Sudan Imci 1

Integrated
Management of
Childhood Illness
IMCI Lecture 1
Adapted from: Alexandria University lectures
Edited By: Dr. Shaza Ahmed Sidahmed
IMCI/ SUDAN
IMCI Student Lectures1 1

The IMCI process relies on:
• Case detection using simple clinical

signs based on expert clinical opinion
and results of research.
• Empirical treatment developed

according to action-oriented
classification rather than exact diagnosis
and covering the most likely diseases.

Age Groups Covered By IMCI
IMCI process can be used by health
providers (Doctors , Medical Assistants
& Nurses) who look after sick infants
and children up to 5 years.
Two Age Groups Are Covered:
– Children aged 2 months up to 5
years
– Infants from one week up to 2
months
Where Care for Children Is Provided?
Home 1st level health facility Specialized hospital
Community REFERRAL
Component
IMCI CARE

Where should IMCI be applied?
At 1st level health facilities:

– Clinics
– Rural and urban health centers
– MCH centers
Since children with potentially fatal

illnesses are brought to these 1st level
facilities.

Diseases Covered By IMCI
• Cough or difficult
breathing
• Diarrhea
• Fever & Measles
3/4
of Episodes of
• Ear Problems Childhood illness
MALNUTRITION
Diseases NOT covered by IMCI
• The IMCI guidelines address the most
important but NOT ALL of the major
reasons a sick child or an infant is
brought to the clinic with.
• IMCI encourages the health provider to
assess problems not included in IMCI
charts. These are considered under the
box :
ASSESS OTHER PROBLEMS
The IMCI Wall Charts
• For sick children aged 2 months – 5
years:
• Assess and Classify the sick child
• Treat the child
• Counsel the mother
• For sick infants from 1 week up to 2
months:
• Assess, Classify and Treat the sick
young infant

Assess & Classify
the Sick Child,
Age 2 months up
to 5 years

Step by Step through the IMCI charts:
ASSESS & CLASSIFY THE SICK CHILD
AGE 2 MONTHS UP TO 5 YEARS,
TREAT THE CHILD, and COUNSEL THE
MOTHER:
• General Danger Signs
• Cough or Difficult breathing
• Diarrhea
• Fever & Measles
• Ear Problems
• Malnutrition and Anemia
• Check the child immunization and vitamin A
supplementation status
• Assess Other problems
• Treat the Child
• Counsel the Mother
• Give follow-up care

General Danger Signs
CHECK
for
GENERAL
DANGER SIGNS
in
ALL SICK
Children
General Danger Signs
Checking for General danger si
gns
:
1- Unable to drink or breastfeed
2-Vomits every thing
3-
Has the child had convulsions?
4- Unconscious, lethargic
5- Is the child convulsing now
ASK THE MOTHER WHAT THE CHILD’S PROBLEMS ARE?
 Determine if this is an Initial or Follow Up visit for this problem

 If Follow Up visit, use the follow up instruction on
TREAT THE CHILD CHART
 If Initial visit, assess the child as follows:
CHECK FOR GENERAL DANGER SIGNS

ASK and check LOOK
· Is the child able to drink or breast- · See if the child is lethargic or

feed? unconscious
· Does the child vomit every thing? · See if the child is convulsing
· Has he had convulsions? (during now
present illness)

Unable to Drink or Breastfeed?
The child is unable (too weak) to suck or
swallow when he is offered a drink or
breast milk
• Ask the mother to describe exactly what
happens when she offers the child
something to drink
• Ask the mother to offer her child a drink of
clean water or breast milk and look to see
if the child is swallowing .

Vomits Everything ?
Not able to hold anything down AT ALL
• Not able to hold down food, fluids or oral
drugs.
• ALL what goes down comes back up
• A child who vomits several times but can
hold down some fluids does not have this
general danger sign.

Has the child had convulsions?
• Ask the mother if the child developed
convulsions during the current illness.
• Use words the mother understands.

Convulsions (cont…)
• Explain what do you mean exactly
by “convulsions”.
• In a convulsing child the arms and
legs stiffen. The child may loose
consciousness or may not be able
to respond to spoken directions.

