Integrated Management of Childhood Illness (IMCI)


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Integrated Management of Childhood Illness (IMCI) is a cost-effective approach
Integrated Management of Childhood Illness (IMCI) - Focuses on the child and not on the illness

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Integrated Management of Childhood Illness (IMCI)

  1. 1. Child Health-Approach in RCH-II • The IMNCI approach is the centrepiece of newborn and child health strategy in RCH II.
  2. 2. UNDER-FIVE MORTALITY RANKINGS COUNTRY UNDER-FIVE MORTALITY RANK Rate(2007) Afghanistan 257 2 Nigeria 189 8 Pakistan 90 43 Bhutan 84 45 India 72 49 Bangladesh 61 58 Nepal 55 62 Iraq 44 66 Maldives 30 88 China 22 107 Sri Lanka 21 110 Vietnam 15 126 Malaysia 11 140The State of the World’s Children- 2009, UNICEF
  3. 3. Recent trends in Neonatal and Infant Mortality Rate 70 58 58 57 60 55 53 50 40 37 37 37 36 35 28 28 29 27 30 26 20 10 0 SRS 2004 SRS 2005 SRS 2006 SRS 2007 SRS 2008 Infant Mortality Rate Neo-Natal Mortality Rate Early Neo-Natal M.R.Neonatal Mortality Rate shows stagnation; need to actIMR high in Bihar, Chhattisgarh, Madhya Pradesh, Orissa,Rajasthan, Uttar Pradesh and Assam
  4. 4. Infant Mortality Rate 80 70 70 69 SRS 2008 67 64 63 60 57 56 53Per 1000 live births 52 50 50 46 45 41 40 35 33 31 30 20 12 10 10 0
  5. 5. Distribution of deaths of children less than 5 Years, by cause, the world, 1990 and projected for 2020The 5 main killers ofchildren: 1990 2020ARI, diarrhoea,measles, malariaand malnutrition 55% 52%PerinatalconditionsOther 5% 7%communicable 9% 18%diseases 19% 12% 11%Non-communicable 11%diseasesInjuries
  6. 6. For many sick children a singlediagnosis may not be apparent or appropriate Presenting complaint Possible cause or associated condition Cough and/or fast breathing Pneumonia Severe anaemia P. falciparum malaria Lethargy or unconsciousness Cerebral malaria Meningitis Severe dehydration Very severe pneumonia Measles rash Pneumonia Diarrhoea Ear infection "Very sick" young infant Pneumonia Meningitis Sepsis
  7. 7. WHO/ UNICEF -Integrated Approach 3 out of 4 children who seek Integrated Management health care are suffering of Childhood Illness from at least one of the five (IMCI) - Focuses on the conditions child and not on the illness Some children are often suffering from more than one condition, making a single diagnosis impossible Integrated Such children need complete Management of assessment and combined Childhood Illness therapy for successful (IMCI) is a cost- treatment. effective approach
  8. 8. Causes of Deaths 0-4 years- 2001-03 Office of Registrar General, India Perinatal conditions Resp Infections 2.7 1.5 2.8 2.7 3.2 Diarrhea 3.4 3311 Infectious and Parasitic diseases Ill defined Injuries 14 Nutritional def 22 Malaria Cong. Anamolies PUO
  9. 9. Share of under-five mortality in IndiaNeonatal deaths Infant deaths within 7 days of birth 40%50% Infant deaths 76% Infant deaths between 7 days of birth and within 28 days 10% Infant deaths between 28 days and within one year of birth 26% Child deaths between one year and within five years of birth 24% Source : SRS 2007
  10. 10. IMCI to IMNCI-INDIA Major Adaptations• The entire 0-5 year period covered including the first week of life• 50% of training time for management of young infants (0-2 months)• The order of training reversed; now begins with management of young infants• Reduced training duration (8 days), separate training materials for physicians & health workers• Management now consistent with current policies of the MOHFW, DWCD and NVBDCP
  11. 11. IMNCI as a key strategy for improving child healthManagement Nutrition Immunization Other diseaseof sick newborn Prevention & & children Promotion of growth and development Integrated Management of Neonatal & Childhood Illness
  12. 12. What Needs to be Done in IMNCI Improving the case management skills of health workers• Improving the health system for effective management of childhood illness• Improving family and community practices
  13. 13. Case Management ProcessTwo groups: (A) Young infants : From birth up to 2 months of age. (B) Older children : From 2 months up to 5 years of age.
  14. 14. What does IMNCI Offer• IMNCI guidelines address most but not all of the major reasons a sick infant and child is brought to a clinic• Only a limited number of signs based on evidence are used to detect a disease• A combination of individual signs leads to action oriented colour coded classification(s)• IMNCI management includes a limited number of drugs and encourages active participation of caretakers• Counselling of caretakers is an essential component
  15. 15. Core interventions to improve child survival • Combating pneumonia/sepsis • Combating diarrhoea • Nurturing newborns (and their mothers) IMNCI • Infant feeding • Immunization • Combating malaria
