1. mortality & morbidity2. Healthy growth & development

To Improve:

C-ase management skills; D-elivery system (health

care) ; E-ncourage family &

community practice

A- assessC- classifyT- treat/ identify

C- counselF- follow up care

C- cough/ Dif. Of breathing

D- diarrhea

F- fever

E- ear pain

Initial

Follow up

1.Young infant to 2 mos

2.2 mos up to 5 yrs

V- vomitA-abnormally sleepyC-convulsionU- unable to feed

**severe at least 1DANGER

SIGNSCONVULSIONS

INABILITY TO DRINKOR BREASTFEED

VOMITING

LETHARGYUNCONSCIOUSNESS

URGENT REFERRALURGENT REFERRAL

TREATMENT AT OUT-PX HEALTH FACILITY

HOME MANAGEMENT

PNEUMONIA MASTOIDITIS ACUTE EAR INFECTION VERY SEVERE DISEASE

FIRST LINE ANTIBIOTICS: AMOXICILLIN

SECOND LINE ANTIBIOTICS: COTRIMOZAXOLE

CIPROFLOXACIN

CHOLERA:

TETRACYCLINE

GENTAMICINBENZYL PENICILLIN

PARACETAMOL 38.5 CEVERY 6 HOURS UNTIL GONE

FIRST LINE ANTIMALARIAL:

ARTEMETHER-LUMEFANTRINE

SECOND ANTIMALARIAL:CHLOROQUINE, PRIMAQUINE, SULFADOXINE AND PYRIMETHAMINE

May have pneumonia Streptococcus pneumoniae/ H. influenza

ASSESS:a. How long is the cough/ DOB; wof:>30daysb. Fast breathingc. Chest indrawing – lying flat d. Stridor when calm

If child is: Fast breathing

12 mos – 5yo 40bpm & >

2 mos up to 12 mos

50bpm & >

Any general danger sign VACU or

Chest indrawing or

Stridor in calm child

severe pneumonia

or

very severe disease

•First dose antibiotics•Vit A•HOSP!!•Tx child to x hypoglycemia

Fast breathing pneumonia 3days anitibiotics

Soothe throat

F.up = 2days

bronchodilator

No signs of pneumonia or very severe disease

no pneumonia:

cough or cold

Soothe throat

F.Up in 5 days

Refer if (+) >30days cough

bronchodilator

Ingestion of contaminated food/ water 3&> watery stool /day Tx: ORESOL infant = AM Home made:1Lt water, 1 tsp salt, 8tsp sugar

ASSESSMENT:a. Irritableb. Sunken eyesc. Skin pinchedd. thirst

<14days diarrhea: DEHYDRATION>14days diarrhea: DIARRHEABlood in the stool: DYSENTERY

VACUSKIN PINCHED SLOWLY

severe DHN

PLAN CREFERFREQUENT SIP OF ORS<2YO (CHOLERA)

2 SIGNS:RESTLESS, IRRITABLESUNKEN EYESDRINKS EAGERLYPINCHED SLOW

Some DHN PLAN BF.UP 5 DAYSSIP OF ORS

NOT ENOUGH SIGN OF DHN

No DHN PLAN AF.UP 5 DAYS

1.E-xtra fluid2.F-eeding3.G-ive zinc4.wH-en to return

PLAN C:Two of the following signs:

Lethargic or unconscious

Sunken eyes

Not able to drink or drinking poorlySkin pinch goes back very slowly

PLAN B:Two of the following signs:

Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

Skin pinch goes back

slowly

PLAN A:

Not enough sign of dehydration

Urgent!

Refer to hosp= IVF

NGT

Oresol:

wt in kg x 75

4 rules of home treatment

4 rules of home treatment

(+) dehydration

Sever, persistent diarrhea

•tx dehyration

•Vit A

•Refer

(-) dehydration

Persistent diarrhea

•Feed

•Vit A

•zinc

•Ff up 5 days

DYSENTERY: BLOOD IN STOOL3 DAYS ORAL ANTIBIOTICS = CIFPROFLOXACIN

SHIGELLA: FF UP IN 2 DAYS

FIRST LINE ANTIBIOTICS: TETRACYCLINE 2X DAILY FOR 3 DAYS 2-5YO

ASSESS:a. Ear pain?b. Ear discharge?c. How long?d. Pus?e. Tender swelling behind ears?

Tender swelling behind the ear

mastoiditis •1st dose antibiotics•1st dose paracetamol•URGENT TO HOSP

Ear discharge for <14 days or

Ear pain

acute ear infection

•Antibiotics for 5 days•Paracetamol•Ear wink•Ff up 5 days

Ear discharge for > 14 days

chronic ear infection

•Dry ear wink•QUINOLONE OTIC DROP FOR 2 WEEKS

Ff up 5 daysNO ear pain and NO ear discharge seen draining from the ear

no ear infection

No additional tx

Dry 3x/dayRoll clean absorbentwink; when wet –repeat until dry

Instill quinolone otic drops after ear wink 2-3 drops, 3x/day for 2 weeks

Lived in malaria area?

Visited / overnight in malaria area past 4 wks?

Fever for how long?

Measles for last 3 mos?

Stiff neck? Runny nose?

