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C - I M C I (Cimci) : Ommunity Ntegrated Anagement OF Hildhood Llness
C - I M C I (Cimci) : Ommunity Ntegrated Anagement OF Hildhood Llness
ILLNESS (CIMCI)
For WHOM?
Community Children:
One week to 2 months
Age 2 months to 5 years
Main Concerns:
• Cough or Difficult Breathing (ARI)
• Diarrhea
• Malaria
• Measles
• Ear Infections
• Malnutrition
• Breastfeeding
• Preventive Activities: Vaccinations & Vitamin A
Algorithm:
1
Out-patient Management:
Children 2 months to 5 years
• History-taking
• General Danger Signs
• Main Symptoms
• Nutritional Status
• Immunization Status
• Other Problems
• History-taking
• Convulsions
• Unconscious or lethargic
• Unable to drink or breastfeed
• Vomits everything
• History-taking
• General Danger Signs
• Main Symptoms
• Nutritional Status
• Immunization Status
• Other Problems
2
(pink) (pink)
Any danger sign or Severe Pneumonia
Chest in-drawing or or
Stridor Very Severe Disease
(yellow) (yellow)
Fast Breathing Pneumonia
(green) (green)
No signs of pneumonia or No Pneumonia
very severe disease Cough or Cold
Interventions:
(pink)
Give the 1st dose of an appropriate antibiotic
Give Vitamin A
Treat the child to prevent the lowering of his or her blood sugar level
Refer the child URGENTLY to a hospital
(yellow)
• Give an appropriate antibiotic for 5 days
• Soothe the throat and relieve the cough with a safe remedy
• Advice the mother regarding when to return to the health center
• Follow-up in 2 days
(green)
• If the coughing persists for more than 30 days, refer to a hospital for
assessment
• Soothe the throat and relieve the cough with a safe remedy
• Advise the mother regarding when to return to the health center
• Follow-up in 5 days if no improvement is observed
• If the coughing persists for more than 30 days, refer to a hospital for
assessment
• Soothe the throat and relieve the cough with a safe remedy
• Advise the mother regarding when to return to the health center
• Follow-up in 5 days if no improvement is observed
History-taking
General Danger Signs
3
Main Symptoms
- Cough or difficult breathing
- Diarrhea
- Fever
- Ear problems
Nutritional Status
Immunization Status
Other Problems
Assess for
General condition
Sunken eyes
Reaction when offered a drink
Elasticity of the skin
Classification of Dehydration
(pink) (pink)
2 of these signs:
- Lethargic or unconscious
- Sunken eyes
- Not able to drink or drinking Severe Dehydration
poorly
- Skin pinch go back very
slowly
(yellow) (yellow)
2 of these signs:
- Restless, irritable Some Dehydration
- Sunken eyes
- Skin pinch go back slowly
(green) (green)
Not enough signs to classify NO Dehydration
Interventions:
(pink)
If the child has no other severe classification:
• Give fluid for severe dehydration OR
If the child has another severe classification:
• Refer the child URGENTLY to a hospital, with the mother giving the
child frequent sips of ORS on the way. Advise the mother to
continue breastfeeding the child.
If the child is 2 yrs old or older, and there is cholera in your area:
• Give the child an antibiotic for cholera
(yellow)
• Give fluid and food
• Advice the mother regarding when to return to the health center
immediately.
• Follow-up in 5 days if no improvement is observed
• Give fluid and food
• Advice the mother regarding when to return to the health center
immediately.
4
• Follow-up in 5 days if no improvement is observed
(green)
• Give fluid and food at home to treat the diarrhea
History-taking
General Danger Signs
Main Symptoms
- Cough or difficult breathing
- Diarrhea
- Fever
- Ear problems
Nutritional Status
Immunization Status
Other Problems
Assess for:
• Stiff neck
• Risk of malaria
• Runny nose
• Duration of fever
• Risk of measles
Classification of Fever
(pink) (pink)
Any danger sign or stiff neck Very Severe Febrile Disease
(pink) (pink)
Any danger sign or clouding of cornea or Severe Complicated
deep/extensive mouth ulcers Measles
(yellow) (yellow)
- fever @ 37.5 and above in high malaria
risk area Malaria
- no runny nose, no measles and no other
causes of fever in low malaria risk areas
(yellow) (yellow)
- obvious causes of fever in no malaria risk Possible Bacterial
areas Infection
(yellow) (yellow)
- pus draining from eye or mouth ulcers Measles with eye or mouth
complication
(green) (green)
In low malaria risk area Fever - malaria unlikely
-Runny nose present or
-Measles present or
-other causes of fever present
(green) (green)
No obvious causes of fever in no Uncomplicated Fever
malaria risk area
(green) (green)
Measles now or in the last three Measles
months
History-taking
General Danger Signs
Main Symptoms
5
- Cough or difficult breathing
- Diarrhea
- Fever
- Ear problems
Nutritional Status
Immunization Status
Other Problems
Assess for:
• Tender swelling behind the ear
• Ear pain
• Ear discharge or pus
Nutritional Status
Immunization Status
Other Problems
History-taking
General Danger Signs
Main Symptoms
- Cough or difficult breathing
- Diarrhea
6
- Fever
- Ear problems
Nutritional Status
Immunization Status
Other Problems
No immunization to CHILDREN:
• Being referred urgently to the hospital
• No live vaccines (BCG, polio, measles) to those with
immunodeficiency diseases, or immuno-suppressed due
malignant disease, or therapy with immuno-suppressant agents
or irradiation
• No DPT2 or DPT3 to those with convulsions or shock within
three days after a previous dose
• No DPT to those with recurrent convulsions or other active
neurological disease of the CNS
Out-patient Management:
Children 1 week to 2 months
• Check for possible bacterial infection
• Assess for presence of diarrhea
• Check for feeding problems or low birth weight
• Check for immunization status
• Check for other problems
(yellow)
• Red umbilicus or draining pus Local Bacterial
• Skin pustules infection
Classification of Feeding Problems or Low Weight
(pink)
• Not able to feed Possible
• No attachment at all Bacterial
7
• No sucking at all Infection
(yellow)
• Not well attached to breast
• Not sucking effectively Feeding
• Fed fewer than 8 times in 24 hours problems
• Receiving other food or drinks or low
• Low weight for age weight
• Thrush
(green)
• Not low weight for age and no NO FEEDING PROBLEMS
• other signs of inadequate feeding
Second-line anti-malarial
Sulfadoxine and Pyrimethamine