International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa SOCIAL AND BEHAVIORAL SCIENCES. Health Care Sciences ORIGINAL RESEARCH Factors Affecting the Implementation of Integrated Management of Neonatal and Childhood Illness by Indian Health Professionals Authors’ Contribution: A – Study design; Madhankumar V. 1 ABCEFG , Uppili V. R. 1 CDEF , B – Data collection; Prabakaran S. 1 EFG , Prasanth S. 1 BEFG C – Statistical analysis; D – Data interpretation; 1 Govt Thiruvarur Medical College, Tamilnadu, India E – Manuscript preparation; F – Literature search; Received: 27.11.2025; Accepted: 23.12.2025; Published: 25.12.2025 G – Funds collection Abstract Background and Integrated management of neonatal and childhood illness (IMNCI) is a globally Aim of Study: proven, primarily community-based strategy to improve child survival and is being implemented worldwide in countries with high burden of child mortality. The aim of the study: to identify the factors that affect the implementation of IMNCI by healthcare professionals in healthcare facilities, and to assess their attitude towards the implementation of IMNCI. Material and Methods: The study was conducted at health care facilities of Thiruvarur district, Tamilnadu, India. A total of 100 health professionals were included in the present study. Mean age of the study participants was 36± 3 years. Most of them were males. Mean age of their work experience was 5.7± 2.1. In the study 79% of respondents attended IMNCI training at different time. Almost 86% of study participants have not received any follow up training in last 2 years. All participants was administered a predesigned, pretested, semi structured questionnaire on IMNCI. Version 21 of the SPSS software was used to record and analyse the responses. Results: Health system related factors identified as hindrance to IMNCI implementation on case management skills according to this study are, overcrowding of people (26%), time consuming (21%), shortage of staffs (17%), untrained staff (10%), lack of supervision(6%), and lack of supplies(12%). Attitude of the health care providers on treating children’s based on algorithm were found to be unsatisfactory. Conclusions: Efforts to improve the quality of child health services provided by health care providers in the less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures, especially the proper use of national guidelines for case management, and meaningful supervision. Government leadership, along with more structured and continued resource and training support, is necessary to foster sustainable IMNCI health care services within the needs of the local community. Keywords: integrated management of neonatal and childhood illness, factors, health care providers, implementation Copyright: © 2025 Madhankumar V., Uppili V. R., Prabakaran S., Prasanth S. Published by Archives of International Journal of Science Annals DOI: https://doi.org/10.26697/ijsa.2025.2.6 Conflict of interests: The authors declare that there is no conflict of interests Peer review: Double-blind review Source of support: This research did not receive any outside funding or support Information about Madhankumar Velu (Corresponding Author) – https://orcid.org/0000-0002-3453- the authors: 126X; madhankumarvelu1228@gmail.com, MD Community Medicine, Associate Professor, Department of Community Medicine, Govt Thiruvarur Medical College, Tamilnadu, India. Uppili Venkat Ragavan – https://orcid.org/0009-0004-2806-3246; MD Community Medicine, Associate Professor, Department of Community Medicine, Govt Thiruvarur Medical College, Tamilnadu, India. Prabakaran Sakthivel – https://orcid.org/0009-0005-1276-9604; Assistant Professor, Department of Ear Nose Throat, Govt Thiruvarur Medical College, Tamilnadu, India. Prasanth Selvakumar – https://orcid.org/0009-0002-0684-9569; Govt Thiruvarur Medical College, Tamilnadu, India. 48 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Introduction Materials and Methods Integrated Management of Neonatal and Childhood The study was conducted at healthcare facilities in four Illness (IMNCI) strategy is an integrated approach to blocks of Thiruvarur district. The Thiruvarur HUD child health that holistically focuses on the well-being of District Health Unit Department functions across 10 the child. IMNCI strategy aims to reduce illness, blocks. Each block has one main primary health centre disability, death, and to promote improved growth and (PHC) and is strengthened by five additional PHCs, development among children under 5 years of age. The making a total of 50 PHCs. Each PHC is attached to four strategy includes both preventive and curative elements sub-centres, making a total of 200 sub-centres which that are implemented by families, communities, and provide services at a grassroots level. Healthcare health care facilities (WHO, 2005). workers were selected from four blocks: Every year about 9 million children in developing Adiyakkamanaglam, Thiruvizhlimalalai, countries die before they reach their fifth birthday, many Perumpanaiyur and Poonthotam. This area was selected of them during the first year