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Key Features

• Diarrhoea duration of 14 days or more.
• Presence of signs classifying as SOME DEHYDRATION or SEVERE DEHYDRATION.
• High risk for malnutrition and underlying infections (including HIV).

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long? (Response is 14 days or more).
• Assess for Dehydration (Look/Feel for signs of Some or Severe Dehydration - see IMCI_2M5Y_005 & 006 assessments).

Classification

• Diarrhoea for 14 days or more AND Dehydration present (Signs of Some or Severe Dehydration) -> SEVERE PERSISTENT DIARRHOEA

Management

Non-Pharmacological Management

• Treat dehydration first (Plan C if severe, Plan B if some) BEFORE referral, unless the child has another severe classification requiring immediate referral.
• If referring, keep child warm.

Pharmacological Treatment

• Treat dehydration as per Plan C or Plan B.
• If child has another severe classification (e.g., Very Severe Febrile Disease), give pre-referral treatments for that condition (e.g., antibiotic, antimalarial).

Pre-Referral Treatment

• Stabilize hydration as much as possible (start Plan C or B).
• Give other essential pre-referral treatments if needed for co-existing severe classifications.
• Keep child warm.
• Advise mother to continue breastfeeding.

Monitoring & Follow-Up

• To be managed at referral hospital, which will investigate cause and provide specialized feeding/treatment.

Counselling Points

• Explain that the long duration of diarrhoea combined with dehydration is serious and requires hospital care.
• Explain any dehydration treatment being given.
• Advise mother to continue breastfeeding frequently.
• Advise on keeping child warm during transport.
• Write a detailed referral note mentioning duration of diarrhoea, dehydration status, and any treatments given.

Differential Diagnosis

• Persistent Diarrhoea (without dehydration)
• Acute Diarrhoea with Dehydration
• Secondary lactose intolerance
• Cow's milk protein allergy
• Other food intolerances/allergies
• Post-enteritis syndrome
• Giardiasis
• Cryptosporidiosis (especially if HIV+)
• Other specific enteropathogens
• Malnutrition-associated gut changes

Potential Complications

• Severe malnutrition
• Micronutrient deficiencies
• Severe dehydration and shock
• Sepsis
• Electrolyte imbalance
• Death

Prevention

• Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
• Good nutrition, Vitamin A.
• Measles vaccination.
• Handwashing, safe water/sanitation.
• Early identification and management of HIV infection.

Key Features

• Diarrhoea duration of 14 days or more.
• Absence of signs of dehydration.
• Management focuses on nutritional rehabilitation and investigating potential underlying causes.

Assessment

• Ask: Does the child have diarrhoea?
• Ask: For how long? (Response is 14 days or more).
• Assess for Dehydration: Confirm NO DEHYDRATION (Not enough signs for Some or Severe Dehydration).

Classification

• Diarrhoea for 14 days or more AND No Dehydration -> PERSISTENT DIARRHOEA

Management

Non-Pharmacological Management

• Advise the mother on feeding a child with PERSISTENT DIARRHOEA:
• If still breastfeeding: Breastfeed more frequently and longer, day and night.
• If taking other milk: Replace with fermented milk products (e.g., yoghurt) OR Replace half the milk with nutrient-rich semisolid food (e.g., porridge).
• For other foods: Ensure adequate energy intake. Give small, frequent meals (at least 6 times/day). Use foods rich in energy and nutrients. Mix foods well.
• Give foods rich in potassium (e.g., bananas, coconut water).
• Ensure adequate fluid intake using ORS or recommended home fluids after loose stools.
• Check for HIV Infection (refer to HIV assessment algorithm page 8).

Pharmacological Treatment

• Give multivitamins and minerals (including zinc) for 10 days (or longer per local guidelines). Ensure Zinc dose is 10mg (=6m) daily.

Monitoring & Follow-Up

• Follow up in 5 days.
• At follow-up (Day 5):
• Ask: Has diarrhoea stopped? How many stools per day?
• Assess feeding and check for dehydration.
• If diarrhoea has not stopped: Do a full reassessment. Treat dehydration if present. Refer to hospital for assessment (including for ART if HIV+).
• If diarrhoea has stopped: Tell mother to follow usual age-appropriate feeding recommendations. Complete 10 days of zinc.

