Integrated
Management
Childhood Illness
Precious Kathleen Abog
Michael Adier
BSN 2A
I What is Integrated Management
Childhood Illness? (IMCI)
a strategy for reducing mortality and morbidity associated with major causes of
childhood illness
Strategy was developed by the World Health Organization (WHO) and United Nations
Children’s Fund (UNICEF)
Introduced in 1995
Implemented 1996 in the Philippines
Majority of these deaths are caused by 5 preventable and treatable conditions namely:
1. Pneumonia
2. Diarrhea
3. Malaria
4. Measles
5. Malnutrition
II Objectives of IMCI:
To reduce SIGNIFICANTLY global mortality and
morbidity assoc. with the major causes of disease in
children
To contribute to healthy growth and development of
children
3 Main components of IMCI strategy:
1. Improvements in case management skills of health care staffs.
2. Improvements in health systems needed for effective management of
childhood
illness.
3. Improvements in family and community practices.
III Who are the children covered by the
IMCI protocol?
Sick children 1 week up to 2 months
(Sick Young Infant)
Sick children 2 months up to 5 years old
(Sick child)
The IMCI protocol guides the Health
Worker in:
1. Assessing signs that indicate severe disease
2. Assessing the child’s nutrition
immunization and feeding
3. Teaching parents how to care for a child at
home
4. Counseling parents to solve feeding
problems
5. Advising parents about when to return to a
health facility
IV
Case Management
Process
is used to assess and classify two age groups:
age 1 week up to 2 months
age 2 months up to 5 years
IV Elements of IMCI
Case Management Process
1. Assess the child or young infant
2. Classify the child’s illness using color-coded
triage system of IMCI
3. Identify the specific Treatment for the child
4. Provide practical treatment
5. Counsel the mother
6. Give follow up care, if necessary reassess the
child for new problems
1. Assess the Child or
Young Infant
1. Take History and do Physical examination
2. Identify any danger sign present
3. Convulsions (During Illness)
4. Ask about four main symptoms
cough
diarrhea
fever
ear problem
5. Review nutrition, immunization, vitamin A,
Deworm status and other problems
2. Classify the child’s illness
using color-coded triage system
of IMCI
Take a decision of the severity of the illness.
Select a category or classification for each of the child’s
major symptoms which corresponds to the severity of
the disease. (Classifications are not specific disease
diagnoses but they are categories used to determine
treatment.)
Color-Coded Triage System of IMCI
Means the child has a severe classification and needs urgent
Pink attention and referral or admission for inpatient care
Means the child needs a specific medical treatment , also teaches the
Yellow mother how to give oral drugs or to treat local infections at home.
Not given a specific medical treatment such as antibiotics or other
Green treatments. Health worker teaches the mother some simple advice
how to take care for her child at home
3. Identify the specific Treatment
for the child
Choose the treatment that corresponds to the
classification of the illness.
An integrated treatment plan is developed.
4. Provide practical treatment
Give treatment in the health center, prescribe drugs or
other treatments to be given at home, and teach the
mother how to carry out the treatments (e.g. oral
drugs, ORS, treatment of local infections, signs to come
back immediately, when to return for routine follow-up
5. Counsel the mother
Assess how the child is fed and tell her about the foods
and fluids to give to the child, and when to bring the
child back to the health center
6. Give follow up care
Give instructions on when to return to the clinic.
Selecting Appropriate
Management Chart
Decide which age group the child is in
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: Use the Chart:
Assess, Classify and Treat the sick young infant Assess, Classify the sick child, Treat the child,
Counsel the mother
V
Overall Integrated
Case Management
Process
Management for
Sick Young Infant
from 1 week up to 2
Months
1.) Assess and Classify the sick
young infant
Ask the mother or caretaker about the young infant
A. Assess, classify, and treat the sick young infant.
1. Check for severe disease and local infection and classify the illness.
2. Check for jaundice and classify.
3. Check for diarrhea and classify.
4. Check for feeding problems or if low-weight-for-age (for breastfed
infants).
