The IMCI chart booklet is for use by doctors, nurses and other health professionals who see young infants and children less than five years old. It facilitates the use of the IMCI case management process in practice and describes a series of all the case management steps in a form of IMCI charts. These charts show the sequence of steps and provide information for performing them. The IMCI chart booklet should be used by all health professionals providing care to sick children to help them apply the IMCI case management guidelines. Health professionals should always use the chart booklet for easy reference.
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Every year about 9 million children in developing countries die before they reach their fifth birthday, many of them during the first year of life. Ethiopia has one of the highest under-five mortality rates with more than , children under the age of five dying every year.
These diseases are also the reasons for seeking care for at least three out of four children who come to health facilities. IMNCI is an integrated approach to child health that focuses on the wellbeing of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMNCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. You will learn how to determine if a child is severely ill and needs urgent referral.
This study session outlines the guidelines for counselling mothers and other caregivers, something which you will also look at in more detail in Study Session 14 of this Module. SAQs 1. First, you are going to look into the importance of the IMNCI strategy and the diseases that are addressed by this strategy. IMNCI is a strategy that integrates all available measures for health promotion, prevention and integrated management of childhood diseases through their early detection and effective treatment, and promotion of healthy habits within the family and community.
As shown in Figure 1. As you can also see in Figure 1. The IMNCI guidelines are designed for the management of sick children from birth up to five years old. As you read in the introduction, the core of the IMNCI strategy is integrated case management of the most common childhood problems, with a focus on the most important causes of death. The clinical guidelines are designed for the management of sick children aged from birth up to five years.
IMNCI will enable you to help reduce the number of babies and children in your community who become ill or die. It will also help you to promote the healthy growth and development of babies and children in the community.
When you are assessing a sick child, a combination of individual signs leads to one or more classifications , rather than to a diagnosis. IMNCI classifications are action-oriented illness categories which enable a healthcare provider to determine if a child should be urgently referred to a health centre, if the child can be treated at the health post e. The guidelines give instructions for how to routinely assess a child for general danger signs or possible bacterial infection in a young infant , common illnesses, malnutrition and anaemia, and to look for other problems.
In addition to treatment, the guidelines incorporate basic activities for illness prevention. This module will help you learn to use the IMNCI guidelines in order to interview caregivers, accurately recognise clinical signs, choose appropriate treatments, and provide counselling and preventive care.
Case management can only be effective to the extent that families bring their sick children to a trained health worker such as you for care in a timely way.
If a family waits to bring a child to a health facility until the child is extremely sick, or takes the child to an untrained provider, the child is more likely to die from the illness. Therefore, teaching families when to seek care for a sick child is an important part of the case management process and is a crucial part of your role as a Health Extension Practitioner. You should always use the chart booklet whenever you manage under-five children. Whenever a sick baby or child under five comes to your health post you should use the IMNCI chart booklet to help you know how to assess, classify and treat the child.
The IMNCI guidelines address most, but not all, of the major reasons a sick child is brought to a health facility. A child returning with chronic problems or less common illnesses may require special care which is not described in this Module. For example, the guidelines do not describe the management of trauma or other acute emergencies due to accidents or injuries.
You need to know the age of the child in order to select the appropriate chart and begin the assessment process. The IMNCI case management process is presented on two different sets of charts: one for managing sick young infants aged from birth up to two months and a separate one for managing sick children aged from two months up to five years. First decide which chart to use depending on the age of the child.
Up to five years means the child has not yet had his or her fifth birthday. If the child is not yet two months of age, the child is considered a young infant. A child who is two months old would be in the group two months up to five years, not in the group birth up to two months. Since management of the young infant aged from birth up to two months is somewhat different from the management of older infants and children, it is described on a different chart:.
The case management process for sick children aged two months up to five years is presented on three charts:. If the child was seen a few days before for the same illness, this is a follow-up visit. A follow-up visit has a different purpose from an initial visit.
You will learn more about follow-up visits in all of the study sessions in this Module. Whether it is an initial or follow-up visit, the mother may well be feeling anxious and it is important that you put her at her ease. This will increase the likelihood of you being able to obtain important information about her child.
