IMNCI

1
DEFINITION
 The Integrated Management of Newborn
and Childhood Illnesses (IMNCI) case
management approach offers simple and
effective methods to comprehensively prevent
and manage the leading causes of serious
illnesses and mortality in children below five
years.
 With IMNCI, sick children or young infants
are not only treated for the signs and symptoms
they present within a health facility, but are also
Assessed for the other disease conditions.
IMNCI IS BASED ON THE FOLLOWING PRINCIPLES:
 All sick children aged up to 5 years are

examined for general danger signs
All young infants are Examined for signs
of very severe disease. These signs
indicate the need for immediate referral
or admission to hospital.
Children and infants are then assessed
for main symptoms. For the older children,
the symptoms include Cough, difficulty
breathing, diarrhea, fever, TB, HIV, ear
infections, anemia, measles and
malnutrition.
IMNCI IS BASED ON THE FOLLOWING PRINCIPLES
A combination of individual signs then lead

to the child’s or young infant’s classification
within one or more symptom groups.
Essential drugs are then used to treat the

children or young infants. Lastly counseling
of caregivers regarding
Home care, appropriate feeding and fluids
and when to return to facility - immediately
or follow-up, is done.
Classification
•The classify (signs and classify) column

of the chart lists clinical signs of
illnesses and their classification.
•“Classify” in the chart means the health
worker has to make a decision on the
severity of the illness.
•Healthcare workers will be able to
classify children or young infants
illnesses using the colour-coded triage
system.
COLOR CODING
"Red", indicating severe conditions
which need urgent referral to an
inpatient facility
“Yellow", indicating situations that
can be managed at the health
centre—often with drugs—but that
require definite follow-up
and
"Green", indicating mild conditions
which require simple home care.
2
3
4
Neonatal mortality(0-4 Post neonatal
weeks) mortality(1-12 months)
• Low birth weight & • Diarrhoeal diseases
prematurity • Acute respiratory
• Birth injury and infections
difficult • Communicable
labour disease
• Sepsis • Malnutrition
• Congenital • Congenital
anomalies anomalies
• Hemolytic • Accidents
disorders
• Conditions of
placenta
and cord
6
IMNCI caters to two groups of children
0-2 months Young 2 months to 5 years

infants. Children
REDUCE IMPROVE
FREQUENCY GROWTH AND
AND SEVERITY DEVELOPMENT
REDUCE DURING THE
MORTALIT OF ILLNESS FIRST 5 YEARS
Y AND OF A CHILD'S
DISABILITY LIFE
Newborns
Young
and
children
infants
(2months-
(under 2
5 years)
months)
8
Collaboration
Effective with other
Training
implementation departments
Improvement
of family
and
community
health
practices
9
10
Training at two levels
In-Service training
for the existing staff
Pre-Service
Training
11
Paediatricians
Selected Medical Officers from

Community Health Centres
and block PHCs
Selected staff nurses ,Lady
Health Visitors and Child
Development Project Officers
from ICDS
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Type of Personnel Duration Package Place of
training to be to be used
trained training
Clinical Medical 8 days Physician Medical

skills Officers, package
training Paediatrician College/
s District
Hospital
8days Health
Health workers District
workers,ANM package Hospital
s,
CDPOs and
13
Type of Personnel to Duration Package to Place of
training be trained be used
training
Supervisory Medical 2 days Supervisory Medical

Skill Training Officers, Skills College/
Paediatricians, Package District
CDPOs and Hospital
LHVs
14
Health worker
component
Improvement in the overall

Health System.
Improvement in family and

community health care
practices.
Improvements in the case-management skills
GUIDELINES
TRAINING
SKILLED CASE-MANAGEMENT
Improvements is needed for effective management
Essential
drugs
Supervision
and Health
monitoring worker
s
Referra Identified
l referral
centers
Swiftly
transferre
d
All sick children under 5 years of age must be
examined for conditions which indicate immediate
referral or hospitalization.
Children must be routinely assessed for major
symptoms, nutritional and immunization status,
feeding problems and other potential problems.
Only a limited number of carefully selected
clinical signs, are used based on evidence of their
sensitivity and specificity to detect disease.
• Based on the presence of selected clinical signs,
the child is placed in a ‘classifications’.
• Classifications are not specific diagnosis but
categories that are used to determine the
treatment.
Treatment in Management
Referra
health facility at home
l
IMNCI guidelines address most common but
not all pediatric problems.
A limited number of essential drugs are used.
Care takers are actively involved in the treatment
of children.
Counselling of caretakers about home care
including feeding, fluids and when to return to
health facility
IMNCI guidelines recommend standardized case
management procedures
That based on two age categories: -
1. Upto 2 months and
2. 2 months to 5 years
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.
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
5. Counseling on feeding for malnourished children
between 2 to 5 years.
IMNCI CASE MANAGEMENT
PROCESS
1. Steps of case management process are the
following:
2. Asses the young infant/ child.
3. Classify the illness.
4. Identify the treatment.
5. Treat the young infant/child.
6. Counsel the mother.
7. Provide follow up care.
1. All sick children must be examined for
“general danger signs” which indicate
the need for immediate referral or
admission to a hospital.
2. All sick children must be routinely
assessed for major symptoms (for
children age 2 months up to 5 years:
cough or difficult breathing, diarrhoea,
fever, ear problems
for young infants up to 2 months: very
severe disease, diarrhoea, jaundice and
feeding.
15
….Contd
3. They must also be routinely assessed for

nutritional and immunization status, feeding
problems and other problems
4. Assess Vitamin A supplementation and de-

worming status for children age 2 months
up to 5 years.
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17
18
IMNCI case management
process
CHECK for danger signs
 Convulsions
 lethargy/unconsciousness
 Inability to drink/breastfeed
 vomiting
ASSESS main symptoms

 Cough/difficulty in breathing
 Diarrhoea
 Fever
 Ear problems
Assess Nutrition and Immunization

status and potential feeding
problems
Check for any other problem

19
…contd CLASSIFY conditions and identify treatment
actions
According to color coded system
(pink) yellow (Green)
Urgent referral Treatment Home

Home
-Pre-referraltreatments
management
management
-advise patients
at outpatient
-refer child
health
facility
Care taker is
Referral facility •Treat local infection counselled on how to
-Emergency triage and •Give oral drugs :
treatment (ETAT) •Advise and teach the •Give oral drugs
-Diagnosis care taker •Treat local infections
-Treatment •Follow up •Continue feeding
-Monitoring •Follow up
-Follow up
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ADVANTAGES OF INTEGRATED
APPROACH
• Speeds up the urgent treatment and treatment
seeking practices.
• Prompt recognition of serious condition, hence
prompt referral.
• Involves parents in effective care of baby at
home.
• Partial Success of Individual disease control
programme.
Cont….
• Involves prevention of diseases by active
immunization, Improved nutrition and
Exclusive Breastfeeding practices.
• Highly cost effective.
• It avoids wastages of resources by using most
appropriate medicines and treatment.
• It reduces duplication of effort.

IMNCI

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1

 All sick children aged up to 5 years are

A combination of individual signs then lead

Essential drugs are then used to treat the

•The classify (signs and classify) column

0-2 months Young 2 months to 5 years

Selected Medical Officers from

Clinical Medical 8 days Physician Medical

Supervisory Medical 2 days Supervisory Medical

Improvement in the overall

Improvement in family and

3. They must also be routinely assessed for

4. Assess Vitamin A supplementation and de-

ASSESS main symptoms

Assess Nutrition and Immunization

Check for any other problem

(pink) yellow (Green)

Urgent referral Treatment Home

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