INTEGRATED

MANAGEMENT
OF
CHILDHOOD ILLNESS
( IMCI )
JANETH ROSE JOSUE ESTAVILLO – TOLEDO RN, MN
SHEANNE AQUE SAPLOT RN
SO HOW DO WE TAKE EFFECTIVE
INTERVENTIONS TO THOSE WHO
NEED THEM?
• Effective interventions exist, but one of the main
challenges is how to take them where they are needed.
WHERE ARE THESE
INTERVENTIONS NEEDED MOST?

MAIN COMPONENTS OF IMCI

FACT # 1
Each year more than
10 million children in
low-and middle-income
countries DIE before they
reach their FIFTH
BIRTHDAY.
FACT # 2
• Seven in ten of these deaths are
 due to just five preventable and
treatable conditions: pneumonia,
diarrhoea, malaria, measles,
and malnutrition, and often to a
combination of these conditions
FACT # 3
• Every day, millions of parents
seek health care for their sick
children, taking them to
hospitals, health centers,
pharmacists, doctors and
traditional healers
FACT # 4
 • Many sick children are not
properly assessed and
treated by these
health care providers, and
that their parents are
poorly advised
WHO AND UNICEF
Integrated
Management of Childhood
 Illness (IMCI).
INTRODUCTION
 Surveys of the management of sick children
in most developing countries reveal that •
Many children are not properly assessed and
treated and that their parents are poorly
advised.
• Diagnostic supports such as radiology and
laboratory services are minimal or
 non-existent. • Drugs and equipment are
scarce.
INTRODUCTION
Projections based on the 1996 analysis The global burden of
disease indicate that common childhood illnesses will continue
to be major contributors to child deaths through the year 2020
unless greater efforts are made to control them. • This
assumption makes a strong case for introducing new
strategies to significantly reduce child mortality and improve
child health and development.
• WHO and UNICEF developed a strategy known as Integrated
Management of Childhood Illness (IMCI).

WHAT IS
IMCI?
IMCI
 WHO and UNICEF used updated technical
findings to describe management of these
illnesses in a set of integrated guidelines for
each illness.
These guidelines have been adapted to each
country
WHY IS IMCI BETTER THAN SINGLE-CONDITION
APPROACHES?
• Children brought for medical treatment in the
developing world are often suffering from more
than one condition
• This overlap means that a single diagnosis may
not be possible or appropriate and treatment
may be complicated by the need to combine
therapy for several conditions.
CONT

• An integrated approach to managing

sick children is, therefore, indicated as is
the need for child health programs to go
 beyond single diseases and address the
overall health of a child.
“Looking to The Child as a Whole”.
BENEFITS OF IMCI
• Addresses major child health problems – The strategy addresses the most
important causes of childhood death and illness

• Promotes prevention as well as cure – In addition to its focus on treatment, IMCI

also provides the opportunity for important preventive interventions such as
immunization and improved infant and child nutrition, including breastfeeding

• Improves health worker performance and their quality of care. •

IMCI improves health worker performance and their quality of care.

• IMCI can reduce under-five mortality and improve nutritional status, if

implemented well;
• IMCI is worth the investment, as it costs up to six times less per child correctly
managed than current care

BENEFITS OF IMCI
• Cost-effective Inappropriate management of childhood
illness wastes scarce resources. Although increased
investment will be needed initially for training and
reorganization, the IMCI strategy will result in cost savings.
• Improves equity – Nearly all children in the developed
world have ready access to simple and affordable preventive
and curative care. Millions of children in the developing
world, however, do not have access to this same life-saving
care. The IMCI strategy addresses this inequity in global
health care.
THE IMCI CASE MANAGEMENT

PROCESS

DISEASES COVERED BY IMCI

 1-Diarrheal diseases
2-Acute respiratory infections
3-Malaria
4-Measles Lead to more than 70% of child
mortality and morbidity
5-Malnutrition
DISEASES NOT COVERED BY IMCI
The IMCI guidelines address the most important but NOT
ALL of the major reasons a sick child or an infant is
brought to the clinic with.
IMCI encourages the health provider to assess problems
not included in IMCI charts. These are considered under
the box :
ASSESS OTHER PROBLEMS IMCI
WHO ARE THE CHILDREN COVERED
BY THE IMCI PROTOCOL? 

