DISASTER MANAGEMENT

what is a disaster?
It is a sudden, calamitous event that disrupts the functioning of a community or society and causes
human, material, material, economic and environmental losses that exceed the community’s or
society’s ability to cope using its own resources.

TYPES OF DISASTERS
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NATURAL DISASTERS
These are violent events that are outside the control of human, they are caused by forces of nature
and may result in loss of life, injury and damage to property.

Examples
 floods
 Tsunami
 Earthquakes
 Wildfires
 Hurricanes
 Volcanic eruptions
 Avalanche
 Landslides

Natural disasters are classified into four groups which are;

 geological
 hydrological
 meteorological
 wildfires
 space disasters

CAUSES OF NATURAL DISASTERS

 global warming
 tectonic activity
 mining
 pollution
 seismic activity
 deforestation
 natural activities in the earth’s crust

GLOBAL WARMING

Global warming is one of the great cause of natural disasters since it affects the entire planet in
different ways. Due to global warming there has been a rapid increase in temperature of oceans
which in turn leads to more and stronger storms and hurricane.
Also the chances of drought increases with the planet’s average temperature increase.
TECTONIC MOVEMENT
Since the earth is made up of many plates sliding over each other, a shift or collision of these plates
can have severe adverse effects, this event can lead to volcanic eruptions, earthquakes and tsunamis.

MINING
Some scientists blame landslides and soil and mountain erosions on mining, mining can potentially
contribute to the emergence of natural disasters.

SEISMIC ACTIVITY
The seismic activities inside our earth can cause earthquakes, earthquakes lead to death and injuries
for many people as well as for animals and other forms of life.

POLLUTION
Nature is sensitive, pollution of all sorts may lead to an imbalance of the earth which in turn may
create natural disasters of several sorts.

DEFORESTATION
Deforestation can contribute to an increase in natural disasters since forests prevent floods and
drought since forests prevent floods and drought by balancing and holding back natural
groundwater resources

SOIL EROSION
Soil erosion can lead to high levels of degradation which in turn can lead to a loss in fertility and
thus famine for local populations

MANMADE DISASTERS
These are unfortunate events caused actions of man either directly or indirectly, these events leads
to loss of life and destruction of property.

Examples
 Oil spills
 Transport accidents
 Industrial accidents
 Nuclear radiation and explosions
 War

FACTORS WHICH INFLUENCE IMPACT OF DISASTERS

 Poverty
 Increased population
 Rapid urbanization
 Environmental degradation
 Political instability

EFFECTS OF DISASTERS

 Environmental issues
 Humanitarian crisis
 Damages to infrastructure
 Public health issues and diseases
  Food security
 Water scarcity
 Displaced population
 Injuries
 Fatalities
 Economic impact
 Emotional shocks

ENVIRONMENTAL ISSUES
Natural disasters not only have dramatic effects on humans but they also destroy the habitat of
animals and plants which may in the worst case even become extinct.

HUMANITARIAN CRISIS
Natural crises lead to humanitarian catastrophes all the over the world, which leads to increased
human suffering. Disasters such as drought, floods and earthquakes leads to loss of life, destruction
of property and displacement of people.

DAMAGES TO INFRASTRUCTURE
Be it man made or natural disasters all lead to destruction of roads, buildings and dams. Essential
infrastructure which is critical in-service delivery.

PUBLIC HEALTH ISSUES AND DISEASES

Natural disasters often leads to destruction of health facilities, this in in-turn leads to increased
disease transmission and low standards of hygiene.

FOOD SCARCITY
Natural disasters can lead to scarcity of resources, which is especially severe when it comes to the
supply of food. If large areas of land have been destructed by natural disasters, farmers will no
longer be able to harvest enough crops this leads to starvation of local population.

DISPLACED POPULATION
Due to disasters people are often forced to move from one location to another to save their property
and also to save their lives.

INJURIES AND FATALITIES

Many people suffer from injuries caused by disasters, in some cases there is even loss of life.

EMOTIONAL SHOCKS
Apart from the physical injuries many more people suffer from mental conditions which are a result
of surviving a big disaster. Many people who lose their children and other family members to
disasters will have emotional scars that will take a very long time to heal.

ECONOMIC IMPACT
To make things worse, there are usually great adverse economic effects from natural disasters.

