Integrated management of neonatal and childhood illness
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INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD
ILLNESS
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7/10<5mort.
ADD
ARI
MalariaMeasles
Mal-nutrition
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Factors contributing to illness
Poor living conditions- lack of safe water supply poor hygieneovercrowding
Inability of parents to recognize danger signs
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delay in seeking appropriate treatment
poor quality of care provided at health facilities.
More than one morbid condition
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"The Integrated Management of Childhood Illness (IMCI)"
1992
UNICEF and WHO
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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
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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.
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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.
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IMNCI
Central pillar of child health interventions under
RCH II
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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
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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.
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Classification - urgent hospital referral or
admission - specific medical Rx or
advice - home management
P Y G
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Management
Assessment Classification of illnessIdentification of specific RxClear instructions to motherCounsel to solve feeding problems Follow-up care.
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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.
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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.
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What it does not address... • Not all major illnesses are included• Management of trauma / other
emergencies not included.
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Challenges
Feasibility
Sustaining what is initiated through indicator-based monitoring
Making home-based care of young infants operational by ANMs and AWWs
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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
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Summarizing...
Major diseasesOrigin
ObjectivesIMCI strategy
IMNCIClassificationManagementAdvantages Challenges
Future aims
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...Very much
Thank you...