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close this bookFact sheet No 178: Reducing Mortality from Major Killers of Children - Revised September 1998 (WHO, 1998, 7 p.)
View the document(introduction...)
View the documentIntegrated Management of Childhood Illness (IMCI)
View the documentPneumonia: correct management could save over 1 million lives per year
View the documentDiarrhoea: correct management could save nearly 1.8 million lives per year
View the documentMeasles: effective prevention and treatment could save 700 000 lives per year
View the documentMalaria: correct management could save 500 000 lives per year
View the documentMalnutrition: improved feeding practices could save 800 000 lives per year
View the documentOther prevention activities
View the documentResearch and development
View the documentImproving health systems
View the documentImproving health worker skills
View the documentImproving family practices

Integrated Management of Childhood Illness (IMCI)

Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible and inappropriate. Such children may need combined therapy for successful treatment. An integrated strategy takes into account the various factors that put children at serious risk. It ensures the combined treatment of major childhood illnesses, it speeds urgent treatment of seriously ill children, it involves parents in the effective care of their children at home whenever possible, and it emphasises prevention of disease through immunization, improved nutrition, and exclusive breastfeeding.

A single diagnosis may be inappropriate for many sick children

Presenting complaint

Possible cause or associated condition

Cough and/or fast breathing

Pneumonia
Severe anaemia
P. falciparum malaria

Lethargy or unconsciousness

Cerebral malaria
Meningitis
Severe dehydration
Very severe pneumonia

Measles rash

Pneumonia
Diarrhoea
Ear infection

"Very sick" young infant

Pneumonia
Meningitis
Sepsis

Integrated management of childhood illness allows for greater efficiency during training and in the supervision and management of outpatient health facilities. It reduces wastage of resources such as intravenous fluids and antibiotics by treating sick children with the most cost-effective intervention for their condition. The approach also avoids the duplication of effort that may occur in a series of separate disease control programmes.

IMCI addresses childhood illness at three levels: it promotes improvements in the health system, improvements in health worker skills, and improvements in family and community practices.

At the heart of the new integrated strategy is the case management of the five most common causes of mortality among children. Standard treatment guidelines have been devised to enable health workers to assess sick children by observing easily recognisable signs. The health worker uses a colour-coded triage system to classify the condition of the child and decide whether it needs urgent referral for more specialized care or medical treatment on the spot, or whether advice on home care given to the parents will suffice. This process does not mean that health workers cease to treat individual diseases. Rather, they must broaden their approach to consider and respond to the condition of the whole child, and to the number of different factors that might be contributing to its sickness.