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Geneva, Switzerland, WHO, Division of Child Health and Development, 2002 Sep 3. 34 p.CHECK FOR GENERAL DANGER SIGNS: ASK: Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions? LOOK: See if the child is lethargic or unconscious. (excerpt)
Evaluation of the WHO / UNICEF algorithm for integrated management of childhood illness between the age of two months to five years.
Indian Pediatrics. 1999 Aug; 36(8):767-8.Objective: To evaluate the utility of the "WHO/UNICEF algorithm for integrated management of childhood illness (IMCI) between the age of 2 months to 5 years. Design: Prospective observational. The Outpatient Department and Emergency Room of a medical college hospital. 203 children presenting to Outpatient Department (n= 101) or Emergency Room (n=102) were assessed and classified as per 'IMCr algorithm and treatment required was identified. A detailed evaluation with all relevant investigations was also done for these subjects. The final diagnoses made and therapies instituted on this basis served as "gold standard'. The diagnostic and therapeutic agreements between the "gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed. Results: More than one illness was present in 135 (66.5%) of subjects as per "gold standard'. The mean (SD) numbers of morbidities as per the gold standard and IMCI- low and high malaria risks were 2.1 (1.1), 1.8 (1.0) and 2.2 (1.1), respectively. Subjects having any referral criteria as per IMCI module had a greater co-existence of illnesses (mean 2.6 vs. 1.6 illnesses per child, respectively). The referral criteria proved useful in predicting hospitalization and a combination of hospitalization and observation; their sensitivity and specificity were 81% and 69% and 74% and 85%, respectively. IMCI algorithms covered majority (92%) of the recorded illnesses. A total agreement with IMCI (malaria low risk) was found in 129 (64%) cases while in 43 (22%) cases, there was partial agreement. Corresponding figures for vertical (split IMCI) program were 93 (46%; p<0.001) and 41 (25%). The difference was primarily due to under diagnoses (30%). Diagnostic discordance of IMCI algorithm and gold standard was evident for the cough category due to under diagnosis of bronchial asthma and bronchiolitis and an over diagnosis of pneumonia whereas the discordance for fever was due to an over diagnosis of malaria. Identical results were found for broad treatment categories. The IMCI algorithm had a provision for preventive services of immunization (16.3% possibility of availing missed opportunities) and feeding advice. There is a sound scientific basis for adopting the IMCI approach since: (i) co-existence of morbidities is frequent; (ii) severe illness is assessed with good sensitivity and specificity; and (iii) the IMCI algorithm is diagnostically and therapeutically superior to the vertical disease specific algorithms. The generic IMCI algorithm needs adaptation to reflect the regional morbidity profile. (author's)
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 281-6.The World Health Organization (WHO) and UNICEF are collaborating in the development of an integrated approach to the management of the sick child. Acute respiratory infections, diarrhea, malaria, measles, and malnutrition cause 7 out of 10 deaths in children under 5 years of age in developing countries. Integrated management means effective, simple, and affordable treatments for all the leading killers of young children. Health workers using such guidelines can prevent serious disabilities resulting from measles and vitamin A deficiency. The integrated clinical guidelines rely on detection of cases based on simple clinical signs and empirical treatment without laboratory tests. They are based on a few essential drugs for outpatient use: oral rehydration salts, an antibiotic (co-trimoxazole), an oral antimalarial, vitamin A, iron tablets, and oral antipyretic (paracetamol), an antibiotic eye ointment, and gentian violet. Parenteral antibiotic and antimalarial drugs and intravenous fluids are needed for severely ill children before referral to hospital. The integrated clinical guidelines for sick children 2 months to 5 years old are summarized on 3 case management charts: 1) assess and classify the sick child 2 months to 5 years old; 2) treat the child; and 3) advise the mother. The implementation of case management will entail the use of several key preventive interventions: immunization, promotion of breast feeding, improved infant feeding, and vitamin A. All children with measles are given vitamin A. Those with severe pneumonia, stridor when calm, corneal clouding, or severe malnutrition are referred to hospital. Mothers are taught to manage mouth ulcers and conjunctivitis at home and to administer antibiotics for otitis media and pneumonia. Wherever Plasmodium falciparum is sensitive to sulfadoxine-pyrimethamine, fast breathing and fever can be treated with co-trimoxazole alone. The WHO prepared a report in 1993 demonstrating that management of the sick child in low-income countries averts 14% of the disease burden at only $ 1.60 per capita annually.