Integrated management of childhood illness in resource-poor countries: an initiative from the World Health Organization.

It is estimated that each year around 12 million children aged < 5 years die in resource-poor countries and that 70% of these deaths are due to communicable diseases and/or malnutrition. The same conditions are responsible for an even higher percentage of childhood illness. Since the mid-1990s the World Health Organization has been leading the development of an integrated approach to care for ill children at the primary care level, a programme know as Integrated Management of Childhood Illness (IMCI). The approach essentially combines improved management of childhood illness with aspects of nutrition, immunization and maternal health. IMCI replaces or complements a number of 'vertical' child health programmes aimed at specific groups of conditions including control of diarrhoeal diseases (CDD), acute respiratory infections (ARI) and the Expanded Programme on Immunization (EPI). As of late 1998 the programme, at various stages of development, had been introduced to 51 countries: Introduction (19 countries), Early Implementation (29 countries) or Expansion (9). The approach has many advantages not least that it is well accepted by tropical country paediatricians because it conforms to practice in secondary care. In some countries paediatricians are playing a greater leadership role than they did with previous specific programmes. Many problems remain: programmatic issues, probable over-diagnosis of malaria, relationships with other specific initiatives ('Roll Back Malaria' and new-born care) and how to integrate HIV infection into the diagnosis and care 'package'. However the initiative deserves support by paediatricians and public health specialists in industrialized countries.