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Management of the Child with a Serious Infection or Severe Malnutrition. Guidelines for Care at the First-Referral Level in Developing Countries

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Management of the Child with a Serious Infection or Severe Malnutrition. Guidelines for Care at the First-Referral Level in Developing Countries. World Health Organisation, 2000 (Pp 162; illustrated; Sw Fr 10.50). World Health Organisation, 2000. ISBN 92-4-154531-3.

An accessible practical text for doctors and senior health workers at first referral centres in developing countries is indeed a worthwhile objective and this WHO sponsored guide largely succeeds. An impressive list of contributors combine to produce a 160 page manual covering common paediatric presentations which maintains throughout that these children can be managed successfully with a combination of good clinical assessment, basic diagnostic facilities, and a core of essential drugs.

Designed to complement the Integrated Management of Childhood Illness guidelines, it has the feel of a classic textbook with many simple black and white drawings and tables which are also refreshingly new, given over as they are to demonstrations of practical clinical assessment and diagnostic procedures. There is even an appendix of toys for severely malnourished children. There is also an excellent chapter on supportive care, and solutions to feeding problems and nutrition is an important theme throughout. Monitoring of children's progress and an encouragement to audit outcomes are welcome as is the pragmatic approach to human immunodeficiency virus. By virtue of the fact that it is designed with brevity and clarity in mind, it is very didactic however. The reader is not invited to question why for instance “very severe pneumonia” is treated with chloramphenicol, “severe pneumonia” with penicillin, and “pneumonia (non-severe)” with septrin. More leeway is given in the advice to monitor local antibiotic sensitivity patterns in treatingShigella andSalmonella infections. Many may appreciate this approach but some will not.

A text on the management of the sick child in a developing country should perhaps be best reviewed by a doctor in a developing country. I agree, but in my own mitigation I might add that I have been lucky enough to have worked for several years in Bangladesh and I have sent this copy onto a good home—the hospital library of the paediatric hospital where I was based. This book deserves a wide distribution and a cover price of Sw Fr 10.50 will help.

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