Integrated Management of Childhood IllnessIMCI Kangaroo Mother care

Integrated Management of Childhood Illness-(IMCI) Kangaroo Mother care (KMC) Under Five Clinic Dr Abhay Nirgude Professor & Head Department of Community Medicine

Case Study • 3 year old girl child was brought to an under five clinic by mother. Child was having loose motions (4 -5 episodes) from last two days. How will you manage the case using IMCI approach?

Specific Learning Objectives • Enlist the elements of IMCI • Discuss the process of Integrated case management process under IMCI • Write the advantages of Kangaroo Mother care • Discuss the services provided through under five clinic.

IMCI Level Meaning Patient Level Case Management Point of Delivery Multiple interventions are provided through one delivery channel System Level Bringing together management & support function of different sub-programmes. IMCI(WHO/UNICEF) : - Strategy combines improved management of childhood illness with aspects of nutrition, immunization & other Important disease prevention & health promotion elements.

IMCI-Components I. Improvement in case management skills of health staff through the provision of locally adapted guidelines on IMCI II. Improvement in the health system required. III. Improvement in the family & community practices.

IMCI • Integrated management of most common childhood problems • Guidelines are tailored to fit the needs, resources & capacity of country’s health system • Clinical guidelines for 1 wk-5 yrs : - evidence-based assessment & management , using a syndromic approach. • Rational, effective & affordable use of drugs. • Assessment : - Danger signs, child’s nutrition, immunization & feeding • Advise : - when to return • Decision : - home based care, primary, secondary & tertiary level care

Elements of IMCI Assess • Check for danger signs • Assess children about other health problem Classify • Pink : urgent pre-referral treatment & referral • Yellow: - specific medical treatment & advice • Green : - simple advice on home management Identify • Specific treatment needs for the child: • If home based : - develop integrated treatment plan

Elements of IMCI Treatment • Teaching the caretaker how to give oral drugs • How to recognize signs & when to return immediately counsel • Counsel to solve any feeding problem • Counsel mother about her own health Follow-up care • Routine follow-up • Reassess the child for new problems.

Integrated management of neonatal & childhood illness(IMNCI) • Most sick children present with signs & symptoms of more than conditions. • Promotion of child health • Prevention of disease • Provision of standard case management of childhood illness • Cost effective

Integrated case management process Check for danger • Convulsions, lethargy/unconsciousness • Inability to drink/breastfeed , vomiting signs Assess main • Cough/difficulty breathing, diarrhoea • Fever, ear problems symptoms Assess nutrition & immunization status & potential feeding problems Check for other problems Classify conditions & identify treatment actions

Colour-coded treatment Pink Yellow Green Treatment at outpatient health facility Home Management Counsel care taker on: - Outpatient health facility Pre-referral treatment, advice parents, refer child Referral facility -ETAT -Diagnosis & treatment -Monitoring & F/U Treat local infection Give oral drugs Teach care taker Follow up Give oral drugs Treat local infections Continue feeding When to return? Follow up

Major adaptations under IMNCI • Inclusion of 0 -7 days age in the programme • Incorporating national guidelines on malaria, anaemia, vit-A supplementations & immunization schedule • Training of health personnel begins with sick young infants up to 2 months • Proportion of training time devoted to sick young infant & sick child is almost equal • Skill based approach.

Case Study • 3 year old girl child was brought to the under five clinic by mother. Child was having loose motions (4 -5 episodes) from last two days. How will you manage the case using IMCI approach?

LBW-Kangaroo mother care • Its key features are: 1. Early, continuous and prolonged skin to skin contact between the mother and the baby. 2. Exclusive breastfeeding. 3. Initiated in a facility and continued at home.

KMC

KMC • Healthful effects KMC: 1. Helps in maintaining temperature of infant. 2. Facilitates breastfeeding. 3. Improves growth. 4. Reduces infections. 5. Improves mother infant bonding.

Institution KMC q All babies less than 2000 g are candidates for KMC. q Place the baby naked, with or without a nappy, upright inside mother's q clothing against skin. (A loose blouse, sweater or wrap tied at the waist holds the baby). q Let baby suckle at breast as often as he wants, but at least every 2 hourly. q Sleep propped up so that the baby stays upright. q Make sure the baby stays warm all times. q If environment is cool, dress the baby with extra clothing and cover his head.

KMC q When mother wants to bathe or rest, ask the father or another family q Take baby for regular check-ups for vaccination and weight record. q Adequacy of feeding can be assessed by the baby's weight gain. q After 7 days of life the baby is expected to gain about 15 -20 gms/day or 100 -140 gms/week.

Under five clinics • • • Care in illness Growth monitoring Preventive care Family planning Health education

Summary

Feedback • What are the elements of IMCI? • Advantages of KMC? • Services provided at under five clinic