WHO Regional Menu Of Essential Health Interventions

Condition: Meningitis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Parenteral antibiotics Intravenous fluids Parenteral corticosteroids
< 5 years
		Parenteral antibiotics Parenteral corticosteroids
5 - 11 years
		Parenteral antibiotics Parenteral corticosteroids
12 - 24 years
		Parenteral antibiotics Parenteral corticosteroids
25 - 59 years
		History and physical examination for meningitis Clinical assessment for early recognition of the need for referral Basic laboratory tests Lumbar puncture Systemic antibiotics for bacterial meningitis
60+ years
		Clinical examination Physical examination Supportive treatment for elderly persons with meningitis including: Fluids/IV fluids therapy for elderly persons Relieve fever with anti-pyretics for elderly persons with fever due to meningitis Relieve aches/pains with analgesics for elderly persons with aches due to meningitis Provision of anti-emetics for elderly persons with vomiting due to meningitis Nutritional support for elderly persons with meningitis Long course therapy for tuberculous meningitis in elderly persons as per guidelines Treatment of non-infectious meningitis depending on the cause e.g. Use of corticosteroids for meningitis due to auto-immune diseases Treatment of specific cancer for cancer induced meningitis. Managmnet of all causes of meningitis as though they are bacterial meningitis until proven otherwise. Management of any complications of meningitis in elderly persons e.g. seizures, raised intra-cranial pressure. ICU services for management of meningitis complications in elderly persons

Condition: Whooping Cough

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and Clinical examination Supportive management Administration of antibiotics Inpatient services Referral to specialised hospital for severely ill eg for ICU services for severely ill
< 5 years
		Antibiotics Antipyretics Hydration Nutritional support Vitamin A
5 - 11 years
		Antibiotics if indicated Antipyretics Hydration Nutritional support Vitamin A
12 - 24 years
		Physical and Clinical examination Outpatient services Anti-microbial therapy Supportive management Management of any complications e.g rib fracture, syncope, abdominal hernia or other complications from the severe, chronic cough Hospitalization for patients at risk of severe pertussis/and complication Rweferral to specialised hospitals for further managemnet eg ICU services for severe illness Laboratory tests,B pertussis, culture, polymerase chain reaction (PCR), serologic testing and direct fluorescent antibody (DFA) testing. Follow up
25 - 59 years
		Physical and Clinical examination Outpatient services Anti-microbial therapy Supportive management Management of any complications e.g rib fracture, syncope, abdominal hernia or other complications from the severe, chronic cough Hospitalization for patients at risk of severe pertussis/and complication Rweferral to specialised hospitals for further managemnet eg ICU services for severe illness Laboratory tests,B pertussis, culture, polymerase chain reaction (PCR), serologic testing and direct fluorescent antibody (DFA) testing. Follow up
60+ years
		Physical and Clinical examination Outpatient services Anti-microbial therapy Supportive management Management of any complications e.g rib fracture, syncope, abdominal hernia or other complications from the severe, chronic cough Hospitalization for patients at risk of severe pertussis/and complication Rweferral to specialised hospitals for further managemnet eg ICU services for severe illness Laboratory tests,B pertussis, culture, polymerase chain reaction (PCR), serologic testing and direct fluorescent antibody (DFA) testing. Follow up

Condition: Encephalitis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Early recognition and treatment of encephalitis Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis Initiate anti-viral treatment immediately Initiate specific regimen after determining the etiology of encephalitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention /or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services - Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests - lumbar puncture (LP) -CSF culture Blood cultures for bacterial pathogens - Serologic tests for Toxoplasma Imaging such as Computerized Tomography CT - MRI Computerized Tomography CT Magnetic Resonance Imaging MRI
< 5 years
		Early recognition and treatment of encephalitis Initiate anti-viral treatment immediately Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Initiate specific regimen after determining the etiology of encephalitis Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including: * Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention /or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests- lumbar puncture (LP) -CSF culture - Blood cultures for bacterial pathogens Serologic tests for Toxoplasma Imaging such Computerized Tomography CT Magnetic Resonance Imaging MRI
5 - 11 years
		Early recognition and Initiate anti-viral treatment immediately Computerized Tomography CT Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis Initiate specific regimen after determining the etiology of encephalitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including: * Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention/or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests lumbar puncture (LP) CSF culture Blood cultures for bacterial pathogens Serologic tests for Toxoplasma Imaging such as Computerized Tomography CT- MRI Magnetic Resonance Imaging MRI
12 - 24 years
		Early recognition and treatment of encephalitis Computerized Tomography CT Initiate anti-viral treatment immediately Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis Initiate specific regimen after determining the etiology of encephalitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including: * Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention /or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests lumbar puncture (LP) -CSF culture Blood cultures for bacterial pathogens Serologic tests for Toxoplasma Imaging such as: Imaging such as Computerized Tomography CT - MRI Magnetic Resonance Imaging MRI
25 - 59 years
		Early recognition and treatment of encephalitis Initiate anti-viral treatment immediately Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis Initiate specific regimen after determining the etiology of encephalitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including: * Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention /or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests - lumbar puncture (LP) -CSF culture - Blood cultures for bacterial pathogens - Serologic tests for Toxoplasma Physical and clinical examination Imaging such as: - Imaging such as Computerized Tomography CT - MRI Computerized Tomography CT Magnetic Resonance Imaging MRI
60+ years
		Early recognition and treatment of encephalitis Initiate anti-viral treatment immediately Initiate anti-microbial therapy including appropriate therapy for presumed bacterial meningitis (use antibiotics for acute bacterial meningitis Initiate specific regimen after determining the etiology of encephalitis For Viral encephalitis use of antiviral treatment.e.g. for herpes simplex virus /Antiviral medications e.g. Acyclovir Antimicrobial therapy targeting the identified infectious agent, Supportive care for severe encephalitis including: * Breathing assistance, Intravenous fluids adminstration Anti-inflammatory drugs administration Administration of Anticonvulsant medications Admissions for persons with encephalitis Management of any complications Prevention /or management of shock or hypertension Prevention/Management of seizures Management of hydrocephalus and increased intracranial pressure ICU services Laboartory diagnostic interventions for Encephalitis including: Blood and urine tests lumbar puncture (LP) CSF culture Blood cultures for bacterial pathogens - Serologic tests for Toxoplasma - Magnetic Resonance Imaging MRI Imaging such as: - Computerized Tomography - CT - MRI

Condition: Measles

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Immunoglobulin/measles antibodies administration for post exposure for Pregnant women Fetal monitoring Follow up of the newborns and manage any complications e.g. Low birth weight, babies born prematurely
< 5 years
		Antibiotics when indicated Antipyretics Vitamin A Hydration
5 - 11 years
		Antibiotics if indicated Antipyretics Hydration
12 - 24 years
		Post exposure vaccination for unvaccinated contacts (within 72 hours of exposure to measles virus) Relieve common symptoms of measles in adolescents Fever Cough Blocked nose Conjunctivitis Sore mouth Provide nutritional support Appropriate Antibiotics administration for any secondary infection e.g. pneumonia Responses for AEFI Identify and manage any complications as per guidelines e.g. pneumonia,croup,diarrhea,malnutrition, otitis media,mouth ulcers,eye complications (conjunctivitis),laryngitis,febrile seizures,encephalitis Intensive care services for adolescents with severe complications of measles Follow up N/B Investigations-carry out necessary confirmatory tests for measles if need be (blood tests,throat swab; urine sample)
25 - 59 years
		Post exposure vaccination for unvaccinated contacts (within 72 hours of exposure to measles virus) Management of measles complications in adults including; otitis media,conjunctivitis, pneumonia, croup, seizures, encephalitis N/B Carry out necessary confirmatory tests for measles if need be (blood tests,throat swab, urine sample)
60+ years
		Isolation of patients with measles to prevent spread

Condition: Trichomoniasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Diagnostic tests - Swab test: Vaginal swab is cultured for identifying the causative of infection. - Antigen test: Rapid test in which antibody reacts with antigen forming a color on positive test. - DNA test: Nucleic acid from vaginal swab undergoes PCR to detect nucleic acid. - Wet prep: Fluid from vagina may be examined under microscope. Treatment with metronidazole or tindazole Treatmnet of sexual partners
< 5 years

5 - 11 years
		Diagnostic tests - Swab test: Vaginal swab is cultured for identifying the causative of infection. - Antigen test: Rapid test in which antibody reacts with antigen forming a color on positive test. - DNA test: Nucleic acid from vaginal swab undergoes PCR to detect nucleic acid. - Wet prep: Fluid from vagina may be examined under microscope. Treatment with metronidazole or tindazole Treatmnet of sexual partners
12 - 24 years
		Diagnostic tests - Swab test: Vaginal swab is cultured for identifying the causative of infection. - Antigen test: Rapid test in which antibody reacts with antigen forming a color on positive test. - DNA test: Nucleic acid from vaginal swab undergoes PCR to detect nucleic acid. - Wet prep: Fluid from vagina may be examined under microscope. - Urine test: For men, urine sample is tested to detect the presence of the parasite. Treatment with metronidazole or tindazole Treatmnet of sexual partners
25 - 59 years
		Diagnostic tests - Swab test: Vaginal swab is cultured for identifying the causative of infection. - Antigen test: Rapid test in which antibody reacts with antigen forming a color on positive test. - DNA test: Nucleic acid from vaginal swab undergoes PCR to detect nucleic acid. - Wet prep: Fluid from vagina may be examined under microscope. - Urine test: For men, urine sample is tested to detect the presence of the parasite. Treatment with metronidazole or tindazole Treatmnet of sexual partners
60+ years

Condition: Tuberculosis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Confirmation of diagnosis using acid fast stain and culture of sputum Treatment of confirmed TB cases with anti TB medication using Direct Observed Therapy (DOT) Treatment with anti-TB medication Direct Observed Therapy (DOT) to promote adherence to medication Managment of TB/HIV co-infection Initiation of co-trimoxazole preventive therpay for TB/HIV co-ifection ART therapy for TB/HIV co-infection TB drugs refill Management of Multi -drug resistance TB Sputum smear /Stain and culture of sputum TB skin test HIV Counseling and Testing for confirmed TB cases Monitoring of TB complications
< 5 years
		Directly Observed Therapy (DOTs) Manage adverse reactions and complications
5 - 11 years
		Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications
12 - 24 years
		Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Manage adverse reactions and complications
25 - 59 years
		Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Manage adverse reactions and complications
60+ years
		Directly Observed Therapy (DOTs) Self-administrative therapy (SAT) to those with good adherence ART therapy for TB/HIV co-infection Referral of people living HIV for regular screening and possible TPT * TB drugs refill for SAT Trace and follow up of defaulters Referral of people with adverse reactions and complications

Condition: Syphilis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Antibiotics Referral to the next higher level for corrective surgery
< 5 years

5 - 11 years
		Treatment with Penicillin
12 - 24 years
		Treatment with PenicillinTreatment of sex partners
25 - 59 years
		Treatment with PenicillinTreatment of sex partners
60+ years
		Treatment with PenicillinTreatment of sex partners

Condition: Other STDs

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Appropriate treatment for condition Concomitant treatment for Chlamydia and Gonorrhea Treatment of sex partners of parents/guardians
< 5 years

5 - 11 years
		History and physical examination for STI and reproductive tract infections Basic laboratory tests for STI Etiologic diagnosis and treatment of STIs Counselling on partner notification, diagnosis and treatment Information on treatment compliance and use of condom Referral for management of complications of STIs
12 - 24 years
		Appropriate treatment for condition Concomitant treatment for Chlamydia and Gonorrhea Treatment of sex partners Conduct investigative laboratory tests Such as chlamydia, RPR test for syphilis Syndromic management of STIs with microscope according to guidelines Develop National STI and mentoring program to support clinicians on-site with diagnosis, treatment, record keeping and greater integration of STI and HIV services Promote regular inquiries of STI symptoms at ANC and general outpatient visits, using the syndromic method of STI management.
25 - 59 years
		History and physical examination for STI and reproductive tract infections Basic laboratory tests for STI Etiologic diagnosis and treatment of STIs Counselling on partner notification, diagnosis and treatment Information on treatment compliance and use of condom Referral for management of complications of STIs
60+ years
		Appropriate treatment for condition Concomitant treatment for Chlamydia and Gonorrhoea Treatment of sex partners Conduct investigative laboratory tests Such as chlamydia, RPR test for syphilis Syndromic management of STIs with microscope according to guidelines Develop National STI and mentoring program to support clinicians on-site with diagnosis, treatment, record keeping and greater integration of STI and HIV services Promote regular inquiries of STI symptoms at ANC and general outpatient visits, using the syndromic method of STI management.

