IMCI

(Integrated Management of FEU-NRMF Dept. of Child

Health
Childhood Illness)
INTRODUCTION
What is IMCI?
An integrated approach to child health that focuses on the
well-being of the whole child.
It aims to reduce death, illness and disability, and to promote
improved growth and development among children under
five years of age.
It includes both preventive and curative elements that
are implemented by families and communities as well
as by health facilities.
Who are the children covered by the IMCI protocol?

• Sick children from birth up to 2 months (Sick young infant)

• Sick children 2 months up to 5 years (Sick child)

What does IMCI offers?

• It offers simple and effective methods to prevent and manage

the leading causes of serious illness and mortality in young
children.

• The guidelines promote evidence-based assessment and

treatment, using a syndromic approach that supports the
rational, effective, and affordable use of drugs.
Where is it intended to be used?

The approach is designed for use in outpatient

clinical settings with limited diagnostic tools,
limited medications, and limited opportunities to
practice complicated procedures.
Components of IMCI strategy
1. Improvements in the case management skills of health worker;
2. Improvements in the health system required to deliver child health
interventions effectively;
3. Improvements in family and community practices.
Why IMCI?
•10M children die each year in
developing countries before they
reach their 5th birthday (1998)

•7 in 10 deaths are due to acute

respiratory infections (mostly
pneumonia), diarrhea, measles,
malaria, or malnutrition --often in
combine

•Many are not properly assessed and

treated and that their parents are
poorly advised
Rationale for the integrated approach in the
management of sick children
• Majority of deaths are caused by 5 preventable and treatable conditions
namely:

pneumonia, diarrhoea, measles, malaria, and malnutrition

• 3 out of 4 episodes of childhood illness are caused by this condition

• most children have more than one illness at one time.

• single diagnosis may not be possible or appropriate

Western Pacific Region

•527,000 children die before their 5th

birthday

•97% occurred in six countries,

namely, Cambodia, China, the Lao
People's Democratic Republic,
Papua New Guinea, the Philippines,
and Vietnam
 IMCI in the
Philippines

Started as a pilot
basis in 1996

Health workers and

hospital staff were
capacitated to implement
the strategy at the
frontline level
 Accelerating Implementation of IMCI in
the Philippines 2015-2025

General objective:
To accelerate IMCI implementation all over the country.

Specific objectives: By 2025,

To establish IMCI-ICATT training units and core trainers in all regions of the
country
To implement IMCI in at least 80% of primary health care facilities (barangay
health centers and BHSs)
To integrate IMCI in all medical, nursing and midwifery
schools
To establish IMCI referral hospitals in all provinces and cities
To establish core IMCI activities in the barangays. (to be identified)
Integrated Case Management Process
• Assess and Classify the sick child

• Treat the child

• Counsel

• Follow-up
Assess
• Check for danger signs (or possible bacterial infection in a young
infant)

• ask questions about common conditions

• examining the child

• check nutrition and immunization status

• check other health problems

Classify

• using a colour-coded triage system

urgent pre-referral treatment and referral (red)

specific medical treatment and advice (yellow)

simple management (green)

Treat the child
•Identify specific treatments for the child

if requires urgent referral, give essential treatment before transfer

if needs treatment at home, develop an integrated treatment plan and give the
first dose of drugs in the clinic

if should be immunized, give immunizations

•Provide practical treatment options

teach caretaker how to give oral drugs

how to feed and give fluids

how to treat local infections

Counsel

• Assess feeding, including assessment of breastfeeding

practices, and counsel to solve any feeding problems.

• Then counsel the mother about her own health.

Follow-up

• Give follow-up care and if necessary, reassess the child for

new problem.
Integrated Case Management Process

• Assess and Classify the sick child

• Treat the child

• Counsel

• Follow-up
Selecting the appropriate case management charts

FOR ALL SICK CHILDREN up to 5 years of age who are brought to the clinic

IF the child is a young infant age up to 2

months
 FOR ALL SICK CHILDREN up to 5 years of age who are brought to the clinic

Summary of the
Integrated Case
Management
Process
The sick child (2 months to 5 years)
Cough or difficult breathing
Diarrhoea
Fever
Ear problem
Malnutrition and feeding
Immunization status
Sick child 2 months up to 5 years
 General Danger Signs

A child with any general danger sign needs URGENT attention;

complete the assessment and any pre-referral treatment immediately so referral is not
delayed.
General Danger Signs

ASK FOR: CLASSIFY MANAGE

• Convulsion is a danger sign only when:
 Occurs in less than 6 months
 More than one episode
 Occurring for more than 15 minutes

• This definition EXCLUDES SIMPLE FEBRILE

CONVULSIONS
Cough or difficult breathing

Classify:
COUGH or
DIFFICULT
BREATHING
Classification of Cough or Difficult Breathing
Rationale for management of children with
wheeze

