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Integrated management of

childhood illnesses
Definition:

IMCI is integrated case


management of the most
important causes of
childhood deaths - acute
respiratory infection,
diarrhea, measles, sore
throat, ear infection and
malnutrition.
Objectives of IMCI

 To reduce death and the


frequency and severity of
illness and disability and
to contribute to improved
growth and development
with low cost.
IMCI Strategy :

 The IMCI strategy combines


improved management of
childhood illness with aspects
of nutrition, immunization and
other important factors
influencing child health,
including maternal health.
IMCI Strategy

Combine IMCI

Nutrition Immunization

Maternal health
Advantages of integration:

 Service is provided
through resources of
health centers and units
with only limited extra
expenses and incentives.
Steps of IMCI:

 Complete assessment of the child in the following


order, then advice the mother for home care,
nutrition, and follow up.
I. Check for general danger sign

Signs
•Unable to drink. Classify
• Repeated vomiting. Very severe disease
• Convulsions.
• Lethargic or unconscious.
• Treatment
•Treat convulsions.
• First dose of appropriate antibiotic.
• Treat the child to prevent low blood sugar
• Refer urgently to hospital.

Complete assessment of the child


II. Ask about main symptoms:

1. Does the child have cough or difficult breathing?

• Follow the standard case management strategy for ARTI

1. Does the child have diarrhea?

• Follow assessment of diarrhea case.

Complete assessment of the child


III. Check for throat problem:

Fever or sore throat Insufficient


and two of the criteria to classify No throat signs
following: as Streptococcal or symptoms.
• Red (congested sore throat.
throat)
• White or yellow
exudate on throat and
tonsils.
• Enlarged tender LN in
front of the neck.

Non No throat
Streptococc
Streptococc problem
al sore
al sore
throat
throat
• Penzathin
• Paracetamol for
penecillin
• Paracetamol for pain
• Soothe the throat
pain
• Soothe the throat with a safe remedy Complete
• follow up in 5 assessment of the
with a safe remedy
sore
throat
IV. Check for ear problem:
Tender Pus is seen draining Pus is seen No ear
swelling from the ear < 14 draining pain or
behind the days from the ear No pus
Or
ear 14 days or draining
Agonizing ear pain
more from the
ear.

Mastoiditi Acute ear No ear


s infection Chronic infectio
• Give first dose ear n
of approp. • Give an infection
antibiotic antibiotic for
• Paracetamol 10 days
• Dry the ear
for pain • Paracetamol
by wicking
• Treat the child for pain
• Refer to
to prevent low • Dry the ear
ENT
blood sugar by wicking
specialist
• Refer urgently • Follow up in
Complete assessment of the child
to hospital 5 days
Check for ear problem:
 If
signs :  Givefirst dose of
 Tender swelling antibiotic
behind the ear  Paracetamol for pain
 Treat the child to
prevent low blood
sugar
 Mastoiditis
 Refer urgently to
hospital
Acute ear infection
 Pus is seen draining  Give an antibiotic
from the ear < 14 days for 10 days
 Or  Paracetamol for
 Agonizing ear pain
pain
 Dry the ear by
wicking
Acute ear infection
 Follow up in 5
days
Chronic ear infection

 Ifsigns:  Treatment
 Pus is seen draining from
 Drythe ear by
the ear 14 days or more
wicking
 Refer to ENT
specialist
Chronic ear infection
 No ear pain or
 No pus draining from the ear.
 So.,
No ear infection

Complete assessment of the child


ear problem
V. Assessment of measles:

• Clouding of cornea, Pus draining Measles now or


or from the eye, within the last 3
• Deep extensive Or months
mouth ulcer, or Mouth ulcer And
• Measles now and None of the above
pneumonia signs

