This document discusses Integrated Management of Neonatal and Childhood Illness (IMNCI), a strategy developed to address high child mortality rates in developing countries. It notes that the majority of under-five deaths are caused by a handful of treatable conditions like pneumonia, diarrhea and malnutrition. IMNCI trains healthcare workers to recognize illness early and provide integrated treatment following an algorithmic approach. The goals are to reduce infant mortality and improve child health by managing the most common conditions in an integrated fashion. IMNCI was adapted in India as IMNCI and focuses on preventative, curative and health system aspects to address the major causes of child deaths.

1. IMNCI
INTEGRATED MANAGEMENT
OF NEONATAL
AND
CHILDHOOD ILLNESS
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2.  Every year about 10 million children
in developing countries die before
they reach their fifth birthday, many
of them during the first year of life.
 Ethiopia has one of the highest
under-five mortality rates with more
than 321,000 children under the age
of five dying every year.
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5.  More than 70% of these child deaths
are due to five diseases, namely
pneumonia, diarrhoea, malaria,
measles and malnutrition, and often
to a combination of these conditions.
 These diseases are also the reasons
for seeking care for at least three out
of four children who come to health
facilities.
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7.  As children usually present with
more than one of these conditions, it
was recognised that there was a
need for an integrated approach in
order to manage the child in
a holistic manner .
Globally, under-five mortality
rate has decreased by 56%, from an
estimated rate of 93 deaths per
1000 live births in 1990 to
41 deaths per 1000 live births in
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8.  The goal is for all countries aiming
reduce under-five mortality to at
least as low as 25 per 1000 live
births. (India =48/39).
 This led to the development of
the Integrated Management of
Childhood Illness (IMCI) strategy.
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10.  The generic IMCI guidelines were
adapted and the Indian version was
named Integrated Management of
Neonatal and Childhood Illness (IMNCI).
 IMNCI strategy is one of the main
interventions under RCHII/ NHM, that
focuses on preventive, promotive and
curative aspects of program.
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11. WHY IMNCI ???
 To Reduce infant and child mortality rates
& Improve child health & survival.
 India is still among high infant mortality
Rate countries but there has been
significant decline from 204 during 1911-
1915 to 129 per 1000 live births in 1970
and remained static at around 127 for
many years.
 As of 2015 data India’s Infant Mortality
Rate is 38 per 1000 live births.
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13. WHY INTEGRATED
APPROACH?
1. Integrated approach is child centred.
2. Five conditions : Pneumonia, Diarrhoea,
Measles, Malaria and Malnutrition are
major cause of Death.
3. 3 out of 4 children seeking health care in
developing countries suffers from one of
these condition.
4. Children likely to be suffering from more
than one condition.
5. Making a single diagnosis may be
difficult. Such children often need
combined therapy for successful
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14. ADVANTAGES OF INTEGRATED
APPROACH:
 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.
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15. INADEQUACIES IN HEALTH
SYSTEM:
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 come to a health facility
– Seeking assistance from unqualified providers
– Poor adherence to health worker advice and treatment
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16. OBJECTIVES OF IMNCI
1) Reducing infant mortality.
2) Reducing the incidence and
seriousness of
illnesses and health problems.
3) Improving growth and development
during the first five years of a child's life
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20. CARE OF YOUNG INFANT
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21. CARE FROM 2 MONTHS- 5 YRS
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).
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22. COMPONENTS OF IMNCI
1. TRAINING:
IMNCI is skill based training based on a
participatory approach combining
classroom sessions with hands-on clinical
sessions in both facility and community
setting.
Two categories of training are included:
1) One for medical officers
2) A second for front-line functionaries
including ANM’s and Anganwadi
Workers (AWW’s).
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23. 2. IMPROVEMENTS TO THE HEALTH
SYSTEM.
The essential elements include:
1. Ensuring availability of health
workers / providers at all levels.
2. Ensuring availability of the essential
drugs.
3. Improve referral to identified
referral facility.
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24. 3. IMPROVEMENT OF FAMILY AND
COMMUNITY PRACTICES: (C-IMNCI)
Counselling of families and creating
awareness among Communities . This
includes:
1.Promoting healthy behaviours such as
breastfeeding, illness recognition, early care
seeking etc.
2. Counselling of care givers and families as part
of management of the sick child when they are
brought to the health worker/health facility.
3. During Home Visits - identification of sickness4/4/2019 24BRIG DR HEMANT KUMAR

25. WORK DISTRIBUTION
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27. A sick young infant up to 2 months of
age is assessed for Possible bacterial
infections, diarrhoea , jaundice
Children of age 2 months to 5 years:
Cough or difficult breathing, diarrhoea,
fever & ear problems
Active participation of caretakers in the
treatment
Use of limited number of essential
drugs
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28. ELEMENTS
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29. THE IMNCI PROCESS FOR CHILDREN < 2
MONTHS OF AGE
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30. FOR CHILDREN 2 MONTHS TO 5 YEARS OF
AGE
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32. IMNCI-F ??
Facility-based integrated Management
of Neonatal and Childhood illness (F-
IMNCI) is a care package to train health
workers in managing new born and
childhood illnesses at the facility
level/inpatient care, providing the
important SKILLS for care of the sick
neonates and children reaching these
facilities from the peripheral centres.
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36. IMNCI +
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 4/4/2019 36BRIG DR HEMANT KUMAR

37. IMNCI+
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40. WHAT “IMNCI +” ADDS??
 Inpatient care component for facilities to
ensure effective care of sick neonates and
children who require hospitalization.
 IMNCI package not cover the vital care of
the neonates at birth in home and facility
settings.
 IMNCI approach includes counselling for
immunization, but the implementation of
immunization in India cannot be
adequately done by the IMNCI contacts
alone. Therefore, a comprehensive
immunization plan will be required.
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