The Integrative Management of Childhood Illnesses is a vital strategy developed by the World Health Organization and UNICEF to reduce child mortality, morbidity, and frequent illnesses in developing countries like Nigeria. Midwives frequently encounter mothers bringing in sick babies and young children with overlapping symptoms. Instead of looking at a single disease in isolation, this protocol looks at the whole child. It combines preventive and curative measures to address the major causes of under-five deaths, which include malaria, pneumonia, diarrhea, measles, and malnutrition.
The framework rests on three distinct pillars that work together to improve child health outcomes at the community and facility levels.
When a mother brings an under-five child to the clinic, the midwife follows a systematic three-step process: Assess, Classify, and Treat.
General danger signs indicate a severe illness that requires urgent referral to a hospital. A midwife must check every sick child for these signs immediately upon arrival.
After checking for danger signs, the midwife evaluates specific major symptoms using standardized inquiry and physical checks.
| Symptom | Key Assessment Check | Primary Action / Treatment |
|---|---|---|
| Cough or Difficult Breathing | Count breaths in one minute, look for chest indrawing | Give oral antibiotics if fast breathing is present; advise on soothing home remedies |
| Diarrhea | Check for dehydration, sunken eyes, skin pinch test | Give Oral Rehydration Salts (ORS) and Zinc supplements |
| Fever | Assess for malaria risk area, check stiff neck or rash | Administer antimalarial or antipyretic; refer if stiff neck is present |
| Ear Problem | Feel for tender swelling behind the ear, check for pus discharge | Clean ear with wick, give oral antibiotics if pus is draining |
Nutritional deficiencies heavily worsen childhood infections. Midwives must systematically check every child for wasting, edema, and pallor.
Look for visible severe wasting, where the child appears extremely thin with prominent ribs and muscle loss. Check both feet for bilateral pitting edema, which is a hallmark of severe acute malnutrition (kwashiorkor). Examine the palms for severe palmar pallor to detect anemia. If severe malnutrition or severe anemia is present, the child requires urgent referral to a stabilization center or outpatient therapeutic feeding program.
Prevention is just as important as curative treatment in the IMCI protocol. The midwife must check the child's immunization card against the national schedule to catch up on missed vaccines such as measles, pentavalent, and polio drops.
In addition, feeding assessment is crucial, especially for infants and toddlers. The midwife should ask about exclusive breastfeeding for babies under six months and the introduction of diverse, nutrient-dense complementary foods alongside continued breastfeeding for older infants. Identifying feeding problems early prevents chronic malnutrition and stunting.
A successful consultation ends with clear, practical communication. Midwives must teach mothers how to give oral medications at home, explaining dosage, frequency, and duration clearly. Mothers must also be taught danger signs that require an immediate return to the clinic.
Beyond the clinic walls, midwives play a vital role in community outreach. They train community health volunteers to recognize danger signs, promote clean water usage, and support exclusive breastfeeding. Strengthening this bridge between the household and the health facility ensures that children receive timely interventions before minor health issues escalate into emergencies.