6.

Child health service (under –five clinic (IMNCI))

6.1 Facility readiness assessment for child health service

Date of the visit /assessment: _____________________

Region: ___________________Town: _______________Name of the HC:

_______________________

Name of HC Director: _____________________

Name of Mentor: __________________________ Name of Mentee:

________________________

Name of the under-five clinic head: ___________________________

Phone number of health facility: _____________________Phone No. of

Mentee_________________
Please answer each question Circle Issues & actions taken to
answer
address major gaps
PART I: AVAILABILITY & FUNCTIONALITY OF SPACE FOR IMNCI (UNDER-FIVE) RELATED
SERVICES (ASK, OBSERVE)
1. Triaging area Yes No

2. Adequate & stand-alone exam Yes No

room for IMNCI

3. ORT corner established & Yes No

functional in the room

4. Presence of unnecessary, non- Yes No

functional medical equipment &
office furniture

5. Adequate ventilation and light in Yes No

the room

6. Room location distant from Yes No

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 adult OPD (Should be located
within the MCH block to reduce
risk of cross-infection)

7. Functional Hand washing area Yes No

with water & soap

PART II: STAFFING OF UNDER-FIVE YES NO TRAINING STATUS: IS

CLINIC (ASK) (#) STAFF WORKING AT THE
CLINIC TRAINED ON
IMNCI? (ASK &
CIRCLE)
1. Medical Doctor (GP) Yes No
Yes No
2. Health Officer (HO) Yes No
Yes No
3. Nurse (BSC) Yes No
Yes No
4. Nurse (Diploma) Yes No
Yes No
5. How frequent is staff rotation
done? (Fill)

6. Is there a need for additional

HR assignment
Yes No
PART III: AVAILABILITY OF PRINT MATERIALS, JOB AIDS (CHECK)
1. Revised/updated IMNCI Chart
booklet
Yes No
2. Revised/ updated IMNCI
Register
Yes No
3. Patient education brochures or
flip charts, cue card on EPI,
Nutrition (if ‘yes’, please
specify)
Yes No
4. Job aid on Amoxicillin
dispersible tablet
Yes No

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5. Job aid on Zinc-ORS for
Diarrhea Management
Yes No
PART IV: AVAILABILITY OF MEDICAL EQUIPMENT, SUPPLIES AND CONSUMABLES
Equipment and Supplies: (Ask, Availability Functionalit
Observe) (circle) y
1. Examination Couch
Yes No Yes No
2. Tongue Blade (spatula)
Yes No Yes No
3. Weight Scale (Infant)
Yes No Yes No
4. Weight Scale (Child)
Yes No Yes No
5. Thermometer
Yes No Yes No
6. Measuring Tape
Yes No Yes No
7. Height measurement board
Yes No Yes No
8. Gloves
Yes No
9. MUAC tape
Yes No Yes No
10. Pulse oximeter,
Yes No Yes No
11. Oxygen cylinders
Yes No Yes No
12. Surgical masks (PPE that is for
Covid-19 prevention)
Yes No
13. Hand sanitizers
Yes No
14. Safety Box
Yes No Yes No
PART V: MONITORING &
EVALUATION TOOLS AND FORMATS
(ASK, CHECK) (CIRCLE)
1. National DHIS-2 monthly
reporting forms Yes No

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2. Referral forms (interfacility,
Intra-facility) Yes No
3. Under-five clinic annual plan
(e.g., Wall chart) Yes No
Part VI: Service Availability/ Continuity (Ask)
1. Were there any interruptions in
provision of care in the last
three months during;
If ‘Yes’, for how long, reasons
and actions taken
 duty hours,
Yes No
 weekends
Yes No
 holidays
Yes No
2. Were there any interruptions in
emergency services; If ‘Yes’,
Yes No
reasons & actions taken

PART VII: DATA USE (TARGETS & REPORTING)

1. Are reports reviewed by under- Yes No
five clinic staff? Review last
report with staff.

2. Practice of using/interpreting Yes No

growth charts

3. Sending reports on time;

Accuracy/quality of reports Yes No

4. Are catchment area targets Yes No

met? Review and make plans
with staff to meet targets.

5. Practice of interpreting results Yes No

of reports and making plans for
quality improvement

6. Does the HW get referral Yes No

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 feedback?

PART VIII: REFERRAL SYSTEMS (BIDIRECTIONAL I.E. ABOVE & BELOW):

1. System for tracking linkage Yes No
within the HC

2. System for tracking Outside Yes No

referrals

3. Using referral and feedback Yes No

forms

4. documenting attempts to track Yes No

loss of follow-up visits

PART IX: AVAILABILITY OF ESSENTIAL DRUGS IN THE LAST THREE MONTHS INCLUDING ON THE
DAY OF THE VISIT (UNEXPIRED)
1. Albendazole Yes No

2. Adrenaline injection Yes No

3. Amoxicillin DT Yes No

4. Arthmeter + Lumfanthrine Yes No

(Coartem) tablet (any packing),

5. Artesunate or IV/IM Yes No

6. Benzyl Penicillin/Ampicillin
Injection

7. Ceftriaxone injection Yes No

8. Chloroquine tablet/suspension Yes No

9. Chlorhexidine Gel Yes No

10. Ciprofloxacin tablet Yes No

11. Dextrose in normal saline Yes No

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12. Diazepam Injection Yes No

13. Ear drops (Ciprofloxacin) Yes No

14. Gentian Violet (GV) Yes No

15. Gentamycin injection Yes No

16. iron tablet and/or iron syrup

17. Glucose 40% Yes No

18. Mebendazole

19. Oral Rehydration Salts (Loose Yes No

or Co-packed with Zinc DT)

20. Oxygen for management of Yes No

hypoxia

21. Paracetamol (syrup or Yes No

suppository)

22. Pulse oximeter Yes No

23. Quinine Sulphate (tablet) Yes No

24. Quinine Injection Yes No

25. Salbutamol Yes No

26. Tetracycline eye ointment Yes No

27. Vitamin A Yes No

28. Vitamin K Yes No

29. Zinc Sulphate DT ((Loose or Co-

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 packed with ORS)

30. IV fluids such as normal saline Yes No

and ringers’ lactate

31. Syringe and needle 1-5 ml size Yes No

32. ORT corner functional (jug, 2 Yes No

cups, spoon, water, ORS; clean)

33. Pediatric cannula or butterfly Yes No

needle

34. Pediatric NG tube (No 8, 10) Yes No

35. Plump Nut/ RUTF Yes No

36. Ambubag with mask Yes No

37. Stock outs or interruptions in Yes No

dispensing child health
commodities with reasons and
actions taken

38. Quality of prescribing (dose, Yes No

completeness, treatment choice
etc.)

