IMCI / COPAR

By: Niel Allison V. Oro, RN, MANc

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

Definition: The Integrated Management of Childhood Illness (IMCI) is a strategy to address the most common causes of illness (morbidity) and mortality (deaths) among children under five which was developed and initiated by the World Health Organization (WHO) in collaboration with UNICEF in 1995.
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Objective: aims to reduce death, illness and disability, and to promote improved growth and development among children under five years old Steps in the IMCI Process o o o o o o Principles of the Integrated Care o Assess for General Danger Signs I L V C Assess for Main Symptoms C D E F M
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B. DIARRHEA AND DEHYDRATION S / SX CLASSIFICATION NURSING INTERVENTION

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Color Classification o o o

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Assess and Identify Classifications

A. Cough and Difficulty Breathing S / SX CLASSIFICATION NURSING INTERVENTION PLAN B: PLAN A:

PLAN C:

C. DIARRHEA FOR MORE THAN 14 DAYS S / SX CLASSIFICATION NURSING INTERVENTION

E. MALARIA RISK (+) S / SX CLASSIFICATION NURSING INTERVENTION

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S / SX D. EAR PROBLEMS S / SX CLASSIFICATION NURSING INTERVENTION

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F. MALARIA RISK (-) S / SX CLASSIFICATION NURSING INTERVENTION

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G. MEASLES S / SX S / SX CLASSIFICATION NURSING INTERVENTION CLASSIFICATION NURSING INTERVENTION

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COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) S / SX CLASSIFICATION NURSING INTERVENTION Community a group of interacting people, living in a particular local area, and often refers to a group that shares common values and attitudes within a shared geographical location Organization group of people working together Community Organization - a process by which people, health services and agencies of the community are brought together to: 1. 2. 3. 4. Basic Methods and Steps in Community Organization Process Fact Finding

H. DEANGUE HEMORRHAGIC FEVER S / SX CLASSIFICATION NURSING INTERVENTION

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Determination of Needs

Program Formation

Education and Interpretation

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Basic Values in Community Organizing 1. Human Rights are universally held principles anchored mainly on the belief in the worth and dignity of people; it includes the right to life and to selfdetermination and development as persons and as a people. 2. Social Justice means equitable access to opportunities for satisfying peoples basic needs and dignity; it requires an equitable distribution of resources and power through peoples participation in their own development.

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3. Social Responsibility is premised on the belief that people as social beings must not limit themselves to their own concerns but should reach out to and move jointly with others in meeting common needs and problems. Aims of Community Organizing 1. Peoples empowerment. Community organizing is aimed at achieving effective power for the people. Through the process of CO, people learn to overcome their powerlessness and develop their capacity to

maximize their control over their situation and start to place the future in their own hands 2. Building relatively permanent structures and peoples organizations. Community organizing aims to establish and sustain relatively permanent organizational structures which best serve the needs and aspirations of the people. These structures ensure peoples maximum participation while, at the same time, they provide the venue through which the peoples organizations can link up with other groups and sectors 3. Improved quality of life. Community organizing also seeks to secure short and long term improvements in the quality of life of the people. Immediately, the process of mobilization can gain concessions for fulfilling basic needs for food, clothing, shelter, education and health. Definition of COPAR:

Emphasis of COPAR: 1. Community working to solve its own problem 2. Direction is established internally and externally 3. Development and implementation of a specific project less important than the development of the capacity of the community to establish the project 4. Consciousness raising involves perceiving health and medical care within the total structure of society Importance of COPAR: COPAR COPAR COPAR Through COPAR COPAR

A collective, participatory, transformative, sustained and systematic process of building peoples organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)

Phases of COPAR Process: 1. Pre-Entry Phase -

Importance of COPAR: 1. Activities in the Pre-Entry Phase: Preparation of the Institution Site Selection Criteria for Initial Site Selection Identifying Potential Municipalities Identifying Potential Barangay Choosing Final Barangay

2.

3.

Principles of COPAR: 1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. 2. COPAR should be based on the interest of the poorest sectors of society 3. COPAR should lead to a self-reliant community and society. Community Organizing Participatory Action Research (COPAR) - is a continuous and a sustained process of: Educating the people

Working with people Mobilizing with people

Process - the sequence of steps whereby members of a community come together to critically assess to evaluate community conditions and work together to improve those conditions. Structure - refers to a particular group of community members that work together for a common health and health related goals.

Identifying Host Family 2. Entry Phase

4. Sustenance and Strengthening Phase

Key Activities

Guidelines for Entry Recognize the role of local authorities by paying them visits to inform their presence and activities. Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model. Avoid raising the consciousness of the community residents; adopt a low-key profile. Activities in the Entry Phase: Integration o o o o

POST TEST:
Situation: During the mid-1990s, the world Health Organization (WHO), in collaboration with UNICEF and many other agencies, institutions and individuals, responded to case management challenge by developing a strategy known as the Integrated Management of Childhood Illness (IMCI). 1. The IMCI guidelines target which of the following groups of children? a. Those from 0 to 24 months b. Under school children c. Infants until 1 year of age d. Less than 5 years old 2. The IMCI guidelines are based on the following principles, except: a. All sick children must be examined for general danger signs which indicate the need for immediate referral or admission to a hospital. b. Only a limited number of carefully-selected clinical signs are used, based on evidence of their sensitivity and specificity to detect disease. c. The IMCI guidelines address most, but not all, of the major reasons a sick child is brought to a clinic. d. IMCI management procedures use unlimited number of essential drugs and encourage active participation of care takers in the treatment of children. 3. In one of your home visits, you found out that Rina, 4 year-old child is having diarrhea. To prevent dehydration you will advise Rinas mother to give ORS amounting to: a. 50-100 ml after each loose stool b. 300 ml twice a day c. 200-300 ml 3 times a day d. 100-200 ml after each loose stool 4. For very severe disease category, the following are guidelines, except: a. Give first dose of antibiotics b. Give Vitamin A c. Mothers should continue breastfeeding d. Give Cotrimoxazole to prevent respiratory infection 5. For a 12-month old child with Pneumonia category, the following are guidelines, except: a. Antibiotic for 5 days

Deepening Social Investigation o o

Core Group Formation o Sociogram

3. Organization-building Phase

Key Activities o o o

b. c. d.

