.

1. I M N C I 1

2. SEMINAR
ON
INTEGRATED MANAGEMENT
OF NEONATALAND
CHILDHOOD ILLNESS
(IMNCI)
P R E S E N T E D B Y,
H I N A R O D G E
I M N C I 2

3. GENERAL OBJECTIVE:
At the end of the seminar the students will be able to gain in
depth knowledge regarding Integrated Management of
Neonatal and Childhood Illness (IMNCI) and appreciate
and develop positive attitude and practice this knowledge in
clinical settings.
I M N C I 3

4. SPECIFIC OBJECTIVES:
At the end of the class students will be able to,
• Describe the concept of IMNCI.
• Explain rationale for an evidence based syndrome
approach.
• Enlist components of IMNCI.
• Enumerate the principles of IMNCI.
• Describe case management process.
I M N C I 4

5. • Enlist the principles of management of sick children in
small hospital.
• Explain outpatient management of young infant’s age up to
2 months.
• Explain outpatient management of children age 2 months up
to 5 years.
• Describe National Population Policy 2000.
I M N C I 5

6. INTRODUCTION
• Every year more than 10 million children die in
developing countries before they reach their 5th birthday.
• Most common causes of infant and children mortality in
developing countries including India are prenatal
condition, ARI, diarrhea, malaria, measles &
malnutrition.
I M N C I 6

7. • In India, according to National Family Health Survey II
(NFHS II) the common childhood illness in children
younger than 3 years of age includes fever, ARI, diarrhea
and malnutrition and/or often a combination of these
condition.
I M N C I 7

8. • In India,
 Infant Mortality Rate (IMR)= 57/1000 live births.
 Under Five Mortality Rate = 95/1000 live births.
 Neonatal mortality contributes to over 64% of Infants
deaths (occurs during 1st week of life).
I M N C I 8

9. • Mortality rate in 2nd month of life is also higher than at
later ages.
• In 1990, the WHO + UNICEF+ other agencies
developed IMCI.
• India adopted as IMNCI.
I M N C I 9

10. CONCEPT OF IMNCI
• IMNCI: Indian adaptation of the WHO-UNICEF
generic Integrated Management of Childhood Illness
(IMCI) strategy.
• Centerpiece: newborn and child health strategy under
RCH II & National Rural Health Mission.
I M N C I 10

11. • Strategy provides an integrated approach for standard
management of major causes of childhood morbidity and
mortality in the out-patient settings.
• Implementation of IMNCI: more and more newborns
and children are being referred to health facilities for
inpatient care.
I M N C I 11

12. • referred cases need to be appropriately managed at the
referral facility need, Government of India with support
from UNICEF & WHO has developed F-IMNCI.
I M N C I 12

13. F-IMNCI
• Is the integration of the Facility based Care package
(inpatient care) and the IMNCI package (outpatient
care).
• Training would empower the Doctors and Staff nurses
with knowledge and skills to manage newborn and
childhood illness at the community level as well as the
health facility level (FRUs).
I M N C I 13

14. RATIONALE FOR AN EVIDENCE BASED
SYNDROMES APPROACH
• Many children present with overlapping signs and
symptoms of diseases
• A single diagnosis can be difficult, and may not be
feasible or appropriate.
• So that a more integrated approach is needed to managed
sick children for achieving better outcomes.
I M N C I 14

15. IMNCI CLINICAL GUIDELINES
• Target children less than 5 years old- bears the highest
burden of deaths from common childhood diseases.
• Guidelines take an evidence-based syndromic approach
to case management that supports the rational, effective
and affordable use of drugs and diagnostic tools.
I M N C I 15

16. • Evidence-based medicine stresses the importance of
evaluation of evidence from clinical research and
cautions against the use of intuition, unsystematic
clinical experience, and untested pathophysiology
reasoning for medical decision-making.
I M N C I 16

17. • Careful and systematic assessment of common
symptoms and well-selected clinical signs provide
sufficient information to guide rational and effective
actions.
I M N C I 17
OBJECTIVES OF THE IMNCI STRATEGY
• To reduce death and the frequency and severity of illness
and disability, and to contribute to improved growth and
development of children under five years of age.

