This presentation includes content on malaria, measles and malnutrition based on IMNCI.

1. IMNCI: Malaria, Measles &
Malnutrition
Dr. Ramya S

2. Sick young infant upto 2 months
Any one of the following
signs:
Classify Treatment
• Not feeding well
• Convulsions
• Fast breathing
• Severe chest indrawing
• Fever (37.5°C or above)
• Low body temperature
(less than 35.5° C)
• Movement only when
stimulated or no
movement at all
VERY
SEVERE
DISEASE
Give 1st dose of
i.m. antibiotic
Treat to prevent
low blood sugar
Refer URGENTLY
Advise mother
how to keep the
infant warm on
the way to
hospital

3. MALARIA
Sick child 2 months upto 5 years

4. Sign Classify Treatment
• Any general
danger sign or
• Stiff neck
VERY SEVERE
FEBRILE
DISEASE
Give 1st dose of
Artesunate or quinine
Give 1st dose of an
appropriate antibiotic
Treat the child to
prevent low blood sugar
Give 1 dose of
paracetamol in clinic for
high fever (38.5° C or
above)
 Refer URGENTLY to
hospital
High or Low malaria risk

5. Signs Classify Treatment
• Malaria
test
positive
MALARIA
 Give recommended 1st line oral
anti-malarial
 Give 1 dose of paracetamol in
clinic for high fever (38.5° C or
above)
 Give appropriate antibiotic for
identified bacterial cause of fever
 Advise mother when to return
immediately
 Follow up in 3 days if fever
persists
 If fever present everyday for more
than 7 days, refer for assessment

6. Signs Classification Treatment
• Malaria test
NEGATIVE
• Other cause
of fever
present
FEVER
NO
MALARIA
 Give 1 dose of paracetamol in
clinic for high fever (38.5° C or
above)
 Give appropriate antibiotic for
identified bacterial cause of
fever
 Advise mother when to return
immediately
 Follow up in 3 days if fever
persists
 If fever present everyday for
more than 7 days, refer for
assessment

7. Sign Classify Treatment
• Any general
danger sign or
• Stiff neck
VERY SEVERE
FEBRILE
DISEASE
Give 1st dose of an
appropriate antibiotic
Treat the child to
prevent low blood sugar
Give 1 dose of
paracetamol in clinic for
high fever (38.5° C or
above)
 Refer URGENTLY to
hospital
No malaria risk & No travel to malaria
risk area

8. Signs Classification Treatment
• No general
danger sign
• No Stiff
neck
FEVER
 Give 1 dose of paracetamol in
clinic for high fever (38.5° C
or above)
 Give appropriate antibiotic
for identified bacterial cause
of fever
 Advise mother when to
return immediately
 Follow up in 2 days if fever
persists
 If fever present everyday for
more than 7 days, refer for
assessment

9. Measles
• If the child has measles now or within
last 3 months:
– Look for mouth ulcers
– Pus draining from the eyes
– Clouding of cornea
Sick child 2 months upto 5 years

10. Sign Classify Treatment
• Any general
danger sign or
• Clouding of cornea
or
• Deep or extensive
mouth ulcers
SEVERE
COMPLICATED
MEASLES
Give Vitamin A
treatment
Give 1st dose of an
appropriate antibiotic
Apply tetracycline eye
ointment for clouding of
cornea
Refer URGENTLY to
hospital
Sick child 2 months upto 5 years

11. Signs Classify Treatment
• Pus
draining
from the
eye or
• Mouth
ulcers
MEASLES WITH
EYE OR MOUTH
COMPLICATIONS
 Give Vitamin A treatment
Apply tetracycline eye
ointment for pus draining from
the eye
Treat mouth ulcers with
Gentian violet
Follow-up in 3 days
Sick child 2 months upto 5 years

12. Signs Classification Treatment
• Measles
now or
within last
3 months
MEASLES • Give Vitamin A
treatment
Sick child 2 months upto 5 years

13. MALNUTRITION
• Look for signs of acute malnutrition
– Oedema of both feet
– Determine WFH/L (Z score)
– Measure MUAC
Sick child 2 months upto 5 years

14. If WFH/L less than -3 Z score or MUAC less
than 115 mm, then:
 Check for presence of any medical complication:
any general danger sign, severe classification,
Pneumonia with chest indrawing
 If no medical complication:
 If child less than 6 months, assess breastfeeding
 If 6 months or older, offer RUTF (Ready-To-Use-
Therapeutic Food) & check if child able to finish it
or not

15. Sign Classify Treatment
• Oedema of both feet
or
• WFH/L less than
-3 Z score or MUAC
less than 115 mm AND
any one of the
following,
 Medical
complication
present
 Not able to finish
RUTF
 Breastfeeding
problem
COMPLICATED
SEVERE ACUTE
MALNUTRITION
Give 1st dose of
appropriate antibiotic
Treat the child to
prevent low blood
sugar
Keep the child warm
Refer urgently to
hospital
Sick child 2 months upto 5 years

16. Signs Classify Treatment
• WFH/L
less than
-3 Z score or
• MUAC
less than
115 mm
AND
• Able to
finish
RUTF
UNCOMPLICATED
SEVERE ACUTE
MALNUTRITION
Give oral antibiotics for 5
days
Give RUTF for a child aged 6
months or more
Counsel the mother on how
to feed the child
Assess for possible TB
infection
Advise mother when to
return immediately
Follow-up in 7 days
Sick child 2 months upto 5 years

17. Signs Classify Treatment
• WFH/L
between
-3 and -2 Z
scores or
• MUAC
115 upto
125 mm
MODERATE
ACUTE
MALNUTRITION
Assess child’s feeding &
counsel the mother on
feeding recommendations
If feeding problem, follow up
in 7 days
Assess for possible TB
infection
Advise mother when to
return immediately
Follow-up in 30 days
Sick child 2 months upto 5 years

18. Sign Classification Treatment
• WFH/L
-2 Z scores or
more or,
• MUAC 125
mm or
more
NO
ACUTE
MALNUTRITION
If child is less than
2 yrs old, assess
child’s feeding &
counsel the mother
on feeding
recommendations
If feeding problem,
follow up in 7 days
Sick child 2 months upto 5 years

19. Thank you