NTA Level 4 • Semester 1 • PST04102

Disease Control and Prevention – Complete Full Notes

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UNITED REPUBLIC OF TANZANIA

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Ministry of Heath, Community Development, Gender, Elderly and Children

Facilitator Guide

Children – 2016

Table of Contents

Background v

Acknowledgment vi

Introduction viii

Abbreviations/Acronym xi

Session 1: Concepts of Disease Control and Prevention 1

Session 2: Methods of Controlling Common Air-borne Diseases 7

Session 3: Methods of Controlling Diseases Transmitted by Faecal

Contamination 12

Session 4: Methods of Controlling Vector-borne Diseases 17

Session 5: Methods of Controlling Disease Transmitted by Animal Bites

Session 6: Measures to Improve Hygiene and Sanitation 27

Session 7: Measures for Preventing Water Contamination 32

Session 8: Water Treatment Methods 39

Session 9: Water for Pharmaceutical Use 44

Session 10: Methods for Safe Sewage Disposal 49

Session 11: Health Hazards of Poor Housing and Ventilation 55

Session 12: Air Purification in Pharmaceutical Settings 62

Session 13: Using Antiseptics and Disinfectants 67

Session 14: Introduction to Common Communicable Diseases 75

Session 15: Identification of Patients with Malaria 83

Session 16: Identification of Patients with Common Cold 94

Session 17: Identification of Patients with Tonsillitis 99

Session 18: Identification of Patients with Bronchitis 104

Session 19: Identification of Patients with Pneumonia 109

Session 20: Identification of Patients with Amoebiasis 115

Session 21: Identification of Patients with Typhoid Fever 121

Session 22: Identification of Patients with Food Poisoning 126

Session 23: Identification of Patients with Cholera 133

Session 24: Identification of Patients with Ascariasis 140

Session 25: Identification of Patients with Scabies 147

Session 26: Identification of Patients with Dermatophytes 154

Session 27: Identification of Patients with HIV/AIDS 161

Session 28: Identification of Patients with Tuberculosis 172

Session 29: Identification of Patients with Leprosy 182

Session 30: Identification of Patients with Gonorrhoea 188

Session 31: Identification of Patients with Syphilis 193

Session 32: Identification of Patients with Trichomoniasis 200

Session 33: Identification of Patients with Vaginal Candidiasis 206

Session 34: Introduction to Common Non-communicable Diseases 212

Session 35: Identification of Patients with Hypertension 217

Session 36: Identification of Patients with Diabetes 223

Session 37: Identification of Patients with Peptic Ulcers 230

Session 38: Identification of Patients with Asthma 236

Session 39: Identification of Patients with Allergic Rhinitis 243

Session 40: Prevention and Control of Contamination in Pharmaceutical

Settings 248

Session 41: Methods for Disposing Pharmaceutical Wastes 255

Session 42: Introduction to Human Nutrition 270

Session 43: Managing Patients with Nutritional Deficiency Diseases 278

Session 44: Specialised Food Therapy 291

Background

There is currently an ever increasing demand for pharmaceutical personnel

in Tanzania. This is due to expanding investment in public and private

pharmaceutical sector. Shortage of trained pharmaceutical human resource

contributes to poor quality of pharmaceutical services and low access to

medicines in the country (GIZ, 2012).

Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together

with Development Partners (DPs) in Germany and Pharmaceutical Training

Institutions (PTIs) worked together to address the shortage of human

resource for pharmacy by designing a project named “Supporting Training

Institutions for Improved Pharmaceutical Services in Tanzania” in order to

improve quality and capacity of PTIs in training, particularly of lower

cadre pharmaceutical personnel.

The Pharmacy Council formed a Steering committee that conducted a

stakeholders workshop from18th – 22ndAugust 2014 in Morogoro to initiate

the implementation of the project.

Key activities in the implementation of this project included carrying out

situational analysis, curriculum review and harmonization, development of

training manual/facilitators guide, development of assessment plan,

training of trainers and supportive supervision.

After the curricula were reviwed and harmonized, the process of developing

standardised training materials was started in August 2015 through Writer’s

Workshop approach.

The approach included two workshops (of two weeks each) for developing

draft documents and a one-week workshop for reviewing, editing and

formatting the sessions of the modules.

The goals of writers workshops were to build capacity of tutors in the

development of training materials and to develop high-quality, standardized

teaching materials.

The training package for pharmacy cadres includes a facilitator guide,

assessment plan and practicum. There are 12 modules for NTA level 4 making

12 facilitator guides and one practicum guide.

Acknowledgment

The development of standardized training materials of a competence-based

curriculum for pharmaceutical sciences has been accomplished through

involvement of different stakeholders.

Special thanks go to the Pharmacy Council for spearheading the

harmonization of training materials in the pharmacy after noticing that

training institutions in Tanzania were using different curricula and train

their students differently.

I would also like to extend my gratitude to St. Luke Foundation

(SLF)/Kilimanjaro School of Pharmacy –Moshi for their tireless efforts to

mobilize funds from development partners.

Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür

Internationale Zusammenarbeit (GIZ), Merck Kgaa, BoehringerIngelheimGmbhand

Bayer Pharma Ag and action medeor.V for the financial and technical

support.

Particular thanks are due to those who led this important process to its

completion, Mrs Stella M. Mpanda Director, Childbirth Survival

Intenational, and Members from the secretariat of National Council for

Technical Education (NACTE) for facilitating the process.

Finally, I very much appreciate the contributions of the tutors and content

experts representing PTIs, hospitals, and other health training

institutions. Their participation in meetings and workshops, and their

input in the development of this training manual/facilitators guide have

been invaluable.

These participants are listed with our gratitude below:

Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of

Pharmacy

Mr.Samwel M. Zakayo- Pharmacy Council

Ms. Ester A. Tuarira MUHAS

Ms. Tumaini H. Lyombe MUHAS

Ms. Dilisi J. Makawia KSP

Ms. Julieth Koimerek KSP

Rev. Baraka A.M. Kabudi MEMS

Mr. Kelvin E. Mtanililwa Royal Pharmaceutical Training Institute

Ms. Rose Bulilo CEDHA

Ms. Diana H. Gamuya CEDHA

Dr.Melkiory Masatu CEDHA

Mr. Habel A. Habel City College of Health and Allied

Sciences

Ms. Zaina Msami Meru District Council

Director of Human Resources Development

Ministry of Health, Community Development, Gender, Elderly and Children

Introduction

Module Overview

This module content is a guide for tutors of Pharmaceutical schools for

training of students. The session contents are based on sub-enabling

outcomes and their related tasks of the curriculum for Basic Technician

Course in Pharmaceutical Sciences. The module sub-enabling outcomes and

their related tasks are as indicated in the in the Basic Technician

Certificate in Pharmaceutical Sciences (NTA Level 4) Curriculum

Target Audience

This module is intended for use primarily by tutors of pharmaceutical

schools. The module’s sessions give guidance on the time, activities and

provide information on how to teach the session. The sessions include

different activities which focus on increasing students’ knowledge, skills

and attitudes.

Organization of the Module

The module consists of forty four (44) sessions; each session is divided

into several parts as indicated below:

• Session Title: The name of the session

• Total Session Time: The estimated time for teaching the session,

indicated in minutes

• Pre-requisites: A module or session which needs to be covered before

teaching the session.

• Learning Tasks: Statements which indicate what the student is expected to

learn by the end of the session

• Resources Needed: All resources needed for the session are listed

including handouts and worksheets

• Session Overview: The session overview box lists the steps, time for each

step, the activity or method used in each step and the step title

• Session Content: All the session contents are divided into steps. Each

step has a heading and an estimated time to teach that step as shown in

the overview box. Also, this section includes instructions for the tutor

and activities with their instructions to be done during teaching of the

contents

• Key Points: Key messages for concluding the session contents at the end

of a session This step summarizes the main points and ideas from the

session, based on the learning tasks of the sssion

• Evaluation: The last section of the session consists of short questions

based on the learning tasks to check the understanding of students.

• Handouts: Additional information which can be used in the classroom while

teaching or later for students’ further learning. Handouts are used to

provide extra information related to the session topic that cannot fit

into the session time. Handouts can be used by the students to study

material on their own and to refer to them after the session. Sometimes,

a handout will have questions or an exercise for the participants

including the answers to the questions.

Instructions for Use and Facilitators Preparation

• Tutors are expected to use the module as a guide to train students in the

classroom and skills laboratory

• The contents of the modules are the basis for teaching and learning

Disease Control and Prevention.

• Use the session contents as a guide

• The tutors are therefore advised to read each session and the relevant

handouts and worksheets as preparation before facilitating the session

• Tutors need to prepare all the resources, as indicated in the resource

section or any other item, for an effective teaching and learning process

• Plan a schedule (timetable) of the training activities

• Facilitators are expected to be innovative to make the teaching and

learning process effective

• Read the sessions before facilitation; make sure you understand the

contents in order to clarify points during facilitation

• Time allocated is estimated, but you are advised to follow the time as

much as possible, and adjust as needed

• Use session activities and exercises suggested in the sessions as a guide

• Always involve students in their own learning. When students are

involved, they learn more effectively

• Facilitators are encouraged to use real life examples to make learning

more realistic

• Make use of appropriate reference materials and teaching resources

available locally

Preparation with Handouts and Worksheets

• Go through the session and identify handouts and worksheets needed for

the session

• Reproduce pages of these handouts and worksheets for student use while

teaching the session. This will enable students to refer to handouts and

worksheets during the session in the class. You can reproduce enough

copies for students or for sharing

• Give clear instructions to students on the student activity in order for

the students to follow the instructions of the activity

• Refer students to the specific page in the student manual as instructed

in the facilitator guide

Using Students Manual When Teaching

• The student manual is a document which has the same content as the

facilitator guide, which excludes facilitator instructions and answersfor

exercises.

• The student manual is for assisting students to learn effectively and

acts as a reference document during and after teaching the session

• Some of the activities included in facilitator guide are in the student

manual without facilitator instructions

Abbreviations/Acronym

ACT Artimesinin Combined Therapy

AIDS Acquired Immune Deficiency Syndrome

ALU Artemether/ Lumefantrine

AMREF African Medical & Research Foundation

ART Anti-retroviral therapy

CEDHA Centre for Educational Development in Health Arusha

CUHAS Catholic University of Health and Allied Sciences

DM Diabetes Mellitus

Giz Deutsche GesellschftFür Internationale Zusammenarbeit

GoT Government of Tanzania

HIV Human Immunodeficiency Syndrome

HKMU Herbert Kairuki Memorial University

ITN Insecticides Treated Nets

JSI John Snow Inc

KSP Kilimanjaro School of Pharmacy

LCD Liquid Crystal Display

LZHRC Lake Zone Health Resource Centre

MOH Ministry of Health

MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and

Children

MOHSW Ministry of Health and Social Welfare

MUHAS Muhimbili University of Health and Allied Sciences

NACP National AIDS Control Programme

NACTE National Council for Technical Education

NCD Non-communicable diseases

NTA National Technical Award

PEM Protein Energy Malnutrition

PMTCT Prevention of Mother-to-Child-Transmission

RuCU Ruaha Catholic University

SLF Saint Luke Foundation

STIs Sexually Transmitted Infections

WHO World Health Organization

Session 1: Concepts of Disease Control and Prevention

Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites

• None

Learning Task

By the end of this session students are expected to be able to:

• Define Terms

• Explain Common Terms in Disease and Disease Control/Prevention

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

|2 | 35 |Presentation |Definition of Common Terms in |

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning task and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Common Terms in Disease and Disease Control (35

minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the common terms in disease and disease control? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition of common terms

Disease

• A disorder with a specific cause and recognisable signs and symptoms

• Any bodily abnormality or failure to function properly, except that

resulting directly from physical injury (the latter, however, may open

the way for disease)

Communicable diseases

• Diseases which can be transmitted from one person to another or from

animal to person

o For example, cholera, tuberculosis

Non- communicable disease

• A medical condition or disease that is non-infectious or non-

transmissible which last for long periods and progress slowly

o For example, cardiovascular diseases, chronic respiratory diseases,

diabetes

Epidemic (from Greek epi- upon + demos people)

• A classification of a disease that appears as new cases in a given

human population, during a given period, at a rate that substantially

exceeds what is ‘expected’, based on recent experience. Therefore, it

is unusual occurrence of a disease in the community

Endemic

• The constant presence of a disease or infectious agents within a

community

Pandemic (from Greek pa? pan all + demos people)

• An epidemic that spreads across a large region (for example a

continent), or worldwide

Nosocomial

• An infection developing in a patient while in a hospital or acquired

in a hospital but could show up after discharge

Principle of disease transmission

Transmission of a disease in human requires the following components:

• An agent capable of infecting man

• A source: an infected host or reservoir of infection

• A portal of exit from the source

• A suitable means of transmission

• A portal of entry into a new host

• A susceptible host

Agent

• Is an organism, mainly a microorganism but including helminthes that is

capable of causing disease

Reservoir (of infection)/ host)

• Refers to any human beings, animals, arthropods, plants, soil or

inanimate matter or a combination of these in which an infectious agent

normally lives and multiplies, and on which it primarily depends for

survival and reproduction in such a manner that it can be transmitted to

a susceptible host.

o A reservoir of infection can also be termed as the natural habitat of

the infectious agent

o Disease that man is the only reservoir is called anthroponeses e.g.

measles and cholera

o Those that involve other animals reservoirs are called zoonoses e.g.

plague and rabies

Portal of exit in the human host

• Include the respiratory passages, the alimentary canal, the opening in

the genital urinary system and the skin lesion

Suitable means of transmission

• Transmission of infectious agent is any mechanism by which a susceptible

host is exposed to an infectious agent. It may be either direct or

indirect

Transmission Cycle of Communicable Diseases

• The transmission cycle describes how an organism grows, multiplies and

spreads

• For the agent to cause a disease; it has to enter the body; routes of

entry are virtually the same as those of escape of the agent.

o The agent must enter and multiply inside the host

o The infectious organism grows and cause disease in the human body

• Different diseases have different transmission cycle

• For an agent to cause disease in an individual it must enter in the human

body and multiply

Common Communicable Diseases in Tanzania

Common communicable diseases include group of the following diseases as per

mode of transmission:

• Air-borne diseases e.g. respiratory infections, pulmonary tuberculosis

• Diseases caused by fecal contamination e.g.cholera, typhoid fever,

amoebiasis

• Vector-borne diseases e.g. malaria, plague, schistosomiasis

• Diseases from animals and products e.g. tetanus, rabies, anthrax,

brucellosis

• Contact (contagious) diseases e.g. scabies, fungal skin infections,

leprosy

• Sexually transmitted infections e.g. gonorrhea, syphilis, trichomoniasis

• Helminthic diseases e.g. ascariasis, hookworm, taeniasis, trichuriasis

Prevention and Control of Communicable Diseases

The main methods of communicable disease prevention/control are:

• Attacking the source or reservoir by:

o Treatment – cases are treated with drugs that destroys the organisms

o Immunization – this increases the host resistance to disease by

increasing the body‟s immune response

o Isolation – the person with the disease is not allowed to come into

close contact with other people, except those who are providing care

o Reservoir control – in those diseases which have their main reservoir

in animals, mass treatment, chemoprophylaxis or immunization of the

animal can be carried out.

o Notification – notification means that one immediately informs the

local authorities (RMO/DMO/MOI/C of the nearby health facility) of the

presence or suspicion of an infectious disease.

• Interrupting transmission by:

o Environmental sanitation

o Personal hygiene and behavior change

o Vector control

o Disinfection and sterilization

o Preventive chemotherapy through mass drug administration (MDA)

• Protecting the host by:

o Immunization – increases the host’s resistance

o Chemoprophylaxis

o Personal protection

o Better nutrition

Disease Control

• Measures designed to prevent further spread of the diseases from the

infected persons and specific treatment to minimize time for transmission

and to reduce morbidity and mortality

• Methods for disease control include:

o Preventive measures e.g. isolation, immunization

o Treatment

o Surveillance

STEP 3: Key Points (5 minutes)

• Diseases may be divided into 2 broad categories which are communicable

and non-communicable diseases.

• Principles of disease transmission includes agent, source, means of

transmission, portal of exit, portal of entry and susceptible host

• Disease control requires immediate preventive measures, proper treatment

and continuous surveillance to reduce morbidity and mortality

STEP 4: Evaluation (5 minutes)

• What common terms are used in disease and disease control?

STEP 5: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on the common terms used in disease and disease |

|control (Give examples for each term used) |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.).

London:

Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011)

(eds.),Hugo& Russell’s Pharmaceutical Microbiology (8th ed). Oxford:

Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013).National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2012).National Guidelines for Management of HIV and AIDS. (4thed) Dar

es Salaam: MOHSW/NACP

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar

es salaam: MOHSW

GoT (2007).National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1st ed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable

Diseases. (4thed.). Nairobi: AMREF.

Tanzania Food and Drugs Authority (2009).Guidelines for safe disposal of

unfit medicines and cosmetic products. Dar es Salaam: MOH

Session 2: Methods of Controlling Common Air-borne Diseases

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Common Airborne Diseases

• Describe Methods for Prevention and Control of Airborne Diseases +

Principles of Prevention and Control

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Airborne Diseases (35 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the common air-borne diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Airborne diseases are diseases that are caused by pathogens and

transmitted through the air

o People spread the disease through sneezing and coughing (see figure

2.1)

[pic]

Source: Slide collection, Department of Medical Microbiology, Edinburgh

University

Figure 2.1: Spread of Airborne Disease

Common air-borne diseases includes:

o Common cold – caused by viruses which are spread by droplets

o Sore throat – acute inflammation of the throat or pharynx

o Flu – acute respiratory tract infection of specific viral origin

o Bronchitis – acute or chronic disease, caused by bacteria or virus

o Pneumonia – acute infection of the lungs

o Measles – acute infection caused by viruses common in children

o Chickenpox – mild viral infection, very common in children

o Meningitis – inflammation of the meninges which covers the brain

o Tuberculosis – infectious chronic disease of the lung tissues

STEP 3: Prevention and Controll Airborne Diseases (60 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the control methods for air borne diseases? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Prevention and control of air borne diseases

Since the infective particles are spread by droplets from the respiratory

tract of patients or carriers, an important part of the control of these

diseases is based on preventing droplets from being inhaled by others.

Methods for Controlling Airborne Disease:

• Improved ventilation

• Avoid overcrowding

• Isolation

• Health education

• Seek treatment for any chronic cough

• Immunization

[pic]

STEP 4: Key Points (5 minutes)

• Airborne diseases are of great public health importance

• Airborne diseases causes unnecessary morbidity and mortality which

could be prevented

• The control is based on preventing droplets infections spreading from

one person to another

STEP 5: Evaluation (5 minutes)

• What are the common airborne diseases?

• What are methods for controlling airborne diseases?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on methods to control outbreak of common cold |

|in your village |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed).

London:

Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011)

(eds),Hugo& Russell’s Pharmaceutical Microbiology (8th ed). Oxford:

Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013).National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar

es salaam: MOHSW

GoT (2007).National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1st ed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable

Diseases. (4thed). Nairobi: AMREF.

Session 3: Methods of Controlling Diseases Transmitted by Faecal

Contamination

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Diseases Transmitted by Faecal Contamination

• Describe Methods for Controlling Diseases Transmitted by Faecal

Contamination

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD projector

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Diseases Transmitted by Faecal Contamination (25 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair and buzz on the following question for 2 minutes |

| |

|What are the common diseases transmitted by faecal contamination? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Diseases transmitted by faecal contamination:

• Causative organisms are excreted in the stools of infected persons

• The causative organisms enter the body through the mouth

• Transmission occurs through faecal contamination of food, water and

hands

• Food plays a central role in transmitting disease as it can be

directly or indirectly contaminated via polluted water, dirty hands,

contaminated soil, flies and animals or animal products

• Water can be polluted directly by faeces, or faecal material may be

washed in from polluted soil

• Hands are contaminated after defaecation or by touching contaminated

objects

Diseases transmitted by faecal-oral contamination:

• Typhoid fever

• Cholera

• Amoebic dysentery

• Bacillary dysentery

• Staphylococcal food poisoning

• Ascariasis

• Taeniasis

• Hydatidosis

STEP 3: Methods for Controlling Diseases Transmitted by Faecal

Contamination (60 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the preventive methods for controlling diseases transmitted by|

|faecal contamination? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Methods for Prevention of faecal-oral diseases includes:

• Proper methods of stool disposal e.g. use of latrines

• Hand washing using soap and water after visiting toilets and before

handling food

• Proper disposal of refuse

• Proper cooking of food

• Proper washing of fruits and vegetables before eating

• Boil milk and water before drinking

• Protection, purification and chlorination of public water supplies

• Health education e.g. dangers of bottle feeding

STEP 4: Key Points (10 minutes)

• Causative organisms of fecal-oral diseases are excreted in the stools of

infected persons

• Transmission occurs through faecal contamination of food, water and hands

• Control of faecal-oral diseases depends on breaking the faecal –oral

transmission cycle

STEP 5: Evaluation (10 minutes)

• What are the diseases transmitted by faecal contamination?

• What are the methods for controlling diseases transmitted by faecal

contamination?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following assignment |

|Prepare a presentation of at least 5 common faecal-oral transmitted |

|diseases in their local area and give measures how to control it. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed).

London:

Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011)

(eds),Hugo& Russell’s Pharmaceutical Microbiology (8th ed). Oxford:

Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable

Diseases. (4thed). Nairobi: AMREF.

Session 4: Methods of Controlling Vector-borne Diseases

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• List Common Vector-borne Diseases

• Describe Vectors of Medical Importance

• Describe Methods of Vector Control

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

|6 | | | |

|7 | | | |

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Vector-borne Diseases (10 minutes)

Common Vector borne Diseases:

• Vector is any carrier of disease (insects, mosquitos, ticks and snails)

which are an essential part of the life cycle of the disease causative

organism

• Vectors acquire disease organisms by sucking blood from infected persons

or animals and pass them on by same route

Common vector borne diseases:

• Malaria

• Filariasis

• Trypanosomiasis

• Yellow fever

• Plague

• Schistosomiasis

STEP 3: Vectors of Medical Importance (20 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are vectors of medical importance? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

The following are Vectors of Medical importance:

Table 4.1 Common vectors and the diseases they transmit

|Vector |Disease(s) |

|Mosquitoes |Malaria, filariasis, yellow fever, dengue |

| |fever |

|Black flies |River blindness |

|Biting flies |Trypanosomiasis ( sleeping sickness) |

|Lice |Relapsing fever ( louse-borne ) |

|Fleas |Plague |

|Soft ticks |Relapsing fever ( tick-borne ) |

|Hard ticks |African tick-borne typhus |

STEP 4: Methods of Vector Control (60 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the methods of vector control? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Methods of Vector Control:

The control may be brought about by:

• Reducing the reservoir host

o Control the vector population

o Killing adults with insecticides

o Killing larva with larvicides

o Prevention of breeding sites by environmental sanitation

• Protecting the susceptible individuals

o Use of insecticide treated nets

o Ue of chemoprophylaxis

o Use of repellents and protective clothing

STEP 5: Key Points (5 minutes)

• Vector is any carrier of disease

• A vector is required for the transmission of vector-borne diseases.

• Measures that reduce vector population and protect susceptible hosts

are used to control vector-borne diseases

STEP 6: Evaluation (10 minutes)

• What are the common vectors borne diseases?

• What are the vectors of medical importance?

• What are the methods of controlling vector-borne diseases?

STEP 7: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following assignment |

|Prepare a presentation of at least 5 common vector-borne diseases in |

|their local area and give measures on how to control it |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed).

London:

Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011)

(eds),Hugo& Russell’s Pharmaceutical Microbiology (8th ed). Oxford:

Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar

es salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable

Diseases. (4thed). Nairobi: AMREF.

Session 5: Methods of Controlling Disease Transmitted by Animal Bites

Total Session Time: 90 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Common Diseases Transmitted by Animal Bites

• Flip charts, marker pens, and masking tape Describe Methods for

Controlling Diseases Transmitted by Animal Bites

Resources Needed:

•

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Diseases Transmitted by Animal Bites (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the commonest disease transmitted by animal bites? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Common disease transmitted by animal bites

Rabies is a disease that affects wild animals such as jackals,

mongooses, fox and hyaenas. These animals may infect domestic animals

such as dogs and cats. It is incidentally transmitted to human beings

by a bite of a rabid animal, commonly domestic dogs or cats.

• Rabies is an important public health problem because when no immediate

action is taken after the bite by an infectious animal, the disease is

fatal.

• The virus has preference for the salivary glands and nervous tissue,

finally causing encephalitis, and resulting in death.

Clinical manifestations

• Anxiety

• Violent behavior

• Seizures

• Hallucinations

• Depression

• Paralysis of the limbs

• Spasm of pharyngeal muscles

• Fear of water (hydrophobia)

STEP 3: Methods for Controlling Rabies (30minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|What are methods for controlling Rabies? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY |

| |

|ASK students to discuss on the following question |

| |

|SUMMARIZE by using the contents below |

Methods for controlling Rabies

• Notify authority because Rabies is a notifiable disease

• Provide antirabies serum or vaccine to affected individuals

• Give health education about preventive measures, such as regular

immunization of dogs and cats (at least every 3 years) and killing of

stray dogs

• Pre-exposure vaccination to high risk individuals, such as veterinary

officers

STEP 4: Key Points (5 minutes)

• Rabies is the most common human disease caused by animal bite

• Death can be avoided if immediate action is taken for those who have

been bitten by a suspect dog

• Control measures include immunization of domestic dogs and individuals

with high risk of exposure

STEP 5: Evaluation (10 minutes)

• What is the common disease transmitted by animal bites?

• What are the methods for controlling Rabies?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

| |

|Prepare a presentation on Rabies, indicating transmission, clinical |

|manifestation and control measures |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed). London:

Saunders Ltd.

Eshuis J, & Manschot, P (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Manson-Bahr PEC.,& Bell DR (2004). Manson’s Tropical Diseases (21sted).

London. Bailliere Tindall.

Nordberg, E., Kingondu T., Mugambi E., Musyoka L, & Otieno F

(2007).Communicable Diseases(4thed). Nairobi: AMREF

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF.

Session 6: Measures to Improve Hygiene and Sanitation

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

Differentiate Hygiene from Sanitation

Describe the Importance of Sanitation and Hygiene

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Hygiene and Sanitation (30 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the difference between hygiene and sanitation? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Hygiene – Things that you do to keep yourself and your surrounding

clean to maintain good health. Few examples of hygiene practices are:

• Personal hygiene

• Food hygiene

• Medical hygiene practices, e.g.

o Sterilization of instruments used in surgical procedures

o Use of protective clothing and barriers, such

as masks, gowns, caps, eyewear and gloves

o Safe disposal of medical waste

o Disinfection of reusable materials such as linen, pads, uniforms

o Hand-washing before and after dispensing of medicines

Sanitation – is promotion of health through prevention of human

contact with the hazards of wastes, treatment and proper disposal of

sewage or wastewater.

Few examples of sanitation are:

• Management of human faeces

• Proper handling of food (Food sanitation)

• Environmental sanitation

Differences between Sanitation and Hygiene

|Sanitation |Hygiene |

|Promotion of healthy living and |Cumulative group of practices |

|good health by preventing human |perceived by group of people to be |

|contact with waste and other forms |a way towards healthy living |

|of organisms causing diseases. | |

|Associated with human wastes, |Associated with human body |

|environmental wastes and other | |

|forms of wastes | |

STEP 3: Importance of Sanitation and Hygiene (60 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the importance of sanitation and hygiene? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Importance of Sanitation

• Prevent variety of harmful or deadly bacteria from infecting people

• Increase lifespan and improve of quality of life

• Ensure safe living environment particularly in the rural setting

• Providing measures to control diseases

Importance of hygiene

• Protects people against disease germs that are present in the environment

• Promote health to “a state of maximum physical and mental well-being”

rather than mere absence of disease

• It promotes professional ethics

STEP 4: Key Points (10 minutes)

• Hygiene are practices done to maintain healthy living

• Sanitation is promotion of health through prevention of human contact

with wastesSanitation and hygiene are important for disease prevention

STEP 5: Evaluation (5 minutes)

• What is the difference between hygiene and sanitation?

• What are the importances of sanitation and hygiene?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|different hygienic measures practiced in their households. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.).

London: Saunders Ltd.