•Sick children birth up to 2 months (Sick Young

Infant)
 •Sick children 2 months up to 5 years old (Sick
child)
WHY NOT USE THE PROCESS FOR CHILDREN
AGE 5 YEARS OR MORE?
The case management process is designed for children < 5yrs of age, although
much of the advise on treatment of pneumonia, diarrhea, malaria, measles and
malnutrition, is also applicable to older children, the ASSESSMENT AND
CLASSIFICATION of older children would differ. For example;-
• The cut off rate for determining fast breathing would be different because
normal breathing rates are slower in older children.
• Chest indrawing is not a reliable sign of severe pneumonia as children get
older and the bones of the chest become more firm.
• In addition, certain treatment recommendations or advice to mothers on
feeding would differ for >5yrs old.
THE IMCI CODE
PINK - indicates urgent hospital referral or admission
- indicates initiation of specific

YELLOW GREEN Outpatient Treatment - indicates

supportive home care

IMCI CASE MANAGEMENT

SICK YOUNG INFANT AGE UP TO 2 MONTHS
ASSESS
ASK THE MOTHER WHAT THE
 YOUNG INFANT'S PROBLEMS
ARE:
Determine if this is an initial or
follow-up visit for this problem:
-if follow-up visit, use the follow-up
instructions.
-if initial visit, assess the child as
follows:
CLASSIFY
USE ALL BOXES THAT MATCH THE
INFANT'S SYMPTOMS AND
PROBLEMS TO CLASSIFY THE
ILLNESS.
 IDENTIFY
TREATMENT
CHECK FOR VERY SEVERE more than 60 breaths
DISEASE AND per minute.
-Look for severe chest in
LOCAL BACTERIAL drawing.
INFECTION ASK: YOUNG
INFANT
-Is the infant having MUST
difficulty in feeding? BE
-Has the infant had
CALM!
convulsions (fits)?
-Count the breaths in one
minute. Repeat the count if
 young infant's movements.
(If infant is sleeping, ask the mother to
wake
him/her.)
-Does the infant move
on his/her own?
(If the young infant is not moving,
gently stimulate him/her.)
-Measure axillary temperature. -Look at -Does the infant not
the umbilicus. (Is it red or draining pus?) move at all?
-Look for skin pustules. -Look at the
E
 IC
If jaundice present, ASK: LOOK AND
FEEL: • When did the

D jaundice appear first?

• Look for jaundice (yellow

N eyes or skin)
U
CHECK FOR JAUNDICE
• Look at the young infant's
palms and soles. Are they
yellow? A
J
DIARRHEA?
IF YES, LOOK AND FEEL:
• Look at the young infant's general condition:
 • Infant's movements
• Does the infant move on his/her own?

• Does the infant not move even when stimulated

but then stops?
• Does the infant not move at all?

• Is the infant restless and irritable?

• Look for sunken eyes.

• Pinch the skin of the abdomen. Does it go back:

• Very slowly (longer than 2 seconds)?

or slowly?
 status?:
• Serological
T

test POSITIVE or
C

NEGATIVE
• What is the
young infant's
EF

ASK HIV status?:

NI

• Has the mother • Virological test

V

I
and/or young POSITIVE or
infant had an NEGATIVE
H
HIV test? • Serological
IF YES:
N

test POSITIVE or
• What is the NEGATIVE
mother's HIV
OI

If mother is HIV positive and NO

positive virological test
in child ASK:
• Is the young infant breastfeeding
 now?
• Was the young infant
breastfeeding at the time of test
• or before it?
• Is the mother and young infant
on PMTCT ARV
• prophylaxis?*

IF NO test: Mother and

young infant status
unknown
Perform HIV test for the
mother; if positive, perform
virological test for the
young infant
Ask: LOOK, LISTEN,
FEEL:
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?
If yes, what do you use to
feed the infant?
Determine weight for age.
Look for ulcers or white
patches in the mouth
(thrush)
Check for the Immunization:
DO FOLLOW UP
CARE
 SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

• NAME OF THE CHILD

• AGE
• WEIGHT
• TEMPERATURE
•CHILD’S PROBLEMS
• INITIAL OR FOLLOW UP VISIT
1. THE GENERAL DANGER SIGNS
Is the child able to drink or breastfeed?
•
 1. THE GENERAL DANGER SIGNS
2-Vomits every thing
3- Has the child had
convulsions?
4- Unconscious, lethargic
5- Is the child convulsing
now?
MANAGEMENT FOR
DANGER SIGNS
ASSESS THE SICK CHILD, AGE 2 MONTHS UP TO 5 YEARS

Assess major four symptoms:

