Dr : Mutaz Abdallah Abdelhadi

12/07/2021 IMCI 1
 The Problem
• The extent of childhood morbidity and
mortality caused by diarrhea, ARI, malaria,
measles and malnutrition cause 70% of U5
deaths
• H. workers are often trained to use separate,
disease specific guidelines
• Treatment may be complicated

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 IMCI
• IMCI is an integrated approach to child health
that focuses on the well-being of the whole child.
• IMCI is a strategy for reducing mortality and
morbidity associated with major causes of
childhood illness.
• IMCI was initiated jointly in 1992 by WHO and
UNICEF.
• IMCI has already been introduced in more than
75 countries around the world.
 IMCI

• IMCI offers the knowledge to evaluate and

integrate the status of child health

• detect the problems frequently affecting the

child health

• gives instructions on disease classification

 IMCI

• Primarily, there are two objectives of IMCI:

1. To significantly reduce global mortality and morbidity
associated with the major causes of disease in children

• major killers:
• (Acute Respiratory Infections, Diarrhoeal
Diseases, Malaria, Malnutrition and Measles)

2. To contribute a healthy growth and development of

children (Health Promotion)
 GOAL

To contribute to healthy growth and

development of U5

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 Sudan
• Started to be implemented in Sudan in 1998
in two states ( Khartoum & Geizera).

• Evaluated, found suitable to the country

situation, so expansion started to include all
the states.
 IMCI

•Three major components of IMCI:

1. Improving case
management
skills of health
workers
 IMCI

2. Improving the
health system

to deliver IMCI
 IMCI

3. Improving
family and
community
health practices
 Why family and community
• The family and the community where
children live play a major role in child health
and development.

• There is a need to involve the family and

community actively and plan and implement
child care interventions in both the health
system and the community.

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 Family and community practices
1. Breastfeeding:
– Exclusively for up to 6 months.
– Complementary (6 months - 2 years or
longer)

2. Micronutrients (Vit. A, iron and zinc etc),

in diet or supplementation

3. Hygiene
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 cont. family and community practices
4. Immunization
5. Protection from Malaria
6.Psychosocial development
7. Home care for Illness:
• continuing feeding and offering more fluids
• oral rehydration treatment and treatment of fever
• prompt care-seeking
• compliance with health provider’s advice

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 cont. family and community practices

8. HOME TREATMENT FOR INFECTIONS:

– Give sick children appropriate home treatment for
infections.
– CARE-SEEKING. Recognize when sick children need
treatment outside the home and seek care from
appropriate providers.

9. COMPLIANCE WITH ADVICE.

– Follow the health worker’s advice about
treatment, follow-up and referral.

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 cont. family and community practices

10. ANTENATAL CARE

◦ Ensure that every pregnant woman has

adequate ANC care. (at least Five antenatal
visits and

◦ Receiving the recommended doses of the TT.

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 cont. family and community practices

11. FAMILY PLANNING

•Advices about:
• Advantages and
• Disadvantages of contraceptives methods

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 cont. family and community practices

12.The mother needs support from

her family and community:
– in seeking care at the time of delivery
and
– during the postpartum and lactation
period

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 Elements of IMCI
1. Assess
2. Classify
3. Identify
4. Treat
5. Counsel
6. Follow-up

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 1. Case Management Process
I. Assess the child or young infant
II. Classify the illness
III. Identify the treatment
IV. Treat the child/Refer
V. Counsel the mother
VI. Give follow-up care
 Case Management Process

I. Assess the child or young infant

“Assess the child” means taking a
history and doing physical
examination.
 Case Management Process
II. Classify the illness
• “Classify the Illness” means taking a decision on the
severity of the illness
• Classifications are not specific disease diagnoses.
Instead, they are categories that are used to
determine treatment
• For effectively manage childhood illness, a colour-
coded system has been utilized which represents:
green yellow pink
 Case Management Process
II. Classify the illness

Colour Presentation Classification of Level of

Disease Management

Green Mild Home Care

Yellow Moderate Management at the

RHU
Pink Severe Urgent Referral
 Case Management Process
III. Identify Treatment
• The chart recommends appropriate treatment
for each classification
• When using this process, selecting a
classification on the chart is sufficient to allow
you to “identify treatment”
 Case Management Process
IV. Treat the child
• “Treat the child” means giving treatment in
the health centre
• prescribing drugs or other treatments to be
given at home
• teaching the mother how to carry out the
treatments.
 Case Management Process
V. Counsel the mother
• “Counsel the mother” includes assessing how
the child is fed
• telling the mother about the foods and fluids
to give the child
• Telling the mother when to bring the child
back to the health center.
 Case Management Process

VI. Give follow-up care

• Specific instructions for
conducting each follow-up visit
 THE INTEGRATED CASE
MANAGEMENT PROCESS

OUT-PATIENT HEALTH FACILITY

Check for GENERAL DANGER SIGNS

•Convulsions (during this illness)
•Lethargy/unconsciousness
•Inability to drink or breastfeed
•Vomiting

Assess MAIN SYMPTOMS

•Coughing/difficulty of breathing
•Diarrhea
•Fever
•Ear Problems

Assess NUTRITION AND IMMUNIZATION STATUS

Urgent Referral
and POTENTIAL FEEDING PROBLEMS
OUT-PATIENT HEALTH
FACILITY Home Management
Pre-referral treatment Check for OTHER PROBLEMS
Advise parents HOME
Refer child CLASSIFY CONDITION AND IDENTIFY TREATMENT ACTIONS Caretaker is counseled on:
According to color-coded treatment •Refer child
•Home treatments
REFERRAL FACILITY •Feeding and fluids
•Emergency Triage and •When to return immediately
Treatment at Out-Patient
treatment (ETAT) •Follow-up
OUT-PATIENT HEALTH FACILITY
•Diagnosis •Treat local infection
•Treatment •Give oral drugs
•Monitoring and •Advise and teach caretakers
Follow-up •Follow-up
 Counsel the Mother
“Counsel the mother” includes
assessing how the child is fed and
telling her about the foods and fluids
to give the child and when to bring
the child back to the health centre.
 Counsel the Mother
• Advise the mother to return immediately if the child has any
of these signs:
Any sick child •Not able to drink or breastfeed
•Becomes sicker
•Develops a fever

If the child has no PNEUMONIA: •Fast breathing

COUGH OR COLD, also return if:
•Difficult breathing

If the child has diarrhoea, also return if: •Blood in stool

•Drinking poorly

If the child has FEVER: DENGUE •Any sign of bleeding

HEMORRHAGIC FEVER UNLIKELY, also •Persistent abdominal pain
return if: •Persistent vomiting
•Skin petechiae, skin rash
 Follow-Up Visit
If the child has: Return for follow up
Pneumonia 2 days
Dysentery
Malaria, if fever persist
Fever: Malaria unlikely, if fever persist
Fever: No Malaria if fever persist
Measles with eye or mouth complications
DHF Unlikely, if fever persist

Persistent Diarrhoea 5 days

Acute Ear Infection
Chronic Ear Infection
Feeding Problems
Any Other Illness if not improving

Anaemia 14 days
Very Low Weight For Age 30 days
 Conclusion
• IMCI is integral case management
• It is a syndromic approach
– A combination of signs leads to one or more
classification
– Management is guided through adapted
guidelines
• IMCI improves family and community
practice

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•Thanks