Unconscious ?
• An unconscious child is a child who cannot
be awakened.
• The child does NOT respond when he is :
• Touched
• Shaken, or
• Spoken to

Lethargic ?
Difficulty in maintaining the aroused
state
• A lethargic child is NOT awake and
alert when he should be.
• He is drowsy and does not show
interest in what is happening around
him.
Lethargic (cont…)
• Often a lethargic child
does not look to his
mother or watch
examiner face when
talks.
• A lethargic child may
stare blankly and
appears not to notice
what is going around.
Cough OR Difficult Breathing
Then
ASK
About:
COUGH OR
DIFFICULT
BREATHING
Acute Respiratory Infections (ARI)
Importance
Definition
Role of IMCI
Pneumonia
Recognition • Fast breathing
Wheezing
Causes •
Why Added ?
How to classify Cough or Difficult breathing?

Severe pneumonia or very severe disease
Pneumonia
No pneumonia, Cough or cold

“Cough OR Difficult Breathing,” NOT
“Cough AND Difficult Breathing”
 Fewer than 25 percent of children

with cough also have difficult
breathing
 Many causes of difficult breathing
are not related to cough
 Using both can cause false positives

Acute Respiratory Infections
( ARI )
Global & National Health Problem
• Common cause of mortality.

• Common cause of morbidity.
• Commonest reason for irrational
drug prescription.

Role of IMCI in ARI
Insure Adequate Case Management
• Identify those who need URGENT REFERRAL
• Identify cases of PNEUMONIA.
• Rationalize the use of DRUGS
• Breast feeding and optimal nutrition
• Vaccination and Vitamin A supplementation

Assessment
THEN ASK ABOUT MAIN SYMPTOMS
Does the child have Cough or Difficult breathing?
IF YES, ASK LOOK and LISTEN
· For how long? · Count the breaths in one Child

minute must
· Look for chest indrawing be calm
· Look and listen for stridor
· Look and listen for wheeze

Pneumonia: Severity
• Recognition is based on:
•• Lower
Lower chest
chest wall
wall indrawing
indrawing
•• Stridor
Stridor
•• Fast
Fast breathing
breathing

LOWER CHEST WALL INDRAWING
Index of :
Severe Pneumonia
or very severe disease
Reasonable sensitivity
& specificity " 89%".

Lower Chest Wall Indrawing
• Studies found that lower chest wall indrawing

best identified children who required referral,
admission or further assessment.
• Must be definite, present all the time in a
calm child. IMCI Student Lectures1 29
STRIDOR
• Is Another Indicator for Severe
Pneumonia or V. Severe Disease.
• It is a harsh Inspiratory Voice.
• Look & Listen to Stridor:
Listen to the harsh voice (in a calm child)
Look at the chest wall (phase of
breathing)

WHY FAST BREATHING ?
Good Predictor of PNEUMONIA

In the sick child 2 months – 5 years
• Simplicity
• Ease in training *
• Reliability
*
“Sensitivity & specificity around 80%”
Sensitivity= proportion of those with the disease who are correctly identified by sign
Specificity= proportion of those without the disease who are correctly called free of the
disease by using the sign.
FAST BREATHING !
Why not other signs of pneumonia?
• Fever is poor predictor of pneumonia.

• Auscultation is less sensitive
indicator
and needs skills

CUT-OFF POINTS
for FAST BREATHING
If the child is: FAST BREATHING IS:
•2 months up to 12 50 breaths per minute
months
or more
•12 months up to 5
years 40 breaths per minute
or more
• Best to count rate in a quiet and alert child

• Fever can affect respiratory rates, but do not
wait for fever to subside
Cut-offs of Fast Breathing
60
50
40
Wheezing: Causes
• Under age of 2 years - Bronchiolitis
• Older children plus those with recurrent
attacks of wheeze - bronchial asthma or
reactive airways disease
– Transient wheezers
– Persistent wheezers
• Other respiratory infections
• Inhaled foreign body
• Tuberculosis node compressing bronchus

