Child Health

Dr. Durdana Khan

Department of Community Health Sciences

Outline…

•Global challenges

•Health status in Pakistan

• IMNCI•Rational •Objectives•Components•Principles•Case Management Process

Outline…

• Exam Assessment• Sample MCQs• Sample SEQs

•Growth and Development

Global challenges…• Children belonging to low and middle income countries are 10 TIMES more

likely to die before reaching 5 years of age than those living in the industrialized world (WHO)

• Every year 10 MILLION children die in developing countries before reaching their 5th B’DAY

• 7 OUT OF 10 deaths are due to TREATABLE CHILDHOOD ILLNESS

• ARI (Pneumonia)

• DIARRHOEA

• MALNUTRITION

• MALARIA

• MEASLES

• OR A COMBINATION OF THE ABOVE

UNICEF Statistics 2015

Health Status In Pakistan

•High Infant Mortality Rate – 78/1000 live births

•High under 5 year mortality rate-97/1000 live births

•Diarrhea, ARI, Malnutrition and Malaria are major contributors in death of Under 5 children

• LOW SOCIAL DEVELOPMENT

• Countries with SAME ECONOMIC development and BETTER SOCIAL development than ours exhibit BETTER HEALTH INDICATORS than us

DO WE HAVE THE TOOLS ???

The Answer is YES…

“We do indeed have the tools to save millions of lives from preventable childhood illness”(Lancet 2003)

All we require are;SIMPLE AND AFFORDABLE INTERVENTIONS

EFFECTIVE STRATEGIES rather than SOPHISTICATED TECHNOLOGIES

HOLISTIC approach is needed

IMNCIIMNCI

IMNCI…What Does It Stand For?

I INTEGRATED

M MANAGEMENT

N NEONATAL

C CHILDHOOD

I ILLNESS

IMNCI…• In the mid 1990’s W.H.O and U.N.I.C.E.F along with other agencies got

together and developed a new strategy “THE IMNCI” for children under 5 years of age

• This approach is realistic and cost effective• Evidence based

• Syndromic approach

IMNCI…

It’s a strategy by which neonatal and childhood

illness are treated according to certain guidelines

which have been standardized

IMNCI…

Designed to teach integrated management of sick

infants and children to first level health workers in

primary care settings that have NO laboratory support

and only a limited number of essential drugs

Background…

• WHO and UNICEF started to develop the IMCI strategy in 1992

• Today more than 100 countries worldwide have adopted it

Objectives…

• To improve the GROWTH and DEVELOPMENT of children

• To reduce the frequency of ILLNESS and DISABILITY

• To reduce the DEATH in children

What Is The Target Age Group?

• Children under 5 years of age

(This is the age group with the highest number of deaths due to childhood illness)

Young Infants (Birth to 2 months)

Older Children (2months to 5 years)

Components of IMNCI…

• Improving case management skills of health workers:• Standard guidelines• Training (pre-service and in-services)• Follow-up after training

• Improving the health system to deliver IMNCI:• Essential drug supply and management • Organization of work in health facilities• Management and supervision

• Improving Family and Community practices

Principles of IMNCI…

All sick children should be examined for

• General danger signs

• Major symptoms

• Clinical signs

All the sick children must be examined for general danger signs…

All the sick children must be assessed for major symptoms…

These are;

• Cough and difficult breathing

• Diarrhea

• Fever

• Ear and throat problems

• Nutritional and immunization status

• Feeding problem

Case Management Process…

•Assess the child or young infantOut-Patient Health Facility

Referral Health Facility

Appropriate Home care

•Classify the illness

• Identify the treatment

• Treat the child

•Communication with Mother (Counselling)

• Follow up care

Referral Case Management…

• Emergency assessment and treatment

•Diagnosis, treatment and monitoring of the patients

Appropriate Home Care…

• Teach the mothers how to give oral drugs at home or treat local infections

•Counseling the mothers about how to feed

Communication with mothers

•Ask questions

• Listen the mother carefully(Use the words understandable)

