THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN STANDARD TREATMENT GUIDELINES AN D ESSENTIAL MEDICINES LIST FOR CHILDREN AND ADOLESCENTS First Edition October 2017 THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN STANDARD TREATMENT GUIDELINES AN D ESSENTIAL MEDICINES LIST FOR CHILDREN AND ADOLESCENTS October 2017 Ministry of Health, Community Development, Gender, Elderly and Children © 2017 Ministry of Health, Community Development, Gender, Elderly and Children Any part of this document may be reproduced in any form without the prior permission of the publisher provided that this is not for profit and that due acknowledgement is given. Any reproduction for profit has to be obtained from MOHCDGEC prior to reproduction. Copies may be obtained from: The Permanent Secretary, Ministry of Health, Community Development, Gender, Elderly and Children, 6 Samora Machel Avenue P.O. Box 9083, 11478 Dar es Salaam Tel: 255 22 2120261 Fax: 255 22 213995 OR University of Dodoma, Faculty of Social Science in Community Development, Bulding N0 11 40478 Dodoma, Tel: +255 26 2323267 Fax: +255 22 2138060 2 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents TABLE OF CONTENTS Foreword .....................................................................................xviii Acknowledgement ........................................................................xix Abbreviations....................................................................................xx How to use these guidelines.................................................................xxii Summary of principles of good clinical practice…………...................xxiii CHAPTER 1: TRIAGE AND EMERGENCY CONDITIONS…………………… 1.1 Summary of steps in emergency triage assessment and treatment……………………………………………………………………………… 1.1.1 Primary survey…………………………………………………….. 1.1.2 Secondary survey………………………………………………… 1.2 Management of emergency conditions 1.2.1 Managing a chocking Infant…………………………… 1.2.2 Managing a chocking child (over One Year of Age)……. 1.2.3 Managing a child with shock………………………………………. 1.2.4 Managing Child with Convulsion……………………………….. 1.3 Maintenance fluids………………………………………………………………… 1.4 Cardiopulmonary Resuscitation (CPR)……………………………… 1.4.1 Standard Techniques for CPR…………………………………….. CHAPTER 2: GROWTH, DEVELOPMENT AND IMMUNIZATION………. 2.1 Growth Monitoring and Anthropometry…………………………………… 2.1.1 linear growth (Length/height) ……………………………. 2.1.2 Weight for age……………………………………… 2.1.3 Head Circumference………………………………………… 2.1.4 Mid Upper Arm Circumference…………………………… 2.2 Vaccination……………………………………………………………….. 2.3 Vitamin A Supplementation and Deworming……………. 3 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents CHAPTER 3: DISEASES OF THE NEWBORN AND YOUNG INFANT…… 3.1 Neonatal resuscitation……………………………………………… 3.2 Severe illness in newborn and young infants……………………… 3.3 Perinatal asphyxia (hypoxic iscehmic encephalopathy)………… 3.4 Prematurity and low birth weight babies…………………………. 3.4.1 Babies with birth weight between 2.5 kg and 1.5 kg……. 3.4.2 Babies with birth weight below 1.5 kg…………… 3.4.3 Apnoea of Prematurity…………………………………………… 3.4.4 Respiratory distress syndrome……………………………………… 3.4.5 Necrotizing Enterocolitis…………………………….. 3.5 Neonatal Jaundice…………………………………………………………… 3.5.1 Normal (physiological)……………………………………… 3.5.2 Pathological (non-physiological)……………………… 3.6 Ophthalmia Neonatorum……………………………………………….. 3.7 Congenital Syphilis………………………………………… CHPTER 4: COUGH OR DIFFICULTY IN BREATHING……… 4.1 Severe Pneumonia………………………………………………….. 4.2 Pneumonia……………………………………………………………………. 