1. Integrated Management of Childhood Illness
IMCI
Integrated Management of Childhood Illness

2. Summary of slides Introduction to IMCI –Slide 3
Rationale for IMCI- Slides 4-10
Advantages – Slide 11
Objectives- Slide 12
Components- Slide13
Intervention areas- Slide 14
IMCI in Nigeria
Implementation steps (in another file)

3. An Approach for who? Clinical Officers Nurses Medical Assistants
Health assistants
Community Health Officers (CHOs)
Other health workers
Not for in-patient care
an approach for health workers who care for sick children in first level health facilities:

4. UNDER FIVE MORTALITY RATES FOR DIFFERENT COUNTRIES –
Countries of Africa
Countries of South America
Countries of Europe
Ethiopia 174
Argentina 26
France
Gabon
Bolivia
Sweden
Nigeria
Guatemala 69
Tajikistan 56
Kenya
Brazil
Spain

5. Leading causes of under five mortality in developing countries
Acute respiratory infections (ARI) - especially pneumonia
Diarrhoea
Malaria
Measles
Malnutrition

6. Frequency of presenting complaints of 450 children (as volunteered by their mothers), Gondar, Ethiopia, 1994
Fever 58%}
Cough 56%
Diarrhoea 47%
Ear problems 10%
Skin lesions 03%
Abd. pains
Eye discharge
Dental problems
Neck swelling
e.t.c.
The first four complaints constitute about 87% of the complaints and these are covered by the chart, the remaining 13 % are not covered by the charts

7. Consequences of Vertical Approach
In practice, the sick child is not managed in a holistic manner at the health centre. More often, only the predominant symptom is considered for diagnosis and treatment.
Many training courses are organised by individual programmes. This disturbs the continuity of services at the health centre.
At health level, programmes often have the same target population and are delivered by the same health workers.
Verticalization usually results in inappropriate use of resources.

8. A single diagnosis may not be apparent or appropriate
______________________________________
Presenting complaint Possible cause or associated
_____________________________ condition________________
Cough and/or fast breathing Pneumonia
Severe anaemia
P.falciparum malaria
Lethargy or unconsciousness Cerebral malaria
Meningitis
Severe dehydration
Very severe pneumonia
Measles rash Pneumonia
Diarrhoea
Ear Infection
“Very sick young infant Pneumonia
Sepsis

9. Integrated Management of Childhood illness (IMCI) as a key strategy for improving child health
The IMCI strategy combines improved case management with aspects of nutrition, immunisation, and several other important influences on child health

10. Integrated Management of childhood illness
The IMCI strategy is an approach, not entirely different from what we have known, as several national programmes have collaborated to develop these guidelines.

11. ADVANTAGES OF IMCI
Accurate identification of illness
More appropriate & combined treatment
Rational use of drugs
Prompt referral of severe cases
Strengthening of preventive services
Attention to the health needs of the mother.

12. Objectives
To reduce significantly mortality and morbidity associated with the major causes of disease in children
To contribute to healthy growth and development of children
In short, the strategy is to improve the health of children up to age of five and reduce their chances of death. The WHO and UNICEF are committed to this strategy. Nigeria has also made a firm commitment to the strategy and has in-fact adopted it as the main thrust of its child survival effort.

13. Components Improving case management skills of health workers
Improving the health system to deliver IMCI
Improving family and community practices
The Health system will be improved through provision of drugs and ensuring that supervisory systems are in place to support the strategy.
The third component of IMCI includes promotyon, education and programs all in an effort to support and improve family and community practices e.g breastfeeding, routine immunisations, use of ITN e.t.c.

14. IMCI components and intervention areas
Improving health Improving health Improving family &
workers skills systems community practices
-Case management - District planning - Appropriate
standards & and management care-seeking &prevention of
guidelines diseases
- Training of - Availability of Nutrition
facility-based public IMCI drugs
health care providers
-Training for private - Improvement and -Home case management
health care providers supervision of referral -Adherence to recommended
pathways treatment
-Maintenance of - Improved Health Community involvement
competence among information system in health planning and
trained health workers monitoring