INTEGRATED MANAGEMENT ON CHILDHOOD ILLNESSES(IMCI)

Presented by: Vernalin B. Terrado, RN Aileen Mitch Presented to: Prescilla Vidal

INTEGRATED MANAGEMENT ON CHILDHOOD ILLNESSES

INTRODUCTION

IMCI
IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI has already been introduced in more than 75 countries around the world.

AIMS:
1. Improve skills of health providers 2. Speed up the referral of sick children 3. Promote appropriate health-seeking behaviours 4. Emphasize disease prevention through immunisation and improved nutrition

5 major killers of children:

Diarrhea Acute Respiratory

Infections (Pneumonia)

Measles Malaria Malnutrition

Inequities of Child Health

World Analysts say that this Global Burden of Disease indicate that these conditions will continue to be major contributors to child deaths through the year 2020 unless significantly greater efforts are made to control them. A. Infant and childhood mortality are sensitive indicators of inequity and poverty 1. children who are most commonly and severely ill, who are malnourished and who are most likely to die of their illness are those of the most vulnerable and underprivileged populations of low-income countries; 2. even within middle-income and so-called industrialized countries, there are often neglected geographical areas where childhood mortality remains high; 3. millions of children are often caught in the vicious cycle of poverty and ill health. poverty leads to ill health and ill health breeds poverty.

B. Quality of care is another important indicator of inequities in child health. Everyday, millions of parents seek health care for their sick children, taking them to hospitals, health centers, pharmacists, doctors, and traditional healers. 1. Surveys reveal that many sick children are not properly assessed and treated by these health providers, and that their parents are poorly counseled;

2. At 1st level health facilities in low-income countries, diagnostic supports e.g. x-ray & laboratory services are minimal or non-existent, and drugs and equipment are often scarce;

3. Limited supplies and equipment, combined with an irregular flow of patients, leave doctors at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs & symptoms to determine a source of management that makes the best use of available resources.

Figure 1. Proportion of Global Burden of Selected Diseases Borne by Children Under 5 Years (Estimated, Year 2000)
ARI Malaria

Children 0-4 years

Children 0-4 years

All Ogther Age Groups

All Ogther Age Groups

Diarrhoea

Children 0-4 years

Children 0-4 years

All Ogther Age Groups

All Ogther Age Groups

Measles

And so, the IMCI strategy, using the case management method targets children less than 5 years old the age group that bears the highest burden of deaths from common childhood diseases.

World Analysts say that this Global Burden of Disease indicate that these conditions will continue to be major contributors to child deaths through the year 2020 unless significantly greater efforts are made to control them

How Can this Situation be Reversed ? How Can we Provide Quality Care to Sick Children ?

Experience and evidence show that improvements in child health are not necessarily dependent on the use of sophisticated and expensive technologies bur rather on effective strategies that are based on a : (1) holistic approach, (2) are available to the majority of those in need, and (3) which take into account the capacity and structure of health systems as well as traditions and beliefs in the community.

IMCI PRINCIPLES

Principles of Integrated Care:

All sick children MUST be examined for general danger signs which indicate the need for immediate referral or admission to a hospital. All sick children MUST be routinely assessed for major symptoms (for children age 2 months up to 5 years: cough or difficult breathing, diarrhea, fever, ear problems; for young infants are 1 week up to 2 months: bacterial infections and diarrhea). They must also be routinely assessed for nutritional and immunization status, feeding problems, and other potential problems. Only a limited number of carefully-selected clinical signs are used, based on evidence of their sensitivity and specificity to detect disease.
(These signs were selected considering the conditions and realities of first level health facilities).

A combination of individual signs lead to a childs

classification(s) rather than a diagnosis. Classification(s) indicate the severity of condition(s).

They call for specific actions based on whether the child: (a) should be urgently referred to another level of care, (b) requires specific treatments (such as antibiotics or anti-malarial treatment), or (c) may be safely managed at home.
The classifications are colour coded: pink - suggests hospital referral or admission, yellow - indicates initiation of treatment, and green - calls for home treatment.

The IMCI Approach addresses most, but not all, of A child returning with chronic problems or less common illnesses may require special care. The IMCI guidelines do not describe the management of trauma or other acute emergencies due to accidents or injuries. IMCI management procedures use a limited children. An essential component of the IMCI guidelines is the counselling of caretakers about home management, including counselling about feeding, fluids and when to return to a health facility.

the major reasons a sick child is brought to a clinic.

number of essential drugs and encourage active participation of caretakers in the treatment of

The IMCI Case Management Process

OUT PATIENT HEALTH FACILITY

Check for DANGER SIGNS Convulsions Lethargy/Unconsciousness Inability to drink/breastfeed Vomiting

Assess MAIN SYMPTOMS Cough / difficulty breathing Diarrhea Fever Ear Problems
PINK Urgent Referral OUTPATIENTHEALTH FACILITY Pre-referral treatments Advise Parents Refer Child Assess NUTRITION and IMMUNIZATION STATUS And POTENTIAL FEEDING PROBLEMS Check for OTHER PROBLEMS CLASSIFY CONDITIONS and IDENTIFY TREATMENT ACTIONS According to colour-coded treatment
YELLOW Treatment at Outpatient Health Facility OUTPATIENT HEALTH FACILITY Treat Local Infections Give Oral Drugs Advise & Teach Caretakers Follow-up GREEN Home Management HOME Caretakers is counselled on: Home treatment(s) Feeding & Fluids When to return immediately Follow-up

REFERRAL FACILITY Emergency Triage & Treatment (ETAT) Diagnosis Treatment Monitoring & Follow-up

First Steps
1. Triage: Age, Name, Weight and Temp 2. Greet the mother and ask what the childs problems are : 3. Determine if this is an initial or follow up visit: Initial visit 1st visit for this episode of an illness or problem Follow-up visit- the child has been seen a few days ago for the same illness - if the childs condition improved, still the same or is getting better

. 4. Decide which age group the child is in:

Age 1 week up to 2 months, use the chart: ASSESS,
CLASSIFY AND TREAT THE SICK YOUNG INFANT

Age 2 months up to 5 years, use the chart: ASSESS

AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

General Danger signs

Check ALL sick children for general danger signs Signs of severe illness that can occur in all serious illnesses, whatever the cause Children with danger signs will need:
Urgent referral to hospital Lifesaving treatment

Check for general danger signs:

Child is not able to drink or breastfeed
o
too weak to drink and is not able to suck or swallow when offered a drink or o Breast-feed o if not sure: ask mother to offer child a drink of clean water or breast milk o A child may have difficulty sucking when his nose is blocked. If the nose is blocked, clean it.

Child vomits everything

o a child is not able to hold anything down at all o if in doubt, offer the child water

Child has had convulsions(during this illness)

o arms and legs stiffen because muscles are contracting o the child may lose consciousness or not be able to respond to spoken directions or o handling, even if eyes are open o fits or spasms or jerky movements

Note: Shiver is not convulsion. There is no loss of

consciousness.

Child is lethargic or unconscious (abnormally sleepy or difficult to awaken) o drowsy and does not show interest in what is happening

around him o stare blankly and appear no to notice what is going on around him o does not respond when touched, shaken or spoken to.

4 MAIN SYMTPOMS Cough or difficult breathing Diarrhea Ear pain Fever

CLASSIFY THE ILLNESS I M C I Color Coding

Needs urgent attention and referral or admission for in-patient care. This is a severe classification

Child needs an appropriate antibiotic, an oral antimalarial or other treatment which can be given in health center

Does not need specific medication / treatment such as antibiotic. Can be manage at home by mother