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  1. 1

    Integrated management of childhood.

    World Health Organization [WHO]. Division of Child Health and Development; UNICEF

    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)
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  2. 2
    Peer Reviewed

    Rapid assessment of the condition of children in Iraq by UNICEF.

    Public Health Reports. 2003 Sep-Oct; 118(5):481.

    UNICEF has conducted an evaluation of the current rate of malnutrition among Iraqi children under the age of 5. The study demonstrated that acute malnutrition or wasting away among these children had jumped from 4% before the war to 7.7% currently, almost doubling. Acute malnutrition sets in quickly and is a good indicator of the overall health of children. Prior to the war, UNICEF ran 3,000 Community Child Care Units (CCCU) that were staffed by a p proximately 13,000 volunteers, their purpose being to screen children for malnutrition and to catch children in the early stages. However, due to the fighting, this system has collapsed. Efforts are being made to reestablish the system; the facilities in Umm Qasr and Baghdad have been reopened. (excerpt)
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  3. 3

    Antibiotic prophylaxis of contacts of diphtheria cases.

    World Health Organization [WHO]. Regional Office for Europe; United States. Centers for Disease Control and Prevention [CDC]; Partnership for Child Health Care. Basic Support for Institutionalizing Child Survival [BASICS]

    Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. [33] p. (EUR/ICP/CMDS 96 06 01 03)

    The WHO/UN Children's Fund Strategy for diphtheria control includes three main recommendations: 1) mass immunization; 2) early diagnosis and proper treatment of cases; and 3) management of close contacts by the use of antibiotics. Whereas the first two recommendations have been implemented in all New Independent States having epidemic diphtheria, in some countries there is a controversial discussion regarding the use of antibiotics for close contacts. Therefore, WHO, with assistance of Centers for Disease Control and Prevention and US Agency for International Development/Basic Support for Institutionalizing Child Survival has drafted guidelines regarding the antibiotic prophylaxis of contacts of diphtheria cases based on international experience. The guidelines include reprints of publications demonstrating the success of this strategy. (author's)
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  4. 4
    Peer Reviewed

    Evaluation of the WHO / UNICEF algorithm for integrated management of childhood illness between the age of two months to five years.

    Shah D; Sachdev HP

    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)
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  5. 5

    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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  6. 6

    Integrated management of the sick child.

    Gove 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.
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  7. 7

    International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. [2], 64 p.

    The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
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