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    278 views2 pages

    Summary of IMCI Case Management

    Uploaded by

    janesky09

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    CHECK FOR GENERAL DANGER • Is the child able to drink or breastfeed? • Convulsions in this illness?

    SIGNS: ASK • Does the child vomit everything? • Is the child lethargic or unconscious?

    CHILD 2 MONTHS TO 5 YEARS: ASSESS CLASSIFY TREATMENT


    • Give ceftriaxone IMI (80mg/kg) and if child < 6
    Any General Danger Sign
    DOES THE CHILD HAVE COUGH SEVERE mths also give cotrimoxazole
    OR
    OR DIFFICULT BREATHING? PNEUMONA OR • Give O2 and check blood sugar
    Chest Indrawing
    VERY SEVERE • If stridor, nebulize with adrenalin
    OR
    • For how long? DISEASE • Keep child warm and refer URGENTLY to
    Stridor in a calm child
    • Count the breaths in one minute hospital
    • Look for chest indrawing • Give amoxycillin for 5 days
    • Look and listen for stridor or Fast breathing PNEUMONIA • Consider symptomatic HIV
    wheeze • Follow up in 2 days
    • Soothe the throat and relieve the cough
    Age Fast breathing No signs of pneumonia or very • If coughing for more than 21 days consider TB
    2 - 12 mths = 50 or > breaths/min COUGH OR COLD
    1 – 5 yrs = 40 or > breaths/min
    severe disease or asthma
    • Follow-up 5 days if not better

    DOES THE CHILD HAVE Two of the following signs:


    DIARRHOEA? • Lethargic or unconscious • Start Fluids for Plan C
    • For how long? • Sunken eyes DIARRHOEA WITH • Refer URGENTLY to hospital
    • If >14 days, has child lost • Not able to drink or drinking SEVERE • Give frequent sips of ORS on the way, continue
    weight? poorly DEHYDRATION breastfeeding
    • Is there blood in the stool? • Skin pinch goes back very slowly • Keep the child warm
    • What Rx is the mother giving? (>2 secs)
    • Look at child’s general condition Two of the following signs:
    • Look for sunken eyes. • Restless or irritable DIARRHOEA WITH • Give fluids: Plan B
    • Offer the child fluids. • Sunken eyes SOME • Continue breastfeeding or feeding
    • Pinch the skin of the abdomen • Child drinks eagerly and is thirsty DEHYDRATION • Follow up in 2 days if not improving
    • Skin pinch goes back slowly
    • Give fluid and food to Rx diarrhoea
    CLASSIFY FOR DEHYDRATION Not enough signs to classify NO VISIBLE
    at home: Plan A
    (All children with diarrhoea) as severe or some dehydration DEHYDRATION
    • Follow up in 5 days if not improving
    • Rx for dehydration if present
    SEVERE
    CLASSIFY FOR PERSISTENT • Child has signs of dehydration • Refer URGENTLY to hospital
    PERSISTENT
    DIARRHOEA • Child has history of weight loss • Give Vit. A unless given in last month
    DIARRHOEA
    (If diarrhoea for 14 or more days) • Give frequent sips of ORS on the way
    • Counsel the mother about feeding
    • No dehydration PERSISTENT • Give Vit. A unless given in last month
    • No history of weight loss DIARRHOEA • Consider symptomatic HIV infection
    • Follow up in 5 days
    • Rx for dehydration if present
    CLASSIFY FOR DYSENTERY • Child has signs of dehydration SEVERE
    • Refer URGENTLY to hospital
    (If diarrhoea with blood) • Child less than 12 months of age DYSENTERY
    • Give frequent sips of ORS on the way
    • Give ciprofloxacin for 3 days
    • Blood in stool DYSENTERY
    • Follow-up in 2 days

    Give quinine for severe malaria (first dose)


