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close this bookThe New Emergency Health Kit 10.000 (WHO)
View the document(introductory text...)
View the documentIntroduction
View the documentChapter 1: Essential drugs and supplies in emergency situations
View the documentChapter 2: Comments on the selection of drugs, medical supplies and equipment included in the kit
View the documentChapter 3: Composition of the new emergency health kit
View the documentAnnex 1 - Basic unit: treatment guidelines
Open this folder and view contentsAnnex 2 - Assessment and treatment of diarrhoea
Open this folder and view contentsAnnex 3 - Management of the child with cough or difficult, breathing
View the documentAnnex 4 - Sample monthly activity report
View the documentAnnex 5 - Sample health card
View the documentAnnex 6 - Guidelines for suppliers
View the documentAnnex 7 - Useful addresses

Annex 1 - Basic unit: treatment guidelines

These treatment guidelines are intended to give simple guidance for the training of primary health care workers using the basic unit. In the dosage guidelines, five age groups have been distinguished. When dosage is shown as I tab. x 2, one tablet should be taken in the morning and one before bedtime. When dosage is shown as 2 tab. x 3, two tablets should be taken in the morning, two should be taken in the middle of the day and two before bedtime.

The treatment guidelines contain the following diagnosis/symptom groups:

· Anemia
· Pain
· Diarrhoea: see detailed diagnosis and treatment schedules in Annex 2A-C.
· Fever
· Respiratory tract infections: see detailed diagnosis and treatment schedules in Annex 3.
· Measles
· Eye
· Skin conditions
· Urinary tract infections
" Sexually transmitted disease
· Preventive care in pregnancy
· Worms


WEIGHT


0. < 4 kg

4. <8 kg

8. < 15 kg

15. < 35 kg

35 kg +

DIAGNOSIS

AGE

SYMPTOM

0. < 2 mths

2 mths. < 1 yr

1. < 5 yrs

5. < 15 yrs

15 yes +


ANEMIA

Severe anemia (edemas, dizziness, shortness of breath)

Refer

Moderate anemia (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






Pain (headache, joint pain toothache...)


Paracetamol tab 100 mg 1/2 tab x 3

Paracetamol tab 100 mg 1 tab x 3

ASA(1)(2) tab 300 mg 1 tab x 3

ASA(1) tab 300 mg 2 tab x 3

Stomach pain



Refer

Aluminium hydroxide 1/2 tab x 3 for 3 days

Aluminium hydroxide 1 tab x 3 for 3 days

1) ASA = Accetylsalicylic Acid.
2) For children under 12 paracetamol is to be prefferred because of the risk of Reye's Syndrome.


WEIGHT






0. <4 kg

4. <8 kg

8. <15 kg

15. <35 kg

35 kg+

DIAGNOSIS

Age





SYMPTOM

0. <2 mths

2 mths <1 yr

1. < 5 yrs

5. <15 yrs

15 yrs+


DIARRHOEA

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

Give ORS according to dehydration stage and refer

Bloody diarrhoea(1) (Check the presence of blood in stools)

Give ORS according to dehydration stage and refer

Diarrhoea with severe dehydration (Plan C, WHO) Annex 2d

ORS, 100 ml/kg as soon as possible, and refer patient for nasogastric tube and/or IV treatment

Diarrhoea with some dehydration (Plan B, WHO) Annex 2c

Treat with ORS, 50-100 ml/kg in first 4-6 hours, reassess the condition after 4-6 hours


250 ml within 6 h

500 ml within 6 h

1 litre within 6 h

2 litre within 6 h

3 litre or + within 6 h

Diarrhoea with No dehydration (Plan A, WHO) Annex 2b

- Continue to feed.
- Advise the patient to return to health worker in case of frequent stools, increased thirst, sunken eyes, fever or when the patient does not eat or drink normally, or does not get better.

FEVER






Fever in malnourished or poor condition patient or when in doubt

Refer

Fever with chills(2) assuming it is malaria

Refer

Chloroquine (2) tab 150 mg base 1/2 tab at once, then 1/4 tab after 6h, 24h and 48h

Chloroquine (2) tab 150 mg base 1 tab at once, then 1/2 tab after 6h, 24h and 48h

Chloroquine (2) tab 150 mg base 2 tab at once, then 1 tab 6h, 24h et 48h

Chloroquine (2) tab 150 mg base 4 tab at once, then 2 tab after 6h, 24h et 48h

Fever with cough

Refer

See "Respiratory tract infection"

Fever (unspecified)

Refer

Paracetamol tab 100 mg 1/2 tab x 3 for 1 to 3 days

Paracetamol tab 100 mg 1 tab x 3 for 1 to 3 days

ASA(3) tab 300 mg 1 tab x 3 for 1 to 3 days

ASA tab 300 mg 2 tab x 3 for 1 to 3 days

1) Protocol to be established according to epidemiological data. Cotrimoxazole will usually be effective.

