ª
ª

ª 
 

  ª
(an approach to strengthen the provision of
comprehensive and essential health package to
children)

     

 eneral Objective:

b At the of the four hours of Lecture-Discussion

the participants will acquire the general
knowledge, skills and attitude needed for the
application of IMCI strategy in the care of sick
children.
 „pecific Objectives:
1. Trace the history of IMCI in the Philippines.
2. Discuss the rationale for an Evidence-based
„yndromic approach to case management of sick
children
3. Appreciate the Integrated case management process
which includes:
a. Assessment of the sick child or infant
b. Classify the illness
c. Identify the specific treatment
d. Treat the child
e. Counsel the caretaker
f. ive follow-up care
 ª
ª   
 Integrates management of most common
childhood problems
 Includes preventive interventions
 Adjust curative interventions to the capacity
and functions of the health system
 Involves the family members and the
community in the health care process
  ªM
ª  
 Children accounts 30-70% of all patients in
out-patients clinics
 „tudents have rare opportunities to develop
essential out-patient skills
 IMCI guidelines define the most essential
knowledge and skills needed to effectively
manage sick children.
ª 
 
 Infant and Childhood Mortality
 Quality of Care

Improvement in Child Health are not

necessarily dependent on the use of
sophisticated and expensive technologies but
rather on effective strategies that are based
on holistic approach.
 M  ª
ª
 Diagnostic tools are minimal or non-existent
 Drugs and Equipments are scarce
 Overlap of conditions
 Health Workers have few opportunities to
practice complicated clinical procedures
 Relies on History and signs and symptoms
    !"
#
 $$  




 A more integrated approach to managing sick

children is needed to achieve better outcomes

 Child Health programs need to move beyond

addressing single disease to addressing the
overall health and well-being of the child
"%     #&
 to reduce death and the frequency and
severity of illness and disability

 to contribute to the improved growth and

development
This program target children less than 5 years
old because this age group bears the highest
burden of deaths from common childhood
diseases.

Careful and systemic assessment of common

symptoms and well-selected specific clinical
signs provides sufficient information to guide
rational and effective action.


$  
$$ &
 Improvement in the case management skills of
health staff through the provision of locally
adapted guidelines on IMCI and activities to
promote their use
 Improvement in the overall health system
required for effective management of
childhood illness
 Improvement in family and community health
care practices.
 ß$  ª
&
 All sick children must be examined for ’   #' which
indicate the need for immediate referral or admission to hospital
 All sick children must be routinely assessed for major symptoms
 For children age 2 months up to 5 years
 Cough
 Diarrhea
 Fever
 Ear Problem
 For young infants age 1 week up to 2 months
 Bacterial infection
 Diarrhea
They must be routinely assessed for nutritional status, feeding
problems and other potential problems.
 Only a limited number of carefully-selected
clinical signs are used based on evidence of the
sensitivity and specificity to detect disease.
 A combination of individual signs leads to a child͛s
classification rather than a diagnosis.
 The IMCI guidelines address most, but not all the
major reasons a sick child is brought to a clinic.
 IMCI management procedures uses a limited
number of essential drug and encourage active
participation of caretakers in the treatment of
children.
 An essential component of the IMCI guidelines is
counseling of caretakers about home
management including counseling about feeding,
fluids and when to return to a healthy facility.
 ($

   
 )
  ($  * 
 Assessment of sick children includes:
 history taking and communicating with the
caretaker about the child͛s problem
 Checking for general danger signs
 Checking main symptoms
 Checking nutritional status
 Assessing the child͛s feeding
 Checking immunization status
 Assessing other problems
  +  

(
,   +
„teps to good communication:
 listen carefully to what the caretaker
says
 Use words the caretaker understand
 ive the caretaker time to answer
questions
 Ask additional questions when the
caretaker is not sure about the
answer

+    &
-  ,    ( " (
 +    &
 The child has had convulsion
 The child is conscious or lethargic
 The child is unable to drink or breastfeed
 The child vomits everything
b If the child has one or more of these signs,
he/she must be considered seriously ill and
will almost always need referral

b In order to start treatment for severe illnesses

without delay, the child should be quickly
assessed for the most important causes of
serious illness and death (ARI, diarrhea, fever,
nutritional status)

+
 
$

The eneric IMCI clinical guidelines suggest the
4 main symptoms
 Cough or difficulty in breathing
 Diarrhea
 Fever
 Ear problem
 ª

(. #(

Illness is not a contraindication to

immunization; sick children may be even more
in need of protection provided by
immunization than well children. A vaccine͛s
ability to protect is not diminished in sick
children.
 À(


 (   
  

(. 
+  
 Children who are being referred urgently to the hospital should
not be immunized

 Live vaccines (BC, measles, polio, yellow fever) should not be

given to children with immunodeficiency disease or to children who
are receiving immunosuppressive agents or radiation.

 DPT2, DPT3 should not be given to children who have had

convulsion or shock within 3 days of a previous dose of DPT

 DPT should not be given to children with recurrent convulsion or

other active neurological disease of the CN„
   $"

Address the child͛s other complaints and asks
questions about the caretaker͛s heath.

-
 $(  +  
IMCI classifications are not necessarily specific
diagnosis, but they indicate what action needs
to be taken.
 ª ª
ª ( 
   
 ߪ/ calls for hospital referral or admission

 xM for initiation of treatment

  means that the child can be sent home

with careful advice on when to return.
IMCI case management in Outpatient Health Facility,
First level Referral Facility & Home for sick child 2
months-5 year
The Integrated Case Management rocess

Outpatient Health Facility

Check for Danger „igns

‹Conclusion
‹Lethargy/Unconsciousness
‹Inability to drink/Breastfeed
‹Vomiting