Integrated management of neonatal and childhood illness
INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS
ADD Mal-nutrition ARI 7/10 <5mort. Measles Malaria
Factors contributing to illness Poor living conditions- lack of safe water supply poor hygiene overcrowding Inability of parents to recognize danger signs
delay in seeking appropriatetreatmentpoor quality of care provided athealth facilities.More than one morbid condition
"The Integrated Management of Childhood Illness (IMCI)" 1992 UNICEF and WHO
Objectives Reduce mortalityReduce frequency and severity of illness and disabilityImprove growth and development during the first 5 years of a childs life
Guidelines Evidence-based syndromic approachDetermining the health problems of the childSeverity of childs conditionEvaluation of the actions takenRational, effective, and affordable use of drugsand diagnostic tools.
IMCI Strategy Health-worker component: Improvements in the case- management skills of health staff through locally adapted guidelines. Health-service component: Improvements in the overall health system required for effective management. Community component: Improvements in family and community health care practices.
IMNCICentral pillar of child health interventions under RCH II
IMNCI• Inclusioin of 0-7 years of age.• Incorporating national programmes.• Training begins with sick infants <2 mths.• Training time devoted to sick infant & sick child are almost equal.• Skill based
ImplicationsStandardized case management proceduresbased on two age categories:1. upto 2 months2. 2 months to 7 years.Only a limited number of carefully-selectedclinical signs are considered, based on theirsensitivity and specificity, to detect thedisease.
Classification PYG- urgent hospital referral or admission- specific medical Rx or advice- home management
ManagementAssessmentClassification of illnessIdentification of specific RxClear instructions to motherCounsel to solve feeding problemsFollow-up care.
AdvantagesEvidence-based management decisions.Eg:oral rehydration therapy for diarrhea.Focus on communication and counsellingskills.Locally adapted recommendation for infantand young child feeding.
Increased effectiveness of care and reductionin cost.Potential of lowering the burden on hospitals. Model for improving one aspect of servicedelivery that could be applied to other aspectsof health care.
What it does not address...• Not all major illnesses are included• Management of trauma / other emergencies not included.
ChallengesFeasibilitySustaining what is initiated throughindicator-based monitoringMaking home-based care of younginfants operational by ANMs andAWWs
Future aimsTo provide a comprehensive newborn and child care package at all levels of care: At the village/household level - AWWs. Sub-center level - through ANMs PHCs - doctors, nurses, and Lady Health Visitors; At First Referral Units – MOs and nurses