Professional Documents
Culture Documents
PREVENTIVE INTERVENTION
EVIDENCE BASED SYNDROMIC
APPROACH
FAMILY AND COMMUNITY
INVOLVEMENT
REDUCE DEATHS AND THE FREQUENCY AND
SEVERITY OF ILLNESS AND DISABILITY
CONTRIBUTE TO IMPROVED GROWTH AND
DEVELOPMENT
IMPROVE CASE MANAGEMENT SKILLS OF
HEALTH WORKERS
IMPROVE HEALTH SYSTEM TO DELIVER IMCI
IMPROVE FAMILY AND COMMUNITY HEALTH
PRACTICES
Allsick children must be examined for “general
danger signs” which indicate the need for
immediate referral or admission to a hospital.
All sick children must be routinely assessed for
major symptoms (for children age 2 months up to 5
years: cough or difficult breathing, diarrhea, fever,
ear problems; for young infants age 1 week up to 2
months: bacterial infection and diarrhea). They
must also be routinely assessed for 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 7 to detect
disease.Careful and systematic assessment of
common symptoms and well-selected specific
clinical signs provide sufficient information to
guide rational and effective actions.
These signs were selected considering the
conditions and realities of first-level health
facilities.
A combination of individual signs leads to a
child’s classification(s) rather than a diagnosis.
Classification(s) indicate the severity of
condition(s). They call for specific actions based
on whether the child (a) should be urgently
referred to another level of care, (b) requires
specific treatments (such as antibiotics or
antimalarial treatment), or (c) may be safely
managed at home. The classifications are colour
coded: “pink” suggests hospital referral or
admission, “yellow” indicates initiation of
treatment, and “green” calls for home treatment.
The IMCI guidelines address most, but not all, of the
major reasons a sick child is brought to a clinic. A
child returning with chronic problems or less common
illnesses may require special care. The guidelines do
not describe the management of trauma or other
acute emergencies due to accidents or injuries.
IMCI management procedures use a limited number
of essential drugs and encourage active participation
of caretakers in the treatment of children.
An essential component of the
IMCI guidelines is the counseling
of caretakers about home
management, including
counseling about feeding, fluids
and when to return to a health
facility
OUTPATIENT HEALTH FACILITY REFERRAL HEALTH FACILITY
child’s caretaker
Follow-up care
Few health workers
opportunities to practice
complicated cases
Reliance on History and S/S
Overlap of conditions
Drink unable
Fever
Ear Problem
Anemia / Malnutrition
SIGNS CLASSIFY AS TREATMENT
Continue feeding
ZINC (10-14 DAYS)
10mg/day: less than 6 months
20mg/day:6 months above
ORS in ml: kg wt X 75
REASSESS AFTER 4
HRS
Plan A or Plan C
PLAN C IVF
TX SEVERE DHN QUICKLY
INFANT: 30ml/kg(1h)
70ml/kg (5h)
Children:30ml/kg(30 mins)
70ml/kg (2.5h)
Reassess and Give ORS
Reclassify: infants (6H)
children (3H)
NGT
SIGNS CLASSIFY AS TREATMENT
BLOOD IN DYSENTERY ANTIBIOTIC 4 5 DAYS
STOOL FOLLOW-UP IN 2
DAYS
ADVISE WHEN 2
RETURN
SIGNS CLASSIFY AS TREATMENT
GDS VERY SEVERE 1ST DOSE OF AM, QUININE
STIFF NECK FEBRILE DSE/ PREVENT LOW BS
MALARIA PARACETAMOL
REFER
SIGNS CLASSIFY AS TREATMENT
+ BLOOD MALARIA ORAL ANTI-MALARIAL
SMEAR PARACETAMOL
NO OTHER ADVISE WHEN 2 RETURN
CAUSES OF FOLLOW-UP 2 DAYS
FEVER
REFER IF FEVER OF 7 DAYS
SIGNS CLASSIFY AS TREATMENT
¯BLOOD FEVER: MALARIA PARACETAMOL
SMEAR UNLIKELY ADVISE WHEN 2 RETURN
-OTHER
FU: 2DAYS
CAUSES OF REFER IF FEVER OF 7 DAYS
FEVER
TREAT OTHER CAUSES
SIGNS CLASSIFY AS TREATMENT
GDS VERY SEVERE 1ST DOSE OF AB, PREVENT
STIFF NECK FEBRILE DSE LOW BS
PARACETAMOL
REFER
NO SIGNS FEVER: NO PARACETAMOL
OF VERY MALARIA ADVISE WHEN 2 RETURN
FEBRILE DSE FOLLOW-UP 2 DAYS
REFER IF FEVER OF 7 DAYS
TREAT OTHER CAUSES
SIGNS CLASSIFY AS TREATMENT
GDS SEVERE VIT A
CLOUDING OF COMPLICATED 1ST DOSE OF AB, PREVENT
CORNEA MEASLES LOW BS
DEEP OR PARACETAMOL
EXTENSIVE TETRACYLCINE OINTMENT
MOUTH REFER
ULCERS
SIGNS CLASSIFY AS TREATMENT
PUS DRAINING MEASLES WITH VIT A
FROM THE EYE EYE OR MOUTH TETRACYCLINE/GENTIAN VIOLET
OR MOUTH COMPLICATIONS PARACETAMOL
ULCERS ADVISE WHEN 2 RETURN
FOLLOW-UP 2 DAYS
SIGNS CLASSIFY AS TREATMENT
-MEASLES NOW MEASLES VIT A
OR WITHIN PARACETAMOL
THE LAST 3 ADVISE WHEN 2 RETURN
MONTHS
FU: 2DAYS
SIGNS CLASSIFY AS TREATMENT
BLEEDING SEVERE DENGUE PLAN B: VOMITING,
PETECHIAE HEMORRHAGIC ABDOMINAL
COLD CLAMMY SKIN FEVER PAIN,PETECHIAE
CAPILLARY PLAN C: SIGNS OF
REFILL>3 SEC BLEEDING
ABDOMINAL PAIN PREVENT LOW BS
VOMITING REFER URGENTLY
+ TOURNIQUET
TEST
SIGNS CLASSIFY AS TREATMENT
CHLOROQUINE
Artemeter-
PRIMAQUINE
Lumefrantine
SULFADOXINE
PYRIMETHAMINE
VITAMIN A IRON
One dose daily for 14
days
IV infusion
Full assessment of
child
MALARIA If child has other
cause of fever: treat.
If malaria is the only
cause: blood smear,
2nd -line ant malarial,
follow-up in 2days
Full assessment of child
If with GDS or stiff neck, treat
as VERY SEVERE FEBRILE
FEVER- DISEASE/MALARIA
MALARIA
If malaria is the only cause of
UNLIKELY
fever: blood smear, 1st -line ant
malarial, follow-up in 2 days
FEVER: NO Full assessment of the child
MALARIA If with GDS or stiff neck, treat as
VERY SEVERE FEBRILE DISEASE
Follow-up in 2 days
MEASLES WITH Look for red eyes and
EYE OR MOUTH
COMPLICATIONS pus draining from eyes
Look at mouth ulcers
Develops a fever
No Fast breathing
pneumonia:cough or
Difficult breathing
cold
Diarrhea Blood in stool
Drinking poorly
Fever: DHF Signs of bleeding
unlikely
Persistent abdominal
pain
Skin petechiae
Skin rash