Integrated Management of Childhood illness

(IMCI)

Malnurtition and anemia

Introduction

• Every year more than 10 million children die in developing

countries before they reach their fifth birthday.
• Seven in 10 of these deaths are due to acute respiratory
infections (mostly pneumonia), diarrhoea , measles,
malaria, or malnutrition and often to a combination of
these illnesses
Causes of Death in children in developing countries
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 is a strategy for reducing mortality and morbidity

associated with major causes of childhood illness.
• The strategy includes preventive and curative
interventions, which aim to improve practices both in the
health facilities and at home
• It is an integrated approach to child health that focuses on
the well being of the whole child
Malnutrition

• a pathological state secondary to relative or absolute

deficiency or excess of one or more essential nutrients
• it can also develop in children with diet lacking in the
recommended amounts of essential vitamins and
minerals( iron)
Major Causes of Malnutrition

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Forms of Malnutrition

Protein Energy Malnutrition is a deficiency of calories and or

protein in a child’s diet
• Forms of PEM
(1) marasmus
(2) kwashiorkor
(2) Nutrient Deficiencies
• Anemia (lack of iron)
• Vitamin A deficiency
• risk of death from measles
• diarrhoea
• blindness
Marasmus
• occur at all ages, more common at 0-2 years old
• child is not getting enough energy from his regular diet
• balanced starvation
• result of unsuccessful breast feeding or insufficient breast
supply
• severely wasted
Marasmus

• gross loss of subcutaneous fat; “all skin and bone; “loose

skin folds in buttocks
• potbelly and winged scapulae
• poor appetite
• apathetic
Marasmus
Kwashiorkor
results from a low protein diet
* presence of bipedal edema is a cardinal sign
Common signs :
- Hair changes - sparse, straight
- dyspigmented (light brown, reddish brown
- flag sign (light and dark bands in hair)
- Diffuse depigmentation – flaky paint or enamel dermatoses
- Puffy and moon faced
- Anemia
 Malnutrition and Anemia
For ALL sick children ask the mother about the child’s difficult breathing, diarrhoea, fever, ear
problem and then
CHECK FOR MALNUTRITION AND ANAEMIA.

THEN CHECK FOR MALNUTRITION AND ANAEMIA

LOOK AND FEEL:
Classify
Look for visible severe wasting. NUTRITIONAL
Look for palmar pallor. Is it: Severe palmar pallor? STATUS
Some palmar pallor?
Look for oedema of both feet.
Determine weight for age.

CLASSIFY the child’s illness using the colour-coded-classification table for malnutrition and anemia

Then CHECK immunization status and for other problems.

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Assesing malnutrition

1. Look for visible severe

wasting
• remove all childs clothes to
check for wasting
• visible wasting
• skin and bones
• outline of the ribs easily seen
2. Look for edema of both feet
3. Determine weight for age
4. Look for palmar pallor- anemia
why palmar pallor

• simple
• less traumatic
• less transmission of eye pathogen
• shown in studies as good performance as single sign for
anemia clinically
• similar/ better sensitivity than conjunctival pallor
• specificity about the same
Iron supplement

• give one dose daily

• review every 14 days
• if child has palmar pallor after 2 months refer for
assesment
AGE or WEIGHT FAC misxture
2 - 4 months (4 - <6kg) 2 ml
4 - 12 months (6 - < 10kg) 3 ml
12 months - 3 years (10 - <14kg) 4 ml
3 - 5 years (14 - <19kg) 5 ml
Give Albendazole

• give every child Albendazole every 6 months from the age

of one year
THANK YOU