Principles of the Integrated Clinical Case Management Guidelines

The IMCI clinical guidelines are based on the following principles:

• All sick children aged up to five years of age are examined for general danger signs and all young infants are examined for signs of very severe disease. These signs indicate the need for immediate referral or admission to hospital.
• The children and infants are then assessed for main symptoms.  For older children the main symptoms include cough or difficulty breathing, diarrhea, fever, and ear infection. For young infants, the main symptoms include local bacterial infection, diarrhea, and jaundice. In addition, all sick children are routinely assessed for nutritional and immunization status, and other potential problems.
• Only a limited number of clinical signs are used, selected on the basis of their sensitivity and specificity to detect disease.
• A combination of individual signs leads to a child's classification within one or more symptom groups rather than a diagnosis. The classification of illness is based on a color-coded triage system: "pink" indicates urgent hospital referral or admission, "yellow" indicates initiation of specific outpatient treatment, and "green" indicates supportive home care.
• IMCI management procedures use a limited number of essential drugs and encourage active participation of caregivers in the treatment of children.
• An essential component of IMCI is the counseling of caregivers regarding home care, appropriate feeding and fluids, and when to return to the clinic - immediately or for follow-up.