Integrated Management of Childhood

Illness (IMCI)

masaba

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 Challenges

 Every year, over 10 million children under the

age of five die from readily preventable and
treatable illnesses such as diarrhoea
dehydration, acute respiratory infection,
measles, and malaria.
 In half of the cases, illness is complicated by
malnutrition.

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 Challenges

 The Integrated Management of Childhood

Illness (IMCI) was first developed in 1992 by
UNICEF and the World Health Organization
(WHO) with the aim of prevention, or early
detection and treatment of the leading
childhood killers

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  The IMCI initiative adopted a broad, cross-
cutting approach recognising that in most cases,
more than one underlying cause contributes to
the illness of the child.

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  A great deal has been learned from disease-
specific control programmes over the past 15
years.
 IMCI attempts to combine the lessons
learned into an effective approach for
managing the sick child.

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  While the management of childhood illness
focuses on treatment, it also provides the
opportunity to emphasise prevention of
illness through education on the importance
of immunizations, micronutrient
supplementation, and improved nutrition -
especially breastfeeding and infant feeding.

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  IMCI seeks to reduce childhood mortality and
morbidity by improving family and community
practices for the home management of
illness, and improving case management of
skills of health workers in the wider health
system.

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 Integrated Management of Childhood
Illness (IMCI)

 Holistic approach to examining and treating the

child
 Focus is on the child, not a specific disease
 CHECK FOR:
– General danger signs
– Is the child able to drink or breastfeed?
– Does the child vomit everything?
– Has the child had convulsions?

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 LOOK FOR:

 See if the child is lethargic or unconscious

 Is the child convulsing now?
 If yes treat immediately
 THEN ASK ABOUT MAIN SYMPTOMS:
 Cough or difficult in breathing
 Diarrhoea
 Fever
 Ear problem

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  CHECK FOR :
 Malnutrition and anaemia
 Suspected symptomatic HIV Infection
 Child,s immunization status
 Asses other problems
 Then classify ,treat the child or refer and
counsel the mother

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 Integrated Management of Childhood
Illness (IMCI)

ADVANTAGES OF IMCI
 Physician’s drug usage costs are reduced
by 80% .

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 Major childhood illnesses

 While cause-specific mortality may be difficult to

accurately ascertain, many childhood deaths in
developing countries can be attributed to five
main causes, or a combination of the causes:
acute respiratory infection, diarrhoea, measles,
malaria and malnutrition. 

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 An Uncertain Divide: Under-five deaths by
cause

 Estimates of under-five deaths by cause are

important for targeting interventions to
reduce child mortality and to monitor
progress.
 Although the total of under-five deaths is
relatively well known, the proportion related
to each cause is much more uncertain and
hence no numbers are used on the chart.

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 Acute Respiratory Infection (ARI)

 ARI is a leading cause of mortality in children under

the age of five in developing countries.
 Respiratory infections caused by viruses or bacteria,
can manifest in any area of the respiratory tract,
including the nose, middle ear, throat, voice box, air
passage, and lungs.
 Respiratory syncytial virus (RSV) and Para influenza
virus type 3 are the main causes of acute respiratory
infection in early childhood.

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 Acute Respiratory Infection (ARI)

 Pneumonia, an infection of the lungs, is the most

serious respiratory infection and often can be treated
with affordable oral antibiotics since the primary
cause of infection is bacteria.
 Children suffering from other conditions, such as
malnutrition or measles, are particularly susceptible
to pneumonia.
 To prevent deaths when children develop ARI, it is
crucial that the signs are recognised - a cough
accompanied by difficult or short, rapid breathing -
and that appropriate health care is sought
immediately

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 Diarrhoeal Disease

 Diarrhoea remains one of the major causes

of death among the world's children.
 Most die of dehydration - the loss of large
quantities of water and salt from the body.
 Many of these deaths can be prevented with
the use of oral rehydration therapy (ORT) at
the first onset of diarrhoea.

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 Diarrhoeal Disease

 Diarrhoea is caused by ingesting certain

bacteria, viruses or parasites found in faecal
matter which may be spread through water,
food, hands, utensils used for eating and
drinking, flies, and dirt under fingernails.