Condition: HIV/AIDS

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Partner notification and expedited treatment for common STIs, /HIV Provider initiated counselling and testing HIV testing Diagnostics - Blood tests - CD4 count - Imaging -X-rays - Microscopy culture and sensitivity Syndromic management of STIs Clinical staging of HIV Chemotherapy for STIs that have progressed into cancer Radiotherapy for STIs that have progressed into cancer Defaulter tracking Management of opportunistic infections - Chronic diarrhoea - Oral Candidiasis -Oesophageal Candidiasis - Bacterial infections - PCP - Toxoplasmosis - TB - Extra pulmonary. - Cytomegalovirus Infection - Kaposi’s sarcoma - Lymphoma and other HIV related malignancies. Screening for TB and other opportunistic infections Management of TB co-infection Management of advanced HIV disease and complications Management of any complications Management for sexual violence cases and referral to support services 8 Treatment literacy /adherence counselling Supportive management - Nutritional support /Supplements Monitoring adherence to prescribed medications ART initiation services ART Monitoring ART refills Referral and linkages
< 5 years
		First-line antiretroviral therapy Second-line antiretroviral therapy Manage moderate to severe adverse reactions * Viral load monitoring Treat moderate to severe OIs Treat TB/HIV co-infection Manage co-morbidities Referral to higher level for to non-responders
5 - 11 years
		First-line antiretroviral therapy Second-line antiretroviral therapy Co-trimoxazole prophylaxis TB preventive therapy Manage moderate to severe adverse reactions * Viral load monitoring Treat moderate to severe OIs Treat TB Manage co-morbidities Referral to higher level for to non-responders
12 - 24 years
		First-line antiretroviral therapy Second-line antiretroviral therapy Co-trimoxazole prophylaxis TB preventive therapy Fluconazole pre-emptive therapy Manage moderate to severe adverse reactions * Viral load monitoring Treat moderate to severe OIs Treat TB Manage co-morbidities (viral hepatitis, NCDs) Referral to higher level for to non-responders
25 - 59 years

60+ years
		First-line antiretroviral therapy Second-line antiretroviral therapy Manage moderate to severe adverse reactions * Viral load monitoring Treat moderate to severe OIs Treat TB/HIV co-infection Manage co-morbidities (viral hepatitis, NCDs) Referral to higher level for to non-responders

Condition: Gonorrhoea

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Treatment with single dose of Ceftriaxone or Cefixime Concomitant treatment for ChlamydiaTreatment of sex partners treatment of Gonococcal conjunctivitis in newborns with Tetracycline ointments or drops and saline irrigation Systemic treatment of newborns with Gonococcal conjunctivitis with IM Ceftriaxone
< 5 years
		Treatment of Gonococcal conjunctivitis in newborns with Tetracycline and saline irrigation Systemic treatment of newborns with Gonococcal conjunctivitis with IM Ceftriaxone
5 - 11 years

12 - 24 years

25 - 59 years
		Treatment with single dose of Ceftriaxone or CefiximeConcomitant treatment for Chlamydia Treatment of sex partners
60+ years

Condition: Genital herpes

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years
		Treatment with Acyclovir, valacyclovir or famciclovir Treatment of sex partners
25 - 59 years
		Treatment with Acyclovir, valacyclovir or famciclovir Treatment of sex partners
60+ years
		Treatment with Acyclovir, valacyclovir or famciclovir Treatment of sex partners

Condition: Diarrhoeal diseases

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements
< 5 years
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements
5 - 11 years
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements
12 - 24 years
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements
25 - 59 years
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements
60+ years
		Intravenous hydration Antibiotics to treat bacterial infections Zinc supplements

Condition: Chlamydia

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Diagnostics tests - Swab test for culturing or antigen testing for chlamydia especially in pregnant women Treatment of confirmed Chlamydia infection antibiotics Treatment of Chlamydia conjunctivitis in newborns with antibiotics (topical or systemic as indicated) Guidance on avoidance of sex until completion of treatment course Referral
< 5 years
		Physical and clinical examination Treatment of Chlamydia conjunctivitis in infants with antibiotics Referral as may be indicated
5 - 11 years

12 - 24 years
		Physical and clinical examination Diagnostics tests - Swab test for culturing or antigen testing for chlamydia especially in women (female adolescents in this case) - Urine culture-especially in men (male aldolescents in this case) Treatment of confirmed Chlamydia infection antibiotics Guidance on avoidance of sex until completion of treatment course Referral
25 - 59 years
		Physical and clinical examination Diagnostics tests - Swab test for culturing or antigen testing for chlamydia especially in women (adult women in this case) - Urine culture-especially in men (adult men in this case) Treatment of confirmed Chlamydia infection antibiotics Guidance on avoidance of sex until completion of treatment course Referral
60+ years
		Physical and clinical examination Diagnostics tests - Swab test for culturing or antigen testing for chlamydia especially in women (elderly women in this case) - Urine culture-especially in men (elderly men in this case) Treatment of confirmed Chlamydia infection antibiotics Guidance on avoidance of sex until completion of treatment course Referral

Condition: Dengue

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		In addition to primary care interventions Conduct virus isolation, genome detection, NS1 Ag, IgA and IgM antigens by rapid test, ELISA and in addition for IgA by IHS and neutralization assays. Implement case management decisions for severe dengue with warning signs (Group B and C) including treatment of profound/compensated shock, electrolyte imbalances, metabolic acidosis, ensure glucose control, hemorrhagic complications
5 - 11 years
		In addition to primary care interventions Conduct virus isolation, genome detection, NS1 Ag, IgA and IgM antigens by rapid test, ELISA and in addition for IgA by IHS and neutralization assays. Implement case management decisions for severe dengue with warning signs (Group B and C) including treatment of profound/ compensated shock, electrolyte imbalances, metabolic acidosis, ensure glucose control, hemorrhagic complications
12 - 24 years
		In addition to primary care interventions Conduct virus isolation, genome detection, NS1 Ag, IgA and IgM antigens by rapid test, ELISA and in addition for IgA by IHS and neutralization assays. Implement case management decisions for severe dengue with warning signs (Group B and C) including treatment of profound/ compensated shock, electrolyte imbalances, metabolic acidosis, ensure glucose control, hemorrhagic complications
25 - 59 years
		In addition to primary care interventions Conduct virus isolation, genome detection, NS1 Ag, IgA and IgM antigens by rapid test, ELISA and in addition for IgA by IHS and neutralization assays. Implement case management decisions for severe dengue with warning signs (Group B and C)including treatment of profound/compensated shock, electrolyte imbalances, metabolic acidosis, ensure glucose control, hemorrhagic complications
60+ years
		In addition to primary care interventions Conduct virus isolation, genome detection, NS1 Ag, IgA and IgM antigens by rapid test, ELISA and in addition for IgA by IHS and neutralization assays. Implement case management decisions for severe dengue with warning signs (Group B and C) including treatment of profound/ compensated shock, electrolyte imbalances, metabolic acidosis, ensure glucose control, hemorrhagic complications

Condition: Lymphatic filariasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years
		Single dose preventive chemotherapy with Albendazole (Alb), Ivermectin (IV) or Diethylcarbamazine (DEC) Management of Hydrocele through surgery
12 - 24 years
		Single dose preventive chemotherapy with Albendazole (Alb), Ivermectin (IV) or Diethylcarbamazine (DEC) Management of Hydrocele through surgery
25 - 59 years
		Single dose preventive chemotherapy with Albendazole (Alb), Ivermectin (IV) or Diethylcarbamazine (DEC) Management of Hydrocele through surgery
60+ years
		Management of Hydrocele through surgery Single dose preventive chemotherapy with Albendazole (Alb), Ivermectin (IV) or Diethylcarbamazine (DEC)

Condition: Diphtheria

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Clinical examination and diagnosis of diptheria in pregnant women Supportive management to pregnant mothers with diphtheria to/Relieve common symptoms Relieve fever with anti pyretics/analgesics such as paracetamol and ibuprofen Immunization with diphtheria toxoid vaccine for pregnant mothers Fetal monitoring Provide nutritional support for the adults with diphtheria Monitoring and Management of complications of diphtheria in pregnant women such as shortness of breath/breathing difficulties Management of neonates with low birth weights, preterm babies/as a result of diphtheria
< 5 years
		Physical and Clinical examination and diagnosis of diphtheria in children under 5 years of age. -based on signs and symptoms of diphtheria including; - Fever Isolation. Respiratory droplet isolation of children under 5s with respiratory diphtheria and contact precautions for under 5s children with cutaneous diphtheria Antitoxin treatment with DAT immediately diphtheria is strongly suspected in children under 5 years (without waiting for lab results) Antibiotic treatment (penicillin or erythromycin) to eliminate the bacteria and toxin production Immunization with diphtheria toxoid vaccine during convalescence for children who have not been vaccinated/have not completed the appropriate course Tests, nasal/pharyngeal swabs for culture Monitor and management of any diphtheria complications such as obstruction of the airways, systemic diphtheria -to the heart, kidney or peripheral nerves Emergency management for diphtheria complication such as airway obstructions
5 - 11 years
		Physical and Clinical examination and diagnosis of diphtheria in children under 5 years of age. -based on signs and symptoms of diphtheria including; - Fever Tests, Nasal/pharyngeal swabs for culture Antitoxin treatment with DAT immediately diphtheria is strongly suspected in school age children (without waiting for lab results) Antibiotic treatment (penicillin or erythromycin) to eliminate the bacteria and toxin production Immunization with diphtheria toxoid vaccine during convalescence for school age children who are immunised/have not completed the appropriate course Isolation. Respiratory droplet isolation of school age children with respiratory diphtheria and contact precautions for those with cutaneous diphtheria Monitor and management of any diphtheria complications such as obstruction of the airways, systemic diphtheria -to the heart, kidney or peripheral nerves Emergency management for diphtheria complication such as airway obstructions
12 - 24 years
		History Clinical examination Isolation Respiratory droplet isolation of adolescents patients with respiratory diphtheria and contact precautions for those with cutaneous diphtheria Antitoxin treatment with DAT immediately diphtheria is strongly suspected in adolescents (without waiting for lab results) Antibiotic treatment (penicillin or erythromycin) to eliminate the bacteria and toxin production Immunization with diphtheria toxoid vaccine during convalescence for adolescents who have not been immunized previously/have who had not completed the appropriate course Tests, nasal/pharyngeal swabs for culture Physical and Clinical examination and diagnosis of diphtheria in children under 5 years Monitor and management of any diphtheria complications such as obstruction of the airways, systemic diphtheria -to the heart, kidney/peripheral nerves of age. -based on signs and symptoms of diphtheria including; - Fever Emergency management for diphtheria complication such as airway obstructions
25 - 59 years
		Identify close contacts such as caretakers, relatives, sexual contacts, friends, Health care workers Monitor close contacts for signs and symptoms of diphtheria Prophylactic antibiotics (penicillin or erythromycin) for close contacts Vaccination with diphtheria toxoid-containing vaccine for unvaccinated contacts and for Under-vaccinated contacts to complete their vaccination series Recording and reporting of diphtheria cases through established reporting mechanisms
60+ years
		Tests, Nasal/pharyngeal swabs for culture Physical and Clinical examination and diagnosis of diphtheria in the elderly -based on signs and symptoms of diphtheria; including - Fever Antitoxin treatment with DAT immediately diptheria is strongly suspected in the elderly (without waiting for lab results) Antibiotic treatment (penicillin or erythromycin) to eliminate the bacteria and toxin production Immunization with diphtheria toxoid vaccine during convalescence for elderly who had not completed the appropriate course Isolation. Respiratory droplet isolation of elderly patients with respiratory diphtheria and contact precautions for those with cutaneous diphtheria Monitor and management of any diphtheria complications such as obstruction of the airways, systemic diphtheria -to the heart, kidney or peripheral nerves Emergency management for diphtheria complication such as airway obstructions

