1.4 IMNCI case management
Case management can only be effective to the extent that families bring their sick children to a trained health worker such as you for care in a timely way. If a family waits to bring a child to a health facility until the child is extremely sick, or takes the child to an untrained provider, the child is more likely to die from the illness. Therefore, teaching families when to seek care for a sick child is an important part of the case management process and is a crucial part of your role as a Health Extension Practitioner.
The complete IMNCI case management process involves the elements listed in Box 1.1.
Box 1.1 The IMNCI case management process
Assessment
- Assess a child by checking first for general danger signs (or possible bacterial infection in a young infant), asking questions about common conditions, examining the child, and checking nutrition and immunization status. Assessment includes checking the child for other health problems.
Classification
- Classify a child’s illnesses using a colour-coded classification system. Because many children have more than one condition, each illness is classified according to whether it requires:
- urgent pre-referral treatment and referral (pink), or
- specific medical treatment and advice (yellow), or
- simple advice on home management (green).
Identify treatment and treat
- After classifying all conditions, identify specific treatments for the child. If a child requires urgent referral, give essential treatment before the patient is transferred. If a child needs treatment at home, develop an integrated treatment plan for the child and give the first dose of drugs in the clinic. If a child should be immunized, give immunizations.
- Provide practical treatment instructions, including teaching the caregiver how to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at home. Ask the caregiver to return for follow-up on a specific date, and teach her how to recognise signs that indicate the child should return immediately to the health post.
- Assess feeding, including assessment of breastfeeding practices, and counsel to solve any feeding problems found. Then counsel the mother about her own health.
Follow-up care
- When a child is brought back to the health post as requested, give follow-up care and, if necessary, reassess the child for new problems.
All these steps are clearly presented in the IMNCI chart booklet and you need to refer to it throughout this Module. You should always use the chart booklet whenever you manage under-five children.
Whenever a sick baby or child under five comes to your health post you should use the IMNCI chart booklet to help you know how to assess, classify and treat the child.
The IMNCI guidelines address most, but not all, of the major reasons a sick child is brought to a health facility. A child returning with chronic problems or less common illnesses may require special care which is not described in this Module. For example, the guidelines do not describe the management of trauma or other acute emergencies due to accidents or injuries.
You are now going to look at the case management process in more detail.
1.3 The IMNCI assessment