DISASTER PREPAREDNESS
To adequately prepare for disaster the following steps should be followed;

[Link] a team
in order for the response to be effective and well-coordinated, there is a need for building a team
made up of different personnel. Emergency plans should be the product of an inclusive team instead
of a single individual.
Putting together a team of experts from different fields will help in making sure that once a disaster
happens the response is well coordinated and is carried out by different experts which helps in
solves all the issues that may arise.
A team can be comprised of the following;
 health workers
 firefighters
 rescuers
 psychologists
 team leaders

[Link] your risks

listing all the potential emergencies and ranking them in regards to importance and likelihood of
them happening is essential in knowing what to do and what resources to invest.
It is very important to carryout risk assessment because this identifies the disasters which have high
probability of happening, by assessing the disasters which are more likely to happen the state and its
machinery can prepare adequately through training, establishing protocols and guideline and
allocating enough financial resources for future use in anticipation of such disaster happening

normally the risk matrix below is applied in risk assessment.

[Link] protocols and guidelines

for a disaster response to be effective there must be protocols and policies directing what
procedures are to be followed when a disaster happens, such protocols give guidance on the
communication channels and leadership structure to be followed during a response to disaster and
decision-making process to be followed.
Protocols are very important in emergency situations they prevent confusion and delay in decision
making.
[Link] plans and drills
to always keep the team ready and prepared it is good to develop plans which are supposed to be
followed during emergencies, such plans help different workers to carry out drills so that they can
be up to date on what they are supposed to when a disaster occurs.
Drills are very critical in preparing for disasters they help emergency workers improving their skills
and response time, regular drills build the confidence of emergency workers
PSYCHO-ACTIVE DRUGS
psychoactive drugs are believed to impact the body’s nervous system,
prompting changes in mood, behavior, consciousness, and more.
To understand the effects and risks of these drugs, many of these substances
are divided into subcategories.
psychoactive drugs can be defined into the following groups:
 (CNS) stimulants
 CNS depressants
 Analogs
 Opioids
 Inhalants
 Cannabis
 Hallucinogens

 CNS Stimulants
Stimulants are a group of drugs known for increasing focus and energy in their
users.
Common stimulants include:
 Amphetamine
 Phenylpropanolamine
 Caffeine
 Nicotine
 Cocaine

Stimulants work by modifying communication in the central nervous

system,they also increase levels of dopamine in the brain.

 Effects of CNS Stimulants

In low doses users may experience an increase in focus, energy, and elevated
mood.
However in higher doses, stimulants can produce these same effects, as well as
a sense of euphoria and a diminished need for sleep.
certain stimulants such as cocaine, can also cause adverse effects such as
dependency, paranoia, increased blood pressure, and insomnia.
 CNS Depressants
CNS depressants are often thought of as the antithesis of stimulants. Instead of
speeding up messaging between the brain and body, they slow it down.
Common depressant types are:
 Ethanol (alcohol)
 Barbiturates
 Benzodiazepines
Depressants slow down the central nervous system in several
ways, one way is by aiding GABA (gamma-aminobutyric acid);
this inhibitor regulates neurological processing by suppressing
activity.
By blocking these processes, activity within the CNS is also
reduced.

 Effects of CNS Depressants

Like all psychoactive drugs, effects can be hugely varied. However, the
most common effects of depressants are:
 Sedation
 Pain relief
 Reduced muscle control
 Cognitive impairment
 Dissociation
 Euphoria
 Lowered blood pressure and heart rate
Many of these effects such as lack of muscle control and a sense of
elation, are particularly common after alcohol consumption. However,
dependency can be a huge problem.
Other depressants, such as benzodiazepines, are often used for
various medical needs, including anxiety, insomnia, OCD, and
seizures.

 Hallucinogens
Hallucinogens is an umbrella term used to define substances that
cause hallucinations, strong changes in perception, and sensory
abnormalities.
Subcategories based on effects include:
Psychedelics
Disassociates
Deliriants
 Psychedelics
Examples of psychedelic substances include:
 LSD
 DMT
 Mescaline
 Psilocybin
The effects of psychedelics are often described as ‘mind-altering’
and evoking a ‘spiritual awakening’.

Cannabis
The psychoactive drug cannabis, also known as marijuana, comes
from the plant Cannabis sativa.
Sub-types of the cannabis plant include sativa, indica, and hybrid
cannabis strains.
All types of cannabis plant contain tetrahydrocannabinol (THC).
THC is the main compound responsible for cannabis’s psychotropic
effects.