Condition: Acute Hepatitis B

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Supportive management Healthy diet Optimum fluids Enough sleep/rest Relieve of pain with painkillers Admission for severe Acute Hepatitis B Anti-retroviral drugs for severe acute Hepatitis B Monitoring and management of any complications
< 5 years
		Supportive management Healthy diet Plenty of fluids Enough sleep/rest Pain reliefe Admission for severe Acute Hepatitis B Anti-retroviral drugs for severe acute Hepatitis B Monitoring and management of any complications
5 - 11 years
		Physical examination,Clinical examination and diagnosis of Hepatitis B Supportive management for patients with Acute Hepatitis B - Provision of Healthy diet - Plenty of fluids - Encourage Exercises - Encourage the patient with Hepatitis B to have Enough sleep/rest Relieve of pain with painkillers Admission for patient with severe Acute Hepatitis B Administer anti-retroviral drugs for severe acute Hepatitis B to prevent complications Monitoring and management of any complications including acute Liver failure Follow up Investigations Blood tests to detect Hepatitis B surface antigen (HBsAg) Serum immunoglobulin M (IgM)Test for Chronic Hepatitis B indicated by persistent Hepatitis B surface antigen for at least 6 months - Test for Hepatitis A and C - Liver ultrasound - Liver Biopsy
12 - 24 years
		Physical examination,Clinical examination and diagnosis of Hepatitis B Supportive management for patients with Acute Hepatitis B Provision of Healthy diet - Plenty of fluids - Encourage Exercises- Encourage the patient with Hepatitis B to have Enough sleep/rest Relieve of pain with painkillers Admission for patient with severe Acute Hepatitis B Administer anti-retroviral drugs for severe acute Hepatitis B to prevent complications Monitoring and management of any complications including acute Liver failure Follow up Investigations Blood tests to detect Hepatitis B surface antigen (HBsAg) Serum immunoglobulin M (IgM)Test for Chronic Hepatitis B indicated by persistent Hepatitis B surface antigen for at least 6 months - Test for Hepatitis A and C - Liver ultrasound - Liver Biopsy
25 - 59 years
		Physical examination,Clinical examination and diagnosis of Hepatitis B Supportive management for patients with Acute Hepatitis B - Provision of Healthy diet - Plenty of fluids - Encourage Exercises- Encourage the patient with Hepatitis B to have Enough sleep/rest Relieve of pain with painkillers Admission for patient with severe Acute Hepatitis B Administer anti-retroviral drugs for severe acute Hepatitis B to prevent complications Monitoring and management of any complications including acute Liver failure Follow up Investigations Blood tests to detect Hepatitis B surface antigen (HBsAg) Serum immunoglobulin M (IgM)Test for Chronic Hepatitis B indicated by persistent Hepatitis B surface antigen for at least 6 months - Test for Hepatitis A and C - Liver ultrasound - Liver Biopsy
60+ years
		Physical examination,Clinical examination and diagnosis of Hepatitis B Supportive management for patients with Acute Hepatitis B Provision of Healthy diet - Plenty of fluids - Encourage Exercises- Encourage the patient with Hepatitis B to have Enough sleep/rest Relieve of pain with painkillers Admission for patient with severe Acute Hepatitis B Administer anti-retroviral drugs for severe acute Hepatitis B to prevent complications Monitoring and management of any complications including acute Liver failure Follow up Investigations Blood tests to detect Hepatitis B surface antigen (HBsAg) Serum immunoglobulin M (IgM)Test for Chronic Hepatitis B indicated by persistent Hepatitis B surface antigen for at least 6 months - Test for Hepatitis A and C - Liver ultrasound - Liver Biopsy

Condition: Hepatitis A

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examinationRelieve any symptom -fever, dehydration i.e.(no specific medicines except to relive symptoms) Relieve any symptom -fever, dehydration i.e.(no specific medicines except to relive symptoms) Investigations Blood test -To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failures
< 5 years
		History taking & Clinical examination Relieve any symptom -fever, dehydration i.e.(no specific medicines except to relive symptoms) Investigations :- Blood test - To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood * Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA - Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failure)
5 - 11 years
		Physical and Clinical examination Relieve any symptom -fever, dehydration i.e. (no specific medicines except to relive symptoms) Investigations;- Blood test -To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood - Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failure)
12 - 24 years
		Physical and Clinical examination Relieve any symptom -fever, dehydration i.e.(no specific medicines except to relive symptoms) Investigations Blood test -To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failure)
25 - 59 years
		Physical and Clinical examination Relieve any symptom -fever, dehydration i.e.(no specific medicines except to relive symptoms) Investigations Blood test -To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failure)
60+ years
		Physical and Clinical examination Relieve any symptom -fever, dehydration i.e.(no specific medicines except to relieve symptoms Investigations ;- Blood test -To detect HAV-specific immunoglobulin G (IgM) antibodies in the blood * Reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA Liver function tests Test also for hepatitis B and C Monitor and management of complications the main one being fulminant hepatitis (acute liver failure)

Condition: Hepatitis E

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		N/b There is no specific treatment capable of altering the course of acute hepatitis E.; usually self-limiting disease Supportive treatment including; - proper nutrition,Adequate rest Monitoring and management of any complications main one being fulminant hepatitis (acute liver failure) Relieving fever through use of pain killers Admission/hospitalization for symptomatic pregnant women. Physical and clinical examination,Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.
< 5 years
		Physical and clinical examination Supportive treatment including: proper nutrition, Adequate rest Admissions for children who may develop severe Hepatitis E (usually due to co-infection with Hep.A) Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Relieving fever through use of pain killers Monitoring and management of any complications main one being fulminant hepatitis (acute liver failure) Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.
5 - 11 years
		N/b There is no specific treatment capable of altering the course of acute hepatitis E.; usually self-limiting disease Supportive treatment including: proper nutrition, Adequate rest relieving fever through use of pain killers Physical and clinical examination Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.
12 - 24 years
		Physical and clinical examination,Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Supportive treatment including: proper nutrition, * Adequate rest Relieving fever through use of pain killers Monitoring and management of any complications main one being fulminant hepatitis (acute liver failure) N/b There is no specific treatment capable of altering the course of acute hepatitis E.; usually self-limiting disease Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.
25 - 59 years
		Monitoring and management of any complications main one being fulminant hepatitis (acute liver failure) N/b There is no specific treatment capable of altering the course of acute hepatitis E.; usually self-limiting disease Supportive treatment including: proper nutrition, Adequate rest relieving fever through use of pain killers Physical and clinical examination Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.
60+ years
		Monitoring and management of any complications main one being fulminant hepatitis (acute liver failure) N/b There is no specific treatment capable of altering the course of acute hepatitis E.; usually self-limiting disease Supportive treatment including: proper nutrition, Adequate rest relieving fever through use of pain killers Physical and clinical examination Diagnosis based on Strong link in appropriate epidemiology settings, e.g. when several cases occur in localities in known disease-endemic areas, or in settings with risk of water contamination. Rule out hepatitis A Blood tests for detection of specific IgM antibodies to the virus for definitive diagnosis.

Condition: Diabetes mellitus

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Pre-natal screening for Gestational diabetes Management of Gestational diabetes and pre-existing diabetes through advice on Lifestyle change including. healthy balanced diet/nutritional therapy - regular daily physical activity. Weight management depending on pregestational weight Medications/use of Insulin for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta Management of pre-existing diabetes in pregnant women through use of insulin Monitoring and prevention of pre-eclampsia in pregnant women with diabetes (use low dose aspirin 60–150 mg/day - Foetal monitoring Monitoring of the neonates blood sugar after delivery Postpartum Follow-up
< 5 years
		Physical and Clinical examination Random and fasting blood sugars for diagnosis of type 1 diabetes Advice to parents on healthy foods for the child with diabetes Guidance and encouraging Exercise regularly Management of type 1 diabetes with insulin injection Frequent blood sugar monitoring and blood glucose control Recognition and management of acute diabetic emergencies (hypoglycaemeia and hyperglycaemia emergencies) Monitoring and control of blood pressure Monitoring and management of any complications including Screening for and management of blood lipid (to regulate cholesterol levels) screening for early signs of diabetes-related kidney disease and treatment Regular examination of the feet and management of any foot ulcers to prevent diabetic foot screening and treatment for retinopathy Follow up
5 - 11 years
		Healthy diet Physical activity Insulin Monitoring glycaemic control Prevent and treat diabetic ketoacidosis
12 - 24 years
		Healthy diet Physical activity Insulin Monitoring glycaemic control Prevent and treat diabetic ketoacidosis
25 - 59 years
		Lifestyle management Medical nutrition therapy Oral glucose-lowering medications Insulin Monitoring glycaemic control Detect and manage DM-specific complications
60+ years
		Lifestyle management Medical nutrition therapy Oral glucose-lowering medications Insulin Monitoring glycaemic control Detect and manage DM-specific complications

Condition: Rabies

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of the pregnant women assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Foetal monitoring Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
< 5 years
		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined.
5 - 11 years
		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present,the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorise exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure, Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
12 - 24 years
		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: * * if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposure assessed as carrying a risk of developing rabies Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure ,Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantine the animal
25 - 59 years
		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
60+ years
		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated, Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined

Condition: Yellow Fever

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical examination clinical diagnosis based on the patient's signs and symptoms, the travel history (when and where), the related travel activities and vaccine history Supportive treatment aimed at relieving symptoms including Relive pain and fever Monitoring and specific management of the disease depending on the severity including Oxygen administration - Intravenous fluid administration for dehydration Blood pressure control -medications to increase collection/blood_pressure in cases of circulatory collapse - transfusion of blood products in cases of severe bleeding Antibiotics for secondary bacterial_infections Management for any complication due to AEFI with yellow fever vaccine Foetal montoring Tests- Blood tests to detect the virus in the early stages of the disease Or demonstrate the presence of virus-specific antibodies (IgM and IgG) in late stages of yellow fever.
< 5 years
		Physiacl examination clinical diagnosis based on the patient's signs and symptoms, the travel history (when and where), the related travel activities and vaccine history Supportive treatment aimed at relieving symptoms including Relive pain and fever Monitoring and specific management of the disease depending on the severity including Oxygen administration - Intravenous fluid administration for dehydration Blood pressure control -medications to increase collection/blood_pressure in cases of circulatory collapse - transfusion of blood products in cases of severe bleeding Antibiotics for secondary bacterial_infections Management for any complication due to AEFI with yellow fever vaccine Diagnostic Tests- Blood tests to detect the virus in the early stages of the disease Or demonstrate the presence of virus-specific antibodies (IgM and IgG) in late stages of yellow fever.
5 - 11 years
		History and physical examination Basic laboratory tests Advanced laboratory tests Supportive care (e.g. fever reduction, hydration, feeding, etc.) IV fluid hydration Treat mild complications Refer if severe or not responding
12 - 24 years
		Physiacl examination clinical diagnosis based on the patient's signs and symptoms, the travel history (when and where), the related travel activities and vaccine history Supportive treatment aimed at relieving symptoms including Relive pain and fever Monitoring and specific management of the disease depending on the severity including Oxygen administration Intravenous fluid administration for dehydration Blood pressure control -medications to increase collection/blood_pressure in cases of circulatory collapse transfusion of blood products in cases of severe bleeding Antibiotics for secondary bacterial_infections Management for any complication due to AEFI with yellow fever vaccine Diagnostic Tests- Blood tests to detect the virus in the early stages of the disease or demonstrate the presence of virus-specific antibodies (IgM and IgG) in late stages of yellow fever. Referral to specilsed hospital for further managemnent eg for dialysis ; ICU services as may be indicated
25 - 59 years
		History and physical examination Basic laboratory tests Advanced laboratory tests Supportive care (e.g., fever reduction, hydration, feeding, etc.) IV fluid hydration Treat mild complications Refer if severe or not responding
60+ years
		Physiacl examination clinical diagnosis based on the patient's signs and symptoms, the travel history (when and where), the related travel activities and vaccine history Supportive treatment aimed at relieving symptoms including Relive pain and fever Monitoring and specific management of the disease depending on the severity including Oxygen administration Intravenous fluid administration for dehydration Blood pressure control -medications to increase collection/blood_pressure in cases of circulatory collapse transfusion of blood products in cases of severe bleeding Antibiotics for secondary bacterial_infections Management for any complication due to AEFI with yellow fever vaccine Diagnostic Tests- Blood tests to detect the virus in the early stages of the disease or demonstrate the presence of virus-specific antibodies (IgM and IgG) in late stages of yellow fever. Referral to specialised hospital for further managemnent eg for dialysis ; ICU services as may be indicated

