Integrated Management of Childhood Illness According to the reports made by the Child Health Epidemiology Research Group (CHERG),

the causes of deaths among children under 5 years of age in developing countries would include: PNEUMONIA DIARRHEA MALARIA MEASLES HIV NEAONATAL CAUSES And other causes 19% 17% 8% 4% 3% 37% -

10%

MALNUTRITION remains the highest attributable causal/associated factor of all childhood deaths in children below five years of age. It was also noted that 40 to 80 % of neonatal deaths are associated with low birth weight. The following are the demographic data involving child health situation among selected childhood illnesses in the Philippines. As in the case of Acute Respiratory infection, 1 for every 10 children under 5 years of age had symptoms of Acute Respiratory Infection, 24% have fever, and 46% were taken to a health facility or health provider for treatment. Children living within urban areas and has living well with mother who has high educational attainment and who belong to wealthiest quintile. In terms of Diarrhea, there is a slight increase in prevalence from 7% in 1998 to 11% in 2003. It is most prevalent among children aged 6 months to 11 months, and in the Cordillera Autonomous Region (CAR) with about 20% of the children; more prevalent among children with mothers without education, and in the poorest sector; and least prevalent among children aged 48 59 months and in the Zamboanga Peninsula. 32% of children with diarrhea are taken to health facilities. As in the case of Malnutrition: Breastfeeding, 54% started breastfeeding within one hour of birth , 83% among those were assisted by a health professional while, 93% of those by a barangay health worker. Less than one month is noted median duration of exclusive breastfeeding. Source: National Demographic and Health Survey-NDHS 2003) IMCI, as a strategy for reducing mortality and morbidity associated with the major causes of childhood illnesses, was initiated jointly in 1992 be DOH, WHO, and UNICEF. The pilot implementation was conducted in Sarangani and Zamboanga del Norte Provinces. As part of the sustainability mechanism, DOH entered into a partnership with the Association of Deans of Philippine College of Nursing, Inc. (ADPCN) and Association of the Philippines Schools of Midwifery, Inc. (APSOM) in April of 2002. A Memorandum of Agreement on Enhancing Nursing and Midwifery Curriculum through IMCI Strategy was signed, hence IMCI strategy was initially integrated in Nursing and Midwifery Curriculum by the eight IMCI pilot schools starting July 2002. Since then, major activities were conducted to efficiently and effectively implement the program throughout the country. In order to address the health situation, the Department of Health Essential Package of Child Survival Interventions was adopted, which includes the following: Skilled attendance during pregnancy, childbirth and the immediate postpartum Care of the newborn Breastfeeding and complementary feeding Micronutrient supplementation Immunization of children and mothers Integrated Management of Childhood Illness (IMCI) Use of insecticide treated bed nets (in malaria areas)

Main reasons for the adoption of the Essential Package of Child Survival Interventions: -skilled attendance during pregnancy, childbirth and the immediate postpartum would prevent approximately 13% of child deaths. -exclusively breastfeeding for six months, and adequate and safe complementary feeding from six months onwards with continued breastfeeding and micronutrient supplementation would prevent approximately 20% of child deaths. -vaccination against common vaccine preventable disease would prevent approximately 3% of child deaths. -Case management of diarrhea would save approximately 21% of childrens lives. -Case management of pneumonia and neonatal sepsis would prevent an estimated 12% of child deaths. -Use of insecticides treated bed nets and prompt treatment of malaria would reduce child mortality by approximately 13% Source: Child Survival Strategy-DOH 2007 Two Objectives of IMCI: 1. To significantly reduce global mortality and morbidity associated with the major causes of disease in children. 2. To contribute to healthy growth and development of children. IMCI as a strategy deals with the management of common childhood illnesses done in an integrated manner. It includes preventive interventions, adjust curative interventions to the capacity and functions of the health

system (evidence based-syndromic approach) and it involves the family members and the community in the health care process. Three Major Components of IMCI: 1. Improving ease management skills of health workers. 2. Improving the health system to deliver IMCI 3. Improving family and community health practices. The Case Management Process The case management process is presented in a series of charts which show the sequence of steps and provide information for performing them. The charts describe the following steps: 1. Assess the child or young infant 2. Classify the illness 3. Identify treatment 4. Treat the child/refer 5. Counsel the mother 6. Give follow-up care
THE INTEGRATED CASE MANAGEMENT PROCESS OUT PATIENT HEALTH FACILITY Check for General DANGER SIGNS. Convulsions (during this illness) Lethargy/unconsciousness Inability to drink/breastfeed Vomiting

Assess MAIN SYMPTOOMS. Cough/difficulty in breathing Diarrhea Fever Ear Problems Assess NUTRITION AND IMMUNIZATION STATUS and POTENTIAL FEEDING PROBLEMS. Check for OTHER PROBLEMS. CLASSIFY CONDITION and IDENTIFY TREATMENT ACTIONS According to color-coded treatment.

Urgent Referral OUT-PATIENT HEALTH FACILITY Pre-referral treatmnt Advise parents Refer child

Treatment at Out-patient Health Facility OUT-PATIENT HEALTH FACILITY

Home Management Home Caretaker is counseled on:

Treat local infection Give oral drugs Advise and teach caretaker Follow-up

Refer child Home treatments Feeding and fluids When to return immediately Follow-up

REFERRAL FACILITY Emergency Triage and Treatment (ETAT) Diagnosis Treatment Monitoring and Follow-up