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Diagnosis It is characterized by high fever purchase prograf with amex, breathlessness buy prograf 1 mg otc, cough productive of large amounts of foul- smelling sputum and haemoptysis buy prograf amex. The infection is usually polymicrobial and necessitates the use of combined drugs. Clinical types are recognized according to findings when the patient is first seen. These include: Threatened abortion, inevitable abortion, incomplete abortion, complete abortion and missed abortion. Diagnosis  Clinical features will depend on the types of abortion  Viginal bleeding which may be very heavy in incomplete abortion, intermittent pain which ceases when abortion is complete and cervical dilation in inevitable abortion  In missed abortion, dead ovum retained for several weeks while sympoms and signs of pregnancy disappear  When infected (septic abortion) patient presents with fever tachycardia, offensive vaginal discharge, pelvic and abdominal pain. Puerperal/Post abortal Sepsis Pyrexia in women who has delivered or miscarried in the previous 6 weeks may be due to puerperal or abortal sepsis and should be managed actively. The uterus may need evacuation however parenteral antibiotics must be administered before evacuation. V)1gm start Plus A: Metronidazole 500mg Plus A: Gentamycin 80mg stat Patient should continue with the following oral antibiotics after evacuation for 5 to 7days For Mild/moderate A: Amoxycillin (O) 500mg every 8 hours for 10 days Plus A: Metronidozole (O)400 mg every 8 hours for 10 days Plus A: Doxycycline (O)100 mg every12hrs for 10 days Treatment Guidelines for severe cases 0  Body temperature higher than (38 C)  Marked abdominal tenderness are signs of severe post abortal sepsis Drug of Choice: A: Benzylpenicillin (I. V) 500mg every 6 hours Plus A: Metronidazole 500mg 8hrly for 5 days For urgent Delivery irrespective of gestational age A: Benzylpenicillin (I. Continue with antibiotics after delivery for 3-5 days Note: Use of antibiotics for prophylaxis during surgery, should be evaluated from situation to situation and not generalized 5. Management  If vomiting is not excessive, advise to take small but frequent meals and drinks  If persistent, vomiting cases, search for other reasons e. General measures  Admit in the hospital Give B: Normal saline Plus C: Nifedipine 10-20 mg 12 hrly; Plus C: Hydralazine 10 mg (I. High blood sugar levels in the mother’s body are passed through the placenta to the developing baby. Gestational diabetes usually begins in the second half of pregnancy and goes away after the baby is born. Management Pregnant women should avoid:  Food and beverages that cause gastrointestinal distress  Tobacco and alcohol  Eating big meals; should eat several small meals throughout the day  Drinking large quantities of fluids during meals  Eat close to bedtime; they should give themselves two to three hours to digest food before they lie down  Sleep propped up with several pillows or a wedge. Elevating upper body will help keep the stomach acids where they belong and will aid food digestion. Major causes are;  Uterine atony  Tears of the vagina/vulva  Retained products of conception  Rarely rupture of the uterus  Bleeding disorder (e. This involves the injection of an oxytocic after the delivery of the foetus followed by controlled cord traction and uterine massage. Recommended methods  Routine Dilation and curettage - up to 7 weeks since last menstrual period  Suction termination – Between 7-12 weeks since the last menstrual period  Prostaglandin termination – after 12 weeks since the last menstrual period. The infection can happen as an ascending infection from the vagina, after delivery (puerperal sepsis), after an abortion (septic abortion), postmenstrual or after Dilation and Curettage (D&C) operation. The common causative organisms are Neisseria gonorrhea, Chlamydia trachomatis and Mycoplasma hominis. Diagnosis The main clinical features are lower abdominal pain, backache, vomiting, vaginal discharge, menstrual disturbance, dyspareunia, fever, infertility and tender pelvic masses. It may also be used in treatment of dysfunctional uterine bleeding, dysmenorrhea or endometriosis. The goal of therapy in the use of these products for contraception is to provide optional prevention of pregnancy while minimizing the symptoms and long term risks associated with excess or deficiency of the oestrogen and progestogen components. The eligibility for hormonal contraception can be obtained from nearest family planning clinic or unit. This type is suitable for lactating mothers or women with mild or moderate hypertension. Management Follow up:  Instruct women always to inform the doctor or nurse that they are on