Condition: Acute Hepatitis C

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical Diagnosis of hepatitis C in pregnant women based on signs and symptoms Supportive therapies pregnant women with Hepatitis C including; - proper nutrition; fluids therapy - plenty of rest - relieve of pain Administration of Antiviral therapy Regular Monitoring for early diagnosis and management of any complications such as liver cirrhosis and liver cancer Nucleic acid test for HCV ribonucleic acid (RNA) to confirm chronic infection Regular Monitoring for early diagnosis and management of any complications such as liver cirrhosis and liver cancer Diagnostic tests Serological tests for anti-HCV antibodies (hepatitis C antibody test) Nucleic acid test for HCV ribonucleic acid (RNA) to confirm chronic infection
< 5 years
		Physical and clinical examination Diagnosis of hepatitis C in children based on signs and symptoms including fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, joint pain and yellowing of skin and the whites of the eyes Supportive therapies for children with Hepatitis C including - proper nutrition - fluids therapy - PLenty of rest - relieve of pain Monitor for any progression to Chronic Hepatitis C Follow up Deferring anti-retroviral treatment for children aged less than 12 years with chronic HCV infection until 12 years of age
5 - 11 years
		Physical and clinical examination Monitor for any progression to Chronic Hepatitis C Diagnosis of hepatitis C in children based on signs and symptoms including fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, joint pain and yellowing of skin and the whites of the eyes Supportive therapies for children with Hepatitis C including; - proper nutrition - fluids therapy - PLenty of rest - relieve of pain Monitor for any progression to Chronic Hepatitis C Follow up WHO -recommends Deferring anti-retroviral treatment for children aged less than 12 years with chronic HCV infection until 12 years of age
12 - 24 years
		Physical and clinical examination Diagnosis of hepatitis C in elderly based on signs and symptoms Supportive therapies to elderly with Hepatitis C including; - proper nutrition; fluids therapy - Adequate rest - relieve pain Administration of Antiviral therapy (use of pan-genotypic direct-acting antivirals (DAAs) for chronic HCV) after careful assessment Serological tests for anti-HCV antibodies (hepatitis C antibody test) Diagnostic tests Monitoring for progression to Chronic Hepatitis C Regular Monitoring for early diagnosis and management of any complications such as liver cirrhosis and liver cancer Nucleic acid test for HCV ribonucleic acid (RNA) to confirm chronic infection
25 - 59 years

60+ years
		Physical and clinical examination,Diagnostic tests Diagnosis of hepatitis C in elderly based on signs and symptoms Supportive therapies to elderly with Hepatitis C including proper nutrition, fluids therapy,Adequate rest - relieve pain Serological tests for anti-HCV antibodies (hepatitis C antibody test) Monitoring for progression to Chronic Hepatitis C Administration of Antiviral therapy (use of pan-genotypic direct-acting antivirals (DAAs) for chronic HCV) after careful assessment Regular Monitoring for early diagnosis and management of any complications such as liver cirrhosis and liver cancer Nucleic acid test for HCV ribonucleic acid (RNA) to confirm chronic infection

Condition: Leprosy

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs; Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch Thickened or enlarged peripheral nerve with loss of sensation and/weakness of the muscles supplied by that nerve Guidance/Advice to elderly patients with leprosy on self-care including Care of Eyes, care of hands and feet, guidance on voluntary muscle testing and sensory testing use of correct footwear Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Follow up Guidance and Ensuring adherence to treatment for known leprosy patients
< 5 years
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs: Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch * Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve* Guidance to the elderly leprosy patient on adherence to treatment, Guidance /Advice to elderly patients with leprosy on self-care including Care of Eyes; care of hands and feet; guidance on voluntary muscle testing and sensory testing use of correct footwear Hospital admission Management of Leprosy with Multidrug therapy (MDT) Prevention and management of disabilities. Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Strengthening surveillance for antimicrobial resistance including laboratory network. Conducting basic and operational research in all aspects of leprosy and maximize the evidence base to inform policies, strategies and activities
5 - 11 years
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs; Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch Thickened or enlarged peripheral nerve with loss of sensation and/weakness of the muscles supplied by that nerve Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Prevention and management of disabilities. Guidance/Advice to parents on care for the child with Leprosy including Care of Eyes, care of hands and feet, guidance on voluntary muscle testing and sensory testing use of correct footwear Referral to a hospital for definitive diagnosis and for further management Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs and eyes Guidance and Ensuring adherence to treatment for known leprosy patients
12 - 24 years
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs: Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch * Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve* Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Prevention and management of disabilities. Hospital admission Management of Leprosy with Multidrug therapy (MDT) Strengthening surveillance for antimicrobial resistance including laboratory network.
25 - 59 years
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs; 1.Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch 2.Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve Guidance to the elderly leprosy patient on adherence to treatment, Guidance/Advice to elderly patients with leprosy on self-care including Care of Eyes, care of hands and feet, guidance on voluntary muscle testing and sensory testing use of correct footwear Management of Leprosy with Multidrug therapy (MDT) Hospital admission Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Guidance and Ensuring adherence to treatment for known leprosy patients
60+ years
		physical and clinical examination Presumptive diagnosis of Leprosy based on cardinal signs; Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch, Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve Guidance/Advice to elderly patients with leprosy on self-care including Care of Eyes,care of hands and feet, guidance on voluntary muscle testing and sensory testing use of correct footwear Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve Follow up and prevention of complications including progressive and permanent damage to the skin, nerves, limbs, and eyes through early diagnosis and early treatment Prevention and management of disabilities. Management of Leprosy with Multidrug therapy (MDT) Hospital admission Follow up for patients Strengthening surveillance for antimicrobial resistance including laboratory network. Guidance and Ensuring adherence to treatment for known leprosy patients

Condition: Ascariasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Clinical diagnosis of ascariasis, history of passage of a live worm in faeces,abdominal pain while others may have cough, difficulty in breathing, or fever Supportive therapy including; Relieve of any abdominal pain with painkillers, Nutritional support (proper nutrition ) Treatment using Anthelminthic medications such as albendazole and mebendazole Prevention and management of any complications due to ascariasis e.g breathing complications, surgical intervention for intraabdominal complications. Diagnostics Microscopy stool for identifying ascaris eggs Blood tests for eosinophilia Imaging for heavily invested individuals Ultrasound to detect hepatobiliary or pancreatic ascariasis Prevention and management of any complications due to ascariasis e.g breathing complications, surgical intervention for intraabdominal complications.
< 5 years
		Anthelmintic Steroids for complication Surgery for obstruction
5 - 11 years
		Anthelmintic Steroids for complication Surgery for obstruction
12 - 24 years
		Anthelmintic Steroids for complication Surgery for obstruction
25 - 59 years
		Anthelmintic Steroids for complication Surgery for obstruction
60+ years
		Anthelmintic Steroids for complication Surgery for obstruction

Condition: Tetanus

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features For neonatal tetanus–an illness occurring in an infant who has the normal ability to suck and cry in the first 2 days of life, but who loses this ability between days 3 and 28 of life and becomes rigid or has spasms Non-neonatal tetanus (in this case affecting the mothers)requires at least one of the following signs; a sustained spasm of the facial muscles in which the person appears to be grinning, or painful muscular contractions. And with a history of injury or wound, tetanus (but may also occur in patients who are unable to recall a specific wound or injury) Relieve of other symptoms such as headache with analgesics, fever with anti pyretic Immediate admission for mothers with tetanus/neonates with neonatal tetanus (Tetanus is a medical emergency) Administration of antibiotics Immediate management with medicines human tetanus immune globulin (TIG) Tetanus Vaccination for the mothers who have recovered since infection with tetanus does not confer natural immunity Prevention and management of any complications such as respiratory failure referral to specialised hospitals for further managemnet eg Intensive care services to mange severe tetanus/any complications eg for
< 5 years
		** Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features Non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning or painful muscular contractions and with a history of injury or wound, tetanus (but may also occur in children whose parents/families are unable to recall a specific wound or injury) Relieve of other symptoms such as headache with analgesics, fever with anti pyretic Management/control of muscle spasms Administration of antibiotics Tetanus Vaccination for the under 5 since infection with tetanus does not confer natural immunity Prevention and management of any complications such as respiratory failure Referral to specialised Intensive care services to manage any complications/severe tetanus e.g for ventilation follow up
5 - 11 years
		** Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features Non-neonatal tetanus)requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning or painful muscular contractions. And with a history of injury or wound, tetanus (but may also occur in patients who are unable to recall a specific wound or injury)* Relieve of other symptoms such as headache with analgesics, fever with anti pyretic Immediate admission for school age child with tetanus(Tetanus is a medical emergency) Immediate management with medicines human tetanus immune globulin (TIG) Prevention and management of any complications such as respiratory failure Referral to specialsed hospital for further managemnet eg Intensive care services to manage any complications/severe tetanus eg for ventilation Follow up
12 - 24 years
		Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features Non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning, or painful muscular contractions. And with a history of injury or wound, tetanus (but may also occur in adolescents who are unable to recall a specific wound or injury)** Supportive therapy-Relieve of other symptoms such as headache with analgesics, fever with anti-pyretic Immediate admission for adolescents with tetanus (Tetanus is a medical emergency) Immediate management with medicines human tetanus immune globulin (TIG) Prevention and management of any complications such as respiratory failure Aggressive wound care for the adolescents with tetanus Management/control of muscle spasms Administration of antibiotics Tetanus Vaccination for the adolescents who have recovered from tetanus since infection with tetanus does not confer natural immunity referral to specialised hosptals for further managemnet eg Intensive care services to manage any complications/severe tetanus eg for ventilation Follow up
25 - 59 years
		Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features Non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning or painful muscular contractions. And with a history of injury or wound, tetanus (but may also occur in adult patients who are unable to recall a specific wound or injury)* Supportive therapy-Relieve of other symptoms such as headache with analgesics fever with anti pyretic Immediate admission for adults with tetanus (Tetanus is a medical emergency)Immediate management with medicines human tetanus immune globulin (TIG) Aggressive wound care for the adults with tetanus Prevention and management of any complications Management/control of muscle spasms Administration of antibiotics Tetanus Vaccination for the adults who have recovered from tetanus since infection with tetanus does not confer natural immunity Referral to specialised hospitals for further managemnet eg Intensive care services to manage any complications/severe tetanus Follow up
60+ years
		Physical and clinical examination Clinical diagnosis of tetanus based on Clinical features Non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning or painful muscular contractions and with a history of injury or wound, tetanus (but may also occur in elderly patients who are unable to recall a specific wound or injury) Supportive management-Relieve of other symptoms such as headache with analgesics fever with anti pyretic Immediate admission for the elderly person with tetanus(Tetanus is a medical emergency) Immediate management with medicines human tetanus immune globulin (TIG) Aggressive wound care for the elderly with tetanus Prevention and management of any complications such as respiratory failure Refferal to specialised hospitals for further managemnet eg Intensive care services to manage any complications/severe tetanus Follow up of elderly patients with tetanus

