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MIS Laboratory Manual and Treatment issues. 10 September 2008 Lusaka. Overview. Laboratory manual components Logistics Diagnostics Treatment issues Medical referral form. Laboratory manual 1 of 4. Important issues to consider from the beginning: What combination of tests will be done?
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MIS Laboratory Manual and Treatment issues 10 September 2008 Lusaka RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Overview • Laboratory manual components • Logistics • Diagnostics • Treatment issues • Medical referral form RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Laboratory manual 1 of 4 Important issues to consider from the beginning: • What combination of tests will be done? • Malaria • RDTs – Which type/brand? • Blood smears – thick and thin smears • Same slide or different slides • Dried blood spots -on filter paper • Anemia • Hemocue RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Laboratory manual 2 of 4 • Selecting participants • Children under 5 or 6 • Other populations • Taking blood / finger / heel sticks • In what order? • General procedures when taking blood • Clean, sterile testing environment • Field staff certification / registration RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Laboratory manual 3 of 4 • Anemia testing • Operating Hemocue analyzers • Using microcuvettes • Reading the results • Cleaning the machines • Troubleshooting RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Laboratory manual 4 of 4 • Malaria testing • How to perform the RDT • Dos and Don’ts • Interpretation of Results • Slide preparations • Materials required • Making blood films • Labeling • Fixing thin films • Staining slides • Supportive learning (show videos) RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Testing supplies • Following national recommendations • Country tested / approved devices • Ordering supplies • Ordering in advance • Over ordering quantities • Field work and pre-testing activities • Using similar batch/lot numbers • Exposed to similar and ideal conditions • Back up supplies and HB machines RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Logistics issues to consider • Planning for daily activities • On-hand daily supplies • Pilot/Pre-testing kinks • Detailed supplies by site or team/population • Supervision of field testing activities • Lab registration sheet / written daily log • Slide / material collection during field work RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Malaria • Is RDT positive? • If positive for Pf • Check if person is pregnant woman. • If not pregnant woman: treat with Coartem • If pregnant: treat with Quinine • If less than 5kgs:treat with SP • If negative: • Do not treat for malaria Also refer or take to health facility based on clinical judgment with danger signs RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Anemia • Is Hb <8g/dl in child under 6 years? • If yes, treat with • 1) Iron • 2) Mebendazole (if 1 year or older) • If no, do not give iron and mebendazole.Coartem depends on RDT results • Also refer to health facility based on clinical judgment (danger signs) RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Treatment Overview • Who will be treated? • Decision rules • Treatment schedules • What about other sick people? • Referral indications RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Decision rules • Things to consider • Is haemoglobin <8 g/dl? • Is the RDT positive? • Is the woman pregnant? • What is the person’s age? • Is child 1 year or older? • Are there danger signs? RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Who will be treated? • People will be treated based only on the results of diagnostic tests performed, not on any other clinical assessment • Who will be treated? • Children with severe anaemia (<8 g/dl haemoglobin) • Anyone with positive RDT for malaria RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
All Children 6<yr & all people in every 4th Household ONLY Children 6<yr RDT (+) (-) Hemocue Pf Hg≥8g/dL Hg<8g/dL Pregnant No Treatment No Treatment No Yes Less than 5kgs Iron Quinine Coartem If Age≥1 yrs SP + mebendazole Treatment Diagram RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Anaemia treatment • Mebendazole (refer to IMCI Guidelines): For children age 1 year and over: Tablet or syrup • Iron tablets or syrup: RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Malaria Treatment • Coartem: (For RDT Pf positive ) • Tablets with 20 mg Artemether plus 120 mg Lumefantrine RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
3. Quinine (For pregnant women and infants) Quinine 8 mg base/kg 3 times daily for 7 days RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
What about other sick people? • You will be approached by others in the village. • Do not use RDTs for non-participants in other households • Explain that you are there mainly for the survey and your supplies have been calculated accordingly. • refer them to the facility for treatment • Refer or transport to health facility if necessary. RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Medical referral form RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia
Summary • Lab manual is useful for training and field referencing • Key decisions at the outset • Who will be stuck? • Which tests will be included? • Which RDT will be used? • How to deal with discordant results-RDTs vs BS • Order sufficient supplies (field work + pre-test, over order!) • Think through the transport and slide reading procedures • Documentation of the process will only help the end result (PDA results+lab registration+supervision+counter checking) • Identify the testing, diagnosis and treatment algorithm – reinforce through training! RBM-MERG Malaria Indicator Training Workshop, 9th-12th September 2008, Lusaka, Zambia