INTEGRATED MANAGEMENT FOR NEONATAL AND CHILDHOOD ILLNESS ( IMNCI) INTRODUCTION

The integrated management for neonatal and childhood illness concept was developed by WHO and UNICEF as a new strategy. For
the union illnesses management among pediatric population, the , IMNCI is working

controlling of morbidity and mortality rates among

children. It working to the under-five morbidity and mortality in the developing countries. Through management the health workers are getting the good-professional training and improving the performance towards child care. Integrated management of childhood illness (IMCI) strategy was developed in mid It is a curative, preventive and promotive strategy aimed
at reducing the death and frequency and severity of illness and disability,

and contributes to improve growth and nutrition of under-five children. This strategy has been expanded in India to include care at home as well as in
the health facilities and it renamed as integrated management of Neonatal and Childhood Illness - (IMNCI). MAJOR COMPONENTS Of THE INTEGRATED: MANAMENT OF NEONATAL AND CHILPHOOD ILLNESS (IMNCI) Components are following 1) Improvement of family and community practices towards child health care. 2) Provision of essential drugs and their supplies. 3) Betterment of technical skill of health care providers in case of management.

4) Community involvement in health care programmes of children. 5) Equitable distribution of health care facilities and maximum reach out to all pediatric population. SERVICE PROVIDED UNDER INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS These are following: Vaccination services Vitamin A' and micro nutrient supplementation Breast feeding. Management of ARI, Prevention of diarrhea. Prevention of malnutrition. Malaria control programmes. Counseling on various health problems

Integrated management of childhood illness is working on preventive and curative aspect of health among pediatric population.

PRINCIPLES OF INTEGRATED CARE

Principles of integrated care depending on a child's age, various clinical signs and symptoms differ in their degree of reliability and diagnostic value and importance. Clinical guidelines focus on neonates, infants as well as children up to 5 years of age. The treatment guidelines have been broadly described under two age categories. 1) Young infants age up to 2 months. 2) Children age 2 months up to 5 years. Integrated management of neonatal and childhood illness guidelines age based on following principles Children below 5 years of age, all should be examined for condition when

indicates immediate referral or hospitalization. Children must be routinely assessed for major symptoms, nutritional immunization status, feeding problems and other potentials problems. Only a limited number of carefully selected clinical signs are used based Evidence of their sensitivity and specificity to detect disease. Based on the presence of selected clinical signs the child is place 'classification Classifications are not specific diagnoses but categories that are used to determine the treatment.

Classifications are colour coded and suggest referral (pink), treatment in

health facility (yellow) or management at home (green).

IMNCI-guidelines address most common, but not all pediatric problems. A limited numbers of essential drugs are used are takers are actively
involved in the treatment of children.

Counseling of caretakers about home care including feeding, fluid and

when to return to health facility.

IMNCI CASE MANAGEMENT PROCESS

Steps of case management process are following

1) 2) 3) 4) 5) 6)

Assess the young infant/child. Classify the illness. Identify the treatment Treat the young infant/child Counsel the mother Provide follow up care.

The ASSESS AND CLASSIFY chart describes how to assess the child, classify the childs illnesses and identify treatments. The ASSESS column on the left side of the chart describes how to take a history and do a physical examination. You will note the main symptoms and signs found during the examination in the ASSESS column of the case recording form. The CLASSIFY column on the ASSESS AND CLASSIFY chart lists clinical signs of illness and their classifications. Classify means to make a decision about the severity of the illness. For each of the childs main symptoms, you will select a category, or classification, that corresponds to the severity of the childs illnesses. You will then write your classifications in the CLASSIFY column of the case recording form.

IDENTIFY TREATMENT
The IDENTIFY TREATMENT column of the ASSESS AND CLASSIFY chart helps you to quickly identify treatment for the classifications written on your case recording form. Appropriate treatments are recommended for each classification. When a child has more than one classification, you must look at more than one table to find the appropriate treatments. You will write the treatments identified for each classification on the reverse side of the case recording form.

TREAT THE CHILD

The IMCI chart titled TREAT THE CHILD shows how to do the treatment steps identified on the ASSESS AND CLASSIFY chart. TREAT means giving treatment in clinic, prescribing drugs or other treatments to be given at home, and also teaching the caretaker how to carry out the treatments.

COUNSEL THE MOTHER

Recommendations on feeding, fluids and when to return are given on the chart titled COUNSEL THE MOTHER. For many sick children, you will assess feeding and counsel the mother about any feeding problems found. For all sick children who are going home, you will advise the childs caretaker about feeding, fluids and when to return for further care. You will write the results of any feeding assessment on the bottom of the case recording form. You will record the earliest date to return for follow-up on the reverse side of the case recording form. You will also advise the mother about her own health.

GIVE FOLLOW-UP CARE

Several treatments in the ASSESS AND CLASSIFY chart include a follow-up visit. At a follow-up visit you can see if the child is improving on the drug or other treatment that was prescribed. The GIVE FOLLOW-UP CARE section of the TREAT THE CHILD chart describes the steps for conducting each type of followup visit. Headings in this section correspond to the childs previous classification(s).

FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic

ASK THE CHILDS AGE

IF the child is from 1 week up to 2 months

IF the child is from 2 months up to 5 years

USE THE CHART: ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT

USE THE CHARTS: ASSESS AND CLASSIFY THE SICK CHILD TREAT THE CHILD COUNSEL THE MOTHER

SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS

SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS

For all sick children age 1 week up to 5 years who are brought to a first-level health facility

ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems.

