Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Integrated management of neonatal and childhood illness (


Published on

Published in: Health & Medicine

Integrated management of neonatal and childhood illness (

  1. 1. Presenter :-Dr. Vaibhav Gupta, MPH2nd year Moderator - Dr. Sunil Kumar D. ( Ast.Prof.) Dept. of community medicine JSSMC 11/01/2014 13/01/2014 1
  2. 2.  Introduction-(IMCI)  Why integrated management  IMCI- Component & Process  Differences; IMCI/IMNCI  IMNCI: Components, Objectives, Strategies  Process of IMNCI  IMNCI Plus  F-IMNCI ,Pre service IMNCI  Home based New Born care  JSSK,NSSK,C-IMCI  SWOT analysis  Current Status  conclusion 13/01/2014 2
  3. 3.  World Health Organization (WHO), UNICEF & other International Partner came out with a new strategy Known as Integrated Management of Childhood Illness (IMCI) in 1995.  An effort to bring health equity for child health.  The strategy emphasises on integrated approach for treating the sick children.  Emphasizes on improving the family and community practices as well as care provided by the health system for better care of child. 13/01/2014 3
  4. 4. IMR 42/1000 and Under 5 mortality 95/1000 live births per year. Neonatal mortality contributes to 64% of infant deaths mostly occurring during first week of life. According to report released on 12 September 2013 by United Nations Children's Fund (UNICEF) the global Infant Mortality rate (IMR) decreased from 61 deaths in 1990 to 37 deaths in 2011. Annual infant deaths declined from 8.4 million in 1990 to5 million in 2011. 13/01/2014 4
  5. 5.  According to the report India’s infant mortality rate shown a minor decline in 2012 compared to 2011. Infant Mortality rate decreased from 44 deaths for every 1000 live births in 2011 to 42 deaths for every 1000 live in 2012.  IMCI seeks to reduce childhood mortality and morbidity by improving family and community practices for the home management of illness, and improving case management of skills of health workers in the wider health system. 13/01/2014 5
  6. 6.  An integrated approach was needed to manage sick children to achieve better outcomes.  Child health programmers needed to move beyond tackling single diseases in order to address the overall health & well being of the child  During mid 1990s, WHO & UNICEF developed a strategy – IMCI 13/01/2014 6
  7. 7. Cont.. IMCI has been expanded in India to include all neonates and renamed as IMNCI Govt of India has made newborn health a priority in the nation’s next five year plan Govt is working with WHO and UNICEF to adapt IMCI guidelines to include newborn care, creating new guidelines called IMNCI 13/01/2014 7
  8. 8.  Integrated approach is child centred:  Five conditions : Pneumonia, Diarrhoea, Measles, Malaria and Malnutrition are major cause of Death.  3 out of 4 children seeking health care in developing countries suffers from one of these condition.  Children likely to be suffering from more than one condition.  Often combination of theses conditions leads to fatal result.  Making a single diagnosis may be difficult.  Such children often need combined therapy for successful treatment. 13/01/2014 8
  9. 9.  Speeds up the urgent treatment and treatment seeking practices.  Prompt recognition of serious condition, hence prompt referral.  Involves parents in effective care of baby at home.  Involves prevention of diseases by active immunization, Improved nutrition and Exclusive Breastfeeding practices.  Highly cost effective.  It avoids wastages of resources by using most appropriate medicines and treatment.  It reduces duplication of effort.  Partial Success of Individual disease control programme. 13/01/2014 9
  10. 10. Health worker skills: ◦ Incomplete examinations and counselling. ◦ Poor communication between health workers and parents. ◦ Irrational use of drugs. Health system issues: - Access to health services and Scarce availability of Skilled Worker - Availability of appropriate drugs and vaccines - Supervision / organization of work Community and family practices: ◦ Delayed care seeking ◦ Poor knowledge of when to return to a health facility ◦ Seeking assistance from unqualified providers ◦ Poor adherence to health worker advice and treatment 13/01/2014 10
  11. 11.  The IMCI strategy includes three important components :  Integrated management of childhood illness.  Health system strengthening.  Community IMCI or promotion of key family and community practices  IMCI strategy are most effective when all three component are implemented simultaneously. 13/01/2014 11
  12. 12. Source: IMCI; Student’s Handbook, WHO 13/01/2014 12
  13. 13. 13/01/2014 13
  14. 14. Features: WHO – UNICEF IMCI IMNCI Coverage of 0 to 6 days (early newborn period) No Yes Basic Health Care Module NO Yes Home visit by the provider for newborn and Young Infant No Yes Training Training Home based Care No Yes Training days for newborn and young infants 2 out of 11 days 4 out of 11 days Sequence of training Child (2 months to 5 years of age) then Young infant ( 7 days to 2 months of age) Newborn and young infants (0 to 2 months).Then Child (from 2 months to 5 years of age.) 13/01/2014 14
  15. 15.  Reduce infant and child mortality rates  Improving child health and survival  Currently in India, it is 42 deaths/1000 live births.  Decline not uniform across states.  Malnutrition and low birth (LBW) are contributors to about 50% deaths. 13/01/2014 15
  16. 16. 13/01/2014 16  Strategy encompasses a range of interventions to prevent and manage five major childhood illnesses  Acute Respiratory Infections,  Diarrhoea,  Measles,  Malaria  Malnutrition  The major causes of neonatal mortality such as prematurity and sepsis.
