Slide imnci neonatal

for all

1. Presented by sanjeev shrivas Msc nursing 1 st year maitri college of nursing

2. INTRODUCTION IMNCI is an integrated approach to child health that focuses on the well-being of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMNCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities

3. Different between imnci and imci Features WHO – UNICEF IMCI IMNCI Coverage of 0 to 6 days (early newborn period) Basic Health Care Module Home visit by the provider for newborn and Young Infant Training Home based Care Sequence of training No   NO   NO   NO Child (2 months to 5 years of age) then Young infant ( 7 days to 2 months of age) YES   YES   YES   YES   Newborn and young infants(0 to 2 months).Then Child (from 2 months to 5 years of age.)

4. MAJOR ADAPTATIONS The entire 0-5 year period covered including the first week of life 50% of training time for management of young infants (0-2 months) The order of training reversed; now begins with management of young infants Reduced training duration (8 days), separate training materials for physicians & health workers • Management now consistent with current policies of the Ministry of health worker & family welfare. Home-based care of young infants by health workers added Potential of the adapted IMNCI Package

5. Guideline for imnci Evidence-based, syndromic approach to case management includes rational, effective and affordable use of drugs and diagnostic tools . An evidence-based syndromic approach can be used to determine the : • Health problem(s) the child may have. • Severity of the child’s condition, • Actions that can be taken to care for the child (e.g. refer the child immediately, manage with available resources, or manage at home). In addition, IMNCI promotes: • Adjustment of interventions to the capacity of the health system, and • Active involvement of family members and the community in the health care process.

6. PRINCIPLES • All sick young infants up to 2 months of age must be assessed for “possible bacterial infection / jaundice”. Then they must be routinely assessed for the major symptom “ diarrhoea ”. • All sick children age 2 months up to 5 years must be examined for “general danger signs” which indicate the need for immediate referral or admission to a hospital. They must then be routinely assessed for major symptoms: cough or difficult breathing, diarrhoea , fever and ear problems. • All sick young infants and children 2 months up to 5 years must also be routinely assessed for nutritional and immunization status, feeding problems, and other potential problems.

7. A combination of individual signs leads to a child's classification(s) rather than diagnosis. - needs urgent hospital referral or admission ( classifies as and colour coded pink) - needs specific medical Rx or advice (classified as and colour coded yellow) 3 - can be managed at home (classified as and colour coded green) • IMNCI use a limited number of essential drugs and encourage active participation of caretakers in the treatment. • IMNCI address most, but not all, of the major reasons a sick child is brought to a clinic. • One of essential component of IMNCI is the counselling of caretakers about home care,feeding,fluids and when to return to health facility.

8. GOALS OF IMNCI • Standardized case management of sick newborns and children • Focus on the most common causes of mortality • Nutrition assessment and counselling for all sick infants and children • Home care for newborns to – promote exclusive breastfeeding – prevent hypothermia – improve illness recognition & timely care seeking

9. ELEMENTS OF CASE MANAGEMENT PROCESS • Assess - Child by checking for danger signs by history and examination. • Classify - Child's illness by color coded triage system. • Identify - Specific treatments. • Treatments- Instructions of oral drugs, feeding & fluids. • Counsel - Mother about breast feeding & about her own health as well as to follow further instructions on further child care. • Follow up care - Reassess the child for new problems.

10. IMPROVING HEALTH & NUTRITION WORKER SKILLS Guidelines for management of sick newborns and children with serious disease in first referral facilities Training course for doctors for outpatient management of sick young infants and children Training course for health and nutrition workers for: Management of sick young infants and children Home visits for young infants Improving health & nutrition worker skills Attention to counselling skills to promote exclusive breastfeeding, complementary feeding & micronutrient supplementation is a key strength of IMNCI

11. HOME VISITS FOR YOUNG INFANTS : Objectives • Promote & support exclusive breastfeeding • Teach the mother how to keep the young infant warm • Teach the mother to recognize signs of illness for which to seek care • Identify illness at visit and facilitate referral • Give advise on cord care and hand washing All newborns: 3 visits (within 24 hours of birth, day 3-4 and day 7-10) Newborns with low birth weight: 3 more visits on day 14, 21 and 28. Home visits for young infants: Schedule

12. COLOUR CODED CASE MANAGEMENT STRATEGY PINK CLASSIFICATION: Child needs inpatient care YELLOW CLASSIFICATION: Child needs specific treatment, provide it at home (e.g. antibiotics, anti-malarial, ORS) GREEN CLASSIFICATION: Child needs no medicine, advise home care

13. OTHER INNOVATIONS IN CASE ASSESSMENT Visible severe wasting as indicator for hospital admission rather than weight for age Palmer pallor to detect anaemia Breast feeding assessment: attachment and suckling Innovations in therapy -Single daily dose gentamycin - Counselling the mother to give oral drugs at home -Clear recommendations for follow up -Negotiated feeding counselling

14. STRENGTHS OF IMNCI TRAINING Evidence based decision making tree Hands-on clinical practice for 50% of training time Focus on communication & counseling skills Locally adapted recommendations for infant and young child feeding

15. CHALLENGES • Feasibility of the proposed hands-on clinical practice in management of young infants at district level • Feasibility of provision of health care at subcentre and village level by ANMs and Anganwadi Workers • Making the home-based care of young infants by ANMs and anganwadi workers operational • Improving logistics and supplies

16. THANK YOU