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The Integrated Management of Childhood Illness in The Philippines
The Integrated Management of Childhood Illness in The Philippines
7%
8% Malaria
15% Measles
54%
Diarrhoea
Penumonia
19%
Perinatal
HIV/AIDS
20% Others
28% 3% Malnutrition
Figure 1. Distribution of 10.5 million deaths among children less than 5 years
old in all developing countries, 1999
Inequities of Child Health
ARI Malaria
Diarrhoea
Measles
And so, the IMCI strategy, using the “case management method”
targets children less than 5 years old – the age group that bears the
highest burden of deaths from common childhood diseases.
Careful and
Rationale for the use of IMCI as an approach to systematic
assessment of
Health Care common symptoms
IMCI makes use of “evidence-based, syndromic” and well-selected
approach to case management that supports the specific clinical
rational, effective and affordable use of drugs signs
and provide
sufficient
diagnostic tools (evidence-based medicine stresses information to
the importance of evaluation of evidence from guide rational and
effective
clinical research and cautions against the use of actions.
intuition, unsystematic clinical experience, and
untested pathophysiologic reasoning for medical decision-making;
a. In situations where laboratory support and clinical resources
are limited, the syndromic approach is a more realistic and
cost-effective way to manage patients;
b. Careful and systematic assessment of common symptoms and
well-selected clinical signs provides sufficient information to
guide rational and effective actions.
c. An evidence-based syndromic approach can be used to
determine the:
* Health problem(s) the child may have;
* Severity of the child’s condition;
* Actions that can be taken to care for the child
to the capacity
and functions of the health
system; and
☺ Active involvement of family
members and the
community in the
health care process.
Components of an Integrated
Approach:
☺ Improvements in the case-
management skills of health staff
through the provision of locally
adapted guidelines on
IMCI and activities to promote their use;
☺ Improvement in the overall health
system required for effective
management of childhood illness;
☺ Improvement in family and
community health care practices.
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, diarrhea, fever,
ear problems; for young infants are 1 week up to 2
months: bacterial infections and diarrhea). They
must also be routinely assessed for nutritional
and immunization status, feeding problems, and
other potential problems.
☺ Only a limited number of carefully-selected
clinical signs are used, based on evidence of their
sensitivity and specificity to detect disease.
(These signs were selected considering the conditions and
realities of first level health facilities).
Principles of Integrated Care: (continued)
☺ A combination of individual signs lead 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: (a) should be urgently referred to another
level of care,
(b) requires specific treatments (such as
antibiotics or anti-malarial
treatment), or
(c) may be safely managed at home.
OUTPATIENT
HEALTH FACILITY GREEN
• Pre-referral YELLOW Home Management
treatments Treatment at Outpatient
• Advise Parents Health Facility HOME
• Refer Child Caretakers is
OUTPATIENT
counselled on:
HEALTH FACILITY
REFERRAL FACILITY • Home treatment(s)
• Treat Local
• Emergency Triage • Feeding & Fluids
Infections
& Treatment (ETAT) • When to return
• Give Oral Drugs
• Diagnosis immediately
• Advise & Teach
•Treatment • Follow-up
Caretakers
• Monitoring &
• Follow-up
WHAT YOU LEARNED FROM
THESE SLIDES WILL NOT MAKE
YOU COMPLETELY COMPETENT IN
USING THE IMCI APPROACH…
LEARN SOME MORE FROM
TRAINED IMCI PROVIDERS.
GO THROUGH IT AND
MASTER THE PROCESS.
ENJOY LEARNING AND LEARN WELL…
FOR THE SAKE OF THE FILIPINO CHILDREN.