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8/2/2019 Commed IMCI
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IMCI STRATEGY
Integrated Management of
Childhood Illness
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Figure 1: Distribution of 11.6 million deaths among
children less than 5 years old in all developing
countries,1995
Perinatal
18%Other
32%
Malnutrition
54%
Malaria
5%
Acute
Respiratory
Infections
( ARI )
19%
Diarrhoea
19%
Measles
7%
• * Approximately 70%of all childhood deaths
are associated with one
or more of these 5
conditions
• Based on data taken from The Global Burden of Diaease 1996 ,edited by Murray CJL and Lopez AD, and Epidemiologic evidence for a potentiating effect of malnutrition on child mortality, Pelletler DL, Frongillo EA andHablcht JP, AMJ Public Health 1993;83:1130-1133
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Integrated management of childhood
illness (IMCI) Objectives
• To reduce significantly global mortality and
morbidity associated with the major causesof disease in children
• To contribute to healthy growth anddevelopment of children
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Integrated Management of Childhood
Illness (IMCI) Components
• Improving case management skills of health workers
─ standard guidelines
─ training (pre- and in- service)
─ Follow-up after training
• Improving the health system to deliver IMCI
─ essential drug supply and management
─ organization of work in health facilities
─ management and supervision
• Improving family and community practices
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Integrated Management of
Childhood Illness (IMCI)
Birth 1 week 2 months 5 years
Pregnancy
IMCI case management guidelines
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For many sick children a single diagnosis may
not be apparent or appropriate
Presenting complaint
Cough and/or fast breathing
Lethargy or unconsciousness
Measles
“Very sick” young infant
Possible cause or associated condition
Pneumonia
Severe anemia
P. falciparum malaria
Celebral malaria
Meningitis
Severe dehydration
Very severe pneumonia
Pneumonia
DiarrheaEar infection
Pneumonia
Meningitis
Sepsis
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Integrated management of childhood illness (IMCI)
as a key strategy for improving child health
Nutrition ImmunizationManagement of
sick children
Other disease
prevention
Promotion of growth and
development
Integrated management of Childhood illness (IMCI)
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Figure 4: Interventions currently included in the IMCI strategy
Promotion of growthPrevention of disease
Community/home based
interventions to improve nutrition
-insecticide – impregnated bednets
Home
Health -Vaccination
services -Complementary feeding andbreastfeeding counseling
-Micronutrient supplementation
Response to sickness(“curative care”)
-Early case management
-Appropriate care seeking
-Compliance with treatment
-Case management of: ARI,
Diarrhea,measles,malaria,
Malnutrition, other serious
infection.
-Complementary feeding andbreastfeeding counseling
-Iron treatment
-Antihelminthic treatment
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IMCI Brings it All Together
Case management
Guidelines and training
for individual diseases
Integrated casemanagement guidelinestraining and follow-up
HealthWorkerskills
Health education
activities for
individual diseases
Interventions toimprove family andcommunity practices
Family andcommunity
Drug supply and management
District management of health services
Health system reform
Healthsystem
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Many programmes benefit from the IMCI strategy
Programme What IMCI offers
ARI and CDD Integrated case management
EPI Less missed opportunities
Malaria control Improved care of childhood malariaPromotion of bednets
Maternal health Opportunity to discuss mother’s health
and provide services
Nutrition Locally adapted feeding guidelines
Nutrition and breastfeeding
counseling
Essential drugs Drug policies for childhood diseases
Standard treatment guidelines
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Benefits of Integrated Management of
Childhood Illness (IMCI) The IMCI strategy:
• Addresses major health problems
• Responds to demand• Is likely to have a major impact on health
status
• Promotes prevention as well as cure
• is cost-effective
• Promotes cost saving
• Improves equity
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THE INTEGRATED CASE MANAGEMENT PROCESS
OUTPATIENT HEALTH FACILITY
Check for DANGER SIGNS
• Convulsions
• Abnormally sleepy or difficult to awaken• Unable to drink/breastfeed
• Vomits everything
Assess MAIN SYMPTOMS
• Cough/difficulty breathing
• Diarrhea• Fever
• Ear problems
Assess NUTRITION, IMMUNIZATION and VITAMIN A SUPPLEMENTATION STATUS and POTENTIAL
FEEDING PROBLEMS
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Check for OTHER PROBLEMS
CLASSIFY CONDITIONS andIDENTIFY TREATMENT ACTIONS
According to color-coded treatment
Treatment at outpatient health facility
OUTPATIENT HEALTH FACILITY
• Treat local infection• Give oral drugs
•Advise and teach caretaker• follow-up
Home management
HOME
Caretaker is counselled on:• Home treatment(s)• Feeding and fluids• When to return
Immediately•
Follow-up
Urgent referral
OUTPATIENTHEALTH FACILITY
• Pre-referral treatments• Advise parents• Refer child
REFERRAL FACILITY • Emergency Triage and
Treatment (ETAT)• Diagnosis• Treatment
• Monitoring and follow-
up
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IMCI Key Family Practices
1. Breast feed infants exclusively for at least six (6)months.
2. Starting at six (6) months of age, feed children with
freshly prepared energy and nutrient rich
complementary foods, while continuing to
breastfeed up to two (2) years or longer.
3. Ensure that children receive adequate amount of
micro-nutrients ( Vitamin A and Iron, in particular ),
either in their diet or through supplementation.
