IMCI - DISEASES

• GREEN: FEVER: NO MALARIA

  • malaria test NEGATIVE
  • present fever
  • one dose of paracetamol for high fever (38.5 or above)
  • give appropriate antibiotic treatment
• YELLOW: MALARIA

  • malaria test POSITIVE
  • give first line oral antimalarial
• PINK: VERY SEVERE FEBRILE DISEASE

  • any general danger sign
  • stiff neck
  • give first dose of artesunate or quinine for severe malaria
  • prevent low blood sugar
  • refer urgently to hospital
• GREEN: FEVER

  • no danger signs
  • no stiff neck
  • give dose of paracetamol for fever (38.5 above)
  • antibiotic treatment for fever
  • follow-up in 2 days if fever persists
• GREEN: MEASLES

  • measles now or within the last 3 months
  • give VITAMIN A treatment
• YELLOW: MEASLES W/ EYE OR MOUTH COMPLICATIONS

  • pus draining from the eye or mouth ulcers
  • treat eye infection with tetracycline eye ointment
  • treat mouth ulcers with gentian violet
• PINK: SEVERE COMPLICATED MEASLES

  • clouding of cornea
  • deep or extensive mouth ulcers
  • first dose of an appropriate antibiotic
  • refer urgently to hospital
• GREEN: NO DEHYDRATION (SIGNS)

  • not enough signs to classify as some or severe dehydration
• YELLOW: SOME DEHYDRATION (SIGNS)

  • restlessness and irritable
  • sunken eyes
  • skin pinch goes back slowly
• PINK: SEVERE DEHYDRATION (SIGNS)

  • lethargic or unconscious
  • sunken eyes
  • not able to drink or drinking poorly
  • skin pinch goes back very slow
• GREEN: DEHYDRATION (TREATMENT)

  • give fluid, zinc supplements, and food to treat diarrhea at home (PLAN A)
• YELLOW: SOME DEHYDRATION (TREATMENT)

  • give fluid, zinc supplements, and food for some dehydration (PLAN B)
  • advise mother to continue breastfeeding
• PINK: SEVERE DEHYDRATION (TREATMENT)

  • give fluid for severe dehydration (PLAN C)
  • if child is 2 years or older and older and there is cholera, give antibiotic for cholera
• GREEN: NO EAR INFECTION

  • no ear pain
  • no pus seen draining from the ear
  • no treatment
• YELLOW: CHRONIC EAR INFECTION

  • pus is draining from the ear
  • discharge is reported for 14 days or MORE
  • dry the ear by wicking
  • treat with topical quinolone eardrops for 14 days
  • follow-up in 5 days
• YELLOW: ACUTE EAR INFECTION

  • pus is draining from the ear/ear pain
  • discharge is reported for LESS than 14 days
  • give antibiotic for 5 days
  • give paracetamol for pain
  • dry the ear by wicking
  • follow up in 5 days
• PINK: MASTOIDITIS

  • tender swelling behind the ear
  • give first dose of an appropriate antibiotic
  • give first dose of paracetamol for pain
  • refer URGENTLY to hospital
• GREEN: COUGH OR COLD (SYMPTOSMS)

  • no signs of pneumonia or severe disease
• YELLOW: PNEUMONIA (SYMPTOMS)

  • chest indrawing
  • fast breathing
• PINK: VERY SEVERE PNEUMONIA/DISEASE (SYMPTOMS)

  • general danger signs
  • stridor in calm child
• PINK: VERY SEVERE PNEUMONIA (TREATMENT)

  • give first dose of an appropriate antibiotic
  • refer URGENTLY to hospital
• YELLOW: PNEUMONIA (TREATMENT)

  • oral amoxicillin for 5 days
  • Wheezing - inhaled bronchodilator for 5 days
  • HIV exposed - first dose of amoxicillin
  • cough >14 days refer for TB/asthma assessment
  • follow-up in 3 days
• GREEN: COUGH/COLD (TREATMENT)

  • Wheezing - inhaled bronchodilator for 5 days
  • soothe the throat and relieve the cough with a safe remedy
  • cough >14 days or recurrent wheezing refer for TB/asthma assessment
  • follow-up in 5 days if not improving
• YELLOW: DYSENTRY

  • blood in the stool
  • ciprofloxacin for 3 days
  • follow up in 3-days
• YELLOW: PERSISTENT DIARRHEA

  • no dehydration
  • advice mother on feeding
  • multivitamins & minerals (zinc) 14 days
  • follow up in 5 days
• PINK: SEVERE PERSISTENT DIARRHEA

  • dehydration present
  • treat dehydration before referral (unless the child has another severe classification)
  • refer to hospital
• GREEN: NO ANAEMIA

  • no palmar pallor
  • less than 2 years old - assess the child's feeding and counsel the mother according to the feeding recommendation
  • feeding problem - follow up in 5 days
• YELLOW: ANAEMIA

  • some pallor
  • give iron
  • mebendazole - 1 year or older (no previous dose in 6 months)
  • advise mother to return immediately
  • follow up - 14 days
• PINK: SEVERE ANAEMIA

  • severe palmar pallor
  • refer URGENTLY to hospital
• GREEN: HIV INFECTION UNLIKELY

  • negative HIV test in mother or child
  • treat, counsel and follow-up existing infection
• YELLOW: HIV EXPOSED (CLASSIFICATION)

  • mother HIV-positive & negative virological test in a breastfeeding child/only stopped less than 6 weeks
  • mother HIV-positive, child not yet tested
  • positive serological test in a child less than 18 months old
• YELLOW: HIV EXPOSED (TREATMENT)

  • cotrimoxazole prophylaxis
  • start/continue ARV prophylaxis
  • virological test - confirm HIV status
  • assess the child's feeding/provide counseling
  • advise the mother on home care
  • follow-up regularly
• YELLOW: CONFIRMED HIV INFECTION (CLASSIFICATION)

  • positive virological test in child
  • positive serological test in a child 18 months older
• YELLOW: CONFIRMED HIV INFECTION (TREATMENT)

  • ART treatment and HIV care
  • cotrimoxazole prophylaxis
  • assess the child's feeding/provide counseling to mother
  • advise the mother on home care
  • assess/refer for TB assessment and INH preventive therapy
  • follow-up regularly
• What does IMCI means?

  Integrated

  Management of

  Childhood

  Illness
• Main components of IMCI

  • COMMUNITY IMCI - knowledge, beliefs and skills of caretakers 
  • POLICY & SUPPORT SUPERVISION - strengthen health system supporters 
  • IMCI TRAINING - improve health worker performance 
• BENEFITS OF IMCI

  • COST EFFECTIVE - investment will be needed initially for training and reorganization, the IMCI strategy will result in cost savings.
  • IMPROVES EQUITY - access to simple and affordable preventive and curative care
• Diseases covered by IMCI 

  1. Diarrheal diseases 
  2. Acute respiratory infections 
  3. Malaria 
  4. Measles
  5. Malnutrition
• THE IMCI CODE

  • PINK - urgent hospital referral or admission
  • YELLOW - initiation of specific Outpatient Treatment
  • GREEN - supportive home care
• Children covered by the IMCI protocol 

  • Sick children birth up to 2 months (Sick Young Infant)
  • Sick children 2 months up to 5 years old (Sick child)