Essential health services – control of communicable diseases standard 2: Communicable disease diagnosis and case management
People have access to effective diagnosis and treatment for those infectious diseases that contribute most significantly to preventable excess morbidity and mortality.
Key actions (to be read in conjunction with the guidance notes)
Develop public health education messages to encourage people to seek care early for fever, cough, diarrhoea, etc.
Provide healthcare at all first-level health facilities based upon standard case management protocol, or the Integrated Management of Childhood Illnesses (IMCI) and Integrated Management of Adult Illness (IMAI) where implemented and referral care for management of severe illness (see Guidance note 1).
Implement triage, diagnostic and case management protocols for early treatment of conditions such as pneumonia, malaria, diarrhoea, measles, meningitis, malnutrition and dengue and train staff on treatment protocols (see Guidance notes 2–3 and Essential health services – child health standard 2).
Introduce tuberculosis control programmes only after recognised criteria are met (see guidance note 4).
Key indicator (to be read in conjunction with the guidance notes)
Standardised case management protocols for the diagnosis and treatment of common infectious diseases are readily available and consistently used (see guidance notes 1–3 and Health systems – health service delivery standard 1).
- Integrated Management of Childhood Illnessesand Integrated Management of Adult Illness: Mortality from communicable diseases can be reduced by early and accurate diagnosis and appropriate treatment. Use of IMCI and IMAI where implemented, or other national diagnostic algorithms, are important to triage and classify disease according to type and severity and to aid the administering of appropriate treatments. Danger signs are indications for referral to an inpatient facility. Standard case management protocols allow for appropriate diagnosis and rational drug use (see also Essential health services – child health standard 2).
- Pneumonia: The key to reducing mortality from pneumonia is prompt administration of oral antibiotics, such as amoxicillin, according to national protocols. Severe pneumonia will require hospitalisation and parenteral therapy.
- Malaria: Access to prompt and effective treatment is key for successful malaria control. In malaria-endemic regions, establish a protocol for early (less than 24 hours) diagnosis of fever and treatment with highly effective first-line drugs. Artemisinin-based combination therapies (ACTs) are the norm for treatment of falciparum malaria. Drug choice should be determined in consultation with the lead health agency and the national malaria control programme. Consider drug quality when sourcing supplies. Malaria should preferably be diagnosed by laboratory test (rapid diagnostic test, microscopy) before treatment is started. However, treatment of clinical malaria should not be delayed if laboratory diagnosis is unavailable.
- Tuberculosis (TB) control: Poorly implemented TB control programmes can potentially do more harm than good, by prolonging infectivity and by contributing to the spread of multidrug-resistant bacilli. While the management of individual patients with TB may be possible during disasters, a comprehensive programme of TB control should only be implemented if recognised criteria are met. These criteria include commitment and resources of agency, an assured stability of the population for at least 12–15 months and that a good quality programme can be delivered. When implemented, TB control programmes should be integrated with the national country programme and follow the Directly-Observed Therapy, Short-course strategy.
In the acute phase of an emergency, the potential interruption of all treatments for all chronic diseases including TB and loss of patient follow-up are likely to be a significant problem. Strong collaboration must be established between the emergency health workers and the established national TB programme services. This will help ensure that people who were already on treatment prior to the disaster continue with their treatment (see Essential health services – non-communicable disease standard 1).