This document provides an introduction to the Integrated Management of Childhood Illness (IMCNI) strategy. The objectives of IMCNI case management are to improve quality of care for children under five and reduce childhood mortality. IMCNI takes an integrated approach by addressing the overlapping signs and symptoms of multiple diseases threatening child health, including pneumonia, diarrhea, measles, malaria, malnutrition and HIV/AIDS. The strategy combines treatment and prevention of major childhood illnesses with aspects of nutrition, immunization and important community practices to improve child growth, development and survival.

1. INTRODUCTIO
N TO IMCNI
mentorship training slides
Tiwi Ward

2. Objectives of IMCNI case
management
 To improve the quality of care provided to
children under five years
 To contribute to the reduction in childhood
mortality

3. cont
Why an integrated approach?:
 Most children present with signs and
symptoms related to more than one of these
diseases mentioned above
 Thus a single diagnosis may neither be
possible nor appropriate
 This approach is needed as need to go
beyond single diseases and address the
overall health

4. Aim?
 At reducing death, and frequency and severity
of illness and disability by
 Integrating treatment and prevention of major
childhood illnesses, to contribute to improved
growth and development

5. cont
 Therefore the IMCNI strategy combines
improved management of childhood illnesses
with aspect of:
 Nutrition
 Immunization
 Other important influences on child health
including maternal health

6. Cont..
 Improvement of family and community practices
 Community and family practices that if adopted can
reduce child mortalities eg
 Exclusive breastfeeding for 6months
 Appropriate complementary feeding from 6months whilst
continuing breastfeeding
 Proper disposal of feces, hand washing
 Child sleeps under ITN
 Prevention and care of HIV/AIDS
 Continue feed child and offer more food and fluids when
child sick
 Give child appropriate home treatment for infections

7. Components of IMCI
 Improvement of health workers skills
? Through training in case management and the systems
should thus be functional and family and community practices
have been improved
 Improvement of health systems
 Ensuring availability of essential drugs and supplies
 Organized hospital emergency area to support rapid
evaluation and management of sick children
 Training of health workers in ETAT
 Adherence to national policies for standards of care

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40
60
80
100
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2003 KDHS 2008-09 KDHS 2014 KDHS SDG Targets
Trends in Childhood Mortality
Deaths per 1000 live births
Neonatal mortality Under 5 mortality

9. Under five mortalities

10. How do we address this high mortality rates?
 We Need simple, standard guidelines for these conditions:
 In diagnosis
 In management
• The guidelines must also be scientifically and professionally sound.
• WHO and UNICEF developed a package for countries with infant
mortality rate >40/1000 live births. Kenya has since adopted this
approach.
• This package is called Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)

11. IMNCI Clinical Guidelines
2 months 5 years
IMNCI Guidelines
Sick Child
Birth
Sick Young infant

12. Important aspects (1)
• IMNCI does not cover all symptoms.
• IMNCI strategy is not reviewing all pediatric medicine
• Emphasis is how to deal more effectively with the most common
problems in sick children brought to the clinic.
• IMNCI strategy takes into consideration the overlapping of these
symptoms and conditions.

13. Important Aspects (2)
 The core interventions is integrated management of six most important
causes of death, namely:
1. Pneumonia
2. Diarrhoea
3. Measles
4. Malaria
5. Acute Malnutrition and Anemia, HIV
6. Young infant infections and birth related conditions.
• IMNCI also addresses the common signs/symptoms that
make the mother bring her child to hospital.

14. The IMNCI Case Management Process
 This must be performed on all sick children
 The IMNCI Case Management Process includes;
– Assessing and classifying the sick child 2 months up to 5
years.
– Identifying treatment and treating the child.
– Counseling the caregiver..
– Check for child’s developmental milestone.
– Assessing for interaction, communication& responsiveness.
– Assessing and classifying the sick young infant
– Follow up care.
This process is detailed in the IMNCI chart booklet
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15. The Chart Booklet and the Recording form
Chart Booklet
 The chart booklet is a IMNCI case management job aid which gives a step
by step guide on the case management process.
 Health care providers need to continuously refer to this document
throughout the case management process.
 Many mistakes service providers make in assessment, classification and
management of sick children and young infants are due to failure to use this
job aid.
Recording Form ( Chart booklet pages 48-53)
 There is a sick child and a sick young infant recording forms
 Each is used for the corresponding age group.
 The assessment findings, Classifications and management options for the
child should be recorded on this form.
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16. The IMCNI strategy
 It is an innovative approach
 Started in 1995 by WHO and UNICEF with aim of
introducing a comprehensive and timely
management of the 5 most common causes of ill
health and death among children
 The illnesses are:
 Pneumonia
 Diarrhea
 Measles
 malnutrition