IMCI

IMCI
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• WHO and UNICEF started to develop the IMCI strategy in 1992, and today
more than 100 countries worldwide have adopted it.
• The implementation of the IMCI strategy produces impressive results,
both in the decrease of childhood mortality and in improving the quality
of life of young children all over the world.
RATIONALE FOR AN INTEGRATED APPROACH
• Every year almost 10 million children die before they reach their fifth
birthday. A majority of these deaths caused by just five preventable and
treatable conditions
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Causes of Death in children
Under-
nutrition
53%
Source: CHERG estimates of under-five deaths, 2000-03

Strategy objectives Focuses on
 Improving case management skills of health-care
providers
 Improving overall health systems
 Improving family and community health
practices.
• The current challenge for the IMCI strategy is to
scale up activities to ensure the appropriate and
effective use of IMCI principles and clinical
guidelines by all types of health-care providers.
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CHILD OF 2 MONTHS UP TO 5 YEARS

• how to assess a sick child and classify the child's

illness.
• You will also how to interact with the child's
mother or other caregiver who brings the child to
you.
• The assess and classify part of the training is
divided into following units:
• Ask the mother about the child's problems
• Check for general danger signs (INABILITY TO
FEED, CONVULSION, LOSS OF CONSCIOUSNESS)
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THE CASE MANAGEMENT PROCESS
The case management of a sick child brought to a
first-level health facility includes a number of
important elements
1. Assessment of the child or young infant
2-.Classification the illness
3. Identification the treatment
4. Referral, treatment or counselling of the child's
caretaker (depending on the identified
classification(s)
6. follow up care
IMCI Case Management
Classification
Focused Assessment
Need to Refer
Danger signs
Main Symptoms
Nutritional status Specific treatment
Immunization status
Other problems Home
management
Counsel & Follow-up Treatment
Counsel caretakers Identify treatment

Follow-up Treat
• Assess main symptoms among which:
– Cough or difficulty breathing
– Diarrhoea
– Fever
• Check for malnutrition and anaemia
• Check immunization status
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• After you have assessed a sick child and classified
his or her illness or illnesses, the next step is to
identify the necessary treatment.
• The oral drugs, intramuscular drugs and other

treatments presented in the IMCI charts are
recommended for first-level health facilities in
particular country.
• Both first- and second-line oral antibiotics and
antimalarials are included.

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• First-line drugs were chosen because they are
effective, easy to give and inexpensive.
• You should give a second-line drug only if a

first-line drug is not available, or if the child's
illness does not respond to the first-line drug.
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Counsel the mother
• A child who is seen at the clinic needs to continue

treatment, feeding and fluids at home.
Therefore :
how to assess feeding and counsel the mother about
feeding,
• advise the mother when to return for follow-up,
• and teach her the signs that mean she should bring the
child back to the clinic immediately for further care.
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follow up
• Assess feeding and make recommendations
• At a follow-up visit you can see if the child is improving on the drug or
other treatment that was prescribed.
• Some children may not respond to a particular antibiotic or antimalarial,
and you may need to try a second drug.
• Children with persistent diarrhoea need follow-up to be sure that the

diarrhoea has stopped.
• Follow-up is especially important for children with a feeding problem, to

be sure they are being fed adequately and are gaining weight.
• A follow-up visit is different from a child's initial visit for a problem.

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SICK YOUNG INFANT.
•
The processes of managing a young infant aged up to 2
months or a sick child aged 2 months up to 5 years are very
similar.
• But young infants have special characteristics that must

be considered when classifying their illnesses.
• For this reason, you will assess, classify and treat the
young infant in a somewhat different way from the way you
would deal with an older infant or young child.
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• IMCI does not include the management of conditions
related to labour and delivery,
• or the conditions of a newborn child that require

special management, such as asphyxia, sepsis from
prematurely ruptured membranes or other
intrauterine infection, birth trauma, or conditions due
to immaturity.

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Young infants have special characteristics that
must be considered when classifying their
illnesses.
• They can become sick and die very quickly

from serious bacterial infections.
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• They frequently have only a very few general danger signs such as
 "movements only when stimulated",

 "fever", or
 "low body temperature".
• Mild chest indrawing is normal in young infants because their chest

wall is soft.
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Steps of management:
• Determine whether this is an initial or follow-up visit

for these problems.

This part has the steps to assess and classify a sick young
infant at an initial visit:
• Check for very severe disease and local infection.
Then classify the young infant based on the signs
found.
• Check for jaundice. Then classify the young infant
based on the signs found.
• Check for pus draining from the eyes. Then classify
according to severity.
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• Ask about diarrhoea. If the infant has diarrhoea,
assess the related signs. Classify the young infant for
dehydration.
• Ask about mother and the child HIV status. Then
classify for HIV infection.
• Check for feeding problem or low weight. This
includes assessing breastfeeding. Then classify feeding.
• Check for birth weight and gestational age for infants
less than 7 days. Then classify appropriately.
• Check the young infant's immunization and assess
any other problems.
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• Some young infants need to return to the clinic
for follow-up.
• Tell their mothers when to come for a follow-up
visit.
• At a follow-up visit you can see if the young
infant is improving on the treatment that was
prescribed, and you can make any necessary
adjustments to the treatment.
• Some young infants may not respond to the
treatment that was prescribed and may need
referral.
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• Follow-up is especially important for infants with a
feeding problem and low weight to be sure they
are being fed adequately and are gaining weight.
• The steps you take at a follow-up visit are different
from those you take at an infant'Identify
treatment for the young infant.
• If a young infant needs urgent referral, give urgent
pre-referral treatment before the patient is
transferred. If a young infant needs treatment at
home, you need to decide how to treat the infant.
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References
• ICATT IMCI
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RATIONALE FOR AN INTEGRATED APPROACH

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Source: CHERG estimates of under-five deaths, 2000-03

• how to assess a sick child and classify the child's

Counsel & Follow-up Treatment

Counsel caretakers Identify treatment

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• The oral drugs, intramuscular drugs and other

• You should give a second-line drug only if a

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• A child who is seen at the clinic needs to continue

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• Children with persistent diarrhoea need follow-up to be sure that the

• Follow-up is especially important for children with a feeding problem, to

• A follow-up visit is different from a child's initial visit for a problem.

• But young infants have special characteristics that must

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• or the conditions of a newborn child that require

• They can become sick and die very quickly

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 "movements only when stimulated",

• Mild chest indrawing is normal in young infants because their chest

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• Determine whether this is an initial or follow-up visit

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