IMCI

IPI
PEDIATRIC REVIEER
PRELIMS
Integrated Management of Childhood Illness (IMCI)
One million children under ve years old die each year in less developed countries. Just ve diseases (pneu-
monia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and mal-
nutrition is often the underlying condition. Effective and affordable interventions to address these common condi-
tions exist but they do not yet reach the populations most in need, the young and impoverish.
The Integrated Management of Childhood Illness strategy has been introduced in an increasing
number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and de-
velopment and is based on the combined delivery of essential interventions at community, health facility and
health systems levels. IMCI includes elements of prevention as well as curative and addresses the most common
conditions that affect young children. The strategy was developed by the World Health Organization (WHO) and
United Nations Childrens Fund (UNICEF).
In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hos-
pital staff were capacitated to implement the strategy at the frontline level.
Objectives of IMCI
Reduce death and frequency and severity of illness and disability, and
Contribute to improved growth and development
Components of IMCI
Improving case management skills of health workers
11-day Basic Course for RHMs, PHNs and MOHs
5 - day Facilitators course
5 day Follow-up course for IMCI Supervisors
Improving over-all health systems
Improving family and community health practices

Rationale for an integrated approach in the management of sick children
Majority of these deaths are caused by 5 preventable and treatable conditions namely: pneumo-
nia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood ill-
ness are caused by these ve conditions
Most children have more than one illness at one time. This overlap means that a single diagnosis may
not be possible or appropriate.

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Who are the children covered by the IMCI protocol?
Sick children birth up to 2 months (Sick Young Infant)
Sick children 2 months up to 5 years old (Sick child)
Strategies/Principles of IMCI
All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and
all Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL BAC-
TERIAL INFECTION. These signs indicate immediate referral or admission to hospital
The children and infants are then assessed for main symptoms. For sick children, the main symp-
toms include: cough or difculty breathing, diarrhea, fever and ear infection. For sick young infants, local
bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional, im-
munization and deworming status and for other problems
Only a limited number of clinical signs are used
A combination of individual signs leads to a childs classication within one or more symptom groups
rather than a diagnosis.
IMCI management procedures use limited number of essential drugs and encourage active participation of
caretakers in the treatment of children
Counseling of caretakers on home care, correct feeding and giving of uids, and when to return to clinic is
an essential component of IMCI
BASIS FOR CLASSIFYING THE CHILDS ILLNESS (please see enclosed portion of the IMCI Chart-
booklet) The childs illness is classied based on a color-coded triage system:
PINK- indicates urgent hospital referral or admission
YELLOW- indicates initiation of specic Outpatient Treatment
GREEN indicates supportive home care

Steps of the IMCI Case management Process
The following is the ow of the iMCI process. At the out-patient health facility, the health worker
should routinely do basic demographic data collection, vital signs taking, and asking the mother about the
child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with
the IMCI process by checking for general danger signs, assessing the main symptoms and other processes indi-
cated in the chart below.
Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals.
Once admitted, the hospital protocol is used in the management of the sick child.
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