IMCI

Dr. Bulemela Janeth

(Mmed. Pead)

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 WHO and UNICEF started to develop the IMCI strategy in 1992,

andtoday more than 100 countries worldwide have adopted it.
The implementation ofthe IMCI strategyproduces impressive
results, both in the decrease of childhood mortality and in
improving the quality of life ofyoung children all over the
world.

RATIONALE FOR AN INTEGRATED APPROACH

Every yearalmost 10 million children die before they reach
their fifth birthday. A majority of these deathscaused byjust
five preventable and treatable conditions

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Strategy objectives Focuses

on
Improving case management skills of
health-care providers
Improving overall health systems
Improving family and community health
practices.
The current challenge for the IMCI strategy
is to scale up activities to ensure the
appropriate and effective use of IMCI
principles and clinical guidelines by all types
of health-care providers.
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CHILD OF 2 MONTHS UP TO
5 YEARS

how to assessa sick child and classifythe

child's illness.
You will also how to interact with the child's
mother or other caregiver who brings the
child to you.
The assessand classify part of the training
is divided into following units:
Ask the mother about the child's problems
Check for general danger signs (INABILITY
TO FEED, CONVULSION, LOSS OF
CONSCIOUSNESS)
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 Assess main symptoms among

which:
Coughor difficulty breathing
Diarrhoea
Fever

Check for malnutritionand anaemia

Check immunization status

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 After youhave assessed a sick child and

classified his or her illness or illnesses, the
next stepis to identify the necessary
treatment.
The oral drugs, intramuscular drugs and
other treatments presented in the IMCI
charts are recommended for first-level
health facilities in particular country.
Both first- and second-line oral antibiotics
and antimalarials are included.

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 First-line drugs were chosen

because they are effective, easy to
give and inexpensive.
You should give a second-line drug
only if a first-line drug is not
available, or if the child's illness does
not respond to the first-line drug.
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Counsel the mother

A child who is seen at the clinic needs to continue
treatment, feeding and fluids at home.
Therefore :
how to assess feeding and counsel the mother
about feeding,
advise the mother when to return for follow-up,
and teach her thesigns that meanshe should bring
the child back to the clinicimmediately for further
care.

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follow up

Assess feeding and makerecommendations

At a follow-up visit you can see if the child is improving on the
drug or other treatment that was prescribed.
Some children may not respond to a particular antibiotic or
antimalarial, and youmay need to try a second drug.

Children with persistent diarrhoea need follow-up to be sure that

the diarrhoea has stopped.

Follow-up is especially important for children with a feeding

problem, to be sure they are being fed adequately and are gaining
weight.

A follow-up visit is different from a child's initial visit for a problem .

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SICK YOUNG INFANT.

The processes of managing a young infant aged up to

2 months or asick child aged 2 monthsup to 5
yearsare very similar.

But young infants have special characteristics

that must be considered when classifying their
illnesses.

For this reason, you will assess, classify and treat

the young infant in asomewhat different way from the
way you would deal with an older infant or young
child.

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 IMCI does not include the management of

conditions related to labour and delivery,

orthe conditions of a newborn childthat

require special management, such as
asphyxia, sepsis from prematurely ruptured
membranes or other intrauterine infection,
birth trauma, or conditions due to immaturity.

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Young infants have special

characteristics that must be
considered when classifying their
illnesses.
They can become sick and die very
quickly from serious bacterial
infections.
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 They frequently have only a very few general danger signs

such as
"movements only when stimulated",
"fever", or
"low body temperature".

Mild chest indrawing is normal in young infants because

their chest wall is soft.

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Steps of management:
Determinewhether this is an initial or followup visit for these problems.

Thispart has the steps to assess and classify a

sick young infant at an initial visit:
Check for very severe disease and local
infection. Then classify the young infant
based on the signs found.
Check for jaundice. Then classify the
young infant based on the signs found.
Check for pus draining from the eyes.
Then classify according to severity.
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 Ask about diarrhoea. If the infant has diarrhoea,

assess the related signs. Classify the young infant
for dehydration.
Ask about mother and the child HIV status.
Then classify for HIV infection.
Check for feeding problem or low weight. This
includes assessing breastfeeding. Then classify
feeding.
Check for birth weight and gestational age for
infants less than 7 days. Then classify
appropriately.
Check the young infant's immunization and
assess any other problems.
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 Some young infants need to return to the

clinic for follow-up.
Tell their motherswhen to come for a
follow-up visit.
At a follow-up visit you can see if the young
infant is improving on the treatment that
was prescribed, and you can makeany
necessary adjustments to the treatment.
Some young infants may not respond to
the treatment that was prescribed and may
need referral.
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 Follow-up is especially important for infants

with a feeding problem and low weight to be
sure they are being fed adequately and are
gaining weight.
The steps you take at a follow-up visit are
different from those you take at an
infant'Identify treatment for the young
infant.
If a young infant needs urgent referral, give
urgent pre-referral treatment before the
patient is transferred. If a young infant needs
treatment at home, you need to decidehow
totreat the infant.
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References
ICATT IMCI

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