|The Management of Nutrition in Major Emergencies (WHO - OMS, 2000, 250 p.)|
|Chapter 6. Prevention, treatment, and control of communicable diseases|
Pneumonia, diarrhoea, malaria, measles, and malnutrition are responsible for more than 70% of the deaths of children under 5 years of age in developing countries and in emergency situations, and both this chapter and Chapter 5 have discussed various aspects of management of these diseases. Health workers have experience in treating the common illnesses of childhood, but are often trained in disease-specific approaches. In emergencies, they are likely to be confronted with large numbers of very sick children with multiple problems. They may then have difficulty in deciding which of the presenting signs and symptoms are the most important, which disorder to treat first if a child has more than one, and how to apply the various guidelines. Health workers must also bear in mind the relationships that exist between different disorders, for example recurrent diarrhoea and malnutrition.
Effective management in these circumstances calls for good diagnostic, therapeutic, and counselling skills. In recent years, a systematic process that deals with case management through a series of algorithms and guidelines has been developed by WHO and UNICEF. It is referred to as "integrated management of childhood illness" (IMCI), and describes the essential processes in sequence:
1. Assess and classify the sick child.
2. Identify and provide appropriate treatment.
3. Counsel the mother.
The processes deal separately with children in two age groups - from 1 week up to 2 months and from 2 months up to 5 years. They include procedures for assessment of the nutritional status of all children and of dietary practices (breast-feeding, complementary feeding) for children who are under 2 years old, who are underweight for age, or who have feeding problems. All the guidelines are based on existing WHO recommendations for the management of these disorders. Training modules are available to assist in the training of trainers and of staff at the health-centre level,1 and complementary guidelines for the management of children needing referral are being developed.
1 Unpublished WHO document series WHO/CHD/97.3 A-M, available on request from Child and Adolescent Health and Development, World Health Organization, 1211 Geneva 27, Switzerland.
The charts are generic in nature and need to be adapted to the local epidemiological and health-service situation before they can be used in any particular country. Many countries are now embarking on such a process with a view to using the guidelines as the basis for first-level child care.
By covering the most important diseases of childhood, the guidelines are particularly relevant to the acute emergency situation, but they also address long-term aspects of disease prevention and health promotion, making them relevant to situations with chronic problems. Health workers fully trained in IMCI will provide more effective clinical care for the sick child than those with more restricted training.
As IMCI is more widely adopted, locally adapted guidelines will be available that can be used as the standard for care in emergency situations. This will facilitate the selection of essential drugs for emergency supplies and the standardization of treatment given by all concerned in an emergency. The longer-term aspects of IMCI will provide a basis for the development of first-line health services for refugees. The introduction of this initiative thus has considerable potential as an element of emergency preparedness.