IMCI

ORIENTATIO
N

INTRODUCTION

Pneumonia, diarrhea, dengue hemorrhagic

fever, malaria, measles and malnutrition cause
more
than 70% of deaths in children under 5 years of
age.
There are feasible and effective ways that
health workers in health centers can care for
children with these illnesses and prevent most
of these deaths.
WHO and UNICEF used updated technical
findings to describe management of these
illnesses in a set of integrated guidelines,
instead of separate guidelines for each illness.

Ten countries that early lead in

implementing IMCI:
1.
2.
3.
4.
5.
6.

BOLIVIA
DOMINICAN REPUBLIC
EQUADOR
INDONESIA
NEPAL
PERU

7. PHILIPPINES
8. TANZANIA
9. UGANDA
10. ZAMBIA

HOW IMCI STARTED?

1995 IMCI was developed by WHO UNICEF
to all developing countries.
1997 IMCI was brought to the Philippines thru
the Department of Health Region I, III,X, XI
(funded by United States Agency for
International Development (USAID) )
2001 - Integration of IMCI to Nursing &
Midwifery Curriculum (attended by the
Academe from different Nursing & Midwifery
schools)

Participating Agencies
DOH Lead Agency
Commission on Higher Education Department
(CHED)
Association of Deans of Philippines College of
Nursing (ADPCN)
Association of Philippine School of Midwifery
(APSOM)
Philippine Regulation Commission (PRC)

IMCI

Integrated
Management
Of Childhood
Illness

What is I.M.C.I.?

is an integrated approach to child s health

that focuses on the well-being of the whole
child.
aims to reduce death, illness and disability,
and to promote improved growth and
development among children under (5)five
years of age .
it includes both preventive and curative
elements that are implemented by families
and communities as well as by health
facilities.

BASIC COMPONENTS /
ADVANTAGES OF IMCI
1. Improving the case management
skills of health workers and health
facilities.
2. Improving the health care system.
3. Improving the family and
community healthcare practices.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
The case management process is
presented on a series of charts
which show the sequence of steps
and
provide
information
for
performing them. The charts
describe the following steps:

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
1. Assess the child or
young infant
taking a history and doing a
physical examination.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
2. Classify the illness
- making a decision on the
severity of the illness.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
3. Identify treatment
the charts recommend
appropriate treatment for each
classification.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
4. Treat the child
giving treatment in health
center, prescribing drugs or
other treatments to be given at
home, and also teaching the
mother how to carry out the
treatments.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
5. Counsel the mother

includes assessing how the

child is fed and telling her
about the foods and fluids to
give the child and when to
bring back to the health center.

SIX ( 6 ) STEPS IN CASE

MANAGEMENT PROCESS
6. Give follow- up care

describe what to do when a

child returns to the health
center by arrangement for a
follow-up visit.

AGE BRACKET:
1. Age 1 week up to 2 months
( Sick young infant )
2. Age 2 months up to 5 years
( Sick child )

I. ASSESS & CLASSIFY THE

SICK CHILD AGE 2
MONTHS UP TO 5 YEARS
LEARNING OBJECTIVES:
This module will describe
and allow you to practice the
following skills:

LEARNING OBJECTIVES:

1. Asking the mother about the childs

problem.
- Greet the mother appropriately and ask her to
sit with her child.

- To use good communication skills:

listen carefully to what the mother tells you

use words the mother understands
give the mother time to answer the questions
ask additional questions when the mother is not
sure about her answer

- Determine if this is an initial or follow-up visit

for this problem

LEARNING OBJECTIVES:
2. Checking for general danger signs Greet the mother appropriately and
ask her to sit with her child.
3. Asking the mother about the four
main symptoms:

cough or difficult breathing

diarrhea
fever
ear problem

LEARNING OBJECTIVES:
4. When a main symptom is present:
assessing the child further for signs
related to the main symptom
classifying the illness according to the
signs which are present or absent

5. Checking for signs of malnutrition and

anemia and classifying the childs
nutritional status.

LEARNING OBJECTIVES:
6. Checking the childs immunization status
and deciding if the child needs any
immunizations today.
7. Checking the childs Vitamin A status and
deciding if the child needs Vitamin A

8. Assessing any other problems

FOUR ( 4 ) MAIN
SYMPTOMS:

1. COUGH OR DIFFICULT
BREATHING : PNEUMONIA
Any general danger sign
Fast breathing
Chest indrawing
Stridor

FOUR ( 4 ) MAIN
SYMPTOMS:
2. DIARRHEA :
DEHYDRATION
ACUTE & PERSISTENT
DIARRHEA
DYSENTERY
CHOLERA

FOUR ( 4 ) MAIN
SYMPTOMS:
3. FEVER :
MALARIA
MEASLES
DENGUE HEMORRHAGIC
FEVER

FOUR ( 4 ) MAIN
SYMPTOMS:
4. EAR PROBLEM:

