15 booklets. Contents: Introduction, self-study modules – Module 1: general danger signs for the sick child – Module 2: The sick young infant. World Health Organization. Integrated Management of. Childhood Illness (IMCI). Sarah Ashley, MD. 14 October Integrated Management of Childhood Illness (IMCI). OBJECTIVES OF IMCI · PRINCIPLES OF THE IMCI CASE MANAGEMENT GUIDELINES · WHAT ARE THE.

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In the Philippines, IMCI was started on a pilot basis in , thereafter more health workers and hospital staff were capacitated to implement the strategy at the. What is the present status of IMCI and IMNCI in high burden settings? . often prevented IMCI (and especially integrated management of neonatal and. On assessment now she is thin, but not wasted. MUAC: 12cm. Wt: kg. Ht: 70cm. Tp: ⁰C. There is no oedema of the feet. She is not pale.

However, viral etiologies may be underestimated in cases of severe pneumonia in the resource-limited countries with limited diagnostic facilities. The role of viral pathogens in severe pneumonia has come into prominence as the role of bacterial infection decreases through early case detection, appropriate antibiotic treatment [ 5 ] and introduction of conjugate vaccines.

Historically, the common viruses most closely associated with childhood pneumonia have included influenza virus Flu , respiratory syncytial virus RSV , parainfluenza virus PIV , and adenovirus AdV. The development of molecular techniques facilitated the detection of novel viruses in patients with respiratory infections.

Human metapneumovirus hMPV was first documented in [ 6 ]. The etiological roles of these novel viruses remain undefined. In this prospective study, we investigated the association between presence of a virus and severity of disease in hospitalized children with severe pneumonia to provide an indication of causality.

With this aim, we detected viral as well as bacterial pathogens in children hospitalized with severe community-acquired pneumonia and assessed the clinical significance of these pathogens.

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The climate of Leyte Province is classified as tropical monsoon, and it usually rains throughout the year with higher rainfall between November and January. This region is generally economically less developed, and the estimated poverty incidence the proportion of people in the population whose income is lesser than the cost of basic needs was The estimated under-five mortality rate in was 64 per live births in Region VIII, which is significantly higher than the national average of 28 deaths per live births in urban areas and 46 deaths per live births in rural areas of the Philippines [ 16 ].

Patients were referred from all over the region, but majority of the patients were from Leyte Province, particularly from Tacloban City. Patients assessed to have severe pneumonia requiring hospitalization were recruited for participation in the study. The definition of severe pneumonia was based on IMCI guidelines.

All cases were screened with the presence of cough or difficulty of breathing as the initial assessment. For patients between 2 months to less than 5 years old, entry criteria included chest indrawing, cyanosis, or an inability to drink or suck. For patients between 5 to 13 years old, entry criteria included co-morbid illness including malnutrition , failure to feed, moderate to severe dehydration, signs of respiratory failure chest indrawing, cyanosis, apnea, or sensorial change , or complications such as plural effusion and pneumothorax.

The exclusion criteria included patients less than 7 days old to exclude perinatal infection, patients admitted to any other department of EVRMC for another illness and who had developed symptoms of pneumonia while in hospital, or patients who had been admitted to another hospital within the last 3 days prior to present admission to EVRMC to exclude nosocomial infection.

This was a prospective observational study. The antibiotics provided were based on the guidelines of the Philippine Pediatric Society [ 18 ].

As supportive therapy, oxygen was provided using a nasal catheter or oxygen mask. Trained project pediatricians and nurses collected relevant clinical information on admission including information on antibiotics administered during the current episode.

They also recorded signs, symptoms and vital signs of enrolled patients twice a day. Radiological assessment Anteroposterior and lateral chest radiographs were taken upon admission.

The specimens were subjected to PCR within 10 days after sample collection. If treatment has been correct. Look for red eyes and pus draining from the eyes. Check that the mother is wicking the ear correctly. If treatment has not been correct.


Follow-up in 5 days. Atlvise mother to return in 14 days for more iron. What food or fluids? Compare the mother's answers to the Feeding mother's answers to the Recommendations for Care for Recommendations for the child's age in the box below.

How do you communicate with your child? How many times per day? Sample Feeding Problem. Do you also breastfeed during the night? What do you use to feed the child? How many times during the day?

If very low weight for age: How large are servings? How do you play with your child?

When to Return ~I 11 ORGANIZATION

Compare the this illness. Ask your child simple '. Breastfeed as often as the child wants. Feed the baby nutritious snacks like fruits. Boiled foods. Look into your child's eyes and smile at him or her. Add any of the following: Give your child things to stack up. Exclusively breastfeed as often as the child. Respond ' to your child and to your child's. Teach your child stories.

When you are breastfeeding.. Do not give other foods or fluids. Lugawwith added oil. Give adequate amount of family foods. Make simple toys for. Provide an area where the child could move. Replace half the milk with nutrient-rich. Replace these with increased breastfeeding.

Help your child count.

Give your child clean. Give adequate amount of family foods at 3. Encourageyourchild to talk.

IMCI chart booklet

Do not use condensed or evaporated filled milk. Show the mother how to feed the child with a cup. As needed. If there is some left-over milk. Make sure that other milk is a locally appropriate breastmilk substitute.

Use soft. Suggest giving more frequent. Sit witbthechild and encourage eating.

