Management of childhood illness
Every day, millions of children with potentially fatal illness are taken by their
caregivers to be seen by health workers. In countries with a high burden of
child mortality, a handful of conditions are responsible for these visits.
Globally, over 80% of the underfive deaths are due to neonatal conditions and
infectious diseases like pneumonia, diarrhoea, malaria, measles and
meningitis, often compounded by malnutrition. Most childhood deaths can be
prevented with effective interventions that are feasible for implementation,
even in resource constrained settings.
Children brought for medical treatment, especially in the low and middle-
income countries, are often suffering from more than one condition. At the first
level of primary health care services, diagnostic supports such as laboratory
and radiology services are commonly limited or non-existent. Health care
providers therefore benefit when they can use evidence-based algorithms
using history, signs and symptoms to determine the course of management.
This enables them to provide quality care and make the best use of the
available resources.
To improve access and quality of care for newborns and children in primary
health care services, WHO and UNICEF designed the Integrated
Management of Childhood Illness (IMCI) strategy. The IMCI strategy aims at
improving health worker skills, improving the health system and improving
family and community practices. The aim is to strengthen prevention and
management of common childhood illnesses, including in the newborn period,
and support children’s healthy growth and development.
Mother waiting at the clinic Sierra Leone Credit Direct Relief
What is Integrated Management of Childhood Illness (IMCI)?
IMCI is an integrated approach that focuses on the health and well-being of
the child. IMCI aims to reduce preventable mortality, minimize illness and
disability, and promote healthy growth and development of children under five
years of age. IMCI includes both preventive and curative elements that can be
implemented by families, in communities and in health facilities.
The strategy includes three main components:
Improving case management skills of healthcare providers;
Improving health systems to provide quality care;
Improving family and community health practices for health, growth and
development.
In health facilities, the IMCI strategy promotes the accurate identification of
childhood illnesses in outpatient settings, ensures appropriate combined
treatment of all major conditions that affect a young child, strengthens the
counselling of caretakers, and speeds up the referral of severely ill newborns
and children. In the home setting, it promotes appropriate care seeking
behaviours, improved nutrition and support for early childhood development,
prevention of illness, and correct implementation and adherence to treatment.
Why is IMCI better than single-condition approaches?
IMCI considers each child that is brought to a health service in a holistic way.
The clinical algorithms take into account the variety of conditions that may
affect a newborn or child and put them at risk of preventable mortality or
impaired growth and development. By facilitating an integrated assessment
and combined treatment of conditions, IMCI focuses on effective case
management and prevention of disease, and contributes to healthy growth
and development, including through immunization and nutritional and
developmental counselling.
What are the key requirements for IMCI implementation?
Implementation of the IMCI strategy requires a great deal of coordination
among health programmes and services at national and sub-national (or
district) levels. It involves working closely with and within ministries of health,
local governments, and communities to plan for implementation based on the
local context. Examples of key requirements are:
The adoption of a national policy and standards on an integrated approach to
child health and development.
Regular review and updating of IMCI clinical guidelines with adaptation to the
country’s epidemiology, medicines and commodities, relevant policies, and
local foods and language used by the population.
Improving quality of care in primary health facilities by training, mentoring and
support supervision of health workers in integrated assessment, treatment and
effective counseling of caregivers.
Ensuring availability of the essential medicines, laboratory tests and key
equipment for prevention and case management.
Strengthening referral pathways and improving quality of care in hospitals for
management of severely ill children referred from the outpatient clinics.
Empowering families and communities to prevent disease, seek timely care
from qualified health care providers for illness, provide adequate home care
for sick children, and support children’s healthy growth and development.
What has been the impact of IMCI?
Since the introduction of IMCI in the mid 1990’s, over 100 countries have
adopted and implemented the strategy, either in part or all of its three
components. Evidence suggests that if fully implemented, IMCI contributes to
reduction in child mortality. A Cochrane review by Gera et al in 2016 found
that the strategy was associated with a 15% reduction in child mortality when
activities were implemented at scale in health facilities and communities.
Over the years, programme reviews have shown that IMCI implementation is
influenced by different political, epidemiological, and social contexts. Three
major determinants of effective implementation coverage are:
political leadership to ensure an enabling environment;
strengthened health systems based on empowered, recognized, motivated,
supplied, and supported frontline health workers; and
empowered communities that can hold systems accountable and utilize IMCI
services.
To achieve the Sustainable Development Goal target 3.2 of reducing child
mortality to at least 25 or less deaths per 1000 live birth by 2030, it is
paramount that key components of IMCI are implemented at scale, especially
in countries with a high burden of preventable childhood mortality.
