6.6.3  Follow-up care for measles with eye or mouth complications

You should give follow-up care to the child after two days: you should look for red eyes and/or pus draining from the eyes and you should check to see whether the child still has the mouth ulcers. If the child’s mouth ulcers are worse, or there is a very foul smell from the mouth, you should refer the child to hospital. If the mouth ulcers are the same or better, you should tell the mother that she must continue to use the gentian violet for a total of five days.

You are now going to do a short activity which will help you to understand the main points that you have covered in this study session.

Activity 6.2  Assess and classify fever (2)

Read Case Study 6.1 and then answer the questions below. You should either have a copy of the Assess and Classify chart to help you with this activity, or you could refer to the sections from the chart that are reproduced in this study session.

Case Study 6.1  Pawlos’s story

Pawlos is ten-months-old. He weighs 8.2 kg. His temperature is 37.5°C. His mother says he has a rash and cough.

The health worker checked Pawlos for general danger signs. Pawlos was able to drink, was not vomiting, did not have convulsions and was not lethargic or unconscious.

The health worker next asked about Pawlos’s cough. The mother said Pawlos had been coughing for five days. The health worker counted 43 breaths per minute. She did not see chest in-drawing nor hear stridor. Pawlos did not have diarrhoea.

The mother said Pawlos had felt hot for two days and that they lived in a high malaria risk area. Pawlos did not have a stiff neck. He has had a runny nose with this illness.

Pawlos had a rash covering his whole body. Pawlos’s eyes were red. The health worker checked the child for complications of measles. There were no mouth ulcers. There was no pus draining from the eye and no clouding of the cornea.

  • a.Does Pawlos have severe febrile disease? Write down your reasons for your answer.
  • b.What malaria classification would you record on Pawlos’s form and why?
  • c.How would you classify Pawlos’s measles? Write down reasons for your answer.


To help you understand the process of classification for Pawlos, we have set out below how the health worker classified Pawlos’s fever, using the table for classifying fever when there is a high malaria risk. (If you have your chart booklet with you, you should open it on page 24.)

  • a.First, the health worker checked to see if Pawlos had any of the signs in the pink row. She thought, ‘Does Pawlos have any general danger signs or a stiff neck? No, he does not. Pawlos does not have any signs of severe febrile disease.’
  • b.Next, the health worker looked at the yellow row. She thought, ‘Pawlos has a fever. His temperature measures 37.5°C. He also has a history of fever because his mother says Pawlos felt hot for two days. He is from a high malaria risk area’. She classified Pawlos as having malaria.
  • c.Because Pawlos had a generalised rash and red eyes, Pawlos has signs suggesting measles. To classify Pawlos’s measles, the health worker looked at the classification table for classifying measles.
    • She checked to see if Pawlos had any of the signs in the pink row. She thought, ‘Pawlos does not have any general danger signs. The child does not have clouding of the cornea. There are no deep or extensive mouth ulcers. Pawlos does not have severe complicated measles.’
    • Next the health worker looked at the yellow row. She thought, ‘Does Pawlos have any signs in the yellow row? He does not have pus draining from the eye. There are no mouth ulcers. Pawlos does not have measles with eye or mouth complications.
    • Finally the health worker looked at the green row. Pawlos has measles, but he has no signs in the pink or yellow row. The health worker classified Pawlos as having measles.

In this study session you have learned about assessing fever in children. As you read earlier, fever may be caused by a serious illness such as malaria, measles or meningitis, and therefore it is critical that you are able to classify these conditions and ensure the sick child receives the correct treatment as quickly as possible.

6.6.2  Measles with eye or mouth complications

Summary of Study Session 6