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Stg Health Center STNDARD TREATMENT GUIDELINE FOR HEALTH CENTERS Drug Administration and Control Authority of Ethiopia Contents January 2010 1 Contents Acknowledgments …………… ….……………………………………………………………….. viii Abbreviations ………………………..…………………………………………………………….. xi Forward …………………………………..…………………………………………………………… xii Introduction ……………………………..………………………………………………………….. xiii General Guidance ………………………………………………………………………………… xiv How to USE the STG ……………………………………………………………………………… xxviii Chapter I INFECTIOUS DISEASES………………………………………………………………………… 111 Acquired Immunodeficincy Syndrome…………………………….……………………… 2 Amebiasis …………………………………………………………………………..……………….. 12 Amebic liver Abscess ……………………………………………………………………………. 13 Bacillary Dysentry …………………………………………………….………………………….. 14 Bronchitis (Acute) ……………………………………………………..………………………….. 15 Brucellosis …………………………………………………………………..………………………. 17 Cholera ………………………………………………………………………..……………………… 18 Gastroenteritis ……………………………………………………………………..……………… 20 Giardiasis …………………………………………………………………………..……………….. 21 Intestinal Parasitic Infestations ……………………………………………………………. 21 Leishmaniasis …………………………………………………………………………………..…. 25 Leprosy ……………………………………………………………………………………………….. 27 Malaria ……………………………………………………………………………………………….. 30 Meningitis …………………………………………………………………………………………… 33 Onchocerciasis ………………………………………….…………………………………………. 38 Pneumonia …………………………………………………………………………………………. 39 Relapsing Fever …………………………………………………………………………………… 41 Schistosomiasis ………………………………………………………….……………………….. 42 Tuberculosis ………………………………………………………………………………………… 42 Typhoid Fever……………………………………………………………………………………….. 52 Typhus ………………………………………………………………………………………………… 53 Urinary Tract Infection ………………………………………………………………………….. 54 2 Viral hepatitis ………………………………………………………………………………………. 55 Chapter II NON ---INFECTIOUS DISEASES ………………………………………………………… 575757 Anemia ………………………………………………………………………….……………………… 58 Anxiety disorder …………………………………………………………………………………….. 60 Bronc hial asthma ………………………………………………………………………………… 61 Constipation ………………………………………………………………………………………… 65 Diabetes mellitus …………………………………………………………………………………. 66 Dyspepsia ……………………………………………………………………………………………. 68 Epilepsy ………………………………………………………………………………………………. 70 Gout ……………………………………………………………………………………………………. 71 Heart Failure ……………………………………………………………………………………….. 72 Hemorrhoids ……………………………………………………………………………………….. 74 Hypertension ………………………………………………………………………………………. 75 Migraine …………………………………………………………………………………………….. 79 Nausea and Vomiting ………………………………………………………………………….. 81 Osteoarthritis ……………………………………………………………………………………….. 82 Rheumatic fever …………………………………………………………………………………… 83 Rheumatic heart disease (Chronic) ……………………………………………………….. 84 Rheumatoid arthritis ………………… …………………………………………………………. 85 Schizophrenia ……………………………………………………………………………………… 86 Chapter III PEDIATRIC DISEASES …………………………………………………………………………… 888888 Bronchial Asthma ………………………………………………………………………………… 89 CROUP (Acute laryngotracheobronchitis) ..……………………………………… ……… 91 Diarrheal disease (Acute) ……………………………………………………………………… 92 Foreign body aspiration ………………………………………………………………………… 98 Heart failure ………………………………………………………………………………………… 99 HIV/ AIDS in Children ……………………………………………………………………………. 100 Jaundice in neonates …………………………………………………………………………… 107 Malnutrition (severe) ……………………………………………………………………………. 108 3 Measles ……………………………………………………………………………………………… 120 Meningitis …………………………………………………………………………………………… 121 Oral thrush ………………………………………………………………………………………….. 123 Osteomye litis ………………………………………………………………………………………. 124 Pertusis ………………………………………………………………………………………………. 125 Pneumocystis Carini Pneumonia (PCP) ………………………………………………… 126 Pneumonia in children …………………………………………………………………………. 127 Rickets ……………………………………………………………………………………… ………… 128 Seizures (Neonatal) ……………………………………………………………………………… 130 Sepsis (Neonatal) ………………………………………………………………………………… 131 Septic arthritis …………………………………………………………………………………….. 132 Tetanus (Neonatal) ……………………………………………………………………………… 133 Tinea capitis ………………………… ……………………………………………………………… 134 Tuberculosis ……………………………………………………………………………………….. 135 Chapter IV DERMATOLOGICAL DISORDERS ……………………………………………………………. 137 Acne vulgaris ……………………………………………………………………………………….. 138 Bacterial folliculitis …………………………………………………………… …………………. 139 Candidiasis …………………………………………………………………………………………. 140 Balanoposthitis ……………………………………………………………………… 140 Candidal intertrigo ………………………………………………………………….. 140 Candidal paronychia …………………………………………………………… …. 141 Oral candidiasis ……………………………………………………………………… 142 Carbuncle ……………………………………………………………………………………………. 142 Cellulites …………………………………………………………………………………………….. 142 Cutaneous leishmaniasis ……………………………………………………………………… 143 Dermatophytes ……………… ……………………………………………………………………………… 144 Eczema ………………………………………………………………………………………………… 147 Atopic Dermatitis …………………………………………………………………………. 