18.  An evidence-based syndrome approach can be used
to determine the:
• Health problem the child may have;
• Severity of the child’s condition;
• Actions that can be taken to care for the child (e.g. refer
the child immediately, manage with available resources,
or manage at home).
I M N C I 18

19. IMNCI PROMOTES:
• Adjustment of interventions to the capacity and functions
of the health system.
• Active involvement of family members and the
community in the health care process because parents if
correctly informed & counseled, can play important role
in improving health status of the child.
I M N C I 19

20. COMPONENTS OF IMNCI
• The IMNCI strategy includes both preventive and
curative interventions that aim to improve practices in
health facilities, the health system and at home.
I M N C I 20

21. THE STRATEGY INCLUDES THREE MAIN
COMPONENTS:
• Improvements in the case-management skills of health
staff through the provision of locally-adapted guidelines
on IMNCI and activates to promote their use.
• Improvements in the overall health system for effective
management childhood illness.
• Improvements in family and community health care
practices.
I M N C I 21

22. I M N C I 22

23. PRINCIPLES OF IMNCI
• The IMNCI guidelines focus on children up to 5 years.
• Treatment guidelines have broadly described under
two categories:
1) Young infants age up to 2 months
2) Children age 2 months to 5 years
I M N C I 23

24. The IMNCI guidelines are based on the
following principles:
I M N C I 24

25. examined for condition which indicate IMMEDIATE
REFERRAL
ROUTINELY ASSESSMENT-major symptoms, nutritional
and immunization status, feeding problems, and other
potential problems.
SELECTED CLINICAL SIGNS- are used to detection of
disease. For considering the conditions for FRUs.
I M N C I 25

26. COLOR CODED CLASSIFICATIONS (pink,
yellow, green)
I M N C I 26
COLOR CODED CLASSIFICATIONS
HOSPITAL REFERRAL OR
ADMISSION
INITIATION OF TREATMENT
HOME TREATMENT
Pink
Yellow
Green

27. GUIDELINES ADDRESS MOST, BUT NOT ALL MAJOR
PEDIATRIC PROBLEMS. IT DOES NOT DESCRIBE
THE CARE AT BIRTH & MANAGEMENT OF TRAUMA
OR OTHER ACUTE EMERGENCIES DUE TO
ACCIDENTS.
IMNCI PROCEDURES USE A LIMITED NUMBER OF
ESSENTIAL DRUGS
I M N C I 27

28. ENCOURAGE ACTIVE PARTICIPATION OF
CARETAKERS IN THE TREATMENT OF CHILDREN
COUNSELING OF CARETAKERS ABOUT HOME CARE,
INCLUDING COUNSELING ABOUT FEEDING, FLUIDS
AND FOLLOW UP
I M N C I 28

29. CASE MANAGEMENT PROCESS
• It presented on series of charts, which show the sequence
of steps and provide information for performing them
• The charts describe the following steps:
 Assess the young infant or child
 Classify the illness
 Identify treatment
 Treat the infant or child
I M N C I 29

30.  Counsel the mother
 Give follow-up care
I M N C I 30

31. I M N C I 31

32. I M N C I 32

33. I M N C I 33

34. I M N C I 34

35.  The case management process for sick children age 2
months up to 5 years is somewhat different from
young infants and is presented on three charts titled:
1. Assess and classify the sick child age 2 months up to 5
years.
2. Treat the child.
3. Counsel the mother.
I M N C I 35

36.  Management of the young infant age up to 2 months
is presented on two charts titled:
1. Assess and classify the sick young infant age up to 2
months and
2. Treat the young infant and counsel the mother.
I M N C I 36

37. PRINCIPLES OF MANAGEMENT OF SICK
CHILDREN IN SMALL HOSPITAL
I M N C I 37

38. • Severely sick children.
• child with a severe (pink) classification is admitted to a
hospital.
• first step in assessing children should be triage -
A quick screening process to determine which class
belongs to a sick child.
I M N C I 38

