Post on 23-Aug-2014
description
1
Integrated Management of Neonatal & Childhood Illness(IMNCI)
Presenter :-Dr. Vaibhav Gupta, MPH2nd yearModerator - Dr. Sunil Kumar D.
( Ast.Prof.)Dept. of community medicine
JSSMC11/01/2014
13/01/2014
2
Introduction-(IMCI) Why integrated management IMCI- Component & Process Differences; IMCI/IMNCI IMNCI: Components, Objectives, Strategies Process of IMNCI IMNCI Plus F-IMNCI ,Pre service IMNCI Home based New Born care JSSK,NSSK,C-IMCI SWOT analysis Current Status conclusion
Plan of presentation
13/01/2014
3
Introduction World Health Organization (WHO), UNICEF & other
International Partner came out with a new strategy Known as
Integrated Management of Childhood Illness (IMCI) in 1995.
An effort to bring health equity for child health.
The strategy emphasises on integrated approach for treating
the sick children.
Emphasizes on improving the family and community
practices as well as care provided by the health system for
better care of child.
13/01/2014
4
IMR 42/1000 and Under 5 mortality 95/1000 live births
per year.
Neonatal mortality contributes to 64% of infant deaths
mostly occurring during first week of life.
According to report released on 12 September 2013 by
United Nations Children's Fund (UNICEF) the global
Infant Mortality rate (IMR) decreased from 61 deaths in
1990 to 37 deaths in 2011.
Annual infant deaths declined from 8.4 million in 1990 to5
million in 2011.
Cont.…
13/01/2014
5
According to the report India’s infant mortality rate shown a minor decline in 2012 compared to 2011. Infant Mortality rate decreased from 44 deaths for every 1000 live births in 2011 to 42 deaths for every 1000 live in 2012.
IMCI seeks to reduce childhood mortality and morbidity by improving family and community practices for the home management of illness, and improving case management of skills of health workers in the wider health system.
Cont.
13/01/2014
6
An integrated approach was needed to manage sick children to achieve better outcomes.
Child health programmers needed to move beyond tackling single diseases in order to address the overall health & well being of the child
During mid 1990s, WHO & UNICEF developed a strategy – IMCI
13/01/2014
History of IMCI
7
Cont..
IMCI has been expanded in India to include all neonates and renamed as IMNCI
Govt of India has made newborn health a priority in the nation’s next five year plan
Govt is working with WHO and UNICEF to adapt IMCI guidelines to include newborn care, creating new guidelines called IMNCI
13/01/2014
8
Why Integrated Approach?
Integrated approach is child centred:
Five conditions : Pneumonia, Diarrhoea, Measles, Malaria
and Malnutrition are major cause of Death.
3 out of 4 children seeking health care in developing countries
suffers from one of these condition.
Children likely to be suffering from more than one condition.
Often combination of theses conditions leads to fatal result.
Making a single diagnosis may be difficult.
Such children often need combined therapy for successful
treatment.13/01/2014
9
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.
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.
Partial Success of Individual disease control programme.13/01/2014
10
Inadequacies in Health system:Health worker skills:
◦ Incomplete examinations and counselling.◦ Poor communication between health workers and parents.◦ Irrational use of drugs.
Health system issues:
- Access to health services and Scarce availability of Skilled Worker
- Availability of appropriate drugs and vaccines
- Supervision / organization of work Community and family practices:
◦ Delayed care seeking◦ Poor knowledge of when to return to a health facility◦ Seeking assistance from unqualified providers ◦ Poor adherence to health worker advice and treatment
13/01/2014
11
Components of IMCI:
The IMCI strategy includes three important components :
Integrated management of childhood illness.
Health system strengthening.
Community IMCI or promotion of key family and
community practices
IMCI strategy are most effective when all three component
are implemented simultaneously.
