Integrated management of Neonatal and Childhood illness among Infants of 0 to...Dhruvendra Pandey
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months, Difference between IMCI and IMNCI, Objective, Elements, Management of Diarrhea, Bacterial Infections, Jaundice, Hypothermia, Feeding problem, counseling of mothers, followup
Integrated Management of Childhood Illness (IMCI) Lalit Kumar
Integrated Management of Childhood Illness (IMCI) is a cost-effective approach
Integrated Management of Childhood Illness (IMCI) - Focuses on the child and not on the illness
Integrated management of Neonatal and Childhood illness among Infants of 0 to...Dhruvendra Pandey
Integrated management of Neonatal and Childhood illness among Infants of 0 to 2 months, Difference between IMCI and IMNCI, Objective, Elements, Management of Diarrhea, Bacterial Infections, Jaundice, Hypothermia, Feeding problem, counseling of mothers, followup
Integrated Management of Childhood Illness (IMCI) Lalit Kumar
Integrated Management of Childhood Illness (IMCI) is a cost-effective approach
Integrated Management of Childhood Illness (IMCI) - Focuses on the child and not on the illness
In 2011 to reduce neonatal mortality government of India launched Home based new born care program based on Gadchirolli model of SEARCH. This presentation will tell about how the program is enrolling in our country.
Clinical Guideline on COVID-19 Vaccination for Adolescents (12 – 17 years)
Prepared by Dr Nik Khairulddin Nik Yusoff, Paediatrician at Hospital Raja Perempuan Zainab II
Adolescent Friendly Health Service is a service provided by health institutions that focuses on the welfare of adolescents (10-19 years of age) through the guidance on how to maximize the use of health care services in the adolescents.
Samundratar Health Post, Nuwakot is providing AFHS with its limited resources given.
In 2011 to reduce neonatal mortality government of India launched Home based new born care program based on Gadchirolli model of SEARCH. This presentation will tell about how the program is enrolling in our country.
Clinical Guideline on COVID-19 Vaccination for Adolescents (12 – 17 years)
Prepared by Dr Nik Khairulddin Nik Yusoff, Paediatrician at Hospital Raja Perempuan Zainab II
Adolescent Friendly Health Service is a service provided by health institutions that focuses on the welfare of adolescents (10-19 years of age) through the guidance on how to maximize the use of health care services in the adolescents.
Samundratar Health Post, Nuwakot is providing AFHS with its limited resources given.
1. Select a health problem in your society (Saudi) 2. Write a para.pdfomarionmatzmcwill497
1. Select a health problem in your society (Saudi)
2. Write a paragraph regarding why you have chosen this problem (it includes significance of
the problem which contains statistical data national and international related to this problem)
3. How can educating the people with the health problem may help in tackling.
4. Also, the weekly assignment answers should be supported by references.
Solution
1.Ans-Health Problems in Saudi- As Saudi Arabia is well developed country but still it is
suffering from several health problems. A major cause of disease is malnutrition, leading to
widespread scurvy, rickets, night blindness, and anemia, as well as low resistance to tuberculosis
and AIDS.
2.Ans-I have choosen this problem because today most of the people in different countries are
suffering from malnutrition and other diseases like tuberculosis, malaria and many more.
Statistical data national and international-
In 1960, life expectancy at birth was 43 years, but it averaged 75.46 years in 2005. During the
same time period, infant mortality fell from 185 to 13.24 per 1,000 live births. The maternal
mortality rate was 22 per 100,000 live births. As of 2002, the crude birth rate and overall
mortality rate were estimated at 37.2 and 5.9 per 1,000 people, respectively. Birth control was
used by 21% of married women. Almost 97% of the population had access to health care
services. Total health care expenditures were estimated at 8% of GDP.
Immunization rates for children up to one year old were tuberculosis, 93%; diphtheria, perteusis,
and tetanus, 97%; polio, 97%; and measles, 94%. The rates for DPT and measles were 96% and
91%, respectively.
Dysentery attacks all ages and classes and trachoma is common. A government campaign was
successful in eradicating malaria. Typhoid is endemic, but acquired immunity prevents serious
outbreaks of this disease. Approximately 95% of the population had access to safe drinking
water and 100% adequate sanitation. The HIV/AIDS prevalence was 0.01 per 100 adults in 2003.
