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PE16.1-6,PE17.1 | Child Health Programs — Graded Quiz
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A 6-week-old infant is brought by her mother with a 1-day history of poor feeding and high temperature. On IMNCI assessment: temperature 38.8°C, respiratory rate 58/min, severe chest indrawing present, no skin rash. The most appropriate IMNCI classification and immediate action is:
In young infants (<2 months), severe chest indrawing + fast breathing (≥60/min; 58/min = <60 here, but severe chest indrawing alone is a PSBI sign) = PSBI → urgent pink referral with pre-referral IM ampicillin + gentamicin. Note: the threshold for young infants is ≥60/min but severe chest indrawing independently classifies PSBI.
Young infant IMNCI (<2 months) PSBI signs include: not able to feed, convulsions, fast breathing ≥60/min, severe chest indrawing, grunting, bulging fontanelle, hypothermia, hyperthermia, movement only on stimulation. ANY one = pink = refer with pre-referral ampicillin + gentamicin.
Severe chest indrawing is a PSBI sign in young infants (<2 months) regardless of RR. PSBI = pink = immediate referral with pre-referral antibiotics. The outpatient 'Pneumonia' classification applies to children 2 months–5 years, not young infants.
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On IMNCI assessment of a 3-year-old with diarrhoea, the child is found to be lethargic, has sunken eyes, is not able to drink, and skin pinch goes back very slowly (>3 seconds). This classifies as severe dehydration. Which treatment plan should be initiated?
Severe dehydration = 2+ severe signs (lethargic, not able to drink, very slow skin pinch) = ORS Plan C: IV Ringer's lactate (100 mL/kg total — 30 mL/kg fast in 30 min [infant] or 1 h [child], then 70 mL/kg in 2.5 h [infant] or 3 h [child]). If no IV access → nasogastric ORS or refer urgently.
IMNCI dehydration treatment plans: Plan A = no dehydration → ORS at home after each stool; Plan B = some dehydration → 75 mL/kg ORS over 4 h supervised; Plan C = severe dehydration → IV Ringer's lactate 100 mL/kg (split as 30+70 mL/kg; adult: 30 mL/kg in 30 min, then 70 mL/kg in 2.5 h). Reassess every 30 min.
Severe dehydration requires Plan C (IV fluids). Plan A = no dehydration (home ORS). Plan B = some dehydration (supervised ORS 75 mL/kg over 4 h). Plan C = severe dehydration (IV Ringer's lactate).
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A 4-year-old child is assessed in a rural PHC. The health worker counts the respiratory rate and finds 42 breaths/min. The child has no general danger signs and no chest indrawing. How should this finding be classified under IMNCI?
For children 12 months–5 years: fast breathing ≥40/min. 42/min ≥40 = fast breathing. No danger signs and no chest indrawing → Pneumonia (yellow) → oral amoxicillin for 5 days + follow-up in 2 days.
IMNCI respiratory thresholds: 1–5 years = ≥40/min fast breathing = Pneumonia (without chest indrawing/stridor/danger signs). Add severe chest indrawing → Severe Pneumonia (referral). Add a general danger sign or stridor → Very Severe Febrile Disease (immediate referral with pre-referral antibiotic).
The threshold for fast breathing in children 12 months–5 years is ≥40/min. Severe Pneumonia requires at least severe chest indrawing or stridor. VSFD requires general danger signs.
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A doctor is reviewing a child at a nutritional rehabilitation centre. The child is 18 months old, weight-for-height Z-score is −2.5 SD, MUAC is 11.8 cm, no bilateral oedema. Based on IMNCI/WHO SAM criteria, the most accurate nutritional classification is:
MAM criteria: weight-for-height Z-score −2 to −3 SD, OR MUAC 11.5–12.5 cm (6–59 months), without bilateral oedema. This child has Z-score −2.5 and MUAC 11.8 cm — both consistent with MAM. Management: supplementary feeding (RUTF/CSB), treat infections, counsel on diet.
Acute malnutrition (wasting) classification: SAM = weight-for-height <−3 SD OR MUAC <11.5 cm OR bilateral pitting oedema → NRC referral. MAM = weight-for-height −2 to −3 SD OR MUAC 11.5–12.5 cm → supplementary feeding. Normal MUAC ≥12.5 cm. Use WHO/IAP growth charts.
SAM = Z-score < −3 SD OR MUAC <11.5 cm OR bilateral oedema. MAM = Z-score −2 to −3 SD OR MUAC 11.5–12.5 cm. This child's values (−2.5 SD, MUAC 11.8) place them in MAM.
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A community health worker is assessing a 10-month-old boy with diarrhoea. He is not thirsty, has no sunken eyes, and the skin pinch goes back immediately. Under IMNCI, this child's dehydration status and management is:
Fewer than 2 signs in either the 'some' or 'severe' column = No Dehydration. Plan A: give ORS after each loose stool (200–400 mL for children 2–10 years, 50–100 mL for children under 2 years for each stool), zinc supplementation (10 mg/day <6 months; 20 mg/day >6 months × 14 days), and continue feeding.
