More than 11 million children die each year before reaching the age of five; of them, 70%, or around 8 million children, die from one or more of five causes: pneumonia, diarrhoea, measles, malaria and malnutrition.
Many of these deaths can be prevented, however, through Integrated Management of Childhood Illness (IMCI), an approach developed by the World Health Organization (WHO) in collaboration with UNICEF. Together, WHO and UNICEF will highlight the urgent need to put the IMCI strategy into practice at an international meeting in Santo Domingo, Dominican Republic, from 9 to 12 September. They are inviting other international, government and private agencies to join the effort to reduce the toll of childhood illness.
The First IMCI Global Review and Coordination Meeting will bring together specialists from WHO, UNICEF, the World Bank, the European Union, government development assistance agencies, nongovernmental organizations and national health authorities to review the first experiences with local implementation of the strategy and develop concrete plans for implementing IMCI globally.
IMCI advocates screening children simultaneously for the five conditions which together cause more than 70% of childhood deaths, as considerable overlap in signs and symptoms means that a single diagnosis may lead to inappropriate or inadequate treatment.
"The current challenge is to apply the lessons from disease-specific control programmes towards greater integration of efforts to prevent and treat childhood illness and to promote development of healthy children," said Dr Tomris Turmen, Executive Director of Family and Reproductive Health in WHO.
More than 20 countries have begun to implement the IMCI strategy at regional and local levels since treatment guidelines and training materials first became available in 1996. Representatives of many of them will provide the conference with successful case histories of using IMCI methods to improve the care of sick children with the aim of reducing child mortality. Another 20 countries have expressed an interest in IMCI and WHO's and UNICEF's goal is now to implement IMCI in developing countries around the world.
Major issues which those implementing IMCI are seeking to address and resolve include the development of treatment guidelines adapted to each country's special needs, the enhancement of health workers' skills, the organization and improvement of health services, and the improved availability of essential drugs.
Examples of successful experimental projects include the use by health workers in six districts of Tanzania of locally-adapted WHO guidelines to improve the treatment of all sick children under the age of five, and the elaboration in Indonesia of recommendations for more nutritional diets based on locally-available foods considered acceptable for feeding to children.
To achieve the goals of IMCI, WHO, UNICEF, and their partners will work not only to improve the case management skills of health staff and to improve the ability of health systems to address childhood illnesses, but also to improve family and community practices with a view to the prevention, early detection and treatment of childhood illnesses.
In 1995, pneumonia, diarrhoea, malaria and measles caused one half of all deaths of children under five. Many of these children also suffered from malnutrition, a causative or contributory factor in an estimated 54% of child deaths, bringing the total proportion of child deaths due to these five conditions to 70%.
"It is clear that the full potential of IMCI will not be realized without the active support of the major partners in child health, both globally and in individual countries. A very encouraging level of collaboration has already been established and we would like to see this increase. If we do not take action now, these five conditions will continue to be the major causes of childhood death ten or twenty years from now," said Dr Jim Tulloch, Director of the Division of Child Health and Development (CHD) at WHO.
Approximately 130 participants from over 35 countries and international organizations are expected to attend the meeting in Santo Domingo.