39. Timely refill of requisition and Yes No

reporting forms (RRF) at
pharmacy store (check date of
the last request)

6.2 Mentee’s Knowledge and Skill Assessment tools

6.2.1 Mentee self-assessment Tool:

 Ask the mentee to present his/her experiences based on the following

questions:
 How should the HC work to improve under-five clinic performance?

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  What support does the mentee expect from the mentorship? ( Probe: To what
depth does the mentor provide support, what tools do to use during the visit
etc.)

Tool for mentee’s self-assessment

To be completed by mentee
submitted to Mentor:
Frequency: Baseline, at last mentorship visit (visit no. 6)
Clinical competency assessment: Mentee self-assessment
Directions for the mentee: The following tasks ask how confident you feel about
your ability to do specific tasks at the under-five clinic. Please complete the form and
submit to the mentor.
1 I am not at all confident: I do not know how to do this task
2 I am somewhat confident: I can perform the task with support
3 I am extremely confident: I am capable of doing this task and consider myself
competent/ proficient
4 I consider myself to have expertise and can teach this task to others
Task/Competency 1-4
SICK YOUNG INFANTFROM BIRTH UP TO 2 MONTHS

Assess the Young Infant and Counsel the mother

1 Assessing the Sick Young Infant from Birth Up to 2 Months
Sick young infant Birth up to two months

2 Checking for Very Severe Disease and Local Bacterial Infection

3 Checking for Jaundice
4 Checking for HIV Exposure and Infection
5 Checking for exclusive breast-feeding practice
6 Checking for Feeding Problem or Underweight
7 Checking for Feeding Problem: HIV Positive Mother Not
Breastfeeding
8 Checking the Young Infant’s Immunization Status
Treating the Young Infant and Counsel the mother
9 Care of the Low-Birth-Weight Newborn
10 Keeping the Young Infant Warm
11 Giving Oral and Intramuscular Antibiotic
12 Teaching the mother to Treat Local Infection at Home
13 Teaching Correct Positioning, Attachment, frequency, mechanism for
Breastfeeding
14 Advising the mother to Give Home Care for the Young Infant
Giving Follow-Up Care for the Sick Young Infant
15 Low Birth Weight/Preterm, Low Body Temperature

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 16 Local Bacterial Infection
17 Jaundice
18 Diarrhea (Some Dehydration)
19 Feeding Problem
20 Thrush
21 Underweight
22 Routine Postnatal Follow-Up Care
SICK CHILD 2 MONTHS UPTO 5 YEARS
Assess and classify and Identify Treatment
23 Checking for General Danger Signs
Asking About Main Symptoms
24 Assessing & classifying the child for Cough or Difficult Breathing
25 Assessing & classifying the child for Diarrhea?
26 Assessing & classifying the child for Fever?
27 Assessing & classifying the child for Ear Problem?
28 Checking & classifying the child for Anemia
SICK CHILD 2 MONTHS UPTO 5 YEARS

29 Checking & classifying the child for Acute Malnutrition (<6 months)
30 Check & classifying the child for Acute Malnutrition (6- 59 months)
31 Checking & classifying the child for HIV Exposure & Infection (2 -
<18 months)
32 Checking & classifying the child for HIV Exposure & Infection (18 -
59 months)
33 Assessing and Classifying the Child for Tuberculosis
34 Checking the Child’s Immunization and Vitamin A Status
TREAT THE CHILD
Teaching the mother to Give Oral Drugs at Home
35 Giving appropriate Oral Antibiotic
36 Giving inhaled Salbutamol for Wheezing (using a spacer)
37 Giving oral Anti-Malarial
38 Giving Cotrimoxazole Prophylaxis
39 Giving Paracetamol for High Fever
40 Giving Vitamin A, Zinc Supplementation & Iron
41 Giving Mebendazole and Albendazole
Teach the mother to Treat Local Infections at Home
42 Treating Eye Infection with Tetracycline Eye Ointment
43 Drying the Ear by Wicking
44 Treating Mouth Ulcer with Gentian Violet
45 Treating Thrush with Nystatin or Gentian violet
46 Soothing the Throat, Relieving the Cough with a Safe Remedy

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 Give These Treatments in the OPD/Clinic
47 Giving an Intramuscular Antibiotic
48 Treating a convulsing Child with Diazepam Rectally
49 Treating the Child to Prevent Low Blood Sugar
50 Giving Artesunate-Arthmeter for Severe Malaria
51 Giving Quinine for Severe Malaria
52 Giving Extra Fluid for Diarrhea
53 Plan A: Treating Diarrhea at Home
54 Plan B: Treating Some Dehydration with ORS
55 Plan C: Treating Severe Dehydration Quickly
COUNSELING THE MOTHER
Food:
56 Assessing the Child’s Feeding
57 Feeding Recommendations for All Children During Sickness &
Health and including HIV Exposed Children on ARV Prophylaxis
58 Feeding Recommendation for a child with Uncomplicated SAM
59 Feeding Recommendations for A Child with Persistent Diarrhea
60 Feeding Recommendation for a non-breast-feeding child (any
reason)
61 Counselling the mother on exclusive breast feeding to 6 months
62 Counselling the mother on complementary feeding after 6 months
63 Counseling the Mother About Feeding Problems
64 Counseling the mother about Safe Preparation of Formula Feeding
65 Counseling the HIV+ Mother who has Chosen Not to Breastfeed
66 Appropriate Amount of Formula Needed per Day
67 How to Feed a Baby with a Cup
68 Counseling the mother about Fluids and When to Return
FLUID:
69 Advising the mother to Increase Fluids During Illness
70 When to Return i.e., Advise the mother when to Return to the Health
worker
71 Counseling the Mother About Her Own Health
72 Use of the Family Health Card
Giving Follow-up Care
72 Pneumonia
73 Persistent Diarrhea
74 Dysentery
75 Malaria (Low/High Malaria Risk)
76 Fever (No Malaria Risk)
77 Fever-No Malaria (Low/High Malaria Risk)