 Effects of Cannabis
Cannabis is used both recreationally and medically. However, the
effects of cannabis use vary significantly from person to person.
In that sense, cannabis is not defined directly under stimulants, depressants, or hallucinogens.
Possible effects include:
 Distortions in time and space
 Relaxation
 Changes in heart rate
 Increased appetite
 Auditory and visual hallucinations
 Euphoria
 Altered consciousness
 Anxiety
 Impaired memory
The drug can be used in several forms including inhalation, orally via
tinctures, edibles, and capsules, topically, and more.

 Inhalants
Inhalants include a group of psychoactive substances that are
typically consumed only through inhalation.

They are often used recreationally even though that’s usually not
their intended purpose. Users may experience effects similar to
depressants, including slurred speech, lack of bodily control,
dizziness, and a sense of euphoria.

However, the long-term effects of inhalants can be severe. Brain

damage, liver damage, and hearing loss are potential outcomes.

Inhalants are found in everyday household items, medical and

industrial products. This makes them popular with younger consumers
and also more challenging to control usage.

One way to categorize inhalants are:

 Volatile Solvents: Glue, paint thinners and removers, gasoline, and lighter fluids.
 Aerosols: Spray paints, deodorant sprays, and oil sprays.
 Gases: Butane lighters and propane tanks. Medical substances are chloroform, nitrous oxide,
and ether.
 Nitrates: Isobutyl (butyl) nitrite, also known as “poppers”. Or
found in small bottles labeled as liquid aroma and leather
cleaner.

Some inhalants are used for medical purposes. Substances like

chloroform and nitrous oxide (also known as laughing gas) are
sometimes used as anesthesia for minor surgeries.

PREVENTION STRATEGIES
 Effectively deal with peer pressure
 Deal with life pressure
 Keep a well-balanced life
 Examine every risk factor
 Seek help for mental illness
HIV/AIDS AND TB MANAGEMENT

HIV is the virus that causes AIDS.

H-Human (affecting human beings)

I-Immunodeficiency (lowers immunity)
V-Virus(pathogen)

Types of HIV virus:

[Link] 1-most common in sub-Saharan Africa and rest of world.
Is divided further into M, N, O but the most dominant is M

[Link] 2-most common in western central Africa and parts of Europe and India

HIV is in a family of viruses called retrovirus.

A-Acquired (to get)

I-Immunodeficiency (lower immunity)
S-Syndrome (group of signs and symptoms)

AIDS is the final stage of the disease caused by infection of HIV.

HIV TRANSMISSION
Through unprotected sex with an infected partner.

Through exposure of broken or wound to infected blood or body fluids

Through transfusion with HIV-infected blood

Injection with contaminated objects

Mother to child during process, birth or breastfeeding.

Exercise 1.0

Oral discussion of stages of HIV?

What health projects can be made or formulated by health

workers??

Testing of HIV
There are three tests that can be carried out to test for HIV
a. Antibody Test-Detects the presence of antibodies against HIV, which develop within 2-8 weeks
after exposure to virus.
b. Combination of antigen-antibody-Detects both the antibody to the HIV and the antigen p24(a
protein part of the virus)
[Link] test-Detects presence of the virus in the blood, RNA test can detect very early infection
within 10-15 days of exposure.

HIV infection can be measured in terms of:

[Link] of virus circulating in the body-called viral load

[Link] of antigen -p24 circulating in the body.
[Link] or cells that protect the body against infection

TUBERCULOSIS
what cause TB?
It is caused by mycobacterium tuberculosis.

Vulnerable groups for TB

[Link]/AIDS positive people
[Link] living in very crowded places
[Link] exposed recently to someone who has symptomatic TB
[Link] workers
[Link] who live in areas that TB is very common.

Classic signs and symptoms of TB

[Link] lasting more than 3 weeks
[Link] weight loss
[Link]-grade fever
[Link] sweats

How is TB diagnosed?
Through the following tests;
a. Tuberculin skin test
b. Blood test called interferon gamma release assay
c. X-ray
d. Sputum microscopy

TREATMENT

TB is treatable and curable even in people living with HIV-infect

First line TB drugs:

[Link](H)
[Link](R)
[Link](E)
[Link](Z)

Gaps in treatment
 high pill burden
 long duration of treatment
 side effects
 drug stock outs
  interactions with ARVS

What is drug -resistant TB?

[Link]-resistant
[Link]-resistant
[Link]-drug resistant
[Link] drug resistant

What causes drug resistant TB?

