Clinical Management and Referral Guidelines - Pharmacy and

172 Pages·2010·0.89 MB·English

Level 1 – Community
Republic of Kenya
Reversing the Trends
The Second National Health Sector Strategic Plan
CLINICAL MANAGEMENT AND
REFERRAL GUIDELINES
Volume I
Clinical Guidelines for Management
and Referral of Common Conditions
at Level 1: The Community
Ministry of Medical Ministry of Public Health
Services & Sanitation
Afya House Afya House
PO Box 30016 – GPO PO Box 30016 – GPO
Nairobi 00100, Kenya Nairobi 00100, Kenya
Email: [email protected] Email: [email protected]
www.health.go.ke
WorldHealthOrganization
2009
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Clinical Guidelines
THIS DOCUMENT was produced with the support of the World Health
Organization (WHO) Kenya Country Office, and all reasonable precautions have
been taken to verify the information it contains. The published material does not
imply the expression of any opinion whatsoever on the part of the World Health
Organization, and is being distributed without warranty of any kind – either
expressed or implied. The responsibility for interpretation and use of the material
lies with the reader. In no event shall the World Health Organization be liable for
damages arising from its use.
Any part of this document may be freely reviewed, quoted, reproduced, or
translated in full or in part, provided the source is acknowledged. It may not be
sold or used in conjunction with commercial purposes or for profit.
The Ministry welcomes comments and queries from users of this publication.
Please send feedback to:
Office of the Director of Medical Services
Afya House
PO Box 3469 – City Square
Nairobi 00200, Kenya
Clinical Management and Referral Guidelines – Volume I:
Clinical Guidelines for Management and Referral of Common Conditions at
Level 1: The Community
Published by: Ministry of Medical Services and Ministry of Public Health and
Sanitation
Afya House
PO Box 3469 – City Square
Nairobi 00200, Kenya
http://www.health.go.ke
Email: [email protected]; [email protected]
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Level 1 – Community
Contents
List of Tables and Figures vii
List of Abbreviations viii
Contributors to This Volume ix
Foreword xiii
Preface xv
Introduction xvii
CHAPTER 1 – Overview of Level 1 Services 1
1.1Organization and Delivery of the Kenya Essential Package for Health 1
1.2KEPH Objectives and Strategies 3
1.3Service Providers at Level 1 5
1.3.1 Health Promotion 6
1.3.2 Disease Prevention 6
1.3.3 Care Seeking and Compliance with Treatment and Advice 6
1.3.4 Governance and Management of Health Services 7
1.3.5 Claiming Rights 7
1.4Structure of Service Provision at Level 1 7
1.4.1 Family Health Care to Expand FP, Maternal, Child, and Youth Services 7
1.4.2 Hygiene and Environmental Sanitation 8
CHAPTER 2 – Pregnancy and Newborn Services 9
2.1Key Messages 9
2.2Communication of the Key Messages 17
2.3Antenatal and Delivery Care 18
2.3.1 Danger Signs in Pregnancy 18
2.3.2 Delivery 18
2.4Care of the Newborn Baby 19
2.4.1 Care of the Baby at Delivery 19
2.4.2 Care of a Newborn 19
2.4.3 Signs of Bacterial Infection in an Infant 19
2.5Congenital Abnormalities 20
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Clinical Guidelines
CHAPTER 3 – Early Childhood (2 Weeks to 5 Years) 21
3.1Child Development 21
3.1.1 Normal Development 21
3.1.2 Development Milestones 23
3.1.3 Development in Children with Disabilities and Special Needs 26
3.2Child Nutrition 27
3.2.1 Types of Food and Food Groups 27
3.2.2 Factors Influencing the Availability and Absorption of Nutrients in the
Body 28
3.2.3 Feeding Children from Birth to 5 years 28
3.2.4 The Micronutrients 32
3.2.5 Factors That Promote Good Nutrition 33
3.2.6 Growth Monitoring and Promotion 34
3.2.7 Food and Environmental Hygiene 37
3.3Child Immunization 39
3.3.1 Childhood Vaccines 39
3.3.2 Nutrition and Immunity 41
3.4Care of Sick Children Aged 2 Months to 5 Years and Disease Prevention 43
3.4.1 Signs to Observe in an Infant 0–2 Months 43
3.4.2 Recognizing a Sick Child 43
3.4.3 Child with Diarrhoea 44
