Integrated management of childhood illnesses
Every year about 11 million children in developing countries die before they reach their fifth birthday, many of them during the first year of life. Ethiopia is one of the developing countries with an unacceptably high infant and under five mortality rates of 113 and 188 per 1000 live births, respectively. More than 70% of these child deaths are due to the five diseases i.e. pneumonia, diarrhea, malaria, measles and malnutrition, and often to a combination of these conditions. These diseases are also the reasons for seeking care for at least three out of four children who come to health facilities.
As children usually present with more than one of these conditions, it is envisaged that there is a need for an integrated approach in order to manage the child in a holistic manner. Cognizant of this fact, WHO and UNICEF responded to this challenge by developing the Integrated Management of Childhood Illnesses (IMCI) strategy. The draft version of the IMCI was pretested in Gondar, Ethiopia in July 1994 with encouraging results. This was followed by a field test in Arusha, Tanzania in February 1995.
The IMCI package is useful for the majority of developing countries with an infant mortality rate of over 40/1000 live births. IMCI is envisaged as the strategy likely to have the greatest impact on reducing the global burden of disease. IMCI is ranked by the World Bank among the ten most cost effective health interventions in low and mid-level income countries. To date over 43 countries out of the 46 member states in the African region are actively implementing IMCI at different stages. Ethiopia is one of these countries.
IMCI has the following objectives:
- To reduce under five mortality and morbidity.
- To improve growth and development of children.
The IMCI approach has three components:
- Improving health worker skills through
- Provision of case management guidelines & standards
- Training of public and private health care providers (pre- and in-service)
- Follow up & support supervision of trained health workers
- Improving health system through
- Sound district planning and management based on burden of disease
- Facilitating essential drug supply and management
- Improving support supervision at health facilities
- Facilitating appropriate and timely referral of severely ill children
- Improving family and community practices by promoting
- Appropriate and timely care seeking behavior
- Appropriate feeding practices
- Appropriate home case management and adherence to recommended treatment prescriptions
- Community involvement in health service planning and monitoring
Success in reducing childhood mortality will not be achieved solely through the availability of adequate health services with well-trained health workers. Effective management of childhood illness involves a partnership between families and health workers. Health workers need to work with families and their communities to ensure that families can provide adequate home care to support the healthy growth and development of children. Families also need to be able to respond appropriately when their children are sick, seeking appropriate and timely assistance when children need additional care and giving the recommended treatments appropriately. The need for improved family and community practices to reduce under five mortality has been substantiated by the Tanzanian Community Based Study where more than 80% of deaths occurred at home and almost 50% of whom did not visit a health facility for their illness even though the large majority were living within five kilometers of radius from the health facilities.
The process of IMCI implementation involves three phases:
- Introduction
- Early implementation in a limited area
- Expansion of activities in a gradual and feasible manner aimed at covering all the regions and all health facilities in the country.
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