Integrated Management Of Childhood Illnesses

Integrated management of childhood illnesses

Definition:

IMCI is integrated case management of the most important causes of childhood deaths - acute respiratory infection, diarrhea, measles, sore throat, ear infection and malnutrition.

Objectives of IMCI



To reduce death and the frequency and severity of illness and disability and to contribute to improved growth and development with low cost.

IMCI Strategy :

 The

IMCI strategy combines improved management of childhood illness with aspects of nutrition, immunization and other important factors influencing child health, including maternal health.

IMCI Strategy Combine

IMCI



Nutrition

Immunization

Maternal health

Advantages of integration:  Service

is provided through resources of health centers and units with only limited extra expenses and incentives.

Steps of IMCI: Complete assessment of the child in the following order, then advice the mother for home care, nutrition, and follow up.



I. Check for general danger sign Signs

•Unable to drink. Classify • Repeated vomiting. Very severe disease • Convulsions. • Lethargic or unconscious. • Treatment •Treat convulsions. • First dose of appropriate antibiotic. • Treat the child to prevent low blood sugar • Refer urgently to hospital. Complete assessment of the child

II.

Ask about main symptoms:

1. Does the child have cough or difficult breathing?

• Follow the standard case management strategy for ARTI

1. Does the child have diarrhea?

• Follow assessment of diarrhea case.

Complete assessment of the child

III. Check for throat problem: Fever or sore throat and two of the following: • Red (congested throat) • White or yellow exudate on throat and tonsils. • Enlarged tender LN in front of the neck. Streptococc al sore throat • Penzathin penecillin • Paracetamol for pain • Soothe the throat with a safe remedy

Insufficient criteria to classify as Streptococcal sore throat.

Non Streptococc al sore throat • Paracetamol for pain • Soothe the throat with a safe remedy • follow up in 5

No throat signs or symptoms.

No throat problem

Complete assessment of the

sore throat

IV. Check for ear problem: Tender swelling behind the ear

Pus is seen draining from the ear < 14 days Or Agonizing ear pain

Mastoiditi s

Acute ear infection

• Give first dose of approp. antibiotic • Paracetamol for pain • Treat the child to prevent low blood sugar • Refer urgently to hospital

Pus is seen draining from the ear 14 days or more

Chronic ear infection

No ear pain or No pus draining from the ear.

No ear infectio n

• Give an antibiotic for 10 days • Dry the ear • Paracetamol by wicking for pain • Refer to • Dry the ear ENT by wicking specialist • Follow up in Complete assessment of the child 5 days

Check for ear problem:  If

signs :  Tender swelling behind the ear

 Mastoiditis

 Give

first dose of antibiotic  Paracetamol for pain  Treat the child to prevent low blood sugar  Refer urgently to hospital

Acute ear infection  Pus

is seen draining from the ear < 14 days  Or  Agonizing ear pain

Acute ear infection

 Give

an antibiotic for 10 days  Paracetamol for pain  Dry the ear by wicking  Follow up in 5 days

Chronic ear infection  If

signs:  Pus is seen draining from the ear 14 days or more

Chronic ear infection

 Treatment  Dry

the ear by wicking  Refer to ENT specialist

 No

ear pain or  No pus draining from the ear.  So., No ear infection

Complete assessment of the child

ear problem

V. Assessment of measles: • Clouding of cornea, or • Deep extensive mouth ulcer, or • Measles now and pneumonia

Severe complicated measles

• Give 1st dose of antibiotic • Paracetamol for fever • Treat to prevent low blood sugar • Apply tetracycline eye ointment • Give vit. A

Pus draining from the eye, Or Mouth ulcer

Measles with eye or mouth complication s

Measles now or within the last 3 months And None of the above signs

Measles

 Paracetamol for • Paracetamol for fever fever  Treat mouth ulcer • Give vit. A with gentian violet • Advice the mother  Apply tetracycline when to retern eye ointment immediately  Give vit. A • Follow up in 2 days  Follow up in 2 days Complete assessment of the child

V. Assessment of measles: 

If Signs:





Clouding of cornea, or Deep extensive mouth ulcer, or Measles now and pneumonia

1.

