IMCI Technical Updates 1.

ANTIBIOTIC TREATMENT OF: (NON SEVERE PHEUMONIA AND SEVERE PHEUMONIA) Previous: First line: Cotrimoxazole 2x a day for 5 days Second line: Amoxicillin 3x a day for 5 days Previous: First line: Chloramphenicol Second line: Benzyl penicillin Update: First line: Amoxicillin 2x a day for 3 days Second line: Cotrimoxazole 2x a day for 3 days Update: First line: Gentamicin plus Benzyl penicillin Second line: Chloramphenicol

2. ACUTE RESPIRATORY INFECTIONS: Previous: No assessment For wheezing Update: Inclusion of wheezing during assessment If wheezing is present y Give a trial of rapid acting inhaled bronchodilator for up to 3x with 1520 minutes interval y 0.5ml salbutamol diluted in 2ml sterile water per dose

3. USE OF ANTIBIOTICS IN THE MANAGEMENT OF DYSENTERY Previous: First line: Cotrimoxazole 2x a day for 5 days Second line: Nalidixic acid 3x a day for 5 days Update: First line: Ciprofloxacin 2x a day for 3 days

4. DIARRHEAL DISEASES TREATMENT Previous: Persistent diarrhea treatment: 1. Give vit. A 1 dose only 2. Advise recommended feeding 3. Follow up 5 days Update: Persistent diarrhea treatment: 1. Give multivitamins and minerals with zinc supplement for 14 days 2. Advise recommended feeding 3. Follow up for 5 days

5. TREATMENT OF MALARIA: Previous: First line: Sulfadoxine-Pyrimethamine Chloroquine Primaquine Second line: Artemether-Lumefantrine Update: First line: Artemether-Lumefantrine Second line: Sulfadoxine-Pyrimethamine Chloroquine Primaquine

6. TREATMENT OF CHRONIC EAR INFECTIONS: Previous: Chronic ear infection treatment; 1. Dry the ear by wicking 2. Follow up 5 days Update: Chronic ear infection treatment; 1. Instill otic drops(quinolone) for 2 weeks 2. Dry the ear by wicking 3. Follow up 5 days

7. MANAGEMENT IF SICK YOUNG INFANT; Previous: Young infant age: 1 week old up to 2 months old Previous: 12 signs Assessment: Signs and Symptoms Convulsions Unable to feed or not feeding well Abnormallly sleepy or no movement at all Fever and low body temperature Fast breathing Umbilical Redness (extended Nasal Flaring and Grunting Chest Indrawing(severe) Ear pus Skin Pustules (severe or many) Bulging of Fontannels Previous: Classifications: Possible Serious Bacterial Infection (PINK) Local Bacterial Infection (YELLOW) Update: Young Infant Age: At birth Up to 2 months old Update: 7 signs Assessment: Signs and Symptoms Convulsions Unable to feed or not feeding well Abnormallly sleepy or no movement at all Fever Fast Breathing Chest Indrawing (severe) Low body Tempretature Update: Classifications: Very Severe Disease (PINK) Local Bacterial Infection (YELLOW) Severe Disease OR Local Bacterial Infection unlikely (GREEN)

8. SICK YOUNG INFANT ADDITIONAL:ASSESSMENT/CLASSIFICATION/TREATMENT Previous: No assessment for jaundice Updated: Inclusion of jaundice during assessment ASSESSMENT CLASSIFICATION TREATMENT Keep the infant warm

Jaundice if age less than 24hours SEVERE JAUNDICE Or (PINK) Yellow palms at any age Jaundice appearing After 24 hours JAUNDICE (Yellow)

Treat to prevent low blood sugar Refer urgently to hospital Advise mother to give home care: (Breastfeed frequently as often, And for as long as the infant wants day and night, during sickness and health) Follow up in 1 day

No jaundice

NO JAUNDICE (GREEN)

Advise mother to give home care: (Breastfeed frequently as often, And for as long as the infant wants day and night, during sickness and health)

9. NUTRITIONAL STATUS: MALNUTRITION AND ANEMIA Previous: SEVERE MALNUTRITION: PINK Visible severe wasting Or Edema on both feet Update: SEVERE MALNUTRITION: PINK Visible severe wasting Or Edema on both feet --------------------------------------------Additional sign: If age 6 mos. And above With MUAC less than 110 mm Classified as: SEVERE MALNUTRITION: PINK *MUAC(Mid Upper Arm Circumference)