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Sunday, February 7, 2016

Guidelines for De-worming Day on 10.02.2015

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Rastriya Bala Swasthya Karyakramam(RBSK) - Andhra Pradesh.

Guidelines for De-worming Day on 10.02.2016

Activities at the District level to be taken up by DMHO:

o   Conduct district coordination meeting under the chairmanship of District Collector with all line departments on 6/02/2016.
o   Allot areas of supervision to all program officers as it is being done in the case of PPI program to monitor the Deworming program,
o   Conduct press meets along with DEOs, PO (SSA) and PO (ICDS) involving print and electronic media to brief the importance of the de-worming day before and after the event.
o   Officers to be attended for coordination meeting Involved:  Commissioners of Municipal Corporation/ Municipalities, CEO-ZP,PD-DRDA,PD-ICDS, DEO, PO-SSA, DCHS, Superintendent of Medical Colleges, All Program Officers, 104,108 Coordinators, RBSK-Coordinators,Municipal Health Officers, JD SW, DD (TW), DD(BCW), AD Disabled Welfare, Minorities Welfare, Dy EOs, & Sectoral Officer’s of SSA MPDOs and Mandal/CHNC Special Officers( if identified).
o   The DM&HOs are requested to meet the District Collector along with DEO, PO(SSA)after preparing Action Plan in this regard for making this program an objective oriented.
o   Awareness activities shall be carried out from district to villages by rallies, banners , posters and media briefings
o   Wide range of awareness activities at school level by conducting drawing competitions and essay writing competitions on sanitation and importance of deworming shall be conducted.
o   Arrange to launch the programme on 10th February 2016 after miday meals at district level by  Honble Ministersand also  involving ZP chairperson, members of parliament(MP), Local MLA, Municipal chairperson(Local body public representative) and district collector.
o   The programme may be launched by honourable MLAs/MLCs/MPP/ZPTC and involving mandal level officers at mandal level duly following the protocols. Mandal special officers may coordinate the programme.
o   The programme may be launched at village level by Panchayat Sarpanchas involving SMC members, parents and other dignitaries.
o   Provide mobility budget from available RBSK to PHC/UPHC Medical Officer.
o   Ensure distribution of drugs as per the requirement to all PHC/UPHCs and to the Anganwadi centres and schools/junior colleges.
o   Ensure coordination between MO-PHC/UPHCs and MEOs/CDPOs of the mandal for proper distribution of the drugs and IEC material in the mandal.  
2. Activities at CHNC level to be taken up by Dy DMHO
o   To prepare Cluster level action plan for distribution of drugs/Planning & Monitoring to conduct the Deworming Day.  Dy DMHO and Supervisory staff of Health & ICDS

3. Activities at Mandallevel to be taken up by PHC medical officers
o   To prepare Mandal level action plan for distribution of drugs and to conduct the Deworming Day. Instruct MPDOs to supervise the deworming program in the mandal. Instruct MPDOs to coordinate/converge with all line departments for effective implementation of the program in the Mandal.
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4. At Village / Habitation:   
(a)At AngawadiCenters:Administering the   Albendazole syrup to the age group of 1 to 5 years ( 5 ml to 1 to 2 years and 10 ml to 2 to 5 years) and 400 mg Albendazole  tablets  (chewable)to out of school children
(b)At School/Junior college: 1st class to 12th standard.    Government & Aided Institutions only administering400 mg Albendazole tablets (chewable) and to organize de-worming day in their school /college
Certain Important instructions to Medical Officers:
1.   Medical officers are instructed to prepare school wise student list in coordination with CDPO,MEO/CRP & IERTs for proper distribution of Drugs.
2.   Medical officers of the PHC/UPHC have to place indent in E aushadhi to draw the required quantity of Albendazole syrup and tablets for further distribution to Anganwadi centres and schools in their jurisdiction through ANMs and ASHAs.
3.   Medical officers have to supply sufficient number of CPM/Cetrizine and Prednisolone tablets to all paramedical staff to  treat any emergency cases along with De-worming drugs,
4.   Budget will be provided to DM&HO for mobility of MO and his team to utilize on the national de worming day of drug administration and MO is instructed to keep emergency drugs and IV fluids with him/her.
5.   MOs have to supervise the program and also to attend any emergency.
6.   MOs are instructed to inform to 104 and 108 coordinators regarding this program and to take their support.
7.   If any adverse reactions, need to have coordinated approach should be established between Health, Education & WCD (ICDS) Departments. The roles and responsibilities of these three primary departments in adverse events managements are detailed below.

