Integrated Management of Newborn and Childhood Illness If you create an account, you can set up a personal learning profile on the site. Integrated Management of newborn and Childhood Illness Module: 1. An Introduction to the Integrated Management of Newborn and Childhood Illness IMNCI Introduction Every year about 9 million children in developing countries die before they reach their fifth birthday, many of them during the first year of life. Ethiopia has one of the highest under-five mortality rates with more than , children under the age of five dying every year. These diseases are also the reasons for seeking care for at least three out of four children who come to health facilities. IMNCI is an integrated approach to child health that focuses on the wellbeing of the whole child.
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Correspondence and reprint requests should be addressed to: Dr. This article has been cited by other articles in PMC. Abstract At the current rate of decline in infant mortality, India is unlikely to achieve the Millennium Development Goal on child survival. This paper assessed the progress of IMNCI in India, identified the programme bottlenecks, and also assessed the effect on coverage of key newborn and childcare practices.
Programme data were analyzed to ascertain the implementation status; rapid programme assessment was conducted for identifying the programme bottlenecks; and results of analysis of two rounds of district-level household surveys were used for comparing the change in the coverage of child-health interventions in IMNCI and control districts.
More than , community health workers and first-level healthcare providers were trained during at a variable pace across districts. Poor supervision and inadequate essential supplies affected the performance of trained workers. During , 12 early-implementing districts had covered most key newborn and child practice indicators compared to the control districts; however, the difference was significant only for care-seeking for acute respiratory infection net difference: Based on the early experience of IMNCI implementation in different states of India, measures need to be taken to improve supportive supervision, availability of essential supplies, and monitoring of the programme if the strategy has to translate into improved child survival in India.
One of the major reasons for the slow decline in the IMR is the stagnation in neonatal mortality. In the current decade, neonatal mortality is declining sluggishly, moving from 40 per 1, livebirths in to 36 per 1, livebirths in The coverage of child-health interventions remains highly inadequate in India. The programme planned a comprehensive package of newborn and child-health interventions aiming at achieving a decisive decline in neonatal, infant and child mortality.
The aim was to implement IMNCI at the household level in districts and at the facility level across the country by 6. The guidelines relied on the detection of cases using simple clinical signs without laboratory tests and offered empirical treatment.
IMCI only covered children aged seven days to five years excluding the early neonatal period and targeted health workers at primary-care facilities 7. Two features distinguish this approach from the generic IMCI.
Recognizing newborn care as critical for improving child survival, it was strengthened in IMNCI by increasing the newborn-care component of the training programme and including prevention and management of health conditions in the first week of life. Second, recognizing that a large proportion of sick children do not come in contact with health workers but most of them can be reached by community-based workers, IMNCI in India focuses on community-based rather than facility-based healthcare providers.
The AWWs manage a village-level community nutrition centre, called Anganwadi, and provide a set of services for promoting the growth and development of under-six children. They receive a fixed remuneration for the services. Description of intervention Training The IMNCI training programme focuses on building of individual skills and includes practice sessions in the field and in the hospital.
Each training programme is run for eight days. The training batch is restricted to about 24 participants with the facilitator-participant ratio of about Frontline community-based workers and auxiliary nursemidwives ANMs are trained together in basic health workers course. Supervisors are trained additionally in a two-day course 10 - Provision of care by IMNCI-trained workers Following training, workers are supposed to make home-visits to all newborns within their areas on day 1, 3, and 7 of life.
During these visits, the health workers assess the newborns, ensure breastfeeding, counsel on warmth and danger-signs, treat local infections, and refer to appropriate facilities for possible serious bacterial infections. In addition, the workers are expected to assess sick children, manage children with minor illness, and refer severelyill children. Line supervisors are supposed to supervise the trained workers, using the structured supervisory checklists.
There is limited information and evidence on the quality of its implementation, operational constraints, and facilitating factors and its effectiveness in improving the coverage of key newborn and childcare practices and interventions. Such information is critical to guide the further implementation of the programme and to modify the course. This information will also be useful to other countries that are implementing large-scale community-based newborn and child-health interventions.
While doing so, it seeks to answer the following questions: What has been the pace of training a large number of health workers HWs and community health workers CHWs on skill-based training using the IMNCI approach? What was the quality of training when the programme was scaled up? What proportion of newborns was the CHW able to visit in the first week of life? What was the quality of care they provided to sick infants and children?
What programme bottlenecks affect the effective implementation of the strategy and how have they been addressed so far, if at all? Incomplete and inconsistent data were corrected by contacting and seeking clarifications from the district and state authorities.
Of the districts in India, A detailed report on progress in training was available for 99 Table 1.
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