Imnci

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1. INTEGRATED MANAGEMENT FOR NEONATAL AND
CHILDHOOD ILLNESS (IMNCI)

INTRODUCTION
The integrated management for neonatal and childhood illness
concept was developed by WHO and UNICEF as a new strategy. For
the union illnesses management among pediatric population, the, IMNCI
is working controlling of morbidity and mortality rates among
children. It working to the under-five morbidity and mortality in the
developing countries. Through management the health workers are getting
the good-professional training and improving the performance towards child
care.
Integrated management of childhood illness (IMCI) strategy was
developed in mid It is a curative, preventive and promotive strategy aimed
at reducing the death and frequency and severity of illness and disability,
and contributes to improve growth and nutrition of under-five children. This
strategy has been expanded in India to include care at home as well as in
the health facilities and it renamed as integrated management of Neonatal and
Childhood Illness - (IMNCI).
MAJOR COMPONENTS Of THE INTEGRATED: MANAMENT OF
NEONATAL AND CHILPHOO D

ILLNESS (IMNCI)
Components are following
1) Improvement of family and

community practices towards child health care.
2) Provision of essential drugs and their supplies.
3) Betterment of technical skill of health care providers in case of management.

2. 4) Community involvement in health care programmes of children.
5) Equitable distribution of health care facilities and maximum reach out to all
pediatric population.
SERVICE PROVIDED UNDER INTEGRATED MANAGEMENT OF
NEONATAL AND CHILDHOOD ILLNESS
These are following:
 Vaccination services
 Vitamin A' and micro nutrient supplementation
 Breast feeding. Management of ARI,
 Prevention of diarrhea. Prevention of malnutrition.
 Malaria control programmes. Counseling on various health problems

Integrated management of childhood illness is working on preventive and
curative aspect of health among pediatric population.

PRINCIPLES OF INTEGRATED CARE
Principles of integrated care depending on a child's age, various clinical
signs and symptoms differ in their degree of reliability and diagnostic value and
importance. Clinical guidelines focus on neonates, infants as well as children up to 5
years of age. The treatment guidelines have been broadly described under two
age categories.
1) Young infants age up to 2 months.
2) Children age 2 months up to 5 years.
Integrated management of neonatal and childhood illness guidelines age based on
following principles
 Children below 5 years of age, all should be examined for condition when

3. indicates immediate referral or hospitalization.
 Children must be routinely assessed for major symptoms,
nutritional immunization status, feeding problems and other potentials
problems.
 Only a limited number of carefully selected clinical signs are used based
Evidence of their sensitivity and specificity to detect disease.
 Based on the presence of selected clinical signs the child is place
'classification
Classifications are not specific diagnoses but categories that are used to determine
the treatment.
 Classifications are colour coded and suggest referral (pink), treatment in
health facility (yellow) or management at home (green).
 IMNCI-guidelines address most common, but not all pediatric problems.
 A limited numbers of essential drugs are used are takers are actively
involved in the treatment of children.
 Counseling of caretakers about home care including feeding, fluid and
when to return to health facility.
IMNCI CASE MANAGEMENT PROCESS
Steps of case management process are following
1) Assess the young infant/child.
2) Classify the illness.
3) Identify the treatment
4) Treat the young infant/child
5) Counsel the mother
6) Provide follow up care.

4. The ASSESS AND CLASSIFY chart describes how to assess the child,
classify the child’s illnesses and identify treatments. The ASSESS column on the
left side of the chart describes how to take a history and do a physical examination.
You will note the main symptoms and signs found during the examination in the
ASSESS column of the case recording form.
The CLASSIFY column on the ASSESS AND CLASSIFY chart lists clinical
signs of illness and their classifications. Classify means to make a decision about
the severity of the illness. For each of the child’s main symptoms, you will select a
category, or “classification,” that corresponds to the severity of the child’s
illnesses. You will then write your classifications in the CLASSIFY column of the
case recording form.

IDENTIFY TREATMENT
The IDENTIFY TREATMENT column of the ASSESS AND CLASSIFY
chart helps you to quickly identify treatment for the classifications written on your
case recording form. Appropriate treatments are recommended for each
classification. When a child has more than one classification, you must look at
more than one table to find the appropriate treatments. You will write the
treatments identified for each classification on the reverse side of the case
recording form.

