An assessment of the causes of malnutrition in Ethiopia: A ...

Box 5.1: Household and Community Integrated Management of Childhood Illnesses
The Integrated Management of Childhood Illness (IMCI) strategy combines improved case
management of childhood illness in first-level health facilities with aspects of nutrition, immunization,
disease prevention, and promotion of growth and development. There are three components to IMCI.
Interventions in all three components encompass both curative and disease prevention and health
promotive activities:
1. Improving the skills of health workers;
2. Improving health system; and
3. Improving household and community practices.
Improving the quality of care at health facilities alone would not be effective in realizing significant
reductions in childhood mortality and morbidity because numerous caretakers currently do not seek
care at facilities. The third component, Household and Community IMCI or HH/C IMCI, is considered
an essential component of the IMCI strategy.
Sixteen key family care practices were identified to contribute to a child’s survival and healthy growth,
based on scientific evidence and country experience. The key family practices, the backbone of the
Household and Community IMCI strategy, are grouped according to practices that:
• promote physical growth and mental development;
• prevent disease;
• facilitate appropriate home care; and
• facilitate care seeking behaviors.
The key family practices are the following:
1. Breastfeed infants exclusively for at least four months and, if possible up to six months.
(Mothers found to be infected with HIV require counseling about possible alternatives to
breastfeeding.)
2. Starting at about six months of age, feed children freshly prepared energy and nutrient rich
complementary food, while continuing to breastfeed up to two years or longer.
3. Ensure that children receive adequate amounts of micronutrients (vitamin A, and iron, in
particular) either in their diet or through supplementation.
4. Dispose of feces, including children’s feces, and wash hands after defecation, before
preparing meals, and before feeding children.
5. Take children as scheduled to complete a full course of immunizations (BCG, DPT, OPV,
and measles) before their first birthday.
6. Protect children in malaria endemic areas by ensuring that they sleep under insecticidetreated
bed-nets.
7. Promote mental and social development by responding to a child’s needs for care through
talking, playing, and providing a stimulating environment.
8. Continue to feed and offer more fluids, including breast-milk, to children when they are sick.
9. Give sick children appropriate home treatment for illness.
10. Recognize when sick children need treatment outside the home and seek care in a timely
manner.
11. Follow the health worker’s advice about treatment, follow-up, and referral.
12. Ensure that every pregnant woman gets adequate antenatal care. This includes having at
least four antenatal visits with an appropriate health care provider, and receiving the
recommended doses of the tetanus toxoid vaccination. The mother also needs support from
her family and community in seeking care at the time of delivery and during the postpartum
and lactation period. She also should receive anti malarial prophylaxis during pregnancy.
13. Promote timely recognition, prevention, and appropriate reaction to child abuse.
14. Promote family practices for survival issues regarding HIV/AIDS.
15. Encourage both men and women to seek reproductive health.
16. Prevention and appropriate management of child injuries.
However, implementation of the IMCI is far from satisfactory. At present, the
program has been initiated in only ten woredas of the country. Even in those woredas, the
progress of implementation has faced numerous challenges. The main constraint has been the
fact that the training of health workers requires two weeks and pediatricians are needed for
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