Usefulness of clinical case-definitions in treatment of childhood malaria or pneumonia

WHO provides health workers with guidelines for case management strategies for children with acute respiratory infections (ARI) to reduce child mortality. Its clinical case definitions for ARI do not assume that a child has only 1 disease however. The guidelines also help health workers diagnose and treat other conditions in those children with fever who live in malaria endemic areas such as Africa where Plasmodium falciparum is transmitted. They also guide health workers on how to refer children with danger signs of severe malaria meningitis or severe malnutrition to the hospital. Based on studies in Malawi and the Gambia WHO 1st recommended using co-trimoxazole and chloroquine to treat children with malaria who have a cough and fever and who are breathing quickly. Experts at a WHO meeting in April 1991 now recommend 5 days of co-trimoxazole alone to treat such children in areas where malaria is moderately to highly endemic the leading parasite is P. falciparum and it is sensitive to sulfadoxine/pyrimethamine. WHO has incorporated this change into its clinical guidelines and training materials. The guidelines emphasize that local health workers must adapt the guidelines for children with concomitant malaria as necessary to guarantee appropriate identification and referral of children with severe anemia. WHO and UNICEF are developing a fully integrated training package to address case management of children with pneumonia diarrhea malaria measles and/or malnutrition. This package also instructs health workers on how to manage middle ear inflammation anemia meningitis and acute ocular problems from measles and vitamin A deficiency. WHO and UNICEF hope to have this integrated training package available in late 1993.