3.4.4 Child with Cough (Respiratory Infection) 48
3.4.5 Child with Fever 51
3.5Malnutrition 55
3.5.1 Detecting Malnutrition 55
3.5.2 What Action to Take 56
3.5.3 Kwashiorkor 56
3.5.4 Marasmus 57
3.5.5 Micronutrient Deficiency 57
3.5.6 Managing Malnutrition Cases at Community Level 59
3.6.7 Consequences of Malnutrition 59
3.5.8 Preventing Malnutrition 59
3.6Anaemia 59
3.7Home Accidents and Poisoning 60
3.7.1 Accidents 60
3.7.2 Poisoning 64
3.8Chronic Illnesses/Disorders 65
3.8.1 Allergic Rhinitis 65
3.8.2 Skin Conditions 65
3.8.3 Heart and Blood Vessel Diseases in Children 66
3.9The Child with Disability 67
3.9.1 Cerebral Palsy 67
3.9.2 Childhood Blindness 67
3.9.3 Hearing Impairment 68
3.9.4 Generalized Seizures (Epileptic Fits) 68
3.10 Summary 69
3.10.1 Working with the Community to Care for Young Children 69
3.10.2 Care of Sick Child and Health Care Seeking Behaviour 69
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Level 1 – Community
CHAPTER 4 – Late Childhood (5–12 Years) 71
4.1School Health 71
4.1.1 The Objectives of a School Health Programme 72
4.1.2 Strategies for Reaching School Health Objectives 73
4.2Promoting the Health and Development of the School Age Child 73
4.2.1 Mental and Psychological Development 73
4.2.2 Nutrition for School Age Children 75
4.2.3 Worm Infestation 76
4.2.4 Malaria Control 77
4.2.5 Healthy Habits 77
4.2.6 Drug and Substance Abuse 78
4.3 Care of Children with an Illness 80
4.3.1 Conjunctivitis 80
4.3.2 Skin Disorders 81
4.3.3 Nose Bleeding 82
4.3Children with Chronic Disorders 82
4.3.1 Eye Care 82
4.3.2 Children on Regular Medication 83
4.4Children with Disability 84
CHAPTER 5 – Adolescence and Youth (13–24 Years) 86
5.1Reproductive Health 86
5.1.1 Pregnancy and Complications of Pregnancy 86
5.1.2 HIV and AIDS 88
5.1.3 Other Sexually Transmitted Diseases 91
5.1.4 Home- and Community-Based Care for People with HIV and AIDS 92
5.1.5 Sexual Assault 96
5.2Drug and Substance Abuse 97
5.2.1 Risks Associated with Substance Abuse 97
5.2.2 Recognizing and Coping with Substance Abuse in a Child or
Teenager 98
5.2.3 Drugs in the School 99
5.3Good Nutrition and Other Appropriate Healthy Behaviour 100
5.4Mental Health 101
5.5Management of Selected Illnesses and Other Conditions 102
5.5.1 Blood Diseases 102
5.5.2 Acute Injuries, Trauma, and Selected Emergencies 103
CHAPTER 6 – Adulthood (25–59 Years) 110
6.1Reproductive Health 110
6.2Physical Exercise 112
6.3Managing Illness 113
6.3.1 Acute Illnesses 113
6.3.2 Chronic Illnesses 115
6.3.3 Diseases Affecting Women 125
6.3.4 Infertility 128
6.4Family Planning (FP) 129
6.5Community TB Control 129
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Clinical Guidelines
CHAPTER 7 – Elderly Persons (60+ Years) 132
7.1Maintaining Good Health 132
7.2Managing Disease 133
7.2.1 Diseases of the Heart and Blood Vessels 133
7.2.2 Cancers and Growths 134
7.2.3 Senile Cataract 134
Index 135
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Level 1 – Community
List of Tables and Figures
Tables
A: KEPH strategic Interventions, by level and life-cycle cohort xxi
1.1: Services needed during the life cycle of an individual 2
3.1: How to feed young children well 29
3.2: Growth chart findings and appropriate relevant recommendations 36
3.3: Immunization schedule 42
3.4: Guidelines for giving ORS to children with diarrhoea 47
4.1: Summary of worms, modes of transmission, and prevention methods 76
5.1: Modes of transmission and preventive measures for HIV infection 96
5.2: Clinical features and treatment of common acute poisonings 105
Figures
A: The comprehensive approach to health care service delivery xix
B: The KEPH system xx
1.1: Levels of care in KEPH 3
3.1: How to manage the choking infant 63
3.2: How to manage the choking child 63
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Clinical Guidelines
List of Abbreviations
ACT Artemesinin combination treatment
AIDS Acquired immune deficiency syndrome
ART Anti-retroviral therapy
ARV Anti-retroviral drug
CHEW Community health extension worker
CHW Community health worker
DOTS Directly observed therapy, short course
EFA Education for All
