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LESSON PLAN ON

Subject

Child health nursing I

Unit

Unit IX

Topic

IMNCI

Group

B.Sc. nursing part III

Place

Govt PG college of nursing kota

Date & time

14-9-2015 2.00 pm

Duration

50 min

Teaching methods

Lecture cum discussion

AV aids

Black board , PPT

Students
prerequisite

Students have some basic knowledge regarding IMNCI

General objectives

At the end of the class students will be able to gain knowledge regarding IMNCI

Specific objectives

At the end of the class students will be able to : explain the origin of IMCI
Explain the origin of Integrated management of neonatal and childhood illness.
Describe the structure of IMNCI.
enlist components of IMNCI

Enumerate the principles of integrated care.


Describe steps of case management process.
Review of previous
class
Introduction

S.No
1

Time/
Duration
5 min

Ask question regarding IMNCI case management.


Today we will discuss about IMNCI and its principle and case management process.

Specific
objectives
explain the
origin of
IMCI

Content
Integrated management of childhood illness was developed in 1992 by
UNICEF and WHO for the prevention or early detection and treatment
of the leading causes of childhood death.
Acute respiratory infections
Acute gastroenteritis
Measles
Malaria
Malnutrition

World Health Organization (WHO), UNICEF & other


International Partner came out with a new strategy Known as
Integrated Management of Childhood Illness (IMCI).
An effort to bring health equity for child health.
The strategy emphasises on integrated approach for treating the
sick children.
Emphasizes on improving the family and community practices
as well as care provided by the health system for better care of
child.

Teaching-learning
activities
T: explaining with the
help of black board &
p.pt.
S: Listens & viewing

Evaluation

5 min

Explain the
origin of
Integrated
management
of neonatal
and childhood
illness

During the mid-1990s, the World Health Organization (WHO) and


UNICEF with many other agencies, institutions and individuals
responded to the challenge of high child morbidity and mortality by
developing a strategy known as the Integrated Management of
Childhood Illnesses (IMCI).
IMCI is a national program not only aiming towards reducing infant
mortality rate but also towards mortality reduction in first two months
of life, particularly in the first week of life. This global strategy
focusing on preventing and treating illness in children 2-59 months of
age

The Indian government has taken advantage of the flexibility of


IMCI to include a neonatal component. This modified programme is
termed Integrated management of neonatal and childhood illness
(IMNCI).
Ministry of Health & Family Welfare, Government of India,
constituted a National Adaptation Group of Experts in 20022003 to localize IMCI strategy and protocols for the Indian
context.
This strategy has been further expanded n India to include
all neonates and renamed is Integrated Management of
National and Childhood disease (MNCI). The guidelines
target children less than 5 years old the age group that
bears the highest burden of deaths from common childhood
disease.
The Indian version of IMCI has been renamed as integrated
management of neonates and childhood illness (IMNCI). It is a center
pillar of child health interventions under the RCH II /NRHM strategy
As of December 2011 about 433 districts are implementing this
programme, of which 156 districts are in high focus state of bihar,
Chhattisgarh, MP, himachal Pradesh, J & K, Jharkhand. Orissa,

T: explaining with the


help of black board &
p.pt.
S: Listens & viewing

Rajasthan, Uttar Pradesh and uttrakhand


29 districts of high focus north-east states, 106 non-high focus large
states and 6 other non-high focus north-east states. 492,611 personnel
have been trained for IMNCI for the programme.
The objective is to implement IMNCI package at the level of
household, and through ANMs, at sub center level, through
medical officers, nurse and LHVs at PHC level

OBJECTIVES

10 min

Explain the
objectives of
IMNCI

Causes of under-five mortality (verbal autopsy) and pathway analysis


of events prior to death and recovery of sick under-five children.

Sickness management practices at household, community level


and health facility level.
Skills and care providing competencies of health care providers
(doctors, heath workers and other community level nonconventional service providers)
Health system support for manpower, logistics, referral
mechanism, inter sectoral coordination, social mobilization and
monitoring & supervision.

