INTEGRATED MANAGEMENT OF NEONATAL

AND CHILDHOOD ILLNESS

Presented by - Aachal Thakur 182

Dipkshika Tayade 180
Kunali Tembhare 181
Aman Tayade 179
Presentation Outline
Integrated Management Of Neonatal And Childhood Illness

● Introduction
● Objectives
● Components
● Principles
● Case Management process which includes :
- Assess

- Classification

- Identify

- Treatment

- Counsel

- Follow up care
Introduction

● WHO & UNICEF have developed new strategy for integrated management of common childhood
illness which are responsible for main causes of morbidity & mortality in the developing countries
by improved performance of health workers.

● 10 million children /year die in developing countries due to acute respiratory infections (ARI),
diarrhoeas, measles, malaria & malnutrition.

● 1990 - WHO+ UNICEF+ other agencies - (IMCI)

● India adopted as (IMNCI)

IMNCI Definition

● IMNCI is an integrated approach to child health that focuses on the well

being of the whole child. It focuses primarily on the most common causes
of child mortality ie. diarrhoea, pneumonia, measles, malaria & malnutrition,
illness affecting under 5 children aged including both preventive & curative
elements to be implemented by families.

● It aims to reduce death, illness & disability& to promote improved growth &
developed among under 5 children
More prone age groups
Effects of ARI, Diarrhoea, measles, malaria & mammunition on
child death
Objectives of IMNCI

● Reduce mortality

● Reduce frequency & severity of illness

● Improve growth & development during first 5 yrs of a child life

 3 Main Components Of IMNCI

Improvement in -

1. Case management skills of health staff under IMNCI guidelines

2. Health system required for effective managements of childhood illness

3. Family & Community practices

Principles of IMNCI
1. All sick children under 5 yrs of age must be examined
for conditions which indicate immediate referral

2. Assessment for major symptoms (cough or difficult

breathing, diarrhoea, fever & ear problems), nutritional
& immunization status should be done routinely

3. Limited no. of selected clinical (danger) signs are used

4. IMNCI guidelines addresses most common pediatric problems but
not all of them

5. Limited no. of essential drugs are used

6. Active involvement of care takers in treatment of children

7. Counseling of care takers about home care including feeding

advices.
 ELEMENTS IN CASE MANAGEMENT

1. Assess the child or young infant

2. Classify the illness
3. Identify the treatment
4. Treat the child
5. Counsel the mother
6. Give Follow up care
 CASES MANAGEMENT PROCESS

2 AGE CATEGORIES :

A) Young infants: From birth upto 2 months

B) Older children: From 2 months upto 5 yrs

CASES MANAGEMENT PROCESS
Congenital Malformation
● Defination:
Congenital disorders are defined as “ those diseases that are
substantially determined before or during birth and which are
in principle recognizable in early life”

● Incidance:
Congenital anomalies also referred as birth defects affect
approximately 1 n 33 infants and results in approximately
3.2 million birth defects related disabilities every year.
● Causes
1.Genetic Factors 2.Environmental Factors
(a) Chromosomal (a)Intrauterine Infections
abnormalities: (b)Drugs
Ex, Down’s syndrome (c)complicated pregnancy
Klinefelter’s syndrome (d)Irradiation
Turner’s syndrome (e)Dietary Factors
(b) Inborn errors of
Metabolism:
Ex, Galactosemia
PKU
Handicapped Children
● Definition
“Handicap” may be defined as “reduction in a persons”
capacity to fulfil a social role as a consequence of an
impairment, inadequate training for the role , or other
circumstances .

“Applied to children, the term usually refers to the presence

of an impairment or other circumstances that are likely to
interfere with normal growth and development or with the
capacity to learn”
● Classification

It is usual to classify handicapped children into

the following groups:

1. Physically Handicapped
2. Mentally Handicapped
3. Socially Handicapped
● Causes
1.Genetic Conditions:
Like, Down’s syndrome , Galactosemia
2.Antenatal Factors:
Like, Neural tube defect , Rh incompatibility

3.Perinatal Factors:
Like, Birth injuries, Hypoxia, Cerebral Palsy
Behaviour Problems
Classified as:

a] Problems anti-social in nature:

Like, Stealing , lying , gambling , cruelty , sexual offences

b] Habit disorders:
Like, Thumb sucking , nail biting , bed wetting , etc

c] Personality Disorders:
Like, Jealousy, day dreaming , fear and anxiety, etc
c] Psychomatic complaints
Like, Tremors , Headache , asthma , depression ,delusion ,
Hallucinations, etc.

d] Educational difficulties:
Like, Backwardness in studies, school phobia, school failure
Battered baby syndrome
● Definition:
“a clinical condition in young children, usually under 3 years
of age who have received non - accidental wholly
inexcusable violence or injury, on one or more occassions “

It has been tentatively suggested that 10 - 15 % of cases of

cerebral palsy and almost double that proportion of the new
mentally retarded children each year may be the result of
the battered baby syndrome.
Girl child and gender bias
● Gender biases pose a specific threat to girl children
across the social and economic strata.

