how to use this booklet

1. A presentation for a facilitator to train health workers who assess children with PNEUMONIA PNEUMONIA every breath counts How to Diagnose It, Treat It and Prevent It how to use this booklet This booklet gives a useful summary of what health workers need to know about PNEUMONIA. Facilitators can use this to teach health workers proven ways to diagnose and prevent PNEUMONIA. Health workers will also learn when to refer children to health centres and how to advise caregivers about caring for children with PNEUMONIA.

2. health worker PNEUMONIA KILLS MORE CHILDREN THAN ANY OTHER DISEASE • PNEUMONIAis the leading killer of children under 5 • But children can be protected from PNEUMONIA. It is preventable and treatable • You play an important role in protecting these children 935,000 CHILDREN UNDER 5 DIED FROM PNEUMONIA IN 2013 1A

3. facilitator PNEUMONIA KILLS MORE CHILDREN UNDER 5 THAN ANY OTHER DISEASE. In 2013, 935,000 children under 5 died from this disease. However, children can be protected from PNEUMONIA. It is preventable and treatable, and you have an important role to play in this. This flipchart should give you the information you need to assess a sick child, decide if the child has PNEUMONIA, and when to refer the child to a health centre. 935,000 CHILDREN UNDER 5 DIED FROM PNEUMONIA IN 2013 1B

4. health worker WHAT IS PNEUMONIA? • A dangerous infection of the lungs • Air sacs in lungs fill with pus and fluid • Not enough oxygen gets into the body • A child has to breathe faster and harder • PNEUMONIA can get worse very quickly • Sick children need care right away PNEUMONIA CAN KILL SO EVERY SECOND COUNTS 2A

5. facilitator PNEUMONIA IS A DANGEROUS INFECTION OF THE LUNGS. PNEUMONIA affects small air sacs in the lungs. These air sacs help get oxygen into the body. When they get infected, they fill with pus and fluid. Not enough oxygen can get in. A child breathes faster and harder, trying to get air. PNEUMONIA can get worse very quickly. Children with PNEUMONIA need care right away because PNEUMONIA can kill. Every second counts. 2B

6. health worker WHAT CAUSES PNEUMONIA? CAUSES OF PNEUMONIA • PNEUMONIA is caused by certain kinds of bacteria or other germs • A child can get PNEUMONIA when these germs get into the nose and throat and are inhaled. PNEUMONIA germs can be spread through the air from coughs and sneezes • Smoke is bad for a child’s lungs. Children who are near a lot of smoke more often get PNEUMONIA and other diseases • Children with poor diets get PNEUMONIAmore often Smoke Germs Poor Diet 3A

7. facilitator • PNEUMONIA IS CAUSED BY CERTAIN KINDS OF BACTERIA OR OTHER GERMS. Treatments are available at the health centre. • A child can get PNEUMONIA when germs get into the nose and throat and are inhaled. PNEUMONIA germs can be spread through the air from coughs and sneezes • Smoke is also bad for a child’s lungs. If a child is often near a lot of smoke, such as a cooking fire or a parent who smokes, the smoke can harm the lungs. Children who are near a lot of smoke more often get PNEUMONIA and other diseases • Children with poor diets also get PNEUMONIA and other diseases more often. Without good nutrition, a child’s body is less able to fight disease. There are many nutrients that strengthen a child’s immune system. The immune system is how the body gets rid of germs and fights disease CAUSES OF PNEUMONIA Smoke Germs Poor Diet 3B

8. health worker SIGNS AND SYMPTOMS • COUGH • FAST BREATHING • Cough with fast breathing is a sign of PNEUMONIA • Sometimes there is a fever, but not always • A sign of severe PNEUMONIA is chest in-drawing • Look for chest in-drawing when the child breathes in • If in-drawing is present, refer the child to a health facility immediately • Assist with the referral in any way you can • ALSO CHECK FOR ANY OTHER DANGER SIGNS (FOUND IN THE OFFICIAL ICCM HANDBOOK) Cough Fast, difficult breathing Chest goes in when child breathes 4A

9. facilitator WHEN CHECKING FOR PNEUMONIA, TWO IMPORTANT SYMPTOMS ARE COUGH AND FAST BREATHING. I’ll explain more about fast breathing in a moment. But when a child has cough and fast breathing together, that is a clear sign of PNEUMONIA. Sometimes a child with PNEUMONIA has a fever, but not always. When PNEUMONIA is severe, the lungs become very stiff. Breathing with very stiff lungs causes chest in-drawing. Look for chest in-drawing when the child breathes in. Normally when a child breathes in, the chest and stomach move out together. But in a child with an in-drawn chest, the chest below the ribs pulls in instead of moving out. The chest does not fill with air. If a child has chest in-drawing, treatment at a health facility will be necessary. You will need to do everything you can to assist in referring the child to the health facility as soon as possible. Write a referral note for the facility, so they understand the diagnosis. You should also make sure to check for the other ICCM General Danger Signs as well, which can be found in the official ICCM Handbook. Cough Fast, difficult breathing Chest goes in when child breathes 4B

10. health worker FAST BREATHING: HOW FAST IS TOO FAST? The child has fast breathing if you count… If the child is… 2 months up to 12 months old or more breaths per minute 12 months to 5 years old or more breaths per minute 50 40 5A

11. facilitator AS I HAVE SAID, FAST BREATHING IS A CLEAR SIGN OF PNEUMONIA. We measure breathing by counting breaths per minute. The number of breaths that defines fast breathing depends on the child’s age. In a child age 2 months up to 12 months, fast breathing is 50 breaths or more per minute. In a child age 12 months up to 5 years, fast breathing is 40 breaths or more per minute. But how do we count breaths? The child has fast breathing if you count… If the child is… 2 months up to 12 months old or more breaths per minute 12 months to 5 years old or more breaths per minute 50 40 5B

