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Integrated Management of Childhood Illness (IMCI)

الكلية كلية التمريض     القسم قسم التمريض العام     المرحلة 7
أستاذ المادة امين عجيل ياسر الياسري       18/10/2018 10:28:52
Integrated Management of Childhood Illness (IMCI)
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Integrated Management of Childhood Illness (IMCI) is a broad strategy to improve child health outcomes developed by WHO and UNICEF. IMCI encompasses interventions at home, in the community and in the health system.
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. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
? The implementation of IMCI strategy involves three components:
a) Improving case management skills of health-care providers
b) Improving overall health systems
c) Improving family and community health practices
? Aims:
1. To reduce childhood deaths, illnesses, and disability (morbidity and mortality).
2. To improve children s growth and development, with a particular focus on the poorest and most disadvantaged children.
The core of the IMCI strategy is integrated case management of the most common childhood problems, with a focus on the most important causes of death. The clinical guidelines, which are based on expert clinical opinion and research results, are designed for the management of sick children aged 1 week up to 5 years.
? IMCI Integrated case management relies on:
1) Case detection using simple clinical signs and treatment.
2) Few clinical signs as possible are used.
3) The signs are based on expert clinical opinion and research results, and strike a careful balance between sensitivity and specificity of the signs and symptoms.
? Sensitivity and specificity measure the diagnostic performance of a clinical sign compared with that of the gold standard, which by definition has a sensitivity of 100% and a specificity of 100%.

? Sensitivity measures the proportion or percentage of those with the disease who are correctly identified by the sign. In other words, it measures how sensitive the sign is in detecting the disease.

Sensitivity = true positives / [true positives + false negatives].
? Specificity measures the proportion of those without the disease who are correctly called free of the disease by using the sign.

Specificity = true negatives / [true negatives + false positives].
? IMCI allows a health care provider to determine
1. If a child should be urgently referred to another health facility
2. If the child can be treated at the first-level facility (e.g. with oral antibiotic, antimalarial, ORS, etc.)
3. If the child can be safely managed at home.
? The core of the IMCI strategy is focus on the most important causes of death:
1. Diarrhea.
2. Acute respiratory infections (ARI): e.g. pneumonia, TB, etc….
3. Malaria.
4. Measles.
5. Malnutrition.
? The complete IMCI case management process involves the following elements:
1. IMCI first assesses the child by Identifying any danger signs: inability to drink or breastfeed, difficult breathing, diarrhea, fever, cough, convulsion, unconsciousness and ear problem. Also, checking malnutrition & anaemia and immunization status.
2. Then, IMCI classifies the child s illnesses: Each illness is classified according to whether it requires:
- Urgent referral (red or pink card).
- Specific medical treatment and advice (yellow card).
- Simple advice on home management (green card).
3. After classification, specific treatments are identified.If the child has to be referred urgently to a hospital, give only essential treatment before departure. Since most children have more than one illness.
4. Counselling, Health education and follow-up:
a) Teach the mother how to administer oral drugs, to increase fluid intake during diarrhea and to treat local infections at home.
b) The mother is advised on the signs which indicate that the child should immediately be brought back to the clinic and when to return for routine follow-up.
c) Feeding is assessed and counseling of mothers on feeding problems is provided.
d) Follow-up instructions for various conditions are given when the child returns to the clinic. If necessary, reassess the child for new problems.
? IMCI assessment categorized according to age:
- Assess the sick young infant, age up to 2 months.
- Assess the sick child, age 2 months up to 5 years.
References:
Abbood, R. K. (2018) Primary Health Care Programs Learner’s Guide. 1st ed. Edited by University Research Company. USA: URC.
World Health Organization (2018) Integrated Management of Childhood Illness (IMCI), Maternal, newborn, child and adolescent health. Available at: http://www.who.int/maternal_child_adolescent/topics/child/imci/en/ (Accessed: 13 October 2018).
World Health Organization and UNICEF (2005) Handbook?: IMCI integrated management of childhood illness. Edited by Department of Child and Adolescent and and Development Health (CAH). Geneva: WHO and UNICEF. Available at: http://www.who.int/maternal_child_adolescent/documents/9241546441/en/.


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