COMMUNITY HEALTH NURSING ●​ Periodic evaluation

●​ Continuing staff education

WITH IMCI
●​ Utilize available community health
(CHN W/ IMCI) resources
●​ Utilize existing active organizations
Lecturer: Ms. Shanelle Kate Sunga
●​ Accurate recording and reporting
November 14, 2025
●​ PREVENTIVE approach to health
●​ Population / Aggregate → focus most
COMMUNITY HEALTH NURSING
●​ Unique blend of public health and nursing patient
for human services with holistic approach. ○​ E.g., 70 elderly, 20 pregnant, 10
●​ Empower individuals/communities to take children → prioritize/ focus larger
change of their own health. ●​ Developmental in nature
●​ Prepayment mechanism → NO libre →
PHILOSOPHY OF CHN advanced payment
BY MARGARET SHETLAND ●​ Care for different levels of clientele
●​ “Worth and dignity of man” ○​ Individual, family, group, community
●​ Regardless of their background
○​ Valve FIELD OF NURSING
○​ Respect PUBLIC HEALTH NURSING
○​ Care ●​ SG 15 (40K)
○​ Dignity ○​ Focus → overall health in
community
ULTIMATE GOAL OF CHN ○​ Target group → entire population
●​ Optimum level of functioning (OLOF) ○​ Common setting → RHU, BHS
Healthy → healthier
SCHOOL HEALTH NURSING
PRIMARY GOAL OF CHN ●​ Annual health assessment
●​ Self-reliance → independence ○​ Focus → health in schools
○​ Target group → students, teachers,
PRIMARY FOCUS staffs
●​ Health promotion and/or disease prevention
○​ Common setting → schools
●​ Health promotion
○​ Healthy → become healthy
OCCUPATIONAL HEALTH NURSING
●​ Disease prevention
●​ Focus → workplace health and safety
○​ Healthy → stay healthy
●​ Target group → employees
●​ Common setting → offices, factories,
PRINCIPLES IN CHN (GARDNER AND COBB)
workplaces.
●​ CHN is based on a recognized NEEDS
○​ Individual → entry point
MENTAL HEALTH NURSING
○​ Family → unit of care / service or
point of care / service ●​ Mental health act “RA 11036”
○​ Group / Aggregate → group of ○​ Focus → mental health
people that shares common location ○​ Target group → all individuals with
and common health needs mental health issues
○​ Community → primary clientele ○​ Common setting → community
●​ Must be available to all mental health programs
●​ Works as a member of health team
●​ Health teaching PHILIPPINE HEALTH CARE DELIVERY SYSTEM

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DEPARTMENT OF HEALTH ●​ “Satellite” station of RHU
●​ National authority for health ●​ Smallest unit
●​ Main governing body of health services in ●​ First contact healthcare facility
the country ●​ Manned by: PHM & BHW
●​ Vision → Filipinos will be healthiest in ●​ Ratio: 1:5,000 populations
SouthEast Asia (2022), Asia (2040)
○​ Philippine in healthiest rankings in TYPES OF HEALTH WORKERS
2022 → 7 out of 12 in SouthEast → 1.​ Auxillary
based on “life expectancy (PH: 70)” ●​ Trained individuals → undergo
●​ Mission → develop PREP (productive, training
resilient, equitable, people oriented health ●​ Provide basic healthcare measures
care system) ●​ First contact in the community
●​ BHW, BHVs, grassroots / villagers,
3 LEVELS OF PREVENTION AHW, traditional birth attendant,
PRIMARY healers
a.​ Who → healthy patient 2.​ Intermediate
b.​ Activity → health promotion and disease ●​ Educated / Professionals → with
prevention license
●​ First source of professional
SECONDARY healthcare
a.​ Who → at risk patient (sick or not) ●​ Attend health problems beyond
b.​ Activity → early screening, diagnosis,
treatment a.​ DOH handles tertiary level
b.​ RA 7160 “Local government code”
TERTIARY ●​ Devolution and decentralization →
a.​ Who → sick/post treatment patient transfer of power
b.​ Activity → rehabilitation, maintenance c.​ LGU handles secondary and primary level
(prevent complications), palliative care i.​ Provincial government
●​ Governor
PHILIPPINE HEALTH CARE DELIVERY SYSTEM ●​ Secondary → PPH
RURAL HEALTH UNIT 1.​ Municipal city government
●​ Health center “Main” ●​ Mayor
●​ Headed by Municipal health officer → ○​ Primary → CHO Dagupan
physician
●​ Focus: promotive and preventive HEALTHCARE WORKERS RATIO
●​ Ratio: 1:20,000 population → complete ●​ 1 midwife : 5,000
healthcare team ●​ 1 nurse : 10,000
●​ Healthcare team ●​ 1 dentist : 50,000
○​ PHM → frontliner ●​ 1 physician : 20,000
○​ PHN → supervisor / coach (PHM & ●​ 1 sanitary inspector : 20,000
BHW) ●​ 1 medtech : 20,000
○​ RHO / Physician → Manager ●​ 1 PT : 20,000
○​ Medtech
○​ Dentist HISTORY PHILIPPINE HEALTH CARE
●​ Old goal → health in the hands of the
○​ Supervisor
people by year 2000
●​ 1997 → PHC movement
BARANGAY HEALTH STATION

