Standard Treatment Guidelines for Children Ghana PDF

Republic of Ghana  Ministry of Health GRvN}voDPbP}Puu ~GNDPZ SvTuvG]o]vb Ministry of Health SvR]}v E ~w th ZUw i  Standard ©...

Republic of Ghana  Ministry of Health GRvN}voDPbP}Puu ~GNDPZ SvTuvG]o]vb Ministry of Health SvR]}v E ~w th ZUw i  Standard © 2017 Ministry of Health (GNDP) Ghana Aoo]PRbXb N}}(R]bo]}vu˙}U}b ]v v˙ ]o ˙bb uU } vbu]' ]v v˙ (}u } ˙ v˙ uvbU o}v]U uRv]oU R}}}˙]vPU }]vP vl} }R`]bU `]R}]}`]'vu]bb]}v}(RM]v]b˙}(HoRX EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU st ]}v E Uı EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU nd ]}v E Uıı EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU rd ]}v E Uııv SvTuvG]o]vb U th ]}v E U SvTuvG]o]vb Uæth ]}v E U SvTuvG]o]vb Uv th ]}v E U SvTuvG]o]vb Uw th]}v E Uw ISBN 978-9988-2-5787-3 For all enquiries write to the publishers: GRvN}voDPbP}Puu~GNDPZ Ministry of Health PXOXB}˘MBræUU A GRvUWbA(] ToPA=~Zvwl  F˘PA=~Zvı ru]o E PPvePRvX}P Wb]P```XPRvX}P Legal Disclaimer Rb C vlv}}v.uR˙}(R]v(}u}vbv v } b] Pvoo˙ bX H}`U R R}bU ]}b v o]bRb v} b}vb]o (} }b v }u]bb]}vb } v˙}vbvb(}uo]}v}(R]v(}u}v]vR]b}}lov ul v} `v˙U ˘bb } ]uo]U `]R b } R }vv }( Ro]}vX Printed by: YuvbPbbL]u]UPXOXB}˘AFwUA ToPr ru]o E P˙uvbbo]u]ePu]oX}u Cover Design: QrouvbL]u]UA ToPrwıUvrv ru]o E PerouvbPRvX}u ii  Tableofonte C nts  P(  ˘]] Alv}`oPuv  ˘]]] Introduction  1 H}`}bR]b}}l  Pb]]vP(}NHIS]ubuv  N}b}v}br+vbb  Referral ]}vb A  Pb]}v`]vP  æ D}b]vPvu]}vb}vAPv}˙`]PR]vR]ov  w PRu}]P]ovvbDP A vE R}vP  w Iu}v}vb  Chatep rX Disorsofder theGatrs ointetina s lTrcta  11 X D]R}  X R}]bD]bbvD]R}  X C}vb}v  ı X PUoD]bb  æX Gb}r}b}RPoRG˘D]bb  æ vX P]vO]P]vvP(}uROb}RPb  wX Hu}R}]b  ı C tep rX ha Disorsof der theLiver  33 X Au}]L]Ab  ıX Jv]  æ X HbA  w X CR}v]Hb  X HEvRo}R˙  X Ab]b  v X V}u]vP  æX H}ooo]v}u C  æ vX DPbvRL]  ææ C tep rX ha NutritionalDisorsder  58 wX Mov]}v  æ C tep rX ha HaematologicalDisorsder  62 wX Avu]  v X Bo]vPD]b}b  væ ıX S]loCooD]bb  vı X PobuCooM˙o}u  w X Llu]  wæ X Mo]PvvL˙uR}u  w C tep ræX ha ImmunisableDissea  80 iii  Standard T G E X Iuuv]b}v  X Mbob  æX Pbb]b  v X Tvb  v w X P}o]}u˙o]b  ı X D]RR]  ı ıX Yoo}`F  ı 30. Haemophilus Influenzae˙D]bb  ı X Pvu}}oD]bb  ıæ X Hb  ıv X R}]bD]bb  ıv Chatep rvX ProblemsoftheNeorwb n~NeonateZ  97 X S]lv`}v  ıw æX N}voH˙}Po˙u]  vX N}voJv]  wX B]RIvi]b  X N}vo}viv]b  v ıX Rv}ob}u  X W]oubTu}  Chatep rwX Disorsofder theCardiovcula sa rSystem  113 X CRbP]v  X IbRu]HD]bb  æ X D˙bv}  X DV]vTR}u}b]b~DVTZ  æX Pou}v˙Eu}o]bu  w vX S}l  ı wX HF]o  X C}vPv]oHD]bb  ıX H˙˙v}'l   æX P]]b  æ æX H˙vb]}v  v æX H˙vb]}v]vR]ovv}obvb  æ æX H˙vb]}v]vPPvv˙  æ æX H˙vb]EuPv]b  æ ææXAR˙Ru]b  æv ævX RRu A F  v æwX D]]vbbvBol}b  v Chatep rX Disorsof der theRespirtor a ySystem  167 æX C}uu}vC}o  vw æıX Pvu}v]  vı vX }vR]o B Ru Ab  wæ vX }vR]b BA  vX CR}v]}vR]b B  vX }vR]b B ]b  w vX LvPbA  ı Chatep rıX Disorsof der theCentralNeouvr sSystem  193 væX HR  ı vX S]b  ıv vwX E]ob˙  vX TRUv}vb]}bPv  Chatep rX PsychiatricDisorsder  207 vıX 'v}v A.] D H˙]˙D]b}~ADHDZ  w wX TRo˙ A D]bPv  ı wX Pb˙R}Pv]S]b  iv  Tableofonte C nts wX Ivb}uv]  w X b]}v D  v w X SR]}Rv]  wæX B]}oD]b}  v wv X Ao}R}oW]R`oS˙v}ub  ı w X Ao}R}o]Do]]uTuvb  w XAv˘]˙D]b}b  wıX SbvUbD]b}b  ı Su XAb D]b}  Chatep rX Disorsof der theSkin  æ ]o B Sl]vIv(}vb  æ X B}]ob  æ X IuP}  v X Cooo]bvE˙b]ob  ı X Bo]Uo  ı æX Y`b  æ FvPoSl]vIv(}vb  252 vX S.]oFvPoSl]vIv(}vb  æ wX P]˙]b]bVb]}o}  ææ V]oSl]vIv(}vb  257 X HbS]uo˘Iv(}vb  æw ıX Hb}bZ Iv(}vb  æı ıX CR]lv}˘  v N}vrS].Sl]vIv(}vb  265 ıX LPCR}v]Uob  væ ıX P]b  vw ıX U]  w ıX RE˙RuvBoo}bR}v  w ıæX AvVoP]b  wv  ıvX uE  wı ıwX Iv]P}  Chatep rX EndocrineandMetaolic b Disorsder  287 ıX D]bMoo]b  w ııX D]K}]}b]b  ı X D]b]vPPvv˙  ıw X TuvrIvH˙}Po˙u]  ı X D˙bo]]u]  X G}]  X H˙}R˙}]]bu  æX H˙R˙}]]bu  æ vX vo A Ivb8]v˙  w wX CbR]vP [bS˙v}u  X O`]PRvOb]˙  Chatep rX Obtes tricCarendObtes tricDisorsder  ıX AvvoC  X H˙ub]bG]u  X H˙vb]}v]vPPvv˙  X Proub]  æ X SPrEoub]vIuu]vvoub E ]  v X oub E ]  æX Mo]]vPPvv˙  vX Avu]]vPPvv˙  wX S]loCooD]bb]vPPvv˙  X D]bMoo]b]vPPvv˙  v  Standard Trtme ae ntGuidelinesUwthEditionUw ıX ]C D]bb]vPPvv˙  X Jv]]vPPvv˙  X P}brPuHu}RP  X P}brPuP˙˘]  ı X AvoPb]]vL}  æ X PuL}]vPuDo]˙  æ æX PuR}(RMuvb  æv Chatep rX Gynaologic ce alDisorsder  358 vX D˙buv}R}  æ wX A}}v  æı X Av}uoVP]voBo]vP  w ıX Av}uoVP]voD]bRP  w X L}` A A}u]voP]v  wı X FuoIv(o]˙  X Mv}b  X ]v}u C }(RC]˘  v Chatep ræX Disorsof der theKidneyandGenitourinayr System  388 X Go}uo}vR]b A  æX NR}S˙v}u  ı vX K]v˙ A Ivi˙  ı wX CR}v]K]v˙D]bb  ıv X Avu]]vCR}v]K]v˙D]bb  ıı ıX U]v˙TIv(}v  X M]]vbvRK]v˙  X C˙bA b  v X Bv]PvP}bH˙ob]  X ]o B P}bb  X S}oMbb  æX TREu˙S}u   vX P]]bu  v wX P}b]}URoVob  w X U]v˙TCoo]  ı ıX URoS]  æX Vb}u˙~MoS]o]b}vZ  æX E]]˙u} A r}R]b  æX TboT}b]}v~T}b]}v}(SuC}Z  æ æX F}v] [bGvPv  w æX BoCv  ı ææX]v}u C }(P}b  ævX oE D˙b(v}v  æwX MoIv(o]˙  æ æX Hu]  w æıX U]v˙SR]b}b}u]b]b  ı vX Pb]bv}RvURoD]bRP  vX Rv}v}(U]v  Chatep rvX SexuallyTransmittedInfections  vX S˘oo˙Tvbu]'Iv(}vb]vAob  vX STIroURoD]bRP]vMob  164. Mycoplasma genitalum 443 væX STIroPb]bv}RvURoD]bRP  vX STIroVP]voD]bRP  æ vwX STIroL}`A}u]voP]v]vW}uv  w vX STIroGv]oUo  vıX STIroS}oS`oo]vP  æ vi  Tableofonte C nts wX STIroIvP]voB}. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX  æ wX STIroGv]oWb  æ wX STIroAv}roRoS˙v}ub  æ wX S˘oo˙Tvbu]'Iv(}vb]vCR]ov  ææ wX STIroN}voC}viv]b~ORou]N}v}uZ  ææ MvPuv}(b].STIvSTI˙v}ub b ]vR]ov  æv wæX STIroURoD]bRPS˙v}u]vCR]ov  æv wvX STIroVP]voD]bRPS˙v}ub]vCR]ov  æv wX STIroL}`A}u]voP]v}Po]IvGuu}˙D]bb S˙v}u]vCR]ov  æw wX STIroGv]oUoS˙v}u]vCR]ov  æ wıX STIroAv}rRoRoS˙v}ub]vCR]ov  æı X HIVIv(}vvAIDS  v Chatep rwX HIVInfectionsandAIDS  v X HIVP}bE˘}bP}R˙o˘]b~PEPZ(}˘}bRoRb}vo  v Chatep rX InfectiousDissande Infetas tions  v X F  v X To}b]b  w X DPb]bvo}b]b~DRrTBZ  wv æX T˙R}]F  wı vX Mo]  wX Uv}uo]Mo]  X SMo]  v ıX Mo]]vPPvv˙  ı ıX Sb}voMo]CRu}v}v~SMCZ  ı ıX Mv]vP]b  ı ıX W}uIv(b}v~IvbvoZ  ı  Chatep rıX yeE Disorsder  503 ıX N}voC}viv]b  æ ıX X}RRou]  æ ıæX F}]Pv}˙]vR˙  æ ıvX R˙E  æv ıwX Go}u  æ ıX C  æ ııX E˘}bK}R˙  æ X S]bub  æ X S]loCooD]bbWRv}R˙  æ X Ev}]vvu}o]]b}b`]R˙}uo]}vb  æ Chatep rX EarUNoseandThroatDisorsder  515 X S]}  ææ X E]Po}hb A  æı æX R}R˙vPobA  æ vX PR˙vP]bvT}vb]oo]b  æ wX S]vbA ]b  æv X Ob A M]  æı ıX CR}v]ObM]  æ X E]b˘]b  æ Chatep rX OralandDentalond C itions  æ X DvoC]b  æ X OoCv]]b]b  ææ X N}b A ]vPUoG]vP]]b  æv X ]o B Ev}]bvP}R˙o˘]b]vDvb˙  æ vii  Standard Trtme ae ntGuidelinesUwthEditionUw æX ]o BA S]o}v]b  æı vX L`]P [bAvP]vlC]}rF]obA  æ w X CR}v]P]}}voIv(}vb  æ X M}RUob  æ ıX O}v}Pv]Iv(}vb  ææ X OoSu}bCoo]v}u C  æ X Tu}}ruv]oJ}]v˙b(v}vvub}˙ubo ˙b(v}v  æı X T]Pu]voNoP]  ææ Chatep rX DisorsOf der TheMuculos s keletalSystem  552 X Ob}R]b  ææ X RRu}]R]b  ææ æX Jv]oI]}R]AR]b  ææw vX Bl]v  æv wX F]}u˙oP]  æv X I]}R]]vGuu}˙u˙}R]b  æv ıX MvPuv}(RH}S`}oovJ}]v  æw X G}  æw X Pb}rP}~R}v}o]v}b]bZ  æwæ X S˙bu]ob˙Ru}bb  æw Chatep rX Trumaa AndInjuries  582 X HIvi]b  æ X A}uv  ææ æX A}u]voTu  æ vX Co}bFb  æı wX OvFb  æı X D]bo}}vb  æıæ ıX }R}] A ]v(}vb  æıw X CR}v]Ob}u˙o]bvCR}v]SAR]b  v  X Cooo]b  v X N}]vPFb]]b  v X HvIv(}vb  v X To}b]b]v}R}]b  væ æX R]lbvOb}uo]  v vX S˙  v wX Ob}}}b]b  vı X S]lorooVb}r}ob]C]b]b  v ıX boA N}b]b  v æX Ob}Pvb]bIu(  v æX Bvb  v æX W}vb  v æX B]bvSvPb  v æX SR}l  v Chatep rX Geneal r Emeger ncies  v ææXAooP]R}v~AvR˙o˘]bZ  v Chatep ræX AntibioticProphylaxisInSuger yr  vw ævX Av]}P}R˙o˘]b]vSP˙  vw Chatep rvX ManagementofcuteA Pain  651 æwX MvPuv}(P]v A  væ Chatep rwX ommon C Malignancies  655 æX CvbB  vææ æıX GvoMvPuv}(P}]b}v]vP  væw Chatep rX Genealr ManagementOfPoisoning  657 vX M]]vbUb]vREoo˙  v viii  Tableofonte C nts Chatep rıX MedicinesUseInTheElderly  662 Chatep rX LocalAnathe se ticgeA nts  v vX L}oAvbRAPvb  v Chatep rX StructuoaredAp chtotheSeriouslyIllChild  666 vX S}R A }RS]}bo˙IooCR]o  v FormsXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Indxe  675  ]˘  Standard Trtme ae ntGuidelinesUwthEditionUw listofTables TorP) To}(u]o]}vb(}b]]vP. XXXXXXXXXXXX  XXXXXXX TorP) D}b]vPvM]}vb}v}˙`]PR]vR]ov  w TorP) To}(]u}v}vbv(ovb  TorP) Abuv}(P}(R˙}v]vR]ov`]R]R}  TorP) Tuv˙Fo]TR˙rPovA  v TorP) Tuv˙Fo]TR˙rPovB  w TorP) Tuv˙Fo]TR˙rPovC  ToræP) Helicobacter pylori]}v E TR˙  TorP) P}br˘}buvPuv}(RoR`}lbL}}vo ˘}b}HbB]v(}v  ToærP) SRo(}}vIuuv]b}v}(R]ovvæ˙b  TovrP) M]vvvG]]uv  TowrP) Woo[bS}Iv}v(}VT D  TowrP) Woo[bS}Iv}v(}PE  w TowrP) TuvG}`R(}u]ouvPuv}(}l b  TowrP) N`Y}lHAb}]}v~NYHAZCobb].}v(}HF]o  TorP)G]}Ru}o}P]ouv}(Rv}vb]}bv  TorP)RP]u(}uvP]vPD]K}]}b]b]vAob  ıæ TorP)RP]u(}uvP]vPD]K}]}b]b]vCR]ov  ıv TorP)R}uuvbRo(}AvvoV]b]b(}N}uoHoR˙ W}uv  æ TorP)AvvoP}}}oC CR  TorP)D}bPP]ub(}M](]b}vvM]b}}b}o(}]}b Pb}voPb  v TorP)M]b}}b}oUbbvD}bP]vMvPuv}(PPvv˙ C}uo]}vb  vı TorP)SPb}(CR}v]K]v˙D]bb  ıv  TorP)Suu˙}(uvPuv}(]}bPb b }(CKD  ıı TorP)D]bvP]bR]vP`vT}b]}vvE]]˙u}r}R]b  v TorP)Cb}(MoIv(o]˙  æ TowrP)ORbo]vb(}HIV  v TowrP) SvTuv~ st L]vTuvZ(}HIVrAIDS  v TowrP) SvTuv~vL]vTuvZ(}HIVrAIDS  v TowrP)SvTuv]vb]o}v]}vb(}HIVrAIDS  v TowræP)R}uuvM}v]}]vP}(DPT}˘]]˙HIVS}o}P˙}( E˘}bHoRPb C }vvo  vw TorP)G]o]vb(}Ruv}(Rv`]R(  w TorP)D}b]vP(}TBM]]vb  wæ TorP)TuvP}}}o(}ORRb]bvT˙b  w TorP)D}b]vP}(S}vrL]vM]]vb  wı ToræP)bvA A=Au}]]v}ro]b(}uo}v~RP]uv(} ONCAILYED DOSINGZ  TorvP)bvA A=Au}]]v}ro]b(}uo}v~RP]uv(} TWICAILY