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Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

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ByDr Ananthesh

2CONTENTS

A. Introduction-goals,MDGs

B. IMCI-integration

-strategies and components

-process

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3C. IMNCI

-difference between IMCI and IMNCI

-principles of IMNCI

-overall strategy

-activities

-management guidelines

-IMNCI package

-highlights of IMNCI

-potential of IMNCI

D. F-IMNCI

E. C- IMNCI

F. IMNCI + 05/02/2023

4INTRODUCTION

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•Bringing down Infant and Child Mortality Rates and improving Child Health & Survival has been an important goal of the Family Welfare Programmes in India. •During the period 1977 to 1992 programmes like UIP; ORT programme and programme for prevention of deaths due to ARI were implemented as vertical programmes.

•Integrated in 1992 under the CSSM Programmes and have continued to be a part of the RCH Programme implemented since 1997

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Infant mortality rate: 40 deaths/1,000 live births

Neonatal mortality rate: 28 deaths/1,000 live births

Under 5 mortality rate: 49 deaths/1,000 live births

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Goal 4: Reduce child mortality

Target 4 A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Indicator 4.1 Under-five mortality rate

Indicator 4.2 Infant mortality rate

Indicator 4.3 Proportion of 1 year-old children immunized against measles

MILLENIUM DEVELOPMENT GOAL 4

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8MDGs

CURRENTIndia

(2013)

MDG 2015

Infant Mortality Rate

40 <28

Neonatal Mortality Rate

28 <20

Under 5 Mortality Rate

49 42

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10Integrated Management of Childhood Illness:

World Health Organization , UNICEF - IMCI in 1992.

(guidelines for case management were completed in 1996)What is IMCI?

IMCI is an integrated approach to child health that focuses on the well-being of the whole child

IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

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IMCI is an integrated strategy, which takes into account the variety of factors that put children at serious risk.

It ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition

12WHY DO WE NEED IMCI?

Sick children not properly assessed and treated

Low income countries-rely on history and signs

and symptoms

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13 STRATEGIES &COMPONENTS OF IMCI Improving case management skills of

health-care staff

Improving overall health systems

Improving family and community health practices.

IMCI strategy are most effective when all components are implemented

simultaneously.

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15 How is IMCI implemented?The main steps are:

•Adopting an integrated approach to child health and development in the national health policy.

•Adapting the standard IMCI clinical guidelines to the country’s needs, available drugs, policies, and to the local foods and language used by the population.

•Upgrading care in local clinics by training health workers in new methods to examine and treat children, and to effectively counsel parents.

(IMCI has already been introduced in more than 75 countries around the world.)

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•Making upgraded care possible by ensuring right low-cost medicines and simple equipment are available.

•Strengthening care in hospitals for those children too sick to be treated in an outpatient clinic.

•Developing support mechanisms within communities for preventing disease, for helping families to care for sick children, and for getting children to clinics or hospitals when needed

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17Why Integrated Approach?

Many children present with overlapping signs and symptoms of diseases, a single diagnosis can be difficult

Children likely to be suffering from more than one condition.

Children often need combined therapy for successful treatment.

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18Single Diagnosis is Inappropriate: Presenting Symptoms Possible cause or associated

condition

Cough / or Fast Breathing PneumoniaSevere AnaemiaAsthma

Lethargy or Unconsciousness Cerebral MalariaMeningitis Severe DehydrationVery Severe Pneumonia

Measles Rash Pneumonia DiarrhoeaEar Infection

Very Sick Young Infant Pneumonia Meningitis Sepsis

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19Inadequacies 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

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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

21More Than One Symptom:

15.3%

18.6%20.5%

16.9%

13.7%

7.6%

4.1%2.3%

0.7% 0.2%

1 2 3 4 5 6 7 8 9 10Number of symptoms

Number of symptoms in previous two weeks reported among

sick children under five in Matlab Thana, Bangladesh, 2000

(n = 1302).

Source: Arifeen S, et al. MCE-Bangladesh baseline household health and morbidity survey, ICDDR,B, 2000. 05/02/2023

22INTEGRATION is at 3 LEVELS

PATIENT : At patient level it means case management.

DELIVERY: At point of delivery it means that multiple interventions are provided through one delivery channel ex: vaccination is used as an opportunity to provide vit A to the child, boosting efficiency and coverage.

