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Seminars in Pediatric Infectious Diseases. 2006 Apr; 17(2):80-98.The Integrated Management of Childhood Illness (IMCI) strategy has helped strengthen the application and expand coverage of key child survival interventions aimed at preventing deaths from infectious disease, respiratory illness, and malnutrition, whether at the health services, in the community, or at home. IMCI covers the prevention, treatment, and follow-up of the leading causes of mortality, which are responsible for at least two-thirds of deaths of children younger than 5 years in the countries of the Americas. The IMCI clinical guidelines take an evidence-based, syndrome approach to case management that supports the rational, effective, and affordable use of drugs and diagnostic tools. When clinical resources are limited, the syndrome approach is a more realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms and well-selected clinical signs provide sufficient information to guide effective actions. (author's)
CHILD SURVIVAL BASICS. 1995 Oct; 1-2.Since there is considerable overlap in the signs and symptoms of several of the major childhood diseases, a single diagnosis is often inappropriate. Treatment is complicated by the need to combine therapy for several conditions. The World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) have developed an approach referred to as integrated management of the sick child. The Basic Support for Institutionalizing Child Survival (BASICS) Project is actively involved. Integrated management leads to more accurate identification of illnesses at health facilities, ensures more appropriate and combined treatment of all major illnesses, and accelerates referral of severely ill children. Integrated outpatient management of the sick child at the first-level health facility has been described by WHO/UNICEF in wall charts and a booklet. Each illness is classified as to whether it requires urgent referral, specific medical treatment and advice, or simple advice on home management. The case management guidelines form the technical core of a training course for first-level health facility workers; the course consists of six training modules, still-photo exercises, video film, and detailed instructions for the course director and facilitators. It emphasizes hands-on practice of the skills taught. A guide to local adaptation of the training materials is in preparation. A pretest in Gondor, Ethiopia, in August 1991 and a complete field test of the materials in Arusha, Tanzania in February-March 1995 demonstrated that the process described on the charts can be taught to literate health workers. They can learn to classify the main childhood illnesses and provide effective treatment and counsel caretakers. The course should be available in November 1995. WHO, UNICEF, and other collaborators will support the adaptation of the course for use in a limited number of countries and closely monitor early experience with its use. Guidelines on managing drug supplies, improving worker's performance, inpatient care of sick children, and assessing and changing family behaviors related to care for sick children are being developed.
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.