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close this bookCommunicable Disease Control in Emergencies - A Field Manual (WHO - OMS, 2003, 223 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
View the documentINTRODUCTION
Open this folder and view contentsCHAPTER 1: RAPID ASSESSMENT
Open this folder and view contentsCHAPTER 2: PREVENTION
Open this folder and view contentsCHAPTER 3: SURVEILLANCE
Open this folder and view contentsCHAPTER 4: OUTBREAK CONTROL
Open this folder and view contentsCHAPTER 5: DISEASE PREVENTION AND CONTROL
View the documentANNEX 1: WHO REFERENCE VALUES FOR EMERGENCIES
View the documentANNEX 2: SAMPLE HEALTH SURVEY FORMS
View the documentANNEX 3: NCHS/WHO NORMALIZED REFERENCE VALUES FOR WEIGHT FOR HEIGHT BY SEX
View the documentANNEX 4: SAMPLE WEEKLY SURVEILLANCE FORMS
View the documentANNEX 5: RECOMMENDED CASE DEFINITIONS
View the documentANNEX 6: OUTBREAK INVESTIGATION FORMS
View the documentANNEX 7: ORGANIZATION OF AN ISOLATION CENTRE
View the documentANNEX 8: BASIC LABORATORY SERVICES
View the documentANNEX 9: LABORATORY INVESTIGATION KIT
View the documentANNEX 10: TREATMENT GUIDELINES
View the documentANNEX 11: MANAGEMENT OF THE CHILD WITH COUGH OR DIFFICULTY IN BREATHING6
View the documentANNEX 12: ASSESSMENT AND TREATMENT OF DIARRHOEA
View the documentANNEX 13: FLOW CHARTS FOR SYNDROMIC MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX 14: SAMPLE HEALTH CARD
View the documentANNEX 15: LIST OF WHO GUIDELINES ON COMMUNICABLE DISEASES
View the documentANNEX 16: LIST OF PUBLISHERS
View the documentANNEX 17: GENERAL REFERENCES

ANNEX 10: TREATMENT GUIDELINES

These treatment guidelines are intended to give simple guidance for the training of primary health care workers, using basic units of New Emergency Health Kits. In the dosage guidelines, five age groups have been distinguished, except for the treatment of diarrhoea with oral rehydration fluid where six age and weight categories are used. When dosage is shown as "1 tab × 2", one tablet should be taken in the morning and one before bedtime. When dosage is shown as "2 tab × 3", two tablets should be taken in the morning, two in the middle of the day and two before bedtime. These guidelines have been adapted from The New Emergency Health Kit 19985.

5 The New Emergency Health Kit 98. Geneva, World Health Organization, 1998 (document WHO/DAP/98.10).

The treatment guidelines contain the following diagnostic/symptom groups:

· anaemia
· pain
· diarrhoea
· fever
· preventive care in pregnancy
· measles
· respiratory tract infections
· worms
· skin conditions
· eyes
· sexually transmitted and urinary tract infections.

Anaemia

Weight

0 - <4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 - < 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Severe anaemia (oedema, dizziness, shortness of breath)

Refer

Moderate anaemia (pallor and tiredness)

Refer

Ferrous sulfate + folic acid, 1 tab daily for at least 2 months

Ferrous sulfate + folic acid, 2 tab daily for at least 2 months

Ferrous sulfate + folic acid, 3 tab daily for at least 2 months

Ferrous sulfate + folic acid, 3 tab daily for at least 2 months

Pain

Weight

0 - <4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 - < 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Pain (headache, joint pain, toothache)


Paracetamol, tab 100 mg, ½ tab × 3

Paracetamol, tab 100 mg, 1 tab × 3

ASA,a,b tab 300 mg, 1 tab × 3

ASA, tab 300 mg, 2 tab × 3

Stomach pain



Refer

Aluminium hydroxide, ½ tab × 3 for 3 days

Aluminium hydroxide, 1 tab × 3 for 3 days

a ASA = acetylsalicylic acid.
b For children under 12 years, paracetamol is to be preferred because of the risk of Reye's syndrome.

