1. Institute of Child Health
Integrated Management of Childhood illness (IMCI) Approach to School care
Adebola E. Orimadegun
Institute of Child Health
College of Medicine
University of Ibadan

2. Introduction What is IMCI? A joint WHO/UNICEF initiative since 1992
Is the integrated strategy that combines and links together existing child health programs.
Is an evidenced based, syndrome approach to case management that supports the rational, effective and affordable use of drugs and diagnostic tools.
A joint WHO/UNICEF initiative since 1992

3. Objectives of IMCI:
To reduce significantly mortality and morbidity associated with the major cause of diseases in children
To promote improved growth and development of children.

4. Major causes of death in under five, 2002
ARI
18%
Other
25%
Diarrhea 15%
Deaths assoc. with
malnutrition
54%
Perinatal
23%
Malaria 10%
Measles 5%
HIV/
AIDS 4%

5. Essential IMCI Drugs at Health Facilities
Oresol
Oral antibiotics
(1st line – Cotrimoxazole
Oral anti malarial
1st line-Chloro quine and Primaquine
2nd line – Aretemether Lumefrantine
Nalidixic Acid Tablets
Tetracycline tablets
Iron
Vitamin A
Paracetamol
Vaccine
Mebendazole /
Albendazole
Tetracycline eye ointment
Gentian violet
Chloramphenicol IM
(optional)
Gentamicin IM (optional)
Benzyl Penicillin IM
(Optional)

6. Other Essential Equipments and Supplies:
1-weighing scale
2-timing devices
3-refrigerator with voltage regulator
4-sterilizers
5-BP apparatus
6-pediatric cuff
7-oral thermometer
Supplies:
1-cold chain supplies and immunization supplies
2-ORT supplies
3-water jars
4-IV fluid (plain LR and insertion sets 0
5-sterile water for dilutions
6-plaster, cotton swab, tongue depressors
7-70% ethyl alcohol

7. IMCI
The IMCI training was designed to teach integrated management of sick infants and children to first level health workers in primary care settings that have NO laboratory support and only a limited number of essential drugs.

8. The IMCI Management Process

9. Action-oriented CLASSIFICATIONS , rather than EXACT DIAGNOSES are used.
A careful balance has been struck between SENSITIVITY and SPECIFICITY.
Using FEW CLINICAL SIGNS as possible which health workers of diverse background can be trained to recognize.

10. The IMCI guidelines rely on detection of cases based on SIMPLE CLINICAL SIGNS without laboratory tests and offer EMPIRIC TREATMENT.

11. IMCI CASE MANAGEMENT PROCESS Health worker assesses the sick child.
- IDENTIFY any danger sign present (unable to feed and drink, vomits everything, convulsion, difficult to awaken or abnormally sleepy)
- ASK about the four(4) main symptoms
cough, diarrhea, fever, and ear problem
- REVIEW nutrition, Vitamin A and immunization

12. IMCI
2. Health worker CLASSIFIES child’s illness using a color-coded triage:
PINK = urgent referral
YELLOW = specific medical treatment and advice
GREEN = simple advice on home care

13. IMCI 3. Heath worker then identifies SPECIFIC TREATMENT.
- an INTEGRATED TREATMENT PLAN is
developed

14. IMCI
4. TREATMENT INSTRUCTIONS are carried out: oral drugs, ORS, treat local infections, signs to come back immediately, when to return for routine follow-up.
5. COUNSELING mothers.
6. Follow-UP instructions when the child returns to clinic.

15. IMCI Management of sick children Nutrition Immunization Other disease
Prevention
Promotion of
growth and
development
Integrated Management
of Childhood Illness (IMCI)

16. IMCI CHILD HEALTH INTERVENTIONS IN IMCI Case Management Interventions:
Pneumonia Malaria
Diarrhea Malnutrition
- dehydration Anemia
- persistent diarrhea Measles
- dysentery Ear infection
Meningitis
Sepsis

17. IMCI Preventive interventions: Immunization during sick child visits
Nutrition counseling
Breastfeeding

18. Identification and provision of treatment
IMCI
Identification and provision of treatment
Rehydration (diarrhea, DHF)
Antibiotics ( e.g. pneumonias)
Antimalarial
Vitamin A