IMNCI

1. INTRODUCTION Improvements in child health are not necessarily dependent on the use of sophisticated and expensive technologies An integrated approach is needed to manage sick children & Child health programmes need to move beyond tackling single diseases for the overall health & well-being of the child Careful & systematic assessment of common symptoms & well selected specific clinical signs provide sufficient information to guide rational & effective actions IMNCI : Integrated Management of Neonatal & Childhood Illness Proportion of Global Burden of Selected Diseases Borne by Children Under 5 Years ( 2000) Distribution of 10.5 Million Deaths Among Children Less Than 5 Years Old in All Developing Countries, 1999 PRINCIPLES OF INTEGRATED CARE Case management procedures based on two age categories: Young infants age up to 2 months Children age 2 months up to 5 years Encompasses all aspects of Preventive, Curative & Child development strategies Clinical guidelines developed for standardized integrated approach Continuum of care provided with community involvement Assess-Identify-Classify-Treat-Council- Followup The Integrated Case Management Process OUTPATIENT HEALTH FACILITY CHECK FOR POSSIBLE BACTERIAL INFECTION ASSESS THE SYMPTOMS ? DIARRHOEA CHECK FOR FEEDING PROBLEM OR MALNUTRITION & IMMUNIZATION STATUS CHECK FOR OTHER PROBLEMS CLASSIFY CONDITIONS & IDENTIFY TREATMENT ACTIONS PINK Urgent referral OUTPATIENT HEALTH FACILITY ? Pre-referral Treatment ? Advise Parents ? Refer Young Infants YELLOW Treatment at Outpatient Health Facility OUTPATIENT HEALTH FACILITY ? Treat Local Infection ? Give Oral Drugs ? Advise and teach caretakers ? Follow-up GREEN Home Mgt HOME Caretakers is counseled how to ? Give Oral Drugs ? Treat local infections ? Continue exclusive breastfeeding ? Keep the Young Infant warm ? When to return immediately ? Follow-up PINK Urgent referral REFERRAL FACILITY ? Emergency Triage & Trial ? Diagnosis ? Treatment ? Follow-up The Integrated Case Management Process OUTPATIENT HEALTH FACILITY CHECK FOR DANGER SIGNS ? Convulsions ? Lethargy ? Inability to Drink/Breastfeed ? Vomiting ASSESS THE SYMPTOMS ? Diarrhoea ? Cough/Difficulty in Breath ? Fever ? Ear Problem ASSESS NUTRITION & IMMUNIZATION STATUS & POTENTIAL FEEDING PROBLEM CHECK FOR OTHER PROBLEMS CLASSIFY CONDITIONS & IDENTIFY TREATMENT ACTIONS PINK Urgent referral OUTPATIENT HEALTH FACILITY ? Pre-referral Treatment ? Advise Parents ? Refer Child YELLOW Treatment at Outpatient Health Facility OUTPATIENT HEALTH FACILITY ? Treat Local Infection ? Give Oral Drugs ? Advise and teach caretakers ? Follow-up GREEN Home Mgt HOME Caretakers is counseled how to ? Give Oral Drugs ? Treat local infections at home ? Continue breastfeeding ? When to return immediately ? Follow-up PINK Urgent referral REFERRAL FACILITY ? Emergency Triage & Trial ? Diagnosis ? Treatment ? Follow-up RATIONALE FOR INTEGRATED EVIDENCE-BASED SYNDROMIC APPROACH Most sick children present with signs & symptoms related to more than one of the five major diseases mentioned & this overlap means that a single diagnosis may be neither possible nor appropriate. Treatment of childhood illness may also be complicated by the need to combine therapy for several conditions. Developed as a strategy by WHO-UNICEF in 1999 to target the five major childhood illnesses of ARI, Diarrhoea , Measles, Malaria & Malnutrition. FEATURES IMCI IMNCI Coverage of 0 -6 Days No Yes Basic Health Care Module No Yes Home Visit Module / Home Based Training No Yes Duration of Training on Newborn Vs Young Infants 2 of 11 Days 4 of 8 Days Less than 2 Months 2 Months to 5 Years IMNCI PLUS : Components of Immunization, Care at Birth & BCC included in IMNCI. F IMNCI : Integration of facility based care package with the IMNCI package STRATEGY Improving Case Management Skills of Health Care Staff (health-worker component) Improving overall Health Systems (health-service component) Improving Family and Community Health Practices (community component)