IMNCI No Dehydration = Plan A. Core components: ORS after each stool (age-appropriate volume), zinc supplementation (20 mg/day for >6 months × 10–14 days), continue breastfeeding and age-appropriate food, teach the mother 4 rules for home treatment, and advise return if signs worsen.
No Dehydration = <2 signs total. Plan A = home therapy with ORS after each stool + zinc. Do not withhold fluids — early oral rehydration is the cornerstone of diarrhoea management.
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JSSK (Janani Shishu Suraksha Karyakram) was launched by the Government of India in 2011 as part of NHM. Which of the following is NOT an entitlement provided under JSSK for a sick newborn admitted to a public health facility?
JSSK entitlements for sick newborns (up to 30 days) in public facilities include: free drugs, free diagnostics, free blood transfusion, free diet for the mother, and free transport. JSSK does NOT guarantee free treatment in private hospitals — it covers entitlements in government/public health facilities.
JSSK (2011): entitlements for pregnant women (free delivery, free C-section, free drugs, diagnostics, blood, diet, transport, exemption from user charges) and sick newborns (free treatment, drugs, diagnostics, blood transfusion, diet for mother, transport) — all in PUBLIC health facilities only.
JSSK entitlements are for government/public health facilities. Private hospital coverage is provided by separate state-level insurance schemes (e.g. Ayushman Bharat), not JSSK.
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RKSK (Rashtriya Kishor Swasthya Karyakram) is a national adolescent health programme under NHM. Which of the following best describes the target age group and focus of RKSK?
RKSK targets adolescents 10–19 years and addresses 6 pillars: nutrition, sexual and reproductive health, mental health and substance abuse prevention, non-communicable diseases, injuries/violence prevention, and non-reproductive aspects of health. It uses Adolescent Friendly Health Clinics (AFHCs) and peer education.
RKSK (10–19 years): 6 pillars — nutrition (weekly iron-folic acid supplementation), sexual and reproductive health, mental health and de-addiction, NCDs, injuries/violence, and non-reproductive health. Adolescent Friendly Health Clinics (AFHCs) are the delivery platform.
RKSK covers 10–19 years with a holistic 6-pillar approach. It replaced the earlier Adolescent Reproductive and Sexual Health (ARSH) programme with a broader framework.
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A medical student is asked to explain ICDS (Integrated Child Development Services) to a community health board. Which of the following is the MOST complete description of the services provided under ICDS?
ICDS provides a package of 6 services delivered through Anganwadi Centres: supplementary nutrition, immunization, health check-ups, referral services, pre-school non-formal education, and nutrition and health education. Beneficiaries include children 0–6 years, pregnant women, and lactating mothers.
ICDS (1975): 6 services via Anganwadi Centres — supplementary nutrition, immunization, health check-up, referral, pre-school education, health and nutrition education. Beneficiaries: children 0–6 years + pregnant and lactating mothers. India's largest integrated child-development programme.
ICDS delivers 6 integrated services (3 through Anganwadi + 3 through health sector links) to children 0–6 years and pregnant/lactating women. It is NOT limited to immunization and nutrition alone.
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A 7-week-old infant is assessed using IMNCI for young infants. The mother reports the infant moves only when stimulated and has had two convulsions in the past 24 hours. Temperature is 37.2°C, respiratory rate 58/min, no severe chest indrawing. Which of the following actions is MOST appropriate as per IMNCI?
Movement only when stimulated AND convulsions are both PSBI signs in young infants (<2 months). ANY one PSBI sign = PSBI classification = pre-referral IM ampicillin + IM gentamicin + urgent referral to hospital. RR 58 is <60/min so does not meet the fast-breathing threshold for this age, but the other PSBI signs are sufficient.
Young infant IMNCI: ANY PSBI sign → classify PSBI → urgent referral with pre-referral IM ampicillin + gentamicin. Do NOT wait for all signs to develop. PSBI signs include: not able to feed, convulsions, fast breathing ≥60/min, severe chest indrawing, grunting, bulging fontanelle, abnormal temperature, movement only on stimulation.
In IMNCI young infant assessment, movement only when stimulated and convulsions are among the PSBI danger signs. Even with only ONE PSBI sign, the infant is classified PSBI → urgent referral. Never observe and delay when PSBI signs are present.
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A district health officer is reviewing the National Health Mission (NHM) framework. Under the RBSK programme, identified children are referred for management to which facility?
Children with positive RBSK screening (for 4Ds: Diseases, Deficiencies, Developmental delays, Disabilities) are referred to District Early Intervention Centres (DEICs) — one per district — for comprehensive assessment, management, and early intervention including surgery for congenital defects, hearing aids, spectacles, and physiotherapy.
RBSK workflow: Mobile Health Teams (MHTs) screen children at AWCs/schools → identify 4D conditions → refer to District Early Intervention Centres (DEICs) → free comprehensive management. DEICs are the cornerstone of RBSK's treatment delivery — one per district under NHM.
RBSK's referral pathway: RBSK mobile health team (MHT) screens → positive find → DEIC for management. DEIC provides comprehensive early intervention services at the district level.
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