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HEALTH ORGANIZATION

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DAP/87.1

ORGANISATION MONDIALE DE LA SANTE

EMERGENCY
HEALTH KIT
Lists of drugs and medical supplies
for a population of 10,000
for approximately 3 months

&

t

si

t.

•"/iiiNITY HEALTH
1 February 1988

THE EMERGENCY HEALTH KIT1

LISTS OF DRUGS AND MEDICAL SUPPLIES FOR A POPULATION OF 10,000
FOR APPROXIMATELY 3 MONTHS
(Latest revision: January 1988)

The WHO Emergency Health Kit has been revised and has been renamed the
Emergency Health Kit. The name has been changed, because other United Nations
agencies and many non -governmental organizations have adopted the list of
drugs and medical supplies for their emergency operations.
The Emergency Health Kit was revised in collaboration among the Action
Programme on Essential Drugs and Vaccines and the Emergency Preparedness and
Response Unit, WHO, Geneva, the Office of the United Nations High Commissioner
for Refugees, Geneva and Medecins sans Frontieres, Paris. The League of Red
Cross and Red Crescent Societies, the Christian Medical Commission/World
Council of Churches, and Comite Internationale de la Croix-Rouge were
consulted. A review of the experience of previous users of the WHO Emergency
Health Kit prepared by the London School of Hygiene and Tropical Medicine was
considered at the time of the revision.

The Emergency Health Kit now consists of two lists of drugs and medical
supplies: the BASIC kit and the SUPPLEMENTARY kit.
The BASIC kit contains drugs and medical supplies for use by health
workers with little training. It contains a limited number of drugs, and does
not include any injectable drugs. Simple treatment guidelines based on
symptoms have been developed to help health workers use the drugs
appropriately. These treatment guidelines, which are printed at the back of
this man al, should be included in each BASIC kit. Additional copies can be
obtained from the Action Programme on Essential Drugs, WHO, Geneva, and from
UNICEF/UNIPAC (see page 3 for address).

Tc f cilitate distribution, the quantities of drugs in the BASIC list
have been calculated for kits destined for populations of 1000. One BASIC kit
for 10,000 people consists of ten identical kits for 1,000 population
(although suppliers may be able to provide kits for 1,000 population in
quantities that are not multiples of ten). Drugs on the BASIC list can be
used by health workers without access to drugs on the SUPPLEMENTARY list.
The SUPPLEMENTARY kit contains drugs for a population of 10,000 to be
used only by senior health workers or doctors, It does not contain any drugs
from the BASIC kit, and can therefore only be used if there is also access to
drugs from the BASIC list.

The selection and quantification of drugs for the BASIC and SUPPLEMENTARY
lists have been based on recommendations for standard treatment regimens from
technical units within WHO. A manual describing the standard treatment
regimens for target diseases, developed in collaboration between Medecins sans
Frontieres and WHO, is available from Medecins sans Frontieres, Paris at
cost price and should be included in each SUPPLEMENTARY kit.
1

This document does not constitute the final document for the Emergency
Health Kit and has a limited distribution. It is expected that UN
agencies and NGOs which adopt this version of the Emergency Health Kit
for their operations will provide the Action Programme on Essential
Drugs, WHO, Geneva, with comments and suggestions for changes before
1 October 1988. The comments will be considered when preparing the final
document for the Emergency Health Kit by the end of 1988.

2

Medecins sans Frontieres
68, Boulevard Saint-Marcel
75005 Paris

Telephone: 47.07.29.29
Telex: 201720 F

2
WHAT IS AN EMERGENCY?

The term ’’emergency" is applied to several different situations ranging
from natural disasters to economic disasters. The WHO Emergency Health Kit
has in the past been mainly used in emergencies created by displacements of
populations, but it has also been used in countries with shortage of drugs due
to economic reasons. It must be emphasized that the drugs in the BASIC and
SUPPLEMENTARY lists cover only the initial needs in an emergency. For a
longer-term solution the local requirements must be assessed and drugs must be
ordered accordingly.

QUANTIFICATION OF DRUG REQUIREMENTS
Quantifying drug requirements in an emergency is very difficult.
Morbidity patterns (the relative frequency of different illnesses, for
example, severe infections of the lower respiratory tract or diarrhoea) are
generally similar in different types of emergencies. However, prevalence
rates (the percentage of the population suffering from a certain illness) may
vary considerably between emergencies. In emergencies where malnutrition is
common, morbidity rates may be initially very high. It must therefore be
recognized that the estimation of drug requirements can only be approximate.
In one emergency high morbidity rates may mean that all the drugs listed are
used within one month, whereas in another emergency there may be sufficient
quantities for six months.
PROCUREMENT

The Emergency Health Kit can be procured from all major suppliers of
pharmaceuticals. UNICEF/UNIPAC, Copenhagen has a constant stock of Emergency
Health Kits ready for shipment within 48 hours, but it is desirable to secure
procurement at the regional level to reduce costs of shipping the Emergency
Health Kits. The procuring agency or NGO should secure that manufacturers
comply with the guidelines for packaging and labelling printed in this
document.