5. Check the sick young infant’s immunization and vitamin A status.
6. Assess other problems.
Classification
Table for
Possible
Bacterial
Infection
Classification
Table for
Jaundice
Jaundice Infant
Classification
Table of
Diarrhea for
Dehydration
Classification
Table of feeding
problems or if
low-weight-for-
age (for
breastfed
infants).
Classification Table of feeding problems or if
low-weight-for-age (for non-breastfed infants).
Classification Table of sick young infant’s
immunization and vitamin A status.
How to Check the Immunization Status
IMMUNIZATION SCHEDULE IF AN INFANT HAS NOT RECEIVED ANY
IMMUNIZATION THEN GIVE,
Birth BCG, HepB1 BCG
DPT 1, OPV 1
DPT1, OPV1, HEPATITIS B 1
6 weeks
HepB2
DPT2, OPV2,
10 weeks
HepB3
DPT3, OPV3,
14 weeks
HepBbooster
9 mos measles
2.) Treat the sick young
infant, Counsel the mother
1. Teach the mother how to keep the young infant 3. Immunize every sick young infant as needed.
warm on the way to the hospital.
Provide skin-to-skin contact. 4. Teach the mother how to treat local infections at
Keep the young infant clothed or covered. home.
skin pustules – 0.5% Gentian Violet
2. Give an appropriate oral antibiotic for local umbilical Infection – wash with water and soap
infection. and keep dry
local bacterial infection o first-line antibiotic: oral thrush – 0.25% Gentian Violet
Amoxicillin o second-line antibiotic:
Cotrimoxazole
Give first dose of IM antibiotics.
Give first dose of both Ampicillin and
Gentamicin. (IM)
To treat diarrhea,
2.) Treat the sick young
infant, Counsel the mother
5. Teach correct positioning and attachment for
breastfeeding.
4 signs of good positioning
head and body in line
approaches breast with nose opposite to the nipple
held close to the mother’s body
whole body is supported
4 signs of good attachment
chin touching the breast (or very close)
mouth not wide open, lips pushed forward
lower lip turned in
more areola (or equal amount) seen below infant’s
bottom lip than above upper top lip
2.) Treat the sick young
infant & Counsel the
mother
6. Advise mother to give home care for the sick young infant.
food and fluid
Breastfeed frequently, as often and for as long as the infant wants day and night, during sickness and health.
7. Communicate and Counsel
Asking Good Questions vs Poor Questions
POOR QUESTIONS: GOOD CHECKING QUESTIONS:
Do you remember how to mix the ORS? How will you prepare the ORS?
Should you breastfed your child How often should you breastfed your child?
Have you used ointment on your child On what part of eye do you apply the ointment?
before? How much extra fluid will you give after each loose
Do you know how to give extra fluids? stool?
Will you remember to wash your hands? Why is it important for you to wash your hands?
3.) Give follow-up care for
the sick young infant if the child has return for the follow-up in:
Pneumonia
1. when to return immediately; signs of the
Dysentery
following: Malaria, if fever persists
2. breastfeeding or drinking poorly Fever only
Measles with eye or
3. becomes sicker mouth Complications 2 days
4. develops a fever Persistent Diarrhea
Acute Ear Infection
5. fast breathing
Chronic Ear Infection
6. difficult breathing Feeding Problem
7. blood in the stool any other illlness
jaundice 1 days
Palor
14 days
Low weight for Age
Management for
Sick Child Aged 2
months up to 5
years
1.) Assess and Classify the
Sick Child
1. Check for general danger signs
ASK:
Is the child able to drink or breastfeed?
Does the Child vomit everything?
Has the child had Convulsion?
LOOK:
See if the child LETHARGIC OR
UNCONCIOUS.
