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Book Review

Indian Pediatrics 2001; 38: 570-571  

Book Review


Management of the child with a serious infection or severe malnutrition: Guidelines for care at the first-referral level in developing countries.
Geneva, World Health Organization, 2000, Pages 162, Price Sw. fr. 15.

This manual is a part of series of documents and tools that support the Integrated Management of Childhood Illnesses (IMCI). This approach is the talk of the town today and has already been adapted by several countries to suit their specific circumstances. This aptly timed treatise shall serve to provide the much needed resource material and help in lowering the case fatality rates in common childhood illnesses; and facilitate improved care of children at small hospitals. Eyeing the global success of IMCI strategy, India too may hasten its adoption in the near future.

The manual describes a sequential process for managing sick children. Triage (quick screening), the first stage in management upon arrival of the child in the hospital, described in the first chapter, helps in identification of those needing prioritization and decision on level of care. The criterion for triage could not have been more objective than described. The second chapter deals with assessing the sickness done at two levels with the help of general (core) and specialized (directed) evaluation tools. Chapters 3 to 8 deal with specific problems such as ARI, diarrhea, fever, young infant, severe malnutrition, and HIV/AIDS respectively. A separate chapter is devoted to the supportive care including nutritional management of a sick child. The last two chapters relate to monitoring, dis-charge, counseling, and follow-up, and contain some very useful practical tips including home treatment.

Appendices aptly complement the text spanning over these 11 chapters. Useful information regarding common practical procedures, drug dosages/regimens, hydration, and feeding of malnourished child, and assess-ment and monitoring of nutritional status are condensed in these appendices. Thoughtfully, a separate section is devoted to play therapy and recreational facilities for sick children. The suggested toys are simple, economical and obtainable indigenously.

The manual focuses on the in-patient management of the major causes of childhood mortality. It is meant for use by doctors, senior nurses, and other senior health workers. This handbook provides up-to-date clinical guide-lines for both inpatient and outpatient care in small hospitals presumed to have basic labora-tory facilities and essential drugs. Unfortu-nately, most of the First Referral Units in developing world still lack the desired staff, supplies, and infrastructure, as envisaged by World Health Organization. It is up to the National governments to ensure that these minimum requirements are taken care of to optimally utilize the efforts put in this manual by the expert group of WHO.

However, the text shares the major lacunae of IMCI, i.e., ignoring the early neonatal period, which accounts for more than one third of all infant deaths in India. It is hoped that as IMCI strategy is strengthened and adapted in more regions; the coverage umbrella is also expanded to provide guidelines to include the most vulnerable period in the life of an infant.

The editors of the manual have done a commendable job in incorporating the major features of more than 15 WHO publications relating to infections and malnutrition in a concise, simple and informative format. The book is lavishly illustrated to exemplify common signs, symptoms, or procedures. The line art is the highlight of the book, being both clear and imaginative.

The book is recommended for all those responsible for the care of young children at the first referral level in developing countries.

Piyush Gupta,
Reader in Pediatrics,
University College of Medical Sciences and GTB Hospital,
Delhi 110 095, India
E-mail: drpiyush@satyam.net.in

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