of life (Jones et al., 2003). because it is covered by the Department of Community It is estimated that in India 2.1 million children die Medicine at GTMC. All health professionals working in before reaching 5 years of age. the selected facilities were present on the days of data Approximately 28% of all deaths of new-borns and 23% collection. of all infant deaths in the world occur in India (UNICEF, A predesigned, pretested, semi-structured questionnaire 2025). contains the following items: Currently almost 2/3rd of infant mortality is comprised a) Identification data, i.e. age, gender, educational of neonates; most of them die within the first week of status, area of residence and socioeconomic status. life (Jones et al., 2006). b) Assessment of case management skills on the IMNCI More than 70 % of the under-five child deaths are due to strategy. five diseases, namely pneumonia, diarrhoea, malaria, c) Factors affecting the implementation of the IMNCI measles and malnutrition, and often to a combination of strategy. these conditions. Many of these deaths could be The study subjects were selected from four blocks of prevented by greater access to and use of high quality Thiruvarur HUD. One block constitutes one block PHC, healthcare in combination with improved new-born and five PHCs and one sub centre. The staff pattern at each infant care practices in families through IMNCI level is as follows: each block is strengthened by three (Darmstadt et al., 2005). staff nurses, one auxiliary nurse midwife and five Implementation of IMNCI in comprehensive and doctors, whereas PHCs are supported by two staff holistic approach that forms bench mark for basic child nurses, one auxiliary nurse midwife and two doctors. health in preventing the under 5 deaths through case Each sub centre is supported by one ASHA/VHN. In management approach which includes the five elements total, a block has 35 healthcare professionals. i.e. assessment, classification, treatment, counselling Subjects were enrolled based on eligibility criteria using and referral (WHO, 2003). simple random sampling until a sample of 25 was The IMNCI strategy provides home-based care for the reached in each block, for a total of 100 health new-borns and the young infants. The home care professionals included in the study across the four component for new-borns aims to promote exclusive blocks. breast feeding, preventing hypothermia, improvement in The selected subjects were interviewed face-to-face. A the recognition of early clinical illnesses by parents and questionnaire was administered to each study subject. health care providers at the grassroots level and The aim was explained to each subject in their local therefore reducing the delays in seeking proper care language before it began, and written informed consent (Ingle &Malhotra, 2007). was obtained in both English and Tamil. Several studies conducted in different countries Informed written consent was taken from all study indicated that the implementation of the IMNCI strategy subjects. No pressure coercion was exerted on subjects is still inadequate. for participation in the study. Confidentiality and The most common identified problems are lack of privacy was ensured at all stages (Institutional Ethical training, poor supervision, lack of IMNCI essential Committee clearance was obtained from GTMC-IEC). drugs and on jobs aid, health workers perception, The data were analysed using the Statistical Package for shortage of the staffs, nature of the strategy and lack of the Social Sciences (SPSS, IBM) software, version 21. support from the government and stake holders For qualitative variables, proportions were calculated, (Bhandari et al., 2012; Mohan et al., 2012). With this and for quantitative variables, the mean, median, range background, this study was undertaken to assess the and standard deviation were calculated. Descriptive factors affecting the Implementation of IMNCI among statistics were calculated and the results are presented in Health Professionals of Rural Health Care Facilities in a pie chart. To test the hypothesis and find the Thiruvarur district of Tamil Nadu. association, a chi-square test was performed. A p-value The aim of the study. To identify the factors affecting the of <0.05 was considered significant. Cronbach’s alpha implementation of the integrated management of was used to test internal consistency. Logistic regression neonatal and childhood illnesses by healthcare analysis was used to identify the association between the professionals in healthcare facilities, and to evaluate dependent variable (factors affecting IMNCI) and the their attitudes towards this implementation. independent variables (age and years of experience). 