Diarrhoea

Weight

0 - < 5 kg

5-7.9 kg

8-10.9 kg

11-15.9 kg

16-29.9 kg

30 kg +

Age a

< 4 months

4-11 months

12-23 months

2-4 years

5-14 years

15 years +

Diagnosis
Symptom


Diarrhoea with some dehydration (WHO Treatment Plan B) b

Approximate amount of ORS solution to give in the first 4 hours (ml)


200-400

400-600

600-800

800-1200

1200-2200

2200-4000

Diarrhoea lasting more than two weeks or in malnourished patient or patient in poor condition

Give ORS according to dehydration stage and refer

Bloody diarrhoea C (check the presence of blood in stools)

Give ORS according to dehydration stage and refer

Diarrhoea with severe dehydration (WHO Treatment

Refer patient for nasogastric tube and/or intravenous treatment

Plan C) d


Diarrhoea with no dehydration (WHO Treatment Plan A) e

Continue to feed Advise the patient to return to the health worker in case of frequent stools, increased thirst, sunken eyes or fever; or when the patient does not eat or drink normally; or does not get better within three days; or develops blood in the stool or repeated vomiting

a Use the patient's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the patient's weight (in grams) times 0.075.

b The New Emergency Health Kit 98, Annex 2c.

C Protocol to be established according to epidemiological data.

d The New Emergency Health Kit 98, Annex 2d.

e The New Emergency Health Kit 98, Annex 2b.

Use of drugs for children with diarrhoea

· Antibiotics should only be used for dysentery and for suspected cases of cholera with severe dehydration. Otherwise they are ineffective and should not be given.

· Antiparasitic drugs should only be used for:

- amoebiasis, after antibiotic treatment of bloody diarrhoea for Shigella has failed, or trophozoites of Entamoeba histolytica containing red blood cells are seen in the faeces; and

- giardiasis, when diarrhoea has lasted for at least 14 days and cysts or trophozoites of Giardia are seen in the faeces or small bowel fluid.

· Antidiarrhoeal drugs and anti-emetics should never be used. None has any proven value and some are dangerous.

Fever

Weight

0 - < 4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 - < 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Fever in malnourished patient or patient in poor condition, or when in doubt

Refer

Fever with chills,a presumed malaria

Refer

Chloroquine, tab 150 mg base, ½ tab at once then ½ tab after 24 hours and ¼ tab after 48 hours

Chloroquine, tab 150 mg base, 1 tab at once then 1 tab after 24 hours and ½ tab after 48 hours

Chloroquine, tab 150 mg base, 2 tab at once then 2 tab after 24 hours and 1 tab after 48 hours

Chloroquine, tab 150 mg base, 4 tab at once then 4 tab after 24 hours and 2 tab after 48 hours

Fever with cough

Refer

See "Respiratory tract infections" below

Fever (unspecified)

Refer

Paracetamol, tab 100 mg, ½ tab × 3 for 1 to 3 days

Paracetamol, tab 100 mg, 1 tab × 3 for 1-3 days

ASA, b,c tab 300 mg, 1 tab × 3 for 1-3 days

ASA, tab 300 mg, 2 tab × 3 for 1-3 days

a Chloroquine, 150 mg base, is equivalent to approximately 250 mg chloroquine phosphate or to approximately 200 mg chloroquine sulfate.

b ASA = acetylsalicylic acid.

c For children under 12 years, paracetamol is to be preferred because of the risk of Reye's syndrome.

Preventive care in pregnancy

Weight

0 - < 4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 - < 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Anaemia

(for treatment see under Anaemia)





Ferrous sulfate + folic acid, 1 tab daily throughout pregnancy

Malaria

(for treatment see under Fever)





Chloroquine, tab 150 mg base, 2 tab weekly throughout pregnancy a

a Chloroquine, 150 mg base, is equivalent to approximately 250 mg chloroquine phosphate or to approximately 200 mg chloroquine sulfate.

Measles

Weight

0 - < 4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 -< 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom




Measles


Treat respiratory tract disease according to symptoms
Treat conjunctivitis as "red eyes"
Treat diarrhoea according to symptoms
Continue (breast) feeding, give retinol (vitamin A)


Respiratory tract infections

Weight

0 - < 4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

5 kg +

Age

0 -< 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Severe pneumonia a

Give the first dose of co-trimoxazole (see under Pneumonia) and refer

Pneumonia a

Refer

Co-trimoxazole, tab 400 mg SMXa + 80 mg TMP,b ½ tab × 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP, 1 tab × 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP, 1 tab × 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP, 2 tab × 2 for 5 days



Reassess after 2 days; continue (breast) feeding, give fluids, clear the nose; return if breathing becomes faster or more difficult, or not able to drink or if the condition deteriorates.