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 Diarrhoeal Disease cont.

 Diarrhoea may present in different forms and have

various treatment protocols:
 Persistent diarrhoea (more than 14 days), acute
watery diarrhoea, or dysentery (blood in stool). Other
diseases that can occur concurrently with diarrhoea
include measles and malaria. Malnutrition also often
accompanies diarrhoea.

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 Measles

 Measles is a highly contagious disease

caused by a virus which is spread easily from
one person to another through the air when
an infected person coughs or sneezes and a
susceptible person inhales the organism.
 Symptoms include fever, runny nose, cough,
and sore eyes, followed by a blotchy rash
usually starting on the face and spreading
down the body.

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 Measles

 Children with measles are susceptible to

pneumonia.
 The best protection against measles is
immunisation.
 In addition, vitamin A supplements have
been found to reduce the severity of both
measles and diarrhoea.

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 Malaria

 Malaria is a widespread tropical disease

caused by a parasite transmitted to humans
by mosquitoes.
 Young children are particularly vulnerable
because they have not developed the partial
immunity that results from surviving repeated
infections.
 The disease may occur year-round or
seasonally.
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 Malaria
cont.

 Symptoms of malaria include fever with

shivering and sweating, headache, and pain
in the back, joints, or body. There may also
be loss of appetite, cough, vomiting, and
diarrhoea, however fever may be the only
sign of malaria, making it difficult to
distinguish.


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 Malaria cont.

 Malaria may cause several weeks or months

of poor health due to repeated attacks of
fever, anaemia, and general weakness.
Children can deteriorate rapidly over 1-2
days, becoming very ill, going into coma
(cerebral malaria) or shock, or manifesting
convulsions, severe anaemia and acidosis.

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 Malaria

 Malnutrition should be recognised as possible co-

existing condition.
 Prevention methods for malaria include the use of
insecticide-impregnated bed nets in endemic areas.
In most cases, children with malaria can be quickly
and effectively treated with a course of inexpensive,
oral anti-malarial tablets that are appropriate for the
area (i.e. without parasitic drug resistance).

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 Malnutrition

 Malnutrition contributes to about half of all

childhood deaths.
 Poor feeding practices - inadequate
breastfeeding, offering the wrong foods at
the wrong age, and giving food in insufficient
quantities - contribute to malnutrition.

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 Malnutrition

 Infection, particularly frequent or persistent

diarrhoea, pneumonia, measles and malaria, also
undermines nutritional status, leaving malnourished
children even more vulnerable to disease.
 Efforts to prevent malnutrition include the promotion
of breastfeeding, the improvement of feeding
practices, and the provision of routine micronutrient
supplements for children who need them.
 

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 Training

 A key element of the IMCI strategy is integrated case

management training for health workers, which
combines classroom work with hands-on clinical
practice to teach health workers how to effectively
manage sick children.
 The health workers are trained to assess, classify
and treat sick children, using guidelines which
approach childhood illness in a comprehensive and
systematic way.

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 Training

 Use of the IMCI guidelines leads to

identification of illnesses in outpatient
settings, appropriate combined treatment of
all major illnesses, and timely referral of
severely ill children.

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 Training

 In addition to the effective case

management, the IMCI training emphasises
disease prevention and communication with
caretakers.

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 Training

 Health workers learn about routine updating of the

immunisations of sick children, micronutrient
supplementation, promotion of breastfeeding, and
counseling to solve feeding problems.
 They also learn techniques to improve their
communication skills so that they can help
caretakers better understand how to treat their sick
children and how to prevent disease. 

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 The complete IMCI case management process
involves the following: 

 The health worker assesses a child by

checking for general danger signs such as
cough or difficult breathing, diarrhoea, fever,
ear problems, malnutrition and anaemia.
 The health worker then asks questions about
common conditions, examines the child, and
checks the nutrition and immunization status

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 The health worker classifies a child's illnesses
according to whether it requires:
 urgent pre-referral treatment and referral,
specific medical treatment and advice, or
simple advice on home management.

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 After classification, the health worker develops
an integrated treatment plan for each child,
including referrals when necessary.

