2. 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
3. SESSION ACTIVITIES
Session Activity Time Method
Registration 20 minutes Listing down the
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
Tools;
4. LEARNING OBJECTIVES
By the end of this training day the participants will be able to;
Assess the child and determine if there is any sing of fever.
Classify the categories of fever
Look for other major signs of illness and treat them if they exist
Refer case which are very serious to health center or hospital
5. DAY-3
SESSION-1 FEVER
Initial Approach
The first objective when assessing a child with fever is to identify whether
the child has meningitis or a similar serious bacterial infection. Thereafter
the issue of malaria needs to be addressed. In the past measles was a
very important contributor to the under-5 morbidity and mortality. This has
changed dramatically during the past decade as a result of an aggressive
immunization campaign.
8. ASSESSMENT OF THE CHILD WITH FEVER
Does the child have a fever?
It is very important that this is determined for every sick child; the
question put to the mother is whether the child has been hot
during this illness. (Again it is important to know the local terms
for fever.)
Although the temperature should have been taken and recorded
on entry into the clinic, always feel for fever on the abdomen and
in the axillae. Any temperature above 37.5ºC is regarded as fever.
9. CONT…
Duration of the fever
If present for 7 days or more, has it been present every day?
The fever of most of the common viral illnesses tends to cease within a week. If
the fever has persisted for longer, one needs to consider the problems.
Feel for a bulging fontanelle
Where the fontanelle is still 2 cms or more open it is important to look and feel
for a bulging fontanelle with the child in the erect sitting position. Normally there
is a slight dip over the fontanelle. If it is full or bulging above the level of the skull
it should be visible. In any case it is necessary to feel for bulging by bringing the
flat of the hand forward over the fontanelle from the occipital.
10. CONT..
Look for a runny nose
A runny nose suggests that the child may have a common cold. It is
also a very common feature of measles. On the other hand it is almost
unknown to have a runny nose with malaria.
Look for other causes of fever
Pneumonia and dysentery are likely causes of fever. Infected lymph
glands from septic sores are a further common cause of fever. Also see
above for the list of other causes of fever.
11. MENINGITIS
This is an infection of the meninges and the cerebro-spinal fluid may be
bacterial or viral. Bacterial, or purulent, meningitis may be a rapidly
progressive illness resulting in severe brain damage or death within a few
hours of onset. It presents with fever, headache and possibly any one of
the General Danger Signs. At times the typical signs of meningitis appear
only after a day or two. An associated feature in the early stages of
meningococcal meningitis is a generalised petechial or purpuric rash.
12. MALARIA
Malaria is caused by a parasite that is injected into the body through the bite of
infected anopheles mosquitos which spread the disease.
The parasite destroys the red blood cells and causes fever and symptoms of
malaria such as headache, chills, sweating, and body pains. In children it
commonly presents with vomiting and diarrhea. Malaria is a very dangerous
disease that causes complications including anaemia, miscarriage, enlarged
spleen, and convulsions and death.
Malaria Risk Present
Here there are four possible classifications, to some extent depending on the
availability of the rapid malaria test: Suspected Severe Malaria, Malaria,
Suspected Malaria and Fever Other Causes.
13. CONT..
Suspected Severe Malaria
This is the classification for those where a
classification of Suspected Meningitis has already been
made, regardless of the rapid malaria test. Even in the
face of a negative test, the child must be considered to
have severe malaria.
15. MALARIA TREATMENT STEPS
Make clinical diagnosis based of symptoms of fever for 2 days.
Take temperature. If > 37.5° or history of fever then do a RDT.
If RDT +, treat with artemether–lumefantrine (AL), first dose under DOT,
and follow up doses at home.
Give one dose of primaquine by mouth on day 2 for all cases of
Plasmodium falciparum.
If RDT + for P. vivax, refer.
Give paracetamol if fever above 38.5°. Other causes of acute febrile
illness should also be looked for.
Refer immediately if any danger signs of severe malaria (unable to drink,
repeated vomiting, anaemia, drowsiness, yellow eyes, convulsions,
unconscious, passing no urine, weak or rapid pulse, severe dehydration,
bleeding, difficulty breathing, neck stiffness)
16. ARTEMETHER–LUMEFANTRINE
Each tablet contains a combination of 20 mg artemether and 120
mg lumefantrine. A six-dose regimen of artemether–lumefantrine
is administered twice a day for 3 days.
Body
weight (kg)
Number of tablets of artemether–
lumefantrine
Day 0 Day1 Day2
1st dose 2nd dose 3rd
dose
4th dose 5th dose
5–14 1 1 1 1 1
15–24 2 2 2 2 2
17. FEVER MANAGEMENT
Fever is a temperature of over 37.5° and is a response by the
body to underlying infection and disease. Fever is a positive
reaction by the body in its fight against infection.
Febrile convulsions
Children with fever may have a febrile convulsion caused by the
fever associated with an infection
Treatment steps
Put the child on their left side.
When recovered give paracetamol.
Give fluids by mouth.
Treat as per Fever Management and treat any cause of fever.
Refer immediately if repeated convulsion, temperature > 40°, or
any danger signs.
18. OTHER ILLNESSES ASSOCIATED WITH FEVER
Whenever fever has lasted for more than a week the child needs
to be referred for further investigation and treatment. Although
the following illnesses usually cause fever of longer duration,
they may also present as an acute illness.
HIV and AIDS may present with prolonged fever in the early
stages.
Tuberculosis: This is a very common condition increasing in
prevalence in many communities throughout Somalia. The AIDS
epidemic is partly to blame for this. There is a need to be
constantly on the lookout for features of TB; fever, cough and
loss of weight are the most common.
Typhoid Fever: In this illness fever is slowly progressive over a
week or so and may reach 39ºC or more. The child will be drowsy
and lethargic and headache may be a troublesome symptom.
Diarrhoea or constipation may occur. Although typhoid is more
common in older children it may occur in young children. A
respiratory infection often accompanies typhoid fever.