Counselling Points

• Explain the importance of special feeding during persistent diarrhoea.
• Provide specific, practical advice on recommended foods and feeding frequency based on local availability and child's age.
• Explain how to give multivitamins and zinc.
• Advise on giving extra fluids.
• Advise when to return immediately (danger signs, signs of dehydration).
• Advise on follow-up visit in 5 days.

Differential Diagnosis

• Severe Persistent Diarrhoea (if dehydration develops)
• Secondary lactose intolerance
• Cow's milk protein allergy
• Other food intolerances/allergies
• Giardiasis
• Cryptosporidiosis
• Malnutrition
• HIV infection

Potential Complications

• Malnutrition
• Micronutrient deficiencies
• Dehydration (if fluid/feeding advice not followed)
• Increased susceptibility to other infections

Prevention

• Appropriate management of acute diarrhoea (ORS, Zinc, continued feeding).
• Good nutrition, Vitamin A.
• Measles vaccination.
• Handwashing, safe water/sanitation.
• Early identification and management of HIV infection.

Key Features

• Pus seen draining from ear for 14 days or more.
• Absence of tender swelling behind the ear.
• Requires meticulous ear cleaning (dry wicking) and topical antibiotic ear drops (quinolone).
• Oral antibiotics are generally NOT effective for uncomplicated CSOM.

Assessment

• Ask: Does the child have an ear problem?
• Ask: Is there ear discharge? If yes, for how long?
• Confirm duration of discharge is 14 days or more.
• Confirm absence of Tender Swelling behind the ear.
• Look: Look for pus draining from the ear.

Classification

• Pus seen draining from ear for >= 14 days AND No tender swelling behind ear -> CHRONIC EAR INFECTION

Management

Non-Pharmacological Management

• Teach mother how to dry the ear carefully by wicking 3 times daily (as described for AOM). Stress the importance of keeping the ear dry.
• Advise to avoid getting water in the ear during bathing.

Pharmacological Treatment

• Treat with topical Quinolone eardrops (e.g., Ciprofloxacin, Ofloxacin - check local availability/guideline) for 2 weeks. Instill drops after dry wicking.
• Check for HIV Infection (refer to HIV assessment algorithm page 8).
• Check for TB (assess symptoms, contact history - see page 9, especially if discharge persists or other symptoms).

Monitoring & Follow-Up

• Follow-up in 5 days.
• At follow-up (Day 5): Reassess ear discharge. Check mother's wicking technique.
• If tender swelling behind ear: Treat as Mastoiditis - Refer URGENTLY.
• If discharge persists: Check wicking technique is correct. Encourage mother to continue. Continue eardrops for full 2 weeks.
• If discharge stopped: Praise mother. Advise to finish 2-week course of eardrops.
• If discharge persists after 2 weeks of treatment, refer for further assessment (e.g., ENT specialist).

Counselling Points

• Explain the diagnosis (chronic ear infection).
• Emphasize the importance of keeping the ear dry through regular, careful wicking. Demonstrate the technique.
• Teach how to instill the eardrops correctly after wicking.
• Explain the duration of treatment (2 weeks).
• Advise to avoid water entering the ear.
• Advise when to return immediately (swelling behind ear, facial weakness, severe pain, danger signs).
• Advise on follow-up visit in 5 days.

Differential Diagnosis

• Mastoiditis
• Acute Ear Infection
• Otitis Externa
• Foreign body with secondary infection
• Cholesteatoma (suspect if discharge persists despite treatment, foul smell, or granulation tissue)

Potential Complications

• Hearing loss (conductive)
• Cholesteatoma formation
• Mastoiditis
• Intracranial complications (meningitis, abscess - less common than with AOM/mastoiditis but possible)
• Facial nerve palsy

Prevention

• Prompt and effective treatment of Acute Otitis Media.
• Immunizations (PCV, Hib).
• Good nutrition.
• Avoiding exposure to smoke.

Key Features

• Definitive positive HIV test result appropriate for age.
• Requires lifelong ART and comprehensive HIV care.
• Requires co-trimoxazole prophylaxis to prevent opportunistic infections.

Assessment

• Ask: Has the mother or child had an HIV test?
• If Yes: Note mother's/child's status.
• Confirm positive test result: Positive DNA PCR test in child OR Positive HIV rapid test in a child 18 months or older.

