The IMCI strategy combines the improved management of childhood illness with aspects of nutrition, immunization and other important factors influencing child health, including maternal health.
The key objectives of the IMCI strategy are to:
- reduce death and the frequency and severity of illness and disability
- contribute to improved growth and development.
The IMCI strategy seeks to reduce childhood mortality and morbidity by adopting a broad and cross-cutting approach with the following three components:
- improving the case management skillsof health workers through the provision of clinical guidelines on the integrated management of childhood illness, adapted to the local context, and training to promote their use;
- Improving the health systemby:
- ensuring the availability of essential drugs and other supplies
- improving the organization of work at the health facility level
- improving monitoring and supervision;
- improving family and community practicethrough the education of mothers, fathers, other caregivers and members of the community, with a focus on health-seeking behavior, compliance, care at home and overall health promotion.
Each component includes a set of specific interventions, with emphasis on their practical implementation. The main interventions of the global IMCI strategy evolve to take account of that become available from analysis of the global burden of childhood disease and from child health research.
Integrated Management of Childhood Illness (IMCI)
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 health workers at this level with few opportunities to practice complicated clinical procedures. Instead, 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 UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI).
Why 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. IMCI is an integrated strategy, which takes into account the variety of factors that put children at serious risk. It ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition.
How is IMCI implemented?
Introducing and implementing the IMCI strategy in a country is a phased process that requires a great deal of coordination among existing health programmes and services. It 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:
- Adopting an integrated approach to child health and development in the national health policy.
- Adapting the standard IMCI clinical guidelines to the country’s needs, available drugs, policies, and to the local foods and language used by the population.
- Upgrading care in local clinics by training health workers in new methods to examine and treat children, and to effectively counsel parents.
- Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available.
- Strengthening care in hospitals for those children too sick to be treated in an outpatient clinic.
- 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..
Nutrition
Good nutrition is essential for survival, physical growth, mental development, performance, productivity, health and well-being across the entire life-span: from the earliest stages of fetal development, at birth, and through infancy, childhood, adolescence and on into adulthood.
Infant and young child feeding and nutrition
Breastfeeding and complementary feeding are a critical aspect of caring for infants and young children. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development. They lead to improved nutrition and physical growth, reduced susceptibility to common childhood illnesses and better resistance to cope with them. Improved health outcomes in young children have long-lasting health effects throughout the life-span, including increased performance and productivity, and reduced risk of certain non-communicable diseases.
Breastfeeding
Over the past decades, evidence for the health advantages of breastfeeding and recommendations for practice have continued to increase. WHO can now say with full confidence that breastfeeding reduces child mortality and has health benefits that extend into adulthood. On a population basis, exclusive breastfeeding for the first six months of life is the recommended way of feeding infants, followed by continued breastfeeding with appropriate complementary foods for up to two years or beyond.
To enable mothers to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend:
- Initiation of breastfeeding within the first hour of life;
- Exclusive breastfeeding – that is, the infant only receives breastmilk without any additional food or drink, not even water;
- Breastfeeding on demand – that is, as often as the child wants, day and night;
- No use of bottles, teats or pacifiers.
Breastmilk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life.
Breastmilk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness.
Breastfeeding contributes to the health and well-being of mothers, it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.
Complementary feeding
When breastmilk is no longer enough to meet the nutritional needs of the infant, complementary foods should be added to the diet of the child. Complementary feeding typically covers the period from six to 24 months of age, and is a very vulnerable period. It is the time when malnutrition starts in many infants, contributing significantly to the high prevalence of malnutrition in children under five years of age worldwide.
Asthma
Asthma is a long-term respiratory condition caused by hypersensitivity and inflammation of the airways. Symptoms include a cough, wheezing, chest tightness and breathlessness, and can vary in severity from person to person. When asthma symptoms get significantly worse, it is known as an ‘asthma attack’.
Causes of asthma
Factors that are known to increase the likelihood of developing asthma include:
- a family history of asthma or other related allergic conditions (known as ‘atopic conditions’), such as eczema, food allergy or hay fever
- developing another atopic condition
- being exposed to tobacco smoke as a child, particularly if your mother smoked during pregnancy
- being born prematurely (especially if you needed a ventilator)
- being born with a low birth weight (less than 2kg).
The symptoms of asthma can have a range of triggers:
- infections of the airways and chest
- allergens, such as pollen, dust mites, animal fur or feathers
- airborne irritants, such as cigarette smoke, chemical fumes and pollution
- some painkillers, such as aspirin and ibuprofen
- emotional factors, such as stress or laughing
- foods containing sulphites, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals
- weather conditions, such as sudden change in temperature, cold air, windy days, poor air quality and hot, humid days
- indoor conditions, such as mould or damp, house dust mites and chemicals in carpets and flooring materials
- exercise.
Asthma treatment
Asthma treatment is based on two important goals:
- relief of symptoms
- preventing future symptoms and attacks from developing.
Depending on how severe your asthma is, a health worker may prescribe you one or more types of asthma medicine:
- A reliever medicine relaxes the airway muscles and makes it easier to breathe when you have asthma symptoms. If you find you are using your reliever more often than two times a week, you should see your doctor.
- A preventer medicine helps to reduce the inflammation in your airways. It should be taken every day, even when you have no symptoms.
- A symptom controller relaxes the airway muscles for 12-24 hours, helping to reduce the symptoms of asthma. Symptom controllers are always used with an inhaled corticosteroid medicine (preventer).
- A combination medication contains both a preventer and a symptom controller in one inhaler.
Asthma medication
Asthma medications are usually grouped into relievers and preventers. Preventers are used daily, whereas reliever medicines are used when necessary to relieve symptoms. Most are taken using inhalers or “puffers”. Some asthma medications are in tablet form, including prednisone, which is usually only used to treat severe asthma flare-ups.
The following can be used to manage asthma.
- Asthma inhalers: Asthma inhalers are hand-held portable devices that deliver medication to your lungs. Most asthma medications are taken using an inhaler (puffer) device.
- Relievers: Relievers are fast-acting asthma medications. They provide quick relief from the symptoms of asthma – wheeze, chest tightness, cough and shortness of breath. Also called ‘bronchodilators’, relievers relax the airway muscles and open your airways, making it easier for you to breathe. They work within minutes, with the effects lasting for up to 4 hours. Anyone with asthma should always carry a reliever. Relievers usually come in a blue or grey inhaler (puffer) device. A well-known reliever is Ventolin (salbutamol). Relievers can have side effects such as a fast heartbeat (palpitations), shaking hands and feelings of anxiety or nervousness.
- Preventers: Preventers help to control asthma symptoms and prevent attacks. They reduce the inflammation (redness and swelling) in your airways, making them less sensitive. Many adults with asthma take a preventer – usually as an inhaler which delivers a low dose of corticosteroid to the lungs.
How to use an inhaler
Most of the asthma medicines come in an inhaler (puffer) device. To help achieve optimal control of asthma, inhalers must be used properly. People using a puffer, should always use a spacer – a plastic container with a mouthpiece or mask at one end – to ensure the asthma medication gets into the lungs.