O/A 5-7
COMMUNITY HEALTH CELL
47/1, (irk j i i
Murktrfioad—
CAN GALORE •
0U1--

I*

- 3

THE EMERGENCY IMMUNIZATION KIT

It is the experience from past emergencies caused by displacements of
populations that measles is one of the major causes of death among younger
children. Measles spreads rapidly in overcrowded conditions, and respiratory
tract infections are frequent and serious particularly in malnourished
children. An adequate supply of essential drugs may reduce the mortality
programme
rate, but MEASLES CAN BE PREVENTED .by immunization. An immunization
_*-- * ' '
should
therefore
be
given
high
priority
in
the
early
phase of
against measles
an emergency, The Expanded Programme on Immunization (EPI), WHO, the Office
of
for Refugees (UNHCR) and OXFAM United Kingdom have
of the
the High
High Commissioner
(-collaborated in the development of the Emergency Immunization Kit which may be
used to set up an emergency immunization programme against measles. It can
also be used for Immunizations against the other target diseases for the
Expanded Programme on Immunization, i.e., tuberculosis, diphtheria, tetanus,
pertussis and polio.
The Emergency Immunization Kit contains cold chain and injection
equipment for 5,000 immunizations, Vaccines are not included. It may be
ordered from:
The Health Advisor
Health Unit
OXFAM
274 Banbury Road
Oxford 0X2 7DZ
United Kingdom

Telephone (0865) 56777
Telex 83610 OXFAM G
Vaccines can be ordered from:

UNICEF/UNIPAC
UNICEF Plads
Freeport
DK - 2100 Copenhagen
Denmark
Telephone 01-262444
Telex 19813 UNICEF COPENHAGEN

-4-

BASIC KIT

Essential drugs
Quantity/1000 population
acetylsalicylic acid, tab. 300 mg
3000
paracetamol, tab. 100 mg
2000
mebendazole, tab. 100 mg
500
sulfamethoxazole + trimethoprim (cotrimoxazole) , tab. 400+80 mg
2000
chloroquine, tab. 150 mg base
2000
ferrous sulfate + folic acid, tab. 60+0.25 mg
2000
aluminium hydroxide, tab. 500 mg
1000
tetracycline eye ointment 1%, tube 5 g
50
oral rehydration salts, sachet for 1 Itr
200
gentian violet, pwdr. 25 g
4
benzyl benzoate lotion 25%, bottle 1000 ml
1
(1) chlorhexidine (as digluconate) 5%, bottle 500 ml
1
Miscellaneous
gauze bandages, 7.5 cm x 5 m
elastic bandages, 8 cm x 10 m
gauze compresses, 7.5 x 7.5 cm
absorbent cotton wool
adhesive tape, 7.5 cm x 5m
scissors, straight and curved, 12-14 cms
forceps, tissue, without teeth, 12-14 cms
tweezers, 12-14 cms
thermometers (oral)
one-litre plastic bottle for dilution of chlorhexidine
and benzyl benzoate
syringe, 10 ml, plastic or nylon for dilution of chlorhexidine
bucket, plastic, 20 litres
balance, "salter” type
tape measure
brushes
bars of soap
plastic bags for tablets
surgeons gloves, size 7
(2) health cards in plastic cover
hardcover exercise books
small notepads (A6)
ballpens
treatment guidelines

40 rolls
20 rolls
500
1 kg
20 rolls
2
2
2
5
2
2
1
1
1
2
10
1000
100 pairs
500
4
10
10
2

(1) May be substituted with another product from the same therapeutic group.
Chlorhexidine may precipitate when diluted with hard water (non-distilled ).
Therefore, when procuring chlorhexidine or another disinfectant it should be
specified that it must be formulated to allow dilution with hard water.
Additional information about the selection of disinfectants may be obtained from
the Action Programme on Essential Drugs, World Health Organization, Avenue Appia,
1211 Geneva 27, Switzerland
(2) A sample of the health card is given in the back, of the manual. Health cards can
be obtained from UNICEF/UNIPAC, Copenhagen (see p.3 for address).

