA

FOUR ( 4 ) MAIN SYMPTOMS:
3. FEVER : MALARIA MEASLES DENGUE HEMORRHAGIC FEVER

FOUR ( 4 ) MAIN SYMPTOMS:
4. EAR PROBLEM:
ACUTE EAR INFECTION CHRONIC EAR INFECTION MASTOIDITIS

Additional Topics
MALNUTRITION : KWASHIORKOR MARASMUS ANEMIA : IRON DEFICIENCY ANEMIA VITAMIN A EXPANDED PROGRAM ON IMMUNIZATION

FOUR ( 4 ) GENERAL DANGER SIGNS:

A general danger sign is present if:

FOUR ( 4 ) GENERAL DANGER SIGNS:

• • •

the child is NOT ABLE TO DRINK or BREASTFEED
the child VOMITS EVERYTHING the child has had CONVULSIONS the child is ABNORMALLY SLEEPY or DIFFICULT TO AWAKEN

II. ASSESS & CLASSIFY THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS
LEARNING OBJECTIVES:
The module will describe the following tasks and allow you to practice some of them ( some will be practiced in the health center ):

LEARNING OBJECTIVES:
1. Assessing and classifying a young infant

for possible bacterial infection . 2. Assessing and classifying a young infant with diarrhea 3. Checking for a feeding problem or low weight, assessing breastfeeding and classifying feeding 4. Treating a young infant with oral or intramuscular antibiotics

Continuation :
5. Giving fluid for treatment of diarrhea 6. Teaching the mother to treat local

infections at home 7. Teaching correct positioning and attachment for breastfeeding 8. Advising the mother how to give home care for the young infant

THREE ( 3 ) MAIN SYMPTOMS
1. POSSIBLE BACTERIAL INFECTION
       has the infant had convulsions count the breaths in one minute; repeat the count if elevated look for severe chest indrawing look for nasal flaring look and listen for grunting look and listen for bulging fontanelle look for pus draining from the ear

THREE ( 3 ) MAIN SYMPTOMS
1. POSSIBLE BACTERIAL INFECTION

 

look at the umbilicus. Is it red or draining pus? Does the redness extend to the skin? measure temperature ( or feel for fever or low body temperature ) look for skin pustules. Are there many or severe pustules? see if the young infant is abnormally sleepy or difficult to awaken

THREE ( 3 ) MAIN SYMPTOMS
 look at the young infant’s movements. Are they less than normal?  look at the young infant’s movements. Are they less than normal?

THREE ( 3 ) MAIN SYMPTOMS
2. DIARRHEA
      for how long? is there blood in the stool? look at the young infant’s general condition, is the infant: abnormally sleepy or difficult to awaken ? restless and irritable? look for sunken eyes pinch the skin of the abdomen, does it go back: - very slowly ( longer than 2 seconds)? - slowly

THREE ( 3 ) MAIN SYMPTOMS
3. FEEDING PROBLEM & LOW WEIGHT
   is there any difficulty feeding? is the infant breastfed? If yes, how many times in 24 hours? does the infant usually receive any other foods or drinks? if yes, how often? what do you use to feed the infant? determine weight for age.


CLASSIFICATION TABLES
Signs of illness & their classification are listed on the ASSESS & CLASSIFY chart in the classification tables. Most classification tables have 3 ROWS. If the chart is in color, each row is colored either PINK, YELLOW or GREEN. The color of the rows tells quickly if the child has a serious illness. You can also quickly choose the appropriate treatment.

CLASSIFICATION TABLES
PINK ROW
- NEEDS URGENT ATTENTION AND REFERRAL OR ADMISSION FOR IN PATIENT CARE. - THIS IS A SEVERE CLASSIFICATION - THE CHILD NEEDS AN APPROPRIATE ANTIBIOTIC, AN ORAL ANTIMALARIAL OR OTHER TREATMENT. TREATMENT INCLUDES TEACHING THE MOTHER HOW TO GIVE THE ORAL DRUGS OR TO TREAT LOCAL INFECTIONS AT HOME. THE HEALTH WORKER ADVISES HER ABOUT CARING FOR THE CHILD AT HOME AND WHEN SHE SHOULD RETURN. - THIS IS A MODERATE OR MILD CLASSIFICATION THIS MEANS THE CHID DOES NOT NEED SPECIFIC MEDICAL TREATMENT SUCH AS ANTIBIOTICS. THE HEALTH WORKER TEACHES THE MOTHER HOW TO CARE FOR HER CHILD AT HOME. AS AN EXAMPLE, ADVISE MOTHER ON HOW TO FEED HER SICK CHILD OR GIVING FLUID FOR DIARRHEA.

GREEN ROW

UPDATES:
At present time, DOH is working on the following new areas within IMCI:
1. Recognition and care of children with HIV/AIDS 2. Interactive care for healthy child development 3. Neonatal Health