39. • Emergency signs: who need emergency treatment
immediately.
 obstructed breathing
 severe respiratory distress
 central cyanosis
 signs of shock
I M N C I 39

40.  Coma
 Convulsions
 signs of severe dehydration
 any sick young infant (less than 2months)
 urgent referral note from another health facility
I M N C I 40

41. • Priority signs: Priority that should be given priority
when waiting in the queue for urgent evaluation and
treatment.
 visible severe wasting
I M N C I 41

42. E d e m a O f B o t h
F e e t
S e v e re P a l m a r
P a l l o r
I M N C I 42

43. L e t h a r g y
C o n t i n u a l
I r r i t a b i l i t y A n d
R e s t l e s s n e s s
I M N C I 43

44. B u r n s
I M N C I 44

45. R e s p i r a t o r y
D i s t re s s
I M N C I 45

46. • Non-urgent cases : neither emergency nor priority signs.
• sick children must be examined fully so that no
important sign will be missed.
- Identified priority order: so that no important sign will
not missed.
- Child must examined fully.
I M N C I 46

47. • Laboratory investigations need to be available at the
small hospital in order to manage sick children:
 Hemoglobin or packed cell volume (PCV)
I M N C I 47

48.  Blood smear for malaria
I M N C I 48

49. • Blood glucose
I M N C I 49

50. Microscopy of CSF Urine analysis
I M N C I 50

51.  Blood grouping and cross-matching
I M N C I 51

52.  for sick young infants (under 1 week old)
 the laboratory investigation for blood bilirubin should be
available.
I M N C I 52

53.  chest X-ray
OTHER INVESTIGATIONS
I M N C I 53

54.  Stool microscopy
 are not considered essential, but could help in
complicated cases
I M N C I 54

55. • An appropriate treatment is given to sick children based
on the results of the diagnostic procedures and according
to the national clinical guidelines.
I M N C I 55

56. THE KEY ASPECTS IN MONITORING THE
PROGRESS OF A SICK CHILD ARE:
• Devising a monitoring plan: The frequency will depend
on the nature and severity of the child’s clinical
condition.
I M N C I 56

57. • Using a standard chart to record essential information
such as correct administration of the treatment, expected
progress, possible adverse effects of the treatment,
complications that may arise, possible alternative
diagnosis.
• Bringing these problems to the attention of senior staff
and if necessary, changing the treatment accordingly.
I M N C I 57

58. OUTPATIENT MANAGEMENT OF YOUNG
INFANT’S AGE UP TO 2 MONTHS
I M N C I 58

59. • Young infants have special characteristics that must be
considered when classifying their illnesses.
• can become sick and die very quickly from serious
bacterial infections.
• Frequently have only general signs such as few
movements, fever or low body temperature.
• assess, classify and treat the young infant somewhat
differently than an older infant or young child.
I M N C I 59

60.  important steps for assessment procedure for this age
group
1. history taking and communicating with the caretaker
about the young infant’s problem
2. checking for possible bacterial infection / jaundice;
I M N C I 60

61. 3. checking for diarrhea;
4. checking for feeding problem or malnutrition;
5. checking immunization status; and
6. Assessing other problems.
I M N C I 61

62. HISTORY TAKING AND COMMUNICATING WITH
THE CARETAKER ABOUT THE INFANT’S YOUNG
PROBLEM
• It is critical to communicate effectively with the infant's
mother or caretaker.
• Good communication techniques and an integrated
assessment are required.
I M N C I 62

63. • Proper communication helps to reassure the mother or
caretaker that the infant will receive appropriate care.
• The success of home treatment depends on how well the
mother or caretaker knows about giving the treatment
and understands its importance.
I M N C I 63

64. • Initial visit: history taking
• follow-up visit: the young infant is not improving or is
getting worse after few days
• the doctor refers the infant to a hospital or changes the
infant's treatment.
I M N C I 64

65. CHECK FOR POSSIBLE BACTERIAL
INFECTION/JAUNDICE
• It is recommended that all sick young infants be assessed
first for signs of possible bacterial infection and
jaundice.
• Many clinical signs point to possible bacterial infection
in sick young infants
I M N C I 65