ED DOSINGZ  TorwP) bvA vAu}]]vF]˘D}bC}u]v}v~Sv RP]uvUb]vPR]oo}b]vPvPRb b Z  TorP)uR A vLu(v]v~D}b]vPRP]uvZ  æ TorıP) D]R˙}u]b]v]vvP]]v~D}b]vPRP]uvZ  æ TorP)D}b]vPRP]uv(}Q]v]vIMIvi}v]v˙}vPCR]ov  w TorP)RobvA ~PrR(oTuv]vCR]ovZ  TorP)A}˘]uvb(}]o}v  ı TorP)Suu˙}(uv}}vb(}]o B Mv]vP]b  ı ˘  Listoftables ToırP)CR]b]vPRA ˙E `]Rv}R]b}˙}(]vi˙  æv ToırP)Suu˙}(R}uu}v˙b}(C}viv]bvR] uvPuv  æw ToırP)CR]bb}(R]}b˙b}(R}uu}v˙b}( Go}u  æı TorP)R}uuv}vb(}b}(}vv}vo]uuv}bb]Pb in lupus æ TorP)Iv]}v(}b}(R]bIuuv}Po}o]vvR]b]v  v ToærP)CR}]}(Av]}b(}}R˙o˘]b  v TorP)Pbv}v}(}uu}vP}]b}vbvR]Av}b  væı ListofFigusre F]PwrP)Fo}`RPAvP]vP}]b  w F]PwrP)Fo}`RPS}l  F]PwræP)Fo}`RPHF]o  F]PwrP)Fo}`RPH˙vb]}v  æ F]PwrıP)Fo}`RPAR˙Ru]b  v F]PrP)Fo}`RPuvPuv}(vu]]vPvv˙  F]PræP)Fo}`RPP}buRu}RP  F]PrvP)Fo}`RPP}bu˙˘]  æ F]PrP)Fo}`RPAv}uoVP]voD]bRP~W]R}SouZ  w F]PrP)Fo}`RPVP]voD]bRP`]RSouAvB]uvoE˘u]v}v  w F]PræP)Fo}`RPL}`A A}u]voP]v  F]PrP)F]}u˙oP]v}]vb  ævw  ˘]  Standard Trtme ae ntGuidelinesUwthEditionUw Preface Sv Tuv G]o]vb ~STGbZ ˙bb uoo˙ o} uvb b R b]b RoR }]b ]v ]]vP }v }] uvb (} b]. o]v]o }oubX TR˙ boo˙ G R }vbvbb }v R }uouv }}vb `]R]v RoR ˙bb u v ]uv.]oo˙]vGv]vPb]]vPR]}oooob}(X HoR ˙bb ubU oo˙ ]v o}]vP }v]bU ( `]R P}`]vP RoR vb }v }v Rv v o]u] b}b }v R }RX P}o]˙ ulb ]}b oob R(} vPP ]v b]Pv]vP }br + RoR ]vv}vb R vb b]o v +}o o]˙(}ooU]voR}}vovoP}bX Iv}] b]]vP ]b }v }( R uv](b}vb }( ]}vo u]}v b R]}X I }b `Rv u]]vb v} b] ]v }v `]R P]o]vb R b }v b]v. ]v } vb(b U+Uv}v}u]bXSTGb}]R}}o(}RoR }]b}P]o]˙v]b b +}o}bX F} GRv[b P}`]vP N}vo HoR Ivbv SRuU vb uv P]o]v ]b bv b }b }v]vuv }}o } vb R ]v8]v]bU ( v }o˙rRu˙U }Lv b}] `]R HoR IvbvSRubUu]v]u]bX RPoU}ivvbv]`b}(STGb˙]u}v b R o}uv }bb ]b }vvo +} v v} o]u] } }vru }}vX TR]b }bb ]vob P]v]vP v }( R }v v ]vP R˘ (} `] }vbo}v v }vbvbb  ]o]vPXTR]b]b}vbR]v(˙ b `]Rv}ooo˙}`vR }bb}(o}uvX TR]b }uv ]b R vR b ]}v }( R M]v]b˙ }( HoR[b }8]oo˙ } b]b[ v ]bvbb[ P] (} oo oob }( RoRX G +} Rb v ]v} o]Pv]vP R ]o]vP RoR ]vbv v.b lP } R]b ]}vX TR }8]o ob }( R]b ]}v `}o R r}˙U ]oo R'Pll```XPRvX}PXTR]b ]}v]bob}]oo}v}u]blX TR M]v]b˙ }( HoR ]b oo˙ P(o } ]b o}uv vbU˘bUv}RlR}ob b (}R]}vv}bb}} RRoR}b X Iu}v.vRoo}( b R]b}uv`}o.vR]b]}v ˙(o b X H}vXK`lAP˙uvrMv Minister for Health Jvw ˘]] cknow A ledgement TR ]` }( R Sv Tuv G]o]vb v Ebvo M]]vb L]b w ˙ R M]v]b˙ }( HoR `]R ]b Pv]b Rb v (oo˙ b }uo b bo }( R }uuv}vb v }v]}vb](}uP Ministry of Health and its agencies H}vXK`lAP˙uvrMv Minister of Health H}vXT]vMvbR D˙M]v]b}(HoR H}vXK]vPbo˙A}P˙G˙ D˙M]v]b}(HoR MXAo˘vPXSP. F}uH}vXM]v]b}(HoR X D V]}Bu} F}uH}vX˙D M]v]b}(HoR X D A.bRl]R Z CR](D]}UM]v]b˙}(HoR~MOHZ X D AvR}v˙Nb]RrAb D]}GvoUGRvHoRS]~GHSZ X D vE A]RrDvl˙] F}uD]}GvoUGRvHoRS] ~GHSZ MbXMRG˙vbrL'} D]}UPRuoS]bUMOHlGHS X D EuuvoOu APXD]}UP}o]˙Povv]vPM}v]}]vPv o}v E ~PPMEZUMOH  MXSuoB}vP F}uD]}P}uvvSo˙UM]v]b˙}( HoR~MOHZ MbXJ}˙o˙vA APXD]}UP}uvvSo˙UMOH MXIbAP˙luAb F]vv]oC}v}ooUMOH MXHuvDb F}uF]vv]oC}v}ooUMOH X D SuoY`Avv} O CE UN}voHoRIvbvAR}]˙~NHIAZ MXNRv]oO}} F}uO CE UN}voHoRIvbvAR}]˙ ~NHIAZ MbDobMXDl} O CE UF}}vDPbUAR}]˙ MXHM}P] F}uO CE UF}}vDPbAR}]˙ X D Fo]˘Av˙R O CE UK}oBTR]vPH}b]o~KBTHZ X D ORvO`brDvb} O CE UK}u(}Av}l˙TR]vPH}b]o~KATHZ X D Dv]oAb O CE UC}bTR]vPH}b]o~CCTHZ X D ]D `u˙ Z K}o]oo O CE UTuoTR]vPH}b]o~TTHZ X D Al`b]Ob] O CE UMvoHoRAR}]˙ ˘]]]  Standard Trtme ae ntGuidelinesUwthEditionUw SR}}ob}(M]]vvPRu˙E˘b P}(XMPL˙ DvUUv]b]˙}(GRvSR}}o}(M]]v Dvb˙~UGSMDZ P}(XY`ArSl}] DvUSR}}o}(M]oS]vb~SMSZUK`u NluRUv]b]˙}(S]vvTRv}o}P˙ ~KNUSTZ P}(XFv]bWXO(] DvUSR}}o}(M]oS]vb~SMSZUUv]b]˙ }(C}b~UCCZ P}(XFv]bAvvP DvUSR}}o}(M]]vvHoRS]vbU Uv]b]˙}(o}uv D S]b P}(XH˙TP} DvUSR}}o}(M]]vUUv]b]˙}(HoRv Allied Sciences P}(XR]D]lb}v DvUFo˙}(PRu˙vPRuo S]vbUKNUST X D IbAb]G˙l˙ DvUUv]b]˙}(GRvSR}}o}(PRu˙ P}(XA(Hbb DvUC}ooP A }(M]]v X D K`b]ORuvP DvUSR}}o}(PRu˙Uvo C Uv]b]˙ C }ooP P}(XTXCXFo]bR DvUSR}}o}(PRu˙UUv]b]˙}(HoRv Allied Sciences  GRvN}voDPbP}Puu~GNDPZ MbX]R E EXG} P}PuuMvPUGNDPUMOH X D APbvK}R P}PuuO8UGNDPUMOH MXB]vAb P}PuuO8UGNDPUMOH MbXFo}BR P]v]oP}Puu}vv A MbXAPvbOb]K}v }v A O8 MXWov}R E }v A O8 MbXD]vb]E O8MvP MbXD}}R˙O}l F}vDblMvP N}voM]]vbSo}vC}uu]'~NMSCZ P}(XFv]bWXO(]~CR]uvZ Duv}(IvvoM]]vvTRbU SMSUUCC X D KvA}R Duv}(SP˙USMSUKNUST ˘] MXOb]BXARu}vP NHIA X D MbXNOl]l}A]b}v Duv}(M]}]}o}P˙UKBTH X D V]}]˙] A Duv}(CR]oHoRUUGSMD P}(XJ}bRA}rY}} Duv}(CR]oHoRUSMSUKNUST X D V]vvAi˙ Duv}(Ob]bvG˙v}o}P˙USMSU UCC X D SRvAl(} Duv}(SP˙UUGSMD X D AoAlo Duv}(M]]vvTRbUUGSMD MbX]R E AXAvvv W}oHoROPv]b}vC}v˙O8(}GRv MbXR˙AXMvbRAvvv P}]P˙uvD]}UNHIA X D PR]o]Avu N}voDPIv(}u}vRb}vC X D T]u}R˙NXAXRu}vP A Duv}(M]]vUUGSMD MXB]vAXAb GRvN}voDPbP}Puu~GNDPZUMOH X D H}o˙˙ A Duv}(IvvoM]]vvTRbU SMSUUCC P}(XHv˙B}} Duv}(AvbRb]UUGSMD  