June 29, Community Medicine III

Integrated Management of Childhood Illness

2015
Djhoanna Aguirre-Pedro, MD

Objectives of this session: Mortality is poorest in those with no education,

 To define IMCI rural area, and poverty.
 To identify the targets and objectives of IMCI
 To identify the different strategies and activities of
IMCI
Why was IMCI created?
-for mother's with young children
-for children in urban/ rural areas
-for those without diagnostic tools (in primary
healthcare) (limited supplies/ human resources)
IMCI aims to:
 Reduce childhood mortality
 Improve the quality of care for major
childhood illnesses

Top causes of child mortality (Every year, 6.6 Million

die ---- most due to preventable diseases) OBJECTIVES OF IMCI
 Acute respiratory infections 1. To strengthen the concept of integrated health care
 Diarrhea of children in health services
 Measles 
Changing the focus of the attention to the
 Malaria overall health status of the child

 Malnutrition (death – infection cycle) Thus making it possible to identify the
principal health problems that affect
Factors of Poor Health children
1. Poor access to health facilities (road also?) 2. To strengthen the planning and response
2. Access to education (mother) capacity of the primary care level
3. Food security (due to poverty) Providing health personnel at that level with the
4. Lack of basic resources [help prevent spread of necessary tools to:

diseases (clean water, toilet)] Address the problems that most frequently

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 June 29, Community Medicine III
Integrated Management of Childhood Illness
2015
Djhoanna Aguirre-Pedro, MD
cause child health problems; and b. Reduce costs as Philippines work to
 achieve these objectives:
The most frequent reasons for health services
visits by children.  To reduce morbidity and mortality associated
3. To achieve greater equity in access to good with the major causes of disease in children.
health care for children  To promote healthy growth and development
Making available to the population of children
appropriate technologies for the diagnosis and
treatment of the most common health problems. How can IMCI help manage sick infants and
children? (OPD)
Integrated Strategy  Who, usually, take/s sick child/ children to a
 Most sick children present with signs and first-level health facility*? [Tatay, nanay
symptoms of more than one condition. (usual), yaya, kapitbahay?]
 ..more than one diagnosis may be necessary.  What are the usual complaint or signs and
 When a child has several conditions.. symptoms of child/ children taken to a first
therapies for those conditions may need to be level health facility? [Ubo - pulmonya; lagnat -
combined. pulmonya/ dehydration (some are fatal;
 Care needs to focus on the child as a whole pwede ring constellations of signs and
and not just the diseases and conditions symptoms)]
affecting the child (TAO PO! Address them
properly). IMCI strategy promotes:
In the home setting
What does integrated management mean?  It promotes appropriate care seeking behaviors
It can give you instruction. It will not just tell  Improved nutrition and preventative care
you what to do, it will tell you after what you're  The correct implementation of prescribed care
going to do with the mother. Assess and treat the Tutulog-tulog, must be taken sa tertiary/ secondary
patient will all the symptoms that are present. hospital
- counselling for feeding (kasama sa IMCI
What is the benefit of integrated case management)
management? - di agad nagbibigay ng levofloxacin sa bata! not co-
 IMCI guides the health care provider through amox agad, mahal at resistance! Pag sinabing
comprehensive care pitong araw, pitong araw!
 IMCI also helps the health care provider to give In outpatient settings
rapid and affordable interventions.  The accurate identification of childhood illnesses
 Ensures appropriate combined treatment of all
Implementation of the IMCI strategy in countries major illnesses
involves the following three components (must  Strengthens the counselling of caretakers
know):  Speeds up the referral of severely ill
1. Improvements in the case management skills of In the Philippines, IMCI was started on a pilot
health-care staff. (So they will not go to basis in 1996
traditional healers rather to healthcare Thereafter more health workers and
providers) hospital staff were capacitated to implement
2. Improvements in the health system required for the strategy at the frontline level
effective management of childhood illness.
3. Improvements in family and community health
practices. Definition of terms:
IMCI is age-specific because young infants and
(IF) there is improved coordination + quality of children show different signs of illness.
existing services in the Philippines = Up to 2 months of age – young infant
a. IMCI strategy will increase the Age 2 months up to 5 years – child
effectiveness of care

