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close this bookCommunicable Disease Control in Emergencies - A Field Manual (WHO - OMS, 2003, 223 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
View the documentINTRODUCTION
Open this folder and view contentsCHAPTER 1: RAPID ASSESSMENT
Open this folder and view contentsCHAPTER 2: PREVENTION
Open this folder and view contentsCHAPTER 3: SURVEILLANCE
Open this folder and view contentsCHAPTER 4: OUTBREAK CONTROL
Open this folder and view contentsCHAPTER 5: DISEASE PREVENTION AND CONTROL
View the documentANNEX 1: WHO REFERENCE VALUES FOR EMERGENCIES
View the documentANNEX 2: SAMPLE HEALTH SURVEY FORMS
View the documentANNEX 3: NCHS/WHO NORMALIZED REFERENCE VALUES FOR WEIGHT FOR HEIGHT BY SEX
View the documentANNEX 4: SAMPLE WEEKLY SURVEILLANCE FORMS
View the documentANNEX 5: RECOMMENDED CASE DEFINITIONS
View the documentANNEX 6: OUTBREAK INVESTIGATION FORMS
View the documentANNEX 7: ORGANIZATION OF AN ISOLATION CENTRE
View the documentANNEX 8: BASIC LABORATORY SERVICES
View the documentANNEX 9: LABORATORY INVESTIGATION KIT
View the documentANNEX 10: TREATMENT GUIDELINES
View the documentANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6
View the documentANNEX 12: ASSESSMENT AND TREATMENT OF DIARRHOEA
View the documentANNEX 13: FLOW CHARTS FOR SYNDROMIC MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX 14: SAMPLE HEALTH CARD
View the documentANNEX 15: LIST OF WHO GUIDELINES ON COMMUNICABLE DISEASES
View the documentANNEX 16: LIST OF PUBLISHERS
View the documentANNEX 17: GENERAL REFERENCES

ANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6

1. ASSESS THE CHILD

Ask

· How old is the child?
· Is the child coughing? For how long?
· Is the child able to drink (for children age 2 months up to 5 years)?
· Has the young infant stopped feeding well (for children less than 2 months)?
· Has the child had fever? For how long?
· Has the child had convulsions?

Look and listen (the child must be calm)

· Count the breaths in a minute.
· Look for chest indrawing.
· Look and listen for stridor.
· Look and listen for wheeze. Is it recurrent?
· See if the child is abnormally sleepy, or difficult to wake.
· Feel for fever, or low body temperature (or measure temperature).
· Look for severe undernutrition.

2. DECIDE HOW TO TREAT THE CHILD

The child aged less than 2 months:

see Table A11.1



The child aged 2 months up to 5 years:



· who is not wheezing:

see Table A11.2


· who is wheezing:

refer



Treatment instructions:

see Table A11.3


1. Give an antibiotic



2. Advise mother to give home care



3. Treat fever.


6 Source: Integrated management of childhood illness. Geneva, World Health Organization, 1997.

Table A11.1. Child under 2 months of age

Signs

No fast breathing (less than 60 per minute)
and
No severe chest indrawing

Fast breathing (60 per minute or more)
or
Severe chest indrawing

Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Wheezing
or
Fever or low body temperature

Classification

No pneumonia - cough
or cold

Severe pneumonia

Very severe disease

Treatment

Advise mother to give following home care: keep infant warm breastfeed frequently clear nose if it interferes with feeding
Advise mother to return quickly if: illness worsens breathing is difficult breathing becomes fast feeding becomes a problem

Refer urgently to hospital
Give first dose of an antibiotic
Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely)

Refer urgently to hospital
Give first dose of an antibiotic
Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely)

Table A11.2. Child 2 months to 5 years of age

Signs

No chest indrawing and
No fast breathing (less than 50 per minute if child 2-12 months of age
or
40 per minute if child 1-5 years)

No chest indrawing and
Fast breathing (50 per minute or more if child 2-12 months of age
or
40 per minute if child 1-5 years)

Chest indrawing

Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
or
Severe undernutrition

Classification

No pneumonia: cough or cold

Pneumonia

Severe pneumonia

Very severe disease

Treatment

If coughing more than 30 days, refer for assessment
Assess and treat ear problem or sore throat if present
Assess and treat other problems
Advise mother to give home care
Treat fever if present

Advise mother to give home care
Give an antibiotic
Treat fever if present
Advise mother to return in 2 days for reassessment, or if the child is getting worse

Refer urgently to hospital
Give first dose of antibiotics
Treat fever if present

Refer urgently to hospital
Give first dose of antibiotics
Treat fever if present If cerebral malaria is possible, give an antimalarial drug




(If referral is not possible, treat with an antibiotic and follow closely)


_

Reassess in 2 days a child who is taking an antibiotic for pneumonia

Signs

Improving
· Less fever
· Eating better
· Breathing slower

The same

Worse
· Not able to drink
· Has chest indrawing
· Has other danger signs

Treatment

Finish 5 days of antibiotics

Change antibiotic or Refer

Refer urgently to hospital

Table A11.3. Treatment instructions

· Give an antibiotic.

· Give first dose of antibiotic in the clinic.

· Instruct mother on how to give the antibiotic for 5 days at home (or to return to clinic for daily procaine penicillin injection).

Age or weight

Co-trimoxazole: trimethoprim (TMP) + sulfamethoxazole (SMX)

Amoxicillin

Procaine penicillin


Twice daily for 5 days

Three times daily for 5 days

Once daily for 5 days


Adult tablet single strength (80 mg TMP + 400 mg SMX)

Paediatric tablet (20 mg TMP + 100 mg SMX)

Syrup (40 mg TMP + 200 mg SMX)

Tablet (250 mg)

Syrup (125 mg in 5 ml)

Intramuscular injection

Under 2 months (< 6 kg)a

¼ b

1 b

2.5 ml b

¼

2.5 ml

200 000 units

2 months to 12 months (6-9 kg)

½

2

5.0 ml

½

5.0 ml

400 000 units

12 months to 5 years (10-19 kg)

1

3

7.5 ml

1

10 ml

800 000 units

a Give oral antibiotic for f days at home if referral is not feasible.

b If the child is less than one month old, give ½ paediatric tablet or 1.25 ml syrup twice daily. Avoid co-trimoxazole in infants under one month of age who are premature or jaundiced. Syrups and paediatric tablets are mentioned here for the sake of completeness; they are not available in the kit.

· Advise mother to give home care (for child aged 2 months to 5 years)

· Feed the child

- feed the child during illness
- increase feeding during illness
- clear the nose if it interferes with feeding

· Increase fluids
- offer the child extra to drink
- increase breastfeeding

- soothe the throat and relieve cough with a safe remedy

Most important: for the child classified as having no pneumonia, cough or cold, watch for the following signs and return quickly if they occur:

- breathing becomes difficult
- breathing becomes fast
- child not able to drink

- child becomes sicker

_ This child may have pneumonia

Treat fever

Fever is high (> 39 °C)

Fever is not high (38-39 °C)

In falciparum malarious area: any fever
or
history of fever

Fever for more than 5 days

Give paracetamol

Advise mother to give more fluids

Give an antimalarial (or treat according to your national malaria programme recommendations)

Refer for assessment


_



Paracetamol doses every 6 hours

Fever alone is not a reason to give an antibiotic, except in a young infant under 2 months of age.
Give first dose of an antibiotic and refer urgently to hospital.

Age or weight

100-mg tablet

500-mg tablet


2 months to 12 months (6-9 kg)

1

¼


12 months to 3 years (10-14 kg)

1

¼


3 years to 5 years (15-19 kg)

½