INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

Question 1

The Integrated Management of Childhood Illnesses
(IMCI) chart serves as a

Answer 1

nutritional assessment tool for case
management of sick children seeking services at the health
center.

Question 2

The six childhood illnesses included in the IMCI are

Answer 2

malnutrition, pneumonia, diarrhea, measles, dengue,
hemorrhagic fever, and malaria.

Question 3

These are all preventable
and treatable with simple and low-cost interventions

Answer 3

malnutrition, pneumonia, diarrhea, measles, dengue,
hemorrhagic fever, and malaria.

Question 4

PINK:

Answer 4

SEVERE (Referral, Pre – referral)

Question 5

o YELLOW:

Answer 5

SPECIFIC TREATMENT (appropriate
antibiotic, an oral anti – malarial or other treatment;
also teaches the mother how to give oral drugs or to
treat local infections at home)

Question 6

GREEN:

Answer 6

MILD (Home Management)

Question 7

(IMCI only covers children
_____)

Answer 7

2 weeks – 5 years of age

Question 8

• Table Format: ASSESS – CLASSIFY – TREAT

Answer 8

Identify the patient.
o Ask for the purpose of the visit/child’s problem
o Ask for the patient’s age.

Check for general danger signs (if severe, REFER!) –

o Check for main symptoms–

Assess status—

Classify Conditions
o Treat the Child
o Give follow up care: 1, 3, 5, 7, 14, 30 (to clients
belong to yellow & green)
o Counsel the mother

Question 9

Check for general danger signs (if severe, REFER!)

Answer 9

C – convulsion
▪ U – Unable to drink/breastfeed
▪ V – vomits everything
▪ A – abnormally sleeping (lethargic;
difficult to awaken)

Question 10

Check for main symptoms

Answer 10

▪ Assess for cough or difficulty of breathing
▪ Assess for diarrhea
▪ Assess for fever
▪ Assess for ear problem

Question 11

o Assess status

Answer 11

▪ Check for acute malnutrition and anemia
▪ Check for HIV/AIDS status
▪ Check for immunization status
▪ Check for Vit. A status (retinol/fat soluble)
* For immunity to reduce severity
of disease
▪ Assess other problems (deworming – 1
yr & up every 6mos until 5y/0

Question 12

SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS

ABCD

Answer 12

A. ASSESS THE CHILD:
B. CLASSIFY THE CHILD’S ILLNESS:
C. IF URGENT REFERRAL is needed and possible
IF NO URGENT REFERRAL is needed and possible.

Question 13

SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS

A. ASSESS THE CHILD:

Answer 13

• Check for danger signs (or possible bacterial infection).
• Ask about main symptoms.
• If a main symptom is reported, assess further. Check
  nutrition and immunization status.
• Check for other problems

Question 14

SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS

B. CLASSIFY THE CHILD’S ILLNESS:

Answer 14

• Use a color-coded triage system to classify the child’s main
  symptoms and his or her nutrition or feeding status.

Question 15

SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS

C. IF URGENT REFERRAL is needed and possible.

Answer 15

• Identify urgent pre – referral treatment(s) needed prior to
  referral of the child according to classification.
• Treat the child:
  o Give urgent pre-referral treatment(s) needed.
• Refer the child:
  o Explain to the child’s caretaker the need for referral.
  o Calm the caretaker’s fears and help resolve any
  problems. Write a referral note.
  o Give instructions and supplies needed to care for the
  child on the way to the hospital.

Question 16

SUMMARY OF INTEGRATED CASE MANAGEMENT
PROCESS

D. IF NO URGENT REFERRAL is needed and possible

Answer 16

• Identify treatment(s) needed for the child’s classifications:
  identify specific medical treatments and/or advice.
• Treat the child:
  o Give the first dose of oral drugs in the clinic and/or
  advice the child’s caretaker.
  o Teach the caretaker how to give oral drugs and how
  to treat local infections at home.
  o If needed, give immunizations.
• Counsel the mother:
  o Assess the child’s feeding, including breastfeeding
  practices, and solve feeding problems, if present.
  o Advise about feeding and fluids during illness and
  about when to return to a health facility.
  o Counsel the mother about her own health.
• Follow – up care:
  o Give follow – up care when the child returns to the
  clinic and, if necessary, reassess the child for new
  problems.

