The New Emergency Health Kit 10.000 (WHO): Annex 1 - Basic unit: treatment guidelines

The New Emergency Health Kit 10.000 (WHO)

		(introductory text...)
		Introduction
		Chapter 1: Essential drugs and supplies in emergency situations
		Chapter 2: Comments on the selection of drugs, medical supplies and equipment included in the kit
		Chapter 3: Composition of the new emergency health kit
		Annex 1 - Basic unit: treatment guidelines
		Annex 2 - Assessment and treatment of diarrhoea
		Annex 3 - Management of the child with cough or difficult, breathing
		Annex 4 - Sample monthly activity report
		Annex 5 - Sample health card
		Annex 6 - Guidelines for suppliers
		Annex 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.