IMNCI MODULE
( INTEGRATAED MANAGEMENT OF
NEONATAL & CHILDHOOD ILLNESS )
INTRODUCTION
The Integrated Management of Neonatal and Childhood Illness
(IMNCI) is a strategy developed by the World Health Organization
(WHO) and UNICEF to improve child health and reduce deaths
among children under five years of age.
Every year, millions of children in developing countries die from
common illnesses like pneumonia, diarrhea, malaria, measles,
malnutrition, and newborn infections. Most of these deaths can be
prevented if the illnesses are detected early and managed
properly.
The IMNCI strategy provides a comprehensive, holistic, and
syndromic approach to managing child health. It combines:
Prevention (immunization, nutrition, hygiene).
Early diagnosis (through simple signs and symptoms).
Prompt treatment (using essential drugs at primary health level).
Referral services (for severe cases).
Parental counseling (for feeding, hygiene, home care, and danger
signs).
Need for IMNCI in India
High neonatal mortality rate (NMR) and under-five mortality rate
(U5MR).
A large proportion of deaths caused by preventable illnesses.
Malnutrition contributing to >40% of child deaths.
Lack of awareness among parents about danger signs and timely
care-seeking.
Inadequate availability of trained pediatricians in rural areas.
Overburdened tertiary hospitals due to lack of effective primary
and secondary level care.
OBJECTIVES OF IMNCI
Reduce neonatal and under-five morbidity and mortality.
Improve growth and development of children.
Improve skills of healthcare providers in child health
management.
Strengthen family and community practices related to child
health.
Ensure timely referral of seriously ill children.
PRINCIPLE OF IMNCI
Integrated approach to manage childhood illnesses rather
than treating diseases separately.
Case management through a syndromic approach (signs &
symptoms).
Focus on nutrition, immunization, and counseling.
Capacity building of health workers, ANMs, ASHAs, and
nurses.
Community and family participation in child care.
IMNCI GUIDELINE
1. Systematic Assessment
Every child must be checked for general danger signs:
Inability to feed or drink
Convulsions
Vomiting , Lethargy or unconsciousness
Difficulty breathing
For young infants (0–2 months): also check for possible serious
bacterial infection, jaundice, diarrhea.
For children (2 months–5 years): assess for cough/difficulty
breathing, diarrhea, fever, ear problems, malnutrition, anemia,
immunization status.
2. Classification of Illness
IMNCI uses a color-coded classification system instead of exact
diagnosis:
Pink → Urgent referral to hospital (severe illness, needs
admission).
Yellow → Specific treatment at primary level (give drugs,
counseling, follow-up).
Green → Manage at home (no serious illness, give home care
advice).
3. Identify Severity
Severity of the condition is determined based on clinical signs and
symptoms, not laboratory tests.
Example:
Child with fast breathing + chest indrawing = Severe pneumonia
(Pink).
Child with mild cough = Simple cold (Green).
4. Provide Appropriate Treatment
Use essential drugs available at primary level (ORS, Zinc,
Cotrimoxazole, Amoxicillin, Vitamin A, Antimalarials, etc.).
Give the first dose before referral if needed.
Treat multiple problems at the same time (holistic care).
5. Counsel the Mother/Family
Explain the child’s illness and treatment.
Teach correct feeding practices (exclusive breastfeeding,
complementary feeding).
Advise when to return immediately (danger signs).
Encourage immunization and hygiene.
6. Ensure Follow-Up and Referral
Serious cases → Refer immediately to higher health facility.
Moderate cases → Review after 2–5 days.
Home cases → Advise follow-up if symptoms worsen.
Components of IMNCI
1. Case Management of Sick Young Infants and Children (0–5
years)
Assessment, classification, and treatment of illness.
Conditions addressed: Pneumonia, Diarrhea, Malaria, Measles, Ear
infection, Malnutrition, Neonatal infections.
2. Health System Strengthening
Ensuring availability of essential drugs, vaccines, and equipment.
Referral linkages with higher centers.
3. Community and Family Practices
Promotion of exclusive breastfeeding, complementary feeding,
immunization , hygiene, ORS use, home-based newborn care.
IMNCI Case Management Process
A. For Young Infants (0–2 months)
Check for danger signs: inability to feed, convulsions, lethargy,
fast breathing, chest indrawing.
Assess for possible serious bacterial infection, jaundice, diarrhea.
Management: Refer urgently, give first dose antibiotics, counsel
mother.
B. For Children (2 months–5 years)
Assess main symptoms: cough/difficult breathing, diarrhea, fever,
ear problems.
Check nutritional and immunization status.
Classify illness into categories: Pink (urgent referral), Yellow
(specific treatment), Green (home care).
Provide treatment: ORS, antibiotics, antimalarials, Vitamin A, Zinc,
etc.
Advise caregivers about home care and follow-up.
IMNCI in Indian Context
Modified to include newborn care (first week of life).
Linked with National Health Mission (NHM), Facility-Based
Newborn Care (FBNC), and Home-Based Newborn Care (HBNC).
IMNCI training is given to doctors, nurses, ANMs, and ASHAs.
Role of Nurse in IMNCI
Early identification of danger signs in neonates and children.
Providing appropriate treatment at primary level.
Counseling mothers about feeding, hygiene, immunization,
and danger signs.
Maintaining records and reports.
Coordinating referrals to higher health facilities.
Health education to the community for child survival and
development
Advantages of IMNCI
Reduces under-five mortality.
Cost-effective approach.
Improves child health outcomes.
Strengthens community awareness.
Provides comprehensive care rather than disease-specific
care.
Limitations
Requires regular training and retraining.
Shortage of medicines and logistics at peripheral level.
Heavy workload on health workers.
Low awareness among families in some rural areas.
Conclusion
IMNCI is an effective child survival strategy that integrates
preventive and curative aspects of child care. For nursing
professionals, it is essential to master IMNCI skills to provide
holistic, evidence-based, and community-centered child health
services, contributing significantly to the achievement of SDG-3
(Good Health and Well-being) and reduction of infant and under-
five mortality in India.
Bibliography
1. Park K. Textbook of Preventive and Social Medicine.
27th ed. Jabalpur: Banarsidas Bhanot Publishers;
2023.
2. World Health Organization. Integrated Management
of Childhood Illness: Handbook. Geneva: WHO; 2005.
3. UNICEF. IMNCI Training Package: Facilitator Guide for
Medical Officers, Nurses and ANMs. New Delhi:
UNICEF India; 2016.
4. World Health Organization, UNICEF. Handbook: IMNCI
Chart Booklet. Geneva: WHO; 2014.
5. Basavanthappa BT. Community Health Nursing. 3rd
ed. New Delhi: Jaypee Brothers Medical Publishers;
2018.
6. Dutta P. Paediatric Nursing. 2nd ed. New Delhi: Jaypee
Brothers Medical Publishers; 2021.
7. Marlow DR, Redding BA. Textbook of Pediatric
Nursing. 7th ed. Philadelphia: Elsevier; 2019.
