IMNCI - Intregrated Management of Neonatal and childhood illness
DEFINITION:IMNCI is an integrated approach to child health thatfocuses on the well being of the whole child. Itfocussed primarily on the most common causes ofchild mortality-diarrhea, pneumonia, measles,malaria, and malnutrition, illness affecting childrenaged 1 week – 2 months, 2 months -5 year includingboth preventive and curative elements to beimplemented by families.
Beneficiaries of IMNCI*care of young infants for new borns(under 2months)*young children(2months-5yrs)
GOALTo assess current statues of child survivalindicators and process indicators forexisting programme activities inintervention and compassion districts.
OBJECTIVES*To determine baseline mortality amongchildren under 5yrs of age(NMR,IMR,USMR)*To determine prevalence of fever,loose stools,coughand any other illness(morbidity density)in twoweeks prior to day of field survey among childrenunder 5yrs of age.*To assess effective programme coverage for specifieddisease condition(cough with fastbreathing)occuring in two weeks prior to day offield survey
*Causes of under 5 mortality and path way analysis ofevents prior to death and recovery of sick under 5children*Sickness management practices at household,community level and health facility level.*Sickness and care providing competencis of health careproviders(doctors,health workers and othercommunity level non convectional service providers)*Health system support for man power,legistics,referalmechanism,intersectoral coordination,socialmoliblisation and monitoring and supervision.
COMPONENTS*HEALTH WORKER COMPONENTCase management skills*HEALTH SERVICE COMPONENTImprovement in overall health*COMMUNITY COMPONENTImprovements in family and community health carepractices
IMPLEMENTATION OF IMNCI*adopting an integrated approach to child health anddevelopment in the national health policy.*adapting the IMNCI clinical guidelines to countriesneeds, available drugs, policies and to the local foodsand language used by the population.*up grading care in local clinics by training health workersin new method examine and treat children and toeffectively council parents.*making up grade care possible by insuring that enoughof the right low-cost medicines and simple equipmentare available.
*strengthening care in hospitals for those children toosick to be treated in an out patient clinic*developing support mechanism within communitiesfor preventing disease,for helping families to care forsick children and for getting children to clinics orhospitals when needed.
PRINCIPLES*All sick young infants upto two months must be assessedfor baerial infection/jaundice and major symptoms ofdiarrhea*all sick children 2months to 5yrs must examine for generaldanger signs which indicate the need for referral oradmission to a hospital*all young infants and child 2months-5yrs of age must beroutinely assessed for nutritional and immunisationstatus,feeding problems and other potential problems
*Only a limited number of care fully selected clinicalsigns are used based on evidence of drugs sensitivityand specificity to detect disease.*A combination of individual signs leads to an infantsor childs classification rather than diagnosis.
CLASSIFICATION ACCORDING TO COLORCODECOLOR*pink*yellow*greenCLASSIFICATIONHospital referral or admissionInitiation of special treatmentHome management
TRAINING IN IMNCITraining is at 2 levels*Inservice training for the existing staff*Pre service training
CARE OF CHILDREN ACCORDINGTO IMNCI0-2 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 managementand/referral.*immunisation*home visit in the post natal period.
2MONTHS-5YRS*management of diarrhea,ARI,malaria,measels,acuteear infecton,mal nutrition and anemia.*recognition of illness and risk.*prevention and management of iron and vitaminAdeficiency*counselling on feeding for all chilkdren below 2yrs.*counselling on feeding for malnutrished.*immunization
Assessment of sick young infantupto 2 monthsPossible bacterial infection / jaundiceDoes the infant have diarrheaFeeding problemsImmunization status
TEACHING & COUNSELING Teach mother to keep infant warm.Teach correct position for breast feedingAdvice on home care of young infantAdvice mother to return immediately if danger signspresent
Assessment of young child2 months – 5 yearsGeneral danger signsAsk about main symptoms [coughing/ breathingdifficulty] diarrheaMalnutrionAnamiaImmunization - prophylactic vit A, iron & folicacid supplement
IRON & FOLIC ACIDAGE / WEIGHT PAEDIATRIC TABLET4-24 MONTHS (6-12 KG) 1 TABLET2 YRS - 5 YRS ( 12 – 19 KG) 2 TABLETVITAMIN A6 – 12 MONTHS 1 ML12 – 5 YRS 2 ML
FEEDING RECOMMENDATION0-6 MONTHSBreast feed as often as child wantDo not give any other foodContinue breast feeding if child is sick
6 – 12 monthsBreast feed as oftenGive smashed roti, rice, bread, biscuit, undil: milkor vegetablesKeep child on your lapWash childs hand before feeding
12 – 2 yrsBreast feed as oftenOffer family foodSit by the side of childWash hands with soap
> 2 yearsGive family foodEnsure that child finishes the servingTeach child to wash hands
CONCLUSIONIMNCI strategy has emerged as a promising approachto deal with issues related to child survival.Major strength is it use evidence based managementdecisionsThis approach could help country to achievemillenium goal.