4.3 Common Cold (Cough or Cold) 4.4 Conditions Presenting with Wheeze 4.4.1 Bronchiolitis……………………………………………………… 4.4.1 Bronchial Asthma………………………………………………… 4.5 Tuberculosis………………………………………………………………. CHAPTER 5: GASTROINTESTINAL DISORDERS…………………… 5.1 Approach to a child with abdominal pain………………………………… 5.2 Diarrhoeal Diseases……………………………………………………………… 5.2.1 Acute watery diarrhea………………………………………… 5.2.1.1 Acute watery diarrhoea with no signs of dehydratioN 5.2.1.2 Acute watery diarrhea with some dehydration…… 5.2.1.3 Acute watery diarrhea with severe dehydration 5.2.2 Persistent diarrhea 5.3 Dysentery………………………………………………………………………… 5.4 Viral Hepatitis………………………………………………………………… 5.4.1 Hepatitis A…………………………………………………… 5.4.2 Hepatitis B……………………………………………….. 5.4.3 Hepatitis C………………………………………………………. 5.5 Schistosomiasis…………………………………………. 5.6 Amoebiasis…………………………………………………………. 4 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents 5.7 Giardiasis………………………………………………………….. 5.8 Ascariasis…………………………………………………………………….. 5.9 Ancylostomiasis (Hookworm Diseases)………………………………. 5.10 Cutaneous Larva Migrants………………………………………………………. 5.11 Cestodiasis……………………………………………………………………………. 5.12 Peptic Ulcer Diseas (PUD) and Gastritis…………………………………. 5.13 Gastro Esophageal Reflux Diseas (GERD)……………………… CHAPTER 6: FEVER……………………………………………………………… 6.1 Malaria………………………………………………… 6.1.1 Severe Malaria…………………………………………………… 6.1.2 Uncomplicated Malaria………………………………………… 6.2 Meningitis……………………………………………………………. 6.3 Septicaemia…………………………………………………………… 6.4 Typhoid Fever…………………………………………………… 6.5 Measles (Rubeola)…………………………………………………… 6.6 Septic Arthritis and Osteomyelitis…………………………… CHAPTER 7: ACUTE MALNUTRITION………………………………… 7.1 Severe Acute Malnutition……………………………………………. 7.1.1 Stabilization………………………………………. 7.1.2 Transition Phase……………………… 7.2.3 Rehabilitation Phase……………………………. 7.2 Severe anaemia………………………………………………… 7.3 Heart failure………………………………………………………….. CHAPTER 8: HIV/AIDS…………………………………………………… 8.1 HIV/AIDS Overview………………………………………….. 8.2 Management of HIV-related conditions…………………………….. 8.2.1 Pneumocystis Jiroveci Pneumonia (PJP)……………………… 8.2.2 Oral and oesophageal candidasis………………. CHAPTER 9: CARDIOVASCULAR DISORDERS………… 9.1 Congestive Heart Failure………………………………………………………… 9.2 Congenital Heart Diseases (CHD)…………………………… 9.3 Acquired Heart Diseases………………………………………………. 9. 3.1 Acute Rheumatic Fever (ARF)…………………… 9.3.2 Rheumatic Heart Diseases………………………… 9.3.3 Acute Myocarditis………………………………………. 9.3.4 Cardiomyopathy…………………………………………. 9.4 Pericarditis………………………………………………………. 9.5 Infective Endocarditis……………………………………………………….. 9.6 Hypertension………………………………………………………………… 5 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents CHAPTER 10: HAEMATOLOGICAL DISORDERS……………………… 10.1 Anaemia…………………………………………………………….. 10.1.1 Severe Anaemia………………………………………… 10.1.2 Iron Deficiency Anaemia…………………… 10.1.3 Guidelines for Blood Transfusion……………… 10.2 Sickle Cell Diseas (SCD) 10.2.1 Management of specific conditions……….. 10.2.1.1 Pain…………………….. 10.2.1.2 Hydration……………………………. 10.2.1.3 Acute Chest Syndrome/Acute Chest Crisis.. 10.2.1.4 Sequestration Syndromes………… 10.2.1.5 Hypersplenism……………………………… 10.2.1.6 Priapism……………………….. 10.2.1.7 Neurological Manifestations…… 10.3 Bleeding Disorders……………………………………………………… 10.3.1 Haemophilia………………………………………………. 10.3.1.1 Haemophilia A…………………………………. 10.3.1.2 Haemophilia B…………………………………….. 10.3.1.3 Immune-thrombocytopenic Purpura (ITP). 10.3.2 Disseminated Intravascular Coagulopathy (DIC)…… 10.4 Aplastic Anaemia (AA)……………………………………………… CHAPTER 11 NEUROLOGICAL DISORDERS…………………………. 11.1 Seizures……………………………………………………………… 11.1.1 Simple Febrile Seizures………………………………………… 11.1.2 Epilepsies…………………………………………………………… 11.1.2.1 Focal epilepsies……………… 11.1.2.2 Generalized Epilepsies………………………… 11.1.2.3 Childhood Absence epilepsies…. 11.1.2.4 Myoclonic epilepsies…………………………. 11.1.2.5 Epilepsy Syndromes………………………… 11.2 Cerebral Palsy (CP)………………………………………. 11.3 Acute Flaccid Paralysis…………………………………………. CHAPTER 12: ENDOCRINOLOGICAL DISORDERS…… 12.1 Diabetes Milletus…………………………………………. 