Medical Ambassadors International and Global CHE Network

IMCI 5: CASE STUDY

Date: 7/09 (1 HOUR)

OBJECTIVES: After working through this lesson, participants will be able to:
1. Use Fatima’s case study to work through the care of a sick child.

2. Know how to assess a sick child.

3. Decide when a sick child needs to go to the doctor or clinic.

OVERVIEW FOR TRAINERS: These lessons are based on the World Health Organizations Integrated
Management of Childhood Illness. They teach health workers how to recognize common health
problems in children, and how to respond. These lessons are introductions to these topics, with links
to other lesson series that explore these areas in more depth. These lessons are for experienced
CHEs, since they involve working through a problem.

METHOD TIME KNOWLEDGE

Case Study: 30”

Divide into small groups. Give each
group a copy of Fatima’s story to work
through. Using the sheet, Care of a
sick child, they will work through
Fatima’s story and fill out the chart
Checking out Fatima. One the chart,
they will note their observations about
Fatima and their recommendations of
what to do next.

----SHO questions----
S = What do you See?
H = What is Happening?
O = Does this happen in Our place?

I. Working through Fatima’s story 25” I. Fatima’s story

A. According to her mother, A. Main problem
what is Fatima’s main 1. She has had a cough for six
problem? days.
2. She has trouble breathing.
B. Does Fatima have any B. General danger signs
general danger signs? 1. She is sleepy.
2. She does not respond much to
clapping or shaking.
3. She does not notice what is
going on.
4. Fatima is lethargic.
C. Does Fatima have a cough C. Cough or breathing problems
or breathing problem? 1. She has had a cough for six
days.
2. She is breathing 41 times a
minute, which is a little fast.
3. She does not have chest
indrawing or stridor.
D. Does Fatima have diarrhea D. Diarrhea or dehydration
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IMCI 5: CASE STUDY

METHOD TIME KNOWLEDGE

or dehydration? 1. She had diarrhea for 3 days.

2. She refused to take water.
3. Her eyes looked sunken.
4. Her skin pinch went back
slowly.
5. She is severely dehydrated.
E. Does she have a fever? E. Fever
1. Her temperature is 37.5o C.
and she feels hot.
2. She has had a fever for two
days.
3. She is at low risk for malaria.
4. She does not have a stiff neck.
5. She has no sign of measles.
6. She has a runny nose.

II. Treatment 10” II. Treatment

A. So what are your A. Conclusions
conclusions about Fatima? 1. She has one general danger
sign.
2. She is lethargic and is not very
responsive.
3. She has a serious illness.
4. She also has diarrhea and
severe dehydration.
5. She has a fever.
6. Her breathing is a little fast,
but that should be rechecked.
B. What should be done now? B. What should be done?
1. She needs urgent medical
care.
2. She should be seen at the
hospital or clinic right away.
3. She is unresponsive and has
severe dehydration.
4. They can try to give her ORS.
5. But do not delay. She needs
urgent medical care.
C. Give out the handout, C. Checking out Fatima
Conclusions and review
anything that is not clear.
References:
Shelov, S. and R. Hannemann, editors. 2004. Caring for Your Baby and Young Child: Birth to Age 5. American
Academy of Pediatrics. Bantam Books.

World Health Organization. 2008. Integrated Management of Childhood Illness Chart Booklet. Available from:
http://www.who.int/child_adolescent_health/documents/pdfs/IMCI_chart_booklet.pdf

World Health Organization. 2005. Integrated Management of Childhood Illness Handbook. Available from:
http://whqlibdoc.who.int/publications/2005/9241546441.pdf

ATTITUDE: Participants will feel confident in their ability to work through a case study of a sick
child.

SKILL: Participants will know the steps to evaluate a sick child, and will know when to refer
to a hospital or clinic?
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IMCI 5: CASE STUDY

METHOD TIME KNOWLEDGE

EVALUATION: Are the participants able to assess sick children from their neighborhood?

MATERIALS: -Newsprint, markers, masking tape

-Care of a sick child handout
-Fatima’s story
-Checking out Fatima handout
-Conclusions handout
This lesson is used in: Care of infants and children/ IMCI
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Care of a sick child

Ask Look and listen

1. Ask the parent about the How is your child today?

child’s problem. What is happening?

Is your child able to drink or See if the child is lethargic

breastfeed? or unconscious.
2. Check for general danger
signs. Does he vomit everything? Is he having a seizure
Has he had a seizure? now?

Count the breaths in one

3. Ask about main symptoms: minute.
Does your child have a
 Cough or difficult cough or difficult breathing? Look for chest indrawing.
breathing
For how long? Listen for stridor.
Listen for wheezing.

Look—Is the child

Does your child have lethargic or restless?
diarrhea?
 Diarrhea Look for sunken eyes.
For how long?
Pinch the skin of the belly.
Is there blood in the poop?
Offer the child fluids.

Does your child have a

Look or feel for stiff neck.
fever?
Look for a runny nose.
For how long?
Look for signs of measles:
Has the fever been present
 Fever every day for at least 7 days?  A rash all over the
body
Is there malaria in your area?
 Cough, runny nose,
Has your child had measles
or red eyes
in the last three months?

 Ear problem

4. Check the child’s nutrition.

Are there signs of
malnutrition or anemia?

5. Check the child’s

immunizations. Does he
need immunizations today?

6. Look for other problems.

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FATIMA’S STORY

Source: World Health Organization. 2005. Integrated Management of Childhood Illness Handbook
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CHECKING OUT FATIMA

Does Fatima have any of the following?

What did you notice? What should they do?

Main problem

General danger
signs

Cough or difficulty
breathing

Diarrhea

Fever
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CONCLUSIONS

Does Fatima have any of the following?

What did you notice? What should they do?

Her mother reports:

1. She has been
coughing for six days.
Main problem 2. She has trouble
breathing.

This is their first visit.

1. Able to drink
She is lethargic—she should go to
General danger 2. Not vomiting
a doctor or health center right
signs 3. No convulsions
away.
4. Lethargic

Her breathing is a little fast.

1. Breathing 41 times a
She may have pneumonia, but it
Cough or difficulty minute
is not severe.
breathing 2. No chest indrawing
Check her breathing again when
3. No stridor
she is calm.

1. She has had diarrhea

for 3 days, but it is not
bloody. She has diarrhea with severe
Diarrhea 2. Her eyes look sunken. dehydration. She must be seen in
3. Her skin goes back the clinic or hospital right away.
very slowly.
4. She refuses to drink.

1. She has a temperature

of 37.5o C. and feels
hot.
2. She has had a fever tor
2 days. She has a fever, but malaria is
Fever 3. There is a low risk of unlikely. There is no sign of
malaria. measles.
4. No sign of measles
5. She does not have a
stiff neck.
6. She has a runny nose.