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed). Nairobi: AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO

Session 7: Measures for Preventing Water Contamination

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session studentsare expected to be able to:

• Describe Sources of Water Supply

• Identify Sources of Water Contamination

• Describe Measures for Preventing Water Contamination

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Sources of Water Supply (25 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are sources of water supply? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Two Main Sources of Water Supply

• Surface water

• Ground water

Surface Water

• The most common source of water for most people

• Located in rivers, lakes, streams, reservoirs, oceans, dams, and rain

water and snow when it falls to the surface

Advantages of surface water

• Easily accessible

• Obtained by hand or by simple pumps

• Large lakes and rivers are permanent supplies of water throughout the

year

Disadvantages of surface water

• Easily and frequently polluted as it runs over the ground where humans

and animals wash and bathe in it

• May be polluted by chemicals used in agriculture or industry

• Surface water needs to be treated before it becomes drinking water

Types of surface water

Rain water

• Obtained during the rainy season and collected from roofing or other

collecting surfaces

Advantages of rain water

• Purest form of natural water if collected into clean, closed tanks

• Does not need treatment when collected in a clean container

Disadvantages of rain water

• Does not contain essential elements (fluoride, iodine, selenium)

Sea water

• Water from the sea contains some salts

o The water is concentrated by evaporation and become too salty for

drinking

Ground Water

• Water which passes through permeable subsoil to the surface

• Ground water can be accessed through:

o Springs

o Wells (shallow well, deep well or Artesian/bore-hole wells)

▪ Shallow well taps water above the first impermeable stratum

▪ Deep wells are those derived from water bearing strata below a least

one impervious stratum

▪ Artesian wells are the result of ground pressure in an aquifer being

released through a natural fault, or a bore-hole, so that water is

forced to the surface of the ground

Advantages of ground water sources

o Underground water is usually clean, often plentiful and permanent

o A reliable resource, especially in dry season

o Not affected by evaporation

o Ground water doesn’t need treatment as surface water

Disadvantages of ground water sources

o Limited resources, extractable quantities are often low compared to

surface water

o Ground water extraction is more expensive due to pump cost

o Water from deep wells and deep springs usually has a lot of dissolved

salts and other

o Fertilizer and insecticides can get washed into aquifers via rain

water and pollute ground water

STEP 3: Sources of Water Contamination (30 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|ASKstudents to brainstorm on the following question: |

| |

|What are the sources of water contamination? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Sources of Water Contamination

• Industrial and mining activities

o Industrial discharge of chemicals wastes and by products

o Spillage of petroleum products

o Acidic rain caused by industrial discharge of sulphur dioxide

o Underground storage tank leakages

o Heavy metals used in mining industries (mercury in gold mining)

o Silt in storm water runoff from construction sites or cleared land

• Agricultural activities

o Farmers use of fertilizers and pesticides

o Food processing wastes, including pathogens

o Excess nutrients added by runoff containing detergents or fertilizers

• Organic materials from human/animals/plants and other living organisms

o The collecting surface for rain water may have leaves, insects, bird

and animal faces

o When water runs over the earth it may become contaminated with human

or animal excreta and solid waste

o Shallow wells may be contaminated by excreta and refuse being washed

into them, if a latrine is near

o Wells may also be contaminated by the use of dirty containers for

drawing water, or by oil from the pump

o Rivers, lakes or dams may be contaminated by bathing and/or urinating

or defecating in the water

o Even piped water may be contaminated from leaks in the pipes

especially when these pass near foul water or dirty drains

o Water may go bad if it is stored for too long in a pot or cistern

o Water from any source may become contaminated if it is drunk from

dirty or communal drinking vessel

[pic]STEP 4: Measures for Preventing Water Contamination(30 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the measures of preventing water contamination? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are measures for preventing water contamination:

• Protection of springs water

o Construct concrete water-proof protection box over the spring

o Keep off sources of water from contamination e.g. fencing the source

of water

• Protection of well water

o Site the well on a higher level of the source of water

o Put a concrete cover over a well

o Fence the well to keep animals away

• Protection of rain water

o Construct gutter that collects rain water from entire roof-surface and

drains into an angled pipe

STEP 5: Key Points (10 minutes)

• There are two major types of water, i.e surface water and ground water

• Water contamination can occur from industrial,mining, agricultural

activities; and materials from human, animals and plants

• Various measures can be used to protect water from contamination

STEP 6: Evaluation (10 minutes)

• What are sources of water supply?

• What are sources of water contamination?

• What are measures for preventing water contamination?

STEP 7: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE in small groups assignment |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a list sources of water contamination |

|Describe preventive measures against the list you have mentioned |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Basset W.H. (1992). Clay’s Handbook of Environmental Health (16thed).

London: Chapman and Hall.

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer

Students. Kilosa, Tanzania.

Wood C. H. (1997). Community Health (2nded). Nairobi: AMREF

Session 8: Water Treatment Methods

Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites

• None

Learning Task

By the end of this session students are expected to be able to:

• Explain Water Treatment Methods

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ orASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Water Treatment Methods (40 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the methods used for treatment of contaminated water? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are common methods for treating contaminated water

(Purification)

• Filtration

• Disinfection

• Boiling

Filtration

• Purification through sand reduces the bacterial content of the water by

85% to 90%

• The two types of filters commonly used in community water supply are:

o Slow sand filter

o Rapid (Pressure) filter

Slow filter

• Requires little operational maintenance skills

• Applicable in rural areas

• Needs attention regularly because it is liable to become a breeding

place for bacteria and water contamination

Home-made sand filter

• Filtration which is done when raw water passes through a fixed depth of

arranged sand medium

• All the suspended matter in water is dropped by the first few top layers

of the sand grain

• The clean water is collected at the bottom of the medium

• It can be used in containers like barrels of steel or concrete or clay

pots

• The home-made sand filter can be used effectively in combination with

chlorination

Disinfection

• It is killing of the organisms causing diseases

o There are different methods used to disinfect water supplies, e.g.

chlorination, silver treatment, ultra-violet radiation

Water Chlorination

• It is the final safe guard of the quality of water

o The Chlorine should be applied in the water system in such a way that

good mixing of the chlorine with water is ensured

Boiling

• Simplest way to treat a small quantity of water for at least 20 minutes

• This will kill the organism and render the water harmless

• Boiled water is tasteless but it is a safe rule to follow that all

drinking water should be boiled to disinfect it

STEP 6: Key Points (5minutes)

• Water purification can be done by boiling, disinfection and filtration

• A properly constructed and carefully maintained sand filter can remove

most of the substances that cause turbidity and odour

• It is important to prevent water from contamination

STEP 7: Evaluation (5 minutes)

• What are the methods of treating contaminated water?

• Why is it important to treat contaminated water?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a list of common methods used to treat water in their |

|household. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Basset W.H. (1992). Clay’s Handbook of Environmental Health (16th ed).

London: Chapman and Hall

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer

Students. Kilosa, Tanzania.

Wood, C. H. (1997). Community Health (2nded). Nairobi: AMREF

Session 9: Water for Pharmaceutical Use

Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites

• None

Learning Task

By the end of this session students are expected to be able to:

• Describe Types of Water for Pharmaceutical Use

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Types of Water for Pharmaceutical Use (40 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the types of water for pharmaceutical use? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• Water is a widely used substance, raw material in the production,

processing and formulation of pharmaceutical products

• Impurities present in water may contaminate or react with intended

product substances, resulting in hazards to health

• Control of the quality of water throughout the production, storage and

distribution processes, including microbiological and chemical quality,

is very important

• Assurance of quality to meet the acceptable standards of pharmaceutical

products is essential

• Microbial contamination in the production of pharmaceutical products can

be minimized by proper designing of the system, periodic sanitization and

by taking appropriate measures to prevent microbial proliferation

• Different grades of water quality are required depending on the route of

administration of the pharmaceutical products (Different grades of water

can be found in pharmacopoeias and related documents)

General principles for pharmaceutical water systems

• Pharmaceutical water production, storage and distribution systems should

be designed, installed, commissioned, qualified and maintained to ensure

the reliable production of water of an appropriate quality.

• The capacity of the system should be designed to meet the average and the

peak flow demand of the current operation.

o All systems, regardless of their size and capacity, should have

appropriate recirculation and turnover to assure the system is well

controlled chemically and microbiologically.

• The use of the systems following initial validation (installation

qualification (IQ), operational qualification (OQ) and performance

qualification (PQ)) and after any planned and unplanned maintenance or

modification work should be approved by the quality assurance (QA)

department using change control documentation.

• Water sources and treated water should be monitored regularly for

chemical, microbiological and, as appropriate, endotoxin contamination.

• There are four types of water used in pharmacy.

o Portable water

o Purified water

o Water for preparation

o Water for injection

Drinking/Portable water

• Portable water is water fleshly drawn from public mains supply

• It does not include water from local storage tank which may be heavily

contaminated with microorganisms

• Portable water is suitable for preparation of pharmaceutical preparation

for internal and external use

• Drinking-water should be supplied under continuous positive pressure in a

plumbing system free of any defects that could lead to contamination of

any product

• Drinking-water is unmodified except for limited treatment of the water

derived from a natural or stored source e.g. springs, wells, rivers,

lakes and the sea

o The condition of the source water will dictate the treatment required

to render it safe for human consumption (drinking)

o Treatment includes desalinization, softening, removal of specific

ions, particle reduction and antimicrobial treatment

• It is the responsibility of the pharmaceutical manufacturer to assure

that the source water supplying the purified water (PW) treatment system

meets the appropriate drinking-water requirements

• Drinking-water quality is covered by the WHO drinking-water guidelines,

standards from the International Organization for Standardization (ISO)

and other regional and national agencies.

Purified water

• This is prepared from suitable portable water by distillation or reverse

osmosis system

• If allowed to stand it may gain a high content of vegetative organisms

• Water for pharmaceutical production must be freshly boiled and cooled

before us

Water for preparation

• Portable or fleshly boiled and cooled purified water is recommended for

preparations of pharmaceutical

• Portable water is suitable only when it is drawn from a public supply

(mains water) and is suitable for drinking

• Water obtained from local storage tank or any other open source e.g.

water from wells is unsuitable for preparation of pharmaceuticals.

• Water for preparation is used for preparation of non-sterile products

such as mixtures.

Water for injections

• This is pyrogen free distilled water or water produced by reverse osmosis

system (ROS) Water for injection is sterilized immediately after

collection and used for parenteral preparation and irrigation in surgical

procedures

STEP 6: Key Points (5 minutes)

• Production and uses of Water for pharmaceutical use should follow the

requirements specified by Pharmacopoeias and other requirements by

international and local authorities

STEP 7: Evaluation (5 minutes)

• What are the types of water for pharmaceutical use?

• What are the uses of each type of water for pharmaceutical use?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a list of common methods used to treat water in their household|

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Liebsch B., Nyamageni DS., Senya SS., & Steinhausen (1988). Tanzania

Pharmaceutical Handbook.Dar es Salaam: Dar es Salaam University Press

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Session 10: Methods for Safe Sewage Disposal

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Sewage

• Describe the Importance of Safe Sewage Disposal

• Describe Methods for Safe Sewage Disposal

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Sewage (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASKstudents to brainstorm on the following question: |

| |

|What is sewage? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Sewage is the mixture of liquid, faeces, toilet paper and food wastes

produced by people

o The liquid in sewage includes urine and wastewater which comes from

the toilet, the kitchen, bathroom and laundry

o Sewage contains lots of disease-causing germs and parasites

o Sewage is treated to get rid of as much of the solid matter as

possible

o The remaining liquid is called effluent

STEP 3: Importance of sewage disposal (30 minutes)

|Activity: Brainstorming (15 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What is the importance of sewage disposal? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Sewage disposal is the process in which sewage is transported from

inhabited areas to sewage treatment plants

o This is important to prevent people from getting infection caused by

microorganisms found in the sewage

Importance of safe sewage disposal

• Protects public health from diseases

• Prevent water pollution from sewage contaminants

• Remove sources of contaminants from the environment to make it safe.

STEP 4: Methods for Sewage Disposal (450 minutes)

|Activity: Small Group Discussion ( 45 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the methods for safe sewage disposal? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

There are main two types of sewage disposal systems which are:

• On-site systems

• Sewage or effluent systems

On-site sewage disposal systems

• It treats the sewage in a septic tank so that most of the sewage becomes

effluent and is disposed of in an area close to the house or buildings

o Example of an on-site disposal system consists of a septic tank and

leach drains

o All the liquid waste from the toilet, bathroom, laundry and sink goes

into pipes which carry it to a septic tank

o The effluent from the tank is then disposed of through effluent

disposal drains often referred to as leach or French drains

o Both of these methods of disposing of liquid waste are on-site

disposal systems. They must be installed and maintained properly.

In these systems, the effluent is soaked into the surrounding soil.

[pic]

Figure 10.1: Plan view (top) of an on-site sewage disposal system

On-site disposal systems cannot be installed in all situations. For

example, they cannot be installed:

• In areas that flood regularly

• In areas that have a high water table (that is, where the underground

water is close to the surface)

• Where the amount of wastewater to be disposed of is large

• Near to drinking water supplies

A sewage or effluent (wastewater) system

• It disposes of the effluent from a community at a central place usually

called a sewage lagoon or effluent pond

• In this method the effluent from the community is carried by large pipes

to the lagoon.

• These pipes serve all the houses and other buildings in the community

[pic]

Fig 10.2: Plan view of a wastewater disposal

system

• Before disposal, the sewage is treated. This involves holding the sewage

in a closed or open space for a few days to allow fluids and solids to

separate and bacterial action to turn the sewage into safer form

• The sewage can be treated:

o In a septic tank at each building

o Just before the lagoon in a large septic tank or macerator system, or

o In the lagoon itself

STEP 6: Key Points (10 minutes)

• Sewage is a mixture of excreta, water and other materials

• Sewage disposal is important to make the environment free from

pollutants and diseases

• There are two main methods for sewage disposal; on-site and sewage

system.

STEP 7: Evaluation (5 minutes)

• Why is the meaning of sewage?

• What is the importance of safesewage disposal?

• What are the methods of safe sewage disposal?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

| |

|Prepare a presentation to be delivered to the class indicating |

|different ways of safe sewage disposal. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Basset, W.H. (1992). Clay’s Handbook of Environmental Health (16th ed).

London: Chapman and Hall

Nyamwaya, D. (1994).A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Wood CH., Vaughan JP., &de Glanville H (1997).Community Health (2nded).

Nairobi: AMREF

Session 11: Health Hazards of Poor Housing and Ventilation

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe health hazards of poor housing

• Explain types of ventilation

• Explain importance of proper ventilation in various settings

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers Projector

• Computer and LCD Projector

• Worksheet 11.1 Diseases caused by poor housing

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Health Hazards of Poor Housing (30 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|ASKstudents to brainstorm on the following question: |

| |

|What are the hazards of poor housing? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Housing conditions play a crucial role in the control of many diseases,

especially in the transmission of communicable diseases

• House can both protect and facilitate diseases

Definition of terms

• House – The usual dwelling place of the family

• Housing – The enclosed and adjoining open space and all structural

components making up those spaces

• Healthful housing – Housing which permits individuals of all ages to

conduct usual household activities without putting excessive burden

upon any organ of the body

Basic requirements for a house

• Adequately shelters people from heat, cold, damp, animals, insects and

invaders

• Able to be kept in good repair

• Adequate elevation, ventilation and water supply

• Adequate size and spacing for occupant(s)

• Good drainage

• Space for preparation, cooking and storage of food

• Room for fuel storage

• Adequate means to dispose of refuse and human waste

• Proximity to roads, neighbours and other centres of population

• Good natural and artificial lighting

Health hazards of poor housing

• A combination of dampness, lack of light, poor ventilation and

overcrowding will contribute to the spread of airborne droplet

infection

• A dirt floor and walls and unscreened windows permit the entry and

breeding of flies, bedbugs and mosquitoes which contributes to the

spread of vector-borne diseases

• Cooking fires placed on the floor are hazardous to small children

• A range of social problems may be associated with poor housing and

living conditions including depression and alcohol abuse

• Excessive noise and overcrowding has an influence on mental disorders

• Crowded, cramped housing conditions facilitate the spread of airborne

(communicable) infections such as measles and tuberculosis

• The use of dirty household fuels for cooking and heating can cause

respiratory problems

• Dirty water and poor sanitation are associated with numerous illnesses

STEP 3: Types of Ventilation (30 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are major types of ventilation? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition of Ventilation

• The process of removing polluted, stale, moisture laden, indoor air and

replacing it with fresh outdoor (often dryer) air

Types of Ventilation

• Natural ventilation – Natural movement of air entering and leaving

openings such as windows, doors, and roof ventilators as well as through

cracks and crevices of buildings

Types of natural ventilation

o Through ventilation – Windows placed on opposite sides of house, air

enters in one window and leaves through the other window

o Cross ventilation – One window is provided and the other window is

provided adjacent, air enters and leaves through the adjacent window

o Back to back ventilation – Window is placed only on one side of the

wall, Air enters and leaves in the same window. This type of

ventilation is not recommended in public health

• Mechanical ventilation – The movement of air by mechanical means

o Wall fan and air conditioning units are examples of mechanical

ventilation

[pic]

STEP 4: Importance of Good Ventilation (30 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What is the importance of good ventilation? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• Good ventilation provides enough air (oxygen) required for normal

physiological function in the body

• Proper ventilation prevents air pollutants from affecting the health of

an individual

• Good ventilation helps in removing unwanted smells, such as from cooking

or pets

• Ventilation controls how much moisture is lingering in a house, and helps

a house stay dry

• Moisture can cause mold to build up; which in turn can cause various

diseases

STEP 6: Key Points (10 minutes)

• Poor housing contribute to diseases in humans

• There are two major types of ventilations; natural and mechanical

• Proper ventilation is important for good health

STEP 7: Evaluation (5 minutes)

• What are health hazards of poor housing?

• What are types of ventilation?

• What is the importance of proper ventilation?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|different types of bad housing and the corresponding diseases caused |

|[pic]REFERstudents to worksheet 11.1 Diseases caused by poor housing |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Salvato, J.A. (1982). Environmental Engineering and Sanitation (3rded). New

York: John Wiley and Sons

Wood C. H., Vaughan JP., & de Glanville H. (1997). Community Health

(2nded). Nairobi: AMREF

|[pic] |Worksheet 11.1 Diseases caused by poor housing Assignment |

|Instructions. Fill in column A examples of poor housing; and in column|

|B diseases resulting from the poor housing |

| |

|Column A (Example of poor housing) |Column B (Diseases) |

| | |

Possible Answers

|Column A (Example of poor housing) |Column B (Diseases ) |

|Poor ventilation |Respiratory diseases such as |

| |Tuberculosis |

|Earth floors and walls |Plague |

|Unscreened windows |Malaria |

|Shortage of water supply |Trachoma, skin diseases such as |

| |scabies |

|Lack of toilets |Diarrhoea diseases, intestinal |

| |parasites such as hookworm |

Session 12: Air Purification in Pharmaceutical Settings

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Students Learning Task

By the end of this session students are expected to be able to:

• Explain process and application of air purification in pharmaceutical

settings

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning task and clarify

ASK students if they have any questions before continuing

STEP 2: The Process and Application of Air Purification in Pharmaceutical

Settings (85 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is air purification? |

|What are the methods used in the process of air purification? |

| |

|ALLOW few pairs to respond and let other pair to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition of Air purification – It is a process of cleansing the air

from impurities and microorganisms

• The process of air purification involve different methods

• The methods used in the process of air purification are applied in a

sterile manufacturing room to provide sterile condition to perform

sterile pharmaceutical production, as explained below:

Sterilization by radiation

• Means energy that is radiated or transmitted in the form of rays or

waves/ particles. The ionizing radiations include Alpha, Beta, Gamma

and X-ray. In a sufficient dose, these radiations are lethal to all

cells, including bacterial spores, which are generally more resistant

than vegetative cells

• Bacterial species differ in their sensitivity to ionizing radiations

and the degree of resistance varies during the growth cycle

• It is used for the commercial sterilization of large amounts of pre-

packed single use items such as plastic syringes and catheters

Laminar Air flow carbinate

• Is a system of circulating filtered air in parallel-flowing planes in

hospitals or in the health care facilities

• The system reduces the risk of airborne contamination and exposure to

chemical pollutants in hospital pharmacies

• It is also used in other areas such as surgical theatres, food

preparation areas and laboratories

Mechanical/ Forced ventilation

• Outside air is delivered indoors typically with fans, which draw air

from outside and forces it through ducts to the place where occupants

are located

• Mechanical ventilation can exacerbate infiltration and/or exfiltration

• There are 3 types of mechanical ventilation as follows:

o Exhaust (vacuum) system: Fans draw air out of the building in

openings high up in the outside walls which is replaced by fresh air

through windows and other inlets

▪ Local exhaust ventilation is absolutely required when the source

have dust, exhaust fumes, solvent vapors, lead fumes, and acid mist,

all known as toxic or corrosive contaminants.The fans may be placed

directly in windows or outside walls or in ducts which lead the air

outside. It is a system that is useful for the removal of dust, smoke

and fumes in some factories

o Pressure (propulsion) system: Unlike the exhaust system, this forces

the air into a building and therefore control of entering air is

possible, the fresh entering air displaces the used up air. The

advantage of this method is that the source of air-entry can be

controlled and its purity thereby ensured. The air can be filtered,

warmed or cooled as required

o Balanced system: This is a combination of the exhaust and pressure

system.

Air is drawn in through ducts by means of a centrifugal fan and

extracted at suitable points by exhaust fan

▪ It facilitates good distribution of fresh air by placing supply and

exhaust vents in appropriate places

▪ Balanced ventilation systems are appropriate for all climates;

however, because they require two duct and fan systems, they are

usually expensive

▪ Air conditioning is generally employed with this type of ventilation

and the temperature and humidity can be controlled

▪ It is suitable for factories where a control of humidity and

temperature is necessary to the processes being carried out

Reasons for using Mechanical/ Forced ventilation

o To keep flammable gases and vapours below the lower flammable limit

(LFL).

o To keep the air movement at a certain level so that the air stress can

be reduced

o To keep toxic contaminants at or below certain concentrations

o To reduce odours

o To control microorganisms, dusts and other particulates

o To limit carbon dioxide build-up

STEP 3: Key Points (10 minutes)

• Air purification is a process which removes contaminants from the air

in a room. Air purification methods are used in pharmaceutical setting

to remove impurities such as carbon-dioxide from air before processing

• Dust, pollen, pet dander, mold spores, mite faeces, smoke particles

and volatile organic compounds are some sources of contaminants that

may affect personnel and products in pharmaceutical setting

• Air purifiers are very important in capturing a greater number of

bacterial and virus particulates. They are used to reduce the

concentration of these airborne contaminants

STEP 4: Evaluation (10 minutes)

• What are the reasons for air purification in pharmaceutical setting?

• What are the three methods used for air purification in pharmaceutical

setting?

STEP 5: Assignment (10 minutes)

| Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK students to work on the following Assignment |

| |

|Visit The Hospital Pharmacy Department and prepare a presentation on |

|the methods that are used for Air Purification in different sections. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Basset, W.H. (1992).Clay’s Handbook of Environmental Health (16thed).

London:

Chapman and Hall

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Salvato J.A. (1982). Environmental Engineering and Sanitation (3rded). New

York:

John Wiley and Sons

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer

Students. Kilosa:

Tanzania

Wood C. H., Vaughan JP., & de Glanville H. (1997). Community Health

(2nded). Nairobi: AMREF

Session 13: Using Antiseptics and Disinfectants

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Differentiate Between Antisepsis and Disinfection

• Classify Agents Used for Antisepsis and Disinfection

• List Characteristics of an Ideal Disinfectant and Antiseptic

• Describe Uses of Various Antiseptics and Disinfectants

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Antisepsis and Disinfection (20 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the difference between Antisepsis and Disinfection? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Antisepsis – Destruction or inhibition of microorganisms on living

tissues, to prevent infection

Antiseptic – A substance that counters sepsis by destroying or inhibiting

the growth of pathogenic microorganisms

• Antiseptics are generally applied to living tissues in the form of wet

dressings, creams, ointments or other substances that involve prolonged

contact with the body

Disinfection – Is the process of removing microorganisms, including

pathogens, from the surfaces of inanimate objects

Disinfectant – An agent that prevents infection by destroying or removing

pathogenic microorganisms

• The term is confined to substances used for the treatment of inanimate

objects

• In practice, both antiseptics and disinfectants are used to destroy or

inhibit the growth of pathogenic microorganisms in the vegetative form

STEP 3: Agents used for Antisepsis and Disinfection (45 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the agents used for Antisepsis and Disinfection? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Antiseptics

Ethanol

Mode of action

• Has a bactericidal action against most vegetative organisms at a

concentration of 60% and 95%, but is not effective against bacterial

spores

Therapeutic uses

• Evaporating lotion used for hand and skin cleaning

• Surgical treatment for various skin lesions

• Prevention of bed sores and diminishing sweating (reduce temperature)

• Used as solvent in different pharmaceutical preparations

• A concentration of 70% either alone or with chlorohexidine or iodine for

disinfection of skin before surgical procedures

Chlorhexidine

Mode of action

• An antiseptic which is effective against a wide range of vegetative gram-

positive and gram-negative bacteria, although it has no activity against

acid fast bacteria, bacterial spores and some viruses

Therapeutic uses

• Chlorohexidine is used in disinfectant solutions, creams, gels and

lozenges

• It is also used in various concentrations for disinfection in the

following conditions:

o Chlorhexidine 0.5% in 70% ethanol for the preoperative disinfection of

the skin

o Chlorhexidine 0.05% solution in glycerin for urethral irrigation and

catheter lubrication

o Chlorhexidine 0.02% solution for bladder irrigation

o Chlorhexidine 1% cream for use in obstetrics

o Chlorhexidine 0.01% as the diacetate for preservation of eye drops

Cetrimide

Mode of action

• A quaternary ammonium disinfectant that has bacterial activity against

both gram- positive and gram-negative organisms

Therapeutic uses

• Cetrimide 0.5% solution for preoperative skin disinfection

• Cetrimide 0.05% to 1% is used for the cleansing of polythene tubing and

catheters, but time of immersion should not exceed 30 minutes

• Cetrimide in higher concentrations of 15 to 35 is used in shampoos to

remove scales in seborrhea

• Cetrimide 1.5% with chlorhexidine gluconate 0.15% is often used as a

general purpose disinfectant

Povidone Iodine

Mode of action

• Acts by inhibiting enzymes essential to microbial metabolism

• It kills on contact a broad spectrum of pathogenic bacteria, viruses,

fungi, protozoa and yeasts

Therapeutic uses

• Skin antiseptics and germicidal skin cleansers

• Disinfectant for wounds, abrasions and insect bites

• Medicated spray for wounds

• Antidandruff shampoos

• Medicated adhesive plasters

• Gargles and throat lozenges

• Vaginal gels and douches

Disinfectants

Sodium Hypochlorite

• A solution 8% to about 18% of chlorine is prepared by absorption of

chlorine in sodium hydroxide solution to give sodium hypochlorite

Mode of action

• Sodium hypochlorite solutions release chlorine gas which kills most

pathogenic organisms at neutral pH

Therapeutic uses

• Rapid disinfection of hard surfaces

• Disinfection of food

• Disinfection of dairy equipment and babies’ feeding bottles

• o Solutions containing up to 0.05% of available chlorine are suitable for

use on skin and wounds

Glutaral

Mode of action

• Glutaral is an effective disinfectant against vegetative forms of gram-

positive and gram-negative bacteria

• It is also effective against acid-fast bacteria, bacterial spores, some

fungi and viruses

Therapeutic uses

• A 2% aqueous solution of Glutaral buffered to pH 7.5-8.5 (the ambient pH

for activity) is used for the sterilization of endoscopic instruments,

thermometers and rubber or plastic equipment that cannot be sterilized by

heat

Cresol and Soap Solution

• Cresol and soap solution BP (Lysol) is an old preparation which is still

widely used in East Africa as a general disinfectant for hospital and

domestic use

Mode of action

• Cresol and soap solution is effective against a wide range of organisms,

but its activity is reduced in the presence of organic matter

• The bactericidal activity of cresol and soap solution varies with the

soap used

• Linseed and castor oil soaps give the highest values and oleic acid the

lowest

• It has further been verified that higher values are obtained with coconut

oil

Therapeutic uses

• In addition to its use as a general disinfectant in hospitals, cresol and

soap solution is widely used in commercial disinfectants

• Because it is clear when diluted with water, its use is an advantage in

the sterilization of surgical instruments, since cleanliness can be

identified with speed and ease

• Adverse effects

o Cresol and soap solution is irritant and corrosive to the skin and

should be handled carefully

o It is caustic to the skin and is unsuitable for skin and wound

disinfection

[pic]

STEP 4: Characteristics of an Ideal Disinfectant and Antiseptic (20

minutes)

Antiseptics

• Should be safe and non-toxic

• Microbial activity should be known

• Should have instructions on how to use

• Should not have residual effects

• Should be cost effective

• Should be active against a wide range of microorganisms

• Should be stable when in contact with organic matter

• Should be effective

• Should be easy to procure

Disinfectants

• Bactericidal or bacterial static

• Rapid activity

• Non corrosive

• Cost effectiveness

• Availability

• Stable when in contact with organic matter

• Active against a wide range of microorganisms

• Not damaging to instruments

• Easily biodegradable and less corrosive to the sewage system

• Less volatile and non toxic when it enters the atmosphere

Note

Before acquiring antiseptics and disinfectants for use, the following are

things to note;

• Expiry date

• Label of container (well labeled with correct generic name of the

disinfectant)

• Cover should explain the type of agent and not be torn

• Instructions on how to dilute (if not followed can damage instruments or

equipment)

• Cautions of use

STEP 5: Uses of various antiseptics and disinfectants (10 minutes)

Antiseptics

Used on skin and mucous membranes to kill microorganisms

• Use on skin and mucous membranes to kill microorganisms

• Surgical hand scrub

• Skin, cervical and vaginal preparation before a clinical procedure

• Hand washing in high risk situations

• Heavy microbial contaminated area

• Before invasive procedures

• Before and after direct contact with pts with antimicrobial resistant

organisms

• Before contact with immune suppressed patients

• Before handling newborns

Disinfectant

Use to kill microorganisms on inanimate objects

• Processing instruments and other items

• Non critical items/devices

• Decontaminating floors, surfaces, walls, and furniture

STEP 6: Key Points (5 minutes)

• Antiseptics are substances applied to living tissues to destroy or

inhibit growth of pathogens

• Disinfectants are substances applied to a non living surface for

preventing infection by destroying pathogenic microorganisms

• There are various antiseptics and disinfectants with different strengths

used in different situations in health facilities

STEP 7: Evaluation (5 minutes)

• What is a disinfectant?

• What is an antiseptic?

• What are the different types of disinfectants?

• What are the different types of antiseptics?

• What are uses of disinfectants and antiseptics?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating common |

|Antiseptics and Disinfectants used in hospitals and other health |

|facilities |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Nyang’hechi et al. (1992).Management of Solid and Liquid Waste. Nairobi:

AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation,

Nairobi: AMREF

MOHSW. (2004). National Infection Prevention and Control Guidelines for

Health Care

Services in Tanzania. Dar es Salaam: MoHSW

MOHSW. (2006). Health Care Waste Management Monitoring Plan. Health

Education

Unit. Dar es Salaam: MoHSW

MOHSW. (2006). National Standards and Procedures for Health Care Waste

Management in Tanzania.Dar es Salaam: MOHSW

Wood CH., Vaughan JP., & de Glanville H. (1997).Community Health. (2nd ed).

Nairobi: AMREF

Session 14: Introduction to Common Communicable Diseases

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define common terms used in communicable diseases

• Identify Medical Importance of Communicable Diseases

• List Common Groups of Communicable Diseases

• Describe Mode of Transmission of Communicable Diseases

• Describe the Principles of Prevention and Control of Communicable

Diseases

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Terms in Communicable Diseases (10 minutes)

Communicable diseases: Are those which can be transmitted from one person

to another or from animals to person

• Epidemic – a widespread occurrence of a disease in a community at a

particular time that appears as new cases at a rate that substantially

exceeds what is ‘expected’, based on recent experience. Therefore it

is the unusual occurrence of a disease in the community

• Endemic: The constant presence of a disease or infectious agents

within a community

• Pandemic (from Greek pan- all + demos- people): An epidemic that

spreads across a large region (for example a continent), or even

worldwide.

