INTEGRATED MANAGEMENT OF THE SICK CHILD
of Child Health and Development (CHD)
World Health Organization
Five diseases cause 7 out of 10 child deaths
Since 1990, around 60 million children died before their fifth birthday.
Forty-two million of them were killed
by diarrhoea, pneumonia, measles, malaria or malnutrition. Unless action
is taken now even more lives will be lost before the year 2000. Inexpensive
treatments would save most of those lives.
At least three in every four of the children seeking health care every
day suffer from one or more of these five conditions. Since symptoms may
overlap, it is not always easy to decide which conditions are present.
Standard treatment guidelines
Newly developed treatment guidelines for the sick child cover the most
common potentially fatal conditions. The health worker assesses every child
The guidelines enable the health worker to classify each child's illness
according to whether the child needs:
non-specific danger signs
four main symptoms:
cough or difficult breathing
The child is given vaccinations as needed and other problems are assessed.
specific medical treatment and advice
simple advice on home management.
Guidelines for management of the sick child in outpatient settings are
available on wallcharts and booklets.
Integrated management of childhood illness focuses on the child
rather than on a specific disease. It makes identification of illnesses
more accurate and avoids duplication of effort.
Training of health workers is based on the treatment guidelines and emphasizes
hands-on practice. The training materials must be adapted to local situations
so that, for instance, local foods and drinks can be mentioned or locally
appropriate drugs recommended.
Further guidelines and training materials will cover:
improving health workers' performance
managing drug supplies at the health facility
assessing and changing family behaviours regarding the care of sick children
hospital care of children with severe illness.
According to the World
Development Report 1993, management of the sick child is among the
most cost-effective health interventions in both low-income and middle-income
It was assessed to be the intervention likely to have the greatest impact
in reducing the global burden of disease.
The 1990 World Summit for Children set a goal for the reduction of childhood
mortality by 50% by the year 2000. Integrated management of the sick
child is essential to reaching that goal. Without it, millions of children
will not live to see the new century.
The Integrated Management of the Sick Child is a collaborative effort
Division of Diarrhoeal and Acute Respiratory Disease Control (CDR)
of Communicable Diseases (CDS)
Division of Control of Tropical Diseases (CTD)
Programme on Essential Drugs (DAP)
Programme for Vaccines (GPV)
Maternal and Child Health and Family Planning (MCH)
Oral Health (ORH)
Programme for the Prevention of Blindness (PBL)
Programme for Research and Training in Tropical Diseases (TDR)
The World Bank
Photo courtesy of UNICEF/5884/Roger Lemoyne