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IMNCI - overview medical presentation.pptx
- 1. INTEGRATED MANAGEMENT OF NEONATALAND CHILDHOOD ILLNESS I
- 2. ‘’The real tragedyis that millions of children are dying needlessly and we are failing to act. We do not need to discover a cure for a little girl with pneumonia, we simply need to apply the knowledge we already have to saving lives’’ Dr. Lee Jong-wook, WHO DG
- 3. Most of thesediseases are preventable. If not; can be treated easily with effective interventions even in resource limited setting Globally over 80% of under-5 deaths are due to just six conditions: neonatal causes, pneumonia, diarrhoea, malaria, measles, and HIV/AIDS.
- 4. INTEGRATED APPROACH • IMCIstarted by WHO & UNICEF in 1994 • Indian version IMNCI under RCH II strategy
- 5. STATISTICS • Infant MortalityRate (IMR) in India 68/1000 live births • Under Five Mortality Rate (U5MR) at 95/1000 live births. • Neonatal mortality contributes >64% of infant deaths (NMR – 63/1000 live birth) • Mortality rate in the second month of life is also higher than at later ages
- 6. INTEGRATED APPROACH • IMCIstarted by WHO & UNICEF in 1994 • Indian version IMNCI under RCH II strategy
- 7. Syndromic approach /action oriented Do not diagnose the disease But classify the Illness IMNCI
- 8. Integrated Management ofChildhood Illness (IMNCI) as a key strategy for improving child health Management of sick children Nutrition Immunization Other disease Prevention Promotion of Growth and Development Integrated Management of Childhood illness (IMCI)
- 9. GOALS OF IMNCI •Standardized case management of sick newborns and children • Focus on the most common causes of mortality • Nutrition assessment and counselling for all sick infants and children • Home care for newborns to – promote exclusive breastfeeding – prevent hypothermia – improve illness recognition & timely care seeking
- 11. THE CASE MANAGEMENT PROCESS 1.Assessthe child or young infant. 2. Classify the illness. 3. Identify treatment. 4. Treat the child. 5. Counsel the mother. 6. Give follow-up care.
- 13. Young Infant (Ageupto 2 mnth)
- 14. • Communicating withcare taker. • Possible Bacterial Infection • Jaundice • Diarrhea • Feeding Problem or Malnutrition • Immunization Status • Other Problems Assess and classify Sick Young Infant
- 15. • Ask aboutthe problems – Listen carefully – Use words which care taker understand – Give caretaker time to answer – Ask additional question to clarify • Initial v/s Follow up visit Communicate with care taker
- 22. Check for possibleBacterial Infection: Assess Signs Classify Identify T/t Ask Has the infant had seizure? Look / Listen/ Feel Count the breath Chest indrawing Nasal flaring Grunting Look for AF Lethargic / unconscious Infants movements Pus draining from ear Look for umbilicus Skin pustules Measure axillary temp Look for jaundice Convulsion Fast breathing Severe chest indrawing Nasal flaring Grunting Bulging fontanelle Pus drainage from ear Umbilical redness extending to skin Fever or hypothermia Many or severe skin pustules Lethargy or unconsciousness Less than normal movement POSSIBLE SERIOUS BACTERIAL INFECTION IM Ampi and Genta Treat low B Sugar Provide warmth to infant by KMC Advice –keep infant warm (transportation) Refer urgently Umbilical redness or pus drainage Pus discharge from ear < 10 skin pustule LOCAL BACTERIAL INFECTION Oral Amoxy x 5 days Teach mother FU in 48 Hrs
- 23. Assess & ClassifyAs: Assess Signs Classify Identify T/t Ask Has the infant had seizure? Look / Listen/ Feel Count the breath Chest indrawing Nasal flaring Grunting Look for AF Lethargic / unconscious Infants movements Pus draining from ear Look for umbilicus Skin pustules Measure axillary temp Look for jaundice Palms and sole – yellow Age - < 24 hrs or > 14 Days SEVERE JAUNDICE Treat low B Sugar Phototherapy Provide warmth to infant by KMC Advice –keep infant warm (transportation) Refer urgently Palm & Soles not yellow JAUNDICE Advice mother - Home care - When to return - FU in 48 Hrs Temp between 35.5 – 36.4 degree C LOW BODY TEMP Provide warmth to infant by KMC Reassess after 1 hrs Treat low B Sugar Check for possible Bacterial Infection/ Jaundice / Hypothermia
- 24. Assess & ClassifyAs: Assess Signs Classify Identify T/t Ask Does the young infant have diarrhoea? If yes How long? Blood in stool? Look / Feel General condition - Lethargic/ Unconscious - restless / irritable Look for Sunken Eyes Pinch the skin of the abdomen 2 of the following- - Lethargic/ Unconscious - Look for Sunken Eyes - Pinch the skin of the abdomen goes back very slowly SEVERE DEHYDRAT ION IM Ampi & Genta Treat dehydration as per Plan C Advice - Continue BF –keep infant warm (transportation) Refer urgently 2 of the following- - Restless/ irritable - Look for Sunken Eyes - Pinch the skin of the abdomen goes back slowly SOME DEHYDRAT ION IM Ampi & Genta Treat low B Sugar Treat as per Plan B Advice - Continue BF –keep infant warm - Home care - When to return - FU in 48 Hrs No sign of dehydration NO DEHYDRATI ON Treat as per Plan A Advice - Continue BF –keep infant warm - Home care Does the young infant have diarrhoea?