SYSTEM : At system level, it means bringing together management and support function of different sub-programs and ensuring complimentarily between different levels of care.

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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.

Involves prevention of diseases by active immunization, Improved nutrition and Exclusive Breastfeeding practices.

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Highly cost effective.

It avoids wastage of resources by using most appropriate medicines and treatment.

It reduces duplication of effort.

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IN SUMMARY…..

Child centred, wholesome care

Five conditions : pneumonia, diarrhoea, measles, malaria and malnutrition are major cause of death

Evidence based care

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26Integrated Management of Neonatal and Childhood Illness (IMNCI)

In 2000, the Government of India adapted the Integrated Management of Neonatal & Childhood Illness (IMNCI) strategy to focus greater attention on neonatal care.

IMCI IMNCI

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Programs under NRHM

UIP Control of ARI and Diarrhoeal diseases Home based new born care Facility based new born care Prevention and treatment of micronutrient

deficiencies, namely Vitamin A and Iron Exclusive breast feeding IMNCI

IMNCI-under RCH-II

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28Indian adaption of WHO – UNICEF IMCI

developed by experts -Child Health Researchers, academicians, the IAP and the NNF for the specific requirements of children in India.

newborn care -bring down the infant mortality rate in India

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29 In Karnataka,

IMNCI was initiated in Karnataka as a pilot in Raichur District in 2005-06 & extended to other districts in a phased manner to cover all districts by 2012-13.

Till now 1414 Doctors, 4648 Staff Nurses & 9704 ANMs have been trained in IMNCI.

Cascading Formats & Case sheets have been supplied to all the districts during 2013-14.

30IMNCI is a Key Strategy

for Improving Child Health

by INTEGRATIONNutrition Immunization Other disease

prevention Promotion of growth and

development

Managementof sick

children

Integrated Management of Childhood Illness

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33 The main adaptations to the package were:

Inclusion of first 7 days of life in the algorithms;

Incorporating National guidelines on malaria, anemia, VitA supplementation and immunization schedule.

Training of health personnel begins with sick young infants up to 2 months

Proportion of training time devoted for sick young infant and sick child is almost equal

34PRINCIPLES

All sick young infants up to 2 months of age must be assessed for “possible bacterial infection / jaundice”. Then they must be routinely assessed

for the major symptom “diarrhoea”.

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All sick children age 2 months up to 5 years must be examined for “general danger signs” which

indicate the need for immediate referral or admission to a hospital. They must then be

routinely assessed for major symptoms: cough or difficult breathing, diarrhoea, fever and ear

problems.

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All sick young infants and children 2 months up to 5 years must also be routinely assessed for

nutritional and immunization status, feeding problems, and other potential

problems.

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Only a limited number of carefully selected clinical signs are used , based on evidence of their sensitivity and specificity to detect disease. These signs were selected considering the conditions and

realities of first-level health facilities.

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38 Combination of individual signs leads to an

infant’s or a child’s classification(s) rather than a diagnosis

Classifications are colour coded: “pink” suggests hospital referral or admission,

“yellow” indicates initiation of specific treatment,

“green” calls for home management.

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IMNCI..

Address most, but not all, of the major reasons a sick infant or child is brought to a clinic.

Encourages active participation of caretakers in the treatment of infants and children

Guidelines do not describe the management of trauma or other acute emergencies due to accidents or injuries

40Overall Strategy

ASK LOOK FEEL SIGNS CLASSIFY ASSIGN CATEGORY OF

TREATMENT

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41ACTIVITIES

Outpatient Health Facility

Assessment;Classification and identification of treatment;Referral, treatment or counselling of the child’s caretaker (depending on the classification(s) identified);Follow-up care.

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42 Referral Health FacilityEmergency triage assessment and treatment (ETAT);Diagnosis, treatment and monitoring of patient progress.

Appropriate Home ManagementTeaching mothers or other caretakers how to give oral drugs and treat local infections at home;Counselling mothers or other caretakers about food (feeding recommendations, feeding problems); fluids; when to return to the health facility; and the mother’s own health.

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43IMNCI Package:

Care of Newborns and Young Infants (infants under 2 months):   Keeping the child warm. Initiation of breastfeeding immediately after birth

and counselling for exclusive breastfeeding and non-use of pre lacteal feeds.

Cord, skin and eye care. Recognition of illness in newborn , management

and/or referral. Immunization.

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44 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.

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45Care 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

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46 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).