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4. Dispose of feces, including children’s feces safely; and
wash hands after defecation, before preparing meals andbefore feeding children.
5. Take children as scheduled to complete a full course of
immunizations (BCG, OPV, DPT and Measles) beforetheir first birthday.
6. Protect children in malaria-endemic areas by ensuring that
they sleep under insecticide-treated bednets.
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7. Promote mental and social development by responding to a
child’s needs for care and through talking, playing, and
providing a stimulating environment.
8. Continue to feed and offer more fluids including breast
milk when they are sick.
9. Give sick children appropriate home treatment for
infections.
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10. Recognize when sick children need treatment outside the
home and seek care from appropriate providers.
11. Follow the health worker’s advice about treatment,
follow-up and referral.
12. Ensure that every pregnant woman has adequate
antenatal care.
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GLOBAL UPDATES
• Antibiotic treatment of severe and non-
severe pneumonia
• Low osmorality ORS and antibiotictreatment for bloody diarrhoea
• Treatment of ear infections
• Infant feeding
• Treatment of helminthiasis
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ANTIBIOTIC TREATMENT OF
SEVERE ANDNON-SEVERE PNEUMONIA
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NON-SEVERE PNEUMONIA
• In low HIV prevalent countries three days of antibiotictherapy (oral amoxicillin and cotrimoxazole) should beused in children 2 months up up 5 years
• Where antimicrobial resistance to cotrimoxazole ishigh oral amoxicillin is the better choice
• Oral amixicillin should be used twice daily at a dose of 25 mg/kg per dose.
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SEVERE PNEUMONIA
• Children with wheeze and fast breathing and/orlower chest indrawing should be given a trial of
rapid-acting inhaled bronchodilator before theyare classified as pneumonia and prescribedantibiotics.
• Where referral is difficult and injection is notavailable, oral amoxicillin could be given tochildren with severe pneumonia.
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VERY SEVERE PNEUMONIA
• Injectable ampicillin plus injection
gentamicin is a better choice than injectable
chloramphenicol for very severe pneumoniain children 2-59 months of age
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LOW OSMOLARITY
AND ANTIBIOTICTREATMENT FOR
BLOODY DIARRHEA
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LOW OSMOLARITY ORS
• Countries should now use and manufacture
the low osmolarity ORS for all children
with diarrhoea but keep the same label toavoid confusion.
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TREATMENT OF
BLOODY DIARRHOEA• Ciprofloxacin is the most appropriate drug
in place of nalidixic acid which leads to
rapid development of resistance.Ciprofloxacin is given in a dose of 15
mg/kg two times per day for three days by
mouth.
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ZINC IN THE MANAGEMENT
OF DIARRHOEA
• Along with increased fluids and continued
feeding, all children with diarrhoea should
be given zinc supplementation for 10-14
days.
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TREATMENT OF
FEVER/MALARIA• Artemether-Lumefantrine (CoartemTM)
• Artesunate (3 days) plus Amodiaquine
• Artesunate (3 days) plus SP in areas where SP efficacyremains high
• SP plus amodiaquine in areas where efficacy of bothamodiaquine and SP remain high.This is mainly limitedto countries in West Africa.\
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TREATMENT OF EAR
INFECTIONSOral amoxicillin is a better choice for the
management of acute ear infection in
countries where antimicrobial resistance toco-trimoxazole is high. Chronic ear
infection should be treated with topical
quinolone ear drops for at least two weeksin addition to dry ear-wicking.
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INFANT FEEDING
EXCLUSIVE BREASTFEEDING
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EXCLUSIVE BREASTFEEDING
up to 6 months (180 days) of age
• Breastfeed as often as the child wants, day and night, atleast 8 times in 24 hours.
• Breastfeed when the child shows signs of
hunger:beginning to fuss, sucking fingers, or movingthe lips.
• Do not give other foods or fluids
• Only if the child is older than 4 months, and-appearshungry after breastfeeding, And-is not gaining weightadequately, add complementary foods (listed under 6
months up to 23 months). Give 1 or 2 tablespoons of these foods 1 or 2 times per day after breastfeeding.
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COMPLEMENTARY FEEDING
6 MONTHS UP TO 23 MONTHS
• Breastfeed as often as the child wants
• Give adequate servings of complementary foods: 3times per day if breastfed, with 1-2 nutritious snacks, asdesired, from 9 to 23 months.
• Give foods 5 times per day if not breastfed with 1 or 2cups of milk.
• Give small chewable items to eat with fingers. Let thechild try to feed self, but provide help.
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MANAGEMENT OF SEVERE
MALNUTRITION WHERE
REFERRAL IS NOT POSSIBLE
• Where a child is classified as having severe
malnutrition and referral is not possible, the
IMCI guideline should be adapted to
include management at first-level facilities.
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HIV AND INFANT FEEDING• In areas where HIV is a public health problem all
women should be encouraged to receive HIV testing andcounselling.
• If a mother is HIV-infected and replacement feeding isacceptable, feasible, affordable, sustainable and safe forher and her infant, avoidance of all breastfeeding isrecommended. Otherwise, exclusive breastfeeding isrecommended during the first months of life.
• The child of an HIV-infected mother who is not beingbreastfed should receive complementary foods as
recommended above.
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TREATMENT FOR
HELMINTHIASIS• Helminth Infestations in children
below 24 months
• Albendazole and mebendazole can be
safely used in children 12 months orolder.
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THANK YOU……..