1-Cough or difficult breathing

 2-Diarrhea
3-Fever
4-Ear problems
CASE STUDY # 1
Monina is 15 mos old, wt: 8.5 kg, T: 38.5 C. The health worker
•
asks, “What are the child’s problems? ”The mother says,
“Monina has been coughing for 4 days, & she is not eating
well.” This is Monina’s initial visit. The health worker checks
Monina for danger signs. He asks, “Is Monina able to drink or
breastfeed?” The mother says, “No, Monina does not want to
breastfeed.” The health worker gives Monina some water to
drink. She is too weak to lift her head. She is not able to drink
from cup. Next, he asks the mother, “Is she vomiting?”. The
mother says, “No”, he then asks, “Has she had convulsions?”.
The mother says, “No”. The health worker checks to see if
Monina is lethargic or unconscious. When the health worker &
the mother are talking, Monina watches them & looks around
the room. Monina is not lethargic or unconscious.
2. COUGH OR DIFFICULTY BREATHING
• Pneumonia
• Killer disease
• CA: Streptococcus
pneumoniae,
Hemophilus influenzae
• MOT: droplet
• System affected:
Respiratory
 system
2. ASSESS COUGH OR
DIFFICULTY OF BREATHING
• Ask: Does child have difficulty of breathing? (fast, noisy,
interrrupted) • For how long?
• Count Number of breaths:
• 0-2 mos : 60 & above
• 2-12 mos: 50 & above
• 1-5 years: 40 & above
DRILL 1- FAST BREATHING
3 mos old 52?
2 year old 38?
6 mos old 48?
12 mos old 38?
12 mos old 42?
3 y/o 37?
8 mos old 54?
18 mos old 45?
3 mos old 52? NORMAL 2 year old 38?
SLOW 6 mos old 48? SLOW 12 mos old
38? SLOW 12 mos old 42? SLOW 3 y/o
37? SLOW 8 mos old 54? NORMAL 18
mos old 45? NORMAL
CLASSIFY
 COUGH OR DIFFICULTY BREATHING
Severe Pneumonia or
Very Severe Disease
Pneumonia
No Pneumonia: Cough or Colds
CASE # 2
•Gimo is 6 mos old. Wt: 5.5 kg. T: 38 C. His mother says
that he has had cough for 2 days. The health worker
checks for danger signs. The mother says Gimo is able
to breastfeed. He has not vomited during the illness. He
has not had convulsions. Gimo is not lethargic or
unconscious. The healthworker says to the mother says
to the mother, “I want to check Gimo’s cough. You said
he has had cough for 2 days now. I am going to count
his breaths per minute. He will need to remain calm
while I do this.” The health worker counts 58 breaths
per minute. He does not see chest indrawing. He does
not hear stridor.
CASE # 3
• Esmhems - 8 mos old; St: 6 kg., T: 39 C. Her father tells the health
corker “Esmhems has had cough for 3 days. She is having trouble
breathing. She is very weak.” The health worker says,” You have
done the right thing by bringing your child here today, I will
examine her now.” The health worker checks for danger signs. The
mother says, “Esmhems will not breastfeed. She will not take any
drink I offer her.” Esmhems does not vomit at all, & has not had
convulsions. She is lethargic. She does not look at the health worker
or her parents when they talk. The health worker counts 55 breaths
per minute. He sees chest indrawing. He decides that Esmhems has
stridor because he hears a harsh noise when she breathes in.
3. ASSESS & CLASSIFY DIARRHEA
•Does the child have diarrhea
•For how long?
•Is there blood in the stool?
 CHECK FOR SIGNS OF DEHYDRATION
LOOK AND FEEL:
1. Look at child’s general condition. Is the
child: • Lethargic or unconscious?
• Restless or Irritable?
2. Look for sunken eyes
3. Feeding status: Offer the child fluid. Is the
child: • Not able to drink or Drinking poorly?
• Drinking eagerly or thirsty?
4. Skin turgor
• Very slowly or slowly ( longer than 2 seconds)?
• Slowly?
 CLASSIFY DEHYDRATION
Severe Dehydration
Some dehydration
No dehydration
CLASSIFY PERSISTENT DIARRHEA
Severe Persistent Diarrhea
Persistent Diarrhea
CLASSIFY DYSENTERY
 Dysentery

CASE # 4
•Boghart has had diarrhea for 5 days. There is
no blood in his stool. He is irritable. His eyes
are sunken. His father & mother also think that
Boghart’s eyes are sunken. The healthworker
offers Boghart some water, & the child drinks
eagerly. When the health worker pinched the
 skin on the child’s abdomen, it went back to its
original state slowly.
CASE # 5
•Jangei has had diarrhea for 3 days. There is no
blood in the stool. The child is not lethargic or
unconscious. She is not irritable or restless. Her
eyes are sunken. She is able to drink, & is not
thirsty. When her skin was pinched, it went
back to its original state immediately.
CASE # 6
Yerin has had diarrhea for 2 days. There is no
•
blood in the stool. She is restless & irritable.
Her eyes are sunken. She is not able to drink.
When her skin was pinched, it went back to its
original state very slowly.