A large proportion of childhood morbidity and mortality in developing countries are caused by five conditions mainly diarrhea, pneumonia, measles, malnutrition and malaria and HIV/AIDS the latter has watered down our efforts.

These diseases are preventable yet they contribute to the high infant morbidity and mortality. In Swaziland the infant mortality rate 85/ 1000 live births and the child mortality rate is 120/1000 live births.
An integrated strategy was needed to address the overall health of children for the following reasons:

  • Most children present with signs and symptoms of more than one condition thus more than one diagnosis may be necessary. Health workers need to be prepared to assess the signs and symptoms of all the most common conditions, not simply those of present illness.
  • When a child has several conditions treatments for those conditions may need to be combined. Health workers need to be prepared to treat conditions when they occur in combination.
  • Care needs to focus on the child as a whole and not just the condition/disease affecting the child.
  • Other factors that affect the quality of care delivered to children such as drug availability. Organization of the health system, referral pathway, services and community behavior are best addressed through integrated strategy.

The IMCI was introduced as a strategy that provides comprehensive and continuous care of sick children.
In Swaziland IMCI came into existence in the year 1996 after realizing that children were dying from preventable diseases such as diarrhea, pneumonia, measles, malnutrition, neonatal, injuries and others ( see table below)

Figure 8: Estimated Causes of Under-5 mortality

In the past Management of sick children was diseases specific and it was easy to miss other illnesses. IMCI targets the major killer diseases and the approach are simply and effective.

It has 3 components:

  • Clinical case management – includes capacity building of health workers currently each health facility has one trained nurse in IMCI. This will assist in improving quality care to sick children and reduce mortality
  • Strengthening of health system-policy issues for effective implementation.
  • Community- IMCI: Promotes appropriate care seeking behavior, improved nutrition and preventive care and adherence to treatment.

Reduce infant morbidity and mortality in children under five years of age and promote their survival, growth and development.


  • To improve the quality of Health care provided to children in order to significantly reduce morbidity and mortality due to common childhood diseases among children under five by the full implementation of IMCI
  • To educate communities on home management of diseases and on disease prevention
  • To strengthen health system by ensuring that policies pertaining to child health are in place.


  • Developed a strategic plan
  • Trained nurses on IMCI; at least there is one person in each facility trained.
  • Sensitized Community Caregivers on home management of childhood illnesses.
  • Developed guidelines on management of children’s diseases
  • All regions have T.O.T to ease the pressure of national office having to train.
  • Oriented nurse managers on IMCI to strengthen supportive supervision.
  • Developed IEC take home messages for caregivers.
  • Procured essential equipments to revive ORT corners.


  • Finalize and launch the strategic plan.
  • Continue training of all service providers in IMCI

Programme Manager Maria Dlamini
Tel: +268 2404 4295

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