HEALTHCARE WORKER INFORMATION HEALTH EFFECTS OF DROUGHT, FROST AND FOOD AND WATER SHORTAGES
What Should Health Care Workers Look For During Food And Water Shortages? Some of the health effects that may be expected include:
Malaria and other diseases caused by mosquitoes (such as dengue and chikungunya) may increase, particularly in areas that are currently on the edge of malaria zones (such as low areas of the Highlands). Watch for patients with fever! Increase in diarrhoeal diseases, including possibly cholera, and dehydration. This can come from either (1) reduced amounts of water available for washing in some drought-affected areas, or (2) flooding and contamination of water supplies with sewage in other areas. Note patients with diarrhoea and make sure it’s not cholera! Increase in respiratory and skin diseases, also due to worse hygiene because of reduced amounts of water. Remind patients to practice good hygiene. Malnutrition - drought may lead to lack of food, which can lead to both general malnutrition and to lack of specific nutrients such as vitamin A. This malnutrition can worsen other diseases like diarrhoea and measles. Assess nutrition status of patients who appear malnourished or wasting. Increased fish poisoning (such as “ciguatera”), due to warm sea water temperatures leading to increases in poisonous algae (seaweeds) eaten by fish, which are then eaten by people. Note patients with allergic reactions or neurological symptoms. Occurrence of other disasters, such as forest fires due to drought; or landslides due to drought or flooding. This can lead to other health effects (for example, in the case of fires, burns and respiratory disease caused by smoke). There may be more burns and smoke inhalation during this time.
What Are The Supplies That All Clinics Should Have On Hand? PNG Paediatric and Adult Standard Treatment Guidelines MUAC for assessing nutrition status Chlorine treatment for water and safe water storage Rapid Test for Malaria (e.g. Paracheck) containers Oral Rehydration Salts Medication for Malaria Prepared Food Product for malnutrition IV Fluids and IV sets
What Else Can Health Care Workers Do? Provide the accompanying Health Advisory to your patients, or explain it to them – particularly what they themselves can do to prevent the health effects of food and water shortages
Ensure you have clean, safe drinking water for patients and start storing water now. Only give safe drinking water to patients.
Report changes and reportable diseases to your Provincial Health Office.
Report ANY: Report an Increase in: - Acute fever with rash - Influenza like syndromes (fever, cough, sore throat) - Acute flaccid paralysis - Prolonged fever (greater than 3 days) without diagnosis - Hemorrhagic fever - Bloody diarrhea - Acute watery diarrhea - Malnutrition - An outbreak or cluster of disease
For more information about the health effects of the drought, please contact the PNG Health Cluster Coordinator,
PNG Health Cluster, Drought Health Care Worker Information, November 2015 World Health Organization [email protected] or [email protected], Ph: 325 7827. To report an outbreak, please contact Mr. Berry Ropa, Programme Manager – Surveillance and Emergency Response, NDOH, Ph: 7129 1609. How Can Health Care Workers Manage Illnesses Related To Food And Water Shortages? When patients present to your clinic, you need to be ready to recognize the signs of diseases and health problems caused by food and water shortages and respond.
If you suspect…
… Diarrhoeal Disease
1. Assess severity of diarrhoea (STANDARD TREATMENT GUIDELINES Paeds p.44, Adult p.50-54) and dehydration (STANDARD TREATMENT GUIDELINES, Paeds p. 55)
2. Important considerations
Is it Cholera?? If there are huge amounts of very watery diarrhoea (sometimes grey in color; like “rice water”) it could be cholera. Treat as per the STANDARD TREATMENT GUIDELINES (Paeds p.55-56, Adult p51-54). Remember that rehydration and replacement of electrolytes are the most important part of Cholera treatment – give ORS immediately and for severe dehydration give IV Fluids. Don’t forget to REPORT cholera cases!
3. Treat per NDOH guidelines – see STANDARD TREATMENT GUIDELINES Paeds p.44 -56
4. Check for dehydration!
a. Remember to give Oral Rehydration Solution (ORS)!!!
