1. Integrated Management of Childhood Illness (IMCI)
Cristina Marie Manzano RN,RM,MAN

2. General Objective
To ensure that before graduation, all students undergo the enhanced curriculum for Nursing where IMCI is integrated starting at Level II up to level IV

3. IMCI as a STRATEGY
Management of common childhood illness is done in an integrated manner
Includes preventive interventions
Adjusts curative interventions to the capacity and functions of the health system (evidence based – syndromic approach)
Involves the family members and the community in the health care process

4. Objectives of IMCI
Reduce deaths and the frequency and severity of illness and disability
Contribute to improved growth and development

5. Why IMCI? Overlap of conditions
Diagnostic tools are minimal or non-existent
Drugs and equipment are scarce
Health workers have few opportunities to practice complicated clinical procedures
Relies on history & signs & symptoms
A global strategy with 1 purpose of improving the health of children up to age 5 and decrease their chances of death

6. Improving case management skills of health workers
Components of the IMCI
Improving case management skills of health workers
Improving the health system to deliver IMCI
Improving family and community health practices
Providing guidelines for managing child health problems
Imrpoving the health system to deliver IMCI
Improving family & community health practices. To improve nutrition and child development thru breastfeeding support groups or child feeding centers. Promote or improve the existing health system.

7. Target age for the IMCI strategy
Young infants - 1 week up to 2 months
Older children – 2 months to five years old

8. Diseases covered in the IMCI
Pneumonia
Diarrhea
Dengue hemorrhagic fever
Malaria
Measles
Malnutrition

9. METHODS IN MANAGING CHILDHOOD ILLNESSES
Color Presentation
Classification of Diseases
Level of Management
Green
Mild
Home care
Yellow
Moderate
Manage at the RHU
Pink
Severe
Urgent referral in Hospital
To effectively manage childhood illnesses a color- coded system has been utilized:

11. A. Danger Signs I. Focused Assessment Vomits everything
Seizure/ convulsions  38.5C & above
sleepiness
Sucking/ drinking inability

12. Check for General Danger Signs
Ask:
- is the child not able to breastfeed
or drink?
- does the child vomit everything?
- has the child had convulsions?
Look:
- see if the child is abnormally sleepy
or difficult to awaken?
If YES…

13. Cough or DOB
Diarrhea
Fever
Ear Problem
B. Main Symptoms

14. 1. Cough or DOB

15. Pneumonia Age <2 mos. >2 mos. Danger signs No Pneumonia
Cough/ colds
(+) fast breathing
>60 cpm
Danger signs
No Pneumonia
Pneumonia
Severe Pneumonia
Home Mg’t
Specific tx
REFER Tx
Cough > 30 days
 Refer
2. Relieve cough w/
safe remedy
3. Advise mother on
danger sign
4. Ff up in 5 days Tx
Antibiotics for
5 days
Relieve cough w/
safe remedy
3. Advise mother on
danger sign
4. Ff up in
2days Tx
1.1st dose
antibiotic
2. Vitamin A
 100,000 IU
3. breast feeding/
water with sugar

16. Pneumonia Age >2 mos. No Pneumonia Pneumonia VSP VSD Home Mg’t
Cough/
colds
(+) fast breathing
2 – 11 mos.  50
1 – 5 y/o 40
(+) fast breathing
chest indrawing
Danger
signs
No Pneumonia
Pneumonia
VSP
VSD
Home Mg’t
Specific tx
REFER Tx
Cough>30days
 Refer
2. Relieve cough
w/ safe remedy
3. Advise mother
on danger sign
4. FF. up in 5 days Tx
Antibiotics for
5 days
Relieve cough w/
safe remedy
3. Advise mother on
danger sign
4. Ff up in 2days Tx
1.1st dose
antibiotic
2. Vitamin A
 100,000 IU
3. breast feeding/
water with sugar

17. 2. Diarrhea

18. Diarrhea How Long? <14 days >14 days. No change NO dehydration
Thirsty
Irritable
Restless
Eye sunken
Skin pinch  back slowly
Sunken eyeballs
Skin pinch  back
very slowly
Abnormally Sleepy
Doesn’t Drink
NO dehydration
Some Dehydration
Severe Dehydration
Home Mg’t
Specific tx
REFER
Tx  Plan A
Give extra fluid
2. cont. feeding
3. Ff up. In 5 days
Tx  Plan B
w/ ORS (good for 24 hrs)
in 4 hours wt(kg)x75ml
frequent sips from cup
child vomits  wait 10
min., cont. slowly
Stop ORS child has
puffy eyelids
after 4 hours re-assess
& classify select tx plan
Tx Plan C
IVF along w/ ORS
IVFLR(100ml/kg)

19. Severe Persistent diarrhea
How Long?
>14 days
Persistent diarrhea
Persistent diarrhea
+ dehydration
Persistent diarrhea
+ NO dehydration
Severe Persistent diarrhea
REFER
Specific Tx Tx
Treat dehydration
first
Give vit. A
Refer to hospital Tx
Advise regarding
feeding
Give vit. A
FF. up in 5 days

20. With blood (dysentery) NO blood( cholera)
Diarrhea
Stool
With blood
No Blood Tx
Oral antibiotics
follow up in 2 days
With blood (dysentery)
NO blood( cholera) Tx
1st linecotrimoxazole
2nd linenalidixic acid Tx
1st line tetracycline
2nd line  cotrimoxazole

