Imnci 21

Integrated management of neonatal and childhood illness

1. Ms. Ulfat Amin Ms. Ulfat Amin M.Sc. Pediatric nursing A disease Management Strategy for children

2. Every year 10 million children/ year- die in developing c ou n tr i es . 7-10 deaths are du e t o five preventable & treatable conditions Pneumonia, diarrhea, malaria, measles and malnutrition & often to a combination of these conditions. 3 out of 4 of the s e c h i ld r en su f fer from o n e of the s e five conditions. Ms. Ulfat Amin

3. WHO and UNICEF recognized the need to strengthen child-health activities in the country and decided to launch IMCI . The generic IMCI guidelines were adapted and the Indian version was named Integrated Management of Neonatal and Childhood Illness ( IMNCI )- main intervention under RCH-II/NRHM ,that focuses on preventive , promotive and curative aspects of program Ms. Ulfat Amin

4. IMNCI caters to two groups of children 0-2 months Young infants. 2 months to 5 years Children Ms. Ulfat Amin

5. REDUCE MO R T ALI T Y REDUCE FREQUENCY AND SEVERITY OF ILLNESS AND DISABILITY IMPROVE GROWTH AND DEVE L O P MENT DURING THE FIRST 5 YEARS OF A CHILD'S LIFE Ms. Ulfat Amin

6. Health worker component Improvement in the overall Health System. Improvement in family and community health care practices. Ms. Ulfat Amin

7. Improvements in the case-management skills SKILLED CASE-MANAGEMENT TRAINING GUIDELINES Ms. Ulfat Amin

8. Improvements is needed for effective management E s s e n tial drugs Health w or k e r s Ide n tif i ed referral Swiftly t r an s f er r ed R e f er r al centers Su p e r v i s i o n and monitoring Ms. Ulfat Amin

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10. Principles for sick children Basic principles of child care Key aspect in monitoring Discharge from the hospital Providing follow-up care Ms. Ulfat Amin

11. All sick children under 5 years of age must be examined for conditions which indicate immediate referral or hospitalization . Ms. Ulfat Amin Basic principles of child care

12. Children must be routinely assessed for major symptoms , nutritional and immunization status, feeding problems and other potential problems. Ms. Ulfat Amin

13. Only a limited number of carefully selected clinical signs, are used based on evidence of their sensitivity and specificity to detect disease. Ms. Ulfat Amin

14. Based on the presence of selected clinical signs, the child is placed in a ‘ classifications ’. Classifications are not specific diagnosis but categories that are used to determine the type of recovery plan. R e f er r al Treatment in health facility Management at home Ms. Ulfat Amin

15. IM N C I g uideline s a d d r ess mo s t c ommo n b u t not all pediatric problems. Ms. Ulfat Amin

16. A limited number of essential drugs are used. Ms. Ulfat Amin

17. Care takers are actively involved in the treatment of children. Ms. Ulfat Amin

18. Counselling of caretakers about home care including feeding, fluids and when to return to health facility Ms. Ulfat Amin

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20. IMNCI guidelines recommend standardized case management procedures That are based on two age categories: - Upto 2 months and 2 months to 5 years Ms. Ulfat Amin

21. Care of Newborns and Young Infants (infants under 2 months) Keeping the child warm. Initiation of breastfeeding immediately after birth and counseling for exclusive breastfeeding and non-use of pre lacteal feeds. Cord, skin and eye care. R e c ognitio n of illness i n n e wborn and management and/or referral). Immunization Home visits in the postnatal period. Ms. Ulfat Amin

22. Care of Infants (2 months to 5 years) Management of diarrhea, acute respiratory infections, malaria, measles, acute ear infection, malnutrition and anemia. Recognition of illness and at risk conditions and management/referral) Prevention and management of Iron and Vitamin A deficiency. Counseling on feeding for all children below 2 years Counseling on feeding for malnourished children between 2 to 5 years. Immunization Ms. Ulfat Amin

23. IMNCI CASE MANAGEMENT PROCESS Steps of case management process are the following: Asses the young infant/ child. Classify the illness. Identify the treatment. Treat the young infant/child. Counsel the mother. Provide follow up care. Ms. Ulfat Amin

24. 24 Assess and classify the sick young infant up to 2 months Ms. Ulfat Amin

25. 25 ASK:- Has the infant had convulsions ? LOOK ,LISTEN ,FEEL:- Count the breaths in one minute , repeat the count Look for severe chest indrawing Look for nasal flaring Look and listen for grunting Look and feel bulging fontanelle Look for pus draining from the ear Look at the umbilicus-is it red or draining pus ? Look for skin pustules. Are there 10 or more skin pustules or a big boil Measure axillary temp. See if the young infant is lethargic or unconscious Look at the young infant’s movements. Are they less than normal? Look for jaundice. Are the palms and soles yellow? Ms. Ulfat Amin

26. 21 Ms. Ulfat Amin Sig n s Class i fy as I d e n tify tre a tment Convulsions or Fast breathing(60 breaths per minute or more) Severe chest in-drawing Nasal flaring Grunting Bulging fontanelle 10 or more skin pustules or a big boil If axillary temp>= 37.5 or temp<=35.5 degree celsius Lethargic or unconscious Less than normal movements Possible serious b a c t e r ial infection Give first dose of intramuscular ampicillin and gentamicin Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5°C (or feels cold to touch) while arranging referral Advise mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to hospital.

27. Umbilicus red or draining pus Pus discharge from ear or < 10 skin pustules LOCAL BACTERIAL INFECTION Give oral co- trimoxazole or amoxycillin for 5 days Teach mother to treat local infections at home Follow up in two days Umbilicus red D r aining pus 22 Ms. Ulfat Amin

28. Signs C l ass i fy as Identify t r e a t m ent Palms &soles yellow Age <24hrs or Age >=14 days SEVERE JAUNDICE Treat to prevent low blood sugar . Warm the young infant by skin to skin contact if temperature less than 36.5°C (or feels cold to touch) while arranging referral . Advise mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to hospital Palms& soles not yellow JAUNDICE Advise mother to give home care for the young infant Advise mother when to return immediately Follow up in 2 days 23 Ms. Ulfat Amin

29. Temperature between 35.5- 36.4degree Celsius LOW BODY T E MPER A TURE Warm the young infant by skin contact for 1 hr and REASSESS Treat to prevent low blood sugar 24 Ms. Ulfat Amin

30. Counsel The Mother Advice mother to give home care for the young infant: Food and fluids Breastfeed frequently as often and for as long as the infant wants. Make sure the young infant stays warm at all times. 30 Ms. Ulfat Amin

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32. IMNCI_BOOKLET.pdf Ms. Ulfat Amin

33. ADVANTAGES OF INTEGRATED APPROACH Speeds up the urgent treatment and treatment seeking practices. Prompt recognition of serious condition , hence prompt referral. Involves parents in effective care of baby at home. Partial Success of Individual disease control programme. Ms. Ulfat Amin

34. Co n t…. Involves prevention of diseases by active immunization, Improved nutrition and Exclusive Breastfeeding practices. Highly cost effective . It avoids wastages of resources by using most appropriate medicines and treatment. It reduces duplication of effort. Ms. Ulfat Amin

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