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Geneva, Switzerland, WHO, Division of Child Health and Development, 2002 Sep 3. 34 p.CHECK FOR GENERAL DANGER SIGNS: ASK: Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions? LOOK: See if the child is lethargic or unconscious. (excerpt)
Evaluation of the WHO / UNICEF algorithm for integrated management of childhood illness between the age of two months to five years.
Indian Pediatrics. 1999 Aug; 36(8):767-8.Objective: To evaluate the utility of the "WHO/UNICEF algorithm for integrated management of childhood illness (IMCI) between the age of 2 months to 5 years. Design: Prospective observational. The Outpatient Department and Emergency Room of a medical college hospital. 203 children presenting to Outpatient Department (n= 101) or Emergency Room (n=102) were assessed and classified as per 'IMCr algorithm and treatment required was identified. A detailed evaluation with all relevant investigations was also done for these subjects. The final diagnoses made and therapies instituted on this basis served as "gold standard'. The diagnostic and therapeutic agreements between the "gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed. Results: More than one illness was present in 135 (66.5%) of subjects as per "gold standard'. The mean (SD) numbers of morbidities as per the gold standard and IMCI- low and high malaria risks were 2.1 (1.1), 1.8 (1.0) and 2.2 (1.1), respectively. Subjects having any referral criteria as per IMCI module had a greater co-existence of illnesses (mean 2.6 vs. 1.6 illnesses per child, respectively). The referral criteria proved useful in predicting hospitalization and a combination of hospitalization and observation; their sensitivity and specificity were 81% and 69% and 74% and 85%, respectively. IMCI algorithms covered majority (92%) of the recorded illnesses. A total agreement with IMCI (malaria low risk) was found in 129 (64%) cases while in 43 (22%) cases, there was partial agreement. Corresponding figures for vertical (split IMCI) program were 93 (46%; p<0.001) and 41 (25%). The difference was primarily due to under diagnoses (30%). Diagnostic discordance of IMCI algorithm and gold standard was evident for the cough category due to under diagnosis of bronchial asthma and bronchiolitis and an over diagnosis of pneumonia whereas the discordance for fever was due to an over diagnosis of malaria. Identical results were found for broad treatment categories. The IMCI algorithm had a provision for preventive services of immunization (16.3% possibility of availing missed opportunities) and feeding advice. There is a sound scientific basis for adopting the IMCI approach since: (i) co-existence of morbidities is frequent; (ii) severe illness is assessed with good sensitivity and specificity; and (iii) the IMCI algorithm is diagnostically and therapeutically superior to the vertical disease specific algorithms. The generic IMCI algorithm needs adaptation to reflect the regional morbidity profile. (author's)
Diagnosis and management of febrile children using the WHO / UNICEF guidelines for IMCI in Dhaka, Bangladesh.
Bulletin of the World Health Organization. 2001; 79(12):1096-105.In Dhaka, Bangladesh, a study was conducted to determine the effectiveness of WHO’s integrated management of childhood illnesses (IMCI) guidelines in identifying children with bacterial infections in need of antibiotics. A systematic sample of 669 sick children aged 2-59 months was enrolled in the study. Weight, tactile, measured temperature, and respiratory rate were obtained from each patient. The study revealed that had IMCI guidelines been used to evaluate the subjects, 78% of those with bacterial infections would have received antibiotics, including the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%), urinary tract infection (83%), bacteremia (50%), dysentery (48%), and skin infections (30%). It was also noted that the fever module identified only one additional case of meningitis. Children with bacteraemia were more likely to be febrile, feel hot and have history of fever than those with dysentery and skin infections. Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current ICMI module. In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections, but improvements in the fever module are possible.
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 281-6.The World Health Organization (WHO) and UNICEF are collaborating in the development of an integrated approach to the management of the sick child. Acute respiratory infections, diarrhea, malaria, measles, and malnutrition cause 7 out of 10 deaths in children under 5 years of age in developing countries. Integrated management means effective, simple, and affordable treatments for all the leading killers of young children. Health workers using such guidelines can prevent serious disabilities resulting from measles and vitamin A deficiency. The integrated clinical guidelines rely on detection of cases based on simple clinical signs and empirical treatment without laboratory tests. They are based on a few essential drugs for outpatient use: oral rehydration salts, an antibiotic (co-trimoxazole), an oral antimalarial, vitamin A, iron tablets, and oral antipyretic (paracetamol), an antibiotic eye ointment, and gentian violet. Parenteral antibiotic and antimalarial drugs and intravenous fluids are needed for severely ill children before referral to hospital. The integrated clinical guidelines for sick children 2 months to 5 years old are summarized on 3 case management charts: 1) assess and classify the sick child 2 months to 5 years old; 2) treat the child; and 3) advise the mother. The implementation of case management will entail the use of several key preventive interventions: immunization, promotion of breast feeding, improved infant feeding, and vitamin A. All children with measles are given vitamin A. Those with severe pneumonia, stridor when calm, corneal clouding, or severe malnutrition are referred to hospital. Mothers are taught to manage mouth ulcers and conjunctivitis at home and to administer antibiotics for otitis media and pneumonia. Wherever Plasmodium falciparum is sensitive to sulfadoxine-pyrimethamine, fast breathing and fever can be treated with co-trimoxazole alone. The WHO prepared a report in 1993 demonstrating that management of the sick child in low-income countries averts 14% of the disease burden at only $ 1.60 per capita annually.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.