Int Egrate D Manageme Nt Of Ch Ildhoo D Illne Ss

Int egrate d Manageme nt of Ch ildhoo d Illne ss

Integrated Management of Childhood Illness WHO Regional Office for the Western Pacific/ Child Health

Cau se s of 10 .5 mi lli on de at hs amo ng ch il dren < 5 in deve lo ping co untri es , 199 9 Pneum on ia 19% One in every two child deaths in developing countries are due to just five infectious diseases and malnutrition

perinatal 20% Maln utr iti on 54% Others 28%

HIV /AID S 3% Source: EIP/WHO, 1999 data

Dia rrh oe a 15%

Me asle s 8% Ma la ria 7%

Import ant El ement s for Improvi ng Chi ld Health • Improve case management of sick children • Improve nutrition • Ensure immunization • Prevent injuries • Prevent other diseases • Improve psychosocial support and stimulation

Too many di ff erent piec es…

Appropriate Care seeking Anemia

Case management

Home care

Nutrition HIV/AIDS

Drug Use

Malaria

Health system

Child rights

Mothers health

New born care

Follow-up

Safe and Supportive Communication Environment

IM CI bri ngs t hem a ll toget he r

IMP RO VEMEN T OF HEA LTH SYSTEM IM PRO VEMEN T OF CA SE MA NAGEMENT FA MIL Y AN D COM MUN IT Y PR AC TI CES

CH IL D RI GHT S

IM CI bri ngs i t all toget he r

Strengthening health system

Improving health workers’ skills

Improving family and community practices

At t he s ta rt of a si ck chi ld (2 mo nths to 5 ye ars) co nsul tat ion

• Ask the mother what the child’s problems are. • Determine if this is an initial or followup visit for this problem.

IMCI Ca se Ma na gement Focus ed Ass essment Dang er sig ns Ma in Sym ptoms Nutri tion al status Immu ni zati on status Other prob lems

Cl as sifi ca tion Nee d to Refer Specif ic treat ment Home management

Coun sel & Fol low-up

Treatme nt

Cou ns el careta kers Fol low-up

Id enti fy trea tm ent Trea t

Chec k f or ge nera l da nger signs Ask: • Not able to dr ink or breas tfee d, • Vomi ts eve rythi ng, • Convuls ions , or Lo ok: • Abnorm all y sle epy or dif fi cult to aw ake n Need t o Re fe r (e xce pt in s ev ere de hy drat ion)

Ask abo ut t he ma in sym pt om s

• Cough or difficulty in breathing • Diarrhea • Fever • Ear problem

Cough or dif fic ult y in br eathi ng Ask: • For how long? Look: • Count RR • Chest indrawing • Stridor

The child must be calm.

 Any gen era l dange r sign or  Che st ind raw ing or  St ridor

SEVER E P NEUM ONIA O R VERY SEVER E D ISEASE    

1 st dos e of ant ibiot ic Vita min A Brea st fe edi ng/s ugar w at er URG EN T REFE RRAL

 Fa st bre at hing 2 – 12 mont hs old: ≥ 50 /m inut e 1 y ear o r ol de r: ≥ 4 0/minut e

PNEUM ON IA

   

Ant ibi otic fo r 5 day s Re lie ve co ugh with s afe re medy Adv ise mot he r on dange r signs Fo llow up in 2 da ys

No s igns o f pn eumo ni a or a very severe dise as e

NO P NEUM ON IA: COUG H OR CO LD

   

If co ug h ≥ 30 day s  re fer to h ospit al for ass ess me nt Re li eve co ugh wi th s afe re medy Adv ise mo the r o n da nge r s igns Fo llow up in 5 d ays i f no impro veme nt

Dia rr hea : C la ssif y For de hydra tio n

Pers ist en t di ar rhe a Bloo d in the stoo l

Cla ss ify for de hydr at io n

2 o r m ore of the fo llow ing:    

Abnor mall y sleepy /di fficul t t o wak e Sunk en eyes Not able t o fe ed/drink ing poor ly Sk in pinch goe s bac k v er y slow ly

SEVER E D EHYD RA TION

Plan C

Plan C: To t rea t dehy dra tion q uick ly IV f luid: LRS 1 00 ml/k g body w eight (in 6 hrs for infant s; 3 hrs f or chil dre n)

NO IV t rea tme nt within 3 0 minut es

NO Ore sol/N GT

Plan C: To t rea t dehy dra tion q uick ly Ore sol/N GT

NO Ore sol p .o.

NO

URGE NT REFERRA L

Cla ss ify for de hydr at io n

2 o f the fo ll ow ing:

 Re st les s, i rri tabl e  Sunk en eyes  Sk in pinch goe s bac k slowly

SOM E D EH YDRAT ION

Plan B

Plan B: Tre at s ome dehy dra tion with ORS Determ ine t he a mount (in ml) of O res ol to be giv en in 4 hours = we ig ht of t he chil d ( in k g) X 7 5, or if we ight i s unk now n, us e t his cha rt . Age

< 4 mos

4-1 2 mos

Amoun t

200-4 00

400- 70 0

Plan B: Tre at s ome dehy dra tion with ORS Determ ine t he a mount (in ml) of O res ol to be giv en in 4 hours = we ig ht of t he chil d ( in k g) X 7 5, or if we ight i s unk now n, us e t his cha rt . Age

12 mos-2 yrs

2-5 y rs

Amoun t

700-9 00

90 0-1 400

Plan B: Tre at s ome dehy dra tion with ORS    

Show th e mo th er how t o gi ve Or es ol t o the chil d: fre quent s ips from a cup If t he chil d v omi ts, wait for 1 0 min ute s. The n cont inue, but mo re s lowly . Co ntinue bre as tfe eding i f t he chi ld wa nts t o bre as tfee d. If t he chil d dev elops puff y ey eli ds , s to p ORS .

