EVALUATION REPORT OF THE INTEGRATED MANAGEMENT OF CHLDHOOD ILLNESSES (IMCI) IN THE CITY OF SANTIAGO

A Thesis Presented to the College of Nursing University of La Salette

In Partial Fulfillment Of the Requirement for the Degree of Bachelor of Science in Nursing (BSN)

By: Bayubay, Irene S. Echanes, Marie Joy D.

I. INTRODUCTON The strategy of Integrated Management of Childhood Illnesses (IMCI) is aimed at reducing child mortality and morbidity in developing countries. It combines improved management of common childhood illnesses (e.g. pneumonia, diarrhea, malaria, measles, ear problems and anemia) with proper nutrition and immunization. The health of children under five remains worrying in developing countries. Indeed, nearly ten million children still die annually before reaching the age of five and the majority of these deaths occur in countries with limited resources (WHO, 2005; UNCEF, 2007). Among these children, 70 to 90% of these deaths are due to one or more of the following conditions: Acute Respiratory Infections (mostly pneumonia), diarrhea, measles, neonatal diseases, malaria and malnutrition (WHO, 2005; UNICEF, 2007). To address this problem to reduce by two thirds the mortality of children less than five years between 1990 and 2015, WHO and UNICEF, in collaboration with other agencies have designed a strategy known as Integrated Management of Childhood illnesses (IMCI), It is a strategy that includes multiple interventions to improve care in preventive and curative health services, strengthen health system and promote health at the household level (WHO, 1997b). It includes a set of clinical guidelines designed for use in resource-limited countries where first line health services often receive a significant number of children under 5 years and almost lacking diagnosis capabilities (radiology, laboratory)(WHO, 1997b). Clinical guidelines were designed for children aged from one week to five years and did not include newborns from zero to seven days. However, statistics show that 40% of deaths among children aged less than five years and 60% of deaths of children less

than one year of age occur during the neonatal period (UNICEF, 2007) and a significant portion of these deaths is due to serious but treatable infections (pneumonia and septicemia). The IMCI strategy is offered to countries which have rates of under five years mortality exceeding 40 per 100 live births (WHO/UNICEF, 1999a) and is a strategy that continues to be central to child survival and development in countries with limited resources (Lawn and Keber, 2006). It is implemented in over 100 countries around the world including Philippines where the child mortality rate is 25 under five years of age died per 1000 live births (UNICEF, 2011) In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital staffs were capacitated to implement the strategy at the frontline level (DOH).

THEORETICAL FRAMEWORK The IMCI strategy logic model is the choice for this study. As noted, IMCI has three main components: Improving technical skills of health workers in the care of sick children. Improving the health system in general, required to support effective management of childhood illness (supervision, essential drugs, vaccines and other supplies); Improving family and community practices in child health.

STATEMENT OF THE PROBLEM This evaluative research was to analyze the effects of the IMCI strategy implementation and to draw lessons to guide its expansion which is already underway in the country. In order to better analyze these effects, the evaluation focused on the presence and actual insertion of IMCI in the health center of Santiago City.

SCOPE AND DELIMITATION The scope of this study is for the Integrated Management of Childhood Illnesses (IMCI) evaluation in the city of Santiago. This study will include analyzing the quality of care for sick children, describing the state of health system strengthening due to the implementation of IMCI and be able to identify the lessons learned in the implementation of IMCI. The study does not cover the any individual evaluation of the health workers.

SIGNFICANCE OF THE STUDY This study shows how the importance and the efficiency of the Integrated management of Childhood illnesses in the city pf Santiago. In addition this will be a useful instrument for the early detection and effective treatment of the principal illnesses that affect health of children under 5 years old, it helps to improve the knowledge and practices of families for disease prevention and health promotion. So that this application in health services and communities can produce an important impact in terms of reducing the number of children deaths, the number and severity of diseases that affect this age group and improving nutritional and development status of children under 5 years old.

DEFINITON OF TERMS Integrated Management for Childhood Illnesses (IMCI) - A strategy for reducing mortality and morbidity associated with major causes of childhood illness Santiago City- is an independent city located in the southwestern part of Isabela in north Luzon Island of the Philippines. World Health Organization (WHO) - is a specialized agency of the United Nations (UN) that is concerned with international public health. United Nations Children's Fund (UNICEF) - is a United Nations Program headquartered in New York City, that provides long-term humanitarian and developmental assistance to children and mothers in developing countries Department of Health (DOH)- is the principal health agency in the Philippines. Pneumonia- is an inflammatory condition of the lungaffecting primarily the microscopic air sacs known as alveoli. Diarrhea- is the condition of having three or more loose or liquid bowel movements per day Malaria- is a mosquito-borne infectious disease of humans and other animals caused by protists (a type of microorganism) of the genus Plasmodium. Measles- is an infection of the respiratory system caused by a virus, specifically a paramyxovirus PINK means the child has a severe classification and needs urgent attention and referral or admission for inpatient care. YELLOW means the child needs a specific medical treatment such as an appropriate antibiotic, an oral anti-malarial or other treatment; also teaches the mother how to give

oral drugs or to treat local infections at home. The health worker teaches the mother how to care for her child at home and when she should return. GREEN not given a specific medical treatment such as antibiotics or other treatments. The health worker teaches the mother how to care for her child at home. Always start at the top of the classification table. If the child has signs from more than 1 row always select the more serious classification.