● For a girl child, life is a constant fight for survival, growth

and development from the time she is concieved till she
attains 18 years

● Protecting girl child in India will not be easy. The nation

cannot any longer afford the cost of hoping that society will
change its mindset on its own.
● The specific goals for girls in the National Plan of Action for
Children 2005

1.Assurance of equality status for girl child as an individual

and citizen in her own right through promotion of special
opportunities for her growth and development.

2.To stop sex selection, female foeticide and infanticide.

3.To eliminate child marriages.

4.To ensure equal opportunity for free and compulsory

elementary education to all girls.
5.To ensure survival, development and protection of the girl.
child and to create an environment wherein she lives a life of
dignity with full opportunity for choice and development.

6.To take measures to protect girl children from any treatment

which undermines their self esteem, and causes their
exclusion from social mainstream and also break down
persistent gender stereotype.

7.Health and Nutrition

Child Abuse
● The WHO defines child abuse and child maltreatment as
“All forms of physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment or
commercial or other exploitation resulting in actual or
potential harm to the childs health, survival, development
or dignity in the context of a relationship of responsibility,
trust or power.”

● Public health problems include all types of abuse and

neglect under the age of 18 years by a parent, caregiver
or another person in a custodial role.
● There are four types of abuse and neglect

1. Physical abuse

2. Sexual abuse

3. Emotional abuse

4.Neglect
● Strategies and aproches to prevent child abuse
can be summarised as:

a] Strengthen economic support to the family.

b] Change social norms to support parents and positive
parenting.
c] Provide quality care and education early in life.
d] Enhance parenting skills to promote healthy child
development.
e] Child protection.
Child Labour and Child Exploitation

● A sizeable number of growing children of poor

socioeconomic class especially in rural areas are known
to be inducted as child lobour.

● India fosters the largest number of child labours in the

world.

● In 2014, about 82 lakh child labour population was

estimated in India.
The Child labour (Prohibition and Recognition )
Act, 1986
● Except in the process of family based work or recognized
school-based activities, children are not permitted to work in
occupations concerned with:

● Passenger, goods mail transport by railways

● Carpet weaving
● Cement manufacturing
● Cloth printing
● Building construction operations
● Dyeing, weaving
Child trafficking
● Child trafficking is the recruitment, transportation,
transfer, harbouring or receipt of a child for the purpose of
exploitation.

● It is estimated that child trafficking affects about 1.2

million children each year.

● In East Asia and pacific, most trafficking is into child

prostitution, though some children are also recruited for
industrial and agricultural work.
UJJAWALA:
● “Ujjawala”, a comprehensive scheme to combat
trafficking was launched in India by the Ministry of
Women and child development on 4 th December, 2007
and is being implemented mainly through NGOs.

● The scheme has five components of prevention, rescue,

rehabilitation, reintegration and repatriation of the victims
trafficked for commercial sexual exploitation.
● Some of the provisions under the scheme are
[1] Formation of community vigilance groups, adolescents
groups, awareness creation and preparation of IEC material,
organizing workshops

[2] Safe withdrawal of victims from the place of exploitation.

[3] Rehabilitation of victims by providing them safe shelter,

basic amenities, medical care, legal aid, vocational training and
employment.

[4] Re-integration of victims into society.

● INSPIRE: Seven strategies for
ending violence against children

INSPIRE is a set of seven evidence-based strategies for

countries and communities working to eliminate violence
against children.
1) Implementation and enforcement of laws

2) Norms and values

3) Safe environments

4) Parent and caregiver support

5)Income and economic strengthening

6) Response and support services

7)Education and life skills

The Children Act, 1960
● The children Act, 1960 in India (1977) provides for the
care,maintenance, welfare, training, education and
rehabilitation of the delinquent child.

● It covers neglected and destitute, socially handicapped,

uncontrollable, victimized and delinquent children.

● In Article 39(f) the Constitution of India provides that “the

state shall in particular direct its policy towards securing
that childhood and youth are protected against moral and
material abandonment.
Juvenile Justice Act, 1986
● With the implementation of the Juvenile Justice Act ,
1986, all Children's Acts applicable in different parts of the
country have been repealed.

● The new Act, apart from rectifying the inadequacies of

Children's Act, provides a comprehensive scheme for
care,protection, treatment, development and rehabilitation
of delinquent juveniles.

● The new Act has come into force from 2nd Oct 1987.
● Some of the special features of the Act are:
a) It provides a uniform legal framework for juvenile justice in
the country so as to ensure that no child under any
circumstances is put in jail or police lock-up.

b) It envisages specialized approach towards prevention and

treatment of juvenile delinquency in keeping with the
developmental needs of children.

c) It establishes norms and standards for administration of

juvenile justice in terms of investigation, care, treatment and
rehabilitation
d) It lays down appropriate linkages and coordination
between the formal system of juvenile justice and voluntary
organization. It specifically defines the roles and
responsibilities.
Thank You