IMCI
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IMCI. not necessarily dependent on the use of sophisticated and expensive technologies a more integrated approach to managing sick children move beyond addressing single diseases to addressing the overall health and well-being of the child. Features of IMCI….

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IMCI

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IMCI


  • not necessarily dependent on the use of sophisticated and expensive technologies

  • a more integrated approach to managing sick children

  • move beyond addressing single diseases to addressing the overall health and well-being of the child

Features of IMCI…


  • careful and systematic assessment of common symptoms and specific clinical signs to guide rational and effective actions

  • integrates management of most common childhood problems (pneumonia, diarrhea, measles, malaria, dengue hemorrhagic fever, malnutrition and anemia, ear problems)

  • includes preventive interventions

Features of IMCI…


  • adjusts curative interventions to the capacity and functions of the health system (evidence-based syndromic approach)

  • involves family members and the community in the health care process

Features of IMCI…


(1) reduce deaths and the frequency and severity of illness and disability; and

(2) contribute to improved growth and development

Objectives of IMCI


IMCI Components

1. Improving case management skills of health workers

  • standard guidelines

  • training (pre-service/in-service)

  • follow-up after training

  • role of private providers


IMCI Components

2. Improving the health system to deliver IMCI

  • essential drug supply and management

  • organization of work in health facilities

  • management and supervision

  • referral system


IMCI Components

3. Improving family and community practices

  • for physical growth and mental development

  • for disease prevention

  • for appropriate home care

  • for seeking care


IMCI Components

3. Improving family and community practices

-For physical growth and mental development

  • Breastfeeding

  • Complementary feeding

  • Micronutrient supplementation

  • Psychosocial stimulation


IMCI Components

3. Improving family and community practices

- For disease prevention

  • immunization

  • handwashing

  • sanitary disposal of feces

  • use of insecticide-treated bednets

  • dengue prevention and control


IMCI Components

3. Improving family and community practices

- For appropriate home care

  • continue feeding

  • increase fluid intake

  • appropriate home treatment


IMCI Components

3. Improving family and community practices

- For seeking care

  • Follow health workers advice

  • When to seek care

  • Prenatal consultation

  • Postnatal (postpartum) consultation


Outpatient Health Facility

  • check for danger signs

  • assess main symptoms

  • assess nutrition and Immunization status

  • and potential feeding problems

  • Check for other problems

  • classify conditions and

  • identify treatment actions

Outpatient Health Facility

  • Urgent referral

  • pre-referral treatment

  • advise parents

  • refer child

Home

Outpatient Health

Facility

  • Caretaker is

  • counselled on:

  • home treatment

  • feeding &fluids

  • when to return

  • immediately

  • follow-up

  • Treatment

  • treat local infection

  • give oral drugs

  • advise and teach

  • caretaker

  • follow up

The Integrated Case Management Process

Referral facility

  • emergency triage &

  • treatment

  • Diagnosis & treatment

  • monitoring & ff-up


  • Sick young infant

    • 1 week up to 2 months

  • Sick young children

    • 2 months up to 5 years

Target Groups


  • lethargy or

  • unconsciousness

  • inability to drink or

  • breastfeed

  • vomiting

  • convulsions

General

Danger

Signs

Assessing the Sick Child


Checking the Main Symptoms

- cough and difficult breathing

- diarrhea

- fever

- ear problem


Checking the Main Symptoms

1. Cough or difficult breathing

3 clinical signs

  • Respiratory rate

  • Lower chest wall indrawing

  • Stridor


Checking the Main Symptoms

2. Diarrhea

  • Dehydration

    • General condition

    • Sunken eyes

    • Thirst

    • Skin elasticity

  • Persistent diarrhea

  • Dysentery


Checking the Main Symptoms

3. Fever

  • Stiff neck

  • Risk of malaria and other endemic infections, e.g. dengue hemorrhagic fever

  • Runny nose

  • Measles

  • Duration of fever (e.g. typhoid fever)


Checking the Main Symptoms

4. Ear problems

  • Tender swelling behind the ear

  • Ear pain

  • Ear discharge or pus (acute or chronic)


