Imci Exercise 2

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Transcript of Imci Exercise 2

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Under five mortality: Estimated trend and MDG goal

Philippines 1980-2004

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DOH Essential Package of Child Survival Interventions

1. Skilled attendance during pregnancy, childbirth and the immediate post partum

2. Care of the Newborn3. Breastfeeding and complementary

feeding4. Micronutrient supplementation5. Immunization of children and mothers6. IMCI7. Use of insecticide treated bed nets

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• IMCI is an integrated approach to child health that focuses on the well-being of the whole child.

• IMCI is a strategy for reducing mortality and morbidity associated with major causes of childhood illness.

• IMCI was initiated jointly in 1992 by DOH, WHO and UNICEF.

• IMCI has already been introduced in more than 75 countries around the world.

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• Primarily, there are two objectives of IMCI:1. To significantly reduce global mortality and morbidity associated with the major causes of disease in children2. To contribute a healthy growth and development of children.

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•Three major components of IMCI:

1. Improving case

management

skills of healthworkers

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2. Improving the health system to deliver IMCI

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3. Improving family and community health practices

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I. Assess the child or young infantII. Classify the illnessIII. Identify the treatmentIV.Treat the child/ReferV. Counsel the motherVI.Give follow-up care

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II. Classify the illness

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Color Presentation Classification of Disease Level of Management

Green Mild Home Care

Yellow Moderate Management at the RHU

Pink Severe Urgent Referral

II. Classify the illness

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III. Identify Treatment• The chart recommends

appropriate treatment for each classification

• When using this process, selecting a classification on the chart is sufficient to allow you to “identify treatment”

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IV. Treat the child• “Treat the child” means giving

treatment in the health center• prescribing drugs or other

treatments to be given at home• teaching the mother how to

carry out the treatments.

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V. Counsel the mother• “Counsel the mother” includes

assessing how the child is fed • telling the mother about the

foods and fluids to give the child • Telling the mother when to bring

the child back to the health center.

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VI. Give follow-up care• Specific instructions for conducting each follow-up visit

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Steps:1.ASK THE MOTHER WHAT’S THE CHILD

PROBLEMS AREa. Greet the mother appropriately and ask her to sit with her childb. Using good communication skills, ask the mother what the child’s problems are and record them on the Recording Formc. Determine if this is an initial visit or follow up visit.

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Exercises: Case 1

Pokwang is 15 months old. She weighs 8.5 kg. Her temperature is 35.5°C.

The health worker asked, “What are the child’s problems?” The mother said, “Pokwang has been coughing for 4 days, and she is not eating well.”This is Pokwang’s initial visit for this problem.

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Answer the following:a.Write Mutya’s name, age, weight, and temperature in

the spaces provided on top of the line form.b.Write Mutya’s problem on the line after the question

“Ask: What are the child’s problems?”c. Tick (√) whether this is the initial or follow-up visit.d.Does Mutya have general danger signs? If yes, circle

the signs on the Recording Form. Then tick(√) “yes” or “no” after the question, “General danger signs present?”

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:_____Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO___

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ASSESSMENT

CHECK THE FOUR GENERAL DANGER SIGNS

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2. CHECK FOR GENERAL DANGER SIGNS

a. The child is not able to drink or breastfeed b. The child vomits everything

c. The child has had convulsion (during this illness)

d. The child is abnormally sleepy or difficult to awaken

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NOT ABLE TO DRINK OR BREASTFEED

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VOMITS EVERYTHING

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CONVULSION

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ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN

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Exercises: Case 1 continuation…The health worker checked Mutya for general

danger signs. He asked, “Is Mutya able to drink or Breastfeed?” The mother said “No. Mutya does not want to breastfeed.” The health worker gave Mutya some water. She was too weak to lift her head. She was not able to drink from a cup.

Next, he asked the mother, “Is she vomiting?” The mother said “No.” Then he asked, “Has she had convulsions?” The mother said “No.” The health worker looked to see if Mutya was abnormally sleepy or difficult to awaken . When the health worker and the mother were talking,

Mutya watched them and looked around the room. She was not abnormally sleepy or difficult to awaken.

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:_____Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO___

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:_____Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES_√__NO___

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Case 2:

Nilo is 4 years old. He weighs 10 kg. His temperature is 38 °C.The health worker asked about the child’s problems. Nilo’s parents

said, “he is coughing and has ear pain. This is the initial visit for this

problem. The health worker asked, “Is your child able to drink?” The parents

answered, “Yes.’ Does Nilo vomit everything?” he asked. The parent

said “No.” The health worker asked, “Has he had convulsions?” they

said “No.” The health worker looked at Nilo, the child was not abnormally sleepy or difficult to awaken.

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Answer the following:a.Write Nilo’s name, age, weight, and temperature

in the spaces provided on top of the line form.b.Write Nilo’s problem on the line after the

question “Ask: What are the child’s problems?”c.Tick whether this is the initial or follow-up visit.d.Does Nilo have general danger signs? If yes, circle

the signs on the Recording Form. Then tick “yes” or “no” after the question, “General danger signs present?”

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:_____Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?____Initial Visit?_follow-up visit?___ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO__√_

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3. ASSESS AND CLASSIFY COUGH OR DIFFICULT BREATHING

• A child with cough or difficult breathing may have pneumonia or another severe respiratory infection

• Pneumonia is an infection of the lungs. Both bacteria and viruses can cause pneumonia

• In developing countries, pneumonia is often due to bacteria. The most common is Streptococcus pnuemoniae.

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3.1 Assess cough and difficult breathingA child with cough or difficult breathing is assessed for:a. How long the child has had cough or difficult breathingb. Fast breathing-consider fast breathing if:2mos-12mos. - 50 breaths/min. or more12mos.-5yrs. - 40 breaths/min. or morec. Chest indrawingd. Stridor in calm child

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3.2 Classify Cough or difficult breathing•Any general danger signs or•Chest indrawing or•Stridor in calm child

SEVERE PNEUMONIA ORVERY SEVERE DISEASE

• Fast breathing PNEUMONIA

•No sign of pneumonia or very severe disease

NO PNEUMONIACOUGH OR COLD

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Exercises: Case 1

Lucite is 8 months old. She weighs 6kg. Her temperature is 39°C. Her father told the worker, “Lucite has had cough for 3 days. She is having trouble breathing. She is very weak.” The health worker said, “You have done the right thing to bring your child today. I will examine her now.”