TREAT THE CHILD
The IMCI chart titled TREAT THE CHILD shows how to do the treatment
steps identified on the ASSESS AND CLASSIFY chart. TREAT means giving
treatment in clinic, prescribing drugs or other treatments to be given at home, and
also teaching the caretaker how to carry out the treatments.

5. COUNSEL THE MOTHER
Recommendations on feeding, fluids and when to return are given on the
chart titled COUNSEL THE MOTHER . For many sick children, you will assess
feeding and counsel the mother about any feeding problems found. For all sick
children who are going home, you will advise the child’s caretaker about feeding,
fluids and when to return for further care. You will write the results of any feeding
assessment on the bottom of the case recording form. You will record the earliest
date to return for “follow-up” on the reverse side of the case recording form. You
will also advise the mother about her own health.

GIVE FOLLOW-UP CARE
Several treatments in the ASSESS AND CLASSIFY chart include a follow-up
visit. At a follow-up visit you can see if the child is improving on the drug or other
treatment that was prescribed. The GIVE FOLLOW-UP CARE section of the
TREAT THE CHILD chart describes the steps for conducting each type of follow-
up visit. Headings in this section correspond to the child’s previous
classification(s).

6. FOR ALL SICK CHILDREN age 1 week up to 5 years who are
brought to the clinic


ASK THE CHILD’S AGE

IF the child is from 1
week up to 2 months

IF the child is from 2
months up to 5 years
USE THE CHART:
● ASSESS, CLASSIFY AND
TREAT THE SICK
YOUNG INFANT

USE THE CHARTS:
● ASSESS AND CLASSIFY THE
SICK CHILD
● TREAT THE CHILD
● COUNSEL THE MOTHER

SELECTING THE APPROPRIATE CASE
MANAGEMENT CHARTS

7. For all sick children age 1 week up to 5 years who are brought to a first-level health
facility
ASSESS the child: Check for danger signs (or possible bacterial infection). Ask
about main symptoms. If a main symptom is reported, assess further. Check
nutrition and immunization status. Check for other problems.
CLASSIFY the child’s illnesses: Use a colour-coded triage system to classify the
child’s main symptoms and his or her nutrition or feeding status.
IF URGENT REFERRAL is
needed and possible
IF NO URGENT REFERRAL
is needed or possible
IDENTIFY URGENT
PRE-REFERRAL
TREATMENT(S) needed for the
child’s classifications.
TREAT THE CHILD: Give
urgent pre-referral treatment(s)
needed.

IDENTIFY URGENT
PRE-REFERRAL
TREATMENT(S) needed for the
child’s classifications.
REFER THE CHILD: Explain to
the child’s caretaker the need for
referral. Calm the caretaker’s fears
and help resolve any problems. Write
a referral note. Give instructions and
supplies needed to care for the child
on the way to the hospital.
IDENTIFY TREATMENT needed
for the child’s classifications: Identify
specific medical treatments and/or
advice.
TREAT THE CHILD: Give the first
dose of oral drugs in the clinic and/or
advise the child’s caretaker. Teach the
caretaker how to give oral drugs and how
to treat local infections at home.
If needed, give immunizations.
COUNSEL THE MOTHER: Assess the
child’s feeding, including breastfeeding
practices, and solve feeding problems, if
present. Advise about feeding and fluids
during illness and about when to return to
a health facility. Counsel the mother
about her own health.
FOLLOW-UP care: Give follow-up care when the child returns to the clinic and, if
necessary, reassess the child for new problems.
SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS

8. INTEGRATED MANAGEMENT OF NEONATAL AND
CHILDHOOD ILLNESS ( IMNCI): SKILL ASSESSMENT OF
HEALTH AND INTEGRATED CHILD DEVELOPMENT
SCHEME (ICDS) WORKERS TO CLASSIFY SICK UNDER -FIVE
CHILDREN
Shewade HD, Aggarwal AK, Bharti B. Indian J Pediatr. 2012
Source
School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh,
India, [email protected].
Abstract
OBJECTIVE:
To assess the skills (diagnostic/counseling) of Integrated Management of Neonatal and
Childhood Illness (IMNCI) trained workers; and to assess the degree of agreement between the
physician and the IMNCI trained workers of Raipurrani block, district Panchkula, India, to
classify sick under-five children in field.
METHODS:
The cross-sectional study was conducted in Raipurrani in the outpatient departments of the
community health centre and one primary health centre in 2010. Workers from health department
and Integrated Child Development Scheme (ICDS) were assessed in this study. They
receivedIMNCI training in 2006, with 1 day refresher training in 2009. Investigator noted his
observations using a skill assessment checklist. Under-five child observations were the unit of
study.
RESULTS:
Sixteen IMNCI trained workers made 128 child observations. Considering color-coded
categorization under IMNCI, agreement with investigator (Kappa) was intermediate; red and
yellow categorizations had poor agreement. Morbidity-wise agreement (Kappa) was poor for
possible serious bacterial infection, feeding problem, respiratory problem and anemia.
Considering final diagnosis, investigator and IMNCI trained worker completely agreed in 45 %
child observations. All symptoms were asked only in 15 %. Skills were poor overall for young
infants. For children between 2 mo to 5 y, danger signs, neck stiffness, edema, wasting and
pallor were checked in <40 % observations. Immunization card was asked for in 20 %
observations. IMNCI trained workers performed well in all aspects of counseling, except follow
up.
CONCLUSIONS:
Training without effective implementation plans will not result in long term skill retention.

9. STUDY COMPARING THE MANAGEMENT DECISIONS
BY IMNCI ALGORITHM AND PEDIATRICIANS IN A
TEACHING HOSPITAL FOR THE YOUNG INFANTS
BETWEEN 0 TO 2 MONTHS
Bhattacharyya A, Saha SK, Ghosh P, Chatterjee C, Dasgupta S. Indian J Public
Health. 2011
Source
Department of Community Medicine, Bankura Sammilani Medical College,
India. [email protected]

Abstract
Integrated management of neonatal and childhood illness (IMNCI) was already
operational in many states of India, but there were very few studies in Indian
scenario comparing its validity and reliability with the decisions of pediatricians.
The general objective of the study is to compare the IMNCIdecisions with the
decisions of pediatricians and the specific objectives are to assess the agreement
between IMNCI decisions and the decisions of pediatricians, to assess the under
diagnosis and over diagnosis in IMNCI algorithm in comparison to the decisions of
pediatricians and to assess the significance of multiple presenting symptoms
in IMNCI algorithm. The study was conducted among the sick young infants
presenting in pediatric department from January to March 2009.
The IMNCI decision was compared with pediatrician's decisions by percent
agreement, Kappa and weighted Kappa with the aids of SPSS version 10. The
overall diagnostic agreement between IMNCI algorithm and pediatrician's
decisions was 55.56%, (Kappa 0.32 and weighted Kappa 0.41) with 33.33% over
diagnosis, and 11.11% under diagnosis. 71.88% young infants with multiple
symptoms and 40% with single symptom were classified as red
by IMNCI algorithm, which is statistically significant (P=0.004) whereas 56.25%
young infants with multiple and 31.76% with single symptom were considered
admissible by pediatricians, which is not statistically significant (P=0.052).

10. BIBLIOGRAPHY

BOOK REFERENCE

 A Textbook of Child Health Nursing, Manoj Yadav, PV Publications, 1
st

Edition,
 Textbook of pediatric Nursing, Dorothy R Marlow, Elsevier Publication,6
th

Editions,
 Essentials of Pediatric Nursing, wongs , Elsevier Publication,7
th
Editions,
 Textbook of of pediatric Nursing, Beevi, Elsevier Publication,1
st
Edition,
 Essentials of Pediatric Nursing, Piyush Gupta, CBS Publication, 2
nd
edition,

JOURNAL REFERENCE
 http://www.ncbi.nlm.nih.gov/pubmed/22878929
 http://www.ncbi.nlm.nih.gov/pubmed/22298145

WEB REFERENCE

 http://www.unicef.org/india/health_6725.htm
 http://202.71.128.172/nihfw/nchrc/index.php?q=taxonomy/term/1192/all
 https://www.google.co.in/#hl=en&output=search&sclient=psy-
ab&q=Integrated+Management+of+Neonatal+and+Childhood+Illness&oq=Int
egrated+Management+of+Neonatal+and+Childhood+Illness