Measles
Severe
with eye or
complicated
mouth
measles Measles
complication
s
 Paracetamol for
• Paracetamol for
• Give 1st dose of fever
fever
 Treat mouth ulcer
antibiotic • Give vit. A
• Paracetamol for fever with gentian violet • Advice the mother
 Apply tetracycline
• Treat to prevent low when to retern
blood sugar eye ointment immediately
 Give vit. A • Follow up in 2 days
• Apply tetracycline eye
 Follow up in 2
ointment
• Give vit. A days Complete assessment of the child
V. Assessment of measles:
 If Signs:  Treatment
 Clouding of cornea, or 1. Give 1st dose of
 Deep extensive mouth antibiotic
ulcer, or
2. Paracetamol for fever
 Measles now and
pneumonia 3. Treat to prevent low
blood sugar
4. Apply tetracycline eye
ointment
5. Give vit. A
Severe 6. Refer urgently to
complicated hospital
measles
Assessment of measles:
 Ifsigns are  Treatment
 Pus draining from the  Paracetamol for
eye, Or fever
 Mouth ulcer  Treat mouth ulcer
with gentian violet
 Apply tetracycline
Measles with eye or eye ointment
mouth complications
 Give vit. A
 Follow up in 2 days
Assessment of measles:
 If signs:  Treatment

 Measles now or within  Paracetamol for fever


the last 3 months  Give vit. A
 And  Advice the mother
 None of the above when to return
signs immediately
 Follow up in 2 days

Measles
measles
VI. Assessment of fever:

Any general Apparent bacterial No apparent


danger sign or cause of fever present bacterial cause
stiff neck e.g. of fever
• Pneumonia
• Dysentry
• Acute ear infection
• Streptococcal sore
throat
Very severe • Other apparent
febrile causes
disease Febrile possible Febrile
bacterial bacterial
infection infection
unlikely for
• Paracetamol
fever
• Paracetamol for • Advice the
• Give first dose of fever mother when to
• Treat apparent retern
appropriate antibiotic
• Paracetamol for fever cause of fever immediately
• Follow up in 2
• Treat the child to • Follow up in 2 days
days
prevent low blood sugar
• Refer urgently to
Complete assessment of the child
VI. Assessment of fever:
If signs are:  Treatment
Any general danger sign  Give first dose of
or stiff neck appropriate antibiotic
 Paracetamol for fever
 Treat the child to
prevent low blood
sugar
Very severe  Refer urgently to
febrile disease
hospital
Assessment of fever:
 Ifsigns:  Treatment
 Apparent bacterial  Paracetamol for
cause of fever fever
present e.g.  Treat apparent
 Pneumonia, Dysentry cause of fever
 Acute ear infection
 Follow up in 2
 Streptococcal sore throat
 Others days

Febrile possible
bacterial infection
Assessment of fever:
 Ifsigns  Treatment
No apparent  Paracetamol for
bacterial cause of fever
fever  Advice the mother
when to return
immediately
Febrile  Follow up in 2
bacterial
infection days
unlikely

Complete assessment of the child


VII. Assessment of malnutrition:

Visible severe Low weight for Not low weight for


wasting, or age age and
Edema of both No other signs of
feet malnutrition

severe Low weight Not low


malnutrition weight

• Counsel the • Counsel the


mother for feeding mother for
• Advice the feeding
mother when to
• Give Vit. A return immediately
• Treat the child to • Follow up in 30
prevent low blood sugar days
• Refer urgently to Complete assessment of the child
VII. Assessment of malnutrition:

 Signs  Treatment
 Visible severe  Give Vit. A
wasting, or  Treat the child to
 Edema of both feet prevent low blood
sugar
 Refer urgently to
hospital
severe
malnutrition
Assessment of malnutrition:
 Signs  Treatment
 Low weight for age  Counsel the mother
for feeding
 Advice the mother
when to return
immediately
 Follow up in 30

Low days
weight
Assessment of malnutrition:
 Signs  Treatment
 Not low weight for • Counsel the mother
age and for feeding
 No other signs of
malnutrition

Not low weight

Complete assessment of the child


VIII. Assessment of Anemia:
Severe palmer Some palmer No palmer pallor
pallor and/or pallor and/or and/or M.M.
M.M. pallor M.M. pallor pallor

severe Anaemia No anaemia


anaemia

• Give iron • If child is aged


• Treat to prevent low • Advice the from 6-30
blood sugar
mother when to months, give
• Refer urgently to
return one dose of iron
hospital
immediately weekly
• Follow up in 30
days
Complete assessment of the child
anaemia
IX. Assessment of immunization
and vitamin A supplementation:

X. Advice the mother for


home care,
nutrition, and
follow up.