PUBLIC HEALTH

PROGRAMS FOR
CHILD HEALTH-
CCM, IMNCI
GROUP MEMBERS
Facilitator: Dr. Maureen King’e
• H31/2116/2018- Macharia Julius
• H31/2117/2018- Kamau John Mwangi
• H31/2119/2018- Ramesh Saxena
• H31/134559/2018- Kahiu Wanuri
Makena
• H31/134585/2018- Dartey Kwaku
Sereta
• H31/2211/2018- Muthamia Jesse
Kirianki
 OBJECTIVES
• Describe CCM
• Describe the reasons behind CCM
• List the Major causes of death in under-fives in developing countries
– where do they die and why?
• Describe Global Status of CCM
• Describe the status of CCM in Kenya
• Describe the role of CCM in the three levels of Prevention (Primary,
Secondary and Tertiary)
• Describe the roles of the Mother, CHW, Levels 2 & 3 in providing
quality CCM.
• IMNCI List the First, Second and Third Components of IMNCI
 WHAT IS CCM?
• CCM is a strategy that aims at
improving health care access and
outcomes by providing basic
medical services to communities.
• Mostly done through the trained
Community Health
Promoters(CHPs).
• It is a valuable strategy where
access to formal healthcare
services might be difficult.
Integrated Community Case Management (iCCM). (2020). Wvi.org. https://www.wvi.org/health/integrated-community-case-management-iccm
 MAJOR REASONS BEHIND CCM
1. Improve access to healthcare;
• This is through overcoming geographical barriers by bringing basic health care services
closer to people in remote areas eliminating the need for patents to travel long
distances, saving time and money.
2.Enhance Care for Common Ailments
• Through addressing prevalent and treatable conditions such as malaria, pneumonia and
diarrhea helps morbidity and mortality by prompt diagnosis and management by the
CHWs.
3. Continuity of care:
• The CHWs can collaborate with healthcare facilities to ensure patients receive seamless
care, helping them navigate the healthcare system and adhere to treatment plans. For
example, people living with HIV and AIDS and TB
4. Community education and empowerment:
• The CHWs often incorporates initiatives to raise awareness about health issues,
promote healthy behaviors, and empower communities to take charge of their health.
MAJOR CAUSES OF DEATH IN UNDER
FIVES IN DEVELOPING COUNTRIES.
1. Malnutrition
2. Prematurity
3. Pneumonia
4. Diarrhoea
5. Malaria
Sheppard, C. (2014, July). Famines, food insecurity and coral reef “Ponzi” fisheries. ResearchGate; Elsevier BV.
https://www.researchgate.net/publication/262490705_Famines_food_insecurity_and_coral_reef_'Ponzi'_fisheries
WHERE DO THEY DIE?
• Sub-Saharan African countries
such as Kenya and Uganda.
• South-east Asian countries such
as Indonesia and Malaysia.
• South-American nations, for
example, Bolivia and
Venezuela.
 WHY DO THEY DIE?
• Limited access to healthcare facilities
due to long distances from said
facilities.
• Low socio-economic status.
• Overcrowding facilitates the rapid
spread of diseases such as pneumonia
malaria and diarrhea.
• Cultural preferences for home births
such as some Western Kenyan
communities.
• Limited availability of nutritious food.
• Inadequate breastfeeding practices as
a result of lack of education.
Tekin, M. (2022). Under-Five Mortality Causes and Prevention. IntechOpen EBooks. https://doi.org/10.5772/intechopen.100526
 GLOBAL STATUS OF
CCM
Where is ICCM happening?

• Mainly in the low and

middle income countries

• Over 30 countries have

implemented iCCM.

Integrated Community Case Management (iCCM). (2020). Wvi.org. https://www.wvi.org/health/integrated-community-case-management-iccm

GLOBAL STATUS OF CCM
• Globally, nearly half of all under 5 deaths occurred in sub-Saharan Africa.
• Overall, iCCM has led to reduced under 5 mortality rates over the last
decade:
⚬ 70% reduction in mortality from pneumonia
⚬ 53% reduction in mortality from severe malaria
⚬ 70-90% prevention of deaths from acute watery diarrhoea.
• In 2012 WHO and UNICEF recommended iCCM as a core component of
IMCI.
• In 2016 a WHO review showed few countries were implementing effective
iCCM.
• In 2018 WHO and UNICEF noted expansion of CCM in most Sub-Saharan
countries but was still compromised by its financial reliance on donors and
STATUS OF CCM IN KENYA
• Kenya adopted the IMCI strategy in 2000 as introduced by WHO/UNICEF.
• In 2011 the Ministry of Health Kenya adopted the iCCM guidelines developed by
WHO and UNICEF.
• iCCM in Kenya tackles the control and management of childhood diarrhea,
malaria, pneumonia, neonatal mortality and malnutrition at COMMUNITY LEVEL.
• iCCM is anchored on various health policies such as:
⚬ Kenya Health Policy 2014 to 2030,
⚬ Kenya Health Sector Strategic Plan 2018–2023,
⚬ Kenya Primary Health Care Strategic Framework (2019 – 2024),
⚬ The Kenya Community Health Policy 2020-2030,
⚬ Kenya Community Health Strategy 2020-2025,
⚬ Newborn and Child Health Strategic Plan 2022 to 2027
 STATUS OF CCM IN KENYA