There are two sets of charts, one for babies up to the age of two months and one set of three charts for babies and children from two months to five years. Therefore you should find out the age of the child from the mother or from a record chart if this is a follow-up visit and there is already information available to you.
This will tell you which chart you should use to assess, classify and determine the correct treatment and follow-up care. So you can provide the best advice, you need to know what the general danger signs are in sick infants and children. You are going to learn about these next. Since IMNCI takes a holistic approach to assessing, classifying and treating childhood illnesses it is important to look for general danger signs as well as symptoms and signs of specific childhood illnesses.
The general danger signs are signs of serious illness that are seen in children aged two months up to five years and will need immediate action to save the life of the child. There are five general danger signs and these are set out in Box 1. Make sure that any infant or child with any danger sign is referred after receiving urgent pre-referral treatment. As you can see in Box 1.
You should assess all sick children who come to your health post for general danger signs. Most children with a general danger sign need urgent referral to hospital. A child with a general danger sign has a serious problem.
Most children with a general danger sign need u rgent referral to hospital. They may need lifesaving treatment with injectable antibiotics, oxygen or other treatments that may not be available in the health post. You should complete the rest of the assessment immediately and give urgent pre-referral treatments before sending the patient to the next facility.
You will learn more about this later in this study session. When you ask the mother if the child is able to drink, make sure that she understands the question. If the mother replies that the child is not able to drink or breastfeed, ask her to describe what happens when she offers the child something to drink. For example, is the child able to take fluid into his mouth and swallow it? Look to see if the child is swallowing the breastmilk or water. A child who is breastfed may have difficulty sucking when his nose is blocked.
A child who vomits everything will not be able to hold down food, fluids or oral drugs. A child who vomits several times but can hold down some fluids does not have this general danger sign.
When you ask the question, use words the mother understands. Give her time to answer. If the mother is not sure if the child is vomiting everything, help her to make her answer clear. For example, ask the mother how often the child vomits. Also ask if each time the child swallows food or fluids, does the child vomit? See if the child vomits. The child may lose consciousness or not be able to respond to spoken directions. Ask the mother if the child has had convulsions during this current illness.
Use words the mother understands. See also if the child is convulsing now. A lethargic child is not awake and alert when he should be. The child is drowsy and does not show interest in what is happening around him. Often the lethargic child does not look at his mother or watch your face when you talk. The child may stare blankly and appear not to notice what is going on around him.
An unconscious child cannot be wakened. He does not respond when he is touched, shaken or spoken to. Ask the mother if the child seems unusually sleepy or if she cannot wake the child. Look to see if the child wakens when the mother talks or shakes the child or when you clap your hands. However, if the child is sleeping and has cough or signs of difficult breathing, you must count the number of breaths first before you try to wake the child because it is easier to count the exact breathing rate when the child is calm.
When you have completed the above steps, you should record what you have found on the sick child case recording form. Case study 1. Fatuma is 18 months old. She weighs Her temperature is This is the initial visit for this illness. The health worker checked Fatuma for general danger signs.
The mother said that Fatuma was able to drink. She had not been vomiting. She had not had convulsions during this illness. The health worker clapped her hands.
She asked the mother to shake the child.
Integrated Management of Childhood Illness (IMCI)
As part of its response to the global epidemic of obesity, WHO is releasing guidelines to support primary healthcare workers identify and help children who are overweight or obese. In an estimated 41 million children under 5 were affected by overweight or obesity. Without effective treatment they are very likely to remain overweight and obese throughout their lives, putting them at risk of cardiovascular disease, diabetes and premature death, as well as suffering physical and psychological consequences in childhood. Taking as its departure point the implementation of Integrated Management of Childhood Illness IMNCI , developed by WHO and UNICEF in , this strategic review shares analysis from 20 years of implementation of child health strategies and provides direction to the global child health community on how to better assist countries to deliver the best possible strategies to help each child survive and thrive. Every day, millions of parents seek health care for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers.
IMCI chart booklet
Every year about 9 million children in developing countries die before they reach their fifth birthday, many of them during the first year of life. Ethiopia has one of the highest under-five mortality rates with more than , children under the age of five dying every year. These diseases are also the reasons for seeking care for at least three out of four children who come to health facilities. IMNCI is an integrated approach to child health that focuses on the wellbeing of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age.