CLASSIFY the childs illnesses: Use a colour-coded triage system to classify the
childs main symptoms and his or her nutrition or feeding status.

IF URGENT REFERRAL is needed and possible

IF NO URGENT REFERRAL is needed or possible

IDENTIFY URGENT PRE-REFERRAL TREATMENT(S) needed for the childs classifications.

IDENTIFY TREATMENT needed for the childs 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 and/or advise the childs caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If needed, give immunizations.

REFER THE CHILD: Explain to the childs caretaker the need for referral. Calm the caretakers fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital.

COUNSEL THE MOTHER: Assess the childs 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 and, if necessary, reassess the child for new problems.

INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI): SKILL ASSESSMENT OF HEALTH AND INTEGRATED CHILD DEVELOPMENT SCHEME (ICDS) WORKERS TO CLASSIFY SICK UNDER-FIVE CHILDREN
Shewade HD, Aggarwal AK, Bharti B. Indian J Pediatr. 2012 Source School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, hemantjipmer@gmail.com. Abstract OBJECTIVE: To assess the skills (diagnostic/counseling) of Integrated Management of Neonatal and Childhood Illness (IMNCI) trained workers; and to assess the degree of agreement between the physician and the IMNCI trained workers of Raipurrani block, district Panchkula, India, to classify sick under-five children in field. METHODS: The cross-sectional study was conducted in Raipurrani in the outpatient departments of the community health centre and one primary health centre in 2010. Workers from health department and Integrated Child Development Scheme (ICDS) were assessed in this study. They receivedIMNCI training in 2006, with 1 day refresher training in 2009. Investigator noted his observations using a skill assessment checklist. Under-five child observations were the unit of study. RESULTS: Sixteen IMNCI trained workers made 128 child observations. Considering color-coded categorization under IMNCI, agreement with investigator (Kappa) was intermediate; red and yellow categorizations had poor agreement. Morbidity-wise agreement (Kappa) was poor for possible serious bacterial infection, feeding problem, respiratory problem and anemia. Considering final diagnosis, investigator and IMNCI trained worker completely agreed in 45 % child observations. All symptoms were asked only in 15 %. Skills were poor overall for young infants. For children between 2 mo to 5 y, danger signs, neck stiffness, edema, wasting and pallor were checked in <40 % observations. Immunization card was asked for in 20 % observations. IMNCI trained workers performed well in all aspects of counseling, except follow up. CONCLUSIONS: Training without effective implementation plans will not result in long term skill retention.

STUDY COMPARING THE MANAGEMENT DECISIONS BY IMNCI ALGORITHM AND PEDIATRICIANS IN A TEACHING HOSPITAL FOR THE YOUNG INFANTS BETWEEN 0 TO 2 MONTHS
Bhattacharyya A, Saha SK, Ghosh P, Chatterjee C, Dasgupta S. Indian J Public Health. 2011 Source Department of Community Medicine, Bankura Sammilani Medical College, India. b.agnihotri@yahoo.com Abstract Integrated management of neonatal and childhood illness (IMNCI) was already operational in many states of India, but there were very few studies in Indian scenario comparing its validity and reliability with the decisions of pediatricians. The general objective of the study is to compare the IMNCIdecisions with the decisions of pediatricians and the specific objectives are to assess the agreement between IMNCI decisions and the decisions of pediatricians, to assess the under diagnosis and over diagnosis in IMNCI algorithm in comparison to the decisions of pediatricians and to assess the significance of multiple presenting symptoms in IMNCI algorithm. The study was conducted among the sick young infants presenting in pediatric department from January to March 2009. The IMNCI decision was compared with pediatrician's decisions by percent agreement, Kappa and weighted Kappa with the aids of SPSS version 10. The overall diagnostic agreement between IMNCI algorithm and pediatrician's decisions was 55.56%, (Kappa 0.32 and weighted Kappa 0.41) with 33.33% over diagnosis, and 11.11% under diagnosis. 71.88% young infants with multiple symptoms and 40% with single symptom were classified as red by IMNCI algorithm, which is statistically significant (P=0.004) whereas 56.25% young infants with multiple and 31.76% with single symptom were considered admissible by pediatricians, which is not statistically significant (P=0.052).

BIBLIOGRAPHY BOOK REFERENCE

A Textbook of Child Health Nursing, Manoj Yadav, PV Publications, 1st Edition, Textbook of pediatric Nursing, Dorothy R Marlow, Elsevier Publication,6 th Editions, Essentials of Pediatric Nursing, wongs , Elsevier Publication,7th Editions, Textbook of of pediatric Nursing, Beevi, Elsevier Publication,1st Edition, Essentials of Pediatric Nursing, Piyush Gupta, CBS Publication, 2nd edition,

JOURNAL REFERENCE
http://www.ncbi.nlm.nih.gov/pubmed/22878929

http://www.ncbi.nlm.nih.gov/pubmed/22298145

WEB REFERENCE
http://www.unicef.org/india/health_6725.htm http://202.71.128.172/nihfw/nchrc/index.php?q=taxonomy/term/1192/all https://www.google.co.in/#hl=en&output=search&sclient=psyab&q=Integrated+Management+of+Neonatal+and+Childhood+Illness&oq=Int egrated+Management+of+Neonatal+and+Childhood+Illness