IMNCI - Intregrated Management of Neonatal and childhood illness

Under the Guidance of our HOD
Asso: Prof Mrs Deepa Danieal

2. DEFINITION:
IMNCI is an integrated approach to child health that
focuses on the well being of the whole child. It
focussed primarily on the most common causes of
child mortality-diarrhea, pneumonia, measles,
malaria, and malnutrition, illness affecting children
aged 1 week – 2 months, 2 months -5 year including
both preventive and curative elements to be
implemented by families.

3. Beneficiaries of IMNCI

*care of young infants for new borns(under 2months)
*young children(2months-5yrs)

4. GOAL

To assess current statues of child survival
indicators and process indicators for
existing programme activities in
intervention and compassion districts.

5. OBJECTIVES
*To determine baseline mortality among
children under 5yrs of age(NMR,IMR,USMR)
*To determine prevalence of fever,loose stools,cough
and any other illness(morbidity density)in two
weeks prior to day of field survey among children
under 5yrs of age.
*To assess effective programme coverage for specified
disease condition(cough with fast
breathing)occuring in two weeks prior to day of
field survey

6. *Causes of under 5 mortality and path way analysis of
events prior to death and recovery of sick under 5
children
*Sickness management practices at house
hold,community level and health facility level.
*Sickness and care providing competencis of health care
providers(doctors,health workers and other
community level non convectional service providers)
*Health system support for man power,legistics,referal
mechanism,intersectoral coordination,social
moliblisation and monitoring and supervision.

7. COMPONENTS
*HEALTH WORKER COMPONENT
Case management skills
*HEALTH SERVICE COMPONENT
Improvement in overall health
*COMMUNITY COMPONENT
Improvements in family and community health care
practices

8. IMPLEMENTATION OF IMNCI
*adopting an integrated approach to child health and
development in the national health policy.
*adapting the IMNCI clinical guidelines to countries
needs, available drugs, policies and to the local foods
and language used by the population.
*up grading care in local clinics by training health workers
in new method examine and treat children and to
effectively council parents.
*making up grade care possible by insuring that enough
of the right low-cost medicines and simple equipment
are available.

9. *strengthening care in hospitals for those children too
sick to be treated in an out patient clinic
*developing support mechanism within communities
for preventing disease,for helping families to care for
sick children and for getting children to clinics or
hospitals when needed.

10. PRINCIPLES
*All sick young infants upto two months must be assessed
for baerial infection/jaundice and major symptoms of
diarrhea
*all sick children 2months to 5yrs must examine for general
danger signs which indicate the need for referral or
admission to a hospital
*all young infants and child 2months-5yrs of age must be
routinely assessed for nutritional and immunisation
status,feeding problems and other potential problems

11. *Only a limited number of care fully selected clinical
signs are used based on evidence of drugs sensitivity
and specificity to detect disease.
*A combination of individual signs leads to an infants
or childs classification rather than diagnosis.

12. CLASSIFICATION ACCORDING TO COLOR
CODE
COLOR
*pink
*yellow
*green
CLASSIFICATION
Hospital referral or admission
Initiation of special treatment
Home management

13. TRAINING IN IMNCI
Training is at 2 levels
*Inservice training for the existing staff
*Pre service training

14. CARE OF CHILDREN ACCORDING
TO IMNCI
0-2 MONTHS
*keeping the child warm
*intiation of breast feeding.
*counselling for exclusive breast feeding.
*cord,skin and eye care.
*recognition of illness in newborn and management
and/referral.
*immunisation
*home visit in the post natal period.

15. 2MONTHS-5YRS
*management of diarrhea,ARI,malaria,measels,acute
ear infecton,mal nutrition and anemia.
*recognition of illness and risk.
*prevention and management of iron and vitaminA
deficiency
*counselling on feeding for all chilkdren below 2yrs.
*counselling on feeding for malnutrished.
*immunization

16. Assessment of sick young infant
upto 2 months
Possible bacterial infection / jaundice
Does the infant have diarrhea
Feeding problems
Immunization status

17. Checking for bacterial
infection/jaundice

19. IN CASE OF DIARRHEA

20. Checking skin turgor

22. FEEDING PROBLEM

26. TEACHING & COUNSELING
 Teach mother to keep infant warm.
Teach correct position for breast feeding
Advice on home care of young infant
Advice mother to return immediately if danger signs
present

27. Assessment of young child
2 months – 5 years
General danger signs
Ask about main symptoms [coughing/ breathing
difficulty]
 diarrhea
Malnutrion
Anamia
Immunization - prophylactic vit A, iron & folic
acid supplement

28. In case of diarrhea

29. In case of fever

30. MALNUTRITION

31. ANEMIA

32. IMMUNIZATION
AGE VACCINE
Birth BCG , OPV ,Hepatitis
6 WEEKS BCG(if not given). OPV-1,HIB 1, DPT 1
10 WEEKS- POV -2 , DPT 2, HEP B 2
14 WEEKS OPV 3, DPT 3, HEP B 3
9MONTHS MEASLES , VIT A
16- 18 MONTHS DPT, OPV,VIT A

33. Vit A Prophylaxis
 9 months - 1 lakh unit
16 – 36 months - 2 lakh unit

34. TREAT DEHYDRATION - ORS

35. IRON & FOLIC ACID
AGE / WEIGHT PAEDIATRIC TABLET
4-24 MONTHS (6-12 KG) 1 TABLET
2 YRS - 5 YRS ( 12 – 19 KG)2 TABLET
VITAMIN A
6 – 12 MONTHS 1 ML
12 – 5 YRS 2 ML

36. FEEDING RECOMMENDATION
0-6 MONTHS
Breast feed as often as child want
Do not give any other food
Continue breast feeding if child is sick

37. 6 – 12 months
Breast feed as often
Give smashed roti, rice, bread, biscuit, undil: milk
or vegetables
Keep child on your lap
Wash childs hand before feeding

38. 12 – 2 yrs
Breast feed as often
Offer family food
Sit by the side of child
Wash hands with soap

39. > 2 years
Give family food
Ensure that child finishes the serving
Teach child to wash hands

40. CONCLUSION
IMNCI strategy has emerged as a promising approach
to deal with issues related to child survival.
Major strength is it use evidence based management
decisions
This approach could help country to achieve
millenium goal.