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Prevention & Treatment G Centres and Hospitals PREVENTION & TREATMENT GUIDELINES FOR PRIMARY HEALTH CARE CENTRES AND HOSPITALS MINISTRY OF HEALTH GOVERNMENT OF SOUTHERN SUDAN 2006 TABLE OF CONTENTS ______________________________________________________ CHAPTER PAG E Foreword i Acknowledgments ii Introduction iii Abbreviations vii PREVENTION OF DISEASES 1. Immunization 1 2. Mass treatment of diseases 5 3. Antenatal care 8 4. Prevention of Malaria, Onchocerciasis & 16 Kala azar (insect borne diseases) 5. HIV/AIDS Prevention 19 6. Family planning and child spacing 25 7. Nutrition and breastfeeding 34 8. Accidents and injuries 40 9. Water and Sanitation 45 10. Prevention of Oral Diseases 48 TREATMENT 1. Paediatric conditions 52 2. Malaria 88 4. Obstetric and Gynaecological Conditions 99 5. Neonatal conditions 109 6. Tuberculosis (TB) 147 7. Leprosy 157 8. Sleeping Sickness 162 9 Eye Care 168 10. Kala azar 182 11. HIV-infection 194 12. Dermatology 204 13. Neurology 214 14. Psychiatry 222 15. Respiratory diseases 231 16. Cardiovascular conditions 240 17. Renal tract conditions 248 18. Gastro intestinal conditions 255 19. Injuries and trauma 265 20. Other infectious diseases 275 21. Poisoning 288 22. Anaemia 295 23. Metabolic / Endocrine diseases 299 25. Dental Conditions 312 26. Palliative care / Home based care 319 27. Natural medicines 324 Paediatric Drug Doses 328 Reference ranges of Common Laboratory Tests 326 FOREWORD _________________________________________________________ In the Government of Southern Sudan (GOSS) Health Policy, the Primary Health Care programme is the cornerstone of the delivery of quality health care to all our people. The program has three basic levels, namely the Primary Health Care Unit, the Primary Health Care Centre and the referral facilities. Being aware of the need to consolidate these services, the Ministry of Health has developed the Prevention and Treatment Guidelines for Primary Health Care Units, Primary Health Care Centres and Hospitals. These Guidelines will ensure the standardization and the maintenance of high quality of care at this level of our Primary Health Care programme. The Ministry of health continues to develop and raise the awareness and training levels of our health care personnel at all levels. This manual provides a vital link in that process and it is our hope that our service providers will use it as such for the improvement of service delivery at all our health facilities. This and other manuals developed by the Ministry will continue to be updated over time to meet any evidence based recommendations arising from scientific research, modern developments, innovations, lessons learned or best practices that will be suitable to our context and deemed necessary to improve our Primary Health Care services. Dr Majok Yak Majok Under Secretary Ministry of Health Government of Southern Sudan October, 2006 i ACKNOWLEDGMENTS ______________________________________________________ ______ Following the conclusion of the comprehensive peace agreement between the government of the Sudan and the Sudan People’s Liberation Movement/Army (SPLM/A) in Kenya on the 9th January, 2005, and the subsequent ending of the war in Southern Sudan. The Ministry of Health, Government of Southern Sudan has a great challenge to ensure equitable, sector wide, accelerated and expanded quality health care for all people in Southern Sudan, with a special focus and emphasis on women and children. Thus the development of the Treatment Guideline is one of the efforts towards this mission, especially at this post conflict period when there is high demand for knowledge and guideline needed for treatment at different levels of health facilities in Southern Sudan. This document will also meet the demand to ensure appropriate management using recommended essential medicines. The Ministry of Health, Government of Southern Sudan would like to thank all the UN Agencies and International and local NGOs in Southern Sudan, as well as the technical health personnel from various institutions who have played an important role in the development and finalization of the Southern Sudan Treatment Guideline. The Ministry gratefully acknowledges the technical guidance and constructive comments provided towards the development of this guideline. Profound gratitude and thanks are also addressed to the agencies which have supported the Ministry financially to develop and process this important document. ii INTRODUCTION ______________________________________________________ ______ Basic health care The main vision of the national health policy for South Sudan is to develop a health care system with access for all. This is further described in the basic health care package. The basic system has three levels, the Primary Health Care Unit, Primary Health Care Centre and the first line referral hospital. In the future, State and Teaching hospitals will be further developed but they are beyond the scope of this book at present. Each level has its own