Ask
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Look
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Classify and Treat as Below
CLINICAL FEATURE |
CLASSIFY AS |
MANAGEMENT |
Any general danger sign |
Very Severe Disease |
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Assess, classify, and treat
In assessing a sick child, assess for the following:
Then check for:
Then counsel the mother on
DANGER SIGN |
RETURN |
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Immediately |
Ask
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Look
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Classify and Treat as Below
CLINICAL FEATURE |
CLASSIFY AS |
MANAGEMENT |
Any general danger sign |
Very Severe Disease |
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Ask
If yes, ask
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Look Listen and feel Ensure the child is calm, then
If wheezing with either fast breathing or chest indrawing:
Fast breathing:
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Classify and Treat as Below
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Severe Pneumonia or Very Severe Disease |
If referral not possible
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Pneumonia |
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No signs of severe disease or pneumonia |
Cough or Cold (No pneumonia) Most likely viral so no antibiotics needed |
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Note: Use age-appropriate spacers to administer salbutamol inhaler
Ask
Look and feel
Classify and treat as below:
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
Any 2 of these signs:
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Severe Dehydration |
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Any 2 of these signs:
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Some Dehydration |
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No Dehydration |
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Dysentery |
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If diarrhoea for 14 days or more: |
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Dehydration present |
Severe Persistent Diarrhoea |
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No dehydration |
Persistent Diarrhoea |
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Note:
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Ask
Look and feel
If child has measles now or had measles in last 3 months
Classify and Treat as Below
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Very Severe Febrile Disease |
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Malaria |
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Fever No Malaria |
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If measles now or in last 3 months, classify as: |
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Severe Complicated Measles |
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Complicated Measles |
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Measles + Eye Or Mouth Complications |
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Measles |
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Note:
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Ask |
Look and feel |
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Look for pus draining from the ear Feel for tender swelling behind the ear |
Classify and treat as below
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Mastoiditis |
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Acute Ear Infection |
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Ask
Look and Feel
If WFH/L is less than -3 z-scores or MUAC < 115 mm, then
If no medical complication presents,
Classify and Treat as directed blow:
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Complicated Severe Acute Malnutrition |
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Uncomplicated Severe Acute Malnutrition (SAM) |
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Moderate Acute Malnutrition (MAM)
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No acute Malnutrition |
If child is < 2 years old, assess the child’s feeding and counsel the mother on feeding according to the feeding recommendations If feeding problem, FOLLOW UP in 7 days Reassess and counsel If you advise the mother to make significant changes in feeding, ask her to bring the child back again after 30 days to measure the weight |
Note:
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Ask In appropriate local language, ask if presence of sickle cell anaemia in the family |
Look Look for palmar pallor. Is it
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Classify and Treat as below
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Severe Anaemia |
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Anaemia |
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No Anaemia |
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Ask
If not, ask
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If yes: decide HIV status
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If no, then test
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If mother is HIV positive and child is negative or unknown, ASK:
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Note For HIV testing algorithm and result interpretation in children, see HIV section |
CLINICAL FEATURES |
CLASSIFY AS |
MANAGEMENT |
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Confirmed HIV Infection |
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HIV Exposed (See HIV Diagnosis and Investigation) |
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HIV Infection Unlikely |
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Child Not Immunized as Per Schedule |
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Child Immunized as Per Schedule |
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For each medicine
Medicines Used Only in Health Centers
DRUG |
DOSE |
INDICATION |
LOC |
Ampicillin | 50mg/kg | Pre referral IM dose in very severe disease or severe pneumonia |
HC3 |
Gentamicin | 7.5mg/kg | Pre referral IM dose in very severe disease or severe pneumonia | HC3 |
Diazepam rectal (suppository or diluted IV ampoule) | 0.5mg/kg | Pre referral treatment of convulsions | HC2 |
Benzylpenicillin | 50,000IU/kg | Pre referral IM dose in very severe disease or severe pneumonia | HC2 |
Rectal Artesunate | 10mg/kg (see Malaria) | Pre referral dose for very severe febrile disease | HC1 |
Artesunate parenteral | 3mg/kg if < 20 kg, 2.4 mg/kg if > 20 kg |
Pre referral IM dose for very severe febrile disease | HC3 |
Salbutamol inhaler | 2 puff | For acute wheezing | HC3 |
Anti-Infective Medicines for Home Use
Teach mother/caretaker how to give oral medicines at home
For each medicine
Amoxicillin DT 250mg | Every 12 hours for 5 days 2-12 months: 250 mg 1-3 years: 500 mg 3-5 years: 750 mg |
Pneumonia Acute ear infection |
Artemether/lumefantrine 20/120 mg |
Every 12 hours for 3 days 2-12 months: 1 tab 1-3 years: 1 tab 3-5 years: 2 tab |
Un-complicated malaria |
Erythromicin | Every 6 hours for 3 days Child < 2 years: 125 mg 2-5 years: 250 mg |
Cholera |
Ciprofloxacin | 15 mg/kg every 12 hours for 3 days If tab 500 mg: Child< 6 months: ¼ tab Child 6 months-5 years: ½ tab |
Dysentery |
Folic acid |
2.5 mg/daily |
Anaemia in child with sickle cell anaemia |
Iron ferrous sulphate (with or without folic acid) |
Once daily for 14 days, tab 200 mg 1-5 years:½ tablet Syrup 25 mg/ ml Child < 1 year: 1 ml |
Anaemia in non sicklers |
Cotrimoxazole 120 mg paediatric tablet |
< 6 months: 1 tablet 6 months- 5 years: 2 tab/day (or half adult tablet) Once a day |
Prophylaxis in HIV positive and HIV exposed |
Mebendazole | Child 1-2 years: 250 mg single dose Child > 2 years: 500 mg single dose |
Routine deworming every 6 months |
Albendazole | Child 1-2 years: 200 mg single dose Child > 2 years: 400 mg single dose |
Routine deworming every 6 months |
Paracetamol |
Every 6 hours (4 doses/24 hours) month-3 years: 125 mg 3-5 years: 250 mg |
Fever > 38.5 o C or (ear) pain |
Vitamin A |
Up to 6 months: 50,000IU 6–12 months: 100,000IU 12 months –5 years: 200,000 IU |
Routine every 6 months from age 6 months, 3 doses for persistent diarrhoea, measles at day 0, 1 and 4 weeks |
ORS |
As per plan A,B,C |
Rehydration |
Zinc |
Daily for 10 days Child 2-6 months: 10mg (1/2 tablet) Child> 6months: 20mg(1 tablet) |
Treatment of diarrhoea |
Nystatin syrup |
1 ml 4 times daily for 7 days |
Oral thrush |
Tetracycline eye ointment |
5 mm of ointment inside lower lid, 4 times daily till pus discharge resolves |
Eye infection |
Ciprofloxacin ear drops |
1-2 drops three times daily |
Chronic otitis |
Ready To Use Therapeutic Food RUTF) |
See chapter 19 of Uganda Clinical Guidelines |
Severe malnutrition |
ARVs |
See HIV Section |
HIV prophylaxis and treatment |
Teach mother/ caretaker how to treat local infections
INFECTION |
TREATMENT |
Eye infection |
Do not put anything else into the eye |
Ear infection |
In chronic ear infection:
Do not put anything else into the ear |
Mouth Ulcers |
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Oral Thrush |
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Sore throat or cough |
Do not use remedies containing codeine or antihistamines (e.g. chlorphenamine, |