2. Recent trends in under 5 child mortality/unequal distribution
World Health Report 1999
10 million deaths each year ( developing world )
Millions of parents seek health care for their sick children each day
Most are not properly assessed/treated and parents advised poorly
Problems at first level health facilities in developing world
Independent prevention and treatment strategies
Integrated approach
UNICEF/WHO 1992 – IMCI
Neonatal component added by Pakistan - IMNCI
Background
3.
4.
5. What is IMCI?
Integrated approach for whole well being of child
Incudes both preventive as well as curative elements
Aims : Reduce deaths, disabilities and illness and Promote improved growth
and development in children under 5
Strategy : Includes 3 main components
1. Improving case management skills of health care staff ( accurate diagnosis,
combined treatment, counseling skills )
2. Improving overall health systems
3. Improving family and community health practices( behaviors ,
immunization, nutrition )
6. Groups : Young infants (up to 2 months), older (2 months-5years)
IMCI guidelines addresses most of the major reasons for a sick child
A combination of individual signs leads to action oriented color coded
classification(s)
Core interventions in IMCI include :
1. Combating pneumonia/sepsis/malaria
2. Combating diarrhea
3. Nutrition of mother/child
4. Infant feeding
5. immunization
Case Management Process
8. Assess
Classify illness
Identify treatment
Treat the child
Counsel the mother
Give follow up care
Case Management Process
9. GREEN: Simple advice on home management
YELLOW: Specific medical treatment and advice
PINK: Patient requires urgent hospitalization, give pre referral
treatment and refer immediately
Classification
10. Country based phased process
Great deal of coordination between existing health programs and services
required
Local governments and ministries of health to adapt the principles of
approach to local circumstances
Integrated approach should become a part of health policy
Training of health workers for better treatment and counseling with
available resources
Developing support mechanisms within communities ( health seeking
behavior and transport availability )
Introduced in more than 75 countries around the world
Global Implementation Of IMCI
11. Introduction phase – 1998 (formally endorsed by Ministry of health)
Early implementation phase – 1999-2002 (National IMCI planning, adaptation
of guidelines, provincial orientation and planning, training of health providers)
Expansion phase – 2003-2009 (evaluation and revitalization of IMCI)
Systematic approach at district level:
1. Selection of districts
2. Orientation and planning workshops
3. Creating pool of facilitators
4. Skills acquisition
5. Skills reinforcement and supervision
IMNCI Pakistan
16. Evaluation and Way forward
MCA ahs undertaken a multi country evaluation to evaluate the impact, cost
and effectiveness of IMCI strategy, the results indicate:
IMCI improves health worker performance and their quality of care
IMCI can reduce under 5 mortality and nutritional status if implemented
properly
Cost effective
Activities which strengthen system support and improve community
behavior
Large scale intervention coverage is needed
17. IMNCI strategy focuses on childhood diseases causing the greatest global
burden
Integrated approach because of overlapping signs/symptoms in children
Treat as a whole, not simply the most apparent problem
Ensures complete assessment and treatment of the sick child
Improves health seeking behavior and health practices at home
Final Thoughts
