Integrated Management of Childhood Illnesses (IMCI)

What Is Integrated Management of Childhood Illnesses (IMCI)?

In order to reduce illness and death, the IMCI strategy is created in healthcare facilities. Moreover, the approach also includes the promotion of good health, development, and growth in children. It also addresses the issues like neglecting evidence-based guidelines, misuse of medications, multiple drug prescriptions without any medical reason, and over-hospitalization. Moreover, it is also a holistic approach to treatment such as vaccinations, oral rehydration therapy, improved feeding, and managing respiratory infections in children.

What Are the Major Causes That Affect Child Mortality Ratios?

There are five main reasons that affect the mortality rate in children, such as,

• Severe diarrhea.

• Acute respiratory infections.

• Malaria.

• Measles.

• Malnutrition.

The integrated management of childhood illnesses approach is not only to provide medical treatment promptly but also to help improve the counseling given to caregivers, an indentation in outpatient establishments, and to provide speedy referrals during medical emergencies.

There are a plethora of resources that get wasted for many reasons, but IMCI helps to provide these resources to needy children. It considers each case in a generalized way by being cognizant of their impaired growth, health condition, and mortality rate. By taking into account the collective assessment and treatment of illness, IMCI’s core value is providing effective case management, treating the illness, and delivering healthy growth.

What Are the Objectives and Goals of IMCI?

Integrated management of childhood illnesses has three main objectives:

1. Decrease the mortality rate in infants.

2. Reduce the incidence and complications of health-related issues and maintain the quality of healthcare.

3. Help to improve the growth and development of children.

What Are the Key Requirements for IMCI?

If the healthcare establishments are looking to implement the integrated management of childhood illnesses strategy, they also need to establish coordination between other health programs by also working closely with the local government, the ministry of health, and local communities. Other key requirements are:

• The adaptation of national policy and standards on healthcare approach.

• According to community epidemiology, commodities, policies, food, and language, the IMCI guideline should be reviewed and updated regularly.

• Make sure about the availability of medicine and laboratory tests, and medical equipment for the management of cases.

• Make sure that all healthcare providers are provided and updated with training and guidelines to ensure treatment and counseling are provided to parents.

• When children with fatal conditions are referred to other hospitals, referrals should be promptly provided.

• Educating parents and caregivers about medical conditions and when to seek help for them. Also, counsel them about maintaining the good health and growth of children.

What Are the Components of IMCI?

For the effectiveness of the IMCI strategy, it should have a strong foundation in any situation. There are three components of integrated management of childhood illnesses such as:

1. Improvement of Health Worker Skills: Well-trained healthcare workers are an essential part of any strong healthcare system. It not only plays an important part in the success of an organization but also in the health of its patients. Even after getting training, it is crucial to reinforce the skill from time to time. IMCI suggests proper case management training for them, which has several components themselves.

• Assess the Child: Sometimes, there are many diseases that do not have any noticeable signs and symptoms; on the contrary, sometimes, even with the visible signs and symptoms, they are easily neglected. In all cases, taking a detailed case history with detailed family and demographic details is the first step of the assessment. Also, it is very important to ask for common conditions like faded rashes, cough, cold and mild fever.Secondly, the doctors should ask about previous hospital visits, history of previous illness, and immunization history. The health workers also assess the child for any physical or developmental defects. Additionally, if required, laboratory or radiographic investigation measures should be taken, too.

• Classify the Illness: When the diagnosis suggests any acute infections like diarrhea or respiratory distress, the illness should be classified using a designated classification chart. The classification should be individually divided according to condition and mode of treatment. Sometimes the illness is classified according to pre-referral treatment or referral, specific medical advice, or home management advice.

• Treat the Child or Refer: After identification and classification of the illness, the treatment plan is customized according to the child’s condition and history. In the case when the child needs a referral, the initial treatment measures should be taken. Additionally, in the case when they need home management, the healthcare providers give them the first dose of medication before discharge from the hospital.

• Counsel the Parents or Caregivers: After the evaluation of the disease, the doctor educates the caregivers or parents about the severity of the condition, medication doses, and how to feed food and fluid and treat the local mild infection at home. In the case of low birth weight babies, the healthcare providers suggest the food chart and other management measures for parents to follow.

• Follow-Up: After counseling, this is the final but very essential step, as the majority of the parents neglect this component to follow up on time. As a result, there are many cases of secondary infection or reoccurrence of the condition seen. Reassessing the child for post-medication recovery and other conditions can decrease the chances of illness.

The ministry of health has adopted various modes of training for their healthcare providers. These include:

• Regular 11 days training as described above.

• On-the-job training provided by well-trained coworkers to an untrained healthcare provider.

• Distance learning module along with on-site practical training.

2. Improvement of Health System: The health systems are required to be supported by IMCI in these ways:

• The availability of medications and supplies should be promptly maintained.

• The emergency department should be capable of providing immediate care. The essential drugs should be available for immediate treatment along with essential supplies. Critically ill children should be attended to without any delay at the front desk. It is very important to attend to referrals on an urgent basis.

• The emergency triage assessment and treatment (ETAT) training should be provided to all healthcare workers.

• Healthcare providers should adhere to national policies for the standard of care.

• In critical areas, help related to the job should be provided.

3. Improvement of Family and Community Practices: It is the last component of IMCI about spreading awareness in the community and family about illness. There are other components added and followed by some of the healthcare systems, such as:

• Growth Promotion and Development:

  • Exclusive breastfeeding till six months of age.

  • Proper micronutrients should be given through diet and supplements.

  • No food or water for the first six months except for the medication.

  • Psychological and mental development should be promoted.

• Disease Prevention:

  • Maintaining the sterile environment by regular hand wash and proper diaper disposal.

  • Prevention of HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome).

  • Prevent child abuse or neglect.

  • Promote the use of sleeping under an insecticide-treated net.

• Home Management:

  • The requirement of an individual child should decide the proportion and frequency of food.

  • Home treatment for infection should be given.

  • Take steps to prevent or manage child injuries or accidents.

• Care Seeking and Compliance:

  • Before the child is one year old, the immunization cycle should be completed.

  • Antenatal care (ANC) attendance and tetanus vaccination during pregnancy are taken.

  • Both parents should take part in childcare activities.

Conclusion

Since the time of adoption of IMCI in healthcare, over 100 countries have participated in and implemented this strategy. The implementation of this strategy has not only noticeably reduced the number of deaths, but also it has affected the political, epidemiological, and social aspects by educating the political leaders about healthcare awareness, strengthening the healthcare system and frontline healthcare providers, and spreading awareness in the community about diseases and their prevention.