IMCI

• Integrated case management relies on case detection using simple clinical signs and
empirical treatment As few clinical signs as possible are used

• The signs are based on expert clinical opinion and research results and strike a
careful balance between sensitivity and specificity

• The treatments are developed according to action oriented classifications rather

than exact diagnosis

• They cover the most likely diseases represented by each classification.

• The complete IMCI case management process involves the following
elements
• Assess the sick child or sick young infant
• Classify the illness
• Identify treatment
• Treat the child or young infant
• Counsel the mother
• Follow up
Classify a child’s illnesses using a colour-coded triage system
Because many children have more than one condition each
illness is classified according to whether it requires
 urgent pre-referral treatment and referral (red)

specific medical treatment and advice (yellow)

simple advice on home management (green)

identify specific treatments for the child
• If a child requires urgent referral give essential treatment
before the patient is transferred
• If a child needs treatment at home develop an integrated
treatment plan for the child and give the first dose of drugs
in the clinic
• If a child should be immunized give immunizations
• Provide practical treatment instructions
• teaching the caretaker how to give oral drugs how to feed
and give fluids during illness and how to treat local infections
at home
• Ask the caretaker 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
• Assess feeding including assessment of breastfeeding practices and
counsel to solve any feeding problems found
• Then counsel the mother about her own health
• When a child is brought back to the clinic as requested give follow-
up care and if necessary reassess the child for new problems
GENERAL DANGER SIGNS
Selecting the appropriate case management charts
Cough and difficult of
breathing
• Respiratory infections can occur in any part of the respiratory tract
such as the nose, throat, larynx, trachea, air passages or lungs
• A child with cough or difficult breathing may have pneumonia or
another severe respiratory infection
• Pneumonia is an infection of the lungs Both bacteria and viruses can
cause pneumonia
cause
 pneumonia is often due to bacteria. The most common are
Streptococcus pneumonia and Hemophilus influenzae
Children with bacterial pneumonia may die from hypoxia
(too little oxygen) or sepsis (generalized infection)
 Many children are brought to the clinic with less serious
respiratory infections
Most children with cough or difficult breathing have only a
mild infection
FOR PNEUMONIA, ACUTE EAR INFECTION OR VERY SEVERE DISEASE:
• FIRST-LINE ANTIBIOTIC
• COTRIMOXAZOLE Bid for 5 days
• SECOND-LINE ANTIBIOTIC
• AMOXYCILLIN Tid for 5 days
• Avoid giving cotrimoxazole to a young infant less than 1 month of age
who is premature or jaundiced. Give this infant amoxicillin or benzyl
penicillin instead
 Immunization status

For ALL sick children ask the mother about the child’s problem check for general
danger signs, ask about cough or difficult breathing, diarrhea, fever, ear problem and
then check for malnutrition and anemia and CHECK IMMUNIZATION STATUS
THEN CHECK THE CHILD’S IMMUNIZATION STATUS

AGE VACCINE
Birth BCG OPV-0
IMMUNIZATION SCHEDULE 6 weeks DPT-1 OPV-1
10 weeks DPT-2 OPV-2
14 weeks DPT-3 OPV-3
9 months Measles
Contraindications to immunization
 Do not give BCG to a child known to have AIDS

Do not give DPT 2 or DPT 3 to a child who has had convulsions or
shock within 3 days of the most recent dose

Do not give DPT to a child with recurrent convulsions or another

active neurological disease of the central nervous system
Counsel the mother
About breast feeding
• If a mother is breastfeeding her infant less than 8 times in 24 hours advise her to increase the
frequency of breastfeeding
• Breastfeed as often and for as long as the infant wants day and night
• If the infant receives other foods or drinks counsel the mother about breastfeeding more
reducing the amount of the other foods or drinks and if possible stopping altogether
• Advise her to feed the infant any other drinks from a cup and not from a feeding bottle
• If the mother does not breastfeed at all consider referring her for breastfeeding counselling and
possible relactation
• If the mother is interested a breastfeeding counselor may be able to help her to overcome
difficulties and begin breastfeeding again
• Advise a mother who does not breastfeed about choosing and correctly preparing an appropriate
breast milk substitute
• Advise the mother to return immediately if the young infant has any
of these signs
 Breastfeeding or drinking poorly
Becomes sicker
 Develops a fever
 Fast breathing
 Difficult breathing
 Blood in stool
• Helen Tesfaye 1513/09
• Belaynesh Eshetu 1501/09
• H/gbreal Yikum 1512/09
• Mikias Ababu 1517/09
• Selome Mebre 15 /09
• Bulign 15 /09