Expect that appetite will improve as child gets better. Recommend substituting a cup for bottle. Clear a blocked nose if it interferes with feeding. If other milk needs to be continued. In addition: Make sure other milk is correctly and hygienically prepared and given in adequate amounts. Give the child an adequate serving in a separate plate or bowl. Breastfeed as much as possible. Breastfeed more frequently and longer if possible.

Prepare only an amount of milk which the child can consume within an hour. Persistentvomiting Persistent abdominal pain. For example. IVllvv I nn. If the child has: Return for follow-up in: Family Planning. Make sure she has access to: If she has a breast problem such as engorgement. Check the mother's immunization status and give her Tetanus Toxoid if needed. Advise her to eat well to keep her own strength and health.

Look and feel for bulging fontanelle. Fever Give an appropriate oral antibiotic. Advise mother how to give home care for young infant. Look at the young infant's movements.

If initial visit. The thresholds for rectal temperature readings are approximately a. Are there many or severe pustules? Look at the umbilicus. If referral is not possible.

Look for pus draining from the ear. Measure temperature or feel for fever or low body temperature. Follow up in 2 days. Are they less than normal? These thresholds are based on axillary temperature. Con""Jlsions or. Look and listen for grunting. Look for skin pustules. Has the infant. Advise m. Treat the local infection in the health. Repeat the count if elevated. Does the redness Is it red or draining extend to the skin?

Many or severe skin pustules or Abnormly. Give fluid for some dehydration Plan B. Very slowly longer than 2 seconds? Restless or irritable? Two of the following signs: Is the young infant: Look at the young infant's general for. Refer to hospital. Advise mother how to keep the young. Give fluid to treat diarrhea at home Plan A.

J if I r f 24 rrhea'? Pinch the skin of the abdomen. Abnormally sleepy or difficult to.

Look for sunken eyes. Not enough signs to classify as some or NO. If the young infant has dehydration. Is the infant sucking effectively that is. If not well attached or not sucking effectively. Not low weight for age. Observe the breastfeed for 4 minutes. Does the infant usually receive any other food or drink? If yes. Less than 8 breastfeeds in 24 hours or. Has any difficulty feeding.

IF YES.. If breastfeeding less than 8 times in 24 hours. Is low weight for age. Advise about the correct preparing of breastmilk substitutes.

OR breastfeeding. Classify Is there any difficulty feeding? Determine weight for age. If not breastfeeding at all: Refer to breastfeeding counseling and Has the infant breastfed If the infant has not fed in the previous hours.

Look for ulcers or white patches in the mouth thrush. Clear a blocked nose if it interferes with breastfeeding. Is taking any other foods or drinks. Mouth wide open Lower lip turned outward More areola visible above than below the mouth All these signs shouldbe present if the attachment is good. Give benzylpenicillin every 6 hours plus gentamicin one dose daily. First-line antibiotic: The mother should: She should return to the health center if the infection worsens.

She should: In cool weather.! If the attachment or sucking is good. Ifthe infant has: Advise the mother to return immediately ifthe young infant has any of these signs: Is red or draining pus? Does redness extend to the skin? Look at the skin pustules. If you do not think that feeding will improve. Ask about any feeding problems found on the initial visit.

If the young infant is still low weight for age.

(IMCI) Integrated Management of Childhood Illness

Continue to see the young infant every few weeks until infant is feeding well and gaining weight regularly or is no longer low weight for age. If you counsel the mother to make significant changes in feeding. Reassess feeding. Weigh the young infant and determine if the infant is still low weight for age. If the young infant is still low weight for age and still has a feeding problem.

Ask the mother to return again in 14 days or when she returns for immunization. If the infant is no longer low weight for age. Ask her to come again within a month or when she returns for immunization. If the young infant is low weight for age.

U W ASK: Chin touching breast Yes. Return for next immunization on: Look at the young infant's general condition.

More areola above than below the mouth Yes. Fever temperature Not low - 'f 6. Repeat if elevated Does it go back: Is there difficulty Is the infant breastfed? Less than normal? See if the young infant is abnormally sleepy or difficult to awaken.. Look for nasal flaring. Is the infant: Abnormally sleepy or difficult to awaken.

Lower lip turned outward Yes. Is it red or draining pus? Does the redness extend to the skin? Mouth wide open Yes.. Count the breaths in one minute.! Has the infant breastfed in the previous hour?

If infant has not fed in the previous hour.

Fast Breathing? Look for severe chest indrawing. Is the infant able to attach? To check attachment. No- If Yes.. Look for ulcers or white patches in the mouth thrush -. Giveany immunizationsneededtoday: South Triangle.. Ext E-mail: Quezon Cit ' Tel. Quezon Ave Quezon Avenue. Distributed by. Baguio UE-Recto As a cfildgelsolder.

Integrated Management of Childhood Illness in the Philippines. Flag for inappropriate content. Related titles. Jump to Page. Jaypee Ravina. Richard Ines Valino. Yam Theresa Remo. Janna Gale Javier. Tsuyoshi Bang. Jefferson Dungca. List of successful examinees in the July Nurse Licensure Examination. Rose Ann. Raymark Morales. Roy Salvador. Star Philippine news. Sharmaine Simon.

Popular in Epidemiology.Classify the dehydration. Breastfeed as much as possible. Is there less blood in the stool? Soothe the throat and relieve the cough with a safe remedy.

Look for chest indrawing.

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