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Check general danger signs first
Young infant 0-2 months Child 2 months-5 years
Common: Malaria Pneumonia Diarrhoea Fever HIV

Results for "Malaria" (Age: 2 months - 5 years)

Malaria 2 months - 5 years

Routine Management / Treat with ACT High match
What to tell caregiver
  • Explain the diagnosis (malaria) and the need for antimalarial tablets.
  • Teach how to give the full course of ACT correctly: dose, timing (especially for AL's 8-hour second dose), duration (3 days), importance of giving with food for AL.
  • Teach how to give Paracetamol for high fever.
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs (cannot drink, vomits everything, convulsions, lethargy), develops stiff neck, becomes sicker.
  • Advise to return in 3 days if fever persists, or sooner if condition worsens.

Classification for a child presenting with fever (or history/hot/temp ≥37.5°C) who has a positive malaria test (RDT or microscopy) and NO signs of Very Severe Febrile Disease. Requires treatment with a recommended first-line antimalarial.

Key Features
  • Fever (current or recent history).
  • Positive malaria diagnostic test.
  • Absence of any general danger sign or stiff neck.
  • Requires treatment with oral Artemisinin-based Combination Therapy (ACT).
Red Flags (Warning Signs)
  • Development of any danger sign or stiff neck (indicates progression to severe malaria/disease).
  • Persistent vomiting preventing oral medication.
  • Fever persisting after 3 days of treatment.
Assessment
Ask
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
  • Confirm absence of General Danger Signs.
  • Confirm absence of Stiff Neck.
  • Perform Malaria Test (RDT or Microscopy) - Result is POSITIVE.
Classification
  • Fever present AND Malaria test POSITIVE AND No signs of Very Severe Febrile Disease -> MALARIA
Urgency / Refer urgently

Routine Management / Treat with ACT

Management
Non-Pharmacological Management
  • Advise adequate fluid intake.
  • Advise tepid sponging for comfort if high fever (optional, do not use cold water).
  • Continue feeding.
Pharmacological Treatment
  • Give first-line oral Artemisinin-based Combination Therapy (ACT): Artemether-Lumefantrine (AL) OR Artesunate-Amodiaquine (AS+AQ).
  • AL Dosing (Coartem® 20/120mg tablets, give dose twice daily for 3 days at 0, 8, 24, 36, 48, 60 hours): Weight 5-<15kg (Age 4m-<3y): 1 tablet per dose. Weight 15-<25kg (Age 3-<9y): 2 tablets per dose. Weight 25-<35kg (Age 9-=35kg (Age >14y): 4 tablets per dose. Give with food/fatty drink.
  • AS+AQ Dosing (Fixed dose combination, give once daily for 3 days): Refer to specific product dosing based on age/weight bands.
  • Give Paracetamol (10-15 mg/kg) if high fever (≥38.5°C axillary) - see dosage on page 15.
  • If fever persists every day for more than 7 days, refer for further assessment.
Monitoring & Follow-Up
  • Follow-up in 3 days IF fever persists.
  • At follow-up: Reassess child fully. If danger signs or stiff neck, treat as Very Severe Febrile Disease and refer. If malaria is only cause of persistent fever, treat with second-line antimalarial (e.g., Quinine) or refer. If other cause identified, treat accordingly.
  • If fever has been present > 7 days total, refer for assessment.
Counselling Points
  • Explain the diagnosis (malaria) and the need for antimalarial tablets.
  • Teach how to give the full course of ACT correctly: dose, timing (especially for AL's 8-hour second dose), duration (3 days), importance of giving with food for AL.
  • Teach how to give Paracetamol for high fever.
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs (cannot drink, vomits everything, convulsions, lethargy), develops stiff neck, becomes sicker.
  • Advise to return in 3 days if fever persists, or sooner if condition worsens.
Differential Diagnosis
  • Very Severe Febrile Disease (especially Severe Malaria)
  • Fever - No Malaria (viral illness, other bacterial infection)
  • Pneumonia
  • Urinary Tract Infection
  • Typhoid fever
  • Other febrile illnesses
Potential Complications
  • Progression to severe malaria
  • Anaemia
  • Febrile convulsions
  • Dehydration
Prevention
  • Sleeping under an Insecticide Treated Net (ITN) every night.
  • Indoor residual spraying (IRS) where implemented.
  • Prompt diagnosis and effective treatment of malaria episodes.
  • Intermittent Preventive Treatment in pregnancy (IPTp) and infancy (IPTi)/Seasonal Malaria Chemoprevention (SMC) where applicable.