The health worker checked for general danger signs. The mother said, “Lucite will not breastfeed. She will not take any other drinks I offer her.” Lucite does not vomit everything and not had convulsions. Lucite is abnormally sleepy. She did not look at the health worker or her parents when they talked.

The health worker counted 55 breaths/min. He saw chest indrawing. He decided Lucite had stridor because he heard a harsh noise when she breathed in.

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:________________Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO___

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING YES____ NO____

•For how long? ______days •Count the breaths in one minute ____breaths per minute. Fast breathing?

•Look for chest indrawing•Look and listen for stridor

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:________________Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES_√__NO___

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING YES__√__ NO____

•For how long? ____3__days •Count the breaths in one minute __55__breaths per minute. Fast breathing?

•Look for chest indrawing

•Look and listen for stridor

Severe Pneumonia or Very Severe Disease

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Case 2Beanie is 6months old. He weighs 5.5kg. His temperature is 38°C. His

mother said he has had cough for 2 days. The health worker checked for general danger signs. The mother said that

Beanie is able to breastfeed . He has not vomited during this illness. He has not had convulsions. Beanie is not abnormally sleepy or difficult to awaken.

The health worker said to the mother, “I want to check Beanie's cough. You said he has had cough for 2 days now. I am going to count his breathes. He will need to remain calm while I do this.”

The health worker counted 58 breathes/min. He did not see chest indrawing. He did not hear stridor.

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:________________Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify

CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO__√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING YES_√___ NO____

•For how long? ___2___days •Count the breaths in one minute __58__breaths per minute. Fast breathing?

•Look for chest indrawing•Look and listen for stridor

Pneumonia

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4. ASSESS AND CLASSIFY DIARRHEA• Diarrhea occurs when stools contain more

water than normal.• Defined as 3 or more loose or watery stools in

a 24-hour period• It is common in babies under 6months who

are drinking cow’s milk or infant feeding formulas

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4.1 Assess DiarrheaA child with diarrhea is assessed fora.How long the child has diarrheab.Blood in the stool to determine if the child has

dysenteryc.Signs of dehydration

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ASK: For how long?To determine the type of diarrhea• Acute Diarrhea- diarrhea lasts for less than 14

days• Persistent Diarrhea- diarrhea last for 14 days

or more

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ASK: Is there blood in the stool?• Diarrhea with blood in the stool, with or

without mucus is called dysentery• The most common cause of dysentery is

Shigella bacteria

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Check for signs of dehydration• Restless and irritable• Abnormally sleepy or difficult to awaken• Sunken eyes• Child is not able to drink or drinking poorly or

drinking eagerly , thirsty• Pinch the skin of the abdomen. Does it goes

back: Very slowly(longer than 2 seconds); Slowly

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4.2 Classify Diarrhea• There are three classification tables for

classifying diarrhea:All children with diarrhea are classified for

dehydrationIf the child has had diarrhea for 14 days or

more, classify the child for persistent diarrheaIf the child has blood in the stool, classify the

child for dysentery.

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4.2 Classify Diarrhea4.2.1 Classify Dehydration

Two of the following signs:•Abnormally sleepy or difficult to awaken•Sunken eyes•Not able to drink or drinking poorly•Skin pinch goes back very slowly

SEVERE DEHYDRATION

Two of the following signs•Restless, irritable•Sunken eyes•Drinks eagerly, thirsty•Skin pinch goes back slowly

SOME DEHYDRATION

•Not enough signs to classify as some or severe dehydration

NO DEHYDRATION

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Case 1: JoelJoel has had diarrhea for five days. He has no

blood in the stool. He is irritable. His eyes is sunken. His father and mother also think that Joel’s eyes are sunken. The health worker offers Joel some water, and the child drinks eagerly. When the health worker pinches the skin on the child’s abdomen, it goes back slowly.

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• Record Joel’s signs of dehydration and classify

DOES THE CHILD HAVE DIARRHEA YES____ NO____•For how long?______days •Look at the child’s general condition. •Is there blood in the stool? Is the child:

Abnormally sleepy or difficult to awaken Restless and irritable? •Look for sunken eyes •Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly and thirsty? •Pinch the skin of the abdomen . Does it go back : Very slowly? (longer than 2 seconds) Slowly?

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• Record Joel’s signs of dehydration and classifyDOES THE CHILD HAVE DIARRHEA YES__√_ NO____•For how long?___5___days •Look at the child’s general condition. •Is there blood in the stool? Is the child:

Abnormally sleepy or difficult to awaken Restless and irritable? •Look for sunken eyes •Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly and thirsty? •Pinch the skin of the abdomen . Does it go back : Very slowly? (longer than 2 seconds) Slowly?

Some Dehydration

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4.2 Classify Diarrhea4.2.2 Classify Persistent Diarrhea

• Dehydration present SEVERE PERSISTENT DIARRHEA

•No dehydration PERSISTENT DIARRHEA

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Case 2: FaridaFarida is 14 months old. She weighs 12 kg. Her temperature

is 37.5°C. Farida’s mother said the child has had diarrhea for 3 weeks.

Farida does not have any general danger signs. She does not have cough or difficult breathing.

The health worker assessed her diarrhea. He noted she has had diarrhea for 21 days. He asked if there had been blood in the stool. The mother said, “No.” The health worker checked Farida for signs of dehydration. The child is irritable throughout the visit. Her eyes are not sunken. The skin pinch goesback immediately.

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• Record Farida’s signs of and classify Persistent Diarrhea

DOES THE CHILD HAVE DIARRHEA YES__√__ NO____•For how long?___21___days •Look at the child’s general condition. •Is there blood in the stool? Is the child:

Abnormally sleepy or difficult to awaken Restless and irritable? •Look for sunken eyes •Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly and thirsty? •Pinch the skin of the abdomen . Does it go back : Very slowly? (longer than 2 seconds) Slowly?

Persistent Diarrhea

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4.2 Classify Diarrhea4.2.3 Classify Dysentery

• Blood in the stool

DYSENTERY

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Case 3: CarloCarlo is 10 months old He weighs 8 kg. Her temperature is

38.5 °C. He is here today because he has had diarrhea for 3 days.