5 min

Describe the
structure of

To determine baseline mortality among children under-five years


of age (NMR, IMR, U5MR)
To determine prevalence of fever, loose motion, cough and any
other illness (morbidity density) in two weeks prior to day of
field survey among children under-five years of age.
To assess effective program coverage for specified disease
condition (cough with fast breathing) occurring in two weeks
prior to day of field survey.

STRUCTURE OF IMNCI:
IMNCI caters to two groups of children

T: explaining with the


help of black board &
p.pt.
S: Listens & viewing

T: explaining with the


help of black board &

IMNCI

0-2 months, referred to as young infants.


2 months to 5 years, referred to as children.

p.pt.
S: Listens & viewing

COMPONENTS OF IMNCI:

8 min

15 min

Enlist the
component of
IMNCI

Describe the
principle of
IMNCI

Improving case management skills of health workers: health


worker component
Standard guidelines
Training (pre-service and in-services)
Follow-up after training
Improving the health system to deliver IMNCI: health service
component
Essential drug supply and management
Organization of work in health facilities
management and supervision
Improving Family and Community practices community
component

PRINCIPLES OF INTEGRATED CARE:


The IMNCI guidelines are based on the following principles:
All sick children under 5 years of age must be examined for
conditions which indicate immediate referral or hospitalization.
Children must be routinely assessed for major symptoms,
nutritional and immunization status, feeding problems and other
potential problems.
Only a limited number of carefully selected clinical signs, are
used based on evidence of their sensitivity and specificity to
detect disease.
Based on the presence of selected clinical signs, the child is

T: explaining with the


help of black board &
p.pt.
S: Listens & viewing

T: explaining with the


help of black board &
p.pt.
S: Listens & viewing

placed in a classifications. Classifications are not specific


diagnosis but categories that are used to determine the treatment.
Classifications are colour coded and suggest referral (pink),
treatment in health facility (yellow) or management at home
(green).
IMNCI guidelines address most common but not all paediatric
problems.
A limited number of essential drugs are used.
Care takers are actively involved in the treatment of children.

Counselling of caretakers about home care including feeding, fluids and


when to return to health facility
7

20 min

Describe the
case
management
process of
IMNCI

IMNCI CASE MANAGEMENT PROCESS:


Steps of case management process are as follows.
i. Assess the young infant/child
Recognition of danger signs
Asking for the presence of major symptoms
other charts are used for,
- malnutrition
- anemia
- immunization
- Vitamin A and folic acid supplementation.
ii.

Classify the illness


There is a color-coded system by which treatment steps can be
decided.

-Pink: indicates immediate care and referral.


-Yellow: indicates that the child needs medication and can be treated
and sent home with appropriate advice. The caregiver is counselled

T: explaining with the


help of black board &
p.pt.
S: Listens & viewing

about the illness, treatment is started and follow-up visits are explained.
-Green: indicates that the child does not have a serious conditions and
that simple home remedies would suffice.
iii.
Identify treatment
Identify all problems before giving advice. If a sick young
infant/child has more than one classification, treatment required
for all the classifications must be identified.
iv.

v.

Treat the young infant/child


Based on the classifications and treatment suggested under
identify treatment. An infant/child is managed with,
Pre-referral treatment for severe classifications
Outpatient treatment
Management at home.
Counsel the mother

feeding of child
feeding problems
fluid
visit
vi.

Provide follow up care

SUMMARY
Today we discussed about the IMNCI and its case management process.

ASSIGNMENT
Make an assignment on IMNCI
EVALUATION
Class test and asking questions
BIBLIOGRAPHY
Books

Datta parul , Pediatric Nursing, Third Edition, Jaypee Brothers Medical Publisher (P) Ltd.2014
Mrs. R.S. Tambulwadkar, Pediatric Nursing, Third edition, Vora medical publications, Mumbai.
Jacob and Singh, pediatric Nursing, Fourth edition, N.R.Brothers, Indore, 2009.
Ghai OP, essential pediatrics, eighth edition, CBS publication

Website
www.nlm.nih.gov/medlineplus
www.chilwelfare.gov
www.slideshare.com
www.scribed.net
www.wikipedia.org