Work Instruction for Management of Communicable Diseases

Document No: MCD/HWC-SC I

I..... Date of lssue:
Version/lssue No: 0l Effective Date:

Work Instruction

For

Management of Communicable Diseases in

ABHWC-HSCs
DABLI
 The signatures below certify that this procedure has been reviewed and approved, and
demonstratethat the Signatories areaware of all the requirements contained herein and are
committed to ensuring their provision.

Name Position Signature

Prepared By

Approved By

Amendment Note:

Page No Context Revision Date

USAD
USAD
FROM THE AMERICAN PEOPLE nishtha jhpiego
Saving ves lmpeoving
horafarrngfutue
healL

Note: Prior to use, ensure this document is the mostrecent issued

This procedure is reviewed to ensure its continuing relevance to the systems and process

that it describes. A record of contextual additions or omissions is given below:

Sabina Yasmiw
Page 2of 24
Community Health Officer
i/e Dabli HWC
Mormoi BPHC, Goalpara
S.No. Content

Purpose and Scope

2 Service Delivery Frame Work
3 National Vector Borne Control Disease Program

3a Malaria

3b Dengue
3c Chikungunya

3d Japanese Encephalitis

3e Filiariasis

3f Kala azar

4 Microbacterial Infections

4a Leprosy

4b Tuberculosis

infections
Sexually Transmitted

5a HIV

6 Hepatitis

Sabie Yasmi

CommunityIHealth Ofticer

Page 3of 24 i/e Dabli HWC

MomoiBPHC, Goalpara
 rurpose: Overall purpose of this work instruction is to ensure quality services for preventive and
management of communicable diseases under various national health program and to improve
surveillance activities in the catchment area of the HWC-SC.

SCope: It applies to the Health and Wellness team which includes (ASHA, ANM and CHO). It includes
role of ASHA,ANM and CHO in completingthe standard process screening, management and reterral

or tne patients at higher centre for timely and correct intervention for communicable diseases.

Service Delivery Framework

o3D8dooM At Community level

Symptomatic care for fevers, URIs, LRIs, body aches & headache, skin infections and
abscesses, with referral as needed.

Preventive action & primary care for waterborne disease like diarrhea, cholera, other
enteritis and dysentery,typhoid, hepatitis (A& E).

Creating awareness about prevention, early identification & referral in cases of helminthiasis
& rabies.

Preventive and promotive measures to address musculoskeletal disorders mainly

osteoporosis, arthritis and referral or follow up as indicated.

Providing symptomatic care for aches and pains - joint pain, back pain etc.

At Health and Wellness Centre-Sub Health Centre level (HWC-SHC)

Identification & management of common fevers, ARIs, diarrhea & skin infections (scabies &
abscess).

ldentification & management of cholera, dysentery. typhoid, hepatitis and helminthiasis.

Managementof common aches, joint pains and common skin conditions.

Vector Borne Disease Control Program

Role of CHO
a. Toact as a mid-level manager of the VBDs activities under the area of his/her jurisdiction.

Sabim Yasmi
Page 4 of 24 Community Health Ofticer
i/e Dabli HWC
Mornoi BPHC, Goalpara
b.
ros verify records of ASHA byvisiting houses of fever cases & ensuring that complete
treatment is provided.

Massess lEC level of the community regarding different VBDs, especially vector control
measures, Signs & symptoms of diseases and usage of LLIN etc.

O. Ensuring chat records of ASHAs are routinely verified andcompiled at SHC-HWC level and
analyzed to ensure that there is no sudden increase in number of fever cases.

e Ensure good communication with field level health care workers to detect any signs of

impending outbreaks and inform MO-PHC, BMO/DVBDCO/Nodal officer IDSP.

f.
Ensure that severe Malaria cases are referred to appropriate health facility with adequate
pre-referral care.

Ensure all fever cases reporting to the SHC-HWC are tested and treated appropriately.

h. Ssupervise all VBDs activities of ASHA and MPW.

Record Keeping

a.
Maintain and submit village wise monthly reports of Malaria in prescribed formats to MO
PHC.

b. Submit monthly stock positions of various drugs and diagnostics available at the HWC.

Role of ASHA

Be the first point of contact for fever cases in the village. Perform Rapid Diagnostic Test and
take blood smear in slides in fever cases and provide treatment based on its results of

RDT/microscopic examination

b. Arrange for transportation of slides to the laboratory and to get back results

C. ldentify warning signs of severe malaria and ensure timely referral of such cases with

adequate pre-referral care, to the nearest First Referral Unit such as nearby Block PHC with
inpatient facility or DH after making blood smear and performing RDT

d. Arrange funds from NRHM flexi-pool for transportation of severe malaria cases

e. ldentify increase in number of fever cases in the community and provide prompt information
of fever outbreak to MPW, CHO, MO-PHC, BMO /DVBDCO/NodalOfficer-|DSP

Early identification and referral of suspected AES cases in proper position to higher health

facility to ensure compliance to medication.

