CHILD HEALTH

(CHE 235)

UNIT 1.0

TOPIC- CHILD RIGHTS

Instructional Materials:

 Posters
 Audio visuals

Teaching Methods

 Line up
 Group discussions

Types of assessment

 Assignments
 MCQ
 Essay

Learning objectives

By the end of the lesson, Students should be able to;

 Explain the rational for a child rights

 Discuss the rights of a child as declared by the United Nations

1.0 Introduction:
The right of the child was adopted from the UN convention on the 20 th of
November, 1989. UNICEF organized a world summit for children on 29 th –
30th September, 1990 at the UN Headquarters.

1.1 Rational for Child Rights;

 Improving the quality of life of children world-wide

 Enhance their dignity protect their inalienable rights
 Mobilize and focus global attention on their physical,
mental, moral and spiritual development.

1.2 Rights of the Child;

1. Right to life:

Every child has the right to life, to survive, to develop and the right to
participate activity in the promotion of his/her right.

2. Right to Identity:
Every child has the right to a name, Family, Nationality and a right to
know his parent and be cared for.

3. Freedom of Association: (Thought and Religion)

- Every child is free to belong to any association or assembly
according to the law.
- A child is free to associate, be it in relationship with other people or
belong to any assembly according to law.
- No child should be separated from his/her family or parents except
on the Authority of a competent court that such separation is in the
best interest of the child.

4. Right to Communicate:

- Every child has the right to express opinions and freely

communicate them on any issues subject to restriction under the
law. The opinions, ideas or thought expressed may be on any issue
concerning his or her interest.
- The child has the right to seek, receive and impart information and
relation to children, under the law.

5. Right to Privacy:

Every child should be protected from any act that interferes with his/her
privacy, honour and reputation in the home, community and school
provided that the parents or legal guardian shall have the right to exercise
reasonable supervision over the conduct of their children.

6. Right to Leisure and Recreation:

Every child is entitled to adequate rest, recreation (leisure and play)

appropriate to his or her age and culture.
7. Right to Education:

Every child, irrespective of sex is entitled to receive free and compulsory

basic education and equal opportunity for higher education based on
individual ability.

8. Right to Good Health:

- Every child is entitled to enjoy good health, protection from
diseases, and proper medical care for survival, personal growth and
development.
- No child should be deprived of his/her right to health care services,
which also include good living standard.

9. Freedom from Discrimination:

No child shall suffer discrimination irrespective of ethnic origin, birth,

colour, sex, language, religion, or social beliefs, status, or disability.

10. Protection from Exploitation and Inhuman Treatment:

Every child must be protected against all forms of exploitation, indecent
or degrading treatment including child labour, abuse, and torture, sexual
exploitation, sale, abduction and drug abuse.

Test item; Line up to demonstrate the rights of the child

Students’ Activity

Topic – Rights of a child

Learning outcome

1. Discuss the rational for child health

2. List and explain the rights of a child

Task; - In pairs, brainstorm on the rights of a child

 UNIT 2.0

TOPIC - CHILDREN WHO ARE ‘AT RISK’ FOR SPECIFIC CONDITIONS

Instructional Materials: Audio visuals, Posters

Teaching Methodology; Brainstorming, Group discussion, Q&A

Types of assessment

 Assignment
 Continuous Assessment test (MCQ, Essay)

Learning objectives; By the end of the lesson, Students should be able

to;

 Define the term ‘At Risk’

 Identify the children who are ‘At Risk’ of
specific conditions
 Explain the process of screening children

2.0 Introduction;

Children-at-risk are persons under 18 who experience an intense and/or

chronic risk factor, or a combination of risk factors in personal,
environmental and/or relational domains that prevent them from pursuing
and fulfilling their God-given potential.