147 Contact dermatitis ………………………………………………………………………… 148 4 Allergic contact dermatitis …………… …………………………………………. 148 Irritant Contact Dermatitis ………………………………………………………. 150 Erysipelas .......................................................................................................... 150 Furunclosis .......................... ............................................................................. 151 Herpes simplex ......................................................................................................... 152 Herpes zoster ................................. ............................................................................ 153 Impetigo ............................................................................................................ 154 Molluscum contagiosum ............................................................................................ 155 Pediculosis corporis and capitis ................................................................................ 156 Pityriasis versicolor .......................................... ................................................ 157 Psoriasis ........................................................................................................... 158 Scabies .................................................................... ................................................... 159 Urticaria ............................................................................................................ 161 Verruca vulgaris …………………………………………………………………………………. 162 Chapter V SEXUALLY TRANSMITTED INFECTIONS …………………………………………………. 164 Urethral discharge ……………………………………………………………………………….. 166 Vaginal discharge ………………………………………………………………………………… 167 Lower abdominal pain …………………………………………………………………………. 170 Genital ulcer disease ………………………………………… …………………………………. 173 Inguinal bubo ……………………………………………………………………………………… 178 Scrotal swelling ……………………………………………………………………………………. 179 Chapter VI OPHTHALMOLOGICAL PROBLEMS ................................................ 181 Acute Dacryocystitis ……………………………… …………………………………………….. 182 Acute Infectious Dacryoadenitis ….………………………………………………………… 183 - Bacterial or infectious …….………………………………………………………….. 183 - Viral ………………………………..…………………………………………………………. 184 Allergic Conjunctivitis …………………..…………………… …………………………………. 184 5 - Atopic Keratoconjunctivitis ……………………………………………………… 184 - Hey fever and Perennial allergic Conjunctivitis ………………………….. 188 - Vernal Keratoconjunctivitis ……………………………………………………… 188 Bacterial Conjunctivitis …………………………………………………………………………. 189 - Conjunctivitis in Children and Adults …………………………………….. 189 - Neonatal Conjunctivitis ………………………………………………………… 190 Blepharitis ………………………………………………………………………………………….. 191 -Seborrhoeic blepharitis ……………………………………………………………. 191 -Staphylococcal blepharitis ………………………………………………………… 192 Chemical Burns ……………………………………………………………………………………. 193 External Hordeolum (Stye) ……………………………………………………………………. 194 Internal Hordeolum ………………………………………………………………………………. 195 Mebomian Cyst (Chalazion) …………………………………………………… …………….. 196 Molluscum Contagiosum ……………………………………………………………………… 196 Ophthalmic Zoster (Herpes Zoster Ophthalmicus) ........................................ 197 Orbital Cellulitis …………………………………………………………………………………… 199 Preseptal Cellulitis …………………………………………… ………………………………….. 199 Trachoma ……………………………………………………………………………………………. 200 Vitamin A deficiency …………………………………………………………………………….. 202 CHAPTER VII Ear, Nose a nd Throat Problems ………………………………………………….. 205 I. EAR PROBLEMS ……………………………………………………………………………… 206 Acut e otitis media ………………………………………………………………………………… 206 Bacterial and Viral diffuse otitis externa ………………………………………………… 207 Chronic otitis media ……………………………………………………………………………… 208 Foreign bodies in the ear ………………………………………………………………………… 208 Idiopathic facial p aralysis …………………………………………………………………… 210 Nonspecific inflammation of the external ear ……………………………………….. 211 II. NOSE AND NASAL SINUSES PROBLEMS ………………………………… 212 Acute rhinitis ………………………………………………………………………………………. 212 Acute rhinosinusitis ………………………………………… ………………………………….. 213 6 Allergic rhinitis ……………………………………………………………………………………. 214 Atrophic rhinitis and ozena ………………………………………………………………….. 215 Chronic sinusitis …………………………………………………………………………………… 215 Epistaxis ………………………………………………………………………………………………. 216 Foreign bodies in the nose …………………………………………………………………….. 217 III. MOUTH and PHARYNX PROBLEMS …………………………………………………. 218 Acute tonsillitis ……………………………………………………………………………………. 218 Peritonsilar abscess 219 IV. LARYNX and HYPOPHARYNX PROBLEMS ………………………………………. 220 Acu te laryngitis ……………………………………………………………………………………. 220 Croup or larngotracheitis ………………………………………………………………………… 221 V. SALIVARY GLAND PROBLEMS ……………………………………………………… 222 Mumps ……………………………………………………………………………………………….. 222 Sialadenitis of the
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