if visit, use the instructions on TREAT THE CHILD chart. if initial visit, assess the child as follows: CHECK FOR GENERAL DANGER SIGNS. Integrated Management of Childhood Illness. Caring for Newborns and Children in the Community. Caring for the Sick Child age 2 months up to 5 years. Chart. INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSSICK CHILD AGE 2 MONTHS UP TO 5 YEARS Assess, Classify and Identify Treatment General Dang .
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There is no specific standardized approach to reach to a final diagnosis in children with fever as this may be difficult and individualized for each child. The integrated management of childhood illness IMCI approach is an approach designed to reach a classification rather than a specific diagnosis. These 50 children divided into 2 groups: The IMCI approach can be applied upon children under five years old with high grade fever to reach to a classification, early diagnosis, much better outcomes and less daily cost than the traditional approach.
Although the fever is one of the most common presenting complaints to emergency department, the approach to the febrile child remains controversial, despite attempts to simplify and unify the approach to febrile children, the evaluation and treatment of these patients varies considerably.
M which aims to apply the best available evidence gained from the scientific method to medical decision making, it seeks to assess the quality of evidence of the risks and benefits of management.
The core of the IMCI strategy is integrated case management of the most common childhood problems, with a focus on the most important causes of death. When assessing a sick child, a combination of individual signs leads to one or more classifications, rather than to a specific diagnosis. The approach is designed for use in outpatient clinical settings with limited diagnostic tools, limited medication and limited opportunities to practice complicated clinical procedure.
These 50 children were 28 males and 22 females divided into 2 main groups: Children with anemia either clinical or laboratorymalnutrition, collagen disease or with metabolic disorders were excluded from the study. Neonates less than 28 days of age were excluded from this study. All children included in this study were subjected to complete history taking and clinical examination. Some children in this group were subjected to chest x-ray when pneumonia was suspected, lumbar puncture and CSF analysis when meningitis was suspected.
Five mls of venous blood were aspirated under complete a septic condition by sterile venipuncture and divided as follows: All children either group I or Group II were admitted and followed up until discharge with the total cost in Egyptian pounds was calculated since time of admission till discharge. The total cost included the cost needed for admission, feeding, investigations needed for diagnosis and treatment.
We calculated the daily cost for each child by dividing the total cost by the number of days in the hospital. The collected data were coded, tabulated and statistically analyzed using SPSS program Statistical package for social science software version Descriptive statistics were done for numerical data by mean and standard deviation, while they were done for categorical data by number and percentage.
Analysis was done for normally distributed quantitative variables using independent sample t test to determine the statistical differences between the two groups.
Analysis was done for not normally distributed quantitative variables using Mann Whitney U test to determine the statistical differences between the two groups. Analysis was done for qualitative data using Chi square test. The level of significance was taken at P value less than 0.
Fever is the primary presentation for a host of childhood illnesses and its underlying cause is generally benign. Fever may have a beneficial effect in terms of fighting the infection, although its value in the recovery process is far from clear, since in vivo data are largely lacking. As a part of the child survival strategy, WHO and UNICEF, in initiated the integrated management of childhood illnesses IMCI to assist developing countries to reduce childhood mortality caused by most childhood killer diseases like diarrhea, acute respiratory infections, malaria, measles and malnutrition.
Fever is part of the assessment steps on the IMCI algorithms. A history of fever or presence of fever by palpation or measured temperature is required as a reason for the assessment of fever, which will lead to specific classifications that are linked to treatment protocols. In the present study, fifty children less than 5 years old, presented with high grade fever, were enrolled for management using the standard IMCI approach or the traditional Non-IMCI approach.
The study by Factor et al.
They did not include pharyngitis or tonsillo-pharyngitis as a bacterial infection in their study, although this condition may be a bacterial infection. The IMCI guidelines, which community health workers use to make classifications, define pneumonia as cough or difficult imcii and fast breathing. The classification of fast breathing is based on age-specific thresholds of breath counts which could not be ascertained based on the caregiver reports. It was not possible to take the baseline assessments of respiratory rates in the children because they were located on day one of treatment-seeking and for some of the children the illness may have changed by the time they were seen.
In addition, the community health workers records could not be used for classification of pneumonia because in the control arm, they do not assess and classify pneumonia symptoms. They had no record of which children had presented with pneumonia symptoms. In developing countries, the causes and patterns of 211 are affected by malnutrition, poor housing, lack of early medical attention and immunization.
Pneumococci, streptococci, coliforms, H. Therefore, the results of appropriate treatment obtained may reflect over-treatment with antibiotics in those children. In a recent study by Kalyango et al. The infection usually arises from a URTI, which spreads to the middle ear through the short and straight Eustachian tube. Streptococcus pneumoniae accounts for most of the bacteria recovered by tympanocentesis. In neonates and infants during the first 6 months of life, the most frequent bacteria are E.
