IMCI / COPAR

By: Niel Allison V. Oro, RN, MANc

INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESSES (IMCI)
O Definition: The ntegrated Management of
Childhood llness (MC) is a strategy to address
the most common causes of illness (morbidity)
and mortality (deaths) among children under five
which was developed and initiated by the World
Health Organization (WHO) in collaboration with
UNCEF in 1995.

O Objective: aims to reduce death, illness and
disability, and to promote improved growth and
development among children under five years
old

O Steps in the IMCI Process
4
4
4
4
4
4

O PrincipIes of the Integrated Care

4 Assess for GeneraI Danger Signs
I
L
'
C

4 Assess for Main Symptoms
C
D
E
F
M

O CoIor CIassification
4

4

4

O Assess and Identify CIassifications

A. Cough and DifficuIty Breathing

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B. DIARRHEA AND DEHYDRATION

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PLAN A:





PLAN B:





PLAN C:



C. DIARRHEA FOR MORE THAN 14 DAYS

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D. EAR PROBLEMS

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E. MALARIA RISK (+)

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F. MALARIA RISK (-)

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G. MEASLES

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H. DEANGUE HEMORRHAGIC FE'ER

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I. ANEMIA AND MALNUTRITION

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COMMUNITY ORGANIZING PARTICIPATORY
ACTION RESEARCH (COPAR)

Community - a group of interacting people, living in a
particular local area, and often refers to a group that
shares common values and attitudes within a shared
geographical location

Organization - group of people working together

Community Organization - a process by which
people, health services and agencies of the community
are brought together to:
1.
2.
3.
4.

Basic Methods and Steps in Community
Organization Process

O Fact Finding



O Determination of Needs



O Program Formation



O Education and Interpretation



Basic 'aIues in Community Organizing

1. Human Rights - are universally held principles
anchored mainly on the belief in the worth and dignity
of people; it includes the right to life and to self-
determination and development as persons and as a
people.

2. SociaI Justice - means equitable access to
opportunities for satisfying people's basic needs and
dignity; it requires an equitable distribution of resources
and power through people's participation in their own
development.

3. SociaI ResponsibiIity - is premised on the belief
that people as social beings must not limit themselves
to their own concerns but should reach out to and
move jointly with others in meeting common needs and
problems.

Aims of Community Organizing

1. PeopIe's empowerment. Community organizing is
aimed at achieving effective power for the people.
Through the process of CO, people learn to overcome
their powerlessness and develop their capacity to
maximize their control over their situation and start to
place the future in their own hands

2. BuiIding reIativeIy permanent structures and
peopIe's organizations. Community organizing aims
to establish and sustain relatively permanent
organizational structures which best serve the needs
and aspirations of the people. These structures ensure
people's maximum participation while, at the same
time, they provide the venue through which the
people's organizations can link up with other groups
and sectors

3. Improved quaIity of Iife. Community organizing
also seeks to secure short and long term
improvements in the quality of life of the people.
mmediately, the process of mobilization can gain
concessions for fulfilling basic needs for food, clothing,
shelter, education and health.

Definition of COPAR:
O



O A collective, participatory, transformative,
sustained and systematic process of building
people's organizations by mobilizing and
enhancing the capabilities and resources of
the people for the resolution of their issues and
concerns towards effecting change in their
existing oppressive and exploitative conditions
(1994 National Rural Conference)

Importance of COPAR:

1.



2.



3.



PrincipIes of COPAR:

1. People, especially the most oppressed, exploited
and deprived sectors are open to change, have the
capacity to change and are able to bring about change.
2. COPAR should be based on the interest of the
poorest sectors of society
3. COPAR should lead to a self-reliant community and
society.

Community Organizing Participatory Action
Research (COPAR) - is a continuous and a sustained
process of:
O Educating the peopIe

O orking with peopIe

O MobiIizing with peopIe

Process - the sequence of steps whereby members of
a community come together to critically assess to
evaluate community conditions and work together to
improve those conditions.

Structure - refers to a particular group of community
members that work together for a common health and
health related goals.

