Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 104 - COMMUNITY HEALTH NURSING I (RLE):

INTEGRATED MATERNAL OF
CHILDHOOD ILLNESS (IMCI)

Group F1:

Ticong, Gwynneth

Tinosan, Mary Angeline M.

Tobias, Roxanne

Tumulak, Alyssa Claire P.

Urbiztondo, Marycon Joy A.

Wasawas, Janeryle Kerry D.

Ycong, Louise Marie C.

Facilitator: Ms. Genevieve Diputado, MAN, RN

Date Submitted: September 2, 2022

1
 TABLE OF CONTENTS

TITLE PAGE

Learning Outcome for Integrated Management of Childhood Illness (IMCI) 3

CLO#1: Describe Integrated Management of Childhood Illness (IMCI)

as to its definition and strategy 4
CLO#2: Analyze the IMCI protocol guidelines for health workers
using an integrated approach. 6
CLO#3: Classify and distinguish the case management process as to:
age appropriate case management and visit 13
CLO#4: Examine the IMCI case management process 17
CLO#5: Compare recording forms used in IMCI. 22

CLO#6
References 32

2
LEARNING OUTCOMES:

After 4.5 hours of various online class activities, the level II nursing students will
be able to:

Integrated Management of Childhood Illness (IMCI)

CLO#1: Describe Integrated Management of Childhood Illness (IMCI)

as to its definition and strategy
CLO#2: Analyze the IMCI protocol guidelines for health workers
using an integrated approach.
CLO#3: Classify and distinguish the case management process as to:
age appropriate case management and visit
CLO#4: Examine the IMCI case management process
4.1 Assess
4.2 Classify
4.3 Identify
4.4 Treatment
4.5 Counsel
4.6 Give follow-up care
CLO#5: Compare recording forms used in IMCI

3
CLO#1: Describe Integrated Management of Childhood Illness (IMCI) as to
its definition and strategy

The Integrated Management of Childhood Illness (IMCI) is a comprehensive approach

to child health that focuses on the whole child's well-being. The strategy was developed
by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF).
IMCI includes both preventive and therapeutic components that are implemented by
families, communities, and health workers in facilities. IMCI aims to reduce death,
illness, and disability, as well as to promote better growth and development in infants
and children under the age of five. Furthermore, IMCI is a collection of clinical
algorithms and training materials that help nurses and other primary health-care
workers manage sick infants and children who present to health facilities. It was
designed primarily for low-resource settings. Growth charts are included in IMCI for
infants aged 0-2 months and 2-59 months.

Strategies/Principles of IMCI

● All sick children aged 2 months up to 5 years are examined for general danger
signs and all sick young infants are examined for very severe disease and local
bacterial infection. These signs indicate immediate referral or admission to
hospital.
● The children and infants are then assessed for main symptoms. For sick children,
the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear
infection. For young children, local bacterial infection, diarrhea and jaundice. All
sick children are routinely assessed for nutritional and immunization and
deworming status and other problems
● Only a limited number of clinical signs are used
● A combination of individual signs leads to a child’s classification within one or
more symptom groups rather than a diagnosis.

4
 ● IMCI management procedures use limited number of essential drugs and
encourage active participation of caretakers in the treatment of children
● Counseling of caretakers on home care, correct feeding and giving of fluids, and
when to return to clinic is an essential component of IMCI

12 Keys of Family and Community Practices

1. Exclusive breastfeeding. Breastfeed infants exclusively for up to 6 months.

(Mothers found to be HIV positive require counseling about possible alternatives
to breastfeeding).
2. Complementary feeding. Starting at about 6 months of age, feed children
freshly prepared energy and nutrient rich complementary foods, while continuing
to breastfeed up to two years or longer.
3. Micronutrients. Ensure that children receive adequate amounts of
micronutrients (vitamin A, iron and zinc, in particular), either in their diet or
through supplementation.
4. Hygiene. Dispose of faeces, including children’s faeces, safely, and wash hands
after defecation before preparing meals and before feeding children.
5. Immunization. Take children as scheduled to complete a full course of
immunizations (BCG, DPT, OPV and measles) before their first birthday.
6. Malaria: use of bednets. Protect children in malaria-endemic areas, by
ensuring that they sleep under insecticide-treated bednets.
7. Psychosocial development. Promote mental and social development by
responding to a child’s needs for care and through talking, playing and providing
a stimulating environment.
8. Home care for illness. Continue to feed and offer more fluids, including
breastmilk, to children when they are sick.
Home care for sick children includes several “practices” which are enumerated
individually in this list of 12 key family practices, such as: continuing feeding and

