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Table 1 Severe disease classifications and recommended treatments from the 2014 IMCI codebook

From: Quality of care for children with severe disease in the Democratic Republic of the Congo

Severe disease classificationsSignsRecommended treatments
Severe pneumonia or other respiratory infection(1) Cough or difficulty breathing AND
(2) Any general danger sign (lethargy or loss of consciousness, convulsions, inability to drink or breastfeed, vomiting all food) OR stridor in calm child
• Give first dose of an appropriate antibiotic.
• Refer urgently to hospital. If referral is not possible, manage the child as described in the pneumonia section of the national guidelines or as in the WHO Pocket Book for hospital care for children.
Severe dehydration(1) Diarrhea AND
(2) Two or more of the following: lethargic or unconscious, sunken eyes, not able to drink or drinking poorly, skin pinch goes back very slowly
• If child has no other severe classification, give fluid for severe dehydration.
• If child has another severe classification, refer urgently to hospital with mother giving frequent sips of ORS on the way.
• Advise the mother to continue breastfeeding.
• If child is 2 years or older and there is cholera in your area, give antibiotic for cholera.
Very severe febrile disease (including malaria)(1) Fever AND
(2) Any general danger sign OR stiff neck
• Give first dose of artesunate or quinine for severe malaria.
• Give first dose of an appropriate antibiotic.
• Treat the child to prevent low blood sugar.
• Give one dose of paracetamol in clinic for high fever (38.5 C or above).
• Refer urgently to hospital.