5

SUPPLEMENTARY KIT

Essential drugs

Anaesthetics
ketamine, inj. 50 mg/ml, vial 10 ml
lidocaine, inj. 1%, vial 50 ml

Analgesics
(1) pentazocine, inj. 30 mg/ml amp. 1 ml
* probenecid, tab. 500 mg

Quantity/10,000 population

25
10

50
500

Antiallergics
dexamethazone, inj. 4 mg/ml, amp. 1 ml
prednisolone, tab. 5 mg

10
500

Ant i e p ile p ti c s
diazepam, inj. 5 mg/ml, amp. 2 ml
phenobarbitone, tab. 50 mg

50
1000

*
*
*
*

Antiinfectives
metronidazole, tab. 250 mg
ampicillin, tab. 250 mg
ampicillin, inj. 500 mg, vial
benzathine benzylpenicillin, inj. 2.4 mill. lU/vial
phenoxymethylpenicillin, tab. 250 mg
procaine benzylpenicillin, inj. 4 mill. lU/vial
chloramphenicol, caps. 250 mg
chloramphenicol, inj. 1 g, vial
tetracycline, caps, or tab. 250 mg
nystatin, vaginal tab. 100,000 IU
quinine, tab. 300 mg
quinine, inj. 300 mg/ml
sulfadoxine + pyrimethamine, tab. 500 mg + 25 mg

1000
2000
100
50
4000
1000
2000
500
2000
2000
3000
50
300

*

Cardiovascular drugs
methyldopa, tab. 250 mg

500

*
*

*
*
*

Disinfectants
(2) povidone iodine 10%, sol., bottle 500 ml

4

Diuretics
furosemide, inj. 10 mg/ml, amp. 2 ml

20

*
See note next page
(1) Pentazocine, although not on the WHO Model List of Essential Drugs, has been
chosen, because of practical considerations, as an alternative to morfia or
pethidine for which inclusion in the kit is restricted by international
regulations on narcotic drugs.
(2) Povidone iodine, although not on the WHO Model List of Essential Drugs, has
been chosen because the use of iodine tincture in hot climates may result in
toxic concentrations of iodine by partial evaporation of the alcohol

6

Quantity710,000 population

&

*

Gastrointestinal Drugs
promethazine, tab. 25 mg
metoclopramide, inj. 5 mg/ml, amp. 2 ml
atropine, inj. 1 mg/ml, amp. 1 ml

500
50
50

Oxytoxics
ergometrine, inj. 0.2 mg/ml, amp. 1 ml

100

Psychotherapeutics
chlorpromazine, inj. 25 mg/ml, amp. 2 ml

20

Respiratory Tract, Drugs acting on
aminophylline, tab. 100 mg
aminophylline, inj. 25 mg/ml, amp. 10 ml
epinephrine (adrenaline), inj. 1 mg/ml, amp. 1 ml

1000
20
50

Solutions Correcting Water, Electrolyte and Acid-Base Disturbances
compound solution of sodium lactate (Ringer's lactate),
inj. sol. bag 500 ml with giving set and needle
glucose, inj. sol. 5%, bag 500 ml with giving set and needle
glucose, inj. sol. 50% amp. 10 ml
water for injection, amp.10 ml

200
50
20
1800

Vitamins
retinol (vitamin A), caps. 200,000, IU
ascorbic acid, tab. 50 mg

2000
500

Drugs marked with an asterisk should be packed separately within the kits to
indicate that they should be used only for those diseases and groups of people
for which they are intended:
diazepam: febrile and other convulsions in children and adults;
phenobarbitone: prevention of convulsions;
ampicillin tabl. and inj.: for use only in neonates and during pregancy;
benzathine penicillin :
treatment of syphilis;
probenecid: to be used with procaine benzylpenicillin fortified for treatment
of gonorrhoea;
tetracycline caps or tabl.: treatment of cholera and chlamydia infections;
nystatin vaginal tabl.: when chewed, these tablets can be used for the direct
treatment of oral candidiasis in children (enteric coated nystatin tablets will
treat oral candidiasis only indirectly)
sulfadoxine + pyrimethamine: treatment of resistant malaria;
quinine inj. and tabl.:
treatment of cerebral and complicated malaria cases;
inj. quinine must always be given diluted in 500 ml glucose 5%;
methyldopa: treatment of hypertension during pregnancy;
metoclopramide: treatment of vomiting during malaria treatment;
glucose 5%, bag 500 ml: for dilution of inj. quinine;

7

Miscellaneous
Quantity/10,000 population
(1) butterfly needle 25 G, disposable
200
needle, resterilisable, 22 G
20 dz
syringe, 2 ml, resterilisable nylon
20
syringe, 5 ml, resterilisable nylon
100
syringe, 10 ml, resterilisable nylon
20
pressure cooker for sterilization, 7.5 litres, e.g., UNIPAC double rack
2
kerosene stove
1
nasogastric tube Ch. 8, reusable
20
nasogastric tube Ch. 12, reusable
10
stethoscope
2
obstetrical stethoscope
1
pair of scissors, straight and curved, 12-14 cms
10
forceps, tissue, without teeth, 12-14 cms
5
scalpel, no. 4
1
scalpel blades, no. 4
100
tweezers, without teeth, 12-14 cms
5
needle holder, 12-14 cms
2
dexon suture with cutting needle, size 3 0
36
tongue depressor, wooden disposable
100
brushes
10
bucket, 20 litres
1
otoscope (with six batteries)
1
tourniquet
2
1
blood pressure apparatus
thermometer (oral)
10
surgeons gloves, size 7
100 pairs
sterilization tray, 16 x 8 x 3 cms
2
1
dressing tray, 25 x 15 cms
kidney tray
1

(]) Must be destroyed after use.

