IMCI

JANE RABURU
INTRODUCTION
• 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 under-five deaths are due to neonatal
conditions and infectious diseases like pneumonia, diarrhea, 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.
INTRODUCTION
• 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.
Definition
• 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.
Components of IMCI
• 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.
Contd
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?

• It involves working closely with and within ministries of health, local

governments, and communities to plan for implementation based on
the local context.
• Implementation of the IMCI strategy requires a great deal of
coordination among health programmes and services at national and
sub-national (or district) levels.
Key requirement
• 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.
•
Requirements contd
• 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.
WHO CAN USE IMCI CASE
MANAGEMENT PROCESS
• The IMCI process can be used by doctors, nurses and other health
professionals who see sick infants and children aged from 1 week up
to five years.
• It is a case management process for a first-level facility such as a
clinic, a health centre or an outpatient department of a hospital.
IMCI CASE MANAGEMENT PROCESS
• The complete IMCI case management process involves the following elements:
[Link] a child by checking first for danger signs (or possible bacterial infection in a young
infant), asking
• questions about common conditions, examining the child, and checking nutrition and
immunization status.
• Assessment includes checking the child for other health problems.

2. Classify a child’s illnesses using a colour-coded triage system. Because many children have
more than one condition, each illness is classified according to whether it requires:
— urgent pre-referral treatment and referral (red), or
— specific medical treatment and advice (yellow), or
— simple advice on home management (green).
IMCI CASE MANAGEMENT PROCESS
[Link] classifying all conditions, identify specific treatments for the
child.
• If a child requires urgent referral, give essential treatment before the
patient is transferred.
• If a child needs treatment at home, develop an integrated treatment
plan for the child and give the first dose of drugs in the clinic.
• If a child should be immunized, give immunizations.
IMCI CASE MANAGEMENT PROCESS
[Link] practical treatment instructions, including teaching the caretaker
how to give oral drugs, how to feed and give fluids during illness, and how to
treat local infections at home.
• Ask the caretaker to return for follow-up on a specific date, and teach her
how to recognize signs that indicate the child should return immediately to
the health facility.
[Link] the mother Assess feeding, including assessment of breastfeeding
practices, and
counsel to solve any feeding problems found.
6. Follow up-When a child is brought back to the clinic as requested, give
follow-up care and, if necessary, reassess the child for new problems.
Age groups in IMCI case
management process
The case management process is presented on two different sets of
charts:
• one for children age 2 months up to five years,
• one for children age 1 week up to 2 months
• Up to 5 years means the child has not yet had his or her fifth birthday.
For example, this age group includes a child who is 4 years 11 months
but not a child who is 5 years old.
• A child who is 2 months old would be in the group 2 months up to 5
years, not in the group 1 week up to 2 months.
Age groups in IMCI case
management process
The case management process for sick children age 2 months up to 5
years is presented on three charts titled:
• ASSESS AND CLASSIFY THE SICK CHILD
• TREAT THE CHILD
• COUNSEL THE MOTHER
Age groups in IMCI case
management process
If the child is not yet 2 months of age, the child is considered a young
infant. Management of the young infant age 1 week up to 2 months is
somewhat different from older infants and children.
• It is described on a different chart titled:
• ■ ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT
IMCI CHART BOOKELET OR GUIDE
The IMCI case management charts and recording forms guide you
through the following steps:
• Assess the sick child or sick young infant
• Classify the illness
• Identify treatment
• Treat the child or young infant
• Counsel the mother
• Give follow-up care
• The case management steps are the same for all sick children from
age 1 week up to 5 years. However, because signs, classifications,
treatments and counselling differ between sick young infants and sick
children, it is essential to start the case management process
• by selecting the appropriate set of IMCI charts.
CONTD
• The ASSESS AND CLASSIFY chart describes how to assess the child, classify the
child’s illnesses and identify treatments.
• The ASSESS column describes how to take a history and do a physical
examination. You will note the main symptoms and signs found during the
examination in the ASSESS column of the case recording form.
• The CLASSIFY column on the ASSESS AND CLASSIFY chart lists clinical signs of
illness and their classifications. Classify means to make a decision about the
severity of the illness.
• For each of the child’s main symptoms, you will select a category, or
“classification,” that corresponds to the severity of the child’s illnesses. You will
then write your classifications in the CLASSIFY column of the case recording
form.
• ASSESS AND CLASSIFY CHART CASE RECORDING FORM