    Any General Danger Sign
    DOES THE CHILD HAVE A Give first dose of an appropriate antibiotic
    OR VERY SEVERE
    FEVER? Treat the child to prevent low blood sugar
    Stiff neck FEBRILE
    HIGH – RISK MALARIA Give one dose of paracetamol in clinic for high
    OR DISEASE
    THEN ASK: fever(38.5°C or above)
    Bulging fontanelle
    • For how long? Refer URGENTLY to hospital
    • If more than 7 days, has fever Give oral co-artemether or other recommended
    been present every day? antimalarial
    • Has the child had measles Give one dose of paracetamol in clinic for high fever
    within the last 3 months? Fever (by history or feels hot or (38.5°C or above)
    MALARIA
    temperature 37.5°C** or above) Advise mother when to return imm.
    LOOK AND FEEL: Follow-up in 2 days if fever persists
    • Look or feel for stiff neck. If fever is present every day for more than 7 days,
    • Look for runny nose. refer forassessment
    Look for signs of MEASLES
    • Generalized rash and Any General Danger Sign Give quinine for severe malaria (first dose) unless no
    • One of these: cough, runny nose, OR malaria risk
    or red eyes. Stiff neck VERY SEVERE Give first dose of an appropriate antibiotic
    OR FEBRILE Treat the child to prevent low blood sugar
    Bulging fontanelle DISEASE Give one dose of paracetamol in clinic for high fever
    LOW – RISK MALARIA (Malaria rapid test or positive (38.5°C or above)
    or negative or not done) Refer URGENTLY to hospital
    Give oral co-artemether or other recommended
    antimalarial
    Give one dose of paracetamol in clinic for high fever
    NO runny nose and
    (38.5°C or above)
    NO measles and MALARIA
    Advise mother when to return immediately
    NO other cause of fever
    Follow-up in 2 days if fever persists
    If fever is present every day for more than 7 days,
    refer for assessment
    Give one dose of paracetamol in clinic for high fever
    • Runny nose PRESENT or (38.5°C or above)
    FEVER -
    • Measles PRESENT or Advise mother when to return immediately
    MALARIA
    • Other cause of fever Follow-up in 2 days if fever persists
    UNLIKELY
    PRESENT If fever is present every day for more than 7 days,
    refer forassessment

    Give Vitamin A treatment


    • Any general danger sign or Give first dose of an appropriate antibiotic
    SEVERE
    If the child has measles now • Clouding of cornea or If clouding of the cornea or pus draining from the
    COMPLICATED
    or within the last 3 months: • Deep or extensive mouth eye, apply
    MEASLES
    ulcers tetracycline eye ointment
    • Look for mouth ulcers. Are they Refer URGENTLY to hospital
    deep and extensive? Give Vitamin A treatment
    • Look for pus draining from the MEASLES WITH If pus draining from the eye, treat eye infection with
    • Pus draining from the eye or
    eye. EYE OR MOUTH tetracycline eye ointment
    • Mouth ulcers
    • Look for clouding of the cornea. COMPLICATIONS If mouth ulcers, treat with gentian violet
    Follow-up in 2 days.
    • Measles now or within the
    MEASLES Give Vitamin A treatment
    last 3 months

    CHILD 2 MONTHS TO 5 YEARS: ASSESS CLASSIFY TREATMENT


    DOES THE CHILD HAVE AN Tender swelling behind the ear MASTOIDITIS • Give ceftriaxone IMI and refer
    EAR PROBLEM? URGENTLY to hospital
    • Ear pain • Rx amoxycillin for 5 days
    • Ear pain? OR ACUTE EAR INFECTION • If ear discharge teach mother dry
    • Is there ear discharge? If yes for • Red tympanic membrane wicking and consider symptomatic HIV
    how long? OR • Analgesia and follow up in 5 days if pain
    • Pus draining from the ear < 14 CHRONIC EAR or discharge persists
    days INFECTION • Teach mother dry wicking
    • Pus draining from the ear > 14 • Consider symptomatic HIV
    days • Follow up in 14 days

    • No ear pain and no pus


    NO EAR INFECTION • No Rx
    draining

    CHECK FOR MALNUTRITION • Very low weight (<60% exp’d)


