Integrated Management of Childhood Illness (IMCI) is a cost-effective approach
Integrated Management of Childhood Illness (IMCI) - Focuses on the child and not on the illness
6. Distribution of deaths of children less
than 5 Years, by cause, the world, 1990
and projected for 2020
The 5 main killers of
children: 1990 2020
ARI, diarrhoea,
measles, malaria
and malnutrition
55% 52%
Perinatal
conditions
Other 5% 7%
communicable
9% 18%
diseases 19%
12% 11%
Non-communicable
11%
diseases
Injuries
7. For many sick children a single
diagnosis may not be apparent or
appropriate
Presenting complaint Possible cause or associated
condition
Cough and/or fast breathing Pneumonia
Severe anaemia
P. falciparum malaria
Lethargy or unconsciousness Cerebral malaria
Meningitis
Severe dehydration
Very severe pneumonia
Measles rash Pneumonia
Diarrhoea
Ear infection
"Very sick" young infant Pneumonia
Meningitis
Sepsis
8. WHO/ UNICEF -Integrated Approach
3 out of 4 children who seek Integrated Management
health care are suffering of Childhood Illness
from at least one of the five (IMCI) - Focuses on the
conditions child and not on the
illness
Some children are often
suffering from more than one
condition, making a single
diagnosis impossible Integrated
Such children need complete Management of
assessment and combined Childhood Illness
therapy for successful (IMCI) is a cost-
treatment.
effective approach
9. Causes of Deaths 0-4 years- 2001-03
Office of Registrar General, India
Perinatal conditions
Resp Infections
2.7 1.5
2.8 2.7
3.2 Diarrhea
3.4
33
11 Infectious and Parasitic
diseases
Ill defined
Injuries
14
Nutritional def
22
Malaria
Cong. Anamolies
PUO
10. Share of under-five mortality in India
Neonatal deaths Infant deaths within 7 days of birth 40%
50%
Infant deaths
76%
Infant deaths between
7 days of birth and within 28 days 10%
Infant deaths between 28 days
and within one year of birth 26%
Child deaths between one
year and within five years of birth 24%
Source : SRS 2007
11. IMCI to IMNCI-INDIA
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
MOHFW, DWCD and NVBDCP
12. IMNCI as a key strategy for improving
child health
Management Nutrition Immunization Other disease
of sick newborn Prevention &
& children Promotion of
growth and
development
Integrated Management of
Neonatal & Childhood Illness
13. What Needs to be Done in IMNCI
Improving the case management
skills of health workers
• Improving the health system for
effective management of childhood
illness
• Improving family and community
practices
14. Case Management Process
Two groups:
(A) Young infants :
From birth up to 2 months of age.
(B) Older children :
From 2 months up to 5 years of age.
15. What does IMNCI Offer
• IMNCI guidelines address most but not all of the
major reasons a sick infant and child is brought to
a clinic
• Only a limited number of signs based on evidence
are used to detect a disease
• A combination of individual signs leads to action
oriented colour coded classification(s)
• IMNCI management includes a limited number of
drugs and encourages active participation of
caretakers
• Counselling of caretakers is an essential
component
17. Standard Clinical Guidelines
“Golden” paediatric standard
Complete
examination Advise to
Preliminary Laboratory Differential Final Treatment Treatment
all signs caretakers
Diagnosis examination Diagnosis Diagnosis strategy procedures
and Follow- up
systems
“IMNCI” approach
Focused Assessment Classification Treatment Counsel & Follow-up
Danger signs Need to Refer
Identify Counsel
Main Symptoms
Specific treatment treatment Caretakers
Nutritional status
Treat Follow-up
immunisation status
Home management
other problems
• Essential Investigations
18. Case Management Process
Assess the Child.
Classify the Illness.
Identify Treatment.
Treat the Child.
Counsel the Mother
Give Follow-Up
Care.
20. Classify The Illness
“Classify the illness” means making a decision
on the severity of the illness according to the
child’s major symptoms.
Classifications are not diagnoses.
They are categories that are used to
determine treatment.
