Case analysis 9

Exercise M

Case 1: Mbira

Mbira is 3 years old. She weighs 13 kg. Her temperature is 37.5°C. Her mother came to the clinic today
because Mbira has felt hot for the last 2 days. She was crying last night and complained that her ear is
hurting. The health worker checked and found no general danger signs. Mbira does not have cough or
difficult breathing. She does not have diarrhoea. Her malaria risk is high. Her fever was classified as
MALARIA. Next the health worker asked about Mbira's ear problem. The mother said she is sure Mbira
has ear pain. The child cried most of the night because her ear hurt. There has been discharge coming
from Mbira's ear on and off for about a year, said the mother. The health worker did not see any pus
draining from the child's ear. He felt behind the child's ears and felt tender swelling behind one ear.

Record Mbira's signs of ear problem and classify them on the Recording Form.

Child’s Name: Mbira Age: 3 years old Weight: 13 kg Temperature:37.5C

What are the child's problems? Mbira has felt hot and she was crying that her ear is hurting.
Initial visit: / Follow up visit:
ASSESS (Circle all signs present) CLASSIFY
CHECK FOR GENERAL DANGER SIGN GENERAL DANGER
- LETHARGIC OR UNCONSCIOUS SIGN PRESENT YES___
- NOT ABLE TO DRINK OR BREASTFEED NO_/__
- CONVULSION
- CONVULSING NOW
- VOMITS EVERYTHING
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES____ NO_/__
- For how long? ____ Days
Look and listen for stridor Look and listen for wheeze Count the breaths in
one minute. (child must be calm) ______ breaths per minute.
Fast breathing? YES____ NO____
DOES THE CHILD HAVE DIARRHOEA? YES____ NO_/___
For how long? ____ Days Look at the child’s general condition. Is
Is there blood in the stools? YES____ NO____ the child: Lethargic or unconscious
Pinch the skin of the abdomen. Does it go back: Restless or irritable
Offer the child fluid. Is the child: Not
Very slowly (longer than 2 seconds)
able to drink or drinking poorly?
Slowly Drinking eagerly, thirsty?

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or Malaria
above) YES_/___ NO____
- Decide malaria risk? High
- Does the child live in malaria area? YES
- Has the child visited/travelled or stayed overnight in the past 3weeks?
- If malaria risk, obtain a blood smear
(+)
For how long has a child had fever? 2 Days
- If more than 7 days, has fever been present every day?
- Has the child had measles within the past 3 months
If the child has measles now or within the last 3 months:
 LOOK AND FEEL
- Look or feel for stiff neck
- Look for runny nose
LOOK for signs of Measles
- Generalized rash and
- One of these, cough, runny nose, red eyes
- Look for any other cause of fever
Look for mouth ulcers, if yes, are they deep and extensive
- Look for pus draining form the eye
- Look for clouding of the cornea

DOES THE CHILD HAVE AN EAR PROBLEM? YES__/__ NO____ Mastoiditis

- Is there severe ear pain?
- Is there ear discharge? Yes, for how long? About a year
- Look for pus draining from the ear.
- Feel for tender swelling behind the ear.

Case 2

Dana is 18 months old. She weighs 9 kg. Her temperature is 37°C. Her mother said that Dana had
discharge coming from her ear for the last 3 days. Dana does not have any general danger signs. She
does not have cough or difficult breathing. She does not have diarrhoea and she does not have fever.
The health worker asked about Dana's ear problem. The mother said that Dana does not have ear pain,
but the discharge has been coming from the ear for 3 or 4 days. The health worker saw pus draining
from the child's right ear. He did not feel any tender swelling behind either ear.

Child’s Name: Dana Age: 18 months Weight: 9kg Temperature: 37C

What are the child's problems? Dana had discharge coming from her ear.
Initial visit: / Follow up visit:
ASSESS (Circle all signs present) CLASSIFY
CHECK FOR GENERAL DANGER SIGN ANY GENERAL
- LETHARGIC OR UNCONSCIOUS DANGER SIGN
- NOT ABLE TO DRINK OR BREASTFEED PRESENT YES___
- CONVULSION NO_/__
- CONVULSING NOW
- VOMITS EVERYTHING
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? YES____ NO_/__
- For how long? ____ Days
Look and listen for stridor Look and listen for wheeze Count the breaths
in one minute. (child must be calm) ______ breaths per minute.
Fast breathing? YES____ NO____
DOES THE CHILD HAVE DIARRHOEA? YES____ NO_/___
For how long? ____ Days Look at the child’s general condition. Is the
Is there blood in the stools? YES____ NO____ child: Lethargic or unconscious
Pinch the skin of the abdomen. Does it go back: Restless or irritable
Very slowly (longer than 2 seconds) Offer the child fluid. Is the child: Not able to
Slowly drink or drinking poorly?
Drinking eagerly, thirsty?

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or

above) YES____ NO_/___
 - Does the child live in malaria area?
- Has the child visited/travelled or stayed overnight in the past 3weeks?
- If malaria risk, obtain a blood smear
(+) (Pf) (Pv) (-) (not done)
- For how long has a child had fever?____ Days
- If more than 7 days, has fever been present every day?
- Has the child had measles within the past 3 months
If the child has measles now or within the last 3 months:
LOOK AND FEEL
- Look or feel for stiff neck
- Look for runny nose
LOOK for signs of Measles
- Generalized rash and
- One of these, cough, runny nose, red eyes
- Look for any other cause of fever

Look for mouth ulcers, if yes, are they deep and extensive
- Look for pus draining form the eye
- Look for clouding of the cornea

DOES THE CHILD HAVE AN EAR PROBLEM? YES_/___ NO____ Acute ear infection
- Is there severe ear pain?
- Is there ear discharge? If Yes, for how long? _3- 4 Days
- Look for pus draining from the ear.
- Feel for tender swelling behind the ear.

Case Analysis 10

Exercise N

Part 2:

Does the child have:

Severe Pallor Some pallor No pallor
Photograph 1 
Baby Howard
Photograph 2 
Baby Sergie
Photograph 3 
Baby Constantine
Photograph 4 
Baby Lawrence
 Exercise O.

Part 2:

Does child have visible severe wasting?

Yes No
Photograph 1 Baby Marco 
Photograph 3 Baby Lexter 
Does the child have oedema?
Yes No
Photograph 2 Baby Kurt 
Photograph 4 Baby Zedrick 