- 8

GUIDELINES FOR LABELLING AND PACKAGING OF DRUGS IN THE EMERGENCY HEALTH KIT

1.

Labelling should be in two languages selected from the official languages
of WHO.

2.

All directions for storage, handling and use should be easy to understand
and remember.

3.

All labels should bear at least the following information:
international nonproprietary name (INN) of active ingredient(s),
dosage form,
content of active ingredient(s) in the dosage unit (e.g. tablet,
ampoule) and the number of units per package or content of the
package in weight or volume,
batch number,
date of manufacture,
expiry date (en clair, not in code),
pharmacopoeial standard (may be stated in usual abbreviations e.g.
BP, USP, etc.),
storage instructions,
directions for use, warnings, precautions when necessary,
name and address (town, country) of the manufacturer,
registration number.

4.

A printed label on ampoules should contain the following information:
INN of the active ingredient(s),
quantity of the active ingredient,
batch number,
name of the manufacturer,
expiry date.

The full label should appear on the collective package (carton, box) of
ampoules.

5.

In cases when there is not enough space on the label for instructions for
use these may be given in leaflets (package inserts). However, leaflets
should be considered as a supplement to labelling, not as an alternative.

6.

At the time of shipment the age of the product should not be more than
six months (from date of manufacture).

7.

For articles requiring constitution prior to use (e.g. powders for
injection) a suitable beyond-use time for the constituted product should
be indicated.

8.

Each consignment must be accompanied by a content list stating the number
of inside packages and the type and quantity of drugs in package.

- 9

9.

Tablets/capsules should be packaged in one of the following types of
containers:
tear off cans with accompanying polythene lids,
deep flanged cans with replaceable lower lids - tablets/capsules
must be sealed in polythene bags,
plastic or glass containers with lines screw cap.

10.

Liquids should be packaged in leak-proof bottles with lined screw caps.

11.

Ampoules must either have break off neck or sufficient files must be
provided.

12.

Containers for above preparations and all other preparations must conform
to the latest edition of either the British, United States, European or
other internationally recognized pharmacopoeial standards for containers
for pharmaceutical preparations and be suitable for shipment, storage and
use world-wide.

Treatment Guidelines for Basic Kit

Introduction
These treatment guidelines are intended to give simple guidance to primary
health care workers using the Basic Kit. In the dosage guidelines four age
groups have been distinguished. When dosage is shown as 1 tab. x 2, one tablet
should be taken in the morning and one before bedtime. When dosage is shown as
* 2 tab. x 3, two tablets should be taken in the morning, two should be taken in
the middle of the day and two before bedtime.

For the daignosis and treatment of diarrhoea fully detailed schedules have
been included as Annex 1 and 2. For the diagnosis and treatment of respiratory
tract infections separate schedules are being used for children under five

The Basic Kit contains the following essential drugs:
acetylsalcylic acid (ASA)
aluminium hydroxyde
chloroquine
cotrimoxazole

ferrous sulphate + folic acid
mebendazole
oral rehydration salts
paracetamol
benzyl benzoate lotion 25%
chlorhexidine, solution 5%
gentian violet
tetracycline eye ointment 1%

tablets 300 mg
tablets 500 mg
tablets 150 mg base
tablets 400 mg sulfamethoxozole +
80 mg trimethoprim
tablets 200 mg + 0.25 mg
tablets 100 mg
sachets for 1 litre solution
tablets 100 mg
bottle 1 litre
bottle 500 ml
powder 25 g
tube 5 g

The Treatment Guidelines contain the following diagnostic groups:
Anaemia
Diarrhoea
Eye
Fever
. Pain
Prevention in pregnanct women
eRespiratory tract infections
Sexually transmitted diseases
Skin conditions
Urinary tract infections
Worms

page 2
2
3
3
3
4
4
5
6
6
7

Special instructions as to the dilution of chlorhexidine and benzylbenzoate
are given as footnotes to the text.

comniun:ty hsalth cell
47/1, (First Fioor)St. Marks iload
BAWGAkOrtE - 5ti0 001

-2-

DIAGNOSIS/SYMPTOM

15 and over

0 to 11 months

1 to 4 years

5 to 14 years

ferrous sulph.
+ folic acid
1 tab. daily

ferrous sulph.
+ folic acid
2 tab. daily

ferrous sulph. !ferrous sulph.
.+ folic acid
4- folic acid
3 tab. daily
j3 tab. daily

ANAEMIA
ANAEMIA
moderate (pallor and
tiredness)