Managing Adverse Events on Deworming
o   One the day of the de-worming, Principals,teachers and Anganwadi workers should be prepared for any Adverse Event or Severe Adverse event by having read through the Adverse Event Protocol/ Guidelines in advance, and ensure that protocol and emergency numbers are on hand.
o   All the teachers and AWWs should clearly understand that children who are sick on the day of De-worming should not be given the De-worming tablet.
o   Teachers and Anganwadi workers MUST administer Albendazole tablet under their direct supervision in schools and Anganwadi on De-worming and Mop up Day. The tablet must not be handed over to the child or their family for consumption later at home.
Mild Adverse reaction
o   Events such as nausea, Mild abdominal pain, vomiting, diarrhea and fatigue may occur among children especially those with high worm infestations.These side effects are transient and do not require hospitalization.
o   What should the teacher / Principal /AWWs do when mild adverse event at school or Anganwadi centers happens?
o   Children with any side effects should be taken to an open shady place and allowed to lie down and rest. They should be provided with clean drinking water.
o   Teachers, AWWs and parents should be prepared for these events and take immediate action in case that they occur.
o   Children should remain at school or Anganwadi till at least 2 hours after treatment.
Severe Adverse Events (SAE)
o   A Severe Adverse Events (SAE) is fatal, life-threatening, disabling, or incapacitating or that results in hospitalization after drug intake.Choking hazard/asphyxia is caused during a severe adverse event,which needs to be responded immediately.
o   Separate theaffected child from other children and stop de-worming activities.
o   School Principal should immediately call the help line number as per shared details by PHC medical officer.
o   The School Principal should use information cascade.
o   If Ambulance services are available, immediate alert to the Ambulance should be given for the transport of the child nearest Government Hospital.
o   The Child’s parents should be informed immediately.
o   Immediate treatment should be provided to the child by health personnel for Medical treatment due to adverse reaction (Annexure 8, Section 6: Guidelines for emergency response team).
o   The ANM should inform the Medical Officer who should complete an incident report in form(Annexure 4) and submit it to Civil Surgeon the same day.
o   Once the report form is received, further notification for the next level must be made   as per cascade of information flow
o   The designated Officer will sign / confirm the reports, and determine if further investigation is needed and submit the report to the Commissioner Health and Family Welfare immediately. TheCommissioner Health and Family Welfare or the designated Officer will be the spokesperson.

Management of SAE after De-Worming Day
Teachers, AWWs, Parents, health facilities and all health officials and providers, including ANMs must be vigilant for such incidents in the area and elevate immediately to the information cascade.






Responsibilities after De-Worming day

WHO
WHAT            
Parents
Should be informed that though mild AEs are expected and severe events are likely to be unrelated to the drugs,, they are encouraged to report the incident at the earliest to ANM ASHA or school principal if they are very worried about the health of their child.
Teachers/AWWS/ASHAs
Should investigate absenteeism more carefully after deworming day and encourage any sick children to seek treatment or inform an ANM if they are worried.
ANMs
To report any case brought into notice to the District Civil Surgeon or Chief Medical Officer through Block Medical Officer or directly as feasible.

Do’s and Don’ts for school and Anganwadi to avoid any SAE:
DO
DON’T
·         Keep telephone numbers for helpline and the nearest health center and / or providers such as ANM and MOIC handy.
·         Always direct the children to CHEW the medicine to avoid choking.
·         Administer the tablet under your direct supervision.
·         For younger children at anganwadi, crush the tablet first and then administer.
·         Do not administer medicine to a sick child.
·         Do not instruct children to swallow the medicine without chewing first.
·         Do not hand over medicine to parents/ children for consumption at home.

Recording and reporting formats.

o   On De-worming Day – National Deworming day(10th Feb 2016) and Mop Up day(15th feb 2016)
o   Anganwadi Teachers will record number of enrolled children dewormed in the school.
o   Anganwadi workers will record number of registered, unregistered & out of going school children dewormed in AWC’s.
o   ASHA will record number of non-enrolled and out of school children dewormed inAWC’s in order to receive her incentives.
o   ANM will compile the reports received from all schools /AWC’s.
At schools level
o   Teachers will record number of enrolled children dewormed in the class attendance register.
o   For every enrolled student dewormed on NDD: a single tick (  ) mark next to the name of dewormed student in the attendance register.
o   For every dewormed student on NDD: a double tick (  ) mark next to the name of dewormed student in the attendance register.
o   At the end teacher will count the single tick marks & double tick marks in the attendance register, separately for both NDD & MUD and will report to the nodal teacher / principal at school.

Commissioner of Health and Family Welfare
To
The District Medical & Health Officers in AP State to instruct all concerned to implement the programme as per guidelines communicated
The District Education Officers in AP State to instruct all concerned to implement the programme as per guidelines communicated
The Project Officer, SSA in AP State to instruct all concerned to implement the programme as per guidelines communicated
The Project Director, ICDS in AP State to instruct all concerned to implement the programme as per guidelines communicated
Copy To
The Director of Medical Education AP Hyderabad
The Director of Public Health & Family Welfare AP Hyderabad
The Commissioner of  VidhyaVidhanParishad AP Hyderabad
The Collector & District Magistrate in AP State
The Director of Women Development & Child Welfare in AP Hyderabad
The State Project Director, SarvaSikshaAbhiyan, AP Hyderabad
The Director of Tribal Welfare, AP Hyderabad
The Commissioner of Intermediate Education AP Hyderabad
The Commissioner & Director of School Education AP Hyderabad
The StateProgramme Manager – NHM O/o CH&FW AP Hyderabad
All Joint Directors O/o CH&FW AP Hyderabad

The Peshi O/o CH&FW AP Hyderabad for information

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