contraceptives while attending clinic or hospital. Contraindications for Norplant  Severe hypertension  Thromboembolism  Active liver disease  Sickle cell anaemia  Undiagnosed genital bleeding  Severe headaches 16. If a major placental separation has occurred, emergency delivery to minimize the possibility of disseminated  Intravascular coagulation 100 | P a g e  Give blood when indicated. Typically, in primary dysmenorrhoea pain occurs on the first day of menses, usually about the time the flow begins, but it may not be present until the second day. Treatment  Allow bed rest  Give Analgesics such as A: Ibuprofen 200-600 mg every 8 hours (maximum 2. It is classified as primary when there has never been a history of pregnancy or it is secondary when there is previous history of at least one conception. Treatment Treatment in all cases depends upon correction of the underlying disorder(s) suspected of causing infertility whether primary or secondary. Alpha-haemolytic streptococci are the most common causes of native valve endocarditis but Staphylococcus aureus is more likely if the disease is rapidly progressive with high fever, or is related to a prosthetic valve (Staphylococcus epidermidis) Diagnosis: Use Modified Dukes Criteria below and consult microbiologist where possible. One-hour peak concentration should not exceed 10mg/l and trough concentration (2 hour pre- dose) should be less than 2mg/l. At any stage, treatment may have to be modified according to:  detailed antibiotic sensitivity tests  adverse reactions  allergy  failure of response Endocarditis leading to significant cardiac failure or failure to respond to antibiotics may well require cardiac surgery. In these cases replace clindamycin with Vancomycin iv [Specialist-only drug] 1g over at least 100 minutes 1-2 hours before procedure. Pharmacological treatment Treatment of acute attack for eradication of streptococci in throat: Regardless of the presence or absence of pharyngitis at the time of diagnosis. Children > 10years 500mg, 5-10 years 250mg, < 5years 125mg two to three times daily for 10 days orally If allergic to Penicillin A: Erythromycin 500mg or 40mg/kg 4 times per day for 10 days orally Treatment of acute Arthritis and Carditis: A: Aspirin orally 25mg/kg* 4 times a day as required. Then reviewsGradual reduction and discontinuation of prednisolone may be started after 3-4 weeks when there has been a substantial reduction in clinical disease. Referral: Ideally all patients should be referred to specialized care  where surgery is contemplated  management of intractable heart failure or other non-responding complications  pregnancy Antibiotic prophylaxis after rheumatic fever: Prophylaxis should be given to all patients with a history of acute rheumatic fever and to those with rheumatic heart valve lesions. The optimum duration of prophylaxis is controversial, but should be continued up to at least 21 years of age. Congenital Heart Disease It is a congenital chamber defects or vessel wall anomalies Valvular Heart Disease and Congenital structural Heart Disease may be complicated by:  Heart failure  Infective endocarditis 107 | P a g e  Atrial fibrillation  Systemic embolism eg Stroke General measures  Advise all patients with a heart murmur with regard to the need for prophylaxis treatment prior to undergoing certain medical and dental procedures  Advise patients to inform health care providers of the presence of the heart murmur when reporting for medical or dental treatment Referral  All patients with heart murmurs for assessment  All patients with heart murmurs not on a chronic management plan  Development of cardiac signs and symptoms  Worsening of clinical signs and symptoms of heart disease  Any newly developing medical condition, e. Lower doses are needed  Recommended an alternative contraceptive method for women using oestrogen 108 | P a g e Containing oral contraceptive  Evidence of end organ damage, i. Potassium Sparing Diuretics Spirinolactone 25mg once daily Eplerenone 25mg once daily 04. Central Adrenergic Inhibotor Methylodopa 250mg 12hrly 112 | P a g e Clonidine 50µg 8hrly 05. Beta Blockers  Non selective Propranolol 80mg 12 hrly  Selective Atenolol 50 – 100mg once daily Metoprolol 100mg 12hrly  Alpha& Beta blockers Carvedilol 12. Referrals are indicated when:  Resistant (Refractory) Hypertension  All cases where secondary hypertension is suspected  Complicated hypertensive urgency/emergencies  Hypertension with Heart Failure  When patients are young (<30 years) or blood pressure is severe or refractory to treatment. Resistant (Refractory) Hypertension Hypertension that remain >140/90mmHgdespite the use of 3 antihypertensive drugs in a rational combination at full doses and including a diuretic.

