INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

BY EJIDIKE AMAKA (NYSC/DR)

OUTLINE
Introduction What is IMCI? Epidemiology Major Causes of Childhood mortality in Nigeria Advantages of IMCI Components of IMCI IMCI in Nigeria The way forward / recommendation References

INTRODUCTION
Every day, millions of parents seek health care for their sick children, With limited supplies and equipment, combined with an irregular flow of patients,health workers are left with few opportunities to practice complicated clinical procedures.

 Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources. These factors, however, make providing quality care to sick children a serious challenge. WHO and UNICEF in 1992 addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI).

What is IMCI?
IMCI is a systematic approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age.

 IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. The IMCI strategy also combines improved case management with aspects of nutrition, immunization, insecticide-treated nets in malariaaffected areas, and several other important influences on child health.

 Its objectives being:

To reduce significantly mortality and morbidity associated with the major causes of disease in children To contribute to healthy growth and development of children

EPIDERMIOLOGY
Childhood mortality is one of the most serious problems affecting the demographics of developing nations. Reduction of mortality rate among children under-five by two-thirds by 2015 is one of the Millennium Development Goals (MDG4). Every year, almost 11 million children under the age of five in developing countries die from readily preventable and treatable illnesses.

 Over the past four decades, Nigeria has been one of the least successful countries at improving child mortality with more than one million children still dying annually from preventable diseases such as diarrhoeal dehydration, acute respiratory infections (ARI), measles, and malaria. In half of the cases, illness is complicated by malnutrition.

 According to a World Bank report published in 2012, the mortality rate of children under 5 years old in Nigeria was last reported at 142 per 1000 in 2010.
NB: Child mortality rate is defined as the number of deaths of children less than 5 years old per 1000 live births. The above figure means that 1 out of every 7 children <5years will die before his or her 5th birthday.

 Because most child deaths occur at home, before reaching health facilities, preventing fatalities by improving child health through the community is at the core of the approach called Integrated Management of Childhood Illness (IMCI).

MAJOR CAUSES OF CHILDHOOD MORTALITY IN NIGERIA

The following diseases have been implicated among the major causes of death among children <5 years;
Malaria 30% Acute respiratory infection 18-20% Measles

 Diarrhea, a leading cause of malnutrition which is considered an important underlying factor (50%) in the mortalities of children <5 yrs. Malnutrition HIV, Nigeria accounts for 14% of total African pediatric HIV burden.90% of infection in children is through MTCT.

ADVANTAGES OF IMCI
Aids in accurate identification of illness More appropriate and combined treatment Rational use of drugs Prompt referral of severe cases Strengthening of preventive services

COMPONENTS OF IMCI
The strategy includes three main components:
Improving case management skills of health workers Improving the overall health system to deliver IMCI Improving family and community health practices (Community Integrated Management of Childhood Illness, C-IMCI).

Improving health workers skills

Case management standard and guidelines Training of facility-based public healthcare providers Training for private healthcare providers Maintenance of competence among trained health workers

Improving health system

District planning and management Availability of IMCI drugs Improvement and supervision of referral pathways Improved health information system

Improving family and community practices

Appropriate care-seeking and prevention of diseases Nutrition Home case management Adherence to recommended treatment Community involvement in health planning and monitoring

IMCI in Nigeria
The Integrated Management of Childhood Illness was introduced into Nigeria in 1997. In recognition of the potentials of IMCI and as part of its response to the challenge of child survival, the National Council of Health, adopted the IMCI as the main thrust of its child survival strategy.

 In line with WHO advice, the implementation of IMCI in Nigeria was carried out in three phases: - The Introductory phase - The Early Implementation phase - Expansion phase

 Main objective of the introductory phase was to ensure that key Ministry of Health staff understood the strategy and its implications. The first IMCI case management training was conducted in Nigeria in May, 1998 at the University College Hospital, Ibadan.

 Subsequently, other training courses were conducted to build national capacity for the early implementation phase which kicked off in a LGA in each of the 6 geopolitical zones in the country

 Follow up reports from these pilot LGAs showed remarkable improvement in the quality of care provided sick children aged <5 years in the facilities where the health workers had been trained on IMCI. Following this assessment, IMCI was expanded to other states.

CHALLENGES TO THE IMPLEMENTATION OF IMCI IN NIGERIA

Met at different levels of administration At government level:
Lack of adequate funds Failure of state and LG to take charge of the programme Despite adoption of IMCI as main thrust of child survival strategy in Nigeria, it has remained difficult to collaborate and coordinate IMCI with related programmes in the FMOH eg Roll Back Malaria programme

 A large number of health workers are yet to be IMCI-trained thereby making it difficult to reach every child in the community as intended.

At health workers level, practicing new skills acquired becomes a challenge as work environment often differs from that in which the training was conducted.

RECOMMENDATIONS
The following needs and opportunities would help in reducing under-five mortality in Nigeria:
1. Primary healthcare delivery, which includes immunization, prompt and effective treatment of illnesses and injuries, and the improvement of nutrition; needs strengthening. 2.There should be a consistent approach to the implementation of National health policies that address under-five mortality.

 3. The capacity of routine immunization services in Nigeria needs to be built. 4. There are opportunities for investment by the Nigerian government, to ensure the scaling up and full coverage of the WHOrecommended Integrated Management of Childhood Illnesses (IMCI). 5. Programme design innovation is needed to expand access to the Prevention of Mother to Child Transmission of HIV (PMTCT).

 6. Opportunities for strengthening cooperation among government health agencies; and between government and NGOs should be ceased in order to ensure the formulation and implementation of appropriate policies at all levels. 7.Improved data collection and analysis to ensure the timely availability of relevant information for appropriate policy and decision-making may be needed to significantly improve current strategies aimed at reducing U5MR.

 8. Continuous and appropriate training for health workers and their strategic placement after training is needed in order to optimize their performance. 9.There is a need to articulate the roles and responsibilities, in regards to U5MR reduction of the federal, state and local governments. 10. There are opportunities for synergistic interventions between programmes in the health sector and activities from other sectors, especially programmes for the education of girls and for poverty reduction.

 In conclusion, the progress of any country depends on how healthy the children are, therefore such children should have access to basic health care, nutritious food and a protective environment. As Nigeria alone contributes about 10% of the total mortality worldwide, if MDG-4 is to be achieved, a lot more has to be done to reduce child mortality in Africa as a whole, and Nigeria in particular.

THANK YOU

REFERENCES
Wikipedia, the free on-line encyclopedia nigeria.unfpa.org www.who.int/maternal_child_adolescent/topics/child/imci/ www.unicef.org/appeals/files/ www.tradingeconomics.com/nigeria/mortality-rate-under5-per-1-000-wb-data.html Infant and Child Mortality in Nigeria: How Far From The Millennium Development Goals? Reducing child mortality in Nigeria - Workshop Report by Nigerian Academy of Science held in Abuja on July 2-3, 2007. IMCI-introductory talk.ppsx