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A large number of childhood morbidity and mortality in the developing countries is caused by five conditions: acute respiratory infections (mostly pneumonia), diarrhoea, measles, malaria, or malnutrition. The Integrated Management of Childhood Illness (IMCI) strategy encompasses a range of interventions to prevent and manage this major childhood illness, both in health facilities and in the home. The IMCI strategy incorporates many elements of diarrhoeal and ARI control programme, as well as child-related aspects of malaria control, nutrition, immunization, and essential drugs programme.

An integrated strategy is needed to address the overall health of children for the following reasons:

  • More sick children present with signs and symptoms of more than one condition. Thus, more than one diagnosis may be necessary.

  • When a child has several conditions, therapies for those conditions may need to combine.

  • Care needs to be focused on the child as a whole and not just the diseases and condition affecting the child.
  • Other factors that affect the quality of care delivered to children such as drug availability, organisation of the health system, referral pathways and services, and community behaviours are best addressed through an integrated strategy.

The Government of Bangladesh has made great strides in reducing childhood mortality from 173 per thousand in the early 80s to 88 per thousand in 2004 (BDHS 2004). However, there has been a slow down in trend in the last decade. Deaths in infancy remain particularly high, mostly caused by acute respiratory infections and diarrhoea often compounded by malnutrition. Neonatal mortality account for about 40% of childhood mortality, emulating in part from complications during pregnancy and delivery and in part from infections acquired after birth. This situation is unnecessary, since effective interventions to reduce childhood mortality are well known and feasible for implementation at high coverage in low-income countries (Lancet 2003:362:65-72)

Implementation of the IMCI strategy involves the following three components:

  • Improvements in the case management skills of health staff through the provision of locally adapted guidelines on integrated management of childhood illness and activities to promote their use.
  • Improvements in the health system required for effective management of childhood illness.
  • Improvements in family and community practices.

By improving the coordination and quality of existing services, the IMCI strategy will increase the effectiveness of care and reduce costs as to achieve the following objectives:

  • To reduce morbidity and mortality associated with the major causes of diseases in children.
  • To promote healthy growth and development of children.

Phases of implementing the IMCI strategy:

  • Introduction phase
  • Early implementation phase
  • Expansion phase

Country situation

Stepwise progress of IMCI in Bangladesh

The Government of Bangladesh decided to pilot the IMCI strategy in 1998. A national steering committee was formed and a functional secretariat established under the auspices of the Deputy Programme Manager CDD. After adaptation of the generic guidelines, implementation started in 2001 in three upazillas. A formal review meeting held in February 2003 and concluded that the IMCI strategy was feasible and effective to address the needs of children in Bangladesh and recommended that the Government make provisions for rapid scaling up. (GOB/WHO Report of the review of early implementation of IMCI, February 2003). Accordingly, in December 2003, the National Working Team (NWT) has developed a plan for scaling-up of IMCI in Bangladesh with technical assistance from WHO-HQ. Till date facility based IMCI has been implemented in 48 upzillas. The NWT also has developed C-IMCI strategy and government has endorsed the document in 2004.

IMCI In-service Training Status:
Training centers: 3 of them are situated in Dhaka, I in Matuail (Narayangonj) and 1 in Rajshahi. Another one in Mymensing will be starting its activity very soon. All trainings provided to the Doctors and other health workers till date, are supported by WHO and UNICEF. The Clinical Management Trainings (11-days CMT) are on going and all service providers (doctors, paramedics) from selected expansion upzilas are being trained on a regular basis.

IMCI Pre-service training status:
During 2004 pre-service training on IMCI has been piloted in 6 medical colleges. By end of 2007, IMCI should be included into the curricula of all medical colleges, Nursing Institutes and MATS.

IMCI implementation status in Bangladesh:
Till date, IMCI is being implemented in 48 upzillas of 15 districts.

Current WHO support

WHO will support all those activities mentioned above regarding implementation of IMCI in 30 more upzillas in 2004 and 50 upzillas in 2005 in collaboration with GOB and other active partners like UNICEF, USAID.

Moreover WHO will be supporting training of Basic Health Workers through the BHW package developed by WHO & UNICEF, adapted by GOB.

WHO will be supporting implementation of C-IMCI through its cadre of VHV's , located at 84 Upzillas of Bangladesh.

WHO is supporting the adaptation of the Global strategy for Infant and Young Child Feeding (IYCF) and development of a national guideline on IYCF.

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