• Nosocomial: An infection developing in a patient while in a hospital

or acquired in a hospital but could show up after discharge.

• Principle of disease transmission: Transmission of a disease in human

requires the following components:

o An agent capable of infecting man

o A source: an infected host or reservoir of infection

o A portal of exit from the source

o A suitable means of transmission

o A portal of entry into a new host

o A susceptible host

• Agent: An agent is an organism, mainly a microorganism but including

helminthes that is capable of causing a disease

• Reservoir (of infection): Refers to any human beings, animals,

arthropods, plants, soil or inanimate matter or a combination of these

in which an infectious agent normally lives and multiplies, and on

which it primarily depends for survival and reproduction in such a

manner that it can be transmitted to a susceptible host

o A reservoir of infection can also be termed as the natural habitat

of the infectious agent

o Disease that man is the only reservoir is called anthroponeses e.g.

Measles and cholera

o Those that involve other animals reservoirs are called zoonoses

e.g. plague and rabies

• Portal of exit in the human host: Include the respiratory passages,

the alimentary canal, the opening in the genital urinary system and

the skin lesion

• Suitable means of transmission: Transmission of infectious agent is

any mechanism by which a susceptible host is exposed to an infectious

agent. It may be either direct or indirect

STEP 3: Medical Importance of Communicable Diseases (20 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|Askstudents to brainstorm on the following question: |

| |

|What is the medical importance of communicable diseases? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

The following is Medical Importance of communicable diseases:

• Many of them are very common

• Some of them are serious and cause death and disabilities

• Some of them cause wide spread outbreak of disease that is epidemic

• Most of them are preventable by fairly simple means

• Many are serious particularly in infants and children

STEP 4: Common groups of Communicable Diseases (20 minutes)

Contagious Diseases

• Contagious (contact diseases) are diseases transmitted by direct or

indirect contact

• Direct contact is by skin to skin e.g. touching an infected person.

• Indirect contact is by handling contaminated objects such as clothing,

bedding materials, dressing and utensils. Example scabies, pediculosis,

fungal skin infections, trachoma and acute bacterial conjunctivitis

Sexually Transmitted Infections and HIV/AIDS

• These are diseases or infections whose predominant mode of transmission

is through sexual contact, be heterosexual or homosexual

o Sexually transmitted infection includes the stage of preclinical

illness (i.e. the typical symptoms and signs have not yet appeared)

for example HIV

o Sexually transmitted disease is the stage of clinical illness (i.e.

the typical symptoms and signs are present) for example AIDS and

gonorrhea

Vector-Borne Diseases

• Vectors are invertebrate hosts (insects, ticks and snails) which are an

essential part of the life cycle of the disease causative organism

• Therefore a vector-borne disease is a disease whose transmission requires

a vector (i.e. part of the life cycle of the causative organism takes

place within the vector)

• Vectors acquire disease organisms by sucking blood from infected persons

or animals and pass them on by same route

• Examples are yellow fever, trypanosomiasis, schistosomiasis and malaria

Diseases Caused by Fecal Contamination

• These are diseases whose causative organisms are excreted in the stools

of infected persons or animals. For example acute gastro-enteritis,

amoebiasis, and cholera

• The portal of entry for these organisms is the mouth

• The organisms have to pass through the environment from the faeces of an

infected person or animal to the gastrointestinal tract of a susceptible

person (fecal – oral transmission route)

Helminthic diseases

• These are diseases caused by parasitic worms. For example; ascariasis,

enterobiasis, trichuriasis, hookworm, strongyloidiasis, taeniasis and

hydatidosis

Airborne diseases

• These are diseases caused by pathogens transmitted through air. For

example; acute respiratory infections, meningitis, tuberculosis and

leprosy

Zoonotic diseases

• These are diseases that can be passed between animals and humans. This

can be through contact with animals or animal products. For example;

anthrax, brucellosis, rabies, hydatidosis and tetanus

STEP 5: Mode of Transmission of Communicable Diseases (20 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the mode of transmission of communicable diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

The following are the Modes of Transmission of Common Communicable

Diseases:

• Direct or indirect contact

• Sexual Contact

• Vector bite, crushed or infection enter skin cracks/abrasions from

infected insect

• Faecal-oral route

• Penetration through intact skin

• Ingestion of infected animal products

• Inhalation (droplet infection)

STEP 6: Principles of Prevention and Control of CommunicableDisease(20

minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the principles of prevention and control of communicable |

|diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Communicable diseases transmission can be controlled by three main ways

namely:

• pting transmission

• Protecting tAttacking the source

• Interruhe host

The components of each of the ways are summarized in Table 1 below:

Table 1: Principles of communicable diseases control

|Attacking the |Interrupting |Protecting the |

|source |transmission |host |

|Treatment |Environmental |Immunisation |

| |sanitation | |

|Isolation |Personal hygiene |Chemoprophylaxis |

|Reservoir |Behaviour change |Personal |

|isolation | |protection |

| |Vector control |Better nutrition |

| |Disinfection and | |

| |sterilisation | |

Level of Prevention

• Primary prevention: These refer to prevention of healthy people from

becoming infected and or develop a disease. The measures include:

o Immunization

o Health education

o Promotion of nutrition

o Vector control

o Provision of adequate housing

o Hand washing

• Secondary prevention: This refers to detection of people who already have

a given disease at the earliest possible stage in order to stop the

disease from developing further and or prevent complications i.e. early

detection and prompt treatment

• Tertiary prevention: This refers to prevention of disease disability and

death in a patient who has already developed the disease, and has

complications or cannot be cured. It includes rehabilitation

STEP 6: Key Points (10minutes)

• Communicable diseases are transmitted from one person to another or from

animals to a person

• There are various ways through which communicable diseases are

transmitted

• Prevention and control include measures that attack the source, interrupt

transmission and protect the host

STEP 7: Evaluation (5minutes)

• What are the common terms used in communicable diseases?

• What is medical importance of communicable diseases?

• What are the common groups of communicable diseases?

• What are the modes of transmission of communicable diseases?

• What are the principles of prevention and control of communicable

diseases?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class explaining most |

|common type of communicable diseases from their home and recommend the |

|most effective control methods. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.).

London:

Saunders Ltd

Eshuis J., & Manschot, P. (1992).Communicable diseases.(1sted). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.)Nairobi: AMREF

Session 15: Identification of Patients with Malaria

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session studentsare expected to be able to:

• Describe Causes of Malaria,

• Describe Mode of Transmission of Malaria

• Describe Major Signs and Symptoms of Malaria

• Explain Treatment of Malaria

• Explain Prevention and Control of Malaria

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD projector

• Handout 15.1; Life cycle of malaria parasite

• Handout 15.2; Treatment of uncomplicated malaria

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Malaria (5 minutes)

Malaria

• An acute infection of the blood caused by protozoa of genus Plasmodium

• Malaria is the most common disease in the tropical Africa

Causative Agents of Malaria

There are 4 different species of Malaria parasite which infect human

beings:

• Plasmodium falciparum (commonest cause of Malaria in Tanzania)

• Plasmodium Malariae

• Plasmodium vivax

• Plasmodium ovale

STEP 3: Mode of Transmission of Malaria (30 minutes)

• Malaria is transmitted by the female Anopheles mosquito which requires

human blood for the development of eggs.

• The male mosquito does not suck human blood.

• Major Anopheles species of importance in Africa include:

o Anopheles Gambiae -Most important vector in Africa.

o Anopheles Funestus – Breeds in permanent vegetation e.g. swamps.

[pic]

Figure 15.1 Spread of malaria

Life cycle of malaria parasite

• Divided into two phases

o Asexual cycle occurring in human

o Sexual or sporogony cycle occurring in female Anopheles (mosquito)

Life Cycle of Malaria Parasites in Man (Asexual Cycle)

• Sporozoites in the mosquito salivary glands are injected into the host

via the proboscis of the mosquito

• They quickly migrate to the liver

• The hepatic (Liver) stage

o The Sporozoites is taken up by the Kupffer cells of the liver and then

passes through into the hepatocytes or liver cells

o There, it develops into hepatic Schizont, releasing thousands of

Merozoites into the general circulation

• Hypnozoites

o This stage of the parasites only occurs in Plasmodium Ovale and

Plasmodium Vivax

o The Hypnozoites mature unpredictably and releases new Merozoites

responsible for recurrent infections up to 18 months after primary

infection, even though earlier blood stages may have been cured

o Without treatment (specific) using primaquine, it is thought that this

stage may remain in the liver for life

• Erythrocytic or Blood Stage

o The merozoites released from the liver invade individual red blood

cells (RBCs) and then develop within the RBCs from “rings” into blood

schizonts

o The schizonts then rupture the RBCs releasing numerous merozoites

which invade new RBCs

o It is this part of the cycle that causes clinical illness, and then

Length of time for each RBC cycle gives the periodicity of the

symptoms

• Gametocytes

o At unknown stage or time in the RBCs cycle, ‘sexual’ forms develop and

are in turn responsible for the survival and transmission of the

parasite

o Male and female gametocytes circulate for a few weeks and are taken up

by the feeding mosquito

Life Cycle of Malaria Parasites in Mosquito (Sexual Cycle of Malaria

Parasites)

• Sexual reproduction, the male and female gametocytes develop into gametes

and then fuse in the stomach of mosquito to form a zygote

• This develops into a mobile ookinete which immigrates through the wall of

the stomach to form an oocyst

• Oocyst matures and releases sprorozoites

• Sporozoites migrate to the salivary glands ready for delivery with the

mosquito’s next meal

[pic]Refer to handout 15.1: Life Cycle of Malaria Parasite

STEP 4: Major Signs and Symptoms of Malaria (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question |

| |

|What are the major signs and symptoms of Malaria? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Signs and symptoms of Malaria

The signs and symptoms of Malaria are non–specific and can mimic

symptoms of systemic viral illnesses or other disease condition. The

occurrence of Malaria signs and symptoms may differ in children and

adults

Signs and symptoms of uncomplicated Malaria

• Fever

• Headache

• Malaise

• Joint pains

• Vomiting /diarrhoea

• Body ache

• Poor appetite

• Body weakness

• Pallor

• Enlarged spleen

Signs and symptoms of Severe Malaria

• Extreme weakness

• Impaired consciousness

• Change of behaviour ( hallucinations, delusions, agitation, and acute

state of confusion)

• Respiratory distress

• Bleeding tendency

• Jaundice

• Circulatory collapse/ shock

• Vomiting everything

• Inability to drink or breastfeed

STEP 5: Treatment of Malaria (30 minutes)

Treatment of Uncomplicated Malaria with First Line Drugs

• Artemether/ Lumefantrine (ALU) an oral fixed combination tablet of 20 mg

Artemether (a derivative of artemisinin) and 120 mg Lumefantrine

• A simple dosage regimen is recommended to improve compliance:

o The first dose should be given as Direct Observation Treatment (DOT)

o The second dose should strictly be given after 8 hours

o Subsequent doses could be given twice daily (morning-evening) until

completion of 6 doses

[pic]Refer to Handout 15.2: Treatment Schedule of uncomplicated Malaria

using ALU

Contra-indications of ALU

• Hypersensitivity to either Artemether or Lumefantrine

• First trimester in Pregnancy

Side Effects of ALU

• Sleep disorders

• Headache

• Dizziness

• Nausea

• Anorexia

• Abdominal pain

• Itching and skin rash

• Joint and muscle pain

• Palpitation

Other Artimesinin Combined Therapy (ACT) options Treatment of Uncomplicated

Malaria

• Recommended ACTs options for the treatment of uncomplicated Malaria are

those with minimum 3-day course which include:

o Dihydroartemesinin-Piperaquine (DPQ) –Oral

o Artesunate-Amodiaquine-oral

o Artesunate-Mefloquine-oral

Treatment of Severe Malaria

• The medicine of choice for treatment of severe Malaria is injectable

Artesunate

• Injectable Quinine is to be used when Artesunate is contraindicated such

as allergy, medicine interaction, non-response or when it is not

available.

Artesunate Injection

• Give injectable antiMalarial for minimum of 24 hours even if the patient

can tolerate oral medication earlier before 24 hours, and thereafter,

complete treatment by giving a complete course of Artemether-Lumefantrine

• Available formulations are: 30mg, 60mg and 120mg of Artesunate for

injection.

The recommended formulation for public sector is 60mg

Injectable Quinine

• Injectable Quinine is the alternative treatment for severe Malaria.

Formulated as Injection 600mg in 2mls

• Indications

o Acceptable alternative choice for treatment of severe Malaria

o Medicine of choice for treatment of severe Malaria in first trimester

of pregnancy

• Contraindications

o Hypersensitivity to quinine

o Optic neuritis

o Myasthenia gravis

• Adverse effects

o Cinconism (Tinnitus, Vertigo and Dizziness)

o Hypotension

o Hypoglycaemia

o Injection site abscess

• Administration

o Quinine dihydrochloride injection 10mg/kg is given by intravenous

infusion Where

▪ Diluted in 10 ml/kg. body weight of 5% dextrose or dextrose –

saline

▪ Infused over 4 hours and repeated every 8 hours.

▪ Nine doses then continue with ALU

STEP 6: Prevention and Control of Malaria (20 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the methods for preventing and controlling Malaria? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Reducing the host reservoir

o This is done by prompt diagnosis and appropriate treatment of infected

individuals

o Controlling the vector population by:

▪ Killing adult mosquito with insecticides

▪ Killing larvae with larvicides

• Prevention of breeding by environmental sanitation

• Using pre intermittent preventive treatment in pregnancy

• Use of insecticides treated nets (ITN)

• Use of chemoprophylaxis for example Mefloquine, Proguanil Hydrochloride

and Doxycycline

STEP 6: Key Points (5 minutes)

• Malaria is an acute infection of the blood with plasmodia,

characterized by fever, joint pains headache and resulting in anaemia

because of haemolysis

• Route of transmission is mostly by the bite of infective female

Anopheles mosquito

• ALu-ACT based combinations are recommended for first line treatment of

Malaria.

• Prevention and control of sources of Malaria is important in reducing

Malaria

STEP 7: Evaluation (5 minutes)

• What are the species that cause Malaria?

• What is the mode of transmission of Malaria?

• What are major signs and symptoms of Malaria?

• What is treatment of Malaria?

• What are methods prevention and control of Malaria?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|prevention and control methods of Malaria you use in your house hold |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.).

London: Saunders Ltd

Denyer, S. P., Hodges, N. A., & Gorman, S. P (2011) (Ed).Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J.& Manschot, P. (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) National Guidelines for Diagnosis and Treatment of Malaria. Dar

es salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed).

Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Handout 15.1 Life Cycle of Malaria Parasite

[pic]

[pic]Handout 15.2 Dosage Schedule for Artemether-Lumefantrine

| |

|Kg | |Day 1 |Day 2 |Day 3 |

| |

Source: National Guidelines for Malaria Diagnosis and Treatment, 2013

Session 16: Identification of Patients with Common Cold

Total Session Time: 60 minutes + 1 hour Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause of Common Cold,

• Describe Mode of Transmission of Common Cold

• Describe Major Signs and Symptoms of Common Cold

• Explain Treatment of Common Cold

• Explain Prevention and Control of Common Cold

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Common Cold (10 minutes)

An introduction to URTI

• Respiratory tract infection: A term used to describe infection of all

the parts of the body that are involved in helping a person to breathe

• Upper Respiratory Tract include the nose, sinuses, pharynx and trachea

• Respiratory tract infection can be divided into:

o Upper respiratory tract infection

o Lower respiratory tract infection

• Common upper respiratory tract infections (URTIs) include:

o Common cold

o Sore throat – usually due to an infection of the pharynx

(pharyngitis)

o Tonsillitis – infection of the tonsils

o Sinusitis – infection of the sinuses

o Laryngitis – infection of the larynx

This session will deal with Common cold

Common cold (Coryza)

Cause: Is caused by a number of viruses which are spread by droplets and by

indirect transmission such as through freshly infected articles

(handkerchiefs)

STEP 3: Mode of Transmission of Common Cold (5 minutes)

• Droplet infection through talks, coughs, laughs, or sneeze discharges

• Causative microorganisms is carried in droplets from infected person to

another via respiratory tract

• Airborne disease spread more easily when there is overcrowding

STEP 4: Major Signs and Symptoms of Common Cold (5 minutes)

• Running nose and sneezing

• Fever

• Malaise

• Headache

• Running eye

• Nasal congestion

• Sore throat

• Cough

STEP 5: Treatment of Common Cold (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What is the treatment of common cold? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• No effective treatment is available.Headache may be relieved by

analgesics

• Nasal congestion may temporarily be relieved by Ephedrine nose drop

STEP 6: Prevention and Control of Common Cold (10 minutes)

• Prevent droplet infection from being inhaled by others

• Improve ventilation for example building houses with adequate window to

allow natural air flow

• Avoid overcrowding e.g. building houses with enough space

• Isolation may be required for some conditions

• Health education about personal hygiene, such as:

o To cover the mouth when coughing and sneezing

o Use handkerchief or paper for disposal of nasal secretion and sputum

o Avoid to spit on the ground or outside the house

o Avoid sharing cigarettes, drinking bowels, or eating utensils

• Wearing of masks in the hospitals

• Immunization

STEP 6: Key Points (5 minutes)

• Among the common Upper Respiratory Tract infections includes Common cold

• Common cold is caused by viruses

• Treatment is symptomatic in most cases

• Prevention and control include improved ventilation, avoiding

overcrowding, personal hygiene and immunization

STEP 7: Evaluation (5 minutes)

• What is the cause of common cold?

• What is the mode of transmission for common cold?

• What are major signs and symptoms of common cold?

• What is the treatment for common cold?

• What are the prevention and control measures of common cold?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a presentation on how to prevent common cold in their location |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.).

London: Saunders Ltd

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011)

(Eds.).Hugo & Russell’s Pharmaceutical Microbiology (8thed). Oxford: Willey-

Blackwell Publishing

Eshuis J., & Manschot, P (1992). Communicable Diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4 ed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF

Session 17: Identification of Patients with Tonsillitis

Total Session Time: 60 minutes + 1 hour Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Tonsillitis

• Describe Mode of tansmission of Tonsillitis

• Describe Major Signs and Symptoms of Tonsillitis

• Explain Treatment of Tonsillitis

• Explain Prevention and Control of Tonsillitis

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Tonsillitis (5 minutes)

Tonsillitis

At the back of throat, two masses of tissue called tonsils act as

filters, trapping germs that could otherwise enter the airways and

cause infection. They also produce antibodies to fight infection. But

sometimes the tonsils themselves become infected, they swell and

become inflamed, a condition known as tonsillitis

Causes

• Streptococcal bacteria

• Viruses can also cause acute tonsillitis

STEP 3: Mode of Transmission of Tonsillitis (5 minutes)

• Droplet infection through talks, coughs, laughs, or sneezes discharges

• Causative microorganism is carried in droplets from infected person to

another via respiratory tract

• Airborne disease spread more easily when there is overcrowding

STEP 4: Major Signs and Symptoms of Tonsillitis (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the major signs and symptoms of Tonsillitis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Major signs and symptoms of Tonsillitis

• Sudden onset with general malaise

• Fever

• Headache

• Sore throat and difficult in swallowing

• Signs of inflammation e.g. redness of tonsils and white spots

STEP 5: Treatment of Tonsillitis (5 minutes)

• Symptomatic treatment

• Bed rest is advised

• Light diet with plenty of hot drinks

• Analgesics such as paracetamol to reduce pain and fever

STEP 6: Prevention and Control of Tonsillitis (15 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the methods for preventing and controlling Tonsillitis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Prevent droplet infection from being inhaled by others

• Improve ventilation such as building houses with adequate window to

allow natural air flow

• Avoid overcrowding for example building houses with enough space

• Isolation may be required for some conditions

• Health education about personal hygiene e.g.

o To cover the mouth when coughing and sneezing

o Use handkerchief or paper for disposal of nasal secretion and sputum

o Avoid to spit on the ground or outside the house

o Avoid sharing cigarettes, drinking bowels, or eating utensils

• Wearing of masks in the hospitals

• Immunization

STEP 6: Key Points (5 minutes)

• Tonsillitis is caused by bacteria and also viruses transmitted by

droplets

• Treatment is symptomatic in most cases

• Prevention and control include improved ventilation, avoiding

overcrowding, personal hygiene and immunization

STEP 7: Evaluation (5 minutes)

• What are causes of Tonsillitis?

• What is the mode of transmission for Tonsillitis?

• What are major signs and symptoms of Tonsillitis?

• What is the treatment for common Tonsillitis?

• What are the prevention and control measures of Tonsillitis?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a presentation on how to prevent Tonsillitis in their location |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G&. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwel publishing

Eshuis, J.& Manschot,P (1992). Communicable diseases,1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Session 18: Identification of Patients with Bronchitis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause(s) of Bronchitis

• Describe Mode of Transmission of Bronchitis

• Describe Major Signs and Symptoms of Bronchitis

• Explain Treatment of Bronchitis

• Explain Prevention and Control of Bronchitis

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

|6 | 30 |Presentation |Prevention and Control of Bronchitis|

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Bronchitis (5 minutes)

Lower respiratory tract infections include infectious processes of the

lungs and bronchi,

for example, Pneumonia and Bronchitis

This session will deal with Bronchitis

Bronchitis

• Bronchitis refers to an inflammatory condition of the large elements of

the trachea-bronchial tree that is usually associated with a generalized

respiratory infection

• The disease entity is frequently classified as either acute or chronic

• Common condition often caused by viral infections of upper respiratory

with secondary bacterial infection

• Common in children with infectious fever e.g. measles, influenza and

whooping cough

• It is also common in smokers, the elderly and people with chronic chest

disorders

Causes

• Bacteria: Mycoplasma pneumonia, streptococcal bacteria, haemophillus

influenza

• Viruses: The common cold viruses, rhinovirus, coronavirus, influenza

virus, adenovirus, and respiratory syncytial virus, account for the

majority of cases

STEP 3: Mode of transmission of Bronchitis (5 minutes)

• Usually airborne transmitted from upper respiratory tract infection

STEP 4: Signs and Symptoms of Bronchitis (20 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of Bronchitis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Cough

o Cough is the hallmark of acute bronchitis

o Frequently, the cough is initially non-productive but progresses,

yielding mucopurulent sputum

• Fever with malaise, headache and loss of appetite

• Dyspnea

• Crepitation in the lungs

• Wheezing

• The patient typically has nonspecific complaints such as malaise and

headache, coryza, and sore throat

STEP 5: Treatment of Bronchitis (30 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASKstudents to brainstorm on the following question: |

| |

|What is the treatment of bronchitis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Bed rest and mild analgesic-antipyretic therapy are often helpful in

relieving the associated lethargy, malaise, and fever

• Bronchitis is primarily a self-limiting illness and rarely a cause of

death

• Patients should be encouraged to drink fluids to prevent dehydration and

possibly decrease the viscosity of respiratory secretions

• Non-steroidal anti-inflammatory drugs such as aspirin or acetaminophen or

ibuprofen is administered every 4 to 6 hours

o In children, aspirin should be avoided and acetaminophen used as the

preferred agent because of the possible association between aspirin

use and the development of Reye’s syndrome

• Persistent, mild cough, may be treated with dextromethorphan;

o more severe coughs may require intermittent codeine or other similar

agents

• When possible, antibiotic therapy is directed toward anticipated

respiratory pathogen(s) for example penicillin

STEP 6: Prevention and Control of Bronchitis (30 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the methods for prevention and control of Bronchitis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• A complete occupational/environmental history for the determination of

exposure to noxious, irritating gases, as well as cigarette smoking,

must be assessed.

• Exposure to bronchial irritants should be reduced.

• Attempts should be made with the patient to reduce or eliminate

cigarette smoking

• Control measures of lower respiratory tract infections are based on

general principles governing control of airborne diseases

STEP 7: Key Points (5 minutes)

• Bronchitis means the bronchial tubes are inflamed and irritated.

• Bronchitis is characterized by cough, fever and difficulty in breathing

• When antibiotic is needed, penicillins is highly recommended

• Control depends on the control of primary diseases

• Mortality can be reduced by early diagnosis and treatment

STEP 8: Evaluation (5 minutes)

• What causes bronchitis?

• What is the mode of transmission for common bronchitis?

• What are the major signs and symptoms of bronchitis?

• What is the treatment of common bronchitis?

• What are the prevention and control measures of bronchitis?

STEP 9: Assignment (10 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Bronchitis |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J,& Manschot,P (1992). Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T.,& Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Session 19: Identification of Patients with Pneumonia

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe cause of pneumonia,

• Describe Mode of Transmission of Pneumonia

• Describe Major Signs and Symptoms of Pneumonia

• Explain Treatment of Pneumonia

• Explain Prevention and Control of Pneumonia

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

|6 | 55 |Presentation |Prevention and Control of Pneumonia |

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Pneumonia (5 minutes)

Lower respiratory tract infections include infectious processes of the

lungs and bronchi,

for example pneumonia and bronchitis

Pneumonia

• Inflammatory condition of the lung caused by infection

Causes

• Virus

• Bacteria: Pneumococci, Streptococci, Staphylococci, Klebsiellae species

and Haemophillus influenzae

STEP 3: Mode of Transmission of Pneumonia (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the modes of transmission of Pneumonia? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Airborne from upper respiratory tract infection, especially influenza in

the elderly, HIV/AIDS, immunocompromised and measles and whooping cough

in children. These infections cause damage to the epithelium of the lungs

and so clear the way for bacterial superinfection

• Transmission is by droplet spread, direct oral contact or indirectly

through freshly infected articles

STEP 4: Signs and Symptoms of Pneumonia (10minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of Pneumonia? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Signs and Symptoms

• Dry or productive Cough

• High Fever with malaise, headache and loss of appetite

• Chest pain

• Dyspnoea (difficult breathing)

• Respiratory distress

• Crepitation in the lungs

• Wheezing

STEP 5: Treatment of Pneumonia (20 minutes)

• Supportive care: Lower temperature by using analgesics, if wheezing

use bronchodilators, daily fluid maintenance(encourage breastfeeding

for children)

• Medicines

o Non-severe pneumonia: Cotrimoxazole, Amoxycillin

o Severe pneumonia: Benzyl-penicillin, Chloramphenicol, Gentamycin,

Ceftriaxone, Erythromycin and Azithromycin

STEP 6: Prevention and Control of Pneumonia (55 minutes)

|Activity: Group Discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of Pneumonia? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Control measures of lower respiratory tract infections are based on

general principles governing control of airborne diseases

• Immunisation to prevent diseases complicated by pneumonia such as

measles and whooping cough is important

• Mortality can be reduced by early diagnosis and treatment especially

in children and elderly

• Prompt adequate therapy started.

STEP 7: Key Points (5 minutes)

• Pneumonia is characterized by cough, fever and difficulty in breathing

• It occurs as a complication of upper respiratory infections

• Treatment will depend if it is a non-severe or severe condition

• Control depends on the control of primary diseases and on general

principles governing control of airborne diseases

• Mortality can be reduced by early diagnosis and treatment

STEP 8: Evaluation (5 minutes)

• What causes Pneumonia?

• What is the mode of transmission for pneumonia?

• What are the major signs and symptoms of pneumonia?

• What is the treatment of pneumonia?

• What are the prevention and control measures of pneumonia?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Pneumonia in |

|children and adults |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. &Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, &Manschot,P (1992). Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed).

Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Session 20: Identification of Patients with Amoebiasis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causeof Amoebiasis,

• Describe Mode of Transmission of Amoebiasis

• Describe Major Signs and Symptoms of Amoebiasis

• Explain Treatment of Amoebiasis

• Explain Prevention and Control of Amoebiasis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

|5 | 05 |Presentation |Treatment of Amoebiasis |

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Amoebiasis (5 minutes)

• Amoebiasis:

o An infection caused by the amoeba Entamoeba histolytica which is a

single-celled organism

o E. histolytica is often found in food or water contaminated with human

faeces.

• The main reservoir of E. histolytica is man

• A pathogenic intestinal amoeba is spread between humans by its cysts,

characterized by diarrhoea

• This infection can be fatal in infant and to older people with low

resistance

STEP 3: Mode of Transmission of Amoebiasis (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASKstudents to brainstorm on the following question: |

| |

|What is the mode of transmission of Amoebiasis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• The only infective form of E. histolytica is the cyst

• It is acquired by ingestion of cysts which is resistant to gastric acid

• Cysts are passed from person-to-person by the faecal oral route, by

fingers soiled with faeces either directly into the mouth or via food

• There have been cases of transmission through sexual contact

• The incubation period ranges from two weeks to many years

[pic]STEP 4: Signs and Symptoms of Amoebiasis (20 minutes)

• Infection with amoebae in most cases is asymptomatic

• The presenting features may be gradual, severe or fulminating, and

include:

o Gradual onset colitis

o Severe acute amoebic dysentery

Gradual Onset Colitis

• Present with:

o Mild intermittent diarrhoea

o Abdominal discomfort, usually progressing to bloody diarrhoea with

mucous.

o nausea,

o headache

o low grade fever

o Anorexia

Severe Acute Amoebic Dysentery

• Amoebic dysentery is a severe form of Amoebiasis

• The symptoms of amoebic dysentery include:

o Severe diarrhoea that contains blood or mucus

o Severe stomach pain

o loss of appetite

o Loss of weight

o Fever

o Chills

• Occasionally, the infection can spread through the bloodstream to other

parts of the body causing an amoebic abscess

STEP 5: Treatment of Amoebiasis (10minutes)

• Asymptomatic patients normally do not need treatment because in time

they clear the infection

• Drug of choice: Metronidazole

• Alternative drugs of choice: Tinidazole, Secnidazole

STEP 6: Prevention and Control of Amoebiasis (50 minutes)

|Activity: Group Discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of Amoebiasis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Prvention and control measures

• Early diagnosis and treatment

• Food handlers may need to be screened periodically during employment

• Drinking water should be boiled to kill the cysts

• Proper faecal and refuse disposal

• Washing hands after visiting the toilet, before eating and before

preparing food

• Foods should be well cooked and covered

• Health education on how the disease is transmitted

• Improvement of living standards

• Amoebiasis can be prevented by good hygiene and sanitary conditions

• Improve water supply and proper disposal of faeces

• Do not eat fresh fruit or vegetables which cannot be peeled before eating

• Make sure raw vegetables are washed thoroughly and cooked properly

STEP 7: Key Points (5 minutes)

• Amoebiasis is an infection caused by potentially pathogenic amoeba E.

histolytica

• Infection occurs through the faecal-oral transmission route

• In severe cases, the onset is more sudden, the patient is ill and toxic

with fever and signs of dehydration

• Treatment should cover both tissue parasites and parasites in the bowel

lumen

• Drug of choice for treatment of Amoebiasis is Metronidazole

STEP 8: Evaluation (5 minutes)

• What is the infective form of entamoeba histolytica?