3.Ans-Educating the people with the health problem may help in tackling-
Nutritional problem in the developing countries can\'t be solved only by the government
interventions. Besides, Non-government Organizations (NGOs) have to play strong role in
spreading knowledge and training. More emphasis is needed in the child and maternal mortality.
If women can be treated properly during the pregnancy, the child will have proper development.
So it starts from the family. Government should have strong monitoring on this maternal health
and child health. Nutritional problem can be treated if we can educate the mother. Besides,
fortified foods can also benefit children to get rid of malnutrition.
Focus needs to be given to those groups who had not benefited from the development that many
others had enjoyed over the last twenty years or so, including the resource poor, low income,
socially excluded, economically marginalized, food insecure and nutritional vulnerab.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. • Altogether more than 10 million children
die each year in developing countries
before they reach their fifth birthday.
• Seven in ten of these deaths are due to
acute respiratory infections (mostly
pneumonia), diarrhoea, measles, malaria,
or malnutrition—and often to a
combination of these conditions.
4.
5. • These conditions will continue to be major
contributors to child deaths in the year
2020 unless significantly greater efforts
are made to control them.
6. WHAT THE LOCAL FIGURES SAY
• In relation to child health, with
– the Under-5 Mortality Rate of 107,
– Infant Mortality Rate of 74.6,and
– Neonatal Mortality Rate (NMR) of 43.1,
• Pakistan ranks high in terms of child mortality with respect
to regional comparisons.
• A wide provincial variation is seen in Infant Mortality Rates
with IMRs of
– 71 for Sindh
– 104 Balochistan
– 77 Punjab and
– 79 per 1,000 live births NWFP
7.
8.
9.
10.
11. Child survival: where we stand
• Although the annual number of deaths among children
less than 5 years old has decreased by almost a third
since the 1970s, this reduction has not been evenly
distributed throughout the world.
• Every day, on average more than 26,000 children under
the age of five die around the world, mostly from
preventable causes.
• Nearly all of them live in the developing world or, more
precisely, in 60 developing countries.
• More than one third of these children die during the first
month of life, usually at home and without access to
essential health services and basic commodities that
might save their lives
12. • Some children succumb to pneumonia, diarrhoea or
malaria that are no longer threats in industrialized
countries or to early childhood diseases that are easily
prevented through vaccines, such as measles.
• In up to half of under-five deaths an underlying cause is
undernutrition, which deprives a young child’s body and
mind of the nutrients needed for growth and development.
• Unsafe water, poor sanitation and inadequate hygiene
also contribute to child mortality and morbidity.
Child survival: where we stand
13. Why child survival matters?
• A greater chance of becoming creative
and productive members of society.
• Investing in children is also wise from an
economic perspective
• Improvements in child health and survival
can also foster more balanced population
dynamics.
14. The inequities of child health
• Infant and childhood mortality sensitive indicators of
inequity and poverty.
• 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.
• Millions of children are often caught in the vicious cycle of
poverty and ill health—poverty leads to ill health and ill
health breeds poverty.
• Quality of care another important indicator of inequities in
child health.
15. Background
• Every day, millions of parents seek health care
for their sick children, taking them to hospitals,
health centers, pharmacists, doctors and
traditional healers.
• Many sick children are not properly assessed
and treated by health care providers, and their
parents are poorly advised.
• At first-level health facilities in low-income
countries, diagnostic supports are minimal or
non-existent, and drugs and equipment are often
scarce.
16. • Limited supplies and equipment, combined with an
irregular flow of patients, leave doctors to rely on history
and signs and symptoms to determine a course of
management that makes the best use of the available
resources.
• These factors make providing quality care to sick
children a serious challenge.
• Improvements in child health are not necessarily
dependent on the use of sophisticated and expensive
technologies.
17. • Improvements in child health rather
depend on effective strategies
– that are based on a holistic approach,
– that are available to the majority of those in
need, and
– which take into account the capacity and
structure of health systems, as well as
traditions and beliefs in the community
18. WHO and UNICEF have addressed this
challenge by developing a strategy called
the
Integrated Management of Childhood
Illness (IMCI)
19. • Diverse approaches are currently employed to
deliver essential health services for children and
mothers.
• These range from initiatives targeted towards a
single disease or condition, such as measles or
undernutrition, to the ideal of providing a
continuum of comprehensive primary health
services that integrate hospital and clinical
facilities, outpatient and outreach services, and
household and community-based care.