66. THE MOST INFORMATIVE AND EASY TO CHECK SIGNS
ARE:
• Convulsion
• Fast breathing
• Look for severe chest in drawing
• Nasal flaring
• Grunting
• Bulging fontanels
I M N C I 66

67. • Pus draining from the ear
• Umbilicus red or draining pus
• Skin pustule
• Temperature
• Lethargy or unconsciousness
• Less than normal movement
• Jaundice
• Yellow palms and soles
I M N C I 67

68. • The most informative and easy to check signs are:
 Convulsions (as part of the current illness): Convulsions
may be associated with meningitis or other life-
threatening conditions.
 All young infants who have had convulsions during the
present illness should be considered seriously ill.
I M N C I 68

69. • Convulsion in young infants may not be characterized by
tonic-clonic movements and up rolling of eyeballs, they
may instead present as repetitive jerky movements of
the eyes, lip smacking or a staring look.
I M N C I 69

70. • Count the breaths in one minute to decide if the young
infant has fast breathing.
FAST BREATHING:
I M N C I 70

71. • Chest indrawing is the inward movement of the
lower chest wall when the child breathes in, and is a sign
of respiratory distress.
LOOK FOR SEVERE CHEST IN DRAWING:
I M N C I 71

72. I M N C I 72

73. Nasal flaring is widening of the nostrils when the young
infant breathes in.
NASAL FLARING:
I M N C I 73

74. GRUNTING:
• Grunting is the soft, short sounds a young infant makes
when breathing out.
• Grunting occurs when an infant is having difficulty in
breathing.
I M N C I 74

75. BULGING FONTANELS:
• Look at and feel the anterior fontanels when the infant is
not crying and held in an upright position.
• A bulging fontanels may indicate that the young infant
has meningitis, a possible serious bacterial infection.
I M N C I 75

76. I M N C I 76

77. • Look for pus draining from either of the ears
PUS DRAINING FROM THE EAR:
I M N C I 77

78. • There may be some redness of the end of the umbilicus
or the umbilicus may be draining pus (The cord usually
drops from the umbilicus by one week of age).
UMBILICUS RED OR DRAINING PUS:
I M N C I 78

79. SKIN PUSTULE:
• Examine the skin on the entire body. Skin pustules are
red spots or blisters that contain pus.
• Presence of 10 or more skin pustules or a large boil
indicates a possible serious bacterial infection.
I M N C I 79

80. • fever = axillary temperature more than 35.70 C is
uncommon in the first two months of life.
TEMPERATURE:
I M N C I 80

81. • Fever in a young infant may indicate serious bacterial
infection and may be the only sign of serious bacterial
infection.
• Young infants can also respond to infection by dropping
their axillary temperature to 35.50 C.
I M N C I 81

82. LETHARGY OR UNCONSCIOUSNESS:
• Young infants often sleep most of the time.
• A lethargic young infant is not awake and alter.
• May be drowsy and not stay awake after disturbances.
• Unconscious : no response
I M N C I 82

83. LESS THAN NORMAL MOVEMENT:
• indicates a serious condition.
• Observe the infant's movements.
• awake young infant will normally move his arms or legs
or turn his head several times in a minute.
I M N C I 83

84. JAUNDICE:
• Visible manifestation of bilirubinemia.
• Yellow discolouration of skin in neonate when serum
bilirubin is more than 5 mg/dl.
I M N C I 84
PHYSIOLOGICAL JAUNDICE
• Almost all neonates may have during 1st week of life due
to several physiological changes after birth.
• Usually appears in 48-72 hours of age.