X D vE VXB} Duv}(CR]oHoRUUGSMD X D M]RoOXB}uR wM]o]˙H}b]oUM]v]b˙}((v D ~MODZ P}(XJ}rNCoPPrLu˙ Duv}(SP˙UUGSMD X D S˙o]DPvb Duv}(Ob]bvG˙v}o}P˙ X D IX D ˙D Duv}(M]]vUKBTH X D Ml}bD ] CvoUv]b]˙C}ooP~CUCZ P}(XMbXI˙Elu Duv}(Hu}o}P˙UUCU C SMS X D Al˙Ebuv Fu]o˙M]]vUv]Uuv D }(C}uuv]˙ HoRUSR}}o}(Po]HoRUUv]b]˙}(GRv X D MbX˙A F}b}v Duv}(M]]vvTRbUUGSMD MbX]R E EXG} GRvN}voDPbP}Puu~GNDPZUMOH P}(XMbXBuvoQXG}l Duv}(CR]oHoRUUGSMD MbXMRG˙vbrL'} Ministry of Health ˘  Standard Trtme ae ntGuidelinesUwthEditionUw P}(XEuuvoX D K]R Duv}(SP˙UUGSMD X D Fv]bK`u]v Duv}(OoPR}o}P˙rOoM]]vU UGSMD X D JubEXMvbR Duv}(SP˙UUGSMD MbXFXAuRNlvbR Duv}(PRu˙UKBTH P}(XMbXAvPoLXO(}]rA' Duv}(Pb˙R]˙UUGSMDlGRvHoR Service X D Suu˙ORv Duv}(Pb˙R]˙UUGSMD X D MbXCRo}'Ob(} Duv}(M]]vvTRbUUGSMD X D IbO`b Duv}(M]]vUSMSUKNUST P}(XMbXL}vRvv Duv}(CR]oHoRUUGSMD X D M]RoSP. Duv}(SP˙UUGSMD MXR˙u}vT'R Duv}(PRu˙UKBTH X D L]oo˙W Duv}(SP˙UUGSMD Co-opted experts MbXR˙A`]'} GHSUAbR]uv  MbXD}bP}lB}vP ]} C rTR}]PRu˙UKBTH MbXP]b]ooElo CR]oHoRPRu˙UKBTH MbXO]Svl CR]oHoRPRu˙UKBTH X D AuV} Fu]o˙PR˙b]]vUN˙R}M]oCv N}vo]v E S˙vRb]bbrP}}(NMSC X D K`uArB}vb+}R Duv}(Ob]bvG˙v}o}P˙UKBTH MbX]R E AXAvvv W}oHoROPv]b}vC}v˙O8(}GRv MXB]vAXAb GNDPUMOH X D K`}`}Nl}uR Duv}(M]]vUKBTH X D Y`O(}]rAi] Duv}(M]]vUKBTH ˘] ]}]o E C}uu]' P}(XFv]bWXO(] Duv}(IvvoM]]vvTRbU SMSUUCC MXB]vAXAb GNDPUMOH X D Y`AXA`l Duv}(IvvoM]]vvTRbU SMSUUCC X D vE VXB} Duv}(CR]oHoRUUGSMD X D K`uOXBvP Fo˙}(PRu˙vPRuoS]vbU KNUST X D M}bD ] Duv}(PRu˙UCvoUv]b]˙C}ooP MbX]R E EXG} GNDPUMOH X D M]RoOb]rB}uR wM]o]˙H}b]oUM]v]b˙}((v D X D Y`O(}]rAi] Duv}(M]]vUKBTH P}(XAo˘N]]O}}D}}} WHOC}oo}vPvC (}PRu}]P]ov X D APbvK}R GNDPUMOH Public Health Programmes E˘vP}Puu}vIuuv]b}v~EPIZUGHS  ˙E P}Puu C UGHS N}voAIDSlSTIC}v}oP}Puu~NACPZ N}voMo]C}v}oP}Puu~NMCPZUGHS N}voTo}b]bP}Puu~NTPZUGHS N}voY`b]}v E P}Puu~NYEPZ NPoT}]oD]bbC}v}oP}Puu N}vr}uuv]oD]bbC}v}oP}Puu R}HoRUv]UGHS Contributors CR]oHoRUGHS CR]bvHoRAb}]}v}(GRv Fu]o˙Povv]vPUGHS ˘]]  Standard Trtme ae ntGuidelinesUwthEditionUw GRvAb}]}v}(Qb]rG}vuvHoRIvb}vb GRvM]oAb}]}v HUD]bbC}v}oUv]UGHS NbbvM]`]bAb}]}v}(GRv N}voBo}}S]}(GRv PRuoS}]˙}(GRv S}]˙}(P]M]ovDvoP}vb S}vPo}uv D Pvb }v E Uv]}vC}uu]bb]}v Uv]K]vP}uDuv(}Ivv}voo}uv D W}oHoROPv]b}vC}v˙O8(}GRv  ˘]]]  Introduction TR G}vuv }( GRvU R}PR R N}vo M]]v P}o]˙U u]vb }uu]' } vb]vP R ]o]o]˙ }( v b]]o]˙ }U +}ovP}}o]˙u]]vb(}ooGRv]vbVv]]b˘ RRbu]]vb`}o}voo˙ b XAR]]vPRb}ib ] }uRvb] P˙ b R v} }vo˙ ]vob bo˙ v ]b]}vU ob} }] v R}PRo b]]vPU ]bvb]vP vb}(u]]vbX TR M]v]b˙ }( HoR b]v ı Rb v o]bR]vP o]b }( Ebvo DPb `]R TR G]o]vb } ] R }vo b }( PbX TR]b }uv Rb v]` ]vb}vb } v` lv}`oP }v Pb v ]bb v RvPb ]v R ]u]}o}P˙ }( ]bb ]v GRvX TR M]v]b˙ Rb ob} } P]o]vb (} b]. ]bb }v}o}PuubU]bbv]v.oRoR}]bX TR Sv Tuv G]o]vb R v b }}o } b]b v P] b]b ~]vo]vP }}bU u]o b]bvbU v u]`]bZU Ru]bbU ]bvbbU v }R RoR+ b `R} b] ]u˙ (]o]b ]v }]]vP o]˙ } vbX TRP]o]vbo]bR(uvb(}}uu}vRoR}oub ˘]v ˙ }o ]v R RoR ˙bb u v ` bi } lR}o b ]bb]}vb(}]vP.vo]b}vbRR}]v]}v }(R]vvb`}vb]v]v}}X TR P]o]vb b]Pv } b b P] } uv R}]b v b (v }}l } Ro ]v R }oo uvPuv }( vbU bR b `Rv } (X TR P]o]vb uv (} b oo oob`]R]vRRoR˙bb uU}Ro]v]X I]b}Pv]bRRuvP]v]o]vR]b}}lu˙ ]+ (}u v X I ]b uRb]b R R R}]b b] R R R `]PR }( b]v. ]v } b} RuU }PR `]R R }oo }]v]}v }( `] P} }( }Pv]b v}vo v ]vv}vo ˘bX TR }uuv}vb R v }v R (}oo}`]vPb]bP ]v E RvP A W ]b ob }v v}u]b }v}o ]o b }( }˙ }( b]v. o] }( }oo P}} o]˙ v }vb]bv˙b]vPRb].}uuv}vX  Standard ]v E RvPWB ]bR]o]o]˙}(`oor}vo]v]o ]bb v}v}u]bo]v]o]ob}vR}]}(}uuv}vX ]vE RvP C W ]b ]v }]v (}u ˘ }uu]' }b } }]v]}vb vl} o]v]o ˘]v }( b R}]bXTR]b]v]bvbv}(]o˙o]oo]v]o]bb }(P}}o]˙X T}uv b }RRvR}b}uuvRu˙R} ib.}}ooPbUuvPbU}]vo`X TR }vv }( Rb uv P]o]vb `]oo vP} }bb }( }vv}b ]`X C}uuvb } bPPb}vb (} ]u}uv `o}uXTR}b}uuvb}bPPb}vb(}]}v}(]bbR}o ]vo]v}(ov`oo b Lb uvP]o]vb]vP R(}u}b ]vR]b}}lXIvRb}((} b v`P} o]vP o]b} `]R v}R}U R]v b ub oo˙.vv]vo`]RRX b TRbbPPb}vbbR}obv}P TRP}PuuMvP GRvN}voDPbP}Puu Ministry of Health POB}˘MBæ U A GRv WbA(] Wb]P```XPRvX}P  How to use this book T} b Rb P]o]vb +o˙U ] ]b ]u}v R ˙} }u (u]o]`]RR}vvbXTlu}R}}lvvbvR }vvvo˙}X TR }vvb }( R]b }}l R v vP ]v }˘]uo˙ oRo } }( R}˙ ˙bb ub[X W]R]v R b}vU vu }( ]bb bU `R]R b]Pv].v ]v GRv R v ]v.X F} R }( Rb ]bb R ]vPb }( R ]v(}u}v v P]v Rb v v]b b } ]vo ]( b]}v }( R }v]}v } ]bb v R u} }uu}v b]Pvb v ˙u}ub b X Iv R b R }ib }( uv R v b }U (}oo}` ˙ }uuv v}vrRu}o}P]o b `oo b R Ru}o}P]o uvR}]bX TRR}]}(uvP]vR b ]b}v b R]v]ob }( R]v b u]]v[X TR ]bU ] ]b b }v R ]vv}vo u]o v Ruo o]U `R]R oo˙ u}vbb R 8˙}(RuvR}]bX TR uv P]o]vb ˙ } l R b R}PR bv }( ]Pv}b]bU uvU uv }ibU v R}] }( uv  Introduction v]`}(}}uXPb]b}vPo˙ b }uuv}} b]u]o}R}X CbR}o lv}}]˙u}u b uvPuv}(v]v]Pv}bbX WRvvPvbU R.vob}vb]]o]˙ (} R `oor]vP }( R ]v]]o vu]vb `]R R b]X Pb]b ubl b } vb R R˙ }uv } uvP R u}b }uu}v }v]}vb bvvP R] v (u]o]]b Rubob oo˙ `]R R}b b }( R uv P]o]vb ovP } R}b}v]}vbX I]b]u}v}uuRRP]vP]v]v R]b}}l]bb}vRbu}vRRb]]b}uv} Rvo vb R]b ooU ]vo]vP R]o]o]˙ }( ]Pv}bb vu}v]}]vP]uvX TR]b ]}v b R R}uuv Ivv}vo N}vrP}]˙ Nu ~INNZ ]v o]v `]R WHO }uuv}vb v X Iv u}b bURB]bR}A Nu~BANZvINNb]u]o]v(` ]vbvb R ]+vbX WR Rb ]+vb }U R AN B Rbv]vvRb}b u]˙b (vX Prescribing for NHIS reimbursement TR N}vo HoR Ivbv SRu ~NHISZ }b `]R.v v.b lP v ]ubb RoR }]b (} b]b v } ]b uub }]vP } R uv }}}ob  }o]v ]v R STGX I ]b ]u}v (} b]b } `]R R v.lPv ob} `]R R}}vo uvob }( RbRu} vbuubv.