Act as Drug Administrator in Mass Drug Administrator for Elimination of LymphaticFilariasis

and ensure directly observed consumption. Line listing of cases of Lymphatic Filariasis

h. Facilitate immunization for Japanese Encephalitis

Sabim asni
Page 5 of 24 CommunityHealthOfficer
i/eDabi HWC
Momoi BPHC,Goalpara
 Involved as Vvillage level team (ASHA., MPW. Kala Azar Technical Supervisor-kTS) 1on
Case Detection and ensure Kala
Azar treatment
Work in close coordination with MPW and Malaria Technical Supervisor (MTS) to ensure

adequate mobilization of the community for acceptance of IRS before the rounds
k

Provide prior information on IRS to the community and village opinion leaders, 7 days in

advance and then again one day before the spray

Provide prior information on LLIN Usage before & after its distribution & ensure usage by
the community

m. Assist MPW and MTS in selection of sites for dumping of insecticides

n.
Educate community about signs and symptoms of malaria, its treatment, prevention and
vector control

o. Undertake advocacy for vector control, e.g. spreading awareness on source reduction

activities and improving utilization of ITNs.

Participate in camps organized for insecticide treatment of bed nets.

q. Be member of the Village Health, Nutrition and Sanitation Committee and take active part

in its meetings and contribute to the discussions.

r. Maintain village level records of fever cases in M-I, record of blood slides in M-2.

Role of MPW Male and Female

a. Conduct weekly domiciliary house to house visit, in areas where ASHAs have not been

deployed, as per schedule developed by CHO.

b Collect blood smears (thick and thin) or perform RDT from suspected malaria cases during

domiciliary visits and keep the records in M-I.

C. Transport slides collected along with M-I to the laboratory for examination.

Provide treatment to positive cases as per drug policy and ensure timely referral of such

cases with adequate pre-referral care, to the nearest referral institution such as Block PHC
or DH after making blood smear and performing RDT.

e. Arrange funds from NRHM flexi pool for transportation of severe malaria cases.

f. Contact the ASHAs during village visits & collect blood smears & M-I for sending to lab.

Cross-verify ASHA's records by visiting patients diagnosed positive between previous &
current visit.

h. Replenish stock of microscopy slides, RDKs and drugs toASHAs.

Maintain record of blood smears collected and patients given antimalarials in M-1.

Sabina Yas
Page 6 of 24
CommunityHealth Otticer
ile Dabli HWC
MornoiBPiIC, Goalpara

TVIOITOTBITIC,UUaIpu
 for insecticides. work
Take decision on dumping sites
a way that
they
in such
squads about
k Deploy thespray proforma
Supervise the work of spray squads.
reportin
prescribed
Make refused
convenience supervision. locked,
in adjacent houses for sprayed, mmissed,

consumed, squads deployed

and human dwellings in all human dwellings.
insecticide quality
is of good
missed. Ensure that spray
and rooms sprayed/rooms
on spray dates to the community/villages.
Provide advance
information and
treatment, prevention
malaria, its
of

about signs and symptoms

Educate community
in antimalaria
month activities.
Participate
vector control. take active part
and Nutrition Committee and
Health, Sanitation
of the Village
m. Be member
the discussions.
in its meetings and lead
subcenter
by blood slides & RDTs in M-1& prepare
fever cases diagnosed it to PHC-HWC.
of ASHAs & submit
of
n.
Maintain record those
including
for all cases in the area,
report (M-4) meetings
tour diary & submit to CHO during monthly
visits in
O. supervisory
Maintain record of
for verification.

Protection For Community Protection

For Individual
Actions nets,
treated
nets, Insecticide
treated
Insecticide
Decreasing human mosquito clothing
full protective full-length
repellents,
protective
contact
length clothing

insecticides
repellent Spraying,fogging of

killers/
adult mosquitos Mosquito on inner
Destruction malathion)
(DDT,
dhoop batti
walls of houses

Spraying of larvicidal agents on

of areas
Cleanliness
Destruction of mosquito larvae of
water surfaces, placement
surrounding house, emptying
of

Gappi fish in water bodies

unused stagnant water (e.g.

discarded items as tyres, drums

placed over rooftops

lids General cleanliness of public

Small scale drainage, Putting
Source reduction
underground drains and
Over open drains near house places,

closing of open drains

Motivation for personal and Health education, IEC activity

Social Participation

family protection

3a. MANAGEMENT
OF MALARIA

Salbina Ysmen
7of 24 Community Health Officer
Page
ile Dabli HWC
Mornoi BPHC, Goalpara
 endemic areas, malaria should be routinely suspected in any febrile person. Susplcion

for those persons from non-endemic area with acute febrile illness, Wno nave
ourd be kept high

aistory of recent travel to malaria endemic zone.

yase Suspected for malaria should be confirmed by laboratory diagnosis. Microscopic examinato

confirms the diagnoSIS.

Dr thick & thin blood smears & visualization of malarial parasite in the slides

SHC-HWC which are easy to

This test is available at all PHCS. RDKs are available at level, reliable,

use & give results within minutes.

Ireatment is recommended only after confirmation of diagnosis of suspected malaria case is done.

