Experts emphasize challenges of IMCI strategy for healthy children

Washington, November 21, 2001 (PAHO) - The expansion of the Integrated Management of Childhood Illness (IMCI) strategy, its integration with other elements of the public health system and mobilization of resources to sustain its application are the main challenges facing the countries of the Americas.

These were the conclusions of a group of experts who met to evaluate and expand this strategy, which has proven effective in cutting childhood deaths and illnesses. Specialists from throughout the Americas and representatives of several institutions and international agencies convened at the headquarters of the Pan American Health Organization (PAHO) in Washington, DC.

"It is good that at this medium-term evaluation meeting we have heard so much good news, but a great deal remains to be done," said Dr. Mirta Roses, Assistant Director of PAHO. "It is important that 17 countries are already applying the IMCI strategy, but the region has almost 50 countries and territories and perhaps the countries that are still missing also have high mortality rates. The same can be occurring within the countries that already apply the strategy, where perhaps we are working in the easier areas but we have not been able to reach the most difficult areas, which are the ones that need it most."

IMCI was designed in 1992 in order to reduce mortality and morbidity associated with the leading causes of diseases in the childhood and to favor an adequate growth and development of children under 5 throughout the world through training, information, and education.

Dr. Roses reaffirmed that expansion and integration of the IMCI strategy are the principal challenges, especially with vulnerable groups. "The continent is ready for the incorporation of IMCI into all the work being done with indigenous groups. This implies adapting the strategy with an anthropological element, to integrate cultural values and health perceptions of these peoples. It is difficult, but necessary to do or we will not be able to reach places where it is really most needed. We also have to reach families and all those responsible, such as mayors, social workers, and teachers, " she said.

The IMCI strategy takes advantage of every child's health center visit to evaluate his general state of health and identify any problem; it identifies critically ill children who require hospitalization and refers them immediately. It focuses on the care of the child as a whole, not only the reason for the consultation, evaluating nutritional status, vaccination, growth and home care practices. It also ensures treatment of all diseases present, not only the one that motivated the consultation.

In a round table on responses to the new challenges of IMCI, Dr. José Luis Di Fabio, of PAHO's Division of Vaccines and Immunization, outlined the situation of antimicrobial resistance to S. pneumoniae in the region. He noted that acute respiratory diseases are one of the leading causes of death in children, and explained work underway to improve epidemiological surveillance of these diseases and to make their care more efficient.

"We are evaluating direct and indirect costs of the pneumococcal diseases in the countries to see the cost effectiveness of introducing a conjugated vaccine," said Dr. Di Fabio. Production costs of the polyvalent or conjugated vaccine are higher and it is more expensive. "Although we do not have all the available incidence data, we believe that immunization of the mothers can have an important effect on the reduction of these diseases, " he said.

The relation of IMCI and the Roll Back Malaria initiative in indigenous communities was addressed by Dr. Rocío Rojas of PAHO, who emphasized the problems of lack of specific information about indigenous peoples, noting that in their epidemiological profile preventable diseases predominate. "The lack of information on health and living conditions of indigenous peoples is one of the greatest limitations for the application of IMCI," she said.

PAHO, which serves as the Regional Office for the Americas of the World Health Organization, was established in 1902 and is the oldest health organization in the world, working with all the countries of the Americas to improve the health and raise the living standards of their peoples.