85. • Physiological jaundice does not need treatment.
• Max. intensity : 4-5 day in term & 7th day in preterm.
• Does not extend palm and soles.
I M N C I 85

86. YELLOW PALMS AND SOLES:
• Press the infant’s palms with your fingers to blanch,
remove your fingers and look for yellow discoloration
under natural light.
• Repeat the process to look for yellow soles.
• Occurrence of jaundice in the first 24 hours of life
• yellow discoloration of palms and soles is always
pathological it requires urgent referral.
I M N C I 86

87. • Severe jaundice beyond the first week may be a result of
cholestasis.
I M N C I 87
ASSESS THE SYMPTOMS OF DIARRHEA
• All infants with diarrhea should be assessed to determine
the duration of diarrhea, if blood is present in the stool
and if dehydration is present.
• A number of clinical signs are used to determine the
level of dehydration:

88.  Infant’s general condition
 Sunken eyes
 Elasticity of skin
I M N C I 88
INFANT’S GENERAL CONDITION
• Depending on the degree of dehydration
• Only infants who cannot be consoled and calmed should
be considered restless or irritable.

89. • The eyes of a dehydrated infant may look sunken.
SUNKEN EYES
I M N C I 89

90. • In a severely malnourished infant who is visibly wasted,
the eyes may always look sunken, even if the infant is not
dehydrated.
• Even though the sign “sunken eyes” is less reliable in a
visibly wasted infant, it can still be used to classify the
infant's dehydration.
I M N C I 90

91. • Check elasticity of skin using the skin pinch test.
ELASTICITY OF SKIN
I M N C I 91

92. • In an infant with severe malnutrition,
the skin may go back slowly even
if the infant is not dehydrated.
• In an overweight infant, or an infant with edema, the skin
may go back immediately even if the infant is dehydrated.
I M N C I 92

93. • infant with diarrhea: asked caretaker how long the
infant has had diarrhea
• if there is blood in the stool, will allow identification of
infants with persistent diarrhea and dysentery.
I M N C I 93

94. CHECK FOR FEEDING PROBLEM OR
MALNUTRITION
• All sick young infants seen in outpatient health facilities
should be assessed for weight and adequate feeding, as
well as for breast-feeding technique.
I M N C I 94

95. Assessment of feeding and malnutrition
Part 2: assessment of breastfeeding
Part 1:
1. ask the mother questions
about feeding
2. Determine weight for age
I M N C I 95

96. CHECKING IMMUNIZATION STATUS
• Immunization status should be checked in all sick young
infants.
• A young infant who is not sick enough to be referred to a
hospital should be given the necessary immunizations
before she/he is sent home.
I M N C I 96

97. ASSESSING OTHER PROBLEMS
• All sick young infants need to be assessed for other
potential problems mentioned by the mother or observed
during the examination.
• If a potentially serious problem is found or there is no
means in the clinic to help the infant, she/he should be
referred to hospital.
I M N C I 97

98. I M N C I 98

99. OUTPATIENT MANAGEMENT OF
CHILDREN AGE 2 MONTHS UP TO 5
YEARS
I M N C I 99

100.  The assessment procedure for this age group includes a
number of important steps that must be taken by the
health care provider, including:
1. history taking and communicating with the caretaker
about the child’s problem
2. checking for general danger signs
I M N C I 100

101. 3. checking main symptoms
4. checking for malnutrition
5. checking for anemia
6. assessing the child’s feeding
7. checking immunization status and
8. Assessing other problems
I M N C I 101

102. I M N C I 102

103. 1. HISTORY TAKING AND COMMUNICATING WITH THE
CARETAKER ABOUT THE CHILD’S PROBLEM:
• Good communication techniques and an integrated
assessment are required
• Proper communication helps to reassure the mother or
caretaker that the infant will receive appropriate care.
I M N C I 103

104. • the success of home treatment depends on how well the
mother or caretaker knows about giving the treatment
and understands its importance.
I M N C I 104

105. 2. CHECKING FOR GENERAL DANGER SIGNS:
• The following danger signs should be routinely checked
in all children.
 The child has had convulsions during the present illness
 The child is unconscious or lethargic
 The child is unable to drink or breastfeed
 The child vomits everything
I M N C I 105

106. • If a child has one or more of these signs, she must be
considered seriously ill and will almost always need
referral.
• In order to start treatment for severe illnesses without
delay.
I M N C I 106

107. • A rapid assessment of nutritional status is also essential,
as malnutrition is another main cause of death.
• the child should be quickly assessed for the most
important causes of serious illness and death.
I M N C I 107