ANAEMIA
severe (oedemas, dizzi
ness, shortness of breath)

DIARRHOEA
|
DIARRHOEA
no dehydration

Refer

Continue (breast)feeding, give more fluids than usual,
Return to health worker in case of frequent stools,
increased thirst, sunken eyes, fever, or when the patient
idoes not eat or drink normally, or does not get better.

loderate dehydration

Treat with oral rehydration salts, 50-100 ml/kg in first 4-6
houres, reassess the condition after 4-6 hours.
For exact dosage of ORS, see Annex 2B

For exact diagnosis
see Annex 1

500 ml
within 6 hours

DIARRHOEA
severe dehydration

I Oral rehydration salts, 100 ml/kg as soon as possible,
land refer patient for nasogastric tube and/or IV treatment

DIARRHOEA
bloody stools
(check stools)

Icotrimoxazole
1/4 tab. x 2
for five days

DIARRHOEA
lasting more than two
weeks, or patient mal
nourished or in poor
condition

■Give ORS as in diarrhoea with moderate dehydration, and refer

DIARRHOEA

1 litre
within 6 hours

I cotrimoxazole
!1/2 tab. x 2
(for five days

2 litres
within 6 hours

cotrimoxazole
1 tab. x 2
for five days

3 litres
within 6

cotrimoxazole
'2 tab. x 2
: for five days

-3-

DIAGNOSIS/SYMPTOM

0 to 11 months

1 to 4 years

5 to 14 years

15 and over

EYE
RED EYE (conjunctivitis)

Apply tetracycline eye ointment 3 times a day for 5 days
If not improved after three days, or if in doubt: refer

FEVER
FEVER
no chills

Younger than
1 month:
paracetamol
1/4 tab. x 3
Older than
1 month:
paracetmol
1/2 tab. x 3
1 to 3 days

paracetamol
1 tab. x 3
for 1-3 days

paracetamol
2 tab. x 3
for 1-3 days

ASA
2 tab. x 3
for 1.3 days

FEVER
with chills:
assume it is
MALARIA

chloroquine
1/2 tab. once,
[1/4 tab. after
;6, 24 and 48h

chloroquine
1 tab. once,
1/2 tabs after
6, 24 and 48h

chloroquine
2 tab. once,
1 tab. after
6, 24 and 48h

chloroquine
4 tab. once,
2 tab. after
6, 24 and 48h

FEVER with cough

!see COUGH

see LOW RESP.TRACT INFECTION

FEVER and patient
malnourished or in
poor condition, or
when in doubt

Refer

PAIN
PAIN
headache, joint pain,
toothache, etc

PAIN IN THE STOMACH

!Older than
one month:
paracetamol
1/2 tab x 3
Refer

paracetamol
1 tab. x 3

paracetamol
2 tab. x 3

ASA
2 tab. x 3

aluminium
hydroxyde
1/2 tab. x 3
for 3 days

aluminium
hydroxyde
1 tab. x 3
for 3 days

-4DIAGNOSIS/SYMPTOM

0 to 11 months

1 to 4 years

5 to 14 years

15 and over

PREVENTION IN PREGNANT WOMEN

PREVENTION OF ANAEMIA
(for treatment, see
under Anaemia)

ferrous sulph.
+ folic acid
1 tab. daily
in pregnancy

PREVENTION OF MALARIA
(for treatment, see
under Fever)

chloroquine
2 tab. weekly
in pregnancy

RESPIRATORY TRACT INFECTIONS
SORE THROAT
with fever and enlarged
ender neck glands

Refer

cotrimoxazole
1/2 tab. x 2
for 5 days

cotrimoxazole
1 tab. x 2
for 5 days

cotrimoxazole
2 tab. x 2
for 5 days

cotrimoxazole
1/2 tab. x 2
for 5 days

cotrimoxazole
1 tab. x 2
for 5 days

cotrimozoxole
2 tab. x 2
for 5 days

EAR
ear pain with fever or
ear discharge for less
than 2 weeks

Younger than
2 months:
Refer
Older than
2 months:
cotrimoxazole
1/4 tab. x 2
for 5 days

EAR
ear discharge for more
than 2 weeks

Once daily clean the ear by syringe without needle using
lukewarm water; repeat untill the water comes out clean.
Dry repeatedly with absorbent paper

-5DIAGNOSIS/SYMPTOM

' 0 to 11 months

1 to 4 years

5 to 14 years

15 and over

COMMON COLD (children over 5 and adults)
malaise, fatigue, slight cough
no or moderate fever, no or watery sputum

ASA
1 tab. x 3

ASA
2 tab. x 3

LOWER RESP. TRACT INFECTION (children over 5 and adults)
cough with fever,
yellow sputum

cotrimoxazole cotrimaoxazole
1 tab. x 2
2 tab. x 2
for 5 days
for 5 days

RESPIRATORY TRACT INFECTIONS (coated)

COUGH (children 0-4)
no fast breathing
no chest indrawing
child able to drink

Continue (breast)fceding , give
fluids, do not allow the child
to become too cold or too hot,
clear the nose to facilitate
breathing, avoid smoke, treat
fever if present.