Checking Nutritional Status, Feeding, Immunization Status

  • Malnutrition

    • visible severe wasting

    • edema of both feet

    • weight for age

  • Anemia

    • palmar pallor

  • Feeding and breastfeeding

  • Immunization status


  • Meningitis

  • Sepsis

  • Tuberculosis

  • Conjunctivitis

  • Others: also mother’s (caretaker’s) own health

Assessing Other Problems


IMCI Essential Drugs and Supply

  • Appropriate antibiotics

  • Quinine

  • Vitamin A

  • Paracetamol

  • Oral antimalarial

  • Tetracycline eye ointment

  • ORS

  • Mebendazole or albendazole

  • Iron

  • Vaccines

  • Gentian violet


Outpatient

1 - assessment

2 - classification and identification of treatment

3 - referral, treatment or counseling of the child’s

caretaker (depending on the classification identified

4 - follow-up care

Referral Health Facility

1 - emergency triage assessment and treatment

2 - diagnosis, treatment and monitoring of patient

progress

Overall Case Management Process


SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS

For all sick children age 1 week up to 5 years who are brought to a first-level health facility

ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems.

CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the child’s main symptoms

and his or her nutrition or feeding status.

IF URGENT REFERRAL is needed and possible

IF NO URGENT REFERRAL isneeded or possible

IDENTIFY TREATMENT needed for the child’s classifications: Identify specific medical treatments and/or advice.

IDENTIFY URGENT

PRE-REFERRAL TREATMENT(S)

needed for the child’s classifications.

.

TREAT THE CHILD:Give the first dose of oral drugs in the clinic

and/or advise the child’s caretaker. Teach the caretaker how to

give oral drugs and how to treat local infections at home. If needed,

give immunizations.

TREAT THE CHILD:Give urgent pre-referral treatment (s) needed.

REFER THE CHILD:Explain to the child’s caretaker the need for referral. Calm the caretaker’s fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital.

COUNSEL THE MOTHER: Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a health facility. Counsel the mother about her own health.

FOLLOW-UP care: Give follow-up care when the child returns to the clinic and,if necessary, reassess the child for new problems.


Summary of the Integrated case Management Process

For all sick children age 1 week up to 5 years who are brought to a first-level health facility


Summary of the Integrated case Management Process

ASSESS the Child:

  • Check for danger signs

    (or possible bacterial infection).

  • Ask about main symptoms.

  • If a main symptom is reported, assess further. Check nutrition and immunization status.

  • Check for other problems


Summary of the Integrated Case Management Process

Classify the child’s illness:

  • Use a color-coded

    triage system to

    classify the child’s

    main symptoms and

    his or her nutrition

    or feeding status.


Summary of the Integrated Case Management Process

IF URGENT

REFERRAL

is needed and possible


Summary of the Integrated Case Management Process

IDENTIFY URGENT PRE-REFERRAL TREATMENT(S)

Needed prior to referral of the child according to classification


Summary of the Integrated Case Management Process

TREAT THE CHILD:

Give urgent pre-referral treatment(s) needed.


Summary of the Integrated Case Management Process

REFER THE CHILD:

  • Explain to the child’s caretaker the need for referral.

  • Calm the caretaker’s fears and help resolve any problems. Write a referral note.

  • Give instructions and supplies needed to care for the child on the way to the hospital


Summary of the Integrated Case Management Process

IF NO URGENT REFERRAL

is needed or possible


Summary of the Integrated Case Management Process

IDENTIFY TREATMENT

needed for the child’s classifications: identify specific medical treatments and/or advice


Summary of the Integrated Case Management Process

TREAT THE CHILD:

  • Give the first dose of oral drugs in the clinic and/or advice the child’s caretaker.

  • Teach the caretaker how to give oral drugs and how to treat local infections at home.

  • If needed, give immunizations.


Summary of the Integrated Case Management Process

COUNSEL THE MOTHER:

  • Assess the child’s feeding, including breastfeeding practices, and solve feeding problems, if present.

  • Advise about feeding and fluids during illness and about when to return to a healthy facility.

  • Counsel the mother about her own health.


Summary of the Integrated Case Management Process

FOLLOW-UP CARE:

Give follow-up care when the child returns to the clinic and, if necessary, re-asses the child for new problems.


SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS

FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic

ASK THE CHILD’S AGE

IF the child is from 1 week up to 2 months

IF the child is from 2 months up to 5 years

USE THE CHART:

œ ASSESS, CLASSIFY AND TREAT

THE SICK YOUNG INFANT

USE THE CHART:

œ ASSESS AND CLASSIFY THE SICK CHILD

TREAT THE CHILD

COUNSEL THE MOTHER


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