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 78 Measles with Eye or Mouth Complications
79 Ear Infection, Feeding Problem, Anemia
70 Uncomplicated Severe Malnutrition
71 Moderate Acute Malnutrition
Where Referral is not Possible
SICK YOUNG INFANT BIRTH UP TO 2 MONTHS
81 Essential Care for VERY SEVERE DISEASE
82 Essential Care for severe pneumonia or very severe disease
83 Treating a child with Wheezing
84 Essential Care for very severe febrile disease
85 Essential Care for SEVERE PERSISTENT DIARRHOEA
86 Essential Care for SEVERE COMPLICATED MEASLES
87 Essential Care for MASTOIDITIS
88 Essential Care for SEVERE MALNUTRITION
89 Essential Care for SEVERE ANEMIA
90 Essential Care for Cough of 14 Days or more - Follow the current
national TB guideline.
91 Essential Care for Convulsions (current convulsions, not by history
but during this illness)
92 Treatment instructions [Recommendations on how to give specific
treatments for severely ill children who cannot be referred e.g.,
Gentamycin, Quinine, Diazepam, Dextrose infusion]
93 Appetite Test & OTP Uncomplicated SAM
94 Recording on the IMNCI Register
95 Plotting & Interpreting WFA Chart (Birth to 5 years Z-Score)
96 Plotting & Interpreting WFL/H (2-5 years Z-Score)
97 Measuring & Interpreting MUAC

6.2.2 Mentee’s Knowledge Assessment

1.3.1 Knowledge assessment questions

Which of the following are among the 5 main causes of mortality in under-five children in the
Ethiopia? (Circle all the correct options)

A. Diarrhoeal diseases
B. Pneumonia
C. Road traffic injuries
D. Malnutrition
E. AIDS

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Which of the following colour-coded classification rows for fever of the IMNCI chart booklet
would apply to a 5-month-old child with fever and stiff neck? (Circle only ONE option)

A. Pink colour-coded row

B. Yellow colour-coded row
C. Green colour-coded row

Which of the following colour-coded rows of the IMNCI chart booklet applies to a
42-month-old child with diarrhoea who has sunken eyes, is thirsty and has no
other problems? (Circle only ONE option)

A. Pink colour-coded row

B. Yellow colour-coded row
C. Green colour-coded row

Which of the following are effective preventive interventions in children under-5?

(Circle all the correct options)

A. Antibiotics for pneumonia

B. Immunization
C. Prompt treatment of malaria
D. Exclusive breastfeeding
E. Treatment of tuberculosis

Which of the following questions should you ask to check for "general danger signs"
in a 4-month-old child with fever for 3 days? (Circle only ONE option)

A. Is s/he able to drink or breastfeed?

B. Has s/he been very irritable since illness started?
C. How many times has s/he vomited in the past 24 hours?
D. Did s/he have convulsions in the past month?

Which of the following signs are "general danger signs" to be checked in any child 2
months up to 5 years brought to the health facility? (Circle all the correct options)

A. Irritability
B. Axillary temperature ≥ 39.0°C
C. Severe wheezing
D. Not able to drink or breastfeed
E. Unconsciousness

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What is needed to count the respiratory rate correctly in an 11-month-old child with
cough? (Circle all the correct options)

A. Child should be calm

B. Child should be alert
C. A special timer is indispensable
D. The count should always be repeated
E. The count should be for a full minute

What is "fast breathing" in a 3-month-old child? (Circle only ONE option)

A. 20 breaths per minute or more

B. 30 breaths per minute or more
C. 40 breaths per minute or more
D. 50 breaths per minute or more
E. 60 breaths per minute or more

Which of the following movements of the lower chest describes chest

indrawing? (Circle only ONE option)

A. Inward movement during inspiration

B. Inward movement during expiration
C. Outward movement during inspiration
D. Outward movement during expiration

Which of the following signs would make you classify any child age 2 months up to
5 years presenting with cough as SEVERE PNEUMONIA OR VERY SEVERE
DISEASE? (Circle all the correct options)

A. Stridor when agitated

B. Respiratory rate of 65 breaths per minute
C. Difficult breathing
D. Vomiting everything
E. Stridor when calm

Which of the following signs in a 5-month-old child with cough are indications for
urgent referral? (Circle all the correct options)

A. Respiratory rate of 60 breaths per minute

B. Unconsciousness
C. Stridor when agitated
D. Chest indrawing
E. Axillary temperature ≥ 39.0°C

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How do you classify a 10-month-old child who has had cough for 4 days, has a
respiratory rate of 52 breaths per minute, has chest in-drawing and has no
stridor? (Circle only ONE option)

A. Severe pneumonia or very severe disease

B. Pneumonia
C. No pneumonia: cough or cold

How do you classify a 6-month-old child who has had cough for 2 days, has no
general danger signs, has a respiratory rate of 54 breaths per minute, has no
stridor and has no chest in-drawing? (Circle only ONE option)

A. Severe pneumonia or very severe disease

B. Pneumonia
C. No pneumonia: cough or cold

Which of the following signs should you LOOK and FEEL for in an 8-month-old child
with diarrhoea to classify his/her dehydration status? (Circle all the correct options)

A. Lethargic or unconscious
B. Skin turgor (skin pinch)
C. Unable to drink
D. Restless, irritable
E. More than 3 watery stools

A "skin pinch goes back very slowly" if it returns: (circle only ONE option)

A. Immediately
B. In less than 1 seconds
C. In less than 2 seconds
D. In 2 seconds or more
E. In more than 2 seconds

What is the recommended procedure to take a skin pinch? (Circle all the correct
Options)