2) Chloroquine 150 mg base is equivalent to 250 mg chloroguine phosphate or to 200 mg chloroguirne sulfate.

3) For children under 12 paracetamol is to be preferred because of the risk of Reye's Syndrome.


WEIGHT






0. <4 kg

4. <8 kg

8. <15 kg

15. <35 kg

35 kg +

DIAGNOSIS

AGE





SYMPTOM

0. <2 mths

2 mths. <1 yr

1. <5 yrs

5. <15 yrs

15 yrs +







RESPIRATORY TRACT INFECTIONS

Severe pneumonia Annex 3

Give the first dose of cotrimoxazole (see pneumonia) and refer







Pneumonia Annex 3

Refer

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1/2 tab x 2 for 5 days

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 2 tab x 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 when the condition deteriorates.

No pneumonia: cough or cold Annex 3

Refer

Paracetamol(1) tab 100 mg 1/2 tab x 3 for 3 days

Paracetamol(1) tab 100 mg 1 tab x 3 for 3 days

ASA(1)(2) tab 300 mg 1 tab x 3 for 3 days

ASA(1) tab 300 mg 2 tab x 3 for 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 condition deteriorates.

Prolonged cough (over 30 days)

Refer

Acute ear pain ant/or ear discharge For less than 2 weeks

Refer

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1/2 tab x 2 for 5 days(1)

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days(1)

Cotrimoxazole tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days

Cotrimoxazole 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.

1) If fever is present
2) For children under 12 paracetamol is to be preferred because of the risk of Reye's syndrome.


WEIGHT


0. <4 kg

4. < 8 kg

8. < 15 kg

15. < 35 kg

35 kg +

DIAGNOSIS

AGE

SYMPTOM

0. <2 mths

2 mths. <1 yr

1. <5 yrs

5. <15 yrs

15 yrs +







MEASLES






Measles


Treat respiratory tract disease according to symptoms. Treat conjunctivitis as "Red eyes". Treat diarrhoea according to symptoms. Continue (brass) feeding. Give retinol (vitamin A)


EYE






Red eyes (conjunctivitis)

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

SKIN CONDITIONS

Wounds: extensive, deep or on face

Refer

Wounds: limited and superficial

Clean with clean water and soap or with diluted chlorhexidine solution*. Apply gentian violet solution** once a day.

Severe burns(on face or very 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 uses then, treat as wounds.

Severe bacterial infection (with fever)

Refer

Mild bacterial Infection

Clean with clan water and soap or diluted chlorhexidine solution*. Apply gentian violet ** 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* and apply gentian violet solution** twice a day.


When infection is cured:


Apply diluted benzyl benzoate***
once a day for 3 days

Apply non diluted benzyl benzoate 25*
once a day for 3 days

Non infected scabies

Apply diluted benzyl benzoate***
once a day for 3 days

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

* Chlorhexidine 5% must always be diluted before use: 20 ml in 1 litre of water (tale one litre plastic bottle supplied with kit. Put 20 ml of chlorhexidine solution into the bottle using the 10 ml syringe supplied with the kit. Fill up the bottle with boiled or clean watery. Chlorhexidine 1.5% + cetrimide 15% solution should be used in the same dilution.

** Dissolve gentian violet: 0.5% concentration I teaspoon of gentian violet powder pa litre of boiled/clean water.

*** Dilute by mixing one ha' liter benzyl benzoate 25% with one hay litre clean water in the one litre plastic bottle supplied with the kit.


WEIGHT


0. < 4 kg

4. < 8 kg

8. < 15 kg

15. < 35 kg

35 kg +

DIAGNOSIS

AGE

SYMPTOM

0. < 2 mths

2 mths. < 1 yr

1. < 5 yrs

5. < 15 yrs

15 yrs+

URINARY TRACT INFECTION

Suspicion of urinary tract infection

Refer

SEXUALLY TRANSMITTED DISEASE

Suspicion of sexually transmitted disease (syphilis, gonorrhea)

Refer

PREVENTIVE CARE IN PREGNANCY

Anemia for treatment see under Anemia


Ferrous sulfate + folic acid 1 tab. daily throughout pregnancy

Malaria for treatment see under Fever


Chloroquine(1) tab. 150 mg base 2 tab. weekly, throughout pregnancy

WORMS

Roundworm Pinworm


Mebendazole tab. 100 mg 2 tab. once

Mebendazole tab. 100 mg 2 tab. once

Mcbendazole tab. 100 mg 2 tab. once

Hookworm


Mebenzadole tab. 100 mg 1 tab. x 2 for 3 days

Mcbenzadole tab. 100 mg 1 tab. x 2 for 3 days

Mebenzadole tab. 100 mg 1 tab. x 2 for 3 days

1) Chloroquine 150 mg base is equivalent to 250 mg chloroquine phosphate or to 200 mg chloroquine sulfate.