Integrated management of childhood illness

Abstract

Each year, at least 4 million African children die before they reach their fifth birthday, and 70% of the deaths are caused by pneumonia, diarrhea, malaria, measles, malnutrition, or, more commonly, a combination of these. Despite the fact that sick children often have more than one condition, busy clinics tend to treat only the one that is most obvious. With much of the effort of the past two decades directed to diarrhea, health workers have been taught their clinical skills in a piecemeal, rather than an integrated, fashion. In response to this problem, the World Health Organization and the UN Children's Fund developed a training course for the integrated management of childhood illnesses (IMCI) in 1993. IMCI is now being used in Uganda, Tanzania, and Zambia, and other African countries are preparing to institute it. IMCI relies on a straightforward clinical assessment and classification of illness that does not require the use of a laboratory. IMCI identifies general danger signs that may call for hospitalization of the child and then bases its assessment on the presence of 1) cough and difficulty breathing, 2) diarrhea, 3) fever, 4) measles, 5) ear infection, and 6) malnutrition. All sick children are screened for all of these conditions because IMCI capitalizes on the presence of the child in the clinic (vaccinations are also given if necessary). Training for IMCI involves 11 days, half of which are spent in clinical practice and demonstration and half in the classroom. Each country must adapt the IMCI guidelines and training course to meet its specific needs. Such adaptation provides an opportunity for collaboration among disease-specific programs; it stimulates a review of technical and clinical guidelines; and it provides an opportunity for the health system to focus on its essential drug needs, referral care, and supervisory system.