49 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Results nurses, 20% were auxiliary nurse midwives (ANMs), This study included a total of 100 healthcare and the rest were doctors (15%). More than half of the professionals. Among the study population, 58% were respondents (119, or 59.2%) had worked as healthcare male. Regarding the age of the respondents, more than providers for less than five years. Of these, 92 (92%) half (69%) were aged between 31 and 40 years. In terms worked in an outpatient department for less than five of occupation, most of the respondents (55%) were staff years (Table 1). Table 1 Sociodemographic Characteristics of the Study Participants Regarding IMNCI training, nearly 79% of respondents not attended any training after joining the service. had attended IMNCI training at different times; Almost 86% of the study participants had not received however, less than half of these participants (21%) had any follow-up training in the last two years (Table 2). Table 2 Status of Health Care Workers on IMNCI Training Table 3 shows the steps in the case management management protocol, nearly half (58%, 57%, 51% and protocol that were difficult to apply. More than half of 47%) found the steps “Provide follow-up”, “Identify the the study participants reported that they always found all treatment”, “Classify the child’s illness” and steps in the IMNCI case management protocol difficult “Assessment of child' and Follow-up of child” the most to apply. Out of the six steps in the IMNCI case difficult, respectively. Table 3 Attitude on Case Management Protocol among Study Participants 50 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa When asked about the factors influencing the or 21%), lack of trained staff (84 people, or 17%), and implementation of case management skills based on the lack of supplies (70 people, or 12%) as the main IMNCI strategy, respondents reported overcrowding (67 challenges of IMNCI implementation (see Figure 1). people, or 26%), time-consuming processes (56 people, Figure 1 Distribution of Factors Influencing the Implementation of Case Management Skills More than half of the study participants did not always practices on IMNCI among the study participants perform the following checks: vaccination (67%), demonstrated acceptable internal consistency temperature (52%), signs of pallor (50%), danger signs (Cronbach's alpha value: 0.978). (50%), fever (73%), malaria (52%), cough (52%), The attitudes of the study participants towards IMNCI weight (83%), weight against chart (87%), ear problems practices are outlined in Table 4. (95%). The 10-item scale measuring attitude towards Table 4 Attitudes towards IMNCI Practices among Study Participants In terms of the factors influencing IMNCI strategy a lack of supply of cards, and 81 respondents (16%) implementation, 57 respondents (20%) cited cited the time-consuming nature of the process. Figure 2 overcrowding as the main challenge, 24 respondents presents the main challenges of IMNCI implementation. (19%) cited a lack of staff, 31 respondents (18%) cited Figure 2 Distribution of Factors Influencing the Implementation of IMNCI Practices 51 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa The attitude of healthcare providers towards treating coding of acute respiratory infections according to ARI based on the algorithm: overall, 71% of IMNCI. respondents exposed the children’s chest to count their Health education on routine immunisation and respiratory rate. While counting the respiratory rate for breastfeeding was reported to be given to children in a full minute, only 14% of respondents performed this 55% and 67% of cases, respectively. Advice on the task for the full duration. danger signs of pneumonia, preventing infections and More than half of them did not properly assess high-risk coming for a follow-up appointment if symptoms cases (44%), classify the illness based on symptoms and worsened was not routinely given to children attending signs (31%), or treat the child (54%) based on the colour PHCs (Table 5). Table 5 Attitudes of Healthcare Providers towards Treating Acute Respiratory Infections Based on the Algorithm The attitude of healthcare providers towards treating infection according to IMNCI. Health education on ADD based on the algorithm was reported by the routine immunisation and breastfeeding was reported to majority of respondents. However, when it came to be given to children in 66% and 70% of cases, checking for signs of dehydration such as dry mouth and respectively. the skin pinch test, as well as taking blood pressure, Counselling on the proper use of ORS and the these were performed consistently in only 7%, 17% and preparation of homemade ORS was routinely 25% of cases, respectively. More than half of them did performed. Advice on the danger signs of diarrhoea, not properly assess high-risk cases (52%), classify the preventing infections, and coming for a follow-up illness based on symptoms and signs (57%), or treat the appointment if symptoms worsened was routinely given child (58%) based on colour coding for acute respiratory to children attending PHCs (Table 6). Table 6 Attitude of Healthcare Providers towards Treating ADD Based on the Algorithm According to the study, 65% of participants agreed that total respondents, 63%, 70% and 66% strongly agreed the IMCI strategy is user-friendly for health workers. that the IMNCI protocol is too long, tedious and not Regarding the idea that the IMNCI protocol is easy to practical for our