[01.25] PED - Integrated Management of Childhood Illness V2.pdf

Integrated Management of Childhood Illness

What does the acronym IMCI stand for?

WHO and UNICEF

Which two global organizations designed the IMCI strategy?

Reduce preventable mortality, minimize illness and disability, and promote healthy growth

What are the three primary goals of the IMCI strategy?

Children under five years of age

What is the specific target age group for the IMCI strategy?

Health worker skills, health system, and family/community practices

What three areas of the health system does IMCI focus on improving?

Neonatal conditions, infectious diseases, and malnutrition

What are the three main categories of common conditions targeted by IMCI?

Diarrhea, malaria, measles, and meningitis

What are four specific infectious diseases targeted by IMCI?

First-level health facilities, community, and hospitals

What are the three levels of the health system where IMCI is implemented?

1996

In what year was the IMCI strategy implemented in the Philippines?

70 percent

What percentage of health facilities nationwide in the Philippines have integrated the IMCI strategy?

Dengue hemorrhagic fever

To what local health concern was IMCI specifically adapted in the Philippines?

Insufficient finances, inadequate training, fragmented leadership, and professional hierarchies

What are four challenges to IMCI implementation mentioned in the source?

27 per 1,000 live births

What is the under-five mortality rate in the Philippines as of 2023?

22 per 1,000 live births

What is the infant mortality rate in the Philippines as of 2023?

23.6 percent

What percentage of Filipino children aged 0 to 59 months are stunted?

5.6 percent

What is the percentage of wasting among Filipino children?

15.1 percent

What percentage of Filipino children are considered underweight?

163,000

How many zero-dose children are reported in the Philippines?

Children who have never received a single routine vaccination

What is the definition of zero-dose children?

Vulnerability to infection

What do high rates of stunting, wasting, and underweight reflect in children?

Neonatal causes

What category of causes accounts for a large proportion of under-five deaths in the Philippines?

Prematurity, birth asphyxia/trauma, and neonatal infections

What are three specific neonatal causes of death?

Pneumonia and diarrhea

What are the two leading causes of death beyond the neonatal period?

Undernutrition

What condition underlies many child deaths and increases risk of mortality even if not on the death certificate?

Socio-economic, nutrition/food environment, health system, environmental/community, and behavior/caregiving

What are the five factors influencing child health according to the situational analysis?

COVID-19 pandemic

What disrupted routine services and nutrition programs recently?

Mental health concerns, violence, and substance abuse

What are three additional challenges affecting children today?

Exclusive breastfeeding

What is a simple, well-implemented intervention to reduce child mortality?

Skilled health professionals

Improving access to whom for antenatal and postnatal care can achieve preventable child death reductions?

Water, sanitation, and hygiene

Improving access to which three environmental factors helps address common causes of child death?

Ending preventable deaths for children under 5

What is the focus of SDG target 3.2?

12 per 1000 live births

What is the SDG target for neonatal mortality by 2030?

25 per 1000 live births

What is the SDG target for under-five mortality by 2030?

Partnerships for the Goal

What is the title of SDG 17?

Improve case management skills, improve health system, and improve family/community practices

What are the three main components of IMCI developed in 1995?

Children rarely have just one problem

What reality about childhood illness does IMCI remind clinicians of?

Systematic

Instead of being complaint-driven, the clinical approach in IMCI must be what?

Assess, Classify/Identify Treatment, Treat, Counsel, and Follow-up

What are the five steps of the IMCI case management process?

Asking, Looking, Listening, and Feeling

What four clinical actions are performed during the assessment step?

Color-coded triage system

What system is used to classify a child's illness severity?

Pink

Which color indicates severe disease requiring urgent pre-referral treatment?

Yellow

Which color indicates specific medical treatment and advice in the primary care clinic?

Green

Which color indicates simple advice on home management?

Ask for the child's name and age

What is the very first step in the IMCI case management process?

Sick Young Infant

What classification is given to a child aged 1 week up to 2 months?

Sick Child

What classification is given to a child aged 2 months up to 5 years?

Has not yet had their 5th birthday

What does the age group up to 5 years old specifically mean?

Birth to first week of life

Which age period is excluded from IMCI because illnesses are often related to labor and delivery?

Unable to feed or drink, vomits everything, convulsions, and lethargic/unconscious

What are the four general danger signs for a sick child?