 Poor quality medication
 inadequate and erratic treatment
 transmission from one person to another

NB; Treatment of MDR TB takes 3-4 times longer and costs 100 times more.

What health projects can be used to control the spread of TB in community?

Case management is a collaborative process, following public health principles, that coordinates an
individual's medical needs over an entire episode of illness or response process. Case management
includes a range of activities specific to the needs of the individual and the needs of the community

GOALS
 Focus on development of the self-care capabilities of communities, systems, individuals, and
families
 Promotion of the efficient use of resources
 Stimulation of the creation of new services where needed
 Assurance of quality care along a continuum of service delivery
 Decrease in the fragmentation of care across settings
 Enhancement of clients' quality of life
 Cost containment
The case manager:
 Follows up on identified cases
 Assesses each individual's situation
 Formulates a plan
 Builds relationships with patients to ensure they are receiving the medical care and other
services they need in order to recover from their disease.

The components of the case management process include:

 Case identification
 Case investigation
 Engagement and retention of care
 Case management completion
CHILDHOOD ILLNESSES

Constipation
Poo becomes hard and difficult or painful to pass. Motions are passed less often or
there is a change from usual bowel habits. May be accompanied by feeling
bloated or sick. Make sure your child drinks plenty of fluids and eats a mixed diet
which includes lots of fiber such as whole meal bread or pasta, and also fruit and
vegetables.
Rashes
Childhood rashes are very common and are often a result of a viral infection or
simply due to heat, food or if you have changed your washing powder.
If a rash is very itchy, try to keep your child cool and apply calamine lotion to the
skin by following the instructions. Encourage your child to rest and keep an eye on
them for any signs of illness. Make sure your child is drinking plenty of
fluids. Ask your pharmacist to recommend a cream for applying to the skin to
provide relief.

Diarrhea & Vomiting

It is common for young children to get an upset tummy from time to time. This
will usually cause one or more of three symptoms: vomiting, diarrhoea and
stomach pains. If your child is otherwise well it is likely the diarrhoea and vomiting
will get better on its own within a few days.

It is important to drink plenty of fluids to avoid dehydration. Avoid giving solid

foods and encourage small, frequent sips of water or oral re-hydration fluid that
you can pick up from your local pharmacist. Also avoid fruit juice, cow’s milk or
squash, as
these drinks can worsen diarrhoea.

Croup
A harsh barking cough accompanied by wheezy breathing. It usually occurs in
children aged one to five years and often develops when they have a heavy cold.
A humid or moist atmosphere will ease your child’s breathing. Supervise your
child in the bathroom or shower with the hot taps running to create steam. Prop
up your child’s bed to help their breathing.

Chicken Pox
Chicken pox is extremely common as it is highly infectious It is spread by
coughing, sneezing or by directly touching the rash. It is characterized by a red,
itchy rash which blisters and crusts over within two weeks. A mild flu like illness is
usually present before the appearance of the rash. Your child may suffer from a
fever, body ache, headache, nausea and loss of appetite.

No specific medical treatment is required. Pain relief such as children’s

paracetamol can help if your child has pain or a fever. Antihistamines or calamine
lotion may
help with the itching. Children should stay at home until the blisters have crusted
over and avoid contact with pregnant women
Meningitis
Meningitis means swelling of the lining around the brain and spinal cord. It can be
hard to recognize at first. Symptoms can appear in any order but the first
symptoms
are usually fever, cold hands and feet, vomiting, headache and feeling unwell, just
like many mild illnesses.

Further symptoms include;

 Severe headache

 Stiff neck (less common in young

children).

 Dislike of bright lights (less common in

young children).

 Very sleepy, vacant or difficult to wake.

 Confused or delirious.

 Seizures.

 Rash (anywhere on the body but not

present in all cases).

Threadworms
Threadworms are small, thin, white cotton-like worms that live in the gut. They are
common in children, but may infect all household members and are not usually
harmful. At night, the worms lay their tiny eggs around the anus which causes
itching. Scratching to relieve the itching whilst asleep can make the area sore and
severe cases can cause the child to be irritable. Infection may spread to the vagina
in girls which can result in a discharge.

The usual treatment is for the whole family to take a medicine to kill the worms.

You should also take the following hygiene measures for two weeks after
treatment;

Wear clean underpants or pajamas night.

Bath or wash around the back passage (anus) each morning.

Change and wash bed linen, nightwear, cuddly toys every few days.

