Self-Assessment Questions (SAQs) for Study Session 15

Now that you have completed this study session you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answer in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

Read Case Study 15.1 and then answer the questions that follow.

Case Study 15.1 for SAQ 15.1

Rediet is six months old. She weighs 6 kg. Her mother has brought her into the health post because the child has a fever.

The health worker checks for general danger signs. Rediet is able to drink, has not vomited, has not had convulsions and is not lethargic or unconscious. She has not had any convulsions while at the health post.

The health worker assesses Rediet for cough or difficult breathing, and counts 54 breaths per minute. She notes that Rediet has no chest in-drawing or stridor when calm. Although Rediet has had diarrhoea for three days, there is no blood in her stool. She drinks eagerly and the skin pinch goes back slowly.

Rediet’s family live where there is a high malaria risk. She has had a fever for five days. There is no rash, her eyes are not red, she does not have a stiff neck or a runny nose. There is some discharge from her ear, and her mother says that Rediet has had this fluid coming out of her ear for some weeks.

The health worker checks Rediet for malnutrition and anaemia; Rediet does not appear to have visible severe wasting. There is no palmar pallor and no signs of oedema. Her weight for age is also checked.

Rediet’s mother tested as HIV-positive during her pregnancy. Rediet has oral thrush, and no enlarged lymph nodes or parotid glands.

SAQ 15.1 (tests Learning Outcomes 15.1, 15.2 and 15.3)

  • a.How would you assess and classify Rediet? Give reasons for your answer.
  • b.What treatment does Rediet need and why? Does Rediet need to be referred urgently for any reason?
  • c.What advice would you give to Rediet’s mother?


  • a.Your assessment and classification for Rediet should have included the following information:
    • Cough or difficult breathing

      Rediet has a cough and her breathing rate is 54. For her age she has fast breathing, but no chest in-drawing or stridor. Thus the classification is pneumonia.

    • Diarrhoea

      Rediet has had diarrhoea for three days. She has also the following signs: drinking eagerly and skin pinch goes back slowly. Thus she is classified as ‘some dehydration’.

    • Fever

      Rediet has fever and she is from a high risk malaria area. Thus the classification is malaria.

    • Ear discharge

      Rediet has had an ear discharge for some weeks. The classification is chronic ear infection, because the discharge has been happening for over two weeks.

      Rediet has oral thrush, pneumonia and chronic ear discharge. Because her mother tested HIV-positive, Rediet must be classified as suspected symptomatic HIV infection. The reason it is suspected and not confirmed is because Rediet has not yet been tested.

  • b.You would provide the following treatments for Rediet, and advise the mother how to provide the best care for her baby:


    • Give cotrimoxazole for five days
    • Soothe the throat and relieve the cough with a safe remedy
    • Advise mother to return immediately if Rediet’s condition gets worse
    • Advise a follow-up visit in two days.


    • Put Rediet on treatment Plan B
    • Advise the mother to continue breastfeeding
    • Advise mother in what circumstances she should return to the health post immediately
    • Tell the mother to return for a follow-up visit in five days if Rediet is not improving.


    • Treat with Coartem
    • Give one dose of paracetamol in the clinic for high fever (38.5˚C or above)
    • Advise mother in what circumstances she should return to the health post immediately
    • Tell the mother to come for a follow-up visit in two days if Rediet’s fever persists
    • If fever is present every day for more than seven days, you would have to refer Rediet for assessment.

    Ear discharge

    • Dry the ear by wicking
    • Treat with topical Quinolone eardrops for two weeks
    • Return to the health post for a follow-up visit in five days.

    Suspected symptomatic HIV infection

    • Give cotrimoxazole prophylaxis
    • Treat HIV-related conditions if present (e.g. thrush)
    • Give multivitamin supplements
    • Assess Rediet’s feeding and counsel the mother as necessary
    • Advise the mother about the benefits of an HIV test for Rediet and refer both of them for voluntary counselling and testing
    • Advise the mother on home care
    • Tell the mother to return for a follow-up visit in 14 days.

    Oral thrush

    • Tell the mother to paint the thrush with gentian violet 0.25% for 7 days
    • Avoid feeding for 20 minutes after medication
    • Check the mother’s breasts for thrush. If present treat with Nystatin or gentian violet
    • Advise the mother to wash her breasts after feeds. If Rediet is bottlefed, you should advise the mother to change to a cup
    • If severe, recurrent or pharyngeal thrush is present, you should consider that Rediet has symptomatic HIV
    • Give paracetamol if needed for pain.
  • c.Rediet’s mother needs referral for HIV counselling and testing.

As you can see from your notes and the information above, you will be providing Rediet’s mother with a lot of information. She may be confused and you need to check carefully that she has understood what she has to do to look after Rediet, and when she should return the health post.

Summary of Study Session 15