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MANAGEMENT GUIDELINES(summary)

For all sick children age up to 5 years who are brought to a first-

level health facility

ASSESS the child: Check for danger signs (or possible bacterial infection/Jaundice). Ask about main symptoms. If a

main symptom is reported, assess further. Check nutrition andimmunization status. Check for other problems.

CLASSIFY the child's illness: Use a colour-coded triage system to classify the child's

mainsymptoms and his or her nutrition or feeding

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IDENTIFY URGENTPRE-REFERRAL TREATMENT(S)

Needed for the child's classifications.

IDENTIFY TREATMENT needed for the child's

classifications: identify specific medical treatments and/or

advice.

TREAT THE CHILD: Give urgent pre-referral

treatment(s) needed.

TREAT THE CHILD: Give the first dose of oral drugs in the clinic and/or advise the child's caretaker. Teach the caretaker

how to give oral drugs andhow to treat local infections at

home. If needed, give immunizations.

IF URGENT REFERRAL is needed and possible

IF NO URGENT REFERRAL is

needed or possible

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FOLLOW-UP care: Give follow-up care when the child returns to the clinic and, if necessary, reassess the child

for new problems.

REFER THE CHILD: Explain to the child's caretaker the need for referral. Calm the caretaker's fears and help

resolve any problems. Write a referral note. Give instructions and supplies needed to care

for the child on the way to the hospital.

COUNSEL THE MOTHER: Assess the child's feeding,

including breastfeeding practices, and solve feeding problems, if present. Advise

about feeding and fluids during illness and about when

to return toa health facility. Counsel the

mother about her own health.

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58 REFERRAL OF YOUNG INFANTS UP TO 2 MONTHS OF AGEThe first step is to give urgent pre-referral

treatment(s).- Possible pre-referral treatments include: First dose of intramuscular or oral

antibiotics Keeping the infant warm on the way to the

hospital Prevention of hypoglycemia with breast

milk or sugar water Frequent sips of ORS solution on the way

to the hospital

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Referral Note Should Include: Name and age of the infant; Date and time of referral; Description of the child's problems; Reason for referral (symptoms and signs

leading to severe classification); Treatment that has been given; Any other information that the referral

health facility needs to know in order to care for the infant, such as earlier treatment of the illness or any immunizations needed.

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60 COUNSELLING A MOTHER OR CARETAKER Ask and Listen to find out what the

infant’s problems are and what the mother is already doing for the infant.

Praise the mother for what she has done well.

Advise her how to care for her infant at home.

Check the mother’s understanding

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Counseling the mother or caretaker of a sick young infant includes the following essential elements:

- Teach how to give oral drugs- Teach how to treat local infection.- Teach how to manage breast or nipple

problem- Teach correct positioning and attachment

for breastfeeding.- Counsel on other feeding problems.- Advise when to return.- Counsel the mother about her own health

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Advise when to returnA) IMMEDIATELY , if the infant has any of

these signs: Breastfeeding or drinking poorly Becomes sicker Develops a fever or feels cold to touch Fast breathing Difficult breathing Yellow palms and soles (if young infant has

jaundice) Diarrhoea with blood in stool

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63B) FOR FOLLOW-UP VISIT If the infant has: Return for

follow-up not later than: LOCAL BACTERIAL 2 days INFECTION JAUNDICE DIARRHOEA ANY FEEDING PROBLEM THRUSH LOW WEIGHT FOR AGE 14 daysC) NEXT WELL-CHILD VISIT Advise when to return for the next

immunization according to immunization schedule.

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64 HOME VISITS FOR YOUNG INFANTS All babies on 1, 3, 7 days Low birth weight babies (weight less

than 2.5 kg) on 1, 3, 7, 14, 21 and 28 days

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CHECK FOR MALNUTRITION

LOOK AND FEEL:· Look for visible severe wasting.· Look for oedema of both feet.· Determine grade of malnutrition by plotting weight for age.

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Visible severe wasting orOedema of both feet

SEVERE MALNUTRITION

Give single dose of vit. A.Treat to prevent low blood sugar.Warm the child .Refer URGENTLY to hospital

Very low weight for age

VERY LOW WEIGHT

Assess and counsel for feeding.Advise mother when to return

immediately.Follow – up in 30 days.