See if the child is Convulsing now
Assess and Classify the
Sick Child
2. Ask the Mother or caretaker about the main
symptoms
1. Cough/difficulty breathing
2. Diarrhea
3. Fever
4. Ear Problem
If a main symptoms is present:
1. Assess the child further for signs related to the
main symptoms
2. Classify the illness according to the signs
which are present or absent
Assess and Classify
for Cough
2. Ask the Mother or caretaker about
the main symptoms
2.1 Cough/difficulty breathing
ASK: Does the Child have Cough or
difficult breathing
If yes, ASK:
For How Long?
Assess and Classify
for Diarrhea
2. Ask the Mother or caretaker about
the main symptoms
2.2. Diarrhea
ASK: Does the Child experiencing
diarrhea?
If yes, ASK:
For How Long?
Is there blood in the stool
Child with dehydration
Assess and Classify
for Malaria Fever
2. Ask the Mother or caretaker about the
main symptoms
2.3. Fever
ASK: Does the Child experiencing fever?
If yes,
Decide Malaria Risk High or Low
then ASK:
For How Long?
If more than 7 days, has fever been
present every day?
Assess and Classify for the
Measles
2. Ask the Mother or caretaker about the main 1. Look for mouth ulcers (deep and extensive)
symptoms 2. Look for pus raining from the eye
2.4. Measles 3. Look for clouding of the cornea
If the Child has measles now or within the last 3
months
Fever with Rashes
Assess and Classify for the
ear infection
2. Ask the Mother or
caretaker about the main
symptoms
2.5. Ear Problem
ASK: Does the Child have an
ear problem?
If yes, ASK:
Is there ear pain?
is there ear discharge? If yes,
for how long?
Ear Infection
Then Check for Acute
Malnutrition
LOOK AND FEEL:
Look for signs of acute malnutrition
• Look for oedema of both feet.
• Determine WFH/L* __z-score.
• Measure MUAC** __mm in a child 6 months or older.
If WFH/L less than -3 z-scores or MUAC less than 115
mm, then
Check for any medical complication present:
• Any general danger signs
• Any severe classification
• Pneumonia with chest indrawing
f no medical complications present:
• Child is 6 months or older, offer RUTF*** to eat. Is the child:
Not able to finish RUTF portion?
Able to finish RUTF portion?
• Child is less than 6 months, assess breastfeeding:
Does the child have a breastfeeding problem?
Child with Malnutrion
Then Check for Anaemia
Check for anaemia
Look for palmar pallor. Is it:
Severe palmar pallor?
Some palmar pallor
Child with signs of Anemia
Then Check for
HIV INFECTION
ASK:
Has the mother or child had an HIV test?
IF YES:
Decide HIV status:
Mother: POSITIVE or NEGATIVE
Child:
Virological test POSITIVE or NEGATIVE
Serological test POSITIVE or NEGATIVE
If mother is HIV positive and child is negative or
unknown, ASK:
Was the child breastfeeding at the time or 6 weeks before
the test?
Is the child breastfeeding now?
If breastfeeding ASK: Is the mother and child on ARV
prophylaxis?
IF NO, THEN TEST:
Mother and child status unknown: TEST mother.
Mother HIV positive and child status unknown: TEST child
B. Treat the Child
1. Give an appropriate antibiotic. dysentery
pneumonia, acute ear Give antibiotic recommended for Shigella in your area for 3 days.
infection/mastoiditis, or very first-line antibiotic: Ciprofloxacin
severe disease cholera
first-line antibiotic: Amoxicillin Give an antibiotic recommended for Cholera in your area for 3 days.
‒2 times daily for 3 days (pneumonia) first-line antibiotic: Tetracycline
‒3 times daily for 5 days (acute ear alternative antibiotic: Erythromycin (250 mg)
infection/mastoiditis) If the classification is dysentery AND with any of the following:
second-line antibiotic: Cotrimoxazole pneumonia, acute ear infection, very severe disease, and
-2 times daily for 3 days (pneumonia) mastoiditis,
‒3 times daily for 5 days (acute ear give only Ciprofloxacin as antibiotic.
infection/mastoiditis)
B. Treat the Child
2. Teach the mother how to give oral drugs at home.
Give an oral antimalarial.
first-line antibiotic:
‒ Artemether-Lumefantrine tablet twice a day on days 1-3
‒ Primaquine tablet on day 4 (single dose)
second-line antibiotic:
‒ Quinine Sulfate + Doxycycline OR Tetracycline OR Clindamycin
Give Paracetamol for high fever (38.5°C or above) or ear pain (give every 6 hours until fever
or ear pain is gone)
B. Treat the Child
2. Teach the mother how to give oral drugs at home.
Give Iron
– therapeutic supplementation one dose daily for 14 days.
