Rationale for an Integrated Approach

Every year almost 10 million children die before they reach their fifth birthday. A majority of these deaths caused by just five preventable and treatable conditions:

• pneumonia
• diarrhea
• malaria
• measles
• malnutrition

Often, those deaths are caused by a combination of the above conditions. Many of childhood deaths could be avoided if those children received appropriate and timely care. In addition, three out of four episodes of childhood illness are caused by these five conditions.

In the 1990s, major progress was made to reduce childhood mortality and morbidity through universal childhood immunization, control of diarrheal diseases and acute respiratory infections, nutrition programs (including the promotion of breastfeeding) and through implementation of other primary health care activities. In 1995, the WHO Department of Child and Adolescent Health and Development (CAH), in collaboration with eleven other WHO programs and UNICEF, finalized the development of the Integrated Management of Childhood Illness (IMCI) strategy. The global implementation of the IMCI strategy applied the lessons learned from these vertical programs to strategies that promote coordination and, where appropriate, greater integration of activities, in order to improve the prevention and management of childhood illness.

The current challenge for the IMCI strategy is to scale up activities to ensure the appropriate and effective use of IMCI principles and clinical guidelines by all types of health-care providers.

The extent of childhood morbidity and mortality in low-income and middle-income countries caused by the above-mentioned five conditions is not in itself the only rationale for an integrated approach to the management of childhood illness. Every day, millions of parents seek health care for sick children, taking them to hospitals, health centers, pharmacists, community health-care providers and traditional healers, and most of these sick children present with signs and symptoms related to more than one disease.

This overlap means that often a single diagnosis may not be possible or appropriate, and treatment may be complicated by the need to combine therapy for several conditions. An integrated approach to managing sick children is, therefore, indicated. There is a real need for a health care provider to go beyond single diseases and address the overall health of a child. Use of IMCI strategy, which takes into account the variety of factors that put children at serious risk, ensures the combined treatment of the major childhood illnesses, while emphasizing prevention of disease through immunization and improved nutrition.