Sarita turned 9 months old the day her mother brought her to a rural health center in El Salvador. The mother was 16, had a third-grade education, and complained that her little girl had been coughing for four days and was not eating well.

In the past, the health worker might have given the mother an antibiotic for the cough and then sent her home. Today, because of a Pan American Health Organization (PAHO) initiative, the health worker has learned not only how to evaluate and treat Sarita's cough, but how to determine Sarita's general health status during the same visit. He has learned how to treat her or refer her elsewhere for more serious health problems that could kill her within days or even hours if not treated properly.

Sarita's story is a composite drawn from the case files of millions of children all over the Americas. According to Dr. Yehuda Benguigui, PAHO's regional advisor in Integrated Management of Childhood Illnesses, children like Sarita are often misdiagnosed and treated incorrectly, even by some doctors. "Three of every four children taken to a health service in Latin America suffer from one or more of a group of diseases that we know how to control: acute respiratory infections, diarrhea, malnutrition, malaria, and measles." In developing countries, Benguigui notes, seven of every 10 deaths of children are due to one or more of those diseases and worldwide, 12 million children die every year from these diseases.

In many cases, opportunities to treat children's health problems are missed because a health worker only focuses on the specific, immediate problem and ignores other potentially dangerous conditions, according to Benguigui. But Sarita's case was handled differently, stemming from an innovative approach called Integrated Management of Childhood Illnesses (IMCI) that combines effective measures to control common childhood diseases. By giving the right information to the right people at the right time, Benguigui says, IMCI is already saving children's lives in Bolivia, Brazil, the Dominican Republic, Ecuador, and Peru. During 1997, IMCI is expected to take root throughout the Hemisphere, as Argentina, Colombia, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay, and Venezuela incorporate its use.

The approach, developed by UNICEF, the World Health Organization (WHO), and PAHO, is simple and practical. Primary health care workers are taught a complete process to evaluate the health status of children brought to a health post or clinic. They learn to recognize signs of disease and evaluate and treat them. They learn to give parents information on how to prevent disease in the home. If they see danger signs indicating the infant could die, they are taught to treat the child immediately or take him or her to a hospital.

In a course PAHO organized in El Salvador in 1996, dozens of health workers who will treat cases like Sarita's learned through case studies and in practice sessions with an instructor how to examine a child for the signs that could mean severe illness or death, and what to do in each case. "It's not high technology, but it is an efficient way to save lives and cut the burden of disease," says Benguigui. And the number of lives that could be saved is staggering. In the Americas alone, some 257,000 children under age 5 die every year from causes that could be prevented with the IMCI approach. This includes more than 97,000 deaths from pneumonia; 90,000 deaths from diarrhea; 30,000 from malnutrition; 18,000 from septicemia, or blood poisoning from infections; 11,000 from meningitis; 8,000 from vaccine-preventable diseases; and 1,300 from malaria. The majority of these children, Benguigui notes, died needlessly and could have been saved if they had received timely, adequate treatment.

Furthermore, these common diseases are relatively easy to treat. For pneumonia, antibiotics can effectively treat most cases. For diarrhea, oral rehydration salts can save a child from dying of dehydration. Basic education on proper nutrition and promotion of breastfeeding can avoid many malnutrition problems. Vaccines, vital to avoid measles and other diseases, are available at health centers daily, and a series of low-cost tablets can protect children from malaria in zones where that disease occurs.

These techniques are being taught from materials developed by PAHO in conjuction with WHO, UNICEF, and the U.S. Agency for International Development (AID) through its BASICS (Basic Support for Institutionalizing Child Survival) project. Regional courses have been held in Peru, El Salvador, Brazil, and other countries. Benguigui says a massive effort is currently under way to reach every health worker in the Americas with this information--either by providing the teaching materials or the training, or both, thus forming a network spanning the Americas--but he notes that more funding will be needed to reach this goal.

During the two-week PAHO course, health workers learn to look for tell-tale symptoms for a variety of childhood diseases and then follow a series of simple evaluation and classification charts to determine how serious the illness is. The charts are color-coded: red means the child's condition is urgent and requires hospitalization; yellow and green indicate the problem is less serious and can usually be treated in the health center or at home. Along with the courses, PAHO also has developed and distributed training modules, posters, and a video.

Having taken the training, the health worker in El Salvador who sees a case follows the procedures outlined in the color-coded charts. He asks the mother if the child has diarrhea, checks her temperature, sees if she has any ear infections, checks her nutritional status, and sees if her immunizations are up to date. Since the mother says her daughter also has diarrhea, the health worker asks when it started and if she has blood in her stool. The child is not lethargic or irritable, she seems thirsty, and her skin returns to its shape slowly when pinched. According to the chart, she is mildly dehydrated, so the health worker gives her oral rehydration salts, and shows the mother how to continue caring for her at home. Also, he notices she has not yet had her measles vaccination, and takes advantage of her presence there to give the child a measles vaccine.

He then asks a series of specific questions about her cough, counting how many breaths she takes per minute, and observing if her chest draws in or rises when she inhales. Since it draws in, and he can hear obstructions in her breathing, she may have severe pneumonia and must be given an antibiotic and taken to a hospital immediately, according to the charts. He convinces the mother to take her daughter to a hospital, calms her fears, and writes a note detailing her symptoms and what he has done during the visit. Then he arranges for a neighbor with a truck to take mother and child to the hospital, where the girl is treated for severe pneumonia and dehydration.

This case illustrates the important advances that have been made in basic health interventions and how they can benefit children like Sarita. A life has been saved because a health worker learned what to do, how and when to do it, and took the appropriate action. Not only will the little girl live, but she won't succumb to measles, either, because now she is vaccinated. Her mother has learned to treat dehydration, and she has gained confidence in the health system. The neighbors who have learned about what happened to the girl through the grapevine have also learned an important lesson in prevention and think of their own children.

"We have many, many cases like this," Benguigui says. "Even saving one life is important. The potential for saving hundreds of thousands of children's lives in the Americas is tremendous, and this integrated management approach shows us the way."