108. 3. CHECKING MAIN SYMPTOMS:
• the health care provider must check following main
symptoms:
1. cough or difficult breathing
2. diarrhea
3. fever and
4. Ear problems.
first three symptoms
are included because
they often result in
death
considered one of the main causes
of childhood disability
I M N C I 108

109. 4. CHECKING FOR MALNUTRITION:
• A mother may bring her child to clinic because the child
has an acute illness.
• The child may not have specific complaints that point to
malnutrition.
• A sick child can be malnourished, but you or the child’s
family may not notice the problem.
I M N C I 109

110. • A child with malnutrition has a higher risk of many types
of disease and death.
• Even children with mild and moderate malnutrition have
an increased risk of death.
• Identifying children with malnutrition and treating them
can help prevent many severe diseases and death.
I M N C I 110

111. • Some malnutrition cases can be treated at home.
• Severe cases need referral to hospital for systemic
antibiotic therapy, treatment and prevention of
complications, special feeding or specific treatment of a
disease contributing to malnutrition (such as
tuberculosis).
I M N C I 111

112. • Assessing for general danger signs and the four main
symptoms, all children should be assessed for
malnutrition
• Two main reasons for routine assessment of
nutritional status in sick children:
1. to identify children with severe malnutrition who are at
increased risk of mortality and need urgent referral to
provide active treatment.
I M N C I 112

113. 2. to identify children with sub-optimal growth (stunting)
resulting from ongoing deficits in dietary intake plus
repeated episodes of infection and who may benefit from
nutritional counseling and resolution of feeding
problems.
I M N C I 113

114. • Clinical Assessment: Because reliable height boards are
difficult to find in most outpatient health facilities,
nutritional status should be assessed by looking and
feeling for the following clinical signs:
 Visible severe wasting
 Edema of both feet
 Weight for age
I M N C I 114

115. VISIBLE SEVERE WASTING
• severe wasting of the shoulders, arms, buttocks, and legs,
with ribs easily seen, and indicates presence of
marasmus.
I M N C I 115

116. • there are many folds of skin on the buttocks and thigh.
• It looks as if the child is wearing baggy pants.
• The face of a child with visible severe wasting may still
look normal.
• The child's abdomen may be large or distended.
I M N C I 116

117. EDEMA
• Edema of both feet.
• The presence of edema (accumulation of fluid) in both
feet may signal kwashiorkor.
I M N C I 117

118. I M N C I 118

119. • Children with edema of both feet may have other
diseases like nephrotic syndrome.
• There is a need to differentiate these with other
conditions in the outpatient settings because referral is
necessary in any case.
I M N C I 119

120. WEIGHT
• Weight for age.
• When height boards are not available in outpatient
settings, a weight for age indicator (a standard WHO
growth chart) helps to identify children with low (Z
score less than –2) or very low (Z score less than –3)
weight for age, who are at increased risk of infection and
poor growth and development.
I M N C I 120

121. I M N C I 121

122. I M N C I 122

123. I M N C I 123

124. 5. CHECKING FOR ANEMIA
• All children also should be assessed for anemia. The
most common cause of anemia in young children in
developing countries is nutritional or because of parasitic
or helminthes infections.
• However, there may be other more serious causes of
anemia such as hemolytic anemia, aplastic anemia or
leukemia.
I M N C I 124

125. CLINICAL ASSESSMENT
• Palmar pallor: Although this clinical sign is less
specific than many other clinical signs included in the
IMNCI guidelines, it can allow health care providers to
identify sick children with severe anemia.
• Where feasible, the specificity of anemia diagnosis may
be greatly increased by using a simple laboratory test for
Hb% estimation.
I M N C I 125

126. • To see if the child has palmar pallor, look at the skin of
the child's palm.
• Hold the child's palm open by grasping it gently from the
side. Do not stretch the fingers backwards.
• This may cause pallor by blocking the blood supply.
• Compare the color of the child's palm with your own
palm and with the palms of other children.
I M N C I 126

127. • If the skin of the child's palm is pale, the child has some
palmar pallor.
• If the skin of the palm is very pale or so pale that it looks
white, the child has severe palmar pallor.
I M N C I 127
6. ASSESSING THE CHILD’S FEEDING:
• All children less than 2 years old and all children
classified as anemia or very low weight need to be
assessed for feeding.