Any danger sign or

Stiff neck

very severe febrile disease

•1st dose: quinine

•Antibiotics

•Prevent low blood sugar

•Paracetamol

•URGENT TO HOSP

Fever (by history or feels hot or temperature 37.5°C or above)

malaria •Oral antimalarial

•Paracetamol

•Ff up 2 days

•If + fever >7 days, refer for assessment

NO runny nose and NO measles and NO other causes of fever

Fever: unlikely malaria

•Paracetamol

•Ff up 2 days persistent fever

•If + fever >7 days, refer for assessment

1. Able to swallow=Breastfeed

2. (-)breastfeed + swallow= GIVE expressed breastmilksugar water; 30-50ml milk/ sugar water before departure

SUGAR WATER: 4 tsp sugar in 200ml cup

3. (-) swallow: 50 ml milk/sugar water NGT Difficult to awaken: START IV

**

•Any danger sign

•Stiff neck

Very severe febrile disease

•Antibiotics

•Prevent low blood sugar

•Paracetamol

•URGENT to HOSP

•(-) sign of very severe malaria

Fever: no malaria

•Paracetamol

•Ff up 2 days

•If + fever >7 days, refer for assessment

Now or w/in last 3 mos: Mouth ulcer? Deep/extensive Pus/drainage eye Clouding of cornea

Generalized rashes Cough Runny nose Red eyes

Any danger sign orClouding of cornea orDeep or extensive mouth ulcers

severe complicated measles

•Vit A•1st dose antibiotics•If + pus & clouding; tetracycline•URGENT TO HOSP

Pus draining from the eye or

Mouth ulcers

measles with

eye or mouth complications

•Vit A•If + pus in eyes; tetracycline•If + mouth ulcer; gential violet•Ff up 2 days

Measles now or within the last three months

measles Give vit A

Clean both eyes 4x/daywipe pusApply eye ointment both eyes 3x/day

Squirt amount in lower lidTx until redness is gone

2x/dayWash handsWash child’s mouth; using soft cloth around fingers wet with salt water

+cotton buds; paint mouth w/ 0.25% Gentian Violet

Wash hands againCont 48 hrs after ulcer has been cured

ASSESS:Bleeding?nose,gums, vomit; stoolBlack vomitusBlack stool+ abdominal pain+ persistent vomitingTourniquet test, petichiae; cold clammy extremities; slow capillary refill

•Bleeding from nose, gums, •(+) black stool;•Vomit; + tourniquet•Petichiae•Abdo pain; cold clammy skin

Severe:DHF

•(+) vomit=PLAN B•(+) bleeding= plan C•Tx prevent low blood sugar•URGENT TO HOSP•X aspirin

(-) sign of severe DHF Fever:

DHF unlikely

•Ff up 2 days•X give aspirin

ASSESS:a. Look for severe wastingb. + edema (feet)c. Palmar pallor? Severe/

somed. Determine weight for age

IF AGE UP TO 6 MOS & VISIBLE SEVERE WASTING, (+) EDEMA BOTH IF AGE 6 MOS AND ABOVE:MUAC IS <115 MM/HAS EDEMA BOTH FEET(+) SEVERE WASTING

SEVEREMALNUTRI-TION

PREVENT LOW BLOOOD SUGARVIT AREFER

VERY LOW WEIGHT FOR AGE

VERY LOW WEIGHT

ASSESS CHILD’S FEEDINGGIVE VIT AFOLLW UP 30 DAYS

NOT VERY LOW WEIGHT FOR AGE AND NO OTHER SIGNS OF MALNUTRITION

NOT VERY LOW WEIGHT

ID CHILD <2YO, ASSESS CHILD’S FEEDING\FF UP 5 DAYS

Visible severe wasting or

Severe palmar pallor or

edema of both feet

severe malnutrition

or severe anaemia

•Vit A•Urgently refer to hospital

Some palmar pallor or

(Very) low

weight for

age

anaemia or

(very) low weight

•Paracetamol;Food box- counsel mother•+feeding problem, ff up 5 days•(Some pallor) Iron, mebendazole/ abendazole if 12mos & up; x take dose 6mos previous= ff up 14days•Weight, ff up in 30days= very low weight

NOT (very) low weight for age and no other signs of malnutrition

no anaemia and not

(very) low weight

If child is <2yo; food box

Ff up 5 days

1ST dose: 6mos & up

Subsequent: q 6 mos.

6 months up to 12 months

100,000 IU

12 months up to 5 years

200,000 IU

AGE VACCINE

Birth BCG HepaB-1

6 wks DPT1 OPV 1 HepaB-2

10 wks DPT2 OPV 2 --

14 wks DPT3 OPV3 HepaB-3

9 mos Measles

FOLLOW UP 2 DAYS

FOLLOW UP 5 D AYS

MALARIA PERSISTENT DIARRHEA

MEASLES with complication ACUTE & CHRONIC EAR INFECTION

FEVER: MALARIA ANY OTHER ILLNESS, if not improving

FEVER: no MALARIA

FEVER: DHF UNLIKELY

PNEUMONIIA and WHEEZE

DYSENTERY

ANEMIA 14 DAYS

VERY LOW WEIGHT FOR AGE

30 DAYS