WHO FHIR Implementation Guide (IG): Integrated Management of Childhood Illness (IMCI) in emergencies
0.1.0 - release

WHO FHIR Implementation Guide (IG): Integrated Management of Childhood Illness (IMCI) in emergencies, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-emcare/tree/feature/update-canonical and changes regularly. See the Directory of published versions

## Questionnaire: Ccc.B18-21.Signs.2m.m

Branch:

Profile: SDCBaseQuestionnaire

Structure

LinkID | Text | Cardinality | Type | Flags | Description & Constraints
--- | --- | --- | --- | --- | ---
Ccc.B18-21.Signs.2m.m |  |  | Questionnaire |  | https://smart.who.int/ccc/Questionnaire/Ccc.b18-21.signs.2m.m#0.1.0
Fever | null | 0..1 | boolean |  | Value Set:
Fever-help | The client is reported to have or has had fever | 0..1 | display |  | Value Set:
Fever-instruction | help | 0..1 | display |  | Value Set:
zscore | null | 0..1 | decimal |  | Value Set:
AgeInMonths | Age in Month | 0..1 | integer |  | Value Set:
AgeInDays | null | 0..1 | integer |  | Value Set:
Ccc.B20S1.DE01 | Diarrhoea | 0..1 | boolean |  | Value Set:
Ccc.A.DE31 | Biological Mother Vital Status | 0..1 | choice |  | Value Set: Options: 3 options
Ccc.B21S1.DE01 | Breastfed | 0..1 | boolean |  | Value Set:
Ccc.B18S1.DE02 | Difficulty with Feeding | 0..1 | choice |  | Value Set: Options: 3 options
YI_sever_but_dhey | YI severe classification other than severe dehydration | 0..1 | boolean |  | Value Set:
YI_sever | YI severe classification | 0..1 | boolean |  | Value Set:
Ccc.B7.DE03 | Convulsion(s) in this Illness | 0..1 | boolean |  | Value Set:
Ccc.B22.RespiratoryRate | null | 0..1 | group |  | Value Set:
Ccc.B22.DE01 | Respiratory Rate (breaths per minute) | 1..1 | quantity |  | Value Set:
Ccc.B22.DE01-help | <b>Count the number of breaths the child takes per minute</b> to determine if fast breathing is present.<br /> It is <b>very important that the child is calm</b> and still. If the child is moving or crying, you will not be able to get an accurate count of breaths. <br /> <b>To count the breaths per minute,</b> use a watch with a second hand or a digital watch. Look for the breathing movement anywhere on the child’s chest or abdomen. <br /> The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b></p> <ul> <li>Under 2 months: More than 60 breaths per minute*</li> <li>2 to 11 months: More than 50 breaths per minute</li> <li>12 to 59 months: More than 40 breaths per minute</li> </ul> <p>*In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display |  | Value Set:
Ccc.B22.DE02 | null | 0..* | choice |  | Value Set: Options: 1 option
second | null | 0..1 | group |  | Value Set:
Ccc.B22.DE04 | Respiratory Rate Second Count (breaths per minute) | 0..1 | quantity |  | Value Set:
Ccc.B22.DE04-help | <b>Count the number of breaths the child takes per minute</b> to determine if fast breathing is present.<br /> It is <b>very important that the child is calm</b> and still. If the child is moving or crying, you will not be able to get an accurate count of breaths. <br /> <b>To count the breaths per minute,</b> use a watch with a second hand or a digital watch. Look for the breathing movement anywhere on the child’s chest or abdomen. <br /> The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b></p> <ul> <li>Under 2 months: More than 60 breaths per minute*</li> <li>2 to 11 months: More than 50 breaths per minute</li> <li>12 to 59 months: More than 40 breaths per minute</li> </ul> <p>*In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display |  | Value Set:
Ccc.B22.DE05 | null | 0..* | choice |  | Value Set: Options: 1 option
Ccc.B22.DE07 | Fast Breathing | 0..1 | boolean |  | Value Set:
Ccc.B22.DE07-help | The number of breaths for <b>‘fast breathing’ depends on the child’s age.</b> * Under 2 months: More than 60 breaths per minute* * 2 to 11 months: More than 50 breaths per minute * 12 to 59 months: More than 40 breaths per minute *In young infants, a second measurement should be taken to confirm, unless there is already another sign of possible serious bacterial infection | 0..1 | display |  | Value Set:
Ccc.B18S2.DE07 | Severe Chest Indrawing | 1..1 | boolean |  | Value Set:
Ccc.B18S2.DE07-help | The young infant must be calm while you assess for severe chest indrawing. Lift the young infant’s shirt. </p> <p>Look for chest indrawing when the young infant breathes in. Lower chest wall indrawing is the inward movement of the bony structure of the chest wall <br /> when the child breathes in. Look at the lower chest wall (lower ribs). The child has chest indrawing if the lower chest wall goes IN when the child breathes IN.<br /> In normal breathing, the whole chest wall (upper and lower) and the abdomen move <span class="caps">OUT</span> when the child breathes IN. </p> <p>Mild chest indrawing is normal in a young infant because the chest wall is soft. Severe chest indrawing is very deep and easy to see. | 0..1 | display |  | Value Set:
Ccc.B18S2.DE08 | Movements | 1..1 | choice |  | Value Set: Options: 3 options