2.1 Define the term “At Risk”

At risk refers to infants and young children who are physically, medically,
or psychologically in danger of failing to thrive and also includes children
who are affected by diverse economic, environmental, and geographical
factors

The term is also used for children in danger of suffering from

Mistreatments, Injury, disease or the effect of dysfunctional behaviors

2.2 Identify the children who are ‘At Risk’ of specific condition;
Children who are associated with one or more of the following are
considered at risk
 Homeless
 Racism
 Disabilities (physical or mental)
  Substance Abuse
 Poverty
 Divorced parent
 Neglected
 Teenage parents

2.3 Explain the process of screening children

- Screening is a brief, simple procedure used to identify infants and
young children who may be at risk for potential health,
developmental, or social-emotional problems. It identifies children
who may need a health assessment, diagnostic assessment, or
educational evaluation.
- Screening helps identify children who need more evaluation and
address concerns early before they become bigger problems
- Screening provides an opportunity for young children and their
families to access a wide variety of services and early childhood
programs, and promotes and support parents, understanding of
their child’s health, development, and learning.

Developmental Screening

 It is the early identification of children at risk of cognitive, motor,

communication, or social-emotional delays
 These are delays that may interfere with expected growth, learning
and development and it may require further diagnosis, assessment,
and evaluation

Socio-emotional Screening

It is a component of developmental screening of young children that

focuses on a child’s ability to;

 Express and regulate emotions

 Forms close and secure relationships
 Explore his/her environment and learn

For children younger than 6 years, it is synonymous with mental health

screening

Mental Health Screening

It is the early identification of children at risk for possible mental health

disorders that may interfere with expected growth, learning, and
development and may require further diagnosis, assessment and
evaluation

Comprehensive family assessment

The comprehensive family assessment is a process for identifying,
considering, and weighing factors that affect the child's safety,
permanency, and well-being. The family assessment is designed to gain a
greater understanding about the family's strengths, needs, and resources
so that children can be safe and the risk of maltreatment can be reduced.

Test item; Continuous Assessment test- MCQ, Essay

Students’ Activity

Topic – Children who are ‘AT RISK’ for specific condition

Learning outcome: 1. Identify and discuss conditions that put children

at risk

2. Discuss the process of Screening ‘At Risk’ children

Task; Group work, Assignment

UNIT 3.0

TOPIC- THE CONCEPT OF INTEGRATED MANAGEMENT OF

CHILDHOOD ILLNESS (IMCI)

Instructional Materials:

 IMCI Flow charts

 Models
 Audio visuals
Teaching Methods;

 Field visit to PHC Facilities

 Case scenarios
 Group discussion
 Demonstration

Types of assessment;

 Assignment, MCQ, Essay questions

Learning objectives; By the end of the lesson, Students should be able

to

 Define integrated management of neonatal and

child hood illnesses
 Identify component of IMNCI
 Explain the rationale behind appropriate
management and / or Referral
  Assess and classify the sick child (0 up 5 years)

3.1 Concept of IMNCI

Integrated management of child hood illness was developed by WHO in

collaboration with UNICEF and other Agencies, institutions and individuals
in 1992. Every year about 9 million children die in the developing
countries before their 5th birth day with many death within the 1st year of
life. More than 70% of these child deaths are due to five (5) diseases,
namely; pneumonia, diarrhea, malaria, measles and malnutrition.

Define integrated management of neonatal and child hood

illnesses;

 IMCI is defined as an integrated approach to child health that

focuses on the well-being of the whole child. It is a strategy for
reducing the morbidity and mortality associated with the major
causes of childhood illness.
 It includes preventive and curative elements that are provided both
in the health facility and at home.

Component of IMNCI;

 Improving the case management skills of

health workers
 Improving family and community practice that
support child survival
 Improving and strengthening overall health
system

3.2 Rationale behind appropriate management and / or Referrals

 It promotes the accurate identification of child

hood illness in the health facilities
 It ensure appropriate combine treatment of all
major illness
 Its strengthens counseling of care givers
 Its ensure speedy referral of severely ill
children
 Its promote appropriate care seeking behaviors

3.3 Assess and classify the sick child (0 up 5 years);

www.unicef.org

Test item; Brainstorm on the component of IMNCI

Students’ Activity
Topic – The Concept of Integrated Management of Neonatal Childhood
Illness (IMNCI)
Learning outcome;
 Discuss the integrated management of
neonatal and child hood illnesses
 List the component of IMNCI
 Explain the rationale behind appropriate
management and / or Referral
 Assess and classify the sick child (0 up 5 years)

Task; Group discussion, brainstorming

UNIT 4.0

TOPIC - CONDITIONS WHICH MAY EXPOSED CHILD TO GRAVE

DANGER

Instructional Materials;

 Posters
 Pictures
Teaching Methods; Lectures, group discussions, Field visit to PHC
Facilities

Types of assessment;

 Continuous Assessment test in form of ;

assignments, MCQ, Essay

Learning objectives; By the end of the lesson, Students should be able

to;

 Describe conditions which may exposed the

child to grave danger
 Identify other condition which may expose child
to grave danger

Introduction;

Many factors affect health of the child. Some of

these factors can be found in the home, others
outside the home.

