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 OCT222015

IMCI in the Philippines B. Classify

- using a colour-coded triage system
• Started as a pilot basis in 1996  Urgent pre-referral treatment and referral
(RED)
• Health workers and hospital staff were
 Specific medical treatment and advice
capacitated to implement the strategy at the (YELLOW)
frontline level  Simple management (GREEN)

Accelerating Implementation of IMCI in the C. Treat the child

Philippines 2015-2025 I. Identify specific treatments for the child
- If requires urgent referral, give essential
General objective: treatment before transfer
- To accelerate IMCI implementation all over the • If needs treatment at home, develop an
country. integrated treatment plan and give the first
dose of drugs in the clinic
Specific objectives: By 2025, • If should be immunized, give immunizations
- To establish IMCI-ICATT training units and core
trainers in all regions of the country II. Provide practical treatment options
- To implement IMCI in at least 80% of primary • teach caretaker how to give oral drugs
health care facilities (barangay health centers • how to feed and give fluids
and BHSs) • how to treat local infections
- To integrate IMCI in all medical, nursing and
midwifery schools D. Counsel
- To establish IMCI referral hospitals in all • Assess feeding, including assessment of
provinces and cities
breastfeeding practices, and counsel to solve
- To establish core IMCI activities in the
any feeding problems.
barangays. (to be identified)
• Then counsel the mother about her own health.

Integrated Case Management Process

E. Follow-up
1. Assess and Classify the sick child
2. Treat the child • Give follow-up care and if necessary, reassess
3. Counsel the child for new problem.
4. Follow-up
Selecting the appropriate case management charts
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

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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 OCT222015

Convulsion is a danger sign only when: FEVER (PAGE 4)

 Occurs in less than 6 months
 More than one episode • Fever is defined by history or feels hot or
 Occurring for more than 15 minutes temperature 37.5 0C or above (based on axillary
This definition EXCLUDES SIMPLE FEBRILE T0; rectal T0 is 0.5 0C)
CONVULSIONS • 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
COUGH OR DIFFICULTY BREATHING (PAGE 2) tender skin or boils, lower abdominal
pain or pain in passing urine in older
Rationale for management of children with wheeze children
• Wheeze can cause fast breathing and or chest
indrawing Malaria Diagnosis
Prompt parasitological confirmation by
• Good response to inhaled bronchodilator may
microscopy or alternatively by Rapid Diagnostic Tests
cause fast breathing or chest indrawing to
(RDTs) is recommended in ALL patients suspected of
disappear
malaria before treatment is started.
• Only children with wheeze and signs of
pneumonia (fast breathing and/or chest
Treatment of Very Severe Disease in Malaria risk area
indrawing) need antimicrobials
• Pre-referral treatment includes rectal
• Wheezing without signs of pneumonia only Artesunate suppository or oral Quinine and IM
need bronchodilator treatment Ampicillin and Gentamicin

Antibiotic treatment for Pneumonia Treatment of Uncomplicated falciparum malaria

• Children aged 2-59 months pneumonia (chest • Artemisinin-based combination therapies (ACTs)
indrawing and or high RR) should be treated should be used in the treatment of
with oral amoxicillin of at least 40mg/kg/dose uncomplicated P. falciparum malaria
• ACTs should include at least 3 days of treatment
twice a day for five days
with an artemisinin derivative

DIARRHEA (PAGE 3) EAR PROBLEM

Treatment for Diarrhea (See page 5)

• Use of low/reduced osmolarity Oral Rehydration
Salts (ORS) ACUTE MALNUTRITION (PAGE 6)
• Providing children with zinc for 14 days:
− Children > 6 months 20 mg zinc
− Children < 6 months 10 mg of zinc Acute Malnutrition
• Ciprofloxacin as first line drug for bloody  Look for edema of both feet
diarrhea (dysentery)  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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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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Dr. Ang OCT222015

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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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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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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