COUGH (children 0-4)
fast breathing (more than
50 breaths per minute but
less than 70 per minute)
no chest indrawing
child able to drink

Younger than
2 months:
Refer
Older than
2 months:
cotrimoxazole
1/4 tab. x 2
for 5 days

t

COUGH (children 0-4)
fast breathing (more than
70 breaths per minute)
or chest indrawing
or child unable to drink

COUGH
Lasting over 30 days

cotrimoxazole
1/2 tab. x 2
for 5 days

Refer

Refer

SEXUALLY TRANSMITTED DISEASE
VENERAL DISEASE
(syphilis, gonorrhoea)

Refer

-6-

DIAGNOSIS/SYMPTOM

0 to 11 months

1 to 4 years

5 to 14 years

15 and over

SKIN CONDITIONS
WOUNDS
limited and superficial

WOUNDS
extended, deep or on face

Clean with diluted chlorhexidine solution (1)
Apply gentian violet once daily
Refer

BURNS
mild, moderate

Immerse immediately in cold water, or use a cold wet cloth
Continue until pain ceases, then treat as WOUNDS

BURNS
severe (on face or very
extensive)

Treat as for MILD BURNS, and refer

BACTERIAL INFECTION
mild

Clean with diluted chlorhexidine solution (1)
Apply gentian violet two times daily
If not improved after 10 days: refer

BACTERIAL INFECTION
severe (with fever)

FUNGAL INFECTION

SCABIES

SCABIES
infected

Refer

Apply gential violet once daily for five days

Apply diluted
benzyl benzoate (2)

| Bacterial infection: clean with diluted chlorhexidine (1)
Apply gentian violet twice daily.
j When infection is cured, apply benzyl benzoate

URINARY TRACT INFECTION
URINARY TRACT INFECTION

Apply benzyl benzoate 25%

Refer

-7DIAGNOSIS/SYMPTOM

0 to 11 months

1 to 4 years

5 to 14 years

15 and over

ROUNDWORM (ascarls)
PINWORM (enterobius)

mebendazole
2 tab. once

mebendazole
2 tab. once

mebendazole
2 tab. once

HOOKWORM, OTHER WORMS
TAPEWORM (taenia)

mebendazole
2 tab. x 2
for 3 days

mebendazole
2 tab. x 2
for 3 days

| mebendazole
I 2 tab. x 2
I for 3 days

WORMS

1 Chlorhexidine 5% must always
____ be diluted before use: take the one-litre plastic bottle
supplied with the kit. Fill
] ’
'
20 ml " of * chlorhexidine
solution into the bottle by using the
10 ml syringe supplied with the kit (20 ml is two full syringes),
. » Fill up the bottle with
boiled or clean water.
2 Dilute by mixing one half litre benzyl benzoate 25% with one half litre clean water in the
one litre plastic bottle supplied with the kit.

HOW TO ASSESS YOUR PATIENT
A

FOR DEHYDRATION
B

C

Less than 4 liquid stools per day

4 Io 10 liquid stools per day

More than 10 liquid stools per day

VOMITING
THIRST
URINE

None or a small amount
Normal
Normal

Some
Greater than normal
A small amount, dark

Very frequent
Unable Io drink
No urine lor 6 hours

CONDITION

Well, alert

Unwell, sleepy or irritable

TEARS
EYES
MOUTH and
TONGUE

Present
Normal
Wet

Absent
Sunken
Dry

Very sleepy, unconscious,
floppy or having fils
Absent
Very dry and sunken
Very dry

BREATHING

Normal

Faster than normal

Very fast and deep

SKIN
PULSE

A pinch goes back quickly
Normal

A pinch goes back slowly
Faster than normal

A pinch goes back very slowly
Very fast, weak, or you cannot
feel it

FONTANELLE
(in infants)

Normal

Sunken

Very sunken

1 ASK ABOUT DIARRHOEA

2 LOOK AT

3 FEEL.

o

FOR OTHER PROBLEMS

4. TAKE TEMPERATURE

Longer than 14 days duration
Blood in the stool

Severe undernulrition

Fever - 38 5°C (or 101°F) or greater

5 WEIGH IF POSSIBLE

Loss of less than 25 grams
for each kilogram of weight

Loss of 25-100 grams
for each kilogram of weight

Loss of more than 100 grams
for each kilogram of weight

6 DECIDE

The patient has no signs of
dehydration

If the patient has 2 or more
of these signs, he has some
dehydration

If the patient has 2 or more
of these danger signs, he has
severe dehydration

O

a

IF YOUR PATIENT HAS:

Blood in the stool and
diarrhoea for less than
14 days

P ’J
Use Plan A

C;

Use Plan B

Use Plan C

c -i
o,
Source: Treatment of diarrhoea; WHO/CDD, 1987

r3

iio

rn

- y

01 r

r

Diarrhoea lor longer
than 14 days with or
without blood

THEN:
Treat with an appropriate oral
antibiotic for shigella dysentery
If this child is also
- dehydrated,
- severely undernourished,
or
- less than 1 year of age,
reassess tire child's progress
in 24 - 48 hours.
For the severely undernourished
child, also refer for treatment
of severe undernulrition

Continue feeding
and
refer for treatment.

