There are no injectable drugs in the basic unit. Basic health workers with little training have usually not been taught to prescribe injections, neither are they trained to administer them. Moreover, the most common diseases in their uncomplicated form do not generally require an injectable drug. Any patient who needs an injection must be referred to the first referral level.
Infectious bacterial diseases are common at all levels of health care, including the most peripheral, and basic health workers should therefore have the possibility to prescribe an antibiotic. However, many basic health workers have not been trained to prescribe antibiotics in a rational way. Cotrimoxazole is the only antibiotic included in the basic unit, and this will enable the health worker to concentrate on taking the right decision between prescribing an antibiotic or not, rather than on the choice between several antibiotics. Cotrimoxazole has been selected because it is active against the most common bacteria found in the field, especially S. pneumoniae and H. influenzae for acute respiratory infections. It is also stable under tropical conditions, needs to be taken only twice daily and its side-effects (exfoliative dermatitis or bone marrow depression) are uncommon. In addition to this it is less expensive than other antibiotics. The risk of increasing bacterial resistance must be reduced by rational prescribing practice.
Medication for children
The only paediatric tablet included in the list is paracetamol tab 100 mg. Syrups for children are not included because of their instability, their short shelf life after reconstitution and their volume and weight. Instead, for children, half or quarter adult tablets may be crushed and administered with a small volume of fluid, with sweets or with food.
Drugs not included in the kit
The kit includes neither the common vaccines nor any drugs against communicable diseases such as tuberculosis3 or leprosy. The vaccines needed and any plans for an expanded programme on immunization should be discussed with the national authorities as soon as possible; the same applies for programmes to combat communicable diseases. In general no special programme should be initiated unless there is sufficient guarantee for its continuation over a longer period.
3The general prerequisites for the establishment of a tuberculosis control programme for refugees and displaced persons are: 1) the emergency phase is over; 2) security in and stability of the camp or site is envisioned for at least six months; 3) basic needs of water, adequate food and sanitation are available; and 4) essential clinical services and drugs are available.
In addition, drugs in the kit do not cover some specific health problems occurring in certain geographical areas, e.g. specific resistant malaria strains. The treatment of choice for eclamptic fits is intravenous and intramuscular magnesium sulfate. Staff may however be unfamiliar with its use and diazepam, which has other therapeutic indications, therefore remains in the kit. Ergometrine injection requires a cold chain because it is unstable if subjected to high ambient temperatures, and is therefore not included in the kit. Oxytocin is being supplied instead. No specific drugs are included for the treatment of sexually transmitted infections.
The kit does not contain:
drugs for tuberculosis
drugs for leprosy
magnesium sulfate injections
drugs for specific resistant malaria strains
drugs for sexually transmitted infections
drugs for regular contraception