Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

Slide 39

Slide 40

Slide 41

Slide 42

IMCI UPDATES

SICK CHILDREN AGED 2 MONTHS TO 59 MONTHS

Main Symptom 1- Cough or Difficult Breathing

(Three days antibiotic treatment of non-severe and severe pneumonia.

Oral antibiotic for non-severe pneumonia should be given for three (3) days instead of 5 days to sick children 2 -59 months old. Shorter courses of antibiotic were found to be equally effective as the five-day duration, reduces cost of treatment in addition to improving compliance and reduces the antimicrobial resistance in the community

Injectable ampicillin plus injectable gentamicin is a better choice than injectable chloramphenicol of severe pneumonia in children 2-59 months old of age. A pre-referral dose of 7.5mg/kg intramuscular injection gentamicin and 50 mg/kg injection ampicillin can be used.

Children with wheeze and fast breathing and/or lower chest indrawing should be given a trial of rapid-acting inhaled bronchodilator (up to three cycles for up to 15-20 minutes apart) before they are classified as pneumonia and prescribed antibiotics.

Use of Amoxicillin and first line antibiotic and Cotrimoxazole as second line antibiotic in the treatment of pneumonia, very severe disease, ear problem is recommended. Main Symptom 2 - Diarrhea

Use of Reformulated Oral Rehydration Salts which should contain 75mEq/L, 75mmol/L glucose concentration and has a total osmolarity of 245 mOsm/L.

Use of Zinc supplements for 10-14 days in the management of diarrhea. Zinc supplementation during the episodes of acute diarrhea reduced the duration and severity of the episode. In addition, studies showed that zinc supplementation given for 10-14 days lowered the incidence of diarrhea in the following 2-3 months. Inclusion of zinc in the management of diarrhea could prevent 300,000 children from dying every year.

In the treatment of bloody diarrhea (Dysentery) Ciprofloxacin is the most appropriate drug in place of Nalidixic acid which leads to rapid development of resistance. Ciprofloxacin is given in a dose of 15 mg/kg two times per day for three (3) days.

Giving of multivitamins and minerals (including Zinc) for 14 days is added in the treatment protocol of PERSISTENT DIARRHEA in addition to continue feeding and follow-up.

Main Syptom 3- Fever

First Line Antibiotic for Malaria Chloroquine,Primaquine, Sulfadoxine and Pyrimethamine. Second line Antibiotic Artemeter-Lumefantrine

Note: New Malaria treatment guidelines will be changed this year making Arthemeter-Lumefantrine as first-line antibiotic.

Main Symptom 4- Ear Problem

Chronic ear infection to be treated with topical quinolone ear drops for at least two weeks in addition to dry ear by wicking

Oral Amoxicillin is first-line antibiotic for the management of acute ear infection and is given two times a day for three (3) days. Even though antibiotics may provide a small benefit for acute ear infection in children, oral amoxicillin plays an important role in reducing the risk of mastoiditis.

Malnutrition and Anemia

Where available, MUAC (Mid-upper arm circumference) less than 110mm is now considered an indicator for Severe Malnutrition. If MUAC is not available, look for visible severe wasting.

Malnutrition and anemia are presented in two separate algorithms

Use of WHO Growth standards instead of the International Reference Standard. (explanation of the WHO GPRS).

Management of severe malnutrition where referral is not possible, manage the child at the health center. If the child has no appetite, a modified milk diet is given. This is made by dried skimmed milk (DSM) sugar and oil.

Mix: 25 g dried skimmed milk

70 g sugar

35 g rice flour

27 g oil and some water

Boil: 5-7 minutes

Allow to cool and then add 20 ml WHO vitamin mineral mix for severe malnutrition and mix again

Make up the volume to 1,000 ml by adding previously boiled water

Feed for a few days 11 ml/kg every 2 hours

Once appetite is restored, a diet with 80 g dried skimmed milk, 50 g sugar and 60 g of oil is prepared. Add water up to 1000 ml and 20 ml WHO mineral and vitamin solution. Increase progressively the feeds up to 200 ml/kg given in 6 feeds (30 ml/kg every 4 hours adjusted to the childs appetite).