A. Pinching the abdomen skin halfway between the umbilicus and the side of the
abdomen
B. Holding the skin firmly between the thumb and the side of the 1st finger

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 C. Holding the skin firmly between the thumb and the tip of the 1st finger
D. Holding the skin across the child’s body
E. Holding the skin in line up and down the child’s body

Which two among the following signs are required to classify a one-year-old child
with diarrhoea as SEVERE DEHYDRATION? (Circle all the correct options)

A. Skin pinch goes back slowly

B. Restless
C. Lethargic
D. Unable to drink
E. Vomiting

Which of the following children with diarrhoea are classified as having SEVERE
DEHYDRATION? (Circle all the correct options)

A. Sunken eyes and skin pinch goes back slowly

B. Sunken eyes and skin pinch goes back very slowly
C. Sunken eyes and lethargic
D. Sunken eyes and restless
E. Sunken eyes and not able to drink

Which of the following children with diarrhoea are classified as having SOME
DEHYDRATION? (Circle all the correct options)

A. Drinks eagerly and skin pinch goes back slowly

B. Has had convulsions during this illness and drinks eagerly
C. Has blood in the stool and is irritable
D. Is restless and has sunken eyes
E. Has sunken eyes and drinks normally

8. How do you classify a 6-month-old child who has been having diarrhoea for 9
days, has vomited this morning, has sunken eyes and in whom the skin pinch
goes back slowly?

(Circle only ONE option)

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A. Severe dehydration, severe persistent diarrhoea
B. Severe dehydration
C. Some dehydration, severe persistent diarrhoea
D. Some dehydration, severe persistent diarrhoea
E. No dehydration

9. Which of the following is consistent with a classification of PERSISTENT

DIARRHOEA?

(Circle only ONE option)

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 A. Diarrhoea lasting for 7 days or more
B. Diarrhoea lasting for more than 7 days
C. Diarrhoea lasting for more than 10 days
D. Diarrhoea lasting for 14 days or more
E. Diarrhoea lasting for more than 14 days

10. Which of the following classifications apply to a 5-month-old child who has been
having diarrhoea for 15 days with blood in the stools, has no general danger
signs, has sunken eyes, drinks normally and in whom the skin pinch goes back
immediately? (Circle all the correct options)

A. Some dehydration
B. No dehydration
C. Severe persistent diarrhoea
D. Persistent diarrhoea
E. Dysentery

11. Which treatment should be given to a 2-year-old child who is having convulsions
at the health facility? (Circle all the correct options)

A. Diazepam (or sodium valproate or paraldehyde) rectally

B. First dose of an appropriate antibiotic
C. First dose of IV calcium
D. Sugar water to prevent low blood sugar
E. Diazepam orally

12. Which of the following should be included in the treatment plan at the health
facility or a 4-month-old child who is lethargic, not able to breastfeed but able to
swallow and has no other main symptoms (no diarrhoea, cough or difficult
breathing, fever, throat or ear problem)? (Circle all the correct options)

A. Diazepam rectally
B. First dose of an appropriate antibiotic
C. Refer urgently to hospital
D. Sugar water to prevent low blood sugar
E. Diazepam orally

13. Which of the following actions should be included in the treatment plan for a 3-
month-old child classified as SEVERE PNEUMONIA OR VERY SEVERE DISEASE?
(Circle all the correct options)

A. Refer urgently to hospital

B. Treat the child to prevent low blood sugar
C. Give oral antibiotic for 7 days

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D. Give first dose of an appropriate antibiotic
E. Give vitamin A treatment

14. Which of the following actions should be included in the treatment plan for a 5-
month-old child classified as PNEUMONIA? (Circle all the correct options)

A. Refer urgently to hospital

B. Follow-up in 2 days
C. Give oral antibiotic for 3 days
D. Follow-up in 5 days if no improvement
E. Give oral antibiotic for 5 days

15. Which of the following actions should be included in the treatment plan for a 4-
month-old child with 58 breaths per minute, no general danger signs, no chest
in-drawing and no stridor? (Circle all the correct options)

A. Follow-up in 5 days if no improvement

B. Give oral antibiotic for 5 days
C. Follow-up in 2 days
D. Refer urgently to hospital
E. Give oral antibiotic for 3 days

16.Which of the following actions should be included in the treatment plan for a 15-
month-old child with cough and wheezing classified as NO PNEUMONIA: COUGH
OR COLD?

(Circle all the correct options)

A. Relieve the cough with a safe remedy

B. Do not give bronchodilator if wheezing disappeared after rapid-acting bronchodilator trial
C. Give oral antibiotic for 3 days
D. Follow-up in 2 days
E. Give inhaled or oral bronchodilator for 5 days

17.Which of the following are included in the rules of home treatment for
diarrhoea?

(Circle all the correct options)

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A. Give extra fluids
B. Stop feeding during illness
C. Give zinc
D. Reduce breastfeeding
E. Continue feeding

18. How much ORS should be given to a 12-month-old child with acute diarrhoea
with SOME DEHYDRATION weighing 11 kg? (Circle only ONE option)

A. As much as the child wants

B. 50 ml of ORS after each loose stool
C. 200 ml of ORS after each loose stool
D. 400 – 700 ml over 4 hours
E. 700 – 900 ml over 4 hours

19.The first line antibiotic for pneumonia would be:

A. Co-trimoxazole
B. Amoxicillin
C. Penicillin
D. Ciprofloxacin

I. True false questions for assessing mentee

__________1. For 2 months to 5 yrs. sick child the following are danger signs: vomits
everything, convulsion, failure to feed and lethargy.
__________2. For 2 months to 5 yrs. sick child, while calm, if she has fast breathing
then she has pneumonia.
__________3. Pneumonia can be treated with five days amoxicillin at health post,
and needs follow up on the fifth day.
__________4. Severe dehydration of a sick child should be treated with 75 ml per kg
ORS over 4 hrs.
__________5. A child with cough of more than two weeks can be classified as a child
with presumed TB.
__________6. All children admitted to OTP should take Amoxicillin.