 

2. 3. 4.

Severe complicated measles

5. 6.

Treatment Give 1st dose of antibiotic Paracetamol for fever Treat to prevent low blood sugar Apply tetracycline eye ointment Give vit. A Refer urgently to hospital

Assessment of measles:  If

signs are  Pus draining from the eye, Or  Mouth ulcer

Measles with eye or mouth complications

 Treatment

Paracetamol for fever  Treat mouth ulcer with gentian violet  Apply tetracycline eye ointment  Give vit. A  Follow up in 2 days 

Assessment of measles:  If

signs:

 Measles now or within  

the last 3 months And None of the above signs

Measles

 Treatment  Paracetamol

for fever

Give vit. A  Advice the mother when to return immediately  Follow up in 2 days 

measles

VI. Assessment of fever: Any general danger sign or stiff neck

Very severe febrile disease

• Give first dose of appropriate antibiotic • Paracetamol for fever • Treat the child to prevent low blood sugar • Refer urgently to

Apparent bacterial cause of fever present e.g. • Pneumonia • Dysentry • Acute ear infection • Streptococcal sore throat • Other apparent causes Febrile possible bacterial infection • Paracetamol for fever • Treat apparent cause of fever • Follow up in 2 days

No apparent bacterial cause of fever

Febrile bacterial infection unlikely for • Paracetamol fever • Advice the mother when to retern immediately • Follow up in 2 days

Complete assessment of the child

VI. Assessment of fever: If signs are: Any general danger sign or stiff neck



   

Very severe febrile disease



Treatment Give first dose of appropriate antibiotic Paracetamol for fever Treat the child to prevent low blood sugar Refer urgently to hospital

Assessment of fever:  If

signs:  Apparent bacterial cause of fever present e.g.    

Pneumonia, Dysentry Acute ear infection Streptococcal sore throat Others Febrile possible bacterial infection

 Treatment  Paracetamol

for

fever  Treat apparent cause of fever  Follow up in 2 days

Assessment of fever:  If

signs No apparent bacterial cause of fever

Febrile bacterial infection

 Treatment  Paracetamol

for

fever  Advice the mother when to return immediately  Follow up in 2 days

unlikely

Complete assessment of the child

VII. Assessment of malnutrition: Visible severe wasting, or Edema of both feet

severe malnutrition

Low weight for age

Low weight

• Counsel the

• Give Vit. A • Treat the child to prevent low blood sugar • Refer urgently to

Not low weight for age and No other signs of malnutrition

Not low weight

• Counsel the

mother for feeding mother for • Advice the feeding mother when to return immediately • Follow up in 30 days Complete assessment of the child

VII. Assessment of malnutrition:  Signs

 Treatment

Visible severe wasting, or  Edema of both feet





severe malnutrition

Give Vit. A  Treat the child to prevent low blood sugar  Refer urgently to hospital

Assessment of malnutrition:  Signs

 Treatment

 Low

 Counsel

weight for age

Low weight

the mother for feeding  Advice the mother when to return immediately  Follow up in 30 days

Assessment of malnutrition:  Signs

 Treatment

 Not

• Counsel the mother for feeding

low weight for age and  No other signs of malnutrition

Not low weight

Complete assessment of the child

VIII. Assessment of Anemia: Severe palmer pallor and/or M.M. pallor

Some palmer pallor and/or M.M. pallor

No palmer pallor and/or M.M. pallor

severe anaemia

Anaemia

No anaemia

• Treat to prevent low blood sugar • Refer urgently to hospital

• Give iron • Advice the

• If child is aged

from 6-30 months, give one dose of iron weekly

mother when to return immediately • Follow up in 30 days Complete assessment of the child

anaemia

IX. Assessment of immunization and vitamin A supplementation:

X. Advice the mother for home care, nutrition, and follow up.