Evolution of health-care systems
and practices
20. Evolution of health-care systems
and practices
• The colonial period: 1900–1949
• Mass disease control campaigns: 1950–
1977
• Primary health care: 1978–1989
• Selective primary care and the child
survival revolution: 1980s
• Focusing on integrated, sector-wide
approaches and health systems: 1990s
21. The colonial period: 1900–1949
• High mortality and disability from such causes as diarrhoea, malaria,
measles, pneumonia, smallpox, tuberculosis and various forms of
undernutrition affected a large population.
• In the first half of the century, a few key malaria programmes were
developed.
• Efforts were however fragmented, undertaken by colonial governments
• Despite their narrow focus, some of the initiatives – for example,
Malaria control from 1930–1950 in and around copper mines in Zambia
was quite successful.
• A national public health system began in the 1920s with efforts to
control the rapidly spreading pneumonic plague in the province of
Manchuria.
22. • Facility-based care vs. mass care by mobile
units focused on a single disease such as
sleeping sickness, elephantiasis, leprosy and
other high-prevalence conditions affecting the
capacity to work.
• Early in the century, such countries as Denmark,
the Netherlands, Norway and Sweden managed
to reduce maternal mortality very quickly.
• Efforts focused on providing professional care
close to where women lived, mainly by
enhancing the skills of community midwives.
The colonial period: 1900–1949
23. Mass disease control campaigns:
1950–1977
• The 1950s, 1960s and 1970s witnessed a
number of disease control efforts, often termed
‘mass campaigns’ or ‘disease focused
responses’.
• The smallpox eradication initiative, which
reported its last case of human-to-human
transmission in 1977 most successful.
• Expanded Programme on Immunization (EPI),
launched in 1974
24. Primary health care: 1978–1989
• The International Conference on Primary Health
Care held in Alma-Ata in 1978 came about as a
result of successful innovations in community
health care developed after World War II in
resource-poor settings.
• The district health system concept, also known
as ‘catchment area focus’ or the ‘small area’ or
‘intermediate group’ approach in Europe and
other countries, was subsequently developed.
25. • The primary-health-care approach encompasses
– the tenets of equity,
– community involvement,
– Intersectoral collaboration,
– use of appropriate technology,
– Affordability and health promotion.
• These have become guiding principles in the
development of health systems that
– take into account broader population health issues, reflecting
and reinforcing public health functions;
– that emphasize the integration of care across time and place;
– that link prevention, acute care and chronic care across all
components of the system;
– that evaluate and try to improve performance
Primary health care approach
26. Selective primary care : Late 1970
• In the late 1970s, two scientists, Julia
Walsh and Kenneth Warren, published
‘Selective Primary HealthCare: An interim
strategy for disease control in developing
countries’ – a milestone paper that
proposed an alternative strategy for
rapidly reducing infant and child mortality
at a reasonable cost.
27. • Concluded that
– a small number of causes (diarrhoea, malaria,
respiratory diseases and measles, among others) were
responsible for the vast majority of under-five deaths
and
– that these deaths could be easily prevented by
• immunization (only 15 per cent of the world’s children were
immunized at the time),
• oral rehydration therapy,
• breastfeeding and
• antimalarial drugs.
• The result was a new strategy known as ‘selective
primary health care
Selective primary care
28. Integrating key elements of vertical
approaches by targeting the diseases
identified as the most important
contributors to high infant and child
mortality rates, it was intended to be
more focused and more feasible
than primary health care.
Selective primary care
29. Child survival revolution:1980s
• The ‘child survival revolution’,
spearheaded by UNICEF and launched in
1982, was based on the framework of
‘selective primary care’
• Focused on four low-cost interventions
collectively referred to as GOBI
30. GOBI
• Growth monitoring for undernutrition,
• Oral rehydration therapy to treat childhood
diarrhoea,
• Breastfeeding to ensure the health of
young children and
• Immunization against six deadly childhood
diseases
31. GOBI-FFF
• Subsequently, GOBI added three more
components:
• Food supplementation,
• Family spacing and
• Female education
32. • Selective primary care initiatives
contributed to the sharp fall in the global
under-five mortality rate, from 115 per
1,000 live births in 1980 to 93 in 1990 – a
reduction of 19 per cent over the course of
the decade.
33. • By the late 1980s, health systems in many
developing countries were under severe
stress.