Require urgent referral

What do all general danger signs indicate?

Jaundice, diarrhea, HIV status, feeding problem/growth, and immunizations

What are the main symptoms assessed in a sick young infant?

Cough/breathing, fever, malnutrition/anemia, diarrhea, ear problems, and HIV

What are the main symptoms assessed in a sick child?

How long the cough has been

What is the first thing to ask if a child has cough or difficulty breathing?

Count the breaths in one minute

What is the first step in looking, listening, and feeling for breathing problems?

Child must be calm

What state must the child be in before counting their breaths?

50 breaths per minute or more

What is the fast breathing cut-off for a child 2 months up to 12 months?

40 breaths per minute or more

What is the fast breathing cut-off for a child 12 months up to 5 years?

Chest indrawing, stridor, and wheezing

Besides fast breathing, what three clinical signs are checked for cough?

Trial of rapid-acting inhaled bronchodilator

What is given to a wheezing child with fast breathing or chest indrawing before re-classification?

Three times 15 to 20 minutes apart

How is the trial of inhaled bronchodilator administered?

Severe palmar pallor

What sign indicates severe anemia?

Give iron and mebendazole

What treatment is given for the classification Anemia (Yellow)?

1 year or older

At what age can mebendazole be given if not received in the previous 6 months?

Vitamin A supplementation

What is given every 6 months from the age of 6 months?

BCG, OPV-0, and Hep B0

What three vaccinations are given at birth?

DPT-HB, OPV, Hep B, RTV, and PCV

What five vaccinations are scheduled at 6, 10, and 14 weeks?

9 months

At what age is the first dose of the measles vaccine typically given?

Pre-referral treatment

What must be identified and administered before urgently referring a child?

Identify all treatments needed

What must be done if a child has multiple classifications?

Bolded inside the chart booklet

How are urgent pre-referral treatments visually identified?

Antibiotic, Vitamin A, and tetracycline eye ointment

What are three pre-referral treatments for severe complicated measles?

Explain the need and calm fears

What are two things a physician must do when telling a caretaker about a referral?

Write a referral note

What must be provided to facilitate the receiving hospital's management?

Treat in the clinic

Where is treatment usually done for Yellow classifications?

Advise on home management

What is the primary action for Green classifications?

Teach the caretaker

What must a health worker do regarding oral drugs and home local infection treatment?

Breastfeeding practices

What must be assessed during maternal counseling to solve feeding problems?

Signs to return immediately

What should a mother be taught regarding when to bring her child back to the clinic?

Breastfeeding poorly, unusually cold, yellow palms/soles, and fast/difficulty breathing

What are five immediate return signs for a young infant?

Not able to drink, becoming sicker, and blood in stool

What are three immediate return signs for a sick child?

Worsening or not improving

A fever warrants an immediate return only if it is described as what?

2 days

What is the typical follow-up timeline for pneumonia or persistent diarrhea?

14 days

What is the follow-up timeline for anemia or a completed medication course?

Feeding problems

For what condition is follow-up especially important to ensure proper weight gain?

No additional fees and not waiting in line

What are two special arrangements to encourage follow-up visits?

Serious bacterial infections

What do young infants often die quickly from?

Fever, low body temperature, and fast breathing

What are three nonspecific signs of severe disease in young infants?

Newborn unable to feed since birth or stopping well-feeding

What history of feeding is a major indicator of severe disease in an infant?

60 breaths per minute or more

What is the fast breathing cut-off for an infant up to 2 months old?

Irregular

How is an infant's breathing rate often described?

Repeat the 60-second count

What must you do if a young infant has fast breathing on the first count?

Mild chest indrawing

Which type of chest indrawing is considered normal in a young infant?

Severe chest indrawing

Which type of chest indrawing is abnormal and characterized by deep movement?

Fever

What may be the only sign of very severe disease in a young infant?

Dropping their body temperature

How else can young infants respond to infection besides fever?

Redness or draining pus

What two things are checked for when assessing an infant's umbilicus?

Red spots or blisters containing pus

What is the definition of skin pustules?

Spontaneous movement

What should you observe for when checking an infant's level of activity?

Gently stimulate the infant

What should be done if an infant does not move spontaneously?

Natural light

In what type of lighting should jaundice be assessed?