NOT very low weight for age andno signs of severe

malnutrition

NOT VERYLOW WEIGHT

Assess and counsel for feeding.If feeding problem follow – up in 5

days.Advise mother when to return

immediately.

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71 CHECK FOR ANAEMIA

• Look for palmar pallor. Is it: Severe palmar pallor? Some palmar pallor?

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Severe palmar pallor SEVERE ANAEMIA

Refer URGENTLY to hospital

Some palmar pallor ANAEMIA Give iron folic acid therapy for 14 days.Assess and counsel on feeding

problem.If feeding problem, follow – up in 5

days.Follow – up in 14 days.

No palmar pallor NO ANAEMIA

Give prophylactic iron folic acid if child 6 months or older.

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CHECK THE CHILD'S IMMUNIZATION STATUS IMMUNIZATION SCHEDULE:

AGE Birth 6 weeks 10 weeks 14 weeks 9 months 16-18months 60 months

VACCINEBCG + OPV-0+ HepBPentavalent-1Pentavalent-2Pentavalent-3Measles DPT + OPV +Measles DPT

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74 CHECK THE CHILD’S PROPHYLACTIC IRON-FOLIC ACID SUPPLEMENTATION STATUS

PROPHYLACTIC VITAMIN A Give a single dose of vitamin A : 100,000 IU (1 ml) at 9 months with

measles immunization 200,000 IU (2 ml) at 16-18 months with

DPT Booster 200,000 IU (2 ml) at 24 months 200,000 IU (2 ml) at 30 months 200,000 IU (2 ml) at 36 months

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PROPHYLACTIC IRON-FOLIC ACID Give 20 mg elemental iron + 100mcg folic

acid for 100 days in a year after child has recovered from acute illness. If :

The child 6 months or older has not received IFA for 100 days in the

last one year.

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76 ASSESS OTHER PROBLEMS

Identify and treat any other problems according to your training and experience.

Refer the child for any other problem you cannot manage.

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77 COUNSELLING A MOTHER OR CARETAKER Advise to continue feeding and increase

fluids during illness; Teach how to give oral drugs or to treat

local infection; Counsel to solve feeding problems (if any); Advise when to return.

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78 COUNSELLING A MOTHER OR CARETAKER Ask and Listen to find out what the

infant’s problems are and what the mother is already doing for the infant.

Praise the mother for what she has done well.

Advise her how to care for her infant at home.

Check the mother’s understanding

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79 Counseling the mother or caretaker of a

sick young infant includes the following essential elements:

- Teach how to give oral drugs- Teach how to treat local infection.- Teach how to manage breast or nipple

problem- Teach correct positioning and attachment

for breastfeeding.- Counsel on other feeding problems.- Advise when to return.- Counsel the mother about her own health

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81A) IMMEDIATELYAdvise to return immediately if the child has any of

these signs. Any sick child Not able to drink or breastfeed Becomes sicker Develops a fever If child has PNEUMONIA: return if: Fast breathing Difficult breathing If child has diarrhoea, also return if: Blood in stool Drinking poorly)

Advise when to return

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82B) Follow up visitIf the child has: Return for

follow-up not later than:

PneumoniaDysenteryMalaria, if fever persistsFever malaria unlikely , if fever persistsMeasles with eye or mouth complications

2 days

Diarrhoea, if not improvingAcute ear infectionChronic ear infectionFeeding problemAny other illness, if not improving

5 days

Anaemia 14 days

Very low weight for age 30 days

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C) NEXT WELL-CHILD VISIT

Advise when to return for the next immunization according to immunization schedule.

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88HIGHLIGHTS OF IMNCI

Inclusion of neonates

Incorporation of national guidelines on Malaria, Anaemia, Vit A supplementation & Immunisation schedule.

Training of health personnel begins with sick young infants upto 2 months

Proportion of training time devoted to sick young infant and sick child is almost equal 05/02/2023

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89 Training in IMNCI

The training under IMNCI is focused on applied skill development.

50% of training time- building skills by “hands-on training”. remaining 50% is spent in classroom sessions.

Physicians spend 6 days in hospital and 1 day in community; workers spend 3 days in hospital and 4 days in community settings

1. Focus on Skill Development

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90IMNCI training package: · Set of 9 IMNCI modules for physicians · IMNCI Physician chart book · IMNCI photo book for Physicians · IMNCI facilitator guide · IMNCI indoor and out-patient guide · IMNCI video CDs

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91 • Module1- Introduction• Module2-Assess & Classify the sick young infant age up to 2 months• Module3-Identify treatment for the sick young infant• Module4-Treat the young infant and Counsel the mother• Module5-Assess & Classify the sick child age 2 months up to 5 years• Module6-Identify treatment for the sick child• Module7-Treat the child• Module8-Counsel the mother• Module9-Follow- up

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Inservice training for the existing staff: - phased manner.