Reference: IMCI Chart Booklet - Page 4, Page 15 (AL/AS+AQ, Paracetamol), Page 23 (Follow-up)

Fever - No Malaria 2 months - 5 years

Routine Management / Treat underlying cause if identified High match
What to tell caregiver
  • If bacterial cause identified: Explain diagnosis and need for antibiotic. Teach how to give antibiotic correctly.
  • If no bacterial cause identified: Explain likely viral cause, reassure that antibiotics are not needed. Explain that fever may last a few days.
  • Teach how to give Paracetamol for high fever at home (correct dose, frequency max every 6 hours).
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs, develops stiff neck, becomes sicker, fever persists > 3 days without improving at all, or develops localizing signs.
  • Advise to return in 3 days if fever persists.

Classification for a child presenting with fever (or history/hot/temp ≥37.5°C) who has a negative malaria test OR malaria test was not done but no obvious cause of fever identified, AND no signs of Very Severe Febrile Disease. Requires management of fever and identification/treatment of any other bacterial cause.

Key Features
  • Fever (current or recent history).
  • Malaria test is negative (or not done but malaria unlikely/ruled out clinically where appropriate).
  • Absence of any general danger sign or stiff neck.
  • Need to search for and treat other potential causes of fever.
  • If no cause found, likely viral, manage symptomatically.
Red Flags (Warning Signs)
  • Development of any danger sign or stiff neck.
  • Fever persisting > 3 days without improvement.
  • Fever present every day for more than 7 days.
  • Fever present for 14 days or more (check for TB).
Assessment
Ask
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
  • Confirm absence of General Danger Signs.
  • Confirm absence of Stiff Neck.
  • Perform Malaria Test (RDT or Microscopy) - Result is NEGATIVE OR test not done.
  • Look for other causes of fever (e.g., signs of pneumonia, ear infection, UTI symptoms, skin infection, throat infection).
Classification
  • Fever present AND Malaria test NEGATIVE (or not done/available) AND Other cause of fever PRESENT -> FEVER - NO MALARIA (Treat the identified cause)
  • Fever present AND Malaria test NEGATIVE (or not done/available) AND No other cause of fever identified -> FEVER - NO MALARIA (Likely Viral)
Urgency / Refer urgently

