Integrated management of childhood illness
( IMCI)
◦ To address the illness of under five children as a whole , the World
Health Organization(WHO), in collaboration with UNICEF &
many other agencies, institutions& professional bodies developed
&introduced a strategy known as the integrated management of
childhood illness. IMCI deals with curative care as well as also
addresses aspects of nutrition ,immunization & other important
elements of disease prevention & health promotion.
◦ In our country IMCI was adopted in 1998 & implementation
started in year 2000.
Objectives of IMCI :
◦ To reduce under five mortality
◦ To reduce the frequency & severity of illness &disability
◦ To improve growth & development.
Components of IMCI
◦ Improvement in the case management skills of health care
provider
◦ Improvements in the overall health system required for
effective management of childhood illness
◦ Improvement in family &community health care practices
◦ Most common causes of under -5 deaths:
ARI ( Acute respiratory infections –
Pneumonia.),diarrhoea , measles ,malaria , malnutrition.
◦ Neonatal death accounts for > 60 % of all under -5 death.
◦ Important causes of neonatal death are – Neonatal sepsis ,
preterm low birth weight, perinatal asphyxia .
◦ Neonatal mortality rate: The probability of dying within 28
days of life ; expressed as per 1000 live birth
◦ Infant mortality rate: The probability of dying before the
first birthday; expressed per 1000 live birth
◦ Under -5 mortality: The probability of dying between birth
&the fifth birthday &; expressed per 1000 live birth .
◦ At present under-5 mortality rate , infant mortality
◦ rate &neonatal mortality rates are 46,38 &28 / 1000 live
birth respectively.
◦ Infant & childhood mortality are sensitive indicators of
inequity & poverty
The principles of integrated care :
◦ All sick children must be examined for general danger sign
◦ All sick children must be routinely assessed for major
symptom
◦ They must be routinely assessed for nutritional &
immunization status ,feeding problem & other problems
◦ Status of vit. A supplementation 6 mo - 5 yr.
◦ De-worming status for children age 1 yr- 5 yrs
◦ Child’s classification rather than a diagnosis.
The IMCI case management process :
Case management procedure based on 2 age catagories
◦ 1. Young infants: 0 day up to 2 months
◦ 2. Children aged 2 months up to 5 yrs
ON arrival of patient , health care provider will do the
following task:
At outpatient Health Facility :
◦ Assessment
◦ Classification & identification of treatment
◦ Referral, treatment of the child, counseling of the
child’s care giver
◦ Follow up care.
At referral health facility
◦ Rapid screening of sick children should be done according
to Emergency Triage assessment & treatment( ETAT).
◦ After admission diagnosis should be done by clinical
evaluation& proper investigations. Then appropriate
treatment & proper monitoring .
◦ Follow up care.
At home :
◦ Teaching mother & other care giver how to give oral drugs
& treat local infections
◦ Counseling mothers / other caregiver about :
◦ Food,
◦ Fluids
◦ When to return
◦ Her own health
General danger signs:
◦ Convulsion
◦ Lethargy
◦ Inability to drink/ breast feed
◦ Vomits every thing
Assessment of main symptom:
◦ Cough / difficult breathing
◦ Diarrhoea
◦ Fever
◦ Ear problem
Emergency Triage assessment & treatment( ETAT).
◦ Death often occurs within 24 hours of hospital admission .
Many of these death could be prevented through ETAT.
TRIAGE :Triage is the process of rapidly screening of sick
children when they first arrive in hospital & placing them in
one of the following groups
◦ Sick children with emergency sign
◦ Sick children with priority sign
◦ Sick children with neither emergency sign nor priority sign
Emergency signs are:
◦ Stridor
◦ Severe respiratory distress
◦ Central cyanosis
◦ Grunting
◦ Sign of shock( CRT > 3 sec, weak , rapid pulse)
◦ Coma
◦ Convulsion
◦ Signs suggesting severe dehydration
Priority signs
◦ Visible severe wasting
◦ Oedema of both feet
◦ Any sick young infant( < 2 months old)
◦ Lethargy , drowsiness, unconsciousness
◦ Continually restless & irritable
◦ Major burn
◦ Any respiratory distress
◦ Child with referral note from another facility