Condition: Trichuriasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Clinical diagnosis of Trichuriasis, history of passage of a live worm, in faeces, abdominal pain while others may have cough, difficulty in breathing or fever Supportive therapy including relieve of any abdominal pain with painkillers, nutritional support (proper nutrition) Treatment using Anthelminthic medications such as albendazole and mebendazole Diagnostic tests, Microscopy–stool for identifying trichuris eggs Endoscopy to see adult worms in GIT Prevention and management of any complications due to Trichuriasis e.g Viatmin A deficiency, anaemia, rectal prolapse
< 5 years
		Anthelmintic
5 - 11 years
		Anthelmintic
12 - 24 years
		Physical and clinical examination Clinical diagnosis of Trichuriasis, history of passage of a live worm, in faeces, abdominal pain while others may have cough, difficulty in breathing, or fever Supportive therapy including relieve of any abdominal pain with painkillers; nutritional support (proper nutrition) Diagnostic tests Microscopy–stool for identifying trichuris eggs Endoscopy to see adult worms in GIT Clinical diagnosis of Trichuriasis, based on history of passage of a live worm in faeces, abdominal pain while others may have cough, difficulty in breathing or fever Treatment using Anthelminthic medications such as albendazole and mebendazole Prevention and management of complications e.g iron deficiency anaemia, rectal prolapse
25 - 59 years
		physical and clinical examination Clinical diagnosis of Trichuriasis, based on history of passage of a live worm in faeces, abdominal pain while others may have cough, difficulty in breathing or fever Supportive therapy including relieve of any abdominal pain with painkillers, nutritional support (proper nutrition) Diagnostic tests; Microscopy–stool for identifying trichuris eggs Endoscopy to see adult worms in GIT Treatment using Anthelminthic medications such as albendazole and mebendazole< Prevention and management of complications e.g Anaemia, rectal prolapse
60+ years
		Physical and clinical examination Clinical diagnosis of Trichuriasis, based on history of passage of a live worm in faeces abdominal pain while others may have cough, difficulty in breathing or fever Supportive therapy including relieve of any abdominal pain with painkillers, nutritional support (proper nutrition) Treatment using Anthelminthic medications such as albendazole and mebendazole Diagnostic tests - Microscopy–stool for identifying trichuris eggs - Endoscopy to see adult worms in GIT Prevention and management of complications e.g. anaemia, rectal prolapse

Condition: Birth asphyxia

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Start neonatal resuscitation for nenates with Apgar scores of 0 to 3 as follows; Dry neonate and place supine under overhead warmer Suctioning of airways Tactile stimulation to encourage spontaneous breathing Oxygen therapy, Bag-mask ventilation (Ambu bag) for non-responsive neonates Endotracheal intubation for neonates not responsive to bag-mask ventilation * * Chest compression if heart rate does not improve Transfer to neonatal intensive care unit for further assessment
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Birth trauma

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Clinical examination Physical examination Nutritional support antibitics terapy where indicated safe transportation of small babies Encourage KFC and /or KMC Refer to specialised hospitals for ICU services where indicated Laboratory services /invstigations that include but are not limited to: blood film microscopy, blood group and cross-match, blood chemistry, CSF and stool and urine microscopy, gram stain, Imaging modalities including x-ray ultra-sound
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Iodine deficiency

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Treat iodine deficiency cases with iodide with or without levothyroxine Plan for sugery for pregnant women with large goiters after delivery
< 5 years
		Treat iodine deficiency cases with iodide with or without levothyroxine
5 - 11 years
		Treat iodine deficiency cases with iodide with or without levothyroxine
12 - 24 years
		Treat iodine deficiency cases with iodide with or without levothyroxine Plan for surgery in cases with large goiters
25 - 59 years
		Treat iodine deficiency cases with iodide with or without levothyroxine Plan for surgery in cases with large goiters
60+ years
		Treat iodine deficiency cases with iodide with or without levothyroxine Plan for surgery in cases with large goiters

Condition: Maternal conditions

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Provide Comprehensive Emergency Obstetric Care services for women with obstetric complications Provide blood transfusion, Caesarean section and laparotomy services
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Neonatal sepsis and infections

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Antibiotics IV hydration Oxygen support Appropriate feeding including breast feeding Blood products transfusion Vasopressor agents
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Protein-energy malnutrition

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial Blood transfusion Manage hypothermia Manage hypoglycaemia Mange electrolyte imbalances
5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		Educate caregivers on feeding of the elderly through provision of practical examples using local foods Provide with multivitamin supplement Provide treatment to correct other specific deficiencies Refer severe cases of protein energy malnutrition to hospital for further management Treat mild to moderate cases with balanced oral diet Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide with multivitamin supplement Treat any underlying conditions

Condition: Preterm birth complications

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and Clinical examinations Assessment and follow up of preterm neonates for complications of prematurity Appropriate treatment of any detected complications of prematurity Intravenous or gavage feeding of preterm neonates born before 34 weeks Gradual transition of preterm neonates from intravenous or gavage feeding to breastfeeding Education of mothers on care of preterm neonates including Kangaroo Mother Care Use of Kangaroo Mother Care especially in hospitals without neonatal intensive care facilities and during period of observation before discharge
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Vitamin A deficiency

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		Physical and clinical assessmnet Guidance to parents/families on feeding child with viatmin A rich foods eg eg, liver, beef, oily fish, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables. Treat Vitamin A deficiency with Vitamin A supplemnts Treating underlying causes /conditions Follow up
5 - 11 years
		Vitamin A Vitamin A-rich foods
12 - 24 years
		Physical and clinical assessmnet Guidance to adolescents on eating viatmin A rich foods eg eg, liver, beef, oily fish, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables. Treat Vitamin A deficiency with Vitamin A supplemnts Treating underlying causes /conditions Follow up
25 - 59 years
		Physical and clinical assessmnet Guidance to adults eating viatmin A rich foods eg eg, liver, beef, oily fish, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables. Treat Vitamin A deficiency with Vitamin A supplemnts Treating underlying causes /conditions Follow up
60+ years
		Physical and clinical assessmnet Guidance to elderly on eating viatmin A rich foods eg eg, liver, beef, oily fish, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables. Treat Vitamin A deficiency with Vitamin A supplemnts Treating underlying causes /conditions Follow up

Condition: Colon and rectum cancers

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Appropriate management of infections Early referral for additional procedures
60+ years
		Appropriate management of infections Early referral for additional procedures

Condition: Larynx cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Chemotherapy or radiation therapy Surgery for disease with extra-laryngeal extension
60+ years
		Chemotherapy or radiation therapy Surgery for disease with extra-laryngeal extension

Condition: Leukemia

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		Immediate transfer of suspected cancer cases to a higher-level health care facility
5 - 11 years
		Immediate transfer of suspected cancer cases to a higher-level health care facility
12 - 24 years
		Immediate transfer of suspected cancer cases to a higher-level health care facility
25 - 59 years
		Assess people with anaemia or easy bruising and bleeding or recurrent infection where benign causes have been excluded for leukaemia
60+ years
		Assess people with anaemia or easy bruising and bleeding or recurrent infection where benign causes have been excluded for leukaemia

Condition: Liver Cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Liver Transplantation
60+ years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment

Condition: Trachea, bronchus, lung cancers

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment
60+ years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment

Condition: Malignant skin melanoma

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Surgical excision Adjuvant therapy after delivery
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Surgical excision Adjuvant radiation therapy Adjuvant interferon alfa
60+ years
		Surgical excision Adjuvant radiation therapy Adjuvant interferon alfa

Condition: Multiple myeloma

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Nasopharynx cancer and other pharyngeal cancers

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Chemotherapy and radiation therapy
60+ years
		Chemotherapy and radiation therapy

Condition: Oesophagus cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Surgery Chemotherapy Radiation
60+ years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment

Condition: Pancreas cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Radiation therapy Surgery Chemotherapy
60+ years
		Radiation therapy Surgery Chemotherapy

Condition: Non-melanoma skin cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Surgical excision Radiation therapy for metastatic cases
60+ years
		Surgical excision Radiation therapy for metastatic cases

Condition: Stomach cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment
60+ years
		Appropriate management of infections Referral to the next level for diagnostic workup and treatment

Condition: Breast cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
< 5 years
		Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
5 - 11 years
		Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
12 - 24 years
		Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
25 - 59 years
		Immediate transfer of suspected cases to a higher-level health care facility
60+ years
		Immediate transfer of suspected cases to a higher-level health care facility

Condition: Cervix uteri cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions Monitoring and managemnet of any complications Blood transfusions Oxygen therapy Surgical interventions eg hysterectomy;further managemnet including managemnet of any complications referral to specialised hospital for Follow up invclidng counselling for compliance with treatmnent INVESTIGATIONS /diagnostics screening -PAP smear colscopic examination Blood tests Other tests eg to check for metastasis x-rays eg chest r-ray CT scan
< 5 years

5 - 11 years

12 - 24 years
		Stages IA1 and IA2 – Surgery (Modified Radical Hysterectomy, Lymphadenectomy) and Brachytherapy Stages IB1, IB2, IIA1 – Open Radical Hysterectomy or Brachytherapy, External Pelvic Radiotherapy and Chemotherapy where surgery may not be indicated Stages IB3, IIA2, IIB, III, IVA – External Pelvic Radiation, Brachytherapy and Chemotherapy. Stage IVB and Recurrent Cancers – Chemotherapy
25 - 59 years
		History and physical examination for cervical cancer Cervical cancer screening using HPV-test or Visual inspection with acetic acid (VIA) Treatment of precancerous lesions with Cryotherapy and/or LEEP Early recognition of need for referral
60+ years
		Cryotherapy Loop electrosurgical excision procedure (LEEP) Intra-cavitary brachytherapy

Condition: Corpus uteri cancer

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations
< 5 years
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations
5 - 11 years
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations
12 - 24 years
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations
25 - 59 years
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy. Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations
60+ years
		Stage I – Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) Stages II and III – Pelvic Radiation and Chemotherapy Surgery (Total Hysterectomy with Bilateral Salpingo-OOphrectomy and Pelvic and Para-aortic lymphadenectomy) may also be done Stage IV – Surgery, Chemotherapy, Radiotherapy and Hormonal Therapy may be used in various combinations

Condition: Malaria

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Intravenous antimalarials for treatment of severe malaria IV Glucose IV anticonvulsants Blood and blood product transfusion Immediate transfer of unresponsive or complicated cases to a higher-level health care facility
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: African trypanosomiasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)
< 5 years
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)
5 - 11 years
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)
12 - 24 years
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)
25 - 59 years
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)
60+ years
		Physical and clinical examinaton Experienced staff to conduct clinical assessment For T.b. gambiense * Treatment under direct observation either through outpatient or as inpatients Admission/inpatient services Treatmnet with relevant medication first-line treatment or second line treatmnet aas indicated Management of relapses Mananagement of nay complications eg reduce the risk of encephalopathy Management of any adverse drug effects- eg Encephalopathy gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Diagnostic tests Microscopy of fresh blood chancre fluid or lymph node aspirate Microscopy of celebral spinal fluid (CSF) (wet preparation)