}]o˙v(]o]b](oo˙uv (}b]bvX TRT]+O}voMvovRNHISM]]vbL]b~NHISMLZ ]u}v (v }uvb (} b] }]bX TR˙ ]v] R]v]]o}v]}vbR}URu]]vb]oo}vR bRu[b(}uo˙vR]+b}b(}]oo]vPX Pb]bubv}R(}˙}v]}vR]b}UR u]]vbo]b]vRNHISML]vo]v`]RRSTG}uuv}vbX Iv ]}vU R NHIS MLb R oo }( b]]vP 'R } R u]]vb]v]]vREbvoM]]vbL]b}(RMOHX M]]vbbR}ob]˙RPv]vub}vRMLv b]bub]v]Rv˙}(u]]vb}bo]}vR b]}vXTR]b]bv}uo]uv(}b]]vPv`]oo˙ Ro(o]vo]ub}bb]vP(}]ubuvX N}b}v}br+vbb  Standard Trtme ae ntGuidelinesUwthEditionUw R(o TRbP]o]vbob}ul}]b]}v(}(o}(vb}}R RoR (]o]bX Pvb bR}o ( `Rv R b] ]b v} o } uvP R v ]R R}PR ol }( b}vo ˘]v }R]o]o]˙ }(}](]o]bXPvbbR}o (U]v }v `]R P vPuvbU } (]o]b `R R vbb˙ }uvU]Pv}b]bvb}(]o]b˘]bXTRvbR}o P]v o'}v}]v]vPR}ouv`RRbv}vb} (U]vo]vPo}}˙vb uvXWRv]v]UuPv˙ uv ub P]v (} (]vP R vX I u˙ ob} vbb˙(}Rv}}uv]˙uu}(RoR+ b v ] bR}o uu R R }( (o }b v} u} (}uRb]Rb}vb]]o]˙(}R`oor]vP}(RvX ]}vb A TR (}oo}`]vP ]}vb }uu}vo˙ b ]v Pvo b ]]vP }( u]]vbX WR]o ob }( Ru u˙ (}v ]v R]b uv P]o]vU ] Rb v} v vbb˙ } b oo }( Ru ]v R ˘}(R]b}}lX TorP) To}(u]o]}vb(}b]]vP  ]}v A C}vv}}v IV Ivv}b IM Ivubo SC Subcutaneous X}X}}o }b~˙u}RZ lP K]o}Pu P Gu uP M]oo]Pu L L] dl D]o] uo Millilitre uu}o M]oo]u}o uE Milliequivalent R~bZ H}~bZ u]v~bZ M]v~bZ  Introduction ]}v A C}vv}}v b~bZ S}v~bZ u M~bZ u Cvu~bZ WB B}˙`]PR °C DPo]b uuHP M]oo]ub}(u˙ XX Av]u~(}(}}Z XX B]b]~R}o˙Z }XX Ouv]]~]o˙Z }XuX Ouv]uv~]vRu}v]vPZ }XvX Ouv]v}~v]PRZ XX P}b]u~L(}}Z XXvX P}v~`Rv]Z XXb Q]buvb ~vR}o˙Z  XXR Quarta quaque hora ~R}o˙Z X b Su~]uu]o˙Ub]v]o}bZ XXbX T]buvb ~R}o˙Z u]]vb`]'vbX}X}}o}oobUbobUobUbvb]}vb}˙bb X Pb]}v`]vP M]]vb bR}o b] }vo˙ `Rv R˙ vbb˙ ]v uv(}oo}`]vPo]Pv}b]bXN}oovbvb]}v (} u]]vV v}vrRu}o}P]ouvu˙ b]o v R]b RbvR]PRo]PR]vRbP]o]vbX Iv oo b R v. }( u]v]b]vP R u]]v bR}o }vb] ]v o}v } R ]bl ]v}oX TR]b ]b oo˙ ]u}v ]vP Pvv˙ `R R ]bl } }R u}R v (}b ub }vb]X Pb]}vbbR}o yy `]'voP]o˙]v]vl}}R`]bb}}b ]vo]o yy `]'v ˙ R b] v v} oL (} v}R b}v } æ  Standard }uo yy be dated yy R b (oovuvb}(Rv yy b](˙ R P v `]PR }( R v ~b]oo˙ ]v R b }( R]ovZ yy b]Pv]v]vl˙Rb] yy R}v]ob }( Rb] ~XPX vu voR}v vuZ WRv`]vPb]}vR(}oo}`]vPbR}ov}P yy Nu }( u]]vb v }vb bR}o `]'v ]v (ooX Uv}8]o ]}vb bR}o v} b R ]b R]PR ]bl}(u]b]v}vX yy N}vr}]˙ ~Pv]Z vub P]v ]v R }}l v R˙ bR}oo`˙bb]vb]]vP yy }] A Rvvbb˙b}(]uo}]vbUXPXuPUv}XuPX yy Qvb}(Pu}u}bR}o`]'vPX yy QvbobbRvPubR}o`]'v]vu]oo]PubUXPXæ uPUvv}XæPX yy Qvb obb Rv uP bR}o `]'v ]v u]}PubU XPX u]}PuUv}XuPX yy WR ]uob v}]o } bR}o `]'v ]v (}v }( R ]uo }]v`RR]b v} }R.PU XPX Xæ uoU v} XæuoX  yy RM]}Pub[vRvv}Pub[bR}oNOT]XS]u]oo˙U Rv]b[bR}oNOT]X yy UbRuRu]oo]o][~uo}uLNOT Z ]vu~U}uZX yy S }b v }b (v˙X Iv R b }( Rb ][U u]v]uu }b ]vo bR}o b].U XPX R˙ rv Rb b ](}]v[X yy SR v˙ } bo] } ]v]R vu }( ˙b }( uv]X yy W] ]}vbU (o˙ ]v EvPo]bR `]R} ]}vX I ]b }Pv]b R b}u Lv ]}vb b v Rb ]o ]v R b}v }v ]}vbX D} NOT b }R ]}vb yy }]A }u]v}v PbU vobb R ]b b]Pv].v R vP}b]vPo]vP]v}vb~XPXC}r]u}˘}oZX yy }] A R b }( ˙u}ub uvb (} u]v} bo(ro]u]vP }v]}vbX yy }] A U`R}bb]oURb]]vP}(o}bXSvb}uu vPvb]vPRvX yy }] A uoo b]]vP ~}o˙Ru˙ZU b]oo˙ `Rv R ]Pv}b]b]bv}oX yy }] A R}( b Rvo}}(u]v]b}v˘`R v  Introduction R oU o]v]o ]v]}vb (} R]b }X Ub R }o } `Rv}bb]oX D}b]vPvu]}vb}vAPv}˙`]PR]vR]ov TorP) D}b]vPvM]}vb}v}˙`]PR]vR]ov AP B}˙`]PR]vlP Children ˙b ı w˙b æ˙b ˙b æ ˙ vu}vRb wXw u}vRb æXv u}vR X N`}v Xæ  TRb.Pbo}(oouvv}u]v(vbX}bA Pu˙] ]vu]v(vbX PRu}]P]ovvbDP A vE R}vP TR o}uv }( v vb]o u]o }v]}v bR b v` ˙u}u b U b]PvU o}}˙ } }R b o}vU ]}}v }( r˘]bvP u]o }v]}vU ]b]o]˙ } R ]vP } (}oo}`]vP u]v]b}v }( u]]vo } ~oo}R] } RoZ } b }( u]o ]U } R ol }( + }( R }U ]b }vb] v b v R vb } }U `RR } v} }vb] boo˙o}R}X S}vv}bU }ov˙ }vP }( b vb ovP } R b }( b]}v }vo˙ u]]vb v ]vbU }rRr}v u]]vb v u]o ]b ]b v}` Pvoo˙ }vb] v}u ]v uv˙ }v]b (} RoR }(bb]}vob v }vbub o]lX F} RoR }(bb]}vobU R v } } b }vb } Rb }b]bob}u}ov}(bb]}vo}o]P}vX AoR}PR u}b u]]vb vP} ]P}}b (˙ b u}v]}]vP ]vP o]v]o ]ob (} }o ]b P]v (} R] P]b}v v b ]v v˙ }v˙U bR ]ob R b}u o]u]}vb ]vo]vP R oo˙ buoo vu }( ]v]]ob ]v}oX P}brulvP b P v u}v]}]vP v }vP vob }v }( obb w  