VITAMIN A Capsule distribution schedule:

PROPHYLAXIS;

Give first dose at age 6 months or above; give subsequent dose every 6 months.

TREATMENT : for nightblindness, bitots spot, xeropthalmia, corneal xerosis

Give 1 capsule today

Give 1 capsule tomorrow

Give 1 capsule 2 weeks after; subsequent dose after 6 months, then

follow the every six months dose.

Routine Worm Treatment

Give every child Mebendazole/Albendazole every 6 months from the age of one (1) year.

SICK YOUNG INFANT AGED UP TO 2 MONTHS

The first symptom to manage among sick young infants, Check for Possible Bacterial Infection was changed to Check for very severe disease and local bacterial infection and the signs to look for in the assessment of this symptom was reduced from 12 to 7 signs.

The seven signs include: not feeding well, or convulsion, or fast breathing (60 bpm or more), or severe chest indrawing, or fever (37.5 C or above), or low body temperature (less than 35.5 C), or movement only when stimulated, or no movement at all .

The new classifications include: Very severe disease (pink), Severe disease (yellow), Severe disease or local bacterial infection unlikely (green)

Checking for JAUNDICE is added in the protocol for Sick Young Infant aged up to 2 months. Classifications include SEVERE JAUNDICE ( pink row),

JAUNDICE (yellow row) and NO JAUNDICE (green row).

UPDATES ON INFANT FEEDING

HIV and Infant Feeding

In areas where HIV is public health problem all women should be encouraged to receive HIV testing and counseling. If a woman is HIV-infected and replacement feeding is acceptable, feasible, affordable, sustainable and safe for her and her infant, avoidance of all breastfeeding is recommended. Otherwise, exclusive breastfeeding is recommended during the first 6 months of life.

Infant and Young Child Feeding Policy

Early initiation of breastfeeding within the first hour of life;Exclusive breastfeeding up to six months;Addition of safe, adequate complementary foods at age 6 completed months while;

Continuing breastfeeding up to 2 years and beyond.

Prepared by:

Rouena Santiago-Villarama

IMCI Facilitator

UST College of Nursing Note: New Malaria treatment guidelines will be changed this year making Arthemeter-Lumefantrine as first-line antibiotic.

PAGE 14

_1336795668.ppt

Ask about the main symptoms

Cough or difficulty in breathingDiarrheaFeverEar problem

_1337141748.ppt

NO PNEUMONIA: COUGH OR COLD

If cough 30 days refer to hospital for assessmentsafe throat remedyFollow-up in 5 days.

If No signs of pneumoniaor a very severe disease

If wheezing, give inhaled bronchodilator for 5 days

_1337141777.ppt

SEVERE DEHYDRATION

2 or more of the following:- Abnormally sleepy/difficult to wake- Sunken eyes- Not able to feed/drinking poorly- Skin pinch goes back very slowly (2 sec)

Classify for dehydration

If with no other severe classification: Plan C- IVF in RHU

If less than 2 yrs & there is choleraIn the area, give TETRACYCLINE

_1337142027.ppt

NO DEHYDRATION

Not enough signs to classify as SEVERE DEHYDRATION orSOME DEHYDRATION

Classify for dehydration

Plan A: Extra Fluids Give Zinc supplementFollow-up in 5 days

_1410267254.ppt

Then CHECK CHILDS IMMUNIZATION STATUS

BirthBCGHepB1 6 weeksOPV1HepB2DPT1 Hib1 10 weeksOPV2 DPT2 Hib 2 14 weeksOPV3HepB3DPT3 Hib 3 9 monthsMeasles 15 months MMR