Classification

• Positive DNA PCR test in child OR Positive HIV rapid test in a child >= 18 months -> CONFIRMED HIV INFECTION

Management

Non-Pharmacological Management

• Assess feeding and provide appropriate counselling based on age and ART status (Refer to pages 25-28).
• Provide counselling on disclosure, adherence, psychosocial support.
• Monitor growth and development closely.
• Assess for TB (see page 9).

Pharmacological Treatment

• Give Co-trimoxazole prophylaxis daily. Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab). Age >6 months - 5 years: 5ml syrup (or 1 adult tab/2 infant tabs). Start from 6 weeks or at diagnosis if older. Continue lifelong unless stopped based on specific criteria (e.g., immune recovery on ART, national guidelines).
• Link child to Early Infant Diagnosis (EID) / ART Clinic for initiation and continuation of Antiretroviral Therapy (ART) and comprehensive HIV care.
• Treat any existing infections or conditions according to IMCI guidelines.
• Ensure immunizations are up-to-date (follow specific schedule for HIV+ children, e.g., avoid BCG if symptomatic/confirmed positive before vaccination).

Monitoring & Follow-Up

• Requires regular, lifelong follow-up at the ART clinic for clinical monitoring, CD4/viral load testing, adherence support, management of side effects or complications.
• Follow up for acute illnesses as per IMCI guidelines.

Counselling Points

• Explain the positive HIV result clearly and sensitively.
• Explain the importance of starting and adhering to lifelong ART.
• Explain the importance of daily Co-trimoxazole prophylaxis.
• Provide age-appropriate feeding advice.
• Counsel on preventing transmission if relevant (mother's health).
• Counsel on hygiene and preventing opportunistic infections.
• Emphasize importance of regular follow-up at ART clinic.
• Address psychosocial needs and support systems.
• Advise on assessing for TB regularly.

Differential Diagnosis

• HIV Exposed (infant <18m with positive antibody test or mother HIV+)
• HIV Infection Unlikely
• Other immunodeficiency conditions (rare)

Potential Complications

• Opportunistic Infections (Pneumocystis pneumonia [PCP], TB, severe bacterial infections, cryptococcosis, candidiasis etc.)
• Malnutrition / Wasting / Stunting
• HIV encephalopathy / Neurodevelopmental delay
• Malignancies (Kaposi sarcoma, lymphoma)
• Chronic lung disease, heart disease, kidney disease
• Immune Reconstitution Inflammatory Syndrome (IRIS) after starting ART.

Prevention

• Prevention of Mother-to-Child Transmission (PMTCT) interventions.
• Safe infant feeding practices for exposed infants.
• General HIV prevention strategies in the community.

Key Features

• Child born to HIV-positive mother.
• Child's definitive HIV status is not yet confirmed negative (either untested, inconclusive test timing relative to breastfeeding, or positive antibody test <18m which reflects maternal antibodies).
• Requires co-trimoxazole prophylaxis until definitive negative status confirmed after breastfeeding cessation.
• Requires timely EID testing (DNA PCR).
• Requires specific counselling on safe infant feeding (AFASS criteria if considering stopping breastfeeding).

Assessment

• Ask: Has the mother had an HIV test? (Mother is HIV-positive).
• Ask: Has the child had an HIV test?
• Determine child's status based on tests and age:
• Case 1: Mother HIV+ AND child had negative DNA PCR test while breastfeeding or stopped < 6 weeks ago.
• Case 2: Mother HIV+ AND child not yet tested.
• Case 3: Mother HIV+ AND child < 18 months had positive serological (antibody) test.
• Ask: Is the child breastfeeding now?
• Ask: Is the mother on ART and child on ARV prophylaxis (if breastfeeding)?

Classification

• (Mother HIV-positive AND Negative DNA PCR test in breastfeeding child or stopped < 6 weeks ago) OR (Mother HIV-positive AND Child not yet tested) OR (Mother HIV-positive AND Positive serological test in infant HIV EXPOSED

Management

Non-Pharmacological Management

• Assess feeding and provide appropriate counselling based on mother's choice and circumstances (breastfeeding vs replacement feeding - counsel on AFASS criteria Page 28 if considering stopping breastfeeding).
• Link child to ART/Mother Baby care point for follow-up, ARV prophylaxis (if breastfeeding), and EID testing.
• Monitor growth and development.
• Assess for TB (see page 9).

