INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES.pptx

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1. INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES BY DR AWALA AND DR UKPE

2. OUTLINE INTRODUCTION DEFINITION RATIONALE FOR THE INTEGRATED APPROACH ADVANTAGES OF THE INTEGRATED APPROACH COMPONENTS OF IMCI IMCI PROCESS OBJECTIVES OF IMCI STRATEGIES OF IMCI

3. INTRODUCTION Pneumonia, diarrhea, fever, malaria ,measles and malnutrition cause more than 70% of the deaths in children under 5 years of age. All these are preventable diseases in which when managed and treated early could have prevented these deaths. In response to this challenge, WHO and UNICEF in the early 1990’s (1995) developed an integrated management of childhood illness, a strategy designed to reduce child morbidity and mortality in developing countries .

4. INTRODUCTION The approach focuses on the major causes of death in children through improving case management skills of health workers ,strengthening the health system , and addressing family and community practices.

5. Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at childmortality.org. Projected data are from the United Nations population Division’s World Population prospects; and may in some cases not be consistent with the data before the current year.

6. INTRODUCTION The reason for these deaths include: Poverty Delay in showing up with the illness Lack of facilities due to rural- urban disparities or absolute lack Inappropriate assessment of children Incompetent health personnel Lack of facilities and resources like drugs ,laboratories and referral systems

7. DEFINITION It is an integrated approach to child health that focuses on the well being of the whole child. It includes both preventive and curative services that are implemented by families and communities as well as by health facilities. It aims to reduce death, illness, and disability , and promote improved growth and development among children under 5 years of age.

8. RATIONALE FOR THE INTEGRATED APPROACH Integrated approach is child centered. 5 conditions are the major cause of death: Pneumonia, Diarrhoea , Malaria, Measles, and Malnutrition are the major causes of death 3 out of 4 children seeking health care in developing countries suffer from one of these conditions Children are likely to be suffering from more than one condition Often combination of these conditions lead to fatal results Making a single diagnosis may be difficult Such children usually need combined therapy for successful treatment

9. ADVANTAGES OF THE INTEGRATED APPROACH Speeds up the urgent treatment and treatment seeking practices Prompt recognition of serious conditions ,hence prompt referral Involves parents in effective care of baby at home Involves prevention of diseases by active immunization Improved nutrition and exclusive breast feeding practices Highly cost effective It avoids wastages of resources by using the most appropriate medicines and treatments It reduces duplication of effort

10. COMPONENTS OF IMCI Improvements in case management skills by health care staff Improvements in overall health systems Improvements in family and community health care practices

11. OBJECTIVES OF IMCI To reduce significantly , global morbidity and mortality associated with the major causes of illnesses in children To contribute to healthy growth and development of children

12. STRATEGIES FOR IMPROVED CASE MANAGEMENT SKILLS OF HEALTH WORKERS It uses charts to describe the following steps 1. Assess the child 2.Classify the illness 3.Identify the treatment 4.Treat the child 5.Counsel the mother 6. Give follow up care

13. IDENTIFICATION AND PROVISION OF TREATMENT INCLUDE: Curative component adapted to address the most common life threatening conditions in each country Rehydration( diarrhea) Antibiotics( pneumonia, “severe disease”) Antimalarial treatment Vitamin A( measles, severe malnutrition)

14. PROMOTIVE AND PREVENTIVE ELEMENTS Reducing missed opportunities for immunization( vaccination given if needed) Breastfeeding and other nutritional counselling Vitamin A and iron supplementation Treatment of helminth infections

15. GENERAL DANGER SIGNS For ALL sick children ask the mother about the child’s problem, then CHECK FOR GENERAL DANGER SIGNS ASK: LOOK: Is the child able to drink or breastfeed? See if the child is lethargic or unconscious Does the child vomit everything? Did the child have convulsions? A child with any general danger signs needs URGENT attention: complete the assessment and any pre-referral treatment immediately so referral is not delayed Then ASK about main symptoms: cough and difficulty in breathing, diarrhea, fever, ear problem. CHECK for malnutrition and anemia, immunization status and for other problems

16. For ALL sick children ask the mother about the child’s problem. Check for general danger signs, ask about cough or difficulty breathing and then ASK: DOES THE CHILD HAVE DIARRHOEA? IF NO IF YES If YES, ask: For how long? Is there blood in the stool Look, listen, feel Look at the child’s general condition Is the child: Lethargic or unconscious? Restless or irritable? Look for sunken eyes Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly, thirsty? Pinch the skin of the abdomen Does it go back: Very slowly(longer than 2 seconds)? Slowly? CLASSIFY the child’s illness using the color-coded classification tables for diarrhea Then ASK about the main symptoms: fever, ear problem, and CHECK for malnutrition and anemia, immunization status and for other problems.

17. STRATEGIES FOR IMPROVEMENTS IN FAMILY AND COMMUNITY HEALTH CARE PRACTICES IMCI aims to reach families and communities where they live and is one way of impacting marginalized and hard to reach children. It promotes and enables the participation of parents ,caregivers and communities in their own development and in actions that will make a difference in the survival and development of their children using the following strategies through key family and community practices as below.

18. GROWTH PROMOTION AND DEVELOPMENT Exclusively breast feed for 6 months Introduce appropriate energy and nutrient rich complementary foods from 6 months while continuing breast feeding up to 24 months Provide adequate micronutrient through diet or supplementation Promote mental and psychosocial development

19. CARE SEEKING AND COMPLIANCE Take child to complete full course of immunization before first birthday Recognize when child needs treatment outside the home and take to health worker Follow correct implementation of prescribed care (treatment, follow up, and referral) Ensure that all women have adequate antenatal care and T.T vaccination during pregnancy Ensure adequate participation of men in child care and reproductive health activities

20. HOME MANAGEMENT Continue to feed and offer more food and fluids when child is sick Give child appropriate home treatment for illness Take appropriate actions to prevent and manage child injuries and accidents

21. DISEASE PREVENTION Carry out proper disposal of feces, washing hands after defecation, before preparing meals, and before feeding the child Ensure that children sleep under insecticide treated nets Ensure prevention and care of persons infected and affected by HIV/AIDS Prevent child abuse /neglect and take appropriate action when it occurs

22. STRATEGIES FOR HEALTH SYSTEM STRENGTHENING. To do this, countries develop interventions to improve the availability of drugs and supplies, strengthen the service quality and organization at health facilities, reinforce referral systems, and ensure equity of access to health care.

23. THANK YOU FOR LISTENING