INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

SALIENT POINTS
Goal: For the family and community to participate in the total health care system Target Setting: Children below 5 years of age Two Age Groups Birth 2 months 2 months 5 years of age

# 1 Cause of Mortality Malnutrition (old IMCI) Pneumonia (new IMCI)

Least Cause of Mortality: HIV Role of the PHN: Facilitator Partner of the PHN: Community

QUESTIONS TO BE ASKED IN IMCI

1. What is the age of the child? 2. What is the problem?

Remember: ask the mother to what the childs problem are: Greet the mother Use good communication skills

1. ASK question and LISTEN to find out what the mother is already doing for the child 2. PRAISE the mother for what she has done well 3. ADVISE her how to treat the child at home 4. CHECK the mothers understanding

Advise the mother how to treat the child at home: 1. GIVE INFORMATION
2. SHOW AN EXAMPLE

3. LET HER PRACTICE

The steps:
1st: Assess for the Danger Sign 2nd: Assess for the Main Sign and Symptoms 3rd: Assess for the Immunization and Nutrition 4th: Classification

Step One: ASSESS FOR THE DANGER SIGNS

Convulsion Cannot drink Continuous vomiting (all)

Stridor

Step Two: ASSESS FOR THE MAIN SIGN AND SYMPTOMS

DIFFICULTY OF BREATHING FEVER DIARRHEA EAR INFECTION MALNUTRITION

Step Three: ASSESS FOR IMMUNIZATION AND NUTRITION (PD 996) goal: reduce morbidity and mortality of 7 immunizable diseases target setting: children below 1 year old important element: target setting cold chain: proper storage of the vaccine from the time it was manufactured until the time it will received by the client
regional: 6 months provincial: 3 months municipal: 1 month RHU: 5 days BHS: 3 days policy: FIFO (first in, first out) Vaccine Sensitive to heat -measles -OPV Temp: -25 C sensitive to freezing -BCG -HEPA B -DPT --TT temp: +18 C

Different types of vaccine

1. BCG-dont give with positive HIV check for KOCHs phenomenon SCAR 2. DPT-dont give with positive convulsion/seizure 3 doses---1st dose---observe for 3 days; if + for convulsion and seizure = dont give DPT 2 completed= 3 TT doses

3. OPVper orem:vomits? ---- repeat the dose

check for allergy to egg; ask if there is pregnant at home 4. anti-measles last vaccine to give; most compatible vaccine

5. Hepa B 1st vaccine to give

9 moths Epidemic=6moths

BCGID Birth0.05ml School entarnt 0.1ml

DPTIM=0.5ml OPVPO=2gtts HepB-IM=0.5ml

Anti measles SQ 0.5ml

Hepa B1 6 weeks Hepa B2 At birth Within 12 hours

8 weeks

Hepa B3

Vitamin A
= starts at 6 months = interval of 6 moths Albendazole

= starts at 1 year
= interval 6 moths

Step Four: CLASSIFY

REFER URGENTLY AND GIVE FIRST DOSE OF ANTIBIOTIC

INITIATE TREATMENT

HOME MANAGEMENT

TABLE APPROACH
A
ASSESSMENT

C
CLASSIFICATION

T
TREATMENT

DRUGS IN IMCI
1. antibiotics: PNEUMONIA, MSTOIDITIS, ACUTE EAR INFECTION and VSD
notes: 1st line: amoxicillin 2nd line: cotrimoxazole 2. Antimalarial notes: check causative agent a. P. falcifarum: single doose of SULFADOXINE then after 2 hours first dose of CHLOROQUINE is given then PRIMAQUINE after 4 days b. P.vivax: give 1st dose of PRIMAQUINE and CHLOROQUINE, then give one dose each day for 13 days *if CHLOROQUINE is given for 3 days, tapering is must *itching is the side effect of the drug *PRIMAQUINE should not be given to children below 12 months 3. Paracetamol 4doses/every 6 hours 4. Vitamin A for 6 months and older/interval of 6 months 5. iron: less than 12 moths, give syrup; more than 12 moths can give folate 6. Mebendazole for 1 year old and above/interval of 6 moths 7. Salbutamol for wheezing

PNEUMONIA
Difficulty of breathing Auscultate stridor during inhalation Breathing: <1=50; >1=40

Chest indrawing during inhalation

Note: child must be calm

Signs
General danger signs Chest indrawing stridor Fast breathing

Classification
Very Severe Disease Severe Pneumonia

treatment
Antibiotic Vitamin A Blood sugar referral Antibiotic 3days Bronchodilator 5 days Follow up 2 days cough >30 daysrefer Condition not improve Follow up 5 days

