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 DiseasesDistribution 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 DaysIMNCI PLUS: Components of Immunization, Care at Birth & BCC included in IMNCI. F IMNCI: Integration of facility based care package with the IMNCI package
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