Imci

IMCI

1. By Mohammed said Under supervision of Prof Dr , Nehad Dabous

2. INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS Goals for today Identify key causes of childhood mortality Explain the meaning and purpose of integrated case management Describe the major steps in the IMCI strategy Introduce use of IMCI tools including chart booklet , wall posters and case management sheets Child Health: Global Profile IMCI Rationale, objectives, components Principles of integrated care IMCI Case Management Process

3. Children in low-middle income countries 10x more likely to die before reaching 5th birthday More than 50 countries had childhood mortality rates over 100 per 1,000 live births 5.9 million children under age five died in 2015, nearly 16 000 every day 83% of deaths in children under age five are caused by infectious, neonatal or nutritional conditions

4. 7 in 10 ten deaths are due to ARI , diarrhea, measles, malaria or malnutrition Major contributors to child deaths through the year 2020

5. 53 million women give birth each year without professional help Global child death rates have been reduced by 14% over the past decade Eight babies in the first month of their lives die every minute world-wide

6. Causes of Death in Children Under- nutrition 53%

7. LEADING CAUSES OF DEATH 2014 UNICEF REPORT 1 . Preterm birth complications (17%) 2. Pneumonia (15 %) 3. Labor and delivery complications (11%) 4. Diarrhea (9 %) 5. Malaria (7 %) Almost half of under five deaths are associated with malnutrition

8. FACTORS ASSOCIATED WITH MORTALITY: Poorest households Rural areas Low rates of maternal education Mortality also varies by country depending on the prevalence of HIV and malaria Children die from more than one condition at once

9. GEOGRAPHICAL DISTRIBUTION Half of under-five deaths occur in five countries : India (21%) Nigeria (13%) Pakistan Democratic Republic of the Congo China

10. PROGRESS MADE Under-five deaths worldwide have declined: 12.7 (12.6, 13.0) million in 1990 5.9 (5.7, 6.4) million in 2015 19,000 fewer children dying every day 48 million children under five saved since 2000

11. Why IMCI ?

12. Reasons for an IMCI Strategy Most children have more than one condition at one time Lack of diagnostic tools (labs or radiology) Providers rely on patient history, signs, and symptoms for diagnosis Need to refer to a higher level of care for serious illnesses Illnesses are interrelated Illnesses should not be only tested, but also prevented

13. Poor quality of care at all levels Vertical delivery mechanisms characterized by low efficiency

14. Many sick children poorly assessed Improperly treated Parents poorly advised Health Care : First –Level Facility

15. * scarce supply of drugs and equipment minimal/ non-existent diagnostic support

16. Few opportunities for MD to practice complicated procedures Reliance on history of signs and symptoms

17. Infant and young child feeding Lack of access to safe water & sanitation Underlying Factors

18. High fertility, poor birth spacing

19. Community and environment

20. Lack of access to basic social services Inadequate care for women

21. In 1995 WHO and UNICEF developed a strategy known as Integrated Management of Childhood Illness (IMCI). IMCI integrates case management of the most common childhood problems, especially the most important causes of death.

22. IMCI IN EGYPT The Government of Egypt adopted the IMCI strategy in 1997 with the aim to accelerate reduction in under-five mortality. In the year 2000, the under-five death rate was 47/1000 live-births2 and most deaths were caused by neonatal conditions (44%), pneumonia (15 %) and diarrhoea (13%).3

23. A national IMCI program was established and a national plan for scaling-up IMCI activities was adopted in 1999 , with the target that all primary healthcare (PHC) units in the country should provide care in accordance with IMCI by 2010.

24. In 2007, the proportion of PHC facilities implementing IMCI reached 84% and there was an internal demand to assess the impact .

25. IMCI implementation was associated with a doubling in the annual rate of under-five mortality reduction (3.3 % in 2000 vs 6.3% in 2006). This mortality impact is plausible, since substantial improvements occurred in quality of care provided to sick children in health facilities implementing IMCI.

26. THE IMCI PROCESS List of conditions to check in children an infants Assess and treat children for all conditions that are present Standardized algorithms guide management and decision to transfer to higher care

27. WHO CAN USE IMCI? The IMCI process can be used by all doctors, nurses and other health professionals who see young infants and children less than five years old. It is a case management process for a first-level facility , such as a clinic, health center or an outpatient department of a hospital.

