Example: 3-year-old boy presents with 3-week history of loss of weight and a cough. No danger signs. No respiratory distress. No wheeze. Not growing well. HIV negative. TST positive.
Management stepsIMCIPACK ChildComments
Check for danger signsYesYesRegardless of multiple possible entry points, in this case, loss of weight, not growing well or cough, PACK guides the clinician to the same management steps.
Assess coughYesYes
Assess for TBYesYes
Identify TB contactYesYes
TB investigations (tuberculin skin test, gastric washing, sputum test, chest X-ray, if available)YesYes
Relieve cough (warm water/weak tea)YesNot included
Advise when to return immediatelyYesYes
Ask about diarrhoeaYesSymptom screen included on routine care
Ask about feverYes
Ask about ear problemYes
Ask about sore throatYes
Assess and interpret growth (check for malnutrition)YesYes
Feeding assessment and counsellingYesNot included, unless feeding problem
Assess HIV riskYesYes
Deworming and vitamin A, if neededYesYes
Arrange follow-upYesYes
Notify and register in TB registerYesYes
Give TB treatment (dosing tables)YesYes
Routine follow-up TBYesYes
Check immunisation statusYesYes
Assess any other problemsYesYes
Check caregiver’s healthYesYes
Step-by-step guidance on how to perform a tuberculin skin test (TST)NoYes
Screen for other contactsNoYes
Advise about importance of treatment adherenceNoYes
Advise about TB treatment side effectsNoYes
Guidance on TB and HIV co-infection (like ART dosage adjustments)NoYes