_1487877920.ppt

New Vaccination Schedule

BirthBCGHepB0 6 weeksPentavalent1 OPV1 RTV1* PCV1* 10 weeksPentavalent2 OPV2 RTV2* PCV2* Pentavalent3 OPV3 RTV3* PCV3* 9 monthsMeasles 12 months MMR

RTV*PCV* - in selected areas only due to limited suppliesPentavalent vaccine includes DPT, HIB, HepB

_1410266534.ppt

Assess Dengue

Bleeding gums, nose, in vomitus or stools ,orPersistent vomiting & abdominal pain, Skin petechiae, orCold clammy extremities, orSlow capillary refill (more than 3 secs) + Tourniquet test

_1337141807.ppt

If with blood in the stool - dysentery

Oral antibiotic- CIPROFLOXACIN for 3 days Follow-up in 2 days

_1337141774.ppt

SOME DEHYDRATION

2 of the following:- Restless, irritable- Sunken eyes- Drinks eagerly, thirsty- Skin pinch goes back slowly (2 sec)

Classify for dehydration

Plan B : ORS, zinc supplement in RHU

_1336796189.ppt

Measles now or w/in last 3 mosNo other signs

Vitamin AAdvise mother when to return immediately

Measles

_1337141630.ppt

IMCI Case Management

Danger signsMain SymptomsNutritional statusImmunization statusOther problems

Need to Refer

Specific treatment

Homemanagement

Classification

Focused Assessment

Identify treatmentTreat

Counsel caretakersFollow-up

Treatment

Counsel & Follow-up

*

_1337141713.ppt

PNEUMONIA

Antibiotic for 3 days (Amoxycillin) safe throat remedy (calamansi, ginger, tamarind, breast milk) Follow-up in 2 days

If Fast breathing only:2 12 months old: 50/minute1 year or older: 40/minute

Note: Exactly 12 mos: 40

If wheezing, give trial of rapid-acting inhaled bronchodilator (up to three cycles for up to 15-20 minutes apart)

_1337141611.ppt

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

1st dose of antibiotic Vitamin A URGENT REFERRALPrevent low blood sugar

If with:- Any general danger sign or- Chest indrawing or- Stridor

_1336795982.ppt

If Malaria risk (+) blood smear

Oral antimalarial Paracetamol for feverFollow-up in 2 days

Malaria

_1336796051.ppt

If with ear problem: with ear discharge < 14 days

Antibiotic for 5 daysParacetamol for painWickingFollow-up in 5 days

Acute ear infection

_1336796188.ppt

If up to 6 months and: Visible severe wasting or Edema on both feet If 6 mos & above: Above symptoms & MUAC is less than 115 mm

Vitamin ATreat to prevent low blood sugarURGENT REFERRAL

Severe malnutrition

_1336796187.ppt

Then ASSESS OTHER PROBLEMS

Prepared by:Rouena S. VillaramaUST College of NursingIMCI Facilitator

_1336796012.ppt

If Malaria risk (-) blood smear

Paracetamol for feverTreat other causes of feverFollow-up in 2 days

Fever, malaria unlikely

_1336795964.ppt

Measles now or w/in last 3 mosPus draining from the eye orMouth ulcers

Vitamin ATetracycline eye ointmentGentian violet Follow up in 2 days

Measles with eye orMouth complications

_1336795967.ppt

If with Measles & with clouding of cornea orwith deep or extensive mouth ulcers or ANY danger sign

1st dose of antibiotic, Vitamin Atetracycline eye ointmentUrgent referral

Severe complicated measles

_1336795866.ppt

Fever: Ask about malaria risk

Residing in endemic area? OR:Travel & overnight stay in endemic area

If YES, then do a blood smear.

w/in past 4 weeks

_1332320761.ppt

If No sign of Severe Dengue Hemorrhagic Fever

DO NOT GIVE ASPIRINFollow-up in 2 days

FEVER, DHF UNLIKELY

_1332320783.ppt

Very low weight for age

Assess for feeding problem Counsel the mother on feedingVitamin A

Very low weight

_1332320801.ppt

Then check the childs DEWORMING status

ROUTINE WORM TREATMENT: Give every child ALBENDAZOLE/ MEBENDAZOLE every 6 months from the age of one year.