Relieve cough with safe remedy Advise mother on danger signs Follow up in 5 days if no improvement

6. Classifying conditions and identifying treatment actions are color coded, what is the color coded treatment for urgent referrals? a. Red c. Pink b. Yellow d. Green 7. To be categorized as persistent diarrhea, how many days has the patient been on diarrhea? a. 3 days or more c. 7 days or more b. 12 days or more d. 14 days or more 8. For a patient with Malaria risk with any general danger sign or stiff neck, the recommended guidelines are, except: a. Quinine c. 1st dose of antibiotic b. Aspirin d. Urgent referral c. 9. For a child with ear discharge less than 14 days or ear pain leading to acute ear infection, the recommended guidelines are, except: a. Antibiotic for 10 days c. Paracetamol for Pain b. Wicking d. Follow up in 5 days 10.In a no Malaria risk area or season, theses presenting symptoms are classified as having Fever Malaria unlikely, except: a. Children with runny nose b. Measles c. Clinical signs of other possible infection d. Dehydration 11.In responding to the care concerns of children with severe disease, referral to the hospital is the essence especially if the child manifests which of the following? a. Wheezing c. Stopped feeding well b. Difficulty to awaken d. Fast breathing 12.If the child has sunken eyes, drinks eagerly, thirsty and skin pinch goes back slowly, the classification would be? a. Moderate dehydration c. Some dehydration b. No dehydration d. Severe dehydration 13.The child with no dehydration needs home treatment. Which of the following is not included in the rules for home treatment in this case? a. Know when to return to the center b. Give the child extra fluids c. Give ORS every 4 hours d. Continue feeding the child 14.A child with chest in-drawing was brought to a clinic, which of the following should the nurse decide to do? a. Let the mother bring the child home with antibiotic b. Refer the child to the hospital c. Treat wheezing d. Continue to observe the child 15.In an area with malaria risk, a client presenting with positive blood smear, no runny nose, no measles is classified as what? a. Very severe malaria c. Malaria b. No malaria d. Fever malaria unlikely

16.Child with diarrhea for 5 days was brought to a health clinic, is abnormally sleepy and drinks poorly. The classification of the child is: a. Dehydration c. Some dehydration b. Severe dehydration d. Persistent diarrhea 17.A 2 year old child with cough, no stridor, no chest in drawing, with respiratory rate of 53 bpm. This child can be classified as: a. No pneumonia c. Pneumonia b. Some Pneumonia d. Severe Pneumonia 18.When you are going to teach a mother regarding home medications, the nurse must consider that the classification of the child is on what color? a. Red c. Pink b. Yellow d. Green 19.Which of the following signs may indicate severe pneumonia or very severe disease? a. Lower chest wall goes in when child breathes in b. Lower chest wall goes out when child breathes in c. Restless and irritable d. Febrile 20.In preventing low blood sugar, what is the most affordable and primary intervention? a. Fluid replacement c. Oresol b. Breastfeeding d. Immunization Situation: Community organizing is a process by which people, health services and agencies of the community are brought together to act and solve their own problems. 21. Nurse Myke wrote a letter to PCSO asking them for assistance in their feeding programs for the communitys nutrition and health projects. PCSO then approved the request and gave Myke 50,000 Pesos and a truckload of rice, fruits and vegetables. Which phase of COPAR is being utilized? A. Preparatory B. Organizational C. Education and Training D. Intersectoral Collaboration E. Phase out 22. Ideally, How many years should the Nurse stay in the community before he can phase out and be assured of a Self Reliant community? A. 5 years C. 10 years B. 1 year D. 6 months 23. The nurse should know that Organizational plan best succeeds when i. People sees its values ii. People think its antagonistic professionally iii. It is incompatible with their personal beliefs iv. It is compatible with their personal beliefs A. i and iii B. i and ii C. ii and iv D. i and iv

24. One of the critical steps in COPAR is becoming one with the people and understanding their culture and lifestyle. Which critical step in COPAR will the Nurse try to immerse himself in the community? A. Integration C. Social Mobilization B. Ground Work D. Mobilization 25. The Actual exercise of people power occurs during when? A. Integration C. Social Mobilization B. Ground Work D. Mobilization 26. Which steps in COPAR trains indigenous and informal

leaders? A. Ground Work B. Core Group formation

C. Mobilization D. Integration

27. As a PHN, One of your role is to organize the community. Nurse Jen knows that the purposes of community organizing are i. Move the community to act on their own problems ii. Make people aware of their own problems iii. Enable the nurse to solve the community problems iv. Offer people means of solving their own problems A. i, ii, iii B. i, ii C. ii, ii, iii, iv D. i, ii, iv

28. Setting up Committee on Education and Training is in what phase of COPAR? A. Preparatory B. Organizational C. Education and Training D. Intersectoral Collaboration E. Phase out 29. This is considered the first act of integrating with the people. This gives an in depth participation in community health problems and needs. A. Residing in the area of assignment B. Listing down the name of person to contact for courtesy call C. Gathering initial information about the community D. Preparing Agenda for the first meeting 30. In community health Nursing, the basic recipient of care is the: A. individual C. family B. community D. municipality