sn Timing | Arm I: Malaria only | Arm 2: Malaria, pneumonia, and diarrhea |
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Mon a.m. | “Check ALL patients with fever or history of fever for signs of severe malaria! If any severe sign TREAT & REFER urgently!” Better be safe than sorry | “Check ALL sick children for any DANGER sign-if unable to drink OR lethargic OR vomit everything OR convulsions TREAT & REFER!” Well begun is half done |
Mon p.m. | “Ask ALL patients about fever, take temperature and check other malaria signs and symptoms.” Where there is smoke there is fire | “Check ALL sick children for danger signs! Check ALL for fever, cough, difficult breathing, diarrhea, pallor, ear and other problems!” The seeker is the finder |
Tues a.m. | “Test for malaria ALL children < 5 and preg women with fever. Also test ALL patients ≥ 5 with fever + 1 symptom.” Look before you leap | “For ALL children with cough or difficult breathing COUNT BREATHS in 1 min & look for chest in-drawing and stridor!” Actions speak louder than |
Tues p.m. | “For febrile patients without severe signs TREAT for malaria ONLY if test is positive—do NOT treat negatives for malaria!” A word to the wise is sufficient | “Child has PNEUMONIA IF breath count is FAST: over 60 if less than 2 months, over 50 if 2–12 mos. or over 40 if 12–59 mos.” Never too old to learn |
Wed a.m. | “When malaria test is NEGATIVE check for other causes; if none found give antipyretic and ask patient to return if fever persists!” Persistent work triumphs | “Child with cough or difficult breathing has SEVERE PNEUMONIA if any danger sign, chest in-drawing or stridor present-TREAT & REFER!” Knowledge is power |
Wed p.m. | “For uncomplicated malaria 1st line Rx is LA; 2nd line is ASAQ. For children < 5 kg and in 1st preg trimester give quinine + clindamycin” Do the right thing | “Child does NOT have pneumonia if breath count is NOT fast and NO danger/severe sign—treat for cold; do NOT give antibiotic!” Things don’t change; we change |
Thurs a.m. | “New pre-referral Rx for severe malaria is IM artesunate; if not available use IM quinine; if quinine 0/S use rectal artesunate.” Never too old to learn | “For pneumonia 1st line Rx is amoxicillin and 2nd line is erythromycin. For SEVERE pneumonia treat with IM X-pen & REFER!” It works if you work it |
Thurs p.m. | “Prescribe LA based on WEIGHT: 1 × 6 for 5–14 kg; 2 × 6 for 15–24 kg; 3 × 6 for 25–34 kg; 4 × 6 for ≥ 35 kg.” A goal without a plan is just a wish | “Give ALL children FIRST antibiotic dose at facility, explain dosing at home and advise to finish all doses even if feel better!” A little late is too late |
Fri a.m. | “Give FIRST LA DOSE to ALL patients with uncomplicated malaria at FACILITY even if on an empty stomach!” To be willing is to be able | “Give ALL children with diarrhea ORS, zinc and advice on extra fluids; give antibiotics ONLY if blood in stool!” First things first |
Fri p.m. | “Advise ALL patients to take 2nd LA dose after 8 h, then every 12 h to complete all 6 doses even if they feel better!” Say little but say it well | “Assess dehydration in child with diarrhea; if some dehydration give ORS + 1st dose zinc at FACILITY; if severe give IV fluid or REFER!” Willingness is the key |