Laboratory 03: Integrated Management of Childhood Disease (IMCI) Flashcards
How has child mortality changed over the past 25 years?
91 to 43 deaths per 1000 live births between 1990 and 2015.
Despite the improvement in child mortality, how many children still died before their 5th birthday in 2015?
An estimated 5-9 million children still died before their 5th birthday, mostly from preventable or treatable conditions.
What are the issues affecting quality of care in child health? (Name at least 3)
(A) Health worker skills (incomplete examination, poor counseling, irrational drug use)
(B) Health system support (high cost of services, inaccessible services, availability of drugs)
(C) Community and family practices (harmful practices, delayed care seeking, poor compliance to health worker’s advice)
What does IMCI stand for?
Integrated Management of Childhood Illness.
This aims to reduce mortality and morbidity associated with major childhood illnesses through preventive and curative interventions to improve practices in health facilities and at home.
Integrated Management of Childhood Illness.
IMCI is also characterized as what?
(A) An integrated approach to child health that focuses on the wellbeing of the child.
(B) A core component for child survival.
What does IMCI include?
(A) Evidence based interventions
(B) Guidelines in managing sick children from birth to 5 years old
(C) Includes three components: improvement in health worker’s skills;
health systems support; family and community practices
What are some of the conditions covered by IMCI?
(A) Respiratory: Pneumonia, cough/cold
(B) Diarrhea: Acute watery, dysentery, persistent
(C) Fever: Malaria, measles, meningitis, encephalitis
(D) Ear problems: Mastoiditis, acute and chronic conditions
(E) Nutritional: Kwashiorkor, marasmus, anemia, feeding problems, breastfeeding counseling
(F) Others: Neonatal sepsis, local infections, hypoglycemia, hypothermia, oral thrush, immunization, vitamin A supplementation, deworming
Who updated the technical guidelines for managing childhood illnesses in IMCI?
WHO and UNICEF used updated technical findings to describe management of the illnesses.
Why is IMCI better than single-condition approaches?
IMCI is better because children in developing countries often suffer from more than one condition, and IMCI provides an integrated approach to treat multiple conditions, rather than focusing on a single disease.
What is the key principle of IMCI regarding child health?
IMCI emphasizes “Looking to the Child as a Whole” by addressing the overall health of a child, not just individual diseases.
What are some home-based interventions included in IMCI?
Growth Promotion:
(A) Community or home based interventions
(B) Insecticide-impregnated bednets
Response to Sickness:
(A) Early case management
(B) Appropriate care-seeking
(C) Compliance with treatment
What are some health facility interventions included in IMCI?
Growth Promotion:
(A) Vaccination
(B) Complimentary feeding
(C) Breastfeeding counseling
(D) Micronutrient supplementation
Response to Sickness:
(A) Case management for ARI, diarrhea, measles, malaria, malnutrition, and serious infections
(B) Iron treatment
(C) Anthelmintic treatment
What is the overall aim of the IMCI strategy?
Reduce childhood death and improve child survival.
What are the specific aims of the IMCI strategy?
(A) To reduce the frequency and severity of sickness and disability
(B) To continue improving growth and development
What are the ways to improve child health according to IMCI?
(A) Improve case management of children
(B) Improve nutrition
(C) Ensure immunization
(D) Prevent injuries
(E) Prevent other diseases
(F) Improve psychosocial support and stimulation
(I) Integration of care
What are the preventive interventions included in IMCI?
(A) Vaccination
(B) Nutrition counseling
(C) Breastfeeding
(D) Vitamin A supplements
(E) iron supplementS
(F) Deworming, personal hygiene, and sanitation
What are the key steps in the Gold Pediatric Standard?
(A) Complete medical history
(B) Physical examination
(C) Primary diagnosis and differential diagnoses
(D) Ancillary procedure (if required)
(E) Initial therapeutic plan
(F) Monitor progress of the patient (revisit #3, #4, #5)
(G) Final diagnosis
(H) Revise therapeutic plan
(I) Counsel and follow-up
What is the IMCI Approach for managing sick children?
(A) Assess (1,2,4,6)
(B) Classify (3,7)
(C) Treatment and follow-up (5,6,8,9)
What is the first step in the IMCI Process?
Assess
(A) Determine the child’s age.
(B) Is this an initial visit or a follow-up visit?
(C) Focused assessment of danger signs and symptoms.
What does classifying mean in the IMCI process?
It’s not a diagnosis but guides the health worker to recognize the severity of the illness and determine the necessary actions based on classification.
What happens during the identify treatment step of the IMCI process?