Wheezing: Why Added ??
• Morbidity from asthma is a problem in Sudan
• Will reduce unnecessary referral to hospital
• Rapid-acting bronchodilators are available at
first-level facilities
• Health workers are trained to recognize audible
wheeze and use bronchodilators
• Health worker can recognize when a child with
recurrent wheeze is not responsive in the first-
level health facility
CLASSIFFY COUGH OR
DIFFICULT BREATHING

Any General D.Sign or
CHEST INDRAWING or
STRIDOR
SEVERE PNEUMONIA
OR VERY SEVERE DISEASE

Severe Pneumonia OR
Very Severe Disease
Recognition:
Urgently Refer Children with Cough
OR Difficult Breathing AND
– Any general danger sign OR

– Lower chest wall indrawing OR
– Stridor in a calm child

FAST
FAST BREATHING
BREATHING
PNEUMONIA
PNEUMONIA
No signs of
Pneumonia
or Very No Pneumonia,
Severe Cough or Cold
Disease
Antibiotics

Diarrhoea
Then
ASK
About :
DIARRHEA
Diarrhoea
Diarrhoea
Assessment
Dehydration
Assessment • Classification
Home Fluids
Selection • Fluids to avoid
Persistent Diarrhoea
Definition • Causes
Classification
Dysentery
Classification
Antibiotics IMCI Student Lectures1 43
Assessment of Diarrhoea
DIARRHEA
DEHYDRAT ION PERSIST ENT DYSENT ERY

For All DIARRHEA Conditional
Conditional

Does the child have diarrhea?
IF YES ASK: LOOK AND FEEL:
•For how long? •Look at the child’s general condition, Is he:
•Is there blood in –Lethargic or unconscious?
the stool? –Restless or irritable?
•Look for sunken eyes
•Offer the child fluid. Is the child:
–Not able to drink or drinking poorly?
–Drinking eagerly, thirsty?
•Pinch the skin on the abdomen.
Does it go back :
–Very slowly (longer than 2 seconds)?
–Slowly?

Dehydration
Assessment is based on 4 signs:
• General Condition (lethargic, unconscious
OR restless, irritable)
• Sunken Eyes (ask caretaker as well)
• Drinking (poorly OR eagerly)
• Skin Pinch (very slowly OR slowly)
– Pinched in a vertical manner
– Pinched between the thumb and the bent fore-finger
– Pinched mid-way between umbilicus & side of
abdominal Wall.
Dehydration
Assessment
• Mistakes in taking a skin pinch:
– Pinching either too close to the midline or too far laterally
– Pinching the skin in an horizontal direction
– Not pinching the skin long enough
– Releasing the skin so that the finger and thumb remain in a
closed position
• Classification of skin pinches:
– Normal — it goes back immediately
– Slowly — the fold is visible for less than 2 second
– Very slowly — the fold is visible for more than 2 seconds.

CLASSIFY FOR
DEHYDRATION

Two of the following signs: Ø If child has no other severe
· Lethargic or unconscious classification: Give fluids for
· Sunken eyes SEVERE severe dehydration (Plan C)
· Drinks poorly or unable DEHYDRATION Give Zinc OR
to drink Ø If child has also another severe
· Skin pinch goes back classification: Refer URGENTLY
very slowly to hospital while giving ORS sips
-Advise to continue breastfeeding
Two of the following signs: Ø Give fluids and food for some
· Restless, irritable dehydration (Plan B)
· Sunken eyes Give Zinc
· Thirsty, drinks eagerly SOME Advise when to return immediately
· Skin pinch goes back DEHYDRATION Follow up in 5 days if not improving OR
slowly Ø If child has also a severe
classification:
- Refer URGENTLY to hospital
while giving frequent ORS sips
-Advise to continue breastfeeding
· NO enough signs to Ø
Ø Give fluids and food to treat diarrhea
classify as some or NO Ø at home (Plan A)
severe dehydration DEHYDRATION Ø Give Zinc
Ø Advise when to return immediately
Ø Follow up in 5 days IF not improving
Home Fluids For Oral Dehydration
Selection:
• Home Fluids for Diarrhea Must Be:
– Safe when given in large volumes
– Easy to prepare
– Acceptable color and palatability
– Effective in preventing dehydration

Home Fluids For Oral Rehydration
Selection:
• Ideal home fluids contain:
– salts and nutrients (sodium, potassium, chloride,
and bicarbonate)
– calories to replenish diet
• Examples of home fluids:

– ORS solution
– salted soup
– salted drinks (Rice water, Nasha)
Selection:
• Other acceptable home fluids that do not contain salt:
– plain clean water
– water in which a cereal has been cooked (unsalted)
– soup (unsalted)
– yoghurt-based drinks (unsalted)
– gongolaze juice
– fresh fruit juice (unsweetened)

Fluids to avoid:
• Fluids causing hypernatremia:
– most soft and carbonated drinks
– sweetened fruit drinks
• Fluids with stimulant, diuretic or purgative
effects:
– coffee
– some medicinal teas or infusions

Persistent Diarrhea
Definition:
• Diarrhea that occurs for 14 or more days
• Less than 10 percent of all diarrhea
• Associated with 30 to 50 percent of
diarrhea deaths
• Malnutrition greatly increases the risk of
death

Persistent Diarrhea
Causes:
• Proximate Causes
• Secondary disaccharidase deficiency
• Salmonella sp.
• Shigella sp.
• Enteroadherent E. coli
• Cryptosporidium
• Contributing Factors
• Protein energy malnutrition
• Micronutrient deficiencies
• Immunodeficiency

CLASSIFY FOR
PERSISTENT
DIARRHEA

Classifying For Persistency
Ø Treat dehydration before referral unless
· Dehydration present SEVERE the child has another severe classification
PERSISTENT Give Zinc
DIARRHEA
Ø Refer to hospital
Ø Advise mother on feeding child with

PERSISTENT Persistent Diarrhea
· No dehydration DIARRHEA Ø Give Zinc
Ø Advise mother when to return immediately
Ø Follow up in 5 days

CLASSIFY FOR
DYSENTERY

•Blood in the •Treat for 5 days with an oral
stools antibiotic recommended for
DYSENTERY Shigella
•Give Zinc
•Advise mother when to return
immediately
•Follow-up in 2 days

Antibiotics for Dysentery
Antibiotics:
• Effective for Shigella species and for
Salmonella in infants under one year of age.
• Early Treatment with Antibiotics:

– shortens the duration of the illness
– reduces risk of serious complications
& death
Antimicrobials against Shigella
EFFECTIVE INEFFECTIVE
• Co-Trimoxazole • Metronidazole
• • Streptomycin
Nalidixic acid
• Chloramphenicol
• Pivmecillinam • Sulfonamide
• Ceftriaxone • Cepholosporins
• Ciprofloxacin • Aminoglycosides
• Other quinolones • Nitrofurans

SUMMARY:
HOW TO CLASSIFY DIARRHEA?
There are 3 Classifications for diarrhea:

• Classify for DEHYDRATION (for ALL Children)
• Classify for PERSISTENT DIARRHEA
(Conditioned)
• Classify for DYSENTERY (Conditioned)

EAR PROBLEM
ASK
about :
EAR
PROBLEM

Ear Infection ?
• External ear :
Otitis Externa
• Middle ear :
Otitis Media
Assessment of Ear Problem
ASK
• Ear Pain
• Discharge :Purulent or Serous
Look:
• Pus draining from the ear
Feel for:
• Tender swelling behind the ear
(Mastoid)
EAR PROBLEM
ASK
• Ear Pain
• Ear Discharge
LOOK
• Pus Draining from the ears
FEEL:
• Tender swelling behind ear

MASTOIDITIS

ASSESS EAR PROBLEM:
Does the child have an ear problem?
IF YES ASK: LOOK AND FEEL
· Is there ear pain? · Look at pus draining from the ear

· If there ear discharge? · Feel for tender swelling behind the ear.
If YES, for how long?