…Mosquito Borne Diseases: Malaria, Chikungunya, Dengue, and others
Know the signs: Most mosquito borne illnesses produce a flu-like syndrome. It’s important to always test for malaria but if tests are not available, it’s better to treat as if it is malaria and watch for signs of pneumonia or worsening illness.
. If the patient has fever, headache, chills, nausea/vomiting, or other flu-like symptoms like joint pain... it could be Malaria do paracheck & treat per guidelines for Malaria (see STANDARD TREATMENT GUIDELINES Paeds p.67; Adult p.56-62)
. Otherwise... it could be Chikungunya or Dengue (especially if there is a rash) there is no treatment other than rest, fluids, and support. PNG Health Cluster, Drought Health Care Worker Information, November 2015 NB: If you suspect Chikungunya or Dengue, patient must not take NSAIDS (e.g. “StopPain”). They can take paracetamol (Panadol).
For any fever in a child, the Standard Treatment Guidelines for Paediatrics says: 1. Treat the cause of the fever
2. If very sick give antimalarials: if not very ill do RDT and treat accordingly OR if no RDT available treat if fever persists (see Paeds p.67).
3. Paracetamol to reduce fever if temperature over 38º C. Do not give paracetamol in infants less than 3 months of age. (Excerpt from STANDARD TREATMENT GUIDELINES Paeds p.57).
For Adults, see Adult STANDARD TREATMENT GUIDELINES p.49-50.
…Poisonous Fish Ingestion If the patient has Gastrointestinal Symptoms and recently ate fish (especially fish that was not fresh or found dead), suspect food poisoning. If there are neurological symptoms (confusion, etc.) – refer to the hospital immediately If there is flushing and/or hives give an antihistamine and treat as an allergic reaction.
…Respiratory Illnesses may be more common during Food and water shortages. Management is the same as any other time. Remember: 1. Respiratory Illness with FEVER – test for Malaria and if positive treat accordingly (STANDARD TREATMENT GUIDELINES p.67, Adult p. 56-62) 2. Immunize! Patients will be more susceptible to disease during this time. Use the opportunity to immunize 3. Teach patients / parents the warning signs of pneumonia (in a child: fast breathing and chest indrawing)
…Burns or Smoke Inhalation from fires Burns: manage burns as normal (see STANDARD TREATMENT GUIDELINES Paeds p. 34-35; Adult p.3-7). Remember for burns covering greater than 10% body area, give IV fluids and refer to the hospital immediately.
Smoke Inhalation: If the patient is suffering from excess smoke inhalation (from a fire) - Give oxygen! If severe, the patient may need to be intubated and hospitalized.
…Skin diseases may be more common, especially because of lack of water and poor hygiene. Watch out especially for Impetigo – look for any secondary skin infection, especially with crusting.
Skin diseases can be managed as routinely (see STANDARD TREATMENT GUIDELINES Paeds p.116-117; Adult p.83- 88)
PNG Health Cluster, Drought Health Care Worker Information, November 2015 Annex 1: Malaria Diagnosis and Management
Annex 2: Diarrhoea Assessment and Management
PNG Health Cluster, Drought Health Care Worker Information, November 2015 PNG Health Cluster, Drought Health Care Worker Information, November 2015 Malnutrition And Wasting May Be Common During Food And Water Shortages (see STANDARD TREATMENT GUIDELINES Paeds p.75-84). How to check:
a. place muac along mid-upper arm of child.
a. See where the tape comes to the arrow.
i. a measurement in the green zone means the child is properly nourished
ii. a measurement in the yellow zone means that the child is at risk of malnutrition
iii. a measurement in the red zone means that the child is acutely malnourished.
Source: www.motherchildnutrition.org
K ey Source: www.motherchildnutrition.org
Source: www.motherchildnutrition.org
PNG Health Cluster, Drought Health Care Worker Information, November 2015 KEY MESSAGES DURING DROUGHT/ FOOD AND WATER SHORTAGES
1. Mosquit o nets prevent malaria and other mosquito diseases. Use mosquito nets every night for everyone in the family, especially for pregnant women and young children.
