IMNCI: Malaria, measles and malnutrition

This presentation includes content on malaria, measles and malnutrition based on IMNCI.

1. IMNCI: Malaria, Measles & Malnutrition Dr. Ramya S

2. Sick young infant upto 2 months Any one of the following signs: Classify Treatment Not feeding well Convulsions Fast breathing Severe chest indrawing Fever (37.5°C or above) Low body temperature (less than 35.5° C) Movement only when stimulated or no movement at all VERY SEVERE DISEASE Give 1 st dose of i.m . antibiotic Treat to prevent low blood sugar Refer URGENTLY Advise mother how to keep the infant warm on the way to hospital

3. MALARIA Sick child 2 months upto 5 years

4. Sign Classify Treatment Any general danger sign or Stiff neck VERY SEVERE FEBRILE DISEASE Give 1 st dose of Artesunate or quinine Give 1 st dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give 1 dose of paracetamol in clinic for high fever (38.5° C or above) Refer URGENTLY to hospital High or Low malaria risk

5. Signs Classify Treatment Malaria test positive MALARIA Give recommended 1 st line oral anti-malarial Give 1 dose of paracetamol in clinic for high fever (38.5° C or above) Give appropriate antibiotic for identified bacterial cause of fever Advise mother when to return immediately Follow up in 3 days if fever persists If fever present everyday for more than 7 days, refer for assessment

6. Signs Classification Treatment Malaria test NEGATIVE Other cause of fever present FEVER NO MALARIA Give 1 dose of paracetamol in clinic for high fever (38.5° C or above) Give appropriate antibiotic for identified bacterial cause of fever Advise mother when to return immediately Follow up in 3 days if fever persists If fever present everyday for more than 7 days, refer for assessment

7. Sign Classify Treatment Any general danger sign or Stiff neck VERY SEVERE FEBRILE DISEASE Give 1 st dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give 1 dose of paracetamol in clinic for high fever (38.5° C or above) Refer URGENTLY to hospital No malaria risk & No travel to malaria risk area

8. Signs Classification Treatment No general danger sign No Stiff neck FEVER Give 1 dose of paracetamol in clinic for high fever (38.5° C or above) Give appropriate antibiotic for identified bacterial cause of fever Advise mother when to return immediately Follow up in 2 days if fever persists If fever present everyday for more than 7 days, refer for assessment

9. Measles If the child has measles now or within last 3 months: Look for mouth ulcers Pus draining from the eyes Clouding of cornea Sick child 2 months upto 5 years

10. Sign Classify Treatment Any general danger sign or Clouding of cornea or Deep or extensive mouth ulcers SEVERE COMPLICATED MEASLES Give Vitamin A treatment Give 1 st dose of an appropriate antibiotic Apply tetracycline eye ointment for clouding of cornea Refer URGENTLY to hospital Sick child 2 months upto 5 years

11. Signs Classify Treatment Pus draining from the eye or Mouth ulcers MEASLES WITH EYE OR MOUTH COMPLICATIONS Give Vitamin A treatment Apply tetracycline eye ointment for p us draining from the eye Treat mouth ulcers with Gentian violet Follow-up in 3 days Sick child 2 months upto 5 years

12. Signs Classification Treatment Measles now or within last 3 months MEASLES Give Vitamin A treatment Sick child 2 months upto 5 years

13. MALNUTRITION Look for signs of acute malnutrition Oedema of both feet Determine WFH/L (Z score) Measure MUAC Sick child 2 months upto 5 years

14. If WFH/L less than -3 Z score or MUAC less than 115 mm , then: Check for presence of any medical complication : any general danger sign, severe classification , Pneumonia with chest indrawing If no medical complication: If child less than 6 months, assess breastfeeding If 6 months or older, offer RUTF (Ready-To-Use-Therapeutic Food) & check if child able to finish it or not

15. Sign Classify Treatment Oedema of both feet or WFH/L less than -3 Z score or MUAC less than 115 mm AND any one of the following, Medical complication present Not able to finish RUTF Breastfeeding problem COMPLICATED SEVERE ACUTE MALNUTRITION Give 1 st dose of appropriate antibiotic Treat the child to prevent low blood sugar Keep the child warm Refer urgently to hospital Sick child 2 months upto 5 years

16. Signs Classify Treatment WFH/L less than -3 Z score or MUAC less than 115 mm AND Able to finish RUTF UNCOMPLICATED SEVERE ACUTE MALNUTRITION Give oral antibiotics for 5 days Give RUTF for a child aged 6 months or more Counsel the mother on how to feed the child Assess for possible TB infection Advise mother when to return immediately Follow-up in 7 days Sick child 2 months upto 5 years

17. Signs Classify Treatment WFH/L between -3 and -2 Z scores or MUAC 115 upto 125 mm MODERATE ACUTE MALNUTRITION Assess child’s feeding & counsel the mother on feeding recommendations If feeding problem, follow up in 7 days Assess for possible TB infection Advise mother when to return immediately Follow-up in 30 days Sick child 2 months upto 5 years

18. Sign Classification Treatment WFH/L -2 Z scores or more or, MUAC 125 mm or more NO ACUTE MALNUTRITION If child is less than 2 yrs old, assess child’s feeding & counsel the mother on feeding recommendations If feeding problem, follow up in 7 days Sick child 2 months upto 5 years

19. Thank you