II. Case scenario/case study questions

1. Karim, a 21-day-old baby boy, is brought to the health center because of passing watery
stools in the past 2 days. This is an initial visit for this problem. He weighs 2.7 kg. His
axillary temperature is 37.2°C. Karim has mild chest indrawing. His respiratory rate is 55
breaths per minute. He has had no convulsions and has no difficulty in feeding. He is
sleepy but wakes up when you clap your hands, stays awake and often moves his arms

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 and legs while you assess him. You find many skin pustules 160. His umbilicus is not red
and not draining pus. How would you classify Karim's illness at this stage of your
assessment? What will be the possible treatment(s)?
2. Karima, a 5-day-old baby girl, is brought to the health center because she had difficulty
breathing since early this morning. Her axillary temperature is 35.4°C. She weighs 3.0
kg. This is an initial visit for this problem. She has had no convulsions and her mother
says that she has difficulty feeding. You count her respiratory rate and find it is 68
breaths per minute. You repeat the count and obtain 63 breaths per minute. While you
count, you see that Karima has mild chest indrawing. She is sleepy but wakes up when
her mother talks to her and moves normally. The umbilicus is normal; there are no skin
pustules. She has no jaundice. How would you classify Karima’s illness at this stage of
your assessment? Which of the following actions should you take to manage Karima’s
illness?
3. Ababu is a 3-weeks-old male neonate. His weight is 3.6 kg and his length is 50 cm His
axillary temperature is 36.5ºC. He is brought to the clinic because he is having difficulty
breathing. The health worker first checks the young infant for signs of very severe
disease. His mother says that Ababu has not had convulsions. The health worker
counts 74 breaths per minute. He repeats the count. The second count is 70 breaths
per minute. He has mild chest indrawing. The umbilicus is normal, and there are no skin
pustules. Ababu is calm and awake, and his movements are normal. No jaundice
detected. He does not have diarrhea. How do you classify Ababu?
4. A 4-month-old child Shewit is lethargic, not able to breastfeed but able to swallow and
has no other main symptoms (no diarrhoea, cough or difficult breathing, fever, throat or
ear problem) what treatment plan should be included at the health facility for Shewit?
5. Shashie is 5 weeks old female infant. Her weight is 4 kg and length is 50 cm. Her
axillary temperature is 37°C. Her mother brought her to the clinic because she has a
rash. The health worker assesses for signs of very severe disease. Shashie’s mother says
that there were not convulsions. Shashie’s breathing rate is 55 per minute. She has no
chest indrawing. Her umbilicus is normal. The health worker examines her entire body
and finds a red rash with just a few skin pustules on her buttocks. She is awake, and
her movements are normal. No jaundice detected. She does not have diarrhea
6. Askale is 9 months old female infant. She weighs 6 kg. Her length is 60 cm. Her
temperature is 39 0C. Her mother told the health worker, Askale has had cough for 3
days. She is having trouble breathing. She is very weak. The health worker (HW) said
that I will examine her now." And he checked for general danger signs. The mother
said, “Askale will not breastfeed. She will not take any other drinks I offer her." Askale
does not vomit everything and has not had convulsions. Askale is lethargic. She did not
look at the health worker or her parents when they talked but she was not convulsing.
The health worker counted 55 breaths per minute. He saw chest indrawing. He decided
Askale had stridor because he heard a harsh noise when she breathed in. How do you
classify

7. Suhaib is a 3-month-old baby boy. His mother has brought him to the health center
because he has been passing 3-4 watery stools a day for the past 2 days. This is an

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 initial visit for this problem. Suhaib's axillary temperature is 36.3°C. He weighs 4.1 kg.
He is awake and calm. He has no vomiting and is able to breastfeed. He has had no
convulsions and has no convulsions during your assessment 159. Suhaib has no cough
and no difficulty breathing. His eyes do not look sunken. The skin pinch goes back
slowly. When you offer him some water, he takes few sips and then stops. His mother
reports no blood in the stools. Suhaib has no ear problem and no throat problem. He
does not look severely wasted and has no oedema of his feet. He has some palmar
pallor. His immunizations are up to date. How do you classify Suhaib's illness? What
actions should be included in the treatment plan for Suhaib?
8. Kamel is a 4-month-old baby boy. His mother has brought him to the health center
because he has had fever for 3 days and looks very sick. This is an initial visit for this
problem. Kamel lives in a high malaria risk area. Kamel's axillary temperature is 39.4°C.
He weighs 6.1 kg. Kamel looks drowsy. When you clap your hands or his mother calls
him by name, he keeps staring at one point in front of him and looks not interested in
the surroundings. Attempts of her mother to breastfeed him fail, as he does not suck.
He has had no vomiting or convulsions. He has cough. You hear no stridor or wheeze.
You count 57 breaths per minute. There is no chest indrawing. Kamel has no ear
problem, no skin rash. There is no resistance when you try to bend his neck forward
toward his chest. How do you classify Kamel's illness at this stage of your assessment?
what will be the possible treatment???
9. Aziz is 18 months old male infant. He weighs 11.5 kg. His height is 77 cm. His
temperature is 37.5 0C. His mother brought him to the health facility because he has a
cough. She says he is having trouble breathing. This is his initial visit for this illness. The
health worker checked Aziz for general danger signs. Aziz is able to drink. He has not
been vomiting. He has not had convulsions. He is not convulsing, lethargic or
unconscious. "How long has Aziz had this cough?" asked the health worker? His mother
said he had been coughing for 6 or 7 days. Aziz sat quietly on his mother's lap. The
health worker counted the number of breaths the child took in a minute. He counted 41
breaths per minute. He thought, "Since Aziz is over 12 months of age, the cut-off for
determining fast breathing is 40. He has fast breathing." The health worker did not see
any chest indrawing. He did not hear stridor. What do you do?
10. Zelika is an 18-month-old female child who is living in Legehida woreda, zena amba
kebele, has had cough for 5 days, has no general danger signs, has a respiratory rate of
30 breaths per minute, has no stridor and has no chest in-drawing. How do you classify
Zelika??
11. A 4-month-old female child named Lyuwork was brought to the health facility because
she had diarrhea for 5 days. The health worker assessed the child’s diarrhea and he
observed that she is restless and irritable. While the health worker gives her oral fluid,
she is eager to drink but she did not have danger signs and she was not coughing. How
do you classify?
12. Gosh is a 2-year-old boy. He is lethargic. He is at high risk of malaria & has a fever of
39C. The health worker classifies Goshu as having VERY SEVERE FEBRILE DISEASE &
CHRONIC EAR INFECTION. He has some palmar pallor so is classified as having
ANEMIA, although he has NO ACUTE MALNUTRITION. He has never had a dose of

