Key Features

• Presence of Chest Indrawing OR Fast Breathing (age-dependent rate).
• Absence of general danger signs and stridor differentiates from Severe Pneumonia.
• Requires treatment with first-line oral antibiotic (Amoxicillin).
• Wheezing requires addition of an inhaled bronchodilator.
• Chest indrawing in HIV exposed/infected child warrants immediate first dose Amoxicillin and referral.

Classification

• Chest indrawing OR Fast breathing -> PNEUMONIA

Usimamizi

Non-Pharmacological Management

• Soothe the throat and relieve the cough with a safe remedy (e.g., warm fluids; honey if child is >1 year old). Avoid harmful remedies like codeine.
• Continue feeding and encourage fluid intake.
• Ensure child is kept warm.

Pharmacological Treatment

• Give oral Amoxicillin twice daily for 5 days. Dosage: Age 2m-<12m (4-<10kg): 250mg dispersible tablet (1 tab) OR 250mg/5ml syrup (5ml) per dose. Age 12m-5y (10-<19kg): 250mg dispersible tablet (2 tabs) OR 250mg/5ml syrup (10ml) per dose.
• If wheezing is present (or wheezing was present and disappeared after a trial of bronchodilator): Give inhaled rapid-acting bronchodilator (Salbutamol 100mcg/puff) 2 puffs via spacer, 3 times daily for 5 days.

Monitoring & Follow-Up

• Follow-up in 3 days.
• At follow-up (Day 3):
• Assess for general danger signs, check for fever, chest indrawing, count breathing rate, assess feeding. Check HIV status.
• If danger signs/stridor: Give pre-referral 2nd line antibiotic/chloramphenicol, treat hypoglycemia, refer URGENTLY.
• If chest indrawing/fast breathing/fever/eating are same or worse: Change to second-line oral antibiotic recommended locally for treatment failure (treat for 5 days), advise immediate return if worsens, ask to return in 3 days OR Refer (especially if measles within last 3 months or HIV exposed/confirmed).
• If breathing slower, less fever, eating better: Continue and complete the 5-day course of Amoxicillin.
• If coughing for 14 days or more at any visit, assess for TB (see page 9).

Counselling Points

• Explain the diagnosis (pneumonia) and the need for antibiotic.
• Teach the mother how to give the oral Amoxicillin: correct dose, frequency (twice daily), duration (full 5 days), how to measure syrup or disperse tablet.
• If Salbutamol prescribed: Teach how to use the inhaler and spacer correctly (shake inhaler, attach, seal mask/mouthpiece, actuate puff, hold for breaths, repeat for 2nd puff), frequency (3 times daily), duration (5 days).
• Teach how to soothe the throat/relieve cough with safe remedies.
• Advise to continue feeding and offer extra fluids.
• Advise mother WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes fast, child not able to drink or breastfeed, child becomes sicker.
• Advise on follow-up visit in 3 days.

Key Features

• Presence of ANY general danger sign automatically classifies as Very Severe Disease.
• Stridor in a CALM child signifies critical upper airway obstruction and is a sign of Very Severe Disease.
• Requires immediate pre-referral antibiotic and treatment for low blood sugar, then urgent referral.

Classification

• Any general danger sign present OR Stridor in a calm child -> SEVERE PNEUMONIA OR VERY SEVERE DISEASE

Usimamizi

Non-Pharmacological Management

• Minimize distress; keep the child calm.
• Allow child to assume position of comfort (often sitting up).
• Keep child warm.
• Quickly complete assessment for other pre-referral needs.

Monitoring & Follow-Up

• To be managed at the referral hospital facility.

Counselling Points

• Explain the need for urgent referral due to severe breathing problem.
• Explain treatments given (antibiotic, sugar).
• Advise on keeping child warm and calm during transport.
• Advise on continuing breastfeeding if possible.
• Write a detailed referral note.

Key Features

• Absence of signs of pneumonia (chest indrawing, fast breathing) and very severe disease (danger signs, stridor).
• This is a diagnosis of exclusion after ruling out more severe respiratory conditions.
• Management focuses on symptom relief and home care advice.
• Antibiotics are NOT indicated unless a specific bacterial complication develops (e.g., acute otitis media).

Classification

• No signs of Pneumonia or Very Severe Disease -> COUGH OR COLD

Usimamizi

Non-Pharmacological Management

• Soothe the throat and relieve the cough with a safe remedy: Encourage breastfeeding. Offer warm drinks like tea with lemon. If child is >1 year old, honey may be given. Avoid harmful remedies (Kabuti, Kisa kya muzadde, codeine, piriton, promethazine).
• Advise mother to continue feeding and encourage fluid intake.
• Clear blocked nose if it interferes with feeding (e.g., saline drops).

Pharmacological Treatment

• If wheezing is present (or was present and disappeared after a trial of bronchodilator): Give inhaled rapid-acting bronchodilator (Salbutamol 100mcg/puff) 2 puffs via spacer, 3 times daily for 5 days.

Monitoring & Follow-Up

• Follow-up in 5 days ONLY IF the child is not improving.
• If coughing for 14 days or more at any visit, assess for TB (History of contact, poor weight gain, persistent fever. Check for GeneXpert/smear if available. See page 9).
• If wheezing is recurrent, refer for asthma assessment.

Counselling Points

• Reassure the mother that the child has a cold and antibiotics are not needed.
• Teach how to soothe the throat and relieve cough using safe home remedies.
• If Salbutamol prescribed for wheezing: Teach correct use of inhaler and spacer (as in Pneumonia counselling).
• Advise to continue feeding and offer extra fluids.
• Advise mother WHEN TO RETURN IMMEDIATELY: Breathing becomes difficult, breathing becomes fast, child not able to drink or breastfeed, child becomes sicker.
• Advise on follow-up in 5 days only if no improvement, or sooner if symptoms worsen.
• Advise to return if cough persists for more than 14 days.