5
 offering more fluids (practice no. 8), oral rehydration treatment and treatment of
fever (practice no. 9), prompt care-seeking (practice no. 10), and compliance
with health provider’s advice (practice no. 11)].
9. Home treatment for infections. Give sick children appropriate home
treatment for infections.
10. Care-seeking. Recognize when sick children need treatment outside the home
and seek care from appropriate providers.
11. Compliance with advice. Follow the health worker’s advice about treatment,
follow-up and referral.
12. Antenatal care. Ensure that every pregnant woman has adequate antenatal
care. (This includes having at least four antenatal visits with an appropriate
health care provider and receiving the recommended doses of the tetanus toxoid
vaccination. The mother also needs support from her family and community in
seeking care at the time of delivery and during the postpartum and lactation
period)

CLO#2: Analyze the IMCI protocol guidelines for health workers using an
integrated approach.

IMCI is a program that incorporates all approaches to disease prevention, early

identification and treatment of health issues that arise in children, as well as community
and family promotion of healthy lifestyles. IMCI provides the information and skills
needed to sequentially assess and integrate the state of children's health and, in doing
so, identify the diseases or issues that commonly impact it in accordance with local
epidemiological patterns. IMCI is currently thought to be the most effective method for
lowering the incidence of disease and disability among people in this age range. Its
main objective is to support healthy development and growth during the first five years
of life. The implementation of protocols enables health professionals to be conscious of

6
their roles within the organization. In the healthcare setting, policy should create the
foundation for delivering high-quality care that is both safe and affordable.

IMCI protocol guidelines for health workers:

● Assessing signs that indicate severe disease

- In order to assess a child, one must first look for danger indicators.
1. Use a color-coded triage system to categorize a child's diseases. Due to
the fact that many kids have many conditions, each ailment is categorized
according to whether it calls for:
● pre-referred care and referral required immediately (red),
● or specialized medical advice and treatment (yellow),
● Some basic home management tips (green).
2. After categorizing each illness, decide on a treatment plan for the child.
Give necessary care before the patient is moved if a youngster needs an
urgent referral.
3. Give the caregiver clear information on how to administer oral
medications, feed and hydrate patients while they are ill, and treat local
infections at home. Specify a time for the caregiver to return for a
follow-up, and instruct her on how to spot symptoms that suggest the kid
should return right away to the medical center.
4. Evaluate feeding, including breastfeeding methods, and offer advice to
address any issues with feeding that are discovered. then provide the
mother advice regarding her own health.
5. Give follow-up care and, if necessary, reassess the kid for new concerns
when a child is brought back to the clinic as requested.

7
Assessing a child’s nutrition
- An essential sign for diagnosis is nutritional status. Among other methods,
anthropometric and biochemical testing are used to determine nutritional
status. Physiological status of the body is evaluated using anthropometric
measurements, such as height and weight, to ascertain nutritional status.

8
9
Assessing a child’s immunization
- Immunization status: a comparison of a child’s past immunizations with the
recommended immunization schedule. Immunization status describes whether or
not a child has received all of the immunizations recommended for his age, and,
if not, what immunizations are needed now.

10
 - The immunization process is regarded as one of the most effective and
economical health interventions. Additionally, it is thought to stop crippling illness
and incapacity and save millions of lives each year. For instance, vaccination
prevents an estimated two to three million deaths from diphtheria, tetanus,
pertussis (whooping cough), and measles each year in all age groups.
Additionally, immunization makes a significant contribution to a nation by
lowering the chance of disability from infectious diseases like poliomyelitis.