Uncomplicated Malaria

Treatment of Uncomplicated P. vivaxCases

Chloroquine: 25 mg/kg body weight divided over 3 days, ie. 10 mg|kg on day I, 10 mg|kg on day 2
& 5 mg/kg on day 3. (For adults above 60 kg, maximum dose is 600 mg)

i. Primaquine: 0.25 mg/kg body weight daily for 14 days with maximum dose for adults 15 mg/day

Age (in years) Tab. Chloroquine 250mg (150 mg base)

Tab. Primaquine

(2.5 mg base)

Day I Day 2 Day 3 Day to 14

<|

|4
5-8 2 2

9-14 3 3 4

15 & above 4 4 2 6

Pregnancy 4 4 2 0

Treatrment of Uncomplicated P. falciparum Cases and Mixed Infections (Pv+P)

Artemisinin based Combination Therapy (ACT): Artesunate 4 mg/kg body weight

tablets daily for 3
days (Caution:ACT is not to be given in Ist trimester of pregnancy)

Sutfadoxine (25 mg/kg body weight) & Pyrimethamine (1.25 mg/kg body weight): As

asingle dose on first day

Primaquine:Single dose of 0.75 mg/kg body weight on day 2 only

Salbia Yasmin
CommunityHealth Ofiicer
Page 8 of 24 ie DabliHWC
Mornoi
btiiCoalpara
 of P. Falciparum
schedule for treatment
Age-wise dosage
packets)
of Artesunate blister
(With colour codes

3rd Day
2nd Day tablets tablets
Age (in Years) Ist Day tablets

Artesunate
Primaquine
SP* (250+|2.5 Artesunate
Artesunate (50mg)
(7.5 mg base)
(50 mg)
(50 mg) mg)

<|

|4 2
2 2
5-8 2
4
3
3 2 3
9-14
4

4
6
4 3
I5 years and

above
4
4
Pregnany 2nd 4 3

I3rd

Trimester

not begiven in either Py, PforMixed

duringpregnancy andshould
Note:Primaquine contraindicated
is
tablet Quinine (10mg/kg
three times a day for
days) is 7
PrtPf infection. For PW
in first trimester,
artesunatecombination therapy
malaria infection instead of
recommnended for uncomplicated

Presenting Complaints
In Addition to Antimalarial Drugs, Give Treatment for Patient's

Do not give ibuprofen,

syrup is effective to treat these symptoms.
Fever and Pain: Paracetamol tablet/

of bleeding in malaria patients. In adults & PW, give PCM

diclofenac or aspirin, as they increase the risk

In children, give PCM syrup/ tablet

500mg 4 times a day for 3-5 days or till symptomsare resolved.

1Smg/kg 4 times a day till symptomsare resolved.

minutes of intake
syrup & tablets may be used. If vomiting occurs within 30
Vomiting Metoclopramide
the patient
Avoid giving antimalarial drugs on empty stomach. Counsel
of medicines, repeat the dose.
are not resolved
to take full course of medicines. Ask patient to report back to HWC, if symptoms
black-reddish round
danger as bleeding from gums, nose or urine,
after 3 days of medicines or if signs

anywhere over the skin.

patches or rash appears

Complicated Malaria Sabim Yasmi

Community Health Oficer

Page 9of 24 ile Dabli HWC

Momoi BPHC, Goalpara
ratients with severe malaria may present with diferent combination of red flag signs; therefore, eveny

case of severe malaria may be different than the other, For example, all 3 of the followingteatures a

seen in three different patients with malaria.

Fever of 3 days with acute onset seizures, or

ii. Fever from 2-3 days and severe shok and respiratory distress, or

ii. Patient with high grade fever and severe vomiting with splenomegaly.

Assessment of Airway, Breathing, Circulation should be done first as per basic life support protocols

and necessary steps be aken accordingly. All sick patients witch severe malaria should receive Ist dose
of antimalarial drugs as well as required resuscitation at HWC level itself, before referral to higher
centres.

3b.DENGUE MANAGEMENT
In mild DF, only symptomatic care is recommended. Paracetamol tablets as antipyretics, good
hydration with plenty of fluids in different forms of home remedies as rice-water, fresh fruit juices,

nimbupani, ORS, etc. are advised.

Aspirin/NSAIDs (nonsteroidal anti-inflammatory drugs) like lbuprofen, Diclofenac, etc. should be

avoided since it may cause gastritis, vomiting & severe bleeding complications in patients with dengue
infection.

Patients should be monitored for 24 48 hours in DHF endemic areas for warning signs even after they

become afebrile. They should be explained about danger signs & symptoms & clearly instructed to
return to SHC-HWC for follow up.

Any person, confirmed with RDK to have dengue infection should be referred to higher center for

treatment, if he/she shows following danger symptoms/signs:

• hypotension (systolic BP <90 mmHg)

signs of severe dehydration

altered sensorium (confusion,

irrelevarnt talk, slurring of speech, etc.) or unconsciousness

•breathing difficulty

• bleeding gums

• decreased urine production or complete absence

•jaundice
•bluish-black patches over skin

Saim Yasmi
Community Healih Oficer

Page 10 of 24
i/e Dabli HWC
Mornoi BPHC, Goalpara
 tluids
el patent is brought
should be done before &
to SHC-HWC in shock as in DHE r DSS: then initial stabilization witnY
during referral from SHC-HWc During referral of DSS
carefully
patena
follow these
principles:

hemodynamic stabilization of patient with reference to vitals which includes treatment or

nypotension for patient in shock. About 10-20 m/ke of V Auids (preferably Ringer's lactate KL
or Normal saline NS) should

if patient is still
be given

hypotensiveduring referral.
in first one hour. Additional 10ml/kg of fluids may be 8e
2.
Contirm the diagnosis using RDK & with
discuss relatives/attendants about severity of illnesS &
plan of referral including place, accompanying persons, vehicle, possible requirement tor
arrangement of blood & blood
donors, etc.
3.
Provide good referral note mentioning
Call and inform the
briefly details of first clinical
assessment & treatment gven.
referral center in advance
about the concerned patient.