4.1 Condition which may exposed the child to grave dangers;

 Severe Pneumonia or very severe diseases

 Severe febrile illness
 Severe Dehydration
 Dysentery
 Severe persistent diarrhea
 Mastoditis
 Severe complicated malnutrition
 Severe uncomplicated malnutrition
 Severe Anemia

4.2 Identify other condition which may expose child to grave

dangers;

 Hemoglobin below 7grm or New born with

hemoglobin below 15grm
 Stiff neck or bulging fontanels
 Abdominal pain with rigidity
 Jaundice
 Oedema

Test item; Discussion on the condition that may expose the child to
grave dangers

Students’ Activity

Topic – Conditions which may exposed child to grave danger

Learning outcome
  Describe the conditions which may exposed the
child to grave danger
 Identify and discuss other condition which may
expose child to grave danger

Task; Line up on condition which may expose the child to grave danger

UNIT 5.0
TOPIC - CURRENT INTERVENTIONS INCLUDED IN IMNCI

Instructional Materials;

 Flip chart

Teaching Methods; Lectures, Group discussion, Role play

Types of assessment

o Continuous Assessment test

o Assignment

Learning objectives; By the end of the lesson, Students should be able

to;

 Explain interventions currently included

in the IMCI strategy
 Explain intervention currently included in
ICCM strategy

Introduction

Integrated community case management (ICCM) in an equity focus

strategy that complement and extends the reach of public health services
by providing timely and effective treatment of malaria, pneumonia and
diarrhea to population with limited access to facility based health care
provider.

5.1 Interventions currently included in the IMCI strategy

 Case management
 Improving health system
 Improving family and community
practices

5.2 Explain intervention currently included in ICCM strategy

- ORT and Zinc for diarrhoae; are effective against childhood

diarrhea mortality. ORS can prevent 93% of diarrhoeal death and
zinc 23% of deaths

- Oral antibiotics for pneumonia; community case management

of pneumonia can prevents 70% of pneumonia related deaths in
children under 5 years

- RDT and anti-malarials (principally artemesinin-based

combination therapy) for malaria. It has the potential to prevent
overall mortality by 40%, malaria-specific mortality by 60%, and
 severe malaria morbidity in under five years by 53% (CHW Central,
2013).

Test item; Brainstorm on IMNCI and ICCM strategies

Students’ Activity

Topic – Current interventions included in IMNCI

Learning outcome

 Explain interventions currently included in the IMCI strategy

 Explain intervention currently included in ICCM strategy

Task

Line up on intervention on IMNCI and ICCM strategies

 UNIT 6.0

TOPIC - USING IMCI ALGORITHM TO MANAGE CHILDHOOD

CONDITIONS;

Instructional Materials:

 Posters/ IMCI Flow Charts

 IMCI Chart booklet/ standing orders
 Videos of children exhibiting dander signs

Teaching Methods

 Lectures
 Brainstorming
 Demonstration
 Group discussing

Types of assessment

 Continuous Assessment test

 Assignment

Learning objectives; By the end of the lesson, Students will be able to;
 Define IMNCI standing orders
 Explain how to use IMNCI algorithm to
manage cases of Neonatal and childhood
illness.
 Explain Case Management with IMNCI
algorithm
 Enumerate the protocol of history taking,
examination, and management of some
cases of illness

6.1 Definition IMCI Booklet Chart/ standing orders

It is a chart used by health professionals providing care to

sick children that shows the sequence of steps and provide
information for performing them. It helps the heath provider to
apply the IMCI case management guidelines

6.2 How to use IMNCI algorithm to manage cases of Neonatal

and childhood illness.
  Assess the child illness
 Classify the illness base on signs
 Identify treatment
 Treat the child
 Counsels the care taker
 Follow up

