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 Started in
ï 1992 particularly by the UNICEF,
WHO, DOH and AUSAID
ï Strategy
ï Reducing
 Childhood Illnesses
ï Mortality
ï Morbidity
 Mortality
ï Death of large
numbers
ï Number of deaths
in a given place or
locality
 Morbidity
ï Rate of incidence
of disease
 Integrated Management of Childhood
Illness (IMCI)

Birth 1 week 2 months 5 years

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 Why 1 week to 2 months up to 5
years?
ï First week of life
ï Labor and Delivery
ï Special Management
 IMCI again...
ï CASE
MANAGEMENT
PROCESS
ï First-level facility
 Guidelines ² How to?
ï Care º brought to a
clinic
ï Illness
ï Scheduled follow up
visit to check the
child·s progress.
 Guidelines º INCLUDES:
1. Instructions
(routine
assessment)
2. Treatment
3. Basic Activities ²
Illness Prevention
è. Do not describe º
management of
trauma
ï Other acute
emergencies due to
accidents or injuries
è. If sought an
untrained provider
ï Too late for
assessment
ï Death!
ï Teaching ²
IMPORTANT >
Case Process
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 Problems why IMCI exist?
1. The under five population
is the most vulnerable
group
2. Child mortality remains
UNACCEPTABLY HIGH
3. Many of these deaths had
no medical attendance or
being seen by first ²level
health facilities
è. First-level facilities:
- undermanned/underpaid
- HW·s are not
appropriately TRAINED
- drug supply
inadequate/not properly
managed
- inaccessible
- poor laboratory support
6
Family and community
profile/ practices
- late ´help seekingµ
behavior
- poor utilization of
health facilities
- literacy
- traditional
beliefs/traditions
- economic
- large families
- crowded, dense,
polluted environment
IMCI - OBJECTIVES

1. To reduce SIGNIFICANTLY global

mortality and morbidity
associated with the major causes of
disease in children
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A must to take note:
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 in primary care
settings that have NO laboratory
support and only a limited
number of essential drugs.µ
 ´ Action oriented
CLASSIFICATIONS , rather
than EXACT DIAGNOSES,
are usedO
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 ´Using FEW CLINICAL SIGNS as
possible which health workers of
diverse background can be trained
to recognizeµ
´ The IMCI guidelines rely on detection of cases based
on SIMPLE CLINICAL SIGNS, without laboratory
tests, and offer EMPIRIC TX ´
COLOR CODING
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ï Severe
ï URGENT PRE REFERRAL
ï Hospital/Treatment
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´ Mild
´ Home Care
´Simple Advice
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1. Assess and Classify
2. Identify Treatment
3. Treat
è. Counsel the Mother
5. Follow Up
 ASSESS
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 CLASSIFY

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 IDENTIFY TREATMENT

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Case Recording Form

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 IMPORTANT BEFORE ASSESSMENT ²
1st

ï Know which the child

age belongs
1 week up to 2 months
2 months up to 5 years
 2 nd

Name
Age in months
Weight in
kilograms
Temperature
and etc.
 Remember!
ï Mothers
knows best!
 3rd

ï Initial
ï Follow Up
 Initial visit
´ 1st VISIT
´ Episode of Illness
 Follow up visit
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THE CASE PROCESS
 I. Assess for the è GENERAL
DANGER SIGNS
ï Not able to drink
ï Severe Vomiting
ï Convulsions
ï Abnormally
Sleepy
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â Ú
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the child·s nose is
blocked!
â POOR SUCKING
 Severe Vomiting «
ï EVERTHING!!
Convulsions «
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Abnormally Sleepy «
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If child is asleep 
COUGH
or DIFFICULT Breathing, „ 



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 II. Assess for COUGH /
DIFFICULTY in BREATHING

1. In breathing
ï LOOK and LISTEN to
STRIDOR
ï Harsh noise when the
child BREATHS IN
2. In cough
ï HOW LONG?
ï Chronic?
ï More than 30 days
 Rules 1-è
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shirt
 Fast Breathing

If the child is Fast breathing is:

1 months -12 months 50 breaths/minute

or more

12 months- 5 years è0 breaths/minute

or more
Is there breathing IN or OUT?
NORMAL CHEST
INDRAWING
The whole chest Ú
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wall and abdomen Ú
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move OUT when 

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the child breaths IN ! 
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 Best Position to Check
ï Lying down
 Stridor means..
ï Harsh Noise º
Breathing IN
ï Swelling of the:
Larynx
Trachea
Epiglottis
 How to check for STIDOR?

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ï Harsh noise while BREATHING OUT ²NOT A
STRIDOR!
III. Assess for DIARHEA
 IMCI definition :
DIARRHEA

´ 3 or more loose
or watery stools
in a 2è hour
period
 uestions to ask..
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ï Blood
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 If there is DIARRHEA
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Persistent Diarrhea
ï 1è days or more
 

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 Dysentery
Infection of the
intestine marked by
severe diarrhea ,
usually of the lower
intestinal tract
 If suspected DEHYDRATION

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with a CUP or a SPOON
Not able to drink Not able to take fluid in
mouth and swallow

Drinking poorly  
 


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Drinking eagerly, thirsty

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Skin goes back VERY Õ


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SLOWLY

Skin goes back SLOWLY „  ! Ú

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IV. Assess for FEVER
 IMCI definition :
FEVER
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fever within 72 hours



 HOT

Axillary temperature =
37.5·c
 


   
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past è weeks
Õ 

 STIFF NECK

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ï Gently support
BACK and BEND
the HEAD forward
to his CHIN

ï Look for RUNNY

NOSE 
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HISTORY of runny
nose!

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ï Generalized rash
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ï Measles rash -º behind the
EARS, NECK, spreads to
the face and to the rest of the
BODY
ï No vesicles or pustules ²no
itchiness


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last 3 months º

 
1. Mouth ulcers ²
painful
 
  
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2. PUS 


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3. Clouding of the
cornea 
  
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 Assess for DENGUE
HEMORRHAGIC FEVER


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BLEEDING/SHOCK:
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ï Skin petechiae
Small hemorrhages in
the skin
  
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Not raised
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 IV. Assess for EAR PROBLEM
ï Palpate
ï Look
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*. Ear pain
2. Ear Discharge
3. Tender swelling behind the
ear
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  Chronic EAR
 
infection
MASTOIDITIS

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V. Assess for MALNUTRITION &
ANEMIA
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KWASHIORKOR

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 ANEMIA
Palmar Pallor
 Weight for age
Basis for Nutrition Imbalanced
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