Learn about I.M.C.I on paediatrics

1. DICM 213
Integrated Management of Childhood Illnesses

2. Learning outcome
• By the end of the Lesson the learner will be ale to understand :
• IMCI stratergy

3. Introduction
• Every year, nearly 11 million children die before reaching their fifth
birthday.
• In response to this challenge, WHO and UNICEF in the early 1990s
developed Integrated Management of Childhood Illness (IMCI),
• a strategy designed to reduce child mortality and morbidity in
developing countries.

4. Introduction
• The approach focuses on the major causes of deaths in
children through
• improving case management skills of health workers,
• strengthening the health system,
• and addressing family and community practices.

5. Introduction
• However, the original IMCI modules did not include care of the sick
newborn during the first week of life, the time when
one in three child deaths occur, and it did not emphasize home-based
newborn care.

6. IMCI
• “IMCI” originally stood for "Integrated Management of Childhood
Illness”, which has since been changed to "Integrated Management of
Childhood Health". It refers to a broad WHO/UNICEF initiative that
was launched globally in 1995 with the objective of reducing under-5
mortality, morbidity and disability,
• and improving child growth and development

7. IMCI
• The initiative challenges the traditional disease-specific approach to
illness by adopting a more integrated approach in line with the
philosophy of primary health care.

8. Objectives and Goals
• Its main goal is to contribute to healthy growth and development
during the first five years of life.
• Reducing infant mortality.
• Reducing the incidence and seriousness of illnesses and health
problems that affect boys and girls.
• Improving growth and development during the first five years of a
child's life.

9. IMCI justification
• Children brought for medical treatment, especially in the low and
middle-income countries, are often suffering from more than one
condition.
• At the first level of primary health care services, diagnostic supports
such as laboratory and radiology services are commonly limited or
non-existent.

10. IMCI justification
• Health care providers therefore benefit when they can use evidence-
based algorithms using history, signs and symptoms to determine the
course of management.
• This enables them to provide quality care and make the best use of
the available resources

11. Why is IMCI better than single-condition
approaches?
• MCI considers each child that is brought to a health service in a
holistic way.
• The clinical algorithms take into account the variety of conditions
that may affect
• a newborn or child and put them at risk of preventable mortality or
impaired growth and development.
• By facilitating an integrated assessment and combined treatment of
conditions,

12. Why is IMCI better than single-condition
approaches?
• IMCI focuses on effective case management and prevention of
disease,
• and contributes to healthy growth and development,
• including through immunization and nutritional and developmental
counselling.

13. What "I", "M", "C", "I" mean in I.M.C.I.

14. I. "Integrated"
• I. "Integrated" refers to a number of characteristics of the strategy, in
addition to the proposed management approach.
• The ultimate aim of this “integration” is for children under-5 to
receive holistic care, whether at home, in the community or at the
health facility.

15. • It is “integrated” because:
• It is meant to bring together curative, preventive and development
aspects of child care into one strategy;
• It is supposed to be managed and coordinated by a committee that
draws on managers and experts from different, key public health
areas;

16. • It enables the clinical management of priority public child health
problems
• through a standardized, fully integrated approach based on clinical
guidelines presented in just one training course package; and
• It aims at creating a continuum of care between health system
services and the care provided in the community.

17. M. "Management"
• M. "Management" here should be seen as having both a clinical and
public health meaning.
• The IMCI clinical management adopts a syndromic approach, where
signs and symptoms are the entry point:
• cases are “classified” into defined categories of severity based on the
presence or absence of a few key signs and symptoms.

18. • The main emphasis is on the resulting action.
• The classifications have the purpose of enabling the primary health
care provider to select a management plan rather than make a
precise diagnosis,
• which would often be impossible at that level based only on clinical
grounds and the assessment of a few signs.

19. • Thus, a sick child is "classified" into one of three main categories,
highlighted with a colour code:
• "red", indicating severe conditions which need urgent referral to an
inpatient facility;
• "yellow", indicating situations that can be managed at the health
centre—often with drugs—but that require definite follow-up; and“
• green", indicating mild conditions which require simple home care.

20. • Apart from the clinical management of sick children,
• many things have to be in place to deliver child care, both in the
health system and in the community.
• These aspects of health care represent the public health meaning of
management.

21. C. "Childhood"
• C. "Childhood" here refers to children below 5 years of age, which is
the child age group most vulnerable to illness and death.
• Investing in this age group gives also great rewards for their future
development and the society as a whole.
• They are the current targets of IMCI. It is the same age group that was
originally targeted by such programmes as the control of diarrhoeal
diseases and acute respiratory infections.

22. • At the beginning, the global IMCI clinical guidelines did not cover the
first week of life,
• but several countries in the Region decided to include this period also
in their adapted guidelines.
• Much work is currently being undertaken to address the issue of
neonatal health.

23. I. "Illness"
• I. "Illness" is used in public health terms, to address conditions that
are first of all a major cause of death, severe illness or disability in
children under-5.

24. • These conditions include:
• acute respiratory infections—including pneumonia
• diarrhoeal diseases, including dehydrating diarrhoea,
• dysentery and persistent diarrhoea;
• meningitis and sepsis;
• malaria;

25. • HIV/AIDS;
• measles;
• ear infections;
• malnutrition; and
• anaemia.

26. NB
• IMCI therefore is not comprehensive paediatrics but focuses on public
child health priorities in under-fives.

27. The three components of IMCI
• IMCI (Integrated Management of Childhood Illness) is meant to move
along the two tracks of the health system and community,
respectively,
• while promoting the establishment of strong links between the two.
Much emphasis is given to capacity-building. Traditionally, then, IMCI
is presented as a strategy which has three components, aiming to:

28. The three components of IMCI
• Improving health providers’ skills
• Improving health systems
• Improving family and community practices

29. Improving health providers’ skills
• Improving health providers’ skills mostly refers to clinical and
communication skills
• and covers both pre-service education and in-service training, public
and private sector.

30. Improving health systems
• Improving health systems to deliver IMCI concerns policy,
• planning and management,
• financing,
• organization of work and distribution of tasks at health facilities,
human resources,
• availability of drugs and supplies, referral,

31. Improving health systems
• monitoring and health information system,
• supervision,
• evaluation and research.
• Health sector reform efforts, although being an umbrella which
covers also human resources and their capacity, are usually listed
under this component.

32. Improving family and community practices
• Improving family and community practices currently refers to 12 key
family and community practices related to child health and
development that,
• if properly promoted and adopted by the targeted communities,
• would potentially contribute to improving child survival, growth and
development.

34. WHAT ARE THE BENEFITS OF THE IMCI STRATEGY?
• Addresses major child health problems because it systematically
address the most important causes of children illness and death.
• Responds to demands.
• Promotes prevention as well as cure because IMCI emphasizes
important preventive interventions such as immunization and
breastfeeding.

35. • Is cost-effective- most cost-effective interventions in low and middle
income countries (World Bank).
• Promotes cost-saving.
• Improves equity – IMCI improves inequity in global health care.

36. Key challenges of health care workers in
implementing the integrated management of
childhood illnesses (IMCI) program

37. IMCI Application
• This application is based on the Integrated Management of
Childhood Illness (IMCI) chart booklet of the World Health
Organization (WHO).
• It aims to help health workers with the management of neonatal
• and childhood illnesses by providing information that is accessible
anywhere .