- 25. Assess & ClassifyAs: Assess Signs Classify Identify T/t Ask Does the young infant have diarrhoea ? If yes How long? Blood in stool? Look / Feel General condition - Lethargic/ Unconscious - restless / irritable Look for Sunken Eyes Pinch the skin of the abdomen Diarrhoea lasting > 14 days PERSISTEN T DIARRHOE A IM Ampi & Genta Treat dehydration as per dehydration Advice - Continue BF –keep infant warm (transportation) Refer to hospital Blood in Stool DYSENTRY IM Ampi & Genta Treat low B Sugar Treat as per dehydration Advice - Continue BF –keep infant warm - Refer to hospital Does the young infant have diarrhoea?
- 26. Assess & ClassifyAs: Assess Signs Classify Identify T/t Ask Is there feeding difficulty? Is the baby of breast? If yes how frequentl y? Does baby receive any other food Look / Feel Determine weight for age Breastfeeding assessment Look and feel for Flat / inverted nipple engorged Breast Not able to feed No attachment at all Not suckling at all Severely under weight (-<3SD) NOT ABLE TO FEED POSSIBLE BACTERIAL INF SEVERE MALNUTRI TION IM Ampi & Genta Treat low B Sugar Advice - Continue BF –keep infant warm (transportation) Refer to hospital < 8 BF in 24 hrs Not well attached to BF Not suckling effectively Receive other food Oral thrush Severely under weight (-<2SD - - 3SD) Breast problem FEEDING PROBLEM Correct BF posture Treat nipple problem Advice - Continue and increase BF freq –keep infant warm - When to return No LBW no sign of Poor BF No Feeding Problem Advice - Continue and increase BF freq Check for Feeding Problem & Malnutrition:
- 40. Young children (2month -5yrs)
- 41. • History taking •General danger signs • Main symptoms • Cough or difficult breathing • Diarrhoea • Fever • Ear problems • Nutritional status • Immunization status • Anemia & Other problems Assess and Classify:
- 42. General Danger signs: ASK: •Isthe child able to drink or breastfeed? •Does the child vomits everything? •Has the child had convulsions? LOOK: •If the child is lethargic or unconscious?
- 43. Assess & ClassifyAs: Assess Signs Classify Identify T/t If Yes Ask How long? Look / Feel Count the breath in 1 min Look for Chest indrawing Look and listen for stridor Note: Fast Breathing (if RR : 2 – 12 mth - > 50/ 1 – 5 yrs - > 40/min) Any danger sign Chest indrawing or stridor SEVERE PNEUMONIA OR VERY SEVERE DISEASE IM Chlormphenicol Treat dehydration Refer urgently Fast Breathing PNEUMONIA Oral Amoxy x 5 days - Continue BF –Sooth the throat if > 6 mth Advice mother - When to return immediately - FU in 48 Hrs No sign of Pneumonia NO PNEUMONIA COUGH & COLD If cough > 30 days : refer for assessment - - Continue BF –Sooth the throat if > 6 mth Advice mother - When to return Does the child have cough or breathing difficulty ?
- 44. Assess & ClassifyAs: Assess Signs Classify Identify T/t Ask If yes How long? Blood in stool? Look / Feel General condition - Lethargic/ Unconscious - restless / irritable Look for Sunken Eyes Offer the child fluid: -Observe for not drinking - drink eagerly Pinch the skin of the abdomen 2 of the following- - Lethargic/ Unconscious - Sunken Eyes - not able to drink - Skin pinch goes back very slowly SEVERE DEHYDRAT ION Treat dehydration as per Plan C Advice - Continue BF –keep infant warm (transportation) Refer urgently 2 of the following- - Restless/ irritable - Drink eagerly - Sunken Eyes - Skin pinch goes back very slowly SOME DEHYDRAT ION Treat as per Plan B Advice - Continue BF - Home care (ORS & Zinc) - When to return immediately - FU in 48 Hrs No sign of dehydration NO DEHYDRATI ON Treat as per Plan A Advice - Continue BF –ORT/ ZINC - Extra fluid & Home Does the child have diarrhoea?