128. • Feeding assessment includes questioning the mother
or caretaker about:
1. breastfeeding frequency and night feeds.
2. types of complimentary foods or fluids, frequency of
feeding and whether feeding is active
3. feeding patterns during the current illness.
• However, if the mother has already received many
treatment instructions so, may delay assessing feeding
I M N C I 128

129. and counseling the mother about feeding until a later visit.
• it is important to take time to counsel the mother
carefully and completely.
• use simple language that the mother can understand for
effective communication.
• Ask question
• Listen carefully to mother answer so it help us to give
relevant advice.
I M N C I 129

130. 7. CHECKING IMMUNIZATION STATUS:
• The immunization status of every sick child brought to a
health facility should be checked.
• Illness is not a contraindication to immunization.
• In practice, sick children may be even more in need of
protection provided by immunization than well children.
I M N C I 130

131. • A vaccine’s ability to protect is not diminished in sick
children.
• As a rule, there are only four common situations that are
contraindications to immunization of sick children:
 Children who are being referred urgently to the hospital
should not be immunized.
I M N C I 131

132.  There is no medical contraindication, but if the child
dies, the vaccine may be incorrectly blamed for the
death.
 Live vaccines (BCG, measles and polio) should not be
given to children with immunodeficiency diseases
OR
I M N C I 132

133. • To children who are immunosuppressed due to malignant
disease, therapy with immunosuppressive agents or
irradiation.
 However all the vaccines, including BCG and yellow
fever, can be given to children who have or are suspected
of having HIV infection but are not yet symptomatic.
I M N C I 133

134.  DPT2/ DPT3 should not be given to children who have
had convulsions or shock within three days of a previous
dose of DPT.
 DT can be administered instead of DPT.
 DPT should not be given to children with recurrent
convulsions or another active neurological disease of the
central nervous system.
I M N C I 134

135.  DT can be administered instead of DPT.
 BCG, if not given at birth, can be given in the next visit.
 Determine if the child needs vitamin A supplementation
and/or prophylactic iron folic acid supplementation.
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136. 8. ASSESSING OTHER PROBLEMS:
• The IMNCI clinical guidelines focus on five main
symptoms.
• In addition, the assessment steps within each main
symptom take into account several other common
problems. Such as meningitis, sepsis, tuberculosis,
conjunctivitis, and different causes of fever.
I M N C I 136

137. • IMNCI guidelines are correctly applied, children with
these conditions will receive presumptive treatment or
urgent referral.
• Nevertheless, health care providers still need to consider
other causes of severe or acute illness. It is important to
address the child’s other complaints and to ask questions
about the caretaker’s health (usually, the mother’s).
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138. IMNCI Case Management in the Outpatient Health
Facility,
First-level Referral Facility and at Home
For the Sick Young Infant up to 2 Months of Age
I M N C I 138

139. IMNCI Case Management in the Outpatient Health
Facility,
First-level Referral Facility and at Home for the Sick
Child
From Age 2 Months up to 5 Year
I M N C I 139

140. NATIONAL POPULATION POLICY 2000
• Population policy in general refers to policies intended to
decrease the birth rate or growth rate.
• In April 1976 India formed its first- “National Population
Policy.”
• It called for an increase in legal minimum age of
marriage from 15 to 18 for females, and from 18 to 21
years for males.
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141. OBJECTIVE OF POLICY 2000
• Immediate Objective
 To improve health services.
• Medium Term Objective
 TFR to replacement level by 2010.
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142. • Long Term Objective
 Economic growth
 Social development
 Environment protection
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143. CAUSES
 Early marriage and universal marriage system
 Poverty and illiteracy
 Age old cultural norm
 Illegal migration
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144. EFFECTS OF OVER POPULATION
 Unemployment
 Manpower utilization
 Pressure on infrastructure
 Resource utilization
 Decrease production and increase costs
I M N C I 144