Pharmacological Treatment

• Give Co-trimoxazole prophylaxis daily. Start at 6 weeks of age (or at first contact if older). Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab). Age >6 months - 5 years: 5ml syrup (or 1 adult tab/2 infant tabs). Continue until HIV infection definitively excluded after cessation of breastfeeding.
• Ensure child receives appropriate ARV prophylaxis according to national PMTCT guidelines (especially if breastfeeding).
• Perform DNA PCR test to confirm HIV status at appropriate time points (e.g., 6 weeks, after breastfeeding cessation - follow national EID algorithm). If DNA PCR is positive -> Confirmed HIV Infection. If negative after breastfeeding cessation -> HIV Infection Unlikely.
• Ensure immunizations are up-to-date (follow schedule, give BCG at birth unless symptomatic).

Monitoring & Follow-Up

• Regular follow-up at Mother-Baby care point/ART clinic for EID testing, monitoring, ARV prophylaxis refills, and continued co-trimoxazole.
• Final HIV test (usually rapid test) around 18-24 months or after breastfeeding cessation to confirm status.

Counselling Points

• Explain the meaning of 'HIV Exposed' - child needs testing to know status.
• Explain the importance of daily Co-trimoxazole prophylaxis.
• Explain the importance of ARV prophylaxis for the baby if breastfeeding.
• Provide detailed counselling on safe infant feeding options (exclusive breastfeeding for first 6 months is generally recommended for exposed infants in resource-limited settings if mother is on ART; discuss stopping breastfeeding and AFASS criteria - page 28). Emphasize exclusive feeding method.
• Explain the schedule for EID testing (DNA PCR).
• Counsel on importance of mother's own health and ART adherence.
• Advise on assessing for TB.
• Advise on signs of illness requiring immediate care.

Differential Diagnosis

• Confirmed HIV Infection
• HIV Infection Unlikely

Potential Complications

• Risk of acquiring HIV infection if PMTCT is suboptimal.
• Increased risk of common childhood illnesses.
• Side effects of prophylactic medications (rare).

Prevention

• Effective PMTCT including maternal ART.
• Infant ARV prophylaxis.
• Safe infant feeding practices.
• Co-trimoxazole prophylaxis.

Key Features

• HIV status of mother and child is unknown.
• Child is young enough (<18m) that maternal status is the primary determinant for exposure risk assessment.
• Requires offering HIV testing and counselling (HTC) to the mother.

Assessment

• Ask: Has the mother or child had an HIV test? (Answer is No, or status unknown).
• Confirm child is less than 18 months old (as management differs slightly for older children where child testing might be offered directly).

Classification

• HIV test not done for mother or infant child less than 18 months old -> HIV INFECTION STATUS UNKNOWN

Management

Non-Pharmacological Management

• Encourage mother to go for HIV counselling and testing in a health facility.
• Provide general health and feeding advice based on age.

Pharmacological Treatment

• Treat any current illness according to IMCI guidelines.
• Withhold Co-trimoxazole until mother/child status is known (unless child is severely malnourished or has confirmed TB where prophylaxis might be indicated regardless - check national guidelines).

Monitoring & Follow-Up

• Follow up depends on whether mother accepts testing.
• If mother tests positive, manage child as HIV Exposed.
• If mother tests negative, manage child as HIV Infection Unlikely.
• Follow up for presenting illness as needed.

Counselling Points

• Explain the importance of knowing HIV status for the health of both mother and child.
• Offer HIV testing and counselling sensitively.
• Explain the testing process and confidentiality.
• Provide general health messages.

Differential Diagnosis

• Child could be HIV Exposed or HIV Unlikely depending on mother's actual status.

Potential Complications

• Delayed diagnosis of HIV infection in mother or child.
• Missed opportunity for PMTCT in future pregnancies.
• Child may unnecessarily lack prophylaxis if exposed, or receive it if not needed.

Prevention

• Routine offering of HIV testing in antenatal care, labour/delivery, postnatal care, and child health services.

Key Features

• Confirmed negative HIV status for the mother or child (using appropriate test and timing).
• Indicates very low likelihood of HIV infection.
• Requires standard IMCI management for presenting conditions.

Assessment

• Ask: Has the mother or child had an HIV test?
• Confirm negative test result:
• Mother tested HIV-negative OR
• Child tested negative by DNA PCR after complete cessation of breastfeeding (>6 weeks prior) OR
• Child >= 18 months tested negative by HIV rapid test.

