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• IMCI

  Integrated Management of Childhood Illnesses - an integrated approach to child health that focuses on the well-being of the whole child
• IMCI Objectives


  • To reduce significantly global mortality and morbidity associated with the major causes of disease in children
  • To contribute to the healthy growth & development of children
• IMCI Components of Strategy

  • Improving case management skills of health workers
  • Improving the health systems to deliver IMCI
  • Improving family and community practices
• For many sick children a single diagnosis may not be apparent or appropriate
• Presenting complaints


  • Cough and/or fast breathing
  • Lethargy/Unconsciousness
  • Measles rash
• Possible course/associated conditions for a very sick young infant

  • Pneumonia, Severe anemia, P. falciparum malaria
  • Cerebral malaria, meningitis, severe dehydration
  • Pneumonia, Diarrhea, Ear infection
  • Pneumonia, Meningitis, Sepsis
• Five Disease Focus of IMCI

  • Acute Respiratory Infection
  • Diarrhea
  • Fever
  • Malaria
  • Measles
  • Dengue Fever
  • Ear Infection
  • Malnutrition
• The IMCI Case Management Process

  1. Assess and classify

  2. Identify appropriate treatment

  3. Treat/refer

  4. Counsel

  5. Follow-up
• General Danger Signs


  • The child is not able to drink or breastfeed
  • The child vomits everything
  • The child has had convulsions
  • The child is lethargic or unconscious
• Main Symptoms Assessed


  • Cough/DOB
  • Diarrhea
  • Fever
  • Ear problems
• Assess and Classify Cough or Difficulty of Breathing

  Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs
• Pneumonia


  • Cough or difficult breathing
  • An infection of the lungs
  • Both bacteria and viruses can cause pneumonia
  • Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection)
• If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more
• Dysentery


  Child with diarrhea and blood in the stool
• Severe Dehydration


  Two of the following signs: Abnormally sleepy or difficult to awaken, Sunken eyes, Not able to drink or drinking poorly, Skin pinch goes back very slowly
• Some Dehydration


  Two of the following signs: Restless, irritable, Sunken eyes, Drinks eagerly, thirsty, Skin pinch goes back slowly
• No Dehydration


  Not enough signs to classify as some or severe dehydration
• Dehydration present


  1. Severe Persistent Diarrhea: Treat dehydration before referral unless the child has another severe classification, Give Vitamin A, Refer to hospital

  2. Persistent Diarrhea: Advise the mother on feeding a child who has persistent diarrhea, Give Vitamin A, Follow up in 5 days

  3. Dysentery: Treat for 5 days with an oral antibiotic recommended for Shigella in your area, Follow up in 2 days, Give also referral treatment
• Does the child have fever?

  1. Malaria Risk: Very Severe Febrile Disease/Malaria - Give first dose of quinine, Give first dose of an appropriate antibiotic, Treat the child to prevent low blood sugar, Give one dose of paracetamol, Send a blood smear with the patient, Refer URGENTLY to hospital

  2. Malaria: Treat the child with an oral antimalarial, Give one dose of paracetamol, Advise mother when to return immediately, Follow up in 2 days if fever persists

  3. Fever: Malaria Unlikely - Give one dose of paracetamol, Advise mother when to return immediately, Follow up in 2 days if fever persists
• No Malaria Risk


  Very Severe Febrile Disease - Give first dose of an appropriate antibiotic, Treat the child to prevent low blood sugar, Give one dose of paracetamol, Refer URGENTLY to hospital
• Malaria


  Refer URGENTLY to hospital if blood smear (+)
• Malaria unlikely


  1. NO runny nose, and

  2. NO measles, and

  3. NO other causes of fever
• Malaria treatment


  1. Treat the child with an oral antimalarial

  2. Give one dose of paracetamol in health center for high fever (38) or above

  3. Advise mother when to return immediately

  4. Follow up in 2 days if fever persists

  5. If fever is present every day for more than 7 days, refer for assessment
• Fever: Malaria unlikely


  1. Give one dose of paracetamol in health center for high fever (38) or above

  2. Advise mother when to return immediately

  3. Follow up in 2 days if fever persists

  4. If fever is present every day for more than 7 days, refer for assessment
• Very severe febrile disease

  1. Give first dose of an appropriate antibiotic

  2. Treat the child to prevent low blood sugar

  3. Give one dose of paracetamol in health center for high fever (38) or above

  4. Refer URGENTLY to hospital
• Fever: No malaria


  1. Give one dose of paracetamol in health center for high fever (38) or above

  2. Advise mother when to return immediately

  3. Follow up in 2 days if fever persists

  4. If fever is present every day for more than 7 days, refer for assessment
• Severe complicated measles


  1. Give Vitamin A

  2. Give first dose of an appropriate antibiotic

  3. If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment

  4. Refer URGENTLY to hospital
• Measles with eye or mouth complications

  1. Give Vitamin A

  2. If pus draining from the eye, apply tetracycline eye ointment

  3. If mouth ulcers, teach the mother to treat with gentian violet
• Measles


  Give Vitamin A
• Cotrimoxazole dosage


  • 2 months up to 12 months (4 3 < 9 kg)
  • 12 months up to 5 years (10 3 19kg)
• Amoxycillin dosage


  • 2 months up to 12 months (4 3 < 9 kg)
  • 12 months up to 5 years (10 3 19kg)
• Cotrimoxazole dosage for dysentery

  • 2 3 4 months (4 3 < 6kg)
  • 4 3 12 months (6 3 < 10 kg)
  • 1 3 5 years old (10 3 19 kg)
• Amoxycillin dosage for dysentery

  • 2 3 4 months (4 3 < 6kg)
  • 4 3 12 months (6 3 < 10 kg)
  • 1 3 5 years old (10 3 19 kg)
• Tetracycline dosage for cholera

  • 2 3 4 months (4 3 < 6kg)
  • 4 3 12 months (6 3 < 10 kg)
  • 1 3 5 years old (10 3 19 kg)
• Cotrimoxazole dosage for cholera

  • 2 3 4 months (4 3 < 6kg)
  • 4 3 12 months (6 3 < 10 kg)
  • 1 3 5 years old (10 3 19 kg)
• Sulfadoxine + Chloroquine dosage

  • 2 months 3 5 months
  • 5 months 3 12 months
  • 12 months 3 3 years old
  • 3 years old 3 5 years old
• Primaquine dosage


  • 2 months 3 5 months
  • 5 months 3 12 months
  • 12 months 3 3 years old
  • 3 years old 3 5 years old
• Pyrimethamine dosage


  • 2 months 3 5 months
  • 5 months 3 12 months
  • 12 months 3 3 years old
  • 3 years old 3 5 years old
• Vitamin A dosage


  • 6 months 3 12 months
  • 12 months 3 5 years old
• Iron/Folate dosage


  • 2months-4months (4 3 <6kg)
  • 4months 3 12months (6 3 <10kg)
  • 12months 3 3 years (10 3 <14kg)
  • 3years 3 5 years (14 3 19kg)