#Module 16:CB-IMNCI

Spotter 1

1. Write the name of the given condition. (0.5)
Diarrhoea with severe dehydration

2. Write Plan C management of the above case as per CB-IMNCI guideline. (1.5)
Plan C is indicated for severe dehydration and requires urgent IV fluid therapy.

• Give IV fluids (Ringer’s Lactate / Normal Saline) immediately

• 30 mL/kg as rapid infusion

  • Infants: over 1 hour

  • Older children: over 30 minutes

• Followed by 70 mL/kg

  • Infants: over 5 hours

  • Older children: over 2.5 hours

• Start ORS orally or by NG tube as soon as the child can drink

• Reassess frequently (every 30 minutes initially) for hydration status and clinical improvement

Spotter 2

1. Enlist diseases included in CB-IMNCI program of Nepal. (1)

• Pneumonia

• Diarrhoea

• Malaria

• Measles

• Malnutrition

• Neonatal sepsis

• Hypothermia

2. Mention the cut-off of respiratory rate for fast breathing in children. (1)

• < 2 months: ≥ 60 breaths/min

• 2–12 months: ≥ 50 breaths/min

• 12–59 months: ≥ 40 breaths/min

Spotter 3

1. Identify the given diagram. (0.5)
ORS (Jeevanjal)

2. Write its full form. (0.5)
Oral Rehydration Solution

3. Mention its composition as currently prescribed in Nepal. (1)
(For 1 litre of water)

• Sodium chloride – 2.6 g

• Glucose (anhydrous) – 13.5 g

• Potassium chloride – 1.5 g

• Trisodium citrate dihydrate – 2.9 g

• Total osmolality – 245 mOsm/L

• Water – 1 litre

Spotter 4

1. What is the leading cause of diarrhoea among children in Nepal? (1)
Rotavirus infection

2. Why is Zinc added with ORS to treat diarrhoea? (1)

• Reduces frequency, fluidity, and severity of diarrhoeal stools.

Note:
Zinc helps in the treatment of diarrhoea by repairing the intestinal mucosa, which is damaged during infection. This improves absorption of water and electrolytes from the intestine, leading to less watery stools (reduced fluidity). Zinc also reduces intestinal secretion and improves enzyme activity, which decreases the number of stools (reduced frequency). By enhancing immune function and gut healing, it shortens the overall duration and severity of diarrhoeal episodes.

Spotter 5

1. What is ReSoMal? (1)
ReSoMal (Rehydration Solution for Malnutrition) is a special low-sodium oral rehydration solution used for children with severe acute malnutrition having diarrhoea with some dehydration.

2. Why is ReSoMal preferred over ORS in SAM? (1)

• Prevents sodium overload

• Corrects potassium and magnesium deficiency

• Reduces risk of oedema and heart failur

Note:

ReSoMal is a low-sodium, high-potassium oral rehydration solution used for rehydration of children with severe acute malnutrition.