Standard Trtme ae ntGuidelinesUwthEditionUw }uu}vo˙ v}vU }voo˙ b]}bbvb u}vP oP }o}vX Oo u]]vb v ]bU `]R `R]R RoR }vb u˙ R˘]v `]R bU v v`}vb `]R `R]R R˙u˙v}UvooP]]b}vbb ]vob ]v]]obX TR]b ]}v }( R SvTuvG]o]vbU o]lR]}b ]}vU ]vob }]b }( R GRv F}} v DPb AR}]˙ ~FDAZ b }v }vP (}uX E˘ }]b }( R b }v }vP(}uu˙}]v(}uRFDA}R}PR]bIvb}vo C}v Pb}vb ]}b RoR (]o]b R}PR} R }v˙X Pvb u˙ ob} } ]o˙ R}PR Pv S(˙ Cvb ]v b]Pv }uuv]˙ Ru]b v}v`]X Ovo]v bu]bb]}v }( }b ˙ }R RoR }(bb]}vob v vb v ob} }v R}PRRS(˙WRS˙buR'PllX(PRvXP}XPRl}R'Pll (PRvXP}XPRll}```X(PRvXP}XPRXAvru]o}(}u˙ ob} bv } R N}vo PRu}]P]ov Cv PXb(˙e (PRvXP}XPRX A R}v oo } ıw } } bR} } æ }ou(}v˙b]bvP]vPP(˙ b ]bbX Ab]Pv]vP bo]˙ } R } v ]b ] } ˙ }uu]'}(˘b (}uob ]b]o]vb ]v u]]v v Ru˙ v }Rb bvvP R Ruo ]vb˙ v }vbu ]vbbU bo ˙ R FDAX TR }bb ]b v}v˙u}b v Rvo `]RR]bb }v.vv]bo]vl}W}oHoROPv]}v Ru}]P]ov˙bb uX TR o˙ ]v.}v }( `v]vP b]Pvob (} o }  (}u b v }vP v Ru}]P]ov ]b vob uo˙]vv}vb}(}boov˙}voRu}Ro]X Important contacts TorP) Table of important contacts and referral centres Uv]lDuvlR(oCv Contacts F}}AvDPbAR}]˙~FDAZ ræUrU ær bPA }vbP TOLLrFREEPæ~V}(}vl Pob}v˙Pb }vb A]oZ }RPRu}]P]ovUv]}(R HOTLINEPıırıUıırı F}}vDPbAR}]˙~FDAZX F˘Prıwı Wb]P```X(PRvXP}XPR Eu]oP(e(PRvXP}XPR T`]'PPR(ePRY( WRbPvrıwvæ SMSbR}}Pæ F}}lPF}}vDPbAR}]˙rGH N}voA]bC}v}oP}Puu~NACPZ rvwævlwllı Wb]P```XPRvXP}XPR  Introduction Uv]lDuvlR(oCv Contacts N}voMo]C}v}oP}Puu rvlv Wb]P```XPRvRoRb]X}P l uo] N}voT}o}b]bC}v}oP}Puu rv Wb]P```XPRvXP}XPR N}voY`bC}v}oP}Puu rv N}voBo]Uo C}v}oP}Puu rvlvw F˘Prv Wb]P```Xo]PRvX}P E˘vP}Puu(}Iuuv]b}v rv N}voAuovS] rvUrvæU rvæı N}voDPIv(}u}vRb}vC rvwææwUrvwææı F˘Prvwææw Wb]P```XPRvP]v(}u}vX}P N}voP}]b}vbC}v}oCv rvUrææ N}voBo}}S] rvwlrvw Wb]P```XvbPRvX}P GRvP}o]S] ıUıııUwrwæ  Wb]P```XPRv}o]X]v(} Teaching Hospitals C}bTR]vPH}b]o ræUrı K}orBTR]vPH}b]o rvwæılvwlvwæ K}u(}Av}l˙TR]vPH}b]o r TuoTR]vPH}b]o wr RP]}voH}b]ob GRP]}vo A H}b]o r ~R]PH}b]oZ CvoRP]}voH}b]o rıw ~W]vvTuS]o]bH}b]oZ V}oRP]}voH}b]o rvıılvlwıæw UWbRP]}voH}b]o ırwlvlæıU ræw N}RvRP]}v wr~TuoTR]vPH}b]oZ URP]}vo bE H}b]o rv ı  Standard Trtme ae ntGuidelinesUwthEditionUw Uv]lDuvlR(oCv Contacts }vP B rAR(}RP]}voH}b]o ærævlævlvUv AbRvRP]}voH}b]o~Kub]S}RZ ærvwUrwvææ WbvRP]}voH}b]o~E8Nl`vZ rærUrıU ræw vbE RP]}voH}b]o rl Laboratory N}voR(vL}}˙ rvwıvlrvı GRvN}voDPbP}Puu C}uuvbvbPPb}vbbR}obv}P TRP}PuuMvP GRvN}voDPbP}Puu Ministry of Health PXOXB}˘MBræUU A GRv ToR}vvuP~Zrvwl F˘vuP~Zrvı ru]o E PPvePRvX}P Wb]P```XPRvX}P   Chapter Disorsofder the Gatrs ointetina s lTrcta 8. Diarrhoea D]R} ]b.vR b bP}((vUo}}bU`˙}}ob b }u}ub˙XD]R}u˙}uv]˙}u]vP X Iv R]ovU R}uu}vbb ]b ]oX TR]b R(}boo˙ v}v}b]v]}bXOR]bbo]luo]Uvu}v]U ]v(}vb v ]v˙ ]v(}vbU u˙ b}] `]R ]R}XFo]o}b}bb ]lo˙]vR]bPP}}( b R]b]X I(v}}U]u˙bo]vR˙}v U`R]Rv(oX A }uo]v }( ]R} bR}o lv b]}bo˙X Ao`˙b bl }R(v˙vR˘}(R}}ob b XG]]vPv]}b]voo b}(]R}u˙`}bv}}o}vPR}v]}v˘]vb]o ]ubvb ~S b}v }v RCb[ o}`ZX Evub v o˘b bR}ov}P]v}vb`]R]R}X sueCa ]R} A ~AM`lbZ yy Iv(}vb yy V]oPXPX}]b Uv}}]b yy ]o B PXPXSou}voo bXU SR]Poo UCu˙o} UE. coliU Vibrio cholerae yy P}}}oPXPX Entamoeba histolytica~u}]b]b Z yy DPr]vPXPXv]]oo]vb Chronic diarrhoea (> 2 weeks) yy CR}v] ]v(}vbP XPX u}]b]b U o}b]bU }}v]b ]v(}vb`]RHIV yy Fv}voPXPX]]o}`o˙v}u b yy IvGuu}˙PXPXo}o]bU}Rv C [b]bb yy Mob}}v˙v}ub b PXPXR}v]vb yy Mo]Pvv˙PXPX}o}vv yy Ev}]vPXPXR˙R˙}]]bu U]}v}u]v}R˙ yy DPr]vPXPXo˘bUNSAIDb Symptoms yy Fv`˙}}ob b yy Bo}}}ub]vR}}o b  Standard Trtme ae ntGuidelinesUwthEditionUw yy Pbv}(( yy Reduced urine output yy Ab}]}u]vP Signs obA yy Avu] yy W]PRo}bb yy Av}˘] yy Ooob]}vbXPX}oobUv]]b]b yy Sl]vob]}vbXPX˙Ruv}}bu yy S]Pvb }( R˙}v ~˙ u}b uuvbU }v ]v bl]v P}U]oo˙.ooAN}vb b UR˙]U}boR˙}vb]}vZ yy EvoPR˙}] yy A}u]voubb yy Roubb B}˘rP) D]Pv}bob(}D]R} yy D]R} WITH}u]vP Uo}`P(`]Rv}ub]v}}ob b P}vb] r ]o]v(}v yy D]R} WITH }u]vP U (U }u]vo ubU o}} v ub ]v }}ob b P}vb]]o]v(}v v*Diarhoea*v yy D]R} WITHo}}vub]v}}o b WITHOUT(P}vb]u} r biasis yy P}(b]R}bv~]`}}ob b WITH Z }u]vP : consider cholr era yy D]R} WITH˘bb]}u]vP ~b]oo˙](]vu}Rv}vuu }(RR}bR}o}P}ZP}vb](}}}]b}v]vP yy D]R} bvvP `]R }o vl} bl]v ob]}vbU `]PR o}bb X } o}vP]}P}vb]HIV yy D]R} ovvP `]R }vb}v ]v obP }vb] }`o uo]P r nancy TR(}oo}`]vPov}b bRP}(R˙}v in children with diarrhoea: TorP) Abuv}(P}(R˙}v in children with diarrhoea Abuv}(P}(R˙}v ]vR]ov`]R]R} A9DEHYDRATION AMæA9 ærA9 ANA9 Nil M]oru} Severe LOOKTA C}v]}v WooUo RbobbU LRP]U irritable v}vb]}bUG}˙ Eyes N}uo Sunken V˙bvlvv dry M}Rv}vP Moist D˙ V˙˙  Chatep rP *Disorsof der theGatrs ointetina s lTrcta Abuv}(P}(R˙}v ]vR]ov`]R]R} A9DEHYDRATION AMæA9 ærA9 ANA9 Nil M]oru} Severe Thirst D]vlbv}uoo˙U TR]b˙U]vlb D]vlb}}o˙ not thirsty Po˙ FEEL Skin Goes back G}blbo}`o˙ Goes