INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Basic Pediatrics

Dr. Ang OCT222015

What is IMCI? measles, malaria, or malnutrition --often in

− An integrated approach to child health that combine
focuses on the well-being of the whole child. − Many are not properly assessed and treated and
− It aims to reduce death, illness and disability, that their parents are poorly advised
and to promote improved growth and
development among children under five years
of age.
− It includes both preventive and curative
elements that are implemented by families and
communities as well as by health facilities.

Who are the children covered by the IMCI protocol?

• Sick children from birth up to 2 months (Sick
young infant)
• Sick children 2 months up to 5 years (Sick child)

What does IMCI offers?

• It offers simple and effective methods to
prevent and manage the leading causes of
serious illness and mortality in young children.
• The guidelines promote evidence-based
assessment and treatment, using a syndromic Rationale for the integrated approach in the
approach that supports the rational, effective, management of sick children
and affordable use of drugs. • Majority of deaths are caused by 5 preventable
and treatable conditions namely:
Where is it intended to be used? o pneumonia, diarrhea, measles, malaria,
The approach is designed for use in outpatient and malnutrition
clinical settings with limited diagnostic tools, limited • 3 out of 4 episodes of childhood illness are
medications, and limited opportunities to practice caused by this condition
complicated procedures. • Most children have more than one illness at one
time.
Components of IMCI strategy • Single diagnosis may not be possible or
1. Improvements in the case management skills of appropriate
health worker;
2. Improvements in the health system required to Western Pacific Region
deliver child health interventions effectively;
• 527,000 children die before their 5th birthday
3. Improvements in family and community
• 97% occurred in six countries, namely,
practices.
Cambodia, China, the Lao People's Democratic
Republic, Papua New Guinea, the Philippines,
Why IMCI?
and Vietnam
− 10M children die each year in developing
countries before they reach their 5th birthday
(1998)
− 7 in 10 deaths are due to acute respiratory
infections (mostly pneumonia), diarrhea,

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Dr. Ang
IMCI in the Philippines
• Started as a pilot basis in 1996
• Health workers and hospital staff were
capacitated to implement the strategy at the
frontline level
Accelerating Implementation of IMCI in the
Philippines 2015-2025
General objective:
- To accelerate IMCI implementation all over the
country.
Specific objectives: By 2025,
- To establish IMCI-ICATT training units and core
trainers in all regions of the country
- To implement IMCI in at least 80% of primary
health care facilities (barangay health centers
and BHSs)
- To integrate IMCI in all medical, nursing and
midwifery schools
- To establish IMCI referral hospitals in all
provinces and cities
- To establish core IMCI activities in the
barangays. (to be identified)
Integrated Case Management Process
1. Assess and Classify the sick child
2. Treat the child
3. Counsel
4. Follow-up
A. Assess
• By checking first the danger signs (or possible
bacterial infection in a young infant)
• Ask questions about common conditions
examining the child
• Check nutrition and immunization status
• Check other health problems
Basic Pediatrics
OCT222015
B. Classify
- using a colour-coded triage system
 Urgent pre-referral treatment and referral
(RED)
 Specific medical treatment and advice
(YELLOW)
 Simple management (GREEN)
C. Treat the child
I. Identify specific treatments for the child
- If requires urgent referral, give essential
treatment before transfer
• If needs treatment at home, develop an
integrated treatment plan and give the first
dose of drugs in the clinic
• If should be immunized, give immunizations
II. Provide practical treatment options
• teach caretaker how to give oral drugs
• how to feed and give fluids
• how to treat local infections
D. Counsel
• Assess feeding, including assessment of
breastfeeding practices, and counsel to solve
any feeding problems.
• Then counsel the mother about her own health.
E. Follow-up
• Give follow-up care and if necessary, reassess
the child for new problem.
Selecting the appropriate case management charts
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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Basic Pediatrics
Dr. Ang OCT222015

Summary of the Integrated Case Management Process

THE SICK CHILD (2 MONTHS TO 5 YEARS)

 Cough or difficult breathing
 Diarrhea
 Fever
 Ear problem
 Malnutrition and feeding
 Immunization status

Then check the

given handouts
(Page 1)