12.1.1 Diabetes Ketoacidosis (DKA)………………………………………………… 12.1.2 Management of complications of Diabetic Ketoacidosis. 12.2 Hypothyroidism……………………………………………. 12.3 Hyperthyroidism………………………………………………………. 6 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents CHAPTER 13: PAEDIATRIC ONCOLOGY……………………. 13.1 Acute Lymphoblastic Leukaemia…………………………….. 13.2 Lymphoma…………………………………………….. 13.2.1 Non-Hodgkin’s Lymphoma ……………………………. 13.2.1.1. Burkitt’s lymphoma……………………………….. 13.2.2 Hodgkin’s Lymphoma…………………………………………. 13.3 Wilm’s Tumour (Nephroblastoma)……………………………………. 13.4 Neuroblastoma…………………………………………………………….. 13.5 Rhabdomyosarcoma………………………………………………….. 13.6 Osteosarcoma………………………………………………………………… 13.7 Brain Tumours………………………………………………………………… 13.8 Management of common complications of neoplastic conditions…. 13.8.1 Febrile Neutropenia……………………………… 13.8.2 Nausea and Vomiting………………………. 13.8.3 Severe Anaemia………………………………… 13.8.5 Management of Pain…………………………. 13.8.6 Mucositis…………………………………….. 13.8.7 Tumour Lysis Syndrome (TLS)……………………….. 13.9 Immunization…………………………………………………………………. CHAPTER14: EYE DISEASE CONDITIONS……… 14.1 Cataract………………………………………………………. 14.2 Congenital Glaucoma…………………………………………. 14.3 Eye Injuries………………………………………………… 14.3.1 Perforating Eye Injury………………………………… 14.3.2 Blunt Eye Injury……………………………………………. 14.3.3 Burns and Chemical Injuries…………………………….. 14.4 Foreign bodies…………………………………………… 14.5 Cornea Ulcer…………………………………………………….. 14.6 Retinoblastoma……………………………………………………… 14.7 Trachoma……………………………………………………….. 14.8 Vitamin A Deficiency (VAD)……………………………….. 14.9 Squint……………………………………………………………….. 14.10 Uveitis………………………………………………… 14.11 Conjuctivitis……………………………………………. 14.11.1 Allergic Conjuctivitis………………………………….. 14.11.2 Viral conjunctivitis……………… 14.11.3 Bacterial conjunctivitis………………………………….. 14.12 Orbital Cellulitis…………………………………………………. 14.13 Cavernous Sinus Thrombosis………………………………………… 14.14 Diseases of the Retina……………………………………………………. 7 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents CHAPTER 15: PAEDIATRIC DENTAL DISORDERS……………… 15.1 Dental Caries (Tooth Decay)…………………………………….. 15.2 Periodontal Diseases…………………………………………… 15.3 Dental Trauma…………………………………………… 15.3.1 Injury to the Dental Hard Tissue of Permanent Teeth…. 15.3.2 Injury to the Supporting Structures……………………. 15.4 Odontogenic and Non Odontogenic Orofacial Infections… 15.4.1 Periapical Abscess……………………………. 15.4.2 Infected Socket…………………………………………. 15.4.3 Dry Socket…………………………………………….. 15.4.4 Dental Abscess…………………………………. 15.5 Osteomyelitis of the Jaw………………………………………. 15.6 Viral Infections…………………………………………….. 15.7 Aphthous Ulceration………………………………………. 15.8 Post Extraction Bleeding……………………………….. 15.9 Malocclusion………………………………………. 15.10 Natal and Neonatal Teeth……………………………………. CHAPTER 16: URINARY TRACT DISORDERS………… 16.1 Nephrotic Syndrome (NS)……………………………………….. 16.2 Acute Glomerulonephritis……………………………………. 16.3 Hemolytic Uremic Syndrome………………………………….. 16.4 Acute Kidney Injury (AKI)………………………………………….. 16.5 Chronic Kidney Disease (CKD)……………………………………… 16.6 Urinary Tract Infection………………………………………………. CHAPTER 17: PRINCIPLES OF ANAESTHESIA………………………….. 17.1 Perioperative Fluids……………………………………………………… 17.2 Giving General Anaesthesia………………………………….. 17.3 Post operative care…………………………………………………… CHAPTER 18: COMMON PAEDIATRIC SURGICAL DISORDERS. 18.1 Cleft Lip and Palate…………………... 18.2 Oesophageal Atresia (OA)…………………….. 18.3 Pyloric stenosis………………………….. 18.4 Hirschsprung’s disease…………………….. 18.5 Meconium ileus (Meconium plug syndrome)………………… 18.6 Anorectal Malformation (ARM)……………… 18.5 Abdominal Wall Defects………………… 18.5.1 Exomphalos………………… 18.5.2 Gastroschisis……………….. 18.6 Hydrocephalus………………………….. 18.7 Myelomeningocele…………………. 8 Standard Treatment Guidelines and Essential Medicines List for Children and Adolescents
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