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

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

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.

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%

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)

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

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.

The IMCI Management Process

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.

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

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

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

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

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.

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

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

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

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