Routine Management / Treat underlying cause if identified

Management
Non-Pharmacological Management
  • Advise adequate fluid intake.
  • Continue feeding.
  • Advise tepid sponging for comfort if high fever (optional).
Pharmacological Treatment
  • Give one dose of Paracetamol (10-15 mg/kg) in the clinic if high fever (≥38.5°C axillary) - see dosage on page 15.
  • If an identified bacterial cause of fever is present (e.g., Pneumonia, Acute Ear Infection, Dysentery): Give appropriate antibiotic treatment for that condition (refer to relevant sections/pages for drug, dose, duration - e.g., Amoxicillin for Pneumonia/AOM, Ciprofloxacin for Dysentery).
  • If fever is present every day for > 7 days, refer for further assessment.
  • If fever is present for > 14 days, check for TB (assess symptoms, contact history - see page 9).
Monitoring & Follow-Up
  • Follow-up in 3 days IF fever persists.
  • At follow-up: Reassess child fully (check danger signs, stiff neck, source of fever). If danger signs/stiff neck, treat as Very Severe Febrile Disease and refer. If fever persists without source, reassess carefully, consider referral if >7 days total or child unwell. If another cause identified, treat. If improving, reassure.
  • Advise mother when to return immediately.
Counselling Points
  • If bacterial cause identified: Explain diagnosis and need for antibiotic. Teach how to give antibiotic correctly.
  • If no bacterial cause identified: Explain likely viral cause, reassure that antibiotics are not needed. Explain that fever may last a few days.
  • Teach how to give Paracetamol for high fever at home (correct dose, frequency max every 6 hours).
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs, develops stiff neck, becomes sicker, fever persists > 3 days without improving at all, or develops localizing signs.
  • Advise to return in 3 days if fever persists.
Differential Diagnosis
  • Viral URTI / LRTI (Flu, adenovirus etc.)
  • Pneumonia
  • Acute Otitis Media
  • Urinary Tract Infection (UTI)
  • Tonsillitis/Pharyngitis (Bacterial or Viral)
  • Skin and soft tissue infection (abscess, cellulitis)
  • Gastroenteritis (may have fever)
  • Typhoid fever
  • Tuberculosis (if prolonged fever)
  • Other less common infections (e.g., Brucellosis, Rickettsial)
  • Non-infectious causes (rare in this context - e.g., Kawasaki disease)
Potential Complications
  • Febrile convulsions
  • Dehydration
  • Complications related to the underlying cause of fever (e.g., mastoiditis from ear infection, pyelonephritis from UTI).
Prevention
  • Immunizations.
  • Handwashing, hygiene.
  • Good nutrition.
  • Malaria prevention (reduces malaria as cause, helps focus on other causes).
  • Prompt care seeking.

Reference: IMCI Chart Booklet - Page 4, Page 9 (TB), Page 15 (Paracetamol), Page 23 (Follow-up), Page 30 (Return signs)

Anaemia 2 months - 5 years

Routine Management / Treat with Iron / Assess for SCD High match
What to tell caregiver
  • Explain the child has anaemia (pale blood) and needs iron medicine.
  • Teach how to give iron supplement correctly (dose, frequency, duration - 14 days initially, then reassess).
  • Advise iron can make stools black.
  • Advise on iron-rich foods.
  • Explain importance of deworming (Mebendazole).
  • If SCD suspected: Explain the need for testing and potential for inherited condition.
  • If SCD confirmed: Provide specific counselling (link to SCD clinic, avoid iron unless prescribed, importance of folic acid, recognize crisis signs).
  • Advise when to return immediately (severe pallor, danger signs).
  • Advise on follow-up in 14 days.

Classification for a child presenting with some palmar pallor (palms look pale, but not severely white). Requires investigation for malaria, treatment with iron (unless contraindicated), and follow-up.

Key Features
  • Presence of Some Palmar Pallor.
  • Absence of Severe Palmar Pallor.
  • Requires malaria testing.
  • Requires iron treatment (unless contraindicated by confirmed SCD + RUTF, or SAM + RUTF).
  • Requires assessment for underlying causes, including SCD.
Red Flags (Warning Signs)
  • Development of severe pallor.
  • Signs of heart failure.
  • History or signs highly suggestive of Sickle Cell Disease crisis (requires specific management/referral).
  • Failure to respond to iron therapy after 2 months (refer).
Assessment
Look, listen, feel
  • Look at the child's palms. Are they pale? (Some Palmar Pallor).
  • Confirm absence of Severe Palmar Pallor.
  • If palmar pallor (some or severe) is present, assess for history and symptoms suggestive of Sickle Cell Disease (SCD):
  • Ask: Family history of SCD or sibling death from anaemia?
  • Ask: History of painful joints/bones, episodes of severe pain (abdomen, chest, bones)?
  • Ask: History of previous blood transfusion?
  • Look/Feel: Swelling of hands & feet (dactylitis, esp. in infants)?
  • Look/Feel: Features suggestive of stroke (weakness of one side)?
  • Look/Feel: Bossing (prominence) of skull?
Classification
  • Some palmar pallor -> ANAEMIA
Urgency / Refer urgently