• What are the clinical features of amoebiasis?

• What are the drugs used in treatment of amoebiasis?

• How can Amoebiasis be prevented and controlled?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Write a presentation on how to handle the following so as to prevent |

|and control Amoebiasis: |

|Drinking Water |

|Food handlers |

|Sewage disposal |

|Write a presentation on transmission cycle of Amoebiasis |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed.Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis ,J, & Manschot, P. (1992). Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed).

Dar es Salaam: MOHSW

Nordberg, E. R. (1999): Communicable Diseases, A Manual for Health Workers

in Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF.

Session 21: Identification of Patients with Typhoid Fever

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause of Typhoid Fever

• Describe Mode of Transmission of Typhoid Fever

• Describe Major Signs and Symptoms of Common Typhoid Fever

• Explain Treatment of Common Typhoid Fever

• Explain Prevention and Control of Typhoid Fever

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Typhoid Fever (5 minutes)

• Typhoid fever is a systemic infectious disease, caused by bacteria

Salmonella typhi and Salmonella paratyphi

STEP 3: Mode of Transmission of Typhoid Fever (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is the mode of transmission of typhoid fever? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Mode of transmission

• The organisms that are responsible for infection are transmitted through

foods or water contaminated with faeces or urine of a patient or carrier

• It is more common in areas where there is insufficient water for washing

hands

• Typhoid is an exclusively human disease

• It is transmitted through the ingestion of food or drink contaminated by

the faeces or urine of infected people

• A person may become an asymptomatic carrier of typhoid fever, suffering

no symptoms, but capable of infecting others

STEP 4: Signs and Symptoms of Typhoid Fever (15 minutes)

• Typhoid fever is characterized by:

o Fever as high as 40 °C (104 °F)

o Profuse sweating

o Drowsiness

o Muscle pain

o Severe headache

o Non-bloody diarrhea although it can sometimes have bloody diarrhea too

o The incubation period of typhoid fever varies with the size of the

infecting dose, and averages from 10 to 20 days

o The onset is gradual

STEP 5: Treatment of Typhoid Fever (15 minutes)

Drug of choice

• Ciprofloxacin

o Contraindication : Pregnancy and Children below 15 years

Alternatively

• Chloramphenicol

o Contraindication: Third trimester of pregnancy

STEP 6: Prevention and Control of Typhoid Fever (35 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the measures for prevention and control of Typhoid? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Measures of prevention and control

• Early diagnosis and treatment of cases is important

• General prevention is as for faecal-oral diseases:

o Cook food thoroughly

o Boil drinking water

o Wash hands before preparing food, after preparing food and before

eating

• It is important to identify carriers who work as food handlers as they

are especially likely to transmit the infection (although searching for

carriers is impracticable in endemic areas)

• Immunization

STEP 7: Key Points (5 minutes)

• Typhoid fever is a systemic bacterial infection caused by Salmonella

typhi, in areas where sanitation is poor

• Drug of choice for treatment of typhoid fever is ciprofloxacin

• Delayed treatment may lead the severe complications such as bleeding from

bowel, bowel perforation and peritonitis

• Safe water, supply and food hygiene will prevent the population from

infection

STEP 8: Evaluation (10 minutes)

• What is the cause of typhoid fever?

• What is the mode of transmission of typhoid fever?

• What are signs and symptoms of typhoid fever?

• What is the treatment of typhoid fever?

• How is typhoid fever prevented?

STEP 9: Assignment (5 minutes)

| Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a presentation explaining how to differentiate a patient |

|suffering Typhoid fever from the one having Amoebiasis |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J, Manschot, P (1992). Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed).

Dar es Salaam: MOHSW

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF

Session 22: Identification of Patients with Food Poisoning

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause of Food Poisoning

• Describe Mode of Transmission of Food Poisoning

• Describe Major Signs and Symptoms of Food Poisoning

• Explain Treatment of Food Poisoning

• Explain Prevention and Control of Food Poisoning

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Food Poisoning (15 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes food poisoning? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition

Food poisoning is an acute intestinal disease acquired by consumption of

contaminated food or water

Causes

Food poisoning can be divided into two categories:

• Chemical (heavy metals, fluoride and others)

• Infectious: Toxins produced by microorganism present in natural food or

bacteria contaminating food or water

o Infectious agents include viruses, bacteria, and parasites

o Toxic agents include poisonous mushrooms, improperly prepared exotic

foods

Bacteria

• Bacteria can cause food poisoning in two different ways

o Some bacteria infect the intestines, causing inflammation and

difficulty absorbing nutrients and water, leading to diarrhoea

o Other bacteria produce chemicals in foods (known as toxins) that are

poisonous to the human digestive system

▪ When eaten, these bacterial toxins can lead to nausea, vomiting,

kidney failure, and even death

• The common bacteria causing food poisoning are:

▪ Salmonellae,

▪ Campylobacter,

▪ Staphylococcus aureus

▪ Escherichia coli

▪ Clostridium botulinum

▪ Vibrio cholerae

Pesticides

• In food and naturally toxic substances like poisonous mushrooms or reef

fish

Viruses

• These viruses include:

o Noroviruses

o Rotavirus

o Enteroviruses

o Hepatitis A

Parasites

• They are usually in contaminated or untreated water and cause long-

lasting but mild symptoms

o Examples of parasites which can cause illness are Giardia and

Cryptosporidium

Note: Toxic agents are the least common cause of food poisoning

STEP 3: Mode of Transmission of Food Poisoning (15 minutes)

|Activity: Brainstorming (15 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|How is food poisoning transmitted? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Illness is often isolated episode caused by poor food preparation or

selection

o Eating wild toxic mushrooms,

o Eating fish and other seafood that contains toxins

o Eating food which has been contaminated with pesticides

• Food poisoning illness usually arises from improper handling,

preparation, or food storage

• The illness is transmitted by undercooked foods such as eggs, potato,

salads poultry, raw milk, dairy products, fish and other sea foods

STEP 4: Signs and Symptoms of Food Poisoning (15 minutes)

• Symptoms of food poisoning depend on the type of contaminant and the

amount eaten

• The symptoms can develop rapidly, within 30 minutes, or slowly,

worsening over days to weeks

• Most of the common signs and symptoms are:

o Nausea,

o Vomiting

o Diarrhoea

o Abdominal cramping

• The incubation period is short depending on the cause of food

poisoning:

o Staphylococcal food poisoning takes 1 – 6 hours

o Salmonella food poisoning takes 12 – 14 hours

o Anthrax gastrointestinal poisoning take 2 – 5 days

• There is acute onset of vomiting and diarrhoea after ingestion of

contaminated food

• Gastrointestinal anthrax presents with vomiting, abdominal pain,

haematemesis, bloody diarrhoea and toxaemia

• Staphylococcus aureus: Causes moderate to severe illness with rapid onset

of nausea, severe vomiting, dizziness, and abdominal cramping

• Clostridium botulinum (botulism): Causes severe illness affecting the

nervous system

o Symptoms start as blurred vision

o The person then develops problems of talking and overall weakness

o Symptoms then progress to difficulty breathing and inability to move

arms or legs

o Botulism has the 4 D’s: diplopia (double vision), dysphagia

(difficulty swallowing), dysarthria/dysphonia (difficulty speaking)

and diarrhoea

• Neurological symptoms suggest insecticides e.g. organophosphorous or

mushroom poisoning and seafood poisoning

STEP 5: Treatment of Food Poisoning (15 minutes)

• Symptomatic treatment to correct dehydration by ORS or intravenous fluid.

o Helps to correct electrolyte imbalance that might arise from diarrhoea

and vomiting

o The patient may need to be admitted to the hospital

▪ This depends on the severity of the dehydration, response to

therapy, and ability to drink fluids without vomiting

• Antibiotics are usually not indicated except for anthrax food poisoning

where large dose of benzyl penicillin together with streptomycin may be

needed

• Atropine is useful in case of organophosphate poisoning

• Antidote in case of eating food contaminated with pesticides

• Aggressive treatment may include pumping the stomach (lavage)

STEP 6: Prevention and Control of Food Poisoning (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of food poisoning? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Serve meals immediately after preparation to avoid growth of

staphylococci

• Thorough cooking of food will prevent most cases of food borne

poisoning

• Exclude people with pyogenic skin infection from food handling

• Preserve and protect food from being contaminated

• Health education to food handlers about necessity of proper food

preservation, washing hands and maintaining a clean kitchen

• Educating communities to avoid eating animals that have died after

illness

• If food poisoning is suspected, trace all the persons who ate the

infected meal and treat them if possible

• Safe steps in food handling, cooking, and storage are essential to avoid

food-borne illness

• Use cooked leftovers within four days if stored in the refrigerator and

make sure to heat them thoroughly before eating

STEP 6: Key Points (5 minutes)

• Food poisoning is common and is due to contaminated food product

• Causes are intoxication or infection by bacteria

• Treatment of food poisoning is mainly symptomatic and antibiotics are

rarely needed

• Food should be served as soon as it is prepared and the remaining should

be kept properly

• Food preservation should follow aseptic procedures

• Hand washing is important to reduce the risk of contaminating food

STEP 7: Evaluation (5 minutes)

• What is food poisoning?

• How is food poisoning transmitted?

• What are the clinical features of food poisoning?

• What is the treatment of food poisoning?

• What are the prevention and control measures of food poisoning?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on common causes of food poisoning in their |

|area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Burton, B. T. & Foster W. R. (1988) Human Nutrition; A textbook of

nutrition in health and disease (4thed). New York: McGraw-Hill Book Company

Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed). Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar

es Salaam: MOHSW/NACP

GoT (2013) National Guidelines for Diagnosis and Treatment of Malaria. Dar

es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF.

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Tanzania Food and Drugs Authority (2009), Guidelines for safe disposal of

unfit medicines and cosmetic products. Dar es Salaam: MOH

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO

Session 23: Identification of Patients with Cholera

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause of Cholera

• Describe Mode of Transmission of Cholera

• Describe major Signs and Symptoms of Cholera

• Explain Treatment of Common Cholera

• Explain Prevention and Control of Cholera

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Cholera (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes cholera? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition

• Cholera is acute diarrheal infection of the intestine caused by vibrio

cholerae

• The infection is often mild or without symptoms, but sometimes can be

severe and fatal

STEP 3: Mode of Transmission of Cholera (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|How is cholera transmitted? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Transmission is through faecal –oral route but almost all cholera

infections are water- borne (see figure 1).

o Vibrio cholera can live in water for 2 weeks and prefer salty water

o Vibrio may survive for longer period and multiply in shellfish

The reservoir of infection is formed mainly by carriers excrete vibrio in

small numbers posing danger to the community

[pic]

STEP 4: Signs and Symptoms of Cholera (10 minutes)

|Activity: Brainstorming (15 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the signs and symptoms of cholera? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• The incubation period is 2-3 days

• The clinical presentation of cholera is caused by water and

electrolyte loss and develop in 3 stages described below:

First stage (last for 3-12 hours)

• Characterized by passage of profuse watery stool

• The stool comprises of clear fluid with flakes of mucous (rice water

appearance)

• vomiting

• Severe cramps in the abdomen and limbs develop from loss of

electrolytes

Second stage:

• There is collapse from dehydration

• The body becomes cold, the skin dry and inelastic

• The blood pressure is low and the pulse is rapid and feeble

• Urine production stops and the patient may die of shock

Third stage:

• Stage of recovery, either spontaneously or with treatment

• Diarrhoea decreases

• Patient is able to take fluids and general condition improves

STEP 5: Treatment of Cholera (10 minutes)

• Patients should be hospitalised

Rehydration

• Cholera is cured by appropriate and timely rehydration

o Patients of all ages who are strong enough to drink will take a lot of

glucose/electrolyte solution needed for rehydration and maintenance

• It is essential to use oral rehydration solution (ORS) or appropriate

intravenous (IV) fluids to replace the necessary electrolytes.

• Patients in shock or who are too weak to drink require intravenous

fluids until they can take in oral fluids.

Antimicrobials

• Antimicrobial agents have been shown to shorten the period of

diarrhoea and the amount of fluid loss

o Tetracycline or doxycycline are the drugs of choice

o Erythromycin is an effective alternative both in children and adults

o Cotrimoxazole is also another alternative

• Strict isolation is not necessary as only vomitus and stool are

infectious

• Patients are treated on ‘Cholera bed’ (beds with central hole) through

which the continuous stool can pass into a bucket and fluid loss be

measured

[pic]

STEP 6: Prevention and Control of Cholera (30minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of cholera? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Prvention and control measures

• Improve quality of public water supply by chlorination in large scale

• Encourage individuals to boil drinking water

• Milk products should be pasteurized

• Avoid eating half cooked food

• Leftovers should be protected against contamination by flies

• Markets and food premises should be free from contamination

• Improvement of sanitation facilities e.g. proper excreta and refuse

disposal

• Give health education to public on how cholera is spread, clinical

features, preventive measures, ways of making water safer (e.g. by

boiling), proper food handling, sanitation and hand washing

• The vomitus and stool should be properly deposited in pit latrine or a

septic tank system

• Hospital equipment should be cleaned with disinfectant such as 5%

lysol

STEP 6: Key Points (5 minutes)

• Cholera is acute intestinal disease caused by vibrio cholerae

• Patients present with profuse watery diarrhoea, vomiting and rapid

dehydration

• The disease is spread by faecal-oral route

• Rehydration can prevent death

• Cholera can be prevented by improving sanitation, water supply, refuse

dispersal and personal hygiene

STEP 7: Evaluation (5 minutes)

• What causes cholera?

• How does cholera spread?

• What are signs and symptoms of cholera?

• What is the treatment of cholera?

• What are the preventive and control measures of cholera?

STEP 8: Assignment (5 hours)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on control measures in the outbreak of cholera |

|in their area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J,& Manschot, P (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and

Sanitation, Nairobi: AMREF

Session 24: Identification of Patients with Ascariasis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Ascariasis

• Describe Mode of Transmission of Ascariasis

• Describe Major Signs and Symptoms of Ascariasis

• Explain Treatment of Ascariasis

• Explain Prevention and Control of Ascariasis

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASKstudents to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Ascariasis (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes Ascariasis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Ascariasis: is one of the commonest infections of the small intestine

• Caused by a nematode called Ascaris lumbricoides ( round worm)

STEP 3: Mode of Transmission of Ascariasis (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of Ascariasis? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Common ways of acquiring Ascariasis include failure to adhere to

hygienic practices such as washing hands before food preparation and

proper storage of food

• Therefore the disease is related to poor sanitation and hygiene

• Infection is acquired from ingestion of food contaminated with mature

eggs

• The usual vehicles are fruits and other raw food

• Children are more frequently infected and have higher worm burden than

adults because they like putting contaminated objects into their

mouths

• Heavy infection in children can contribute to under-nutrition

• Adults have much lighter infections, although re-infection can occur

throughout life

[pic][pic]Refer students to Handout 24:1 Life cycle of ascaris

lumbricoides for further reading

STEP 4: Signs and Symptoms of Ascariasis (10 minutes)

• Fever

• Cough

• Abdominal discomfort, restlessness and insomnia (sleeplessness)

• Eosinophilia due to allergic reaction

• Intestinal obstruction

• Passing adult worm in the stool or vomitus

• Obstructive jaundice

STEP 5: Treatment of Ascariasis (10 minutes)

• Treatment is effective only against the adult worms

• The drugs of choice are as follows:

o Albendazole: for children 2-5 years a single dose of 200mg and for

older children and adults, one dose of 400mg is given

o Mebendazole: a single dose 500mg

o Levamisole: a single of 2.5mg/kg body weight

o Piperazine (antepar): syrup at a dose of 150mg/kg body weight (to a

maximum of 4g) as a single dose

▪ Note that these drugs are given between meals

▪ They should be avoided during the first tree monthsr of pregnancy

STEP 6: Prevention and Control of Ascariasis (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|How is Ascariasis transmitted? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Environmental measures such as provision of adequate and safe water

supplies.

• Proper disposal of faeces

• prevention of faecal contamination of food and water

• Discourage use of fresh human faeces as manure

• Health education on:

o Proper use of latrines

o Personal hygiene e.g. washing hands after using toilet or before

handling food

o Washing fruits and vegetables before eating

o Use of dry racks for utensils so that they are above the soil and dust

STEP 7: Key Points (5 minutes)

• Ascariasis is a common nematode infection.

• The prevalence of Ascariasis is related to poor sanitation and hygiene

• Control is mainly by improving faeces disposal

• A heavy infection in a child can contribute to malnutrition

STEP 8: Evaluation (5 minutes)

• What is Ascariasis?

• How does a person acquire Ascariasis infection?

• What are the signs and symptoms of Ascariasis?

• What is the treatment of Ascariasis?

• What are preventive and control measures of Ascariasis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following assignment |

|Prepare a presentation on common causes of food poisoning in their |

|area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell Publishing

Eshuis J, Manschot, P (1992). Communicable diseases, (1sted). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

|[pic] |Handout 24.1: Life cycle of Ascaris lumbricoides |

[pic]

Session 25: Identification of Patients with Scabies

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause(s) of Scabies

• Describe Mode of Transmission of Scabies

• Describe Major Signs and Symptoms of Scabies

• Explain Treatment of Scabies

• Explain Prevention and Control of Scabies

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Titles and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Scabies(10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes scabies? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Scabies: A parasitic infection of the skin characterised by an intense

itching with typical distribution caused by the mite Sarcoptes scabies

• Prevalence is high in areas with shortage of water

• Common in people who do not take bath regularly

• Low socio-economic conditions favour the spread of the disease

STEP 3: Mode of Transmission of Scabies (10 minutes)

• Transmission is by direct close body contact from infected person and

indirectly through bed clothes and sharing clothing

• The female mite enters the skin and makes a small tunnel or burrow

• The burrow is always superficial

• The skin selected for burrow is always thin and wrinkled giving

scabies rash a typical distribution

• In the burrows, eggs and faeces are produced

• The eggs hatch in 4-5 days

• The larvae leave the parent tunnel and bury in the skin in other

places, but do not make tunnels

STEP 4: Signs and Symptoms of Scabies (30 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the signs and symptoms of scabies? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Intensive itching, especially at night

• Eczema-like signs

o The itching leading to scratching

o Secondary bacterial infection

• In case of immune suppression such as HIV and AIDS, infestation can be

extensive

• Typical distribution of severe itch and rash are:

o Anterior axillary fold

o Nipples, lower abdomen in women

o Belt line (umbilicus)

o Front side of wrist and elbows

o External genitalia

o Thighs and buttocks

o Sides of fingers and toes

o Sides and webs of fingers

o Scalp and feet (infants under 1 year)

• Patients with leprosy or other diseases which interfere with normal

sensation may not feel the itching caused by scabies. In these cases,

scabies can be very extensive and thick crusts can form

[pic]

STEP 5: Treatment of Scabies (30 minutes)

• The drug of choice is 10% Benzyl benzoate emulsion (BBE)

• Administration information

o After the patient has taken a warm bath, the drug is applied over the

whole body except the face

o After 24 hours of first treatment, the patient should bath again and

put on clean clothes

o The drug has no effect on the eggs, therefore repeat BBE after 4 – 7

days to kill larvae which have hatched after the first treatment

• Other drugs which can be used in the absence of BBE include:

o Tetmosol solution or soap

o Permethrin cream 5% (applied to areas of the body from neck downward

and washed off after 8-14 hours)

o Ivermectin 200µg/kg orally and repeated after 2 weeks or Lindane (1%)

lotion or cream

o Antibiotics are used only when there is a secondary infection

(preferably Penicillin)

STEP 6: Prevention and Control of Scabies (30 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the measures of preventing scabies? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Prevention and control of scabies

• Regular bathing with soap

• Washing clothes regularly

• Give health education to stress the use of soap and personal hygiene

• Treat the whole family

• Decontamination of bedding materials and clothing

• Improve water supply

STEP 7: Key Points (5 minutes)

• Scabies is characterized by severe itching

• It is treated with BBE, Tetmosol, Ivermectin or Lindane.

• Treatment of scabies should include all family members

• Control is by regular bathing using water and soap

STEP 8: Evaluation (5 minutes)

• What is the cause of scabies?

• What is the mode of transmission of scabies?

• What are signs and symptoms of scabies?

• What is the treatment of scabies?

• What are control measures for scabies?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDEstudents into small groups assignment |

| |

|ASK the students to work individually on the following Assignment |

|Prepare a presentation on how to control scabies at home. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G. & Zumla, A. (2003).Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed.Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis,J, & Manschot,P (1992). Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Session 26: Identification of Patients with Dermatophytes

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause(s) of Dermatophytes

• Describe Mode of Transmission of Dermatophytes

• Describe Major Signs and Symptoms of Dermatophytes

• Explain Treatment of Dermatophytes

• Explain Prevention and Control of Dermatophytes

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Dermatophytes (10 minutes)

Definition

• Dermatomycosis is a term applied to fungal infection of the skin and its

appendages i.e. hair and nails

o Different types are identified according to causative organism, site

and clinical appearance

o They are sometimes indicators of immune suppression as occurs in AIDS,

cancer, diabetes and tuberculosis.

Types of dermatomycosis

• Tinea capitis (ringworm of the scalp)

• Tinea corporis (ringworm of the body)

• Tinea pedis (ringworm of the foot or ‘athlete’s foot’)

• Tinea unguium (ringworm of the nails)

• Tinea versicolor or pityriasis

STEP 3: Mode of Transmission of Dermatophytes (30 minutes)

|Activity: Group discussion (20 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of dermatophytes? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• All fungi may be transmitted to humans by direct skin contact from

their habitat in the soil, vegetation, animals or other individuals

• Genital infection (balanitis and vulvo-vaginitis) may spread during

sexual intercourse but most candida infections are not sexually

transmitted

• Local conditions on the skin such as moist and hot environment are

predisposing factors

[pic]

STEP 4: Signs and Symptoms of Dermatophytes (15 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of dermatomycosis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Tinea Capitis (Ringworm of the scalp)

• Begins as a small papule which spreads to involve a larger area

• Hairs in the affected skin become brittle and break off easily

• Occurs mainly in children under 10 years and often disappears after

puberty

Tinea Corporis (Ringworm of the body)

• Characterized by flat ring shaped spreading lesions

• The ring lesions are reddish, vesicular or pastula, and may be dry and

scaly, or moist and crusted

• The central area often clears leaving apparently normal skin

Tinea Pedis (Ringworm of the foot or athlete’s foot)

• Characterized by scaling and cracking of the skin between the toes,

particularly the fourth and fifth toes

Tinea Unguium (Ringworm of the nails)

• Characterized by a thickening, discolouration and brittleness of the

nails

• There is accumulation of caseous materials beneath the nail which

becomes chalky and disintegrates

Tinea Versicolor or Pityriasis

• This is a very superficial infection

• Skin on side of face, neck and chest show many irregular, round and light-

coloured areas

STEP 5: Treatment of Dermatophytes (15 minutes)

Tinea Capitis

• Griseofulvin is the drug of choice, although oral therapy with

itraconazole and terbinafine are effective alternatives.

• Oral fluconazole seems to have similar efficacy to Griseofulvin

• Give Griseofulvin at a dosage of 250 mg twice a day or 500mg once a day

in adults and 20-25mg/kg for children for 6-12 weeks

• Whitefield’s ointment applied twice daily for 3 – 6 weeks has also been

used in areas where the above drugs are not available.

Tinea Corporis

• This responds well with application of topical antifungal such as

Clotrimazole 1% cream, lotion or solution (use twice daily), and

ketoconazole 2% cream (used once daily)

• Severe disease and disease in immune compromised patients should be

treated with systemic agents

Tinea Cruris

• Topical antifungal treatment should be used (just as in Tinea corporis)

• Resistant lesions can be treated with griseofulvin or other systemic

agents

• Patients should be advised to dry the area completely after bath and not

to wear tight clothing

Tinea Pedis

• Topical agents applied for duration of 4 weeks are usually effective

• Chronic or extensive disease may require

o Griseofulvin 250 – 500mg twice daily for 6 – 12 weeks, or

o Terbinafine 250 mg daily or itraconazole 200 mg daily

Tinea Unguium

• Systemic antifungal are indicated

• Terbinafine and itraconazole are more effective than other agent

STEP 6: Prevention and Control of Dermatophytes (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of dermatophytes? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Dermatomycosis Prevention and Control

• Early diagnosis and treatment of infected person

• Improve personal hygiene – regular bathing with water and soap

• Dry skin well (especially feet)

STEP 7: Key Points (5 minutes)

• Dermatomycosis is a fungal infection of the skin

• Four types of dermetomycosis are common i.e. tinea capitis, corporis,

pedis, unguim and vesicolor

• Fungal infections are mostly transmitted through body contact

• Signs and symptoms depends on the area affected

• Treatment depends on the site of infection

• Prevention is through improved personal hygiene

STEP 8: Evaluation (5 minutes)

• What causes of dermatophytes?

• What is the mode of transmission of dermatophytes?

• What are major signs and symptoms of dermatophytes?

• What is the treatment of dermatophytes?

• What are the prevention and control measures of dermatophytes?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Bronchitis |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G. & Zumla, A. (2003).Manson’s Tropical Diseases. (21st ed.).

London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Session 27: Identification of Patients with HIV/AIDS

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of HIV/AIDS

• Describe Mode of Transmission of HIV/AIDS

• Describe Major Signs and Symptoms of HIV/AIDS

• Explain Treatment of HIV/AIDS

• Explain prevention and control of HIV/AIDS

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of HIV/AIDS (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes HIV/AIDS? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Human Immunodeficiency Virus (HIV) infection:

• State of being infected with the Human Immunodeficiency Virus without

showing signs and symptoms

Acquired Immunodeficiency Syndrome (AIDS)

• A state of being HIV infected with presentation of signs and symptoms

STEP 3: Mode of Transmission of HIV/AIDS (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of HIV? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Unprotected sexual intercourse with infected partner

• Vertical transmission:

o During pregnancy

o During delivery

o During breast feeding

• Contact with infected blood products

• Transfused with infected blood

• Injection drug use (IDU) through needle-sharing, needle stick accidents,

unsterilized needles.

Factors influencing transmission of HIV/AIDS

• Risky sexual behaviour e.g. unsafe sex with infected partner and multiple

sexual partners

• Social economic e.g. commercial sex

• Cultural practices e.g. female genital mutilation

• Biological e.g. young age and early sexual indulgence

• Political e.g. war and political instability

• Unsterile procedures e.g. sharing instruments for circumcision

• Peer pressure towards involvement into sexual intercourse

• Substance abuse e.g. cocaine, bhang, heroine and alcohol

[pic][pic]Handout 27.1: Life cycle of HIV for further reading

STEP 4: Signs and Symptoms of HIV/AIDS (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is the signs and symptoms of HIV/AIDS? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Signs and symptoms of HIV infection:

• Fever

• Headache

• Cough

• Lymphadenopathy

• Skin rashes, which resolve spontaneously

• Mental illness (dementia)

The natural history of HIV can be explained in different stages or clinical

presentation

• Acute HIV infection (window period): can present as any acute viral

illness

o HIV antibodies take time to be produced and show up on a blood test

o Window period is the period between time of infection and hen initial

detection of HIV antibodies is possible by laboratory tests

o People who test HIV negative must be tested again after 3 months, when

antibodies should have developed

o DNA/RNA testing can be used to diagnose HIV infection before

antibodies are formed

• Latent HIV infection

o This is a period when the patient has no symptoms at all

o The body is still able to fight against most of the diseases just as

in HIV negative individuals

o Patient may have generalized lymphadenopathy

• Late stages of HIV infection

o The immunity of the patient falls and severe life threatening

infections occur e.g. cryptococcal meningitis, toxoplasmosis and

pneumocystis pneumonia

STEP 5: Treatment of HIV/AIDS: (10 minutes)

• Not all HIV positive patients are eligible for treatment withARVs

• Two classes of patients eligible to begin treatment:

o All patients in WHO stage 3 and 4 clinical criteria, regardless of CD4

cell count.

o All adolescences and adults including pregnant women with a CD4 count

< 350cells/mm3, regardless of clinical symptoms

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

o Zidovudine (AZT)

o Lamivudine (3TC)

o Abacavir (ABC)

o Emtricitabine (FTC)

o Stavudine (d4T)

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

o Nevirapine (NVP)

o Efavirenz (EFV)

• Nucleotide Reverse Transcriptase Inhibitors (Nucleotide Analogues)

o An example of this relatively new class of antiretroviral drugs is

Tenofovir (TDF)

• Protease Inhibitors (PIs)

o Lopinavir (LPV)

o Atazanavir (ATV)

• Antiretroviral therapy involves the use of a combination of 3 drugs

(triple therapy) e.g.

o 2 NRTI + 1 NNRTI, OR

o 2 NRTI + 1 PI, OR

o 3 NRTI’s

STEP 6: Prevention and Control of HIV/AIDS: 40 minutes

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the preventive and control measures of HIV/AIDS? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Development/Empowerment Interventions

• Development/empowerment interventions improve general living conditions

through:

o Poverty-alleviation and income-generation programmes e.g. MKUKUTA

o Improvements to infrastructure

o Workshops and training to address gender inequality or to empower

youth

Health-Services Interventions

• Improve health-services issues:

• Provider-initiated testing and counseling (PITC) or voluntary counseling

and testing (VCT)

• Provision of ART and care of People Living with HIV (PLHIV)

• Strengthening management of STIs

• Strengthening prevention of mother-to-child-transmission services (PMTCT)

and provision of ART

• Strengthening training for health-care providers

• Integrating HIV prevention into care and treatment services

• Safe medical practices such as use of sterile syringes and needles

• Post exposure prophylaxis (PEP) to health workers

Management of STIs

• All patients should be assessed by clinicians for STIs because:

o STIs share similar risk factors with HIV infection

o STIs increase the risk of HIV acquisition or HIV transmission

o STIs can often be treated and cured

• Abstinence

o Encourage delaying sexual activity for young people

• Sexual and reproductive health education to young people in and out of

school

• Faithfulness (have one faithful uninfected partner)

• Using condoms correctly and consistently

o Correcting myths and misconceptions about condoms

• Screening and effective treatment of asymptomatic cases

• Male circumcision

STEP 6: Key Points (5 minutes)

• HIV/AIDS is a viral infection affecting all age groups

• Mode of transmission is mainly through unprotected sexual intercourse

• Infection may be asymptomatic in early stages

• Not all HIV positive patients are eligible for treatment with ARVs

• Antiretroviral therapy involves the use of a combination of 3 drugs

(triple therapy)

• Prevention of HIV/AIDS includes developmental or empowerment

initiatives; health service interventions and management of STIs

STEP 7: Evaluation (5 minutes)

• What causes HIV/AIDS?

