Integrated Management of Childhood illness (IMCI) Approach to School care

Adebola E. OrimadegunInstitute of Child Health

College of MedicineUniversity of Ibadan

Introduction• What is IMCI?– Is the integrated strategy that combines and links

together existing child health programs.– Is an evidenced based, syndrome approach to

case management that supports the rational, effective and affordable use of drugs and diagnostic tools.

• A joint WHO/UNICEF initiative since 1992

Objectives of IMCI:• To reduce significantly mortality and

morbidity associated with the major cause of diseases in children• To promote improved growth and

development of children.

Major causes of death in under five, 2002

ARI 18%

Diarrhea 15%

Malaria 10%

Measles 5%HIV/AIDS4%

Perinatal23%

Other25%

Deaths assoc. withmalnutrition

54%

Essential IMCI Drugs at Health Facilities

Oresol Oral antibiotics(1st line – CotrimoxazoleOral anti malarial1st line-Chloro quine and Primaquine2nd line – Aretemether LumefrantineNalidixic Acid TabletsTetracycline tablets

Iron Vitamin AParacetamolVaccineMebendazole /AlbendazoleTetracycline eye ointmentGentian violetVitamin AChloramphenicol IM(optional)Gentamicin IM (optional)Benzyl Penicillin IM(Optional)

Other Essential Equipments and Supplies:

Equipments:1-weighing scale2-timing devices3-refrigerator with voltage regulator4-sterilizers5-BP apparatus6-pediatric cuff7-oral thermometer

Supplies:1-cold chain supplies and immunization supplies2-ORT supplies3-water jars4-IV fluid (plain LR and insertion sets 0 5-sterile water for dilutions6-plaster, cotton swab, tongue depressors 7-70% ethyl alcohol

IMCI

• The IMCI training was designed to teach integrated management of sick infants and children to first level health workers in primary care settings that have NO laboratory support and only a limited number of essential drugs.

The IMCI Management

Process

• Action-oriented CLASSIFICATIONS , rather than EXACT DIAGNOSES are used.

• A careful balance has been struck between SENSITIVITY and SPECIFICITY.

• Using FEW CLINICAL SIGNS as possible which health workers of diverse background can be trained to recognize.

• The IMCI guidelines rely on detection of cases based on SIMPLE CLINICAL SIGNS without laboratory tests and offer EMPIRIC TREATMENT.

IMCICASE MANAGEMENT PROCESS1. Health worker assesses the sick child. - IDENTIFY any danger sign present (unable to

feed and drink, vomits everything, convulsion, difficult to awaken or abnormally sleepy)

- ASK about the four(4) main symptoms cough, diarrhea, fever, and ear problem - REVIEW nutrition, Vitamin A and

immunization

IMCI2. Health worker CLASSIFIES child’s illness

using a color-coded triage: PINK = urgent referral YELLOW = specific medical treatment

and advice GREEN = simple advice on home care

IMCI

3. Heath worker then identifies SPECIFIC TREATMENT.

- an INTEGRATED TREATMENT PLAN is developed

IMCI

4. TREATMENT INSTRUCTIONS are carried out: oral drugs, ORS, treat local infections, signs to come back immediately, when to return for routine follow-up.

5. COUNSELING mothers.6. Follow-UP instructions when the child returns

to clinic.

IMCI

Management of sick children

Nutrition Immunization Other diseasePrevention Promotion of growth and development

Integrated Management of Childhood Illness (IMCI)

IMCICHILD HEALTH INTERVENTIONS IN IMCICase Management Interventions: Pneumonia Malaria Diarrhea Malnutrition - dehydration Anemia - persistent diarrhea Measles - dysentery Ear infection

Meningitis Sepsis

IMCI

• Preventive interventions:–Immunization during sick child visits

–Nutrition counseling

–Breastfeeding

IMCI

• Identification and provision of treatment–Rehydration (diarrhea, DHF)–Antibiotics ( e.g. pneumonias)–Antimalarial –Vitamin A