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Pneumonia
19%
Integrated
One in
every two
child deaths
in perinatal
Management of developing
countries
are due to
20% Malnutrition
54%
Diarrhoea
Important Elements
for Improving Child Health
Appropriate
Case Care seeking Anemia
management IMPROVEMENT OF HEALTH SYSTEM
Home
Nutrition HIV/AIDS care
Drug
Use IMPROVEMENT OF CASE MANAGEMENT
New born
Malaria care
Child Follow-up FAMILY AND COMMUNITY PRACTICES
rights
Health Safe and
system Mothers Supportive CHILD RIGHTS
Communication
health Environment
1
IMCI Case Management
At the start of a sick child
(2 months to 5 years) consultation Classification
Focused Assessment
Need to Refer
• Ask the mother what the child’s Danger signs
Main Symptoms
problems are. Nutritional status Specific treatment
Immunization status
• Determine if this is an initial or follow- Other problems Home
up visit for this problem. management
Need to Refer
(except in severe dehydration) p. 2 p. 2
2
Wheeze,
Fast breathing
2 – 12 months old: ≥ 50/minute
1 year or older: ≥ 40/minute, OR
Lower chest indrawing
No signs of pneumonia
After trial no improvement or a very severe disease
If cough ≥ 30 days
Antibiotic for 3 days refer to hospital for assessment
Relieve cough with safe remedy Relieve cough with safe remedy
Advise mother on danger signs Advise mother on danger signs
Follow up in 2 days Follow up in 5 days if no improvement
p. 3 p. 3
3
Classify for dehydration
URGENT REFERRAL
Oresol/NGT p. 15 p. 15
4
Plan B: Treat some dehydration with ORS Plan B: Treat some dehydration with ORS
Determine the amount (in ml) of Oresol Show the mother how to give Oresol to
to be given in 4 hours the child: frequent sips from a cup
= weight of the child (in kg) X 75, or If the child vomits, wait for 10 minutes.
if weight is unknown, use this chart. Then continue, but more slowly.
Continue breastfeeding if the child
wants to breastfeed.
Age 12 mos-2 yrs 2-5 yrs
Amount 700-900 900-1400
p. 14 p. 14
After 4 hours:
Reassess the child & classify for
Not enough signs to classify as
dehydration. SEVERE DEHYDRATION or
Select appropriate plan. SOME DEHYDRATION
Begin feeding the child in the health
center.
NO DEHYDRATION Plan A
p. 14 p. 3
Reformulated Oresol
Give extra fluid.
Up to 2 yrs 50 – 100 ml after each LBM • Less electrolytes (75 mEq/L) and
glucose (75 mmol/L)
2 -4 yrs 100 – 200 ml after each LBM
• Lower osmolarity (total = 245
Continue feeding. mOsm/L)
5
Persistent diarrhea: 14 days or more Persistent diarrhea: 14 days or more
p. 3 p. 3
Malaria risk?
Dengue risk?
p. 3 p. 4
6
Malaria risk + Malaria risk +, blood smear +
any general danger sign or stiff neck No runny nose, no measles
Malaria
Very severe febrile disease/malaria
• Oral antimalarial
• Quinine (under med. supervision) • Paracetamol
• 1st dose of antibiotic, Paracetamol • Follow up in 2 days
• Urgent referral • > 7 days fever hospital for
assessment
Measles now or w/in last 3 mos Measles now or w/in last 3 mos
Pus draining from the eye or No other signs
Mouth ulcers
• Vitamin A
Vitamin A
• Tetracycline eye ointment
• Gentian violet
• Follow up in 2 days
7
If there is Dengue risk Any of the danger signs
or + tourniquet test
Bleeding gums, nose, in vomitus or
stools
Severe Dengue hemorrhagic fever
Black vomitus or stools
Persistent abdominal pain
Persistent vomiting
• If skin petechiae, persistent abdominal
Skin petechiae pain or vomiting, or + tourniquet test
Slow capillary refill only signs, give ORS
No signs, but fever > 3 days • Any other signs of bleeding Plan C
Tourniquet test • Urgent referral
• Do not give aspirin
Ear problem:
tender swelling behind ear
Mastoiditis
8
Visible severe wasting or
Edema on both feet or
Severe palmar pallor
Severe malnutrition or
severe anemia
• Vitamin A
• Urgent referral