Integrated Management of Childhood Illness IMCI Integrated Management of Childhood Illness

Summary of slides Introduction to IMCI –Slide 3 Rationale for IMCI- Slides 4-10 Advantages – Slide 11 Objectives- Slide 12 Components- Slide13 Intervention areas- Slide 14 IMCI in Nigeria Implementation steps (in another file)

An Approach for who? Clinical Officers Nurses Medical Assistants Health assistants Community Health Officers (CHOs) Other health workers Not for in-patient care an approach for health workers who care for sick children in first level health facilities:

UNDER FIVE MORTALITY RATES FOR DIFFERENT COUNTRIES – Countries of Africa Countries of South America Countries of Europe Ethiopia 174 Argentina 26 France 9 Gabon 132 Bolivia 91 Sweden 6 Nigeria 191 Guatemala 69 Tajikistan 56 Kenya 107 Brazil 70 Spain 8

Leading causes of under five mortality in developing countries Acute respiratory infections (ARI) - especially pneumonia Diarrhoea Malaria Measles Malnutrition

Frequency of presenting complaints of 450 children (as volunteered by their mothers), Gondar, Ethiopia, 1994 Fever 58%} Cough 56% Diarrhoea 47% Ear problems 10% Skin lesions 03% Abd. pains Eye discharge Dental problems Neck swelling e.t.c. The first four complaints constitute about 87% of the complaints and these are covered by the chart, the remaining 13 % are not covered by the charts

Consequences of Vertical Approach In practice, the sick child is not managed in a holistic manner at the health centre. More often, only the predominant symptom is considered for diagnosis and treatment. Many training courses are organised by individual programmes. This disturbs the continuity of services at the health centre. At health level, programmes often have the same target population and are delivered by the same health workers. Verticalization usually results in inappropriate use of resources.

A single diagnosis may not be apparent or appropriate ______________________________________ Presenting complaint Possible cause or associated _____________________________ condition________________ Cough and/or fast breathing Pneumonia Severe anaemia P.falciparum malaria Lethargy or unconsciousness Cerebral malaria Meningitis Severe dehydration Very severe pneumonia Measles rash Pneumonia Diarrhoea Ear Infection “Very sick young infant Pneumonia Sepsis

Integrated Management of Childhood illness (IMCI) as a key strategy for improving child health The IMCI strategy combines improved case management with aspects of nutrition, immunisation, and several other important influences on child health

Integrated Management of childhood illness The IMCI strategy is an approach, not entirely different from what we have known, as several national programmes have collaborated to develop these guidelines.

ADVANTAGES OF IMCI Accurate identification of illness More appropriate & combined treatment Rational use of drugs Prompt referral of severe cases Strengthening of preventive services Attention to the health needs of the mother.

Objectives To reduce significantly mortality and morbidity associated with the major causes of disease in children To contribute to healthy growth and development of children In short, the strategy is to improve the health of children up to age of five and reduce their chances of death. The WHO and UNICEF are committed to this strategy. Nigeria has also made a firm commitment to the strategy and has in-fact adopted it as the main thrust of its child survival effort.

Components Improving case management skills of health workers Improving the health system to deliver IMCI Improving family and community practices The Health system will be improved through provision of drugs and ensuring that supervisory systems are in place to support the strategy. The third component of IMCI includes promotyon, education and programs all in an effort to support and improve family and community practices e.g breastfeeding, routine immunisations, use of ITN e.t.c.

IMCI components and intervention areas Improving health Improving health Improving family & workers skills systems community practices -Case management - District planning - Appropriate standards & and management care-seeking &prevention of guidelines diseases - Training of - Availability of - Nutrition facility-based public IMCI drugs health care providers -Training for private - Improvement and -Home case management health care providers supervision of referral -Adherence to recommended pathways treatment -Maintenance of - Improved Health - Community involvement competence among information system in health planning and trained health workers monitoring