• The contributing factors were
– population growth,
– the debt crisis in many Latin American and
sub-Saharan African countries, and
– political and economic transition in the former
Soviet Union and Central and Eastern Europe
Integrated, sector-wide approaches
and health systems: 1990s
34. Integrated, sector-wide
approaches:1990s
• In response, a number of countries
stressed on efforts
– to reform deteriorating, under-resourced health
systems,
– raise their effectiveness, efficiency and
financial viability, and
– increase their equity.
• One such approach used by many
countries was the Bamako Initiative
35. Integrated, sector-wide approaches and
health systems: 1990s
• The Bamako Initiative:
– launched in 1987 at the World Health Organization
meeting of African health ministers in Bamako, Mali.
– focused on delivering an integrated minimum health-
care package through health centres.
– emphasis was placed on
• access to drugs and
• regular contact between health-care providers and
communities.
36. • Integration:
– ‘Bamako Initiative’ became the driving force of
integrating the essential services approach in
the 1990s
– Integrated approach sought to combine the
merits of selective primary care and primary
health care.
Integrated, sector-wide approaches
and health systems: 1990s
37. Integrated, sector-wide approaches
• Like selective approaches, they placed a strong
emphasis on providing
– a core group of cost-effective solutions in a timely way
to address specific health challenges
• Like primary health care, they also focused
attention on
– community participation,
– intersectoral collaboration and
– integration in the general health-delivery system.
38. • A long-standing example of the greater
emphasis on integration during the 1990s
is IMCI, the
Integrated Management of Childhood
Illness
39. • Developed in 1992 by UNICEF and WHO,
• Employed in more than 100 countries since
then.
• IMCI adopts a broad, cross-cutting
approach to case management of
childhood illness, acknowledging that there
is usually more than one contributing cause
IMCI
40. IMCI
• IMCI is an integrated approach to child health
that focuses on the well-being of the whole child.
• IMCI aims to reduce death, illness and disability,
and to promote improved growth and
development among children under five years of
age.
• IMCI includes both preventive and curative
elements that are implemented by families and
communities as well as by health facilities.
41. • The strategy includes three main
components:
– Improving case management skills of health-
care staff
– Improving overall health systems
– Improving family and community health
practices.
IMCI
42. Improving health worker
performance
• This involves
– training health workers to assess symptoms of diseases,
– correct mapping of illness to treatment, and
– provision of appropriate treatment to children and
– information to the caregivers.
• Through provision of locally adapted guidelines, health
staff are taught case management skills for five major
causes of childhood mortality:
– acute respiratory infections, especially pneumonia;
– diarrhoeal diseases;
– measles;
– malaria; and
– undernutrition
43. Improving health systems
• Seeks to strengthen health systems for effective
management of childhood illnesses.
• Measures employed include
– supporting drug availability,
– enhancing supervision,
– strengthening referral and
– deepening health information systems.
• Planning guides are provided for managers at the
district and national levels.
44. Improving community and family
practices
• Often referred to as Community Integrated
Management of Childhood Illness (C-IMCI).
• Based on the basic household practices for
families and communities
45. • The clinical guidelines, which are based on
expert clinical opinion and research results, are
designed for the management of sick children
aged 1 week up to 5 years.
• They promote evidence-based assessment and
management, using a syndromic approach that
supports the rational, effective and affordable
use of drugs.
IMCI Guidelines
46. IMCI Guidelines
• They include
– methods for assessing signs that indicate severe
disease;
– assessing a child’s nutrition, immunization and feeding;
– teaching parents how to care for a child at home;
– counselling parents to solve feeding problems; and
– advising parents about when to return to a health
facility
– recommendations for checking the parents’
understanding
– of the advice given and for showing them how to
administer the first dose of treatment
47. The 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,
• diarrhoea,
• fever,
• ear problems;
– for young infants age 1 week up to 2 months:
• Bacterial infection and
• Diarrhoea
They must also be routinely assessed for nutritional and
immunization status, feeding problems, and other potential
problems.
48. • Only a limited number of carefully-selected clinical signs are
used
• A combination of individual signs leads to a child’s classification(s)
rather than a diagnosis.
Classification(s) indicate the severity of condition(s). They call for
specific actions based on whether the child
– should be urgently referred to another level of care,
– requires specific treatments (such as antibiotics or antimalarial
treatment), or
– 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.
The principles of integrated care
49. • Address most, but not all, of the major reasons a sick
child is brought to a clinic.
The 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.
• counselling of caretakers about home management,
including counselling about feeding, fluids and when to
return to a health facility.
