NOTHING

1. INTEGRATED MANAGEMENT OF
NEONATAL AND CHILDHOOD
ILLNESS
DR RAJWALI KHAN
MBBS FCPS
MRCP
DISTRICT PUBLIC HEALTH COORDINATOR

2. LEARNING OUTCOMES
• At the end of this lecture the student will be able to:
• Describe the background, objective, component, and principle of
IMNCI.
• State the Family and community practices that promote child survival,
growth, and development.
• Summarize the importance of its application

3. KEY FACTS
• 5.6 million children under age five died in 2016, 15,000 every day.
• 7 in 10 of these deaths are due to the 5 major killers of children: Acute
respiratory infections (mostly pneumonia), diarrhea, measles, malaria, and
malnutrition- and often to a combination of these conditions.
• About 45% of all child deaths are linked to malnutrition.
• More than half of these early child deaths are due to conditions that could
be prevented or treated with access to simple, affordable interventions.
(WHO)

4. CONT;
• Most child deaths (and 70% in developing countries) result from one
or more of the following five causes:

6. Rational For an Evidence Base Syndromic
Approach To Case Management
• Prevention and treatment strategies proven effective for saving young
lives such as
Childhood vaccinations reduced deaths due to measles.
ORS reduction in diarrhea deaths.
Effective antibiotics have saved millions of children with pneumonia.
Prompt treatment of malaria and breastfeeding practices have
reduced childhood deaths.

7. CONT;
• A single diagnosis may not be appropriate. Treatment needs to combine
therapy for several conditions.
• A more integrated approach to managing sick children is needed to achieve
better outcomes
• Child health programmes need to move beyond addressing single diseases
to addressing the overall health and well-being of the child.
• While each of these interventions has shown great success, accumulating
evidence suggests.
• Because many children present with overlapping signs and symptoms of
diseases, a single diagnosis can be difficult, and may not be feasible or
appropriate. This is especially true for first-level health facilities where
examinations involve few instruments, little or no laboratory tests, and no x
ray

8. CONT,
• During the mid-1990s, (WHO), in collaboration with UNICEF and many
other agencies, institutions, and individuals, responded to this
challenge by developing an Integrated Management of Childhood
Illness (IMNCI) strategy.
• Major reason for developing the IMNCI strategy is not only the needs
of curative care, the strategy also addresses aspects of nutrition,
immunization, and other important elements of disease prevention
and health promotion.

9. What is IMNCI?
• 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
facilitators.

11. The objectives
• To reduce death and the frequency and severity
• of illness and disability among children under five years of age.
• To improved growth and development among children under five
years of age.
• Parents, if correctly informed and counselled, can play an important
role in improving the health status of their children by following the
advice given by a health care provider.
• By applying appropriate feeding practices .
• By bringing sick children to a doctor as soon as symptoms arise.

12. Components of the integrated approach
improving the case management skills of health workers through the
provision of clinical guidelines on the integrated management of childhood
illness, adapted to the local context, and training to promote their use;
Improving the health system by ensuring the availability of essential drugs
and other supplies improving the organization of work at the health facility
level improving monitoring and supervision;
improving family and community practice through the education of
mothers, fathers, other caregivers, and members of the community, with a
focus on health-seeking behavior, compliance, care at home, and overall
health promotion.

13. Family and community practices that promote
child survival, growth and development
• Exclusive breastfeeding
• Complementary feeding
• Micronutrients
• Hygiene
• Immunization
• Malaria: use of bed nets
• Antenatal care
• Home care for illness
• Parents, if correctly informed and counseled, can play an important role in
improving the health status of their children by following the advice given by a
healthcare provider. By applying appropriate feeding practices.By bringing sick
children to a doctor as soon as symptoms arise.

14. The principles of integrated care
• All sick children must be examined for “general
danger signs” which indicate the need for immediate referral or
admission to a hospital.
• All sick children must be routinely assessed
for major symptoms
• Children aaged2 months up to 5 years: cough or difficulty breathing,
diarrhea, fever, ear problems;
• Young infants aged up to 2 months: bacterial infection, jaundice, and
diarrhea)

15. •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 problem

16. CONT;
• Only a limited number of carefully selected clinical signs are used , based
on evidence of their sensitivity and specificity to detect disease.
• A combination of individual signs leads to a child’s classification(s) rather
than a diagnosis.
• Classification(s) indicate the severity of condition(s). They call for specific
actions based on whether the child
• (a) should be urgently referred to another level of care,
• (b) requires specific treatments ( antibiotic/antimalarial
• treatment),
• (c) may be safely managed at home.

17. Cont;
• The classifications are colour coded:
• “red suggests hospital referral or admission,
• “yellow” indicates initiation of treatment,
• “green” calls for home treatment

18. •The IMNCI guidelines address most, but not
all, of the major reasons a sick infant or
child is brought to a clinic such as an infant
or child returning with chronic problems or
less common illnesses, the management of
trauma or other acute emergencies due to
accidents or injuries, care at birth .

19. CONT
• ;
• IMNCI management procedures use a limited number of essential
drugs and encourage active participation of caretakers in the
treatment of infants and children.
• Guidelines to counsel the caretakers about home care, including
counseling about feeding, fluids and when to return to a health
facility.
• "those drugs that satisfy the health care needs of the majority of the
population; they should therefore be available at all times in
adequate amounts and in appropriate dosage forms, at a price the
community can afford."

20. Where should IMNCI be applied ?
• IMNCI should be applied
• 1st level health facilities (clinics, rural and urban health centers, MCH
centers),
• outpatient departments of hospitals

21. AGE GROUPS COVERED BY IMCI
•
Birth up to 5 years.
• The case management process is presented in 2 different
sets of charts:
• 1. A set for children aged 2 months up to 5 years (up to 5
years means that the child has NOT yet reached his or her
5th birthday. For example a child who is 4 years 11
months but not a child who is 5 years old). This set is
presented on 3 charts titled: ASSESS AND CLASSIFY THE
SICK CHILD TREAT THE CHILD and COUNSEL THE MOTHER

22. • 2 . A set for young infants age up to 2 months (up to 2 months means
that the infant is NOT yet 2 months of age. An infant who is 2 months
old would be included in the group 2 months up to 5 years). This set is
presented on a chart titled:
• ASSESS, CLASSIFY AND
TREAT THE SICK YOUNG INFANT

23. WHY NOT TO USE IMNCI FOR CHILDREN AGE
5 YEARS OR MORE?
•
Much of the treatment advice in IMNCI may be helpful for a child
aged 5 years or more. However, because of differences in the clinical
signs of older and younger children who have these illnesses, the
assessment, and classification process, using these clinical signs, is
not recommended for older children

27. •
• THANK YOU