Malnutrition, especially in the form of stunting, wasting, and micronutrient deficiencies, is a critical issue in sub-Saharan Africa.

Regularly monitor children’s growth (height and weight) to identify malnutrition early. Use growth charts to assess stunting (height-for-age) and wasting (weight-for-height) or mid-upper arm circumference (MUAC). Severe acute malnutrition is characterised by oedema of both feet or severe wasting (WFH less than -3 SD or MUAC <115 mm). It is a medical emergency requiring prompt assessment and specialised treatment.

Children with good appetite and no medical complications can be managed as outpatients with PlumpyNut (a ready-to-use therapeutic food (RUTF). Children with poor appetite or medical complications should be admitted for inpatient care. This care is divided into three main stages:

Correct hypoglycaemia, hypothermia, severe anaemia, severe dehydration and electrolyte imbalance, shock, congestive heart failure, corneal ulceration, etc.

Treat and prevent malnutrition's main features and complications.

As soon as the child’s appetite returns and oedema resolves, switch to high-calorie feeds such as F100 and RUTF.

All malnourished children have vitamin and mineral deficiencies. It is not necessary to give separate supplementation of any micronutrients to children receiving F75, F100 or PlumpyNut except in a child with measles or eye complications. Vitamin A supplementation is crucial in reducing child mortality.

Encourage exclusive breastfeeding for the first six months and continued breastfeeding with complementary feeding for up to two years or beyond.

These guidelines stress early detection of malnutrition using mid-upper arm circumference (MUAC) or weight-for-height, and they provide protocols for the treatment of SAM and moderate acute malnutrition (MAM).

This community-based program is widely implemented in Africa, focusing on the detection and management of acute malnutrition at the community level.

Infectious diseases, particularly malaria, pneumonia, diarrhea, and tuberculosis, remain leading causes of childhood mortality in sub-Saharan Africa.

Any child with fever in malaria-endemic areas should be tested with a rapid diagnostic test (RDT). If positive, treat promptly with artemisinin-based combination therapy (ACT).

Children with diarrhea should receive ORS to prevent dehydration. Zinc supplementation (10–20 mg/day for 10–14 days) reduces the duration and severity of diarrhoea.

Treat suspected bacterial pneumonia with antibiotics (e.g., amoxicillin). Use the presence of fast breathing and chest indrawing to diagnose pneumonia in resource-limited settings. HIV Care: Routine testing of infants born to HIV-positive mothers is crucial. Early initiation of antiretroviral therapy (ART) in HIV-infected children significantly reduces mortality.

WHO and UNICEF developed IMCI to manage common childhood illnesses at the community and health facility levels. It provides evidence-based protocols for treating malaria, pneumonia, diarrhea, and other infections.

Recommend ACT as first-line treatment for uncomplicated malaria and provide guidance on the management of severe malaria.

Vaccination is one of the most effective interventions for reducing child morbidity and mortality in sub-Saharan Africa. However, coverage is still below optimal levels in many areas.

Ensure children receive routine immunizations, including for BCG (tuberculosis), polio, diphtheria, tetanus, pertussis, hepatitis B, measles, and pneumococcal disease.

Community Outreach: Use community health workers to improve vaccine coverage, particularly in remote or underserved areas. Ensure vaccines are stored at the correct temperatures, particularly in rural areas with limited electricity, to maintain vaccine efficacy.

Provides a schedule for childhood vaccines that countries can adapt to local conditions. It also emphasizes strategies for increasing vaccine coverage and introducing new vaccines (e.g., rotavirus, pneumococcal, and HPV vaccines).

Neonatal mortality rates in sub-Saharan Africa are among the highest in the world, driven by complications from preterm birth, birth asphyxia and infections like neonatal sepsis, pneumonia, meningitis and tetanus.

Provide immediate skin-to-skin contact after birth to prevent hypothermia, initiate breastfeeding within the first hour, and administer vitamin K and tetracycline eye ointment to prevent hemorrhagic disease and eye infections, respectively.