Emphasis of COPAR:
1. Community working to solve its own problem
2. Direction is established internally and
externally
3. Development and implementation of a specific
project less important than the development of
the capacity of the community to establish the
project
4. Consciousness raising involves perceiving
health and medical care within the total
structure of society

Importance of COPAR:
O COPAR


O COPAR


O COPAR


O Through COPAR


O COPAR


Phases of COPAR Process:

1. Pre-Entry Phase -



Activities in the Pre-Entry Phase:

Preparation of the Institution
O
O
O
O

Site Selection
O
O
O
O

Criteria for Initial Site Selection
O
O
O
O
O

Identifying Potential Municipalities
O

Identifying Potential Barangay
O
O
O

Choosing Final Barangay
O
O
O
O
O
O
O

Identifying Host Family
O
O
O
O
O
2. Entry Phase



uidelines for Entry
O Recognize the role of local authorities by
paying them visits to inform their presence and
activities.
O Her appearance, speech, behavior and
lifestyle should be in keeping with those of the
community residents without disregard of their
being role model.
O Avoid raising the consciousness of the
community residents; adopt a low-key profile.

Activities in the Entry Phase:
O ntegration
4
4
4
4

O Deepening Social nvestigation -
4
4

O Core Group Formation
4 Sociogram



3. Organization-buiIding Phase -


Key Activities
O
4
4
4
O
O
O
O
O
4. Sustenance and Strengthening Phase -



Key Activities
O
O
O
O
O
POST TEST:
Situation: uring the mid-1990's, the world Health
Organization (WHO), in collaboration with UNICEF and
many other agencies, institutions and individuals,
responded to case management challenge by developing
a strategy known as the Integrated Management of
Childhood Illness (IMCI).

1. The MC guidelines target which of the following
groups of children?
a. Those from 0 to 24 months
b. Under school children
c. nfants until 1 year of age
d. Less than 5 years old

2. The MC guidelines are based on the following
principles, except:
a. All sick children must be examined for general danger
signs which indicate the need for immediate referral or
admission to a hospital.
b. Only a limited number of carefully-selected clinical
signs are used, based on evidence of their sensitivity and
specificity to detect disease.
c. The MC guidelines address most, but not all, of the
major reasons a sick child is brought to a clinic.
d. MC management procedures use unlimited number
of essential drugs and encourage active participation of
care takers in the treatment of children.

3. n one of your home visits, you found out that Rina, 4
year-old child is having diarrhea. To prevent dehydration
you will advise Rina's mother to give ORS amounting to:
a. 50-100 ml after each loose stool
b. 300 ml twice a day
c. 200-300 ml 3 times a day
d. 100-200 ml after each loose stool

4. For very severe disease category, the following are
guidelines, except:
a. Give first dose of antibiotics
b. Give Vitamin A
c. Mothers should continue breastfeeding
d. Give Cotrimoxazole to prevent respiratory infection

5. For a 12-month old child with Pneumonia category, the
following are guidelines, except:
a. Antibiotic for 5 days
b. Relieve cough with safe remedy
c. Advise mother on danger signs
d. Follow up in 5 days if no improvement

6. Classifying conditions and identifying treatment actions
are color coded, what is the color coded treatment for
urgent referrals?
a. Red c. Pink
b. Yellow d. Green

7. To be categorized as persistent diarrhea, how many
days has the patient been on diarrhea?
a. 3 days or more c. 7 days or more
b. 12 days or more d. 14 days or more

8. For a patient with Malaria risk with any general danger
sign or stiff neck, the recommended guidelines are,
except:
a. Quinine c. 1
st
dose of antibiotic
b. Aspirin d. Urgent referral
c.
9. For a child with ear discharge less than 14 days or ear
pain leading to acute ear infection, the recommended
guidelines are, except:
a. Antibiotic for 10 days c. Paracetamol for Pain
b. Wicking d. Follow up in 5 days

10. n a no Malaria risk area or season, theses presenting
symptoms are classified as having Fever Malaria
unlikely, except:
a. Children with runny nose
b. Measles
c. Clinical signs of other possible infection
d. Dehydration

11. n responding to the care concerns of children with
severe disease, referral to the hospital is the essence
especially if the child manifests which of the following?
a. Wheezing c. Stopped feeding well
b. Difficulty to awaken d. Fast breathing

