1. INTRODUCTIO
N TO IMCNI
mentorship training slides
Tiwi Ward

2. Objectives of IMCNI case
management
 To improve the quality of care provided to
children under five years
 To contribute to the reduction in childhood
mortality

3. cont
Why an integrated approach?:
 Most children present with signs and
symptoms related to more than one of these
diseases mentioned above
 Thus a single diagnosis may neither be
possible nor appropriate
 This approach is needed as need to go
beyond single diseases and address the
overall health

4. Aim?
 At reducing death, and frequency and severity
of illness and disability by
 Integrating treatment and prevention of major
childhood illnesses, to contribute to improved
growth and development

5. cont
 Therefore the IMCNI strategy combines
improved management of childhood illnesses
with aspect of:
 Nutrition
 Immunization
 Other important influences on child health
including maternal health

6. Cont..
 Improvement of family and community practices
 Community and family practices that if adopted can
reduce child mortalities eg
 Exclusive breastfeeding for 6months
 Appropriate complementary feeding from 6months whilst
continuing breastfeeding
 Proper disposal of feces, hand washing
 Child sleeps under ITN
 Prevention and care of HIV/AIDS
 Continue feed child and offer more food and fluids when
child sick
 Give child appropriate home treatment for infections

7. Components of IMCI
 Improvement of health workers skills
? Through training in case management and the systems
should thus be functional and family and community practices
have been improved
 Improvement of health systems
 Ensuring availability of essential drugs and supplies
 Organized hospital emergency area to support rapid
evaluation and management of sick children
 Training of health workers in ETAT
 Adherence to national policies for standards of care

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20
40
60
80
100
120
140
2003 KDHS 2008-09 KDHS 2014 KDHS SDG Targets
Trends in Childhood Mortality
Deaths per 1000 live births
Neonatal mortality Under 5 mortality

9. Under five mortalities

10. How do we address this high mortality rates?
 We Need simple, standard guidelines for these conditions:
 In diagnosis
 In management
• The guidelines must also be scientifically and professionally sound.
• WHO and UNICEF developed a package for countries with infant
mortality rate >40/1000 live births. Kenya has since adopted this
approach.
• This package is called Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)

11. IMNCI Clinical Guidelines
2 months 5 years
IMNCI Guidelines
Sick Child
Birth
Sick Young infant

12. Important aspects (1)
• IMNCI does not cover all symptoms.
• IMNCI strategy is not reviewing all pediatric medicine
• Emphasis is how to deal more effectively with the most common
problems in sick children brought to the clinic.
• IMNCI strategy takes into consideration the overlapping of these
symptoms and conditions.

13. Important Aspects (2)
 The core interventions is integrated management of six most important
causes of death, namely:
1. Pneumonia
2. Diarrhoea
3. Measles
4. Malaria
5. Acute Malnutrition and Anemia, HIV
6. Young infant infections and birth related conditions.
• IMNCI also addresses the common signs/symptoms that
make the mother bring her child to hospital.

14. The IMNCI Case Management Process
 This must be performed on all sick children
 The IMNCI Case Management Process includes;
– Assessing and classifying the sick child 2 months up to 5
years.
– Identifying treatment and treating the child.
– Counseling the caregiver..
– Check for child’s developmental milestone.
– Assessing for interaction, communication& responsiveness.
– Assessing and classifying the sick young infant
– Follow up care.
This process is detailed in the IMNCI chart booklet
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15. The Chart Booklet and the Recording form
Chart Booklet
 The chart booklet is a IMNCI case management job aid which gives a step
by step guide on the case management process.
 Health care providers need to continuously refer to this document
throughout the case management process.
 Many mistakes service providers make in assessment, classification and
management of sick children and young infants are due to failure to use this
job aid.
Recording Form ( Chart booklet pages 48-53)
 There is a sick child and a sick young infant recording forms
 Each is used for the corresponding age group.
 The assessment findings, Classifications and management options for the
child should be recorded on this form.
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16. The IMCNI strategy
 It is an innovative approach
 Started in 1995 by WHO and UNICEF with aim of
introducing a comprehensive and timely
management of the 5 most common causes of ill
health and death among children
 The illnesses are:
 Pneumonia
 Diarrhea
 Measles
 malnutrition