IMCI

NUR 4306
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
2020/21 SESSION
KHADIJA NUHU NASIDI

Any idea…
• What is mortality
• What is morbidity
• Burden of childhood mortality
• Age group affected
Overview
• In 1998, more than 50 countries still had childhood
mortality rates of over 100 per 1000 live births.
• Altogether more than 10 million children die each
year in developing countries before they reach their
fifth birthday.
• Seven in ten of these deaths are due to acute
respiratory infections (mostly pneumonia),
diarrhoea, measles, malaria, or malnutrition—and
often to a combination of these conditions (figure 1).
• If significantly greater efforts are made to control
them, these conditions will continue to be major
contributors to child deaths
• Every day, millions of parents take children with
potentially fatal illnesses to first-level health
facilities such as clinics, health centers and
outpatient departments of hospitals.
• Overlap
• Poor Assessment and Trx… Challenge
Birth of IMCI
• In response to this challenge, WHO and
UNICEF developed a strategy known as
Integrated Management of Childhood Illness
(IMCI) to provide curative care.
• The strategy combines improved management
of childhood illness with aspects of nutrition,
immunization, and other important disease
prevention and health promotion elements.
Why IMCI?
Numerous reasons…
• Promote evidence-based assessment and

management, using a syndromic approach
that supports the rational, effective and
affordable use of drugs
Why?
• Include methods for assessing signs that indicate
severe disease;
• Assessing a child’s nutrition, immunization, and
feeding;
• Teaching parents how to care for a child at home;
• Counseling parents to solve feeding problems; and
• Advising parents about when to return to a health
facility.
Why?
• The IMCI guidelines also include
recommendations for checking the parents’
understanding of the advice given and for
showing them how to administer the first dose
of treatment.
• When assessing a sick child, a combination of
individual signs leads to one or more
classifications, rather than to a diagnosis.
Definition
• IMCI is an integrated approach to child health
that focuses on the well-being of the whole
child. IMCI aims to reduce death, illness and
disability, and to promote improved growth
and development among children under five
years of age.
• includes both preventive and curative
elements that are implemented by families
and communities as well as by health facilities.
Objectives of IMCI
• The objectives are to reduce deaths and the

frequency and severity of illness and disability
and to contribute to improved growth and
development.
Strategy of IMCI
• Improvements in the case-management skills
of health staff through the provision of locally
adapted guidelines on IMCI and through
activities to promote their use
• Improvements in the health system required
for effective management of childhood illness
• Improvements in family and community
practices
Classification
• Action oriented
• thorough assessment of common serious
conditions, nutrition and immunization;
promotes rapid and affordable interventions;
strengthens the counseling of caretakers and
the provision of preventive services; and
assists health care providers to support and
follow national guidelines.
Diagnosis and management
• Integrated case management relies on case
detection using simple clinical signs and
empirical treatment.
• As few clinical signs as possible are used.
• The treatments are developed according to
action oriented classifications rather than
exact diagnosis.
• It is a case management process for a first-
level facility such as a clinic, a health centre or
an outpatient department of a hospital.
• The IMCI guidelines describe how to care for a
child who is brought to a clinic with an illness,
or for a scheduled follow-up visit to check the
child’s progress.
Population
• The IMCI process can be used by doctors,
nurses and other health professionals who see
sick infants and children aged from 1 week up
to five years.
Elements of IMCI
The complete IMCI case management process

involves the following elements:
• Assess the sick child or sick young infant
• Classify the illness
• Identify treatment
• Treat the child or young infant
• Counsel the mother
• Give follow-up care
• Classify a child’s illnesses using a colour-coded
triage system. Because many children have
more than one condition, each illness is
classified according to whether it requires: —
urgent pre-referral treatment and referral
(red), or — specific medical treatment and
advice (yellow), or — simple advice on home
management (green).
• identify specific treatments for the child. If a
child requires urgent referral, give essential
treatment before the patient is transferred. If
a child needs treatment at home, develop an
integrated treatment plan for the child and
give the first dose of drugs in the clinic. If a
child should be immunized, give
immunizations.
• Provide practical treatment instructions,
including teaching the caretaker how to give
oral drugs, how to feed and give fluids during
illness, and how to treat local infections at
home. Ask the caretaker to return for follow-
up on a specific date, and teach her how to
recognize signs that indicate the child should
return immediately to the health facility.
• Assess feeding, including assessment of
breastfeeding practices, and counsel to solve
any feeding problems found. Then counsel the
mother about her own health.
• When a child is brought back to the clinic as
requested, give follow-up care and, if
necessary, reassess the child for new
problems.
Limitatons of IMCI
• 1-IMCI does not cover management of tuberculosis,
epilepsy and asthma at first health facility level.
• 2-children over 5 years are excluded. This is because
mortality is not high in this age group and causes of
death are different.
• 3-infant below one week are not included since the
condition peculiar to this age group are covered by
the mother- baby package and integrated
management of pregnancy and child birth strategy.
Conclusion
• Case management can only be effective to the extent
that families bring their sick children to a trained
health worker for care in a timely way.
• If a family waits to bring a child to a clinic until the
child is extremely sick, or takes the child to an
untrained provider, the child is more likely to die
from the illness.
• Therefore, teaching families when to seek care for a
sick child is an important part of the case
management process.

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NUR 4306

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

KHADIJA NUHU NASIDI

• Promote evidence-based assessment and

• The objectives are to reduce deaths and the

The complete IMCI case management process

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