- 45. Diarrhoea lasting 14days and Dehydration present SEVERE PERSISTENT DIARRHOEA • Treat dehydration before referral unless the child has another severe classification No Dehydration PERSISTENT DIARRHOEA •Advice mother on feeding • Single dose of Vit A •Zn sulphate 20 mg daily*14 d •Follow up in 5 days Does the child have diarrhoea? Blood in stools SEVERE DYSENTRY •Treat for 5 days with Ciprofloxacin • Follow up in 2 days
- 46. • FEVER: •Ask: -How long? -Does fever present every day? - Has the child had measles within last 3 months? •Look: -Stiff neck - Bulging fontanelle - Runny nose - Signs of measles:- Generalized rash Cough Runny nose Red eyes •If history of measles present: -Deep/ extensive mouth ulcers - Pus draining from eyes - Clouding of cornea
- 47. • Any dangersign • Stiff neck • Bulging Fontanelle VERY SEVERE FEBRILE ILLNESS • Give first dose of IM quinine after making blood smear • Give first dose of IV or IM Chloramphenicol • Treat the child to prevent low blood sugar • Give one dose of PCM in clinic • Refer URGENTLY to hospital •Fever (By history or temp >37.5) MALARIA • Give oral antimalarial after making a blood smear •Give one dose of PCM • Advice mother to return back immediately •Follow up in 2 days if fever persist •If fever is present everyday for 7 day , reassess HIGH MALARIA RISK
- 48. LOW MALARIA RISK •Any general danger sign • Stiff neck • Bulging fontanelle VERY SEVERE FEBRILE DISEASE • Give first dose of IM quinine after making blood smear • Give first dose of IV or IM Chloramphenicol • Treat the child to prevent low blood sugar • Give one dose of PCM in clinic • Refer URGENTLY to hospital • NO runny nose •NO measles •NO other cause of fever MALARIA • Give oral antimalarial after making a blood smear •Give one dose of PCM • Advice mother to return back immediately •Follow up in 2 days if fever persist •If fever is present everyday for 7 day , reassess •Runny nose present •Measles Present •Other causes if FEVER present FEVER- MALARIA UNLIKELY •Give one dose of PCM • Advice mother to return back immediately •Follow up in 2 days if fever persist •If fever is present everyday for 7 day , reassess
- 49. If H/O ofMEASLES (now or with in last 3 months ) • Any general danger sign • Clouding of Cornea •Deep or Extensive mouth ulcer SEVERE COMPLICATED MEASLES • Give first dose of Vitamin A • Give first dose of inj. Chloramphenicol •If clouding of cornea or pus from eyes, apply tetracycline eye ointment •Refer URGENTLY to hospital •Pus drainage from eyes •Mouth ulcers MEASLES WITH EYE OR MOUTH COMPLICATION •Give first dose of Vitamin A •If pus from eyes, apply tetracycline eye ointment •If mouth ulcers, gentian violet •Follow up in 2 days •Measles now or within last 3 months MEASLES •Give first dose of Vit. A
- 50. • EAR PROBLEM: •Tender Swelling behind ear MASTOIDITIS • Give first dose of inj. Chloramphenicol • Give first dose of PCM for pain •Refer URGENTLY to hospital •Pus discharge from ear <14 days ACUTE EAR INFECTION • Give Cotrimoxazole for 5 days • Give PCM for pain •Dry ear by wicking •Follow up in 5 days •Pus discharge from ear >14 days CHRONIC EAR INFECTION • Dry the ear by wicking • Follow up in 5 days •No ear pain •No pus discharge from ear NO EAR INFECTION •No additional treatment
- 51. Check for Malnutrition,Anemia and Immunization : • Malnutrition and Anaemia • Visible severe wasting (Marasmus) •Oedema of both feet (Kwashiorkor) • Weight for age • Palmar pallor
- 55. • Visible severewasting • Oedema of both feet • Severe palmer pallor SEVERE MALNUTRITION OR SEVERE ANAEMIA • Give single dose of Vit. A • prevent low blood sugar level • Keep the baby warm •Refer URGENTLY to hospital •Very low weight for age • Some palmar pallor VERY LOW WEIGHT OR ANAEMIA •Give IRON and FOLIC ACID therapy for 14 days •Assess the child's feeding and counsel the mother •Advice mother when to return back immediately •Not very low weight for age •No other signs of malnutrition •No pallor NOT VERY LOW WEIGHT NO ANAEMIA •Give prophylactic Iron and FOLIC ACID if child is 6 months and older •Assess child's feeding and counsel the mother •Advice mother for follow up
- 56. • ALPAC strategy –Ask – Listen – Praise – Advice – Check Understanding Counselling of Mother or Caretaker
- 57. IMNCI – Effectivestrategies Sr No Health indicators 2003 (per 1000 live birth) 2022 (per 1000 live birth) Target (per 1000 live birth) 1 Under 5 Mortality Rate 95 35 23 by 2025 2 Infant Mortality Rate 68 27.695 28 by 2019 3 Neonatal Mortality Rate 63 20 by 2020 16 by 2025
- 58. We are hereto add value to practice. We are able to spend time with patients to answer their questions, help them understand their treatment and educate them about preventable communicable and non- communicable diseases. Possibly there is more we can offer if we collaborate.
- 59.