The principles of integrated care
50. The IMCI case management process
Outpatient health facility
• Assessment;
• Classification and identification of
treatment;
• Referral, treatment or counselling of the
child’s caretaker (depending on the
classification(s) identified);
• Follow-up care.
51. Referral health facility
• Emergency triage assessment and treatment (ETAT);
• Diagnosis, treatment and monitoring of patient progress.
Appropriate home management
• Teaching the mother or other caretaker how to give oral
drugs and treat local infections at home;
• Counselling the mother or other caretaker about food
(feeding recommendations, feeding problems); fluids;
when to return to the health facility; and her own health.
The IMCI case management process
52. The IMCI guidelines recommend case
management procedures based on two
age categories:
• Children age 2 months up to 5 years
• Young infants age 1 week up to 2 months
53.
54.
55. • In health facilities, the IMCI strategy
– promotes the accurate identification of childhood
illnesses in outpatient settings,
– ensures appropriate combined treatment of all major
illnesses,
– strengthens the counseling of caretakers, and
– speeds up the referral of severely ill children.
• In the home setting, it
– promotes appropriate care seeking behaviors,
– improved nutrition and preventative care, and
– the correct implementation of prescribed care.
IMCI
56. Why is IMCI better than single-
condition approaches?
• Children brought for medical treatment often
suffering from more than one condition, making a
single diagnosis impossible.
• IMCI an integrated strategy,
– takes into account the variety of factors that put
children at serious risk.
– Ensures the combined treatment of the major
childhood illnesses,
– emphasizes prevention of disease through
immunization and improved nutrition.
57. How is IMCI implemented?
• Introducing and implementing the IMCI strategy
in a country is a phased process that requires a
great deal of coordination among existing health
programmes and services.
• It involves working closely with local
governments and ministries of health to plan and
adapt the principles of the approach to local
circumstances.
58. Steps for implementing IMCI
• The main steps are:
– Adopting an integrated approach to child health and
development in the national health policy.
– Adapting the standard IMCI clinical guidelines to the
country’s needs, available drugs, policies, and to the
local foods and language used by the population.
– Upgrading care in local clinics by training health
workers in new methods to examine and treat children,
and to effectively counsel parents.
59. • Making upgraded care possible by ensuring that
enough of the right low-cost medicines and
simple equipment are available.
• Strengthening care in hospitals for those children
too sick to be treated in an outpatient clinic.
• Developing support mechanisms within
communities for preventing disease, for helping
families to care for sick children, and for getting
children to clinics or hospitals when needed.
Steps for implementing IMCI…
contd
60. What has been done to evaluate the
IMCI strategy?
• A Multi-Country Evaluation (MCE) has been
undertaken to evaluate the impact, cost and
effectiveness of the IMCI strategy.
• The results of the MCE support planning and
advocacy for child health interventions by
ministries of health in developing countries, and
by national and international partners in
development.
• To date, MCE has been conducted in Brazil,
Bangladesh, Peru, Uganda and Tanzania.
61. • The results of the MCE indicate that:
– 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;
– child survival programmes require more attention to
activities that improve family and community behaviour;
– the implementation of child survival interventions needs
to be complemented by activities that strengthen system
support;
– a significant reduction in under-five mortality will not be
attained unless large-scale intervention coverage is
achieved.
62. IMNCI
• Stimulated by a series of studies on
maternal, newborn and child survival
integrated models of health care have been
developed within the context of the
maternal, newborn and child health
continuum of care
• In effect, the continuum of care concept
expands IMCI to include integrated
management of neonatal illness
63. • Successful preliminary experience with the
new approach, called the
Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)
has been pioneered and fully implemented
in India.
64. Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)
• Modifies IMCI with specific actions taken to
promote neonatal health and survival.
• Like IMCI, IMNCI supports three pillars for the
effective delivery of essential services to
neonates, infants and young children:
– Strengthening health-system infrastructure,
– enhancing the skills of health workers and
– promoting community participation
• All with additional emphasis on
– neonatal health and survival.
65. IMNCI
• In practice, IMNCI consists of
– three home visits in the first 10 days after birth to
promote best practices for the young child;
– a special provision at the village level for follow-up of
infants with low birth weights;
– reinforcement of messages through meetings of
women’s groups and
– establishing a linkage between the village and the
home; and
– Assessment of the child at local health facilities based
on referral.
Editor's Notes
Every day, millions of parents seek health care for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers. Surveys reveal that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised. At first-level health facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave doctors at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources.
These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI).