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Definition
IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children under five
Goal
By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.
Aim
To reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
IMCI Objectives
To reduce significantly global mortality and morbidity associated with the major causes of disease in children To contribute to the healthy growth & development of children
**For many sick children a single diagnosis may not be apparent or appropriate Presenting complaint: Cough and/or fast breathing Lethargy/Unconsciousness Measles rash Very sick young infant Possible course/ associated condition:
Pneumonia, Severe anemia, P. falciparum malaria Cerebral malaria, meningitis, severe dehydration Pneumonia, Diarrhea, Ear infection Pneumonia, Meningitis, Sepsis Five Disease Focus of IMCI:
Acute Respiratory Infection Diarrhea Fever Malaria Measles Dengue Fever Ear Infection Malnutrition
** A child with cough or difficult breathing is assessed for: How long the child has had cough or difficult breathing Fast breathing Chest indrawing Stridor in a calm child. Remember: o o ** If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.
Color Coding
PINK YELLOW (URGENT (Treatment at outpatient health REFERRAL) facility) OUTPATIENT OUTPATIENT HEALTH HEALTH FACILITY FACILITY Pre-referral treatments Advise parents Refer child Treat local infection Give oral drugs Advise and teach caretaker Follow-up GREEN (Home management) HOME Caretaker is counseled on: Home treatment/s Feeding and fluids When to return immediately Follow-up Give first dose of an appropriate antibiotic Give Vitamin A Treat the child to prevent low
REFERRAL FACILITY Emergency Triage and Treatment ( ETAT) Diagnosis, Treatment SEVERE PNEUMONIA OR VERY SEVERE DISEASE
Monitoring, follow-up
blood sugar Refer urgently to the hospital Give paracetamol for fever > o 38.5 C Give an appropriate antibiotic for 5 days Soothe the throat and relieve cough with a safe remedy Advise mother when to return immediately Follow up in 2 days Give Paracetamol for fever > o 38.5 C If coughing more than more than 30 days, refer for assessment Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow up in 5 days if not improving
PNEUMONIA
Fast breathing
Two of the following signs : Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly
SOME DEHYDRATION
Dehydration present
Treat dehydration before referral unless the child has another severe classification Give Vitamin a Refer to hospital Advise the mother on feeding a child who has persistent diarrhea Give Vitamin A Follow up in 5 days Treat for 5 days with an oral antibiotic recommended for Shigella in your area Follow up in 2 days Give also referral treatment
No dehydration
DYSENTERY
Blood smear ( + )
MALARIA
If blood smear not done: NO runny nose, and NO measles, and NO other causes of fever
Treat the child with an oral antimalarial Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refer for assessment Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refer for assessment
Blood smear ( - ), FEVER : MALARIA or UNLIKELY Runny nose, or Measles, or Other causes of fever
No Malaria Risk Any general danger sign or Stiff neck VERY SEVERE FEBRILE DISEASE Give first dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for high fever o (38.5 C) or above Refer URGENTLY to hospital Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more
FEVER : NO MALARIA
Measles
Clouding of cornea or Deep or extensive mouth ulcers SEVERE COMPLICATED MEASLES Give Vitamin A Give first dose of an appropriate antibiotic If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment Refer URGENTLY to hospital Give Vitamin A If pus draining from the eye, apply tetracycline eye ointment If mouth ulcers, teach the mother to treat with gentian violet Give Vitamin A
MEASLES
Dengue Fever
Bleeding from nose or gums or SEVERE DENGUE HEMORRHAGIC Bleeding in FEVER stools or vomitus or Black stools or vomitus or Skin petechiae or Cold clammy extremities or Capillary refill more than 3 seconds or If skin petechiae or Tourniquet test,are the only positive signs give ORS If any other signs are positive, give fluids rapidly as in Plan C Treat the child to prevent low blood sugar DO NOT GIVE ASPIRIN Refer all children
Abdominal pain or Vomiting Tourniquet test ( +) No signs of severe dengue hemorrhagic fever FEVER: DENGUE HEMORRHAGIC UNLIKELY
Urgently to hospital
DO NOT GIVE ASPIRIN Give one dose of paracetamol in health center for o high fever (38.5 C) or above Follow up in 2 days if fever persists or child shows signs of bleeding Advise mother when to return immediately
Age or Weight
Adult tablet
Syrup
Tablet
Syrup
1/2
5 ml
1/2
5 ml
7.5 ml
10 ml
B. For Dysentery COTRIMOXAZOLE BID FOR 5 DAYS AMOXYCILLIN BID FOR 5 DAYS
AGE OR WEIGHT
TABLET
SYRUP
SYRUP 250MG/5ML
5 ml
1.25 ml ( tsp )
5 ml
2.5 ml ( tsp )
7.5 ml
( 1 tsp )
C. For Cholera TETRACYCLINE QID FOR 3 DAYS COTRIMOXAZOLE BID FOR 3 DAYS
AGE OR WEIGHT 2 4 months ( 4 - < 6kg ) 4 12 months ( 6 - < 10 kg ) 1 5 years old ( 10 19 kg) Give an Oral Antimalarial
Capsule 250mg 1
Primaquine CHOLOROQUINE Give for 3 days Give single dose in health center for P. Falciparum
AGE
TABLET ( 150MG )
TABLET ( 15MG)
TABLET ( 15MG)
TABLET ( 15MG)
DAY1
DAY2
DAY3
1/2
3/4
1/2
AGE or WEIGHT Iron/Folate Tablet Iron Syrup FeSo4 200mg + 250mcg FeSo4 150 mg/5ml Folate (60mg elemental (6mg elemental iron per iron) ml ) 2months-4months 2.5 ml (4 - <6kg ) 4months 4 ml 12months (6 - <10kg ) 12months 3 1/2 5 ml years (10 <14kg) 3years 5 years ( 1/2 7.5 ml 14 19kg ) GIVE PARACETAMOL FOR HIGH FEVER (38.5 C OR MORE) OR EAR PAIN AGE OR TABLET ( 500MG ) WEIGHT 2 months 3 years (4<14kg ) 3 years up to 5 1/2 years (14 19 kg ) GIVE MEBENDAZOLE Give 500mg Mebendazole as a single dose in health center if : o hookworm / whipworm are a problem in children in your area, and o the child is 2 years of age or older, and o the child has not had a dose in the previous 6 months SYRUP ( 120MG / 5ML ) 5 ml
o
10 ml