On September 10 and 11, 2002, the Second Meeting of the Technical Advisory Group on IMCI (IMCI-TAG) will be carried out in the Texas Children's Hospital in Houston, Texas. The group—which consists of international experts of the area of pediatrics, public health, and epidemiology—is summoned annually by the Pan American Health Organization (PAHO) for the purpose of analyzing the implementation of the IMCI strategy and providing recommendations for its strengthening and expansion.
The IMCI Strategy
IMCI is currently the main strategy recommended by PAHO/WHO and UNICEF (United Nations Children's Fund) to promote healthy growth and development during childhood, to reduce the incidence and severity of the diseases that most frequently affect children’s health, and to reduce the number of deaths caused by such illnesses.
In the Region of the Americas, it is estimated that diseases that are easily preventable, such as infectious diseases and nutritional disorders, cause 27% of all annual deaths of children under five. The number of yearly deaths due to such causes was 170,000 at the end of the 20th Century, and most of them could have been avoided through simple prevention measures or early diagnosis and treatment.
The IMCI strategy is aimed the prevention and control of these diseases. In view of the fact that the majority of these deaths occurred in countries or areas with an infant mortality rate of 20 or more per 1,000 live births, special priority was assigned to the implementation of the strategy in these areas.
Currently, the IMCI strategy is incorporating additional actions to supplement its basic structure, in order to cover other diseases and problems that impair child health and impinge negatively on healthy growth and development during childhood. These include, among others, the prevention and control of perinatal disorders; the prevention and treatment of accidents, abuse and violence; and the prevention and control of asthma and broncho-obstructive syndrome. All of these problems are responsible to a varying extent for child mortality and cause a major proportion of child morbidity.
In addition, and for the purpose of improving child health and development, IMCI is incorporating actions to prevent and control developmental disorders, diabetes and obesity, as well as to promote oral health.
Components of the IMCI Strategy: Health Workers, Health Services, and Community
IMCI implementation is structured around three components:
- The first is aimed at improving the case-management skills of health workers through providing locally adapted guidelines on IMCI and activities to promote their use.
- The second IMCI component is oriented towards improving the health system required for effective management of childhood illness.
- Finally, the third component aims at improving parental and community knowledge and practices with regard to disease prevention and adequate child care in households.
Through this last component the IMCI strategy promotes and disseminates sixteen key family practices for a healthy growth and development. Such recommended practices include behaviors pertaining to disease prevention, adequate nutrition, and child stimulation, as well as suggestions on what to do when a disease affects the child.
IMCI in the Region of the Americas
The IMCI strategy is recommended by PAHO through a Resolution of its Directing Council. This Resolution urges all countries to incorporate IMCI as a basic standard for child care. In twenty countries of the `Region of the Americas` the strategy was adapted in order to adjust it to the specific local epidemiological and operational features, and currently is in full process of implementation and expansion. In other countries, the strategy already is incorporated through different programs and national initiatives that are being implemented since the early 1990s.
On the basis of the commitment of the countries with the strategy, in 1999, PAHO launched the initiative Healthy Children: Goal 2002, with a view to reducing in 100,000 the number of deaths of children under 5 during the period 1999–2002. This reduction was estimated as feasible to be reached by increasing the rate of reduction of the mortality from diseases targeted by the IMCI strategy. Such diseases are usually the greatest killers of children and attacking them will make the most significant impact on the goals of mortality and morbidity reduction.
The intermediate evaluation of the initiative, carried out at the end of 2001, showed that the estimates are not just being reached, but even surpassed, which means that it is expected that at the end of 2002 the expected reduction will have been achieved. An evaluation of the achievements of the 2002 goal will take place in early 2003.
The Technical Advisory Group on IMCI (IMCI-TAG)
The extent of the IMCI strategy, as well as the need for its continuous adaptation to the changing epidemiological and operational situation of the countries and of the Region of the Americas as a whole, motivated the creation of the IMCI Technical Advisory Group. Internationally renowned experts with strong credentials in the field of pediatrics, epidemiology, and public health compose this group.
IMCI-TAG meets every year for the purpose of reviewing and analyzing IMCI progress, and to formulate recommendations with regard to priorities for its enhancement and strengthening, and to draw the lines of action to guide IMCI activities in the coming years. IMCI-TAG was organized in 2001 and held its first meeting in September of that year, at the Miami Children's Hospital headquarters in Miami, Florida.
For the 2002 meeting, the Texas Children's Hospital (TCH)—the place of work of Dr. Fernando Stein, a member of IMCI-TAG—will host the two-day event. TCH is a state-of-the-art center in world pediatrics, and has been an important source of support for PAHO/WHO IMCI initiatives in the Region of the Americas.
Representatives of PAHO at such an important meeting will be Dr. Stephen Corber, Director of the Division of Disease Prevention and Control, and Dr. Yehuda Benguigui, Regional IMCI Advisor in the Program on Communicable Diseases. The members of the IMCI-TAG that will be participating at the meeting at the TCH are as follows:
- Dr. Stephen Berman, former President, American Academy of Pediatrics (APA), USA.
- Dr. David Bratt, Professor, University of West Indies, Trinidad & Tobago.
- Dr. Deisee Granado Villar, Director, Division of Preventive Medicine, Health Promotion and Community Health, Miami Children’s Hospital, USA.
- Dr. Edgar Mohs, Office of the Director General of the Children's Hospital of San Jose, Costa Rica, and ex Minister of Health, Costa Rica.
- Dr. Elsa M. Moreno, Director of the Master's Degree in Public Health of the National University of Tucumán, Argentina; and former Secretary of Health of the Argentine Republic.
- Prof. Dr. Antonio Sáez, Public Health Professor, Universidad Complutense, Madrid, Spain; and President, Ibero-American Association of Medicine and Health Schools. .
- Dr. José Ignacio Santos Preciado, General Director of the National Center for child and Adolescent Health, National Commission on Vaccination (CONAVA), Ministry of Health, México.
- Dr. Fernando Stein, Associate Professor of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, USA
- Dr. Javier Torres Goitia, Bolivian Society of Pediatrics, former Minister of Health of Bolivia.
- Dr. João Yunes, Director of the School of Public Health of the Universidade de São Paulo, Brasil. Former Secretary General of Policies of the Ministry of Health, Brazil.
During the meeting, the experts will discuss IMCI advances and challenges on the basis of current IMCI technical and health policy documents, and will prepare a report with relevant recommendations on the strengthening of IMCI role as a key strategy to improve child health in the continent, and also to enhance its application particularly among most vulnerable population groups.
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