• How is HIV/AIDS transmitted?

• What are the major signs and symptoms of HIV/AIDS?

• What is the treatment of HIV/AIDS?

• What are the preventive and control measures of HIV/AIDS?

STEP 8: Assignment (5 hours)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on common causes of food poisoning in their |

|area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.).

London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J. &Manschot, P. (1992).Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar

es Salaam:

MOHSW/NACP

GoT. (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive

Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., &Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

|[pic] |Handout 27.1: Life Cycle of HIV |

Life cycle of HIV is divided into seven (7) main steps as described below

• Attachment of HIV virus through the interaction between viral

glycoprotein and CD4 receptors and co-receptors:

o The spikes on HIV virus attach to special areas on the surface of T-

cells called receptors

• Fusion and release of RNA into the cytoplasm of the cell:

o After attachment the envelope and capsid fuse with cell membrane of

the human cell thus releasing the RNA into the cytoplasm of the human

white blood cell

• Reverse transcription to produce viral DNA

o Using other components from the T- cell, the viral enzyme, reverse

transcriptase produces a DNA copy of viral RNA; this DNA copy is

called a pro-viral DNA

• Integration of pro-viral DNA to host DNA using other components from the

T- cell.

o The viral enzyme (integrase) integrates the proviral DNA into the T-

cell DNA.

• Synthesis of viral proteins:

o Using other cellular components from T. cell, the viral enzyme

(protease) synthesises viral protein necessary for a completion of

virion.

• Assembly and release of a complete virion.

o Virions are distributed to infect other more T-helper cell: virion are

released from T- cells and can infect more T-cell

[pic]

|[pic] |Handout 27.2: Life Cycle of HIV |

• An opportunistic infection (OI): An infection caused by an organism

that does not usually cause disease in a healthy person with a normal

immune system

• When the immune system is compromised such as through HIV infection,

the pathogen then gets an opportunity ‘to infect and cause disease’

• Other examples of people with suppressed immunity include very young

children and very old people, patient with advanced cancer and/or on

chemotherapy, patients taking steroids for a long time, and those on

immunosuppressive therapy following organ transplantation

• Opportunitistic Infections affecting gastrointestinal system include:

o Oral-oesophageal candidiasis (thrush)

o Herpes Simplex Virus

o Kaposis sarcoma as well as diarrhoeal illnesses

o Cytomegalo Virus

• Opportunistic Infections affecting Respiratory System includes:

o Pneumocystis carinii pneumonia (PCP), currently is also known as

pneumocystis jirovecii pneumonia (PJP)

o Recurrent respiratory tract infection (RTI), bacterial

pneumonias

o Pulmonary tuberculosis (PTB) and pleura infusion

• OIs in the cardiovascular system can lead to the following include;

o Pericarditis

o Cardiomyopathy

• OIs affecting Skeletal Muscular System include:

o Herpes zoster and herpes simplex

o Kaposi’s sarcoma o Pyomyositis and Abscesses

• OIs affecting Central Nervous System include:

o Cryptococcus Meningitis

o Toxoplasmosis

|[pic] |Handout 27.3: WHO Clinical Staging of HIV/AIDS in adults |

• The WHO Clinical staging system is based on clinical features believed

to have prognostic significance resulting in four stages of disease

progression

• WHO staging is done where HIV infection is confirmed by HIV antibody

or virological markers

• Staging determines eligibility for ART

• WHO staging looks at the clinical presentation of the client or

patient

• WHO clinical staging can be used effectively without access to CD4 or

other laboratory testing

WHO Clinical Stage I: Asymptomatic

• A person with Stage I infection:

o Feels well and can do all his or her normal activities

o Has no signs or symptoms of any illness

o May experience Persistent Generalized Lymphadenopathy (PGL)

WHO Clinical Stage II: Minor Symptoms

• A person in this stage may feel

o Ill at times, but still can perform all of his or her activities

o Moderate unexplained weight loss (<10% body weight)

o Recurrent respiratory tract infections

o Minor mucocutaneous manifestations

o Herpes zoster

WHO Clinical Stage III: Moderate Symptoms

• People in this stage

o Often cannot do their usual activities, but are in bed less than half

the time

o Severe unexplained weight loss (<10% of presumed or measured body

weight)

o Unexplained chronic diarrhoea for >1 month

o Unexplained persistent fever above 37.6C intermittent or constant for

>1 month

o Persistent oral candidiasis

o Oral hairy leukoplakia

o Pulmonary tuberculosis (current)

o Severe bacterial infections

o Acute necrotising ulcerative stomatitis, gingivitis or periodontitis

WHO Clinical Stage IV: AIDS-Defining Conditions

• A person in this stage is ill often and may stay in bed more than 50% of

the time

o Wasting can take place in this stage: weight loss >10% of body weight

• Involved organ systems:

o Cutaneous and oral

o Respiratory

o Gastrointestinal

o Neurological and ocular

o Generalised

• Main infections include:

o Kaposi sarcoma

o Cryptococcal meningitis

o CNS toxoplasmosis

o Pneumocystis pneumonia

Session 28: Identification of Patients with Tuberculosis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Tuberculosis

• Describe mode of Transmission of Tuberculosis

• Describe Major Signs and Symptoms of Tuberculosis

• Explain Treatment of Tuberculosis

• Explain Prevention and Control of Tuberculosis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Tuberculosis (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes tuberculosis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Definition

• Tuberculosis (TB) is a chronic infectious disease caused mainly by

mycobacterium tuberculosis (M. tuberculosis) and occasionally by

mycobacterium bovis or mycobacterium africanum.

Tuberculosis can be grouped into two main types:

Pulmonary tuberculosis (PTB)

• Affects the lungs

• Most common and accounts for 80% of all cases of TB

Extra-pulmonary (EPTB)

• Affects organs other than the lungs

• Non-infectious

• Accounts for 20% of all cases of TB

• The most common types of extra-pulmonary tuberculosis are:

o TB lymphadenitis

o TB of the bones and joints

o TB meningitis

• Tuberculosis is on the increase, especially in countries with high

prevalence of HIV

• Tuberculosis can kill or render the patient disabled for life if

untreated or inadequately treated

STEP 3: Mode of Transmission of Tuberculosis (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of tuberculosis? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The transmission of tubercle bacilli occurs by airborne spread of

infectious droplets

• TB is transmitted from one person to another through inhalation of

droplets during:

o Coughing

o Laughing

o Talking

o Sneezing

o Spitting

o Singing

• Coughing is the common means of transmission

• The risk of acquiring the infection is higher for individuals close to

the patient

• Direct sunlight kills tubercle bacilli within minutes, but they can

survive in the dark for many hours (24-48 hours)

Note: The majority (90%) of people without HIV infected with

mycobacterium tuberculosis do not develop tuberculosis because their

immune system is strong enough to prevent the development of

tuberculosis

STEP 4: Signs and Symptoms of Tuberculosis (10 minutes)

The most common symptoms of pulmonary tuberculosis are:

• Persistent cough for 2 weeks or more

• Blood stained sputum (haemoptysis)

• Shortness of breath

• Chest pain

• Fatigue (tiredness)

• General malaise

• Loss of appetite

• Loss of weight

• Night sweats

• Fever

The symptoms for extra-pulmonary tuberculosis depend on the organs

involved, for example:

• Chest pain in Tb pleurisy

• Swelling of lymph nodes in Tb lymphadenitis

• Pain and swelling of joints in Tb arthritis

• Deformity of the spine (Pott’s disease)

• Headache, fever, stiffness of the neck and mental confusion in Tb

meningitis

STEP 5: Treatment of Tuberculosis (10 minutes)

Treatment is divided into three groups:

• New patients who have no history of TB treatment or who have received

less than one month of anti-TB drugs regardless of their smear or culture

results

• Previously treated patients who have received anti-TB drugs for one month

or more in the past with a second episode

• Drug-resistant patients with tubercle bacilli that are resistant to

rifampicin and isoniazid

Direct observation treatment (DOT) strategy

• Direct observation treatment means that a trained health care provider or

other designated individual, including family members, observe the

patient swallow all tablets

• Ensures that a TB patient takes the right drugs, in the right doses, at

the right intervals and finishes treatment within the required duration,

There are five essential first-line anti-TB drugs for adults and children

in Tanzania, as recommended by the MOHSW and WHO.

• Drugs are formulated in fixed drug combinations (FDCs)

o Isoniazid (H)

o Rifampicin (R)

o Pyrazinamide (Z)

o Ethambutol (E)

o Streptomycin (S)

• Treatment of TB requires multiple drugs for effectiveness

o This is called Multi-Drug Treatment (MDT)

o If one or two drugs are used alone, other organisms will not be killed

and resistance will develop

• Treatment of TB is divided into two phases as described below;

Initial (intensive) phase

• At least 4 drugs are used in this phase:

o Isoniazid

o Rifampicin

o Pyrazinamide

o Ethambutol

• Majority of TB bacilli are rapidly killed and patients become non-

infectious within two weeks

• The duration of treatment for initial phase is at least two (2) months

Continuation phase

• There are always bacilli that remain metabolic inactive, hiding in tissue

or macrophages even after the initial phase of treatment

• These are called persisters or semi-dormant and they need much longer

treatment before they are killed

• Two drugs are used

o Isoniazid

o Rifampicin

• The duration for this phase is at least four (4) months to make a total

duration of at least six (6) months to complete treatment

[pic][pic]Handout 28.1: Mode of Action, Potency and Recommended dose of

Anti-TB drugs for further reading

• [pic] Handout 28.1: Adverse Reactions of Anti-TB Drugs for further

reading

STEP 6: Prevention and Control of Tuberculosis (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the preventive prevention and control measures of |

|tuberculosis? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The control of TB depends on success of treatment of registered TB

patients and contact tracing.

o Emphasis must be placed on those who are sputum smear-positive (open

TB) to make them smear-negative

o All patients with open TB must be put on treatment as early as

possible to prevent them from infecting others

o Early case finding is an important aspect of TB control

▪ Passive case finding – all health care workers should know the

early symptoms of TB and diagnose it whenever patients reports to

facilities

▪ Active contact tracing/case finding – community health workers to

visit the homes of all TB cases to look for other cases

• Appropriate health education should be given to patients and relatives so

that symptomatic contacts can be brought to the health facility for

investigation

• Case holding – those who are put on treatment, should be maintained on

treatment until they finish the whole course of treatment

• Strengthen the efficiency and reliability of the health services

o Advertise the routine methods of TB treatment in health facility

o Having special day in a week/month where TB patients are seen

• The role of BCG immunization

o Provides partial active immunity against TB

• Other important measures are:

o TB patients should be advised not to spit anywhere carelessly

o A sputum mug should be provided in which to spit and disposed

carefully

o Overcrowding and poor ventilation at homes should be avoided

o Patients should cough into a piece of cloth to reduce distribution of

particles b in the air

o Hand washing after coughing

STEP 7: Key Points (5minutes)

• TB is transmitted from one person to another through inhalation of

droplets

• Treatment of TB requires multiple drugs for effectiveness

• Majority of TB bacilli are rapidly killed and infectious patients become

non- infectious within two weeks

• There are five essential, first-line anti-TB drugs which are Isoniazid,

Rifampicin, Pyrazinamide, Ethambutol and Streptomycin

• The control of TB depends on successful treatment of registered TB

patients and contact tracing

• Early case finding is an important aspect of TB control

STEP 8: Evaluation (5 minutes)

• What causes of tuberculosis?

• What is the mode of transmission of tuberculosis?

• What are major signs and symptoms of tuberculosis?

• What is the treatment of tuberculosis?

• What are the preventive prevention and control measures of tuberculosis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Tuberculosis |

|in your area |

|ALLOCATE time for students to do the assignments and submit |

|REFER students to recommended references |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:

Saunders Ltd.

Eshuis, J. Manschot, P. (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

|[pic] |Handout 28.1: Mode of Action, Potency and Recommended dose |

| |of Anti-TB drugs |

[pic]

|[pic] |Handout 28.2: Adverse Reactions of Anti-TB Drugs |

[pic]

Session 29: Identification of Patients with Leprosy

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause(S) of Leprosy

• Describe Mode of Transmission of Leprosy

• Describe Major Signs and Symptoms of Leprosy

• Explain Treatment of Leprosy

• Explain Prevention and Control of Leprosy

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Leprosy (15minutes)

• Leprosy is a chronic infectious disease caused by mycobacterium leprae

(M. leprae)

• Mainly affects the skin, peripheral nerves, and mucous membranes

• The disease affects people of all ages and sexes

STEP 3: Mode of Transmission of Leprosy (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What is the mode of transmission of leprosy? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Leprosy bacilli are mainly transmitted through infectious droplets that

are spread by an infectious individual through coughing and sneezing

• Patients carrying many leprosy bacilli are called multibacillary (MB)

patients

o They are the main source of infection

• Individuals with few bacilli in their body are called paucibacillary (PB)

o They are not a significant source of infection

• Healthy carriers are people carrying the bacilli without developing the

disease

o They are not a significant source of infection

• Skin contact with leprosy patients not a means of transmitting leprosy

infection

• Leprosy has a very long incubation period of 3-30 years, with an average

of five years

STEP 4: Sign and Symptoms of Leprosy (20minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of leprosy? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• One or more pale or reddish, hypo-pigmented patch(es) on the skin with

diminished or loss of sensation

• Painless swelling or lumps in the face and/or earlobes

• Enlarged and/or tender nerves

• Burning sensation of the skin

• Numbness or tingling of hands and/or feet

• Weakness of eyelids, hands, and/or feet

• Painless wounds or burns on the hands and/or feet

• The skin lesion can be single or multiple and in many cases less

pigmented than the surrounding skin. Sometimes lesion is reddish or

copper-coloured

• The skin lesion may show loss of sensation on light touch, a key feature

in leprosy

• Lesions can present in different ways, but macules (flat), papules

(raised) or sometimes nodules are the most common

STEP 5: Treatment of Leprosy (30 minutes)

• The aim of leprosy control is to:

o Cure patients

o Detect and treat leprosy reactions

o Prevent further damage to nerves and other tissue in patients with an

already existing disability

o Prevent further transmission to other community members

• Multi Drug Treatment (MDT) is the only adequate chemotherapy that will

kill bacilli

• MDT is a combination of a minimum of two anti-leprosy drugs, prescribed

in the correct dosage, taken regularly for a period of 6-12 months

• Multi bacillary (MB) patients are treated for a period of 12 months

• Paucibacillary (PB) patients are treated for 6 months

• Treatment of leprosy with only one drug will result in development of

drug-resistance

• Treatment is given according to WHO recommended MDT regimens based on the

• classification of Multibacillary or Paucibacillary

• The patient receives a combination of rifampicin, dapsone and clofazimin

in case of MB or rifampicin and dapsone in case of PB

• The patient should thus attend the nearest clinic where she/he is

registered to collect

• blister pack and for clinical assessment.

• The patient takes the first dose under direct observation of a health

worker

• In the following 27 days the patient then takes the medicine without

being supervised by the health worker

[pic]

STEP 6: Prevention and Control of Leprosy ( 15 minutes)

• Early diagnosis and prompt treatment with Multi Drug Therapy

o Case holding and patient compliance

o Early detection of leprosy reactions and prompt treatment with

prednisolone to prevent disabilities

STEP 6: Key Points (20 minutes)

• Leprosy is a chronic infectious disease caused by Mycobacterium leprae

• The cardinal signs are skin lesion with loss of sensation, one or more

enlarged peripheral nerves and a positive skin smear.

• Treatment is given according to WHO recommended MDT regimens based on the

classification of Multibacillary or Paucibacillary.

• Early detection and prompt treatment are important measures

STEP 7: Evaluation (5 minutes)

• What causes leprosy?

• How is leprosy transmitted?

• What are the major signs and symptoms of leprosy?

• Hat is the treatment of leprosy?

• Explain prevention and control of leprosy

• What are the preventive and control measures of leprosy?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control leprosy |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G., & Zumla, A. (2003), Manson’s Tropical Diseases. (21st ed.).

London: Saunders

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

Kingondu, T. et al. (2007), Communicable Disease, Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4th ed.). Nairobi: AMREF

Session 30: Identification of Patients with Gonorrhoea

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Gonorrhoea

• Describe Mode of Transmission of Gonorrhoea

• Describe Major Signs and Symptoms of Gonorrhoea

• Explain Treatment of Gonorrhoea

• Explain Prevention and Control of Gonorrhoea

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Gonorrhoea (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What is Gonorrhoea? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Gonorrhea is an acute or chronic purulent infection of the urogenital

tract caused by gonococcus is known as Neisseria gonorrhoeae

• Gonorrhea is by far the commonest of so called ‘classical STIs’ known

before the

• emergence of HIV and AIDS all over the world

• Gonorrhea can cause sterility in both males and females and accounts for

a serious

• decline in birth rate in some communities

• The Gonococcus is not able to penetrate intact skin or squamous

epithelium but prefers columnar epithelium such as in the urethra,

endocervix, rectum and conjunctiva

STEP 3: Mode of Transmission of Gonorrhoea (15 minutes)

• Gonorrhoea is mainly transmitted through sexual intercourse,

o However, there are exceptions e.g. gonorrheal ophthalmia neonatorum is

an acute inflammation of the conjunctiva of the new born, contacted

during passage through the birth canal of an infected mother

STEP 4: Signs and Symptoms of Gonorrhoea (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the signs and symptoms of gonorrhoea? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

The signs and symptoms may differ between men to females as follows;

In males

• The earliest symptom is irritation at the urinary meatus

o After an incubation period of 2 – 10 days, symptoms of urethritis

develop in majority of infected men

• A burning sensation when passing urine

• A purulent yellow and profuse discharge soon follow

• Dysuria (difficult in passing urine) may be slight or very severe

• Severe dysuria is often accompanied by urgency and frequency and

occasionally

• Terminal haematuria (blood in urine)

• In untreated cases, the discharge which was purulent and profuse

gradually become

o Scant and less purulent discharges may present only in the mornings

In females

• About 50 -80% of infected women have no symptoms

• Urethritis and discharge often may go unnoticed

• Cervicitis may cause a discharge

• Most of symptoms in females are due to complications of gonorrhoea

• The risk of infection after a single exposure to an infected partner

ranges from 20 to 35% in male and from 60 to 90% in females

STEP 5: Treatment of Gonorrhoea (20 minutes)

• The recommended first line drugs for treatment of Gonorrhoea include the

following:

o Ceftriaxone

o Norfloxacin

o Ciprofloxacin

• The recommended alternative or second line drugs for treatment of

Gonorrhoea include the following:

o Cefixime

o Cefoxitin

o Cefotaxime

o Spectinomycin (Togamycin)

o Azithromycin

o Cotrimoxazole

• Treatment of Ophthalmia neonatorum include:

o Gentamycin and Kanamycin

o Gentamicin can be available in form of eye drops

o Zinnat syrup (oral cephalosporin-cefuroxime)

o The eyes should be washed with saline 2 hourly for the first 12 hours

and subsequently every 4 hours

STEP 6: Prevention and Control of Gonorrhoea (20 minutes)

• Abstinence

• Avoid multiple partners and stick to one uninfected partner

• Proper and consistent use of condom

• Early diagnosis and treatment is important to reduce/prevent

complications and further spread of infection among the community

• Partners must be treated regardless of their symptoms or test results

• Health education on public awareness and specific knowledge of STIs in

the target groups

STEP 7: Key Points (5 minutes)

• Gonorrhoea is a common STI in the community which needs prompt diagnosis

and

treatment

STEP 8: Evaluation (5 minutes)

• What is Gonorrhoea?

• What are signs and symptoms of gonorrhea?

• What is mode of transmission of gonorrhea?

• What is the treatment of gonorrhea?

• How can you prevent Gonorrhoea in the community?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control Gonorrhoea |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. &Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J, & Manschot,P (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1st ed). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Session 31: Identification of Patients with Syphilis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Syphilis

• Describe Mode of Transmission of Syphilis

• Describe Major Signs and Symptoms of Syphilis

• Explain Treatment of Syphilis

• Explain Prevention and Control of Syphilis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Syphilis (5minutes)

• Syphilis: A chronic multi-systemic disease caused by the bacteria

spirochetal bacterium Treponema pallidum.

STEP 3: Mode of Transmission of Syphilis (15 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the mode of transmission of Syphilis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The spirochaete Treponema pallidum enters the body through mucous

membranes and skin.

• The route of transmission of syphilis is almost always through sexual

contact, although there are other routes such as:

o Congenital Syphilis via transmission from mother to child in utero.

o Transfusion of unscreened blood.

o A patient with secondary syphilis who has mucosal or cutaneous lesion

may transmit the disease through physical contact.

o Unusual but possible transmission is accidental contact with infective

tissue.

STEP 4: Signs and Symptoms of Syphilis (40 minutes)

|Activity: Group discussion (20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the signs and symptoms of Syphilis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

There are 3 main stages of the disease namely:

• Primary Syphilis

• Secondary Syphilis

• Tertiary Syphilis

Note: Different manifestations occur depending on the stage of the disease;

as outlined below:

Primary Syphilis

• Primary syphilis is typically acquired via direct sexual contact with the

infectious lesions of a person with syphilis.

• Approximately 10-90 days after the initial exposure (average 21 days), a

skin lesion

appears at the point of contact, which is usually the genitalia, but can

be anywhere on the body

o This lesion, called a chancre which is a firm, painless skin

ulceration localized at the point of initial exposure to the

spirochete, often on the penis, vagina, rectum or elsewhere like lips,

tongue, breast etc.

• The lesion may persist for 4 to 6 weeks and usually heals spontaneously.

• Local lymph node swelling can occur.

[pic]

Secondary Syphilis

• Secondary syphilis occurs approximately 1–6 months (commonly 6 to 8

weeks) after the primary infection.

• There are many different manifestations of secondary disease.

• A patient with syphilis is most contagious when he or she has secondary

syphilis.

• There may be a symmetrical reddish pink non-itchy rash on the trunk and

extremities.

• This is accompanied with mild constitutional systems, often described as

flu-like.

• These rashes tend to be symmetrical can involve the palms of the hands

and the soles of the feet.

• In moist areas of the body such as anus, vulva, perineum, mouth, and

axilla the rash becomes flat, broad, whitish lesions known as condylomata

lata.

• All of these lesions are infectious and harbor active treponema

organisms.

Tertiary Syphilis

• Tertiary syphilis usually occurs 1–10 years after the initial infection,

though in some

• Cases it can take up to 50 years.

• This stage is characterized by the formation of gummas which are soft,

tumor-like lesions of inflammation known as granulomas.

• They may appear almost anywhere in the body including the skeleton and

brain.

• The more severe manifestations include neurosyphilis and cardiovascular

syphilis

• The incubation period of syphilis varies from 10 days to 10 weeks with

average of 3 weeks.

STEP 5: Treatment of Syphilis (10 minutes)

• The drug of choice is intramuscular Benzathine benzylpenicillin

• Doxycycline

• Erythromycin

STEP 6: Prevention and Control of Syphilis (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of Syphilis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Abstinence

o Encourage delaying sexual activity for young people

• Sexual and reproductive health education to young people in and out of

school

• Faithfulness (have one faithful uninfected partner)

• Using condoms correctly and consistently

o myths and misconceptions about condoms

• Screening and effective treatment of asymptomatic cases

• Effective treatment of STIs/RTIs

• Voluntary counseling and testing (VCT)

• Screening of blood for transfusion

• All pregnant women should be screened for syphilis routinely to prevent

congenital syphilis

STEP 7: Key Points (5minutes)

• Syphilis is sexually transmitted diseases cause by Treponema pallidum

• Syphilis is a disease characterized by a primary lesion, a later

secondary eruption and

tertiary manifestation.

• Syphilis can also be transmitted from mother to the newborn leading to

congenital

Syphilis.

• Syphilis can be prevented by proper and consistent condom use.

STEP 8: Evaluation (5minutes)

• What causes Syphilis?

• What is the mode of transmission of Syphilis?

• What are the signs and symptoms of Syphilis?

• What is the treatment of Syphilis?

• What are preventive and control measure of Syphilis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|prevention and control methods of Syphilis. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G, & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.).

London: Saunders Ltd.

Denyer, S. P. Hodges, N. A., & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis, J, & Manschot, P. (1992). Communicable diseases, (1st ed).

Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1sted). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF.

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Session 32: Identification of Patients with Trichomoniasis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Trichomoniasis

• Describe Mode of Transmission of Trichomoniasis

• Describe Major Signs and Symptoms of Trichomoniasis

• Explain Treatment of Trichomoniasis

• Explain Prevention and Control of Trichomoniasis

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Trichomoniasis (5 minutes)

Definition

• Trichomoniasis: A highly transmissible protozoal infection of the genital

tract of males and females caused by Trichomonas vaginalis

STEP 3: Mode of Transmission of Trichomoniasis (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What is the mode of transmission of Trichomoniasis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Trichomoniasis is a very common infection of the female genital tract,

affecting about

10% of all women

• Transmission is by sexual intercourse or by indirect contact through

contaminated clothes and other articles

• Susceptibility is general for both male and females but common in females

• The parasite survive in acidic environment (pH 4) found in the vagina of

adult women during the reproductive years

• The period of communicability spans from months to years if left

untreated

• No protective immunity occurs in an individual infected with

trichomoniasis

STEP 4: Signs and Symptoms of Trichomoniasis (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the signs and symptoms of Trichomoniasis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The incubation period is 5 to 28 days

• Trichomonas vaginalis infection in women is frequently symptomatic

presenting with

o Itching vaginitis

o Vulvar and cervical lesions

o Lower abdominal pain

o Dysuria and dyspareunia

o Increased vaginal foamy greenish yellow discharge

• In most males, the infection is frequently asymptomatic occasionally,

urethritis,

epididymitis, and prostatitis can occur

STEP 5: Treatment of Trichomoniasis (30 minutes)

• The treatment of choice is a single dose of metronidazole

o Metronidazole is incompatible with alcohol and must not be given to

women in first trimester of pregnancy

• Tinidazole can also be used

• Clotrimazole pessaries in women with Trichomonas vaginalis (TV) who

are pregnant

• Encourage the patient to bring the sexual partner for treatment.

STEP 6: Prevention and Control of Trichomoniasis (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of Trichomoniasis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Abstinence

• Encourage delaying sexual activity for young people

• Sexual and reproductive health education to young people in and out of

school

• Faithfulness (have one faithful uninfected partner)

• Use of condoms correctly and consistently

o Correct myths and misconceptions about condoms

• Screening and effective treatment of asymptomatic cases e.g. partners of

the patients

• Effective treatment of STIs

STEP 7: Key Points (5 minutes)

• Trichomoniasis is a protozoal infection of the genital tract of males and

females

• Transmission is by sexual intercourse or by indirect contact through

contaminated clothes

• Treatment of as well as their partners is important even if the partner

is asymptomatic

• Prevention and control measures of Trichomoniasis are just like other

STIs

STEP 8: Evaluation (5 minutes)

• What is Trichomoniasis?

• What is the mode of transmission of Trichomoniasis?

• What are signs and symptoms of Trichomoniasis?

• What is the drug of choice for treatment of Trichomoniasis?

• What are control and preventive measures of Trichomoniasis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|prevention and control methods of Trichomoniasis. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. , Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, &Manschot, P (1992).Communicable diseases,(1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare

Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1sted). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF. Nordberg, E. (1999): Communicable

Diseases, A Manual for Health Workers in Sub-Saharan Africa, Nairobi: AMREF

Session 33: Identification of Patients with Vaginal Candidiasis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Cause(S) of Vaginal Candidiasis

• Describe Mode of Transmission of Vaginal Candidiasis

• Describe Major Signs And Symptoms of Vaginal Candidiasis

• Explain Treatment of Vaginal Candidiasis

• Explain Prevention and Control of Vaginal Candidiasis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Vaginal Candidiasis (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes vaginal candidiasis? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Candidiasis: A fungal infection, caused by yeast called candida albicans

• Candidiasis usually affects people with impaired body immunity e.g.

o Skin or mucosal membranes, including:

▪ oral cavity (thrush; seen around the mouth as white patches)

▪ pharynx or esophagus

▪ gastrointestinal tract

▪ urinary bladder

• Candida can be isolated from the vagina in a high proportion of women of

child bearing age, many of whom will have no symptoms

• Infection in the vagina, it is known as vulvo-vaginal candidiasis.

STEP 3: Mode of Transmission of Vaginal Candidiasis (20 minutes)

• Candidiasis is not sexually transmitted, although occasionally can be

spread from one

sexual partner to the other

o Partner of someone who has a yeast infection does not need treatment

• Candida can overgrow for many reasons including;

o Stress

o Pregnancy

o illnesses that affect the immune system may allow yeast to multiply

o Long term use of antibiotics and steroids.

• Women who have diabetes or HIV that is not controlled are at a higher

risk for

candidiasis

• Recurrent yeast infections is a common complaint in women with HIV

infection

STEP 4: Signs and Symptoms of Vaginal Candidiasis (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the major signs and symptoms of vaginal candidiasis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Common signs and symptoms of Candida infections in women include:

o Itching and irritation in the vagina

o Redness, swelling, or itching of the vulva (the folds of skin outside

the vagina)

o A thick, white discharge that can look like cheese-like discharge

(curd-like

o Appearance) and is usually odourless, although it might smell like

bread or yeast.

o Pain or burning when urinating

o Pain or discomfort during sexual intercourse

STEP 5: Treatment of Vaginal Candidiasis (20 minutes)

• Topical; pessaries or creams containing one of the antifungal such as

clotrimazole,

miconazole and nystatin

• The following medicines are often used;

o Clotrimazole

o 1% cream

o 100 mg vaginal tablet at

o Miconazole

▪ 2% cream 5 gm intra-vaginally

▪ vaginal pessaries ,

o Nystatin 100,000-unit vaginal tablet, one per day

• Fluconazole for involvement of systemic or recurrent infection

STEP 6: Prevention and Control of Candidiasis (30 minutes)

|Activity: Group discussion (15 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the prevention and control measures of vaginal candidiasis? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Keep the external genital area clean and dry

• Avoid irritating soaps, vaginal sprays and douches

• Change tampons and sanitary napkins frequently

• Wear loose cotton (rather than nylon) underwear that does not trap

moisture.