CLASSIFY EAR
PROBLEM

Ø Give 1st dose of appropr. antibiotic
· Tender swelling behind Ø Give 1st dose of paracetamol for pain
the ear MASTOIDITIS Ø Treat child to prevent low blood
sugar
Ø Refer URGENTLY to hospital
· Pus seen draining from Ø Give antibiotic for 5 days

ear Ø Give paracetamol for pain
and Discharge reported Ø Dry the ear by wicking
for ACUTE EAR Ø Advise when to return immediately
less than 14 days OR INFECTION Ø Follow up in 5 days
· Agonising ear pain
· Pus seen draining from Ø Dry the ear by wicking

ear CHRONIC Ø Follow up in 5 days
and Discharge reported EAR Advise when to return immediately
INFECTION
for 14 days or more
· No ear pain and

· No pus seen draining NO EAR Treat according to condition or
from INFECTION Refer for further assessment
the ear

FEVER
ASK
about
FEVER

Fever
Febrile Illness
Causes
Fever After seven Days

Referral
Classification of Fever
Overview
Stiff neck
Classification of fever

Febrile Illness
Causes:
• Fever as a secondary cause
– management of the condition results in
management of the fever
– Malaria, pneumonia, measles, dysentery, ear
infections, runny nose
• Fever associated with severe illnesses which use

danger signs for classification and treatment
– meningitis, septicemia, sepsis

Febrile Illness
• Non-localizing signs do not allow for
distinction at a first-level health facility
• Danger signs identify a seriously ill child
who needs to be referred
• Meningitis, septicemia
• Severe pneumonia or Very severe disease
• Mastoiditis
• Severe complicated Measles, etc

Fever after seven Days
• Conditions do not have any obvious simple
clinical sign but have fever in common
• Prevalence too low to include specific signs
and symptoms for each condition
Referral
Fever after seven Days
Referral in Order To:
• Differentiate between simple viral fevers and other
diseases where the only presenting symptom is fever
• Detect conditions needing diagnostic and therapeutic
intervention
– Tuberculosis
– Urinary tract infection
– Typhoid, Brucellosis, Osteomyelitis, etc.

Does the child have fever?
(by history or feels hot or temperature 37.5 oC or more)
IF YES, Decide Malaria Risk LOOK, FEEL AND CHECK

(High or Low), then ASK:
•
For how long?
.
· Look or feel for stiff neck
Look for runny nose
· If more than 7days, has fever Check BF Results +ve -ve
been present every day? Look for signs of Measles:
· Has the child had measles · Generalised rash and
within the last 3 months? · One of these: cough, runny nose,
or red eyes.
If the child has measles now or · Look for mouth ulcers

within the last 3 months: Are they deep and extensive?
· Look for pus draining from the eye
· Look for clouding of the cornea
Looking and
Feeling
for
STIFF NECK

CLASSIFY
FEVER

IN HIGH MALARIA RISK AREA
Give 1st dose of Quinine
Any general danger
--
Give 1st dose of appropriate antibiotic
sign. VERYSEVERE Treat to prevent low blood sugar
-Stiff neck FEBRILE Give one dose of paracetamol in clinic
DISEASE for high fever.
Ø Refer urgently to hospital
Ø Give oral antimalarial
MALARIA Ø Give 1st dose of paracetamol for high
· Fever (by history, fever.
feeling hot or Ø Advise mother when to return immediately
temperature 37.5 c or Ø Follow up in 2 days if not improving
more. if fever present for more than 7 days refer for
further assessment

LOW RISK MALRIA AREA
• WHEN LAB. SERVICE IS AVAILBLE:

• THE BF RESULT IS USED IN
CLASSIFICATION.

· Any general danger VERY Ø Give 1st dose of appropriate antibiotic
sign OR SEVERE Ø Treat child to prevent low blood sugar
· Stiff neck FEBRILE Ø Give one dose of paracetamol in clinic for
DISEASE
high fever 38.5oC or above
· positive thick blood Ø Give oral antimalarial

film for malaria Give 1st dose of paracetamol in the clinic
for high fever (38.5oC or more).
MALARIA Ø Advise mother when to return immediately
Ø Follow Up in 2 days IF fever persists
Ø If fever is present every day for more than
7days, refer for further assessment.
Ø Give 1st dose of paracetamol for high fever

· Negative thick blood FEVER- (38.5oC or more)
MALARIA Ø Advise mother when to return immediately
film for malaria
UNLIKELY Ø Follow Up in 2 days IF fever persists
Ø If fever is present every day for more than
7 days, refer for assessment

IN LOW RISK AREA
• WHEN LAB. SERVICE IS NOT

AVAILABLE:
• CLASSIFY BY EXCLUDING CAUSES
OTHER THAN MALARIA.