Canadian accreditation standards give clear direction to health care facilities that ongoing assessment of the efectiveness of pain management is an expected component of the Accreditation Canada evaluation best prograf 5mg. Structure of Care Performance data include characteristics of health care professionals and organizations such as training purchase prograf us, education purchase prograf amex, type of facility and ownership indicators; • Availability and access to practitioners or health care providers identifed as pain specialists. Process of Care Process data describes the activities of the health care provider in the encounter between the patient and the provider such as tests ordered, medication prescribed, assessments completed and interventions implemented. Process data are considered credible if it can be demonstrated that variations in the attribute measured leads to a diference in outcomes. Outcomes of Care Outcome data refer to the patient’s subsequent health status and may include items such as mortality, quality of life, improvement in symptoms or functional status and patient satisfaction. Outcome data indicators include: • Patient Satisfaction Scale; • Pain Intensity Scores. This Committee hopes this work will beneft those patients who require efective pain management to maintain their dignity, functional capacity and overall quality of life. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The management of cancer-related breakthrough pain: Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Cancer-related pain management: A report of evidence-based recommendations to guide practice. Introduction Progress has been made over the last decade to detect, report and learn from patient safety incidents, but further improvements are needed to increase the number of incident reports, improve data quality and maximise what is learned from medication errors. To support this initiative, a National Medication Safety Network will be created which will give continual learning and identify and spread medication safety improvements across the health economy. This supporting information gives additional information and clarifcation on the thinking behind this Patient Safety Alert and its recommended actions. The latter include, for example, omitted dose or a failure to monitor, such as international normalised ratio for anticoagulant therapy. Details of a new National Patient Safety Alerting System have recently been issued. The value of the scheme has been demonstrated many times and it has helped identify many important safety issues. The cost of medication errors Research evidence indicates the following medication error rates in the medicine use process: • prescribing error rate in hospital, 7% of prescription items2; • prescribing errors rate in general practic, 5% of prescriptions of which 0. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. Of these, 86,821 (16%) of medication incidents reported actual patient harm, 822 (0. For an example of how a medication error report should be completed see Appendix B (pages 14 and 15). Essential information to allow understanding of medication error incidents, both locally and nationally, may not be included in reports. This will allow more detailed assessment, support national analysis of potential safety concerns resulting in regulatory action (if necessary) and enable feedback to healthcare professionals which will support local learning. This will lead to the safer use of medicines and greater protection of public health. Senior managers in healthcare organisations are not always aware of important patient safety issues, or the quality of the reporting and learning systems that operate in their organisations. The oversight role of the medical / nursing director or superintendent pharmacist A board director (medical or nursing supported by the chief pharmacist) or superintendent pharmacist in a community pharmacy or home healthcare company, should have oversight responsibilities and oversee medication error incident reporting and learning systems. In the independent sector, ensure that there is an auditable line of delegated authority from the board to the medication safety offcer and that the board retains the oversight responsibilities and oversees medication safety incident reporting and learning. The board director or superintendent pharmacist should foster a safety culture and satisfy themselves that; these systems are operating effectively, the quality of incident reports supports learning, important patient safety issues identifed by these systems are adequately addressed locally and incident reports are submitted in a timely fashion for national learning. These individuals should have relevant knowledge and experience, and their current role should cover appropriate responsibilities. This may entail reviewing all medication incident reports to ensure data quality for local and national learning and where necessary to investigate and fnd additional information from reporters. The role of the medication safety committee An existing or new multi-professional committee should be identifed to support the safe use of medicines in the organisation. Defnition of a small healthcare provider organisation Any healthcare organisations not defned in section 7. Communication and support Receive support for reporting and learning from medication safety offcers in healthcare commissioning organisations and medication safety champions who are members of local professional committees and multi-professional committees. Medication safety champions Medication safety champions are individuals who have chosen to take an active role in improving the safe use of medicines. A safety champion will be someone who is already working to improve patient safety. Safety champions do not need to be appointed, however where champions are active organisations should try to capitalise on the contributions they can make. Defnition of healthcare commissioners Healthcare commissioning organisations purchase healthcare services. Clinical Commissioning Groups are responsible for commissioning secondary care and, depending on local arrangement, they may receive support from Commissioning Support Units. Both types of commissioners are responsible for improving quality and safety in primary and secondary care. The oversight role of clinical governance Invited arrangements for improving reporting and learning for medication error incidents should be part of clinical governance structures in commissioning organisations. These structures should ensure that medication error reporting systems are operating effectively, that the quality of incident reports supports learning, that important patient safety issues identifed by these systems are adequately addressed locally and that incident reports are submitted in a timely fashion for national learning. These individuals should have appropriate knowledge and experience and their current work is likely to cover broadly similar responsibilities. The role of the medication safety committee An existing or new multi-professional committee can help to support the safe use of medicines in the organisation. It should be made up of: • medical staff; • nursing staff; • pharmacy staff; • those in risk management and general management; and, • a patient representative. Some patient complaints may contain information about incidents involving medication errors. The overall number of medication incidents for each organisation is provided as part of this summary. Reporting and Learning System in England and Wales over six years (2005 – 2010) Br J Clin Pharmacol. Insulin, hospitals and harm: a review of patient safety incidents reported to the National Patient Safety Agency. Drug Safety Update is essential reading for all healthcare professionals, bringing them the very latest information and advice to support the safer use of medicines. Communications via the Central Alerting System • Safety warnings and messages about medicines Available at: www. This includes all reports received from healthcare professionals, members of the public and pharmaceutical companies.