• Avoid prolonged use of antibiotics

• Control of diabetes mellitus minimizes the occurrence of candidiasis in

diabetic patients

STEP 7: Key Points (5 minutes)

• Candidiasis is a fungal infection, caused by yeast called candida

albicans

• The organism is also responsible for balanitis in men

• Women who have diabetes or HIV that isn't controlled are at a higher risk

for candidiasis

• Control of diabetes mellitus minimizes the occurrence of candidiasis in

diabetic patients

STEP 8: Evaluation (5 minutes)

• What is vaginal candidiasis?

• What are clinical features of vaginal candidiasis?

• What is the treatment is of vaginal candidiasis?

• What are the control and preventive measures of vaginal candidiasis?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|prevention and control of vaginal candidiasis. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, Manschot, P (1992). Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004) National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF.

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar

es Salaam: MOHSW/NACP

GoT (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E. (1999) Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

Session 34: Introduction to Common Non-communicable Diseases

Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites

• None

Learning Task

By the end of this session students are expected to be able to:

• Describe Non-communicable Diseases

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Types of Communicable Disease (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the types of non-communicable diseases? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below: |

Non-communicable diseases (NCD) are medical conditions or diseases which

are not infectious and cannot be transferred from person to person

o Diseases last for long periods of time and progress slowly

Common groups of non-communicable diseases include:

• Cardiovascular diseases (CVDs) – e.g. heart failure, hypertension

• Cancers – e.g. lung cancer, breast cancer, cervical cancer

• Gastrointestinal disorders- e.g. peptic ulcers

• Chronic respiratory diseases – e.g. chronic pulmonary diseases (COPDs),

asthma

• Diabetes

STEP 3: Risk factors for Non-Communicable Diseases (10 minutes)

Risk factors for NCD are divided into two groups:

• Biological risk factors:

o Hypertension

o High cholesterol in the blood

o Glucose

o Obesity

• Behavioral risk factors:

o Tobacco use

o Unhealthy diet

o Harmful use of alcohol

o Physical inactivity

STEP 4: Prevention and Control of Common Non-Communicable Diseases (20

minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are preventive measures of non-communicable diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Early detection and treatment is important to reduce morbidity and

mortality for NCD related disorders

• Advise people to stop smoking tobacco to minimize chance of acquiring

chronic respiratory, cardiovascular and other pathological disorders

• Encourage balanced diet and regular physical exercise to avoid

being overweight or obesity

• Encourage people to stop or reduce alcohol intake

• Focus on behavioural change as the core component of all clinical

programmes for the prevention and management of NCDs

• Establish centers to improve preventive programmes for NCDs in local

areas

STEP 5: Key Points (5 minutes)

• NCDs are chronic diseases which last for long periods and progress

slowly.

• Common groups of non-communicable diseases include diabetes,

cardiovascular diseases and cancer

• Biological and behavioral risks factors are of medical importance in

NCDs.

• Majority of NCDs are preventable that requires environmental and

lifestyle modifications

STEP 6: Evaluation (5minutes)

• What are non-communicable diseases?

• What are risk factors for non-communicable diseases?

• What are preventive measures for non-communicable diseases?

STEP 7: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control |

|non-communicable diseases in your area |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008) Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006) Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006) Textbook of Clinical Medicine. Churchill:

Livingstone.

Session 35: Identification of Patients with Hypertension

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Hypertension

• Describe Types of Hypertension

• Describe Major Signs and Symptoms of Hypertension

• Explain Treatment Of Hypertension

• Explain Prevention and Control of Hypertension

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Hypertension (5 minutes)

• Hypertension or high blood pressure is a chronic medical condition in

which the blood pressure in the arteries is persistently raised

• Blood pressure is expressed by two measurements:

o The systolic pressure occurs when the left ventricle contract

o The diastolic pressure occurs when the left ventricle relaxes before

the next contraction

• Normal blood pressure at rest is within the range of 100–140 millimeters

mercury (mmHg) systolic and 60–90 mmHg diastolic.

• Hypertension is present if the blood pressure is persistently at or above

140/90 mmHg for most adults

STEP 3: Types of Hypertension (20 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the types of hypertension? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Hypertension is classified as either:

• Primary (essential) hypertension defined as high blood pressure with no

obvious underlying cause.

o About 90–95% of cases are categorized as primary hypertension

• Secondary hypertension; defined as hypertension due to an identifiable

cause

o Accounts for remaining 5–10% of cases of hypertension,

o Causes of secondary hypertension;

▪ chronic kidney disease,

▪ pregnancy

▪ alcohol

▪ narrowing of the aorta or kidney arteries

▪ Endocrine disorder e.g. excessive aldosterone, cortisol,

or catecholamines

▪ Drugs such as corticosteroids, non-steroidal anti-inflammatory

drugs

[pic]

STEP 4: Signs and Symptoms of Hypertension (15 minutes)

• Hypertension usually does not cause symptoms initially

• Some patients report;

o Headaches (particularly at the back of the head and in the morning)

o Vertigo,

o Tinnitus (buzzing or hissing in the ears)

o Altered vision or fainting episodes

• Sustained hypertension over time is a major risk factor for:

o Heart disease

o Coronary artery disease

o Stroke

o Aortic aneurysm

o Peripheral artery disease

o Chronic kidney disease

STEP 5: Treatment of Hypertension (20 minutes)

• Refer patients to the hospital for investigations and initial treatment

and follow up may be even done at dispensary or health centre

• Antihypertensive medications are available for treating hypertension

• First line medications for hypertension include:

o Tthiazide – diuretics e.g. hydrochlorothiazide

o Calcium channel blockers, e.g. diltiazem

o Angiotensin converting enzyme inhibitors e.g. captopril

o Angiotensin receptor blockers e.g. losartan

▪ These drugs may be used alone or in combination

▪ The majority of people require more than one medication to

control their hypertension.

STEP 6: Prevention and Control of Hypertension (40 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are preventive and control measures of hypertension? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Lifestyle changes are recommended to lower blood pressure, before

starting drug therapy.

o Maintain normal body weight for adults (e.g. Body mass index 20 –

25 kg/m2)

o Reduce dietary sodium intake

o Engage in regular physical activity e.g. Walking

o Limit alcohol consumption

• consume a diet rich in fruit and vegetables

• Stop smoking and reduce intake of dietary saturated fat and cholesterol

• Lifestyle modification may lower blood pressure as much as

antihypertensive drug

• Patient education

o Hypertension is a lifelong disorder

▪ Long-term commitment to lifestyle modifications and

pharmacological therapy is required.

▪ Repeated in-depth patient education and counselling improve

compliance and reduce cardiovascular risk factors.

STEP 7: Key Points (5 minutes)

• Hypertension is diagnosed by properly measuring elevated blood pressure

at three or more separate occasions based on 2 or more readings.

• Treatment approach in hypertension is based upon its severity by

classification ranging from non pharmacological to pharmacological.

• Patient’s education repeatedly carries a great role for optimal control

of hypertension by lifelong commitment to lifestyle modification and drug

therapy.

STEP 8: Evaluation (5 minutes)

• What is hypertension?

• How is hypertension classified?

• What is the pharmacological treatment of hypertension?

• What are preventive measures of hypertension?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures for hypertension |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill:

Livingstone.

MOHSW (2005).Tanzania National Formulary. Dar es Salaam: MoHSW

Session 36: Identification of Patients with Diabetes

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Diabetes

• Describe Types of Diabetes

• Describe Major Signs and Symptoms of Diabetes

• Explain Treatment of Common Diabetes

• Explain Prevention and Control of Diabetes

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Diabetes (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What causes diabetes? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Diabetes mellitus (DM) comprises Hyperglycemia is a cardinal

manifestation due to;

o Insulin deficiency or

o Insulin resistance

• Several distinct types of DM exist and are caused by a complex

interaction of genetics, environmental factors and life-style choices

• Factors contributing to hyperglycemia may include:

o Reduced insulin secretion

o Decreased glucose usage, and

o Increased glucose production

STEP 3: Types of Diabetes (10 minutes)

There are three main types of diabetes mellitus:

• Type 1 DM results from failure of pancreases to produce enough insulin

o This form was previously referred to as "insulin-dependent diabetes

mellitus" (IDDM) or "juvenile diabetes".

o The cause is unknown

• Type 2 DM begins with insulin resistance, a condition in which cells fail

to respond to insulin properly.

o As the disease progresses a lack of insulin may develop

o This form was previously referred to as "non insulin-dependent

diabetes mellitus" (NIDDM) or "adult-onset diabetes"

o The primary cause is excessive body weight

o Risk Factors for Type 2 Diabetes Mellitus

▪ Family history of diabetes (i.e. parent or sibling with type 2

diabetes)

▪ Obesity i.e. body mass index (BMI) >27kg/m2

▪ Age >45 years

▪ History of gestational diabetes mellitus

▪ Hypertension

▪ High density lipoprotein (HDL) cholesterol <0.90 mmol/l (35mg/dl)

▪ In HIV patients, the HAART therapy can increase risk of diabetes

• Gestational diabetes, is the third main form and occurs when pregnant

women without a previous history of diabetes develop a high blood

sugar level.

STEP 4: Signs and Symptoms of Diabetes (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of diabetes? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Clinical features of DM depend on the severity of disease and its

complications. They include:

• Polyuria

• Polydipsia

• Polyphagia

• Hyperglycaemia

• Glycosuria

• Keto acidosis

• Coma

• Weight loss

• Fatigue

• Weakness

• Blurred vision

• Frequent superficial infections e.g. vaginitis, fungal skin infections

• Slow healing of skin lesions after minor trauma

[pic]

Figure 36.1: Main symptoms of diabetes

STEP 5: Treatment of Diabetes (20 minutes)

• Treatment of DM should be initiated at hospital after thorough evaluation

• Follow up may be done in the health centre when patients are stable

Type I Diabetes Mellitus

Insulin is required

• The commonly used types of insulin are:

o Fast-acting: Includes the insulin analogues aspart, lispro,

and glulisine.

▪ These begin to work within 5 to 15 minutes and are active for 3

to 4 hours.

o Short-acting: Includes regular insulin

▪ Begins working within 30 minutes and is active about 5 to 8

hours.

o Intermediate-acting: Includes NPH insulin

▪ Begins working in 1 to 3 hours and is active 16 to 24 hours.

o Long acting: Includes the analogues glargine and detemir,

o Begins working within 1 to 2 hours and continue to be active, without

major peaks or dips, for about 24 hours, although this varies in many

individuals.

o Ultra-long acting: Currently only includes the analogue degludec,

▪ Begins working within 30–90 minutes, and continues to be active

for greater than 24 hours

o Combination insulin products – Includes a combination

▪ of either fast-acting or short-acting insulin

Type 2 Diabetes Mellitus

• There are several classes of anti-diabetic medications available such as:

o Biguanides; e.g. Metformin

o Sulfonylureas,

▪ First generation e.g. Chlorpropamide, Tolbutamide

▪ Second generation e.g. Glipizide, Gliclazide, Glibenclamide,

Glyburide

▪ Third generation e.g. Glimepiride, Gliclazide MR (DIAMICRON MR

60)

o Thiazolidinediones e.g Rosiglitazone

STEP 6: Prevention of Diabetes (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the preventive measures of diabetes? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Regular daily exercise is important; recommendation is 20-30 minutes of

exercise daily (this can be walking).

• Educated patients about long term consequences of uncontrolled diabetes

such as:

o Renal impairment

o Higher risk of ocular damage

o Increased risk of heart attack

o Neuropathy

• Patient education allows individuals with DM to assume greater

responsibility for their care including compliance with medications

STEP 7: Key Points (5 minutes)

• Diabetes mellitus is a group of common metabolic disorders that present

with hyperglycemia

• Diabetes mellitus is caused by insulin deficiency or insulin resistance

• Types of diabetes mellitus includes type I, type II and gestational

diabetes

• Signs and symptoms are Polyuria, hyperglycemia, Glycosuria, weight loss

and blurred vision

• Treatment depends on the type of diabetes mellitus; type I requires

insulin where as type II requires ant-diabetic medicine

• Preventive measures include regular daily exercise and patient education

about long term consequences of uncontrolled diabetes

STEP 8: Evaluation (5 minutes)

• What is diabetes mellitus?

• What are the causes of diabetes mellitus

• What are the types of diabetes?

• What are the signs and symptoms of diabetes mellitus?

• What is the treatment of diabetes mellitus?

• What are the preventive measures of diabetes mellitus?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control diabetes |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill:

Livingstone.

Session 37: Identification of Patients with Peptic Ulcers

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Peptic Ulcers

• Describe Types of Peptic Ulcers

• Describe Major Signs and Symptoms of Peptic Ulcers

• Explain Treatment of Common Peptic Ulcers

• Explain Prevention and Control of Peptic Ulcers

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Related Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Peptic Ulcers (5 minutes)

• Definition : An ulcers is a break in the mucosal surface >5 mm in size,

with depth to the submucosa

• Common causes include;

o The bacteria, helicobacter pylori

o non-steroidal anti-inflammatory drugs

o tobacco smoking

o Alcohol

o Psychological stress

o Diet: certain foods can cause dyspepsia, but no convincing studies

indicate an association between ulcer formation and a specific diet.

STEP 3: Types of Peptic Ulcers (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the types of peptic ulcers? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• PUD encompasses:

o Gastric ulcers (GU) which is an ulcer in the stomach

o Duodenal ulcers (DU) which is an ulcer in the first part of the small

intestines (duodenum)

• Duodenal and gastric ulcers share common features in terms of

pathogenesis, diagnosis, and treatment, but several factors distinguish

them from one another.

STEP 4: Signs and Symptoms of Peptic Ulcers (30 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are signs and symptoms of peptic ulcers? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Signs and symptoms of peptic ulcer can include one or more of the

following:

• Epigastric pains associated with mealtimes

o pain appears about three hours after taking a meal in duodenal ulcers

• Bloating and abdominal fullness

• Hematemesis (vomiting of blood); this can occur due to bleeding directly

from a gastric ulcer, or from damage to the esophagus from

severe/continuing vomiting.

• Melena (tarry, foul-smelling feces due to presence of oxidized iron

from hemoglobin);

• Nausea, and copious vomiting;

• Loss of appetite

• Weight loss

• Dyspepsia that becomes constant not relieved by food or antacids,

radiating to the back may indicate a penetrating ulcer

STEP 5: Treatment of Peptic Ulcers (20 minutes)

• Treatment is initiated at the hospital

• The clinician's goal in treating PUD is to:

o Provide relief of symptoms (pain or dyspepsia)

o Promote ulcer healing

o Prevent ulcer recurrence and complications

• Therapy for H. Pylori Eradication

o H. pylori should be eradicated in patients with documented PUD

o The agents used with the greatest frequency include:

▪ Amoxicillin

▪ Metronidazole

▪ Tetracycline

▪ Clarithromycin

▪ Bismuth compounds

o Triple Therapy Regimes include:

▪ Amoxicillin, Metronidazole and omeprazole

▪ Lansoprazole, clarithromycin, and amoxicillin

▪ Bismuth subsalicylate, tetracycline, and metronidazole etc.

• Antacids e.g. Magnesium Trisilicate – offer symptomatic relief by

neutralizing stomach acidity

• Acid inhibitory agents – decrease the amount of acid in the stomach

helping with healing of ulcers.

o Histamine 2 receptors blockers (H2 blockers) e.g. Ranitidine,

fomatidine

o Proton Pump Inhibitors (PPIs)e.g. Omeprazole, Lansoprazole

• Prostaglandin analogue (misoprostol) for prevention of NSAID-induced

ulceration

STEP 6: Prevention and Control of Peptic Ulcers (30 minutes)

|Activity: Group discussion (20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are preventive and control measures of peptic ulcers? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Personal hygiene – It's not clear how H. pylori spread, but there's some

evidence that it could be transmitted from person to person or through food

and water.

o Wash hands with soap and water before handling

o Eat foods properly cooked

• Use NSAIDs with caution.

o Avoid taking aspirin, ibuprofen, and other non-steroidal anti-

inflammatory drugs

o Take medication with meals

• Avoid drinking or drink alcohol in small amounts

o Avoid drinking alcohol when taking medication

• Don't smoke. Smokers are much more likely to get ulcers

STEP 7: Key Points (5 minutes)

• Peptic ulcer is caused by bacterial infection, drugs, alcohol and

stress

• Types of peptic ulcer includes duodenal and gastric ulcers

• Signs and symptoms are epigastric pains, abdominal fullness, loss of

weight, nausea and vomiting

• Treatment is mainly with antacids and antibiotics may be required

• Prevention strategies includes avoid alcohol, smoking and stress

STEP 8: Evaluation (5 minutes)

• What causes peptic ulcer?

• What are the types of peptic ulcers

• What are signs and symptoms of peptic ulcers?

• What is the treatment of peptic ulcers?

• What are preventive measures of peptic ulcers?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control peptic ulcers|

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (15thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill:

Livingstone

MOHSW (2005).National Formulary. Dar es Salaam: Ministry of Health and

Social Welfare.

Swash, M. & Glynn, M. (2007). Hutchison’s Clinical Methods (22nded.).

London: Harcourt Publishers Ltd.

Session 38: Identification of Patients with Asthma

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Asthma

• Describe Major Signs and Symptoms of Asthma

• Explain Treatment of Asthma

• Describe Prevention and Control of Asthma

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Handout 38.1: Bronchial Asthma – Precipitating or Aggravating Factors

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Cause(s) of Asthma (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the causes of asthma? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Asthma is a respiratory tract disorder characterized by chronic

inflammatory reversible airways obstruction.

• Involves the respiratory system constricting the airway

• Bronchial asthma may be either episodic (the patient has no respiratory

symptoms between episodes, or signs of asthma.

• Paroxysm of wheeze and dyspnoea may occur at any time and can be of

sudden onset

• May be extrinsic (this occurs to young people due to allergy) or

intrinsic (occurs in older people)

Causes

• The symptoms are caused by constriction of bronchial smooth muscle

(bronchospasm), oedema of bronchial mucous membrane and blockage of the

smaller bronchi with plug of mucous

• It can also be triggered by factors like allergens, infections, exercise,

tobacco smoke inhaled chemicals and drugs for example aspirin

• High risk jobs such as farming, painting, janitorial work and plastic

manufacturing

• Generally it can be caused by a complex interaction of environmental and

genetic factors

[pic][pic]Handout 38.1: Bronchial Asthma – Precipitating or Aggravating

Factors

STEP 3: Major Signs and Symptoms of Asthma (10 minutes)

• Signs and Symptoms of Asthma:

o Wheezing

o Productive cough

o Shortness of breath (dyspnoea)

o Chest tightness

o Increased respiratory rate

o Increased heart rate

o Diaphoresis (excessive sweating)

o Decreased exercise tolerance

Cough and wheeze are common during the night and may disturb sleep

STEP 4: Treatment of Asthma (10 minutes)

• Acute severe asthma and life threatening asthma in adult

o Perform pre-referral treatment:

▪ Nebulized salbutamol or inhaled salbutamol (if available)

▪ Hydrocortisone 200mg i.v slowly (if available)

▪ Aminophylline 250mg i.v slowly or tabs

▪ Monitor vital signs

o Refer to hospital immediately

• Treatment at the hospital

o Oxygen 40-60% via nasal prongs or face mask if available

o Nebulized salbutamol or inhaled salbutamol delivered by a spacer

o Hydrocortisone 200mg i.v slowly then oral prednisolone 30-60mg for 5-7

days

o Aminophylline 250mg i.v slowly or tabs when therapy above fails

STEP 5: Prevention and Control of Asthma (50 minutes)

|Activity: Small Group Discussion ( 10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the measures for the prevention and control of asthma? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Patient Education

• Should begin at the time of diagnosis and be revisited in every

subsequent consultation.

• Education involves the patient understanding the nature of asthma, the

practical skills necessary to manage asthma successfully for example

using inhaler devices and monitor the effect of treatment

• Patients should appreciate the differences between the reliever

medication (bronchodilator) and the controller medication (anti-

inflammatory)

Prevention of Asthmatic Attack

• Avoidance of exposure to allergen to which patients are sensitive to:

o Animal dander: Avoid contact with dogs, cats, horses or other animals.

o Feathers in pillows or quilts: Substitute latex foam pillows and

terylene quilts.

o Avoid all preparations of relevant drugs for example beta-blockers,

aspirin and other nonsteroidal anti-inflammatory drugs if the patient

is sensitive.

o Food: Identify and eliminate from diet.

o Industrial chemicals e.g. isocyanates, epoxy resins, perfumes: Avoid

exposure to chemical or change occupation.

o Do not smoke and avoid environmental smoke.

o Pollens: Try to avoid exposure to flowering vegetation and keep the

bedroom windows closed.

o Avoid exertion during high levels of pollution.

STEP 6: Key Points (5 minutes)

• Asthma can either be caused by a complex interaction of environmental and

genetic factors.

• Major signs and symptoms includes wheezing, shortness of breath

(dyspnoea) and chest tightness

• Severe bronchial asthma is an emergency which need urgent attention.

• Educating patients with bronchial asthma should start early when

diagnosis is established in order to carry out necessary precautions.

STEP 7: Evaluation (10minutes)

• What are the cause(s) of asthma?

• What are the major signs and symptoms of asthma?

• What is the treatment of asthma?

• What are the measures for prevention of asthma?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on how environmental and genetic factors cause |

|Asthma? |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine (6thed.).

Churchill: Livingstone

MoHSW. (2013). Standard Treatment Guidelines & National Essential

MedicinesList (4thed.). Dar es Salaam: MoHSW

Wikipedia. (2010). Asthma Before-After.Retrieved

fromhttp://en.wikipedia.org/wiki/File:Asthma_before-after.png

|[pic] |Handout 38.1: Bronchial Asthma – Precipitating or |

| |Aggravating Factors |

[pic]

Session 39: Identification of Patients with Allergic Rhinitis

Total Session Time: 60 minutes + 1 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Allergic Rhinitis

• Describe Mode of Transmission of Allergic Rhinitis

• Describe Major Signs and Symptoms of Allergic Rhinitis

• Explain Treatment Allergic Rhinitis

• Explain Prevention and Control Allergic Rhinitis

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Allergic Rhinitis (5 minutes)

Definition

• Allergic rhinitis is inflammation of the nasal membranes characterized by

a combination of the following symptoms:

o Sneezing

o Nasal congestion

o Conjunctival irritation

o Nasal and pharyngeal itching

o Lacrimation (rhinorrhea)

• Rhinitis is present if sneezing attacks, nasal discharge or blockage

occur for more than an hour on most days for:

o A limited period of the year (seasonal rhinitis-often called hay

fever)

o Throughout the whole year (perennial rhinitis)

Causes of Allergic Rhinitis

• Allergic rhinitis is caused by things that trigger allergies (allergens)

• These allergens can be found both outdoors and indoors

• When allergic rhinitis is caused by common outdoor allergens such as mold

or trees, grass and weed pollens

• Allergic rhinitis may also be triggered by allergens that are in your

house, such as animal dander (tiny skin flakes and saliva), indoor mold,

or the droppings of cockroaches or house dust mites.

STEP 3: Signs and Symptoms of Allergic Rhinitis (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the major signs and symptoms of allergic rhinitis? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Symptoms of Allergic Rhinitis

o Sneezing

o Itching (of nose, eyes, ears, and Palate)

o Rhinorrhea

o Postnasal drip

o Congestion

o Anosmia

o Headache

o Ear ache

o Tearing

o Red eyes

o Eye swelling

o Fatigue

o Drowsiness

o Malaise

STEP 4: Treatment of Allergic Rhinitis (10 minutes)

Antihistamines

• Antihistamines work well for treating allergy symptoms, especially when

symptoms do not happen very often or do not last very long.

• Antihistamines taken by mouth can relieve mild to moderate symptoms, but

can cause sleepiness e.g. Citerizine

• Azelastine is a nasal spray used to treat allergic rhinitis

Corticosteroids

• Nasal corticosteroid sprays are the most effective treatment for allergic

rhinitis.

• They work best when used for long term, but they can also be helpful when

used for

shorter periods

Decongestants

• Decongestants may also be helpful in reducing symptoms such as nasal

congestion.

• Nasal spray decongestants should not be used for more than 3 days.

STEP 5: Prevention and Control of Allergic Rhinitis (10 minutes)

Identify and avoid all triggers of allergic symptoms

STEP 6: Key Points (5 minutes)

• Allergic rhinitis is inflammation of the nasal membranes

• Allergic rhinitis is caused by allergens common in childhood, adolescence

and early adult hood

• Treatment depends on the type and severity of symptoms, age, and whether

there are other medical conditions (such as asthma)

• Prevention involves avoiding all triggering factors of your symptoms

STEP 7: Evaluation (5minutes)

• What is allergic rhinitis?

• What are signs and symptoms of allergic rhinitis?

• What is the treatment of allergic rhinitis?

• What is preventive and control measures of allergic rhinitis?

STEP 8: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation to be delivered to the class indicating |

|prevention and control of allergic rhinitis |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed)

Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine (6th ed.).

Churchill:

Livingstone

Swash, M. & Glynn, M. (2007). Hutchison’s Clinical Methods (22nded.).

London:

Harcourt Publishers Ltd.

Session 40: Prevention and Control of Contamination in Pharmaceutical

Settings

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Explain Sources of Contamination in Pharmaceutical Settings

• Explain The Consequences of Contamination on Pharmaceutical Products

• Describe Measures for Preventing and Controlling Contamination in

Pharmaceutical Settings

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Sources of Contamination in Pharmaceutical Settings (20 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are sources of contamination in pharmaceutical setting? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Microbiological contamination

Refers to non- intended or accidental introduction of infectious material

like bacteria, yeast, mould, fungi, virus, prions, protozoa or their toxins

and by-products

Sources of contamination in pharmaceutical settings

In manufacture/ compounding

• Regardless of whether manufacture takes place in industry or on a smaller

scale in the hospital pharmacy, the microbiological quality of the

ﬁnished product will be determined by:

o Formulation components used

o Environment in which they are manufactured

o Manufacturing process itself.

• Quality must be built into the product at all stages of the process and

not inspected at the end of manufacture or compounding. The following are

sources of contamination:

o Raw materials: particularly water and ingredients

o Processing equipment

o Cleaning equipment: Premises/environment

o Staff

o Packaging

In use

• Pharmaceutical manufacturers may argue that their responsibility ends

with the supply of a well- preserved product of high microbiological

standard in a suitable pack and that the subsequent use, or abuse, of

the product is of little concern to them.

• Products such as multi-dose may acquire contamination on their

continued use or if subjected in a contaminated state, particularly in

hospitals where it could result in the spread of cross – infection.

• Human sources:

o During normal usage, patients may contaminate their medicine with

their own microbial ﬂora; subsequent use of such products may or may

not result in self – infection.

o Topical products are considered to be most at risk, as the product

will probably be applied by hand, thus introducing contaminants from

the resident skin ﬂora of staphylococci,

o Micrococcus species and diphtheroids but also perhaps transient

contaminants, such as pseudomonas or coliforms, which would normally

be removed with effective hand- washing.

o A further potential source of contamination in hospitals is the

nursing staff responsible for medicament administration.

• Environmental sources:

o Small numbers of airborne contaminants may settle in products left

open to the atmosphere.

• Equipment sources:

o Patients and nursing staff may use a range of applicators (pads,

sponges, brushes and spatulas) during medicament administration,

particularly for topical products

o If reused, these easily become contaminated and may be responsible for

perpetuating contamination between fresh stocks of product, as has

indeed been shown in studies of cosmetic products.

STEP 3: Consequences of Contamination on Pharmaceutical Products (20

minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the consequences of contamination on pharmaceutical products? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Initiating infections

o Cross-contamination of medicines contributes to most of the

nosocomial infections occurring in hospitals

o It also accounts for most of the postsurgical infections and deaths

occurring in hospitals.

o Cross-contaminated medicines weaken the relationship between patients

and healthcare givers.

o This occurs mostly in the event of drug resistance and treatment

failure, but also infections due to contaminated medicines make

patients lose trust in their health care givers.

• Medicines spoilage

o This occurs by microorganisms chemically decomposing the active

ingredient or the excipients. This may lead to:

▪ The product being under- strength,

▪ Physically or chemically unstable, or possibly

▪ Contaminated with toxic materials.

• Financial loss

o Contaminated products have financial implications in terms of:

▪ additional treatment costs

▪ product recalls

▪ possible litigation/ legal action

▪ damage to the reputation of the manufacturer or compounder

STEP 4: Measures for Preventing and Controlling Contamination in

Pharmaceutical Settings (50 minutes)

|Activity: Small Group Discussion (10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the measures for preventing and controlling contamination in |

|pharmaceutical settings? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• Raw materials, particularly water and those ingredients of natural

origin, must be of a high microbiological standard.

• Water for pharmaceutical manufacture requires some further treatment,

usually by distillation, reverse osmosis or deionization

• Processing and compounding equipment should be subjected to planned

preventive maintenance and should be properly cleaned after use to

prevent cross – contamination between batches

• Cleaning equipment should be appropriate for the task in hand and should

be thoroughly cleaned and properly maintained.

o These are responsible for distributing organisms around the pharmacy

area.

o For example mops, buckets, cleaning cloths and scrubbing machines if

stored wet they provide a convenient niche for microbial growth.

• Manufacture should take place in suitable premises, supplied with

ﬁltered air, for which the environmental requirements vary according

to the type of product being made.

• Free – living opportunist pathogens, such as pseudomonas aeruginosa,

can normally be found in wet sites, such as drains, sinks and taps.

o This may be minimized by observing good manufacturing practices (GMP),

by installing heating traps in sink U – bends, thus destroying one of

the main reservoirs of contaminants

• Patients and nurses use a range of applicators (pads, sponges,

brushes, spatulas and spoons) during medicament administration,

particularly for topical and oral products.