  17. 17.  Survival has been an important goal of the Family Welfare Programmes in India.  During the period 1977 to 1992 programmes like universal immunization programme;  oral rehydration therapy (ORT) programme and programme for prevention of deaths due to acute respiratory infections (ARI) were implemented as vertical programmes. 13/01/2014 17
  18. 18.  These programmes were integrated in 1992 under the Child Survival and Safe Motherhood Programmes and have continued to be a part of the Reproductive & Child Health Programme implemented since 1997.  IMNCI is an integrated to child health that focuses on the well being of the whole child.  affecting children aged 1week – 2month , 2months - 5years including both preventive and curative elements to be implemented by families. 13/01/2014 18
  19. 19.  It also teaches about nutrition including breast feeding promotion, complementary feeding and micronutrients. It focuses on preventive, promotive and curative aspects.  IMNCI is the Indian adaptation of the WHO- UNICEF generic IMCI( integrated management of Childhood Illness.) 13/01/2014 19
  20. 20.  Care of Newborns and Young Infants (infants under 2 months): ◦ Keeping the child warm. ◦ Cord, skin and eye care. ◦ Recognition of illness in newborn , management and/or referral. ◦ Immunization.  Home visits in the postnatal period: ◦ Home visits by health workers (ANMs, AWWs, ASHAs ). ◦ Three home visits are to be provided to every newborn:  first visit on the day of birth (day 1).  Next two visit on day 3 and day 7. ◦ For low birth weight babies, 3 more visits: on Day 14, 21 and 28. ◦ care of mothers during the post-partum period. 13/01/2014 20
  21. 21. Management of diarrhoea, acute respiratory infections (pneumonia), malaria, measles, acute ear infection, malnutrition and anaemia. • Recognition of illness / at risk conditions and management/referral. • Prevention and management of Iron and Vitamin A deficiency. • Feeding Counselling for all children below 2 years • Feeding Counselling for malnourished children between 2 to 5 years. • Immunization. Who will provide IMNCI Services ?  The health workers in the community (ANM, AWW, ASHA) or  Providers at the facility (PHC/CHC/FRU). 13/01/2014 21
  22. 22. 13/01/2014 COMPONENTS 22
  23. 23. Improve health worker skills Improve health systems Improve family and community practices Case management standards and guidelines District and block planning management Appropriate Care seeking Training of facility- based public health care providers Availability of IMNCI drugs Nutrition IMNCI roles for private providers Quality improvement and supervision at health facilities – public and private Home case management and adherence to recommended treatment Maintenance of competence among trained health workers Referral pathways and services Community services planning and monitoring Health information system 13/01/2014 23
  24. 24. 13/01/2014 24
  25. 25. 13/01/2014 25
  26. 26. 13/01/2014 26
  27. 27. 13/01/2014 27
  28. 28. 13/01/2014 28
  29. 29.  Implement by 2010 a comprehensive new born and child health package at the household level Three complementary elements :  care at birth  IMNCI  Immunization 13/01/2014 29
  30. 30.  Evidence – based intervention  approach integrated with RCH program  equity –drive implementation and monitoring  rational mix of community and facility based interventions .  phased decentralized priority setting at state and district levels.  Participate of the private sector. 13/01/2014 30
  31. 31. The objectives of the newborn and child health strategy are: ◦ Increase coverage of skilled care at birth for newborns in conjunction with maternal care. ◦ Implement a newborn and child health package of preventive, promotive and curative interventions using a comprehensive IMNCI approach: At the level of all: ◦ Sub-centres. ◦ Primary health centers. ◦ Community health centers. ◦ First referral units 13/01/2014 31
  32. 32.  At the household level in rural and poor peri urban settings in at least 125 districts (through AWWs / ASHAs) ◦ Implement the medium-term strategic plan for the UIP (Universal Immunization Program). ◦ Strengthen and augment existing services in areas where IMNCI is yet to be implemented. 13/01/2014 32
  33. 33. 13/01/2014 33
  34. 34.  Facility Based Care for severely ill children is complementary to primary care for providing a continuum of care for severely ill children.  Integration of existing IMNCI package and the Facility Based Care package in to one package. 13/01/2014 34
  35. 35. Majority of the health facilities (24x7 PHCs, FRUs, CHCs and District hospitals) do not have trained paediatricians. F-IMNCI training will help in skill building of the medical officers and staff nurses posted in these health facilities to provide IMNCI care. 13/01/2014 35
  36. 36. 13/01/2014  To enhance the skills and to overcome the acute shortage of paediatricians in the country.  No. of posts of paediatricians in rural health facilities: Required = 4045 In position = 898* * 36
  37. 37.  Focus on Skill Development  50% of training time is spent on building skills by “hands-on training” involving actual case management and counselling.  Remaining 50% in classroom for building theoretical understanding of essential health intervention.  Training at two levels: ◦ In service training for the existing staff. ◦ Pre-Service Training– For including F-IMNCI in the pre-service teaching of doctors and nurses. 13/01/2014 37