Question 17

MALNUTRITION AND ANEMIA

Answer 17

Look – Feel Assessment
* Look for visible severe wasting, edema of both feet, and
palmar pallor.
* Determine weight for age using growth monitoring chart

Question 18

MALNUTRITION AND ANEMIA

FOR A YOUNG INFANT – LESS THAN 2 MONTHS

Answer 18

• Check for Feeding Problem of Low Weight
• ASK – LOOK – LISTEN – FEEL Assessment
• Look, Listen, Feel: Determine weight for age.

Question 19

MALNUTRITION AND ANEMIA

CLASSIFY FEEDING:

Answer 19

1. Not Able to Feed – Possible Serious Bacterial Infection
2. Feeding Problem or Low Weight
3. No Feeding Problem

Question 20

MALNUTRITION AND ANEMIA

CLASSIFY FEEDING:
Not Able to Feed – Possible Serious Bacterial Infection

Signs:
Treatment:

Answer 20

Signs: Not able to feed, no attachment at all or not
sucking at all

Treatment:
▪ Give the 1st dose of intramuscular
antibiotic.
▪ Treat to prevent low blood sugar.
▪ Advise the mother how to keep the young
infant warm on the way to the hospital.
▪ Refer urgently to hospital.

Question 21

MALNUTRITION AND ANEMIA

CLASSIFY FEEDING:
2. Feeding Problem or Low Weight

Signs:
Treatment:

Answer 21

Signs: Not well attached to breast, not sucking
effectively, less than 8 breastfeeds in 24 hours,
receives other foods or drinks, low weight for age, or thrush (ulcers or white patches in mouth)

Question 22

MALNUTRITION AND ANEMIA

CLASSIFY FEEDING:2. Feeding Problem or Low Weight

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Question 23

MALNUTRITION AND ANEMIA

CLASSIFY FEEDING:
No Feeding Problem
Signs:
Treatment:

Answer 23

o Signs: Not low weight for age and no signs of
inadequate feeding.
o Treatment:
▪ Advise mother to give home care for the
young infant.
▪ Praise the mother for feeding the infant
well.

Question 24

CLASSIFY NUTRITIONAL STATUS

Answer 24

. Severe Malnutrition or Sever Anemia

Anemia or Very Low Weight

No Anemia and Not Very Low Weight

Question 25

CLASSIFY NUTRITIONAL STATUS a. Signs: Treatment: 1. Severe Malnutrition or Sever Anemia

Answer 25

a. Signs: Visible severe wasting or edema of both feet or severe palmar pallor. b. Treatment: i. Give Vit A ii. Refer urgently to hospital

Question 26

CLASSIFY NUTRITIONAL STATUS a. Signs: Treatment: . Anemia or Very Low Weight

Answer 26

Signs: Some palmar pallor or very low weight for age Treatment: child's feeding and counsel the mother on feeding If feeding problem, follow-up in 5 days pallor: give Iron, mebendazole if child is 2 years or older If very low weight for age: give vitamin A; follow-up in 30 days Advise mother when to return immediately

Question 27

CLASSIFY NUTRITIONAL STATUS a. Signs: Treatment: No Anemia and Not Very Low Weight

Answer 27

a. Signs: Not very low weight for age and no other signs of malnutrition b. Treatment: i. If the child is less than 2 years old, assess the child’s feeding and counsel the mother on feeding. ii. If feeding is a problem, follow-up in 5 days iii. Advise mother when to return immediately

Question 28

COUGH OR DIFFICULTY IN BREATHING

Answer 28

ASK - LOOK - LISTEN Assessment * Ask: for how long? (cough that persist for more than 14 weeks or 30 days is considered chronic cough. Look: o Count the breaths in one minute. Look for fast breathing and chest indrawing. o Fast breathing is; 60bpm more -less 2 months 50bpm if 2-12 months 40 bpm if 12-5 years Listen: for stridor

Question 29

Chronic cough is not related to pneumonia but relation to other conditions such as:

Answer 29

▪ Emphysema ▪ Asthma ▪ Diphtheria ▪ Orthosis

Question 30

COUGH OR DIFFICULTY IN BREATHING . Very Severe Disease signs n treatment

Answer 30

Signs: stopped feeding well, convulsions, abnormally sleepy or difficult wake, stridor or wheezing, fever or low body temperature. b. Treatment: i. give 1% dose of antibiotic ii. keep warm iii. refer urgently to the hospital

Question 31

COUGH OR DIFFICULTY IN BREATHING Severe Pneumonia signs n treatment

Answer 31

a. Signs: with fast breathing or severe chest in – drawing b. Treatment: i. give 1st dose of antibiotic ii. keep warm iii. refer urgently to the hospital

Question 32

COUGH OR DIFFICULTY IN BREATHING No Pneumonia: Cough or Cold signs n treatment

Answer 32

a. Signs: no fast breathing, no severe chest indrawing or danger signs. b. Treatment: i. instruct mother on home care ii. advise the mother when to return immediately iii. no antibiotics needed.

Question 33

CHECK FOR POSSIBLE BACTERIAL INFECTION 1. Possible Serious Bacterial Infection

Answer 33

Signs: With fast breathing, severe chest indrawing, convulsion, nasal flaring or grunting, bulging fontanelle, pus draining fiom car umbilical redness extending to the skin, Treatment: i. Give the 1° dose of intramuscular antibiotic ii. Treat to prevent low blood sugar iii. Advise mother how to keep the infant warm on the way to the hospital iv. Refer urgently to the hospital

Question 34

CHECK FOR POSSIBLE BACTERIAL INFECTION 2. Local Bacterial Infection

Answer 34

a. Signs: Red umbilicus or draining pus or skin pustules. b. Treatment: c. Give an appropriate oral antibiotic. d. Treat local infection in the health center and teach the mother to treat local infection at home. e. Advise mother to give home care to the young infant. f. Follow up in 2 days. For Local Bacterial Infection: a. First-line antibiotic: Cotrimoxazole b. Second-line antibiotic: Amoxicillin

Question 35

DIARRHEA

Answer 35

* Check: How long? (Classify if persistent diarrhea) * Assess for: o General Danger Signs o Sunken eyes, capillary refil

Question 36

Dysentery

Answer 36

– blood in the stoo

Question 37

If more than 14 days + No DHN – * If more than 14 days + DHN –

Answer 37

Persistent Diarrhea Severe Persistent Diarrhea

Question 38

FEVER MEASLES

Answer 38

o Filterable virus of measles o Check if there are complications

Question 39

MEASLES plications. ▪ Cloudy cornea – ▪ Mouth ulcerations -

Answer 39

keratomalacia/xeropthalmia (causes blindness = give Vit A half strength gentian violet

Question 40

DENGUE Best management

Answer 40

st management: ▪ ORS / Fluid Replacement Therapy ▪ Paracetamol ▪ Aspirin – BIG NO! - * Aspirin damages the platelet; there would be deliberate decrease of platelet. * Complication: Hypovolemic Shock

Question 41

* MALARIA

Answer 41

Check if the family lives or visited a malaria endemic area. Severe Malaria * Nucchal rigidity / stiff neck + GDS * Give first dose of quinine. ▪ Malaria * Check for positive malaria smear

Question 42

Causative agents of malaria: o Plasmodium species:

Answer 42

▪ P. falciparum (dangerous) ▪ P. vivax ▪ P. ovale (rarest) ▪ P. malariae

Question 43

* MALARIA Drug of choice:

Answer 43

Drug of choice: chloroalkanes/ quinine

Question 44

EAR PROBLEM

Answer 44

Check for ear pain – ask for how long, where is it located?

Question 45

o Mastoiditis

Answer 45

▪ Pain behind the ear: danger sign; (requires immediate management of antibiotics and referral because it may lead to permanent ear damage.

Question 46

EAR PROBLEM Acute ear problem Chronic ear problem

Answer 46

Acute ear problem: less than 14 days ▪ Give antibiotic for 5 days ▪ Paracetamol for pain\ Chronic ear problem: more than 14 days ▪ Dry the ear by wicking

Question 47

For Pneumonia, Acute Ear Infection or Very Severe Disease First line Antibiotic: o Second line antibiotic:

Answer 47

Cotrimoxazole Amoxicillin