Make sure everyone uses their own towel and flannel.

Wash hands and scrub under fingernails every morning, after using the toilet,
changing nappies, and before eating.
Head Lice
Head lice are tiny (pin-head sized) grey-brown, wingless insects which live by
sucking blood from the scalp. Their eggs are laid at the base of the hair and
are known as nits. These will hatch out in seven to ten days with the empty egg
sacs sticking to the hair. Head lice can be found on all hair colors and types
regardless of whether hair is dirty or clean. The scalp will feel itchy and may
be worse behind the ears or on the back of the neck.

There are two options available for treatment. You can get medicated treatment
such as shampoos or scalp lotions from your local pharmacy. Alternatively try the
‘wet combing’ method which is the removal of live lice by combing through the
hair with a very fine plastic nit detection comb, together with a conditioner

Burns & Scalds

Burns are caused by dry heat, such as hot objects or the sun. Scalds are
caused by hot liquid and steam. The skin may be painful and look pink, red
or mottled and there may be blisters

The burn or scald should be cooled as quickly as possible. Run it under cold
water for at least ten minutes

If the burn or scald covers a large area or the damage is deep into the skin,
cover the area with a sterile dressing or non-fluffy material like cling film or a
clean plastic bag and seek urgent medical attention.
MALARIA NOTES

Malaria is one of the leading causes of morbidity and mortality more so in children under the age of
5 years.
Plasmodium falciparum is the commonest cause of malaria.

Common interventions of controlling malaria are:

provision of prompt and effective treatment of malaria case management

vector control using long lasting insecticidal nets, indoor residual spraying and other integrated
vector management strategies.
Prevention and treatment of malaria in pregnancy
epidemic preparedness and response

The treatment policy for malaria has changed in the last 12 years due to failing therapeutic efficacy
from chloroquine (CQ) to sulphadoxine-pyrimethamine (sp) in 1998 and subsequently to the
currently recommended artemisinin-based combination therapies (ACTS).

DIAGNOSIS
Diagnosis of malaria is based on clinical suspicion and on the detection of parasites in the blood
(parasitological or confirmatory diagnosis).
Currently it is recommended to confirm diagnosis of malaria in all age-groups of patients in all
epidemiological settings.
Use of a confirmatory diagnosis with either microscopy or RDTs is expected to reduce the overuse
of antimalarial by ensuring that treatment is targeted at patients with confirmed malaria infection
as opposed to treating all patients with fever.
Efforts are being made to ensure that there are enough diagnostic tests at all levels of the healthcare
system.

MALARIA IN KENYA
malaria is a disease that is caused by parasites of the genus plasmodium, nationally plasmodium
falciparum is the predominant species (98.2%) while p. malariae and p. ovale account for 1.8%.
P. vivax accounts for up to 40.50% of the infections mixed with p. falciparum in the north eastern
parts of kenya.

EPIDEMIOLOGY OF MALARIA IN KENYA

Kenya has four malaria epidemiological zones with the main determining factors being altitude,
rainfall patterns and temperature.

Endemic: areas of stable malaria cases have altitude ranging from 0 to 1,300 metres such areas
include lake victoria and the coastal regions. The vector life cycle is usually short and survival rates
are high because of the suitable climatic conditions hence transmission of malaria is intense all year
round.

Seasonal transmission: arid and semi-arid areas of northern and south-eastern parts of the
country experience short periods of intense malaria transmission during the rainfall seasons.

Epidemic prone areas of western highlands of Kenya: malaria transmission in western

highlands of kenya is seasonal with considerable year to year variation. The whole population is
vulnerable and case fatality rates during an epidemic can be up to ten times greater than those
experienced in regions where malaria occurs regularly.

Low risk malaria areas: this zone covers the central highlands of kenya including Nairobi. The
temperatures are usually too low to allow breeding of the malaria vectors.

Clinical features and classification of malaria

malaria can be classified as either uncomplicated or severe.

Uncomplicated malaria: it is characterized by fever, chills, profuse sweating, muscle pains,

joint pains, abdominal pain, diarrhoea, nausea, vomiting, irritability and refusal to feed

severe malaria: this is life threatening manifestation of malaria and is defined as the detection of
p. falciparum in the peripheral blood. It is characterized by respiratory distress, pulmonary oedema,
abnormal bleeding, jaundice, acute anaemia, hypoglycaemia, shock (circulatory collapse), coma

parasitological diagnosis of malaria

The commonly test used to confirm pr detect the presence of malaria parasites is microscopy and
rapid diagnosis tests (RDTS).