3c.
MANAGEMENT OFCHIKUNGUNYA

Diagnosis of Chikungunya is based on serological tests which are reliable only after first week of
infection; these tests are mostly available at medical colleges. Clinical suspicion should be kept high
based on presentation of symptoms.
There is no specific antiviral treatment for Chikungunya. Only
symptomatic management advised that includes rest, antipyretics (Paracetamol), good hydration
with plenty of oral fluids, home remedies. Do not give aspirin and other non-steroidal anti
inflammatory drugs to avoid risk of bleeding. Paracetamol and opioid analgesics (eg. Tramadol) can be
given for management of severe joints pain.

3d. MANAGEMENT OF JAPANESE ENCEPHALITIS

Management of Acute Encephalitis Syndrome including JE is essentially symptomatic. To reduce severe

morbidity & mortality, it is important to identify early warning signs & refer patients to health facility
in proper position & educate the health workers about the first line of management.

It is important to exclude other causes of

CNS affliction like meningitis or cerebral malaria which
require specific treatment. Since patients are likely to arrive with high grade fever & change in mental
status or convulsions,proceed with the
assessment of airway patency. Patients are to be transferred
to the nearest higher centre for
further management.

3e. MANAGEMENT OF FILIARIASIS

Microfilariae that cause lymphatic filariasis

circulate in the blood at night (called nocturnal periodicity).
Blood collection should be done at night to coincide with the
smear is
appearance of microfilariae &a thick
prepared & examined under microscope to visualize microfilaria. Microscopy is available at
PHC-HVWC& CHC/DH levels. Other rapid tests are also but not at
available
SHC-HWC level.

Page 11 of 24 Sabine Yasmi

Community llealth
Ofticer
i/e Dabli HWC
Mornoi BPHC,
Goalpara
Management of Different Stages of Lymphatic Filariasis.

Treatment for Acute Phase llIness-Mild and Uncomplicated Form:

(500 mg given 4 times a day). Give oral antibiotic such as

Give Analgesic such as Paracetamol

(500 mg given 3times a day) for at least 8 days. Clean the limb with antiseptic. Good daily
Amoxicillin

hygiene practices such as washing the afected parts may play an important part in prevenang
wounds,
progression of the early stages of lymphoedema, thus reducing acute attacks. Check for any

between toes & Give advice about prevention of chronIC

Cuts, abScesses & infection fingers.

lymphedema caused by lymphatic flariasis. Do not give anti-filarial medicine. No exercises are advised
during acute attacks. Cold compression willhelp the patient. Home managementincludes following
measures: drinking plenty of water, rest, limb elevation. Follow-up after 2 days at home. situation If

does not improve, then refer the patient.

Treatment of Acute Phase illness-Severe Form

High fever, confusion, Headache, Drowsiness, Pain in affected part, skin splitting, Sudden increase in

SIZe of limb, vomiting and no response to treatment within 24 hours are symptomsof severe form.

Give analgesiclantipyretic such as Paracetamol/lbuprofen.Clean and dress up open wound if present.

Refer the patient to higher centers urgently. Do not give anti-filarial medicine at this stage.

Hydrocele and Elephantiasis

with
Individuals scrotal or limb swelling should be referred to MO in PHC-HWC or higher facilities
for evaluation & surgery. Elephantiasis needs comprehensive care
relatives for regular exercises limb
including training of patients &
elevation, taking care of skin over swollen area & preventing skin
injuries. MMDP Kits are provided to the patient of Elephantiasis.

Treatment of Asymptomatic Microfilaremia

Treat Microfilaria carriers with Diethyl Carbinamine (DEC)at a dose of 6 mg/kg per day (3 divided
dose) for 12 days.

3f. MANAGEMENT OF KALA AZAR

At SHC-HWC level, malaria and dengue should be ruled out in patient first visit. Those with borh
negative tests presence of short duration of only nonspecific symptomsas pain, fever,
may have some other mild viral infection that can resolve
vomiting, etc.
with symptomatic treatment.

Saloin Yasmin
Page 12 of 24 Community1lealth Oficer
i/e Dabli HWC
Mornoi BPHC, Goalpara
 for both dengue & malaria tests and have signs as large spleen,
Those patients with negative results

loss of weight, long duration of fever for more than 2 weeks. skin lesions. etc. in addition to non
specific symptomsshould be referred to CHC or DH for early diagnosis using rapid tests.

Visceral leishmaniasis needs hospitalization for management with other supportive therapy inciuos
nutrition. Mostly management at SHCHWC level is symptomatic, includes giving antipyretics ano

counseling of patient & family regarding nature of disease before referral.

4 MICROBACTERIAL INFECTIONS
4a.LEPROSY MANAGEMENT
Role of CHO
I. Ensure implementation of Active Case Detection & Regular Surveillance (ACD&RS) for leprosy
in the villages as per the following mandate:

a.
ldentify eligible population for leprosy screening

b. ldentify suitable teams of female & Male health worker for leprosy screening

C
Ensure village level availability of House-hold screening registers referral slips for record

keeping of ACD&RS

Ensure sharing of missing members data with concerned MO- PHC

e
Submission of monthly screening report of ACD&RS to MO-PHC/UPHC
2 Screening round completion certification as per ACD&RS guidelines

3
Referral of leprosy suspected cases to MO-PHC for confirmation of diagnosis

4
Identification of early signs of & &
reactions (| I)/ Neuritis referral to MO-PHC for management
5 ldentification of eligible grade disability cases for Reconstructive surgery & referral.