Carlo does not have any general danger signs. He does not have cough or difficult breathing.

The health worker assesses the child for diarrhea. “You said Carlo has had blood in the stool. I will checked for signs of dehydration.” The child is not abnormally sleepy or difficult to awaken. He is not restless nor irritable. He does not have a sunken eyes. The child drank normally when offered some water and does not seem thirsty. The skin pinch goes back immediately.

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• Record Carlo’s signs and classify

DOES THE CHILD HAVE DIARRHEA YES__√__ NO____•For how long?____3__days

•Look at the child’s general condition. •Is there blood in the stool? Is the child:

Abnormally sleepy or difficult to awaken Restless and irritable? •Look for sunken eyes •Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly and thirsty? •Pinch the skin of the abdomen . Does it go back : Very slowly? (longer than 2 seconds) Slowly?

Dysentery

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• A child with fever may have malaria, measles, Dengue Hemorrhagic Fever(DHF) or another severe disease. Or a child with fever may have a simple cough or cold or another viral infection.

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A. Malaria• Malaria is caused by parasites in the blood

called “plasmodia”• They are transmitted through the bite of

anopheles mosquitoes.• Four species of plasmodia can cause malaria,

but the only dangerous one is Plasmodium Falciparum

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• Fever is the main symptom of malaria• Other signs of falciparum malaria are

shivering, sweating, and vomiting.• In most areas in the Philippines where there is

malaria transmission, malaria is a significant cause of death of children.

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• Deciding Malaria Risk (Category of Provinces)Category A- Provinces with no significant

improvement in malaria situation in the last 10 years or situatione worsened in the last 5 years, average number of cases of more than 1,000 in the last 10 years.

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Category AKalinga Davao del Norte ApayaoDavao del Sur Mt. Province Davao OrientalIfugao Bukidnon IsabelaCompostela Valley Cagayan SarangganiQuirino Zamboanga del Sur ZambalesAgusan del Norte Agusan del Sur Mindoro OccidentalPalawan Tawi-tawi QuezonSulu Misamis Oriental Basilan

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Category B- Provinces where situation has improved in the last 5 years or average number of cases of 100-1,000 per year.

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Category BAbra Laguna PangasinanCamarines Norte Ilocos Norte Camarines SurNueva Ecija Sultan Kudarat BulacanNorth Cotabato Bataan Lanao del SurMindoro Oriental Maguindanao RizalZamboanga del Norte Tarlac Romblon

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Category C-Provinces with significant reduction in cases in the last 5 yearsAlbay Batanes BenguetAntique Ilocos Sur SorsogonLa Union Negros Oriental PampangaNegros Occidental Batangas Eastern SamarCavite Western Samar MarinduqueMisamis Occidental Masbate Surigao del Norte

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Category D- Provinces that are malaria free although are still potentially malarious due to presence of vector.Cebu Bohol CatanduanesAklan Capiz GuimarasSiquijor Biliran LeyteNorthern Samar Camiguin

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B. Measles• Measles is highly infectious caused by virus• It infects the skin and the layer of cells that

line the lungs, eyes, mouth and throat.• Fever and generalized rash are the main signs

of measles• Most cases occur in children between 6

months and 2 years.

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C. Dengue Hemorrhagic Fever(DHF)• DHF is caused by virus that is spread by Aedes

mosquitoes• Children with DHF have fever which may last for 2

to 7 days• The disease causes damage to the blood and

blood vessels which may lead to bleeding. This bleeding may occur in the skin , where petechiea are seen, or inside the body.• The most severe signs of DHF often occur in the 2

days after the fever has disappeared

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5.1 ASSESS FEVER• Ask: Does the child have fever?(by history, or

feels hot or Temperature is 37°C or above)a.Decide Malaria RiskAsk:Does the child live in a malaria areaHas the child visited or stayed overnight in a

malaria area in the past 4 weeks.If Yes to either, obtain a blood smear

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THEN ASK: LOOK AND FEEL• For how long has the child had •Look or feel stiff neck fever? •Look for runny nose• If more than 7 days, has the fever been present everyday?• Has the child had measles within •Look for signs of MEASLES: the last 3 months - Generalized rash and

-One of these: cough, runny nose, or red eyes

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If the child has measles •Look for mouth ulcersNow or within last -Are they deep and extensive3 months •Look for pus draining from the

eyes•Look for clouding of the cornea

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Assess Dengue Hemorrhagic FeverASK: LOOK AND FEEL• Has the child had any bleeding •Look for bleeding from the nose or gums

from the nose or gums, or in the •Look for skin petechiaevomitus or stools? •Feel for cold and clammy extremities

• Has the child has black vomitus? •Check for slow capillary refill• Has the child had black stools? •Perform for the torniquet test• Has the child has persistent

abdominal pain?• Has the child has persistent vomiting?

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5.2 CLASSIFY FEVER• There are 2 classification tables on the ASSESS

AND CLASSIFY CHART:1.Malaria Risk2.No Malaria Risk• To classify fever, you must know if there is

malaria risk or not. Then select the appropriate classification table.

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• Malaria Risk•Any general danger sign or•Stiff neck

VERY SEVERE FEBRILE DISEASE/ MALARIA

•Blood smear (+)If blood smear not done:•NO runny nose and•NO measles and•NO other cause of fever

MALARIA

•Blood smear(₋) OR•Runny nose OR•Measles OR•Other causes of fever

FEVER:MALARIA UNLIKELY

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Example:A 2 year old-boy is brought to the health center because he has felt hot for 2 days. There is Malaria risk. He does not have general danger signs. He does not have cough or difficult breathing or diarrhea. A blood smear was done with negative result. The child observed to have runny nose. When the health worker assessed the child’s fever, he recorded this signs.

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•DOES THE CHILD HAVE FEVER ?(By history/feels hot/temp.37.5°C or above YES_√_NO____

Decide MALARIA risk:•Does the child live in malaria area? LOOK AND FEEL:•Has the visited or stayed overnight •Look and feel for stiff neck in a malaria area for the past 4 weeks? •Look for runny noseIf Malaria risk, obtain a blood smear:(+) (Pf) (Pv) (-) NOT DONETHEN ASK: Look for signs of MEASLES•For how long has the child has fever?__2__days. •Generalized rash and•If more than 7 days, has fever been present everyday? •One of these: cough, runny nose•Has the child had measles with the last 3 months? Or red eyes.

