Tuesday, November 17, 2009

- Integrated Management of Childhood Illness (Imci).

- Def:-
An integrated approach to child health which focuses on the well being of whole child.

- Aims (Broad goals-الأهداف العامة):-
  • Reduce death, illness and disability
  • Promote improved growth and development among children under five years of age.
  • Includes both preventive and curative elements implemented by families,communities and health facilities.
-Objectives(الأهداف الصغيرة-underlying goals):-

1- In Health facilities,IMCI strategy promotes:-
  • The accurate diagnosis of childhood illnesses in outpatient clinics.
  • Appropriate combined treatment of all major illnesses.
  • Improving skills of PHC staff.
  • Speeding up the referral of severely ill children.
2- In the home setting,IMCI strategy promotes:-
  • Appropriate care seeking behaviours
  • Improved nutrition and preventative care.
  • Correct implementation of prescribed care/and drugs.
- Why is IMCI better than single-condition approaches?
  • Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible.
  • IMCI ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition.
-Rationale of IMCI in developing countries:-

1-More than10million deaths/year among children under 5 years of age in developing countries.

2-70% of these deaths are due to just 5 preventable and treatable
malaria,measles and malnutrition).

3-Surveys show that many sick children aren't properly treated by healthcare providers as their parents are poorly advised.

4-In developing countries diagnostic aids (Radiology or lab) are minimal or absent.

5-In developing countries drugs and equipment are limited.

6-These limitations leave doctors helpless,they often rely on history,signs and symptoms to determine the management with least cost.

- Components :-
The strategy includes three main components:-
  • Improving case management skills of health-care staff(health-worker component).
  • Improving overall health systems(health-service component).
  • Improving family and community health practices(community component).
-The department responsible for IMCI in WHO is called "Child and adolescent health department"(CAH) here.

-Benefits of Integrated Management of Childhood Illness (IMCI)(3):-
  • Addresses major child health problems by addressing the most important causes of childhood death and illness.
  • Responds to demand – Every day millions of parents take their sick children to hospitals and health centres,pharmacists and community health care providers. At least three out of four of these children are suffering from one of the five conditions that are the focus of IMCI.
  • Promotes prevention as well as cure .
  • Is cost-effective – Investing in Health ranked IMCI among the 10 most cost-effective interventions in both low- and middle-income countries.
  • Promotes cost saving – 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 which protects them from death due to ARI, diarrhoea, measles, malaria and malnutrition. Millions of children in the developing world, however, do not have access to this same life-savingcare. The IMCI strategy addresses this inequity in global health care.
-Implementation of IMCI:-
(How does IMCI achieve these goals?)
1-Adopting this strategy in the national health policy.
2-Adapting the standard IMCI clinical guidelines to the country's needs,Available drugs,policies,and to local foods.
3-Upgrading care in PHC units by training staff in new methods of management of children.
4-Implementation of the concept of the essential drug list.
5-strengthening the referral system.
6-Implementation of IMCI is done in conjugation with other health strategies (e.g Roll back malaria,Nutrition,EPI,IMPAC).

- Some WHO publications concerned with IMCI:-

*IMCI chart booklet - standard,
* Handbook:IMCI integrated management of childhood illness.
* Integrated Management of Childhood Illness (Imci) Photographs:-
(1)Mohammed Kamel Farag ,community medicine, non communicable disorders & management in health care ,Ch 14 ,Child health care services, p.g 181-183.
(2)About Integrated Management of Childhood Illness (IMCI), Pan American Health Organizationn here.
(3)IMCI information package (here) ,WHO/CHS/CAH/98.1 A-M Rev.1 1999, BOX 1,p.g 4.
(Figer 1)UNICEF:The state of the worlds children 2008: child survival(here)UNICEF/HQ07-0108/Thierry Delvigne Jean
(Figer 2)UNICEF:The state of the worlds children 2008: child survival(here)New York: UNICEF; 2007.


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