This outlines the actions to be taken, including whether the case requires an urgent referral or home management.
What is the focus of the treatment step in the IMCI process?
It provides guidelines on:
(A) Dosages of drugs
(B) Home care interventions
What is the role of BHW in Care for the Newborn in Community IMCI?
BHWs are capacitated to make prenatal visits to the mother and postnatal visits to both the mother and child.
What is the focus of Care for Growth and Development in Community IMCI?
Enhance BHW skills to promote growth and development interventions, including:
(A) Nutrition
(B) Immunization
(C) Injury prevention
(D) Hygiene
(E) Early care seeking
What are the three main components of the IMCI strategy?
(A) Improvement of health worker skills
(B) Improvement of health systems
(C) Improvement of family and community practices related to child health
These three components are complementary. They all need to be functioning well to fully benefit the child.
What does Component 1 of IMCI focus on?
Component 1 focuses on improving health worker skills through:
(A) Case management guidelines for managing sick infants and children.
(B) Training of health providers who care for children up to 5 years old.
Pre-service: Training before admission.
In-service: Training during admission.
What does Component 2 of IMCI address?
(A) First-level health facilities
(B) Organization of work
(C) Availability of drugs and supplies
(D) Monitoring and supervision
(E) Referral pathways and systems
(F) Health information systems
What key family practices are improved in Component 3 of IMCI?
Key family practices include:
(A) Exclusive breastfeeding
(B) Complementary feeding
(C) Continuous feeding during illness
(D) Use of iodized salt
(E) Routine vaccination
(F) Irregular growth monitoring
(G) Early care-seeking
(H) Compliance to provider advice
(I) Home care of sick children
(J) Recognition of severe illness
(K) Proper waste disposal
(L) Use of long-lasting treated nets (LLTN)
(M) Antenatal care
(N) Tetanus toxoid for pregnant women
(O) Proper nutrition for pregnant women
What major child health problems does IMCI address?
IMCI targets the most important causes of childhood death and illness.
How does IMCI promote both prevention and cure?
IMCI provides opportunities for preventive interventions like immunization and improved infant and child nutrition, including breastfeeding.
How does IMCI improve healthcare provider performance?
IMCI enhances health worker skills and the quality of care they provide.
How does IMCI impact under-five mortality and nutrition?
If implemented effectively, IMCI can reduce under-five mortality and improve nutritional status.
Why is IMCI considered cost-effective?
IMCI costs up to six times less per child correctly managed compared to traditional care.
How does IMCI help in resource management?
IMCI prevents inappropriate management of childhood illnesses, reducing waste and ensuring cost savings despite initial training investments.
How does IMCI improve healthcare equity?
IMCI ensures access to affordable preventive and curative care for children in developing countries, addressing global health disparities.
What are the diseases covered by IMCI?
IMCI covers:
(A) Diarrhoeal diseases
(B) Acute respiratory infections
(C) Malaria
(D) Measles
(E) Malnutrition
How significant are these diseases in child mortality and morbidity?
These diseases account for more than 70% of child mortality and morbidity.
Does IMCI cover all childhood illnesses?
No, IMCI focuses on the most important but not all major reasons why a sick child is brought to the clinic.
What does IMCI recommend for problems not included in the IMCI guidelines?
Health providers are encouraged to assess other problems under the “Assess Other Problems” section of the IMCI chart.
What are the two age categories covered by IMCI?
(A) Young infants (up to 2 months old)
(B) Children (2 months up to 5 years old)
Why does IMCI not include children aged 5 years or older?
The IMCI process is specifically designed for children under 5 years old because:
(A) The assessment and classification of illnesses differ for older children.
(B) The breathing rate cut-off for fast breathing changes as children grow.
(C) Chest indrawing becomes less reliable for diagnosing pneumonia in older children.
(D) Treatment recommendations and feeding advice differ for children older than 5 years.
What are the key steps in the IMCI case management process?
(A) Assessment of the child or young infant
(B) Classification of the illness
(C) Identification of the treatment
(D) Referral, treatment, or counseling of the child’s caretaker
(E) Follow-up care
What does the RED classification indicate in IMCI?
It means the child has a severe condition requiring urgent attention and referral for inpatient care.
What does the YELLOW classification indicate in IMCI?
It means the child needs specific medical treatment, such as antibiotics or anti-malarial drugs, and the mother is taught how to manage the illness at home.
What does the GREEN classification indicate in IMCI?
It means the child does not need specific medical treatment, and the mother is given instructions on how to care for the child at home.
What is the purpose of the ASSESS step in IMCI?
