The New Emergency Health Kit 98: Drugs and Medical Supplies for 10,000 People for Approximately 3 Months: Annex 1: Basic unit: treatment guidelines

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

Table des matières

	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 1: Basic unit: treatment guidelines

These treatment guidelines are intended to give simple guidance for the training of primary health care workers using basic units. 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 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.

Photo: CICR/G. Leblanc

The treatment guidelines contain the following diagnostic/symptom groups:

• anaemia
• pain
• diarrhoea (see detailed diagnosis and treatment schedules in Annex 2)
• fever
• respiratory tract infections (see detailed diagnosis and treatment schedules in Annex 3)
• ear infections
• measles
• eyes
• skin conditions
• sexually transmitted and urinary tract infections
• preventive care in pregnancy
• worms.

Anaemia

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*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 sultate + 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 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*Diagnosis Symptom*
Pain headache, joint pain, toothache)		paracetamol tab 100 mg 1/2 tab x 3	paracetamol tab 100 mg 1 tab x 3	ASA^32,33 tab 300 mg 1 tab x 3	ASA 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

³²ASA = acetylsalicylic acid.
³³For children under 12 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^*	Less than 4 months	4 - 11 months	12 - 23 months	2 - 4 years	5 - 14 years	15 years or older
*Diagnosis Symptom*
Diarrhoea with some dehydration (Plan B, WHO) Annex 2c	Approximate amount of ORS solution to give in the first 4 hours.
Quantity of ORS in mls.	200 - 400	400 - 600	600 - 800	800 - 1,200	1,200 - 2,200	2,200 - 4,000
Diarrhoea lasting more than two weeks or in malnourished or poor condition patient	Give ORS according to dehydration stage and refer.
Bloody diarrhoea³⁴(check the presence of blood in stools)	Give ORS according to dehydration stage and refer.
Diarrhoea with severe dehydration (Plan C, WHO) Annex 2d	Refer patient for nasogastric tube and/or IV treatment.
Diarrhoea with no dehydration (Plan A, WHO), Annex 2b	Continue to feed. Advise the patient to return to the 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 within three days, or develops blood in the stool or repeated vomiting.

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

³⁴Protocol to be established according to epidemiological data.

Use of drugs for children with diarrhoea

• ANTIBIOTICS should ONLY be used for dysentery and for suspected cholera cases 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 E. Histolytica containing red blood cells are seen in the faeces.

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

• ANTIDIARRHOEAL DRUGS and ANTIEMETICS should NEVER be used. None has 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 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*Diagnosis Symptom*
Fever in malnourished or poor condition patient or when in doubt	Refer
Fever with chills³⁵ assuming it is malaria	Refer	chloroquine tab 150 mg base 1/2 tab at once, then 1/2 tab after 24h and 1/2 tab after 48h	chloroquine tab 150 mg base 1 tab at once, then 1 tab after 24h and 1/2 tab after 48h	chloroquine tab 150 mg base 2 tab at once, then 2 tab after 24h and 1 tab after 48h	chloroquine tab 150 mg base 4 tab at once, then 4 tab after 24h and 2 tab after 48h
Fever with cough	Refer	See “Respiratory tract infections”
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	ASA³⁶ 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

³⁵Chloroquine 150 mg base is equivalent to approximately 250 mg chloroquine phosphate or to approximately 200 mg chloroquine sulfate. See also footnote 8.

³⁶For children under 12 paracetamol is to be preferred because of the risk of Reye’s Syndrome.

NB

Resistance to chloroquine is increasing and it is difficult to give a global recommendation for the treatment of malaria. There is an international trend to replace chloroquine with sulfadoxine + pyrimethamine. It is recommended to seek advice from the national malaria programme.

Respiratory tract infections

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*Diagnosis Symptom*
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	paracetamol³⁷ 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	ASA³⁸ 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
		Supportive therapy; 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.
Prolonged cough (over 30 days)	Refer

³⁸For children under 12 paracetamol is to be preferred because of the risk of Reye’s Syndrome.

Ear infections

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*Diagnosis Symptom*
Acute ear pain and/or ear discharge for less than 2 weeks	Refer	cotrimoxazole tab 400 mg SMX + 80 mg TMP 1/2 tab x 2 for 5 days³⁷	cotrimoxazole tab 400 mg SMX + 80 mg TMP 1 tab x 2 for 5 days³⁷	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 water comes out clean. Dry repeatedly with clean piece of cloth.

³⁷If fever is present.

Measles

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*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).

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.

Skin conditions

Wounds: extensive, deep or on face	Refer
Wounds: limited and superficial	Clean with clean water and soap or diluted chlorhexidine solution³⁹. Gently apply gentian violet solution⁴⁰ 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 wounds
Severe bacterial infection (with fever)	Refer
Mild bacterial infection	Clean with clean water and soap or diluted chlorhexidine solution.³⁹ Apply gentian violet solution⁴⁰ twice a day. If not improved after 10 days refer.
Fungal infections	Apply gentian violet solution⁴⁰ once a day for 5 days.
Infected scabies	Bacterial infection: clean with clean water and soap or diluted chlorhexidine solution³⁹. Apply gentian violet solution⁴⁰ twice a day. When infection is cured:
	Apply diluted benzyl benzoate⁴¹ once a day for 3 days.	Apply non diluted benzyl benzoate 25% once a day for 3 days.
Non infected scabies	Apply diluted benzyl benzoate⁴¹ once a day for 3 days.	Apply non diluted benzyl benzoate25% once a day for 3 days.

³⁹Chlorhexidine 5% must always be diluted before use: 20 ml in 1 litre of water. Take the one 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.

⁴⁰Gentian violet 0.5% concentration = 1 teaspoon of gentian violet powder per litre of boiled/clean water. Shake well, or use warm water to disolve all powder.

⁴¹Dilute by mixing one half litre benzyl benzoate 25% with one half litre clean water in the one litre plastic bottle supplied with the kit.

Sexually transmitted and urinary tract infections

Suspicion of sexually transmitted or urinary tract infection

Refer

Preventive care in pregnancy

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*Diagnosis Symptom*
Anaemia for treatment see under anaemia					ferrous sulfate + folic acid 1 tab daily throughout pregnancy
Malaria for treatment see under fever					chloroquine⁴² tab 150 mg base 2 tab weekly throughout pregnancy

⁴²Chloroquine 150 mg base is equivalent to approximately 250 mg chloroquine phosphate or to approximately 200 mg chloroquine sulfate. See also footnote 8.

NB

Resistance to chloroquine is increasing and it is difficult to give a global recommendation for malaria prophylaxis in pregnancy. It is recommended to seek advice from the national malaria programme.

Worms⁴³

*Weight*	0 - <4 kg	4 - <8 kg	8 - <15 kg	15 - <35 kg	35 kg +
*Age*	0 - <2 mths.	2 mths. - <1 yr.	1 - <5 yrs.	5 - <15 yrs.	15 yrs. +
*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 x 2 for 3 days	mebendazole tab 100 mg 1 tab x 2 for 3 days	mebendazole tab 100 mg 1 tab x 2 for 3 days

⁴³Note: treatment of hookworm in pregnancy with mebendazole is recommended in endemic areas: mebendazole can be safely given in the second and third trimesters of pregnancy.