· Any general danger VERY Ø Give 1st dose of appropiate antibiotic (I.M)
sign SEVERE Ø Treat child to prevent low blood sugar
OR FEBRILE Ø Give one dose of paracetamol in clinic for
DISEASE
· Stiff neck fever 38oC or above
· Ø Give oral antimalarial

Give paracetamol for fever (38.5oC or
more)
No runny nose MALARIA Ø Advise mother when to return immediately
No measles Ø Follow Up in 2 days IF fever persists
No other cause of fever Ø If fever is present every day for more than
7 days, refer for assessment.
Ø Give paracetamol for fever (38.5oC or

· Runny nose present FEVER- more)
MALARIA
or UNLIKELY
Treat other causes of fever
Measles present now or Ø Advise mother when to return immediately
another cause of fever Ø Follow Up in 2 days IF fever persists
is present Ø If fever is present every day for more than
7 days, refer for assessment

MALNUTRITION & ANAEMIA
CHECK
For
MALNUTRITION
and
ANEMIA
in ALL SICK
CHILDREN
MALNUTRITION & ANEMIA
Anemia
Clinical signs for classification
Sensitivity and specificity of signs
Nutritional status
Iceberg of malnutrition
Weight for age as indicator
Other indicators
Growth Monitoring
Checking for Malnutrition and Anemia
Wasting Edematous feet Weight for age CHART Pallor
Classification
of nutritional status
of anemia
Anaemia
Clinical Signs for Identification:
• Severe anaemia: classified by using severe
palmar pallor.
• Anaemia: classified by using some palmar
pallor.
• Study in Alexandria (2000-01):
Clinical Sign Sensitivity Specificity
Severe Palmar Pallor 60.6% 96.4%
Some Palmar Pallor 87.3% 47.7%
Severe Conjunctival Pallor 52.7% 98.1%
Some Conjunctival Pallor 49.9% 64.0%
Severe Lip Pallor 42.9% 97.8%
Some Lip Pallor 53.1% 57.1%
Nutritional Status
• All children should be assessed for nutritional status
• Low weight requiring home management or
nutritional counseling
• Severe malnutrition needs referral, It is indicated by:
– visible severe wasting (marasmas)
– Edematous malnutrition (kwashiorkor) indicated
by edema of both feet
– Cloudiness of the cornea

severe forms
Mild & Moderate forms
The Iceberg of Malnutrition

Weight for Age as Indicator
• Weight for height assessments most

accurate but not routinely performed
• Weight for age Z-score can be

viewed as a proxy estimate for weight
for height

Other Indicators
• Low WFA (<-2 Z-score)

– Population-based nutritional surveys only
– For comparison of different areas and time
– Not for patient-based disease
• Mid upper arm circumference (MUAC)

– Not as effective as WFH gold standard
– Prone to errors: even half a centimeter could
result in wrong classification
– Useful for screening an emergency situation
Growth Monitoring
Limitations:
• Could provide valuable information about a child’s current
growth -- potential powerful tool
• No consensus on quantitative definition of growth faltering
– Weight loss between 2 monthly measurements
– Weight gain over 3 monthly measurements
– Falling off the curve
• Efficacy difficult to demonstrate
– No effect on nutritional status
– Health workers have difficulty recognizing “faltering”

THEN CHECK FOR MALNUTRITION AND
ANAEMIA
LOOK AND FEEL:

Look for visible severe wasting
Look for clouding of the cornea
Look for edema of both feet
Look for palmar pallor. Is it:
- Severe palmar pallor?
- Some palmar pallor?
Determine weight for age. Is it:
Very Low
Not Very Low