Give Vitamin A: treatment
‒ 1 capsule today (day 1)
‒ 1 capsule tomorrow (day 2)
‒ 1 capsule 2 days after day 2
supplementation: Give one dose in the health center if:
‒ child is 6 months of age or older, AND
‒ child has not received a dose of Vitamin A in the past 6 months
B. Treat the Child
2. Teach the mother how to give oral drugs at home.
Give Mebendazole or Albendazole.
-Give 500 mg Mebendazole or 400 mg Albendazole as a single dose in the health center if the child is
12 months up to 59 months and has not had a dose in the previous 6 months.
Give oral Salbutamol for wheezing.
Give Multivitamins and Minerals for persistent diarrhea.
B. Treat the Child
3. Teach the mother to treat local infections at home
Treat eye infection with Tetracycline Eye Ointment.
Dry the ear by wicking. Instill Quinolone Otic Drops.
Treat mouth ulcers with Gentian Violet.
Soothe the throat and relieve cough with a safe remedy.
breastmilk for exclusively
breastfed infant o calamansi juice
B. Treat the Child
4. Give extra fluid for diarrhea. Continue feeding
Plan A: Treat diarrhea at home.
Give extra fluid – ORS (oral rehydration solution)
Give zinc supplement.
‒ 2 months up to 6 months old = ½ tab daily for 14 days
‒ 6 months old or more = 1 tablet daily for 14 days
Continue breastfeeding if age is less than 6 months.
Plan B: Treat some dehydration with reformulated ORS.
Give in the health center the recommended amount of reformulated ORS over a 4-hour period.
Plan C: Treat severe dehydration quickly.
Give IV fluid immediately.
If IV treatment is available, within 30 minutes refer urgently to the hospital.
If trained to use NGT for rehydration and if the child can drink, start rehydration by tube or mouth with ORS
solution.
If none of the above is applicable, refer urgently to a hospital for IV or NG treatment.
C. Counsel the mother
1. Food
Assess child’s feeding.
Assess child’s care for development.
2. Fluid
Advise mother to increase fluid intake for any sick child.
3. When To Return
Advise mother when to return to the health worker
C. Counsel the mother
3. When To Return
Advise mother when to return to the health worker
IF THE CHILD HAS: RETURN FOLLOW-UP IN:
pneumonia wheeze dysentery diarrhea malaria, if fever persists
fever, malaria unlikely, if fever persists fever, no malaria, if fever 2 days
persists measles with eye or mouth complications dengue
hemorrhagic fever unlikely, if fever persists
persistent diarrhea acute ear infection chronic ear infection
5 days
feeding problems any other illness, if not improving
anemia 14 days
very low of weight for age 30 days
Programs in Philippines
run by Department of
Health (DOH) relatively
to IMCI
“Garantisadong Pambata”
Garantisadong Pambata (GP) is a response to the call of the United Nations Children’s Fund (UNICEF) to reduce
mortality of children aged five years old and below. It is an integrated package of services concerning health,
nutrition, and environmental sanitation that mainly covers micronutrient supplementation of Vitamin A and iron
among children.
Goal:
Achievement of better health outcomes sustained health financing and responsive health system
by ensuring that all Filipinos, esp. the disadvantaged group (lowest 2 income quintiles) have
equitable access to affordable health care.
