| 6 | TASK SHIFTING | ||
| Example: 3-year-old girl has a 3-day history of wheeze. This is the 4th presentation for wheeze in 3 months. No danger signs. No respiratory distress. Nocturnal cough. Not on asthma treatment. Growing well. | |||
| Management steps | IMCI | PACK Child | Comments |
| Check for danger signs | Yes | Yes | This clinical scenario demonstrates how PACK Child might empower a nurse to perform additional tasks where she previously referred to a doctor. In this case, task-shifting may include instituting a trial of asthma treatment, screening for triggers and other allergy symptoms, providing advice and education, and demonstrating inhaler techniques. |
| Assess cough | Yes | Yes | |
| Salbutamol via spacer for 5 days | Yes | Yes | |
| Refer non-urgently for assessment | Yes | Prompted later for confirmation of diagnosis | |
| Ask about diarrhoea | Yes | Symptom screen included in routine care | |
| Ask about fever | Yes | ||
| Ask about ear problem | Yes | ||
| Assess and interpret growth (then check all children for malnutrition) | Yes | Yes | |
| Check for anaemia | Yes | Yes | |
| Assess HIV risk | Yes | Yes | |
| Assess TB risk | Yes | Yes | |
| Then check immunisation status | Yes | Yes | |
| Assess any other problem | Yes | Yes | |
| Check the caregiver’s health | Yes | Yes | |
| Vitamin A and deworming, if needed | Yes | Yes | |
| Addresses smoking in house | No | Yes | |
| Excludes TB | No | Yes | |
| Assesses recurrent respiratory symptoms (asthma diagnosis algorithm) | No | Yes | |
| Trial of treatment given: | No | Yes | |
| Corticosteroid inhaler for 2 months | |||
| Step-by-step guidance on inhaler (with spacer) technique | No | Yes | |
| Refer non-urgently for assessment if trial of treatment not effective | No | Yes | |
| Prompts a likely asthma diagnosis if trial effective (non-urgent doctor confirmation within 1 month) | No | Yes | |
| Asthma routine care started | No | Yes | |
| Assesses symptom control | No | Yes | |
| Allergy screen | No | Yes | |
| Adherence screen (inhaler technique assessment) | No | Yes | |
| Advice covers passive smoking, treatment education, recognition of acute exacerbations, trigger avoidance | No | Yes | |
| Annual influenza vaccination | No | Yes | |
| Step-up and step-down corticosteroid inhalers according to symptom control | No | Yes | |
| Prednisone course for acute exacerbations | No | Yes | |
| When to return immediately | No | Yes | |
| When to follow up for routine asthma visit | No | Yes | |
ART, antiretroviral therapy; IMCI, Integrated Management of Childhood Illness; PACK, Practical Approach to Care Kit; TB, tuberculosis.