6.3 The protocol of history taking, examination, and

management of some cases of illness;

o Protocol of history taken

Welcome the caregiver and try


to establish rapport with him or
her through the normal greeting
etc.
 Offer him/her a seat
 Take his/her particulars eg-
name, age, sex etc.
 Obtained complain starting with
the chief {main} complain
presented and the day it
started
 Assemble all the complaints
received as presented by the
caregiver of the child
 Physical examination
Physical examination can also
be defined as an act or a
process of screening for features
of diseases in a patient from
head to toe. For an examiner to
accurately diagnose an ailment,
it is pertinent that the fellow
should be familiar with the
range of normal signs before
abnormalities can be confidently
recognized.

Methods of physical examination

Inspection;

Inspection as one of the methods of physical examination requires the

Community Health Student {CHS} to use his/her special sense of sight
{eyes} to observe the patient from the first moment he/she comes in to
the healthcare facility
 (www.edu.gov)

Palpation

Simply means to feeling by uses of hand

www.edu.gov

Percussion
Percussion is a clinical procedure carried out in examining the two body
cavities of thoracic cavity and abdomino-pelvic cavity in order to detect
any abnormality like accumulation of fluid as in fleurisy effusion, ascites
etc.

www.edu.gov
Auscultation
Auscultation is another examination technique/clinical procedure requiring
the use of stethoscope. It is defined as an act of listening to sounds arising
with in body organs {lungs, heart, abdominal cavity, upper arm etc} as
aid to diagnosis and treatment of disease(s). It is the only method of
physical examination {among the IPPAs/IPPAOs} requiring the use of
clinical-instrument {stethoscope}.

www.who.

Olfaction : using sense of smell in examination

6.4 How to use Pulse Oximeter

 Pulse oximeter is a small device that measures the oxygen

saturation in the blood
 It is useful in identifying warning signs for chronic lungs or heart
conditions.

- To use the oximeter, clip the device to the patients toe, finger, or
earlobe to get an accurate reading
- Position the probe correctly
- Make sure the pt is sitting still to avoid shaking which will affect
reading

A reading of 95% to 100% is considered normal, a lower level may

indicate;

o Blocked airways
o Difficulty in breathing
o Lung Infection
o Poor blood circulation
o Drug interference from anesthesia, muscle relaxants, or
anaphylaxis
Test item

Discussions and practical demonstrations Using IMCI algorithm to manage

childhood conditions

Students’ Activity

Topic - Using IMCI algorithm to manage childhood conditions

Learning outcome

 How to use IMNCI algorithm to manage

cases of Neonatal and childhood illness.
 Define IMCI Booklet/ standing order
 Case Management with IMNCI algorithm
 The protocol of history taking,
examination, and management of some
cases of illness

Task

Brainstormed using fish bowl on using IMCI algorithm to manage cases of

neonatal and childhood illness

UNIT 7.0

TOPIC – IMPROVING HEALTH SYSTEM TO DELIVER IMCI

Instructional Materials;
• Flip charts

Teaching Methods;

Lectures, group discussions, Field visit to PHC Facilities

Types of assessment;

• Continuous Assessment test in form of assignments, MCQ,

Essay

Learning objectives; By the end of this session, the students will be

able to;

 Highlight essential drug supply

 Explain referral services and care
 Discuss quality of care and equity of access
  Discuss health management information system
 Discuss management and supervision

Introduction

Improving health systems to deliver IMCI concerns policy, planning and

management, financing, organization of work and distribution of tasks at
health facilities, human resources, availability of drugs and supplies,
referral, monitoring and health information system, supervision,
evaluation and research.

7.1 Essential Drug Supply

Ensure regular (un-interrupted) essential drugs and supply and proper
management through DRF.

7.2 Work organization in Health facility

Organization of the hospital emergency areas to support rapid evaluation
and management of sick children.

7.3 Referral services and care

All clients that are identified for referral to higher centres should be
assisted in organizing and reaching the centre.

7.4 Quality of Care and equity of access

o Quality care should be ensured at all times giving every one equal
opportunity and access.
o Training of health workers in emergency triage assessment
treatment (a system of sorting out or identifying sick children who
need urgent attention so that they can receive prompt
management)
o Facilities that are necessary for management of different common
condition should be provided.