21. 3. Fever

22. a. Malaria

23. Malaria unlikely  fever
Malaria Risk Area
Non-Malaria Risk Area
(+) malaria risk
(-) blood smear
no runny nose/measles
(+) Malaria risk
(+) blood smear
no runny nose
(+) Malaria risk
any danger sign
stiff neck
Malaria unlikely  fever
Malaria
Malaria
Home Mg’t
Specific tx
REFER Tx
Paracetamol
 fever >38C
Ff. up in 2
days
fever > 7 days
REFER Tx
antimalarial
a. 1st line 
chlorquine,
primaquine
b. 2nd line 
sulfadoxin,
pyrimethamine
Paracetamol- >38.5C
fever >7 days REFER Tx
quinine  under medical
Supervision,if a hosp.
is not accessible
1st dose  antipyretic
URGENT referral

24. Very Severe Febrile Dse.
MALARIA
Non-Malaria Risk Area
Any danger sign
stiff neck
NO signs of very severe
febrile disease
NO Malaria
NO Malaria
Very Severe Febrile Dse.
Fever (NO malaria) Tx
1st dose antibiotics
paracetamol  >38.5C
REFERRAL. Tx
paracetamol  >38.5C
follow up in 2 days 
if fever persists
fever is > 7 days present
 REFER to hosp.

25. b. measles

26. MEASLES now or w/in last 3 mos
pus draining from eye
mouth ulcers
Clouding of Cornea or
Deep mouth ulcer
 oral thrush, Koplik spots
Home Mg’t
Specific tx
REFER Tx
Vit. A admin.
child100,000 IU
adult200,000 IU
Pregnant10,000 IU Tx
Vit. A  100,000 IU
tetracycline ointment
 pus from the eye
3.half strength
gentian violet 
mouth ulcer or oral thrush
3. follow up in 2 days Tx
1st dose of antibiotics
Vit. A
Tetracycline ointment
URGENT referral

27. c. Dengue

28. If There is Dengue Risk
bleeding gums
black vomitus or stool
persistent abdominal pain
persistent vomiting
skin petechiae
slow capillary refill
if no sign  tourniquet test if fever is present > 3 days

29. dengue hemorrhagic fever + Danger risk Any Danger Signs or
No sign of severe
dengue hemorrhagic fever
+ Danger risk
Any Danger Signs or
+ tourniquet test
DHF UNLIKELY
SEVERE DHF
Home Mg’t
REFER Tx
Tx the cause
fever > 7 days  REFER
if NO apparent cause of
fever  return daily to
H. center until there
is no fever
Give more fluids
Do not Give Aspirin Tx
Plan C  if with other
signs of bleeding
Do NOT give Aspirin
REFERRAL

30. 4. Ear Problems

31. Tx antibiotics for 5 days paracetamol for pain dry ear by wicking
EAR PROBLEM
NO ear pain
No pus
Pus draining from
ear < 14 days
Ear pain
Pus draining from
ear >14 days
Ear pain
Tender swelling
behind the ear
NO ear infection
Acute
Ear Infection
Chronic Ear
Infection
Mastoiditis
No Mg’t
Specific Tx
Specific Tx
REFER
NO further
assessment Tx
antibiotics
for 5 days
paracetamol
for pain
dry ear by
wicking
Ff up in
5 days Tx
dry ear by
wicking
Ff up in
5 days Tx
1st dose of
antibiotic
paracetamol
REFER

32. C. Nutritional Status

33. 1. Nutrition

34. Visible severe wasting
(<13cm upper arm circ.)
edema on both feet or
severe palmar pallor
Some palmar pallor or
very low weight for age
SEVERE MALNUTRITION/
SEVERE ANEMIA
Anemia or
Very low weight for age
REFER
Specific Tx
Vitamin A
Today, tomorrow &
2 weeks after tomorrow
Wait for 30 min.
before lifting the child
Vitamin A
Assess for feeding problem
& counsel mother
Pallor  iron
Albendazole
(> 12 mos. Or
no doze in previous 6 mos.)
Very low weight 
vitamin A & ff. up after

35. 2. Immunization 3. Vitamin A Supplementation

36. THEN CHECK THE CHILD’S IMMUNIZATION STATUS
IMMUNIZATION SCHEDULE
AGE VACCINE
Birth BCG Hep B-1
6 weeks DPT-1 OPV-1 Hep B-2
10 weeks DPT-2 OPV-2
14 weeks DPT-3 OPV-3 Hep B-3
9 months Measles
THEN CHECK THE VITAMIN A STATUS
VITAMIN A SUPPLEMENTATION SCHEDULE:
The first dose at 6 months or above.
Subsequent doses every 6 months.

37. THEN CHECK THE CHILD’S IMMUNIZATION STATUS
IMMUNIZATION SCHEDULE
AGE VACCINE
Birth BCG Hep B-1
6 weeks DPT-1 OPV-1 Hep B-2
10 weeks DPT-2 OPV-2
14 weeks DPT-3 OPV-3 Hep B-3
9 months Measles
THEN CHECK THE VITAMIN A STATUS
VITAMIN A SUPPLEMENTATION SCHEDULE:
The first dose at 6 months or above.
Subsequent doses every 6 months.

38. THAT’S ALL FOLKS!!!

39. Thank you!