MICROSCOPY
microscopy is the standard method for parasitological diagnosis of malaria and is performed by
examining a stained thick or thin blood smear for the presence of malaria parasites.
Thick films are recommended for parasite detection and quantification and be used to monitor
response to treatment.

RAPID DIAGNOSTIC TESTS

Rapid diagnostic tests (RDTs) are immunochromatographic tests based on detection

of specific parasite antigens.

The use of RDTs is however not recommended for follow-up as most of the tests
remain positive for between 2 to 3 weeks following effective antimalarial treatment
and clearance of parasites. They also cannot be used to determine parasite density.

TREATMENT OF UNCOMPLICATED MALARIA

The recommended first line treatment for uncomplicated malaria in Kenya is

artemether-lumefantrine (AL).

MANAGEMENT AND TREATMENT OF SEVERE MALARIA

severe malaria is a medical emergency and should be treated immediately. Delay in diagnosis and
inappropriate treatment, especially in infants, children and non-immune adults leads to rapid
worsening of the situation and is often fatal.
Cerebral malaria
Clinical assessment;
a. Assess level of consciousness using coma score (Annex 4).
b. Determine the presence of severe anemia by examining for pallor on the
palms and conjunctiva
c. Determine presence of respiratory distress (deep and fast breathing, chest
in-drawing)
d. Determine hydration status (check for sunken eyes, loss of skin tugor, dry
tongue and measuring blood pressure).
e. Assess for renal insufficiency (measuring urine output)
f. Assess for evidence of disseminated intravascular coagulopathy
(spontaneous bleeding from the gums, injection sites, or any other site.
g. Check for clinical signs of meningitis (stiff neck, Kernig’s sign in children,
photophobia) cerebral malaria does not cause meningism although patients
may present with opisthotonus.

TREATMENT OF SEVERE MALARIA

The recommended treatments for severe malaria are parenteral quinine or parenteral
artemisinins (artesunate or artemether). The preferred route of administration is the
intravenous route. However the intramuscular route can be used as an alternative
where intravenous route is not feasible.

Signs and symptoms in expectant women

Type of malaria Signs and symptoms (Normal Signs and symptoms (sometimes
Uncomplicated malaria fever/chills Enlarged spleen
headaches
muscle and joint pains
nausea and vomiting
false labor (uterine
contractions)

TREATMENT OF UNCOMPLICATED MALARIA IN PREGNANT WOMEN

The recommended treatment for uncomplicated malaria in the first trimester is a
7-day therapy of oral quinine. Do not withhold artemether-lumefantrine or any other
treatment in 1st trimester if quinine is not available. Malaria if untreated can be fatal
to the pregnant woman.
Artemether-lumefantrine is the recommended treatment in the 2nd and 3rd trimesters.
Oral quinine may also be used but compliance must be ensured.

Signs and symptoms of severe malaria in pregnant women

Type of malaria Signs and symptoms (Normal Signs and symptoms
(sometimes
Severe malaria Confusion, drowsiness, coma Convulsions
Fast breathing/ Severe jaundice
breathlessness/difficulty Signs of severe
breathing dehydration, especially
Vomiting at every feed or if woman has been
unable to feed vomiting repeatedly
 Pale conjuctivae, mucous Sudden weight loss
membranes, tongue and Sunken eyes
palms Reduced skin tugor,
Jaundice dry mouth
Reduced amount of
urine or no urine at all

TREATMENT OF SEVERE MALARIA IN PREGNANT WOMEN

The recommended medicine for severe malaria in pregnancy is parenteral quinine
or parenteral artemisinins (artemether or artesunate). The preferred route of
administration is the intravenous route for quinine and artesunate. However the
intramuscular route can be used as an alternative where intravenous route is not
feasible. Due to the increased risk of hypoglycaemia in pregnant women, a dextrose containing
solution must be used for quinine administration.

PREVENTION OF MALARIA IN PREGNANCY

The goal of prevention of malaria in pregnancy is to reduce maternal and perinatal
morbidity and mortality associated with malaria.
The strategies in prevention of malaria in pregnancy are integrated in the overall antenatal care
(ANC) package for maternal health.

Intermittent preventive treatment for malaria in pregnancy (IPTp)

Long lasting Insecticidal Nets
Provision of prompt diagnosis and treatment of fever due to malaria
Health education.