    AND ANAEMIA OR • Vit. A unless given in the last month
    • Visible severe wasting SEVERE MALNUTRITION • Refer URGENTLY to hospital
    • Has the child lost weight? OR • Check blood sugar and keep warm
    • Plot the weight on the RTHC • edema of both feet
    • Look for visible severe wasting • Low weight • Consider Vit. A and mebendazole
    • Feel for oedema of both feet OR • Check and treat for oral thrush
    • Poor weight gain NOT GROWING WELL • Consider symptomatic HIV, TB contact
    OR • Assess feeding and counsel
    • Mother reports weight loss • Follow up in 14 days
    • Not low weight and... • Check feeding
    • Look for palmar pallor GROWING WELL
    • Good weight gain • Consider Vit A and mebendazole
    • Check hemoglobin level
    • Severe palmar pallor OR • Refer URGENTLY to hospital
    SEVERE ANAEMIA
    • Hb < 6 g/dl • Keep the child warm
    • Some palmar pallor OR • Rx with iron and counsel about feeding
    ANAEMIA
    • Hb < 10 g/dl • Follow up in14 days
    • No pallor and Hb > 10 g/dl NO ANAEMIA • No additional Rx

    ASSESS FOR SYMPTOMATIC • Any pneumonia now • Offer HIV testing for mother and
    HIV INFECTION: • Ear discharge now or in the past? SUSPECTED child if status unknown
    • Low weight for age SYMPTOMATIC HIV • Start co-trimoxazole prophylaxis
    • 3 OR MORE POSITIVE • Poor weight gain or weight loss? (3 or > positive findings) • Counsel the mother
    FINDINGS OF THESE 8 • Persistent diarrhoea in last 3 • Follow up for counselling about results
    SYMPTOMS AND SIGNS months?
    • Enlarged lymph nodes in 2 or
    SYMPTOMATIC HIV
    more of the following 3 sites: • Counsel mother about her health
    UNLIKELY
    Neck, axilla or groin and precautions against HIV infection
    (< 3 positive findings)
    • Oral thrush
    • Parotid gland enlargement

    INFANT: 1 WEEK - 2 MONTHS ASSESS CLASSIFY TREATMENT


    CHECK FOR One of the following signs:
    POSSIBLE • Fast breathing 60 or > breaths/min. (Repeat if
    BACTERIAL fast)
    INFECTION • Severe chest indrawing (deep and easy to see)
    • Nasal flaring or grunting
    • Convulsions • Give IMI ceftriaxone (80mg/kg)
    • Bulging fontanelle • Give O2
    • Umbilical redness extending to skin, and or • Give rectal diazepam if convulsing
    POSSIBLE SERIOUS
    draining pus • Check and Rx low blood sugar
    BACTERIAL INFECTION
    • Fever (> 37.5C) or low body temperature • Refer URGENTLY to hospital
    (<35.5C) • Continue breastfeeding
    • Many or severe skin pustules (> 5 pustules) • Keep the child warm
    • Lethargic, unconscious or less than normal
    movements
    • Apnea attacks
    • Not taking feeds or taking feeds poorly
    • Jaundice worsening or still present after 2 weeks
    • Red umbilicus • Give erythromycin for 7 days
    LOCAL BACTERIAL
    • Skin pustules • For eye infection give ceftriaxone IMI
    INFECTION
    • Pus draining from the eye • Advise mother on care of the infection
    NO BACTERIAL
    None of the above signs: • Relevant health counselling
    INFECTION

    CHECK FOR FEEDING • Not able to feed • Give IMI ceftriaxone (80mg/kg)
    NOT ABLE TO FEED
    PROBLEM OR LOW WEIGHT IN • Infant not able to attach to breast • Check blood sugar and keep warm
    BREASTFED BABIES: • Not suckling at all • Refer URGENTLY to hospital
    • Not suckling at all
    • Advise on breastfeeding esp.
    • Infant not well attached to breast
    correct positioning and attachment
    • Infant not suckling effectively
    FEEDING PROBLEM OR • Breastfeed > 8x in 24 hrs and at
    • Less than 8 breastfeeds in 24 hrs
    NOT night
    • Infant receiving other foods
    GROWING WELL • Breastfeed more, reducing other
    • Low weight for age or poor wt.
    foods
    gain
    • Follow up weight gain
    • Oral thrush
    • Nystatin drops
    • Using a feeding bottle
    • Not low weight and feeding well NO FEEDING PROBLEM • Relevant health counselling

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