Assessing a child’s feeding

60% of mortality in children under the age of five are attributed to malnutrition. Every
child under the age of two and every child whose weight is below the third centile
should have their feeding evaluated, according to IMCI. In order to do this, information
on the child's diet and feeding schedule must be gathered. After that, contrast this with
the advice for the child's age. Encourage healthy feeding habits and provide the mother
advice on how to make the child's feeding better. Ask the mother the following inquiries
to evaluate feeding. Both the bottom of the sick child case recording form and the top

11
of the COUNSEL chart have these questions. You can learn more about the child's
typical nutrition and feeding during this sickness by asking the following questions:

- Do you breastfeed your child? If yes: how many times during the day? Do you
also breastfeed during the night?
- Does the child take any other food or fluids? If yes: What food or fluids? How
many times per day? What do you use to feed the child? If very low weight for
age: How large are servings? Does the child receive his own serving? Who feeds
the child and how?
- During this illness, has the child’s feeding changed? If yes, how? Note that
certain questions are asked only if the child is very low weight for age. For these
children, it is important to take the extra time to ask about serving size and
active feeding. Listen for correct feeding practices as well as those that need to
be changed. As you listen to the mother, you may look at the Feeding
Recommendations During Sickness and Health that are appropriate for the child’s
age on the COUNSEL chart. If an answer is unclear, ask another question. For
example, if the mother of a very-low-weight child says that servings are “large
enough,” you could ask, “When the child has eaten, does he still want more?”

● Teaching parents how to care for a child at home

- Describe the treatment and why it should be administered.
- Describe the steps in the treatment plan that are stated in the relevant
box on the TREAT charts.
- Watch the parent administer the initial therapy in the clinic.
- Inform them of the frequency of the home treatment.
- Check the parent’s understanding before they leave the clinic.
● Counseling parents to solve feeding problems
- For many unwell children, you will assess feeding and counsel the mother
about any feeding problems observed. Recommendations on feeding,

12
 fluids, and when to return are given on the chart headed COUNSEL THE
MOTHER.
- You will give caretakers of unwell children who are going home advice on
feeding, fluid intake, and when to call for more help. The bottom of the
case recording form is where you will record the findings of any feeding
assessments.
- On the back of the case recording form, you will enter the earliest time for
"follow-up." You will also give the mother health-related advice.
● Advising parents about when to return to a home facility
- It is necessary to inform every mother or caregiver who is taking a sick
young child or infant home when to see a medical facility again. You
should tell her when to come back for follow-up appointments and
educate her on the signals that indicate she needs to come back right
away for more care.
- The mother or caretaker may need to return:
● for a FOLLOW-UP VISIT in a predetermined number of days (for
instance, when it's important to assess how an antibiotic is
working),
● IMMEDIATELY, if symptoms emerge that imply the condition is
deteriorating, or
● for the NEXT IMMUNIZATION of the child (the next WELL-CHILD
VISIT).

CLO#3: Classify and distinguish the case management process as to: age
appropriate case management and visit

Integrated Management of Childhood Illness Strategy, which is focused on

infants and children who present with illness in medical facilities, encourages accurate
identification of pediatric illnesses in outpatient settings, ensures appropriate treatment

13
of all major illnesses, strengthens caregiver counseling services, and accelerates the
referral of seriously ill children.

Case management process according to:

● Age-appropriate case management

❖ Age birth up to two months, or
❖ Age two months up to five years.

In order to choose the proper chart and start the assessment procedure, you
must first determine the child's age. The IMCI case management procedure is
displayed on two unique sets of charts: one for managing ill young infants aged
from birth up to two months and another for managing ill children aged from two
months up to five years. Depending on the child's age, first choose which chart
to use. The term "up to five years" denotes that the child has not reached the
age of five. A child is regarded as a young infant if they are under two months
old. Two-month-old children belong in the age range from two months to five
years, not birth to two months.

14
 The management of early infants, from birth to two months old, is described on
a distinct chart since it differs from the management of older infants and
children:

❖ Assess, classify and treat the sick young infant.

