This document contains a 5 page assessment on integrated management of childhood illness (IMCI). It includes: 1) A 32 question multiple choice test on IMCI guidelines and case management steps. Questions cover signs/symptoms, classifications, treatments, and immunization schedules. 2) A series of case studies where the reader must identify if urgent referral is needed based on the child's classification. 3) Short answer questions requiring the reader to list the steps of IMCI case management and components of essential newborn care. The assessment evaluates understanding of the IMCI clinical protocol and case management process for treating sick children under 5.

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By Eric Chisupa
Principal Lecturer
Paediatricsand ChildHealth Nursing
Lusaka College ofNursing
SECTION A (1 mark each)
Chose the mostappropriate answer
1. According to IMCI protocol all sick children aged up to five years of age are examined for ……
a) general danger signs
b) signs of very severe disease
c) Jaundice
d) Malnutrition
2. According to IMCI protocol All sick children aged up to five years of age are examined for …
a) general danger signs
b) signs of very severe disease
c) Jaundice
d) Malnutrition
3. During assessment a combination of individual signs leads to a child’s …..
a) classification
b) diagnosis
c) referral
d) review
4. An essential component of IMCI is the counselling of caregivers regarding home care,
appropriate feeding and fluids, and
a) when to return to the clinic
b) when to immunize the child
c) when to give hospital treatment
d) when to have another child
5. IMCI is a case management process for WHICH level of health care EXCEPT……
a) First-level hospital
b) health centre
c) Outpatient department of a hospital.
d) Community health post

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6. After classifying all the conditions present, a health-care provider identifies specific treatmentsfor
the sick childor the sick younginfant. If a childrequiresurgentreferral whichcategorywill the child
fall in ……….
a) yellow classification
b) green classification
c) pink classification
d) white classification
7. The …………………………….. Are designed to help you to systematically record information
about child or young infant condition.
a) Chart booklet
b) The wall chart
c) Under five recording forms
d) case recording forms
8. Which one of the following is a number one killer of children under five worldwide ………..
a) Malaria
b) Diarrheal
c) Malnutrition
d) Pneumonia
9. Which diseases does the DPT vaccine protect against? Tick the correct answer:
a) Diphtheria, polio and tetanus
b) Diphtheria, pertussis and tetanus
c) Diphtheria, pertussis and tuberculosis
d) Diphtheria, Pertussis and Measles
10. Mubanga a ten-montholdchildisbroughtto the immunizationsessionfor the firsttime.He has not
yetreceivedanyvaccine.Whichvaccine shouldthe health workergive himat thisfirstvisit?Tickthe
correct answer:
a) BCG and OPV0 only
b) DPT+ HIB+Hep B1, OPV1, BCG, PCV1, Rota1,
c) DPT+ HIB+Hep B1, OPV0, BCG, PCV1, Rota1,
d) DPT+ HIB+Hep B1, IPV0, BCG, PCV1, Rota1,
11. Taonga is 10 monthsold, he has a coughthat lasted two days,has a breathingrate of 46 breathsper
minute and chest in drawing? What is a child’s classification
a) cough or cold
b) pneumonia
c) severe pneumonia
d) very severe febrile disease
12. What are the four main symptoms for which every sick child should be checked?
a) Malnutrition,fever,cough and ear problem

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b) cough, diarrhoea, malnutrition, and ear problem
c) anaemia, cough,diarrhoea,andfever
d) cough, diarrhoea, fever, ear problem
13. The IMCI clinical guidelinesare designedforuse with certainage groups. One group is2 monthsup
to 5 years. What is the other age group?
a) birth up to 5 years
b) birth up to 2 months
c) 2 months up to 1 year
d) 2 monthsupto 9 years
14. If a childlessthan5 years of age anddid notreceive immunizationforDPT-HBas recommended,it is
necessaryto:
a) increase the dose of the vaccine prescribedforthatage
b) not immunize atall – because itistoo late
c) immunize the childany time,and give the remainingdoses4 weeksapart
d) immunize the childanytime,andgive the remainingdoses6weeksapart
15. To be classified as having MASTOIDITIS a child must have the following signs:
a) severe ear pain
b) pus draining from both ears
c) redness behind the ear
d) tender swelling behind the ear
16. To be classified as having JAUNDICE a young infant must have the following signs:
a) yellow palms and soles if age is more than 24 hours
b) pus draining from the eyes
c) only yellow eyes and skin if age is more than 24 hours
d) Any jaundice if age less than 24 hours
17. What is the cut-off rate for fast breathing in a child who is 11 months old?
a) 60 breaths per minute or more
b) 40 breaths per minute or more
c) 50 breaths per minute or more
d) 30 breaths per minute or more
18. Complementaryfoodsshouldbe startedif the child:
a) showsinterestinsemisolidfoods
b) doesnotappear hungryafterbreastfeeding
c) doesnotshowinterestinsemisolidfoods
d) is sixmonths old