•Praise the mothers

• Take feedback from her and check her understanding

Follow up care…

•When a child come for scheduled follow up;

•Reassess the problem and providing appropriate care

Classification based on a colour-coded triage system

IMNCI Case Management Process

Yellow - specific medical treatment and advice

Red - urgent pre-referral treatments and referral

Green - simple advice on home management

IMNCI WHO Booklet, March 2014

http://apps.who.int/iris/bitstream/10665/104772/16/9789241506823_Chartbook_eng.pdf

Cough and difficult breathingThree Clinical signs are used to assess cough or difficult

breathing.

• BREATH RATE

2months to 12 months--- 50 or more

12months up to 5 years--- 40 more

Below 2 moths age---------60 or more

If there is a fast breathing, it means Pneumonia

• lower chest wall in drawing Severe Pneumonia

• STRIDOR when CALM Severe Pneumonia

Classification of dehydration

1. Lethargic/unconsciousness2. Sunken eyes 3. Drinking poorly4. Skin pinch goes back very slowly===============1. Restless irritable2. Sunken eyes3. Drinks eagerly, thirsty4. Skin pinch goes back slowly===================

Not enough signs to classify

Severe dehydration

=================Some dehydration

====================No dehydration

IMNCI Video Clip…

https://www.youtube.com/watch?v=fdWSS6H1q8Y

Fever classification

1. Any danger sign2. Stiff neck

Very severe febrile disease

If from malaria risk area

History of fever with or without any cause

malaria

If from no malaria risk area.

Fever malaria unlikely

Classification of ear problem

Mastoiditis Tender swelling behind the ear

Acute ear infection Ear pain… or pus is draining or discharge is recorded for less than 14 days

Chronic ear infection pus is draining or discharge is recorded for more than 14 days

No ear problem No ear pain and no pus seen draining from ear

Check for malnutrition and anemia

Severe malnutrition or severe anemia

1. Visible severe wasting2. Edema of both the legs3. Severe palmer pallor

Anemia or very low weight 1. Some palmer pallor2. Very low weight for age

No anemia and not very low weight

Not very low weight for age and no other sign of malnutrition

Exam Assessment…

•MCQs

•Case Scenarios

MCQ Sample…A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMNCI) guidelines of assessment, her breathing is considered

A. Fast

B. Slow

C. Normal

D. Insignificant

MCQ sample…

The IMCI clinical guidelines are designed for use with certain age groups. One group is 2 months up to 5 yeas. What is the other age group?

a) birth up to 5 years

b) 2 months up to 9 years

c) birth up to 2 months

d) 6 months up to 10 years

MCQ sample…

According to the IMCI guidelines, which of the following key questions should be asked of the mother of every child with diarrhoea? (circle all the correct options)

a. For how long has the child had diarrhoea?

b. Does the child have mucous in the stools?

c. What did the child eat before the diarrhoea started?

d. Does the child have blood in the stools?

e. Does the child have pus in the stools?

SEQ Sample…

A mother presented to you with her 36 months child with diarrhea for 14 days, her eyes was sunken, skin pinch goes back slowly (1 second) and was very thirsty drinks eagerly and according to mother there was blood in the stool. According to IMNCI guidelines;

a. Classify dehydration and diarrhea

b. Formulate appropriate treatment plan for the child

c. How will you counsel the mother and advise her for follow up care

Growth and Development…

•GROWTH:

Refers to increase in physical size of the body

•DEVELOPMENT:

Refers to increase in skills and functions

Determinants of normal growth

•Genetic inheritance

•Nutrition

•Age

• Sex

•Physical surroundings

• Infections and parasitosis

• Economic factors

Mehtods

• Following methods are generally used:

•Weight for age

•Height (Length) for age

•Weight for height

•Head and chest circumference

Thank you