INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS
INTRODUCTION
• IMNCI (Integrated Management of Neonatal and Childhood Illness) was developed by WHO
and UNICEF to tackle the leading causes of child mortality under five—pneumonia, diarrhea,
malaria, measles, and malnutrition—through a unified strategy that addresses preventive,
promotive, and curative care .
• By holistically integrating newborn care into the IMCI framework, many countries now
implement the extended version—IMNCI—which covers the first week of life along with later
infancy .
• The strategy promotes care across all settings—home, community, and health facility—and
emphasizes standardized clinical decision-making and community empowerment .
DEFINITION
• IMNCI is defined by WHO as an “Integrated approach aimed at reducing preventable
death, illness, and disability in children under five by combining preventative, promotive,
and curative interventions across home, community, and facility environments .
• It emphasizes comprehensive, protocol-driven clinical assessment and treatment of the sick child,
enhancing diagnostic accuracy and coverage of key interventions .
GOALS AND OBJECTIVES
• The primary goal is the reduction of under-five mortality by improving early recognition and
management of major childhood illnesses—especially in resource-limited regions .
• It seeks to decrease illness severity and prevent long-term consequences such as growth failure or
neurodevelopmental delay.
• By integrating nutrition, immunization, and caregiver education, it supports better physical,
cognitive, and emotional development.
• The strategy aims to boost the skills and consistency of frontline providers—including doctors,
nurses, ANMs, and ASHAs—by standardizing case management using visual algorithms and
periodic training.
CORE COMPONENTS
Strengthening case management skills via algorithmic training
• This means that health workers like nurses and ASHAs are trained to use simple step-by-step
guides or flowcharts (called “algorithms”) while checking a sick child. These guides help them to
ask the right questions, look for the right signs, and decide what treatment is needed.
• This method is useful because they don’t have to remember everything, and it reduces the chances
of making mistakes while treating children.
• For example, if a child has fever and cough, the chart helps the health worker decide if it’s a
simple cold or pneumonia and what to do next.
Enhancing health system support
• This means improving the overall support system in healthcare, so that health workers have
everything they need to treat children properly.
• This includes making sure there are always enough medicines, basic equipment, trained staff, and
supervisors to guide and check the work. It also includes having a clear referral system, so if a
child is very sick, they can be quickly sent to a bigger hospital.
Promoting family and community engagement
• This means encouraging parents and communities to take good care of children at home and in
their surroundings.
• This includes teaching families about the importance of exclusive breastfeeding, washing hands
properly, vaccinating children on time, feeding the child well during sickness, and taking the child
to a health center quickly when danger signs appear (like the baby not eating, vomiting a lot, or
becoming very weak).
• By doing this, even the home becomes a safe and caring environment for the child, not just the
hospital.
AGE GROUPS TARGETED
• IMNCI covers children aged 0 to 59 months in two main groups: newborns and young infants
(0–2 months) and older infants and children (2–59 months).
• India’s adaptation includes specific focus on the first week after birth—home visits and facility
protocols during this high-risk period—to strengthen neonatal survival .
ILLNESSES COVERED
• For children aged 2–59 months, IMNCI uses syndromic categories such as cough/difficulty
breathing, diarrhoea, fever/malaria, ear infection, malnutrition, and general danger signs including
persistent vomiting, convulsions, inability to feed, and lethargy .
• Young infants are evaluated for sepsis, feeding difficulties, jaundice, low birth weight, and
hypothermia—conditions responsible for a large share of neonatal deaths .
6 STEP CASE MANAGEMENT PROCESS
Step 1: Assess the child fully
• The health worker first checks the child carefully for any general danger signs like convulsions,
inability to drink, or extreme sleepiness.
• Then, they look for symptoms like fever, cough, or diarrhea. They also ask about the child’s
feeding habits, check if the child has taken all vaccines, and assess the child’s weight and
nutrition.
Step 2: Classify the illness using color codes
• Once the assessment is done, the health worker uses a color-coded chart to decide how serious
the illness is:
• Red means the child is in serious danger and must be referred immediately to a hospital.
• Yellow means the illness is moderate and can be treated at the health center.
• Green means the child has a minor illness and can be safely treated at home with guidance.
Step 3: Give the right treatment
• The health worker gives treatment based on WHO-approved guidelines.
For example:
• ORS and zinc for children with diarrhea.
• Antibiotics for pneumonia.
• Antimalarial medicines if malaria is suspected.
• Micronutrient supplements for undernourished children.
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• Feeding advice is also given to help the child regain strength.
Step 4: Counsel the caregiver
The health worker talks to the mother or caregiver and teaches them how to:
• Continue feeding the child during sickness.
• Give the medicine properly at the right time.
• Watch for any danger signs that mean the child needs urgent medical help.
• Keep the child clean and safe at home.
Step 5: Refer if necessary
• If the child is very sick (like in red category), the health worker quickly arranges for the child to
be taken to a bigger hospital.
• Before sending, they may give some urgent treatment, like first dose of antibiotic, to keep the
child safe during transfer.
Step 6: Follow-up visit
• The health worker asks the caregiver to bring the child back for follow-up after a few days.
• This is done to check if the child is getting better, if there are any side effects, and to give further
advice if needed.
• They also check if the caregiver understood the instructions given earlier.
IMPLEMENTATION IN INDIA
• India launched IMNCI in 2005, extending coverage to early neonatal care .
• By 2009, IMNCI had been introduced in 223 out of 627 districts (over one-third of the country) .
• Training of over 49,000 healthcare workers—including ASHAs, ANMs, staff nurses, and doctors
—was supported by visual chart booklets and digital apps for real-time decision-making .
• Pilot programs in aspirational districts like Ferozepur involved multi-modal pulse oximeters and
smartphones, achieving 96% diagnostic accuracy and 95% appropriate treatment compliance .
IMPACT & EVIDENCE
• Facility-based IMNCI implementation in Haryana and Odisha led to significant knowledge and
competency improvements among frontline workers, including ASHAs and ANMs .
• A BMJ-cluster randomized controlled trial (C-RCT) in India demonstrated reductions in under-
five and neonatal mortality and high caregiver satisfaction .
• Studies from Zimbabwe and Indonesia report 30% reductions in neonatal and infant deaths
following national IMNCI rollout .
CHALLENGES & OPPORTUNITIES
• Scalability is challenged by uneven training quality, poor supervision, intermittent drug
availability, and varying adherence across regions .
• WHO recommends algorithm adjustments in low-malaria zones to reduce misclassification of
fever and unnecessary treatments .
• NITI Aayog’s 2023 “Transforming Child Nutrition” report emphasizes community-based
protocols like Community Management of Acute Malnutrition CMAM, aligning with IMNCI
goals of nutrition, screening, and follow-up.
• Opportunities include digital tools, tele mentoring, stronger supply chains, and integration with
ICDS and Anganwadi programs to ensure seamless delivery.
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