28. Objectives Reduce illness, disability and death from common childhood illnesses

29. To promote improved growth and development among under-5 children

30. An evidence- based syndromic approach can be used to determine the: Health problem/s Severity of the condition Actions

31. Improving the health system to deliver IMCI IMCI Components Improving case management skills of health workers

32. Improving family and community practices

33. IMCI Component 1: Improves Health Worker Skills Case management guidelines Training of health providers (Doctors , Medical Assistants & Nurses) who look after sick infants and children up to 5 years (pre-service and in-service) Follow-up after training 46

34. IMCI Component 2: Improves Health Systems Targets first level health facilities Organization of work Availability of drugs and supplies Monitoring and supervision Referral pathways and systems Health information systems 47

35. IMCI Component 3: Improves Family and Community Practices To improve the knowledge, attitude and practices of families mainly the mothers regarding Key Family practices which include :- Exclusive Breastfeeding Complementary feeding Cont. feeding during illness. Using of iodized salt Routine vaccination Regular growth monitoring. Early care seeking. Compliance to provider advice Home care of sick children Recognition of severe illness 48

36. IMCI Component 4: Improves Family and Community Practices Proper waste disposal. Use of LLTN. Antenatal care TT for pregnant ladies. Proper nutrition for pregnant ladies. 49

37. VOLUNTEERS WERE TRAINED ON KEY FAMILY PRACTICES AND COMMUNICATIONSKILLS .

38. PRINCIPLES OF INTEGRATED CARE IMCI guidelines address most, but not all, of the major reasons a sick child is brought to a clinic.

39. A combination of individual signs leads to a child’s classification/s rather than a diagnosis

40. Counseling of caretakers an essential component

41. IMCI management use a limited number of essential drugs

42. All sick children must be examined for “general danger signs” -- immediate referral or hospital admission

43. All sick children must be routinely assessed for: 2 mos.-5 yrs. Old: (cough/difficult breathing, diarrhea, fever, ear problem) 1 week-2 mos : (bacterial infection and diarrhea)

44. Nutritional, immunization status, feeding problems , care for development and other problems

45. Only a limited number of carefully-selected clinical signs are used (sensitivity and specificity to detect disease)

46. A combination of individual signs leads to a child’s classification/s rather than a diagnosis; classifications are color-coded

47. IMCI Case Management Process Classify Assess Identify Treatment Treat/Refer Counsel Follow-Up Classify Identify Treatment Treat/Refer Counsel Assess Follow-Up Assess Identify Treatment

48. Check for General Danger Signs Convulsions Lethargy/unconsciousness Inability to drink/breastfeed Vomiting Assess Main Symptoms Cough/difficulty breathing Diarrhea Fever Ear Problems Assess Nutrition , Immunization status , Care for Development and Other Problems

49. Classify conditions/identify treatment actions Pre-referral Treatment Advise Parents Refer Child Urgent Referral OUT-PATIENT HEALTH FACILITY REFERRAL FACILITY Emergency Triage & Treatment (ETAT) Diagnosis Treatment Monitoring & Follow-up

50. OUT-PATIENT HEALTH FACILITY Treatment at OP Health Facility Treat Local Infections Give oral drugs Advise/teach caretaker Follow-Up OUT-PATIENT HEALTH FACILITY Treatment at OP Health Facility

51. HOME Caretaker is counseled on: Home treatment Feeding & fluids When to return immediately Follow-up Home Management

52. Vertical” health programmes and an individual health worker Separate disease specific clinical guidelines & trg. materials National programmes conduct disease specific trg. courses “Integration” of clinical guidelines by the health worker

53. IMCI and an Individual Health Worker Integrated clinical guidelines & trg. materials National programmes collaborate in integrated training courses Integrated clinical case management

54. For many sick children a single diagnosis may not be apparent or appropriate Presenting complaint Cough and/or fast breathing Lethargy/ unconsciousness Measles rash “Very sick” young infant Possible cause/ associated condition Pneumonia, Severe anemia, P. falcifarum malaria Cerebral malaria , Meningitis, Severe dehydration,Very severe Pneumonia Pneumonia, Diarrhea, Ear Infection Pneumonia , Meningitis, Sepsis

55. Interventions included in IMCI guideline for first-level health workers Conditions covered by case mgt. Interventions Preventive interventions Generic Version ARI, Diarrhea, Dehydration, Persistent Diarrhea, Dysentery, Meningitis, Sepsis, Malaria, Measles, Anemia, Malnutrition, Ear Infection Immunizations during sick child visits, Nutrition counseling, Breastfeeding support, Vit. A supplementation Using the IMCI Adaptation Guide HIV/AIDS, Dengue Hemorrhagic Fever, Wheeze, Sore Throat Periodic Deworming

56. Mgt.of sick children Nutrition Immunization Other Disease prevention Growth & Devt. IMCI as a key strategy For improving child health

57. BENEFITS OF IMCI Addresses major child health problems – The strategy addresses the most important causes of childhood death and illness Promotes prevention as well as cure – In addition to its focus on treatment, IMCI also provides the opportunity for important preventive interventions such as immunization and improved infant and child nutrition, including breastfeeding

58. Benefits of IMCI IMCI improves health worker performance and their quality of care. IMCI can reduce under-five mortality and improve nutritional status, if implemented well; IMCI is worth the investment, as it costs up to six times less per child correctly managed than current care

59. BENEFITS OF IMCI Cost-effective Inappropriate management of childhood illness wastes scarce resources. Although increased investment will be needed initially for training and reorganization, the IMCI strategy will result in cost savings. Improves equity – Nearly all children in the developed world have ready access to simple and affordable preventive and curative care. Millions of children in the developing world, however, do not have access to this same life-saving care. The IMCI strategy addresses this inequity in global health care.

60. 77

61. 78