Severe undernulrition

Fever - 38.5°C
(or 101°F) or greater

Show the mother how to cool
the child with a wet cloth and
fanning.

Look for and treat other
causes (for example,
pneumonia, malaria).

£
(D
X

Annex 2A

TREATMENT PLAN A
TO TREAT DIARRHOEA
EXPLAIN THE THREE RULES FOR TREATING DIARRHOEA AT HOME:
1. GIVE YOUR CHILD MORE FLUIDS THAN USUAL TO PREVENT DEHYDRATION.
SUITABLE FLUIDS INCLUDE:
* The recommended home fluid or food-based fluids, such as gruel, soup, or rice water.
• Breastmilk or milk feeds prepared with twice the usual amount of water.

2. GIVE YOUR CHILD FOOD

• Give freshly prepared foods. Recommended foods are mixes of cereal and beans, or cereal
and meat or fish. Add a few drops of oil to the food, if possible.
• Give fresh fruit juices or bananas to provide potassium.
• Offer food every 3 or 4 hours (6 times a day) or more often for very young children.
• Encourage the child to eat as much as he wants.
• Cook and mash or grind food well so it will be easier to digest.
• After the diarrhoea stops, give one extra meal each day for a week, or until the child has
regained normal weight.
3. TAKE YOUR CHILD TO THE HEALTH WORKER IF THE CHILD HAS ANY OF
THE FOLLOWING:
• passes many stools )
• is very thirsty
These 3 signs suggest your child is dehydrated.
• has sunken eyes
• has a fever
• does not eat or drink normally
• seems not to be getting better.

TEACH THE MOTHER HOW TO USE ORS SOLUTION AT HOME, IF:
• The mother cannot come back if the diarrhoea gets worse,
• It is national policy to give ORS to all children who see a health worker for diarrhoea
treatment, or
• Her child has been on Plan B, to prevent dehydration from coming back.
SHOW HER HOW TO MIX AND GIVE ORS

SHOW HER HOW MUCH TO GIVE

• 50-100 ml (’A to 7z large cup) of ORS solution after each stool for a child less than 2 years old.
• 100-200 ml (1/2 to 1 large cup) for older children.
• Adults should drink as much as they want.
TELL HER IF THE CHILD VOMITS, wait 10 minutes. Then continue giving the solution
but more slowly - a spoonful every 2 - 3 minutes.

GIVE HER ENOUGH PACKETS FOR 2 DAYS

Note: While a child is getting ORS, he should be given breastmilk or dilute milk feeds and should
be offered food. Food-based fluids or a salt and sugar solution should NOT be given in addition to ORS.

EXPLAIN HOW SHE CAN PREVENT DIARRHOEA BY:
Giving only breastmilk for the first 4 - 6 months and continuing to breastfeed for at least the first
year.

Introducing clean, nutritious weaning foods at 4 - 6 months.

Giving her child freshly prepared and well-cooked food and clean drinking water.
Having all family members wash their hands with soap after defecating, and before eating or
preparing food.
Having all family members use a latrine.
Quickly disposing of the stool of a young child by putting it into a latrine or by burying it.

Annex 2B

TREATMENT PLAN B
TO TREAT DEHYDRATION
1. AMOUNT OF ORS SOLUTION TO GIVE IN FIRST 4 TO 6 HOURS
2 4 6 8 10 12 18 2

Patient's age *

3

— months------ *Patient's weight
in kilograms

Give this
much
solution
for 4-6
hours

3

5

7

9

11

13

4 6
• years

8

15

15

20

30

I i hh I i I i I i I
in ml:

200-400

400-600

600-800

800-1000

adult

40

50

J
1000-2000

2000-4000

in local
unit of
measure

‘ Use the patient s age only when you do not know the weight.
NOTE: ENCOURAGE THE MOTHER TO CONTINUE BREASTFEEDING.

If the patient wants more ORS, give more.
If the eyelids become puffy, stop ORS and give other fluids. If diarrhoea continues,
use ORS again when the puffiness is gone.
If the child vomits, wait 10 minutes and then continue giving ORS. but more slowly.

2. IF THE MOTHER CAN REMAIN AT THE HEALTH CENTRE
• Show her how much solution to give her child.
• Show her how to give it - a spoonful every 1 to 2 minutes.
• Check from time to time to see if she has problems.

