IMCI

• IMCI

  Integrated Management of Childhood Illness
• IMCI as a strategy

  • Management of common childhood illness is done in an integrated manner
  • Includes preventive interventions
  • Adjusts curative interventions to the capacity and functions of the health system (evidence based – syndromic approach)
• IMCI


  • Involves the family members and the community in the health care process
• Why IMCI?

  Overlap of conditions<|>Diagnostic tools are minimal or non-existent<|>Drugs and equipment are scarce<|>Health workers have few opportunities to practice complicated clinical procedures<|>Relies on history & signs & symptoms
• Components of the IMCI

  • Improving case management skills of health workers
  • Improving the health system to deliver IMCI
  • Improving family and community health practices
• Target age for the IMCI strategy

  • Young infants 1 week up to 2 months
  • Older children - 2 months to five years old
• Diseases covered in the IMCI

  • Pneumonia
  • Diarrhea
  • Dengue hemorrhagic fever
  • Malaria
  • Measles
  • Malnutrition
• Color


  Presentation
• Classification of Diseases

  Level of Management
• Classification of Diseases

  • Green - Mild - Home care
  • Yellow - Moderate - Manage at the RHU
  • Pink - Severe - Urgent referral in Hospital
• Assess and classify the sick child age 2 months up to 5 years


  1. Ask the mother what the child's problems are

  2. Determine if this is an initial or follow-up visit

  3. Check for general danger signs

  4. Ask about main symptoms

  5. Look, listen and count breaths

  6. Use all boxes that match the child's symptoms and problems to classify the illness

  7. Identify treatment
• General danger signs

  • Not able to drink or breastfeed
  • Vomits everything
  • Has had convulsions
  • Abnormally sleepy or difficult to awaken
• Cough or Difficult Breathing

  1. Ask for how long

  2. Count the breaths in one minute

  3. Look and listen for stridor

  4. Look for chest indrawing
• Cough or Difficult Breathing Classification

  • Severe Pneumonia or Very Severe Disease
  • Pneumonia
  • No Pneumonia (Cough or Cold)
• Focused Assessment

  1. Danger Signs

  2. Main Symptoms (Cough or DOB, Diarrhea, Fever, Ear Problem)
• Cough or DOB (< 2 months)

  • Cough/colds - Home Management
  • Pneumonia - Specific treatment
  • Severe Pneumonia - Urgent referral
• Cough or DOB (> 2 months)

  • No Pneumonia (Cough/colds) - Home Management
  • Pneumonia - Specific treatment
  • Very Severe Pneumonia - Urgent referral
• Diarrhea

  1. Ask how long

  2. Check for dehydration signs

  3. Classify dehydration level

  4. Identify treatment plan
• Diarrhea Classification


  • No dehydration - Plan A
  • Some dehydration - Plan B
  • Severe dehydration - Plan C (Urgent referral)
• Diarrhea Treatment

  • No blood - Oral antibiotics
  • With blood (dysentery) - Cotrimoxazole, Nalidixic acid
  • No blood (cholera) - Tetracycline, Cotrimoxazole
• Fever

  1. Assess malaria risk

  2. Check blood smear

  3. Identify treatment
• Fever Classification

  • Malaria unlikely - Home management
  • Malaria - Specific treatment
  • Very Severe Febrile Disease - Urgent referral
• Malaria Treatment

  • Malaria risk area - Chloroquine, Primaquine
  • Non-malaria risk area - Quinine under medical supervision
• Tx

  Plan C
• IVF along w/ ORS

  IVF→LR(100ml/kg
• Diarrhea

  With blood<|>No Blood
• Tx (with blood)

  1. Oral antibiotics

  2. follow up in 2 days
• Tx (with blood - dysentery)

  1. 1st line cotrimoxazole

  2. 2nd line→nalidixic acid
• Tx (no blood - cholera)

  1. 1.1st line tetracycline

  2. 2.2nd line cotrimoxazole
• Malaria

  Malaria Risk Area<|>Non-Malaria Risk Area
• Tx (Malaria Risk Area)

  1. Paracetamol

  2. Ff. up in 2 days

  3. fever > 7 days→REFER
• Tx (Non-Malaria Risk Area)

  1. antimalarial

  2. Paracetamol- >38.5C

  3. fever >7 days→ REFER
• Tx (Malaria - any danger sign or stiff neck)


  1. quinine under medic Supervision, if a hosp. is not accessible

  2. 1st dose antipyretic

  3. URGENT referral
• Tx (Non-Malaria Risk Area - no malaria, very severe febrile dse.)

  1. 1st dose antibiotics

  2. paracetamol → ≥38.5C

  3. REFERRAL
• Tx (Non-Malaria Risk Area - fever, no malaria)

  1. paracetamol →≥38.5C

  2. follow up in 2 days →if fever persists

  3. fever is 7 days present → REFER to hosp.
• Tx (Measles)

  1. Vit. A admin.

  2. pus draining from eye

  3. mouth ulcers
• Tx (Measles - specific)

  1. Vit. A 100,000 IU TX

  2. tetracycline ointment

  3. half strength gentian violet
• Tx (Measles - REFER)

  1. 1st dose of antibioti

  2. Vit. A

  3. Tetracycline ointme

  4. URGENT referral
• Dengue


  Danger signs<|>No sign of severe dengue hemorrhagic fever
• Tx (Dengue - severe DHF)

  1. Plan Cif with other signs of bleeding

  2. Do NOT give Aspirin

  3. REFERRAL