By Onnik Krikorian/UNICEF Armenia

Eighteen days after his birth, Hovik was breathing so rapidly that his alarmed mother rushed to get medical attention. With a temperature of 38.5 degrees centigrade, the doctor diagnosed pneumonia. Hovik, now two years old, was saved, thanks to the swift action of his mother, quick diagnosis and rapid treatment.

A few years ago, however, the story might have been very different. Hovik might well have lost his fight for life.

When Armenia declared its independence in 1991, few realised that spending on social services – particularly on health – was about to slump. Infant mortality soared in the post-Soviet Republic, which was still suffering from the devastation of earthquake and war.

Alarm bells first rang in 1998, when official statistics found that one third of the children who died from pneumonia in Armenia did not receive any treatment in the 24 hours before their death. And in 2001, according to the Armenian Ministry of Health, over 20 per cent of infant deaths occurred at home or on the way to hospital.

UNICEF and WHO leapt into action, pushing and supporting the introduction of Integrated Management of Childhood Illnesses (IMCI) in Armenia. IMCI aims to give parents life-saving information that will help them detect the early signs of child illness and take immediate action. It aims to give health workers the skills they need for accurate diagnosis and effective treatment.

After orientation meetings between UNICEF, WHO and the Government October 1999, training for IMCI began in May 2001 in Ijevan region of Armenia. The following year, additional training was carried out in Martuni, a district situated in Armenia's north eastern Gegharkunik region which had, until recently, one of the highest rates of infant mortality in the country.

"This is a highland region," says Dr. Lena Hovannisian, Senior Pediatrician and Deputy Director of the Polyclinic in Martuni. "The winters are very harsh and last seven or eight months. There is no industry and living conditions are very poor."

By consulting a chart that conforms to international standards and is adapted for use in Armenia, nurses can now identify the most common symptoms of illnesses to which children under the age of five are prone and can respond to their immediate needs.

"First the nurse checks if any symptoms are listed in the red section of the chart because these are the serious problems," explains Hovannisian. "Then they check the yellow section which lists conditions that can be treated without hospitalization if the proper medicines are prescribed. Finally, symptoms that can be treated at home without medicines are listed in green."

© UNICEF/Armenia/O.Krikorian
Parents participating in one of the parent education classes on IMCI in a policlinic in a village of Zorakar, 2 km of Martuni.

The programme aims to raise awareness on child care and common childhood illnesses among parents themselves -- especially in a region where conservative traditions still play an important role in family life. In the past, some mothers would seek medical treatment only upon the advice of other family members rather than on the recommendation of trained medical professionals.

Now, mothers feel empowered enough to make decisions based on all that they have learned from IMCI.

"Before the programme, mothers would take up our time with questions and concerns but now they know how to treat their children if they display minor and less serious symptoms," says Karine Grigorian, a District Pediatrician and Trainer for IMCI.

"Medical personnel are now very self-confident and competent," adds Dr. Hovannisian, "The number of unnecessary hospitalizations has even decreased because nurses can identify if and when it's possible to treat a child at home."

There have been other improvements as well. For example, the number of children suffering from acute dehydration has fallen dramatically. According to Hovannisian, this is almost entirely due to the introduction of Oral Rehydration Salt (ORS).

"If you visited a hospital a few years ago, you would see about ten children suffering from dehydration. Now, thanks to IMCI and ORS, it's unlikely that you'll see any. The introduction of ORS was really a revolution."

"Before the programme there were many serious cases here," agrees Karine Manoukian, a nurse in the village of Zorakar on the outskirts of Martuni.

"So serious was one case of dehydration in a three-year-old that the girl's parents thought that she would die. By chance, we ran into the parents and thanks to IMCI, could administer the correct treatment in time."

But IMCI has also resulted in other less visible achievements.

"Another change has been that for many years we were unable to expand our knowledge and acquire new skills," says Manoukian. "IMCI has helped us upgrade both our knowledge and skills as well as encourage our own professional growth. Now we feel like real pediatricians."

For more information:
Emil Sahakyan, 
Communication Officer,

UNICEF Armenia

Tel: (374 1) 523-546,