Integrated Management of Childhood Illness (IMCI) Classification:

- requires straining 1. Severe Pneumonia

- target population is less than 5 yrs old Assessment: presence of cough and cold + either danger sign
2 categories: and/or stridor in a calm child
 young infant (1 week to 2 months old) Treatment: give appropriate antibiotic (ampicillin or gentamycin
 young child (2 months to 5 yrs old) plus penicillin) and urgent referral to hospital
Goal of IMCI: 2. Pneumonia
- reduce morbidity (disease) and mortality (death) among less Assessment: cough and cold + fast breathing and/or chest
than 5 yrs old suffering from common childhood illnesses indrawing
- decrease death Treatment:
- reduce frequency and severity of illnesses and disability - oral amoxicillin 2× per day for 5 days
- contribute to the improvement of growth and development - rapid bronchodilator 5× a day
- if chest indrawing in child with HIV mother treat as pink (severe,
Assessment: requires urgent referral)
1. identify if it is a follow up or initial visit - soothe the throat (breastmilk or warm water)
2. check for danger signs (CUVA) - for 14 days cough and cold and wheezing, refer for asthma and
• Convulsion, within 3 days or now (different approach; give PTB assessment
diazepam if convulsion now) - advice when to return
• Unable to drink or breastfeed - follow up within 3 days
• Vomiting (vomits everything) 3. Cough and colds
• Abnormally sleepy/lethargic/difficult to awaken Assessment:
3. Main symtoms - No signs of Pneumonia
- cough or DOB Treatment:
- diarrhea - same with Pneumonia except antibiotic *wala naman kasi
- fever infection*
- ear problems - follow up 5 days
4. Monitor Nutrition
5. Assess immunization (RA10152) ●Diarrhea●
6. Monitor supplementation status (Vit. A, deworm: albendazole Assessment:
400mg half if less than 2 yrs old, mebendazole 500mg full doze 1. initial or follow up visit
for above 12 months|both given as early as 6 months) 2. danger signs
7. Feeding problem 3. main symptoms: diarrhea
8. HIV status Classifications:
1. Dehydration
Classifications: 3 colors (green, yellow and pink) a. Severe dehydration
Pink – severe: requires urgent referral Assess for:
Yellow – moderate - lethargy or unconscious
Green – mild - sunken eyes or sunken fontanel if less than 2 months
- not able to drink or breastfeed, drinks poorly
General Treatment: - skin pinch very slowly, lower chest or upper abdomen (poor
1. Appropriate antibiotic – ampicillin + gentamycin (give skin turgor)
q6 if referral is impossible) Treatment:
Note: if ampicillin is not available, replace it with benzyl penicillin - if no other classification, give plan C
Note: 4x the dose for suspected meningitis - if with other classification, manage and refer urgently while
2. The use of diazepam (classification treatment; given giving ORS and continuously breast feeding the child
when child is convulsing/seizing now; route: 0.5 mg/kg - antibiotic for cholera for child less than 2 yrs old in cholera area
via rectum; this is fluid administered using syringe or (places with cholera cases), cotrimoxazole for child younger than
catheter) 2 yrs old, furazolidone if cotrimoxazole is not available; 2× every
day for 3 days
Specific Conditions
●Cough and Colds● Plan A: 4 rules (home remedy/pwede gawin sa bahay)
Assessment 1. Give extra fluid (exclude milk) (includes: clean water, ORS or
1. initial or follow up visit sugar water, food-base water like buko juice or rice water) (less
2. watch for danger sign than 2 years old give extra 100 to 200 ml/loose stool if above 2
3. main symptoms (cough, cold or DOB); check for breaths per yrs and above give 200 ml
minute: 2. Give Zinc supplements (given to children above 2 months old
- 0 to 2 month – more than 60 3. Give continue feeding the child (BRAT diet)
- 2 to 12 months – more than 50 4. When to return (depending on classification)
- 1 to 5 yrs old – more than 40 Plan B:
4. check for breath sounds: - ORS in clinic for 4 hours, reassess after
- Stridor (harsh sound while breathing) Plan C: for pre-referral
- Weazing (high pitch) – give trial rapid bronchodilator - insert IV access and give isotonic solution (PNSS, and LRS)