back very ]lo˙L L]vR]vP bo}`o˙L ]vR]vP ]vR]vP CIDDE E TRv I(RvRb I(Rv Rbv}b]Pvb}( `}}u}b]PvbU Rb`}}u} R˙}v ]vo]vPob b]PvbU]vo]vP }vb]Pvvo]vU ob}vb]Pv R]bb}u vo]vUR]b R˙}v R˙}v b TRETME A NTPLAN W]PRv W]PRvv W]PRvv and use bTuv bTuv TuvPovA PovB PovC v*Diarhoea*v (}u A IvPMvPuv}(CR]oR}}IoovbbUWHO Invtiga se tions yy FBC yy Bo}}.ou(}uo]b]b yy S}}o}v˘u]v}v yy S}}o(}ovbvb]]˙ yy Bo}}vv]v Trtme ae nt Tuv}ib yy T}vR˙}v yy T}oo}bG] yy T} u]v]v v]}v ˙ vb]vP ]˙ ]vl ]vP illness yy T}u]v]vb}voR˙P]v yy T}o]u]v]v(vP}Pv]bub`R}] Non-pharmacological treatment yy K}v]vPbb ov yy Iu}b}voR˙P]vXPXRv`bR]vPL}]o yy A G] ]vl r }o v ]vv}b b vbb˙ ~S b}v}vRFo]uvPuv(}R]ov`]R]R}[Z yy M]v]vv]}vv b }o  Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AX]o B Pb}v]b ~(U}u]voubUo}}v mucus in stools) Note 1-1 N} v]}b ] (} b ]o Pb}v]b X A R˙ r }v]bRu]v]uvX st L]vTuv ]v E RvPPA yy C]}G}˘]v U}oU Adults æuPR}o˙(}æ˙b Children~(}ooR]oPP}bZ æuP llPR}o˙(}æ˙b nd L]vTuv ]v E RvPPA yy (}˘]u C UIVU Adults wæuPR}o˙ Children æuP llP}˙`]PRR}o˙ v*Diarhoea*v Neonates AN˙bw V æuP llP}˙`]PRR}o˙ AM˙bw V æuP llP}˙`]PRR}o˙ Then yy (}˘]u C U}oU Adults æuPR}o˙(}ær˙bw Children r˙bV æuPR}o˙(}ær˙bw r˙bV æ uP llP }˙ `]PR (} ærw ˙b ~u˘X æuPR}o˙Z u}vRbr˙bV uP llP }˙ `]PR (} ærw ˙b ~u˘X æuPR}o˙Z Note 1-2 Sbvb]}v v }vo˙ P]v} R]ov } u}vRbU R}`R IVv P]v}v}vbX BX Au}]˙bv˙ ~v b (]o]vP}b}v} u]]ouv(}]oPb}v]b within 2 days or based on stool microscopy) ]v E RvPPA yy M}v]}o U}oU Adults uPR}o˙(}æ˙b Children  Chatep rP *Disorsof der theGatrs ointetina s lTrcta r˙bV uPR}o˙(}æ˙b rw˙bV uPR}o˙(}æ˙b r˙bV uPR}o˙(}æ˙b C. CholeraP}(b]R}~]`}}o b ZA=}u]vP st L]vTuv ]v E RvPPA yy TetracyclineU}oU Adults æuPvR}o˙(}˙b Children N}}uuv Or yy D}˘˙˙o]v U}oU Adults uPR}o˙(}˙b Children N}}uuv Or yy E˙R}u˙]v U}oU Adults æuPR}o˙(}æ˙b v*Diarhoea*v Children AN˙bV æuPR}o˙(}æ˙b vr˙bV æræuPR}o˙(}æ˙b rv˙bV æuPvR}o˙(}æ˙b u}vRr˙bV æuPvR}o˙(}æ˙b NeonatesV XæuP llPvR}o˙(}æ˙b D. Zincbouv}v(}]R} ]vE RvPPA yy Z]vbouvU}oU Adults Not required Children ANvu}vRbV uP l˙(}r˙b AMvu}vRbV uP l˙(}r˙b Refealr Criteria R(vb`R}(]o}]u}U}P`}bUb]R˙(} ]R}X R( oo vb `]R R}v] ]R} } b]o]b (}(Ro}vvuvPuvX Trtme ae ntalgorithm Fluid management for children with diarrhoea uTvPoN} R˙ Wv}v A yy CR]ov(o˙ b R}u yy Ivbu}R}P]R}urbG]bo]l]`Ul}l}Ub}U æ  Standard Trtme ae ntGuidelinesUwthEditionUw `UvOoRR˙}vSo~ORS ZX yy ]bbB bR}oP]vu]ol b vORS yy G]buRbR]o`vb}(ooRG]b yy CR]obR}o}vv}( yy AblRu}R}v}RRoR(]o]˙](RR]oPb`}bU bu}`˙}}ob b U}u]bo˙U}ub˙R]b˙U b}]vlb}}o˙}]bv}']v˙b yy Ivbu}R}vR}`}v]R} ORSvo˙}uuv (} b ]v u]o } u}]R} Rbb}]uvPo}b}vv}v~o}`}bu}o]˙ZX How to prepare ORS ORSP D]bb}o R }vvb }( }v bR }( ORS ]v v uo } uobv]vP}v˙}(ORSX yy T} P v uoU b buoo ~ uoZ b}L ]vl }'ob } ]P }'o yy T}PuoUbLu]vo`}'o TRR]o}obR}o]vlASMUCH}(]R b lbR`vbXI(R R]o}u]bURu}RbR}o`]}u]vbvP]]P]vX TorP) Tuv˙Fo]TR˙rPovA v*Diarhoea*v P A ORSBb]Au}v ORS(}˙˘}}o b passed AM˙b æuo}u} æWuo W˙b uo}u} Wuo AN˙b uo}u} Wuo uTvPoR˙ u]o }v Wv}B u} For the child with mild-moderate dehyd}v Uuse treatment Plan B yy Child to be treated in the health facility yy G]ORS }R.bR}bbR}`v]vRTo(}PovB yy I(R]o}u]bU`]u]vbvP]v b yy C}vv`]R}RG]bRR]o`]oo yy Ivbu}R}}vv(]vP b ](R]o]b]vP b yy Ob}}ob b bv}v˙ yy CRl(}b]Pvb}(`}bv]vPR˙}v yy I(˙b}u+˙U]uvb}}uRG]RbvP]vb}}b ORSvro yy Rb}(b R˙}v LR}b yy I(o]v]oRb b ]u}`]Rv}R˙}v rP}}ovA yy I(R]boob u]oru}R˙}v ovB yy I(}v]}v]b`}bv]vPrP}}ovC v  Chatep rP *Disorsof der theGatrs ointetina s lTrcta TorP) Treatment by Fluid Therapy - Plan B W]PR AMvlP vAMlP rAMlP WılP AP U}u}vRb u}vRb} u}vRb} ˙b}æ u}vRb ˙b years Au}v ruo rwuo wrıuo ıruo }(ORS UbRR]o[bP}vo˙`Rv˙}}v}lv}`R`]PRXTR}˘]uu}v}(ORS ]~]vuovZ ob}oo˙uoo˙]vPRR]o[b`]PR~]vlP˙Z wæ Treatment Plan R˙ }vCSW yy A R]o `]R b R˙}v ]b Pv uv `]R IV G]b]vR}b]o yy I( R R]o v ]vlU P] ORS ˙ u}R `R]o R IV o]v ]b ]vP set up yy S IV G]b ]uu]o˙X G] uollP R]vP [b o b}o}v }U](v}]ooUv}uobo]v}R}oouvG]~æPPZU ]]bR}`v]vRTo(}PovCo}`P yy I(˙}vv}P]R}uvvvv}vbb }Pb] U(}RoR(]o]˙Rv}b}X v*Diarhoea*v yy Rbb R R]o ˙ r R}bX I( R˙}v b ]b v} ]u}]vPU P] R IV G] u}]o˙ Rv b ]v R To (}PovB yy Aob}P]ORS ~}æuollP}˙`]PRlR}b}}v Z R b R]o v]vlPboo˙LrR}b~]v(vbZ}WR}b~R]ovZ yy Rbb v ]v(v L v R}b v R]o L R}bX Cobb](˙ R˙}v X TRv R}}b R }] ov ~AU U B } CZ } }vvuv yy R]o Ab R}o˙XI(v}]u}]vP}R˙}v ]b`}bU]vb drip rate yy D} v}}b R IV G]b vo R R]o Rb v }b}]v R ORS (} ob R} v R ]b ]u}uv ]v R o]v]o }v]}v yy C}vv ORS }v uv ov B v }vv } }b R]o voR]oRbv}b]Pvb}(R˙}v URvu}}PovA yy S]R} u˙ }uo]˙ ulG] o}bb }uv] ˙ o}bb }( }bb]u ~R˙}lou]Z } }v R }R RvU]u]vo(v}vo]vP}]}b]bvoo}} }bb]u~R˙lou]Z yy WRv R v ]b b]vP u}vb }( ]vU }o˙ ]v]vPP}}vo(v}vU}bb b]u}v]v]vP(}}bbR }}v b `v(bR(]b~XPXvvZ yy