_1332321065.ppt

If with Malaria risk: & with any general danger sign or stiff neck

Quinine (under med. supervision)1st dose of antibiotic, ParacetamolPrevent low blood sugarSend the blood smear with patientURGENT REFERRAL

Very severe febrile disease/malaria

_1332321103.ppt

If no malaria risk but withAny general danger sign or stiff neck

One dose of antibiotic, ParacetamolTreat to prevent low blood sugarURGENT REFERRAL

Very severe febrile disease

_1332321115.ppt

If no malaria risk & NO sign of very severe febrile disease

One dose ParacetamolIf with fever every day for more than 7 days, REFER for assessment

FEVER, NO MALARIA

_1332320808.ppt

ASSESS CARE DEVELOPMENT:

Ask questions about how the mother cares for her child. ASK - How does she play with your child? - How does she communicate with the child?

_1332320890.ppt

Cough or difficulty in breathing

Look for:Count RRChest indrawingListen for StridorListen for wheezing

The child must be calm & not eating

_1332320804.ppt

Then ASSESS THE CHILDS FEEDING

If the child has ANEMIA or VERY LOW WEIGHT or LESS THAN 2 YEARS OLD.

Examples of feeding problems: Difficulty in breastfeeding Child less than 6 months taking other milk/ food Use of breastmilk substitute/ cows milk, evap Use of feeding bottles Child 6 months above not yet given complementary food

_1332320790.ppt

Some palmar pallor or

Assess for feeding problem / counsel motherGive iron & Albendazole (if 1 yr old & older)

Anemia

_1332320797.ppt

Then CHECK VITAMIN A SUPPLEMENTATION STATUS(for children 6 months or older)

Given if child was not given in the past 6 months. May be given even if given one in the past 6 months if Vit. A is part of urgent pre-referral treatment.

_1332320787.ppt

Severe palmar pallor

URGENT REFERRAL

Severe anemia

_1332320772.ppt

Ear discharge for 14 days or more

Wicking Quinolone ear drops for 2 weeksFollow-up in 5 days

Chronic ear infection

_1332320776.ppt

Then check for malnutrition & anemia

Look for:Visible severe wastingEdema of both feetPalmar pallorIf 6 months or older, determine if MUAC (Mid-upper Arm Circumference) is less tha 115 mm.

Determine weight for age

_1332320765.ppt

Classify Ear problem:Tender swelling behind ear

1st dose of antibioticParacetamol for painURGENT REFERRAL

Mastoiditis

_1332320709.ppt

Persistent diarrhea: 14 days or more

Treat dehydrationGive Vitamin AREFER to hospital

Dehydration present- severe persistent diarrhea

_1332320719.ppt

If with fever?

Determine: Malaria risk?

Measles now or w/in last 3 mos

Dengue risk?

_1332320758.ppt

Any of the mentioned symptoms

Plan C if with + bleedingPlan B if with either abdominal plain, or skin petechia, or + torniquet testDo not give aspirinTreat to prevent low blood sugar.URGENT REFERRAL

Severe Dengue hemorrhagic fever

_1332320712.ppt

Persistent diarrhea: 14 days or more

Advise regarding feedingGive Vitamin AGive multivitamins & minerals with zinc for 14 daysFollow-up in 5 days

No dehydration- persistent diarrhea

_1332320673.ppt

Check for general danger signs

Not able to drink or breastfeed, orVomits everything, orConvulsions, orAbnormally sleepy or difficult to awaken

If YES: URGENT REFERRAL is needed

_1332320695.ppt

If with Diarrhea, then classify

For dehydration

If persistent

If with blood in the stool

_1332320666.ppt

The Integrated Management of Childhood Illness