• These should be made as disposable so as to minimise contamination.

• In busy wards:

o Hand – washing between attending to patients may be overlooked and

o Contaminants may subsequently be transferred to medicaments during

administration

o Emphasize use of non – touch techniques for medicament administration

• Staff involved in manufacture or compounding should not only have good

health but also a sound knowledge of the importance of personal and

production hygiene.

• They should dress appropriately and use protective gears such as boots,

coats, caps, gloves and masks in controlling contamination

• The end – products requires suitable packaging which will protect it from

contamination during its shelf- life and is itself free from

contamination.

• Sacking, cardboard, card liners, corks and paper are unsuitable for

packaging pharmaceuticals, as they are heavily contaminated.

o These have now been replaced by non -biodegradable plastic materials.

o Re-use of packaging materials should be discouraged.

o Effective control method includes the supply of products in individual

patient’s packs.

STEP 5: Key Points (5 minutes)

• Contamination of pharmaceutical products may occur during

manufacturing/compounding and use

• Consequences of medicine contamination include; initiation of infections,

products spoilage and financial loss

• It is important to use different preventive measures for controlling

contamination in pharmaceutical settings in order to minimize the risks

of contamination.

STEP 6: Evaluation (10 minutes)

• What are the sources of contamination in pharmaceutical settings?

• What are the consequences of contamination on pharmaceutical products?

• What are the measures for preventing and controlling contamination in

pharmaceutical settings?

STEP 7: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Visit a hospital pharmacy department, basing on its design/set up; |

|write a presentation on factors responsible for contamination of |

|pharmaceutical products and give suggestions on what should be done to |

|avoid the consequences of contamination. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Denyer, P. D, Hodges, N. Gorman, S. P. & Gilmore, B. F. (2011). Hugo &

Russell’sPharmaceutical Microbiology. (8thed.). West Sussex:Blackwell

Publishing Ltd,

Gabriel J (2008). Infusion therapy: Prevention and management of

complications. Nurs Stand.; 22(32): 41-48

Senya, S., Mwasha, C.Y.S, Muyinga, A.M, Amir, R.I, & Mauga, E.A.S.K, (2011)

Tanzania Pharmaceutical Handbook. (2nded.). Dar es Salaam: ARU Printing

Unit

Session 41: Methods for Disposing Pharmaceutical Wastes

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Terminologies Applied in Disposal of Pharmaceutical Wastes

• Describe Categories of Healthcare Wastes

• Describe Principles of Waste Management

• Describe Methods for Disposal of Pharmaceutical Wastes

• Explain Consequences of Improper Disposal of Pharmaceutical Wastes

• Describe Procedure for Safe Disposal of Unfit Medicines as per Tanzania

Foods, Drugs and Cosmetics Act, 2003

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD

• Handout 41.1: Categories of Health Care Wastes

• Handout 41.2: Category of products and their recommended disposal methods

SESSION OVERVIEW

|7 | 10 |Presentation |Procedure for Safe Disposal of Unfit|

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Terminologies Applied in Disposal of Pharmaceutical Wastes (5

minutes)

• Pharmaceutical waste includes expired, unused, spilt, and contaminated

pharmaceutical products, drugs, vaccines, and sera that are no longer

required and need to be disposed of appropriately.

• The category also includes discarded items used in the handling of

pharmaceuticals, such as bottles or boxes with residues, gloves, masks,

connecting tubing, and drug vials.

• Also medicines and cosmetic products are considered as unfit when they

are:

o Improperly sealed

o Damaged

o Unexpired and improperly stored

o Improperly labelled

o Counterfeit

o Substandard and adulterated

o Prohibited and unauthorized

STEP 3: Categories of Health Care Wastes (20 minutes)

|Activity: Brainstorming (10 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the categories of healthcare wastes? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Classification of HCW

[pic]

Source: WHO. National Health-Care Waste Management Plans in Sub-Saharan

Countries. Guidance Manual (1999).

[pic][pic]Refer students to Handout 41.1: Categories of Health Care

Wastes for further reading

STEP 4: Principles of Waste Management (10 minutes)

Pharmaceutical waste

• Pharmacy department stores in each health care facility should be

rigorously managed to reduce the generation of pharmaceutical waste.

Especially, stocks of pharmaceuticals should be inspected periodically

and checked for their durability (expiration date). Stock positions

should be recorded on a regular basis.

Pharmaceutical waste

• Pharmacy department stores in each health care facility should be

rigorously managed to reduce the generation of pharmaceutical waste.

Especially, stocks of pharmaceuticals should be inspected periodically

and checked for their durability (expiration date). Stock positions

should be recorded on a regular basis.

• These wastes usually arise at central locations, i.e. in pharmacies

and laboratories and they are also often found at places where the

ready-to-use cytotoxic solutions are prepared.

• The precautions taken during the use of cytotoxic pharmaceuticals must

also be applied on their journey outside the respective establishment,

as releases of these products can have adverse environmental impacts.

The management of these wastes, in covered and impermeable containers,

must be strictly controlled. Solid containers must be used for

collection. The use of coded containers is recommended. For reasons

of occupational safety, cytotoxic pharmaceutical wastes must be

collected separately from pharmaceutical waste and disposed in a

hazardous waste incineration plant.

STEP 5: Methods for Disposal of Pharmaceutical Wastes (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the methods for disposal of pharmaceutical wastes? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Disposal Methods

• Landfill

o Involves placing unfit medicines and cosmetic products directly into a

land disposal site without prior treatment.

o The method is used in disposing off solid waste.

o Small quantities of unfit medicines and cosmetic products produced on

a daily basis may be land filled provided that they are dispersed in

large quantities of general waste.

o Cytotoxic, narcotic drugs and cosmetic products containing heavy

metals such as mercury should not be land filled, even in small

quantities.

Types of landfill methods

• There are three types recognized as outlined below:

o Landfill for untreated unfit medicines and cosmetic products

o The method is applicable to small quantities of unfit medicine and

cosmetic products. It involves placing untreated waste medicine and

cosmetic into an uncontrolled, non-engineered open dump. The unfit

medicine and cosmetic products should be covered immediately with

large quantities of other type of waste or soil/sand to prevent

scavenging by unscrupulous people.

▪ Discarding of untreated unfit medicine and cosmetics into such a

site is not recommended except as a last resort. They should

preferably be discharged after immobilization by encapsulation or

inertization.

o Discarding in open uncontrolled dump with insufficient isolation from

the aquifer or other watercourses can lead to pollution, with the risk

of drinking water contamination in the worst cases.

o The disposal exercise should be done amid tight security by Police and

be supervised by technical personnel. This method is applicable to

solids, semi-solids, powders, medicines, waste dosage forms and

cosmetics.

• Engineered landfill

Such landfill has some features to protect from loss of chemicals into the

aquifer. Direct deposit of medicines and cosmetics is second best to

discharging immobilized unfit medicines and cosmetic products into such a

landfill.

• Highly engineered sanitary landfill

Properly constructed and operated landfill sites offer relative safe

disposal route for unfit medicines and cosmetic products. An appropriate

landfill consists of an evacuated pit isolated from watercourses and which

is above water table. Once unfit medicine and cosmetic products are thrown

into the pit, they are compacted and covered with soil to maintain sanitary

environment.

• Landfill for treated unfit medicines and cosmetics (medicines and

cosmetics waste immobilization)

Immobilization of unfit medicine and cosmetics can be done in the following

ways:

2. Encapsulation

In this process waste medicines and cosmetics are immobilized in a solid

block within a plastic or steel drum. The drum should be cleaned before

using them and they should not have contained explosive or hazardous

materials previously.

The exercise starts by filling the drum to 75% of their capacity with solid

and semi-solid waste medicines and cosmetics. The remaining space is filled

by pouring in a medium such as cement or cement-lime mixture, plastic foam

or bituminous sand.

For ease and speed of filling, the drum lids should be cut open and bent

back. Once the drums are filled to 75% capacity, the mixture of lime,

cement and water in the proportions 15:15: 5 (by weight) is added and drum

filled to capacity.

Steel drum lids should then be bent back and sealed by seam or spot

welding. The sealed drum lids should be placed at the base of a landfill

site and covered with fresh municipal solid waste. The method is

applicable to solids waste, semi-solids, powders, and liquids

3. Inertization

The method involves removing the packaging materials (inner and outer

container). The unfit medicines and cosmetics are then ground and a mix of

water, cement and lime added to form a homogenous paste. The paste is then

transported in liquid state by concrete mixer truck to a landfill site and

decanted into a normal municipal waste. The paste then sets as a solid mass

dispersed within the municipal solid waste.

The main tools required for the operation are a grinder or road roller to

crush the medicines/cosmetics, concrete mixer, cement, lime and water.

Medicines or cosmetics waste, lime, cement and water are mixed in the

following ratios by weight 65%, 15%, 15% and 5% respectively. Water can be

added more than the required amount when need arises to have satisfactory

liquid consistency.

The method is applicable to solids, semi-solids, powders, antineoplastics

controlled drugs of that nature and cosmetics containing heavy metals (e.g.

mercury).

4. Sewer

This is a method used whereby waste medicines and cosmetic products in

liquid form e.g. syrups, lotions and intravenous fluids are diluted with

water and flushed into a proper functioning sewerage system/sewers in small

quantities over a period of time without causing serious public health or

environmental effect. Fast flowing watercourses may likewise be used to

flush small quantities of well-diluted liquid medicines/cosmetics or

antiseptics.

5. Medium temperature incineration

This method involves the use of medium temperature incinerators. Unwanted

solid pharmaceuticals may be destructed by using a two-chamber incinerator

that operates at the minimum temperature of 8500C, with a combustion

retention time of at least two seconds in the second chamber. It is

recommended that prior to destruction; pharmaceutical waste should be

diluted with large quantities of municipal waste (approximately 1:1000).

Medium temperature furnaces may be used in absence of medium temperature

incinerators. This type of incinerator is not suitable for incineration of

halogenated compounds, as they need a more high temperature incinerator.

The method is applicable to solids, semi-solids, powders and controlled

drugs of that nature.

6. High temperature incineration

This involves the use high temperature incinerator, which operates at a

temperature well in excess of 8500C. Our country does not possess such

expensive and sophisticated incinerators so the uses of industrial plant

such as cement kilns serve the purpose. Cement kilns can reach temperatures

of 14500C – 20000C that is suitable for total destruction of organic waste

component. These have long combustion retention times and disperse exhaust

gases via tall chimneys, often to high altitudes thus reducing the risk of

environmental effect.

It may be necessary prior to incineration to remove packaging materials to

avoid clogging and blockage of incinerator or kiln.

7. Burning in open containers

Paper and cardboard packaging materials, if they are not to be recycled,

may be burnt. Polyvinyl Chloride (PVC) plastic however must not be burnt.

Unfit medicines and cosmetics should not be destroyed by burning at low

temperatures in open containers, as toxic pollutants may be released into

the air. It is strongly recommended that only very small quantities of

unfit medicines and cosmetics be disposed of in this way.

8. Return to donor or manufacturer

Wherever practical the possibility of returning unfit medicines and

cosmetic products for safe disposal by the manufacturer should be explored;

particularly medicines and cosmetics which present problems, such as

antineoplastics and heavy metals. For unwanted, unrequested donations,

especially that arrive with past or unreasonably expiry dates, it may be

possible to return them to the donor for disposal.

[pic] Refer students to Handout 41.2: Category of products and their

recommended disposal methods for further reading.

STEP 6: Consequences of Improper Disposal of Pharmaceutical Wastes (15

minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the consequences of improper disposal of pharmaceutical |

|wastes? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

In general, improper disposal of pharmaceutical wastes and unfit

medicines and cosmetics presents a serious threat to public health. Some

of the health risks are;

• Contamination of drinking water.

• Non-biodegradable antibiotics, antineoplastics and disinfectants may

kill bacteria necessary for the treatment of sewage.

• Burning medicines and cosmetics at low temperatures or in open

containers results in release of toxic pollutants into the air which

should ideally be avoided.

• Inefficient and insecure sorting and disposal may allow medicines and

cosmetics beyond their expiry dates to be diverted for resale to the

general public.

• In the absence of suitable disposal sites, if stored in their original

packing there is a risk of diversion.

STEP 7: Procedure for Safe Disposal of Unfit Medicines as per Tanzania

Foods, Drugs and Cosmetics Act, 2003 (10 minutes)

Disposal of unfit medicines and cosmetic products shall involve the

following procedures:

1. A Drug Inspector, Health Officer, Environmental Officer and Policeman

shall supervise the transport of consignment from the owner’s premises to

the disposal site for destruction exercise.

2. The destruction exercise shall be supervised by Health Officer,

Environmental Officer, Policeman and Drug Inspector.

3. Unfit medicines and cosmetic products shall be transported in a closed

motor vehicle to avoid pilferage.

4. Supervisors shall wear protective gears such as overalls, gloves, masks,

caps and boots during the exercise.

5. Upon completion of the exercise, a Drug Disposal Form shall be duly

filled in and signed by the supervisors and owner/owner’s representative.

6. Drug Disposal Form shall be sent to TFDA headquarter offices.

7. Once TFDA has received the form, a certificate of destruction of unfit

medicines and cosmetic products shall be prepared and sent to the

consignee.

8. Particular care shall be taken while handling anti- cancer drugs,

narcotic drugs and penicillins to avoid associated hazards.

STEP 8: Key Points (5 minutes)

• Pharmaceutical waste includes expired, unused, spilt, and contaminated

pharmaceutical products and drugs that are no longer required and need to

be disposed of appropriately

• Stocks of pharmaceuticals should be inspected periodically and checked

for their durability (expiration date) in order to minimize amount of

wastes.

• Improper disposal of pharmaceutical wastes and unfit medicines and

cosmetics presents a serious threat to public health.

• Procedure for safe disposal of unfit medicines as per Tanzania Foods,

Drugs and Cosmetics Act, 2003 should be adhered in order to get away from

consequences involved.

STEP 9: Evaluation (10 minutes)

• What is the pharmaceutical wastes?

• What are the categories of healthcare wastes?

• What are the principles of waste management?

• What are the methods for disposal of pharmaceutical wastes?

• What are the consequences of improper disposal of pharmaceutical wastes?

• What is the procedure for safe disposal of unfit medicines as per

Tanzania Foods, Drugs and Cosmetics Act, 2003?

STEP 10: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Basing on Handout 41.1, prepare a presentation on pharmaceutical |

|wastes, giving specific examples of wastes on each category that is |

|found in their pharmaceutical setting. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

TFDA. (2009). Guidelines for safe disposal of unfit medicines and cosmetic

products(1sted). Dar-es- salaam: MoHSW

WHO (1999).National Health-Care Waste Management Plans in Sub-Saharan

Countries

Guidance Manual. Geneva.WHO

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO

|[pic] |Handout 41.1: Categories of Health Care Wastes |

A. Non-risk HCW: includes all the waste that has not been infected like

general office waste, packaging or left over food. They are similar to

normal household or municipal waste and can be managed by the

municipal waste services. Three groups can be established:

A1. Recyclable waste: It includes paper, cardboard, non-

contaminated plastic or metal, cans or glass that can be recycled if any

recycling industry exists in the country.

A2. Biodegradable waste: This category comprises for instance,

left over food or garden waste that can be composted.

A3. Other non-risk waste: all the non-risk waste that do not

belong to categories A1 and A2.

B. Biomedical and health-care waste requiring special attention:

B1. Human anatomical waste: This category comprises non-infectious

human body parts, organs and tissues and blood bags. Examples of such

wastes: tissue waste, removed organs, amputated body parts and

placentas

B2. Waste sharps: Sharps are all objects and materials that are

closely linked with health-care activities and pose a potential risk

of injury and infection due to their puncture or cut property. For

this reason, sharps are considered as one of the most hazardous waste

generated and they must be managed with the utmost care. Examples of

such wastes: all types of needles, broken glassware, ampoules, scalpel

blades, lancets, vials without content

B3. Pharmaceutical waste: This category comprises expired

pharmaceuticals or pharmaceuticals that are unusable for other

reasons. They are divided into three classes:

B3.1 Non-hazardous pharmaceutical waste: This class includes

pharmaceuticals such as chamomile tea or cough syrup that pose no

hazard during collection, intermediate storage and waste management.

They are not considered hazardous wastes and should be managed jointly

with municipal waste.

B3.2 Potentially hazardous pharmaceutical waste: This class

embraces pharmaceuticals that pose a potential hazard when used

improperly by unauthorized persons. They are considered as hazardous

wastes and their management must take place in an appropriate waste

disposal facility.

B3.3 Hazardous pharmaceutical waste: This comprises heavy metal

containing and unidentifiable pharmaceuticals as well as heavy metal

containing disinfectants, which owing to their composition require

special management. They must be considered as hazardous wastes and

their management must take place in an appropriate waste disposal

facility.

B4. Cytotoxic pharmaceutical waste: these can arise by use

(administration to patients), manufacture and preparation of

pharmaceuticals with a cytotoxic (antineoplastic) effect. These

chemical substances can be subdivided into six main groups: alkylated

substances, antimetabolites, antibiotics, plant alkaloids, hormones,

and others. A potential health risk to persons who handle cytotoxic

pharmaceuticals results above all from the mutagenic, carcinogenic and

teratogenic properties of these substances. Consequently, these wastes

pose a hazard, and the measures to be taken must also include those

required by occupational health and safety provisions. Examples of

such wastes: Discernible liquid residues of cytotoxic concentrates,

post-expiration-date cytotoxic pharmaceuticals and materials proven to

be visibly contaminated by cytotoxic pharmaceuticals must be disposed

of as cytotoxic pharmaceutical waste.

B5. Blood and body fluids waste: these are wastes that are not

categorized as infectious waste but are contaminated with human or

animal blood, secretions and excretions. It is warranted to assume

that these wastes might be contaminated with pathogens. Examples of

such wastes: Dressing material, swabs, syringes without needle,

infusion equipment without spike, bandages

C. Infectious and highly infectious waste: Special requirements

regarding the management of infectious wastes must be imposed whenever

waste is known or – based on medical experience – expected to be

contaminated by causative agents of diseases and when this

contamination gives cause for concern that the disease might spread.

In this category two groups can be considered depending on the degree

of infectiousness that is expected.

C. 1 Infectious waste: This class comprises all biomedical and health-

care waste known or clinically assessed by a medical practitioner or

veterinary surgeon to have the potential of transmitting infectious

agents to humans or animals. Waste of this kind is typically generated

in the following places: isolation wards of hospitals; dialysis wards

or centers caring for patients infected with hepatitis viruses (yellow

dialysis); pathology departments; operating theatres; medical

practices and laboratories which mainly treat patients suffering from

the diseases specified above. It includes: Discarded materials or

equipment contaminated with blood and its derivatives, other body

fluids or excreta from clinically confirmed infected patients or

animals with hazardous communicable diseases. Contaminated waste from

patients known to have blood-borne infections undergoing haemodialysis

(e.g. dialysis equipment such as tubing and filters, disposable

sheets, linen, aprons, gloves or laboratory coats contaminated with

blood); Carcasses as well as litter and animal faeces from animal

test laboratories, if transmission of the above-mentioned diseases is

to be expected. Examples of such wastes: Blood from patients

contaminated with HIV, viral hepatitis, brucellosis, Q fever. Faeces

from patients infected with typhoid fever, enteritis and cholera.

C2. Highly infectious waste: It includes all microbiological cultures

in which a multiplication of pathogens of any kind has occurred. They

are generated in institutes working in the fields of hygiene,

microbiology and virology as well as in medical laboratories, medical

practices and similar establishments; laboratories. Examples of such

wastes: Sputum cultures of TB laboratories, contaminated blood clots

and glassware material generated in the medical analysis laboratories,

high concentrated microbiological cultures carried out in medical

analysis laboratories.

D. Other hazardous waste: This category of waste is not exclusive to the

health-care sector. They include: gaseous, liquid and solid chemicals,

waste with high contents of heavy metals such as batteries and

pressurized containers. Chemical waste consists of discarded chemicals

that are generated during disinfecting procedures or cleaning

processes. Not all of them are hazardous but some have toxic,

corrosive, flammable, reactive, explosive, shock sensitive, cyto- or

genotoxic properties. Examples of such wastes: thermometers, blood-

pressure gauges, photographic fixing and developing solutions in X-ray

departments, halogenated or non-halogenated solvents, organic and in-

organic chemicals.

E. Radioactive health-care waste: this includes liquids, gases and

solids contaminated with radionuclides whose ionizing radiations have

genotoxic effects. The ionizing radiations of interest in medicine

include X and γ-rays as well as α- and β- particles

[pic] Handout 41.2: Category of products and their recommended disposal

methods

|S/N |Category |Disposal methods |

|1. |Solids, semi-solids and powders|Landfill, incineration and waste|

| | |immobilization |

|2. |Liquids |Sewer, high temperature |

| | |incineration and treated waste |

|3. |Antineoplastics |Treated waste and landfill, high|

| | |temperature incineration and |

| | |return to manufacturer |

|4. |Controlled Drugs |Treated waste and landfill, high|

| | |temperature incineration |

|5. |Aerosols and inhalers |Landfill without waste |

| | |inertization |

|6. |Disinfectants |Sewer or fast-flowing |

| | |watercourse |

|7. |PVC plastics, glass (ampoules, |Landfill and re-cycling |

| |bottles and vials) | |

|8. |Paper, cardboard |Recycle, burn, landfill |

Session 42: Introduction to Human Nutrition

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Sources of Different Food Substances

• Describe the Composition of each Class of Food (Carbohydrates, Proteins,

Fats And Oils, Vitamins And Minerals)

• Define Balanced Diet and Explain its Importance to Human Health

• Differentiate Between Fat Soluble and Water Soluble Vitamins

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD projector

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Sources of Different Food Substances (15 minutes)

|Activity: Brainstorming (5 minutes) |

|Ask students to brainstorm on the following question: |

|What are sources and classes of different food substances? |

|ALLOW few students to respond |

|WRITE their responses on the flip chart/ board |

|CLARIFY and SUMMARISE by using the content below |

Important terms

• Food: is what is eaten or taken into the body by parenteral routes for

the purpose of nourishing the body.

o Foods contain elements called nutrients.

• Nutrients: are a variety of chemical substances that, in nature, form

part of food. Nutrients are not the same, they can be quite be different

from one another.

• Nutrition: is the term standing for the sum of all processes involved in

food intake, assimilation and utilization by the body.

o Food must be available and accessible for consumption

o Body ingests, rearranges, assimilates and utilizes the nutrients

consumed in food, for the purpose of:

▪ Production of energy

▪ Growth

▪ Functioning of organs and systems

▪ Maintenance of life.

• Nutritional status: is the result of the body’s nutrient intake and

utilization, which may be good or bad.

• Malnutrition: literally means ‘bad nutrition’.

o It means any deviation from normal nutrition.

o Can be either under-nutrition or over-nutrition

Sources of different food substances

The main sources of different food substances are:

• Cereals: For example maize, rice, millet, wheat and sorghum

• Pulses: For example lentils, beans, soya beans and peas

• Nuts: groundnuts and cashew nuts

• Vegetables:

o Green leafy vegetables: cabbage, cauliflower, spinach and lettuce

o Roots and tubers: yams, cassava, potatoes, sweet potatoes, carrots and

beetroots

o Other vegetables: ladiesfingers, brinjals, pumpkins, green peas

• Fruits: pawpaws, mangoes, oranges, banana, tangerines, pineapples as

well as wild fruits such as baobab fruits and tamarind

• Foods of animal origin: meat, fish, eggs, milk and milk products

• Sugar, Honey, Fats and Oils

o Examples of fats and oils are:

▪ Ghee

▪ Butter

▪ Coconut oil

▪ Margarine

▪ Sunflower

▪ Palm oil

STEP 3: The Composition of each Class of Food (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is the composition of classes of food? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Carbohydrates

• These are organic compounds composed of the elements carbon, hydrogen and

oxygen.

• Carbohydrates provide the main source of energy for the body.

• Carbohydrates are classified as:

o Monosaccharide (glucose, fructose, galactose and mannose) are the

simplest carbohydrates.

o For their absorption they can pass through the wall of the alimentary

tract without being changed by digestive enzymes.

o Disaccharides (sucrose, maltose and lactose) and oligosaccharides are

also simple carbohydrates.

▪ These have to be converted by the body into monosaccharides

before they can be absorbed from the alimentary tract.

o Polysaccharides, also called complex carbohydrates, are chemically the

most complicated carbohydrates. Examples are starch, cellulose and

glycogen.

▪ These are long chain molecules in which a large number of

monosaccharides are combined.

Lipids

• These are organic compounds made of the elements carbon, hydrogen and

oxygen but in different proportions and different structural arrangements

• Fats and oils provide the body with fuel with very high efficiency

• Dietary lipids transport the fat-soluble vitamins (vitamin A, D, E and K)

• Absorption of these vitamins does not take place very efficiently in the

absence of fat

• Lipids that are solid at room temperature (butter, beef fat) are referred

to as ‘fats’

• Lipids that are in liquid at room temperature are referred to as ‘Oils’

Proteins

• Proteins are organic molecules that contain the elements carbon,

hydrogen, oxygen and nitrogen.

• Frequently proteins contain sulphur and phosphorus and less frequently,

other elements such as iron, copper and iodine

• Nitrogen is the element characteristic of all amino acids and therefore

of proteins

• Amino acids are classified into two groups:

o Those amino acids which cannot be synthesized in the human body (or

synthesized in inadequate amounts) are termed essential.

o Those which can be synthesized in the body are non-essential amino

acids.

Importance of Protein in Nutrition

• Necessary for growth, development and repair of the body.

• Main structural constituents of the cells and tissues making up the

greater proportion muscles and organs.

• For producing metabolic and digestive enzymes

• Constituent of certain hormones such as thyroid hormones and insulin.

• Amount exceeding the requirement for growth, cell and fluid replacement

and other metabolic functions is used to provide energy

• The body obtains this energy by changing the protein into carbohydrate

Vitamins

• Vitamins are organic compounds that perform specific metabolic functions

in the body Most of them are not synthesized in the body, must be

provided by dietary sources

• Vitamins, unlike carbohydrates, lipids and proteins, do not produce

energy.

• Vitamins differ widely from one another in terms of chemical structure

and biological functions

Minerals

• Minerals are naturally occurring, inorganic, homogenous substances.

• These substances are very important to keep the human body in a balancing

working order

• Minerals are constituents of the bones, teeth, soft tissue, muscle,

blood, and nerve cells.

• Minerals act as catalysts for many biological reactions within the body

• Mineral classification:

o Major minerals includes:

▪ Calcium

▪ Iron

▪ Sodium

▪ Potassium

▪ Magnesium

▪ Phosphorus

▪ Sulfur

o Trace minerals are:

▪ Zinc

▪ Copper

▪ Cobalt

▪ Manganese

▪ Iodine

▪ Chromium

▪ Chloride

▪ Fluoride

Water

• This is an essential component of healthy diet. About 60-70% of the total

body weight of a person is water

• It is important for transport of nutrients, removal of waste and assists

in metabolic activities of all cells and provides lubrication to moving

parts of the body and assist in regulating body temperature.

• Clean and safe water is essential for avoiding water-borne and water

related diseases.

• Water requirement of a person varies with climate, age, activity,

dietetics habits and body build.

STEP 4: Balanced Diet and Explain its Importance to Human Health (40

minutes)

|Activity: Small Group Discussion (10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What is balanced diet? |

|What is the importance of balanced diet to human health? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Balanced diet

• A diet that contains the proper proportions of carbohydrates, fats,

proteins, vitamins, minerals, and water necessary to maintain good

health.

• A balanced meal should contain at least one food from each of the food

groups

• Balanced diet is important for growth and development

[pic]

Figure 1: Nutrition and Diseases: Vicious Cycle

STEP 5: Fat Soluble and Water Soluble Vitamins (10 minutes)

Classification of Vitamins

• Fat soluble vitamins are vitamins A, D, E and K.

• They are soluble in fats and fat solvents

• They are utilized only if there is enough fat in the body.

• They have the following general properties:

o Consist of carbon, hydrogen and oxygen

o They are relatively stable during:

▪ Processing,

▪ Preservation

▪ Preparation

o They are stored in the liver and fatty deposits of the body therefore

do not have to be consumed on daily basis

o If consumed in excess can produce toxicity

• Water-soluble vitamins are vitamins C, folic acid and the B vitamins.

• They cannot be stored in the body therefore, a day to day supply is

essential

STEP 6: Key Points (5 minutes)

• The main sources of different food substances are: cereals, nuts, pulses

and vegetables

• The major nutrients in the bodies are carbohydrates, proteins, lipids,

vitamins and minerals.

• Balanced diet is important for growth and development

• Balanced diet contains the proper proportions of carbohydrates, fats,

proteins, vitamins, minerals, and water

• Water soluble vitamins are soluble in water whereas fat soluble are not.

STEP 7: Evaluation (5 minutes)

• What are sources and classes of different food substances?

• What is the composition of each class of food?

• What is balanced diet?

• What is the importance of balanced diet to human health?

• What is the difference between fat soluble and water soluble vitamins?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Explain how water requirement of a person varies with climate, age, |

|activity, dietetics habit and body build |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva:

WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing

Countries.(2nded.) Oxford: Felicity Oxford University Press.

Kumar, P. & Clark, M. (2006).Clinical Medicine.(6thed.) Phidalephia:

Elsevier Limited.

Latham, M. C (1997).Human Nutrition in the Developing World.David Lubin

Memorial Library.

McLaren, S. (1992).A Colour Atlas and Text of Diet-Related

Disorders.(2nded.) Aylesbury: BPCC Hazells Ltd

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd.

