IMCI

2. B y
Mohammed said
Under supervision of
Prof Dr, Nehad Dabous

3. INTEGRATED MANAGEMENT
OF CHILDHOOD ILLNESS
Goals for today
1. Identify key causes of childhood mortality
2. Explain the meaning and purpose of integrated case management
3. Describe the major steps in the IMCI strategy
4. Introduce use of IMCI tools including chart booklet, wall posters
5. and case management sheets
6. Child Health: Global Profile
7. IMCI Rationale, objectives, components
8. Principles of integrated care
9. IMCI Case Management Process

4. •Children in low-middle income countries
10x more likely to die before reaching 5th
birthday
•More than 50 countries had childhood
mortality rates over 100 per 1,000 live
births
•5.9 million children under age five died in
2015,
nearly 16 000 every day
•83% of deaths in children under age five are
caused by infectious, neonatal or nutritional
conditions

5. •7 in 10 ten deaths
are due to ARI ,
diarrhea, measles,
malaria or
malnutrition
•Major contributors
to child deaths
through the year
2020

6. 53 million women give birth each
year without professional help
Global child death rates have been
reduced by 14% over the past decade
Eight babies in the first month of their
lives die every minute world-wide

8. Causes of Death in Children
Under-
nutrition
53%

10. LEADING CAUSES OF DEATH
2014 UNICEF REPORT
1. Preterm birth complications (17%)
2. Pneumonia (15 %)
3. Labor and delivery complications (11%)
4. Diarrhea (9 %)
5. Malaria (7 %)
Almost half of under five deaths are
associated
with malnutrition

11. FACTORS ASSOCIATED WITH
MORTALITY:
Poorest households
Rural areas
Low rates of maternal education
Mortality also varies by country depending
on the prevalence of HIV and malaria
Children die from more than one condition at
once

12. GEOGRAPHICAL DISTRIBUTION
• Half of under-five deaths occur in five
countries:
India (21%)
Nigeria (13%)
Pakistan
Democratic Republic of the Congo
China

14. PROGRESS MADE
• Under-five deaths worldwide have declined:
12.7 (12.6, 13.0) million in 1990
5.9 (5.7, 6.4) million in 2015
19,000 fewer children dying every day
48 million children under five saved since
2000

20. Reasons for an IMCI Strategy
Most children have more than
one condition at one time
 Lack of diagnostic tools (labs or
radiology)
 Providers rely on patient history,
signs, and symptoms for
diagnosis
 Need to refer to a higher level of
care for serious illnesses
• Illnesses are interrelated
• Illnesses should not be only
tested, but also prevented

21. • Poor quality of care at all levels
• Vertical delivery mechanisms
characterized by low efficiency

22. • Many sick
children poorly
assessed
• Improperly
treated
• Parents poorly
advised
Health Care : First –Level Facility

23. 
*scarce supply of
drugs and
equipment
•minimal/
non-existent
diagnostic support

24. • Few opportunities
for MD to practice
complicated
procedures
•Reliance on history
of signs and
symptoms

25. •Infant and
young child
feeding
Lack of access
to safe water &
sanitation
Underlying Factors

26. High fertility, poor birth spacing

27. Community and environment

28. •Lack of access
to basic social
services
•Inadequate care
for women

29. • In 1995 WHO and UNICEF developed a
strategy known as Integrated Management of
Childhood Illness (IMCI). IMCI integrates
case management of the most common
childhood problems, especially the most
important causes of death.

31. IMCI IN EGYPT
The Government of Egypt adopted the IMCI
strategy in 1997 with the aim to accelerate
reduction in under-five mortality. In the year
2000, the under-five death rate was 47/1000
live-births2 and most deaths were caused by
neonatal conditions (44%), pneumonia (15%)
and diarrhoea (13%).3

32. A national IMCI program was established
and a national plan for scaling-up IMCI
activities was adopted in 1999, with the
target that all primary healthcare (PHC)
units in the country should provide care in
accordance with IMCI by 2010.

33. In 2007, the proportion of PHC facilities
implementing IMCI reached 84% and there
was an internal demand to assess the
impact.

35. • IMCI implementation was associated
with a doubling in the annual rate of under-five
mortality reduction (3.3% in 2000 vs 6.3% in
2006).
• This mortality impact is plausible, since
substantial improvements occurred in quality of
care provided to sick children in health facilities
implementing IMCI.

37. THE IMCI PROCESS
• List of conditions to check in children an
infants
• Assess and treat children for all conditions
that are present
• Standardized algorithms guide
management and decision to transfer to
higher care

39. WHO CAN USE IMCI?
• The IMCI process can be used by all doctors,
nurses and other health professionals who
see young infants and children less than five
years old.
• It is a case management process for a first-
level facility, such as a clinic, health center or
an outpatient department of a hospital.

41. Objectives
•Reduce illness,
disability and death
from common
childhood
illnesses

42. To promote improved growth and
development among
under-5 children

43. An evidence- based syndromic approach can be used to determine the:
Health
problem/s
Severity of
the condition
Actions

44.  Improving the health system to
deliver IMCI
IMCI Components
Improving case management
skills of health workers

45. Improving family and
community practices

46. IMCI Component 1:
Improves Health Worker Skills
• Case management guidelines
• Training of health providers (Doctors ,
Medical Assistants & Nurses) who look after
sick infants and children up to 5 years (pre-
service and in-service)
• Follow-up after training
46

47. IMCI Component 2:
Improves Health Systems
Targets first level health
facilities
Organization of work
Availability of drugs and
supplies
Monitoring and supervision
Referral pathways and
systems
Health information systems
47

