Integrated Management of Childhood Illness (IMCI)

One million children under five years old die each year in less developed countries. Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and malnutrition is often the underlying condition. Effective and affordable interventions to address these common conditions exist but they do not yet reach the populations most in need, the young and impoverish. The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and development and is based on the combined delivery of essential interventions at community, health facility and health systems levels. IMCI includes elements of prevention as well as curative and addresses the most common conditions that affect young children. The strategy was developed by the World Health Organization (WHO) and United Nations Childrens Fund (UNICEF). In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital staff were capacitated to implement the strategy at the frontline level.

Objectives of IMCI

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Reduce death and frequency and severity of illness and disability, and Contribute to improved growth and development

Components of IMCI

Improving case management skills of health workers 11-day Basic Course for RHMs, PHNs and MOHs 5 - day Facilitators course 5 day Follow-up course for IMCI Supervisors

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Improving over-all health systems Improving family and community health practices

Rationale for an integrated approach in the management of sick children Majority of these deaths are caused by 5 preventable and treatable conditions

namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood illness are caused by these five conditions

Most children have more than one illness at one time. This overlap means that a single diagnosis may not be possible or appropriate.

Who are the children covered by the IMCI protocol? Sick children birth up to 2 months (Sick Young Infant) Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI

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All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital The children and infants are then assessed for main symptoms. For sick children, the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional, immunization and deworming status and for other problems Only a limited number of clinical signs are used A combination of individual signs leads to a childs classification within one or more symptom groups rather than a diagnosis. IMCI management procedures use limited number of essential drugs and encourage active participation of caretakers in the treatment of children Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILDS ILLNESS (please see enclosed portion of the IMCI Chartbooklet) The childs illness is classified based on a color-coded triage system: PINKindicates urgent hospital referral or admission

YELLOW- indicates initiation of specific Outpatient Treatment GREEN indicates supportive home care

Steps of the IMCI Case management Process The following is the flow of the iMCI process. At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the

child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and other processes indicated in the chart below. Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. Once admitted, the hospital protocol is used in the management of the sick child.

THE INTEGRATED CASE MANAGEMENT PROCESS

Food and Waterborne Diseases Prevention and Control Program

The program covers diseases of a parasitic, fungal, viral, and bacteria in nature, usually acquired through the ingestion of contaminated drinking water or food. The more common of these diseases are bacterial in nature, the most common of which are typhoid fever and cholera. These two organisms had been the cause of major outbreaks in the Philippines in the last two years. Parasitic organisms are also an important factor, among them capillariasis, Heterophydiasis, and paragonimiasis, which are endemic in Luzon, Visayas, and Mindanao. Cysticercosis is also a major problem since it has a neurologic component to the illness. The approaches to control and prevention is centered on public health awareness regarding food safety as well as strengthening treatment guidelines.

Goal and Objectives: The program aims to: 1. Prevent the occurrence of food and waterborne outbreaks through strategic placement of water purification solutions and tablets at the regional level so that the area coordinators could respond in time if the situation warrants; 2. Procure Intravenous Fluid solutions, venosets and IV cannula for adult and pediatric patients in diarrheal outbreaks and to be stockpiles at the 17 Centers for Health Development (CHD) and the Central Office for emergency response to complement the stocks of HEMS; 3. Place first line and second line antimicrobial and anti-parasitic medicines such as albendazole and praziquantel at selected CHDs for outbreak mitigation as well as emergency stocks at the DOH warehouse located at the Quirino Memorial Medical Center (QMMC) compound; 4. Increase public awareness in preventable food-borne illnesses such as capillaria, which is centered on unsafe cultural practices like eating raw aquatic products; 5. Increase coordination between the National Epidemiology Center (NEC) and Regional epidemiology surveillance Unit (RESU) to adequately respond to outbreaks and provide technical support; 6. Procure Typhidot-M diagnostic kits for the early detection and treatment of typhoid patients; 7. Procure Typhoid vaccine and oral cholera vaccine to reduce the number of cases seen after severe flooding; 8. Provide training to local government unit (LGU) laboratory and allied medical personnel on the Accurate laboratory diagnosis of common parasites and proper culture techniques in the isolation of bacterial food pathogens; and

9. Provide guidance to field medical personnel with regard to the correct treatment protocols vis-vis various parasitic, bacterial, and viral pathogens involved in food and waterborne diseases.

Beneficiaries/Target Population: The Food and Waterborne Disease Control Program targets individuals, families, and communities residing in affected areas nationwide. For parasitic infections, endemic areas are more common.

Strategies/Management: Case monitoring is maintained through the Philippine Integrated Disease Surveillance and Response (PIDSR) framework of NEC and the sentinel sites of the RESU. To add to that, quarterly reports of the regional coordinators supplement the data and the regular updating from NEC Outbreak Surveillance. Outbreaks are being prevented though public education in print and radio stations. The need for safe food and water intake by adequate cooking and boiling of drinking water is inculcated to the public. Multi-drug resistant cases of typhoid are monitored through reports from the hospital sentinel site and the data from the Research Institute of Tropical Medicines Antibiotic Resistance & Surveillance Program.

Partner Organizations/Agencies: The following organizations and agencies take part in the achievement of program objectives:

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University of the Philippines-National Institutes of Health (UP-NIH) Department of Agriculture-National Meat Inspection Service (DA-NMIS) Asia Centric Disease Bureau World Health Organization-Western Pacific Regional Office (WHO-WPRO) World Health Organization-Southeast Asia Regional Office (WHO-SEARO)