IMCI Dr. Bulemela Janeth (Mmed. Pead) 1IMCI for athens

WHO and UNICEF started to develop the IMCI strategy in 1992, and today more than 100 countries worldwide have adopted it. The implementation of the IMCI strategy produces impressive results, both in the decrease of childhood mortality and in improving the quality of life of young children all over the world. RATIONALE FOR AN INTEGRATED APPROACH Every year almost 10 million children die before they reach their fifth birthday. A majority of these deaths caused by just five preventable and treatable conditions IMCI for athens2

Strategy objectives Focuses on  Improving case management skills of health-care providers  Improving overall health systems  Improving family and community health practices. The current challenge for the IMCI strategy is to scale up activities to ensure the appropriate and effective use of IMCI principles and clinical guidelines by all types of health-care providers. IMCI for athens3

CHILD OF 2 MONTHS UP TO 5 YEARS how to assess a sick child and classify the child's illness. You will also how to interact with the child's mother or other caregiver who brings the child to you. The assess and classify part of the training is divided into following units: Ask the mother about the child's problems Check for general danger signs (INABILITY TO FEED, CONVULSION, LOSS OF CONSCIOUSNESS) 4IMCI for athens

Assess main symptoms among which: – Cough or difficulty breathing – Diarrhoea – Fever Check for malnutrition and anaemia Check immunization status 5IMCI for athens

After you have assessed a sick child and classified his or her illness or illnesses, the next step is to identify the necessary treatment. The oral drugs, intramuscular drugs and other treatments presented in the IMCI charts are recommended for first-level health facilities in particular country. Both first- and second-line oral antibiotics and antimalarials are included. 6IMCI for athens

First-line drugs were chosen because they are effective, easy to give and inexpensive. You should give a second-line drug only if a first-line drug is not available, or if the child's illness does not respond to the first-line drug. 7IMCI for athens

Counsel the mother A child who is seen at the clinic needs to continue treatment, feeding and fluids at home. Therefore : how to assess feeding and counsel the mother about feeding, advise the mother when to return for follow-up, and teach her the signs that mean she should bring the child back to the clinic immediately for further care. 8IMCI for athens

follow up Assess feeding and make recommendations At a follow-up visit you can see if the child is improving on the drug or other treatment that was prescribed. Some children may not respond to a particular antibiotic or antimalarial, and you may need to try a second drug. Children with persistent diarrhoea need follow-up to be sure that the diarrhoea has stopped. Follow-up is especially important for children with a feeding problem, to be sure they are being fed adequately and are gaining weight. A follow-up visit is different from a child's initial visit for a problem. 9IMCI for athens

SICK YOUNG INFANT. The processes of managing a young infant aged up to 2 months or a sick child aged 2 months up to 5 years are very similar. But young infants have special characteristics that must be considered when classifying their illnesses. For this reason, you will assess, classify and treat the young infant in a somewhat different way from the way you would deal with an older infant or young child. 10IMCI for athens

IMCI does not include the management of conditions related to labour and delivery, or the conditions of a newborn child that require special management, such as asphyxia, sepsis from prematurely ruptured membranes or other intrauterine infection, birth trauma, or conditions due to immaturity. 11IMCI for athens

Young infants have special characteristics that must be considered when classifying their illnesses. They can become sick and die very quickly from serious bacterial infections. 12IMCI for athens

They frequently have only a very few general danger signs such as  "movements only when stimulated",  "fever", or  "low body temperature". Mild chest indrawing is normal in young infants because their chest wall is soft. 13IMCI for athens

Steps of management: Determine whether this is an initial or follow-up visit for these problems. This part has the steps to assess and classify a sick young infant at an initial visit: Check for very severe disease and local infection. Then classify the young infant based on the signs found. Check for jaundice. Then classify the young infant based on the signs found. Check for pus draining from the eyes. Then classify according to severity. 14IMCI for athens

Ask about diarrhoea. If the infant has diarrhoea, assess the related signs. Classify the young infant for dehydration. Ask about mother and the child HIV status. Then classify for HIV infection. Check for feeding problem or low weight. This includes assessing breastfeeding. Then classify feeding. Check for birth weight and gestational age for infants less than 7 days. Then classify appropriately. Check the young infant's immunization and assess any other problems. 15IMCI for athens

Some young infants need to return to the clinic for follow-up. Tell their mothers when to come for a follow-up visit. At a follow-up visit you can see if the young infant is improving on the treatment that was prescribed, and you can make any necessary adjustments to the treatment. Some young infants may not respond to the treatment that was prescribed and may need referral. 16IMCI for athens

Follow-up is especially important for infants with a feeding problem and low weight to be sure they are being fed adequately and are gaining weight. The steps you take at a follow-up visit are different from those you take at an infant'Identify treatment for the young infant. If a young infant needs urgent referral, give urgent pre-referral treatment before the patient is transferred. If a young infant needs treatment at home, you need to decide how to treat the infant. 17IMCI for athens

References ICATT IMCI 18IMCI for athens