IMCI  Check first for the general danger signs, which would

indicate any life-threatening condition. (Refer the child in

Topic 1 hospital) (TDTM)
The situation of child health  Assess main symptoms:
- Cough or difficulty breathing
Birth asphyxia, prematurity, sepsis, and congenital anomalies are - Diarrhea
common death in the first month of life - Fever
- Ear problem
- Pneumonia, diarrhea, measles, and malnutrition causes
 Check for acute malnutrition and anemia
post-neonatal death
 Check immunization status, Vitamin A (vision, immune
Ways to improve child health system), oral health, and deworming status
 Assess other problems
- Improve case management of children
- Improve nutrition Check for the general danger signs
- Improve the system and healthcare worker
Always check ALL sick children for general danger signs
ELEMENT

1. ASSESSMENT
GENERAL DANGER SIGNS ARE:
2. CLASSIFIED THE ILLNESS
3. IDENTIFY THE TREATMENT  The child is not able to drink or breastfeed
4. TREAT THE CHILD  The child vomits everything
5. COUNSEAL THE MOTHER  The child has had convulsions during the present illness
or has convulsions now
 The child is lethargic or unconscious
 Ensure immunization
 Prevent injuries
 Prevent other disease CONVULSIONS
 Improve psychosocial support and stimulation
Convulsion as a danger sign only when:
IMCI STRATEGY
 Occurs in children less than 6 months
- Innovative approach introduced in 1995 by WHO and  More than one episode during the present illness
UNICEF  Occurring for more than 15 minutes in children aged 6
- Addresses the most common causes of morbidity and months or more
mortality among the under-five
- Includes evidence- based preventive and curative Simple febrile convulsions (not general danger signs)
interventions to improve child survival
- One episode of generalized convulsions during febrile
AIM OF IMCI illness in a child aged 6 months or more lasting for
less than 15 min
General  A child with any one or more of four danger signs in sow
classified
 To reduce childhood death- improve child survival

Specific
DURING THE VISIT
 To reduce the pregnancy and severity of sickness and
disability  Ask the mother how many times ha the child had
 To contribute to improved growth and development convulsions during this current illness
 Ask the mother for how many minutes had convulsions
Components of IMCI
lasted
1. Improvements of health workers  Classify the child as VERY SEVERE DISEASE
2. Improvements of health system  Pre referral treatment before Refer
3. Improvements of family planning and community

IMCI
Color coded triage
Topic 2.
Pink- severe classification and urgent pre-referral treatment and
Step 1. Assess ( CHECK FOR GENERAL DANGER SIGNS) referral

 Greet the mother appropriately Yellow- a child condition requires a specific medical treatment
 Use good communication skills and advice
 Ask the mother what the child’s problems are
Green – child should receive appropriate home management
Step 2. Classify

 Any general danger signs + very severe disease

Assess
STEP 3. Identify treatment
Look for chest indrawing
 If a child require urgent referral, essential treatment to be
given referral is identified - Lower chest wall indrawing ( inwards movement of
the bony structure of the chest wall when the child
 If a child needs specific treatment (yellow), a treatment
breathes in )
plan is developed, and the drugs to be administered
Look and listen for stridor
Step 4. Treat the child
Stridor – is a harsh noise made when the chil;d breathes in. happens
Step 5. Counsel
when there’s a swelling of the larynx, trachea, and epiglottis.
Step 6. Follow up
Wheezing is a soft musical noise made when the child is breathing
out

IMCI topic 3 Severe pneumonia – a child with any general danger sign or stridor,
you classified the child for having severe pneumonia.
Case management process
Give bronchodilators – to expand the bronchioles, alveoli or the
After assessing the child assess the main symptoms lungs itself.
( local bacterial infection, diarrhea, jaundice) Lecture 5
- All sick children aged up to five years age examine for
general danger signs
- Assess for main symptoms. Diarrhea
- SELECT THE APPROPRIATE IMCI CHART
- Child classification
 Loose or watery stools
LESSON 4.
 Three times or mose loose or watery stools in a 24-
hoursperiod
 Common in children, especially between 6 months and 2
IMCI: pneumonia years of year
 More common in babies aged 6 months who are drinking
Cough or difficulty breathing
cow’s milk or infant formulas. ( lactose intolerance,
contaminated water)

Pneumonia Diarrhea

- Is another severe respiratory infection Assess for signs of dehydration

- Children w/ bacterial pneumonia may die from  General condition
hypoxia or sepsis
 Sunken eyes
- Both bacteria and viruses can cause pneumonia
- as the child loses fluid,
The most common are: - Deciced if you think eyes are sunken
- Then ask mother of she thinks her child eyes look
 Strep. Pneumoniae unusual
 Haemophilus influenza  Thirst
- not able to drink?
Child’s age – fast breathing - Drinking poorly?
2 months up to 12 month – 50 or more breaths per min. - Drinking eagerly thirsty?
12 months up to 5 years- 40 or more breaths per minutes  Reaction to skin pinch
- Pinch in the skin abdomen. Does it goes back very
??? for how long ???
slowly (longer than 2 seconds)?
- Look, listen and feel - Pinch for 1 seconds
- Count the breaths - Very slowly (2 seconds)
- Look for chest indrawing - Slowly (skin stays up even for brief intant)
- Look and listen for stridor
( look )
- Look and listen for wheezing
 Restless and irritable

The child must be calm

( during RR)
 Child is calm when breastfeeding but again restless and
irritable when he or she stops breastfeeding
Classify
Three possible classification:
(Oral rehydration salt solution- ORS)