Condition: Schistosomiasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Echinococcosis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Cysticercosis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures
< 5 years
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures
5 - 11 years
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures
12 - 24 years
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures
25 - 59 years
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures.
60+ years
		Anthelminthic therapy using albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis Co-administration of corticosteroids that cross the blood brain barrier (e.g. dexamethasone) is used to mitigate these effects Treatment of edema, intracranial hypertension or hydrocephalus, which may include ventricular shunt or other neurosurgical procedures

Condition: Alzheimer disease and other dementias

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		Cholinesterase inhibitors Psychosocial therapy Behavioural therapy Cognitive stimulation

Condition: Autism and Asperger syndrome

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		Behaviour therapy Speech-language therapy Play-based therapy Physical therapy Occupational therapy Nutritional support Referral for specialized mental health and other needed services
5 - 11 years
		Behavioural therapy Symptomatic Pharmacotherapy
12 - 24 years

25 - 59 years

60+ years

Condition: Asthma

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		physical and clinical examination Diagnostic tests including Measure of lung function (Spirometry, Peak flow.) Methacholine challenge. Allergy testing. Either through a skin test or blood test Nitric oxide test to measure the amount of nitric oxide gas in the breath Sputum eosinophils Provocative testing for exercise and cold-induced asthma Imaging tests- chest x ray] Advice and guidance to the patient on recognition of asthma triggers and how to avoid them Use of medications -bronchodilator Quick-relief (rescue) medications for rapid, short-term symptom relief during an asthma attack. /inhalers Use Allergy medications Treatment of aggravating factors such as lower and upper respiratory tract infections Monitoring for and management of any complications Regular follow up
< 5 years
		Short-acting bronchodilator, Low-dose inhaled corticosteroid (ICS) Long-acting bronchodilator (LABA) Long-acting muscarinic agonist (LAMA) Supplemental oxygen Bilevel Positive Airway Pressure (BiPAP) Counselling on personalised asthma management plan
5 - 11 years
		Short-acting bronchodilator, Low-dose inhaled corticosteroid (ICS) Long-acting bronchodilator (LABA) Long-acting muscarinic agonist (LAMA) Supplemental oxygen Bilevel Positive Airway Pressure (BiPAP) Counselling on personalised asthma management plan
12 - 24 years
		Short-acting bronchodilator, Low-dose inhaled corticosteroid (ICS) Long-acting bronchodilator (LABA) Long-acting muscarinic agonist (LAMA) Supplemental oxygen Bilevel Positive Airway Pressure (BiPAP) Counselling on personalised asthma management plan
25 - 59 years
		Short-acting bronchodilator, Low-dose inhaled corticosteroid (ICS) Long-acting bronchodilator (LABA) Long-acting muscarinic agonist (LAMA) Oxygen supplementation Bilevel Positive Airway Pressure (BiPAP)
60+ years
		Short-acting bronchodilator, Low-dose inhaled corticosteroid (ICS) Long-acting bronchodilator (LABA) Long-acting muscarinic agonist (LAMA) Oxygen supplementation Bilevel Positive Airway Pressure (BiPAP)

Condition: Conduct disorder

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years
		Treat comorbid conditions such as attention-deficit/hyperactivity disorder Group parent training programme Parent and child training programmes Referral for specialized mental health and other needed services
12 - 24 years
		Treat comorbid conditions such as attention-deficit/hyperactivity disorder Group parent training programme Parent and child training programmes Referral for specialized mental health and other needed services
25 - 59 years

60+ years

Condition: Eating disorders

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Early detection and treatment of eating disorders Assessment mental and social well being Multi-disciplinary treatment approach involving psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers, Diet education and advice/Nutrition counseling Medical nutrition therapy Advisory on exercises/exercise moderation /reducing excessive exercises Psychological interventions Cognitive behavioral therapy to help the patient control their thoughts Behavioral therapy focusing on assisting patient to gain control and change unwanted behaviors Medications Management of any concurrent mental ailments like depression and anxiety disorders. Monitoring: prevention and management of complications related to eating disorders in women such as infertility, threat of miscarriage Monitoring and management of other complications associated with eating disorders such as obesity, diabetes, hypertension (high blood pressure) Hospitalization for more serious cases. Follow up
< 5 years

5 - 11 years
		Assessment of mental and social wellbeing of children with eating disorder multi-disciplinary treatment approach involving psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers Medical nutrition therapy Psychological interventions Cognitive behavioural therapy Behavioural therapy Oral medications for eating disorders Management of any concurrent mental ailments like depression and anxiety disorders. Hospitalization for serious cases Referral
12 - 24 years
		Early detection and treatment of eating disorders Assessment mental and social well being Multi-disciplinary treatment approach involving psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers, Diet education and advice/Nutrition counseling Medical nutrition therapy Advisory on exercises/exercise moderation/reducing excessive exercises Psychological interventions Cognitive behavioral therapy to help the patient control their thoughts Behavioral therapy focusing on assisting patient to gain control and change unwanted behaviors Medications Management of concurrent mental ailments like depression anxiety disorders and substance abuse Monitoring and management of any complications associated with eating disorders such as obesity, diabetes, Hospitalization for more serious cases. Follow up
25 - 59 years
		Early detection and treatment of eating disorders Assessment mental and social well being Multi-disciplinary treatment approach involving psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers, Diet education and advice/Nutrition counseling Medical nutrition therapy Advisory on exercises/exercise moderation/reducing excessive exercises Psychological interventions Cognitive behavioral therapy to help the patient control their thoughts Behavioral therapy focusing on assisting patient to gain control and change unwanted behaviors Medications Management of concurrent mental ailments like depression and anxiety disorders. Monitoring and management of any complications associated with eating disorders such as obesity, diabetes, hypertension (high blood pressure) and heart disease. Hospitalization for more serious cases. Follow up
60+ years
		Early detection and treatment of eating disorders Assessment mental and social well being Multi-disciplinary treatment approach involving psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers, Diet education and advice /Nutrition counseling Medical nutrition therapy Advisory on exercises/exercise moderation /reducing excessive exercises Psychological interventions Cognitive behavioral therapy to help the patient control their thoughts Behavioral therapy focusing on assisting patient to gain control and change unwanted behaviors Medications Management of concurrent mental ailments like depression and anxiety disorders. Monitoring and management of any complications associated with eating disorders such as obesity, diabetes, hypertension (high blood pressure) and heart disease. Hospitalization for more serious cases. Follow up

Condition: COVID-19

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years
		Physical examination Perform triage and clinical assessment,Check vital signs,temperature, respiratory rate,pulse, blood pressure, mental status (AVPU) and pulse oximetry. Supportive treatment aimed at relieving symptoms including Relive pain and fever Monitoring and specific management of the disease depending on the severity Management of airways for patient with severe disease Oxygen therapy for patient with severe disease Medication for patient with severe or critical covid-19 including administration of corticosteroids,anti coagulants Blood pressure control Blood sugar monitoring and control Antibiotics for any secondary bacterial infections Management for any complication due to AEFI Referral to a specialised hospital for ICU services for endotracheal intubation and mechanical ventilation in cases of respiratory complications Follow up Diagnostics /investigations Polymerase Chain reaction test (PCR test) for COVID Blood test Chest Xrays Ultra-sound
25 - 59 years

60+ years

Condition: Periodontal disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including; * Study models for diagnostics especially of gingival recession * Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession * Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs & or panoramic radiographs Treatment planning and Patient education on the treatment choice Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g. crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication; Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where there is pain Advanced treatment through periodontal surgery to prevent more bone loss Management of any underlying conditions such as diabetes/cardiovascular disease that predisposes to periodontal disease Supportive periodontal therapy-long term program of Follow up and check ups after successful periodontal treatment
< 5 years
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including; * Study models for diagnostics especially of gingival recession * Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession * Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs & or panoramic radiographs Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g. crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication; Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where there is pain Supportive periodontal therapy-long term program of Follow up and check ups after successful periodontal treatment
5 - 11 years
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including; * Study models for diagnostics especially of gingival recession * Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession * Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs or panoramic radiographs Treatment planning and school age child education on the treatment choice Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g. crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication; Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where there is pain Advanced treatment through periodontal surgery to prevent more bone loss Management of any underlying conditions in school age child such as diabetes /cardiovascular disease that predisposes to periodontal disease Supportive periodontal therapy-long term program of Follow up and check ups after successful periodontal treatment
12 - 24 years
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including; * Study models for diagnostics especially of gingival recession * Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession * Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs & or panoramic radiographs Treatment planning and Patient education on the treatment choice Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g. crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication, Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where there is pain Advanced treatment through periodontal surgery to prevent more bone loss Management of any underlying conditions such as diabetes /cardiovascular disease that predisposes to periodontal disease Supportive periodontal therapy-long term program of Follow up and check-ups after successful periodontal treatment
25 - 59 years
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including; Study models for diagnostics especially of gingival recession Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs & or panoramic radiographs Treatment planning and Patient education on the treatment choice Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g. crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication; Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where History and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every there is pain Advanced treatment through periodontal surgery to prevent more bone loss Management of any underlying conditions such as diabetes /cardiovascular disease that predisposes to periodontal disease Supportive periodontal therapy-long term program of Follow up and check ups after successful periodontal treatment
60+ years
		Physical, clinical and full periodontal assessment involving charting of recession, probing depths, bleeding on probing and mobility for every tooth Diagnostics including: Study models for diagnostics especially of gingival recession Use of clinical photographs calibrated by inclusion of a probe to monitor gingival recession Use of Radiographs (x-rays) to determine the extent of periodontal disease and for treatment planning. These include periapical radiographs & or panoramic radiographs Treatment planning and Patient education on the treatment choice Oral Hygiene instructions modelled on patient behaviour change strategies (TIPPS-talk, instruct, practice, plan, support) Use of mouth washes as a temporary primary oral hygiene measure Removal of plaque and calculus including supragingival debridement and root surface instrumentation Ensure that the patient is motivated to achieve and maintain effective plaque removal. Management of Local Plaque-retentive Factors e.g.crowded teeth, partial dentures, bridgework, orthodontic appliances Antimicrobial Medication, Local antimicrobials, including disinfectants such as chlorhexidine and systemic antimicrobials Use of analgesics where there is pain Advanced treatment through periodontal surgery to prevent more bone loss Management of any underlying conditions such as diabetes /cardiovascular disease that predisposes to periodontal disease Supportive periodontal therapy-long term program of Follow up and check ups after successful periodontal treatment

Condition: Trachoma

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years
		Physical and clinical examination _ Medication --Chemotherapy with Azithromycin (AZM) Trichiasis surgery for trachoma
25 - 59 years

60+ years

Condition: Onchocerciasis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years
		Oral ivermectin Manage Mazzotti reaction
25 - 59 years

60+ years

Condition: Eye Conditions

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years
		Admission when necessary Follow up Antibiotics treatment for eye infections Provide specialized medical and surgical eye interventions High care Vision impairment assessments Management of any underlying conditions such as diabetes, hypertension Screen for refractory errors & provide eye glasses surgical treatment for eye conditions Clinical and physical examination Visual assessment
25 - 59 years

60+ years

Condition: Otitis media

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Attention deficit/hyperactivity syndrome

