Treating the Whole Child

Christopher J. Drasbek
Pan American Health Organization

Wed., Jul. 5, 2006

Every year nearly 11 million children in the developing world die before reaching their fifth birthday. Most of these deaths result from diarrhea, pneumonia, measles, malaria and problems surrounding childbirth (such as asphyxia, birth trauma, and low birth weight). Underlying factors include malnutrition, poor access to healthcare, and a lack of healthcare knowledge at home.

To improve the chances for childhood survival, the World Health Organization (WHO) and UNICEF a decade ago launched a strategy known as Integrated Management of Childhood Illness (IMCI). It takes a �holistic� approach to child health and considers the child as a whole rather than focusing on individual diseases or symptoms.

IMCI initially focused on teaching healthcare providers to detect, and more effectively treat, the most common illnesses of children under five. More recently, it has turned its attention to family and community behaviors and how these affect children�s health. The result is Community IMCI, a collection of �family practices� that families and communities can use to help stimulate physical and mental development, prevent illness, and ensure that children get the healthcare they need both in and outside the home.

Because nutrition plays such a critical role in maternal and child survival and health, dissemination of state-of-the-art information and the establishment of quality nutrition programs are vital. © Yadira Pacheco / CORE Group

Four of IMCI�s key practices have been singled out by the Pan American Health Organization (PAHO) as especially critical to child health in Latin America and the Caribbean. They are: exclusive breastfeeding of babies for their first six months; ensuring that children get a full course of immunizations before their first birthday; learning to recognize when sick children need treatment outside the home; and ensuring good prenatal care for pregnant women.

PAHO�s experience in the town of Chao, Peru, shows that Community IMCI can have a real effect on parents� knowledge about child health. A recent survey showed that 95 percent of mothers now know that babies should be breastfed exclusively for the first six months, compared with only 34 percent five years ago. Three-quarters know how to treat a child�s infection versus just over half before Community IMCI was introduced. And 90 percent of mothers have kept their children up-to-date on their vaccines, compared with 58 percent in the past. In an unexpected development, cases of malaria dropped almost 99 percent between 2000 and 2004. Public health workers credit the decline to IMCI�s success in getting Chao�s citizens active on issues of public health.

Achieving results such as these requires the involvement of a wide range of actors to help raise awareness and encourage behavior change. In Chao, as elsewhere, this has meant involving everyone from the mayor and the police to the Red Cross, labor unions, �mothers� clubs,� and schools. Training teachers to include maternal and child health themes in their classrooms has proved a particularly effective way of reaching parents through their kids.

Today, IMCI and its key practices are being implemented in more than 100 countries around the world. The challenge now is to scale these efforts up, from small-scale projects to universal implementation. This can only be achieved with increased backing from governments, international agencies, non-governmental organizations, and individual donors. With increased support, IMCI can continue to be a global health �best buy� and help more families, communities, and health care providers do their part to ensure that every child has the chance to survive and thrive.

Christopher J. Drasbek
Regional IMCI Advisor
Pan American Health Organization

For more information, see IMCI sites at PAHO and WHO.

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