Integrated Management of Childhood

Illness (IMCI)

Introduction
Each year more than 10 million children in developing countries die before they
reach their fifth birthday. Seven in ten of these deaths are due to just five preventable
and treatable conditions: pneumonia, diarrhoea, malaria, measles, and malnutrition, and
often to a combination of these conditions. The ntegrated Management of Childhood
llness (MC) strategy encompasses a range of interventions to prevent and manage
this major childhood illness, both in health facilities and in the home. The MC strategy
incorporates many elements of diarrhoea and AR control programme, as well as child-
related aspects of malaria control, nutrition, immunization, and essential drugs
programme.

hat is IMCI?
MC is an integrated approach to child health that focuses on the well being of
the whole child. MC includes both preventive and curative elements that are
implemented by families and communities as well as by health facilities.

Objectives
O To reduce significantly mortality and morbidity associated with the major causes
of disease in children
O To contribute to healthy growth and development of children

Component of IMCI
The MC strategy includes 3 main components:
O mproving case management skills of health-care staff
O mproving overall health systems
O mproving family and community health practices

$tatus of IMCI
mplementation of MC involves 3 phases: (1) ntroduction Phase, (2) Early
mplementation Phase, (3) Expansion Phase. Bangladesh is now at expansion phase
with piloting in 3 Upazillas (Matlab, Damrai, Kahaloo), which have been reviewed. Now
MC in expanded in another 6 upazillas of Bangladesh

IMCI $tudy at Matlab
A two cell randomized experimental study. 20 Facility catchment areas were
determined out of this 10 are intervention and 10 are comparison. After adaptation of
the generic WHO/UNCEF guidelines and training materials, implementation started in
2001 focusing mainly on training of health workers in first-level health facilities. From
2002 interventions to improve family and community practices for child health and
development started for successful implementation of MC.

ackground

Every day, millions of parents seek health care for their sick children, taking them
to hospitals, health centres, pharmacists, doctors and traditional healers. Surveys reveal
that many sick children are not properly assessed and treated by these health care
providers, and that their parents are poorly advised. At first-level health facilities in low-
income countries, diagnostic supports such as radiology and laboratory services are
minimal or non-existent, and drugs and equipment are often scarce. Limited supplies
and equipment, combined with an irregular flow of patients, leave doctors at this level
with few opportunities to practice complicated clinical procedures. nstead, they often
rely on history and signs and symptoms to determine a course of management that
makes the best use of the available resources.

These factors make providing quality care to sick children a serious challenge.
WHO and UNCEF have addressed this challenge by developing a strategy called the
ntegrated Management of Childhood llness (MC).

hat is IMCI?
MC is an integrated approach to child health that focuses on the well-being of
the whole child. MC aims to reduce death, illness and disability, and to promote
improved growth and development among children under five years of age. MC
includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.

The strategy includes three main components:
O mproving case management skills of health-care staff
O mproving overall health systems
O mproving family and community health practices.

n health facilities, the MC strategy promotes the accurate identification of
childhood illnesses in outpatient settings, ensures appropriate combined treatment of all
major illnesses, strengthens the counselling of caretakers, and speeds up the referral of
severely ill children. n the home setting, it promotes appropriate care seeking
behaviours, improved nutrition and preventative care, and the correct implementation of
prescribed care.


hy 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. MC is an
integrated strategy, which takes into account the variety of factors that put children at
serious risk. t ensures the combined treatment of the major childhood illnesses,
emphasizing prevention of disease through immunization and improved nutrition.

How is IMCI implemented?
ntroducing and implementing the MC strategy in a country is a phased process
that requires a great deal of coordination among existing health programmes and
services. t involves working closely with local governments and ministries of health to
plan and adapt the principles of the approach to local circumstances. The main steps
are:
O Adopting an integrated approach to child health and development in the national
health policy.
O Adapting the standard MC clinical guidelines to the country's needs, available
drugs, policies, and to the local foods and language used by the population.
O Upgrading care in local clinics by training health workers in new methods to
examine and treat children, and to effectively counsel parents.
O Making upgraded care possible by ensuring that enough of the right low-cost
medicines and simple equipment are available.
O Strengthening care in hospitals for those children too sick to be treated in an
outpatient clinic.
O Developing support mechanisms within communities for preventing disease, for
helping families to care for sick children, and for getting children to clinics or
hospitals when needed.

MC has already been introduced in more than 75 countries around the world.

hat has been done to evaluate the IMCI strategy?
CAH has undertaken a Multi-Country Evaluation (MCE) to evaluate the impact,
cost and effectiveness of the MC strategy. The results of the MCE support planning
and advocacy for child health interventions by ministries of health in developing
countries, and by national and international partners in development. To date, MCE has
been conducted in Brazil, Bangladesh, Peru, Uganda and the United Republic of
Tanzania.

The results of the MCE indicate that:
O MC improves health worker performance and their quality of care;
O MC can reduce under-five mortality and improve nutritional status, if
implemented well;
O MC is worth the investment, as it costs up to six times less per child correctly
managed than current care;
O Child survival programmes require more attention to activities that improve family
and community behaviour;
O The implementation of child survival interventions needs to be complemented by
activities that strengthen system support;
O A significant reduction in under-five mortality will not be attained unless large-
scale intervention coverage is achieved.