7.5 Health Management System

There must be a very good system and culture of record keeping for all
activities and contacts. These records are the basic tool for planning
future activities and assessment of performance.

7.6 Management and Supervision

For all the aforementioned to be in place and shape there must be a good
management structure with close supervision by competent personnel.
Test item

Discussions on how to improve health system to deliver IMCI

Students’ Activity

Topic – Improving Health System to deliver IMCI

Learning outcome

 Explain essential drug supply

 Discuss referral services and care
 Discuss quality of care and equity of access
 Discuss health management information
system
 Discuss management and supervision

Task

Brainstorming and group discussions on how to improve health system

looking at each item

UNIT 8.0

TOPIC – IMPROVING FAMILY AND COMMUNITY PRACTICE FOR IMCI

Instructional Materials;

• Flip charts, VIPP

Teaching Methods;

Lectures, group discussions, role plays, songs

Types of assessment;

• Continuous Assessment test in form of assignments, MCQ, Essay

Learning objectives; By the end of this session, the students will be
able to;

 Describe how to improve family and community practices of IMCI

Introduction

Community IMCI is an integrated child care approach that aim at the

following:
- Initiate, reinforce and sustain the key community, family and
household practices that are likely to have the greatest impact on
child survival, growth and development,
- Bring about the desirable behavioral change through information,
education and communication.

8.1 Improving family and community household practices strategies

can be grouped as follows:
 Growth monitoring and development
 Exclusive breast feeding for six month.
 Appropriate complementary feeding from 6 month in addition
to breast feeding.
 Adequate micronutrient through diet or supplement.
 Growth monitoring.
 Promote mental and psychological development.
 Birth registration.
 Disease prevention
 Proper disposal of faeces/ waste, hand washing.
 Use of insecticide treated net.
 Prevention of HIV transmission
 Prevent child abuse/neglect and take appropriate action
 Home management
 Continue to feed and offer fluids when child is sick
 Give child appropriate home treatment e.g. recommended
dose of pcm, anti malarial, give extra breast milk, ORS etc
 Take appropriate action to prevent and manage child
injuries
 Care seeking and compliance
 Take child to complete full course of immunization before
first birth day.
 Recognize when child needs treatment outside home and
take him to health facility/health worker.
 Follow health workers advice about treatment, follow up
and referral.
  ANC attendance and TT vaccination and recognition of
danger signs during pregnancy
 Active participation of men in child and reproductive health
activities.
 Birth registration and issuance of birth certificate.
 Growth monitoring.
 House hold water safety.
 Control of indoor air pollution.
 Essential community new born care

Test item

Describe how to improve family and community practices of IMCI

Students’ Activity
Topic – Improving family and community practices of IMCI

Learning outcome

 Explain how to improve family and community

practice
 Describe how to promote key household
practices

Task

Brainstorming and group discussions on how to improve family and

community practices of IMCI

UNIT 9.0

TOPIC – CONCEPT OF INTEGRATED COMMUNITY CASE

MANAGEMENT (ICCM) INTERVENTION.
Instructional Materials;

• Flip charts, VIPP

Teaching Methods;

Lectures, group discussions, role plays

Types of assessment;

• Continuous Assessment test in form of assignments, MCQ, Essay

Learning objectives; By the end of this session, the students will be

able to;

 Explain the concept of ICCM intervention

 Explain Interventions currently included in the ICCM strategy


Introduction

ICCM is an extension of IMCI, providing treatment services outside of the

healthcare facility at community level and c-IMCI, the original community
based component of IMCI which focused on promoting key family and
community practices for improving child health.

9.1 Concept of ICCM

ICCM is an approach to providing integrated case management services

for two or more illnesses – including diarrhoea, pneumonia, or malaria
among children younger than 5 years of age at community level by lay
health worker where there is limited access health facility-based case
management services.

9.2 Interventions currently included in the ICCM Strategy

Refer to 5.2 above.

Test item

Describe the Concept of ICCM intervention

Students’ Activity

Topic – Concept of ICCM Intervention

Learning outcome

 Explain the concept of ICCM Intervention

 Describe the Interventions currently included in
the ICCM strategy

Task

Group discussions on Intervention strategies included in ICCM