Program: B.Sc.

Nursing, 5th Semester, Third year

BNSG 502: Child Health Nursing
Unit no. IV
Unit Name- Integrated Management of Neonatal &
Childhood Illness (IMNCI)
Topic Name- IMNCI - I

Lecture No- 1
Mrs. Snigdha Chakraborty
Clinical Instructor, SONS
Outlines
• Introduction of IMNCI
• Objectives.
• Principles.
• Goals of IMNCI.
• IMNCI package.
• IMNCI case management process.
• Learning outcomes.
• SELO(students effective learning outcome)
• References.
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• Introduction
• Every year more than 10 million children die in developing countries
before they reach their fifth birthday.

• 7 in 10 of these deaths are due to five preventable and treatable

conditions.

• Pneumonia, diarrhea, malaria, measles and malnutrition – and

often to a combination of these conditions.

• 3 out of 4 of these children suffer from one of these five conditions.

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• 1- ARI:-

• 2- DIARRHOEA:-

• 3- MEASLES:-

• 4- MALARIA:-

• 1990-WHO+UNICEF +other agencies- (IMCI) India adopted as

(IMNCI).

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 What is IMNCI

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.

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 The strategy includes three main components:=

Improving case management skills of health-care staff

Improving overall health systems

Improving family and community health practices.

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Objectives
• Objectives are at the end of the lecture the students are able to know
about the IMNCI and its principles.

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• Almost 19,000 children under 5 yrs of age, died everyday across the
world. 50% of it occurs in just five countries i.e. India, Nigeria, Congo,
Pakistan and China.

• • In India, there are nearly 16.55 lakhs child deaths during 2011 and we
rank top among the countries with highest child mortality.

• • India IMR-42/1000 live births. (46 – Rural, 28 - Urban) in 2012, which

was 47 in 2010.

• World IMR-35/1000 live births

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• In INDIA- M.P. has the highest IMR followed by ASSAM,ORISSA
and UP.

• MP=56,ASSAM=55,ORISSA and UP=53/1000 live births.

• WHO and UNICEF recognized the need to strengthen child-health

activities in the country and decided to launch IMCI.

• The generic IMCI guidelines were adapted and the Indian version
was named Integrated Management of Neonatal and Childhood
Illness (IMNCI)-main intervention under RCH-II/NRHM ,that
focuses on preventive,promotive and curative aspects of program.
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• Reasons for the delay in assessment and accessibility of newborn to
reach healthcare setting:

• 1.Starting of a problem
• 2. Delay in recognizing problem
• 3.Home based treatment
• 4.Delay in selecting health facility
• 5.Treatment from traditional advisors and village doctors
• 6.Delay in selecting formal health facility causing delay in treatment and
increased cost
• 7.Increased chances of death of newborn.

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 Principles of integrated care

• • 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.

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• • 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.

• 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
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 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

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 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.

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• 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.

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 IMNCI PACKAGE

IMNCI guidelines recommend standardized case management

procedures

That based on two age categories: -

1= Up to 2 months and

2= 2 months to 5 years

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 Care of Newborns and Young Infants (infants under 2 months)
• 1. Keeping the child warm.

• 2. Initiation of breastfeeding immediately after birth and counseling for

exclusive breastfeeding and non-use of pre lacteal feeds.

• 3. Cord, skin and eye care.

• 4. Recognition of illness in newborn and management and/or referral).

• 5. Immunization
• 6. Home visits in the postnatal period.

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 Care of Infants (2 months to 5 years)

1. Management of diarrhea, acute respiratory infections, malaria,

measles, acute ear infection, malnutrition and anemia.

2. Recognition of illness and at risk conditions and management/referral)

3. Prevention and management of Iron and Vitamin A deficiency.

4. Counseling on feeding for all children below 2 years

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5. Counseling on feeding for malnourished children between 2 to 5
years.

6. Immunization

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 IMNCI CASE MANAGEMENT PROCESS

Steps of case management process are the following:

• 1. Asses the young infant/ child.

• 2. Classify the illness.
• 3. Identify the treatment.
• 4. Treat the young infant/child.
• 5. Counsel the mother.
• 6. Provide follow up care.

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 Counselling a mother or caretaker

• • Ask and Listen

• • Praise
• • Advice
• • Check

Essential elements-

• • Teach how to give oral drugs

• • Teach how to treat local infection
• • Teach how to manage breast or nipple problem

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• • Teach correct positioning and attachment for breastfeeding

• • Counsel on other feeding problems

• • Advise when to return

• • Counsel the mother about her own health

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Exercise
• Learn all the IMNCI

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Learning Outcomes

• Students are able to know The IMNCI

• Students are able to know about objectives and functions also.

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SELO
• 1. Ability to solve problem through application of theoretical and
prectical concept.

• 2. Ability to observe and develop logical skills for abstract concepts.

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References
• 1. .Parul Datta, Essential of pediatric nursing, 5th edition, moshby
Publisher.

• 2. https://www.google.co.in/imnci

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