IMCI

• IMCI


  Integrated Management of Childhood Illness
• Assess and Classify


  Describes how to assess and classify sick children aged 2mos-5yrs so that signs of diseases are not overlooked
• Assess and Classify the sick child aged 2 months up to 5years

  1. Greet the mother appropriately and ask her to sit with her child

  2. Determine the child's age in months using the child's birthdate

  3. If the child is aged 2 months up to 5years, assess and classify the child according to the steps Assess and Classify chart

  4. If the child is from birth up to 2months, assess and classify the young infant according to the steps YOUNG INFANT chart
• Using good communication skills, ask the mother what the child's problems are and record them on the Recording Form


  1. Listen carefully to what the mother tells you

  2. Use words the mother understands

  3. Give the mother time to answer the questions

  4. Ask additional questions when the mother is not sure about her answer
• Determine if this is an initial visit or follow-up visit for this problem
• General Danger Signs


  Signs that indicate the child has a serious problem and needs urgent referral to a hospital
• General Danger Signs


  • The child is not able to drink or breastfeed
  • The child vomits everything
  • The child has had convulsions (during illness)
  • The child is abnormally sleepy or difficult to awaken
• Most children with a general danger sign need URGENT referral to a hospital
• They may need life-saving treatment with injectable antibiotics, oxygen or other treatments which may not be available in your health center
• How to provide urgent treatment

  Described in the IDENTIFY TREATMENT CHART
• Check for General Danger Signs

  1. ASK: Is the child not able to drink or breastfeed?

  2. Does the child vomit everything?

  3. Has the child had convulsions? (during the present illness)

  4. LOOK: See if the child is abnormally sleepy or difficult to awaken
• If the child has any GENERAL DANGER SIGN, they should be referred after the first dose of an appropriate antibiotic and other urgent treatments
• Exception: Rehydration of the child according to PLAN C may resolve the danger signs so that referral is no longer needed

  
• Assess and Classify cough or difficult breathing

  1. Assess how long the child has had cough or difficult breathing

  2. Assess for fast breathing

  3. Assess for chest indrawing

  4. Assess for stridor in a calm child

  5. Assess for wheeze in a calm child
• Pneumonia


  An infection of the lungs, caused by both bacteria and viruses. Common causes are streptococcus pneumoniae and hemophilus influenzae.
• Pneumonia


  • It can lead to hypoxia (deficiency in the amount of oxygen reaching the tissues) or sepsis (a serious condition resulting from the presence of harmful microorganisms in the blood or other tissues and the body's response to their presence, potentially leading to the malfunctioning of various organs, shock, and death)
  • When children develop pneumonia, their lungs become stiff. The body's responses to stiff lungs and hypoxia are fast breathing. As it becomes more severe, chest indrawing may develop.
• Chest indrawing


  The abnormal inward movement of subcostal tissue (the tissue inferior to the costal cartilage of the lower anterior chest wall) during inspiration. It is a sign of severe pneumonia.
• Stridor


  A harsh noise made when the child breathes in, caused by swelling of the larynx, trachea or epiglottis (croup). It is a life-threatening condition when it causes blockage of the child's airway.
• Wheeze


  A high-pitched, continuous, adventitious lung sound produced by oscillation of opposing airway walls whose lumen is narrowed. It is caused by swelling and narrowing of small airways of the lungs or by contraction of the smooth muscles surrounding the airways.
• The child who is exactly 12 months old has fast breathing if you count 40 breaths per minute or more
• If the child has wheeze and either fast breathing or chest indrawing, go to treat wheezing directly before selecting the classification. Children with wheeze should be given a trial of rapid acting inhaled or oral bronchodilator for up to three times, 15-120 minutes apart. After treatment for wheezing, count the breaths and look for chest indrawing again and then classify.
• Diarrhea


  Occurs when stools contain more water than normal. Also called loose or watery stools. Defined as three or more loose or watery stools in a 24-hour period.
• Types of Diarrhea


  • Acute diarrhea - episode lasts less than 14 days
  • Persistent diarrhea - up to 20% of episodes become persistent
  • Dysentery - diarrhea with blood in the stool with or without mucus

  
• Acute watery diarrhea


  Causes dehydration and contributes to malnutrition. Death of child with acute diarrhea is usually due to dehydration.
• Persistent diarrhea


  Causes nutritional problems and contributes to death in children.
• Dysentery


  Diarrhea with blood in the stool, caused by Shigella bacteria.
• Assess a child with diarrhea


  1. Assess how long the child has had diarrhea

  2. Assess for blood in the stool to determine if the child has dysentery

  3. Assess for signs of dehydration

  
• Signs of dehydration


  The child is first restless and irritable. If dehydration continues, the child becomes abnormally sleepy or difficult to awaken. As the child's body loses fluids, the eyes may look sunken and the skin will go back slowly or very slowly when pinched.
• In a severely malnourished child who is visibly wasted (marasmus), the eyes may always look sunken, even if the child is not dehydrated. Even though sunken eyes is less reliable in a visibly wasted child, still use the sign to classify the child's dehydration.
• Not able to drink


  The child is not able to take fluid in his/her mouth and swallow it.
• Drinking poorly


  The child is weak and cannot drink without help. He/she may be able to swallow only if fluid is put in his/her mouth.
• Drinking eagerly, thirsty


  It is clear that the child wants to drink. The child reaches out for the cup or spoon when offered water and is unhappy when the water is taken away.
• Skin Pinch Test for Assessing Dehydration

  1. ASK the mother to place the child on the examining table so that the child is flat on his back with his arms at his sides and his legs straight

  2. USE YOUR THUMB AND FIRST FINGER to locate the area on the child's abdomen halfway between the umbilicus and the side of the abdomen

  3. PICK UP all the layers of skin and the tissue underneath them

  4. HOLD the pinch for one second

  5. Then release it

  6. LOOK to see if the skin pinch goes back very slowly (more than 2 seconds), slowly (less than 2 seconds, but not immediately), or immediately
• The skin pinch test is not always an accurate sign. In a child with severe malnutrition, the skin may go back slowly even if the child is not dehydrated. In a child is overweight or has edema, the skin may go back immediately even if the child is dehydrated.
• Malaria


  A disease caused by parasites in the blood called plasmodia, transmitted through the bite of Anopheles mosquitos. The only dangerous species is Plasmodium falciparum.
• Malaria


  • Fever is the main symptom. Other symptoms include shivering, sweating and vomiting. A child with malaria may also have chronic anemia (with no fever).
  • In areas with very high malaria transmission, malaria is a major cause of death in children. A case of uncomplicated malaria can develop into severe malaria as soon as 24 hours after the fever first appears. Severe malaria is malaria with complications such as cerebral malaria or severe anemia. The child can die if he does not receive urgent treatment.
• Signs of malaria can overlap with signs of other illnesses. Malaria and cough with fast breathing, a sign of pneumonia - treatment for both falciparum malaria and pneumonia.
• Treatment: Cotrimoxazole. It is effective both as an antimalarial and antibiotic. Children with malaria can have diarrhea.
• Decide malaria risk


  1. Take a blood smear and examine it for malaria

  2. ASK - Fever everyday for more than 7days

  3. LOOK and FEEL for stiff neck (a child with fever and stiff neck may have meningitis - needs urgent treatment with injectable antibiotics and referral to the hospital)

  4. LOOK for runny nose (common cold)

  
• To classify and treat children with fever, you must know the malaria risk in your area. There is a high malaria risk in areas where more than 5% of the fever cases in children are due to malaria. There is a low malaria risk in areas where 5% or less of the fever cases in children are due to malaria.