IMCI Approach: Fever (2m-5y)

Clinical assessment

Assessment based on presence/absence of general danger signs, stiff neck, malaria test result, duration of fever, presence of localizing signs of bacterial infection, and signs of measles or its complications.

Investigations

• Malaria Test (RDT or Microscopy): MANDATORY for all fever cases.
• Temperature measurement.
• Lumbar Puncture (Referral level, if meningitis suspected based on danger signs/stiff neck).
• Other investigations based on suspected local cause (e.g., urinalysis, CXR - referral level).

Diagnostic criteria

IMCI Classification based on signs: - Very Severe Febrile Disease: Any General Danger Sign OR Stiff neck. - Malaria: Positive Malaria Test. - Fever - No Malaria: Negative Malaria Test. - Severe Complicated Measles: Measles now or <3m ago AND (Any General Danger Sign OR Clouding of cornea OR Deep/extensive mouth ulcers). - Measles + Eye or Mouth Complications: Measles now or <3m ago AND (Pus draining from eye OR Mouth ulcers). - Measles: Measles now or <3m ago AND none of the above complications.

Non-pharmacological management

• All Fever: Advise mother on home care (fluids, feeding), when to return immediately (danger signs). Counsel on mosquito net use and environmental sanitation.
• Measles: Encourage fluid intake, continue feeding.
• Very Severe Febrile Disease: Keep warm, prevent low blood sugar during referral.

Pharmacological treatment

• Very Severe Febrile Disease:
• - Give FIRST DOSE pre-referral antimalarial: Rectal Artesunate (10 mg/kg) OR IM/IV Artesunate (3 mg/kg if <20kg, 2.4 mg/kg if >20kg).
• - Give FIRST DOSE pre-referral antibiotic: Ampicillin 50 mg/kg IM + Gentamicin 7.5 mg/kg IM (HC3+) OR Benzylpenicillin 50,000 IU/kg IM (HC2).
• - Give Paracetamol 10-15 mg/kg for high fever (>=38.5°C).
• - Treat convulsions if present (Rectal Diazepam).
• - Refer URGENTLY to Hospital.
• Malaria:
• - Give first-line oral ACT (Artemether-Lumefantrine - AL) - Dose by weight/age band (See UCG 2.5.2).
• - Give Paracetamol 10-15 mg/kg for high fever (>=38.5°C).
• - Treat any identified co-existing bacterial infection.
• - Follow up in 3 days if fever persists (reassess, check adherence, consider referral/2nd line if needed). Refer if fever >7 days.
• Fever - No Malaria:
• - Give Paracetamol 10-15 mg/kg for high fever (>=38.5°C).
• - Treat identified bacterial infection if present.
• - If no bacterial cause, reassure, advise paracetamol for fever, follow up in 3 days if fever persists (reassess, repeat malaria test, consider referral). Refer if fever >7 days.
• Severe Complicated Measles:
• - Give Vitamin A (Age-appropriate dose - See Nutrition/Vit A section).
• - Give FIRST DOSE pre-referral antibiotic (as for Very Severe Febrile Disease).
• - If eye signs (clouding/pus): Apply Tetracycline eye ointment 1%.
• - Refer URGENTLY to Hospital.
• Measles + Eye or Mouth Complications:
• - Give Vitamin A.
• - If pus from eye: Apply Tetracycline eye ointment 1% TID.
• - If mouth ulcers: Apply Gentian Violet 0.5% paint BID.
• - Follow up in 3 days (assess eye/mouth, check treatment, refer if worse/not improving).
• Measles (Uncomplicated):
• - Give Vitamin A.
• - Advise mother on home care.

Monitoring

Follow-up as per classification (usually 3 days if fever persists). Reassess danger signs, temperature, feeding, other symptoms. Monitor response to antimalarials/antibiotics.