2. Don’t make baby mosquitos - Cover water reservoirs and remove open containers that can hold rain water.
3. Educate about clean drinking water and hygiene practices a. Drink safe water – use chlorine (2 drops per litre; use only on non-cloudy water; let stand for 30 minutes before drinking) or boil water for 15 minutes before drinking or use “aquatabs” water disinfection tablets according to instructions on label b. Cover all drinking water and do not use water that is used by animals c. Wash hands with soap after you use the toilet, after you clean up a baby, before you eat and whenever they get dirty. d. Keep children’s hands clean. e. Wash fruits and vegetables with clean water before eating
4. Store water now! There may be a water shortage.
5. If you or your child has severe diarrhoea, come to the clinic! Do not delay. Children can die quickly from diarrhoea.
6. Do not dispose human waste in places where you collect drinking water and food.
7. Avoid eating dead fish and predator fish because these fish may be eating poisonous algae in the water. Always eat fresh fish. If you or your
PNG Health Cluster, Drought Health Care Worker Information, November 2015 child has signs of confusion or other mental changes, hives, or flushing after eating fish, come to the clinic immediately.
8. Avoid bush fires because they can get out of control. If you or your child is burned, it is important to come to the clinic immediately for care. Even small burns can be very dangerous.
PNG Health Cluster, Drought Health Care Worker Information, November 2015 KI TOKSAVE OLSEM DRAUT / KAIKAI NA WARA I WOK LON SOT
1. Moskito umben save pasim Malaria na ol narapela sik bilon Moskito. Usim moskito umben olgeta nait lon olgeta insait lo famili, Bikpela luksave lon ol meri igat bel na ol yanpela pikinini.
2. Karamapim wara lon ol tank na rausim ol konteina we i save holim ren wara lo abrusim moskito taim, em save mekim niupela bebi moskito.
3. Skul lon drinkim klin wara na helt pasin
a. Long dringim klinpela gutpela wara , putim wan ti spun cloren marasin insait long twenti litre wara. Wara mas no ken doti na mas kllini olgate taim yu putim cloren marasin insait. Larim marasin wara istap inap 30 pela minit bipo yu dringim dispela marasin wara . O long narapela wai long dringim safe wara ; yu mas oltaim bolim wara inap 15 minit bipo yu dringim wara. O Bihainim tok save istap long pipa taim yu laik usim “Aquatabs” marasin belong klinim wara
b. Pasim olgeta war bilon drin na noken usim wara we ol enimol i usim.
c. Wasim han waitaim sop, behain lon yu usim toilet, behain lon yu klinim ol bebi na wanem taim han bilon yu i Doti
d. Han bilon ol pikinini mas’ stap klin olgeta taim.
e. Wasim olgeta fruts na ol garden kaikai waitaim klin wara bipo yu kaikai.
4. Pulmapim na bungim wara Nau! Nogut bai yumi sot lon wara.
5. Sapos yu or pikinini blo yu igat stronpela pekpek wara, go lo haus sik noken wait, pikinini ken dai hariap lon pek pek.
6. Noken tromoi pipia na pek pek lo ples or hap we yumi save kisim wara na kaikai.
7. Kaikai fres pis olgeta taim, noken kaikai pis we i dai, na ol pis we yumi no save kaikai, nogut ol pis i kaikai poisin nogut we ol kisim lo wara. Sapos yu o pikinini bilon yu igat kainkain sick, o tintin blo yu no stret, o pekpek wara na troutim pis yu mas igo lon haus sik hariap.
8. Noken mekim bus paia, blon wanem paia ken kamap bikpela na abrusim mak blon em. Sapos pikinini bilon yu paia i kukim, kisim em hariap i go lon haus sik lon kisim marasin na halivim.
PNG Health Cluster, Drought Health Care Worker Information, November 2015