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 ●​ September 06-12, 1978 → PHC meeting in Goal → ensure all people provide access to health
Alma ata, USSR Philosophy → health care workers to rally behind
●​ October 19, 1979 → PHC is adapted in the the communities to assume responsibility for their
PH via LOI 949 → signed by Pres. F. health
Marcos, Sr. Strategy → collaborations of private and public
●​ October 2018 → PHC meeting in Astana,
Kazakhstan 4 PILLARS OF PRIMARY HEALTH CARE
●​ Inter/Intrasectoral linkages
PHILIPPINE HEALTH CARE ●​ Use of appropriate technology
●​ Multi-sectoral policies ●​ Support mechanism made available
●​ Integrated health services ●​ Active community participation → goal
●​ Determinants of health → physical, mental,
social health and well-being CHARACTERISTICS OF PHC
●​ Whole of government approach → PHC aim ●​ Community based
●​ Interventions that encompass the entire ●​ Available
life-course ●​ Sustainable
●​ Focusing on equity ●​ Affordable
●​ Empowering individuals, communities for ●​ Self reliance
increased participation in health ●​ Accessible
●​ Alma Atta Declaration
○​ WHO → USSR (Kazakhstan, 1978) ELEMENTS OF PHC
○​ PH → LOI 949 ○​ Education
■​ Legal basis PHC (1979) ○​ Locally endemic disease
■​ 1st PHC in SE Asia ○​ Essential drugs
■​ Former Pres. Marcos Sr. ○​ Maternal and child health
●​ 4A’s: ○​ EPI
○​ Accessible → within reach (within ○​ Nutrition
30 mins, <3 km) ○​ Treatment of CDs, NCDs, and emergencies
○​ Available → present (ready to use) ○​ Sanitation
○​ Affordable → low cost but quality
○​ Acceptable → culturally appropriate DEPARTMENT OF HEALTH
●​ Vision → health in the hands of people ●​ Vision → Filipinos are among the the
●​ Mission → increase opportunities that healthiest people in Asia by 2040
people will manage their own health ●​ Mission → promote healthy settings, and
●​ Goal → self-reliance steer the development of an effective,
resilient, equitable, and people-centered
2 CORE PRINCIPLES OF PHC health system for Universal Health Care
●​ Partnership with people → active
●​ Empowering HEALTH SECTOR GOALS
●​ Access to all levels of care
CORE VALUES OF PRIMARY HEALTH CARE ●​ Better health outcomes
1.​ Social justice ●​ Stronger health systems
2.​ Solidarity
3.​ Self-reliance 8 ACTION AGENDA ITEMS
4.​ Equity → most important 1.​ Bawat Pilipino, ramdam ang kalusugan
5.​ Respect to human dignity / human rights 2.​ Ligtas, dekalidad at mapagkalingang
serbisyo