Ccc.B18S2.DE08-help | Look at the young infant’s movements. Does the young infant move on his/her own? Does the infant move only when stimulated but then stops? Does the infant not move at all?<br /> Young infants often sleep most of the time, and this is not a sign of illness. It is not necessary for the infant to be awake if he/she is moving spontaneously. <br /> If a young infant is not moving spontaneously and does not wake up during the assessment, ask the mother to wake him. An awake young infant will normally move his arms or legs or turn his head several times in a minute if you watch him closely. If the infant is awake but has no spontaneous movements, gently stimulate the young infant. Stimulation is a gentle, painless touching of the baby with enough pressure that would evoke movements, sound making and eye opening. The presence of any movement such as a grimace of the face, eye-opening or movement of a limb will qualify &#8220;Movement only when stimulated but then stops&#8221;. An infant who cannot be woken up even after stimulation is considered to have the sign &#8220;Does not move even with stimulation. &#8220; | 0..1 | display |  | Value Set:
Ccc.B18S2.DE12 | Umbilicus Red or Pus Draining | 1..1 | boolean |  | Value Set:
Ccc.B18S2.DE12-help | &#8220;The umbilical cord usually separates one week after birth and the wound heals within 15 days. Redness of the end of the umbilicus or pus draining from the umbilicus are signs of umbilical infection.&#8221; | 0..1 | display |  | Value Set:
Ccc.B18S2.DE13 | Skin Pustules | 1..1 | boolean |  | Value Set:
Ccc.B18S2.DE13-help | Examine the skin on the entire body. Skin pustules are red spots or blisters which contain pus. | 0..1 | display |  | Value Set:
Ccc.B19S2.DE01 | Yellow Skin | 1..1 | boolean |  | Value Set:
Ccc.B19S2.DE01-help | Jaundice is a yellow discoloration of skin and mucus membranes. It is important to look for jaundice in natural light. To look for jaundice, press the infant’s skin over the forehead with your fingers to blanch, remove your fingers and look for yellow discolouration. If there is yellow discoloration, the infant has jaundice | 0..1 | display |  | Value Set:
Ccc.B19S2.DE02 | Yellow Palms or Yellow Soles | 1..1 | boolean |  | Value Set:
Ccc.B19S2.DE02-help | Jaundice is a yellow discoloration of skin and mucus membranes. Jaundice in the palms of hands or soles of feet is a sign of Severe Jaundice. It is important to look for jaundice in natural light. To assess for severe jaundice, press the infant&#8217;s skin in the palm of there hand and then in the sole of their feet with your fingers to blanch, remove your finders and look for yellow dicoulouration in the palm or the sole. If there is yellow discoloration of the palm or sole, the infant has severe jaundice. | 0..1 | display |  | Value Set:
Ccc.B19S2.DE04 | When did the Jaundice first appear? | 0..1 | choice |  | Value Set: Options: 3 options
Ccc.B19S2.DE04-help | Ask the caregiver when the baby&#8217;s skin first turned yellowish. If the caregiver didn&#8217;t notice the yellow discolouration or can&#8217;t remember when it started, select &#8220;don&#8217;t know&#8221;. <br /> Jaundice that appears in less than 24 hours after birth is always due to an underlying disease. These babies should be referred urgently. <br /> Many normal babies, particularly small babies, may have jaundice during the first week of life. This jaundice usually appears on the third or fourth day of life and is mild and disappears before the age of two to three weeks. It does not need any treatment. | 0..1 | display |  | Value Set:
Ccc.B11S2.DE01 | Sunken Eyes | 1..1 | boolean |  | Value Set:
Ccc.B11S2.DE01-help | The eyes of a dehydrated infant may look sunken. In a low-weight infant, the eyes may always look sunken, even if the young infant is not dehydrated. Even though the sign “sunken eyes” is less reliable in a low-weight infant, it can still be used to classify the young infant‘s dehydration. </p> <p>Decide if you think the eyes are sunken. Then ask the mother if she thinks her child’s eyes look unusual. Her opinion can help you confirm. | 0..1 | display |  | Value Set:
Ccc.B11S2.DE02 | Skin pinch of Abdomen | 1..1 | choice |  | Value Set: Options: 3 options
Ccc.B11S2.DE02-help | Locate the area on the infant’s abdomen halfway between the umbilicus and the side of the abdomen. To do the skin pinch, use your thumb and first finger. Do not use your fingertips because this will cause pain. Place <br /> your hand so that when you pinch the skin, the fold of skin will be in a line up and down the child’s body and not across the child’s <br /> body. Firmly pick up all of the layers of skin and the tissue under them. Pinch the skin for <br /> one second and then release it. When you release the skin, look to see if the skin pinch <br /> goes back:</p> <p>• very slowly (longer than 2 seconds)<br /> • slowly<br /> • immediately<br /> If the skin stays up for even a brief time after you release it, decide that the skin pinch goes back slowly | 0..1 | display |  | Value Set:
Ccc.B11S2.DE06 | Restless and Irritable | 1..1 | boolean |  | Value Set:
Ccc.B11S2.DE06-help | Look at the young infant&#8217;s general condition Is the infant restles and irritable? <br /> An infant has teh sign &#8220;restless and irritable&#8221; if the infant is restless and irritable all the time or every time he is touched and handled. If an infant is calm when breastfeeding but again <br /> restless and irritable when he stops breastfeeding, he has the sign “restless and irritable”. A healthy infant will be consoled when put on the breast. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE01 | Weight Status | 0..1 | string |  | Value Set:
Ccc.B21S2.DE01-help | Weight status is calculated based on the young infant&#8217;s weight for age Z-score, which is determined from a standardized chart for weight -for-age for the infant&#8217;s sex. <br /> A young infant is low weight for age if the z-score is below -2. <br /> A young infant who is less than 7 days old and weighs less than 2 kg is considered very low weight.<br /> Some young infants who are low weight for age were born with low birth weight. Some did not gain weight well after birth. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE05 | Breastfed how many times in 24 hours? | 1..1 | integer |  | Value Set:
Ccc.B21S2.DE05-help | Ask the caregiver how many times in 24 hours (one day and one night) they usually breastfeed the young infant. The recommendation is that the young infant be breastfed as often and for as long as the <br /> infant wants, day and night. This should be 8 or more times in 24 hours. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE06 | Sufficient feeds | 0..1 | integer |  | Value Set:
Ccc.B21S2.DE08 | Young Infant receives food or fluids other than breast milk | 1..1 | boolean |  | Value Set:
Ccc.B21S2.DE08-help | Find out if the young infant is receiving any other foods or drinks such as other milk, juice, tea, thin porridge, dilute cereal, or even water. Ask how often he receives it and the amount. You need to know if the infant is mostly breastfed, or mostly fed on other foods | 0..1 | display |  | Value Set:
Ccc.B21S2.DE09 | What milk is being given as a replacement feed? | 1..* | choice |  | Value Set: Options: 2 options
Ccc.B21S2.DE09-help | Ask the mother questions to determine what replacement milk or milks are used. It may be a breastmilk replacement, animal milk or some other fluid or some combination. Determine if this type of replacement feed is appropriate or not appropriate in your setting. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE12 | How many replacement feeds during the day and night (24 hours)? | 1..1 | integer |  | Value Set:
Ccc.B21S2.DE12-help | A young infant up to one month of age should be fed 8 times and a young infant between 1 <br /> and 2 months of age should be fed 7 times in 24 hours. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE13 | Sufficient replacement feeds (in 24 hours) | 1..1 | boolean |  | Value Set:
Ccc.B21S2.DE15 | How much milk is given at each feed (ml)? | 1..1 | quantity |  | Value Set:
Ccc.B21S2.DE15-help | A young infant up to one month of age should be given approximately 60 ml per feed, 8 times per day, and a young infant between 1 and 2 months of age approximately 90 ml at each feed, 7 times per day. It is helpful to have common bottles or cups available so that a mother can show you the amount that she gives. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE16 | Sufficient replacement feeds | 1..1 | boolean |  | Value Set:
Ccc.B21S2.DE18 | How is the milk prepared? | 1..1 | choice |  | Value Set: Options: 2 options
Ccc.B21S2.DE18-help | Let mother demonstrate or explain how a feed is prepared and how she gives it to the infant. Determine if the breastmilk substitute is being prepared correctly and hygienically. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE21 | How is the milk given? | 1..1 | choice |  | Value Set: Options: 2 options
Ccc.B21S2.DE24 | How are the feeding utensils cleaned? | 1..1 | choice |  | Value Set: Options: 2 options
Ccc.B21S2.DE24-help | Ask the caregiver how they clear the feeding utensils. Determine if this is a safe and hygienic cleaning method. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE27 | Do you give any breastmilk at all? | 1..1 | choice |  | Value Set: Options: 2 options
Ccc.B21S2.DE30 | Ulcers or White Patches in Mouth | 1..1 | boolean |  | Value Set:
Ccc.B21S2.DE30-help | Look inside the mouth at the tongue and inside of the cheek. Thrush looks like milk curds on the inside of the cheek, or a thick white coating of the tongue. Try to wipe the white off. The white patches of thrush will remain. | 0..1 | display |  | Value Set:
Ccc.B21S2.DE31 | null | 0..* | choice |  | Value Set: Options: 1 option
Respiratory Rate profile | null | 0..1 | quantity |  | Value Set:
force-collection | null | 0..1 | boolean |  | Value Set:
Respiratory Rate Second Count Profile | null | 0..1 | quantity |  | Value Set:
Fast Breathing profile | null | 0..1 | boolean |  | Value Set:
timestamp | null | 0..1 | dateTime |  | Value Set:
Documentation for this format