ACUTE EAR INFECTION

CHRONIC EAR INFECTION
MASTOIDITIS

Additional Topics
MALNUTRITION :
KWASHIORKOR
MARASMUS
ANEMIA :
IRON DEFICIENCY
ANEMIA
VITAMIN A
EXPANDED PROGRAM ON
IMMUNIZATION

FOUR ( 4 )
GENERAL DANGER
SIGNS:

A general danger
sign is present if:

FOUR ( 4 )
GENERAL DANGER
SIGNS:

the child is NOT ABLE TO DRINK

or BREASTFEED

the child VOMITS EVERYTHING

the child has had CONVULSIONS

the child is ABNORMALLY

SLEEPY or DIFFICULT TO
AWAKEN

II. ASSESS & CLASSIFY THE

SICK YOUNG INFANT AGE
1 WEEK UP TO 2 MONTHS
LEARNING OBJECTIVES:
The module will describe the
following tasks and allow you
to practice some of them
( some will be practiced in the
health center ):

LEARNING OBJECTIVES:
1. Assessing and classifying a young infant

for possible bacterial infection .

2. Assessing and classifying a young infant
with diarrhea
3. Checking for a feeding problem or low
weight, assessing breastfeeding and
classifying feeding
4. Treating a young infant with oral or
intramuscular antibiotics

Continuation :
5. Giving fluid for treatment of diarrhea
6. Teaching the mother to treat local

infections at home
7. Teaching correct positioning and
attachment for breastfeeding
8. Advising the mother how to give home
care for the young infant

THREE ( 3 ) MAIN
SYMPTOMS
1. POSSIBLE BACTERIAL INFECTION

has the infant had convulsions

count the breaths in one minute; repeat the
count if elevated
look for severe chest indrawing
look for nasal flaring
look and listen for grunting
look and listen for bulging fontanelle
look for pus draining from the ear

THREE ( 3 ) MAIN
SYMPTOMS

1. POSSIBLE BACTERIAL INFECTION

look at the umbilicus. Is it red or draining

pus? Does the redness extend to the skin?
measure temperature ( or feel for fever or
low body temperature )
look for skin pustules. Are there many or
severe pustules?
see if the young infant is abnormally sleepy
or difficult to awaken

THREE ( 3 ) MAIN
SYMPTOMS
look at the young infants movements.
Are they less than normal?
look at the young infants movements.
Are they less than normal?

THREE ( 3 ) MAIN
SYMPTOMS
2. DIARRHEA

for how long?

is there blood in the stool?
look at the young infants general condition,
is the infant: abnormally sleepy or
difficult to awaken ? restless and irritable?
look for sunken eyes
pinch the skin of the abdomen, does it go
back: - very slowly ( longer than 2 seconds)?
- slowly

THREE ( 3 ) MAIN
SYMPTOMS
3. FEEDING PROBLEM & LOW WEIGHT

is there any difficulty feeding?

is the infant breastfed? If yes, how many
times in 24 hours?
does the infant usually receive any other
foods or drinks? if yes, how often?
what do you use to feed the infant?

determine weight for age.

CLASSIFICATION
TABLES

Signs of illness & their classification are

listed on the ASSESS & CLASSIFY chart
in the classification tables. Most
classification tables have 3 ROWS. If the
chart is in color, each row is colored
either PINK, YELLOW or GREEN.
The color of the rows tells quickly if the
child has a serious illness. You can also
quickly choose the appropriate
treatment.

CLASSIFICATION
TABLES- NEEDS URGENT ATTENTION AND REFERRAL OR

PINK ROW

ADMISSION FOR IN PATIENT CARE.

- THIS IS A SEVERE CLASSIFICATION

- THE CHILD NEEDS AN APPROPRIATE

ANTIBIOTIC, AN ORAL ANTIMALARIAL OR
OTHER TREATMENT. TREATMENT INCLUDES
TEACHING THE MOTHER HOW TO GIVE THE
ORAL DRUGS OR TO TREAT LOCAL INFECTIONS
AT HOME. THE HEALTH WORKER ADVISES HER
ABOUT CARING FOR THE CHILD AT HOME AND
WHEN SHE SHOULD RETURN.
- THIS IS A MODERATE OR MILD
CLASSIFICATION

ELLOW ROW

GREEN ROW

THIS MEANS THE CHID DOES NOT NEED

SPECIFIC MEDICAL TREATMENT SUCH AS
ANTIBIOTICS. THE HEALTH WORKER TEACHES
THE MOTHER HOW TO CARE FOR HER
CHILD AT HOME. AS AN EXAMPLE, ADVISE
MOTHER ON HOW TO FEED HER SICK CHILD

UPDATES:
At present time, DOH is working on
the following new areas within
IMCI:
1. Recognition and care of children
with HIV/AIDS
2. Interactive care for healthy child
development
3. Neonatal Health