Routine Management / Treat with Iron / Assess for SCD

Pre-referral treatment
  • If referring due to confirmed SCD needing assessment: Manage pain, ensure hydration.
Management
Non-Pharmacological Management
  • Counsel on iron-rich foods.
  • If SCD confirmed, provide specific counselling and link to care.
Pharmacological Treatment
  • Do Malaria Test (RDT or Microscopy). Treat if positive (see Malaria classification).
  • Give Iron: Provide Iron/Folate supplement (e.g., Ferrous sulfate 200mg + Folic acid 250mcg tablet, containing ~60mg elemental iron) or Iron Syrup (e.g., Ferrous fumarate 100mg/5ml, containing ~20mg elemental iron/5ml) once daily for 14 days initially. Syrup Dose: 2-3m (<6kg): 1.0ml (<1/4 tsp). 4m-<12m (6-<10kg): 1.25ml (1/4 tsp). 12m-<3y (10-<14kg): 2.0ml (<1/2 tsp). 3y-5y (14-19kg): 2.5ml (1/2 tsp). Tablet Dose: 12m-<3y: 1/2 tablet. 3y-5y: 1/2 tablet. (Note: Doses match syrup/tab given on page 17, continue for 14 days initially).
  • Give Folic Acid (5mg tablet) if giving plain iron (not iron+folate compound). Dose: 1/2 tablet daily for 2-3m, 1 tablet daily for 4m-5y.
  • **IMPORTANT Iron Contraindications:** If child has confirmed Sickle Cell Disease AND/OR Severe Acute Malnutrition AND is receiving RUTF, DO NOT give iron supplement. Give Folic Acid instead.
  • Give Mebendazole 500mg single dose if child >= 1 year and not dewormed in past 6 months (Page 20).
  • If child has history or symptoms suggestive of SCD: Recommend testing for SCD (e.g., Hb electrophoresis). If child already confirmed with SCD and has pallor/illness, REFER.
Monitoring & Follow-Up
  • Follow-up in 14 days.
  • At follow-up (Day 14): Reassess palmar pallor. If still some pallor, continue giving iron daily for 2 months total. If severe pallor, refer urgently. If no pallor, stop iron.
  • Advise mother when to return immediately (develops severe pallor, danger signs).
Counselling Points
  • Explain the child has anaemia (pale blood) and needs iron medicine.
  • Teach how to give iron supplement correctly (dose, frequency, duration - 14 days initially, then reassess).
  • Advise iron can make stools black.
  • Advise on iron-rich foods.
  • Explain importance of deworming (Mebendazole).
  • If SCD suspected: Explain the need for testing and potential for inherited condition.
  • If SCD confirmed: Provide specific counselling (link to SCD clinic, avoid iron unless prescribed, importance of folic acid, recognize crisis signs).
  • Advise when to return immediately (severe pallor, danger signs).
  • Advise on follow-up in 14 days.
Differential Diagnosis
  • Severe Anaemia
  • No Anaemia
  • Causes of anaemia: Iron deficiency, Malaria, Hookworm, Sickle Cell Disease, Other haemoglobinopathies, Chronic infection/inflammation, Malnutrition.
Potential Complications
  • Progression to severe anaemia
  • Impaired cognitive development (iron deficiency)
  • Reduced exercise tolerance
  • Increased susceptibility to infection
  • Complications related to underlying cause (e.g., SCD crisis)
Prevention
  • Malaria prevention.
  • Routine iron supplementation in high-risk populations/ages.
  • Deworming.
  • Diet rich in iron and enhancers of iron absorption (Vitamin C).
  • Delayed cord clamping at birth.
  • Newborn screening and management for SCD.

Reference: IMCI Chart Booklet - Page 7, Page 17 (Iron/Folate Dosing), Page 20 (Mebendazole), Page 25 (Follow-up Anaemia)

Very Severe Febrile Disease 2 months - 5 years

Refer URGENTLY High match
What to tell caregiver
  • Explain the extreme seriousness of the child's condition and the urgent need for hospital care.
  • Explain treatments given (antimalarial, antibiotic, sugar, paracetamol if given).
  • Advise on keeping the child warm during transport.
  • Advise on continuing breastfeeding if possible.
  • Write a detailed referral note listing findings, classifications, and all treatments given (drug, dose, time).
Dosage Helper

Enter child weight (kg). Verify against local protocol before prescribing.