  38. 38.  PRE-TRAINING STATUS PACKAGE TO BE USED DURATION IMNCI not trained F-IMNCI complete package 11 days IMNCI trained Facility based care package of F-IMNCI 5 days 13/01/2014 38
  39. 39. 13/01/2014  In medical colleges will need to include training on F- IMNCI in the training schedules –  undergraduate students and interns, during their postings in the Departments of Paediatrics and Preventive & Social Medicine.  Staff Nurse’s training schools - training on F-IMNCI in their training schedules. 39
  40. 40.  The government of India has approved the implementation of Home Based new-born care based on the Gadchirolli model, where appreciable decline in the infant mortality rates has been documented .  Appreciable decline in the infant mortality rates has been documented.  ASHAs and ANM are being trained in the state of Rajasthan, Bihar, Madhya Pradesh, Orissa and Uttar Pradesh. 13/01/2014 40
  41. 41.  The new initiative of jssk would provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30days after birth ) in government health institutions in both rural and urban areas.  Jssk initiative is estimated to benefit more than one core pregnant women & new born who access public health institutions every years in both urban & rural areas. 13/01/2014 41
  42. 42. The free Entitlements under JSSK include:  free and cashless Delivery  free C section  free treatment of sick new born up to 30days  free drugs consumable , Diagnostics , Diet during stay in health institution – 3days ND, 7days- CS  free transport Home to Health institutions 13/01/2014 42
  43. 43.  Every year 12 lakh new-born babies die in India.  India lunched a program on 15sept.2009 train the health care providers at district hospitals. CHC, PHC, across the country in management of – prevention of infection, hypothermia (temperature management) early initiation of breast-feeding of the new borns. 13/01/2014 43
  44. 44.  Community IMCI is basically Component 3 of the IMCI Package.  It aims at improving family and community practices by promoting those Practices with the greatest potential for improving child survival, growth and development.  Evidence that 80% of deaths of children under five years of age occur at home with little or no contact with health providers.  C-IMCI seeks to strengthen the linkage between health services and communities, to improve selected family and community practices and to support and strengthen community-based activities. 13/01/2014 44
  45. 45. 13/01/2014 45
  46. 46.  Strengths :  IMNCI focuses on enhancement of the skills of health care personnel.  strengthening the health system and creating community participation.  Provide the home based care to the baby and the mother.  Weaknesses :  IMCI strategy is for sick child and not for promotion of child health.  IMNCI is very exhaustive and difficult to practice in felid by health workers mainly AWW, ASHA, and ANM. 13/01/2014 46
  47. 47.  Opportunities:  Home based training for ANMs, ASHA  Entitlements facility available  Threats:  Referral system and proper feedback is still lacking in majority of areas. More monitoring and supervision is needed for proper implementation of program. 13/01/2014 47
  48. 48.  IMNCI programme is currently being implemented in 359 districts. IMNCI fact sheet is based on analyses of the IMNCI standard formatted reports submitted quarterly by the MoHFW, GOI.  The positive trends in IMNCI trainings of health workers and submission of IMNCI implementation status reports by the states. Trained IMNCI workers are providing care to a huge number of new-borns and children as shown by the number of new born home visits and sick children assessed. 13/01/2014 48
  49. 49. 13/01/2014 INDIA (Period 2010) KARNATAKA (Period 2010) No. of districts IMNCI to be implemented. 452 30 No. of districts IMNCI implemented 309* 14 Health personnel to be trained 674491 35347 Health personnel trained 398184(59%) 17997(50.9%) 49
  50. 50.  Close to 50 per cent of new-born deaths in India occur during the first seven days of birth.  Many young lives are lost due to parents failing to recognise warning signs and sick children not being taken to health facilities on time, and because many mothers do not have sufficient knowledge on the protective value of breastfeeding. The IMNCI addresses such issues.  It focuses on strengthening home based care and provides special care for under-nourished new-borns. During home visits by health workers the mother is taught how to recognise diseases early and when to seek medical help. 13/01/2014 50
  51. 51. 1.Operational Guidelines for Implementation of Integrated Management of Neonatal and Childhood Illness.[cited on 2012 Nov 20]. Available from : URL : 2.Integrated management of childhood illness. [cited on 2012 Nov 20]. Available from: URL: 3.Kishore J. National Health Programs of India, 10th edition. New Delhi:Century;2012 4. Student’s Handbook for IMNCI. Integrated Management of Neonatal and Childhood Illness. Ministry of Health and Family Welfare , Government of India; 2003 13/01/2014 51
  52. 52. 5.Integrated Management Of Neonatal and Childhood Illness Fact Sheet- India, UNICEF India;2010. 6. _Bulletin_December_2011.pdf 7. Improving Child Health; IMCI, The Integrated Approach. WHO, 1997. Downloaded on 04/ 06/2011 from URL: 8.World Health Statistics 2011. Downloaded from URL; 13/01/2014 52
  53. 53. 13/01/2014 53