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Diabetologia 2005 cheap prograf 1mg;48:2460–2469 eral density and fracture risk in patients with Sleep-disorderedbreathingandtype2diabetes: 31 purchase 1mg prograf visa. Risk of dementia in di- Osteoporos Int 2007 order prograf once a day;18:427–444 ation Taskforce on Epidemiology and Preven- abetes mellitus: a systematic review. Periodontal status of diabetics Diabetes mellitus and risk of dementia: a meta- Research Group; Health, Aging, and Body Com- compared with nondiabetics: a meta-analysis. Br Dent J 2014;217:433–437 S32 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 40, Supplement 1, January 2017 64. Psycho- of hypoglycemia in adults with type 1 diabetes: clinical sample of type 2 diabetes mellitus pa- logical conditions in adults with diabetes. Rev Bras Psiquiatr 2005;27:135–138 Psychol 2016;71:552–562 tes Care 2015;38:1592–1609 85. Psychometric properties of the Hypo- Int J Eat Disord 2013;46:819–825 view and meta-analysis. Diabetes Diabetes Care 2010;33:450–452 quantification, validation, and utilization. Ele- ders in the National Comorbidity Survey Repli- Christensen T, Clauson P, Gonder-Frederick L. Biol Psychiatry 2007;61:348–358 A critical review of the literature on fear of hy- medicine use, and risk of developing diabetes 90. Martyn-Nemeth P, Quinn L, Hacker E, Park H, poglycemia in diabetes: implications for diabe- during the DiabetesPreventionProgram. Injection related anxiety in insulin-treated di- pression in adults with diabetes: a meta-analysis. Diabetes Res Clin Pract 1999;46:239–246 Diabetes Care 2001;24:1069–1078 for disordered eating in youth with type 1 di- 71. Psychosom Med 2003;65:376–383 21:45–57 tic and Statistical Manual of Mental Disorders 82. Available from http:// orative care for patients with depression and diabetes among persons with schizophrenia and psychiatryonline. Eur Arch Psychiatry Clin Neurosci 2008; 2016 Eating disorders in adolescents with type 1 di- 258:129–136 73. As- implications of anxiety in diabetes: a critical review World J Diabetes 2015;6:517–526 sessment of independent effect of olanzapine of the evidence base. Interventions that restore awareness eating disorders and psychiatric comorbidity in a nested case-control study. Patients and care providers should focus together on how to opti- mize lifestyle from the time of the initial comprehensive medical evaluation, throughout all subsequent evaluations and follow-up, and during the assessment of complications and management of comorbid conditions in order to enhance diabetes care. B c Effective self-management and improved clinical outcomes, health status, and quality of life are key goals of diabetes self-management education and support that should be measured and monitored as part of routine care. C c Diabetes self-management education and support should be patient centered, respectful, and responsive to individual patient preferences, needs, and values and should help guide clinical decisions. A c Diabetes self-management education and support programs have the neces- sary elements in their curricula to delay or prevent the development of type 2 diabetes. Diabetes self-management education and support programs should therefore be able to tailor their content when prevention of diabetes is the desired goal. B c Because diabetes self-management education and support can improve out- comes and reduce costs B, diabetes self-management education and support should be adequately reimbursed by third-party payers. Monitor patient performance of self- management behaviors as well as psychosocial factors impacting the person’s Suggested citation: American Diabetes Associa- self-management. More infor- of diabetes as they face new challenges and as advances in treatment become mationis available at http://www. Despite these bene- quality foods with less focus on specific should be evaluated by the medical care fits, reports indicate that only 5–7% of nutrients. Annually for assessment of education, other identified barriers such as logistical tion recommendations. To promote and support healthful eat- the tools to make informed self-management nized by the American Diabetes Associa- ing patterns, emphasizing a variety of decisions (4). To address individual nutrition needs Evidence for the Benefits always be reimbursed. To maintain the pleasure of eating by coping (13,14), and reduced health care following a food plan. Individual and group development of an individualized eating Body weight management is important approaches are effective (11,24). All individuals with diabe- for overweight and obese people with ing evidence is pointing to the benefitof tes should receive individualized medi- type 1 and type 2 diabetes. Patients who participate in about nutrition therapy principles for the Treatment of Type 2 Diabetes”). E Energy balance c Modest weight loss achievable by the combination of reduction of calorie intake and A lifestyle modification benefits overweight or obese adults with type 2 diabetes and also those with prediabetes. Eating patterns and macronutrient c As there is no single ideal dietary distribution of calories among carbohydrates, fats, E distribution and proteins for people with diabetes, macronutrient distribution should be individualized while keeping total calorie and metabolic goals in mind. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia. A Micronutrients and herbal supplements c There is no clear evidence that dietary supplementation with vitamins, minerals, C herbs, or spices can improve outcomes in people with diabetes who do not have underlying deficiencies, and there may be safety concerns regarding the long-term use of antioxidant supplements such as vitamins E and C and carotene. Alcohol c Adults with diabetes who drink alcohol should do so in moderation (no more than C one drink per day for adult women and no more than two drinks per day for adult men). Education and awareness regarding the recognition and management of delayed hypoglycemia are warranted. Sodium c As for the general population, people with diabetes should limit sodium B consumption to ,2,300 mg/day, although further restriction may be indicated for those with both diabetes and hypertension. Nonnutritive sweeteners c The use of nonnutritive sweeteners has the potential to reduce overall calorie and B carbohydrate intake if substituted for caloric sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels. S36 Lifestyle Management Diabetes Care Volume 40, Supplement 1, January 2017 5% of initial body weight, has been shown Individuals with type 1 or type 2 di- the recommended daily allowance of to improve glycemic control and to reduce abetes taking insulin at mealtimes 0. Reducing the need for glucose-lowering medications should be offered intensive education the amount of dietary protein below (51–53). Sustaining weight loss can be chal- on the need to couple insulin administra- the recommended daily allowance is lenging (54). For people not recommended because it does not with lifestyle programs that achieve a whose meal schedules or carbohydrate alter glycemic measures, cardiovascular 500–750 kcal/day energy deficit or pro- consumption is variable, regular counsel- risk measures, or the rate at which glo- vide ;1,200–1,500 kcal/day for women ing to help them understand the com- merular filtration rate declines (71,72). For many obese individuals with In addition, education regarding the response to dietary carbohydrates (73). Individuals who consume The ideal amount of dietary fat for indi- The diets used in intensive lifestyle meals containing more protein and viduals with diabetes is controversial. The management for weight loss may differ fat than usual may also need to make Institute of Medicine has definedanac- in the types of foods they restrict (e. The pattern with respect to both time and ized controlled trials including patients diet choice should be based on the patients’ amount (37).

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Percentage of health facilities reporting no stock-out of key commodities during the reporting period generic 1 mg prograf free shipping. Rationale Ensuring adequate and continued supply of the recommended anti-malarial commodities is key to the success in preventing and controlling malaria through the delivery of effective treatment and preventive services at health facilities best 5mg prograf. All cause Under-Five Mortality Rate Definition of the indicator: The probability of children dying between birth and their fifth birthday for every 1 order cheap prograf,000 children born alive. Definition of key terms: Numerator: Number of deaths of children under five years during a specified period x 1,000. Denominator: Number of children under-five years in the same period Data Sources: Data is usually obtained from registration of vital events, population census demographic and health survey. Use: This indicator is a measure of the general health status of the population and the performance of the child health programmes. The test positivity rate is usually computed for a specified period of case detection activities. In areas with unstable malaria, an increasing test positivity rate among fever patients is one of the warning signs of a possible epidemic. Numerator: Number of laboratory-confirmed malaria cases (tested positive) Denominator: Number of suspected malaria cases tested (microscopy. Inpatient malaria deaths per 1,000 persons Rationale Mortality is a major component of the burden caused by malaria, and the overall goal of the Roll Back Malaria Partnership is to reduce malaria deaths to near zero by 2015. With intervention coverage data and repeated estimation, understanding of the epidemiology of malaria can be improved and progress of control efforts can be tracked more effectively if estimates of parasitemia prevalence are available. Under 5 Malaria Case Fatality Rate Definition of the indicator: Under 5 malaria case fatality rate is defined as the proportion of children under five years of age who die of malaria out of the total number of children under-five (5) years admitted with malaria. In other words it expresses the proportion of children under five years with malaria who die from it (ratio of deaths to cases). Data Sources: The data is obtained from the hospital In-patient Morbidity and Mortality