  • Rectal Artesunate: --
  • IM Ampicillin: --
  • IM Gentamicin: --

Classification for a child presenting with fever (or history of fever/feels hot/temp ≥37.5°C) who has any general danger sign OR a stiff neck. This indicates a potentially life-threatening infection (like severe malaria, meningitis, sepsis) requiring immediate pre-referral treatment and urgent referral.

Key Features
  • Presence of Fever (current or recent history).
  • Presence of ANY General Danger Sign OR a Stiff Neck.
  • Stiff neck strongly suggests meningitis.
  • Requires immediate pre-referral antimalarial, antibiotic, and hypoglycemia prevention, followed by urgent referral.
Red Flags (Warning Signs)
  • Any general danger sign
  • Stiff neck
  • Impaired consciousness / lethargy
  • Convulsions
  • Signs of shock
Assessment
Ask
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
Look, listen, feel
  • Look or feel for stiff neck (difficulty or pain when gently flexing the neck forward).
  • Check for General Danger Signs (Any ONE: Unable to drink/breastfeed, Vomits everything, Had convulsions, Lethargic/unconscious, Convulsing now).
Classification
  • Fever present AND (Any general danger sign OR Stiff neck) -> VERY SEVERE FEBRILE DISEASE
Urgency / Refer urgently

Refer URGENTLY

Pre-referral treatment
  • Give 1st dose of pre-referral antimalarial: Rectal Artesunate (10 mg/kg) OR IM/IV Artesunate (3 mg/kg if =20kg) OR IM Quinine (see page 11 for specific dosing based on formulation).
  • Give 1st dose of appropriate IM antibiotic: Ampicillin (50 mg/kg) AND Gentamicin (7.5mg/kg) OR alternative based on local guidelines (e.g., Ceftriaxone). See page 12 for Ampicillin/Gentamicin dosing.
  • Treat child to prevent low blood sugar: If child can breastfeed, ask mother. If cannot breastfeed but can swallow, give 30-50ml EBM/substitute/sugar water (4 tsp sugar in 200ml water). If cannot swallow, give 50ml via NG tube.
  • Give one dose of Paracetamol (10-15 mg/kg) if high fever (≥38.5°C axillary). Dosage (500mg tablet): 2-3m (<6kg): 1/4 tab. 4m-3y (6-<14kg): 1/2 tab. 4-5y (14-19kg): 3/4 tab (or 1/2 of 500mg tab from p15). Note: page 15 suggests 10mg/kg for paracetamol, use local guideline preference.
  • If convulsing now, give rectal Diazepam (see page 11 for dose).
Management
Non-Pharmacological Management
  • Quickly complete assessment.
  • Ensure airway is clear, position appropriately.
  • Keep child warm.
Monitoring & Follow-Up
  • To be managed at referral hospital facility.
Counselling Points
  • Explain the extreme seriousness of the child's condition and the urgent need for hospital care.
  • Explain treatments given (antimalarial, antibiotic, sugar, paracetamol if given).
  • Advise on keeping the child warm during transport.
  • Advise on continuing breastfeeding if possible.
  • Write a detailed referral note listing findings, classifications, and all treatments given (drug, dose, time).
Differential Diagnosis
  • Severe Malaria (Cerebral malaria)
  • Bacterial Meningitis
  • Sepsis
  • Severe Pneumonia (may present with fever and danger signs)
  • Typhoid fever (severe)
  • Encephalitis
  • Other severe systemic infections
Potential Complications
  • Coma
  • Permanent neurological damage (from meningitis, cerebral malaria, hypoglycemia)
  • Shock
  • Severe anaemia (malaria)
  • Kidney failure
  • Respiratory failure
  • Death
Prevention
  • Use of Insecticide Treated Nets (ITNs).
  • Prompt diagnosis and treatment of uncomplicated malaria.
  • Immunizations (Hib, Pneumococcal, Meningococcal if available/indicated).
  • Good nutrition.
  • Prompt care seeking for any fever.

Reference: IMCI Chart Booklet - Page 4, Pages 1, 11, 12, 15

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