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19. If a childhashad ear painand pusdrainingfromthe ear for10 days,and notenderswellingbehind
the ear, youwill classifythischildashaving:
a) acute ear infection
b) mastoiditis
c) chronicear infection
d) not enoughsignstoclassifythischild
20. What isthe cut-off rate forfast breathingina childwhois11 monthsold?
a) 60 breathsperminute or more
b) 40 breathsperminute or more
c) 50 breaths per minute or more
d) 30 breathsperminute or more
SECTION B
For eachof the followingcases,select Yesifurgentreferral isneededor selectNo ifurgent referral is
not needed.
21. A 6-month-oldboydoesnothave general dangersigns.He isclassifiedwith: MASTOIDITIS,NO
ANEMIA,and NOTVERY LOW WEIGHT AND.Doeshe needanurgentreferral?
a) ____Yes
b) _____No
22. A 7-month-oldgirl doesnothave general dangersigns.She isclassifiedwith: NOPNEUMONIA:
COUGH OR COLD,NO DEHYDRATION,PERSISTENTDIARRHOEA,NOANEMIA,NOT VERY LOW
WEIGHT. Does she needanurgentreferral?
a) _____Yes
b) _____ No
23. A 9-month-oldboyislethargic.He isclassifiedwith:SEVEREDEHYDRATION,NOANEMIA,andNOT
VERY LOW WEIGHT. Your cliniccan give IV fluids. Doeshe needanurgentreferral?
a) _____Yes
b) _____ No
24. A 2-year-oldgirl doesnothave general dangersigns.She isclassifiedwith:SEVEREDEHYDRATION,
SEVERE MALNUTRITION,and SEVEREANEMIA Your cliniccan give IV fluids.Doesshe needanurgent
referral?
a) _____Yes
b) _____ No
25. A 24-month-oldboyhashistoryof convulsionsinthe previousillness.He isclassifiedwith:
Pneumonia.Doeshe needanurgentreferral?

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a) _____Yes
b) _____ No
26. A 36-month-oldisunconscious.The motherreportsthathe has fever.Doeshe needanurgent
referral?
a) _____Yes
b) _____ No
SECTION C (2 marks each)
STEPS IN INTEGRATED CASE MANAGEMENT
The IMCI integratedcase managementprocessconsistsof anumberof stepsthatshouldbe takenby a
health-care providertoensure effective case management.WRITEthe steps
27. STEP 1. ……………………………………………………………….ASSESS
28. STEP 2. ……………………………………………………………….CLASSIFY
29. STEP 3………………………………………………………………… IDENTIFY TREATMENT
30. STEP 4. ………………………………………………………………..TREAT
31. STEP 5. ……………………………………………………………………COUNSEL
32. STEP 6. ……………………………………………………………………FOLLOW-UP
(Note tothe marker: the stepsmustbe in correct order.If one is missedthen the all processwill become
wrong)
Essential care of the new-borninvolvestakingintoconsiderationssix (6) simple thingswhichwill keep
the baby safe.Listthe six (6) includedin the essentialnew bornpackage (2marks each)
33. …………………………………………………………………………..(warmth)
34. ………………………………………………………………………….(breastfeeding)
35. …………………………………………………………………………..(love andsafety)
36. ……………………………………………………………………………(infectioncontrol throughcleanliness PMTC)
37. ……………………………………………………………………………(immunization)
38. …………………………………………………………………………….(timelyrecognitionofthe infant'scondition)
Total marks50