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And the National Essential Medicines List (Nemlit) for Mainland Tanzania THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE STANDARD TREATMENT GUIDELINES (STG) AND THE NATIONAL ESSENTIAL MEDICINES LIST (NEMLIT) FOR MAINLAND TANZANIA THIRD EDITION 2007 1 TABLE OF CONTENTS TABLE OF CONTENTS .............................................................................................................................. ii FOREWORD .............................................................................................................................................. iii ACKNOWLEDGEMENT ......................................................................................................................... iv ABREVIATIONS AND SYMBOLS ..............................................................................................................v 1. GASTRO INTESTINAL DISEASE CONDITIONS ...........................................................................1 2. RESPIRATORY DISEASE CONDITIONS .....................................................................................27 3. OBSTETRICAL/GYNAECOLOGICAL DISEASE CONDITIONS AND CONTRACEPTION ......43 4. CARDIOVASCULAR DISEASE CONDITIONS .............................................................................59 5. MALARIA........................................................................................................................................70 6. SKIN DISEASE CONDITIONS ......................................................................................................77 7. SEXUALLY TRANSMITTED INFECTIONS (STI) ........................................................................90 8. ORAL DISEASE CONDITIONS ...................................................................................................101 9. KIDNEY DISEASE CONDITIONS ..............................................................................................110 10. EAR, NOSE AND THROAT DISEASE CONDITIONS ................................................................113 11. EYE DISEASE CONDITIONS ......................................................................................................119 12. TUBERCULOSIS AND LEPROSY................................................................................................124 13. MUSCULO SKELETAL AND JOINT DISEASE CONDITIONS ..................................................139 14. METABOLIC AND ENDOCRINE DISEASE CONDITIONS .......................................................144 15. NERVOUS SYSTEM DISEASE CONDITIONS ............................................................................151 16. OTHER DISEASE CONDITIONS .................................................................................................162 17. VIRAL INFECTIONS ....................................................................................................................165 18. ALLERGIC REACTIONS ..............................................................................................................177 19. HAEMATOLOGICAL DISEASE CONDITIONS ..........................................................................178 20. NUTRITIONAL DISEASE CONDITIONS ....................................................................................184 21. MALIGNANT DISEASE CONDITIONS .......................................................................................186 22. BITES ............................................................................................................................................188 23. BURNS ..........................................................................................................................................190 24. FOREIGN BODIES.......................................................................................................................191 25. PAIN .............................................................................................................................................192 26. POISONING .................................................................................................................................193 NATIONAL ESSENTIAL MEDICINE LIST FOR TANZANIA (NEMLT)………………………........