12. health worker HOW TO COUNT BREATHS The child has fast breathing if you count… If the child is… 2 months up to 12 months old or more breaths per minute Get a timer, clock, or watch that can measure one minute. With the mother’s help, make sure the child is calm and still. The child should be undressed from the waist up. Start keeping track of the time. For one minute, watch the child’s breathing. After one minute, record the number of breaths. If you are unsure, do the count again. 12 months to 5 years old or more breaths per minute 50 40 If fast breathing is present, refer straight away to health facility. Every second counts. 6A

13. facilitator KNOWING HOW TO COUNT A CHILD’S BREATH IS IMPORTANT FOR UNDERSTANDING IF A CHILD HAS PNEUMONIA. HERE IS HOW YOU DO IT: The child has fast breathing if you count… If the child is… 2 months up to 12 months old or more breaths per minute 12 months to 5 years old Get a timer, clock, or watch with a second hand. You can even use your phone if it has a timer or clock that counts seconds. Put the watch somewhere where you can see the child and the watch at the same time. If it is difficult to look at the watch and the child at the same time, ask someone else to help keep time. The child must be calm and still. Have the mother hold the child if necessary. If the child is sleeping, do not wake the child. Start keeping track of the time. For one minute, watch the child’s breathing. Breathing in and out counts as one breath. It is easier if you just count every time the child breathes out. At the end of one minute, stop counting and record the number of breaths per minute. Sometimes, children get restless, and their breathing becomes hard to count. If you are unsure, do the count again. If the child starts to cry or moves too much, wait until the child is calm and count again. or more breaths per minute 50 40 If fast breathing is present, refer straight away to health facility. Every second counts. 6B

14. health worker ADVICE TO THE CAREGIVER: • Seek care at the health centre immediately • Follow all advice and instructions from the health centre • Ask questions if instructions are unclear • Make sure the child finishes any medicine the health centre gives, even if the child looks better • Continue feeding and give more fluids to the child 7A

15. facilitator HERE IS SOME ADVICE YOU SHOULD GIVE THE CAREGIVER ABOUT TREATMENT. Make sure the caregiver knows they must seek treatment at the nearest health centre immediately. It is important for the caregiver to follow all advice and instructions from the health centre. Let the caregiver know that she should ask questions if she is unclear about any of the instructions, and have her repeat the instructions if necessary. Make sure the child finishes all the medicine that the health centre instructs the child to take. The caregiver should not stop treatment early, even if the child looks better. The caregiver should also continue feeding the child and give more fluids. 7B

16. health worker • WHEN TO SEEK FURTHER CARE • You should advise the caregiver to come back to you or go directly to the clinic if any of these danger signs appear: • Fever • Coughing or breathing gets worse • Unusually sleepy or unconscious • Not able to drink or feed • Convulsions • Chest in-drawing • Follow up after 3 days to make sure none of these danger signs are present. DANGER SIGNS Coughing gets worse Convulsions Chest in-drawing 5 Fever 2 1 3 6 Refusing to eat 4 Unusually sleepy/can’t wake up 8A

17. facilitator • YOU ALSO NEED TO ADVISE THE CAREGIVER ABOUT WHEN TO SEEK ADDITIONAL CARE. If the caregiver sees any of the following danger signs, she should bring the child back to you or to the nearest health facility. These signs are: • Fever • Coughing or breathing gets worse • Unusually sleepy or unconscious. What I mean by “unusually sleepy” is if the child is not alert when he or she should be, or is very drowsy and does not seem to notice what is around him or her. An unconscious child cannot awaken and does not respond when touched or spoken to • Not able to drink or feed. For instance, if the child is not able to breathe well enough to suckle, or is too weak to suckle or swallow, then the child is not able to drink or feed • Convulsions. This is when the child’s arms and legs stiffen. Sometimes the child stops breathing, or may lose consciousness • Chest in-drawing (as described before) • If possible, you should follow up with the caregiver after 3 days to make sure none of these danger signs has happened. DANGER SIGNS Chest in-drawing Coughing gets worse Fever Unusually Sleepy/ Can’t wake up Convulsions 1 2 6 3 5 Refusing to eat 4 8B

18. health worker • PNEUMONIA CAN BE PREVENTED • Vaccines • Hand washing • Smoke-free home • Breastfeeding and good nutrition HOW TO PREVENT PNEUMONIA Vaccines and hand washing Smoke-free home Good nutrition 9A

19. facilitator • PNEUMONIA IS PREVENTABLE. HERE ARE SOME WAYS YOU SHOULD ENCOURAGE CAREGIVERS TO HELP KEEP THEIR CHILDREN FROM GETTING SICK IN THE FUTURE. • Vaccines. Check the child’s vaccination record. Make sure the child is getting all recommended and available vaccines according to schedule • Hand washing. Have everyone in the family wash their hands often, with soap and clean water. This is an excellent way to prevent PNEUMONIA and many other diseases • A smoke-free home. Keep cooking fires and cigarette smoke out of the home as much as possible. Encourage the caregiver to make sure that their home is well ventilated, meaning that it has enough fresh air moving around inside • Breastfeeding and good nutrition. Nutritious food and breast milk help a child fight disease. Being malnourished makes a child more at risk of getting sick and slower to get well. All mothers should exclusively breastfeed for the first 6 months of a child’s life HOW TO PREVENT PNEUMONIA Vaccines and hand washing Smoke-free home Good nutrition 9B

20. Remember what you need to know about pneumonia: • Know how to spot when a child has PNEUMONIA • Know how to count breaths • Know when to refer a child to a health centre • Know how to prevent PNEUMONIA PNEUMONIA CAN KILL SO EVERY SECOND COUNTS