Three charts show the case management process for sick children from two
months to five years old:

❖ Assess and clarify the sick child

❖ Treat the child
❖ Counsel the mother

● Visit

The steps on the ASSESS AND CLASSIFY THE SICK CHILD chart describe what you
should do when a mother brings her child to the clinic because her child is sick. The
chart should not be used for a well child brought for immunization or for a child with an

15
injury or burn. When patients arrive at most clinics, clinic staff identify the reason for
the child’s visit. Clinic staff obtain the child’s weight and temperature and record them
on a patient chart, another written record, or on a small piece of paper. Then the
mother and child see a health worker.

There are two types of visit which is the initial visit and the followup visit.

Before Determining the two types of visit we need to ask the mother about the child’s
problem. We need to take the child's weight and temperature and write it down on a
patient chart,another written document, or a scrap of paper. The mother and infant are
then seen by health worker

Afterwards we will decide between if it’s a follow up visit or an initial visit.

Howyoufindoutif this is an initial or follow-up visit depends on how the health facility
registers patients and identifies the reason for their visit. Some clinics give mothers
follow up slips that tell them when to return. In other clinics, a health worker writes a
follow up note on the multi-visit card or chart.

How you find out if this is an initial or follow-up visit depends on how the health facility
registers patients and identifies the reason for their visit. Some clinics give mothers
follow-up slips that tell them when to return. In other clinics a health worker writes a
follow-up note on the multi-visit card or chart. Or, when the patient registers, clinic staff
ask the mother questions to find out why she has come.

16
DETERMINE IF THIS IS AN INITIAL OR FOLLOW-UP VISIT FOR THIS
PROBLEM

● If this is the child’s first visit for this episode of an illness or problem, then this is
an initial visit.
● If the child was seen a few days before for the same illness, this is a follow-up
visit. A follow-up visit has a different purpose than an initial visit. During a
follow-up visit, you find out if the treatment given during the initial visit has
helped the child. If the child is not improving or is getting worse after a few
days, refer the child to a hospital or change the child’s treatment.

CLO#4: examine the IMCI case management process

Case management of sick children covers those infants aged up to 2 months old
and children aged 2 months old up to 5 years.

Assess

A child must be assessed first for danger signs (or possible bacterial infection in a
young infant), asking questions about common conditions, examining the child, and
checking nutrition and immunization status. Assessment includes checking the child for
other problems.

17
Classify

A child’s illness is categorized using a color-coded triage system. Because many

children have more than one condition, each illness is classified according to whether it
requires:

● Urgent prereferral treatment and referral (PINK)

● Specific medical treatment and advice (YELLOW)
● Simple advice on home management (GREEN)

Identify

After classifying all conditions, specific treatments for the child should be
decided. If the child requires an urgent referral, give essential treatment before the
essential treatment before the patient is transferred. If the child needs treatment at
home, develop an integrated treatment plan for the child and give the first dose of the
medication in the clinic. If a child should be immunized, provide immunization.

Treatment

Provide practical management instructions, including teaching the mother or

caregiver how to give oral drugs, how to feed and give fluids during illness, and how to
treat local infections at home. Ask the caregiver to return for follow-up on a specific
date and teach her how to recognize signs that indicate the child should return
immediately to the health facility. The chart describes how to:

● Give oral drugs

● Treat local infections
● Give intramuscular drugs
● Treat the child to prevent low blood sugar
● Give extra fluid for diarrhoea and continue feeding, and
● Give follow-up care

18
Counsel

It is important to have good communication with the child’s mother or caretaker

from the beginning of the visit. Using good communication helps to reassure the mother
or caretaker that the child will receive good care. Assess feeding, including assessment
of breastfeeding practices, and counsel to solve any feeding problem found. Then
counsel the mother about her own health.

To provide effective and therapeutic counsel, one may:

● Ask and listen to find out what the child’s problems are and what the mother is
already doing for the child.
● Praise the mother for what she has done well.
● Advise her how to care for her child at home.
● Check the mother’s understanding.

Follow-up care

When a child is brought back to the clinic as requested, give follow-up care and,
if necessary, reassess the child for new problems.