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 3.​ Teknolohiya para sa mabilis na serbisyo
4.​ Handa sa krisis
5.​ Pag-iwas sa sakit
6.​ Ginhawa ng isip at damdamin
7.​ Kapakanan at karapatan ng health workers
8.​ Proteksyon sa anumang pandemya

FAMILY NURSING CARE / HOME VISITS

●​ Family → collection of people who are
●​ Planning
integrated, interacting, and interdependent
○​ Prioritization of problem criteria
focal point or focus care → center in
■​ Nature of the problem
delivery of care
(W:1)
●​ Wellness (3)
TYPES OF FAMILY
●​ Health deficit (3)
1.​ Nuclear family → mother, father, child
●​ Health threats (2)
2.​ Extended family → nuclear + lola, tita, etc.
●​ Foreseeable crisis (1)
3.​ Single parent family → mother / father, child
■​ Modifiability of the problem
4.​ Binuclear family → divorced + child
(2)
5.​ Step family → mother, child, new asawa
●​ Easily (2)
6.​ Cohabiting family → live in partner
●​ Partially (1)
7.​ Homosexual family → same gender = same
●​ Not modifiable (0)
house
■​ Preventive potential (W:1)
8.​ Communal family
●​ High (3)
●​ Moderate (2)
FAMILY CARE PLAN (APIE)
●​ Low (1)
●​ Assessment ■​ Salience (W:1)
○​ First level assessment ●​ Problem needing
■​ Review of records immediate attention
■​ Interview → history taking (2)
■​ Observation ●​ Attention (1)
■​ Physical exam ●​ Not perceived as
■​ Lab test problem (0)
○​ Categories of health problems ●​ Interventions
■​ Wellness state → enhance ○​ Independent
health ○​ Dependent
■​ Health deficit → (+) illness ○​ Collaborative / Interdependent
■​ Health treats → conditions ●​ Evaluation
that may lead ○​ Quality assurance element (QAE)
■​ Foreseeable crisis/stress ○​ 3 elements (SOP)
point → risk to future ■​ Structural elements
problem ■​ Outcome elements
■​ Process elements

EXPANDED PROGRAM IMMUNIZATION

●​ Goal → to reduce morbidity and mortality
among children against the most vaccine
preventable diseases.

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 ●​ PD 996 → basic compulsory immunization ●​ Pentavalent vaccine / DPT to children with
for infant and children below 8 years old recurrent convulsions or for those with
●​ RA 10152 → mandatory infant and children another active disease of the CNS
health immunization act of 2011 → below 5 ●​ Rotavirus vaccine for child with history of
years old hypersensitivity, intussusceptions or
intestinal malformation, or acute
ELEMENTS OF EPI (SICAT) gastroenteritis
●​ Surveillance and research ●​ BCG to a child who has signs and
●​ IEC → information, education, symptoms of AIDS or other immune
communication deficiency conditions/immunosuppressed
●​ Cold chain → transport and storage of ○​ Due to live attenuated vaccine
vaccine
●​ Assessment and evaluation of the FALSE CONTRAINDICATION
program’s overall performance ●​ Malnutrition → (x) if severe
●​ Target setting → distribution ●​ Low-grade fever → <38.5oC
○​ Infant (total population x 2.7%) ●​ Mild respiratory infection
○​ Pregnant (total population x 3.5%) ●​ Diarrhea → (x) if severe
●​ 1 Storage ●​ Giving vaccines at the same time
○​ 6 months → regional level ○​ Can vaccines at the same time? →
○​ 3 months → provincial / city / district Yes but different sites
○​ 1 month → RHU with refrigerator ○​ Vastus lateralis → away major blood
○​ 5 days → BHS with cold dogs vessels and nerves and most
●​ 2 Transport → use cold bags develops in children
○​ Vaccine carriers ○​ Do not administer more than one
○​ Cold dogs dose of same vaccine in one session
●​ 3 Handling → (x) double dose
○​ Follow appropriate vaccine interval
VACCINE STORAGE → at least 4 weeks
●​ -15oC – -25oC → check twice a day
(morning and afternoon) EPIDEMIOLOGY
○​ Varicella zoster vaccine ●​ Occurrence and distribution of diseases
○​ Oral polio vaccine ●​ Backbone of preventing disease
○​ Measles vaccine ●​ Backbone of preventing infection →
●​ Light sensitive → BCG, rotavaccine handwashing
●​ Body temp → 2oC-8oC
●​ FEFO → first expiry first out CLASSIFICATION
●​ Vaccine vial monitor ●​ Sporadic → few / isolated / rare /
intermittent / unrelated / occasional
●​ Endemic → continuous occurrence /
always presents
●​ Epidemic / Outbreak → sudden increase
period of time
●​ Pandemic → worldwide epidemic