(Albuterol); for children less than 5 yrs old use spacer 3× every 15 - refer child if unable to secure IV access within 30 minutes travel
to 20 minutes and reassess after - if not possible for referral, secure OJT or orogastric tube or
5. Chest indrawing/inward movement of lower chest wall nasogastric tube then deliver ORS, then stay rehydrated for 6
hours
- reassess every 1 to 2 hours
- refer urgently with a sip of ORS if nurse can apply OJT or NGT
 ●Malaria Only
b. Moderate or Some dehydration Assessment
- at least 2 of the following signs: - no danger sign (no stiff neck)
• restlessness - test positive for malaria test
• irritability Treatment:
• sunken eyes - 1st dose of anti-malaria drugs
• drinks eagerly/child appears thirsty - 1st dose antibiotic for other cause of fever
• skin pinch slowly (1 to 2 secs) - follow up 3 days then paracetamol for fever
Treatment: plan B
- refer if there are other severe classification ●No Malaria
- advice when to follow up Assessment
- follow up within 5 days if the child is not improving - negative malaria test, no danger sign
- fever, no malaria
c. No dehydration Treatment
Assessment: - 1st dose antibiotic
- Not enough signs and symptoms to classify as some or - paracetamol for fever
severe dehydration - follow up 3 days
Treatment: plan A
- Follow up 5 days ○ No Malaria Risk ○
● Very Severe Febrile Disease
*Plan A, B and C can be used for Dengue* Assessment
- Danger sign; stiff neck
2. Persistent Diarrhea Treatment
- more than 14 days diarrhea - antibiotic for cause of fever
Classification: - treatment of and prevention of low blood sugar
a. Severe persistent diarrhea - paracetamol for fever
Assessment: - refer
- persistent diarrhea for 14 days ●Fever
- with dehydration Assessment
Treatment: - No danger sign; no stiff neck
- Dehydration as some (treat as yellow) or severe (treat as Treatment
pink) then treat with plan and then refer - appropriate antibiotic
- follow up 3 days
b. Persistent diarrhea - refer 3 days
Assessment: ●Measles
- No dehydration - membranes are affected
Treatment: Classification:
- advice mother on feeding a child who has persistent diarrhea 1. Severe Complicated Measles
- give multivitamin (vit. A for 6 months and above) and minerals Assessment
(zinc) - any danger sign or presence of cloudy cornea
- follow up 5 days - deep or extensive mouth ulcers
c. Dysentery (infection) Treatment
Assessment: - give Vit A
- Diarrhea + blood in the stool - give appropriate antibiotic
Treatment: - tetracycline ointment 4× per day for eye complications
- ciprofloxacin for 3 days - refer
- follow up after 3 days 2. Measles with eye and mouth complications
Assessment
●Fever● - Puss draining from the eye or mouth ulcers
Assessment Treatment
- initial or follow up - appropriate antibiotic
- danger signs - genshan violet for mouth ulcer
Classification: - Tetracycline for eye
1. Malaria - advice when to return
○ malaria risk? (Magubat) - follow up 3 days
●Very severe febrile disease 4. Measles
- danger signs Assessment
- stiff neck/nuchal rigidity; torticollis - Measles now or measles within 3 months
Treatment Treatment
- 1st dose of artesunate or oral quinine - Vit. A
- 1st dose of appropriate antibiotic (ampicillin + gentamycin) ●Dengue
- treat and prevent low blood sugar; non breast feeding gives Classification:
sugar water 1. Severe dengue haemorrhagic fever
- for temp. Of 38.5 c give paracetamol Assessment:
- refer urgently - positive bleeding signs
Causative agent: - positive petechiae
- Falciparum - cold clammy skin; hypothermia: sign of impending shock
- capillary refill: more than 3 secs
- abdominal pain 3. Participatory or transformative
- vomiting - participate and transform
Treatment PAR
- stop bleeding and rehydrate Aspects – problem identification
- plan C (IV) + plus B (ORS) • problem identification
- treatment and prevention of low blood sugar • researcher
- give paracetamol: Tylenol • methods
- no ASA (has anticoagulant effect) • use of results
2. Dengue haemorrhagic fever unlikely • purpose
Assessment: Traditional research
- No sign of bleeding or SDH • individual A.
