The New Emergency Health Kit 98: Drugs and Medical Supplies for 10,000 People for Approximately 3 Months: Annex 4: Sample data collection forms

The New Emergency Health Kit 98: Drugs and Medical Supplies for 10,000 People for Approximately 3 Months
(1998; 82 pages) [French] [Spanish]

Table of Contents

	Acknowledgments
	Introduction
	Chapter 1: Essential drugs and supplies in emergency situations
		What is an emergency?
		Quantification of drug requirements
		Contents of the kit
		Referral system
		Drug and supply management control
		Procurement of the kit
		Immunization in emergency
		Reproductive health
		Post emergency needs
	Chapter 2: Comments on the selection of drugs, medical supplies and equipment included in the kit
		Selection of the drugs
		Selection of renewable supplies
		Selection of equipment
		Major drug, equipment and supply changes since the 1990 edition
	Chapter 3: Composition of the New Emergency Health Kit 98
		Basic unit (for 1,000 persons, 3 months)
		Supplementary unit (for 10,000 persons for 3 months)
	Annex 1: Basic unit: treatment guidelines
	Annex 2: Assessment and treatment of diarrhoea
		Annex 2a: Assessment of diarrhoeal patients for dehydration
		Annex 2b: Treatment Plan A to treat diarrhoea at home
		Annex 2c: Treatment Plan B to treat dehydration
		Annex 2d: Treatment Plan C to treat severe dehydration quickly
	Annex 3: Management of the child with cough or difficult breathing
		Annex 3a: Child less than two months old
		Annex 3b: Child two months to five years old
		Annex 3c: Treatment instructions
	Annex 4: Sample data collection forms
	Annex 5: Sample health card
	Annex 6: Guidelines for suppliers
		Specifications for drugs and materials
		Packaging
		Packing list
		Information slips
	Annex 7: Other kits for emergency situations
		Immunization
		Nutritional support - feeding kits
		Reproductive health kits for emergencies
	Annex 8: Guidelines for Drug Donations⁴⁸
		Selection of drugs
		Quality assurance and shelf-life
		Presentation, packing and labelling
		Information and management
	Annex 9: Model Guidelines for the International Provision of Controlled Medicines for Emergency Medical Care⁵²
		Introduction
		Definitions
		Purpose and principle
		Scope of application
		Selection of suppliers
		Outline of standard agreement between suppliers⁵³ and control authorities of exporting countries
		Summary of the request procedure
		Model shipment request/notification form for emergency supplies of controlled substances
	Annex 10: References
		Drugs and drug management
		Gastrointestinal disease
		General public health
		HIV and STDs
		Immunization
		Laboratory support
		Malaria
		Materials
		Mental health
		Nutrition
		Reproductive health
		Respiratory tract infections
		Tuberculosis
	Annex 11: Useful addresses
	Organizations which have collaborated in the preparation of the New Emergency Health Kit 98
	Back Cover

Annex 4: Sample data collection forms

Daily morbidity data

Location:	Clinic:
Date:
	Children under 5 years old	Children 5 years and older, and adults	Total
Diarrhoea with blood
Diarrhoea without blood
Faver/suspected malaria
Malnutrition
Measles
Meningitis
Severe acute respiratory infections/pneumonia
Sexually transmitted infections
Others
Totals
Number of cases referred to other services:
Other information:

Weekly mortality statistics

Location:			Total population:
Week:
Cause of death	Children under 5 years old		Children 5 years and older, and adults		Total
	*Male*	*Female*	*Male*	*Female*	*Male*	*Female*
ARI⁴⁷/pneumonia
Diarrhoea
Diarrhoea with blood
Fever/suspected malaria
Malnutrition
Maternal deaths
Measles
Meningitis
Others
Totals
Other information:

⁴⁷ARI = Acute respiratory infection

Daily drug consumption form

Date:	Location:
Item/drug	Quantities dispensed*	Total
1. acetylsalicylic acid
2. aluminium hydroxide
3. chloroquine
4. cotrimoxazole
5. ferrous sulfate + folic acid
6. gentian violet powder
7. mebendazole
8. ORS
9. paracetamol
10. tetracycline eye ointment
11.
12.
13.
14.
15.
16.
17.

* For example: 10 + 30 + 20...