This power-point includes content on brief introduction and classification & management of pneumonia based on Integrated Management of Neonatal & Childhood Illness (IMNCI).

1. INTEGRATED MANAGEMENT
OF NEONATALAND
CHILDHOOD ILLNESS
(IMNCI)
Dr. Ramya S

2. IMNCI
• One of the main interventions under RCH II/NRHM
• Focusses on preventive, promotive and curative
aspects of the programme
• WHO and UNICEF developed IMCI
• Management of childhood illness with aspects of
nutrition, immunization and other disease
prevention and health promotion

3. IMNCI: Indian version
Difference of IMNCI from IMCI:
1. Inclusion of 0-7 days age in the program
2. Training of health personnel begins with sick
young infant up to 2 months
3. Proportion of training time devoted to sick young
infant (upto 2 months) and sick child (2 months
to 5 yrs) is almost equal
4. Incorporates the national guidelines on malaria,
anaemia, vit A supplementation & Immunization
schedule

4. INTEGRATION
• Patient level-Case management
• Point of delivery-Multiple interventions
are provided through one delivery
channel.

5. STRATEGY
• Integrated case management of the most
common childhood problems.
• Focus is given on the most important causes
of death

6. Diarrhoea
ARI
Malaria
Measles
Malnutrition
IMNCI

7. ELEMENTS
Assess
Classify
Identify
Treatment
Counsel
Follow up
and care

8. ASSESS
First danger sign
Asking questions about common conditions
Examining the child
Checking nutrition
Immunization status

9. Check for danger signs
Convulsions Lethargy
Inability to
drink/
breastfeed
Vomiting

10. Assess main symptoms
Cough/difficulty
in breathing
Diarrhoea
Fever Ear problems

11. ASSESS
NUTRITION &
IMMUNIZATION
STATUS
CHECK FOR
OTHER
PROBLEMS
CLASSIFY
CONDITIONS

12. CLASSIFY
Colour coded triage system
 PINK- Urgent pre-referral treatment and referral
 YELLOW- Specific medical treatment and advice
 GREEN- Simple advice on home management

13. URGENT REFERRAL
OUT PATIENT HEALTH
FACILITY
• Pre referral
treatments
• Advice parents
• Refer child
TREATMENT AT
OUTPATIENT
HEALTH
FACILITY
• Treat local
infections
• Give oral drugs
• Advice and
teach caretaker
• Follow-up
HOME
MANAGEMENT
• Oral drugs
• Treat local
infection at
home
• Continue feeding
• When to return
immediately
• Follow-up
REFERRAL
FACILITY
• Emergency triage and
treatment
• Diagnosis
• Treatment
• Monitoring and
follow-up

14. IDENTIFY
 Urgent referral-give essential treatment
 Treatment at home-integrated treatment
plan + first dose of drugs
 If child should be immunized, give
immunization

15. TREATMENT
 How to give oral drugs ?
 How to feed and give oral drugs ?
 How to treat local infections at home ?
 How to recognize signs that indicate the child
should return immediately to the health facility ?

16. COUNSEL
 Assess feeding
 Counsel to solve any feeding
problems found

17. Follow up care
 When child is brought back to the
clinic as requested give follow up care

18. CASE MANAGEMENT
Children aged up to 2 months
Children aged 2 months up to 5 years

19. PNEUMONIA
Check
• general danger signs
Ask about the main symptoms
• cough
• difficulty in breathing
Look
• Count the breaths in one minute
• Chest indrawing
• Stridor

20. General danger signs
Child not
able to drink
or
breastfeed
Child vomits
everything
Convulsions
Child is
lethargic or
unconscious

21. Pneumonia
S.no Child’s Age Fast breathing
1 Less than 2 months 60 breaths/
minute or more
2 2 months up to 12
months
50 breaths/
minute or more
3 12 months up to 5
years
40 breaths /
minute or more

22. Sick young infant upto 2 months
Any one of the following
signs:
Classify Treatment
• Not feeding well
• Convulsions
• Fast breathing
• Severe chest indrawing
• Fever (37.5° C or
above)
• Low body temperature
(less than 35.5° C)
• Movement only when
stimulated or no
movement at all
VERY
SEVERE
DISEASE
Give 1st dose of
i.m. antibiotic
Treat to prevent
low blood sugar
Refer URGENTLY
Advise mother
how to keep the
infant warm on
the way to
hospital

23. Signs Classification Treatment
• Any general
danger sign or
• Stridor in calm
child
SEVERE
PNEUMONIA
(OR)
VERY SEVERE
DISEASE
• Give first dose
of an
appropriate
antibiotic
• Refer
URGENTLY to
hospital
Sick child 2 months upto 5 years

24. Signs Classification Treatment
• Chest
indrawing
• Fast breathing
PNEUMONIA
• Give oral Amoxicillin for 5 days
• If wheezing, give an inhaled
bronchodilator for 5 days
• Soothe the throat and relieve the
cough
• If chest indrawing in HIV infected
child, give 1st dose amoxicillin & refer
• If cough for more than 14 days or
recurrent wheeze, refer for possible
TB or asthma assessment
• Advise mother when to return
• Follow-up in 3 days

25. Signs Classification Treatment
• No signs of
pneumonia
or very
severe
disease
COUGH OR COLD
• If wheezing, give an
inhaled bronchodilator
for 5 days
• Soothe the throat and
relieve the cough
• If cough for more than 14
days or recurrent
wheeze, refer for possible
TB or asthma assessment
• Advise mother when to
return
• Follow up in 5 days if not
improving

26. Thank you