IMCI - it is the strategy for reducing the
mortality and morbidity associated with 5
major causes of childhood illness. it is a
global strategy of the different organization
specifically, headed by WHO, UNICEF,
AusAID and DOH.
- WHO and UNICEF started to develop the
IMCI strategy in 1992. The implementation
of the IMCI strategy produces impressive
results, both in the decrease of childhood
mortality and in improving the quality of life
of young children all over the world.
Iniquities of Child Health
 Children in low-middle income
countries 10x more likely to die
before reaching 5th birthday
 the majority of this death caused by
5 preventable and treatable
condition we have
o pneumonia, diarrhea,
malaria, measles and
malnutrition
 More than 50 countries had
childhood mortality rates over 100
per 1,000 live births
 Seven in ten deaths are due to ARI
(PNA), diarrhea, measles, malaria or
malnutrition
 Above conditions will continue to be
major contributors to child deaths
through the year 2020
The no. 1 cause of death of children 5 years
and below is Prematurity with a rating of
15.3 % and out of this prematurity,
Neonatal deaths is 44%. It was followed by
Pneumonia with 13.0%. And there were
already children lessen 5 years old who
have HIV/AIDS with 1.6%
Under Five-Year-Old Deaths, 2008
 From 1988, childhood death rates in
the Philippines initially showed a
substantial decline, but the
downward trend leveled off in the
past 10 years because the neonatal
mortality rate remained practically
unchanged.
Underlying Factors
 Infant and young child feeding
 Poverty
 Lack of access to safe water &
sanitation
 High fertility, poor birth spacing
o according to our family code
there were only a maximum
of 4 children in a couple
 Community and environment
 Lack of access to basic social services
o Basic services that giving free
by the DOH
 immunization both
given for women and
children 1 yr and
below
 Inadequate care for women
Reasons for an IMCI Strategy
 Most children have more than one
condition at one time
 Illnesses are interrelated
 Illnesses should not be only tested,
but also prevented
 Poor quality of care at all levels
 Vertical delivery mechanisms
characterized by low efficiency
IMCI the corner stone is a set of evidence
based clinical guidelines, the guidelines
have been designed to provide first level
health workers with simple and effective
tools to combat the major causes of
childhood mortality and morbidity.
An evidence- based syndromic approach
can be used to determine the:
 Health problem/s the child may have
 Severity of the child’s condition
 Actions to be taken to care for the
child
IMCI piloted in Saranggani, Zamboanga
2000 - IMCI strategy was adopted in nursing
curriculum but also in all health-related
courses. Namely: Nursing, Midwifery,
Medicine.
Pediatricians not amenable in IMCI
strategy
Essential package of child survival
interventions
 Skilled attendance during
pregnancy, childbirth and the
immediate postpartum
 Care of the newborn
 Breastfeeding and complementary
feeding
o breastfeed - 2 years and
beyond
o breastfeed exclusively - 6
months
 Micronutrient supplementation
o Vitamin A
o Iron
o Iodine
o Zinc (diarrhea)
 immunization of children and
mothers
o Mothers: TD


Integrated management of sick
children
Use of insecticide treated bed nets
(in malarious areas)
Rationale
 A more integrated approach to
managing sick children needed to
achieve better outcomes
 Child health programs need to move
beyond addressing the over-all
health and well-being of the child
IMCI Vision
 All Filipino children have access and
equity to quality health care services
supported with empowered families
and communities capable of
sustained actions that will ensure a
child friendly environment conducive
to development of the full potential
of the child by 2025.
IMCI Objectives
 Reduce significantly global mortality
and morbidity among children.
 Contribute to healthy growth and
development of children.
IMCI Components
 Improving case management skills
of health workers
o through a provision of clinical
guidelines on IMCI adopted
to the local context and
training to promote their
use.
 Improving the health system to
deliver IMCI
o by ensuring the availability of
essential drugs and other
supplies improving the
organization of work at the

health care facility and
improving monitoring and
supervision.
Improving family and community
practices
o through the education of
mothers, fathers’ other
caregivers and members of
the community with a focus
on health picking behaviors,
complaints, care at home
and overall health care
promotions.
Principles of Integrated Care
 IMCI guidelines address most, but
not all, of the major reasons a sick
child is brought to a clinic.
o exceptions: domestic
violence, burns, wounds
 A combination of individual signs
leads to a child’s classification/s
rather than a diagnosis.
o IMCI Color code: Pink,
yellow, green
 IMCI management procedures use a
limited number of essential drugs.
o Cotrimoxazole change to
amoxicillin
o first line antibiotic used:
amoxicillin
 very effective
 affordable
 accessible
o Second line:
Cotrimoxazole
o Vitamin A - given as a
treatment of choice for
children who has measles,
because Vitamin A is very
effective for treatment of
measles in order to prevent
complications.
o Gentian Violet - best
treatment to treat local

wounds for adults and
children
Counselling of caregivers is an
essential component of IMCI
o counseling - consider as the
best principle
IMCI Case Management Process
 Assess - Classify - Identify treatment
- treat/refer - counsel - follow-up
IMCI two categories
1. Cater to sick children
 ages: 2 months up to 5 years
Check for General Danger Signs
 Convulsions
 Lethargy/unconsciousness
 Inability to drink/breastfeed
 Vomiting
Assess Main Symptoms
 Cough/difficulty breathing
 Diarrhea
 Fever
 Ear Problems
Assess Nutrition and Immunization
status and Potential Problems
2. Sick infants
 Ages: sick infants up to 2 months
Classify conditions/identify treatment
actions
Pink (severe cases)
Urgent referral
 Out-patient health facility
o pre-referral treatment
 advise parents
 refer child
o referral facility





emergency triage &
treatment (ETAT)
diagnosis
treatment
monitoring &
follow up
Yellow
Treatment at OP health facility
 Out-patient health facility (child can
go home)
o Treat local infections
o give oral drugs
o advise/teach caretaker
o follow-up
Green
Home management
 HOME
o Caretaker is counseled on:
 home treatment
 feeding & fluids
 when to return
immediately
 follow - up
Summary of IMCI case management
process
Consist of number of steps:
Step 1: Assess
Step 2: Classify
Step 3: Identify treatment
Step 4: Treat/refer
Step 5: Counsel
Step 6: Follow - up