Fever:MalariaUnlikely

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• No Malaria Risk

•Any general danger sign or•Stiff neck

VERY SEVERE FEBRILE DISEASE

•No signs of severe febrile disease

FEVER:NO MALARIA

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• Very Febrile Disease:-presence of Danger Signs/Stiff neck-Needs URGENT REFERRAL

• Fever: No Malaria1. Severe Pneumonia or Very Severe Disease2. Pneumonia3. No Pnuemonia: Cough or cold4. Dysentery5. Severe complicated Measles6. Measles7. Severe DHF8. Abscess9. Typhoid Fever10. Infected wounds

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5.3 CLASSIFY MEASLES•Any general danger sign or•Clouding of the cornea or•Deep or extensive mouth ulcers

SEVERE COMPLICATED MEASLES

•Pus draining from the eye or•Mouth ulcers

MEASLES WITH EYE AND MOUTH COMPLICATIONS

•Measles now or within the last 3 months

MEASLES

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5.4 Classify Dengue Hemorrhagic Fever•Bleeding from nose or gums •Bleeding in stools or vomitus •Skin petechiae•Cold and clammy extremities•Capillary refill more than 3 seconds•Persistent abdominal pain•Persistent vomiting•Torniquet test positive

SEVERE DENGUE HEMORRHAGIC FEVER

•No signs of severe dengue hemorrhagic fever

FEVER: DENGUE HEMORRHAGIC FEVER

UNLIKELY

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Example: Case of FidelFidel is 10 months old. He weighs 8.2 kg. His temperature is 37.5°C. His mother says he has a

rash and cough.The health worker checked Fidel for general danger signs. Fidel was able to drink. Was not

vomiting, and was not abnormally sleepy or difficult to awaken.The health worker asked about Fidel’s cough. The mother said Fidel had been coughing for 5

days. He counted 43 breaths per minute. He did not see chest indrawing. He did not hear stridor when Fidel was calm.

Fidel did not have diarrhea.Next, The health worker asked about Fidel’s fever. There is Malaria risk. The mother said Fidel

has felt hot for 2 days. Fidel did not have a stiff neck. He had a runny nose with this illness. The health worker did not have the facilities for examination of a blood smear.

Fidel has rash covering his whole body. Fidel’s eyes were red. The health worker checked the child for complications of measles. There were no pus draining from the eye and no clouding of the cornea. There have been no cases of dengue in their area.

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:________________Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO__√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING YES__√__ NO____

•For how long?__5_days •Count the breaths in one minute __43__breaths per minute. Fast breathing?

•Look for chest indrawing•Look and listen for stridor

•No Pneumonia•Cough or cold

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DOES THE CHILD HAVE DIARRHEA YES____ NO__√__•For how long?______days •Look at the child’s general condition. •Is there blood in the stool? Is the child:

Abnormally sleepy or difficult to awaken Restless and irritable? •Look for sunken eyes •Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly and thirsty? •Pinch the skin of the abdomen . Does it go back : Very slowly? (longer than 2 seconds) Slowly?

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•DOES THE CHILD HAVE FEVER ?(By history/feels hot/temp.37.5°C or above YES_√_NO____

Decide MALARIA risk:•Does the child live in malaria area? LOOK AND FEEL:•Has the visited or stayed overnight •Look and feel for stiff neck in a malaria area for the past 4 weeks? •Look for runny noseIf Malaria risk, obtain a blood smear:(+) (Pf) (Pv) (-) NOT DONETHEN ASK: Look for signs of MEASLES•For how long has the child has fever?__2__days. •Generalized rash and•If more than 7 days, has fever been present everyday? •One of these: cough, runny nose•Has the child had measles with the last 3 months? Or red eyes.

Fever:MalariaUnlikely

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If the child has measles •Look for mouth ulcersnow or within last If yes, are they deep 3months and extensive?

•Look for pus draining from the eye •Look for clouding of

the cornea

Measles

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Assess Dengue Hemorrhagic FeverASK: LOOK AND FEEL•Has the child had any bleeding •Look for bleeding from from the nose or gums or in the nose or gums vomitus or stool? •Look for skin petechiea•Has the child has black vomitus •Feels for cold and clammy or black stool? extremities•Has the child had persistent •Check for capillary refill abdominal pain? •Perform torniquet test•Has the child had persistent vomiting?

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Exercises: Case of NestorNestor is 5 months old. He weighs 5.2 kg. His axillary temperature is 37.5°C. His

mother said he is not eating well. She said he feels hot, and she want a health worker to help him.

Nestor is able to drink, has not vomited, does not have convulsions, and is not abnormally sleepy or difficult to awaken. Nestor does not have cough and diarrhea.

Because Nestor’s temperature is 37.5°C and feels hot, the health worker assessed Nestor further for signs related to fever. It is rainy season, and there is a risk of malaria. There is no dengue risk. The mother said Nestor’s fever began 2 days ago. He has not had measles within the last 3 months. He does not have stiff neck, his nose is Not runny, and there are no signs suggesting measles. The blood smear for malariawas positive.• Record’s Nestor sign’s and classify them in the recording form.

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•DOES THE CHILD HAVE FEVER ?(By history/feels hot/temp.37.5°C or above YES_√_NO____

Decide MALARIA risk:•Does the child live in malaria area? LOOK AND FEEL:•Has the visited or stayed overnight •Look and feel for stiff neck in a malaria area for the past 4 weeks? •Look for runny noseIf Malaria risk, obtain a blood smear:(+) (Pf) (Pv) (-) NOT DONETHEN ASK: Look for signs of MEASLES•For how long has the child has fever?__2__days. •Generalized rash and•If more than 7 days, has fever been present everyday? •One of these: cough, runny nose•Has the child had measles with the last 3 months? Or red eyes.

Malaria

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6. ASSESS AND CLASSIFY EAR PROBLEM• A child with ear problem may have ear

infection• Sometimes the infection can spread from the

ear to the bone behind the ear (the mastoid) causing mastoiditis.

