IMNCI

INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI)

Every day, millions of parents seek health care for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers. Surveys reveal that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised. At first-level health facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave health workers at this level with few opportunities to practice complicated clinical procedures. Instead, they often .rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources.

These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Neonatal and Childhood Illness (IMNCI).

DEFINITION

IMNCI is an integrated approach to child health that focuses on the well-being of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMNCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. The strategy includes three main components:

• Improving case management skills of health-care staff

• Improving overall health systems

• Improving family and community health practices.

In health facilities, the IMNCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caregivers, and speeds up the referral of severely ill children. In the home setting, it promotes appropriate care seeking behaviours, improved nutrition and preventative care, and the correct implementation of prescribed care.

PURPOSE

The purpose of IMNCI is an integrated approach to child health that focuses on the wellbeing of the whole child. IMNCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age.

RATIONALE

The WHO/UNICEF IMNCI (Integrated Management of Childhood Illness) guidelines were originally designed to address the most common causes of mortality in children age 1 week up to five years old, especially in countries with an infant mortality higher than 40 per 1000 live births.

In these situations, there is often a substantial incidence of communicable diseases in children under-5 taken to primary health care facilities, and risk factors such as malnutrition and low birth weight are common.

The generic version of the guidelines therefore concentrates on the outpatient management of the following conditions:

• Acute respiratory infections, including pneumonia

• Diarrheal diseases, including dehydration, bloody and persistent diarrhea

• Meningitis and sepsis

• Malaria

• Measles

• Ear infection

• Malnutrition

• Anaemia

OBJECTIVES OF IMNCI

The objectives of the IMNCI strategy are:

• To reduce mortality and morbidity associated with the major causes of disease in children less than five years of age.

• To contribute to the healthy growth and development of children.

ADVANTAGES OF IMNCI 

• Promotes the accurate identification of childhood illnesses in out-patient settings

• Ensures appropriate combined treatment of all major childhood illnesses

• Strengthens the counselling of mothers or caregivers

• Strengthens the provision of preventive services

• Speeds up the referral of severely ill children

• Aims to improve the quality of care of sick children at the referral level.

• IMNCI improves health worker performance and their quality of care;

• IMNCI can reduce under-five mortality and improve nutritional status, if implemented well;

COMMON CHILDHOOD DISEASES

1. MEASLES

The rubeola virus causes measles, and it used to be an extremely common childhood infection prior to routine vaccination. Unfortunately, due to an increased rate of vaccination refusals by parents, we are starting to see sporadic outbreaks amongst those groups. Measles is an acute viral illness that can lead to serious complications, even death, and generally begins with nonspecific symptoms such as high fever, runny nose, and cough. Following these symptoms, patients develop a rash that spreads from the face to the feet. Symptoms generally start one to two weeks after exposure, and the symptoms last for less than a week.

2. MUMPS

Mumps is a viral illness that typically starts with flu-like symptoms and then results in acute painful swelling of the salivary glands (parotitis). Prior to routine vaccination, this was a very common illness. Symptoms generally appear more than two weeks after exposure, and the illness lasts seven to 10 days. As with many of the childhood viral illnesses, though most infections are mild, there is a real risk for complications, including meningitis and death.

3. RUBELLA (GERMAN MEASLES)

Rubella, also known as German measles, causes mild illness in most individuals. This is not the case for unvaccinated pregnant women. The virus can cause serious and fatal birth defects in the fetus. Vaccination is routine and has resulted in a huge decrease in the spread. The virus begins as a fever and rash and, in most cases, resolves after two to three days.

4. WHOOPING COUGH (PERTUSSIS)

Bordetella pertussis is the bacteria that cause whooping cough. It is highly contagious and is sometimes fatal in young children, especially babies. The infection is preventable with vaccination; however, it is often unrecognized in older children and adults. The infection usually begins with cold symptoms and then develops into a cough that is persistent and violent, making it hard to catch a breath. Whooping cough got its name due to the deep whooping inspiration many children and infants make after the cough stops. Vaccination is recommended for young children, teenagers, and adults.

5. MENINGITIS

Meningitis is an inflammation of the tissue surrounding the brain and spinal cord (meninges). Viruses or bacteria may cause meningitis. Symptoms include headache, stiff neck, fever, and malaise. Routine vaccination has decreased the incidence of many bacterial causes; however, viral causes are still common. Bacterial meningitis can result in severe outcomes, including permanent hearing loss, brain damage, and even death.

6. STREP THROAT

A strain of Streptococcus, a common skin bacterium, causes strep throat. Symptoms include a sore throat and fever that lasts more than a few days. Often there may be a white-colored discharge (pus) in the back of the throat and enlarged lymph nodes on the neck. Strep throat will resolve on its own, however, antibiotics are recommended due to the risk of developing rheumatic heart disease, a serious but preventable consequence of strep infections.

7. REYE'S SYNDROME

Aspirin and aspirin-containing medications should never be given to children. Reye's syndrome is a potentially fatal illness that is caused by exposure to these medications and results in life-threatening liver failure and subsequent brain swelling. It is luckily an uncommon illness today since the recognition of aspirin exposure as a cause.

8. IMPETIGO

Staph or strep, two very common skin bacteria, may cause impetigo. It generally appears as a bunch of small blisters that pop and form honey-colored crust. Impetigo can appear anywhere on the body and is most commonly diagnosed in young children. Antibiotics are necessary in most cases.

9. RINGWORM

A common fungus causes ringworm. This is not a "helminthic" disease (no worms involved). The name was developed due to the "worm-like" ring that is seen during these infections. Antifungal medications treat ringworm. It can spread from child to child, so care needs to be taken.

10. FLU

The flu typically is seen during the winter months and causes high fever, chills, body aches, and other symptoms. It usually resolves on its own, but in some, it can result in serious complications including pneumonia. Currently, annual vaccination is recommended universally for all people aged 6 months and older.