LOW WEIGHT FOR AGE

CLASSIFY
NUTRITIONAL
STATUS

CLASSIFY NUTRITIONAL STATUS
· Visible severe wasting SEVERE Ø Give vitamin A
OR MALNU- Ø Treat the child to prevent low blood
Cloudiness of cornea or TRITION sugar
· Edema of both feet or OR Ø Refer URGENTLY to hospital
SEVERE
severe palmar pallor ANAEMIA
Ø Assess the child’s feeding & counsel
ANEMIA mother according to FOOD box
· Low weight for age OR If pallor: Give iron
some palmar pallor V.LOW Give oral antimalarial (high risk malaria)
WEIGHT Follow in 14 days
Ø If v.low weight: Follow up in 30 days
Ø Advise when to return immediately
NO Ø If child is less than 2 years old, assess
· Not low weight for age ANEMIA- feeding & counsel mother according to
and no other signs of NOT FOOD box
malnutrition LOW If there is feeding problem: F. up in 5 days
WEIGHT Advice the mother when to return
immediately

CHECK THE CHILD
IMMUNIZATION STATUS
CHECK
IMMUNIZATION
and
VITAMIN A
Supplementation
status
In ALL CHILDREN

CHECK THE CHILD’S IMMUNIZATION AND
VITAMIN A SUPPLEMENTATION STATUS
AGE VACCINE VITAMIN A
At birth BCG &

OPV-0 From the 6th
6 weeks OPV-1 Penta 1 month up to 5
10 weeks OPV-2 Penta 2 years, to be
14 weeks OPV-3 Penta 3 given 6
9 months Measles monthly
ASSESS OTHER PROBLEMS

TREAT THE CHILD
Give an Appropriate Oral Antibiotic…..
Teach the Mother to Give Oral Drugs at Home…
Teach Mother to Treat Local Infections at Home…
Treatments Given in Clinic Only….

Give Extra Fluid for Diarrhea
Continue Feeding…
Immunize Every Child, as Needed…

GIVE FOLLOW-UP CARE
Pneumonia, No pneumonia-Wheeze
Dysentery, Persistent Diarrhea
Malaria, Fever- Malaria unlikely, Measles, Ear Infection
Feeding Problems, Low weight
Pallor
COUNSEL THE MOTHER
FOOD:
• Assess Child’s Feeding
• Feeding Recommendations during Illness & Health
• Counsel the Mother about Feeding Problems
FLUID
• Advise the Mother to Increase Fluid During
Illness
Advise the Mother when to Return to Health Worker
Counsel the Mother About Her Own Health

UNCONSCIOUS CHILD

LETHARGIC CHILD

CLASSIFY GENERAL DANGER SIGNS:
SIGNS CLASSIFY AS TREAT
Ø Treat convulsions IF present now

· Any Ø Complete assessment immediately
Danger Ø Give 1st dose of appropriate
antibiotic
Sign VERY Ø Treat child to prevent low blood
SEVERE sugar
DISEASE Ø Refer URGENTLY to hospital

Sunken
Eyes

Skin Pinch returnsIMCIVery Slowly (> 2 seconds108
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Integrated

IMCI Student Lectures1 1

• Case detection using simple clinical

• Empirical treatment developed

IMCI Student Lectures1 2

Home 1st level health facility Specialized hospital

IMCI Student Lectures1 4

At 1st level health facilities:

Since children with potentially fatal

IMCI Student Lectures1 5

IMCI Student Lectures1 8

IMCI Student Lectures1 9

IMCI Student Lectures1 10

 Determine if this is an Initial or Follow Up visit for this problem

CHECK FOR GENERAL DANGER SIGNS

· Is the child able to drink or breast- · See if the child is lethargic or

IMCI Student Lectures1 13

IMCI Student Lectures1 14

IMCI Student Lectures1 15

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How to classify Cough or Difficult breathing?

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 Fewer than 25 percent of children

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• Common cause of mortality.

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THEN ASK ABOUT MAIN SYMPTOMS

Does the child have Cough or Difficult breathing?

IF YES, ASK LOOK and LISTEN

· For how long? · Count the breaths in one Child

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• Studies found that lower chest wall indrawing

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Good Predictor of PNEUMONIA

• Fever is poor predictor of pneumonia.

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• Best to count rate in a quiet and alert child

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– Any general danger sign OR

– Stridor in a calm child

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DEHYDRAT ION PERSIST ENT DYSENT ERY

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– Safe when given in large volumes

– Acceptable color and palatability

– Effective in preventing dehydration

• Examples of home fluids:

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Ø Advise mother on feeding child with

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