Strategies:
Deploy Community/Barangay Health Workers to actively assist families in
assessing and acting on their health needs
Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC,
IPP, GP for 0-14 years old
Aggressive promotion of healthy lifestyle change
“Newborn Hearing Screening”
On June 12, 2009, Republic Act 9709 also known as the Universal Newborn Hearing Screening and Intervention Act
was approved and signed into law. RA 9709 establishes a UNHS program for the prevention, early diagnosis, and
early intervention of hearing loss and requiring all newborns to have access to hearing screening.
Vision
“No Filipino newborn shall be deprived of a functional sense of hearing.”
Every newborn shall be given access to physiologic hearing screening examination prior to hospital
discharge or at the earliest feasible time for the detection of hearing loss.
Goals
1. To implement an effective system to have all newborns undergo hearing
screening and increase the proportion of infants who are screened for hearing
loss within their first month of life.
2. To identify hearing loss through audiologic evaluation among infants
diagnosed with hearing loss within six months of age.
“Newborn Screening”
Newborn Screening Program (NBS) is an essential public health strategy that enables the early detection and
management of several congenital metabolic disorders, which if left untreated, may lead to mental retardation
and/or death. It is done ideally in the first 24 hours of life but not later than 3 days after complete delivery.
Vision
The National Comprehensive Newborn Screening System shares the vision of the Child 2015
Planning Framework aiming that by 2015, every Filipino child will be:
- Born healthy and well, with an inherent right to life, endowed with human dignity; and
- Reaching his/her full potential with the right opportunities and accessible resources.
Mission
To ensure that all Filipino children will have access to and will avail of total
quality care for the optimal growth and development of their full potential
“Dental Health”
Oral health is an essential component of general health and is a major determinant of quality of life. Unfortunately,
the oral disease continues to be a serious public health problem in the Philippines. Aside from physical deformity,
these two oral diseases may also cause disturbance of speech significant enough to affect work performance,
nutrition, social interactions, income, and self-esteem.
Vision
Empowered and responsible Filipino citizens taking care of their own personal oral health for an
enhanced quality of life
Mission
The state shall ensure quality, affordable, accessible, and available oral health
care delivery.
“Infant and Young Child Feeding (IYCF)”
Poor nutrition increases the risk of illness and is responsible, directly, or indirectly for deaths among children.
Hence, the first two years of life is a critical window of opportunity for ensuring children's appropriate growth and
development through optimal feeding practices (WHO, 2009).
The infant and young child feeding program include exclusive breastfeeding for six (6) months and nutritionally
adequate and safe complementary feeding from the age of six (6) months with continued breastfeeding up to 2
years and beyond.
Goal
Reduction of child mortality and morbidity through optimal feeding of infants and young children.
Objective
To ensure and accelerate the promotion, protection, and support of good IYCF
practice.
“National Safe Motherhood Program”
the Sustainable Development Goal (SDG) 3, the Safe Motherhood Program, has focused on making pregnancy and
childbirth safer by bringing quality emergency obstetrics and newborn care services to homes.
Objective
Objectives
1. Reduce maternal and neonatal mortality through sustainable, cost-effective
approach of delivering health services and quality maternal and newborn
health services.
2. Establish core knowledge and support systems that facilitate the delivery of
quality maternal and newborn health services to provide emergency obstetrics
and newborn care within the framework of Philippine Health Agenda.
“Family Planning”
Family Planning is a national mandated priority public health program to attain the country’s national health
development for the improvement of the health and welfare of mothers, children, and other members of the family.
It also provides information and services for the couples of reproductive age to plan their family according to their
beliefs and circumstances through legally and medically acceptable family planning methods.
Goal
To provide universal access to FP information and services whenever and
wherever these are needed.
Objectives
The FP program addresses the need to help couples and individuals achieve
their desired family size within the context of responsible parenthood and
improve their reproductive health.
“Family Planning”
Vision
Empowered men and women living healthy, productive, and fulfilling lives and
exercising the right to regulate their own fertility through legally and acceptable
family planning services.
Mission
The DOH in partnership with LGUs, NGOs, private sectors, and communities
ensures the availability of FP information and services to men and women who
need them.
Intended/Target Audience
Men and women of reproductive age (15-49 years old) including adolescents.
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