IMCI
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Features of IMCI…
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not necessarily dependent on the use of
sophisticated and expensive
technologies
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a more integrated approach to
managing sick children
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move beyond addressing single
diseases to addressing the overall
health and well-being of the child
Features of IMCI…
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careful and systematic assessment of common
symptoms and specific clinical signs to guide
rational and effective actions
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integrates management of most common
childhood problems (pneumonia, diarrhea,
measles, malaria, dengue hemorrhagic fever,
malnutrition and anemia, ear problems)
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includes preventive interventions
Features of IMCI…
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adjusts curative interventions to the
capacity and functions of the health
system (evidence-based syndromic
approach)
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involves family members and the
community in the health care process
Objectives of IMCI
(1) reduce deaths and the frequency and
severity of illness and disability; and
(2) contribute to improved growth and
development
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IMCI Components
1. Improving case management
skills of health workers
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standard guidelines
training (pre-service/in-service)
follow-up after training
role of private providers
IMCI Components
2. Improving the health system to deliver
IMCI
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essential drug supply and management
organization of work in health facilities
management and supervision
referral system
IMCI Components
3. Improving family and community
practices
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for physical growth and mental
development
for disease prevention
for appropriate home care
for seeking care
IMCI Components
3. Improving family and community
practices
-For physical growth and mental
development
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Breastfeeding
Complementary feeding
Micronutrient supplementation
Psychosocial stimulation
IMCI Components
3. Improving family and community
practices
- For disease prevention
immunization
handwashing
sanitary disposal of feces
use of insecticide-treated bednets
dengue prevention and control
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IMCI Components
3. Improving family and community
practices
- For appropriate home care
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continue feeding
increase fluid intake
appropriate home treatment
IMCI Components
3. Improving family and community
practices
- For seeking care
Follow health workers advice
When to seek care
Prenatal consultation
Postnatal (postpartum) consultation
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The Integrated Case Management Process
Outpatient Health Facility
•check for danger signs
•assess main symptoms
•assess nutrition and Immunization status
and potential feeding problems
•Check for other problems
•classify conditions and
• identify treatment actions
Outpatient Health Facility
Urgent referral
•pre-referral treatment
•advise parents
•refer child
Referral facility
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•emergency triage &
treatment
•Diagnosis & treatment
•monitoring & ff-up
Outpatient Health
Facility
Treatment
•treat local infection
•give oral drugs
•advise and teach
caretaker
•follow up
Home
Caretaker is
counselled on:
•home treatment
•feeding &fluids
•when to return
•immediately
•follow-up
Target Groups
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Sick young infant
◦ 1 week up to 2 months
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Sick young children
◦ 2 months up to 5 years
Assessing the Sick Child
General
Danger
Signs
• lethargy or
unconsciousness
• inability to drink or
breastfeed
• vomiting
• convulsions
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Checking the Main Symptoms
- cough and difficult breathing
- diarrhea
- fever
- ear problem
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Checking the Main Symptoms
1. Cough or difficult breathing
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clinical signs
Respiratory rate
Lower chest wall indrawing
Stridor
Checking the Main Symptoms
2. Diarrhea
 Dehydration
◦ General condition
◦ Sunken eyes
◦ Thirst
◦ Skin elasticity
 Persistent diarrhea
 Dysentery
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Checking the Main Symptoms
3. Fever
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Stiff neck
Risk of malaria and other endemic
infections, e.g. dengue
hemorrhagic fever
Runny nose
Measles
Duration of fever (e.g. typhoid
fever)
Checking the Main Symptoms
4. Ear problems
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Tender swelling behind the ear
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Ear pain
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Ear discharge or pus (acute or
chronic)
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Checking Nutritional Status,
Feeding, Immunization Status
Malnutrition
◦ visible severe wasting
◦ edema of both feet
◦ weight for age
 Anemia
◦ palmar pallor
 Feeding and breastfeeding
 Immunization status
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Assessing Other Problems
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Meningitis
Sepsis
Tuberculosis
Conjunctivitis
Others: also mother’s (caretaker’s) own
health
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IMCI Essential Drugs and
Supply
Appropriate antibiotics
 Quinine
 Vitamin A
 Paracetamol
 Oral antimalarial
 Tetracycline eye ointment
 ORS
 Mebendazole or albendazole
 Iron
 Vaccines
 Gentian violet
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Overall Case Management Process
Outpatient
1 - assessment
2 - classification and identification of treatment
3 - referral, treatment or counseling of the child’s
caretaker (depending on the classification
identified
4 - follow-up care
Referral Health Facility
1 - emergency triage assessment and treatment
2 - diagnosis, treatment and monitoring of patient
progress
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SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS
For all sick children age 1 week up to 5 years who are brought to a first-level health facility
ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a
main symptom is reported, assess further. Check nutrition and immunization status. Check for other
problems.
CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the child’s main symptoms
and his or her nutrition or feeding status.
IF URGENT REFERRAL is needed and possible
IDENTIFY URGENT
PRE-REFERRAL TREATMENT(S)
needed for the child’s classifications.
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TREAT THE CHILD: Give urgent prereferral treatment (s) needed.
REFER THE CHILD: Explain to the
child’s caretaker the need for referral.
Calm the caretaker’s fears and help
resolve any problems. Write a
referral note. Give instructions and
supplies needed to care for the child
on the way to the hospital.
IF NO URGENT REFERRAL isneeded or possible
IDENTIFY TREATMENT needed for the child’s classifications:
Identify specific medical treatments and/or advice.
TREAT THE CHILD: Give the first dose of oral drugs in the clinic
and/or advise the child’s caretaker. Teach the caretaker how to
give oral drugs and how to treat local infections at home. If needed,
give immunizations.
COUNSEL THE MOTHER: Assess the child’s feeding, including
breastfeeding practices, and solve feeding problems, if present.
Advise about feeding and fluids during illness and about when to
return to a health facility. Counsel the mother about her own
health.
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FOLLOW-UP care: Give follow-up care when the child returns to the
clinic and,if necessary, reassess the child for new problems.
Summary of the Integrated case
Management Process
For all sick children
age 1 week up to 5
years who are
brought to a firstlevel health facility
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Summary of the Integrated case
Management Process
ASSESS the Child:
Check for danger signs
(or possible bacterial
infection).
Ask about main
symptoms.
If a main symptom is
reported, assess further.
Check nutrition and
immunization status.
Check for other problems
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Summary of the Integrated Case
Management Process
Classify the child’s
illness:
Use a color-coded
triage system to
classify the child’s
main symptoms
and
his or her nutrition
or feeding status.
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Summary of the Integrated Case
Management Process
IF URGENT
REFERRAL
is needed and
possible
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Summary of the Integrated Case
Management Process
IDENTIFY URGENT
PRE-REFERRAL
TREATMENT(S)
Needed prior to
referral of the child
according to
classification
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Summary of the Integrated Case
Management Process
TREAT THE
CHILD:
Give urgent prereferral
treatment(s)
needed.
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Summary of the Integrated Case
Management Process
REFER THE CHILD:
Explain to the child’s
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caretaker the need for
referral.
Calm the caretaker’s
fears and help resolve
any problems. Write a
referral note.
Give instructions and
supplies needed to care
for the child on the
way to the hospital
Summary of the Integrated Case
Management Process
IF NO URGENT
REFERRAL
is needed or
possible
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Summary of the Integrated Case
Management Process
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IDENTIFY
TREATMENT
needed for the
child’s
classifications:
identify specific
medical
treatments and/or
advice
Summary of the Integrated Case
Management Process
TREAT THE CHILD:
Give the first dose of
oral drugs in the clinic
and/or advice the
child’s caretaker.
Teach the caretaker
how to give oral drugs
and how to treat local
infections at home.
If needed, give
immunizations.
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Summary of the Integrated Case
Management Process
COUNSEL THE
MOTHER:
Assess the child’s feeding,
including breastfeeding
practices, and solve feeding
problems, if present.
Advise about feeding and
fluids during illness and
about when to return to a
healthy facility.
Counsel the mother about
her own health.
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Summary of the Integrated Case
Management Process
FOLLOW-UP
CARE:
Give follow-up care
when the child
returns to the clinic
and, if necessary,
re-asses the child
for new problems.
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SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS
FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic
ASK THE CHILD’S AGE
IF the child is from 1 week up to 2 months
USE THE CHART:
ASSESS, CLASSIFY AND TREAT
THE SICK YOUNG INFANT
IF the child is from 2 months up to 5 years
USE THE CHART:
ASSESS AND CLASSIFY THE SICK CHILD
TREAT THE CHILD
COUNSEL THE MOTHER
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