The highest fever is recorded in children less than 2 years of age. In the present study, for the purposes of our analysis, children were assigned only one diagnosis, although many children had more than one diagnosis recorded by the examining physicians. Many children fulfilled the criteria for several different IMCI classifications.
The assignments to multiple classifications may represent misclassifications or may accurately reflect the presence of more than one clinical problem e. Meningitis is one of the most important infectious causes of neurodisability and death in childhood. Ninety percent of reported cases occur below 5 years of age.
The study by Lozano et al. According to IMCI classification, children with active measles were classified as measles, measles with eye and mouth complications, or severe complicated measles. Measles is defined as generalized maculopapular rash with fever and cough, coryza or conjunctivitis.
Integrated Management of Childhood Illness(IMCI) CHART BOOKLET
Severe complicated measles is defined as measles with any general danger sign child unable to breastfeed, vomiting, lethargic or convulsionsclouding of cornea or deep and extensive mouth ulcers.
The study by Hussain et al. On the contrary, in Non-IMCI approach, intervention and treatment may be delayed until a list of investigations is completed to be sure of diagnosis Is it viral or bacterial? The significant improvement of illness with IMCI standard approach helps reduction of pediatric morbidity outcomes which have been similarly reported in a number of studies from different countries.
A recent study from Egypt by Rakha et al. This mortality impact is plausible, since substantial improvements occurred in quality of care provided to sick children in health facilities implementing IMCI. Therefore, further prospective studies are needed in order to clarify the true impact of IMCI on child mortality.
In health facilities, the IMCI strategy promotes the accurate identification of childhood illness in the outpatient settings, ensures appropriate combined treatment of all major illnesses and speeds up the referral of severely ill children. The IMCI clearly offers several benefits to children in areas where it is implemented. It improves health-worker performance and leads to better quality of care and rational drug use at costs that are lower or similar to investments in routine child health services.
In a study by Khan et al. In a study by Wammanda et al. These results are in agreement with us. In Egypt, El-Mahalli and Akl 26 showed that correct drug choice, dose, dosage form and route of administration were significantly higher cuart the clinic adopting IMCI In Egypt, the Ministry of Health and Population adopted the IMCI strategy in in the context of its efforts to integrate vertical program activities.
Integrated Management of Childhood Illness(IMCI) CHART BOOKLET
chzrt In the present study, there were no cases of mortality in both approaches of management which may be due to small sample size and admission for all cases with high grade fever and management of the in hospital, so further prospective studies are charf in order to clarify the true impact of IMCI on child mortality. These findings confirm the evidence in literature supports applying of IMCI for management of children infectious diseases in developing countries, as since its introduction, multi-country evaluations of IMCI MCE-IMCI chaart Uganda, Tanzania, Bangladesh, Brazil, and Peru have shown benefits in health service quality as well as reductions in mortality and health care costs.
However, there were several constraints to national implementation of IMCI, including training, health system, and financial constraints. As a result, many countries have only implemented the training components of IMCI without complementary reform of health systems or policy to support national expansion.
Throughout this evaluation, the four concerns regarding training were that it imcj perceived to be too long and expensive, that advocacy around IMCI should increase, that content should be regularly updated, and that new content areas should be introduced with more attention to skills-building rather than knowledge accumulation. The total and daily cost per child for hospital admission and therapy were much less when the IMCI approach was applied than the traditional Non-IMCI approach which makes this approach more suitable for developing countries like Egypt.
Authors declared they have no conflict of interest. Conception and design, interpretation of data, revision of the manuscript.
All authors shared in and approved the final imcl revision. National Center for Biotechnology InformationU. Int J Health Sci Qassim.
Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Conclusion The IMCI approach can be applied upon children under five years old charr high grade fever to reach to a classification, early diagnosis, much better outcomes and less daily cost than the traditional approach.
Background Although the fever is one of the most common presenting complaints to emergency department, the approach to the febrile child remains controversial, despite attempts to simplify chat unify the approach to febrile children, the evaluation and treatment of these patients varies considerably. Statistical methods The collected data were coded, tabulated and statistically analyzed using SPSS program Statistical package for social science software version Discussion Fever is the primary presentation for a host of cahrt illnesses and its underlying cause is generally benign.
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Distribution of chrt time needed for diagnosis in studied approaches. Distribution of the outcome after treatment in studied approaches. Distribution of the outcome after treatment to time of diagnosis in IMCI approach.
Table 1 Time needed to reach a diagnosis in the studied approaches. Table 2 The outcome after 48 hours of admission and the daily cost in the studied approaches. Table 3 Final diagnoses in the studied groups. Management of fever in children. Fever in the young infant. Evidence-based pediatrics and child health.
IMCI information package; pp. Integrated approach to child heath in developing countries. IMCI integrated management of childhood illness. Fever and antipyretic use in children.