• Infection can also spread from the ear to the brain causing meningitis

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6.1 ASSESS EAR INFECTIONA child with ear problem is assessed for:

Ear painEar discharge-if yes, how long?

- present for more than 2 weeks is treated as chronic ear infection-present for less than 2 weeks is treated as an acute ear infection

Tender swelling behind the ear, a sign of mastoiditis

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6.2 CLASSIFY EAR PROBLEM•Tender swelling behind the ear

MASTOIDITIS

•Ear pain•Pus is seen draining from the ear, and discharge is reported for less than 14 days

ACUTE EAR INFECTION

•Pus is seen draining from the ear, and discharge is reported for 14 days or more

CHRONIC EAR INFECTION

•No ear pain and•No pus is seen draining from the ear

NO EAR INFECTION

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Case I:SallySally is 3 years old. She weighs 13 kg. Her temperature is 37.4°C. Her mother came to the health center today because Sally is sick 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. Sally does not have cough or difficult breathing. She does not have diarrhea and fever.Next the health worker asked about Sally’s ear problem. The mother said she is sure Sally has ear pain. The child cried most of the night because her ear hurts. There has been discharge coming from Sally’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.

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• Record Sally’s sign of ear problem and classify them on the Recording form.

DOES THE CHILD HAVE AN EAR PROBLEM? YES__ NO__

•Is there ear pain? •Look for pus draining from the ear•Is there ear discharge? •Feel for tender swelling behind the earIf yes, for how long____days

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• Record Sally’s sign of ear problem and classify them on the Recording form.

DOES THE CHILD HAVE AN EAR PROBLEM? YES__√__ NO____

•Is there ear pain? •Look for pus draining from the ear •Feel for tender swelling behind the ear•Is there ear discharge? If yes, for how long? On and off about a year

Mastoiditis

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Case 2: SusanSusan is 18 months old. She weighs 9 kg. Her temperature is 37°C. Her

mother said Susan had discharge coming from ear for the last 3 days.Susan does not have any general danger signs. She does not have cough or

difficult breathing. She does not have diarrhea and fever.The health worker asked about Susan’s ear problem. The mother said that

Susan 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 the ear.

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• Record Susan’s sign of ear problem and classify them on the Recording form.

DOES THE CHILD HAVE AN EAR PROBLEM? YES__√__ NO____

•Is there ear pain? •Look for pus draining from the ear •Feel for tender swelling behind the ear•Is there ear discharge? If yes, for how long? _3 or 4 days

ACUTE EAR INFECTION

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7.0 CHECK FOR MALNUTRITION AND ANEMIA• One type of malnutrition is protein-energy malnutrition.

When the child has PEM:-The child may become severely wasted, a sign of marasmus-The child may develop edema, a sign of kwashiorkor-The child may not grow well and become stunted(too short)

• A child whose diet lacks recommended amounts of essential vitamins and minerals can develop malnutrition.

• Anemia is reduced number of red cells or a reduced amount of hemoglobin in each red cell.

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7.1 Assess Malnutrition and Anemia• Look for visible wasting

-A child with visible wasting has Marasmus, a form of severe malnutrition.-The child is very thin, has no fat, and looks like skin and bones-The face of the child with visible severe wasting may still look normal. The child’s abdomen may be large or distended

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• Look and feel for edema of both feet-A child with edema of both feet may have Kwashiorkor, another form of severe malnutrition-Signs of kwashiorkor include thin, sparse and pale hair which easily falls out; dry, scaly skin especially on the arms and legs; and a puffy or “moon” face.

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• Look for palmar pallor-Pallor is unusual paleness of the skin. It is a sign of anemia

• Determine Weight for Age-Weight for age compares the child’s weight with the weight of other children who are of the same age

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7.2 Classify Nutritional Status

•Visible severe wasting or•Edema of both feet or•Severe palmar pallor

SEVERE MALNUTRITION OR SEVERE ANEMIA

•Some palmar pallor or•Very low weight for age

ANEMIA OR VERY LOW WEIGHT

•Not very low weight for age and no other signs of malnutrition

NO ANEMIA AND NOT VERY LOW WEIGHT

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Case 1: AnaAna is 18 months old. She weighs 7kg.Her temperature is 38.5°C. Her mother

brought her today because the child has felt hot and has a rash. The health worker saw that Ana looks like skin and bones.

The health worker checked for general danger signs. Ana is able to drink, has not vomited, has not had convulsions, and is not abnormally sleepy or difficult to awaken.

She does not have cough or difficult breathing. She does not have diarrhea.Because Ana’s mother said the child felt hot, and because her temperature is

38.5°C, the health worker assessed her for fever. Ana lives where there is a malaria risk. She has had fever for 5 days. Her rash is generalized rash, and she has red eyes. She has measles. She does not have a stiff neck. She does not have a runny nose. Her blood smear was positive for Plasmodium vivax. There is no dengue risk in the area.

The health worker assessed her for signs of measles complications. Ana does not have mouth ulcers. There is no pus draining from the eye and no clouding of the cornea.

Ana does not have an ear problem. The health worker next checked her for malnutrition and anemia. Ana has visible wasting. There is no palmar pallor. She does not have edema on both feet. The health worker determined her weight for age.

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•DOES THE CHILD HAVE FEVER ?(By history/feels hot/temp.37.5°C or above YES_√_NO____

Decide MALARIA risk:•Does the child live in malaria area? LOOK AND FEEL:•Has the visited or stayed overnight •Look and feel for stiff neck in a malaria area for the past 4 weeks? •Look for runny noseIf Malaria risk, obtain a blood smear:(+) (Pf) (Pv) (-) NOT DONETHEN ASK: Look for signs of MEASLES•For how long has the child has fever?__5__days. •Generalized rash and•If more than 7 days, has fever been present everyday? •One of these: cough, runny nose•Has the child had measles with the last 3 months? Or red eyes.

MALARIA

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If the child has measles •Look for mouth ulcersnow or within last If yes, are they deep 3months and extensive?