• ASSESS
• CLASIFY • IDENTIFY
TREATMENT

ASSESS CLASSIFY
• Identify treatment
• The IDENTIFY TREATMENT column of the ASSESS AND CLASSIFY chart
helps
• you to quickly identify treatment for the classifications written on
your case recording form. Appropriate treatments are recommended
for each classification. When a child has more than one classification,
you must look at more than one table to find the appropriate
treatments.
• You will write the treatments identified for each classification on
the reverse side of the case recording form
CONTD
• Treat the child
The IMCI chart titled TREAT THE CHILD shows how to do the treatment
steps identified on the ASSESS AND CLASSIFY chart.
TREAT means giving treatment in clinic, prescribing drugs or other
treatments to be given at home, and also teaching the caretaker how to
carry out the treatments.
CONTD
• Counsel the mother
• Recommendations on feeding, fluids and when to return are given on the chart titled
COUNSEL THE MOTHER. For many sick children, you will assess feeding and counsel
the mother about any feeding problems found.
• For all sick children who are going home, you will advise the child’s caretaker about
feeding, fluids and when to return for further
• care.
• You will write the results of any feeding assessment on the bottom of the case
• recording form. You will record the earliest date to return for “follow-up” on the
reverse
side of the case recording form. You will also advise the mother about her own health.
• Give follow-up care
Several treatments in the ASSESS AND CLASSIFY chart include a follow-
up visit.
At a follow-up visit you can see if the child is improving on the drug or
other treatment that was prescribed. The GIVE FOLLOW-UP CARE
section of the TREAT THE CHILD
• chart describes the steps for conducting each type of follow-up visit.
Headings in this section correspond to the child’s previous
classification(s).
• If this is an INITIAL VISIT for the problem, follow the steps given.
• (If this is a follow-up visit for the problem, give follow-up care according
to )Check for general danger signs.
• Ask the mother or caretaker about the four main symptoms:
• cough or difficult breathing,, and
• diarrhoea,
• fever, and
• ear problem.
• When a main symptom is present: assess the child further for signs related
to classify the illness according to the signs which are present or absent
CONTD
• Check for signs of malnutrition and anaemia and classify the child’s
nutritional status.
• Check the child’s immunization status and decide if the child needs
any immunizations today.
• Assess any other problems.
• Then: Identify Treatment, Treat the Child
and Counsel the Mother.
When a child is brought to the
clinic-all sick children age 2
months up to 5 years
• GREET the mother appropriately and ask about her child.
LOOK to see if the child’s weight and temperature have been recorded
• ASK the mother what the child’s problems are.

Use Good Communication Skills: In doing the above

• Listen carefully to what the mother tells you
• Use words the mother understands
• Give the mother time to answer the questions
• Ask additional questions when the mother is not sure about her answer
CONTD
• DETERMINE if this is an initial visit or a [Link]-up visit for this p
Problem-INITIAL VISIT for the problem ASSESS and CLASSIFY the child
following the guidelines.
• GIVE FOLLOW-UP CARE according to the guidelines.
General danger signs
• For ALL sick children ask the mother about the child’s problem, then
• CHECK FOR GENERAL DANGER SIGNS

• STUDY THE CHART BOOKLET TO GUIDE

C0MMUNITY COMPONENT OF THE
IMCI
• HOUSEHOLD PRACTICES
• KEY FAMILY PRACTICES IN CHILD CARE
1. EXCLUSIVE BREASTFEEDING. Breastfeed infants exclusively for up to 6 months10.
(Mothers found to be HIV positive require counselling about possible alternatives
to breastfeeding)
2. COMPLEMENTARY FEEDING. Starting at about 6 months of age, feed children
freshly prepared energy and nutrient rich complementary foods, while continuing
to breastfeed up to two years or longer.
3. MICRONUTRIENTS. Ensure that children receive adequate amounts of
micronutrients (vitamin A and iron, in particular), either in their diet or through
supplementation.
CONTD
4HYGIENE. Dispose of faeces, including children’s faeces, safely and wash
hands after defecation before preparing meals and before feeding children.
5. IMMUNIZATION. Take children as scheduled to complete a full course of
immunizations (BCG, DPT, OPV and measles) before their first birthday.
6. MALARIA: USE OF BEDNETS. Protect children in malaria-endemic areas, by
ensuring that they sleep under insecticide-treated bednets.
7. PSYCHOSOCIAL DEVELOPMENT. Promote mental and social development by
responding to a child’s needs for care and through talking, playing and
providing a stimulating environment.
CONTD
[Link] CARE FOR ILLNESS. Continue to feed and offer more fluids,
including breastmilk, to children when they are sick.
9. INFECTIONS. Give sick children appropriate home treatment for
infections.
10. CARE-SEEKING. Recognize when sick children need treatment
outside the home and seek care from appropriate providers.
11. COMPLIANCE WITH ADVICE. Follow the health worker’s advice
about treatment, follow-up and referral.
CONTD
[Link] CARE. Ensure that every pregnant woman has adequate
antenatal care. (This includes having at least four antenatal visits with
an appropriate health care provider and receiving the recommended
doses of the tetanus toxoid vaccination.
The mother also needs support from her family and community in
seeking care at the time of delivery and during the postpartum and
lactation period).
CONTD
• In the International Workshop on improving children’s health and nutrition
in communities, held in Durban, South Africa, 20–23 June 2000, these 12
practices were endorsed and four additional practices proposed.
• These practices need to be further defined and reviewed and relate to the
following areas:
• HIV/AIDS prevention and care for sick orphans;
• active involvement of men in child care and reproductive health initiatives;
• prevention of child abuse and neglect, taking appropriate action when that
occurs; and
• taking appropriate action to prevent and manage injuries and accidents
CONTD
To provide the type of care highlighted in the above list, families need:
• Knowledge about what to do;
• Skills to provide appropriate care;
• Motivation to try and sustain new practices; and
• Support for care, social and material needs from the community and
the health system.
READ
• FANC
• ESSENTIAL OBSTETRIC CARE
• TARGETED PNC
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