The Implementation of Integrated Management of Childhood Illness ...

More documents

Recommendations

Info

ii. Implementation of IMCI in Developing Countries The IMCI is applicable in every developing country that has an under-five mortality rate of >40 per 1000 live births and where there is transmission of Plasmodium falciparum malaria (9). The IMCI guidelines are adapted to each country, taking into account local epidemiology of diseases, drug resistance, and available essential drugs (16). In 1995, a small number of countries showed interest in implementing the approach. However, in the first few years more than 60 countries started implementing IMCI (16) and currently, more than 100 countries are practicing IMCI on a small or large basis (6). iii. The IMCI Classifications 1. Acute Respiratory Infections Acute Respiratory Infections (ARI) are the major cause of death in children under five and accounts for more than 2 million deaths per year (6). Pneumonia is the most serious of the ARI but can be treated at health centres with relatively inexpensive antibiotics (2). However, the major drawback is that children are not always brought to health centres. In many countries, only half of children with ARI are taken to a health care provider. Besides directing a health worker to treat ARI, the IMCI also teaches guardians the signs of ARI and what signs in a child indicate that it should be taken to a health care provider (2). As shown in Figure 1-4, the IMCI classifies an illness to be pneumonia in the presence of coughing or difficulty in breathing as well as rapid breathing. Rapid breathing is defined as respiratory rate above 60 per minute for children less than two months, above 50 per minute for children aged 2- 11 months, and above 40 per minute for children aged one to four years (24). Hence, the IMCI relies on a few clinical criteria for the detection of pneumonia and does not rely on the use of stethoscopes. 2. Malariaa The Plasmodium species causes 300-500 million cases of malaria per year (2). It is the most important parasitic infection in humans and accounts for more than a million deaths every year (25), 94% of which occur in Africa (26). In Africa alone, malaria is the second leading cause of deaths in children under five years of age (26). 14
The childhood deaths resulting from malaria declined from the 1960s until 1990. Since 1990, childhood deaths caused by malaria have been increasing at the same time as drug resistance has become widespread (27). Presently, reducing the incidence of malaria is a major priority for the international community. According to the IMCI guidelines, in places where malaria is endemic but parasitological diagnosis is unavailable, children who present with fever should be given antimalarials even though other diagnoses such as pneumonia are regarded more likely (25). The malaria classification in the IMCI flow-chart is shown in Figure 1-5. Figure 1-5: IMCI case management guidelines for fever: Assess, classify, identify treatment (24). 3. Measless Measles is an important cause of child mortality and various disabilities, such as blindness, severe malnutrition, chronic lung disease, and neurological dysfunction (2). The immunosuppression and vitamin A deficiency that occurs as a result of measles leads to a much greater susceptibility to the other conditions that are dealt with in IMCI. The IMCI emphasises detection of measles and instructs the health worker to give vitamin A. The measles classification in the IMCI guidelines is shown in Figure 1-5. 15
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 and 12: (16). The vertical programmes were
Page 13: The case-management guidelines are
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

The Implementation of Integrated Management of Childhood Illness ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?