- Follow-up visits are recommended for young infants who are classified as LOCAL
BACTERIAL INFECTION, DYSENTERY, FEEDING PROBLEM OR LOW WEIGHT
(including thrush).
- As with the sick child who comes for follow-up, a sick young infant is assessed
differently at a follow-up visit than at an initial visit. Once you know that the
young infant has been brought to the clinic for follow-up, ask whether there are
any new problems. An infant who has a new problem should receive a full
assessment as if it were an initial visit.

19
SUMMARY OF INTEGRATED MATERNAL AND CHILDHOOD ILLNESS

2 months up to 5 years chart

This section describes the steps you should take to assess and classify a sick young
infant at the initial visit.

When a sick child is brought to your health post for an initial visit you should always do
the following:
● Check for signs of possible bacterial infection. Then classify the young infant
based on the clinical signs found
● Ask about diarrhoea. If the infant has diarrhoea, assess for related signs. Classify
the young infant for dehydration. Also classify for persistent diarrhoea and
dysentery, if present
● Check for feeding problems or low weight. This may include assessing
breastfeeding. Then classify feeding
● Check the young infant’s immunization status
● Assess any other problems.

If you find a reason that a young infant needs urgent referral, you should continue the
assessment. However, you should not carry out the breastfeeding assessment because
this can take some time. Figure below summarizes these steps.

20
1 week up to 5 years chart

This process is to ASSESS A SICK YOUNG INFANT AGE 1 WEEK UP TO 2

MONTHS and to classify the infant’s illnesses. The process is very similar to the one
you learned for the sick child aged 2 months up to 5 years. All the steps are described
on the chart titled ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT.

Young infants have special characteristics that must be considered when classifying
their illnesses. They can become sick and die very quickly from serious bacterial
infections. The ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT chart

21
lists the special signs to assess, the classifications, and to identify treatments for young
infants.

CLO#5: compare recording forms used in IMCI.

The case management steps are the identical for all unwell kids from 1 week to five
years. However, due to the fact signs, classifications, remedies and counselling range
among unwell younger babies and unwell kids, it's crucial to begin the case control

22
procedure through deciding on the precise set of IMCI charts which leads to the
different IMCI recording forms on the next step.

1. Sick young infant

- recording form used for a child younger than 2 months.

This assessment step is done for every sick young infant. In this step you are
looking for signs of bacterial infection, especially a serious infection. A young
infant can become sick and die very quickly from serious bacterial infections such
as pneumonia, sepsis and meningitis.

23
24
This chapter describes the steps to assess and classify a sick young infant during
an initial visit:

● Check for signs of possible bacterial infection. Then classify the young
infant based on the clinical signs found.
● Ask about diarrhoea. If the infant has diarrhoea, assess for related signs.
Classify the young infant for dehydration.

25
 ● Classify for persistent diarrhoea and dysentsery if present.
● Check for feeding problems or low weight. This may include assessing
breastfeeding. Then classify feeding.
● Check the young infant’s immunization status.
● Assess any other problems.

2. Sick child
- recording form used for a child aged 2 months up to 5 years
- “up to 5 years” means the child has not yet reached their fifth birthday

A mother or other caretaker brings a sick child to the clinic for a particular
problem or symptom. If you only assess the child for that particular problem or
symptom, you might overlook other signs of disease.

26
27
This chapter describes the steps to assess and classify a sick child during an
initial visit:

● Check for general danger sign.

● Observe if the the child have cough or difficult breathing
● Does the child have a fever?
● If the child has measles now or within the last 3 months.
● Assess dengue hemorrhagic fever.
● Check for acute malnutrition and anemia.
● If the child has MUAC less than 115 mm or WFH/L less than -3 Z score.
● Check for HIV Infection and child’s immunization status.
● Assess feeding if the child is less than 2 years old, has moderate acute
malnutrition, anemia or is HIV exposed or infected.

28
 3. Weight for age chart

- The weight for age chart compares a child's weight to that of other kids of the
same age. With this chart, you will be able to identify children who have weight
below the bottom curve. These are children who have a very low weight for their
current age. However, children on or above the bottom curve of the chart can
still be malnourished. Therefore, children that go below the bottom curve are
extremely underweight and require extra attention in their nutrition.