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years
		physical and clinical examination Symptomatic diagnosis of AHDD-Inattention, hyperactivity, disruptive behavior and impulsivity Diagnosis based on assessment of child’s behavioral and mental development (must have been diagnosed by the age of six) Psychotherapy and Psychosocial Interventions including; Behavioral therapy to help the patient change their behavior Cognitive behavioral therapy to teach on mindfulness techniques or meditation and help patient adjust to the life changes that come with treatment, Medication therapy (e.g. use of non-stimulants & stimulants) to reduce hyperactivity and impulsivity and improve ability to focus, work, learn and physical coordination Monitoring and management of complications including those related to medication use including headaches; increased anxiety and irritability Rule out effects of drugs, medications and other medical or psychiatric problems as the cause of ADHD Follow up
5 - 11 years
		physical and clinical examination Symptomatic diagnosis of AHDD-Inattention, hyperactivity, disruptive behavior and impulsivity Diagnosis based on assessment of child’s behavioral and mental development (must have been diagnosed by the age of six) Psychotherapy and Psychosocial Interventions including; Behavioral therapy to help the patient change their behavior Cognitive behavioral therapy to teach on mindfulness techniques or meditation and help patient adjust to the life changes that come with treatment, Medication therapy (e.g. use of non-stimulants & stimulants) to reduce hyperactivity and impulsivity and improve ability to focus, work, learn and physical coordination. Monitoring and management of complications including those related to medication use including headaches; increased anxiety and irritability Rule out effects of drugs, medications and other medical or psychiatric problems as the cause of ADHD Follow up
12 - 24 years
		physical and clinical examination Symptomatic diagnosis of AHDD-Inattention, hyperactivity, disruptive behavior and impulsivity Diagnosis based on assessment of child’s behavioral and mental development (must have been diagnosed by the age of six) Psychotherapy and Psychosocial Interventions including; Behavioral therapy to help the patient change their behavior Cognitive behavioral therapy to teach on mindfulness techniques or meditation and help patient adjust to the life changes that come with treatment. Medication therapy (e.g. use of non-stimulants & stimulants) to reduce hyperactivity and impulsivity and improve ability to focus, work, learn and physical coordination. Monitoring and management of complications including those related to medication use including headaches; increased anxiety and irritability Rule out effects of drugs, medications and other medical or psychiatric problems as the cause of ADHD Follow up
25 - 59 years

60+ years

Condition: Epilepsy

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years

Condition: Migraine

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		History, and physical and neurologic examination to help make a diagnosis Non-pharmacological (Non -drug) measures /management of migraine in pregnant women including ; Hydration regular meals advice on Reduction of caffeine intake Sleep hygiene —(Avoid bright lights, enough sleep) Regular exercise Relaxation therapy, Pharmacological/drug management of migraine in pregnant women with first line analgesisc such as; paracetamol use of anti-emetics if there is history of vomiting Migraine prophylaxis Blood pressure monitoring Monitor and manage any secondary causes of headaches in pregnant women such as pre-eclampsia and cerebral venous thrombosis, sub arachnoid haemorrhage, space occupying lesions Provide alternatives to Hormonal contraception for women who may experience onset or aggravation of migraine after starting them. Follow up and support to patients to ensure optimum treatment is achieved
< 5 years
		Physical and neurologic examination to help in the diagnosis Identification of features of migraine in children including shorter-lasting headaches attacks, commonly bilateral and less usually pulsating headache, gastrointestinal disturbance Use of drug therapy -analgesics (ibuprofen) in children with migraine, anti-emetics when vomiting is present Use of non-drug treatment (non- pharmacologic therapy for migraine in children through bed rest, relaxation therapy, physiotherapy Management of any underlying conditions that may be causing migraine in under 5 e.g. . cancer, space occupying lesions Monitor for any features of migraine headaches due to underlying conditions such as; headache projectile vomiting that may be due to intracranial space-occupying lesion, new headache in a patient with a history of cancer, HIV infection or immunodeficiency Follow up to ensure optimum treatment is achieved
5 - 11 years

12 - 24 years
		Nonsteroidal anti-inflammatory drugs Triptans Dopamine antagonist Antiemetic Non-pharmacologic therapy: lifestyle changes to reduce stress and improve relaxation
25 - 59 years

60+ years

Condition: Edentulism

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		Physical and clinical examination Complete dentures as replacement of teeth in edentulous elderly i.e. Complete Removable acrylic dentures Digitally fabricated complete dentures Tooth retained over denture Dental implants/implant supported prosthesis for edentulous elderly patients Management of any conditions due to use of dentures such as mucosal changes: traumatic ulcers, denture stomatitis, candida infection, angular chelitis and soft tissue hyperplasia. Management of other cormobidities associated with being edentulous includng poor dietray habits and nutritional intake; increased risk of hypertension and coronary artery disease. Nutritional support including vitamins supplementation Patient education on use of the dentures Radigraphc examination --Orthopantomography (OPG) Recall and Follow up

Condition: Parkinson disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Medical history and neurological examination Diagnosis through neuro-imaging -MRI Symptomatic treatment Diet therapy/guidance on balanced diet Use of medication such as levodopa Surgery for deep brain stimulation has been used to reduce motor symptoms in severe cases where drugs are ineffective. Monitoring the disease progression and management of any complications arising Management of difficulties in swallowing/feeding e.g., through use of feeding tube Managing breathing complications e.g., through use of non-invasive ventilator, and tracheostomy. Management of Urine incontinence Management of constipation, pain, blood pressure Management of secondary causes of parkinsonism’s such as stroke
60+ years
		Dopaminergic medications Non-dopaminergic medications

Condition: Hookworm disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Diagnosis based of the different clinical entities of hookworm disease i.e. Classic hookworm disease (gastrointestinal (GI) infection), Cutaneous larva migrans and Eosinophilic enteritis - Nutrition support/therapy to address any deficiency of nutrients due to the worms (e.g. Iron, Protein) Administration of anthelminthic drugs (e.g. mebendazole, albendazole) to pregnant women with hook worm disease Management of larvae in the skin (Topical administration of anthelminthic e.g. .Thiabendazole to destroy the larvae in the skin. Local cryotherapy to destroy the hookworms while still in the skin, Management of anemia and its complications (use of iron supplements, vitamin C. Folic acid and vitamin B12 supplements) Diagnostic tests Examination of a stool sample to identify hookworm eggs Blood tests to check for anemia and nutritional deficiencies Chest X-ray to check lung involvement in hookworm infection.
< 5 years

5 - 11 years
		Anthelmintic Iron supplementation Blood transfusion
12 - 24 years
		Nutritional support/therapy to address any deficiency of nutrients due to the worms (e.g. Iron,Protein) Administration of anthelminthic drugs (e.g. mebendazole; albendazole) to adolescents with hook worm disease Management of larvae in the skin (Topical administration of anthelminthic e.g. .Thiabendazole to destroy the larvae in the skin. Local cryotherapy to destroy the hookworms while still in the skin, Management of anemia and its complications (use of iron supplements, vitamin C. Folic acid and vitamin B12 supplements) Diagnostic tests Examination of a stool sample to identify hookworm eggs Blood tests to check for anemia and nutritional deficiencies Chest X-ray to check lung involvement in hookworm infection.
25 - 59 years
		Nutrition support/therapy to address any deficiency of nutrients due to the worms (e.g. Iron, Protein) Administration of anthelminthic drugs (e.g. mebendazole; albendazole) to adults with hook worm disease Management of larvae in the skin (Topical administration of anthelminthic e.g. .Thiabendazole to destroy the larvae in the skin. Local cryotherapy to destroy the hookworms while still in the skin Management of anemia and its complications (use of iron supplements, vitamin C. Folic acid and vitamin B12 supplements) Diagnostic tests Examination of a stool sample to identify hookworm eggs Blood tests to check for anemia and nutritional deficiencies Chest X-ray to check lung involvement in hookworm infection.
60+ years
		Diagnosis based of the different clinical entities of hookworm disease i.e. Classic hookworm disease (gastrointestinal (GI) infection), Cutaneous larva migrans and Eosinophilic enteritis Nutrition support/therapy to address any deficiency of nutrients due to the worms (e.g. Iron, Protein) Administration of anthelminthic drugs (e.g. mebendazole; albendazole) to elderly persons with hook worm disease Management of larvae in the skin ( Topical administration of anthelminthic e.g. .Thiabendazole to destroy the larvae in the skin. Local cryotherapy to destroy the hookworms while still in the skin Management of anemia and its complications (use of iron supplements, vitamin C. Folic acid and vitamin B12 supplements) Diagnostic tests Examination of a stool sample to identify hookworm eggs Blood tests to check for anemia and nutritional deficiencies Chest X-ray to check lung involvement in hookworm infection.

Condition: Lower respiratory tract infections (LRTI)

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Parenteral antibiotics Oxygen supplementation IV fluids
< 5 years
		Parenteral antibiotics Oxygen supplementation IV fluids
5 - 11 years
		Parenteral antibiotics Oxygen therapy IV fluids
12 - 24 years
		IV/IM antibiotics Oxygen supplementation IV fluids Oxygen therapy IV fluids
25 - 59 years
		IV/IM antibiotics Oxygen supplementation IV fluids
60+ years
		Antibiotics Oxygen supplementation IV fluids

Condition: Non-migraine headache

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Identify and distinguish the different types of non-migraine headaches based the clinical features including; For tensional headache, usually mild or moderate, more generalized and typically described as pressure or tightness For cluster headache, severe headache strictly unilateral around the eye red and watering eyes with running or blocked nostrils and marked agitation Medication over use headache-usually due to chronic use of medication mainly for migraine or tension headache (usually diagnosed if symptoms improve within 2 months of medicine withdrawal) Encourage patient to keep a headache diary to study the patterns of the headache and associated symptoms Medication -use of analgesics such as ibuprofen Guidance to patient on relaxation techniques including; Heat therapy, such as applying warm compresses or taking a warm shower Massage Meditation Neck stretching Relaxation exercises Identify warning features of serious headaches or headaches due to underlying conditions such as new headache in a patient with cancer, HIV, headache with motor weakness could indicate stroke, Management of any underlying conditions causing headaches Patients follow up
< 5 years

5 - 11 years
		Physicaland clinical examination Identify and distinguish the different types of non-migraine headaches based the clinical features including; For tensional headache, usually mild or moderate; more generalized and typically described as pressure or tightness For cluster headache, severe headache strictly unilateral around the eye, red and watering eyes with running or blocked nostrils and marked agitation Medication over use headache -usually due to chronic use of medication mainly for migraine or tension headache (usually diagnosed if symptoms improve within 2 months of medicine withdrawal) Encourage patient to keep a headache diary to study the patterns of the headache and associated symptoms Medication -use of analgesics such as ibuprofen Guidance to patient on relaxation techniques including; Heat therapy, such as applying warm compresses or taking a warm shower Massage Meditation Neck stretching Relaxation exercises Identify warning features of serious headaches or headaches due to underlying conditions such as new headache in a patient with cancer,HIV, headache with motor weakness could indicate stroke, Management of any underlying conditions causing headaches Patients follow up
12 - 24 years
		Physical and clinical examination Identify and distinguish the different types of non-migraine headaches based the clinical features including; For tensional headache, usually mild or moderate, more generalized and typically described as pressure or tightness For cluster headache; severe headache strictly unilateral around the eye; red and watering eyes with running or blocked nostrils and marked agitation Medication over use headache -usually due to chronic use of medication mainly for migraine or tension headache (usually diagnosed if symptoms improve within 2 months of medicine withdrawal) Encourage patient to keep a headache diary to study the patterns of the headache and associated symptoms Medication-use of analgesics such as ibuprofen Guidance to patient on relaxation techniques including; heat therapy, such as applying warm compresses or taking a warm shower Massage Meditation Neck stretching Relaxation exercises Identify warning features of serious headaches or headaches due to underlying conditions such as new headache in a patient with cancer, HIV, headache with motor weakness could indicate stroke, Management of any underlying conditions causing headaches Patients follow up
25 - 59 years
		Physical and clinical examination Identify and distinguish the different types of non-migraine headaches based the clinical features including; For tensional headache, usually mild or moderate, more generalized and typically described as pressure or tightness For cluster headache, severe headache strictly unilateral around the eye, red and watering eyes with running or blocked nostrils and marked agitation Medication over use headache-usually due to chronic use of medication mainly for migraine or tension headache (usually diagnosed if symptoms improve within 2 months of medicine withdrawal) Encourage patient to keep a headache diary to study the patterns of the headache and associated symptoms Medication -use of analgesics such as ibuprofen Guidance to patient on relaxation techniques including; heat therapy, such as applying warm compresses or taking a warm shower Massage Meditation Neck stretching Relaxation exercises Identify warning features of serious headaches or headaches due to underlying conditions such as new headache in a patient with cancer, HIV, headache with motor weakness could indicate stroke, Management of any underlying conditions causing headaches Patients follow up
60+ years
		Physical and clinical examination Identify and distinguish the different types of non-migraine headaches based the clinical features including; For tensional headache, usually mild or moderate, more generalized and typically described as pressure or tightness For cluster headache, severe headache strictly unilateral around the eye, red and watering eyes with running or blocked nostrils and marked agitation Medication over use headache-usually due to chronic use of medication mainly for migraine or tension headache (usually diagnosed if symptoms improve within 2 months of medicine withdrawal) Encourage patient to keep a headache diary to study the patterns of the headache and associated symptoms Medication-use of analgesics such as ibuprofen Guidance to patient on relaxation techniques including; Heat therapy, such as applying warm compresses or taking a warm shower Massage Meditation Neck stretching Relaxation exercises Identify warning features of serious headaches or headaches due to underlying conditions such as new headache in a patient with cancer, HIV, headache with motor weakness could indicate stroke, Management of any underlying