health facility, and time consuming, understand and apply, only 31% of respondents strongly respectively (Table 7). agreed; more than half of them (60%) disagreed. Of the 52 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 7 Attitudes of Healthcare Providers towards Implementing the IMNCI Strategy Let us consider the following significant factor: time with spending between 30 and 45 minutes using the spent managing an under-5 patient when using the IMNCI protocol. Based on this study, 54% of IMNCI case management protocol (Table 8). According respondents agreed that they spent between 11 and 30 to this study, 11% of respondents strongly agreed that minutes using the IMNCI protocol, which is in line with they spent more than one hour using the IMNCI the WHO-recommended consultation time of 15–20 protocol, whereas 30% strongly disagreed/disagreed minutes. Table 8 Time Spent Managing a Child under Five When Using the IMCI Case Management Protocol Regarding the availability of resources, 38% of facility equipment, 42% strongly agreed/agreed that respondents strongly agreed that IMNCI drugs are their health facility is not fully equipped to support the frequently out of stock. In contrast, only 24% disagreed use of the IMNCI strategy. The attitude of the study with the statement that IMNCI wall charts and chart participants regarding the availability of resources is booklets are frequently unavailable. In terms of health outlined in Table 9. Table 9 Attitudes towards the Availability of Resources among the Study Participants The majority of respondents (64%) either agreed or while 13% disagreed with the statement that there is a strongly agreed with the statement that their supervisor lack of supervision by IMNCI trainers for the proper does not understand the rationale behind IMNCI. implementation of IMNCI (see Table 10). Similarly, 28% of respondents disagreed or strongly Regarding the lack of follow-up training by IMNCI disagreed with the statement that their supervisor is not facilitators, the majority of respondents (76%) strongly IMNCI-trained. agreed that this is the main challenge to implementing Among the study participants, 66% agreed with the the strategy. statement about a lack of supervision by IMNCI trainers, Table 10 Attitudes towards Supervision when Implementing IMNCI 53 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Discussion against a chart, and checking for ear problems. This study aimed to identify the implementation of the Examining the factors influencing the implementation of Integrated Management of Neonatal and Childhood the IMNCI strategy, we found overcrowding, lack of staff Illnesses (IMNCI) programme and the factors and supplies, and time constraints to be the main influencing its implementation by healthcare workers challenges. (HCWs) in rural health centres in Thiruvarur, South A survey conducted in Afghanistan and Indonesia Tamil Nadu. identified the following challenges to implementing the A total of 100 HCWs were included in the study. Of IMNCI strategy: short training duration, lack of ongoing these, 79% had attended IMNCI training at various points follow-up and clinical supervision, high training costs, in their careers, but less than half (21%) had not received lack of political support, lack of human and material any further training after joining the service. Almost 86% resources and time, poor health worker reading ability, of the study participants had not received any follow-up mismatch between training needs and available training in the last two years. This finding is consistent resources, frequent health worker turnover, and poor with a study conducted by Abebe et al. (2019). However, IMCI implementation quality by those specifically this finding is higher than that of a study conducted in trained in the use of job aids and protocols for Tanzania, which showed that only 43% of health workers assessment, classification, treatment and counselling were IMNCI-trained (Isangula et al., 2023). (Mayhew et al., 2015; Titaley et al., 2014). The study participants reported that they always found all One study conducted in Indonesia categorised the factors steps in the IMNCI case management protocol difficult affecting IMNCI implementation into three levels: health to apply. Out of the six steps in the IMNCI case worker, facility and community. The main challenge at management protocol, nearly half found the steps the health worker level is the health worker's perception 'Provide follow-up', 'Identify the treatment', 'Classify the of skills uptake and case management guidelines, while child's illness', 'Assessment of the child' and 'Follow-up the main challenges at the facility level are time of the child' difficult to apply. This finding is consistent constraints (time taken to complete the protocol, long with a study by Abebe et al. (2019). queues and short staffing) and inadequate facility support A facility survey conducted in Nigeria showed that few (medical equipment, job aids and drugs). At the sick children were fully assessed and that only 43.8% community level, the main challenges to implementing were