13/01/2014
12
IMCI Process:
Source: IMCI; Student’s Handbook, WHO 13/01/2014
13
IMCI case management at first level health facility, referral level, and home :
13/01/2014
14
Difference between IMCI and IMNCI:Features: WHO – UNICEF IMCI IMNCI
Coverage of 0 to 6 days (early newborn period)
No Yes
Basic Health Care Module NO Yes
Home visit by the provider for newborn and Young Infant
No Yes
Training
Training Home based Care No Yes
Training days for newborn and young infants
2 out of 11 days 4 out of 11 days
Sequence of training Child (2 months to 5 years of age) then Young infant ( 7 days to 2 months of age)
Newborn and young infants (0 to 2 months).Then Child (from 2 months to 5 years of age.)
13/01/2014
15
Reduce infant and child mortality rates
Improving child health and survival
Currently in India, it is 42 deaths/1000 live births.
Decline not uniform across states.
Malnutrition and low birth (LBW) are contributors to
about 50% deaths.
Why IMNCI
13/01/2014
16
What is IMNCI?
13/01/2014
Strategy encompasses a range of interventions to prevent and
manage five major childhood illnesses
Acute Respiratory Infections,
Diarrhoea,
Measles,
Malaria
Malnutrition
The major causes of neonatal mortality such as prematurity
and sepsis.
17
Survival has been an important goal of the Family Welfare
Programmes in India.
During the period 1977 to 1992 programmes like universal
immunization programme;
oral rehydration therapy (ORT) programme and programme
for prevention of deaths due to acute respiratory infections
(ARI) were implemented as vertical programmes.
13/01/2014
Cont..
18
These programmes were integrated in 1992 under the Child
Survival and Safe Motherhood Programmes and have
continued to be a part of the Reproductive & Child Health
Programme implemented since 1997.
IMNCI is an integrated to child health that focuses on the well
being of the whole child.
affecting children aged 1week – 2month , 2months - 5years
including both preventive and curative elements to be
implemented by families.
13/01/2014
Cont.
19
It also teaches about nutrition including breast feeding
promotion, complementary feeding and micronutrients. It
focuses on preventive, promotive and curative aspects.
IMNCI is the Indian adaptation of the WHO- UNICEF generic
IMCI( integrated management of Childhood Illness.)
Cont.
13/01/2014
20
IMNCI Package: Care of Newborns and Young Infants (infants under 2
months): ◦ Keeping the child warm.◦ Cord, skin and eye care.◦ Recognition of illness in newborn , management and/or
referral.◦ Immunization.
Home visits in the postnatal period:◦ Home visits by health workers (ANMs, AWWs, ASHAs ).◦ Three home visits are to be provided to every newborn:
first visit on the day of birth (day 1). Next two visit on day 3 and day 7.
◦ For low birth weight babies, 3 more visits: on Day 14, 21 and 28.
◦ care of mothers during the post-partum period.13/01/2014
21
Care of Infants (2 months to 5 years)Management of diarrhoea, acute respiratory infections (pneumonia), malaria, measles, acute ear infection, malnutrition and anaemia.• Recognition of illness / at risk conditions and
management/referral.• Prevention and management of Iron and Vitamin A
deficiency.• Feeding Counselling for all children below 2 years• Feeding Counselling for malnourished children between 2 to
5 years.• Immunization.
Who will provide IMNCI Services ? The health workers in the community (ANM, AWW, ASHA)
or Providers at the facility (PHC/CHC/FRU).
13/01/2014
2213/01/2014
COMPONENTS
23
What Needs to be done in IMNCI Improve health worker skills
Improve health systems Improve family and community practices
Case management standards and guidelines
District and block planning management
Appropriate Care seeking
Training of facility- based public health care providers
Availability of IMNCI drugs Nutrition
IMNCI roles for private providers
Quality improvement and supervision at health facilities – public and private
Home case management and adherence to recommended treatment
Maintenance of competence among trained health workers
Referral pathways and services Community services planning and monitoring
Health information system
13/01/2014
24
Management Algorithm:
13/01/2014
25
The IMNCI Process for Children < 2 Months of Age
13/01/2014
2613/01/2014
27
The IMNCI case management Process: for children 2 months to 5 years of Age
13/01/2014
2813/01/2014
29
Implement by 2010 a comprehensive new born and child health package at the household level
Three complementary elements : care at birth IMNCI Immunization
objectives
13/01/2014
30
Evidence – based intervention approach integrated with RCH program equity –drive implementation and monitoring rational mix of community and facility based
interventions . phased decentralized priority setting at state and
district levels. Participate of the private sector.
