The Implementation of Integrated Management of Childhood Illness ...

(16). The vertical programmes were furthermore shown to reduce the efficiency of
the overburdened and undermanned health systems, which called for a different
approach to child health care delivery (18).
Sick children usually present with signs of diarrhoea, ARI, malaria, measles
and/or malnutrition, and 70% of under-five deaths are related to these diseases. (16).
For example, signs and symptoms of malaria and pneumonia overlap considerably
(19). Hence, these findings indicate the need for approaches that combine treatments
for two or more diseases (16).
It is generally accepted that co-morbidity may lead to synergism, i.e. the rate of
mortality from having two diseases is greater than the mortality rates of each of the
diseases combined (7). Epidemiologic synergism has most clearly been shown in
children with both malnutrition and an infectious disease, where mortality is clearly
elevated (20). An approach that addresses the nutritional needs as well as treating
the present condition of children is clearly beneficial.
Maternal perception of an acute respiratory infection plays a decisive role in
whether the mother seeks treatment for her child (21, 22). Findings have suggested
that mothers were not always taking children to a health facility when needed. The
mother′s decision whether to seek treatment for her child influences its chances of
surviving in situations of severe disease. This suggested that increased health
education for the community was needed and launching campaigns that would
increase self-referral of children who need antibiotic therapy was crucial (21).
Finally, providing health care to children should not have the single aim of
reducing the incidence of a limited number of diseases. The child should be
approached as a whole, considering immunizations, the nutritional needs, and other
possible underlying conditions for the present illness (6).
In response to many of the above mentioned considerations, the United Nations
Children′s Fund (UNICEF) and the World Health Organisation (WHO) initiated in
1992 the Integrated Management of Childhood Illness concept (IMCI) (2). The IMCI
combines effective treatments that have the potential to reduce childhood mortality
and interventions that aim at improving healthy growth and development of
children under the age of five (6).
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