LESSON 2

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

Statistics shows that one million children under five years old die each year in less
developed countries, because of 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 (IMCI) 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
1. Reduce death and frequency and severity of illness and disability, and
2. Contribute to improved growth and development

Components of IMCI
Implementer
Rural Health Midwives (RHM)
Public Health Nurse (PHN)
Municipal Health Officer (MHO)
IMCI Supervisor

Rationale for an integrated approach in the management of sick children

      
Majority of these deaths are caused by 5 preventable and treatable conditions namely: 
1. pneumonia,
2. diarrhea,
3. malaria,
4. measles and 
5. 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? 
1. Sick children birth up to 2 months (Sick Young Infant)
2. 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’s classification 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 Chart
booklet) 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.
Read and analyze the question and write your answer on the space provided.

1. What is Integrated Management for Childhood Illness (IMCI)?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. When did they introduce it to the different countries?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. When was it adopted in the Philippines?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. Who developed this strategy?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Why it is helpful in the community when dealing with childhood illness?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. What are the objectives of IMCI?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7. Who are the implementers of IMCI?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Choose the five preventable and treatable conditions related to IMCI.

Pneumonia
Diarrhea
Dengue Hemorrhagic Fever
Malnutrition
Cancer
Obesity
 Majority of these deaths are caused by 5 preventable and treatable conditions namely: 

1. ____________________
2. _____________________
3. _____________________
4. _____________________
5. _____________________

1. Who are examined for GENERAL SIGNS? __________________________________ 

2. Who are examined for VERY SEVERE DISEASE AND LOCAL BACTERIAL
INFECTION___________________________________________________________
3.

What does the color Indicate: Color coded triage system.

PINK-      ______________________________________________

YELLOW -------------------------------------------------------------------------

GREEN ______________________________________________

Draw the IMCI case mgt Flow:

FLEXIBLE TEACHING LEARNING MODALITY (FTLM) ADOPTED

Lecture will be Online (synchronous)
Zoom, Edmodo (for those who have internet access)
Remote (asynchronous)
Module, Exercises (for those who cannot join the zoom discussion)