48. IMCI Component 3:
Improves Family and Community Practices
To improve the knowledge, attitude and practices of
families mainly the mothers regarding Key Family
practices which include :-
• Exclusive Breastfeeding
• Complementary feeding
• Cont. feeding during illness.
• Using of iodized salt
• Routine vaccination
• Regular growth monitoring.
• Early care seeking.
• Compliance to provider advice
• Home care of sick children
• Recognition of severe illness
48

49. IMCI Component 4:
Improves Family and Community
Practices
Proper waste disposal.
Use of LLTN.
Antenatal care
TT for pregnant ladies.
Proper nutrition for pregnant ladies.
49

50. VOLUNTEERS WERE TRAINED ON KEY FAMILY
PRACTICES AND COMMUNICATIONSKILLS.

51. PRINCIPLES OF INTEGRATED CARE
IMCI guidelines
address most, but
not all, of the
major reasons a
sick child is
brought to a
clinic.

52. A combination of
individual signs
leads to a child’s
classification/s
rather than a
diagnosis

53. Counseling of caretakers an
essential component

54. IMCI management use a limited
number of essential drugs

55. All sick children must be examined for “general
danger signs” -- immediate referral or hospital
admission

56. All sick children must be
routinely assessed for:
2 mos.-5 yrs. Old:
(cough/difficult breathing,
diarrhea, fever, ear problem)
1 week-2 mos:
(bacterial infection and
diarrhea)

57. Nutritional, immunization status,
feeding problems , care for
development and other problems

58. Only a limited number of carefully-
selected clinical signs are used
(sensitivity and specificity
to detect disease)

59. A combination of individual signs
leads to a child’s classification/s
rather than a diagnosis;
classifications are color-coded

60. IMCI Case Management Process
Classify
Assess
Identify Treatment
Treat/Refer
Counsel
Follow-Up
Classify
Identify Treatment
Treat/Refer
Counsel
Assess
Follow-Up
Assess
Identify Treatment

61. Check for General Danger Signs
Convulsions
Lethargy/unconsciousness
Inability to drink/breastfeed
Vomiting
Assess Main Symptoms
Cough/difficulty breathing
Diarrhea
Fever
Ear Problems
Assess Nutrition , Immunization
status , Care for Development
and Other Problems

63. Classify conditions/identify treatment actions
Pre-referral Treatment
Advise Parents
Refer Child
Urgent Referral
OUT-PATIENT
HEALTH FACILITY
REFERRAL
FACILITY
Emergency Triage
& Treatment (ETAT)
Diagnosis
Treatment
Monitoring &
Follow-up

64. OUT-PATIENT
HEALTH FACILITY
Treatment at OP Health Facility
•Treat Local Infections
• Give oral drugs
• Advise/teach caretaker
• Follow-Up
OUT-PATIENT HEALTH FACILITY
Treatment at OP Health Facility

65. HOME
Caretaker is counseled on:
Home treatment
Feeding & fluids
When to return immediately
Follow-up
Home Management

69. Vertical” health programmes and an individual
health worker
Separate
disease specific
clinical
guidelines & trg.
materials
National
programmes
conduct disease
specific trg.
courses
“Integration” of
clinical guidelines
by the health
worker

70. IMCI and an Individual Health Worker
Integrated
clinical
guidelines &
trg. materials
National
programmes
collaborate in
integrated training
courses
Integrated
clinical case
management

71. For many sick children a single diagnosis
may not be apparent or appropriate
 Presenting complaint
 Cough and/or fast
breathing
 Lethargy/
unconsciousness
 Measles rash
 “Very sick” young infant
 Possible cause/
associated condition
 Pneumonia, Severe anemia, P.
falcifarum malaria
 Cerebral malaria , Meningitis,
Severe dehydration,Very severe
Pneumonia
 Pneumonia, Diarrhea,
Ear Infection
 Pneumonia , Meningitis,
Sepsis

72. Interventions included in IMCI guideline
for first-level health workers
Conditions covered by
case mgt. Interventions
Preventive
interventions
Generic
Version
ARI, Diarrhea, Dehydration,
Persistent Diarrhea,
Dysentery,
Meningitis, Sepsis,
Malaria, Measles,
Anemia, Malnutrition, Ear
Infection
Immunizations
during sick child
visits, Nutrition
counseling,
Breastfeeding
support, Vit. A
supplementation
Using the
IMCI
Adaptation
Guide
HIV/AIDS,
Dengue Hemorrhagic
Fever, Wheeze,
Sore Throat
Periodic
Deworming

73. Mgt.of sick
children
Nutrition Immunization Other
Disease
prevention
Growth &
Devt.
IMCI as a key strategy
For improving child health

74. BENEFITS OF IMCI
 Addresses major child health problems – The strategy
addresses the most important causes of childhood
death and illness
 Promotes prevention as well as cure – In addition to
its focus on treatment, IMCI also provides the
opportunity for important preventive interventions
such as immunization and improved infant and
child nutrition, including breastfeeding

75. Benefits of IMCI
• IMCI improves health worker performance
and their quality of care.
• IMCI can reduce under-five mortality and
improve nutritional status, if implemented well;
• IMCI is worth the investment, as it costs up to
six times less per child correctly managed
than current care

76. BENEFITS OF IMCI
 Cost-effective Inappropriate management of childhood
illness wastes scarce resources. Although increased
investment will be needed initially for training and
reorganization, the IMCI strategy will result in cost savings.
 Improves equity – Nearly all children in the developed
world have ready access to simple and affordable preventive
and curative care. Millions of children in the developing
world, however, do not have access to this same life-saving
care. The IMCI strategy addresses this inequity in global
health care.

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