Building a Better Future through Improved Case Management of Childhood Illnesses

Ashley Schmidt

MCSP/JSI | Senior Program Officer

Elizabeth Hourani

MCSP/JSI | Program Coordinator
Mothers wait to see health workers to weigh and vaccinate their children in a clinic in Accra, Ghana.

Mothers wait to see health workers to weigh and vaccinate their children in a clinic in Accra, Ghana. (Kate Holt/MCSP)

Over the past quarter-century, the number of children dying each year has more than halved. Yet in 2016, an estimated 5.6 million children still died before reaching their fifth birthday. Most of these deaths occur from conditions such as pneumonia, malaria, diarrhea, and malnutrition, all of which are readily preventable or treatable with cost-effective interventions. This global burden of child deaths is not distributed equally: Higher rates of under-five deaths reflect longstanding underlying causes of disadvantage and persistent inequities in certain regions of the world. Sub-Saharan Africa and South Asia account for more than 80%, while Sub-Saharan Africa remains the region with the highest under-five death rate (79 per 1,000 live births on average in 2016). This means that 1 in 13 children die before their 5th birthday in Sub-Saharan Africa, compared to 1 in 189 children in high-income countries.

To combat these preventable illnesses, in 1995 WHO and UNICEF developed the cornerstone strategy for case management of sick children: Integrated Management of Childhood Illness (IMCI). The IMCI strategy was developed for professional health workers at the primary facility level and is an integrated approach to child health that focuses on the well-being of the whole child. It is composed of three complementary components:

  1. Improvement of health worker skills
  2. Strengthening of health systems
  3. Improvement of household and community practices (Community IMCI)
Josiane Pierre, a health worker, helps Rosemeline with her newborn, along with her mother, husband, and two other children.

Josiane Pierre, a health worker, helps Rosemeline with her newborn, along with her mother, husband, and two other children. (Katen Kasmauski/MCSP)

As case management of childhood illness requires continual treatment and care from the household to the hospital, simplified guidelines based on IMCI were developed for Community Health Workers (CHWs), known as Integrated Community Case Management (iCCM). iCCM allows for CHWs to treat non-complicated cases of common childhood illnesses and to identify severe cases for referral to the next level of care. Additionally, for managing more complicated cases of childhood illness, Emergency Triage Assessment and Treatment (ETAT) guidelines prioritize inpatient arrivals for immediate assistance at the secondary facility level. The WHO Pocket Book of Hospital Care for Children is then used to manage longer patient stays.

Over 100 countries have adopted IMCI and implemented it to varying degrees. These countries have also committed to the new targets of the Sustainable Development Goals, which call for ending preventable deaths of newborns and children under five years of age, with all countries aiming to reduce under-five mortality to 25 or less per 1,000 live births. While these targets are ambitious, they are achievable provided there is political will, adequate investment, and concerted action. Strengthening case management of childhood illness can bring these countries closer to their SDG goals.

For more information on child health case management strategies and program management implications, please see the newly developed Case Management of Childhood Illness course on the Global Health eLearning Center. This two-hour course, designed by child health experts working internationally, will teach you all the basics you need to know!