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June 29, Community Medicine III
Integrated Management of Childhood Illness
2015
Djhoanna Aguirre-Pedro, MD

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 June 29, Community Medicine III
Integrated Management of Childhood Illness
2015
Djhoanna Aguirre-Pedro, MD

Basis for Classifying the Child’s Illness

The child’s illness is classified based on a color-coded 5. Convulsions
triage system: 6. Not able to drink or feed anything
Pink – indicates urgent hospital referral or admission 7. Vomits everything
8. Has chest indrawing (sign of impending danger pa
lang!)
9. Is unusually sleepy or unconscious
10. Shows red on the MUAC strap
Key points: 11. Has swelling of both feet
There are eleven danger signs for which a child
must be referred to a health facility: Characteristics of the Strategy of IMCI
1. Cough for 21 days or more 1. Assessment of the child and identification of
2. Diarrhea for 14 days or more danger signs
3. Diarrhea with blood in the stool A. Convulsions
4. Fever for 7 days or more B. Intractable Vomiting

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 June 29, Community Medicine III
Integrated Management of Childhood Illness
2015
Djhoanna Aguirre-Pedro, MD
C. Poor feeding Poor Questions
D. Decrease sensorium - Do you remember how to mix the ORS?
2. Assessment of the child with - Should you breastfeed your child?
 Difficult breathing - Have you used ointment on your child before?
 And identification of signs of pneumonia - Do you know how to give extra fluid?
3. Assessment of the child diarrhea and - Will you remember to wash your hands?
identification of signs of dehydration
4. Assessment of fever and identification of signs of Good Checking Questions
pneumonia, malaria or measles. - How will you prepare the ORS solution?
5. Assessment of ear problems. - How often should you breastfeed your child?
6. Identification of signs of malnutrition - On what part of the eye do you apply the
7. Assessment of child’s immunization status. ointment?
8. Treatment of illnesses and health problems - How much extra fluid will you give after each
detected. loose stool?
9. Education of the mother and/or care giver on - Why is it important for you to wash your hands?
home care of the child.
Look for Signs of Severe malnutrition
Strategies/ Principles of IMCI The two signs are:
- All sick children aged 2 months up to 5 years are - Red on Mid Upper Arm Circumference (MUAC)
examined for general danger signs strap
- All sick young infants birth up to 2 months are - Swelling on both feet
examined for VERY SEVERE DISEASE, LOCAL
BACTERIAL INFECTION
- The children and infants are then assessed
for main symptoms
o For sick children, the main symptoms
include cough or difficulty breathing,
diarrhea, fever and ear infection
o For sick young infants, local bacterial
infection, diarrhea and jaundice
o All sick children are routinely assessed for
nutritional, immunization, and deworming
status and for other problems
- Only a limited number of clinical signs are used
- A combination of individual signs leads to a
child’s classification within one or more
symptom groups rather than a diagnosis. (like
kung may ubo, masakit tainga, nag-tatae)
- IMCI management procedures use limited
number of essential drugs (i.e. paracetamol and CONCLUSION:
antibiotics) and encourage active participation  The risk of becoming ill and dying is reduced
of caretakers in the treatment of children (they through vaccination, use of oral rehydration
will be the ones who will give the ORS) -ORS - therapy, treatment of pneumonia with antibiotic,
very effective! and use of the therapeutic and preventive
- Counseling of caretakers on home care, correct measures.
feeding and giving of fluids, and when to return  The strategy of IMCI contributes efficiently to the
to clinic is an essential component of IMCI prevention, early detection, and treatment of the
principal child health problem.

-end-
Aral mabuti! 

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