Plan B: Tre at s ome dehy dra tion with ORS Aft er 4 ho urs :  Re as se ss t he chi ld & clas sify f or dehy dra tion.  Se lect appropriat e pl an.  Begin fee di ng t he child in t he he alt h cen te r.

Cla ss ify for de hydr at io n

Not enough signs to cla ssif y as SEV ERE DE HYD RA TIO N o r SOME DE HYDR ATIO N

NO D EH YDRAT ION

Plan A

Plan A: Tr ea t diarr hea a t home 

Giv e ext ra fl uid. Up to 2 yr s 2 -4 yrs

50 – 1 00 ml af ter each LB M 100 – 200 ml aft er ea ch LB M



Co ntinue fee di ng.



Kn ow whe n t o re turn.

Persi st ent di ar rh ea: 1 4 da ys or mor e

+ Dehy dra tion= se ver e pe rsis te nt di arrhe a

• Tr eat de hydra tio n • Give Vit amin A • Refer t o hos pit al

Persi st ent di ar rh ea: 1 4 da ys or mor e

No dehydra ti on=pers is tent dia rr hea

• Advis e rega rdi ng feeding • Give Vit amin A • Fol lo w up in 5 da ys

Blo od in the sto ol = dysent ery

• Ora l ant ibi ot ic for shige lla fo r 5 days • Foll ow up in 2 d ays

Fe ver: (hi st ory/t empera tu re 3 7.5 °C or above)

Ma lari a ris k?

Meas les now or w/i n las t 3 m os Dengu e ri sk ?

Feve r: A sk ab out mal ari a ris k • Residi ng in ende mic a rea? OR: • Tra ve l & ove rnight stay in ende mic a rea, or w/in pa st 6 mos • Blood tra ns fus io n

Ma la ria ri sk +

• Blood smear • Ask: Dura ti on of fever? Pre sen t eve ryda y? • Lo ok: St if f nec k Run ny no se Ot he r si gns of meas les

Ma lar ia ri sk + any g ene ral da nger s ign or sti ff nec k

Very s ever e fe bri le dise as e/ ma lari a

• Quinine (under med. supervis ion) • 1 st do se of anti bio tic , Par ac eta mol • Urgen t referr al

Ma la ri a ris k +, blo od sm ear + No runny nos e, no meas les

Ma la ri a

• • • •

Or al ant ima lar ia l Para cet amol Foll ow up i n 2 da ys > 7 da ys feve r  hospi ta l for ass essment

No ma la ri a r is k Any ge nera l da ng er sig n or st iff neck

Ve ry se vere febrile di seas e

• 1 st do se of ant ibio tic , Par ac et am ol • Urgent referr al

Measle s now or w/ in la st 3 mos Cl ouding of cornea or Dee p or ext ensi ve mouth ulc ers

Se vere compli ca ted me as les

• 1 st do se of ant ibio tic , Vi tam in A • Urgent referr al

Mea sl es n ow or w /i n la st 3 mos Pus dr ai ni ng fr om t he eye or Mouth ul cers

Measles wi th eye or Mout h compl ications

• • • •

Vi tamin A Tetr acycli ne eye oin tment Gent ia n viol et Foll ow up i n 2 da ys

Measle s now or w/ in la st 3 mos No other signs

Meas les

• Vi tamin A

If the re is Dengue ri sk Bl eeding gums , no se , i n vomit us or stools Bl ack v omit us or s tools Per sist ent abdominal pai n Per sist ent v om iting Sk in p etechi ae Slow ca pi ll ary re fi ll No signs, b ut fe ver > 3 da ys  To urni que t t es t

Any of th e da ng er s ig ns or + t ourn iqu et t est

Se vere Dengue hemorrha gi c f ev er

• If ski n pet echia e, p ersi st ent abdomina l p ain or vo mi ting , or + tourni qu et t est onl y s ig ns, gi ve OR S • An y oth er s igns of bl eedi ng  P la n C • Urgent r efe rra l • Do not g ive as pi ri n

Ea r pr obl em: tender swelling beh ind ear

Mas toid it is

• 1 st do se of anti bio tic • Pa ra cetamo l fo r pa in • Urgen t referr al

Ea r di scha rg e < 14 da ys or Ea r pa in

Ac ut e ea r in fe ct ion

• • • •

Ant ibi otic for 5 d ays Para ceta mol f or pa in Wicking Foll ow up i n 5 da ys

Ea r di scha rg e for 14 d ays or more

Chr onic ea r in fec tion

• Wicking • Foll ow up i n 5 da ys

Vis ible seve re wa sti ng or Edema on both f eet or Seve re pa lma r pa ll or

Sev ere malnut rit ion or se vere a nem ia

• Vit amin A • Urgent referr al

Some p al ma r pa ll or or Ver y low weig ht f or a ge

Ane mi a or very low w eigh t for ag e

• Assess f or f eed ing p robl em • Pall or: i ron & A lb end azole • Wt for age very low: V it amin A