IMNCI - 6th Sem

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 chloramphenicol (40 mg/kg).
Very severe febrile disease 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

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Integrated Management of

Neonatal and Childhood Illness

their fifth birthday.

• Seven in 10 of these deaths are due to,

- acute respiratory infections (17% )

- diarrhoea (13% ) and

and often in combination (NFHS-5).

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

• To reduce the number of under-5 deaths

• To reduce frequency and severity of illness and disability

• To improve growth and development

Step: Follow-up care

• 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)

• Most common paediatric problems only

• Use of limited Essential drugs

• Active involvement of care takers

• Counselling of care takers

Identify urgent pre-referral

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

• Breastfeeding or drinking poorly

• Develops fever or feels cold to touch

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

Severe complicated measles Give first dose of appropriate antibiotic.

Tetracycline eye ointment

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