Pre-Service Training: For including IMNCI in the pre-service teaching of doctors, nurses, ANM’s, LHV’s and others.

2. Training at two levels:

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93 3. Personnel to be Trained:

There are 2 types of trainings under IMNCI:

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The trainers at district level includes all pediatricians in the district, selected medical officers from CHCs and block PHCs, selected staff nurses and LHVs and CDPO’s and Mukhiya Sevikas from ICDS.

40-50 trainers are required for undertaking training of the health staff on a continuous basis.

Total training time is 10 days: 8 days (Clinical skills training ) + 2 days for supportive supervision.

4. Training of Trainers

95F- IMNCI: (facility based IMNCI)

WHAT?

Integration of existing IMNCI package and the Facility Based Care package in to one package.

To empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as the facility.

It helps to build capacities to handle referrals taking place from the community.

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96 WHY?

IMNCI excludes the skills required at facilities to manage new born and childhood illness.

The long term program needs therefore can only be met if the health personnel and workers possess optimum skills for managing newborn and children both at the community level as well as the facility level.

F-IMNCI training will help in skill building of the medical officers and staff nurses posted in these health facilities to provide IMNCI care

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97 Components of F-IMNCI

1.Training2. Improvements to the health system.3. Improvement of Family and

Community Practices

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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.

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1. TRAININGS in F- IMNCI

99Personnel to be Trained: There are 2 types of trainings under F- IMNCI:

PRE-TRAINING STATUS

PACKAGE TO BE USED

DURATION Place of Training

IMNCI not trained

F-IMNCI complete package

11 days Medical college /District Hospital

Already IMNCI trained

Facility based care package of F-IMNCI

5 days Medical college /District Hospital

*For Medical Officers and Nurses 05/02/2023

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100 Facility based care of sick newborns and

children:

•·Module1-Emergency Triage Assessment andTreatment (ETAT)•·Module2-Care of sick young infant•·Module3-Care of sick child•·Chart book•·Facility care video CD

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Module1- ETAT (Emergency Triage Assessment and Treatment)

· Triage· Maintain Temperature· Check & Treat hypoglycaemia· Airway & Breathing· Give oxygen· Circulation· Coma and Convulsions· Dehydration

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Module2- Facility based care of sick young infant

· Care at birth including neonatal resuscitation· Care of newborn in postnatal ward· Management of sick newborn· Management of low birth weight babies· Neonatal transport

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Module3- Facility based care of sick child

•·Case Management of Children Presenting with Cough or Difficult Breathing.•·Case Management of Children Presenting with Diarrhoea•·Case Management of Children Presenting with Fever•·Management of Children with Severe Anaemia•·Case Management of Children with Severe Malnutrition

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Training of Trainers: Faculty from the departments of Paediatrics and

community medicine of the medical colleges. The trainers at district level include all the

paediatricians in the district. The TOT for State and District facilitators will be

facilitated by National F-IMNCI facilitators.

Facilitator to trainees ratio:   Participant to facilitator ratio of 4-6 : 1

Training Institutions: The Departments of Pediatrics and Preventive &

Social Medicine in each college.

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2. Improvements to the health system.

Newborn care facilities at different levels:

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Capacity building of service providers at NBSU will be done under F-IMNCI training.

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C - IMNCI: Community and Household IMNCI: Community IMCI is basically Component 3 of the

IMCI Package.

Improving child health through the community is at the core of the IMCI strategy.

It aims at improving family and community practices by promoting those Practices with the greatest potential for improving child survival, growth and development.

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109 Evidence that 80% of deaths of children under

five years of age occur at home with little or no contact with health providers. ( Kirk et al.)

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

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3 ELEMENTS OF C-IMNCI

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According to a study published in Ethiop. J. Health Dev by Tigist G/Selassie1 et al, C- IMNCI intervention areas reported better child care practices in terms of time of breastfeeding initiation (OR=9.10, 95% CI=5.45, 12.43),

avoiding pre lacteal feeding (OR=11.01, 95% CI=7.98, 15.43),

initiation of supplementary feeding (OR=3.63, 95% CI=2.23, 5.93) compared to mothers/care takers form non intervention areas.