I(R]bo]v]ovl}o}}˙]v}(R˙}lou] b U }bb]ubR}oP]v˙R]vv}b}b]vP}bb]u Ro}] }vo˙ ]v R}b]oX P}bb]u }v]v]vP G]b bR b w  Standard Trtme ae ntGuidelinesUwthEditionUw Ro(vPRb }` D [bb}o}v}R]vP [bo u˙ yy I(}bb]o]v(vbvR]ovbR}o}vv}}b ]vPR]}}(]R} TorP) Treatment by Fluid Therapy - Plan C P A F]bP]uollP]vP TRvP]wuollP]vP Iv(vb~AMu}vRbZ R} æR}b Children ~u}vRb}æ˙bZ u]vb A*R}b R}v](]oob]boo b ˙`l}v}oX Note 1-3 Avr]R}o u]]vb o]l M]b K}o]v U ]Rv}˘˙o l}]v U }]v U o}u] bR}o v} b ]v R uv }( ]R} ]v R]ov v o]lo˙ } } u} Ru Rv P}}X S]u]oo˙U v]} }vb `]R l}o]v}v}(v}Ro]vRuvPuv}(]R}X v*RotavirusDisseandDiarhoea*v 9. R}]b Disease and Diarrhoea Rotavirus ]b R u}b }uu}v b }( b ]R} ]v ˙}vP R]ovX I }vb (} u} Rv R] }( oo R}b]o]}vb }( R]ov obb Rv æ ˙bX I }b ˙ }v `]R lb `v R ˙u}vRb~DurMRZXCR]ov]v(˙P}˙b vr]v(}vb}uu}vX sueCa yy RotavirusPæ˙b}(}]b lv}`v}bANıA9}(oob `}o`] Symptoms yy F yy V}u]vP yy P}(b`˙]R} yy Thirst Signs yy Sunken eyes yy D]u]v]bRbl]vP} yy Ao}vb]}bvbbUv]vP}vRP}(R˙}v Invtiga se tions yy }v D }( }]b vPv ]v }}o b ˙ v v˙u ]uuv}b˙b ~EIAZ Trtme ae nt Tuv}ib yy C}}v}(G]vo}o˙.]b  Chatep rP *Disorsof der theGatrs ointetina s lTrcta yy Rouv}(}vrP}]vPG]o}bb yy v]}v A }vuov]}v Non-pharmacological treatment yy H}urbG]bXPXu]ol b U}]PbU}}v]vl yy N]}vP(bv}o]vPR]b}UP]v˘ uo˙(}`lbLR]b} Pharmacological treatment AX ORS and Zincbouv}v ~Sb}v}vRD]R} [Z Refeal r Criteria yy P}} b}vb } R˙}v }bb ~bb]vP u} }}ob b Rv ]vl]vPZ yy P}}]vl]vP yy Bo}}]v}}o b yy P}}(]vP yy Ao}vb]}bvbbl}vob]}vb yy D]R} v}u]vP }vv]vP(}AN˙b N}r v*Constiption Pv}vP T`}~}bZ }( b R}]b ]vU P]vrv `lbU]b+]vv r a *v ]vP }]b ]R}X TR v }b bR}o P]v ˙ v `lbU v v} oRv`lbXR}]b]v]bv}`vo˙P]vb}(}v ]uuv]}v]vGRvX~Sb}v}vRIuuv]b}v[ZX 10. C}vb}v Iv PvoU }vb}v (b } }`o u}uvb R ]v(v } }}ob b R ]8o } bX TR ]b P ]v]]o ]}v ]v v}uo }`o R]bV R(} uRb]b bR}o o] }v RvPb]vR}`oR]X D]R} ovvP `]R }vb}v u˙ ]v] oP }`o v b]oo˙ ]v R}b P ˙b v }X Iv R]ov v R oo˙UR]bu˙]v]R}v]}vb}v`]Rb]}b]R}X TRR]ob}(o˘b]b˙}uu}v]vR}uuv]˙XTR]b ub]b}P}}]R˙}lou]v]b}vbvbX sueCa Medical yy D].]v]v}PRP yy IPv}]vPRP}(XPX}]uu}]o]˙ yy H˙}R˙}]]bu yy I]o}`o˙v}ub yy H˙ou] yy DPb XPX }]v U }]v U u}R]v U ]˙o] vbbvbU ı  Standard Trtme ae ntGuidelinesUwthEditionUw ]b}˙u] yy L˙}`o(}uR}v]o˘b]vo]vPRRo[}vb yy Ll}(˘]b yy DR˙}v v}v b ~oo˙]vR]ovZ Surgical yy Gb}]vbvo}b}v yy Avo.bvb }R]v(o]voob]}vb yy ]v}u C }(Ruvb]Pu}]}o}v yy F}]Pv}˙]vRP yy Po]ubbXPX.}]U(}b yy APvPo]}v]v]uP}o}v yy Pb}r}`o }b}v ~OP]o] ˙v}ub Z (}oo}`]vP ]uu}]o]˙ (}uv˙b Symptoms yy Iv]o]˙}u}}`ob yy Pbb]vPR}}ob b yy Iv(vb]vP}(}}ob b yy S]v]vP}}}ob b yy Fo]vP}(]v}uo}v}(}`o yy Iv]o]˙ } b GbU }o]l˙ }u]vo ]v `]R } `]R} v*Constiption }u]vP a *v Signs yy Fv R]PR ]R }`o b}vb r b uRv]o }`o }b}v yy bv A }`ob}vbro˙ b ]ob yy S]Pvb }( ]}v]b ~Pvo]b vvbbU P]vP v }v vvbbU(}]b}vZrbbPvPv}b}`o Invtiga se tions yy D]P]o o ˘u]v}v ~ub ] } ]v oo vb `]R ]Pv}b b ]b}(}vb}vZ yy Stool for occult blood yy Po]v}u]voXr˙~vb]vZ yy P}}b}˙ l}}b]Pu}]}b}˙ l}o}v}b}˙ ~ub v} }v ](]vbvo}b}v]bZb Trtme ae nt Tuv}ib yy T}]v(˙}bb]ob}(}vb}v yy T}o]}vb}v Non-pharmacological treatment yy ARv}Po˘]b yy H]PR.] yy A G] ]vl ~u]v]uu }( XL }( ` ˙ ]( v} }v]v]}vb˘]bZ  Chatep rP *Disorsof der theGatrs ointetina s lTrcta Pharmacological treatment AX MvPuv}(C}vb}v]vAob st L]vTuv ]v E RvPPC yy B]b}˙o U}oUruPv]PR Or yy SennaU}oUæruPu~u˘]uuwruP]o˙ZXD}bb }wuPbR}o]]R}o˙ Or yy Lo}b U}oUæruo]o˙vob}vbURvruo]o˙ nd L]vTuv ]v E RvPPC yy B]b}˙o UoUuP]vRu}v]vP Or yy Glycerolb}b]}]bUoUPv]PR Or yy L]]8v U}oUruov]PR Or yy M]ol}(MPvb] U}oUæruo]vPobb}(`UrR}o˙ v*Constiption B. MvPuv}(C}vb}v]vCR]ov L]vTuv a *v st ]v E RvPPC yy Lo}b U}oU r˙bV æuoR}o˙ ær˙bV uoR}o˙ ræ˙bV æuoR}o˙ AM˙V XæuoR}o˙ Or yy Glycerolb}b]}]bUoU ræ˙bV Pv]PR AM˙V Pv]PR Or yy B]b}˙o UoU AN˙bV æuP]vRu}v]vP AM˙bV }vu]o]}vo˙ Or yy SennaU}oU vr˙bV æruou rv˙bV Xæruou Note 1-5 D}v}buPvb]ubob]vvb`]R]u]vo(v}vX  Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria TR(}oo}`]vPP}]b}(vbbR}o(}P}v b P yy Pvb`]Rbv}`ob}vbU}u]vP }v}b]vPGb yy b]bC v}u]ouv yy Av˙P]o b b 11. PUo Disease Po u˙ }vo } Pb]X D}vo ob u} }uu}v v } u} }Lv ]v ˙}vP obX Gb] ob usually } L u]o PX Gb] ob bR}o lv b]}bo˙ b R˙u˙uo]PvvX Pobu˙o}o](Rv]vP}uo]}vb}(o]vPU (}}vvPb]}o}b}vX sueCa yy Helicobacter pylori (H. pyloriZ]v(}v yy E˘bb]}v b }(Pb]] yy Iv }}v }( R o]v]vP }( R }uR b v }vu v*Petic P]vb]Pb}v˙]vb]v yy M]]vb XPX v}vrb}]o vr]vGuu}˙ Pb ~NSAIDb ZU p UlcerDisse*a v }}b}]b Symptoms yy E]b}] }u]vo ]v ~}Lv PP˙ ]˙ ]v]b}vb vo](b˙oZ yy M˙u]v}]b}u(}UPv`]vPUv]vPUooR}˙ severe pain yy T˙]oo˙]v]b]vR]Pb]u}]PRR˙}R}v]u yy Ob]}voo˙ R]PR R]v R vu b } o}` }`v }v Ru]o]b yy Iv }vo oU ]v ˙]oo˙ }ub }v `Rv R v ]b RvP˙vu˙`lRv]vRu]o}(Rv]PRX yy IvPb]oU]]b˙]oo˙`}bv˙(}}Uvu˙