Integrated management of neonatal and childhood illness

INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD

ILLNESS

7/10<5mort.

ADD

ARI

MalariaMeasles

Mal-nutrition

Factors contributing to illness

Poor living conditions- lack of safe water supply poor hygieneovercrowding

Inability of parents to recognize danger signs

delay in seeking appropriate treatment

poor quality of care provided at health facilities.

More than one morbid condition

"The Integrated Management of Childhood Illness (IMCI)"

1992

UNICEF and WHO

Objectives

Reduce mortality

Reduce frequency and severity of illness and disability

Improve growth and development during the first 5 years of a child's life

Guidelines

Evidence-basedsyndromic approach

Determining the health problems of the child Severity of child's conditionEvaluation of the actions takenRational, effective, and affordable use of drugs and diagnostic tools.

IMCI StrategyHealth-worker component:

Improvements in the case-management skills of health staff

through locally adapted guidelines.

Health-service component: Improvements in the overall health

system required for effective management.

Community component: Improvements in family and community

health care practices.

IMNCI

Central pillar of child health interventions under

RCH II

IMNCI

• Inclusioin of 0-7 years of age.• Incorporating national programmes.• Training begins with sick infants <2

mths.• Training time devoted to sick infant &

sick child are almost equal.• Skill based

Implications

Standardized case management procedures based on two age categories: 1. upto 2 months 2. 2 months to 7 years.

Only a limited number of carefully-selected clinical signs are considered, based on their sensitivity and specificity, to detect the disease.

Classification - urgent hospital referral or

admission - specific medical Rx or

advice - home management

P Y G

Management

Assessment Classification of illnessIdentification of specific RxClear instructions to motherCounsel to solve feeding problems Follow-up care.

AdvantagesEvidence-based management decisions. Eg:oral rehydration therapy for diarrhea.

Focus on communication and counselling skills.

Locally adapted recommendation for infant and young child feeding.

Increased effectiveness of care and reduction in cost.

Potential of lowering the burden on hospitals.

Model for improving one aspect of service delivery that could be applied to other aspects of health care.

What it does not address... • Not all major illnesses are included• Management of trauma / other

emergencies not included.

Challenges

Feasibility

Sustaining what is initiated through indicator-based monitoring

Making home-based care of young infants operational by ANMs and AWWs

Future aims

To provide a comprehensive newborn and child care package at all levels of care:

At the village/household level - AWWs.Sub-center level - through ANMsPHCs - doctors, nurses, and Lady Health Visitors;At First Referral Units – MOs and nurses

Summarizing...

Major diseasesOrigin

ObjectivesIMCI strategy

IMNCIClassificationManagementAdvantages Challenges

Future aims

...Very much

Thank you...