Pneumonia

Cough and colds

No Pneumonia

Prevention of Low Blood Sugar

*blood sugar *breast feed *swallow *sugar water (30-50ml) *not swallow *NGT Sugar water: 4 tsps of sugar + 200 ml of water

Vitamin A <1 year = 100,000 IU >1 year = 200,000 IU

DIARRHEA
Abnormally sleepy Blood in the stool Check eyeball, turgor and mood

For Dehydration
Signs Classification treatment

Sleepy Sunken eye ball Slow turgor

Severe Dehydration

Plan C Refer Ors Breasfeeding >2 y/o; cholera antibiotic =tetracycline

Plan b Refer Ors Breastfeeding Return 5 days w/o improvement Plan a Return 5 days w/o improvement

Restless Sunken eye ball Slow turgor

Some dehydration

No signs

No dehydration

DIARRHEA FOR MORE THAN 14 WEEKS

SEVERE PERSISTENT
With dehydration refer

Persistent
Without dehydration Follow up in 5 days

Multivitamins for 14 days

Vitamin A

Blood in the stool

DYSENTERY

Oral antibiotic for 3 days CIPROFLOXACIN follow up in 2 days

PLANS FOR DIARRHEA A At home Buko juice Breast feeding Continue feeding fluids fast referral Zinc 2 months-6months = TAB 6moths-5 yrs = 1 TAB 14 days B C (iv) With ORS Weight in KG x 75 mL vomits? Wait for 10 mins After 4 hours? Assess and classify Plan for treatment

Fluids
<2 years = 100 mL >2 years = 200 mL

Food
6 months = breastfeed (8/24) 12 months = feed 3x (BF) =feed 5x (NBF) 2 years = BF and feed 5x Older = 3 meals/day with 2 healthy snacks

FEVER
Malaria Living in malaria area? Stay overnight/travel in malaria area? Blood transfusion?

BLOOD SMEAR

MALARIA RISK

SIGNS
Danger sign Stiff neck

CLASSIFICATION
Very severe malaria

TREATMENT
Antibiotic Blood sugar Paracetamol Quinine Refer urgently Antimalaria Chloroquine (1st) Sulfadoxine (2nd) Paracetamol persist? Refer 2 days 7 days hospital Paracetamolpersist? Refer 2 days 7 days hospital

Blood smear (+) No measles No runny nose No other cause

malaria

Blood smear (-) Measles Runny nose Other cause

Malaria unlikely

No malaria risk signs classification treatment

Any danger signs Stiff neck

Very severe febrile disease

Antibiotic Blood sugar Paracetamol Refer urgently

No signs

Fever: No malaria

Paracetamol persist? Refer 2 days 7 days hospital

Signs Clouding of cornea Deep mouth ulcer

Pus from eyes Mouth ulcer

Measles now Within the last 3 moths

Treatment Vitamin A Antibiotic Tetracycline Refer urgently Measles with eye Vitamin A and mouth Tetracycline complication Gentian violet Follow up in 2 days measles Vitamin A

Measles Classification Severe complicated measles

Tetracycline
Clean eyes 3x Wash hands Wipe pus Wet cloth No pus/redness: STOP Redness: continue

Gentian Violet
5 days treatment Wash hands Wipe with cloth (salt) Wet mouth with strength GV

DENGUE FEVER
Abdominal pain

Blood (stool. Vomitus, gum)

Severe Ors Blood sugar Paracetamol Refer urgetly Note: no aspirin no antibiotic no ibuprofen (Dolan) Unlikely Paracetamol Fever persist/bleeding Follow up in 2 days

Signs Tender Swelling pain+pus <14 days Pus >14 days -

Ear problem Classification Mastoiditis

Treatment Paracetamol Antibiotic Refer urgently Paracetamol Antibiotic 5 days Wicking Quinolone, 2 weeks Wicking Follow up 5 days -

Acute ear infection

Chronic ear infection

No ear infection

Malnutrition Signs Wasting Edema Palmar pallor Very low weight Some palmar pallor Classification Severe malnutrition Severe anemia Very low weight anemia Treatment Vitamin A Refer urgently Vitamin A Iron 5 mL (14 days) Albendazole 500 (single dose) -

No anemia

BIRTH TO MONTHS
Signs Classification Treatment

Convulsion No movement Chest indrawing

VSD

Antibiotic (ampicillin & ggentamicin) Prevent low blood sugar Referral Keep warm Give an appropriate antibiotic (amoxicillin & cotrimoxazole) Follow up in 2 days -

Red umbilicus Skin pustules

Local bacterial infection

Severe disease or local infection unlikely