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Year : 2016  |  Volume : 9  |  Issue : 4  |  Page : 215-216
Standardizing the assessment and management protocol of critically ill under-five children: World Health Organization

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication28-Jun-2016

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Standardizing the assessment and management protocol of critically ill under-five children: World Health Organization. Ann Trop Med Public Health 2016;9:215-6

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Standardizing the assessment and management protocol of critically ill under-five children: World Health Organization. Ann Trop Med Public Health [serial online] 2016 [cited 2021 Apr 11];9:215-6. Available from:
Globally, it has been observed that the majority of the reported under-five deaths occur within the initial 24 h of admission.[1] However, many such deaths could be easily prevented, provided very sick children are identified early after their arrival in the health establishments, and appropriate treatment is initiated promptly.[1],[2] In fact, the global estimates for the year 2015 revealed that close to 5.9 million under-five children died, of which in excess of 50% could be averted by extending simple and affordable interventions.[2]

Furthermore, an under-five child from the sub-Saharan Africa region is almost 14 times more likely to die than their counterparts in the developed regions.[2] Moreover, the risk of a death of a child is highest in the neonatal period (due to preterm birth, childbirth-related complications, and infections), accounting for around 45% of the share of under-five deaths.[2],[3] Further, in the subsequent period, conditions such as pneumonia, diarrhea, and malaria account for the maximum proportion of the deaths, with malnutrition being the predominant underlying cause in about one-half of these deaths.[1],[2],[4]

Even though, the under-five mortality rate reduced from 91 deaths per 1000 live births in 1990 to 43 in 2015, the world failed to achieve the desired target of two-third reduction as set under the Millennium Development Goals.[2] In continuation, with the global commitment, the member states have set their goal to achieve an under-five mortality rate to 25 or less per 1000 live births by the year 2030, under the adopted sustainable development goals.[2],[3]

Acknowledging the importance of adequate and appropriate management of critically ill children, the World Health Organization has released a set of new guidelines to respond to most of the common emergency conditions.[3] Children who present to the health facilities with any of the emergency signs (viz., obstructed or absent breathing, severe respiratory distress, central cyanosis, signs of shock or severe dehydration, coma, seizures), has to be identified promptly by the triage mechanism and should be offered immediate emergency care to prevent deaths.[1],[3] However, those children without any emergency signs are considered “nonurgent” on triage completion.[3]

These guidelines lays down maximum attention to the three commonest presentations, namely respiratory distress and hypoxemia (such as when to start and stop oxygen therapy, the rate of oxygen flow, humidification levels, etc.); severely impaired circulation or shock (viz., which intravenous fluids, at what rate and for how long); and seizures with altered consciousness (like the drug of choice for seizures for both oral or intravenous modes of access, second-line seizure medications for status epilepticus, strategies to prevent recurrence of febrile seizures, and appropriate diagnostic tests).[3]

Even though the proposed triage framework can be utilized universally, it will add maximum benefits if strictly implemented in the low-resource settings, which are generally devoid of easy access to the trained specialists.[3] Hence, the primary objective is to assist health workers to appropriately manage infants and children presenting with emergency signs in a standardized manner within the available resources.[2],[3] At the same time, it can also reduce the incidence of medication prescribing errors, prolonged stay in intensive care units, the necessity of mechanical ventilation, minimize the burden on the health system, and even reduce the risk of catastrophic expenditure by the families.[1],[2],[3],[5]

In addition, for achieving sustained results, it is extremely important to facilitate universal coverage of quality-assured maternal and newborn care; prevention and treatment of pneumonia and diarrhea; improvement in the feeding practices of infant and young child nutrition; reduction in the incidence of malaria and its associated mortality; and bring about an expansion in the routine and supplementary immunization activities geographically.[1],[2],[4]

To conclude, it is the need of the hour to adopt the proposed triage framework and guidelines on a national scale and ensure the presence of an enabling environment by conducting training sessions of the health workers, to eventually save the lives of millions of under-five children, especially in low-resource settings.

   References Top

Al-Mendalawi MD. Mortality patterns among critically ill children in a pediatric intensive care unit of a developing country. Indian J Crit Care Med 2015;19:293-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
World Health Organization. Children: Reducing Mortality – Fact Sheet; 2016. Available from: [Last accessed on 2016 Mar 04].  Back to cited text no. 2
World Health Organization. Paediatric emergency triage, assessment and treatment: Care of critically-ill children: Updated guideline. Geneva: WHO Press; 2016. p. 1-26.  Back to cited text no. 3
Bagri NK, Jose B, Shah SK, Bhutia TD, Kabra SK, Lodha R. Impact of malnutrition on the outcome of critically ill children. Indian J Pediatr 2015;82:601-5.  Back to cited text no. 4
Glanzmann C, Frey B, Meier CR, Vonbach P. Analysis of medication prescribing errors in critically ill children. Eur J Pediatr 2015;174:1347-55.  Back to cited text no. 5

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, 3rd Floor, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur–Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.184813

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