Strategies
13/01/2014
31
IMNCI PLUS
The objectives of the newborn and child health strategy are:
◦ Increase coverage of skilled care at birth for newborns in conjunction
with maternal care.
◦ Implement a newborn and child health package of preventive, promotive
and curative interventions using a comprehensive IMNCI approach:
At the level of all:
◦ Sub-centres.
◦ Primary health centers.
◦ Community health centers.
◦ First referral units
13/01/2014
32
At the household level in rural and poor peri urban
settings in at least 125 districts (through AWWs /
ASHAs)
◦Implement the medium-term strategic plan for the
UIP (Universal Immunization Program).
◦Strengthen and augment existing services in areas
where IMNCI is yet to be implemented.
13/01/2014
33
IMNCI strategy under RCH-2
13/01/2014
34
F- IMNCI: (facility based IMNCI)
Facility Based Care for severely ill children is
complementary to primary care for providing a
continuum of care for severely ill children.
Integration of existing IMNCI package and the
Facility Based Care package in to one package.
13/01/2014
35
Majority of the health facilities (24x7 PHCs, FRUs, CHCs
and District hospitals) do not have trained paediatricians.
F-IMNCI training will help in skill building of the medical
officers and staff nurses posted in these health facilities to
provide IMNCI care.
13/01/2014
Why F-IMNCI ?
36
Need for F- IMNCI
13/01/2014
To enhance the skills and to overcome the acute shortage of
paediatricians in the country.
No. of posts of paediatricians in rural health facilities:
Required = 4045
In position = 898*
*www.unicef.org/India
37
Focus on Skill Development
50% of training time is spent on building skills by “hands-
on training” involving actual case management and counselling.
Remaining 50% in classroom for building theoretical
understanding of essential health intervention.
Training at two levels:
◦ In service training for the existing staff.
◦ Pre-Service Training– For including F-IMNCI in the pre-
service teaching of doctors and nurses.
13/01/2014
TRAININGS in F- IMNCI
38
Personnel to be Trained:
There are 2 types of trainings under F-IMNCI:
PRE-TRAINING STATUS PACKAGE TO BE USED DURATION
IMNCI not trained F-IMNCI complete package 11 days
IMNCI trained Facility based care package of F-IMNCI
5 days
13/01/2014
39
PRE- SERVICE IMNCI
13/01/2014
In medical colleges will need to include training on F-
IMNCI in the training schedules –
undergraduate students and interns, during their postings
in the Departments of Paediatrics and Preventive &
Social Medicine.
Staff Nurse’s training schools - training on F-IMNCI in
their training schedules.
40
The government of India has approved the implementation
of Home Based new-born care based on the Gadchirolli
model, where appreciable decline in the infant mortality rates
has been documented .
Appreciable decline in the infant mortality rates has been
documented.
ASHAs and ANM are being trained in the state of Rajasthan,
Bihar, Madhya Pradesh, Orissa and Uttar Pradesh.
Home Based New Born Care
13/01/2014
41
The new initiative of jssk would provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30days after birth ) in government health institutions in both rural and urban areas.
Jssk initiative is estimated to benefit more than one core pregnant women & new born who access public health institutions every years in both urban & rural areas.