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 Mebendazole. Goshu needs referral for VERY SEVERE FEBRILE DISEASE. Following is a
list of treatments for all of Goshu's classifications. Which of the following managements
you think are important or appropriate?

a. ______ Give artesunate or Quinine for severe malaria (first dose).

b. ______ Give first dose of an appropriate antibiotic.
c. ______ Treat the child to prevent low blood sugar.
d. ______ Give one dose of Paracetamol in clinic for 38.5  C or above).
e. ----------Refer URGENTLY to hospital.
f. ______ Dry the ear by wicking.
g. ______ Follow-up in 5 days.
h. ______ Assess the child's feeding and counsel the mother on feeding. If feeding
problem, follow-up in 5 days.
i. ______ Give iron.
j. ______ Give oral antimalarial.
k. ______ Give Mebendazole.
l. ______ Advice mother when to return immediately.
m. ______ Follow-up in 14 days (for pallor).

Check/Observe for the provision of proper Counseling and teaching to the mother
according to the national protocol:

 How to give oral drugs at home

 How to treat local infections at
home
 On breast feeding and
supplementary feeding
 On child feeding
 About feeding problems
 About safe preparation of formula
feeding (for HIV positive mothers)
 About fluids and when to return
 About her own health
 Using the family health card (FHC)

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6.3.: Review clinic-based records

The mentor should be familiar with the medical records and should review the facility reports
during the mentorship visit. The facility report can indicate the IMNCI practice that the mentor
needs to target, as the report includes treatment outcome.

During mentorship the clinical mentor should:

 Make sure that the IMNCI register, patient charts are available when reviewing the
management of specific cases with a health care worker.
 Select and review the IMNCI register at random. This is to help the mentor better
understand how to help and mentor the under-five OPD staff, not to audit errors.
 Reinforce the importance of keeping good patient record: good patient medical records
are essential to ensure continuity of care required in SYI or SC care and treatment.
 Demonstrate to the under-five clinic team how to calculate some of the indicators and
use them to monitor and improve quality of care.

 How to review the SC and SYI registers for completeness consistency, and
utilization:

 Explain to mentee that this session is a continuation of the previous schedule

and he/she should not take it as an exam or evaluation; encourage them to be
ready to ask, comment and learn more,
 Explain and demonstrate what completeness and consistency means

Mentor:

- review the registers of SC and SYI-using form below for each visit recording, review of the
new born register.

- Encourage the mentee to refer to the chart booklet for all IMNCI tasks

- Give feedback –start from the strengths and then the areas for improvement

- Sign the date of the review on the register-at the end of the last case as this will allow starting
place for the next mentorship.

Quality of IMNCI service review (completeness and consistency) The last two cases
of each classification

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 Agreement between case management Treatment
Classifications of Check
tasks outcome
SYI and sick child 2 Classif

Immunizatio
month to 5 years # Of Assess & Classify

stated FUD
y&

Worsened

Visit done
Improved
including severe classify & Treat
classificat follow

before
classification

Same
#

Died
ions # Agree # Agree
Agree
2-59 months
1. Severe pneumonia
/very sever disease
(VSD) referred
2. Severe pneumonia
/very sever disease
treated HC
2.Pneumonia
3. Very severe febrile
diseases/severe
4.Malaria
5.diarhea: No/some
dehydration/persiste
nt
diarrhea/dysentery
6. Severe
dehydration /severe
persistent diarrhea
7. Complicated SAM
8. Uncomplicated
SAM
Total classifications
(2-59 months
9. VSD referred to
hospital
10. VSD treated at
HC
11. Preterm or low
birth
weight problem
12. Feeding
or underweight
Total classifications
(< 2 month)
Total Classification
(0-59 months)

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Quality of IMNCI service review (consistency)

# Of Assess & Classify &

Classify & Treat
classify follow up
classificatio # Agree # Agree # Agree
ns
1.Pneumonia
2.Malaria
3.Diarrhea
/Dehydration
4. SAM
Total
classifications
VSD
Preterm or low birth
weight
Feeding problem or
underweight
Total
classifications
Step 3: Clinical case review

The next step of the mentoring visit is a review of cases, to provide the mentee with the
opportunity for practical learning, as well as to allow the mentor to get a better idea of the
clinical competency of the mentee. Clinical case reviews are designed to represent actual
patient encounters and are effective tools for demonstrating clinical decision-making.
Approaches to clinical case review include: -

 Use of Casebooks e.g., IMNCI Training Exercise Booklet,

 Real case presentation and discussion and,
 Logbook of cases prepared by the mentee between mentorship visits, the mentee
should be instructed to keep a logbook of cases to be discussed with the mentor.

……………………………………………………………………………………………………………….

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 2. Nutrition service – Focusing on the first 1000 days Nutrition

(Service area - ANC, under –five OPD, Nutrition room and Immunization room)

6.1Facility readiness assessment for NUTRITION service

7.1.1. Health Center Information

Region: Zone:
Woreda: Kebele:
Name of Health Centre: Catchment population:
Name of Referral Hospital: Distance to Referral hospital:|_______|Kms
Name of satellite HPs and Name of the Health post # of HEWs
number of HEWs 1.

2.

3.

4.

