The document discusses Integrated Management of Neonatal and Childhood Illness (IMNCI), an integrated approach to child health that focuses on well-being from birth to 5 years old. IMNCI aims to reduce mortality, illness, and disability in children while promoting growth and development. It includes both preventative and curative elements implemented by families, communities, and health facilities. Key aspects of IMNCI include assessing children for danger signs and illnesses, classifying conditions, treating illnesses, counseling caretakers, and conducting home visits for young infants to promote health. The approach uses standardized case management, focuses on common causes of mortality, and improves health worker skills through evidence-based training.

2. INTRODUCTION
IMNCI is an integrated approach to child
health that focuses on the well-being of the
whole child. IMNCI aims to reduce death,
illness and disability, and to promote
improved growth and development among
children under five years of age. IMNCI
includes both preventive and curative
elements that are implemented by families
and communities as well as by health
facilities

3. Different between imnci and
imci
Features WHO – UNICEF IMCI IMNCI
•Coverage of 0 to 6
days (early newborn
period)
•Basic Health Care
Module
•Home visit by the
provider for newborn
and Young Infant
•Training Home based
Care
•Sequence of training
No
NO
NO
NO
Child (2 months to 5 years of
age) then Young infant ( 7
days to 2 months of age)
YES
YES
YES
YES
Newborn and young
infants(0 to 2
months).Then Child (from
2 months to 5 years of
age.)

4. 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 Ministry of health worker & family welfare.
 Home-based care of young infants by health
workers added Potential of the adapted IMNCI
Package

5. Guideline for imnci
Evidence-based, syndromic approach to case
management includes rational, effective and
affordable use of drugs and diagnostic tools.
 An evidence-based syndromic approach can be
used to determine the:
• Health problem(s) the child may have.
• Severity of the child’s condition,
• Actions that can be taken to care for the child (e.g.
refer the child immediately, manage with available
resources, or manage at home).
 In addition, IMNCI promotes:
•Adjustment of interventions to the capacity of the
health system, and
•Active involvement of family members and the
community in the health care process.

6. PRINCIPLES
 • All sick young infants up to 2 months of age must be
assessed for “possible bacterial infection / jaundice”. Then
they must be routinely assessed for the major symptom
“diarrhoea”.
 • All sick children age 2 months up to 5 years must be
examined for “general danger signs” which indicate the need
for immediate referral or admission to a hospital. They must
then be routinely assessed for major symptoms: cough or
difficult breathing, diarrhoea, fever and ear problems.
 • All sick young infants and children 2 months up to 5 years
must also be routinely assessed for nutritional and
immunization status, feeding problems, and other potential
problems.

7. A combination of individual signs leads to a child's classification(s)
rather than diagnosis.
1. - needs urgent hospital referral or admission ( classifies as and
colour coded pink)
2. - needs specific medical Rx or advice (classified as and colour
coded yellow)
3 - can be managed at home (classified as and colour coded green)
 • IMNCI use a limited number of essential drugs and
encourage active participation of caretakers in the treatment.
 • IMNCI address most, but not all, of the major reasons a
sick child is brought to a clinic.
 • One of essential component of IMNCI is the counselling of
caretakers about home care,feeding,fluids and when to
return to health facility.

8. 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

9. ELEMENTS OF CASE MANAGEMENT
PROCESS
• Assess - Child by checking for danger signs by
history and examination.
• Classify - Child's illness by color coded triage
system.
• Identify - Specific treatments.
• Treatments- Instructions of oral drugs, feeding
& fluids.
• Counsel - Mother about breast feeding & about
her own health as well as to follow further
instructions on further child care.
• Follow up care - Reassess the child for new
problems.

10. IMPROVING HEALTH & NUTRITION WORKER
SKILLS
Guidelines for management of sick newborns and
children with serious disease in first referral facilities
 Training course for doctors for outpatient
management of sick young infants and children
 Training course for health and nutrition workers for:
Management of sick young infants and children
 Home visits for young infants Improving health &
nutrition worker skills Attention to counselling skills to
promote exclusive breastfeeding, complementary
feeding & micronutrient supplementation is a key
strength of IMNCI

11. HOME VISITS FOR YOUNG INFANTS:
Objectives
• Promote & support exclusive breastfeeding
• Teach the mother how to keep the young infant
warm
• Teach the mother to recognize signs of illness for
which to seek care
• Identify illness at visit and facilitate referral
• Give advise on cord care and hand washing All
newborns: 3 visits (within 24 hours of birth, day 3-
4 and day 7-10) Newborns with low birth weight: 3
more visits on day 14, 21 and 28.
Home visits for young infants: Schedule

12. COLOUR CODED CASE MANAGEMENT
STRATEGY
 PINK CLASSIFICATION: Child needs
inpatient care
 YELLOW CLASSIFICATION: Child
needs specific treatment, provide it at
home (e.g. antibiotics, anti-malarial,
ORS)
 GREEN CLASSIFICATION: Child
needs no medicine, advise home care

13. OTHER INNOVATIONS IN CASE
ASSESSMENT
 Visible severe wasting as indicator for hospital
admission rather than weight for age
 Palmer pallor to detect anaemia
 Breast feeding assessment: attachment and
suckling Innovations in therapy
-Single daily dose gentamycin
-Counselling the mother to give oral drugs at
home
-Clear recommendations for follow up
-Negotiated feeding counselling

14. STRENGTHS OF IMNCI TRAINING
 Evidence based decision making tree
 Hands-on clinical practice for 50% of
training time
 Focus on communication & counseling
skills
 Locally adapted recommendations for
infant and young child feeding

15. CHALLENGES
• Feasibility of the proposed hands-on clinical
practice in management of young infants at
district level
• Feasibility of provision of health care at
subcentre and village level by ANMs and
Anganwadi Workers
• Making the home-based care of young infants
by ANMs and anganwadi workers operational
• Improving logistics and supplies

16. THANK YOU