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IMCI Updates
IMCI Updates
Department of Health
July 30, 2008
DEPARTMENT CIRCULAR
No. 2008________
FOR:
THE UNDERSECRETARIES, ASSISTANT SECRETARIES, SECRETARY OF HEALTH FOR ARMM,
CHDs/BUREAU/SERVICE/PROGRAM/PROJECT DIRECTORS, MEDICAL CENTER & SPECIALTY
HOSPITAL CHIEFS, EXECUTIVE DIRECTOR OF THE NATIONAL NUTRITION COUNCIL, ASSOCIATION OF
DEANS OF PHILIPPINE COLLEGES OF NURSING (ADPCN Inc.), ASSOCIATION OF PHILIPPINE
SCHOOLS OG MIDWIFERY (APSOM) MEMBER SCHOOLS, ASSOCIATION OF PHILIPPINE MEDICAL
SCHOOLS, AND OTHERS CONCERNED.
SUBJECT:
TECHNICAL UPDATE ON THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
PROTOCOL.
Over the years since IMCI has been introduced, much has been learnt through the adaptation and
implementation processes in countries. The Department of Child and Adolescent Health and Development (CAH)
and other institutions have undertaken work to evaluate the evidence base for the technical guidelines of the IMCI
strategy. Research results have emerged and these results lead to the updating the technical guidelines on IMCI.
CAH conducted a series of meetings and in 2004 it was recommended that CAH finalize the IMCI updates on the
basis of the best available and country program feedback, prioritizing those updates most likely to reduce child
mortality.
The World Health Organization came up with document on IMCI Technical Updates entitled: Technical
Updates of the Guidelines on Integrated Management of Childhood Illness, Evidence and Recommendations for
further Adaptations, 2005. The adaptation of the recommendations underwent consultations with experts on child
health.
The technical updates were considered necessary for the following reasons:
New knowledge becomes available through research into clinical management of childhood diseases.
Research results should be examined in a systematic manner to improve and update the IMCI guidelines.
IMCI guidelines should be reviewed with regard to experiences and lessons learned through the adaptation
and implementation process.
Implementation of IMCI has identified problems and questions, some of which have been addressed
through operational research in regions and countries.
Since the development of the IMCI guidelines, the epidemiology of diseases has evolved and thus a revised
version has to accommodate and reflect these changes. For example, the prevalence of HIV/AIDS has
increased significantly over the last 10 years and specific aspects require updating in the context of IMCI.
The current technical update have compiled new evidence and recommended adaptation in the following six areas:
SICK CHILDREN AGED 2 MONTHS TO 59 MONTHS
Main Symptom 1- Cough or Difficult Breathing
Three days antibiotic treatment of non-severe and severe pneumonia. Oral antibiotic for non-severe
pneumonia should be given for three (3) days instead of 5 days to sick children 2-59 months old. Shorter
courses of antibiotic were found to be equally effective as the five-day duration, reduces cost of treatment
in the addition to improving compliance and reduces the antimicrobial resistance in the community.
Injectable ampicillin plus injectable gentamicin is a better choice than injectable chloramphenicol of severe
pneumonia in children 2-59 months old of age. A pre-referral dose of 7.5mg/kg intramuscular injection
gentamicin and 60 mg/kg injection ampicillin can be used.
Use of amoxicillin and first line antibiotic and Cotrimoxazole as a second line antibiotic in the treatment
of pneumonia, very severe disease, ear problem is recommended.
Use of Reformulated Oral Rehydration Salts which should contain 75mEq/L, 75mmol/L glucose
concentration and has a total osmolarity of 245 mOsm/L.
Use of Zinc supplements for 10-14 days in the management of diarrhea. Zinc supplementation during
the episodes of acute diarrhea reduced the duration and severity of the episode. In addition, studies showed
that zinc supplementation given for 10-14 days lowered the incidence of diarrhea in the following 2-3
months. Inclusion of zinc in the management of diarrhea could prevent 300,000 children dying every year.
In the treatment of bloody diarrhea (Dysentery) Ciprofloxacin is the most appropriate drug in place of Nalidixic
acid which leads to rapid development of resistance. Ciprofloxacin is given in a dose of 15 mg/kg two times
per day for three (3) days.
Giving of multivitamins and minerals (including Zinc) for 14 days is added in the treatment protocol
Where available, MUAC (Mid-upper arm circumference) less than 110mm is now an
indicator for severe malnutrition. If MUAC is not available, look visible severe wasting.
Malnutrition and anemia presented in two separate algorithms
Use of WHO Growth standards instead of the international Reference Standard (explanation of the
WHO GPRS)
Management of severe malnutrition where referral is not possible, manage the child at the health
center.
If the child has no appetite, a modified milk diet is give. This is made by dried skimmed milk (DSM)
sugar and oil.
Mix: 25g dried skimmed milk
70g sugar
35g rice flour
27g oil and some water
Boil: 5-7 minutes
Allow to cool and then add 20 ml WHO vitamin mineral for severe malnutrition and mix again.
Make up the volume to 1,000ml by adding previously boiled water.
Feed for a few days 11ml/kg every 2 hours.
Once appetite is restored, a diet with 80g dried skimmed milk, 50g sugar and 60g of oil is
prepared. Add water up to 1000ml and 20ml WHO mineral and vitamin solution. Increase
progressively the feeds up to 200ml/kg in 6 feeds (30ml/kg every 4 hours adjusted to the childs
appetite).
Vaccine
BCG
OPV1
HepB1
HepB2 DPT1
OPV2
_____ DPT2
OPV3
HepB3 DPT3
Measles