Date of Facility Assessment (dd/mm/yy):

Name of Telephome /email
mentor:___________________________

Name of
mentee:___________________________

1.1.2 Human Resources (health professionals)

I. STAFFING OF UNDER-FIVE OPD YES NO TRAINING STATUS: TRAINING

/ NUTRITION ROOM (ASK) (#) IS STAFF WORKING STATUS: IS
AT THE CLINIC STAFF

26 | P a g e
 TRAINED ON WORKING AT
CMAM? (ASK & THE CLINIC
CIRCLE) TRAINED ON
IYCF? (ASK &
CIRCLE)
1.Nutritionist (applied, clinical or Yes No
Yes No Yes No
public health nutrition)
1. Medical Doctor (GP) Yes No
Yes No Yes No

2. Health Officer (HO) Yes No

Yes No Yes No

3. Nurse (BSC) Yes No

Yes No Yes No

4. Nurse (Diploma) Yes No

Yes No Yes No

5. How frequent is staff

rotation done? (Fill)

6. Is there a need for

additional HR assignment
Yes No
II. STAFFING OF ANC CLINIC YES NO TRAINING STATUS:
(ASK) IS STAFF WORKING
AT THE CLINIC
TRAINED ON
AMIYCF? (ASK &
CIRCLE)
1. Health Officer (HO) Yes No
Yes No

2. Midwifery Yes No
Yes No

3. Nurse (BSC) Yes No

Yes No

4. Nurse (Diploma) Yes No

Yes No

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 1.1.3 Service Availability

S. Type of service Available Comment

No
.
Maternal and Child Nutrition Yes No
Services
1 Maternal nutrition/PLW
2 GMP
3 Under-five screening
4 OTP
5 SC
6 Adolescent Nutrition

1.1.4 Availability of functional space

Please answer each question Circle Issues & actions taken to

answer
address major gaps
I. AVAILABILITY & FUNCTIONALITY OF SPACE FOR NUTRITION (UNDER-FIVE)
RELATED SERVICES (ASK, OBSERVE )

1. Triage area Yes No

2.Adequate Nutrition screening Yes No
area
3.Appetite testing corner Yes No
4.Adequate ventilation and light Yes No
in the room
5.Room location distant from Yes No
adult OPD (Should be located
within the MCH block to reduce
risk of cross-infection)
6.Functional Hand washing area Yes No
with water & soap

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 1.1.5 Availability of guidelines and protocols

I. AVAILABILITY OF PRINT MATERIALS, JOB AIDS (CHECK) AT UNDER-FIVE

CLINIC/NUTRITION ROOM

UNDER-FIVE NUTRITION
OPD ROOM/
OTP/ SC
1.Guideline for the management
of SAM Yes No Yes No
2.Quick reference guide Yes No Yes No
3.Management of SAM register Yes No Yes No
4.WFH/L reference tables Yes No Yes No
5.SAM classification Wall chart Yes No Yes No
6.RUTF reference card Yes No Yes No
7.OTP treatment and follow up
card? Yes No Yes No
2. CINS register
Yes No Yes No
3. CINS tally sheet
Yes No Yes No
4. Growth monitoring chart/
register
Yes No Yes No
5. Nutrition IEC materials and
calendars (if ‘yes’, please
specify)
Yes No Yes No
II. AVAILABILITY OF PRINT MATERIALS, JOB AIDS (CHECK) AT ANC

1. Pregnant and lactating women

register
Yes No
2. Nutrition IEC materials and Yes No
calendars (if ‘yes’, please

29 | P a g e
 specify)

5.1.2 Medical equipment and supplies

AVAILABILITY OF MEDICAL EQUIPMENT, SUPPLIES AND CONSUMABLES AT UNDER-

FIVE/ NUTRITION ROOM
Equipment and Supplies: Availability Functiona
(Ask, Observe) (circle) lity
1. Weight Scale (Infant) Yes No Yes No
2.Weight Scale (Child)

(Uni- Scale/ Salter scale (25

kg) plus pants) Yes No Yes No
3. Thermometer
Yes No Yes No
4. Height measurement board
Yes No Yes No
5. Gloves
Yes No
6. MUAC tape
Yes No Yes No
7. Alcohol/ Hand sanitizers
Yes No
AVAILABILITY OF MEDICAL EQUIPMENT AND SUPPLIES AT ANC
1. Weight scale (Adult)
Yes No Yes No
2. Adult MUAC
Yes No Yes No

5.1.3 Availability of essential drugs and supplements

I. AVAILABILITY OF ESSENTIAL DRUGS IN THE LAST THREE MONTHS INCLUDING

ON THE DAY OF THE VISIT (UNEXPIRED) AT UNDER-FIVE OPD/ NUTRITION
ROOM

30 | P a g e
3. Albendazole Yes No

4. Amoxicillin DT Yes No

5. Vitamin A Yes No

6. Plump Nut/ RUTF Yes No

7. Stock outs or interruptions in Yes No

dispensing nutrition
commodities with reasons and
actions taken

8. Timely refill of requisition and Yes No

reporting forms (RRF) at
pharmacy store (check date
of the last request)

II. AVAILABILITY OF ESSENTIAL DRUGS IN THE LAST THREE MONTHS INCLUDING

ON THE DAY OF THE VISIT (UNEXPIRED) AT ANC

1. IFA Yes No

2. Albendazole for Yes No

deworming

5.1.4 Monitoring and evaluation tools and formats

I. MONITORING &
EVALUATION TOOLS AND
FORMATS (ASK, CHECK)
(CIRCLE)
1. National DHIS-2 monthly
reporting forms/ nutrition data
elements Yes No
2. Monthly statistic reporting forms Yes No

31 | P a g e
for SAM/MAM/GMP/PLW
3.Monthly Supplies Report for SAM
and MAM Yes No
4. Referral forms/Slip (inter-facility,
Intra-facility) Yes No
II. DATA USE (TARGETS & REPORTING)

1.Are reports reviewed by under-five Yes No

OPD/Nutrition room staff? Review
last report with staff.
2.Practice of using/interpreting Yes No
Growth Monitoring charts
3. Sending reports on time; Yes No
Accuracy/quality of reports

4. Are catchment area targets Yes No

met? Review and make plans
with staff to meet targets.

5. Practice of interpreting Yes No

results of reports and making
plans for quality improvement

6. Does the HW get referral Yes No

feedback?

