more than 16 years of experience with case management of diarrheal diseases, primarily by oral rehydration therapy, and more than 7 years of research on, and program management of, acute respiratory infections (ARI). The major purpose of the SCI is to train primary health care providers to diagnose diseases and prescribe the appropriate treatment at the health center level, or to refer cases with complications immediately to a district hospital. As such, the SCI is not intended to be the main program or substitute for existing preventive and community health and nutrition activities. Research and development activities of the SCI, coordinated at WHO by the Division of Diarrhoeal and Acute Respiratory Disease Control (CDR), are called the Integrated Management of Child Illness (IMCI). A number of other institutions and individuals—including, for example, UNICEF, USAID, and the U.S. Centers for Disease Control and Prevention (CDC)—are collaborating in these activities.
According to the SCI, the sick child is assessed initially through a limited range of questions and observation of easily recognized symptoms. The child's nutritional and immunization status are recorded, and immunization is given if needed. The child's condition is classified according to disease grouping and severity guidelines, which are used as a basis for treatment and possible referral to a hospital or other higher-level care if the illness or condition is of sufficient severity. The final step is to give the mother advice on follow-up care.
Support for an integrated approach to the management of childhood illness was given further impetus by the estimation of the World Development Report 1993: Investing in Health (World Bank, 1993, p. 77), that the SCI could potentially prevent up to half of deaths in low-income countries, because there is a high fatality rate from common childhood diseases among malnourished children (Pelletier et al., 1993). In addition, the World Development Report 1993 considered integrated management of childhood illnesses to be one of the most cost-effective health interventions and recommended that SCI be given a high priority in countries with child mortality rates of more than 30 deaths per 1,000 children under the age of 5 (World Bank, 1993, p. 114).
The charge from USAID was as follows:
Drawing on the scientific and technical knowledge of individual members, background information and other pertinent data, the Committee is requested to make recommendations as to: (1) practicality of the nutrition components of the (SCI) algorithm; (2) whether the nutrition components of the algorithm should or should not be modified, and if to be modified, how; and (3) the additional information or data required to improve the performance of the integrated management of childhood illness algorithm's nutritional effectiveness [see Appendix A].