Integrated Management of

Neonatal and Childhood Illness

(IMNCI)
Dr. Muralidhar M Kulkarni
Associate Professor
Department of Community Medicine
 Introduction

Burden:

• Over the last 3 decades there is almost a third decline in U-5 deaths.

• However, this reduction has not been evenly distributed throughout the world.

• Every year >10 million children die in developing countries before they reach

their fifth birthday.

 Introduction

• Seven in 10 of these deaths are due to,

- fever (27% )

- acute respiratory infections (17% )

- diarrhoea (13% ) and

- malnutrition (43%)

and often in combination (NFHS-5).

 IMNCI

- IMNCI is an integrated approach to child health that focuses on the well-

being of the child.

Objectives:

• To reduce the number of under-5 deaths

• To reduce frequency and severity of illness and disability

• To improve growth and development

Key steps in IMNCI

Step 1: Assess

Step 2: Classify

Step 3: Treat

Step 4: Counsel

Step: Follow-up care

 Principles

• Examine for conditions which indicate immediate referral

• Routine assessment- major symptoms, nutritional, immunization status, feeding

and other problems

• Selected clinical signs

• Color coded classification (Pink, Yellow, Green)

 Principles

• Most common paediatric problems only

• Use of limited Essential drugs

• Active involvement of care takers

• Counselling of care takers

 IMNCI Case Management Process
For all sick children age up to 5 years who are brought
to a first-level health facility

ASSESS the child: Check for danger signs. Ask about main
symptoms. Check nutrition and immunization status. Check for
other problems.

Inpatient care
Specific
CLASSIFY the child's illness: Using colour-coded triage system treatment

Home care
 IF URGENT REFERRAL is IF NO URGENT REFERRAL is
needed and possible needed or possible

Identify urgent pre-referral

treatment(s) needed IDENTIFY TREATMENT needed for the
child's classifications: identify specific
medical treatments and/or advice.
TREAT THE CHILD:
Give urgent pre-referral
treatment(s) needed. TREAT THE CHILD: Give the first dose of oral
drugs in the clinic or advise the child's
REFER THE CHILD: caretaker.
- Explain the need for referral. Teach the caretaker how to give oral drugs
- Write a referral note. and how to treat local infections at home.
- Give instructions and supplies needed to If needed, give immunizations.
care for the child on the way to the
hospital.
 COUNSEL THE MOTHER
- Assess the child's feeding, including
breastfeeding practices, and solve feeding
problems, if present.
- Advise about feeding and fluids during illness
and about when to return to a health facility.
- Counsel the mother about her own health

FOLLOW-UP care:
- Give follow-up care when the child returns to the clinic
- If necessary, reassess the child for new problems.
Identify
Outpatient Management Of Young
Infants
Up To 2 Months Of Age
 Checking Immunization Status

• Immunization status should be checked in all sick young infants and should be
given the necessary immunizations before s/he is sent home.
• IMMUNIZATION SCHEDULE:
AGE VACCINE
Birth BCG, OPV “0”dose, HEP-B 1*
6 weeks LPV 1, OPV 1, IPV 1
Refer urgently:
1st dose of IM ampicillin and Gentamicin
Rx of severe dehydration, ORS on the way
Prevent hypoglycemia- BF/expressed milk
Warm – skin to skin contact (Kangaroo Mother
Care), keep warm on the way
Counsel, Home care
When to return immediately
Follow up in 5 days
Initiate Rx in the clinic, continue at home
Local Infection: oral co-trimoxazole for 5 days
Gentian violet locally, wicking ear
Treatment continuation at home, Keep warm
When to return immediately
Follow up in 2 days
Advise when to return:

I. IMMEDIATELY, if the infant has any of these signs:

• Breastfeeding or drinking poorly

• Becomes sicker

• Develops fever or feels cold to touch

In the next 2 days
• Fast breathing

• Difficult breathing

• Yellow palms and soles (if young infant has jaundice)  Child with low weight for
age in 14 days
• Diarrhoea with blood in stool  Return to next
immunization according
to immunization schedule
Outpatient management of children
AGE 2 MONTHS UP TO 5 YEARS
 Urgent pre-referral treatments for the sick child age 2
months up to 5 years
Classification Treatment
Danger Sign- Convulsions Diazepam (10 mg/2 ml solution) in dose
0.2 mg per kg (0.05 ml/kg) IV or rectally

Severe pneumonia or Very severe Give first dose of IV or IM

disease
Very severe febrile disease
chloramphenicol (40 mg/kg).
Give one dose of paracetamol for high
fever (38.5°C or above)
Give first dose of IM quinine for severe
malaria

Severe complicated measles Give first dose of appropriate antibiotic.

Give vitamin A.
Severe dehydration WHO Treatment Plan C
Other specific treatment and home treatment
• Pneumonia, acute ear infection, dysentery: Co-trimoxazole
• Cholera >2years old: Doxycycline
• Diarrhoea:
ORS, Zinc and Vit. A
• Anemia:
IFA for 14 days
• Local infection:

Tetracycline eye ointment

wicking ear
gentian violet for mouth ulcers
Thank you