6. Follow-up of under treatment leprosy cases and disability cases

7. Dispensing of MDT and Prednisolone for neuritis/lepra reaction

8. Ensure follow up of all on treatment cases MDT

leprosy till treatment completion/Releasefrom
Treatment

9 Retrieval of Defaulters/dropouts

10. Distribution of MCR footwear and Self-care kits to the eligible cases twice a year

||. Counseled Leprosy patients, uunder ttreatment, release from treatment & family members
12. Active participation in Sparsh Leprosy Awareness Campaigns and
awareness generation among
general population through appropriate IECI BCC
13. Overall supervision of field level activities done by ASHA/MPW

Page 13 of 24
Sabi m
CommunityHealth
Yam
Oficer
Vc Dabli HWC
Mornoi BPHC,Goalpara
Record Keeping

Maintain & submit village/urban pocket level monthly screening report

PHC/UPHC of ACD&RSto

b. Screening round completion

certification of village screeningas per
level
ACD&RS guidemieo
C. Follow-ups and record
maintenance of under treatment
cases.
d.
Maintain and update line list of Grade I and Grade lldisabilities
and new and old cases
e. Submit monthly progress
report (MPR)to MO-PHC
f Maintenance of record ofULFI-NLEP card

Role of ASHA in leprosy management

a
Screening of assigned villagel urban wards population as per
ACD&RS guidelines

b Refer suspected cases for

diagnosis and treatment to nearest
health facility.

C. Generating awareness to reduce

stigma & encourage
self-reporting

d. Encourage leprosy affected person to take treatment

regularly and complete the treatment

Encourage leprosy disabled person to practice self-care to prevent deformity

Role of MPW M/F in Leprosy Management

a. Support ASHA ensuring regularity and completion of treatment

b Contact tracing of confirmed case & administration of PEP as per guideline & maintain record
C Detailed of grade
investigation Il disability cases as per standard norms & submit monthly report
to CHO

d. Demonstration of self-care activities to the patients having residual or new grade deformities.
monitor them and refer when required.

e. ldentify adverse effects of MDT on new patients and counseling

Impart Health Education on Leprosy and its treatment to the community

8 Refer suspect new cases and those with complications to PHC-HWC

h. Provide subsequent doses of MDT to patients & ensure regularity &treatment completion and
assist health supervisor in retrieval of absentee/ defaulter

Update case cards at SHC-HWC & treatment register at PHC-HWC

Sabim Yasmi
Page 14 of 24 CommunityHealth
Officer
i/e Dabli HWC
Momoi BPHC,
Goalpar
ecord Keeping

a.
Maintain HH level screening registers as given in ACD&RS guidelines

b. Maintain and share information of missing members of HH

C.
Filling and sharing of referral slip for suspects

d. Follow up on MDT/treatment cases for MDT completion

MANAGEMENT OF LEPROSY AT HWC-SC

and
presenting at SHC-HWC or detected during Active Case Detection
Any suspect case, either

Regular Surveillance should immediately be referred to MO at PHC-HWC. Ffollowing signs should be

carefully looked for:

or complete of sensation
color (Pale or Reddish patches) with partial loss
I. Any change in skin

2 Thickened skin on patches

3 Shiny or Oily face skin

4. Nodules on skin

5. Thickening of ear lobe(s)/ Nodules on earlobe(s)/ nodules on face

6. Inability to close eye(s)/ watering of eye(s)

7. Eyebrow loss

8 Nasal infiltration (saddle nose deformity)

9 Thickened peripheral nerve(s)

Pain and/ or tingling in the vicinity of elbow, knee or ankle

10.

||. Inability to feel cold or hot objects.

12. Loss of sensation in palm(s)

13. Numbness in hand(s)/ foot/ feet

hand(s)/ painless wounds or burns on palm(s)

14. Ulceration in

to grasp or hold objects

hand(s) when grasping or holding
objects; inability
I5. Weakness in

in buttoning up shirt/ jacket etc.

16. Difficulty

in fingers(s)/ toe(s) hand(s)/ foovfeet

17. Tingling

painless wounds or burns on foov/feet

18. Ulceration in foot/ feet;

19. Clawing/ bending of finger(s)/

toe(s) Sabin Yesmi
CommunityHealth Officer
Page 15 of 24 i/e Dabli HWC
Mornoi BPHC,Goalpara
 20. Loss of sensation in sole of foot/ feet

foot/ feet/ footwear comes off while walking

21. Weakness in

22. Foot drop/ dragging the foot while walking

MO will inform the concerned

MPW
new case of leprosy, CHO/PHCIUPHC
After confirmation of guidelines
of such index case following
ASHA and shall ensure screening of all close contacts
HIM and shall be screened
tor
The close contacts of every 'Index Case'
for Post Exposure Chemoprophylaxis. of CHO/MO
health worker, under overall supervision
SIgns or symptoms
of leprosy by trained
in the contacts, treatment
needs to be immediately initiated
PHCIUPHC. If a confirmed case is found as Post
ís required to be administered
Single Dose of Rifampicin
with MDT. For remaining
contacts,

Exposure Chemoprophylaxis.