•Look for pus draining from the eye •Look for clouding of

the cornea

Measles

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CHECK FOR MALNUTRITION AND ANEMIA

•Look for visible severe wasting•Look for edema of both feet•Look for palmar pallor Severe palmar pallor? Some palmar pallor?•Determine weight for age Very low?

SEVERE MALNUTRITIONOR SEVERE ANEMIA

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Case 2: DavidDavid is 11 months old. He weighs 8kg. His temperature is 36.5°C.

His mother says he has had a dry cough for the last 3 weeks.David does not have any general danger signs. The health worker

assessed his cough. It has been present for 21 days. He counted 41 breathes/min. The health worker does not see chest indrawing. There is no stridor when the child is calm.

David does not have diarrhea. He has not had a fever during this illness. He does not have an ear problem.

The health worker checked David for malnutrition and anemia. David does not have visible severe wasting. His palms are very pale and appear almost white. There is no edema of both feet. The health worker determined David weight for age.

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MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARSChild’s Name:________________Age:_____ Weight______kg. Temperature_______ASK:What are the child’s problems?______________Initial Visit_______follow-up visit__________ Assess(Circle all signs present) Classify CHECK FOR DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED ABNORMALLY SLEEPY OR DIFFICULT TO AWAKENVOMITS EVERYTHINGCONVULSIONS

General DangerSigns Present?YES___NO__√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING YES__√__ NO____

•For how long?__21 days •Count the breaths in one minute __41__breaths per minute. Fast breathing?

•Look for chest indrawing•Look and listen for stridor

•No Pneumonia•Cough or cold

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CHECK FOR MALNUTRITION AND ANEMIA

•Look for visible severe wasting•Look for edema of both feet•Look for palmar pallor Severe palmar pallor? Some palmar pallor?•Determine weight for age Very low?

SEVERE MALNUTRITIONOR SEVERE ANEMIA

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8.0 Check the Child’s Immunization status Age Vaccine

Birth BCG Hepa B-1 6 weeks DPT-1 OPV-1 Hepa B-2 10 weeks DPT-2 OPV-2 14 weeks DPT-3 OPV-3 Hepa B-3

9 months Measles

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CHECK IMMUNIZATION STATUS OF THE FOLLOWING CHILDREN:1.Metro, 6 months old. No general danger signs. Classified as No Pneumonia: Cough or Cold and No Anemia and Not Very Low Weight for Age.

Immunization history: BCG, HEP B1 at birth; OPV1, DPT1,HEPB2; OPV2 and DPT2 given 6 weeks ago.

2. Victor, 3 months old. No general danger signs. Classified as Diarrhea with no Dehydration and also Anemia.

Immunization history: BCG, OPV1, DPT1, and HEP B1 given 5 weeks ago. Victor has diarrhea.

3. Mark, 9 months old. No general danger signs. Classified as Pneumonia, Malaria. No Anemia and No Very Low Weight

Immunization history: BCG, OPV1, DPT1 and HEP B1. When Mark was 7 months old, he received OPV2, DPT2 and HEP B2.

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QUESTIONS Metro Victor Mark

1. Is the child up to date with his immunization?

2. What immunizations, if any, does the child need today?

3. When should he return for his next immunization

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9.0 Check the Child’s Vitamin A Status

AGE 100,000 IU 200,000 IU

6 months

Above 6 months to 59 months

1

1

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• Use recommended Vitamin A schedule-All children at 6 months of age should receive 100,000IU of Vitamin A. They should then receive 200,000 IU of vitamin A every 6 months up to the age of 59 months

• Observe precautions in Vitamin A administration-To avoid over dosage of vitamin A supplementation, always ask two questions:

Is the child 6 months of age or older? If yes, has the child had a dose of Vitamin A supplementation in the past 6

months?• If the child is 6 months of age or older and has not had a dose of vitamin A

supplementation in the past 6 months, then give a single dose.• The child may develop vomiting, headaches, or nausea after taking vitamin

A. Reassure the mother that should this symptoms develop, they will disappear within 24 hours.

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In this exercise you will determine whether the child needs Vitamin A supplementation or not. Make a check on the appropriate column.

You will give Vitamin A to a child:

1. Who is 36 months old, has no illness classification , not a very low weight and no anemia. The last dose of Vitamin A was 4 months ago

2. Who is 7 months old, has no pneumonia, and is up-to-date with immunization

3. Who is 10 months old, has had measles vaccination but no Vitamin A.

YES NO

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• The last box on the ASSESS side of the chart reminds you to assess other problems that the child may have.

• Since the ASSESS AND CLASSIFY chart does not address of a sick child’s problems, you will now assess other problems that the mother told you.

• For example, she may have said the child has a skin infection, itching, swollen neck glands.

• Identify and treat other problems according to your training, experience and health center policy.

• Refer the child for any problem you cannot manage in the health center.

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1.0

Determine if urgent referral is needed

2.0 Identify patient who do not need urgent referralNO

3.0 Identify urgent pre- referral treatment needed

YES4.0 Give pre-referral treatment

5.0 Refer the child

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Aged 2 Months Up to 5 Years

TREAT THE CHILD

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Select an Appropriate Oral Drug and Determine the Dose and the ScheduleGive an appropriate antibiotic

The following needs antibioticGeneral danger signsSevere pneumonia or very severe diseasePneumoniaSevere dehydration with cholera in the areaDysenteryVery severe febrile disease/malariaSevere complicated measlesMastoiditisAcute ear infection

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule– Give first-line oral antibiotic if it is available.

