Integrated Management of

Childhood Illnesses
IMCI
 Specific objectives of the current lecture
At the end of this lecture you will be able to:
1. Enumerate most common causes o underfives
death in developing countries.
2. Define IMCI.
3. Identify objectives of IMCI.
4. Discuss elements of IMCI.
5. Draw charts show summary of IMCI for children
2months-5 years and 1 week to 2 months.
 IMCI

Altogether more than 10 million children die each year in

developing countries before they reach their fifth
birthday.

Seven in ten of these deaths are due to

acute respiratory infections (mostly pneumonia),
diarrhea,
measles,
malaria, or
malnutrition; and often
to a combination of these conditions
 IMCI

Every day, millions of parents take

children with potentially fatal illnesses
to first-level health facilities such as
clinics, health centers and outpatient
departments of hospitals.
 IMCI

In some countries, three in four

episodes of childhood illness are caused
by one of these five conditions. And
most sick children present with signs
and symptoms related to more than one.
 IMCI

This overlap means that a single

diagnosis may not be possible or
appropriate, and that treatment may be
complicated by the need to combine
therapy for several conditions.
 IMCI

Surveys of the management of sick

children at these facilities reveal that
many are not properly assessed and
treated and that their parents are
poorly advised.
 IMCI

At this level, in most developing countries,

Diagnostic supports such as radiology and
laboratory services are minimal or non-
existent;
drugs and equipment are scarce;
combined with an irregular flow of patients,
 IMCI
Health care providers at primary health
care centers have few opportunities to
practice complicated clinical procedures.
Instead, they must often rely on history
and signs and symptoms to determine a
course of management that makes the
best use of available resources.
 IMCI

WHO and UNICEF developed a strategy

known as Integrated Management of
Childhood Illness (IMCI).
The strategy combines Improved management
of childhood illness with aspects of
nutrition,
immunization, and
other important disease prevention
In addition to health promotion elements.
 IMCI

The objectives of IMCI are to:

1. reduce deaths, frequency and severity
of illness and disability, and
2. contribute to improved growth and
development.
 IMCI

Integrated case management relies on:

 Case detection using simple clinical signs
and treatment.
 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 of the signs and
symptoms.
 IMCI
Sensitivity and specificity measure the
diagnostic performance of a clinical sign
compared with that of the gold
standard, which by definition has a
sensitivity of 100% and a specificity of
100%.
 IMCI
Sensitivity measures the proportion or
percentage of those with the disease
who are correctly identified by the sign.
In other words, it measures how
sensitive the sign is in detecting the
disease.
Sensitivity = true positives / [true
positives + false negatives]
 IMCI
Specificity measures the proportion of
those without the disease who are
correctly called free of the disease by
using the sign.
Specificity = true negatives / [true
negatives + false positives
 IMCI
IMCI allows a health care provider to
determine
 If a child should be urgently referred to
another health facility
Or
If the child can be treated at the first-level
facility (e.g. with oral antibiotic, antimaiarial,
ORS, etc.)
Or
If the child can be safely managed at home.
 The core of the IMCI strategy

The core of the IMCI strategy is

focus on the most important causes of
:death
 Diarrhea
 ARI
Malaria
 Measles
Malnutrition
 IMCI
The complete IMCI case management
process involves the following elements:
 IMCI
First assesses the child by
i. Identifying any danger signs,
ii. Asking about the four main symptoms in
all children (cough or difficult
breathing, diarrhea, fever, and ear
problem), Carrying out further assessment
if a main symptom is reported, and
iii. Reviewing the nutritional and
immunization status in all children.
 IMCI
Then classifies the child's illnesses.
Each illness is classified according to
whether it requires:
i. - urgent referral;
ii. - specific medical treatment and
advice; or
iii. - simple advice on home management.
 IMCI
After classification, specific treatments
are identified.
If the child has to be referred
urgently to a hospital, give only
essential treatment before departure.
Since most children have more than one
illness.
 IMCI
Practical treatment instructions are carried
out, including
 Teach the mother how to administer oral
drugs,
 To increase fluid intake during diarrhea and
to treat local infections at home.
 The mother is advised on the signs which
indicate that the child should immediately be
brought back to the clinic and when to return
for routine follow-up.
 IMCI
Feeding is assessed and counseling of
mothers on feeding problems is
provided.
Follow-up instructions for various
conditions are given when the child
returns to the clinic.
If necessary, reassess the child for new
problems.
• Conclusion
IMCI is a strategy combined management of
illnesses of children <5 years of age and
taking care of their nutrition, immunization,
and other health promotion aspects. The core
elements are: assessment, classification,
treatment, giving practical instructions,
feeding assessment and counseling, and lastly
giving follow up instructions.