DEMOGRAPHY
ABSOLUTE CONTRAINDICATIONS OF EPI
VACCINES

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 ●​ Study of population size, composition, and Wounds, vaginal
BAYABAS
spatial distribution as affected by births, wash
death, and migration Hypertension,
BAWANG
toothache
3 SOURCES YERBA BUENA Pain
1.​ Census → most ideal (bulk data)
ENVIRONMENTAL SANITATION PROGRAMS
a.​ De facto → based on actual place
FOOD SANITATION PROGRAM
b.​ De jure → based on residence
2.​ Survey → most practical (questionnaire) ●​ Food establishment
3.​ Registration system ○​ Class rating
○​ Sanitary permit
TRADITIONAL AND ALTERNATIVE ○​ Health certificates
HEALTHCARE ●​ 4 Rights of food safety
●​ RA 8423 → traditional and alternative ●​ Rule in food safety
medicine act of 1997
●​ Principles in use of herbal medicines WATER FACILITY PROGRAM
○​ Use fresh leaves ●​ 3 types of approved water supply facilities
○​ Use only part of plan that is ○​ Level 1 → point source
advocated ○​ Level 2 → communal faucet / stand
○​ Avoid use of insecticides post
○​ Use clay pot ○​ Level 3 → waterworks system
○​ Follow accurate dosing
○​ STOP when: TOILET FACILITY PROGRAM
■​ (+) adverse reactions ●​ Types of approved toilet facilities
■​ (+) s/sx after 2-3 doses ○​ Level 1 → non water carriage
●​ Decoction → boiling (20 mins) ○​ Level 2 → water carriage type
●​ Infusion → soaking (10-15 mins) ○​ Level 3 → water carriage +
●​ Poultice →applying sewerage system

USE / ENVIRONMENTAL SANITATION

PREPARATION ●​ PD 856 environmental code of sanitation
INDICATION
Edema, BLACK Non infectious, dry, non bio
SAMBONG diuretics, kidney GREEN Non infectious, wet, bio
stones YELLOW Infectious
Antifungal, YELLOW WITH
AKAPULKO ringworm, Chemicals, pharmaceuticals
BAND
scabies RED Sharps
NIYOG-NIYOGA ORANGE Radioactive
Parasitism
N
TSAANG Stomach ache, MILLENIUM DEVELOPMENT GOALS (MDG)
GUBAT diarrhea ●​ Proposed by UNDP
DM (Mild
●​ 2000-2015
AMPALAYA non-insulin
dependent)
ASCOF
LAGUNDI (asthma, cough,
fever)
ULASIMANG
Uric acid (gout)
BATO

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 PROTOCOL
1.​ Sick young infant → birth to 2 months
2.​ Sick child → 2 months to 5 years old

COLOR-CODED IMCI CHART

●​ Pink → severe classification
●​ Yellow → moderate classification
SUSTAINABLE DEVELOPMENT GOALS (SDG) ●​ Green → mild classification
●​ Proposed by UNDP
●​ 2015-2030 COUGH / DIFFICULTY OF BREATHING
●​ 3Ps: PINK: SEVERE PNEUMONIA OR VERY SEVERE
○​ Poverty eradicate/reduce DISEASE
○​ Protect planet earth ●​ S/Sx → stridor in calm child
○​ Peace and prosperity ●​ Give first dose of an appropriate antibiotic
●​ Refer urgently to hospital