3. AFTER 4 TO 6 HOURS, REASSESS THE CHILD USING THE

ASSESSMENT CHART. THEN CHOOSE THE SUITABLE TREATMENT
PLAN.
NOTE: If a child will continue on Plan B, tell the mother to offer small amounts of food.

If the child is under 12 months, tell the mother to:
• continue breastfeeding or
if she does not breastfeed, give 100-200 mis of clean water’before continuing ORS

4. IF THE MOTHER MUST LEAVE ANY TIME BEFORE COMPLETING
TREATMENT PLAN B
Give her enough ORS packets for 2 days and show her how to prepare the fluid.
’ ?
hef h°W muCh ORS t0 give t0 finish the 4‘6 hour treatment at home.
e
er to give the child as much ORS and other fluids as he wants after the 4-6 hour
treatment is finished.
• Tell her to offer the child small amounts of food every 3-4 hours.
• Tell her to bring the child back to the health
worker if the child has any of the following:
- passes many stools
- is very thirsty
These 3 signs suggest the child is dehydrated.
- has sunken eyes
- has a fever
- does not eat or drink normally
- seems not to be getting better.

Annex 2C

TREATMENT PLAN C
TO TREAT SEVERE
DEHYDRATION QUICKLY
Follow the arrows. If the answer to the questions is ‘yes’, go across. If it is ’no', go down

START HERE

Can you give
intravenous (IV)
fluids?

F ■■

YES

NO

Can the child
drink?

YES E

1. Give IV fluids (preferably
Ringers lactate). Note: If
child can drink, give ORS
until IV is begun.
2. After 3 hours, reassess
the child, and if
appropriate, begin ORS.
3. After 1-3 more hours,
reassess the child and
choose the suitable
treatment plan.

1. Start treatment with ORS
solution, as in Treatment
Plan B.
2. Send the child for IV
treatment.

NO

Are you trained
to use a naso
gastric tube for
rehydration?

1. Start rehydration using
the tube.

YES

2. If IV treatment is
available nearby, send
the child for immediate
IV treatment.

NO

URGENT: Send
the child for
IV treatment.

NOTE: If the child is above 2 years of age and cholera is known to be currently
occunng in your area, suspect cholera and give an appropriate oral
antibiotic once the child is alert.

HCR 1 84

CARD No
CARTE No.

HEALTH CARD
CARTE DESANTE

DATE OF REGISTRATION
DATE D'ENREGISTREMENT
SITE
LIEU

SECTION/HOUSE No.
SECTION/HABITATION No.

FAMILY NAME
NOM DE FAMILLE

GIVEN NAMES
PRENOMS

DATE OF BIRTH OR AGE
DATE DE NAISSANCE OU AGE
C
H
I

MOTHER S NAME
NOM DE LA MERE

L
D
R

HEIGHT
HAUTEUR

E
N

E
N
F
A
N
T
S

W

F

O
M
E
N

E
M
M

3.

DATE OF ARRIVAL AT SITE
DATE D ARRIVEE SUR LE LIEU

OR
OU

YEARS
ANS

SEX
SEXE

M/F

NAME COMMONLY KNOWN BY
NOM D'USAGE HABITUEL

FATHER'S NAME
NOM DU PERE
Cm

WEIGHT
POIDS

Kg

%

PERCENTAGE WT/HT
POURCENTAGE POIDS/HAUT.

FEEDING PROGRAMME
PROGRAMME D ALIMENTATION

IMMUNIZATION

IMMUNISATION

MEASLES
ROUGEOLE

DATE

DPT
DTP

DATE

POLIO

DATE

BCG

DATE

PREGNANT
ENCEINTE

YES/NO
OUl/NON

TETANUS
TETANOS

DATE

GENERAL
GENERALES

1

No. OF PREGNANCIES
No. DEGROSSESSES

2

3

OTHERS
AUTRES
No. OF CHILDREN
No. D'ENFANTS

LACTATING
ALAITANTE

YES/NO
OUI/NOk

FEEDING PROGRAMME
PROGRAMME DALIMENTATION

(Family circumstances
living conditions etc.)
(Circonstances familiales

COMMENTS
OBSERVATIONS

conditions de vie etc.)

HEALTH

(BrieJ history present condition)

MEDICALES

(Bref resumd des conditions actueiles)

CONDITION
(Signs/symptoms/diagnosis)

TREATMENT
(Medication/dose time)

COURSES
(Medication due/
given

OBSERVATIONS
(Change in condition)/
NAME OF HEALTH WORKER

Etat

TRAITEMENT
(M6dication/dose duree)

APPLICATION
(Medication requisa/
ettectuee)

OBSERVATIONS
(Changement d etaty
NOM DE L'AGENT DE SANTE

DATE
(Signes/symptdmes diagnostic)

A

/

L

I

I

I

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