III. REFERRAL SYSTEMS (BIDIRECTIONAL I.E. ABOVE & BELOW):

1. System for tracking linkage within Yes No

the HC/ integration with other
services
2.System for tracking Outside Yes No
referrals

32 | P a g e
 1. System to link to social Yes No
support/ TSFP, PSNP

2. Using referral and feedback Yes No

forms

3. documenting attempts to Yes No

track loss of follow-up visits/
defaulters

5.2 Mentee self-assessment Tool:

 Ask the mentee to present his/her experiences based on the following

questions:
 How should the HC work to improve nutrition services performance?
 What support does the mentee expect from the mentorship? ( Probe: To what
depth does the mentor provide support, what tools do to use during the visit
etc.)

Tool for mentee’s self-assessment

To be completed by mentee
submitted to Mentor:
Frequency: Baseline, at last mentorship visit (visit no. 6)
Clinical competency assessment: Mentee self-assessment
Directions for the mentee: The following tasks ask how confident you feel about your ability to do
specific tasks at the under-five OPD/Nutrition room. Please complete the form and submit to the
mentor.
1 I am not at all confident: I do not know how to do this task
2 I am somewhat confident: I can perform the task with support
3 I am extremely confident: I am capable of doing this task and consider myself competent/
proficient
4 I consider myself to have expertise and can teach this task to others
Task/Competency 1-4
PREGNANT and LACTATING WOMEN

Assess and counsel the pregnant women

33 | P a g e
 1 Perform nutritional screening (Adult MUAC, managing accordingly) If needed
link: to TSF/ Food support, PSNP, Reproductive health services

2 Perform nutrition assessment and counseling

3 Checking for Weight gain during pregnancy
4 Counsel on one extra meal and rest during pregnancy
Pregnant and Lactating women

5 Counsel on healthy eating, diversified meal and use of Iodized salt

6 Advise on ITN use for Malaria endemic areas
7 Advice on early initiation of breast feeding and feeding of colostrum
8 Advise on Avoidance of pre-lacteal feeding
9 Checking for Iron Folate and Folic acid supplementation adherence
10 Deworming the pregnant women
Counsel the lactating mother

11 Counsel on two extra meal and rest during lactation

12 Counsel on healthy eating, diversified meal and use of Iodized salt

13 Advice on use of ITN

14 Counsel to continue use of Iron folate

15 Advice on Family Planning

16 Counsel on Optimal breast feeding (early initiation, proper attachment and

positioning, feeding on demand)
17 Advice on exposing the child on direct sunlight

BABY FROM BIRTH UP TO 6 MONTHS

Assess the Young Infant and Counsel the Mother

1 Assessing the Young Infant from Birth Up to 6 Months
young infant Birth up to six

2 Checking for Underweight at birth

3 Checking for early initiation of breast feeding and colostrum feeding
4 Checking for exclusive breast feeding practice
5 Checking for proper positioning and attachment of BF
6 Checking for Breast Feeding Problem/ Pre-lacteal feeding, any bottle feeding,
formula feeding
7 Checking for Feeding Problem: HIV Positive Mother Not Breastfeeding
8 Checking & classifying the child for Acute Malnutrition
Treating the Young Infant and Counsel the Mother
9 Care for the child with Acute malnutrition

34 | P a g e
 m 10 Keeping the Young Infant Warm
o 11. Teaching early initiation of BF within one hour and avoidance of prelacteal
n feeding and exclusive BF practice
t 12 Teaching Correct Positioning, Attachment, frequency, mechanism for
h Breastfeeding and benefits of BF
s 13 Teaching the Mother to Continue breast feeding during illness and recovery
14 Teaching the Mother to Breast feed on demand day and night, empty one
breast at a time
15 Advising the Mother to bring the child for growth monitoring and promotion
monthly
CHILD 6 MONTHS UPTO 5 YEARS
Assess and Classify and Identify Treatment
1. Checking & classification the child for underweight/ Growth monitoring and
promotion/

2. Plotting & Interpreting WFA Chart (Birth to 5 years Z-Score)

3. Checking initiation of complementary feeding practice

CHILD 6 MONTHS UPTO 5 YEARS

4. Check quality of complementary feeding; diet diversity and frequency

5. Perform cooking demonstration for improved CF

6. Check & classifying the child for Acute Malnutrition (6- 59 months)

7. Plotting & Interpreting WFL/H (Z-Score)

8. Measuring & Interpreting MUAC

9. Check appetite test

10. Checking the Child’s Immunization, Deworming and Vitamin A Status

35 | P a g e
 Treat the child and counsel the mother
11. Giving Vitamin A

12. Giving Albendazole for Deworming

13. Treating the child for acute malnutrition according to the protocol

14. Teaching age appropriate CF (IYCF) and continuation of BF until 2 years and
beyond

15. Teaching WASH practices

16. Link the child with underweight to TSFP

COUNSELING THE MOTHER

Food:
17. Assessing the Child’s Feeding

18. Counseling the mother on early initiation of breast feeding and avoidance of
prelacteal and bottle feeding

19. Feeding Recommendations for All Children During Sickness & Health and
including HIV Exposed Children on ARV Prophylaxis

20. Feeding Recommendation for a child with Uncomplicated SAM

21. Feeding Recommendations for A Child with Persistent Diarrhoea

22. Feeding Recommendation for a non-breast-feeding child (any reason)

23. Counselling the mother on exclusive breast feeding up to 6 months

36 | P a g e
 24. Counselling the mother on complimentary feeding after 6 months

25. Counseling the Mother About Feeding Problems

26. Counseling the Mother about Safe Preparation of complementary feeding

preparation

27. Counseling the HIV+ Mother who has Chosen Not to Breastfeed/ Appropriate
Amount of Formula Needed per Day

28. How to Feed a Baby with a Cup

29. Counseling the Mother about Fluids and When to Return

30. FLUID:

31. Advising the Mother to Increase Breast feeding During Illness

32. When to Return i.e. Advise the Mother when to Return to the Health worker

33. Counseling the Mother About Her Own Health

34. Use of the Family Health Card

35. Giving Follow-up Care

36. Every month growth monitoring and promotion (GMP)

37. Uncomplicated Severe Acute Malnutrition follow up visit

37 | P a g e
 38. Moderate Acute Malnutrition

39. Vitamin A and Deworming every six months

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