Second-line antibiotic is given only if the first-line is unavailable, or the illness does not respond to the first-line antibiotic

– Sometimes, one antibiotic can be given for several illnesses. Do not double the dose or prolong the duration of giving the drug

– To determine the correct dose, choose the row for the weight or age. Weight is better used in choosing the right dose

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• For PNEUMONIA, ACUTE EAR INFECTION, VERY SEVERE DISEASE, MASTOIDITIS– First-line antibiotic: Amoxicillin– Second-line antibiotic:Cotrimoxazole

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• For DYSENTERY: Give antibiotic recommended for Shigella in your area for 5 days– First-line antibiotic: Cotrimoxazole– Second-line antibiotic: Nalidixic Acid

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• For CHOLERA: Give an antibiotic recommended for Cholera in your area for 3 days– First-line antibiotic: Tetracycline– Second-line antibiotic: Cotrimoxazole

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Select an Appropriate Oral Drug and Determine the Dose and the ScheduleGive an Oral Antimalarial

Treatment with Chloroquine assumes that the child has not yet been treated with that drug before. Confirm this with the mother. Use instructions in the GIVE FOLLOW-UP CARE MALARIA on the TREAT THE CHILD chart if it is a follow-up visit

Reduce the dose for the three-day treatment of Chloroquine Explain the possible itching as a side effect of the drug If (+) for P. Falciparum, a single dose of Sulfadoxine/Primaquine

is given. Then the first dose of Chloroquine is given after two hours to minimize gastric irritation. A single dose of Primaquine will be given on Day 4 at the health center

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule– If (+) P. Vivax, a first dose of Primaquine and

Chloroquine is given in the center, the, one dose each day for another 13 days

– For mixed infections, treat as P. Falciparum and start Primaquine as in P. Vivax

– If no blood smear test done, treat as P. Falciparum

– DO NOT give Primaquine to children under 12 months of age

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• Give an oral antimalarial– First-line: Chloroquine, Primaquine, Sulfadoxine

and Pyrimethamine– Second-line: Artemeter-Lumefrantine

• If Chloroquine– Explain to watch child carefully for 30 minutes

after giving a dose of Chloroquine. Repeat ifthe child vomits after 30 minutes

– Itching is a possible side-effect of the drug

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• If Sulfadoxine + Pyrimethamine– Give single dose in the health center 2

hours before intake of Chloroquine

• If Primaquine– Give single dose on Day 4 for P.

Falciparum

• If Artemeter-Lumefrantine– Give for three days

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• Give Paracetamol for High Fever (38.5˚ or higher) or Ear Pain–Give one dose Paracetamol in the center then give enough for one day

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule• Give Vitamin A–Vitamin A is given in • SEVERE PNEUMONIA or VERY SEVERE DISEASE, • SEVERE PERSISTENT DIARRHEA or PERSISTENT DIARRHEA, or •MEASLES, or SEVERE MALNUTRITION• VERY LOW WEIGHT

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• Give Iron– Some palmar pallor– Give syrup to a child under 12 months old.

Iron/folate tablet for children above 12 months– Give mother enough iron for 14 days and tell to

give one dose daily. Teach how to give and what to observe

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Select an Appropriate Oral Drug and Determine the Dose and the Schedule

• Give Mebendazole– A one-year old child who is anemic and with

hookworms or whipworms needs to be given this drug

– Mebendazole 500 mg or Albendazole 400 mg as single dose is given at the center if the child has not been given one in the previous six months

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Use Good Communication Skills

Success of home treatment depends on how well the health care worker communicated. The mother needs to know how to give the treatment and understand the importance of the treament

Skills in communication include the following ASK questions and LISTEN to find out what the mother

is already doing for the child PRAISE for what she has done well ADVISE how to treat at home CHECK the understanding

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Use Good Communication Skills

ADVISE THE MOTHER HOW TO TREAT HER CHILD AT HOME Three basic steps in teaching

Give information – explain how to do the taskShow an example – show how to do the taskLet her practice – ask to do the task while you watch

When teachingUse words easily understoodUse teaching aids that are familiar, such as common

containersGive feedbackEncourage to ask questions

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Use Good Communication Skills

• CHECK THE MOTHER’S UNDERSTANDING– Use good checking questions to help make sure

that the mother learns and remembers how to treat her child

– Good checking questions require that she describe WHY, HOW, or WHENGOOD CHECKING QUESTIONS POOR CHECKING QUESTIONS

How will you prepare the ORS?How often should you breastfeed your child?On what part of the eye do you apply the ointment?How much extra fluid should you give after each loose stool?Why is it important for you to wash your hands?

Do you remember how to mix the ORS?Should you breastfeed your child?Have you used ointment on your child before?Do you know how to give extra fluids?

Will you remember to wash your hands?

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Teach the Mother to Give Oral Drugs at Home

Follow these instructions Determine the appropriate drugs and dosage for age

and weight Tell the reason for giving the drug including why and

what problem it is treating Demonstrate how to measure a dose If the drug is in syrup form, show how to measure

using common household teaspoon1.25 mL – ¼ tsp2.5 mL – ½ tsp5 mL – 1 tsp

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Teach the Mother to Give Oral Drugs at Home

Show how to give Vitamin A capsuleWatch the mother practice measuring a doseAsk the mother to give the first dose. If the child

vomits within 30 minutes, give another dose. If the child is dehydrated and vomiting, wait until the child is rehydrated before giving the dose again

Explain carefully, then label and package the drug To write information on a drug label

Full name of the drug and the total amount to complete the treatment

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Teach the Mother to Give Oral Drugs at Home

Write the correct dose and when to giveWrite the daily dose and schedule

Write clearly Put the drug in its own labelled container, keeping it

clean and dry Ask questions to make sure the mother understands If more than one drug will be given, package each

drug separately Explain that all oral drugs must be used to finish the

course of treatment even if the child gets better Advise to store drugs properly Check mother’s understanding before she leaves

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Teach the Mother to Treat Local Infections at Home

• Treat eye infection with Tetracycline eye ointment– If the child will be referred, clean eye gently and squirt

a small amount– If the child will not be referred, teach how to apply

drug at home– Treat both eyes until redness is gone from the infected

eye– Do not use any other eye ointments, drops, or

alternative treatments– Bring the child to health center after two days

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Teach the Mother to Give Oral Drugs at Home

• Dry the ear by wicking– Use clean, absorbent cotton cloth or soft strong

tissue paper for making a wick– Done three times daily until wick no longer gets

wet– Do not place anything in the ear between wicking

treatments. Do not allow water to get in the ear

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Teach the Mother to Give Oral Drugs at Home

• Treat mouth ulcers with gentian violet– Use half-strength gentian violet– Use clean soft cloth dipped in salt water– Use cotton-tipped stick to paint the gentian violet

on the mouth ulcers. Do not allow child to drink the gentian violet

– Treat mouth ulcers two times per day for five days

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Teach the Mother to Give Oral Drugs at Home