Condition: Ischaemic (Coronary) Heart Disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Thrombolytic drugs Oxygen supplementation and ventilation support Antiplatelet drugs (e.g. Aspirin) Angiotensin-converting enzyme (ACE) inhibitors Lipid lowering medications (statins) Beta blockers, Calcium channel blockers Therapeutic lifestyle modification Stabilization and referral of acute complications
60+ years
		Thrombolytic drugs Oxygen supplementation and ventilation support Antiplatelet drugs (e.g. Aspirin) Angiotensin-converting enzyme (ACE) inhibitors Lipid lowering medications (statins) Beta blockers, Calcium channel blockers Therapeutic lifestyle modification Stabilization and referral of acute complications

Condition: Haemorrhagic Stroke

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		Immediate emergency treatment for elderly persons with hemorrhagic stroke. Controlling the bleeding in the brain Reducing the pressure caused by the bleeding. Supportive care Fluids therapy-IV fluids Plenty of rest rest Surgical interventions for serious haemorrhagic stroke-e.g. to repair raptured vessels Management of other associated medical problems e.g. blood pressure ICU services Follow up

Condition: Ischaemic Stroke

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		ABC (Airway, breathing, and circulatory) support Thrombolytic medications Antihypertensive medication Glycaemia control Temperature control DVT Prophylaxis Anti-seizure medications Antiplatelet treatment (e.g. ASA) Lipid lowering medications

Condition: Peptic Ulcers

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Physical and clinical examination Diagnostic tests including; ** Blood tests for antibodies due to H.pylori Stool for signs of the bacteria Urea breath test Advice on Cessation of tobacco smoking Advice/guidance on Stoppage of alcohol Stoppage of use of NSAIDs for ulcers caused by taking NSAIDs Fluids therapy Combination therapy to eradicate H.Pylori bacteria Medication to decrease stomach acidity - proton pump inhibitor (PPI) or an H2 blocker Follow up, prevention and management of Peptic ulcer complications including Gastrointestinal bleeding; Perforation, peritonitis.Cancer Management of anemia due to bleeding complication Blood transfusion if ulcers bleeding is severe Follow up
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Physical and clinical examination Diagnostic tests including; Endoscopy X-rays/barium swallow. Blood tests for antibodies due to H.pylori Urea breath test, Stool for signs of the bacteria Biopsy of the stomach Cessation of tobacco smoking Stoppage of alcohol Stoppage of use of NSAIDs for ulcers caused by taking NSAIDs Fluids therapy Combination therapy to eradicate H.Pylori bacteria Medication to decrease stomach acidity - proton pump inhibitor (PPI) or an H2 blocker Follow up, prevention and management of Peptic ulcer complications including Gastrointestinal bleeding, Perforation, peritonitis.Cancer Management of anemia due to bleeding complication Blood transfusion if ulcers bleeding is severe Surgical interventions e.g. endoscopy with open surgery for bleeding ulcers Follow up
60+ years
		Physical and clinical examination Diagnostic tests including; Endoscopy X-rays/barium swallow Blood tests for antibodies due to H.pylori Urea breath test Stool for signs of the bacteria Biopsy of the stomach Cessation of tobacco smoking Stoppage of alcohol Stoppage of use of NSAIDs for ulcers caused by taking NSAIDs Fluids therapy Combination therapy to eradicate H.Pylori bacteria Medication to decrease stomach acidity - proton pump inhibitor (PPI) or an H2 blocker Follow up, prevention and management of Peptic ulcer complications including Gastrointestinal bleeding; Perforation; peritonitis.Cancer Blood transfusion if ulcers bleeding is severe Management of anemia due to bleeding complication Surgical interventions e.g. endoscopy with open surgery for bleeding ulcers Follow up

Condition: Multiple Sclerosis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years

60+ years
		Physical and clinical examination Therapy focused on returning function after an attack, preventing new attacks and preventing disability Management of acute attack with high doses of intravenous corticosteroids e.g. oral prednisone and intravenous methylprednisolone Diagnostic test Paralysis, Depression, Epilepsy Blood tests Spinal tap (lumbar puncture) MRI. Plasma exchange (plasmapheresis). Follow up and management of complications Including Muscle stiffness or spasms; Paralysis, Depression, Epilepsy

Condition: Dental Caries

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Investigations including dental x-rays Relieve of pain with analgesics Use of Local anesthetics, in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. Use of topical fluoride to promote remineralization for small lesions Dental restorations -Dental fillings for carious lesions using amalgam or composite fillings Repair or replacement of fillings where necessary Dental extractions Endodontic therapy/Root canal treatment Use of Crown in extensive caries with little tooth structure left Monitor and manage any complication as a result of dental caries such as dental abscesses; gum inflammations Follow up
< 5 years
		Investigations including dental x-rays Relieve of pain with analgesics Use of Local anesthetics, in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. Use of topical fluoride to promote remineralization for small lesions Dental restorations -Dental fillings for carious lesions using amalgam or composite fillings Repair or replacement of fillings where necessary Dental extractions Endodontic therapy/Root canal treatment Use of Crown in extensive caries with little tooth structure left Monitor and manage any complication as a result of dental caries such as dental abscesses, gum inflammations Follow up
5 - 11 years

12 - 24 years
		Investigations including dental x-rays Relieve of pain with analgesics Use of Local anesthetics, in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. Use of topical fluoride to promote remineralization for small lesions Dental restorations -Dental fillings for carious lesions using amalgam or composite fillings Repair or replacement of fillings where necessary Dental extractions Endodontic therapy/Root canal treatment Use of Crown in extensive caries with little tooth structure left Monitor and manage any complication as a result of dental caries such as dental abscesses, gum inflammations Follow up
25 - 59 years
		Investigations including dental x-rays Relieve of pain with analgesics Use of Local anesthetics, in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. Use of topical fluoride to promote remineralization for small lesions Dental restorations -Dental fillings for carious lesions using amalgam or composite fillings Repair or replacement of fillings where necessary Dental extractions Endodontic therapy/Root canal treatment Use of Crown in extensive caries with little tooth structure left Monitor and manage any complication as a result of dental caries such as dental abscesses, gum inflammations Follow up
60+ years
		Investigations including dental x-rays Relieve of pain with analgesics Use of Local anesthetics, in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. Use of topical fluoride to promote remineralization for small lesions Dental restorations -Dental fillings for carious lesions using amalgam or composite fillings Repair or replacement of fillings where necessary Dental extractions Endodontic therapy/Root canal treatment Use of Crown in extensive caries with little tooth structure left Monitor and manage any complication as a result of dental caries such as dental abscesses, gum inflammations Follow up

Condition: Rheumatic Heart Disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Complete physical and clinical examination Management of pain with analgesics Management of fever with antipyretics Use of anti-coagulants with close monitoring including Foetal monitoring Antibiotics prophylaxis to avoid recurrence of rheumatic fever and worsening of the rheumatic heart disease. Foetal monitoring Admissions for close monitoring of women with moderate or severe rheumatic heart disease Prevention and management of any maternal cardiac complications in pregnancy due to RHD including heart arrythmias and heart failure, pulmonary oedema Prevention and management of delivery complications due to heart damage ICU services for women with severe rheumatic heart disease Close follow up N/B Assessment pre conception or early in pregnancy for women acute rheumatic fever or mild rheumatic disease to establish safest birth pathway Diagnostics -tests including. Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)- check the heart's chambers and valves
< 5 years
		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up
5 - 11 years
		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admissions for management of severe disease/complications Management of heart failure or heart rhythm abnormalities heart failure e.g.with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up
12 - 24 years
		Antibiotic therapy Analgesics Antipyretics Heart failure management Referral to next level
25 - 59 years
		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases /complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves ICU services for severely ill patients e.g. post-surgery Follow up
60+ years
		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases/complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners/anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up

Condition: Upper Respiratory Tract Infections

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g. pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways
< 5 years
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g. pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways
5 - 11 years
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g.pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways
12 - 24 years
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g. pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways
25 - 59 years
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g.pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways
60+ years
		Diagnostic tests including culture and sensitivity, radiological examination (X-rays, CT scans) Hydration/fluids therapy Management of Nasal congestion/use of decongestants/e.g. pseudoephedrine Management of pain -Analgesics e.g. paracetamol and NSAIDs) Management of fever Management of allergies – use of antihistamines e.g. chlorpheniramine Antibiotics therapy e.g. co*amoxiclav Management of cough- use of mucolytics Vitamin C Zinc gluconate Humidified hot air Follow up, prevention and management of complications such as otitis media, compromised airways

Condition: Cardiomyopathy - Myocarditis

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Physical and clinical examination Diagnostic including; Chest X-ray. Blood tests cardiac CT scans Medications e.g for blood pressure; Referral to specilised hospitals for specialsied management including of any complications Follow up
60+ years
		Physical and clinical examination Diagnostic including; Chest X-ray. Blood tests cardiac CT scans Medications e.g for blood pressure; Referral to specilised hospitals for specialsied management including of any complications Follow up

Condition: Chronic Obstructive Pulmonary Disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn

< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Antibiotics
60+ years
		Smoking cessation Short-acting beta2-agonists (SABAs) Long-acting beta2-agonists (LABA) Short-acting antimuscarinic agents (SAMA) Long-acting antimuscarinic agents (LAMA) Inhaled corticosteroids (ICS) Systemic glucocorticoids Antibiotics

Condition: Hypertensive heart disease

Community Level	Primary Care	Referral Facility: General	Referral Facility: Specialist
Pregnancy and newborn
		Management of gestational hypertension or pre-existing hypertension in pregnant women based on severity and gestational age Non-pharmacological management including close supervision, advice on limitation of activities, and some bed rest Use of Nutritional supplements eg folic acid Review of medication accordingly for mother with pre-existing hypertension Blood pressure control in pregnant women Admissions for women with moderate to severe gestational or pre-existing hypertension Regular testing of proteinuria Blood tests-full blood count, renal and liver function test Monitoring foetal growth-ultrasound examination Follow up Post-natal monitoring
< 5 years

5 - 11 years

12 - 24 years

25 - 59 years
		Tobacco cessation Decreased alcohol use Increased physical activity Low sodium diet Thiazide diuretics Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers Calcium channel blockers
60+ years
		Tobacco cessation Decreased alcohol use Increased physical activity Low sodium diet Thiazide diuretics Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers Calcium channel blockers