No pneumonia: cough or cold a

Refer

Paracetamol c tab 100 mg ½ tab × 3 for 1-3 days

Paracetamol tab 100 mg 1 tab × 3 for 1-3 days

ASA d,e tab 300 mg 1 tab × 3 for 1-3 days

ASA tab 300 mg 2 tab × 3 for 1-3 days



Supportive therapy; continue (breast) feeding, give fluids, clear the nose; return if breathing becomes faster or more difficult, or not able to drink or if the condition deteriorates.

Prolonged cough (30 days)

Refer





Acute ear pain and/or ear discharge for less than 2 weeks

Refer

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP ½ tab x 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days

Co-trimoxazole, tab 400 mg SMX + 80 mg TMP 2 tab x 2 for 5 days

Ear discharge for more than 2 weeks, no pain or fever

Clean the ear once daily by syringe without needle using lukewarm clean water. Repeat until the water comes out clean. Dry repeatedly with clean piece of cloth.

a SMX = sulfamethoxazole.
b TMP = trimethoprim.
c If fever is present.
d ASA = acetylsalicylic acid.
eFor children under 12 years, paracetamol is to be preferred because of the risk of Reye's syndrome.

Wormsa

Weight

0 - <4 kg

4 - < 8 kg

8 - < 15 kg

15 - < 35 kg

35 kg +

Age

0 -< 2 months

2 months - < 1 year

1 - < 5 years

5 - < 15 years

15 years +

Diagnosis
Symptom






Roundworm, pinworm



Mebendazole, tab 100 mg, 2 tab once

Mebendazole, tab 100 mg, 2 tab once

Mebendazole, tab 100 mg, 2 tab once

Hookworm



Mebendazole, tab 100 mg, 1 tab × 2 for 3 days

Mebendazole, tab 100 mg, 1 tab × 2 for 3 days

Mebendazole, tab 100 mg, 1 tab × 2 for 3 days

a Treatment of hookworm in pregnancy with mebendazole is recommended in endemic areas; mebendazole can safely be given in the second and third trimesters of pregnancy.

Skin conditions

Wounds: extensive, deep or on face

Refer

Wounds: limited and superficial

Clean with clean water and soap or diluted chlorhexidine solution.a Gently apply gentian violet solution b once a day.

Severe burns (on face or extensive)

Treat as for mild burns and refer.

Mild moderate burns

Immerse immediately in cold water, or use a cold wet cloth. Continue until pain eases, then treat as for wounds.

Severe bacterial infection (with fever)

Refer

Mild bacterial infection

Clean with clean water and soap or diluted chlorhexidine solution.
Apply gentian violet solution twice a day.
If not improved after 10 days, refer.

Fungal infection

Apply gentian violet solution once a day for 5 days.

Infected scabies

Bacterial infection: clean with clean water and soap or diluted chlorhexidine solution. Apply gentian violet solution twice a day.


When infection is cured:


Children <12 years

Children =>12 years and adults


Apply diluted benzyl benzoate c once a day for 3 days.

Apply non-diluted benzyl benzoate (25%) once a day for 3 days.


Children <12 years

Children =>12 years and adults

Non-infected scabies

Apply diluted benzyl benzoate c once a day for 3 days.

Apply non-diluted benzyl benzoate (25%) once a day for 3 days.

a Chlorhexidine 5% must always be diluted before use: 20 ml made up to 1 litre with water. Take the 1-litre plastic bottle supplied with the kit; put 20 ml of chlorhexidine solution into the bottle using the 10-ml syringe supplied and fill up the bottle with boiled or clean water. Chlorhexidine 1.5% + cetrimide 15% solution should be used in the same dilution.

b Gentian violet 0.5% concentration = 1 teaspoon of gentian violet powder per litre of boiled/clean water. Shake well, or use warm water to dissolve all the powder.

c Children 1-12 years,at half strength (12.5%): dilute by mixing 0.5 litre benzyl benzoate 25% with 0.5 litre clean water in the 1-litre bottle supplied with the kit. Infants (0-12 months),at quarter strength (6.25%): dilute by mixing 0.5 litre benzyl benzoate 12.5% with 0.5 litre clean water.

Eyes

Red eyes (conjunctivitis)

Apply tetracycline eye ointment 3 times a day for 7 days. If not improved after 3 days or in doubt, refer.

Sexually transmitted and urinary tract infections

Suspicion of sexually transmitted or urinary tract infection

Refer