• Soothe the throat and relieve cough with safe remedy– Should not contain atropine (oral and nasal

decongestants), codeine derivatives or alcohol– Safe remedies to recommend• Breastmilk for exclusively breastfed infants• Tamarind, calamansi, or ginger

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Determine Priority of Advice

• When the child has several problems, the instructions to the mother can be quite complex. In this case, instructions will have to be limited to what is most important– How much likely can this mother understand and

remember?– Is she likely to come back for follow-up

treatment? If so, some advice can wait until then– What advice is most important

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Determine Priority of Advice

• Essential treatments include giving antibiotics or antimalarial drugs, and giving fluids to a child with diarrhea

• If necessary, OMIT or DELAY– Feeding assessment and couselling– Soothing remedy for cough and cold– Paracetamol– Iron treatment– Wicking the ear

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Give These Treatments in Health Center Only

May need to be given in the health center Intramuscular antibiotic if the child cannot take oral

antibiotic Quinine for severe malaria Breastmilk or sugar water to prevent low blood sugar

Intramuscular Chloramphenicol may need to be given before leaving for the hospital if Not able to drink or breastfeed Vomits everything Has convulsions Abnormally sleepy or difficult to awaken Cannot take oral antibiotic

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Give These Treatments in Health Center Only

• Give an intramuscular antibiotic– First dose is given then refer urgently to hospital– If referral is not possible• Repeat injection every 12 hours for 5 days• Change to appropriate antibiotic to complete 10 days

of treatment

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Give These Treatments in Health Center Only

Quinine injection is given to a child with VERY SEVERE FEBRILE DISEASE/ MALARIA if there is going to be any delay in the child reaching the referral hospital. It is given intramuscularly ONLY because of these possible side effects Sudden drop in blood pressure Dizziness Ringing of the ears Sterile abscess

Should remain lying down for one hour

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Give These Treatments in Health Center Only

• Give first dose of intramuscular Quinine then refer urgently to hospital

• If referral is not possible– Repeat Quinine injection at 4 to 8 hours later,

then 12 hours until child is able to take oral antimalarial. Do not continue injections for more than 1 week

– DO NOT GIVE QUININE TO A CHILD LESS THAN 4 MONTHS OF AGE

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Give These Treatments in Health Center Only

• Treat the child to prevent low blood sugar– Low blood sugar occurs in serious infections such

as severe malaria or meningitis, or when the child is not able to eat for many hours

– Giving some breastmilk– Give 30-50 mL of milk or sugar water before

departure

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Give These Treatments in Health Center Only

– If the child is not able to swallow• Give 50 mL of milk or sugar water by nasogastric tube

– If the child is difficult to awaken or unconscious, start IV infusion• Give 5 mL/ kg of 10% of dextrose solution (D10) over a

few minutes• Or give 1 ml/ kg of 50% (D50) by slow push

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

• Plan A: Treat diarrhea at home– Treatment plan for child with diarrhea with NO

DEHYDRATION– Three rules of home treatment• Give extra fluids (as much as the child will take)• Continue feeding• When to return

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

GIVE EXTRA FLUIDSTell the mother

For exclusively breastfed babies, breastfeed frequently and longer, and give ORS or clean water. For children over six months, no food-based fluids

For children not exclusively breastfed, give one or more of the following: ORS, food-based fluids, and/or clean water

Teach how to mix and give ORS. Give two packets of ORS to use at home

Show how much fluid to give in addition to the usual fluid intake

Up to 2 years – 50 to 100 mL after each loose stool 2 years or older – 100 to 200 mL after each loose stool

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

– CONTINUE FEEDING– WHEN TO RETURN• The following signs indicate that the child should be

returned immediately– Not able to drink of breastfeed– Becomes weaker– Develops fever

• If the child has diarrhea, also tell the mother to return if the child– Has blood in the stool– Drinking poorly

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

Plan B: Treat some dehydration with ORS Initial treatment for four hours in the health center If the child is for referral, do not try to rehydrate

before leaving. The child will be given frequent sips of ORS on the way

After four hours, reassess and classify DETERMINE THE AMOUNT OF ORS TO GIVE DURING

THE FIRST FOUR HOURSThe age or weight, degree of dehydration, and number of

stools passed during rehydration will affect the amount of ORS needed

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

• To determine the amount needed– Multiply child’s weight (in kilograms) by 75

• Giving ORS should not interfere with breastfeeding. For infants under six months who are not breastfed, 100-200 mL clean water should be given during the first four hours in addition to the ORS

– SHOW MOTHER HOW TO GIVE ORS• Food should not be given within the first four hours of

treatment

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

AFTER FOUR HOURSReassess using the ASSESS and CLASSIFY chartReassess child BEFORE four hours if child is not taking ORS or

seems to be getting worse If child’s eyes are puffy, it is a sign of overhydration. Stop ORS and

give clean water or breastmilk. ORS is resumed when puffiness is gone

IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT

Show how to prepare ORSShow how much to give to complete the 4-hour treatmentGive enough packets to complete rehydration plus two more

packets as recommended in Plan AExplain the three Rules of Home Treatment

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Give Extra Fluid for Diarrhea and DHF and Continue Feeding

Plan C: Treat severe dehydration quickly Treatment depends on

Type of equipment availableTraining of the health workerWhether the child can drink

Treat persistent diarrhea Requires special feeding

Treat dysentery Oral antibiotic recommended for Shigella is given and

mother is told to return in two days for follow-up

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Immunize Every Sick Child as Needed

If the child is well enough to go home, give the necessary immunization before he/she leaves the center

Immunization is given even if only one child needs the immunization

Reconstituted vaccines must be discarded after six hoursOpened vials of OPV may be kept if

Not yet expired Stored between 0 to 8 degrees Celsius Not taken out of the health center

OPV vials with vaccine vial monitors that changed in color indicate expiration

Page 162: Imci Exercise 2

Immunize Every Sick Child as Needed

Record all immunizations on the child’s immunization card

If the child has diarrhea and needs OPV, give it but do not record the dose. Tell the mother to return in four weeks for an extra dose

Tell the possible side effects of each vaccine BCG: ulceration OPV: none DPT: fever, irritability and soreness Measles: fever and mild rash a week after lasting for oneto

three days Hepatitis B: none

Page 163: Imci Exercise 2