 If home treatment is needed, the health worker

advises the caretaker on how to administer oral
drugs, how to feed and give fluids during illness,
and how to treat local infections at home.

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  The health worker asks the caretaker to
return for follow-up on a certain date, and
teaches the caretaker how to recognise signs
that indicate that the child should return
immediately to the health facility.

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 Home management of illness

The IMCI approach teaches caretakers that

proper home management of childhood
illness requires giving increased fluids plus
continued feeding to sick children.
 The combination is expected to supply salt,
carbohydrates and water, thus preventing the
occurrence of dehydration and severe
nutrient and energy loss during a period of
illness.

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 Home management of illness

 Illness may compromise the nutritional status of

children by reducing their appetite, increasing faecal
losses of fluids and nutrients, increasing their need
for specific nutrients, or reducing their food and fluid
intake due to painful mouth lesions, nausea, or
vomiting.
 Children are encouraged to eat and drink relatively
small amounts frequently.
 The food should be rich in energy and nutrients, and
easily eaten and digested.

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  When children experience severe illness they
should be taken immediately to a health
facility.
 Some of the key signs of illness which
require medical attention include: not being
able to drink or breastfeed, drinking poorly,
becoming more sick, developing a fever,
breathing rapidly, having difficult breathing,
and having bloody stools.

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 IMCI family and community health care practices

 Communities need to be strengthened and

families supported to provide the necessary
care to improve child survival, growth and
development.
 Families need knowledge, skills, motivation and
support.
– They need to know what to do in specific
circumstances and as the child grows and develops.

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 IMCI family and community health care practices

– They need skills to provide appropriate care and to solve

problems.
– They need to be motivated to try and to sustain new
practices.
– They need social and material support from the community.
– And finally, families need support from the health system,
in the form of accessible clinics and responsive services,
and health workers should be able to give effective advice,
drugs and more complex treatments when necessary.

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 IMCI family and community health care practices

The evidence suggests that families should

follow some key practices to provide care for
children:

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 Physical and Mental Growth:

 Breast feed infants exclusively for at least six

months. (mothers found to be HIV positive
require counseling about possible
alternatives to breastfeeding).
 Starting at about 6 months of age, feed
children freshly prepared energy and nutrient
rich complementary foods, while continuing
to breastfeed up to two years or longer.

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 Physical and Mental Growth:

 Ensure that children receive adequate

amounts of micronutrients (vitamin A and iron
in particular), either in their diet or through
supplementation.
 Promote mental and social development by
responding to a child's needs for care, and
through talking, playing, and providing a
stimulating environment.

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 Disease Prevention:

 Take children as scheduled to complete a full course

of immunizations (BCG, DPT, OPV, and measles)
before their first birthday.
 Dispose off faeces, including children's faeces safely
and wash hands after defecation, before preparing
meals, and before feeding children.
 Protect children in malaria-endemic areas, by ensuring
that they sleep under insecticide-treated bed nets. 
 Adopt and sustain appropriate behaviour regarding
prevention and care for HIV/AIDS affected people,
including orphans.

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 Appropriate Home Care:

 Continue to feed and offer more fluids to children

when they are sick.
 Give sick children appropriate home treatment for
infections.
 Take appropriate actions to prevent and manage
child injuries and accidents.
 Prevent child abuse/neglect and take appropriate
action when it has occurred.
 Ensure that men actively participate in provision of
childcare, and are involved in reproductive health
initiatives.

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 Care seeking and Compliance:

 Recognise when sick children need

treatment outside the home and seek care
from appropriate providers.
 Ensure that every pregnant woman has
adequate antenatal care . This includes
having at least four antenatal visits with an
appropriate health care provider, and
receiving the recommended doses of the
tetanus toxoid vaccination.

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 Care seeking and Compliance:

 The mother also needs support from her

family and community in seeking care at the
time of delivery and during the postpartum
and lactation period.
 Follow the health worker's advice about
treatment, follow-up and referral.

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 Sources:

UNICEF.(2001) Community IMCI: A strategy

for accelerating child survival and
development interventions Discussion
paper. New York : UNICEF- New York.

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