Integrated Management Of Childhood Illnesses With Reference To Kenya
According to WHO Kenya is one of the third world countries that record a devastatingly high child mortality rate resulting from easily treatable and curable illnesses. This can be attributed to the fact that in children especially under the age of five, often times an illness occurs with other comorbidities with masked symptoms which often go untreated and eventually become fatal. However, this situation is not unique to Kenya, 42 countries contribute 90% child fatality on the higher end and only 6 countries contribute 50% child fatality (Black et al., 2003). Needless to say, this has raised the alarm and interventions are being sought on how to curb this growing need.
The Integrated Management of Childhood Illnesses (IMCI) was created by WHO and UNISEF in 1995 to offer guidelines on how children get medical attention, the treatment and overall wellbeing to curb the growing child mortality rate.as with all other policies by WHO, IMCI has to be customized before being implemented in every country. This is to ensure it remains relevant and effective according to the particular context of any given country. The year 2000 is when Kenya adopted and integrated the IMCI. Since the IMCI implementation, we are grateful to have enjoyed a great reduction in fatality of children under the age of 5 years.
IMCI is the blue print upon which prevention and treatment of diarrhea, pneumonia, malnutrition, measles and malaria is done. It is applied by both in-patient and out-patient health workers at all levels of healthcare facilities.
IMCI has three general goals which sum up all the steps taken by the health workers:
- Training of health workers in the IMCI guidelines that have been modified to fit their specific environment and encouragement to use in their practice.h3
- Ensuring the organization of healthcare protocols for efficient intervention on childhood illness. h3
- Using evidence and research based community practices.h3
- Kenya has taken big strides over the past few years in adaptation on the IMCI who guidelines through:h3
The IMCI training of out-patient health workers to use a step by step approach as follows;
Assessment of the child and identification of danger signs i.e. Dyspnea, cough, ear problem, diarrhea and fever.
The immunization status of the child using the KEPI schedule is checked.
Classification of the child’s disease according to action to be taken in a colour triage system adopted from the WHO ARI (management guidelines for acute respiratory infections and diarrhea). Here the cases that are above the level of the health facility are classified as referral cases.
Identification of specific treatments and implementation of integrated interventions. First aid is given to referral cases before they are sent off.
Treatment instructions are given to the caregiver/mother on how to give the drugs and hydrate the child as well as manage small infections.
Caregiver/mother is advised on the signs and symptoms which would warrant an urgent visit to the healthcare facility.
Nutrition of the child is assessed and the mother/caregiver is educated on proper nutrition of the child.
On subsequent return to the health care facility, follow-up instructions are given.
Healthcare workers are trained on the guidelines both through theory and practical sessions, and they are tested and approved as qualified childhood health care givers.
Challenges of IMCI adaptation in Kenya:
Given that model of adaptation has involved mainly improvement of skills of primary healthcare givers, the effects may be slow because of the dense population of health care centres in Kenya.
Education of healthcare workers can only go so far, given that the community practices have not yet been sufficiently improved. A shift in community practices will take time.
IMCI adaptation in the Kenyan healthcare system has contributed greatly to reduced child mortality rate and the general improvement of the quality of life of children under the age of 5. It has also contributed to a healthier general population and a turn in our community health practices for the better. The cost of healthcare will also go down due to the efficiency of intervention and proper utilization of resources.