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Dr. Ang
Convulsion is a danger sign only when:
 Occurs in less than 6 months
 More than one episode
 Occurring for more than 15 minutes
This definition EXCLUDES SIMPLE FEBRILE
CONVULSIONS
COUGH OR DIFFICULTY BREATHING (PAGE 2)
Rationale for management of children with wheeze
• Wheeze can cause fast breathing and or chest
indrawing
• Good response to inhaled bronchodilator may
cause fast breathing or chest indrawing to
disappear
• Only children with wheeze and signs of
pneumonia (fast breathing and/or chest
indrawing) need antimicrobials
• Wheezing without signs of pneumonia only
need bronchodilator treatment
Antibiotic treatment for Pneumonia
• Children aged 2-59 months pneumonia (chest
indrawing and or high RR) should be treated
with oral amoxicillin of at least 40mg/kg/dose
twice a day for five days
DIARRHEA (PAGE 3)
Treatment for Diarrhea
• Use of low/reduced osmolarity Oral Rehydration
Salts (ORS)
• Providing children with zinc for 14 days:
− Children > 6 months 20 mg zinc
− Children < 6 months 10 mg of zinc
• Ciprofloxacin as first line drug for bloody
diarrhea (dysentery)
Basic Pediatrics
OCT222015
FEVER (PAGE 4)
• Fever is defined by history or feels hot or
temperature 37.5 0C or above (based on axillary
T0; rectal T0 is 0.5 0C)
• Decide if the area is Malaria Risk
• Look for any bacterial cause of fever
o local tenderness, oral sores, refusal to
use limb, hot tender swelling, red
tender skin or boils, lower abdominal
pain or pain in passing urine in older
children
Malaria Diagnosis
Prompt parasitological confirmation by
microscopy or alternatively by Rapid Diagnostic Tests
(RDTs) is recommended in ALL patients suspected of
malaria before treatment is started.
Treatment of Very Severe Disease in Malaria risk area
• Pre-referral treatment includes rectal
Artesunate suppository or oral Quinine and IM
Ampicillin and Gentamicin
Treatment of Uncomplicated falciparum malaria
• Artemisinin-based combination therapies (ACTs)
should be used in the treatment of
uncomplicated P. falciparum malaria
• ACTs should include at least 3 days of treatment
with an artemisinin derivative
EAR PROBLEM
(See page 5)
ACUTE MALNUTRITION (PAGE 6)
Acute Malnutrition
 Look for edema of both feet
 Determine WFH/L z-score using the WHO
growth standard charts
 Measure the Mid-Upper Arm Circumference
using MUAC tape in all children 6 months or
older
 Offer Ready-to-Use Therapeutic Food (RUTF) for
appetite test
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Appetite Test COUNSEL AND FOLLOW-UP CARE

Offer appropriate amount of RUTF to the child to eat:
• After 30 minutes check if the child was able to finish
or not able to finish the amount of RUTF given and
decide:
- Child ABLE to finish at least one-third of a
packet of RUTF portion (92 g) or 3 teaspoons
from a pot within 30 minutes.
- Child NOT ABLE to eat one-third of a packet of
RUTF portion (92 g) or 3 teaspoons from a pot
within 30 minutes.

ANEMIA

(See page 7)

HIV INFECTION (PAGE 8)

HIV Infection
• What we need to know about HIV:
- We need to ask if the mother had an HIV test
- Learn how to decide the HIV status of the
mother
- Ask about the breastfeeding status of the child
- If no test has been done, to request for the test

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Basic Pediatrics
Dr. Ang OCT222015

SICK YOUNG INFANT UP TO 2 MONTHS

Check for the following:

 Very severe disease and local bacterial infection
 Jaundice
 Diarrhea
 HIV infection
 Feeding problem or low weight for age

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Dr. Ang OCT222015

VERY SEVERE DISEASE AND LOCAL BACTERIAL

INFECTION

JAUNDICE

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DIARRHEA (PAGE 3)

What is diarrhea in a young

infant?
 A young infant has
diarrhea if the
stools have change
from usual pattern
and are many and
watery (more
water than fecal
matter).
 The normally
frequent or semi-
solid stools of a
breastfed baby are
not diarrhea.

HIV INFECTION

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Dr. Ang OCT222015

ASSESS BREASTFEEDING

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Basic Pediatrics
Dr. Ang OCT222015

FEEDING PROBLEM OR LOW WEIGHT FOR AGE

(FOR HIV EXPOSED INFANTS AND NOT BREASTFEEDING)

THEN CHECK THE YOUNG INFANT’S IMMUNIZATION AND

VITAMIN A STATUS

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Basic Pediatrics
Dr. Ang OCT222015

COUNSEL AND FOLLOW-UP CARE COMMUNICATE AND COUNSEL

GOOD CHECKING POOR QUESTIONS

QUESTIONS
How will you prepare the Do you remember how to
ORS solution? mix the ORS?

How often should you Should you breastfeed

breastfeed your child your child?

On what part of the eye do Have you used ointment

you apply the ointment? on your child before?
How much extra fluid will
Do you know how to give
you give after each loose
extra fluids?
stool?
Why is it important for you Will you remember to
to wash your hands? wash your hands?

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