  16. 16. Standard Clinical Guidelines “Golden” paediatric standard Completeexamination Advise to Preliminary Laboratory Differential Final Treatment Treatment all signs caretakers Diagnosis examination Diagnosis Diagnosis strategy procedures and Follow- up systems “IMNCI” approach Focused Assessment Classification Treatment Counsel & Follow-up Danger signs Need to Refer Identify Counsel Main Symptoms Specific treatment treatment Caretakers Nutritional status Treat Follow-up immunisation status Home management other problems • Essential Investigations
  17. 17. Case Management Process Assess the Child. Classify the Illness. Identify Treatment. Treat the Child. Counsel the Mother Give Follow-Up Care.
  18. 18. Assess the ChildTools for assessment: Ask, Look, Listen, and Feel.
  19. 19. Classify The Illness “Classify the illness” means making a decision on the severity of the illness according to the child’s major symptoms. Classifications are not diagnoses. They are categories that are used to determine treatment.
  20. 20. PINK: Patient requires URGENT hospitalization.Give pre-referral treatment andRefer URGENTLY to hospital.YELLOW: Specific medical treatment and advice, as you do in your OPD or Clinic.GREEN: Simple advice on home-management. May require some home made safe remedy.
  21. 21. IDENTIFY TREATMENT This is further direction to management If a child needs urgent referral (hospitalization), give pre-referral treatment If a child needs treatment at home, explain mother how to do it home If a child needs immunization, give it
  22. 22. TREAT THE CHILD This explains complete treatment to be given at clinic and at home This includes teaching the mother (or caretaker) how to give oral drugs, how to feed and give fluid during illness, and how to treat local infection at home Return for follow up When to return immediately
  23. 23. COUNSEL THE MOTHER Assess and Counsel the mother to solve any feeding problem found Counsel on home care Counsel on when to return immediately Counsel the mother about her own health
  24. 24. Classify ALL YOUNG INFANTS SIGNS CLASSIFY AS Convulsion or Fast Breathing (60 breaths per minute or more) or POSSIBLE SERIOUS Severe chest indrawing or BACTERIAL INFECTION Nasal flaring or Grunting or Bulging fontanel or 10 or more skin pustules or a big boil or If axillary temperature 37.50C or above (or feels hot to touch) or temperature less than 35.50C (or feels cold to touch) or Lethargic or unconscious or Less than normal movemento Umbilicus red or draining pus or LOCAL BACTERIALo Pus discharge from ear or INFECTIONo < 10 skin pustules
  25. 25. Classification- Pneumonia
  26. 26. VIDEOS & PHOTO BOOK Good attachment to Breast lower lip is curled outward baby’s mouth is wide openchin touches lower portion ofthe breast the areola is not visible
  27. 27. VIDEOS & PHOTO BOOKPoor attachment to Breast
  28. 28. VIDEOS & PHOTO BOOKBreastfeeding- Correct Positioning
  29. 29. Is this baby well positioned ?
  32. 32. VIDEO• GRUNTING- Short expiratory sound, signifies infant having difficulty in breathing- Severe illness• 2 Grunting.wmv
  33. 33. VIDEOSIGNS OF SEVERE PNEUMONIA• CHEST INDRAWING- Lower chest wall goes in during inspiration• STRIDOR- Harsh sound when child breathes in• 2 Severe Respiratory Distress_Large.wmv
  34. 34. VIDEO• VISIBLE SEVERE WASTING- severe wasting of the shoulders, arms buttocks and legs with ribs easily seen- MARASMUS• 11Severe malnutrition_Large.wmv
  35. 35. REMEMBER- SEVERE CLASSIFICATIONSSick Young Infant age up Sick Child age 2 months upto 2 months to 5 years• Possible serious bacterial • Severe Pneumonia Or Very infection Severe Disease • Severe Dehydration with• Severe Jaundice another severe classification• Severe Dehydration • Severe Persistent Diarrhea• Severe Persistent Diarrhea • Very Severe Febrile Disease• Severe Dysentery • Severe Complicated Measles• Not able to feed- Possible • Mastoiditis serious bacterial infection • Severe Malnutrition OR Severe Malnutrition • Severe Anemia ACTION- PRE- REFERRAL TREATMENT & URGENT REFERRAL
  36. 36. Hospital is the best place fortreating a very sick infant/child But if Referral is not possible, IMNCI Guidelines can save a life !
  37. 37. TAKE HOME MESSAGE IMNCI--Colour coded case management strategy• PINK CLASSIFICATION: Child needs inpatient care, Provide Pre-referral treatment and Refer Urgently• YELLOW CLASSIFICATION: Child needs specific treatment, provide it at home (e.g. antibiotics, anti- malarial, ORT)• GREEN CLASSIFICATION: Child needs no medicine, advise home care
  38. 38. CONCLUSION The IMNCI Strategy focuses on the diseases of the childhood that cause the greatest global burden. An integrated approach is needed because the overlap in the signs and symptoms of the major diseases is common.
  39. 39. Conclusion (continued) It is important to treat the child as a whole, not simply the most apparent disease. The IMNCI approach ensures a complete assessment of a sick child, provision of treatment and counseling the mother to improve health practices at home and to promote health seeking behavior.
  40. 40. THANK YOU