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 stepsIMCIPACK ChildComments
Check for danger signsYesYesThis 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 coughYesYes
Salbutamol via spacer for 5 daysYesYes
Refer non-urgently for assessmentYesPrompted later for confirmation of diagnosis
Ask about diarrhoeaYesSymptom screen included in routine care
Ask about feverYes
Ask about ear problemYes
Assess and interpret growth (then check all children for malnutrition)YesYes
Check for anaemiaYesYes
Assess HIV riskYesYes
Assess TB riskYesYes
Then check immunisation statusYesYes
Assess any other problemYesYes
Check the caregiver’s healthYesYes
Vitamin A and deworming, if neededYesYes
Addresses smoking in houseNoYes
Excludes TBNoYes
Assesses recurrent respiratory symptoms (asthma diagnosis algorithm)NoYes
Trial of treatment given:NoYes
Corticosteroid inhaler for 2 months
Step-by-step guidance on inhaler (with spacer) techniqueNoYes
Refer non-urgently for assessment if trial of treatment not effectiveNoYes
Prompts a likely asthma diagnosis if trial effective (non-urgent doctor confirmation within 1 month)NoYes
Asthma routine care startedNoYes
Assesses symptom controlNoYes
Allergy screenNoYes
Adherence screen (inhaler technique assessment)NoYes
Advice covers passive smoking, treatment education, recognition of acute exacerbations, trigger avoidanceNoYes
Annual influenza vaccinationNoYes
Step-up and step-down corticosteroid inhalers according to symptom controlNoYes
Prednisone course for acute exacerbationsNoYes
When to return immediatelyNoYes
When to follow up for routine asthma visitNoYes
  • ART, antiretroviral therapy; IMCI, Integrated Management of Childhood Illness; PACK, Practical Approach to Care Kit; TB, tuberculosis.