It helps detect cases using simple clinical signs, focusing on serious illness, common health conditions, and nutrition/immunization status based on observation.
What is the purpose of the CLASSIFY step in IMCI?
It helps classify illnesses using color-coded IMCI charts based on history, symptoms, and test results to determine the appropriate treatment.
What do the color classifications in IMCI indicate?
(A) RED: Requires urgent pre-referral treatment and hospital referral
(B) YELLOW: Needs treatment and advice in the clinic
(C) GREEN: Needs home treatment and caregiver education
If a child shows signs from both a RED and YELLOW classification, which one should be used?
The more severe classification (RED) should always be followed.
What is the purpose of the TREAT step in IMCI?
To develop an integrated treatment plan based on classifications, provide first doses of medication, and ensure urgent referrals if needed.
What is the purpose of the COUNSEL step in IMCI?
To educate caregivers on home treatment, feeding, fluids, breastfeeding, and when to seek immediate medical attention for their child.
What is the importance of FOLLOW-UP CARE in IMCI?
To reassess the child’s condition, ensure improvement, detect new problems, and continue appropriate management.
How does IMCI determine a young infant vs. a child?
(A) Young Infant: Up to 2 months old
(B) Child: 2 months to 5 years old
What does “up to 5 years” mean in IMCI?
It includes children who have not yet turned 5 years old (e.g., a child who is 4 years and 11 months is included, but a 5-year-old is not).
How is a child classified if they are exactly 2 months old?
A child who is exactly 2 months old is classified as a sick child, not a young infant.
(GO BACK To TRANSES PAGE 6 and 7)
What should be assessed in a sick child aged 2 months up to 5 years?
(A) Check for nutrition, immunization, vitamin A supplementation, and feeding problems
(B) Assess other health problems
What are the four major symptoms assessed in IMCI?
(A) Cough or difficult breathing
(B) Diarrhea
(C) Fever
(D) Ear problems
What are the objectives of the Global Child Health Program?
(A) Reduce global child mortality and morbidity
(B) Promote healthy growth and development
What are the steps in the IMCI case management process?
(A) Assess – Check for danger signs, common conditions, nutrition, immunization, and other health problems
(B) Classify – Use the color-coded triage system
(C) Identify specific treatments
(D) Provide practical treatment instructions – Teach how to give oral drugs, fluids, and treat infections at home
(E) Counsel – Solve feeding problems after assessment
(F) Give follow-up care – Reassess the child when they return
What are the steps in the overall case management process for OUTPATIENT care?
(A) Assessment
(B) Classification and identification of treatment
(C) Referral, treatment, or counseling for the child’s caretaker based on classification
(D) Follow-up care
What are the steps in the overall case management process for a REFERRAL HEALTH FACILITY?
(A) Emergency triage assessment and treatment
(B) Diagnosis, treatment, and monitoring of patient progress
What are the target groups in the IMCI case management process?
(A) Sick young infants – 1 week up to 2 months
(B) Sick young children – 2 months up to 5 years
What are the general danger signs to assess in a sick child?
(A) Lethargy or unconsciousness
(B) Inability to drink or breastfeed
(C) Vomiting
(D) Convulsions
What are the main symptoms to check in a sick child?
(A) Cough or difficulty breathing
(B) Diarrhea
(C) Fever
(D) Ear problems
What are the clinical signs to check for cough or difficulty breathing?
(A) Respiratory rate
(B) Lower chest wall indrawing
(C) Stridor
What are the clinical signs to check for diarrhea in a sick child?
(A) Dehydration
(B) General condition:
1. Sunken eyes
2. Thirst
3. Skin elasticity
(C) Persistent diarrhea
(D) Dysentery
What are the clinical signs to check for fever in a sick child?
(A) Stiff neck
(B) Risk of malaria and other endemic infections, e.g., dengue hemorrhagic fever
(C) Runny nose
(D) Measles
(E) Duration of fever, e.g., typhoid fever
What are the clinical signs to check for ear problems in a sick child?
(A) Tender swelling behind the ear
(B) Ear pain
(C) Ear discharge or pus (acute or chronic)
What is involved in assessing nutritional status, feeding, and immunization status?
(A) Malnutrition:
Visible severe wasting
Edema of both feet
Weight for age
(B) Anemia:
Palmar pallor
(C) Feeding and breastfeeding
(D) Immunization status
What other problems should be assessed in a sick child?
(A) Meningitis
(B) Sepsis
(C) Tuberculosis
(D) Conjunctivitis
(E) Others: Also consider the mother’s (caretaker’s) own health
