The Implementation of Integrated Management of Childhood Illness ...

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i. IMCI and its Components The IMCI expresses as simply as possible what needs to be done by a health care worker to treat sick children in a first-level health facility with the goal of reducing the likelihood of mortality and disability (18). IMCI is intended for first-level facilities because children who have diseases that are potentially fatal are usually first brought to such facilities (9). In order to ensure an effective introduction and implementation of IMCI in every country, three components of the IMCI programme have been defined: i) improvements in case-management skills of health workers by providing locally adapted guidelines and promoting their use; ii) improvements in the health system that ensure effective management of childhood illnesses; and iii) improvements in family and community health-related behaviour (16). Each of the components are adapted to the needs of each country (23). The IMCI concept assumes that there is usually more than one condition causing illness in children (2). Therefore, signs and symptoms of the most life-threatening and common diseases are checked on each visit to the health centre. When IMCI was developed, as few clinical signs as possible were used and a fine balance hit between sensitivity and specificity (9). The case-management guidelines direct the health worker through a series of steps that enable him or her to classify the disease, to give a treatment, to counsel the guardian, and to make other provisions in controlling the present illness and preventing future illnesses (Table 1-2). Table 1-2: IMCI Case Management Steps (9). Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 IMCI Case Management Steps Assess the child by identifying any danger signs, asking for cough or difficult breathing, diarrhoea, fever, and ear problem. Carry out further assessments when relevant. Review the nutritional and immunization status in all children. Classify the child′s illnesses using the IMCI flow-chart. Classify illness into one of the following: needs urgent referral, needs specific medical treatment and advice, or needs simple advice on home management. Identify specific treatments. Usually the children have more than one disease, which calls for an integrated treatment plan. Give practical treatment instructions (teach the guardian to administer drugs, increase fluid intake, etc.). Teach the guardian about symptoms and signs that indicate that the child should be brought back and when tell the guardian when to return for follow-up. Assess the feeding and counsel the mother on feeding problems. When the child returns for follow-up, give instructions for various medical conditions. 12
The case-management guidelines are set up in a flow chart that guides the health worker to ask simple questions on the child′s disease in a step-by-step process. An example of the flow-chart is given in Figure 1-4. In the first IMCI case management step, the guidelines stress the importance of identifying danger signs in children so that those who require immediate referral are sent without delay (16). Subsequently, the child is assessed and classified according to presenting symptoms. After systematic classification the health worker arrives at one or more disease classifications and one of the following actions are taken: the child is referred or admitted to a hospital, treatment is initiated at the outpatient department, or the child is sent home with an advice when to return for follow-up. In addition, the nutritional status is assessed, the immunization status is checked and due immunizations are given (16). Counselling plays an important role in IMCI. The guardian is counselled about breast-feeding and complementary feeding, care for sick children at home, and when the child is to be brought for follow-up. At last, the guardian′s understanding of the advice is checked. Figure 1-4: IMCI case management guidelines: Assess, classify, and identify treatment. General danger signs and cough or difficulty breathing (24). 13
Page 1 and 2: The Implementation of Integrated Ma
Page 3 and 4: . Diagnoses .......................
Page 5 and 6: List of Abbreviations ARI………
Page 7 and 8: Since 1970 there has been a conside
Page 9 and 10: over half of all deaths associated
Page 11: (16). The vertical programmes were
Page 15 and 16: The childhood deaths resulting from
Page 17 and 18: though ear infection is not one of
Page 19 and 20: guidelines after training seems unn
Page 21 and 22: 3. Material and Methods a. The Sett
Page 23 and 24: perform surgical procedures. Illnes
Page 25 and 26: workload at the Mangochi District h
Page 27 and 28: The respiratory tract infections in
Page 29 and 30: 4. Results a. Health Care Workers I
Page 31 and 32: In all health facilities there were
Page 33 and 34: c. Diagnoses Children could be clas
Page 35 and 36: Pro ii. Pneumonia In total, about 7
Page 37 and 38: iv. Diarrhoea As shown in Figure 4-
Page 39 and 40: Table 4-10: Availability of IMCI-re
Page 41 and 42: 5. Discussion The results of this s
Page 43 and 44: . Diagnoses The fact that around 84
Page 45 and 46: This is interesting in the light of
Page 47 and 48: In the present study, of the just l
Page 49 and 50: eceived care from the trained healt
Page 51 and 52: Acknowledgments This project is a c
Page 53 and 54: area of Kenya with high malaria tra
Page 55 and 56: 53. Creese A, Kutzin J. Lessons fro
Page 57 and 58: Annexes 57
Page 59 and 60: Annex 2 59
Page 61 and 62: Annex 4 61

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