correctly classified by health workers. The use of IMNCI guidelines were identified as long waiting times, antibiotics for sick children was also high and not in high user fees and non-compliance by caregivers and accordance with the guidelines (Afolalu, 2020). patients (Haryanti et al., 2022). Regarding the factors influencing the implementation of The attitude of healthcare providers towards treating case management skills based on the IMNCI strategy, acute respiratory infections (ARI) based on an algorithm some respondents reported overcrowding, time- was examined. While counting respiratory rate for a full consuming processes, a lack of trained staff and a lack of one minute, only 14% of providers performed this task supplies as the main challenges of IMNCI for the full duration. Classification of ARI based on implementation. symptoms and signs was reported in only 31% of cases, Similarly, several factors were identified as hindering and treatment of the child based on colour coding IMNCI implementation. These include untrained staff according to IMNCI was found to be less than 44%. (56.2%), lack of supervision (27.4%), lack of supplies Health education on routine immunisation and (37.3%), poor attitude (11.9%) and shortage of staff breastfeeding was provided in 55% and 67% of cases, (16.4%). A study by Seid et al. (2019) identified similar respectively. Advice on the danger signs of pneumonia factors, including lack of supplies (37.3%), frequent and how to prevent infections, as well as advice on unavailability of IMNCI drugs (43.8%), lack of wall coming for a follow-up appointment if symptoms charts and chart booklets (39.4%), and unequipped health worsened, was not routinely given to children attending facilities (49.7%). PHCs. Our results were inconsistent with those of a study This is inconsistent with a study carried out in Panchkula conducted in Botswana, which showed that only 10% of district. Overall, 77.9% of children had their chest respondents agreed that IMNCI-recommended drugs exposed in order to count their respiratory rate. The were often out of stock, and 15% claimed that IMNCI respiratory rate was counted for a full minute in 47.4% of chart booklets and wall charts were often unavailable in children, and for less than a minute in 28% (29.8%). The their health facilities. Meanwhile, 56% of participants respiratory rate was not counted at all in 22% of children. responded that their health facilities were not fully 20% of children were treated with medication only, while equipped to support the application of IMNCI skills and the remaining 80% were treated with medication and procedures (Renosa et al., 2020). This difference may be counselling (Venkatachalam et al., 2012). due to differences in socio-economic status, the study The attitude of healthcare providers towards treating area, and sample sizes. ADD based on the algorithm was reported by the In the current study, more than half of the participants majority of respondents as not regularly checking for agreed that they were carrying out routine steps such as signs of dehydration, such as dry mouth and the skin checking vaccination status, taking temperatures, looking pinch test, or taking blood pressure. More than half of for signs of pallor or danger, assessing fevers, malaria them did not properly assess high-risk patients, classify and coughs, weighing children and checking their weight illnesses based on symptoms and signs, or treat children 54 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa based on the colour coding of acute diarrhoeal diseases Primary health care nurses at selected clinics in Nepal according to IMNCI. Health education on routine cite the following difficulties in implementing IMNCI: immunisation and breastfeeding was reported to be given lack of resources and poor working conditions; lack of to children 66% and 70% of the time, respectively. human resources; lack of material resources; and Counselling on the proper usage of ORS and the shortage of medication. preparation of homemade ORS was routinely performed. The absence of computers at clinics and the lack of Advice on the danger signs of diarrhoea, preventing physical resources are categorised as a lack of resources, infections and coming for a follow-up if symptoms while the lack of support from supervisors, burnout worsened was always or sometimes given to children related to a lack of support from stakeholders, a lack of attending PHCs. cooperation from community members, a lack of support This is consistent with a study conducted in Panchkula from the media, a lack of political support, and symptoms by Venkatachalam et al. (2012), in which the dehydration related to work overload are categorised as poor working of 93.3% of children was assessed by pinching their conditions, which have a negative impact on nurses abdominal wall. 40% of mothers were advised to give (Subedi et al., 2024). Similar consistent results (Haryanti their children extra food and fluids, and 66.7% were et al., 2022) have identified inadequate facility support advised to give ORS and told how much to give. Only (medical equipment, job aids and drugs) as a challenge at 26.7% of mothers were shown how to prepare ORS, and the facility level. 