Rev.ed.) New Delhi: Sterling Publishers Private Ltd

Tanzania Food and Nutrition Centre.(2009). National Guidelines for

Nutrition Care and Support for People Living with HIV.(2nded.) Dar es

Salaam: TFNC

Session 43: Managing Patients with Nutritional Deficiency Diseases

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Common Nutritional Deficiency Diseases

• Describe Management of Nutritional Deficiency Diseases

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and LCD projector

• Handout 43.1

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Common Nutritional Deficiency Diseases (50 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the common nutritional deficiency diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Malnutrition

• Can occur at any time in the life cycle

• When it occurs early in life, irreversible damages can be done to the

body and brain

• Affects a significant proportion of populations, presenting as macro

and or micronutrient deficiency disorders

• Nutrition disorder means any kind of disorder caused by eating too

little or too much of one or more different nutrients

Classification of Malnutrition

• Can be classified in different ways but most commonly as under

nutrition or over nutrition

o Under Nutrition occurs when nutrients intake does not meet nutrients

needs

o Many nutrients are in high demand due to the constant state of cell

lose and later regeneration in the body

o Over nutrition is prolonged consumption of more nutrients than the

body needs

Protein Energy Malnutrition (PEM)

• A deficiency of energy and protein which results in body wasting,

• Occurs more frequently in infants and young children but is also

observed in adolescents and adults

• Severe forms of PEM are Kwashiorkor and Marasmus

Kwashiorkor

• Caused by failure to provide an adequate dietary sources of protein

to substitute for the protein

• Signs and symptoms includes:

o failure of growth but the child is not severely wasted,

o swollen abdomen,

o hair changes (hair becomes brown, straight and soft)

o skin rashes,

o child becomes inactive, apathetic, irritable and is difficult to feed,

o oedema of lower limbs

Marasmus

• Causes: severe loss or chronic waste of fat, muscles and other tissues of

the body. The disease occurs due to shortage of basic nutrition,

proteins, vitamins and calories to the body. It is inadequate energy

intake in all forms, including protein.

• Signs and Symptoms of Marasmus: remarkable failure of growth, severe

muscle wasting with flaccid, wrinkled skin and bony prominence, the child

looks awake and hungry and displays what is referred to as ‘old person’s

face and oedema is absent

Prevention of PEM

• The different strategies may include:

o Incorporating nutrition objectives into development of policies and

programmes

o Improving household food security

o Protection and promotion of good health

o Improving the quality and safety of foods

o Protect and promote breastfeeding and complementary feeding

o Early treatment of common diseases

o Immunization

o Growth monitoring

o Promoting appropriate diets and healthy lifestyles

Vitamins and Minerals Nutritional Deficiencies

Vitamin A Deficiency

• It plays important roles in the body including vision, maintenance of

epithelial tissue, and synthesis of mucous secretion, growth,

reproduction and immunity.

• The organ that is most readily affected is the eye

Symptoms and Signs:

• Night blindness (Reduced ability to see in dim light)

• Conjunctival xerosis/ drying

• Corneal xerosis/drying,

• Xerophthalmic fundus (retina has white dots).

• Keratomalacia: Perforation of the cornea prolapsed of the iris, loss

of ocular contents and perhaps destruction of the eye.

Vitamin B1 Deficiency (Beriberi):

• Occurs when people consume highly milled polished rice or maize, and

starchy roots such as cassava, which are deprived of thiamine content

Signs and Symptoms:

• Heart palpitation, chest pain.

• Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and

distended neck veins with visible pulsations

• The heart is found to be enlarged

• Cyanosis

• Increased oedema

• Severe dyspnoea

• Acute circulatory failure and death

• The patient is thin with weak, wasted muscles Anaesthesia and ‘pins-and-

needles’ feelings in the feet and arms may increase, eventually causing

difficulty in walking

• Foot drop and wrist drop commonly occur

Vitamin B2 (Riboflavin) Deficiency (Beriberi)

Sign and symptoms:

• Angular stomatitis

• Glossitis

• Skin changes

• Seborrheic dermatitis

• Vascularization of the cornea

Vitamin B3 (Niacin) Deficiency (Pellagra):

• It is generally associated with maize diet

• Early Symptoms of Pellagra: A person appears poorly malnourished,

often weak and underweight. A person may also have diminished

sensitivity to gentle touch and sometimes some muscular weakness and

tremor. Untreated cases of pellagra may die of the disease

• The disease is later characterized by the three ‘Ds’:

o Dermatitis: deepening of the pigmentation, dry skin, scaly and

eventual cracked, desquamation, occasionally the skin may blister, the

tongue and other parts of the mouth are often sore, red, smooth and

raw-looking

o Diarrhoea: a patient with pellagra may frequently have bouts of

abdominal pain, diarrhoea and other digestive upsets. The upsets

include nausea, excessive salivation, and a burning sensation in the

epigastrium.

o Dementia: this involves the effect of pellagra in nervous system which

brings about Irritability, loss of memory, anxiety and insomnia

Vitamin C Deficiency (Scurvy):

• Ascorbic acid is essential for the formation of intercellular collagen

and hence for the development of cartilage, bone and teeth and for the

healing of fractures and wounds.

Symptoms and Signs:

• The walls of blood vessels lack solidity and become fragile and

bleeding or haemorrhage from various sites results. Other

haemorrhages include nosebleeds, blood in the urine or faeces

• Moderate deficiency of vitamin C may result in poor healing of wounds.

People who do not eat enough vitamin C may not absorb enough iron and

may develop iron deficiency anaemia especially in pregnancy

• Tiredness and weakness

• Swollen gums which bleed easily at the base of the teeth

• In the skin – follicular hyperkeratosis, skin bruising haemorrhages

and broken coiled hair

• Swollen painful joints particularly of the knees, hip and elbow also

pain in all muscles

• Loss of secretion of lachrymal and salivary glands, loss of hair,

dryness of the skin and loss of dental fillings.

• Beading of the ribs

Vitamin D Deficiency (Rickets and Osteomalacia)

• The main feature of both rickets and osteomalacia is lack of calcium in

the bones.

• Rickets occurs in children whose bones are still growing. Often children

are plump and appear well fed

• Osteomalacia occurs in adults who have formed bones. Both conditions are

caused mainly by a deficiency of vitamin D, and not by a dietary lack of

calcium.

Symptoms and Signs of Rickets:

• Child tends to be miserable

• Flabby (toneless state of muscles that causes a pot-belly)

• Impairment of normal development

• Gastro-intestinal upset and excessive sweating of the head

• The main signs of the disease are bone deformation

Vitamin E Deficiency

• It is not common among human beings as it is widely distributed in foods.

Signs and symptoms:

• Muscular dystrophy

• Paralysis

• Impaired fat absorption

• Haemolytic anaemia in babies after delivery

• Liver necrosis, erythrocyte haemolysis and anaemia in adults

Vitamin K Deficiency (haemorrhagic disease)

• Dietary deficiency is not common. Deficiency occurs due to deficient

production of it by the gut, with prolonged antibiotic therapy, due to

poor absorption of vitamin K, in malabsorption of fat and due to low

prothrombin synthesis in liver disease

Signs and symptoms:

• Tendency to bleed from skin and mucous membranes

Anaemia

• Anaemia is a pathological condition arising as a result of low level of

haemoglobin which impairs oxygen transport to the tissues. There are

various types of Anaemia such Haemorrhagic, haemolytic and nutritional

Anaemia.

• Nutritional anaemia is due to deficiency of nutrients that are needed for

the synthesis of red blood cells: iron, folic acid and vitamin B12.

• Thus nutritional anaemia includes: Iron deficiency anaemia, Folic acid

deficiency anaemia and Vitamin B12 deficiency anaemia.

Iron Deficiency Anaemia (IDA)

Symptoms and Signs

• Tiredness and fatigue

• Dizziness and/or headaches

• Palpitations

• Difficulty in breathing on exertion

• Inadequate temperature regulations

• Mild degree of splenomegaly

• Brittle finger nail

Folate and vitamin B12 (Megaloblastic anaemia) Deficiency

Symptoms and Signs:

• Glossitis, sometimes stomatitis, hyper pigmentation of skin and mucosa,

peripheral neuropathy and dementia

o In children, severe Vitamin B12 deficiency may produce mental

regression, convulsions, coma and ultimate death

Note: The symptoms are quite variable, and they can be caused by other

conditions. The only sign you can look for is paleness, which is not very

reliable. So to know whether a person is anaemic or not, you need to

measure the amount of haemoglobin in the blood.

Iodine Deficiency

• Deficiency of iodine in the body leads to conditions termed iodine

deficiency disorders (IDD)

• Iodine is found in the soil and is picked up by different foods (plants,

animals, water) obtainable in the area

• The major cause of iodine deficiency is its loss from the soil through

leaching. Iodine deficiency manifests as goitre as well as a variety of

conditions termed hypothyroidism.

Symptoms and Signs of Iodine Deficiency Disorders:

Goitre

• A person who is hypothyroid: Feels cold easily, moves slowly and lacks

energy, think slowly and appear unconcerned, may be sleepy, has a dry

skin and may be constipated

• A child who is hypothyroid: Also grows slowly, may be very short and may

not do well in school

• Women who are hypothyroid during pregnancy may also have; Miscarriage or

still birth, Low birth weight babies, Babies with congenital deformities

and Babies with cretinism

[pic]

STEP 3: Management of Nutritional Deficiency Diseases (40 minutes)

|Activity: Small Group Discussion ( 10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|How are nutritional deficiency diseases managed? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Vitamin A

• Promotion of horticultural foods (fruits and vegetables such as carrots,

cabbage and sweet potatoes)

• Promotion of production and use of red palm oil and other cooking oils

• Improvement of appropriate child feeding: Breastfeeding and Improved

complementary foods

• Use of milk and milk products

• Early treatment of diseases (measles, respiratory tract infections,

diarrhea)

• Promotion of immunization coverage

• Vitamin A supplementation (to children, lactating women)

• Fortification of foods with Vitamin A

Vitamin B1 (Thiamine)

• Consumption of diet containing adequate quantities of vitamin B

• If highly milled white rice is the staple food, diet should be

supplemented with foods rich in thiamine: nuts, beans, peas and other

pulses, whole grain cereals and yeast based products

• Nutrition education to stress cause of diseases, foods that should be

consumed, and ways to minimize vitamin loss

Vitamin B2 (Riboflavin)

• Consumption of diet containing adequate quantities of vitamin B2 such as

eggs, milk and milk products, meat, fish, whole cereals, oil seeds, nuts

and leafy vegetables

Vitamin B3 (Niacin)

• Diversity in the diet

• Production and consumption of food known to prevent pellagra i.e. those

rich in niacin such us nuts and tryptophan such as eggs, milk, lean meat

and fish should be increased

• Enrich milled maize meal with niacin

• Niacin tablets are administered as prophylaxis in prisons, refugee camps

and institutions in areas where pellagra is endemic.

• Nutrition education

Vitamin C

• Increased production and consumption of vitamin C rich foods: fruits and

vegetables. Encourage the use of wild edible fruits and vegetables

• Provision of vegetable fruits and fruits juices to all community members

(including children beginning at six months)

• Nutrition education in consumption of vitamin C rich foods, minimizing

vitamin C loss in cooking and food preparation

Vitamin D

• All children get adequate amount of sunlight

• Children, pregnant women and lactating women should have adequate calcium

and vitamin D in their diet

• Attend clinic regularly

• Fish- liver oils, egg yolk, milk, butter, cheese and ghee

• Establish allowing supplementation of cod-liver oil or other vitamin D

supplements

• Nutrition education (including child spacing)

Vitamin E

• It is widely distributed in nature that it is difficulty to prepare a

diet deficient in vitamin E

• Human milk is enough for the infants

• Cereal especially wheat germ oils are the richest source. Vegetable fats

from corn, soya bean, peanuts and coconut or cotton seeds are good

sources followed by cereals, eggs and meat and green leaves such as

spinach.

Vitamin K

• Bacteria in the intestine normally produce it in adequate amount

• Fresh dark green vegetables especially spinach, kale and cauliflower

• Plant oils, rice bran oil and wheat germ oil, soya bean and cotton seed

oils are best sources

Iodine

• Various medicinal preparations are administered, such as:

o Injectable iodized oil

o Iodinated oil capsules

o Salt iodation: emphasis should be on salt iodation only because

currently other strategies are less commonly usedControl of Iodine

Deficiency

Iron

• Promotion of consumption of iron- and vitamin-rich foods

• Prevention and treatment of anemia-related diseases (malaria, worm

infestation)

• Iron and folic acid supplementation to the most at risk groups (children,

pregnant women, sickle cell disease patients)

• Fortification of foods with relevant nutrients (iron, folic acid)

• Prevention and treatment of anaemia-related diseases (malaria, worm

infestation)

[pic][pic] Handout 43.1: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.2: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.3: Nutrition Supplements

STEP 4: Key points (5 minutes)

• Common nutritional deficiency diseases are Protein Energy Malnutrition

and Vitamins and Minerals Nutritional Deficiencies

• Management of nutritional deficiency diseases depends much on handling

their signs and symptoms

STEP 5: Evaluation (10 minutes)

• What are the common nutritional deficiency diseases?

• How are nutritional deficiency diseases managed?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation about different types of Anaemia and how they |

|can be managed |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva:

WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries.

(2nded.). New York: Felicity Oxford University Press

Kumar P. & Clark, M. (2006).Clinical Medicine.(6thed.) New York: Elsevier

Limited.

Latham M. C (1997). Human Nutrition in the Developing World.David Lubin

Memorial Library.

McLaren.S. (1992).A Colour Atlas and Text of Diet-Related

Disorders.(2nded.)BPCC Hazells Ltd, Aylesbury, England.

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd

Rev.ed.). New Delhi: Sterling Publishers Private Ltd,.

Tanzania Food and Nutrition Centre.(2009). National Guidelines for

Nutrition Care and Support for People Living with HIV.(2nded.) Dar es

Salaam: TFNC

Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights. (4thed.)

Phidalephia: Mc GrawHill,

|[pic] |Handout 43.1: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.2: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.3: Nutrition Supplements |

[pic]

Session 44: Specialised Food Therapy

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Specialised Food Therapy

• Explain Nutrients Required for Different Groups

• Explain Entry and Exist Criteria for Specialised Food Products

• Describe Different Types of Specialised Food Products

• Describe the Importance of Nutritional Therapy for Acute Malnourished

Clients

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD projector

• Handout 44.1

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Common Nutritional Deficiency Diseases (50 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the common nutritional deficiency diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Malnutrition

• Can occur at any time in the life cycle.

• When it occurs early in life, irreversible damages can be done to the

body and brain

• Affects a significant proportion of populations, presenting as macro

and or micronutrient deficiency disorders.

• Nutrition disorder means any kind of disorder caused by eating too

little or too much of one or more different nutrients.

Classification of Malnutrition

• Can be classified in different ways but most commonly as under

nutrition or over nutrition.

o Under Nutrition occurs when nutrients intake does not meet nutrients

needs.

o Many nutrients are in high demand due to the constant state of cell

lose and later regeneration in the body.

o Over nutrition is prolonged consumption of more nutrients than the

body needs

Protein Energy Malnutrition (PEM)

• A deficiency of energy and protein which results in body wasting,

• Occurs more frequently in infants and young children but is also

observed in adolescents and adults

• Severe forms of PEM are Kwashiorkor and Marasmus

Kwashiorkor

• Caused by failure to provide an adequate dietary sources of protein

to substitute for the protein

• Signs and symptoms includes:

o failure of growth but the child is not severely wasted,

o swollen abdomen,

o hair changes (hair becomes brown, straight and soft)

o skin rashes,

o child becomes inactive, apathetic, irritable and is difficult to feed,

o oedema of lower limbs

Marasmus

• Causes: severe loss or chronic waste of fat, muscles and other tissues of

the body. The disease occurs due to shortage of basic nutrition, proteins,

vitamins and calories to the body. It is inadequate energy intake in all

forms, including protein.

• Signs and Symptoms of Marasmus: remarkable failure of growth, severe

muscle wasting with flaccid, wrinkled skin and bony prominence, the child

looks awake and hungry and displays what is referred to as ‘old person’s

face and Oedema is absent

Prevention of PEM

• The different strategies may include:

• Incorporating nutrition objectives into development of policies and

programmes

• Improving household food security

• Protection and promotion of good health

• Improving the quality and safety of foods

• Protect and promote breastfeeding and complementary feeding

• Early treatment of common diseases

• Immunization

• Growth monitoring

• Promoting appropriate diets and healthy lifestyles

Vitamins and Minerals Nutritional Deficiencies

Vitamin A Deficiency

• It plays important roles in the body including vision, maintenance of

epithelial tissue, and synthesis of mucous secretion, growth,

reproduction and immunity.

• The organ that is most readily affected is the eye.

Symptoms and Signs:

• Night blindness (Reduced ability to see in dim light)

• Conjunctival xerosis/ drying

• Corneal xerosis/drying,

• Xerophthalmic fundus (retina has white dots)

• Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of

ocular contents and perhaps destruction of the eye

o All of these may lead to complete blindness

Vitamin B1 Deficiency (Beriberi):

• It occurs when people consume highly milled polished rice or maize, and

starchy roots such as cassava, which are deprived of thiamine content.

• Signs and Symptoms:

o Heart palpitation, chest pain.

o Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and

distended neck veins with visible pulsations

o The heart is found to be enlarged

o Cyanosis

o Increased oedema

o Severe dyspnoea

o Acute circulatory failure and death

o The patient is thin with weak, wasted muscles Anaesthesia and ‘pins-

and-needles’ feelings in the feet and arms may increase, eventually

causing difficulty in walking

o Foot drop and wrist drop commonly occur

Vitamin B2 (Riboflavin) Deficiency (Beriberi)

Sign and symptoms:

• Angular stomatitis

• Glossitis

• Skin changes

• Seborrheic dermatitis

• Vascularization of the cornea

Vitamin B3 (Niacin) Deficiency (Pellagra):

• It is generally associated with maize diet.

• Early Symptoms of Pellagra: A person appears poorly malnourished, often

weak and underweight. A person may also have diminished sensitivity to

gentle touch and sometimes some muscular weakness and tremor. Untreated

cases of pellagra may die of the disease

• The disease is later characterized by the three ‘Ds’:

o Dermatitis: deepening of the pigmentation, dry skin, scaly and

eventual cracked, desquamation, occasionally the skin may blister, the

tongue and other parts of the mouth are often sore, red, smooth and

raw-looking

o Diarrhoea: a patient with pellagra may frequently have bouts of

abdominal pain, diarrhoea and other digestive upsets. The upsets

include nausea, excessive salivation, and a burning sensation in the

epigastrium.

o Dementia: this involves the effect of pellagra in nervous system which

brings about Irritability, loss of memory, anxiety and insomnia

Vitamin C Deficiency (Scurvy):

• Ascorbic acid is essential for the formation of intercellular collagen

and hence for the development of cartilage, bone and teeth and for the

healing of fractures and wounds.

Symptoms and Signs:

• The walls of blood vessels lack solidity and become fragile and bleeding

or haemorrhage from various sites results. Other haemorrhages include

nosebleeds, blood in the urine or faeces

• Moderate deficiency of vitamin C may result in poor healing of wounds.

People who do not eat enough vitamin C may not absorb enough iron and may

develop iron deficiency anaemia especially in pregnancy

• Tiredness and weakness

• Swollen gums which bleed easily at the base of the teeth

• In the skin – follicular hyperkeratosis, skin bruising haemorrhages and

broken coiled hair

• Swollen painful joints particularly of the knees, hip and elbow also pain

in all muscles

• Loss of secretion of lachrymal and salivary glands, loss of hair, dryness

of the skin and loss of dental fillings.

• Beading of the ribs

Vitamin D Deficiency (Rickets and Osteomalacia)

• The main feature of both rickets and osteomalacia is lack of calcium in

the bones.

• Rickets occurs in children whose bones are still growing. Often children

are plump and appear well fed

• Osteomalacia occurs in adults who have formed bones. Both conditions are

caused mainly by a deficiency of vitamin D, and not by a dietary lack of

calcium.

Symptoms and Signs of Rickets:

• Child tends to be miserable

• Flabby (toneless state of muscles that causes a pot-belly),

• Impairment of normal development

• Gastro-intestinal upset and excessive sweating of the head.

• The main signs of the disease are bone deformation.

Vitamin E Deficiency

• It is not common among human beings as it is widely distributed in foods.

Signs and symptoms:

• Muscular dystrophy

• Paralysis

• Impaired fat absorption

• Haemolytic anaemia in babies after delivery

• Liver necrosis, erythrocyte haemolysis and anaemia in adults

Vitamin K Deficiency (haemorrhagic disease)

• Dietary deficiency is not common. Deficiency occurs due to deficient

production of it by the gut, with prolonged antibiotic therapy, due to

poor absorption of vitamin K, in malabsorption of fat and due to low

prothrombin synthesis in liver disease.

Signs and symptoms:

• Tendency to bleed from skin and mucous membranes

Anaemia

• Anaemia is a pathological condition arising as a result of low level of

haemoglobin which impairs oxygen transport to the tissues. There are

various types of Anaemia such Haemorrhagic, haemolytic and nutritional

Anaemia.

• Nutritional anaemia is due to deficiency of nutrients that are needed for

the synthesis of red blood cells: iron, folic acid and vitamin B12.

• Thus nutritional anaemia includes: Iron deficiency anaemia, Folic acid

deficiency anaemia and Vitamin B12 deficiency anaemia.

Iron Deficiency Anaemia (IDA)

Symptoms and Signs Iron Deficiency Anaemia (IDA)

• Tiredness and fatigue

• Dizziness and/or headaches

• Palpitations

• Difficulty in breathing on exertion

• Inadequate temperature regulations

• Mild degree of splenomegaly

• Brittle finger nail

Folate and vitamin B12 (Megaloblastic anaemia) Deficiency

Symptoms and Signs:

• Glossitis, sometimes stomatitis, hyper pigmentation of skin and mucosa,

peripheral neuropathy and dementia

o In children, severe Vitamin B12 deficiency may produce mental

regression, convulsions, coma and ultimate death

Note: The symptoms are quite variable, and they can be caused by other

conditions. The only sign you can look for is paleness, which is not very

reliable. So to know whether a person is anaemic or not, you need to

measure the amount of haemoglobin in the blood.

Iodine Deficiency

• Deficiency of iodine in the body leads to conditions termed iodine

deficiency disorders (IDD).

• Iodine is found in the soil and is picked up by different foods

(plants, animals, water) obtainable in the area.

• The major cause of iodine deficiency is its loss from the soil through

leaching. Iodine deficiency manifests as goitre as well as a variety

of conditions termed hypothyroidism.

• Symptoms and Signs of Iodine Deficiency Disorders:

Goitre

• A person who is hypothyroid: Feels cold easily, moves slowly and lacks

energy, think slowly and appear unconcerned, may be sleepy, has a dry

skin and may be constipated

• A child who is hypothyroid: Also grows slowly, may be very short and may

not do well in school

• Women who are hypothyroid during pregnancy may also have; Miscarriage or

still birth, Low birth weight babies, Babies with congenital deformities

and Babies with cretinism

[pic]

STEP 3: Management of Nutritional Deficiency Diseases (40 minutes)

|Activity: Small Group Discussion ( 10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|How are nutritional deficiency diseases managed? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Vitamin A

• Promotion of horticultural foods (fruits and vegetables such as carrots,

cabbage and sweet potatoes)

• Promotion of production and use of red palm oil and other cooking oils

• Improvement of appropriate child feeding: Breastfeeding and Improved

complementary foods

• Use of milk and milk products

• Early treatment of diseases (measles, respiratory tract infections,

diarrhea)

• Promotion of immunization coverage

• Vitamin A supplementation (to children, lactating women)

• Fortification of foods with Vitamin A

Vitamin B1 (Thiamine)

• Consumption of diet containing adequate quantities of vitamin B

• If highly milled white rice is the staple food, diet should be

supplemented with foods rich in thiamine: nuts, beans, peas and other

pulses, whole grain cereals and yeast based products

• Nutrition education to stress cause of diseases, foods that should be

consumed, and ways to minimize vitamin loss

Vitamin B2 (Riboflavin)

• Consumption of diet containing adequate quantities of vitamin B2 such as

eggs, milk and milk products, meat, fish, whole cereals, oil seeds, nuts

and leafy vegetables

Vitamin B3 (Niacin)

• Diversity in the diet

• Production and consumption of food known to prevent pellagra i.e. those

rich in niacin such us nuts and tryptophan such as eggs, milk, lean meat

and fish should be increased

• Enrich milled maize meal with niacin

• Niacin tablets are administered as prophylaxis in prisons, refugee camps

and institutions in areas where pellagra is endemic.

• Nutrition education

Vitamin C

• Increased production and consumption of vitamin C rich foods: fruits and

vegetables. Encourage the use of wild edible fruits and vegetables

• Provision of vegetable fruits and fruits juices to all community members

(including children beginning at six months)

• Nutrition education in consumption of vitamin C rich foods, minimizing

vitamin C loss in cooking and food preparation

Vitamin D

• All children get adequate amount of sunlight

• Children, pregnant women and lactating women should have adequate calcium

and vitamin D in their diet

• Attend clinic regularly

• Fish- liver oils, egg yolk, milk, butter, cheese and ghee

• Establish allowing supplementation of cod-liver oil or other vitamin D

supplements

• Nutrition education (including child spacing)

Vitamin E

• It is widely distributed in nature that it is difficulty to prepare a

diet deficient in vitamin E

• Human milk is enough for the infants

• Cereal especially wheat germ oils are the richest source. Vegetable fats

from corn, soya bean, peanuts and coconut or cotton seeds are good

sources followed by cereals, eggs and meat and green leaves such as

spinach.

Vitamin K

• Bacteria in the intestine normally produce it in adequate amount

• Fresh dark green vegetables especially spinach, kale and cauliflower

• Plant oils, rice bran oil and wheat germ oil, soya bean and cotton seed

oils are best sources

Iodine

• Various medicinal preparations are administered, such as:

o Injectable iodized oil

o Iodinated oil capsules

o Salt iodation: emphasis should be on salt iodation only because

currently other strategies are less commonly usedControl of Iodine

Deficiency

Iron

• Promotion of consumption of iron- and vitamin-rich foods

• Prevention and treatment of anemia-related diseases (malaria, worm

infestation)

• Iron and folic acid supplementation to the most at risk groups (children,

pregnant women, sickle cell disease patients)

• Fortification of foods with relevant nutrients (iron, folic acid)

• Prevention and treatment of anaemia-related diseases (malaria, worm

infestation)

[pic][pic] Handout 43.1: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.2: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.3: Nutrition Supplements

STEP 4: Key points (5 minutes)

• Common nutritional deficiency diseases are Protein Energy Malnutrition

and Vitamins and Minerals Nutritional Deficiencies

• Management of nutritional deficiency diseases depends much on handling

their signs and symptoms

STEP 5: Evaluation (10 minutes)

• What are the common nutritional deficiency diseases?

• How are nutritional deficiency diseases managed?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation about different types of Anaemia and how they |

|can be managed |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva:

WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries.

(2nded.). New York: Felicity Oxford University Press

Kumar P. & Clark, M. (2006).Clinical Medicine. (6thed.) New York: Elsevier

Limited

Latham M. C (1997). Human Nutrition in the Developing World.David Lubin

Memorial Library

McLaren.S. (1992).A Colour Atlas and Text of Diet-Related Disorders.

(2nded.) BPCC Hazells Ltd, Aylesbury, England

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd

Rev.ed.). New Delhi: Sterling Publishers Private Ltd

Tanzania Food and Nutrition Centre.(2009). National Guidelines for

Nutrition Care and Support for People Living with HIV. (2nded.) Dar es

Salaam: TFNC

Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights. (4thed.)

Phidalephia: Mc GrawHill,

|[pic] |Handout 43.1: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.2: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.3: Nutrition Supplements |

[pic]

Hand Out 44.1: Specialised Food Products Used in Tanzania

a) F 75 and F 100

|2 |Protein |10% de |5% de |

|3 |Lipids |45% de |31% de |

|4 |Vit.A |800 ug |0.9 mg |

|5 |Vit.D |15 ug |18 ug |

|6 |Vit.E |20 mg |20 mg |

|7 |Vit.C |50 mg |59 mg |

|8 |Vit.B1 |0.5mg |0.5 mg |

|9 |Vit.B2 |1.6 mg |1.2 mg |

|10 |Niacin |5 mg |5 mg |

|11 |Vit.B6 |0.6 mg |0.6 mg |

|12 |Folic acid |200 ug |200 ug |

|13 |Vit.B12 |1.6 ug |1.6 ug |

|14 |Biotin |60 ug |60 ug |

|15 |Pantothenic acid |3 mg |3 mg |

|16 |Vit.K |16 ug |24 ug |

|17 |Sodium |<290 mg |<87 mg |

|18 |Calcium |300 mg |560 mg |

|19 |Phosphorus |300 mg |330 mg |

|20 |Magnesium |80 mg |50 mg |

|21 |Zinc |11 mg |12.2 ug |

|22 |Iodine |70 ug |100 ug |

|23 |Potasium |1100 mg |775 mg |

|24 |Copper |1.4 mg |1.7 mg |

|25 |Selenium |20 ug |30 ug |

|26 |Iron |<0.2 mg |<0.3 mg |

b) READY TO USE THERAPETIC FOOD ‘Plumpy'Nut.

[pic]

It is a paste of groundnut composed of vegetable fat, peanut butter,

skimmed milk powder, lactoserum, maltodextrin, sugar, mineral and vitamin

complex

|Nutrient |Per sachet of 92 |Nutrient |Per sachet of 92 g |

| |g | | |

|Energy |500 kcal |Vitamin A |840 mcg |

|Proteins |12.5 g |Vitamin D |15 mcg |

|Lipids |32.86 g |Vitamin E |18.4 mg |

|Calcium |276 mg |Vitamin C |49 mg |

|Phosphorus |276 mg |Vitamin B1 |0.55 mg |

|Potassium |1 022 mg |Vitamin B2 |1.66 mg |

|Magnesium |84.6 mg |Vitamin B6 |0.55 mg |

|Zinc |12.9 mg |Vitamin B12 |1.7 mcg |

|Copper |1.6 mg |Vitamin K |19.3 mcg |

|Iron |10.6 mg |Biotin B5 |60 mcg |

|Iodine |92 mcg |Folic acid |193 mcg |

|Selenium |27.6 mcg |Pantothenic acid|2.85 mg |

|Sodium |< 267 mg |Niacin B3 |4.88 mg |

c) FORTIFIED BLENDED FOOD (FBF)

High Energy Pre-cooked Porridge Flour, Fortified with Vitamins & Minerals

| |

|Composition Table of Fortified Blended Flour (Fbf) |

|Foundation Plus+- (Corn Soy Blend ) Frominsta Health |

|Builder |

| |

| |Maize |64.4%, |

| |Soybeans |25% |

| |Sugar |5%, |

| |Palm Olein Oil |5%, |

| |Vitamins & Minerals |0.6% |

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PST 04102Disease Control and Prevention

NTA Level 4 Semester 1

December 2016

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