Returns. Use: This indicator is used to assess the performance of the malarial control programme and quality of inpatient care of the health services. Malaria-specific deaths per 1,000 persons Rationale Mortality is a major component of the burden caused by malaria, and the overall goal of the Roll Back Malaria Partnership is a 50 percent reduction in malaria-associated mortality among children under-five (5) years old by 2010. Pharmacovigilance Data sources: Complete or sample vital registration systems, verbal autopsy (surveys). Reporting Timelines Reporting of serious adverse events (death, life threatening, prolonged hospitalisation) should be reported immediately and not later than 7 calendar days. For non-serious adverse effects, reports could be submitted within a period of 28 days. It is then spread on a glass slide ("blood smear"), dipped in a reagent that stains the malaria parasites (Giemsa stain), and examined under a microscope at a 1000-fold magni- fication. Malaria parasites are recognisable by their physical features and by the appearance of the red blood cells that they have infected. These characteristics often allow the laboratory technicians to identify the type (species) of parasite causing the infection, a finding that will guide the treatment. The laboratory technicians or Biomedical Scientist can also assess the percentage of red blood cells that are infected, a measure of severity of the infection. Microscopy can only be performed by specially trained laboratory technicians and other specially trained health care workers. For microscopy guidelines and Standard Operating Procedures, refer to the Guidelines for Laboratory Diagnosis of Malaria (Ghana Health Service: 2014). There is currently no international consensus on any particular brand and type, although the field is advan- cing rapidly. For a full set of technical guidelines, refer to the Guidelines for Laboratory Diagnosis of Malaria (Ghana Health Service: 2014). Principle and Purpose The test utilises a device coated with monoclonal antibodies against malaria parasite antigens. Blood flows along the device and if malaria parasite antigens are present in the sample, the antigen antibody complex binds with a conjugate forming a coloured line (usually red). The purpose of the test is to determine if a person has been recently exposed to malaria infection. Some tests are able to distinguish Plasmodium falciparum from other malaria species. Reagents and Materials Tests contain the following components in the kit: Ÿ Instruction sheet. Method: a· Ensure the kits have not expired by checking the date at the back of the package and read manufacturer’s insert. Therefore, test results must be read only within the time specified by the manufacturer. C T Negative Results: One line ‘C’ appears in the result window Positive Results: P. Test is positive even if the test line is faint Invalid Results: No ‘C’ line appears in the results window. This means that, in patients with suspected malaria, a confirmed diagnosis is recommended, wherever possible, before giving anti-malaria treatment. On the basis of clinical judgement, these patients may be treated for malaria in addition to any other cause of fever. Treatment failure may be due to drug resistance, poor adherence to treatment, poor quality of drugs, unusual pharmacokinetic properties in that individual, or misdiagnosis. The development of malarial symptoms and signs 28 days or more after the initiation of malaria therapy is considered as indicative of a new infection, and requires appropriate investigation. In all patients with suspected severe/complicated malaria with or without fever or history of fever, the use of a confirmatory blood slide is recommended, so that parasitaemia can be quantified. Note that, high parasitaemia is not always present in severe disease and initial blood slide examination may be negative. When effective malaria prevention strategies are in place, the number of children with fever due to malaria may markedly reduce. This information will be used to determine the need for change in national diagnostic guidelines. In patients with non-severe symptoms and signs, anti-malaria treatment may be withheld if the diagnostic test is negative, and the patient carefully observed. In patients with severe symptoms and signs, anti-malaria treatment should be offered if the malaria test results are negative, and repeat blood film examination is recommended to confirm the diagnosis. Although clinicians may treat patients for malaria even if the test results are negative, they must note that, in all cases, fever may have another cause. Apart from preventive measures, early diagnosis and complete treatment are the important modalities that have been adopted to contain the disease. In view of widespread chloroquine resistance in Plasmodium falciparum infection, and other recent developments, the national policy has been revised to meet these challenges. These guidelines are the collaborative effort of National Vector Borne Disease Control Programme, National Institute of Malaria Research and experts from different parts of the country.

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