145. • However the most part, the 1976 statement became
irrelevant and the policy was modified in 1977.
• New policy statement reiterated the importance of the
small family norm without compulsion and changed the
programme title to "family welfare programme".
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146. • The National Health Policy approved by the parliament
in 1983 had set the long-term demographic goals of
achieving a Net Reproductive Rate (NRR) of one by the
year 2000 (which was not achieved).
• "National Population Policy 2000" is the latest in this
series.
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147. • It reaffirms the commitment of the government towards
target free approach in administering family planning
services.
• It gives informed choice to the people to voluntarily
avail the reproductive health care services.
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148. • The new NPP 2000 is more than just a matter of fertility
and mortality rates.
• It deals with
 women education
 empowering women for improved health and nutrition
child survival and health
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149.  the unmet needs for family welfare services
 health care for the under-served population groups like
urban slums, tribal community, hill area population and
displaced and migrant population
 adolescent's health and education
 increased participation of men in planned parenthood
 collaboration with NGOs.
I M N C I 149

150. THE NATIONAL SOCIO-DEMOGRAPHIC GOALS
TO BE ACHIEVED BY THE YEAR 2010 WERE AS
FOLLOWS:
1. Address the unmet needs for basic reproductive and
child health services, supplies and infrastructure.
2. School education up to the age 14 free and compulsory,
and reduce drop-outs at below 20%.
I M N C I 150

151. 3. Reduce infant mortality rate to below 30 per 1000 live
births.
4. Reduce maternal mortality ratio to below 100 per
100,000 live births.
5. Achieve universal immunization of children.
6. Promote delayed marriage for girls, not earlier than age
18 and preferably after 20 years of age.
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152. 7. Achieve 80% institutional deliveries and 100%
deliveries by trained persons.
8. Achieve universal access to information/counseling,
and services for fertility regulation and contraception
with a wide basket of choices.
9. Achieve 100% registration of births, deaths, marriage
and pregnancy.
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153. 9. Promote greater integration between the management of
reproductive tract infections (RTI) and sexually
transmitted infections (STI) and the National AIDS
Control Organization.
11. Prevent and control communicable diseases.
12. Integrate Indian Systems of Medicine (ISM) in the
provision of reproductive and child health services, and
in reaching out to households.
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154. 13. Promote the small family norm to achieve replacement
levels of TFR.
14. Implementation of related social sector programmes so
that family welfare becomes a people centered
programme.
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155. CONCLUSION:
• Integrated management of neonatal and childhood illness
concept was developed by WHO and UNICEF for the
common illness management among pediatric
population.
• IMNCI is working towards controlling the mortality and
morbidity.
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156. • It is curative, promotive and preventive strategy at
reducing the death and severity of illness.
• Today, this strategy has been expanded in India to
include neonatal care at home as well as in the health
facilities and it was renamed as integrated management
of neonatal and childhood illness (IMNCI)
I M N C I 156

157. BIBLIOGRAPHY
• Parul Datta. Pediatric Nursing. Second Edition. Jaypee
Brothers Medical Publishers (P) Ltd.
• Marlow Dorothy R, Redding Barbara A. Textbook of
Pediatric Nursing. South Asian Edition. Elsevier. a
division of Reed Elsevier India Private Limited.
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158. • Hockenberry Marilyn J, Wilson David, Wong’s.
Essentials of Pediatric Nursing. Eight Edition. Elsevier. a
division of Reed Elsevier India Private Limited.
• TM Beevi Assum. Textbook of Pediatric Nursing.
Elsevier India Private Limited.
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159. • Parthasarathy A, Menon PSN, Piyush Gupta, Nair MKC.
IAP Textbook of Pediatrics. Fourth Edition. Jaypee
Brothers Medical Publishers (P) Ltd.
• James Susan Rowen, Ashwill Jean Weiler. Nursing Care
of Children, Principles and Practice. Third Edition.
Elsevier. a division of Reed Elsevier India Private
Limited.
• www.wikipedia.com.
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160. I M N C I
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