12. f the child has sunken eyes, drinks eagerly, thirsty and
skin pinch goes back slowly, the classification would be?
a. Moderate dehydration c. Some dehydration
b. No dehydration d. Severe dehydration

13. The child with no dehydration needs home treatment.
Which of the following is not included in the rules for
home treatment in this case?
a. Know when to return to the center
b. Give the child extra fluids
c. Give ORS every 4 hours
d. Continue feeding the child

14. A child with chest in-drawing was brought to a clinic,
which of the following should the nurse decide to do?
a. Let the mother bring the child home with antibiotic
b. Refer the child to the hospital
c. Treat wheezing
d. Continue to observe the child

15. n an area with malaria risk, a client presenting with
positive blood smear, no runny nose, no measles is
classified as what?
a. Very severe malaria c. Malaria
b. No malaria d. Fever malaria unlikely

16. Child with diarrhea for 5 days was brought to a health
clinic, is abnormally sleepy and drinks poorly. The
classification of the child is:
a. Dehydration c. Some dehydration
b. Severe dehydration d. Persistent diarrhea

17. A 2 year old child with cough, no stridor, no chest in
drawing, with respiratory rate of 53 bpm. This child can be
classified as:
a. No pneumonia c. Pneumonia
b. Some Pneumonia d. Severe Pneumonia

18. When you are going to teach a mother regarding home
medications, the nurse must consider that the
classification of the child is on what color?
a. Red c. Pink
b. Yellow d. Green

19. Which of the following signs may indicate severe
pneumonia or very severe disease?
a. Lower chest wall goes in when child breathes in
b. Lower chest wall goes out when child breathes in
c. Restless and irritable
d. Febrile

20. n preventing low blood sugar, what is the most
affordable and primary intervention?
a. Fluid replacement c. Oresol
b. Breastfeeding d. mmunization

Situation: Community organizing is a process by which
people, health services and agencies of the community
are brought together to act and solve their own problems.

21. Nurse Myke wrote a letter to PCSO asking them for
assistance in their feeding programs for the community's
nutrition and health projects. PCSO then approved the
request and gave Myke 50,000 Pesos and a truckload of
rice, fruits and vegetables. Which phase of COPAR is
being utilized?
A. Preparatory
B. Organizational
C. Education and Training
D. ntersectoral Collaboration
E. Phase out

22. deally, How many years should the Nurse stay in the
community before he can phase out and be assured of a
Self Reliant community?
A. 5 years C. 10 years
B. 1 year D. 6 months

23. The nurse should know that Organizational plan best
succeeds when
i. People sees its values
ii. People think its antagonistic professionally
iii. t is incompatible with their personal beliefs
iv. t is compatible with their personal beliefs

A. i and iii C. ii and iv
B. i and ii D. i and iv

24. One of the critical steps in COPAR is becoming one
with the people and understanding their culture and
lifestyle. Which critical step in COPAR will the Nurse try to
immerse himself in the community?
A. ntegration C. Social Mobilization
B. Ground Work D. Mobilization

25. The Actual exercise of people power occurs during
when?
A. ntegration C. Social Mobilization
B. Ground Work D. Mobilization

26. Which steps in COPAR trains indigenous and informal
leaders?
A. Ground Work C. Mobilization
B. Core Group formation D. ntegration

27. As a PHN, One of your role is to organize the
community. Nurse Jen knows that the purposes of
community organizing are
i. Move the community to act on their own problems
ii. Make people aware of their own problems
iii. Enable the nurse to solve the community problems
iv. Offer people means of solving their own problems

A. i, ii, iii C. ii, ii, iii, iv
B. i, ii D. i, ii, iv

28. Setting up Committee on Education and Training is in
what phase of COPAR?
A. Preparatory
B. Organizational
C. Education and Training
D. ntersectoral Collaboration
E. Phase out

29. This is considered the first act of integrating with the
people. This gives an in depth participation in community
health problems and needs.
A. Residing in the area of assignment
B. Listing down the name of person to contact for
courtesy call
C. Gathering initial information about the community
D. Preparing Agenda for the first meeting

30. n community health Nursing, the basic recipient of
care is the:
A. individual C. family
B. community D. municipality