STANDARD TREATMENT
MB The Standard Child (Ages 1014) Treatment
The Standar d Adult Treatment Regimen for
Lepr os Regimen for MB Lepr osy

Rifampiin 450mg once a month

Clofazimine 150 mgonce a month
Rifampiin 600 mgonce a month
and 50 mg every
Clofazimine 300mg once a month
and 50mg daly other day

Dpsone, 100 mgdäly Dapsone 50mg daily

Duration: 12months(12blister packs) Dur ation: 12 months(12blister pacdks

d Child (Ages 10-14) Treatment
The Standa d Adult Treatment Regmen for PB The Standar

Lepr osy
Regmen for PB Leprosy
600 mg once a month Rifampian 450 mg once a month
Rifanpian
Dpsone 100 mg daly Dapsone 50mg daily

Duration:6 months(6 blister packs) Duration: sx months(6 blister packs)

First dose of the month

Doses for alternate days

from second day

Daily dose from

second day
MB (Adult) Blister pack MB (Child) Blister pack

First dose of the

month

Daily dose
from second
day
PB (Child) Blister pack
PB (Adul)Blister pack

Salina Yasmi
Page 16 of 24 Community Health Officer
ilc Dabli HWC
Mornoi BPHC,Goalpra
Four key messages are suggested to generate leprosy awareness in community:

that are
is with medicines
a. Leprosy Curable: Disease caused by leprosy germs & can be cUred
available free of charge in all health facilities.

sensation or
as

Early Symptoms of
Leprosy: Leprosy usually starts as a skin patch with loss of

numbness & tingling in hands and/feet, Consult health worker on occurrence of any OT tnese

of
C. Disabilities can be Prevented: helps prevention
Early detection with appropriate treatment
disability due to leprosy.

NoPlace for Segregation: Leprosy is treatable & once on treatment patient does not intect ou

& hence there is no place for segregation of persons affected by leprosy. Accept Persons Anecte
by Leprosy needs compassion & empathy. Discrimination of patients is inhuman

4b. TUBERCULOSIS MANAGEMENT UNDER NTEP

Role of CHO
a
Plan & monitor awareness & community mobilization activities at village level for TB controll

b
Sensitize VHSNC members, JAS & PRI members etc. and their potential role in eliminating TB
C
Screen person for symptomsof TB & ensure periodic screening of patients with diabetes, those
on immunosuppressants and smokers

d.
Refer presumptive TB patient to PHC-HWC to ensure complete diagnostic evaluation with
microscopy,radiology, molecular test

e. Ensure follow up testing of patients at regular frequency

f.
Clinically monitor patients identified as high risk for complications/deathand ensure that they

undergo required investigations at suggested intervals

Monitor treatment of patients through visits at least once a month and review treatment record
on fortnightly basis. Support in retrieval of TB patients who have stopped taking antiTB drugs
before prescribed period

h. Plan, organize and implement active case finding. Early identification of adverse drug reaction and
prompt management

Ensure comorbidity & drug susceptibility testing, linkages comorbidity

of patients and drug
resistant TB patients

Ensure inventory of laboratory request form, specimen container, anti-TB drugs

k
Coordinate with PHC-HWC for logistics, patient's management

Ensure record maintenance, reporting on NIKSHAY

m. Educate patients and family members on TB, treatment, etc.

Salbin Yasmin
Page 17 of 24
CommunityHealth
Oflicer
ile Dabi HWC
MornoiBPHC,
Goalpara
 for TB/LTBI
TB patients
Ensure screening and testing of contacts of sputum positive
TB
for pediatric
Coordinate with RBSK team and PHC MO for ensuring screening
examination
and/or radiological
Facilitate for ruling out TB complete evaluation by microbiological for LTBI
and others vulnerable
P.

and/or other investigations for contacts of TB patients

as needed
treatment
Ensure that eligible person undergo TB Treatment or TB preventive

in the program
their participation
ldentify potential TB championsamong TB survivors & facilitate
r.
TB
& monitoring
train them on supporting
S Identify & engage community treatment supporters &

treatment

Role of ASHA

home community mee

Awareness generation about TB in village during visits/survey,

VHSNDs etc.

b Filing of the CBAC forms and identification of presumptive TB patients in the communiy

C. Mobilize and preferably accompany presumptive TB patients to nearby AB-HWC-SHC

d. Sample collection and transportation to SHC/PHC/UPHC as per local need, following essental

infection practices such as hand-washing/hand sanitization, wrapping of sputum cup/falcon tube

with tissue paper, carrying sample to PHl in zip-lock cover/leak proof containerlbox etc.

e Work as treatment supporter for local TB patients

f Submit patient's bank details to health facility for Nikshay Poshan Yojna

Counsel patients on treatment adherence, nutrition, healthy life-styles and cough etiquettes

h. Monitor nutritional status of patients and provide feedback to MPWICHO

Ensure treatment adherence and timely follow up of patient

j. Update TB patient's treatment cards/health diaries provided by HWCs duly updating the family
folders

k. Alert patients for ADR, if any and facilitate seeking medical care

Motivate household contacts of

confirmed TB patients for undergoing TB screening and eligible
contacts for taking complete chemoprophylaxis

m. Participate in
vulnerability assessment of population by doing
enumeration and further annual exercises
household survey during CBAC
or other household level surveyys
done by AB-HWcs
and in active case finding among identified vulnerable
population