The likelihood of seeking care for diarrhoea was about five times and that of fever is three times higher in the intervention areas compared to the non-intervention one

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Key family practices:

16 key family practices identified Under Four Broad Heading:

The promotion of growth and development of the child: Exclusive Breastfeeding for six months. Good quality

complementary foods after six months. Continue breastfeeding for two years or longer.

Ensure enough micronutrients – such as vitamin A, iron and zinc – in diet or through supplements. 

Promote mental and social development by responding to a child’s needs for care and by playing, talking and providing a stimulating environment.

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Disease prevention: Dispose of all faeces safely, wash hands

after defecation, before preparing meals and before feeding children.

Protect children in malaria endemic areas, by ensuring that they sleep under Insecticide - treated bed nets.

Provide appropriate care for HIV/AIDS affected people, especially orphans, and Take action to prevent further HIV infections.

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 Appropriate care at home:

Continue to feed and offer more fluids, including breast milk to children when they are sick.

Appropriate home treatment for infections. Protect children from injury and accident

and provide treatment when necessary. Prevent child abuse and neglect, and take

action when it does occur. Involve fathers in the care of their children

and in the reproductive health of the family.

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Care-seeking outside the home:

Recognize when sick children need treatment outside the home and seek care from appropriate providers. 

Complete a full course of immunization before first birthday.

Follow the health provider’s advice on treatment, follow-up and referral. 

Ensure that every pregnant woman has adequate antenatal care, and seeks care at the time of delivery and afterwards.

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IMNCI +

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What “IMNCI +” Adds?

Inpatient care component for facilities to ensure effective care of sick neonates and children who require hospitalization.

Even in this comprehensive form, the IMNCI package would still not cover the vital care of the neonates at birth in home and facility settings.

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117 IMNCI approach includes counselling for

immunization, but the implementation of immunization in India cannot be adequately done by the IMNCI contacts alone. Therefore, a comprehensive immunization plan will be required.

It is in the light of the above reasons that the newborn and child health strategy for RCH, is named as ‘The IMNCI Plus’ to connote the wider, comprehensive range of interlinked interventions that form the newborn and child health component of the RCH Phase II program.

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CURRENT STATUS OF IMNCI IN INDIA

Operationalised in more than 500 districts

5.9 lakh health and other functionaries, including physicians, nurses, AWWs, and ASHAs trained under IMNCI

26,800 medical officers and specialists placed at theCHCs/FRUs trained under F-IMNCI.

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Introductory phase= 0-3 months after inclusion in state's PIPEarly Implementation phase= up to 50% training load completed and from 03-12 months after inclusion in PIPExpansion phase= 50-90% training load completedConsolidation phase= More than 90% training load completed

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*(Status report as on March 2011 -Office of Child Health & Immunization, MOH&FW, New Delhi). 05/02/2023

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References

Park’s Textbook of Preventive and Social Medicine,23rd edition, Bhanot:2015. p 456-459, 576.

J. Kishore , National Health Programs Of India,11th edition, Century: p 167-170.

World Health Statistics 2011. Downloaded from URL;http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf

RCH 2 – National Programme Implementation Plan: MOHFW, GOI.

http://mohfw.nic.in/nrhm/reproductivechild health/programme document.pdf /

Operational Guidelines for Facility Based IMNCI. MOHFW, GOI. Downloaded from URL:

http://mohfw.nic.in/nrhm/ Operational Guidelines for Implementation of IMNCI.

MOHFW,GOI. Downloaded from URL;http://mohfw.nic.in/dofw%20website/F%20IMNCI%20Operational%20Plan%2013%20june%202006.htm

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Arifeen S, et al. MCE-Bangladesh baseline household health and morbidity survey, ICDDR,B, 2000.

Students handbook and teachers guide on IMNCI http://mohfw.nic.in/NRHM/IMNCI/IMNCI Students' Handbook and Teachers' Guide/IMNCI Students' Handbook.pdf Tigist G/Selassie, Mesganaw Fantahun. In what ways

can Community Integrated Management of Neonatal and Childhood Illnesses (C-IMNCI) improve child health?, Ethiop. J. Health Dev. 2011;25(2):143-149

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Thank You.