IMCI

1. IMCI

2. not necessarily dependent on the use of sophisticated and expensive technologies • a more integrated approach to managing sick children • move beyond addressing single diseases to addressing the overall health and well-being of the child Features of IMCI…

3. careful and systematic assessment of common symptoms and specific clinical signs to guide rational and effective actions • integrates management of most common childhood problems (pneumonia, diarrhea, measles, malaria, dengue hemorrhagic fever, malnutrition and anemia, ear problems) • includes preventive interventions Features of IMCI…

4. adjusts curative interventions to the capacity and functions of the health system (evidence-based syndromic approach) • involves family members and the community in the health care process Features of IMCI…

5. (1) reduce deaths and the frequency and severity of illness and disability; and (2) contribute to improved growth and development Objectives of IMCI

6. IMCI Components 1. Improving case management skills of health workers • standard guidelines • training (pre-service/in-service) • follow-up after training • role of private providers

7. IMCI Components 2. Improving the health system to deliver IMCI • essential drug supply and management • organization of work in health facilities • management and supervision • referral system

8. IMCI Components 3. Improving family and community practices • for physical growth and mental development • for disease prevention • for appropriate home care • for seeking care

9. IMCI Components 3. Improving family and community practices -For physical growth and mental development • Breastfeeding • Complementary feeding • Micronutrient supplementation • Psychosocial stimulation

10. IMCI Components 3. Improving family and community practices - For disease prevention • immunization • handwashing • sanitary disposal of feces • use of insecticide-treated bednets • dengue prevention and control

11. IMCI Components 3. Improving family and community practices - For appropriate home care • continue feeding • increase fluid intake • appropriate home treatment

12. IMCI Components 3. Improving family and community practices - For seeking care • Follow health workers advice • When to seek care • Prenatal consultation • Postnatal (postpartum) consultation

13. Outpatient Health Facility • check for danger signs • assess main symptoms • assess nutrition and Immunization status • and potential feeding problems • Check for other problems • classify conditions and • identify treatment actions Outpatient Health Facility • Urgent referral • pre-referral treatment • advise parents • refer child Home Outpatient Health Facility • Caretaker is • counselled on: • home treatment • feeding &fluids • when to return • immediately • follow-up • Treatment • treat local infection • give oral drugs • advise and teach • caretaker • follow up The Integrated Case Management Process Referral facility • emergency triage & • treatment • Diagnosis & treatment • monitoring & ff-up

14. Sick young infant • 1 week up to 2 months • Sick young children • 2 months up to 5 years Target Groups

15. lethargy or • unconsciousness • inability to drink or • breastfeed • vomiting • convulsions General Danger Signs Assessing the Sick Child

16. Checking the Main Symptoms - cough and difficult breathing - diarrhea - fever - ear problem

17. Checking the Main Symptoms 1. Cough or difficult breathing 3 clinical signs • Respiratory rate • Lower chest wall indrawing • Stridor

18. Checking the Main Symptoms 2. Diarrhea • Dehydration • General condition • Sunken eyes • Thirst • Skin elasticity • Persistent diarrhea • Dysentery

19. Checking the Main Symptoms 3. Fever • Stiff neck • Risk of malaria and other endemic infections, e.g. dengue hemorrhagic fever • Runny nose • Measles • Duration of fever (e.g. typhoid fever)

20. Checking the Main Symptoms 4. Ear problems • Tender swelling behind the ear • Ear pain • Ear discharge or pus (acute or chronic)

21. Checking Nutritional Status, Feeding, Immunization Status • Malnutrition • visible severe wasting • edema of both feet • weight for age • Anemia • palmar pallor • Feeding and breastfeeding • Immunization status

22. Meningitis • Sepsis • Tuberculosis • Conjunctivitis • Others: also mother’s (caretaker’s) own health Assessing Other Problems

23. IMCI Essential Drugs and Supply • Appropriate antibiotics • Quinine • Vitamin A • Paracetamol • Oral antimalarial • Tetracycline eye ointment • ORS • Mebendazole or albendazole • Iron • Vaccines • Gentian violet

24. Outpatient 1 - assessment 2 - classification and identification of treatment 3 - referral, treatment or counseling of the child’s caretaker (depending on the classification identified 4 - follow-up care Referral Health Facility 1 - emergency triage assessment and treatment 2 - diagnosis, treatment and monitoring of patient progress Overall Case Management Process

25. SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS For all sick children age 1 week up to 5 years who are brought to a first-level health facility ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems. CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the child’s main symptoms and his or her nutrition or feeding status. IF URGENT REFERRAL is needed and possible IF NO URGENT REFERRAL isneeded or possible IDENTIFY TREATMENT needed for the child’s classifications: Identify specific medical treatments and/or advice. IDENTIFY URGENT PRE-REFERRAL TREATMENT(S) needed for the child’s classifications. . TREAT THE CHILD:Give the first dose of oral drugs in the clinic and/or advise the child’s caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If needed, give immunizations. TREAT THE CHILD:Give urgent pre-referral treatment (s) needed. REFER THE CHILD:Explain to the child’s caretaker the need for referral. Calm the caretaker’s fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital. COUNSEL THE MOTHER: Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a health facility. Counsel the mother about her own health. FOLLOW-UP care: Give follow-up care when the child returns to the clinic and,if necessary, reassess the child for new problems.

26. Summary of the Integrated case Management Process For all sick children age 1 week up to 5 years who are brought to a first-level health facility

27. Summary of the Integrated case Management Process ASSESS the Child: • Check for danger signs (or possible bacterial infection). • Ask about main symptoms. • If a main symptom is reported, assess further. Check nutrition and immunization status. • Check for other problems

28. Summary of the Integrated Case Management Process Classify the child’s illness: • Use a color-coded triage system to classify the child’s main symptoms and his or her nutrition or feeding status.

29. Summary of the Integrated Case Management Process IF URGENT REFERRAL is needed and possible

30. Summary of the Integrated Case Management Process IDENTIFY URGENT PRE-REFERRAL TREATMENT(S) Needed prior to referral of the child according to classification

31. Summary of the Integrated Case Management Process TREAT THE CHILD: Give urgent pre-referral treatment(s) needed.

32. Summary of the Integrated Case Management Process REFER THE CHILD: • Explain to the child’s caretaker the need for referral. • Calm the caretaker’s fears and help resolve any problems. Write a referral note. • Give instructions and supplies needed to care for the child on the way to the hospital

33. Summary of the Integrated Case Management Process IF NO URGENT REFERRAL is needed or possible

34. Summary of the Integrated Case Management Process IDENTIFY TREATMENT needed for the child’s classifications: identify specific medical treatments and/or advice

35. Summary of the Integrated Case Management Process TREAT THE CHILD: • Give the first dose of oral drugs in the clinic and/or advice the child’s caretaker. • Teach the caretaker how to give oral drugs and how to treat local infections at home. • If needed, give immunizations.

36. Summary of the Integrated Case Management Process COUNSEL THE MOTHER: • Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present. • Advise about feeding and fluids during illness and about when to return to a healthy facility. • Counsel the mother about her own health.

37. Summary of the Integrated Case Management Process FOLLOW-UP CARE: Give follow-up care when the child returns to the clinic and, if necessary, re-asses the child for new problems.

38. SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic ASK THE CHILD’S AGE IF the child is from 1 week up to 2 months IF the child is from 2 months up to 5 years USE THE CHART: œ ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT USE THE CHART: œ ASSESS AND CLASSIFY THE SICK CHILD TREAT THE CHILD COUNSEL THE MOTHER