Discuss TB related agenda in VHSNCIMAS meeting

Role of MPW M/F for Tb Management

Sabine Yasmi
Page 18 of 24 Community !fealth Oticer
i/e Dabi
HWC
Mormoi BPHC,
Goalpara
a. IEC and Social Behavior
Change
Communication
b. Co-ordinate activities for awareness generation
participate in outreach
activities for patient
Educateand
screen PW for TB and support & regular active case finding

Mobilization of
support PW with TB to
undergo TB treatment
communitymembers
and leaders
e. Sample collection
for
transport to
the
f Home visits of
nearest
appropriate health
patients for facility/Referral Centre
public health
action
Monitoringpatient
adherence and
facilitate
followup and
h. Undertake
minimum 3 visits to ADR management.
treatment each
DSTB patient & minimum 6 visits to DRTB patients during
i. Support in
retrieval of
TB patients
period who have
stopped taking anti-TB
drugs before prescribed

Supervision of
treatment
to treatment Supporters in the area,
supporter Work as
treatment supporter.Supply
k
Maintain TB drugs
records
Long term
follow-up of
treated patients
m. Map vulnerable every 6 months
populationfor
Active case
for next 2years
finding and and
screening referral for LTBI
Management of Tb at
HWC-SC level
Active case
finding Anyone with
following
Pulmonary TB" symptomsshall be
referred for test for
Cough >2 weeks, fever >2 "Presumptive
weeks, significant
weight loss,
haemoptysis (blood in
sputum)

Children with
persistentfever
and/or cough >2
with pulmonary
TB cases must be evaluated weeks, loss of weight or no
weight gain,
for TB and/or contact

Anyone with following

symptomsshall be referred
for test for
"Presumptive Extra
Anyone with presence of Pulmonary TB"

in joints,
organ-specific symptoms& signs like swelling
neck stiffness,
disorientation, etc., and/or constitutional
of lymph node, pain & swelling
persistent fever for 2 weeks or more, night sweats.
symptoms like significant weight loss.

Enhanced case finding and contact screening

should be undertaken in high
in the table given priority
populations
below: listed

Sabim Yesm
Page 19 of 24 CommunityHealth
Officer
VeDabli HWC
Momoi BPHC,
Goalpara
 Sodal
Cinical Geogaphical
Clients
attending HIV Cae Pisoner s Urban Slurns
Settings
abuse
sbstance induding| O aupations reach a eas
with rish Had to
STokers developing TB tribal
Co-morbiities like Diabetes and
on dialyss
People in Cong egated settings Indigenous
patients and long shelters De-addictions centres populations
term immunouppr essant old age homes
ther
apy
Heathcae Workers
HOusehold and work place
Contacts
Patients with past History of TB
Malnourished
Antenata mother s attending
antenatal dinics/ MCH dinics

Presumptive TB patients should be referred to the nearest microscopy or molecular laboratory

through laboratory request forms by MPW-Female/Male/CHO,

with information provided to PHC
MO. Referal cases should be appropriately registered on Nikshay platform as presumptive TB patient
and forwarded to the DMC or the concerned laboratory. Tb treatment should be initiated by the
MBBS Medical Officer.

Calculation of Drug dosage for Adult TB

Weicht category Number of tablets (Adult

FDCs)
Intensive phase HRZE Continuation phase HRE
75/150/400/275 mg 75/150/275 mg
25-39 kg
40-54 kg 3 3
55-69 kg 4 4
>=70 5

Role of CHO in DRTB prevention and management

DR-TB can be prevented by effective implementation of DOTS strategy & supporting patients in

completing treatment of DS-TB.

Early detection of DR-TB is important to interrupt transmission of this difficut-totreat TR

infection to others, to treat them, prevent death & reduce chance of problems after treatment

CHOS can ensure that all TB patients are offered Universal Drug Sensitivity Test & follow-un
out to monitor treatment.
Sputum smearexamination is carried

with DRTB:
Supporting patients identified
Satoi Yasm
Community lHealth Officer
Page 20 of 24 Ve Dabi HWC
Mornoi BPHC,Goalpara
 Health Nodal/District
a. education/counseling is by
provided to patient family
members the
DRTB Centre
8& with
counsellors. CHOs can also about the need to continue
counsel
taken
treatment with the may have
recommended and patient
drugs
duration as the
incomplete treatment in the past leading to drug resistance.

Monitoring side as there are

b effects andearly referral for is also very important
management
many side effects for the DRTB treatment.

Sexually Transmitted Infections

Sa. HIV/AIDS

Role of CHO
a. Identification of high-risk persons and confirmation of diagnosis.

b. Initiation of free of cost treatment from ICIC centers and follow up includin8 ae
of opportunistic infections.

C Keeping privacy of information and identity of patient.

Awareness among community to decrease the stigma associated.

e. Ensure treatment compliance of the patients.

Role of ASHA

a Awareness generation for HIV prevention, testing promotion, treatment compliance and

stigma reduction.

b. IEC activities on HIVIAIDS and STI their spread and prevention.

C. Distribution of condoms.

d. Support behavior screening and referral of people with high-risk behavior to MO for further

services.

Role of MPW- Male/Female

Awareness generation for HIV prevention, testing promotion, treatment compliance and

stigma reduction.

b IEC activities on HIV/AIDS and STI their spread and prevention.