YELLOW: PNEUMONIA
●​ S/Sx → chest indrawing, fast breathing
●​ Give oral amoxicillin → 5 days
●​ If wheezing (disappeared) → give an
inhaled bronchodilator → 5 days
●​ If chest indrawing in HIV exposed child →
give first dose of amoxicillin and refer
●​ Soothe the throat and relieve the cough with
INTEGRATED MANAGEMENT OF CHILDHOOD a safe remedy
ILLNESSES (IMCI) ●​ If coughing >14 days or recurrent wheeze
●​ Reduce child mortality → refer (possible TB / asthma)
●​ Improve the quality of care ●​ Advise mother when to return immediately
●​ Developed by → WHO & UNICEF ●​ Follow-up → 3 days

IMCI GUIDELINESS GREEN: COUGH OR COLD

1.​ Assess → serious illness, immunization, ●​ S/Sx → (-) signs
common health conditions ●​ If wheezing (disappeared) → give an
2.​ Classify inhaled bronchodilator for 5 days
3.​ Treat ●​ Soothe the throat and relieve the cough with
4.​ Counsel a safe remedy
5.​ Provide follow-up care ●​ If coughing >14 days or recurrent wheeze→
refer (possible TB / asthma)
STEPS IN IMCI ●​ Advise mother when to return immediately
1.​ Greet the mother ●​ Follow-up → 5 days (no improvement)
2.​ Ask / Inquire about the child’s condition
3.​ Assess the child DEHYDRATION
4.​ Classify the child PINK: SEVERE DEHYDRATION
5.​ Identify the treatment ●​ S/Sx:
6.​ Treat the child ○​ Lethargic / unconscious
7.​ Counsel mother about feeding and nutrition ○​ Sunken eyes
8.​ Follow up

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 ○​ Not able to drink / drink poorly ●​ Advise mother on feeding a child who has
○​ Skin pinch goes back very slowly persistent diarrhea
●​ If child has no severe classification ●​ Give multivitamins and minerals (zinc) → 14
○​ Give fluid for severe dehydration days
(plan c) ●​ Give vitamin A
●​ If child also has another severe ●​ Follow-up → 5 days
classification:
○​ Refer urgently → mother giving IF BLOOD IN STOOL
frequent sips of ORS on the way YELLOW: DYSENTERY
○​ Advise the mother to continue ●​ S/Sx → (+) blood in stool
breastfeeding ●​ Give ciprofloxacin → 3 days
●​ If child is 2 years or older (+ cholera) → give ●​ Advise mother when to return immediately
antibiotic for cholera
MALARIA RISK
YELLOW: SOME DEHYDRATION PINK: VERY SEVERE FEBRILE DISEASE
●​ S/Sx: ●​ S/Sx → any general danger signs and stiff
○​ Restless, irritable neck
○​ Sunken eyes ●​ Give first dose of artesunate or oral quinine
○​ Drinks eagerly, thirsty (under medical supervision)
○​ Skin goes back slowly ●​ Give first dose of an appropriate antibiotics
●​ Give fluid, zinc supplements, and food for ●​ Treat the child → prevent ↓blood sugar
some dehydration (plan b) ●​ Give one dose of paracetamol → ↑fever
●​ If child also has a severe classification: (>38.5oC)
○​ Refer urgently → mother giving ●​ Refer urgently to hospital
frequent sips of ORS on the way
○​ Advise the mother to continue YELLOW: MALARIA
breastfeeding ●​ S/Sx → (+) malaria
●​ Advise mother when to return immediately ●​ Give recommended first line oral
●​ Follow-up → 5 days (not improving) antimalarial
●​ Give one dose of paracetamol → ↑fever
GREEN: NO DEHYDRATION (>38.5oC)
●​ S/Sx → not enough signs to classify ●​ Give appropriate antibiotic treatment for an
●​ Give fluid, zinc supplements, and food for identified bacterial cause of fever
some dehydration (plan b) ●​ Advise mother when to return immediately
●​ Advise mother when to return immediately ●​ Follow-up → 3 days → fever persists
●​ Follow-up → 5 days (not improving) ●​ If (+) fever every day for >7 days → refer for
assessment
IF DIARRHEA 14 DAYS OR MORE
PINK: SEVERE PERSISTENT DIARRHEA GREEN: FEVER, NO MALARIA
●​ S/Sx → dehydration present ●​ S/Sx → (-) Malaria, other causes of fever
●​ Treat dehydration before referral unless the present
child has another severe classification ●​ Give one dose of paracetamol → ↑fever
●​ Refer to hospital (>38.5oC)
●​ Give appropriate antibiotic treatment for an
YELLOW: PERSISTENT DIARRHEA identified bacterial cause of fever
●​ S/Sx → no dehydration ●​ Advise mother when to return immediately
●​ Follow-up → 3 days → fever persists