… 194 ii ACKNOWLEDGEMENT The review of the STG and NEMLIT has been successfully undertaken as a result of collaboration between health professionals namely doctors, pharmacists, laboratory technologists and others from the public and private sectors. The Ministry would like to thank all those who have contributed greatly to the development of this version in one way or another. While it is not possible to mention all who participated in the review of this manual, the Ministry would like to acknowledge the following: Prof. A. Massele Clinical Pharmacologist, MUCHS Mr. J.S. Muhume Assistant Director, Pharmaceutical Services, MOHSW Mr. Y.G. Mlavwasi Pharmacist, Muhimbili National Hospital Mr. C.Y. Mwasha Pharmacist, School of Pharmaceutical Sciences Dr. J. Katarahya Physician, Bugando Medical Centre Ms. R. Aaron Pharmacist, Tanzania Food and Drug Authority MS. M. Kinyawa Registrar, Pharmacy Council Dr. M. Nyang’anyi Medical Offi cer, National AIDS Control Program (STI) Mr. V. Mgaya Lab. Technologist, Ministry of Health and Social Welfare Dr. N.G. Simkoko Medical Offi cer, National Tuberculosis & Leprosy Program Dr. S. Chale Physician, WHO Country Offi ce Ms. L. Nderimo Quality Control Manager, Medical Stores Department Ms R. Shija National Professional offi cer, EDM – WHO Country Offi ce Mr S. W. Kitundu Pharmacist, Ministry of Health and Social Welfare Mr W. Shango Pharmacist, Ministry of Health and Social Welfare Mr T. Mikindo Pharmacist, Kigoma Hospital Dr. S. K. Mgude Principal, Clinical Offi cers’ School Tanga Dr C. Winani Gynaecologist, Tumbi Hospital, Kibaha Dr. E. Kirumbi Medical Offi cer, MOHSW Mr H. Mchunga Pharmacist, Medical Stores Department Dr. C. Asman Medical Offi cer, National Health Insurance Fund Dr.E.P. Mung’ong’o Assistant Director, Private & Voluntary Services, MOHSW The Ministry wishes also to acknowledge the members of the National Therapeutic Committee for their input and guidance that enabled the fi nalization of these guidelines. They include: Dr. G. L. Upunda Chairman Ministry of Health & Social Welfare Dr. Z.A. Berege Member Ministry of Health & Social Welfare Dr. J. G. Sayi Member Muhimbili College of Health Sciences Dr. Y. Mgonda Member Muhimbili College of Health Sciences Dr. A. Kitua Member National Institute for Medical Research Dr. G. Mbaruk Member Kigoma Regional Hospital Dr. S. Kalluvya Member Bugando Medical Centre Dr. E. R. Samky Member Mbeya Referral Hospital M. Ndomondo-Sigonda Member Tanzania Food and Drug Authority Dr. G. Massenge Member Kilimanjaro Christian Medical Centre Mr. C. W. Msemo Member Medical Stores Department Dr. E. Nangawe Member World Health Organization Mr. J. S. Muhume Secretary Ministry of Health & Social Welfare iv The Ministry of Health and Social Welfare would like to express its gratitude to the World Health Organization (WHO) for providing financial and technical support in reviewing and production of these guidelines. Thanks also extended to the Danish International Development Agency (DANIDA) through Health Sector Programm Support, Ministry of Health and Social Welfare for funding the review process and printing the manual. Last but not least, the Ministry would like to thank Ms. Anna Mrimi, Ministry of Health and Social Welfare and Ms. Joyce Komba, Tanzania Food and Drug Authority (TFDA) for typing the manual. Wilson Mukama PERMANENT SECRETARY v ABREVIATIONS AND SYMBOLS BCG = Bacillus Calmette – Guerin Vaccines BP = Blood Pressure CCF = Congestive Cardiac Failure CNS = Central Nervous System CVP = Central Venous Pressure DC = Direct Curent Dpm = Drops Per Minute DTLC = District Tb and Leprosy Coordinator FBC = Full Blood Count g = Gramme HIV = Human Immunodefi ciency Virus HTLV = Human T-Cell Leukemia/Lymphonia Virus i.m (I.M) = Intramuscular i.v (I.V) = Intravenous l(L) = litre mmHg = Millimeters of Mercury MU = Mega Unit ns = Nanosecond O = Oral PEM = protein energy malnutrition PHC = Primary Health Care PID = Pelvic Infl ammatory Disease PR = Prosthion PIH = pregnancy induced hypertension SC = Subcutaneous SLE = Systemic Lupus Erythematous Tab = Tablet TT = Tetanus Toxoid μg = Microgram ARI = Acute Respiratory Infection STD = Sexually Transmitted Diseases SSS = Salt Sugar Solution APH = Antepartum Haemorrhage UTI = Urinary Tract Infection NS = Normal Saline D&C = Dilation and Curettage ATS = Anti Tetanus Serum AE = Acute Epiglottis RR = Reversal Reaction vi 1. GASTRO INTESTINAL DISEASE CONDITIONS 1.1 Parasitic Diseases 1.1.1 Amoebiasis Clinical features: Amoebiasis is caused by a protozoan parasite Entamoeba histolytica. It is usually transmitted from person to person through faecal contamination of food or hands, but may also be transmitted vial anal sexual contact. Amoebic dysentery occurs when the parasites invade the intestinal wall and abscesses may develop in the liver or, less frequently, in the lung or brain as a result of haematogenous spread. Skin lesions may also occur. Pregnant women and individuals who are malnourished or immunocompromised are most vulnerable to systemic infection. Treatment guidelines Intestinal amoebiasis Drug of choice Metronidazole (O) Adult 750-800mg 8 hourly with food for 5 days Children 10mg/kg weight per day Indicative 1-3 years 200-250mg 8 hourly for 5 days 3-7 years 200-250mg 6 hourly for 5 days 7-10 years 400-500mg 8 hourly for 5 days Above 10 years as for adult Second choice Tinidazole (O) Adult 2g daily as a single dose for
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