WHY DO WE NEED TO

ADOPT THE I.M.C.I.

APPROACH
OR THE
INTEGRATED
MANAGEMENT
OF CHILDHOOD ILLNESS
IN THEMarco
PHILIPPINES
?
Antonio C. Sto Tomas
Board of Nursing

Child Health Situation Based on World Health Report

Figure 1. Distribution of 10.5 million deaths among children less than 5

years old in all developing countries, 1999

Inequities of Child Health

World Analysts say that this Global Burden of Disease
indicate that these conditions will continue to be major
contributors to child deaths through the year 2020
unless significantly greater efforts are made to control
them.
A. Infant and childhood mortality are sensitive
indicators of
inequity and poverty
1. children who are most commonly and severely ill,
who are
malnourished and who are most likely to die of
their illness
are those of the most vulnerable and
underprivileged
populations of low-income countries;
2. even within middle-income and so-called
industrialized
countries, there are often neglected geographical

World Analysts
say that this
Global Burden of
Disease indicate
B. Quality of care is another important indicator of
that these
inequities in child health. Everyday, millions of
conditions will
parents
continue to be
seek health care for their sick children, taking them
major
contributors to
to
child deaths
hospitals, health centers, pharmacists, doctors, and
through the year
traditional healers.
2020 unless
significantly
1. Surveys reveal that many sick children are not greater efforts
properly assessed and treated by these health are made to
control them.

Inequities of Child Health (continued)

providers, and that their parents are poorly

counseled;

2. At 1st level health facilities in low-income

countries,
diagnostic supports e.g. x-ray & laboratory
services
are minimal or non-existent, and drugs and
equipment are often scarce;
3. Limited supplies and equipment, combined with
an
irregular flow of patients, leave doctors at this

How Can this Situation be Reversed ?

How Can we Provide Quality Care to Sick Children ?

Experience and evidence show that

improvements in child health are not
necessarily dependent on the use of
sophisticated and expensive
technologies bur rather on effective
strategies that are based on a (1)
holistic approach,
(2) are
available to the majority of those in
need, and (3) which take into
account the capacity and structure
of health systems as well as
traditions and beliefs in the
community.

Rationale for adopting an Evidence-Based

Syndromic Approach to Case Management
A more integrated approach to managing sick children is needed to achieve
better outcomes.
Child health programmes need to move beyond addressing single diseases
to addressing the over-all health and well-being of the child.
So in the mid-1990s, the WHO and UNICEF and many other agencies,
institutions, and individuals responded to the challenge by developing a
strategy known as the Integrated Management of Childhood Illness (IMCI).
Although the major reason for developing IMCI stemmed from the needs of
curative care, the strategy also addresses aspects of nutrition,
immunization, and other important elements of disease prevention and
health promotion.
The objectives of the strategy are to reduce death and the frequency and
severity of illness and disability, and to contribute to improved growth and
development.

Figure 2. Proportion of Global Burden of Selected Diseases

Borne by Children Under 5 Years (Estimated, Year 2000)

And so, the IMCI strategy, using the case management

method targets children less than 5 years old the age
group that bears the highest burden of deaths from common

Careful and
systematic
Rationale for the use of IMCI as an approach to
assessment of
Health Care
common
IMCI makes use of evidence-based, syndromic symptoms and
well-selected
approach to case management that supports
the
specific clinical
rational, effective and affordable
use
signs provide
of drugs and
diagnostic tools (evidence-based
sufficient
medicine stresses
the importance
of to
information
guide rational
evaluation of evidence from
and effective
clinical research and cautions against the use ofactions.

intuition, unsystematic clinical experience, and

untested pathophysiologic reasoning for medical decisionmaking;
a. In situations where laboratory support and clinical
resources
are limited, the syndromic approach
is a more realistic and
cost-effective way to
manage patients;
b. Careful and systematic assessment of common symptoms
and
well-selected clinical signs provides sufficient
information to
guide rational and effective actions.
c. An evidence-based syndromic approach can be used to
determine the:
* Health problem(s) the child may have;
* Severity of the childs condition;
* Actions that can be taken to care for the child

IMCI Promotes:

Careful and
systematic
assessment of
common
symptoms and
well-selected
specific clinical
signs provide
sufficient
information to
guide rational
and effective
actions.