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 ●​ If (+) fever every day for >7 days → refer for ●​ Advise the mother when to return
assessment immediately
●​ Follow-up → 3 days
NO MALARIA RISK AND NO TRAVEL TO
MALARIA RISK AREA GREEN: MEASLES
PINK: VERY SEVERE FEBRILE DISEASE ●​ S/Sx → measles now or within the last 3
●​ S/Sx → any danger signs and stiff neck months
●​ Give first dose of appropriate antibiotics ●​ Give vitamin A
●​ Treat the child → prevent ↓blood sugar
●​ Give one dose of paracetamol → ↑fever DENGUE HEMORRHAGIC FEVER
(>38.5oC) PINK: SEVERE DENGUE HEMORRHAGIC
●​ Refer urgently to hospital FEVER
●​ S/Sx:
GREEN: FEVER ○​ Bleeding from nose / gums
●​ S/Sx → (-) danger signs and (-) stiff neck ○​ Bleeding in stools/ vomitus
●​ Give one dose of paracetamol → ↑fever ○​ Black stool / vomitus
(>38.5oC) ○​ Skin petechiae
●​ Give appropriate antibiotic treatment for any ○​ Cold and clammy extremities
identified bacterial cause of fever ○​ Capillary refill → (N) 3 seconds
●​ Advise mother when to return immediately ○​ Persistent abdominal pain
●​ Follow-up in 3 days if fever persists ○​ Persistent vomiting
●​ If fever persists every day for <7 days → ○​ (+) tourniquet test
refer for assessment ●​ If persistent vomiting / persistent abdominal
pain / skin petechiae / (+) tourniquet test →
MEASLES (+), give ORS (plan b)
(NOW OR WITHIN LAST 3 MONTHS) ●​ If any other signs of bleeding present →
PINK: SEVERE COMPLICATED MEASLES give fluids rapidly (plan c)
●​ S/Sx ●​ Treat the child → prevent ↓blood sugar
○​ Any general danger signs
○​ Clouding of cornea GREEN: FEVER DENGUE HEMORRHAGIC
○​ Deep / extensive mouth ulcers FEVER UNLIKELY
●​ Give vitamin A ●​ S/Sx → no sigs
●​ Give first dose of an appropriate antibiotic ●​ Give ORS
●​ If clouding of the cornea / pus draining from ●​ Advise mother when to return immediately
the eye → apply tetracycline eye ointment ●​ Follow-up → 3 days (if fever persists or
●​ Refer urgently to hospital child shows signs of bleeding)
●​ Do not give aspirin
YELLOW: MEASLES WITH EYE OR MOUTH
COMPLICATIONS EAR PROBLEM
●​ S/Sx → pus draining from the eye, mouth PINK: MASTOIDITIS
ulcers ●​ S/Sx → tender swelling behind the ear
●​ Give vitamin A ●​ Give first dose of an appropriate antibiotic
●​ If pus draining from the eye → apply ●​ Give first dose of paracetamol → pain
tetracycline eye ointment ●​ Refer urgently to hospital
●​ If mouth ulcers → teach the mother to treat
with gentian violet YELLOW: ACUTE EAR INFECTION
●​ S/Sx:

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 ○​ (+) pus draining from the ear and ○​ Edema of both feet
discharge ○​ WFH/L → <-3 z-scores
○​ (+) pain is reported → <14 days ○​ MUAC → <115mm
●​ Give an antibiotic → 5 days ■​ (+) medical complication
●​ Give paracetamol → for pain ■​ (-) able to finish RUTF
●​ Dry the ear → wicking ■​ Breastfeeding problem
●​ Follow-up → 5 days ●​ Give first dose appropriate antibiotic
●​ Treat the child to prevent ↓blood sugar
YELLOW: CHRONIC EAR INFECTION ●​ Keep the child warm
●​ S/Sx: (+) pus is draining from the ear and ●​ Refer urgently to hospital
discharge is reported → >14 days
●​ Dry the ear → wicking YELLOW: UNCOMPLICATED SEVERE ACUTE
●​ Treat → topical quinolone eardrops (14 MALNUTRITION
days) ●​ S/Sx:
●​ Follow-up → 5 days ○​ WFH/L → <-3 z-scores
○​ MUAC → <115 mm
GREEN: NO EAR INFECTION ○​ Able to finish RUTF
●​ S/Sx → (-) ear pain, (-) pus ●​ Give oral antibiotics → 5 days
●​ No treatment ●​ Continue breastfeeding
●​ Give ready-to-use therapeutic food if
ANEMIA available for a child → >6 months year old
PINK: SEVERE ANEMIA ●​ Counsel the mother on how to feed the child
●​ S/Sx → severe palmar pallor ●​ Assess for possible TB infection
●​ Refer urgently to hospital ●​ Advise mother when to return immediately
●​ Follow-up → 5 days
YELLOW: ANEMIA
●​ S/Sx →some pallor YELLOW: MODERATE ACUTE MALNUTRITION
●​ Give iron ●​ S/Sx:
●​ Give mebendazole → child is 1 year older ○​ WFH/L → -3 & -2 z-scores
and has not had a dose in the previous 6 ○​ MUAC → 115-125 mm
months ●​ Assess the child’s feeding and counsel the
●​ Advise mother when to return immediately mother on the feeding recommendations
●​ Follow-up → 14 days ●​ If feeding problem → follow-up (5 days)
●​ Assess for possible TB infection
GREEN: NO ANEMIA ●​ Advise mother when to return immediately
●​ S/Sx → no palmar pallor ●​ Follow-up → 30 days
●​ If child is <2 years old → assess the child
feeding and counsel the mother according GREEN: NO ACUTE MALNUTRION
to the feeding recommendations ●​ S/Sx:
○​ If feeding problem → follow-up in 5 ○​ WFH/L → >-2 z-scores
days ○​ MUAC → >125 mm
○​ Give micronutrient powder (MNP) ●​ If child is <2 years old → assess the child’s
feeding and counsel the mother on feeding
NUTRITIONAL STATUS according to the feeding recommendations
PINK: COMPLICATED SEVERE ACUTE ●​ Give micronutrient powder supplement
MALNUTRITION ●​ If feeding problem → follow-up (5 days)
●​ S/Sx:

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 HIV STATUS
YELLOW: CONFIRMED HIV INFECTION
●​ S/Sx
○​ (+) virological test → child
○​ (+) serological test → child >18
months
●​ Initiate ART treatment and HIV care
●​ Give contrimoxazole prophylaxis
●​ Assess the child’s feeding and provide
appropriate counseling to the mother
●​ Advise the mother on home care
●​ Assess or refer → TB assessment and INH
preventive therapy

YELLOW: HIV EXPOSED

●​ S/Sx:
○​ Mother:
■​ (+) HIV, (-) virological test in
a breastfeeding child / only
stopped <6 weeks age
■​ (+) HIV, child not yet tested
○​ (+) serological test in a child <18
months old
●​ Give contrimoxazole prophylaxis
●​ Start or continue ARV prophylaxis as
recommended
●​ Do virological test → confirm HIV status
●​ Assess the child’s feeding and provide
appropriate counseling to the mother
●​ Advise the mother on home care
●​ Follow-up → regularly (national guidelines)

GREEN: HIV INFECTION UNLIKELY

●​ S/Sx → (-) mother / child
●​ Treat, counsel, and follow-up existing
infections

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