for mera

3. Integrated Management of Childhood Illness
•Child Health: Global Profile
•IMCI Rationale, objectives,
components
•Principles of integrated care
•IMCI Case Management Process

4. •Children in low-middle
income countries 10x
more likely to die
before reaching 5th
birthday
•More than 50
countries had childhood
mortality rates over 100
per 1,000 live births

5. •7 in 10 ten deaths
are due to ARI ,
diarrhea, measles,
malaria or
malnutrition
•Major contributors
to child deaths
through the year
2020

6. Study of 163 countries,
SAVE THE CHILDREN, 2001
53 million women give birth each
year without professional help
Global child death rates have been
reduced by 14% over the past decade
Eight babies in the first month of their
lives die every minute world-wide

7. Causes of Death in Children
Under-
nutrition
53%

9. • Many sick
children poorly
assessed
• Improperly
treated
• Parents poorly
advised
Health Care : First –Level Facility

10. 
*scarce supply
of drugs and
equipment
•minimal/
non-existent
diagnostic support

11. • Few opportunities
for MD to practice
complicated
procedures
•Reliance on history
of signs and
symptoms

12. WHO/UNICEF/DOH
Regional Child
Survival Strategy
and
Assessment of
Philippine Situation

13. •Infant and
young child
feeding
Lack of access
to safe water &
sanitation
Underlying Factors

14. High fertility, poor birth spacing

15. Community and environment

16. •Lack of access
to basic social
services
•Inadequate care
for women

18. Reasons for an IMCI Strategy
•Most children have more
than one condition at one
time
• Illnesses are interrelated
• Illnesses should not be
only tested, but also
prevented

19. • Poor quality of care at all levels
• Vertical delivery mechanisms
characterized by low efficiency

21. Objectives
•Reduce illness,
disability and
death from
common
childhood
illnesses

22. To promote improved growth and
development among
under-5 children

23. An evidence- based syndromic approach can
be used to determine the:
Health
problem/s
Severity of
the condition
Actions

24.  Improving the health system
to deliver IMCI
IMCI Components
Improving case management
skills of health workers

25. Improving family and
community practices

26. Principles of Integrated Care
IMCI guidelines
address most, but
not all, of the
major reasons a
sick child is
brought to a
clinic.

27. A combination of
individual signs
leads to a child’s
classification/s
rather than a
diagnosis

28. Counseling of caretakers an
essential component

29. IMCI management use a limited
number of essential drugs

30. All sick children must be examined for
“general danger signs” -- immediate
referral or hospital admission

31. All sick children must be
routinely assessed for:
2 mos.-5 yrs. Old:
(cough/difficult breathing,
diarrhea, fever, ear problem)
1 week-2 mos:
(bacterial infection and
diarrhea)

32. Nutritional, immunization status,
feeding problems , care for
development and other problems

33. Only a limited number of carefully-
selected clinical signs are used
(sensitivity and specificity
to detect disease)

34. A combination of individual signs
leads to a child’s classification/s
rather than a diagnosis;
classifications are color-coded

35. IMCI Case Management Process
Classify
Assess
Identify Treatment
Treat/Refer
Counsel
Follow-Up
Classify
Identify Treatment
Treat/Refer
Counsel
Assess
Follow-Up
Assess
Identify Treatment

36. Check for General Danger Signs
Convulsions
Lethargy/unconsciousness
Inability to drink/breastfeed
Vomiting
Assess Main Symptoms
Cough/difficulty breathing
Diarrhea
Fever
Ear Problems
Assess Nutrition , Immunization
status , Care for Development
and Other Problems

37. Classify conditions/identify treatment actions
Pre-referral Treatment
Advise Parents
Refer Child
Urgent
Referral
OUT-PATIENT
HEALTH FACILITY
REFERRAL
FACILITY
Emergency Triage
& Treatment (ETAT)
Diagnosis
Treatment
Monitoring &
Follow-up

38. OUT-PATIENT
HEALTH FACILITY
Treatment at OP Health Facility
•Treat Local Infections
• Give oral drugs
• Advise/teach caretaker
• Follow-Up
OUT-PATIENT HEALTH FACILITY
Treatment at OP Health Facility

39. HOME
Caretaker is counseled on:
Home treatment
Feeding & fluids
When to return
immediately
Follow-up
Home Management

40. Vertical” health programmes and an
individual health worker
Separate
disease specific
clinical
guidelines & trg.
materials
National
programmes
conduct disease
specific trg.
courses
“Integration” of
clinical guidelines
by the health
worker

41. IMCI and an Individual Health Worker
Integrated
clinical
guidelines &
trg. materials
National
programmes
collaborate in
integrated training
courses
Integrated
clinical case
management

42. For many sick children a single diagnosis
may not be apparent or appropriate
 Presenting complaint
 Cough and/or fast
breathing
 Lethargy/
unconsciousness
 Measles rash
 “Very sick” young infant
 Possible cause/
associated condition
 Pneumonia, Severe anemia,
P. falcifarum malaria
 Cerebral malaria , Meningitis,
Severe dehydration,Very severe
Pneumonia
 Pneumonia, Diarrhea,
Ear Infection
 Pneumonia , Meningitis,
Sepsis

43. Interventions included in IMCI guideline
for first-level health workers
Conditions covered by
case mgt. Interventions
Preventive
interventions
Generic
Version
ARI, Diarrhea, Dehydration,
Persistent Diarrhea,
Dysentery,
Meningitis, Sepsis,
Malaria, Measles,
Anemia, Malnutrition, Ear
Infection
Immunizations
during sick child
visits, Nutrition
counseling,
Breastfeeding
support, Vit. A
supplementation
Using the
IMCI
Adaptation
Guide
HIV/AIDS,
Dengue Hemorrhagic
Fever, Wheeze,
Sore Throat
Periodic
Deworming

44. Mgt.of sick
children
Nutrition Immunization Other
Disease
prevention
Growth &
Devt.
IMCI as a key strategy
For improving child health

45. IMCI Vision
All Filipino children have access and equity to
quality health care services supported with
empowered families and communities capable of
sustained actions that will ensure a child friendly
environment conducive to development of the full
potential of the child by 2025.

46. “ Lo, children are an
heritage of the
LORD..” Psalm 127: 3a
“..And the King shall
answer and say unto
them, Verily I say
unto you, Inasmuch
as ye have done it
unto one of the least
of these my
brethren, ye have
done it unto me.”
Matthew 25:40

48. Resources
• WHO. Department of Child and Adolescent Health and
Development. Model Chapter for Textbooks –IMCI , 2001
•news.bbc.co.uk/olmedia/1535000/images/_153685.
September, 2001
•DOH Report presented during IMCI National Program
Implementation Review, December 2006
•http://www.who.int/child_adolescent_health/
•topics/prevention_care/child/imci/en/index.html
•http://www.google.images.com
•http://greenhealthinformation.com/wp-content/pic/healthy_children.jpg
•http://web.ivenue.com/standrewlutheranchurch/images/children.jpg
•http://www.ibiblio.org/obl/docs/yearbooks/images/Photo-RC010.gif
•http://hamilton.co.nz/images/1151.jpg