Treatment: PAR
- plan A and give ORS Phases of COPAR:
- do not give ASA 1. Pre-entry Phase (bago pumasok)
- follow up 3 days Obj. – site selection
●Ear Problem Specific act.
Assessment: (PET) - create Vision, mission, obj
- Pain - select copar staff and training
- Ear discharge (how long) - establish criteria for site selection
- Tender swelling behind ear Criteria includes DOPES
CLASSIFICATION: • depress
1. Mastoiditis • oppress
Assessment • poor
- tender swelling behind the ear • exploited
- pink classification • struggling
Treatment - less than 100 empowered families
- 1st dose of appropriate antibiotic - no safety issues
- paracetamol for pain - complaint/acceptance
- refer
2. Acute ear infection PSI – preliminary social investigation
Assessment - collect secondary data; data collected through reports
- less than 14 day of pain and ear discharge - Community Baseline Study
- (+) ear pain - Courtesy to the brgy official
Treatment - Occular inspection (windshield survey: roam around the
- amox oral 2× a day for 5 days community; spot map)
- paracetamol for pain - community profiling
- dry ear by wicking (rolled tissue paper) - community assembly
- follow up 5 days - coordinate with LGU for foster family
3. Chronic ear infection 2. Entry Phase
Assessment Obj.
- More than 14 day of ear discharge - Arrival and integration
Treatment Act.
- topical quinolone drops for 15 days - establish rapport with the people
- dry by wicking - information dissemination
- follow up 5 days - immertion or living with the people
5. No ear infection DSI – defining social investigation
Assessment - primary data
- No ear pain and discharge - core group formation (salt) means self awareness leadership
Treatment training
- None Levels of training
1. Salt
Community Organizing Participatory Action Research 2. Basic health skills training
*if the question is positive, hanapin mo lang sa choices ang 3. Project management training
positive* sabi ni sir 4. Specialized health skills training
CO – continuous and sustained process of 3 things: 5. Advanced health skills training
- Health Education – increased awareness of people to identify 3. Research Phase
problems according to needs; educated by the nurse Obj.
- Organization as a Group not as an Individual – grupo, a decision - Problem identification (analysis of the problem)
is done by the entire community Act.
- Mobilization – involving people into action - formation of research team or training
Note: until the achievement of the end goal of community - validation or actual study phase (validate the data that have
organizing = community development ends in better quality of collected)
life - summarize results
Approaches: - present results
1. Dole out also known as wellfare - prioritize problem according to needs
- worse approach 4. Organization and capability building phase
2. Western or modernization Obj.
- application of western methodology - Creation of community health organization
Act.
- election of officers
- undergo training
- team building
- ARAS (action, reflection, action session) – done through open
forums
- organization of working committees
5. Community Action Phase
- main objective is mobilization with the people
Act.
- identification of research mobilization scheme
- establish networks linkages and referrals
- PIME (problem, identification, monitoring and evaluation)
-providing solution
- develop criteria for CHWs and trainings
6. Sustenance and Sustainability Phase
Obj.
- Mobilization by the people
Act.
- continuing eval of CHOs and CHWs
- formulation of by laws
- registration with sec, security and exchange commission
- formulize linkages networks and referrals
- retraining of members for future leaders
- beginning of termination
- PHASE OUT