Classification

• Negative HIV test in mother or child (definitive) -> HIV INFECTION UNLIKELY

Management

Non-Pharmacological Management

• Provide routine assessment and management for any presenting illness using standard IMCI protocols.
• Provide age-appropriate feeding counselling.

Pharmacological Treatment

• Treat any current illness according to IMCI guidelines.
• Co-trimoxazole prophylaxis is NOT indicated.

Monitoring & Follow-Up

• Follow up for presenting illness as needed.
• Continue routine child health services (growth monitoring, immunization).

Counselling Points

• Reassure mother about the negative HIV status.
• Provide counselling for any presenting illness.
• Provide general health and feeding advice.
• Advise on ongoing HIV prevention measures for the mother/family.

Prevention

• Continued safe practices to prevent HIV acquisition.

Key Features

• Positive DNA PCR test confirms HIV infection in an infant.
• Requires urgent initiation of lifelong ART.
• Requires co-trimoxazole prophylaxis starting at 6 weeks.

Assessment

• Ask: Has the mother or child had an HIV test?
• Confirm infant has had a positive HIV virological test (DNA PCR).

Classification

• Infant has positive virological test (DNA PCR) -> CONFIRMED HIV INFECTION

Management

Non-Pharmacological Management

• Link infant URGENTLY to HIV Care/ART clinic for initiation of Antiretroviral Therapy.
• Assess feeding and provide appropriate counselling (balancing benefits of breastfeeding with transmission risk, supporting safe replacement feeding if chosen/appropriate - follow national guidelines).
• Assess for TB.
• Provide psychosocial support to mother/family.

Pharmacological Treatment

• Start Co-trimoxazole prophylaxis from 6 weeks of age (or immediately if diagnosed after 6 weeks). Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab) daily. Continue lifelong.
• Initiate ART as per national guidelines under specialist care.
• Treat any current illness according to IMCI guidelines (be aware of increased severity risk).
• Ensure immunizations are up-to-date (BCG usually given at birth unless symptomatic infant; other EPI vaccines as per schedule for HIV+ infants).

Monitoring & Follow-Up

• Requires lifelong, regular follow-up at ART clinic for monitoring (clinical, growth, CD4, viral load), adherence support, management of complications.

Counselling Points

• Explain the positive HIV result clearly and sensitively.
• Explain the critical importance of starting ART immediately for the baby's health.
• Explain the need for daily Co-trimoxazole.
• Provide detailed counselling on safe and appropriate infant feeding according to national guidelines for HIV-positive infants.
• Emphasize importance of adherence to both ART and co-trimoxazole.
• Counsel on preventing opportunistic infections.
• Address mother's health and ART adherence.
• Assess for TB and counsel on monitoring.
• Link family with support services.

Differential Diagnosis

• HIV Exposed

Potential Complications

• Rapid disease progression
• Severe opportunistic infections (PCP, TB etc.)
• Failure to thrive / Severe malnutrition
• Neurodevelopmental delay
• Early death

Prevention

• Effective PMTCT interventions.
• This classification represents a failure of prevention, focus shifts to treatment.

Key Features

• Infant born to HIV-positive mother.
• Infant's HIV status not confirmed negative post-exposure.
• Requires Co-trimoxazole prophylaxis from 6 weeks.
• Requires infant ARV prophylaxis as per national PMTCT guidelines.
• Requires timely EID testing (DNA PCR) at 6 weeks and after breastfeeding cessation.
• Requires specific counselling on safe infant feeding.

Assessment

• Ask: Has the mother had an HIV test? (Mother is HIV-positive).
• Ask: Has the infant had an HIV virological test (DNA PCR)? (If yes, was it negative? When was it done relative to breastfeeding?)
• Determine infant's status based on mother's status and infant testing:
• Case 1: Mother HIV+ AND infant not yet tested.
• Case 2: Mother HIV+ AND infant had negative DNA PCR but exposure (breastfeeding) is ongoing or stopped < 6 weeks ago.
• Ask: Is the infant breastfeeding?
• Ask: Is mother on ART and infant on ARV prophylaxis?

