INTEGRATED MANAGEMENT OF CHILDHOOD

ILLNESS (IMCI)

One million children under five years old die each year in less developed countries.
Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic
fever) account for nearly half of these deaths and malnutrition is often the underlying
condition. Effective and affordable interventions to address these common conditions
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 development 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 Children’s
Fund (UNICEF).

               In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more
health workers and hospital 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 preventableand treatable conditions

namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out
of four (4) episodes of childhood illness are caused by these five conditions

            Most children have more than one illness at one time. This overlap means that
a single diagnosis may not be possible or appropriate.

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 BACTERIAL 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 symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick
young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely
assessed for nutritional, immunization and deworming status and for other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’sclassification 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 fluids, and when to
return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILD’S ILLNESS (please see enclosed

portion of the IMCI Chartbooklet) The child’s illness is classified based on a color-
coded triage system:

PINK-         indicates urgent hospital referral or admission

YELLOW- indicates initiation of specific Outpatient Treatment

GREEN –   indicates supportive home care

Steps of the IMCI Case management Process

            The following is the flow 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 indicated 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.