• Under 5 mortality rate in Kenya has decreased from 102 deaths per 1,000 live births (1990) to 41 deaths
per 1,000 live births in 2022. (KDHS 2022)
• Needs to reduce the under-five mortality rate to 25 deaths per 1,000 live births to achieve SDG 3 by 2030.
• Still facing challenges such as inadequate funding of iCCM programs, data quality, quality of services
provided, training and follow up of community health workers and lack of public awareness.
ROLE OF CCM IN PREVENTION
1) Primary prevention
• This is mainly done through health education and
promotion
• Good sanitation practices (hand hygiene, proper
disposal of waste)
• Immunization
• Adequate nutrition: Exclusive breastfeeding and
complementary feeding
• Vitamin and Micronutrient supplementation
• Use of insecticide treated nets (ITNs)
Ministry of Health, Kenya. Integrated Community Case Management for Sick Children Under 5 Years. 2022
 2)SECONDARY
PREVENTION
• Screening for various diseases:
⚬ —Malaria- rapid diagnostic test
(RDT)
⚬ Malnutrition- MUAC tape
• Detection of key signs of illness
⚬ Pneumonia
￭ Cough and fast breathing
￭ Lower chest wall indrawing
(severe pneumonia)
⚬ Malnutrition- oedema of the feet
Ministry of Health, Kenya. Integrated Community Case Management for Sick Children Under 5 Years. 2022
2)SECONDARY PREVENTION
• Administer home treatment for diseases
that are not severe in nature:
⚬ Amoxicillin DT for pneumonia
⚬ Zinc and ORS in diarrheal diseases
⚬ Oral antimalarial
(Artemether-Lumefantrine) for malaria
• Counseling the family on how to effectively
administer prescribed treatment, adherence
to home treatment and when to visit their
nearest health facility
Ministry of Health, Kenya. Integrated Community Case Management for Sick Children Under 5 Years. 2022
3)TERTIARY PREVENTION
• Referral of children with severe
disease or disease that is
unresponsive to treatment.
• DANGER SIGNS are used as
indicators of severe disease.

Ministry of Health, Kenya. Integrated Community Case Management for Sick Children Under 5 Years. 2022
ROLE OF THE MOTHER IN PROVIDING QUALITY
CCM • A mother is the primary caregiver in most
situations.
• They act as a link between child and
caregivers
⚬ Ensures adherence to medication
⚬ Schedules appointment on need
• They track the progress of the child during
therapy
• Ensures full immunization of the child
• Educate on disease prevention
ROLE OF THE CHP IN PROVIDING QUALITY
• Improve child mortality through
CCM improved access to MCH care
• They ensure continuity of care
(Antenatal to Postnatal)
• They are charged with pediatric health
education
• Play a central role in immunization
campaigns
• Provide home-based care
⚬ Administer basic treatments
⚬ Monitor progress
ROLE OF LEVEL 2 & 3 HCPS IN PROVIDING
• Level 2
QUALITY CCM ⚬ Pediatric Training- Supervising CHWs in
pediatric care.
⚬ Diagnosis and Treatment- Managing routine
pediatric health issues
• Level 3
⚬ Specialized Pediatric Care- Handling
complex cases
⚬ Consultation and Collaboration;
⚬ Guiding challenging pediatric cases
⚬ Contributing to the overall quality of
pediatric care
COMPONENTS OF IMNCI STRATEGY
1.Improving health worker's skills
Mostly refers to clinical and communication
skills in all sectors.
2.Improving health systems
Policy, planning and management
Building blocks of a health system
3.Improving family and community
practice.
Practices that would contribute to child
“IMCI Strategy.” World Health Organization - Regional Office for the Eastern Mediterranean, 2024.

survival, growth and development.

https://www.emro.who.int/child-health/imci-strategy/three-components.
 THE KEY 12 PRACTICES
• Exclusive breastfeeding. • Home care for illness.
• Complementary feeding. • Home care for sick children
• Micronutrients. • Home treatment for
• Hygiene. infections.
• Immunization. • Care-seeking.
• Malaria: use of bednets. • Compliance with advice.
• Psychosocial development. • Antenatal care
“IMCI Strategy.” World Health Organization - Regional Office for the Eastern Mediterranean, 2024.
https://www.emro.who.int/child-health/imci-strategy/three-components.
 REFERENCES
• Community-based case management and RAcE. (2016). Who.int.
https://www.who.int/teams/global-malaria-programme/case-management/community-based-case-management-race-pro
gramme
• The Child Health Task Force. (2023, August 31). Child Health Task Force. https://www.childhealthtaskforce.org/
• Institutionalizing integrated community case management (iCCM) to end preventable child deaths.(2019)
https://iris.who.int/bitstream/handle/10665/333541/9789240006935-eng.pdf?sequence=1
• Integrated community case management in Kenya
https://www.childhealthtaskforce.org/sites/default/files/2021-12/iCCM%20Gap%20Analysis-Investment%20Case_final%2
0report.pdf
• Makeba Shiroya-Wandabwa, Kabue, M., Dyness Kasungami, Jonesmus Wambua, Otieno, D., Waka, C., Ngindu, A.,
Ayuyo, C., Sanyu Kigondu, Oliech, J., & Malonza, I. (2018). Coaching Community Health Volunteers in Integrated
Community Case Management Improves the Care of Sick Children Under-5: Experience from Bondo, Kenya.
International Journal of Integrated Care, 18(4). https://doi.org/10.5334/ijic.3971
• Integrated Community Case Management for Sick Children under 5 years (Participant’s