Imci lecture 4

Integrated Management of
Childhood illnesses (IMCI)
IMCI TRANING-DEVELOPED BY-
DR.HASAAN ALI INDHOY (MEDICAL
DOCTOR )

SESSION ACTIVITIES
Session Activity Time Method
Registration 20 minutes Listing down
participants
names
Formal opening of the
training
20 minutes Lecturer
Expectations of the training 20 minutes Plenary
discussions
Objectives of the training 20 minutes Presentation
Tool; IMCI Training Attendance Form ,Pens ,Notepads

DAY-4
SESSION-1MALNUTRITION AND ANEMIA
Malnutrition refers to deficiencies, excesses or imbalances in a
person’s intake of energy and/or nutrients. The term malnutrition
covers 2 broad groups of conditions. One is ‘under nutrition’—
which includes stunting (low height for age), wasting (low weight
for height), underweight (low weight for age) and micronutrient
deficiencies or insufficiencies (a lack of important vitamins and
minerals). The other is overweight, obesity and diet-related non-
communicable diseases.

CONT..
As malnutrition, including iron and/or vitamin A
deficiency, affects more than 25% of under-5 year olds, it
is obviously a very important problem, which has to be
dealt with at every level of health care.
The great majority of malnourished children does not
present with overt clinical features of nutritional
deficiency and are easily missed unless a careful
assessment is carried out on every child. Sub-clinical
forms of malnutrition contribute to the severity of many
of the common childhood diseases.

PROTEIN ENERGY MALNUTRITION
There are several forms of this deficiency:
Stunting
Underweight
Marasmus
Kwashiorkor
Marasmic kwashiorkor
Stunting – inadequate growth -- is probably the most
common form of malnutrition. As it requires the
measurement of the length or height of the child it is
also the one that is least commonly identified.
Although it may be associated with Underweight, the
two are not necessarily found in combination.

CONT….
The child with either of these conditions may readily thought
to be adequately nourished, as a round face and healthy
looking hair can be deceptive.
The classification applied to these moderate forms of
malnutrition is NOT GROWING WELL.
Marasmus is the term applied to the child that is of very low
eight and is obviously very thin, with little or no
subcutaneous fat and muscle tissue.

CONT..
Kwashiorkor is one of the most severe forms of malnutrition where
there is oedema, mainly of the limbs and face, associated with
breakdown of the skin resulting in ulceration, commonly in skin
folds and on the buttocks and perineum. Characteristically the hair
is sparse, reddish and with loss of curl. The extremities are cold and
the body temperature at times is subnormal. The child is apathetic
with a very poor appetite.
Marasmic Kwashiorkor is a combination of the above two and must
be considered to have the worst prognosis.
Kwashiorkor, Marasmus and Marasmic Kwashiokor are all classified
as SEVERE MALNUTRITION.

ANEMIA
Anaemia is clinically characterised by pallor, which is best
identified by varying degrees of paleness of the palm of the
hand. Inspection of the oral mucosa or conjuntiva was
thought to be more effective, but it has been adequately
demonstrated that the palm is more accurate. It is of note
that anaemia, i.e. lack of haemoglobin in the red corpuscles
and/or low number of red cells, becomes clinically apparent
when there is considerable deficiency of these. Lack of
dietary iron is the most common cause of anaemia but
intestinal parasites, notably hookworm infestation and

TREATMENT STEPS
Refer all suspect cases of anaemia. Refer immediately any
case of breathlessness from anaemia.
Continue iron folate for 3 months if anaemia diagnosed in
the health centre.
Give all young children deworming medicine.
Reinforce all prevention measures, including
handwashing, exclusive breastfeeding, IYCF and the best
food for children and pregnant women.

CLASSIFICATION OF MALNUTRITION

ASSESSMENT OF THE CHILD FOR
MALNUTRITION AND ANAEMIA
Has the child lost weight?
It has been shown that the history of loss of weight is of
significant value. In many communities it is customary
to observe the child for increase in growth by tying a
waist or wrist-band on to the child.
Look for visible severe wasting
This sign is positive if the child has no or very little
subcutaneous fat and muscle. Wasting is particularly
obvious on the upper arm and the thighs and buttocks,
where the skin hangs in loose folds. ‘Baggy pants’
appearance has been appropriately applied to the latter.

CONT..
Feel for oedema of both feet
Oedema is an essential sign of kwashiorkor. Although this is
not the only cause of oedema in a child, for the purpose of
managing children at first level, oedema requires that the
child is referred. Investigations for other causes can be
carried out at hospital level when deemed necessary.
Look for palmar pallor
Pallor of the palm is an unusual paleness of the skin of the
palm of the hand. The hand should be held open from the
side and the fingers held back gently. Avoid overextending
the fingers as this will squeeze the blood from the
capillaries.

COMMUNICATE AND COUNSEL MOTHERS&
CAREGIVERS
Use good communication skills
It is important to have good communication with the child’s mother or
caretaker from the beginning of the visit. Using good communication helps to
reassure the mother or caretaker that the child will receive good care.
Use the following in order to gain insight depth of mothers and caregivers
attention
Ask and Listen to find out what the child’s problems are and what the
mother is already doing for the child.
Praise the mother for what she has done well.
Advise her how to care for her child at home.
Check the mother’s understanding
When you teach a mother how to treat a child, use 3 basic teaching steps:
Give information.
Show an example.
Let her practice.

TEACH THE CARETAKER TO GIVE ORAL
DRUGS AT HOME
Determine the appropriate drugs and dosage for the child’s age
or weight.
Tell the mother the reason for giving the drug to the child,
including:
Demonstrate how to measure a dose.
Watch the mother practice measuring a dose by her.
Ask the mother to give the first dose to her child
Explain carefully how to give the drug, then label and package
the drug
Explain that all the oral drug tablets or syrups must be used to
finish the course of treatment, even if the child gets better.
Check the mother’s understanding before she leaves the clinic.

COUNSEL THE MOTHER ABOUT
BREASTFEEDING PROBLEMS
You need to counsel the mother of the infant about any breastfeeding
problems that were found during the assessment.
If a mother is breastfeeding her infant less than 8 times in 24 hours,
advice her to increase the frequency of breastfeeding. Breastfeed as
often and for as long as the infant wants, day and night.
If the infant receives other foods or drinks, counsel the mother about
breastfeeding more, reducing the amount of the other foods or drinks,
and if possible, stopping altogether. Advise her to feed the infant any
other drinks from a cup, and not from a feeding bottle.
If the mother does not breastfeed at all, consider referring her for
breastfeeding counseling and possible relactation. If the mother is
interested, a breastfeeding counselor may be able to help her to
overcome difficulties and begin breastfeeding again.

FOLLOW-UP CARE FOR THE SICK
CHILD
Some sick children need to return to the health worker for follow-up. Their
mothers are told when to come for a follow-up visit (such as in 2 days, or 14
days).
At a follow-up visit the health worker can see if the child is improving on the
drug or other treatment that was prescribed. Some children may not respond
to a particular antibiotic or antimalarial and may need to try a second drug.
Children with persistent diarrhoea also need follow-up to be sure that the
diarrhoea has stopped. Children with fever or eye infection need to be seen if
they are not improving.
Follow-up is especially important for children with a feeding problem; to be
sure they are being fed adequately and are gaining weight.
Because follow-up is important, you should make special arrangements so
that followup visits are convenient for mothers. If possible, mothers should
not have to wait in the queue for a follow-up visit.

Tuesday, April 5, 2022 IMCI TRANING-DEVELOPED BY-TAHLIL IMBRAHIM (BSCPH,MPH)

Imci lecture 4

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Imci lecture 4