Options Sets

Answer options for Ccc.A.DE31

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE46 ("Dead")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE34 ("Alive")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.A.DE33 ("Unknown")

Answer options for Ccc.B18S1.DE02

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE03 ("Not Able to Feed At All")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE04 ("Not Feeding Well")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S1.DE05 ("Feeding Well")

Answer options for Ccc.B22.DE02

- null#Ccc.B22.DE02 ("Unable to perform Respiratory Rate at this time")

Answer options for Ccc.B22.DE05

- null#Ccc.B22.DE05 ("Respiratory Rate Second Count Not Possible")

Answer options for Ccc.B18S2.DE08

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE11 ("Moves on his or her own or moves spontaneously or without stimulation")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE10 ("Movement only when stimulated but then stops")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B18S2.DE09 ("No movement at all")

Answer options for Ccc.B19S2.DE04

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE05 ("Within less than 24 hours of birth")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE06 ("24 hours or more after birth")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B19S2.DE07 ("Unknown when Jaundice first appeared")

Answer options for Ccc.B11S2.DE02

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE03 ("Skin Pinch goes back very slowly (More than 2 seconds)")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE04 ("Skin Pinch goes back slowly (2 seconds or fewer, but not immediately)")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B20S2.DE05 ("Skin Pinch goes back Normally (immediately)")

Answer options for Ccc.B21S2.DE09

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE11 ("Inappropriate replacement milk")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE10 ("Appropriate replacement milk")

Answer options for Ccc.B21S2.DE18

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE19 ("Correct and hygienic feed preparation")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE20 ("Incorrect or unhygienic feed preparation")

Answer options for Ccc.B21S2.DE21

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE22 ("Cup")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE23 ("Bottle")

Answer options for Ccc.B21S2.DE24

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE26 ("Feeding utensils not cleaned hygienically")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE25 ("Feeding utensils cleaned hygienically")

Answer options for Ccc.B21S2.DE27

- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE28 ("Breastmilk also given")
- https://smart.who.int/ccc/CodeSystem/Ccc-custom-codes#Ccc.B21S2.DE29 ("No Breastmilk at all")

Answer options for Ccc.B21S2.DE31

- null#Ccc.B21S2.DE31 ("Unable to check if Ulcers or White Patches in Mouth")