C. Distribution of condoms.

d. Support screening and referral of suspected STI/HIVIAIDS cases to MO for further services

PW to HTCS through ANC clinics,group meetings and

e Provide counseling and referral of

household contacts.

among PW and people engaged in high-risk behavior using

f Offer HIV screening services

kits.
appropriate test Sabina Yani
Page 21 of 24 Community Heaitn COticer
ieDabli HWC
Morioi BPHC,
Goalpara
 screened reactive
Follow-up persons for
their
to treatment centers if linkage to
linkage
confirmed confirmatory
positive. centers and
and motivate PLHIV then their
h.
Counsel for
treatment
of
compliance and
anti-retroviral periodic
Dispensation drugs to viral
stable
load
testing.
PLHIV.

at SHC. HWC and PHC. HWC should be

A/staff trained on
and correct techniques of how to
injuries. handling prevent
stick Bio Medical instruments, blood oneself
from
Waste stained needle
proper Management surfaces
blow guidelines. etc. All staff
should

in high risk behaviors such

engaged as
People injecting
drug users
through sharing of used may be
HIV transmission needles, counselled on the
Ito nearest TLNGOs
syringes and injecting risk of

relerred implementing harm

reduction and drug paraphernalia and may be
as IDU Targeted Intervention,
Such Opioid dependency
Substitution treatment services
Rehabilitation Centre etc. Therapy centre,
Deaddiction
Centrel

6. HEPATITIS

Role of CHO
of P\W for
Screening
hepatitis B using Rapid DiagnosticTest Kits
Screening of HBV and
HCV of high-risk groups e.g.
blood Intravenous Drug Users,
transfusions, recipients
commercial sex workers, of multiple
etc. using Rapid
DiagnosticTest Kits
c Ensure of the Hepatitis
referral
B positive women after
& management delivery to MTCITCfor further evaluation

d. Drug dispen sation after

prescription by MO for treatment of
HBV and/or
basis HCV, on a monthly

e Supervision of MPWs undertaking home

visits to ensure
follow up regarding
HWC for collection of medicines, appointments at
treatment adherence and any
side effects
Mionthly reportingformat tobe filled and submitted to the
PHC-HWC MO

.
B
Ensure
availability of
kits/drugs by timely indent to avoid stock outs
Awareness
generation
Role of
ASHA
2
Raising
awareness on hepatitis modes of transmission and its prevention
b.
Mobilize all PW for screening of
G. Hepatitis B

Ensure and facilitate

referral for institutional delivery of the PW if screened positive for hepatitis
B&receipt of birth
dose of hepatitis B vaccine & HBIG to new born

Sabine Yasm
Page 22 of 24 CommunityHealth Oflicer
icDabi HWC
Mornoi BPHC, Goalparn
 Record keeping and
documentation of hepatitis B positive PW along with their EDD

Role of MPW-Male/Female

a
Raising awareness on hepatitis modes of transmission and prevention
Conduct & ensure screening
b of hepatitis B in PVW & hepatitis B & C in High Risk Groups

C. Ensure referral/facilitate for institutional delivery of the PW if screened positive for hepatitis B&
receipt of dose of
birth
hepatitis B vaccine & HBIG to new born
Follow up of the patients for treatment adherence &
any complications

Follow up of
e. patients regarding appointments at HWc for collection of medicines, treatment
adherence and any side effects

Record keeping and documentation

Hepatitis A and E Management

a Promote and advOcate safe water,

hygiene and sanitation: washing hands after using toilet and
before eating food; safe drinking water-boiled/ filtered/ packaged/ safe portable etc., ensure safe
disposal of human excreta, avoid open defecation.

b. Promote and advocate for safe food: ensuring that eating well cooked and
appropriately stored
food itenms; avoiding or peeling fruits and vegetables that may have been
washed or grown in
contaminated water etc.

Hepatitis B and C Management

Vaccination:Ensure hepatitis B birth dose to all newborn within 24 hours of
birth, followed by
three doses at 6,10 and |4 weeks.
Vaccination of all healthcare workers with hepatitis B
vaccine
at 0,I &6 months.
b. Safety of Blood and Blood Products: Promote
information regarding availability of safe blood at
licensed blood banks.

C.
Harm Reduction in High-Risk Groups: Prevention package to that under
is similar NACP ie.
behavioural change communication, condom promotion, community mobilization and enabling

environment and linkages to TC/MTC for further management.

Sereeningof PW for hepatitis B using Rapid Diagnostic Test kits

JCreeningof HBV and HCV of high-risk groups eg. Intravenous Drug Users, recipients of multiple
Olood transfusions, commercial sex workers, etc. using Rapid Diagnostic Test kits

Saloine Yasm

Page 23 of 24 Community lfeaith Oticer

ie Dabt HWC
Mormoi BPHC,Goalpaa
 Injection Safety and
Infection Control. for use
of Reuse Limit use of injections
and promotion
prevention syringes unnecessary
when needed. the socio-
cultural Safe while respecting
practices injections practices
like tattooing,
religious piercing etc.
ceremonies (e.g. mundans), ear/body

REFERENCES

Operational Guidelines for through

health and wellness centres, Comprehensive primary healthcare services
NHSRC, 2018
2
anagement of Communicable Diseases for CHO at HWC-SC, NHSRC, 2021

Sabin Yasm
Health Oficer
Page 24 of 24 Community
i/e Dabli HWC
Mornoi BPHC, Goalpara