training module for medical officers primary health centre - NVBDCP

Oral antimalarial drugs including ACTInjectable Quinine, injectable artemsinin preparationSaline / glucose / dextrose for intravenous transfusion.Oxygen for serious and complicated cases.Antipyretics, anticonvulsants, diuretics, antibiotics.Criteria for referral from PHC to referral / district hospitalPatients should be referred if they have any one or more of the complications of severe malaria, asgiven below, which cannot be managed: Cerebral malaria patients not responding to initial treatment with intravenous Quinine. Severe anaemia warranting blood transfusion. Bleeding and clotting disorder. Haemoglobinuria. Pulmonary oedema. Cerebral malaria complicating pregnancy. Oliguria not responding after correction of fluid deficit and administration of diuretics. Fluid electrolyte and acid base disturbance.Patients with severe malaria who do not respond to antimalarials or those who worsen despite treatmentshould be referred. Referral should be more prompt in cases of pregnant women, postpartum womenand children below five years with severe malaria, because they have a higher risk of complications.Safe referral transportation must be considered, e.g. patients should not be referred during shock.Essential Facilities at referral hospitalThe following facilities should be available at the referral centre to which severe malaria cases arereferred: Specialized biochemical, radiological and microbiological tests Intensive care management and round-the-clock monitoring to deal with the critical illness Ventilatory support, particularly volume ventilator Blood transfusion Peritoneal dialysisThe PHC medical officer will send the case-sheet along with the patient, also indicating antimalarialsadministered, dosage and time of administration, reports of blood smears and other investigations forguidance to the second referral level. The staff in the PHC should explain to the patient’s attendants theneed for referral to a higher facility. There may be some patients/attendants who are reluctant fortransfer. In such cases, the problems should be identified and the concerns and worries overcome.The common problems for reluctance to go to the hospital and their possible solutions are as follows:49