Classification

• (Mother HIV positive AND negative virological test in infant who is breastfeeding or stopped less than 6 weeks ago) OR (Mother HIV positive, young infant not yet tested) -> HIV EXPOSED: POSSIBLE HIV INFECTION

Management

Non-Pharmacological Management

• Link infant to Mother-Baby care point / PMTCT services for follow-up, ARV prophylaxis, and EID testing.
• Assess feeding and provide counselling on safe infant feeding options (Exclusive breastfeeding recommended for first 6 months if mother adherent to ART and infant receiving prophylaxis; discuss replacement feeding risks/benefits - follow national guidelines).
• Assess for TB.
• Monitor growth.

Pharmacological Treatment

• Start Co-trimoxazole prophylaxis from 6 weeks of age. Dose: 2.5ml syrup (or 1 infant tab) daily. Continue until HIV excluded after breastfeeding cessation.
• Ensure infant receives appropriate ARV prophylaxis (e.g., Nevirapine or Zidovudine) daily from birth for duration recommended by national guidelines (e.g., 6 weeks or duration of breastfeeding).
• Perform DNA PCR test at 6 weeks of age. If positive -> Confirmed HIV Infection. If negative, continue prophylaxis and re-test after breastfeeding cessation.
• Treat any current illness according to IMCI guidelines.
• Ensure immunizations are up-to-date (give BCG at birth unless symptomatic).

Monitoring & Follow-Up

• Regular follow-up at Mother-Baby care point for EID testing, ARV prophylaxis, co-trimoxazole, feeding support, growth monitoring.
• Definitive testing after breastfeeding cessation.

Counselling Points

• Explain 'HIV Exposed' status and need for testing.
• Explain importance of daily Co-trimoxazole starting at 6 weeks.
• Explain importance of daily infant ARV prophylaxis.
• Provide detailed counselling on safe infant feeding (exclusive breastfeeding preferred if mother on ART, or safe replacement feeding).
• Explain EID testing schedule.
• Counsel on mother's own health and ART adherence.
• Advise on assessing for TB.
• Advise on signs of illness requiring immediate care.

Differential Diagnosis

• Confirmed HIV Infection
• HIV Infection Unlikely

Potential Complications

• Risk of HIV transmission.
• Increased risk of common illnesses.

Prevention

• Effective PMTCT.
• Infant ARV prophylaxis.
• Safe infant feeding.
• Co-trimoxazole.

Key Features

• HIV status of mother (and therefore infant exposure) is unknown.
• Requires urgent HIV testing and counselling (HTC) for the mother to guide infant management.

Assessment

• Ask: Has the mother had an HIV test? (Answer is No, or status unknown).
• Confirm infant has not had HIV testing.

Classification

• HIV test not done for mother or infant -> HIV INFECTION STATUS UNKNOWN

Management

Non-Pharmacological Management

• Strongly encourage mother to go for HIV counselling and testing immediately.
• Provide general infant care advice.

Pharmacological Treatment

• Treat any current illness according to IMCI guidelines.
• Do NOT start Co-trimoxazole or infant ARV prophylaxis until mother's status is known.

Monitoring & Follow-Up

• Depends on mother accepting testing.
• If mother tests positive -> Manage infant as HIV Exposed.
• If mother tests negative -> Manage infant as HIV Infection Unlikely.
• Follow up for presenting illness.

Counselling Points

• Explain the importance of knowing mother's HIV status for the baby's health.
• Offer/facilitate immediate HIV testing and counselling for the mother.
• Explain confidentiality.

Potential Complications

• Delayed diagnosis of maternal/infant HIV.
• Missed opportunity for PMTCT.
• Delayed infant prophylaxis if exposed.

Prevention

• Routine offering of HTC in all maternal and child health settings.

Key Features

• Confirmed negative HIV status of the mother.
• Indicates infant is not exposed to HIV.
• Requires standard IMCI management.

Assessment

• Ask: Has the mother had an HIV test?
• Confirm mother tested HIV-negative.

Classification

• Negative HIV test for mother -> HIV UNLIKELY

Management

Non-Pharmacological Management

• Provide routine assessment and management for any presenting illness.
• Provide age-appropriate feeding counselling (exclusive breastfeeding).

Pharmacological Treatment

• Treat any current illness according to IMCI guidelines.
• Co-trimoxazole prophylaxis and ARV prophylaxis are NOT indicated.

Monitoring & Follow-Up

• Follow up for presenting illness as needed.
• Continue routine child health services.

Counselling Points

• Reassure mother about negative HIV status.
• Provide counselling for any presenting illness.
• Provide general infant care and feeding advice.

Prevention

• Mother remaining HIV negative.