21.4% were advised how much to give. Children with diarrhoea were given medicine only in 46.7% of cases, Conclusions and counselling was provided alongside medicine in This study identifies factors affecting the uptake and 53.3% of cases. implementation of IMNCI from the perspective of According to this study, 65% of respondents either frontline healthcare providers. Our review revealed that agreed or strongly agreed that the IMCI strategy is user- the experiences of HCWs in implementing IMNCI were friendly for health workers. Regarding the idea that the characterised by the demotivating realities of an IMNCI protocol is easy to understand and apply, only unsupportive healthcare system, lack of resources, and 31% of respondents strongly agreed; more than half weak programme execution with no proper follow-up disagreed. Of those who agreed with the notion that the training. IMNCI protocol is too long, tedious and impractical for The following bottlenecks were recognised as hindering our health facility, many also felt that it was time the reach of IMNCI in the community: imperfect consuming. supervision and monitoring mechanisms; inadequate Similar results were reported in a study (Bharani et al., availability of basic equipment and drug supplies; an 2012), which identified various IMNCI-related barriers inefficient referral system; poor training in terms of to implementation by healthcare workers, such as the quality and duration; a lack of regular reinforcement of IMNCI protocol being too long (59.7%), tedious guidelines; and poor performance of healthcare staff. In (41.3%), time-consuming (55.2%), and difficult to order to improve the quality of child health services understand and apply (11.0%). provided by PHC workers in less developed countries, According to the present study, 11% of respondents efforts should focus not only on resource-intensive strongly agreed or agreed that they spent more than one structural improvements, but also on cheap, cost- hour using the IMNCI protocol, while 54% strongly effective measures. agreed or agreed that they spent between 11 and 30 These measures should include the proper use of national minutes using the IMNCI protocol, which is consistent guidelines for case management and meaningful with the WHO’s recommended consultation time of 15– supervision. Government leadership, along with more 20 minutes. This is consistent with a study by Subedhi et structured and continued support in terms of resources al. (2024), which found that the average consultation in and training, is necessary to foster sustainable IMNCI this study was also in line with the WHO’s recorded healthcare services that meet the needs of the local average of 16 minutes. IMNCI consultations were about community. 2–4 minutes longer than traditional consultations. Similarly, several other studies have also identified these Acknowledgments factors as barriers to the implementation of the IMNCI Authors are thankful to Indian Council of Medical protocol. Research for considering this study under Short-Term Regarding the availability of resources, 38% of Studentship Programme. We heartily acknowledge the respondents strongly agreed that IMNCI drugs were cooperation and support of Primary Health Centres for frequently out of stock, while only 24% disagreed with supporting this study. the statement that IMNCI wall charts and chart booklets were frequently unavailable. Concerning health facility Ethical Approval equipment, 42% strongly agreed/agreed that their health Clearance from the Institutional Ethical Committee facility is not fully equipped to support the IMNCI (GTMC-IEC, No. 050/IEC/GTMC/2023) was obtained. strategy. Among the study participants, 66% agreed with the statement that there is a lack of supervision by IMNCI Funding Source trainers for the proper implementation of IMNCI, while This research did not receive any outside funding or 13% disagreed. support. 55 International Journal of Science Annals, Vol. 8, No. 2, 2025 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa References Jones, G., Schultink, W., & Babille, M. (2006). Child Abebe, A.M., Kassaw, M.W., & Mengistu, F.A. (2019). survival in India. Indian Journal of Paediatrics, Assessment of factors affecting the 73, 479–487. https://doi.org/10.1007/BF02759891 implementation of integrated management of Jones, G., Steketee, R. W., Black, R. E., Bhutta, Z. 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IOSR Journal of Dental and Medical newborn-child-adolescent-health-and- Sciences, 1(6), 46–50. ageing/child-health/integrated-management-of- https://doi.org/10.9790/0853-0164650 childhood-illness Cite this article as: Madhankumar, V., Uppili, V. R., Prabakaran, S., & Prasanth, S. (2025). Factors affecting the implementation of integrated management of neonatal and childhood illness by Indian health professionals. International Journal of Science Annals, 8(2), 48–57. https://doi.org/10.26697/ijsa.2025.2.6 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 57