Janani Shishu suraksha karyakram (JSSK)
13/01/2014
42
The free Entitlements under JSSK include:
free and cashless Delivery
free C section
free treatment of sick new born up to 30days
free drugs consumable , Diagnostics , Diet during stay
in health institution – 3days ND, 7days- CS
free transport Home to Health institutions
Cont.…
13/01/2014
43
Every year 12 lakh new-born babies die in India.
India lunched a program on 15sept.2009 train the
health care providers at district hospitals. CHC, PHC,
across the country in management of – prevention of
infection, hypothermia (temperature management)
early initiation of breast-feeding of the new borns.
NAVJAAT SHISHU SURAKSHA KARYAKRAM(NSSK)
13/01/2014
44
C - IMNCI: (Community and Household) Community IMCI is basically Component 3 of the IMCI
Package. It aims at improving family and community practices by
promoting those Practices with the greatest potential for improving child survival, growth and development.
Evidence that 80% of deaths of children under five years of age occur at home with little or no contact with health providers.
C-IMCI seeks to strengthen the linkage between health services and communities, to improve selected family and community practices and to support and strengthen community-based activities.
13/01/2014
4513/01/2014
46
Strengths : IMNCI focuses on enhancement of the skills of
health care personnel. strengthening the health system and creating
community participation. Provide the home based care to the baby and the
mother. Weaknesses : IMCI strategy is for sick child and not for promotion
of child health. IMNCI is very exhaustive and difficult to practice in
felid by health workers mainly AWW, ASHA, and ANM.
Swot analysis
13/01/2014
47
Opportunities: Home based training for ANMs, ASHA Entitlements facility available
Threats: Referral system and proper feedback is still lacking
in majority of areas. More monitoring and supervision is needed for proper implementation of program.
Cont..
13/01/2014
48
IMNCI programme is currently being implemented in
359 districts. IMNCI fact sheet is based on analyses of the IMNCI standard formatted reports submitted quarterly by the MoHFW, GOI.
The positive trends in IMNCI trainings of health workers and submission of IMNCI implementation status reports by the states. Trained IMNCI workers are providing care to a huge number of new-borns and children as shown by the number of new born home visits and sick children assessed.
CURRENT STATUS
13/01/2014
49
IMNCI : Status
13/01/2014
INDIA(Period 2010)
KARNATAKA(Period 2010)
No. of districts IMNCI to be implemented.
452 30
No. of districts IMNCIimplemented
309* 14
Health personnel to be trained
674491 35347
Health personnel trained 398184(59%) 17997(50.9%)
50
Close to 50 per cent of new-born deaths in India occur during the first
seven days of birth.
Many young lives are lost due to parents failing to recognise warning
signs and sick children not being taken to health facilities on time,
and because many mothers do not have sufficient knowledge on the
protective value of breastfeeding. The IMNCI addresses such issues.
It focuses on strengthening home based care and provides special care
for under-nourished new-borns. During home visits by health workers
the mother is taught how to recognise diseases early and when to seek
medical help.
CONCLUSION
13/01/2014
51
1.Operational Guidelines for Implementation of Integrated Management of Neonatal and Childhood Illness.[cited on 2012 Nov 20]. Available from : URL : www.similima.com
2.Integrated management of childhood illness. [cited on 2012 Nov 20]. Available from: URL: http://www.unicef.org/health/23958_imci.html
3.Kishore J. National Health Programs of India, 10th edition. New Delhi:Century;2012
4. Student’s Handbook for IMNCI. Integrated Management of Neonatal and Childhood Illness. Ministry of Health and Family Welfare , Government of India; 2003
REFERENCES
13/01/2014
52
5.Integrated Management Of Neonatal and Childhood Illness Fact Sheet- India, UNICEF India;2010.6.http://censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS_Bulletin_December_2011.pdf
7. Improving Child Health; IMCI, The Integrated Approach.
WHO, 1997. Downloaded on 04/ 06/2011 from URL:
http://www.who.int/imci-mce/publications.htm
8.World Health Statistics 2011. Downloaded from URL;
http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf
13/01/2014
Cont..
5313/01/2014