Administer broad-spectrum antibiotics (e.g., ampicillin and gentamicin) for suspected sepsis in neonates. Early identification and treatment are critical for survival.

For low birth weight or preterm infants, promote KMC, which involves continuous skin-to-skin contact and breastfeeding. It reduces the risk of infections, improves weight gain, and enhances bonding.

Train birth attendants in neonatal resuscitation using bag-and-mask ventilation to reduce deaths from birth asphyxia.

Provide protocols for the essential care of newborns, including neonatal resuscitation, infection prevention, and treatment of low birth weightlow-birth-weight infants.

A WHO initiative aimed at reducing neonatal mortality and stillbirths by promoting high-impact interventions such as antenatal care, skilled birth attendance, and essential newborn care.

Paediatric TB, especially when associated with HIV, is a major public health issue in sub-Saharan Africa.

Suspect TB in children with chronic cough, failure to thrive, or a history of contact with TB-infected individuals. Use a combination of clinical, radiological, and bacteriological tests for diagnosis.

Use fixed-dose combinations (FDCs) to improve adherence and ensure accurate dosing. Treat drug-sensitive TB for six months with first-line drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol

Diarrheal diseases are preventable through improved hygiene and sanitation practices, yet they remain a major cause of death among children in sub-Saharan Africa.

Encourage continued breastfeeding and feeding during diarrheal episodes. Malnutrition and diarrhoea often coexist, and withholding food can worsen nutritional status. Give oral rehydration solution (ORS) to correct fluid deficit and ongoing losses in a child with diarrhoea. Add oral zinc sulfatesulphate at a dose of 20mg per day for 10-14 days (10mg in infants under the age of 6 months). Antibiotics for Dysentery: Use antibiotics only in cases of bloody diarrhoea (dysentery), typically caused by Shigella. Ciprofloxacin or ceftriaxone are commonly recommended antibiotics in such cases.

Recommend ORS and zinc supplementation as the cornerstones of diarrhoea management. Antibiotics are only indicated for specific causes, such as cholera or dysentery.

Focuses on prevention strategies, such as vaccines (rotavirus, cholera), breastfeeding, and sanitation.

HIV/AIDS remains a significant public health issue in sub-Saharan Africa, with a high burden of paediatric HIV.

All infants born to HIV-positive mothers should receive HIV testing within the first six weeks of life. Early infant diagnosis (EID) using PCR is crucial to start treatment early if necessary.

Initiate ART in all HIV-positive infants and children as soon as possible to reduce morbidity and mortality. Follow national protocols for first-line ART regimens.

Administer cotrimoxazole prophylaxis for children with HIV to prevent opportunistic infections. Prevention of mother-to-child transmission (PMTCT) programs, including maternal ART during pregnancy and breastfeeding, are essential for reducing paeediatric HIV infections.

Recommend early ART initiation for all children diagnosed with HIV. Guidelines also focus on PMTCT, nutritional support, and managing co-infections.

Adapt WHO recommendations to local contexts, providing comprehensive HIV services, including PMTCT, ART initiation, and routine follow-up care for children.

Administer cotrimoxazole prophylaxis for children with HIV to prevent opportunistic infections. Prevention of mother-to-child transmission (PMTCT) programs, including maternal ART during pregnancy and breastfeeding, are essential for reducing paeediatric HIV infections.

Sickle cell disease is a genetic disorder with high prevalence in sub-Saharan Africa, contributing significantly to childhood morbidity and mortality.

Where possible, screen newborns for SCD to allow early diagnosis and intervention.

Administer daily prophylactic antibiotics (e.g., penicillin) and ensure full vaccination to prevent life-threatening infections in children with SCD.

Encourage proper hydration and manage pain crises promptly with appropriate analgesics. Hydroxyurea can reduce the frequency of crises in severe cases. Children are better managed by haematologists utilising a comprehensive care package. If available, refer to a haematologist. As SCD is a multi-systemic illness, early detection and management of complications involve a multi-specialities approach.

Stress early diagnosis, infection prevention, and management of complications. The guidelines emphasize comprehensive care that includes vaccination, prophylactic antibiotics, and hydroxyurea use where available.