FP Family planning
GOK Government of Kenya
HBC/HCBC Home-based care / Home- and community-based care
HIV Human immunodeficiency virus
IEC Information, education and communication
ITN Insecticide treated net
IUCD Intrauterine contraceptive device
KEPH Kenya Essential Package for Health
MDGs Millennium Development Goals
MDR Multiple drug resistant (TB)
MOH Ministry of Health
MOMS Ministry of Medical Services
MOPHS Ministry of Public Health and Sanitation
NHSSP II Second National Health Sector Strategic Plan 2005–2010
PEP Post-exposure prophylaxis
PID Pelvic inflammatory disease
PLWHA Person/people living with HIV/AIDS
PMTCT Prevention of mother-to-child transmission (of HIV)
STI Sexually transmitted infections
TB Tuberculosis
TBA Traditional birth attendant
TT2 Tetanus toxoid
UNICEF United Nations Children’s Fund
VCT Voluntary counselling and testing
WHO World Health Organization
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Level 1 – Community
Contributors to This Volume
EDITORS
Prof. Ezekiel M. Wafula, MB.ChB (Nairobi), M.Med (Nairobi), Associate
Professor and Consultant Paediatrician, Department of Paediatric and Child
Health, University of Nairobi, project editor
Prof. Nicholas A. Othieno Abinya, MB.ChB (Nairobi), M.Med (Nairobi),
Associate Professor, Department of Medicine, Section of Oncology, Aga Khan
University Hospital
Prof. Joseph G. Karanja, MB.ChB (Nairobi), M.Med (Nairobi), Associate
Professor and Consultant Obstetrician and Gynaecologist, Department of
Obstetrics and Gynaecology, University of Nairobi
Prof. Dan C.O. Kaseje, MB.ChB (Nairobi), MPH, PhD, Professor of Community
Health, Great Lakes University, Kisumu
Prof. Rachel Musoke, MB.ChB (East Africa), M.Med (Makerere), FABM,
Associate Professor and Consultant Paediatrician and Neonatologist,
Department of Paediatrics and Child Health, University of Nairobi
Prof. Stephen W.O. Ogendo, MB.ChB (Nairobi), M.Med (Nairobi), FCS
(ECSA), Associate Professor and Consultant Cardiothoracic Surgeon,
Department of Surgery, University of Nairobi
REVIEWERS
Dr. Kirtida Acharya, Endocrinologist (Diabetes), MP Shah Hospital
Dr. John Aduda, Kenya Medical Supply Agency
Dr. Maureen Ambetsa, Med Sup, Nakuru
Dr. Dianne Amojong, Machakos Level 5
Dr. K. Chesang, WHO
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ClinicalGuidelines
Dr.SarahChuchu,ProvincialPharmacist–NairobiProvince
Dr.Samuel Gatere,MOMS–MathariHospital
Dr.EstherGetambo,MinistryofMedicalServices(MOMS)
Dr.MichaelM.Gichangi,MOMS
Dr.EvansImbuki,NewNyanzaProvincialGeneralHospital
Dr.AnneIndaloUniversityofNairobiPharmacyDepartment
Dr.AliceInyangala,MOMS/Pharmacy
Prof.FrancisD.Juma,UON-FacultyofMedicine
Mr.JohnKabanya,ClinicalOfficer,ClinicalOfficersCouncil
Dr.CharlesKamotho,ThikaDistrictHospital
Mrs. LydiaKarimuria,MinistryofPublicHealthandSanitation(MOPHS),
DivisionofChildandAdolescentHealth
Mrs.MercyKasina,MinistryofHealth,DepartmentofNursing
Dr.HarrisonKiambati,HeadTechnicalPlanning,MOMS
Dr. Humphrey Karamagi, Technical Officer, Health System Development,
WHO Kenya
Dr.DavidKiima,DiretorofMentalHealth,MOMS,DivisionofMentalHealth
Mr.TitusM.Kilika,MOMS
Dr.Kilonzo,headofsurgery,Machakoslevel5hospital
Dr.SylvesterJ.N.Kimaiyo,MoiTeachingandReferralHospital(MTRH)
Dr.FrancisM.Kimani,DirectorofMedicalServices,MOMS
Dr.MaureenKameneKimenye,MinistryofHealth,NASCOP/PASCOs
Mr.JuliusKimitei
Mr.Michael Kisoo,ChiefClinicalOfficer,MOMS
Mr.AlexK.Kisyanga,MinistryofMedicalServices
Dr.NdindaKusu,ClinicalPharmacist,ManagementSciencesforHealth/
SupportingPharmaceuticalServices
Dr.WilliamK.Maina,MinistryofHealth,DivisionofNonCommunicable
Diseases(DNCD)
Dr.BethMaina,Paediatrician,EmbuLevel5
Dr.JohnJaoMajimbo,ClinicalPharmacist,KPA
Dr.WekesaMasasabi,Head,MOMS,Dept.ofSurgery
Dr.JohnsonMasese,ClinicalPharmacist,ProvincialGeneralHospital–
Kakamega
Dr.JaneMasiga,ClinicalPharmacist,MedicalEquipment&DrugSupplies
Dr.ChrisMasila,ProgrammePharmacist,MOPHS/DivisionofLeprosy,
TuberculosisandLungDiseases(DLTLD)
Dr.JosephineMaundu,ClinicalPharmacist,ManagementSciencesforHealth/
SupportingPharmaceuticalServices
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