Management of the child with a serious infection or severe malnutrition: Guidelines for care at the first referral level in developing countries

This manual is for use by doctors, senior nurses and other senior health workers who are responsible for the care of young children at the first referral level in developing countries. It presents up-to-date clinical guidelines, prepared by experts, for both inpatient and outpatient care in small hospitals where basic laboratory facilities and essential drugs and inexpensive medicines are available. In some settings, the manual can be used in large health centres where a small number of sick children can be admitted for inpatient care. The guidelines require the hospital to have: (1) the capacity to carry out certain essential investigations such as blood smear examinations for malaria parasites, estimations of hemoglobin or packed cell volume can blood glucose, blood grouping and cross matching, and basic microscopy of CSF and urine; (2) essential drugs available for the care of seriously ill children. Expensive treatment options, such as new antibiotics or mechanical ventilation, are not described. The manual focuses on the inpatient management of the major caused of childhood mortality, such as pneumonia, diarrhoea, severe malnutrition, malaria,meningitis,measles, and related conditions. It complements standard, more comprehensive pediatric textbooks, which should be consulted for information on the management of rarer conditions or complications. This manual is part of a series of documents and tools that support the Integrated Management of childhood Illness(IMCI). It is consistent with the IMCI guidelines for outpatient management of sick children. They are applicable in most areas of the world and may be adapted by countries to suit their specific circumstances.