It stresses the complexity of the disease and the need for a multi-disciplinary management approach.

Neonatal jaundice, especially in preterm infants or those with hemolytic conditions (such as G6PD deficiency), can lead to severe complications if left untreated.

Monitor newborns for jaundice, particularly in the first week of life. Look for yellowing of the skin and eyes, starting from the face and progressing downward.

Use phototherapy to treat moderate jaundice, especially in preterm or low-birth-weight infants. In severe cases, exchange transfusion may be required. Treat underlying causes such as sepsis, etc

Ensure proper breastfeeding techniques and frequent feeding to prevent dehydration and exacerbate jaundice.

Recommend phototherapy as the first-line treatment for moderate jaundice and exchange transfusion for severe cases. The guidelines also emphasize early breastfeeding and follow-up for high-risk infants.

Respiratory infections like bronchiolitis caused by RSV are common in young children, particularly during seasonal peaks.

Usually present with coryza and nasal congestion, low-grade fever, and difficulty feeding. These may progress to respiratory distress (tachypnoea, nasal flaring, retractions), irritability and possibly, cyanosis.

Most cases of bronchiolitis can be managed with supportive care, including adequate hydration, nasal suctioning, and oxygen therapy for severe cases.

Bronchiolitis is usually viral, and antibiotics are not indicated unless there is a secondary bacterial infection. Monitor for Hypoxia: Children with severe respiratory distress may require oxygen therapy, and pulse oximetry should be used to monitor oxygen saturation levels.

Focus on supportive care, such as oxygen and hydration, for managing bronchiolitis. Antibiotics should only be used when bacterial co-infection is suspected.

Avoid Unnecessary Antibiotics: Bronchiolitis is usually viral, and antibiotics are not indicated unless there is a secondary bacterial infection. Children with severe respiratory distress may require oxygen therapy, and pulse oximetry should be used to monitor oxygen saturation levels.

Though relatively rare, childhood cancers such as Burkitt’s lymphoma and retinoblastoma are significant concerns in sub-Saharan Africa.

Suspect cancer in children with persistent symptoms such as unexplained weight loss, prolonged fever, or swelling. Early referral to specialized centers is crucial for timely diagnosis and treatment.

In many regions, chemotherapy may be limited, so referral to appropriate tertiary centers is essential for treatment. Encourage community support to facilitate access to care.

Manage Side Effects: Provide supportive care during chemotherapy to manage side effects like anaemia, infections, and malnutrition.

Emphasize early detection, referral to specialized care, and the use of chemotherapy protocols tailored to resource-limited settings. WHO also advocates for improving access to essential cancer medications.

Pediatric tuberculosis remains an important cause of morbidity and mortality in sub-Saharan Africa, particularly in areas with high HIV prevalence.

Actively screen children who are contacts of TB patients, particularly those with HIV. Children with persistent cough, fever, or weight loss should be evaluated for TB.

Administer DOTS (directly observed therapy) for confirmed cases of pediatric TB, ensuring adherence to treatment regimens to prevent drug resistance.

Ensure routine BCG vaccination to provide some protection against severe forms of TB in infants and young children.

Recommend a six-month course of first-line anti-TB drugs for children with drug-sensitive TB. WHO also emphasizes the integration of TB and HIV services for co-infected children.

Birth defects, including neural tube defects, congenital heart disease, and cleft palate, are a growing concern in sub-Saharan Africa, with many going undiagnosed or untreated.

The commonest congenital abnormality in humans is congenital heart disease (CHD). Others are cleft lip and/or palate, Down syndrome, spina bifida, clubfoot, etc.

Ensure women of reproductive age receive adequate folic acid supplementation to reduce the risk of neural tube defects in newborns.

Screen newborns for congenital abnormalities during routine postnatal check-ups. Early identification allows for better planning and intervention.

Refer children with correctable birth defects, such as cleft lip or congenital heart disease, to specialized centers for surgical intervention.  

Promote prevention through maternal folic acid supplementation and early detection and treatment of congenital anomalies.