WHY DO WE NEED TO ADOPT

THE I . M . C . I . APPROACH

OR THE

INTEGRATED MANAGEMENT
OF CHILDHOOD ILLNESS
IN THE PHILIPPINES ?

Marco Antonio C. Sto Tomas

Board of Nursing
 Child Health Situation Based on World Health Report

7%
8% Malaria
15% Measles
54%
Diarrhoea
Penumonia
19%
Perinatal
HIV/AIDS
20% Others
28% 3% Malnutrition

e 1. Distribution of 10.5 million deaths among children less than 5 years old in all developing countries, 1999
se conditions will continue to be major contributors to child deaths through the year
say that this Global Burden of Disease indicate that these conditions will continue to be major contributors to
Inequities of Child Health (continued)
B. Quality of care is another important indicator of
inequities in child health. Everyday, millions of parents
seek health care for their sick children, taking them to
hospitals, health centers, pharmacists, doctors, and
traditional healers.

1. Surveys reveal that many sick children are not

properly assessed and treated by these health
providers, and that their parents are poorly
counseled;

2. At 1st level health facilities in low-income countries,

diagnostic supports e.g. x-ray & laboratory services
are minimal or non-existent, and drugs and
equipment are often scarce;

3. Limited supplies and equipment, combined with an

irregular flow of patients, leave doctors at this level with
few opportunities to practice complicated clinical
procedures. Instead, they often rely on “history and
signs & symptoms to determine a source of
management that makes the best use of available
resources.
 How Can this Situation be Reversed ?
How Can we Provide Quality Care to Sick Children ?

rategies that are based on a (1) “holistic approach”, (2)

nale for adopting an Evidence-Based Syndromic Approach to Case Management

outcomes .
sing the over - all health and well - being of the child .
d individuals responded to the challenge by developing a strategy kno
care , the strategy also addresses aspects of nutrition , immunization ,
y of illness and disability , and to contribute to improved growth and
rtion of Global Burden of Selected Diseases Borne by Children Under 5 Years (Estima

ARI Malaria

Children 0-4 Children 0-4

years years

All Ogther Age All Ogther Age

Groups Groups

Diarrhoea

Children 0-4 Children 0-4

years years

All Ogther Age All Ogther Age

Groups Groups

Measles

ent method” targets children less than 5 years old – the age group that bears the highest burden
 Careful and systematic assessment of common symptoms and well-selected specific clinical sig

he rational, effective and affordable use of drugs and di

l experience, and untested pathophysiologic reasoning for medical decision-making;
realistic and cost-effective way to manage patients;
ormation to guide rational and effective actions.
 Careful and systematic assessment of common symptoms and well-selected specific clinical sig

ntions to the cap

he community in th
h staff through the provision of loca

management of childhood illness;

need for immediate referral or admission to a hospital.
2 months up to 5 years: cough or difficult breathing, diarrhea, fe
nization status, feeding problems, and other potential problems.
n evidence of their sensitivity and specificity to detect disease.
nosis. Classification(s) indicate the severity of condition(s). The

ial treatment), or

reatment, and “green” - calls for home treatment.

brought to a clinic. A child returning with chronic problems or

ge active participation of caretakers in the treatment of children.

retakers about home management, including counselling about
 The IMCI Case Management Process
OUPATIENT HEALTH FACILITY
Check for DANGER SIGNS
•Convulsions
•Lethargy / Unconsciousness
•Inability to
drink / breastfeed
•Vomiting
Assess MAIN SYMPTOMS
•Cough / difficulty
breathing
•Diarrhea
•Fever
•Ear Problems
Assess NUTRITION and IMMUNIZATION
STATUS
And POTENTIAL FEEDING PROBLEMS
Check for OTHER PROBLEMS

CLASSIFY CONDITIONS and

IDENTIFY TREATMENT ACTIONS
PINK According to colour - coded
Urgent Referral treatment
OUTPATIENT
HEALTH FACILITY
•Pre-referral GREEN
treatments YELLOW Home Management
•Advise Parents Treatment at Outpatient
•Refer Child Health Facility HOME
Caretakers is
OUTPATIENT counselled on:
HEALTH FACILITY •Home treatment(s)
REFERRAL FACILITY •Treat Local •Feeding & Fluids
•Emergency Triage Infections •When to return
& Treatment ( ETAT ) •Give Oral Drugs immediately
•Diagnosis •Advise & Teach •Follow-up
•Treatment Caretakers
•Monitoring & •Follow-up
Follow - up
 WHAT YOU LEARNED FROM THESE
SLIDES WILL NOT MAKE YOU
COMPLETELY COMPETENT IN USING
THE IMCI APPROACH … LEARN
SOME MORE FROM TRAINED IMCI
PROVIDERS .
GO THROUGH IT AND
MASTER THE PROCESS .

ENJOY LEARNING AND LEARN WELL…

FOR THE SAKE OF THE FILIPINO CHILDREN.