• Wheeze can cause fast breathing and or chest indrawing

• Good response to inhaled bronchodilator may cause fast breathing

or chest indrawing to disappear

• Only children with wheeze and signs of pneumonia (fast breathing

and/or chest indrawing) need antimicrobials

• Wheezing without signs of pneumonia only need bronchodilator

treatment
Antibiotic treatment for Pneumonia

• Children aged 2-59 months pneumonia (chest indrawing

and or high RR) should be treated with oral
amoxicillin of at least 40mg/kg/dose twice
a day for five days
Diarrhea

Classify
DIARRHEA for
Dehydration
Ask, Look & Feel:
CLASSIFY MANAGE
Ask, Look, & Feel: CLASSIFY MANAGE
Treatment for Diarrhea

• Use of low/reduced osmolarity Oral Rehydration Salts (ORS)

• Providing children with zinc for 14 days:

− Children > 6 months 20 mg zinc
− Children < 6 months 10 mg of zinc

• Ciprofloxacin as first line drug for bloody diarrhoea (dysentery)

Composition of the old and reformulated ORS
Fever

Fever is defined by history or feels hot or temperature 37.5

0
C or above (based on axillary T0; rectal T0 is 0.5 0C higher)

Decide if the area is Malaria Risk

Look for any bacterial cause of fever

• local tenderness, oral sores, refusal to use limb, hot tender swelling,
red tender skin or boils, lower abdominal pain or pain in passing
urine in older children
 Malaria Diagnosis

• Prompt parasitological confirmation by microscopy or alternatively by

Rapid Diagnostic Tests (RDTs) is recommended in ALL patients
suspected of malaria before treatment is started.
Fever: Malaria Risk

CLASSIFY MANAGE
Treatment of Very Severe Disease in Malaria
risk area

• Pre-referral treatment includes rectal Artesunate suppository

or oral Quinine and IM Ampicillin and Gentamicin
Treatment of Uncomplicated falciparum
malaria

 Artemisinin-based combination therapies (ACTs) should be used in the

treatment of uncomplicated P. falciparum malaria
 ACTs should include at least 3 days of treatment with an artemisinin derivative
Fever: No Malaria Risk and No Travel to Malaria-
Risk Area

CLASSIFY MANAGE
Fever: Measles
Fever: Measles

Check for signs of Measles now or within the last 3 months

Ask & look for: CLASSIFY MANAGE

Fever: Dengue Hemorrhagic Fever

Ask & Look for: CLASSIFY MANAGEMENT

Ear problem
Ear Problem

ASK, LOOK, & FEEL: CLASSIFY MANAGE

Acute Malnutrition

Look for edema of both feet

Determine WFH/L z-score using the WHO growth standard

charts

Measure the Mid-Upper Arm Circumference using MUAC

tape in all children 6 months or older

Offer Ready-to-Use Therapeutic Food (RUTF) for appetite

test
Appetite Test

Offer appropriate amount of RUTF to the child to eat:

•After 30 minutes check if the child was able to finish or not able to finish
the amount of RUTF given and decide:

- Child ABLE to finish at least one-third of a packet of RUTF portion

(92 g) or 3 teaspoons from a pot within 30 minutes.

- Child NOT ABLE to eat one-third of a packet of RUTF portion (92 g) or 3

teaspoons from a pot within 30 minutes.
Acute Malnutrition
Acute Malnutrition
Anemia

Look for: CLASSIFY MANAGE

HIV Infection

What we need to know about HIV:

• We need to ask if the mother had an HIV test
• Learn how to decide the HIV status of the mother
• Ask about the breastfeeding status of the child
• If no test has been done, to request for the test
HIV Infection
Counsel and Follow-up Care
Counsel and Follow-up Care
Sick young infant age up to 2 months
Sick young infant age up to 2 months

Check for the following:

Very severe disease and local bacterial infection

Jaundice

Diarrhea

HIV infection

Feeding problem or low weight for age

Summary Management of Sick Young Infant
 Very Severe Disease and Local Bacterial Infection
Ask, Look,
Listen & Feel CLASSIFY TREATMENT

*These thresholds are based on ancillary temperature. The thresholds for rectal temperature readings are approximately 0.5 ’C higher.
** If referral is not possible, manage the sick young infant as described in the national referral care guidelines or WHO Pocket Book for hospital care for children.
Jaundice

Ask & Look for: CLASSIFY TREATMENT

Diarrhea

What is diarrhea in a young infant?

A young infant has diarrhea if the stools have change from

usual pattern and are many and watery ( more water than fecal
matter).

The normally frequent or semi-solid stools of a breastfed baby

are not diarrhea.
Diarrhea

Ask, Look & Feel

for: CLASSIFY MANAGE
HIV Infection
CLASSIFY TREATMENT
Feeding Problem or Low Weight for Age
(except HIV-exposed young infants not breastfed)
Ask, Look,
Listen, & Feel: CLASSIFY MANAGE
Assess Breastfeeding
Feeding problem or Low Weight for Age
(for HIV exposed infants and not breastfeeding)

Ask, Look, Listen, & Feel: CLASSIFY MANAGE

Counsel and Follow-up Care
Counsel and Follow-up Care
Communicate and counsel
END