BASIS FOR CLASSIFYING THE CHILD’S ILLNESS

The child’s illness is classified based on a color-coded triage system:

● PINK : indicates urgent hospital referral or admission

● YELLOW : indicates initiation of specific Outpatient Treatment

29
 ● GREEN : indicates supportive home care

Classification of Illness

Classify cough or difficulty in breathing

30
Classify Dehydration

31
LIST OF REFERENCES:

1. About Integrated Management of Childhood Illness (IMCI). (n.d.). Integrated

Management of Childhood Illness.
https://www3.paho.org/english/ad/dpc/cd/imci-aiepi.htm

2. cah. (2022). Key family practices. World Health Organization - Regional Office for

the Eastern Mediterranean.

http://www.emro.who.int/child-health/community-family/family-practices.html

3. Department of Child and Adolescent Health and Development (CAH). (n.d.).

Handbook in Integrated Management of Childhood Illness. World Health
Organization.
http://apps.who.int/iris/bitstream/handle/10665/42939/9241546441.pdf

4. Handbook - IMCI - Integrated Management of Childhood Illness (WHO - OMS,

2000, 173 p.): Part III: The sick young infant age 1 week up to 2 months: Assess

and classify: Chapter 15: Assess and classify the sick young infant. (2022).

Nzdl.org.

http://www.nzdl.org/cgi-bin/library?e=d-00000-00---off-0helid--00-0----0-10-0---

0---0direct-10---4-------0-1l--11-en-50---20-about---00-0-1-00-0--4----0-0-11-10-

0utfZz-8-10&cl=CL1.2&d=HASH01824811d313f3cec87b765f.6.2&x=1

5. Handbook - IMCI - Integrated Management of Childhood Illness (WHO - OMS,

2000, 173 p.): Part II: The sick child age 2 months up to 5 years: Assess and

classify: Chapter 9: Fever. (2022). Nzdl.org.

http://www.nzdl.org/cgi-bin/library?e=d-00000-00---off-0helid--00-0----0-10-0---

32
 0---0direct-10---4-------0-1l--11-en-50---20-about---00-0-1-00-0--4----0-0-11-10-

0utfZz-8-10&cl=CL1.2&d=HASH01824811d313f3cec87b765f.5.6&x=1

6. Integrated Management of newborn and Childhood Illness Module: 1. An

Introduction to the Integrated Management of Newborn and Childhood Illness
(IMNCI): View as single page. (2022). Open.edu.
https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=245&printa
ble=1

7. IMCI Integrated Management of Childhood Illness HANDBOOK Department of

Child and Adolescent Health and Development (CAH). (n.d.).
https://apps.who.int/iris/bitstream/handle/10665/42939/9241546441.pdf

8. “MANAGEMENT OF THE SICK YOUNG INFANT AGED UP TO 2 MONTHS” From

The World Health Organization With Additional Resources - Tom Wade MD.

(2020, January 11). Tom Wade MD.

https://www.tomwademd.net/management-of-the-sick-young-infant-aged-up-to-

2-months-from-the-world-health-organization/

9. Meleko, A., Geremew, M., & Birhanu, F. (2017). Assessment of Child

Immunization Coverage and Associated Factors with Full Vaccination among
Children Aged 12–23 Months at Mizan Aman Town, Bench Maji Zone, Southwest
Ethiopia. International Journal of Pediatrics, 2017, 1–11.
https://doi.org/10.1155/2017/7976587

10. Słowik, J. (2019). Nutritional Status Assessment in Children and Adolescents with
Various Levels of Physical Activity in Aspect of Obesity. FullText - Obesity Facts
2019, Vol. 12, No. 5 - Karger Publishers. Retrieved August 18, 2022, from

33
 https://www.karger.com/Article/FullText/502698#:%7E:text=Anthropometric%20
measurements%20used%20to%20determine,method%20for%20nutritional%20
status%20assessment.

11. World Health Organization; UNICEF. Model IMCI handbook: Integrated

Management of Childhood Illness. Geneva: World Health Organization; 2005
(http://apps​.who.int/iris​/bitstream/10665/42939/1/9241546441​.pdf, accessed 20
January 2017).

34