1. IMNCI : Integrated Management of Neonatal & Childhood Illness
Developed as a strategy by WHO-UNICEF in 1999 to target the five major childhood illnesses of ARI, Diarrhoea, Measles, Malaria & Malnutrition.
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
Proportion of Global Burden of Selected Diseases
Distribution of 10.5 Million Deaths Among Children Less clinical signs provide sufficient information to guide rational & effective actions Borne by Children Under 5 Years ( 2000)
Than 5 Years Old in All Developing Countries, 1999
RATIONALE FOR INTEGRATED EVIDENCE-BASED SYNDROMIC APPROACH
The Integrated Case Management Process
The Integrated Case Management Process  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 OUTPATIENT HEALTH
Less than
OUTPATIENT HEALTH
FACILITY
may be neither possible nor appropriate. FACILITY
2 Months
2 Months to 5 Years
CHECK FOR POSSIBLE
 Treatment of childhood illness may also be complicated by the need to combine CHECK FOR DANGER SIGNS
? Convulsions
BACTERIAL INFECTION
therapy for several conditions. ? Lethargy
? Inability to Drink/Breastfeed
? Vomiting
ASSESS THE SYMPTOMS
? DIARRHOEA
PRINCIPLES OF INTEGRATED CARE ASSESS THE SYMPTOMS
? Diarrhoea
o Case management procedures based on two age categories:
? Cough/Difficulty in Breath
CHECK FOR FEEDING ? Fever
PROBLEM OR ? Ear Problem
MALNUTRITION &
IMMUNIZATION STATUS  Young infants age up to 2 months
CHECK FOR OTHER
 Children age 2 months up to 5 years ASSESS NUTRITION &
IMMUNIZATION STATUS &
POTENTIAL FEEDING
PROBLEMS
o Encompasses all aspects of Preventive, Curative & Child development strategies PROBLEM
CLASSIFY CONDITIONS & o Clinical guidelines developed for standardized integrated approach CHECK FOR OTHER
IDENTIFY TREATMENT PROBLEMS
ACTIONS o Continuum of care provided with community involvement
o Assess-Identify-Classify-Treat-Council-Followup CLASSIFY CONDITIONS &
IDENTIFY TREATMENT
ACTIONS
PINK YELLOW GREEN
Urgent
referral
Treatment at
Outpatient Health
Home Mgt
STRATEGY
Facility
OUTPATIENT
HEALTH
HOME
Caretakers is
Improving Case Management Skills of Health Care Staff (health-worker component) PINK
Urgent referral
YELLOW GREEN
counseled how to Treatment at Home Mgt
Improving overall Health Systems (health-service component)
FACILITY
? Pre- OUTPATIENT HEALTH ? Give Oral Drugs Outpatient Health
referral FACILITY ? Treat local
? Treat Local Infection infections OUTPATIENT
Facility
Treatment
? Advise
Parents
? Refer
? Give Oral Drugs
? Advise and teach
caretakers
? Continue exclusive
breastfeeding
? Keep the Young
Improving Family and Community Health Practices (community component) HEALTH FACILITY
? Pre-referral
Treatment
HOME
Caretakers is
counseled how to
? Follow-up OUTPATIENT HEALTH ? Give Oral Drugs
Young Infant warm ? Advise Parents FACILITY ? Treat local
Infants ? When to return ? Refer Child ? Treat Local Infection infections at home
immediately
? Give Oral Drugs ? Continue
? Follow-up
FEATURES IMCI IMNCI ? Advise and teach
caretakers
breastfeeding
? When to return
? Follow-up immediately
? Follow-up
PINK Coverage of 0 -6 Days No Yes PINK
Urgent Urgent referral
referral
Basic Health Care Module No Yes REFERRAL FACILITY
REFERRAL ? Emergency Triage
FACILITY & Trial
? Emergency ? Diagnosis
Triage & Trial ? Treatment
? Diagnosis Home Visit Module / Home Based Training No Yes ? Follow-up
? Treatment
? Follow-up
Duration of Training on Newborn Vs Young Infants 2 of 11 Days 4 of 8 Days
IMNCI PLUS: Components of Immunization, Care at Birth & BCC included in IMNCI. F IMNCI: Integration of facility based care package with the IMNCI package