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    Guest commentary.

    Tulloch J

    CHILD SURVIVAL BASICS. 1995 Oct; 1-2.

    Since there is considerable overlap in the signs and symptoms of several of the major childhood diseases, a single diagnosis is often inappropriate. Treatment is complicated by the need to combine therapy for several conditions. The World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) have developed an approach referred to as integrated management of the sick child. The Basic Support for Institutionalizing Child Survival (BASICS) Project is actively involved. Integrated management leads to more accurate identification of illnesses at health facilities, ensures more appropriate and combined treatment of all major illnesses, and accelerates referral of severely ill children. Integrated outpatient management of the sick child at the first-level health facility has been described by WHO/UNICEF in wall charts and a booklet. Each illness is classified as to whether it requires urgent referral, specific medical treatment and advice, or simple advice on home management. The case management guidelines form the technical core of a training course for first-level health facility workers; the course consists of six training modules, still-photo exercises, video film, and detailed instructions for the course director and facilitators. It emphasizes hands-on practice of the skills taught. A guide to local adaptation of the training materials is in preparation. A pretest in Gondor, Ethiopia, in August 1991 and a complete field test of the materials in Arusha, Tanzania in February-March 1995 demonstrated that the process described on the charts can be taught to literate health workers. They can learn to classify the main childhood illnesses and provide effective treatment and counsel caretakers. The course should be available in November 1995. WHO, UNICEF, and other collaborators will support the adaptation of the course for use in a limited number of countries and closely monitor early experience with its use. Guidelines on managing drug supplies, improving worker's performance, inpatient care of sick children, and assessing and changing family behaviors related to care for sick children are being developed.
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