Integrated
Management
of Childhood
Illnesses
The Integrated Management of Childhood Illnesses
(IMCI) has been established as an approach to
strengthen the provision of essential and
comprehensive health package to children. It was
developed in 1992 by the World Health
Organization (WHO) and the UNICEF with the
objective of early detection of the leading causes
of mortality in children like dehydration due to
diarrhea, acute respiratory infection specifically
pneumonia, measles and malaria. These
conditions are further aggravated by malnutrition.
According to the 1999 World Health
Report, children from low to middle income
countries are 10 times more likely to die
before reaching 5 years old than those
coming the rich /industrialized countries
showing that infant and childhood
mortality are clear indicators of poverty
and inequity of access to and delivery of
healthcare services and information.
COMPONENTS
IMCI is an approach that brings the
elements for improving child health with
the three components of:
1. Improving health workers' skills
2. Improving the health system
3. Improving family and community
practices
It even integrates nutrition, immunization,
vitamin supplementation, and counseling the
Methods in Managing Childhood
Illnesses
Some childhood diseases have similar symptoms that need
further assessment and observation before a diagnosis or
classification is reached and treatment is instituted. To
effectively manage childhood illnesses, a color-coded
system is utilized as follows:
COLOR CLASSIFICATION LEVEL OF
PRESENTATION OF DISEASES MANAGEMENT
GREEN MILD Home Care
YELLOW MODERATE Managed at the
RHU
PINK SEVERE Urgent referral
to hospital
IMCI Strategy
IMCI is an integrated approach to child health that focuses on
the wellbeing of the whole child. It aims to reduce death,
illness and disability and to promote improved growth and
development among children under 5 years old using the
preventive and curative aspects of care that are implemented
by families, communities and health facilities.
1. Focused assessment.
A. Danger Signs- unable to drink or breastfeed; vomits everything
taken in; has convulsions, abnormally sleepy or difficult to awaken
B. Main Symptoms- cough or cold, fast breathing, stridor, chest in-
drawing, diarrhea, signs of dehydration; fever, signs and symptoms
associated with malaria, measles, dengue; and car pain, mastoiditis.
C. NutritionalStatus
D. Immunization Status
E. Other Problems
2. Classification
A. Urgent Referral (Pink/Red)
B. Specific Treatment (Yellow)
C. Home Management (Green)
3. Treatment includes identifying the treatment,
treating, counseling and follow-up, and
counseling the caretakers and follow-up.
PRINCIPLES OF THE
INTEGRATED CLINICAL
CASE MANAGEMENT
IMCI clinical guidelines are based on the following principles :
1. Examining all sick children aged up to five years of age for general
danger signs and all young infants for signs of very severe disease.
2. The children and infants are then assessed for main symptoms.
In older children the main symptoms include:
-Cough or difficulty breathing.
-Diarrhea.
-Fever, and
-Ear infection.
In young infants, the main symptoms include:
-Local bacterial infection,
-Diarrhea, and
-Jaundice.
3. Then in addition, all sick children are routinely checked for:
-Nutritional and immunization status,
-HIV status in high HIV settings, and
-Other potential problems.
4. Only a limited number of clinical signs are used, selected on
the basis of their sensitivity and specificity to detect disease
through classification.
5. An essential component of IMCI is the counseling of
caregivers regarding home care:
-Appropriate feeding and fluids.
-When to return to the clinic immediately, and
-When to return for follow-up
IMCI Chart Booklet
This IMCI chart booklet is for use by nurses,
clinicians and other health professionals who see
young infants and children less than five years
old. It facilitates the use of the IMCI case
management process and the charts describe the
sequence of all the case management steps. The
chart booklet should be used by all health
professionals providing care to sick children to
help them apply the IMCI case management
guidelines. Health professionals should always
use the chart booklet for easy reference during
the process of clinical care.
The chart booklet is divided into two main parts
because clinical signs in sick young infants and older
children are somewhat different and the case
management procedures also
differ between these age groups:
-SICK CHILD AGED 2 MONTHS TO 5 YEARS. This
part contains all the necessary clinical algorithms,
information and instructions on how to provide care to sick
children aged 2 months to 5 years.
-SICK YOUNG INFANT AGED UP TO 2 MONTHS. This
part includes case management clinical algorithms for the
care of a young infant aged up to 2 months Each of these
parts contains IMCI charts corresponding to the main steps
of the IMCI case management process.
THANK
YOU
GROUP 1