21. PINK: Patient requires URGENT hospitalization.
Give pre-referral treatment and
Refer URGENTLY to hospital.
YELLOW: Specific medical treatment and advice,
as you do in your OPD or Clinic.
GREEN: Simple advice on home-management.
May require some home made safe remedy.
22. IDENTIFY TREATMENT
This is further direction to management
If a child needs urgent referral (hospitalization),
give pre-referral treatment
If a child needs treatment at home, explain
mother how to do it home
If a child needs immunization, give it
23. TREAT THE CHILD
This explains complete treatment to be given at
clinic and at home
This includes teaching the mother (or caretaker)
how to give oral drugs, how to feed and give
fluid during illness, and how to treat local
infection at home
Return for follow up
When to return immediately
24. COUNSEL THE MOTHER
Assess and Counsel the
mother to solve any
feeding problem found
Counsel on home care
Counsel on when to
return immediately
Counsel the mother about
her own health
25. Classify ALL YOUNG INFANTS
SIGNS CLASSIFY AS
Convulsion or
Fast Breathing (60 breaths per minute or more) or POSSIBLE SERIOUS
Severe chest indrawing or BACTERIAL INFECTION
Nasal flaring or
Grunting or
Bulging fontanel or
10 or more skin pustules or a big boil or
If axillary temperature 37.50C or above (or feels hot to
touch) or temperature less than 35.50C (or feels cold to
touch) or
Lethargic or unconscious or
Less than normal movement
o Umbilicus red or draining pus or LOCAL BACTERIAL
o Pus discharge from ear or INFECTION
o < 10 skin pustules
27. VIDEOS & PHOTO BOOK
Good attachment to Breast
lower lip is curled outward baby’s mouth is wide open
chin touches lower portion of
the breast the areola is not
visible
34. VIDEO
• GRUNTING- Short expiratory sound, signifies
infant having difficulty in breathing- Severe
illness
• 2 Grunting.wmv
35. VIDEO
SIGNS OF SEVERE PNEUMONIA
• CHEST INDRAWING- Lower chest wall goes in
during inspiration
• STRIDOR- Harsh sound when child breathes in
• 2 Severe Respiratory Distress_Large.wmv
36. VIDEO
• VISIBLE SEVERE WASTING- severe wasting of
the shoulders, arms buttocks and legs with
ribs easily seen- MARASMUS
• 11Severe malnutrition_Large.wmv
37. REMEMBER- SEVERE CLASSIFICATIONS
Sick Young Infant age up Sick Child age 2 months up
to 2 months to 5 years
• Possible serious bacterial • Severe Pneumonia Or Very
infection Severe Disease
• Severe Dehydration with
• Severe Jaundice another severe classification
• Severe Dehydration • Severe Persistent Diarrhea
• Severe Persistent Diarrhea • Very Severe Febrile Disease
• Severe Dysentery • Severe Complicated Measles
• Not able to feed- Possible • Mastoiditis
serious bacterial infection • Severe Malnutrition
OR Severe Malnutrition • Severe Anemia
ACTION- PRE- REFERRAL TREATMENT & URGENT
REFERRAL
38. Hospital is the best place for
treating a very sick infant/child
But if Referral is not possible,
IMNCI Guidelines can save a life !
39. TAKE HOME MESSAGE
IMNCI--Colour coded case management
strategy
• PINK CLASSIFICATION: Child needs inpatient care,
Provide Pre-referral treatment and Refer Urgently
• YELLOW CLASSIFICATION: Child needs specific
treatment, provide it at home (e.g. antibiotics, anti-
malarial, ORT)
• GREEN CLASSIFICATION: Child needs no medicine,
advise home care
40. CONCLUSION
The IMNCI Strategy focuses on the diseases of
the childhood that cause the greatest global
burden.
An integrated approach is needed because the
overlap in the signs and symptoms of the
major diseases is common.
41. Conclusion (continued)
It is important to treat the child as a whole,
not simply the most apparent disease.
The IMNCI approach ensures a complete
assessment of a sick child, provision of
treatment and counseling the mother to
improve health practices at home and to
promote health seeking behavior.