tasks, responsibilities and limitations. A manual for the PHC Unit has been written in 2005. These guidelines are mainly meant to describe the different tasks for the PHC Centre and the Hospital in prevention as well as in treatment. Specific hospital tasks such as details of surgery, obstetrical procedures and anaesthesia have been left out, there are excellent textbooks available for that and the procedures are not specific for Sudan. Other treatments like sleeping sickness or dental care obviously need more detailed training. In these guidelines they have been written as overviews for the present health staff of the possibilities or as a reminder. Patient Care It is not stressed in each chapter but it cannot be stressed enough that the corner stone of good health care is a good relationship with the patient as well as with the surrounding community. Medicine is not only a technical science, it is a social science. If there is no basis of trust between health staff and patient not a lot will be achieved. Rational drug use This book is based on the concept of rational drug use. A good health care system provides health care for all. This can be achieved with limited resources but only when proper guidelines are followed. Patients need medicines that are safe, effective and of good quality. The drugs have to be affordable and they have to be available. Because each government has financial limitations only the use of iii essential drugs will ensure that people can get the best possible treatment within the resources present. I. The first step to achieve this is: only use medicines with their generic names; these are the original names of the active ingredients of the drug, also known as an international non- proprietary name (INN). The same drug, may be sold under a brand name (given by the company / manufacturer) which is often far more expensive. It is of vital importance that only good quality drugs are used. II. The next step is to make essential drugs available at each level of health care; the Primary Health Care Unit (PHCU), the PHC Centre (PHCC) and the Hospital. Each level has different diagnostic facilities and staff with different qualifications and responsibilities. Uncomplicated malaria or bronchitis can be treated at the PHC Unit level whereas a disease like tuberculosis will only be treated at PHC Centre or Hospital level and major surgery can only be performed at Hospital level. Therefore different essential drugs are needed for each level. An essential drug list for South Sudan has been developed which is also in line with both PHCU and PHCC/Hospital guidelines. III. The last step is Rational Drug Use. To give all patients the best care possible health workers have to use drugs wisely. There are many conditions that do not need medical treatment at all, for example a common cold, a headache or mild diarrhoea. With some advice and rest they will resolve within a short time. Also for common complaints like constipation and joint pains local herbal medicine may be available. I am sure that all of us are familiar with the situation that medicines are finished in our clinics before the month is finished. So we really have to use them only for the patients who need them. For other diseases it is important to use medicines that have proven to be effective and to give them in the right dose and for the right period of time. Using drugs rationally will give the best treatment result and will reduce costs. Over the past it has become clear that many medicines have been used too much or not in a sensible way. This has resulted in increasing resistance against certain drugs, for example antibiotics, but also anti- malarial and TB medication. Some medicines that were very useful in iv the past are now becoming ineffective. We can partly prevent this if health workers use medicines rationally and in accordance to protocols. Future reviews This book is based on the latest evidence and experience. But essential drugs and guidelines will change over time. As new drugs become available and affordable and drug resistance increases, these guidelines and protocols will need to be adapted. A National Drug and Therapeutic Committee must be established to keep abreast with new evidence on a regular basis and review the manuals every 3 years. How to use this book To use this book optimally you need to: • Familiarise yourself with the contents • Study the sections and know where to find them when you need them • Keep this book readily available at work place or carry it with you • Please give comments to improve the information for you The Ministry of Health is fully committed to improving the general health of the population of Southern Sudan. The best and most effective strategy to do this is to prevent diseases. Until this point in history preventive activities have been quite limited. The first part of this book deals with preventive health which will help every health facility or programme cover the full range of preventive activities mentioned.
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