Adjustment of the
curative interventions
to the
capacity and functions of
the health system; and
Active involvement of
family members and the
community in the health

Components of an Integrated
Approach:
Improvements in the casemanagement 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

Principles of Integrated Care:

All sick children MUST be examined for
general danger signs which indicate the need
for immediate referral or admission to a
hospital.
All sick children MUST be routinely assessed
for major symptoms (for children age 2 months
up to 5 years: cough or difficult breathing,
diarrhea, fever, ear problems; for young infants
are 1 week up to 2 months: bacterial infections
and diarrhea). They
must also be routinely
assessed for nutritional
and
immunization status, feeding problems, and
other potential problems.
Only a limited number of carefully-selected
clinical signs are used, based on evidence
of their sensitivity and specificity to detect

Principles of Integrated Care: (continued)

A combination of individual signs lead to a
childs classification(s) rather than a diagnosis.
Classification(s) indicate the severity of
condition(s). They call for specific actions
based on whether the child: (a) should be
urgently referred to another
level
of care,
(b) requires specific treatments (such
as
antibiotics or anti-malarial
treatment), or
(c) may be safely managed at home.
The classifications are colour coded:
pink
- suggests hospital referral or
admission, yellow
- indicates initiation
of treatment, and green
- calls for home
treatment.

Principles of Integrated Care: (continued)

The IMCI Approach addresses most, but not
all, of the major reasons a sick child is brought
to a clinic. A child returning with chronic
problems or less common illnesses may require
special care. The IMCI guidelines do not
describe the management of trauma or other
acute emergencies due to accidents or injuries.
IMCI management procedures use a limited
number of essential drugs and encourage
active participation of caretakers in the
treatment of children.
An essential component of the IMCI
guidelines
is the counselling of
caretakers about home management, including
counselling about
feeding, fluids
and when to return to a health
facility.

The IMCI Case Management

OUPATIENT HEALTH FACILITY
Process
Check for DANGER SIGNS
Convulsions
Lethargy/Unconsciousness
Inability to drink/breastfeed
Vomiting
Assess MAIN SYMPTOMS
Cough / difficulty breathing
Diarrhea
Fever
Ear Problems
Assess NUTRITION and IMMUNIZATION STATUS
And POTENTIAL FEEDING PROBLEMS
Check for OTHER PROBLEMS

PINK
Urgent Referral
OUTPATIENT
HEALTH FACILITY
Pre-referral treatments
Advise Parents
Refer Child
REFERRAL FACILITY
Emergency Triage &
Treatment (ETAT)
Diagnosis
Treatment
Monitoring & Follow-up

CLASSIFY CONDITIONS and

IDENTIFY TREATMENT ACTIONS
According to colour-coded treatment

YELLOW
Treatment at Outpatient
Health Facility
OUTPATIENT
HEALTH FACILITY
Treat Local Infections
Give Oral Drugs
Advise & Teach Caretakers
Follow-up

GREEN
Home Management
HOME
Caretakers is counselled on:
Home treatment(s)
Feeding & Fluids
When to return immediately
Follow-up

WHAT YOU LEARNED FROM

THESE SLIDES WILL NOT
MAKE YOU COMPLETELY
COMPETENT IN USING THE
IMCI APPROACH LEARN
SOME MORE FROM TRAINED
IMCI PROVIDERS.
GO THROUGH IT AND
MASTER
THE PROCESS.
ENJOY LEARNING AND LEARN WELL
FOR THE SAKE OF THE FILIPINO CHILDREN.