ANNEX 1: RECOMMENDED IMMUNIZATUION SCHEDULE

Recommended schedule for immunization according to EPI program

Recommended schedule of immunization for children attending clinic at later age but before 5 years.

Hepatitis B vaccine (Engrix B 10 microgram)is also available and three doses are recommended (at birth, at one month and at six months of age) Booster dose is given after 10 years.

ANNEX 2: FEEDING PROBLEMS

Feeding of normal baby:

Mother should be told to start feeding the baby with in one to two hours after delivery. First feed should be the breast milk and there is no need for any test feed with water or dextrose. First few feeds should be supervised and records of feeds should be documented.

Feeding of a preterm, small for date (SGA) and infants of diabetic mothers (IDM): Infants less than 1500 grams should receive all the fluids and calories intravenously for the first 24 hours. SGA and IDM babies should be started feeding by one hour of age, First few feeds may be given by NG tube and they should be fed at least two hourly if sucking is poor. Once sucking is well established and blood sugar is normal these babies should be given to the mother for supervised breast feeding.

Feeding of term asphyxiated infants:

Mildly asphyxiated infants should feed like any healthy baby but must be closely supervised for the first 12 hours. Babies with severe asphyxia should be started with 2/3 maintenance IV fluids and strict intake records should be maintained routinely.

Evidence for adequate nutrition

Weight gain should be 20 - 30 g/kg/day for premature infants and 10 g/kg/day for full term infants

Adequate growth requires:

100-120 kcal/kg/day in term infants
115-130 kcal/kg/day for preterm infants
150 kcal/kg/day for very low birth weight infants.

ANNEX 3: FLUID AND ELECTROLYTE

Normal maintenance requirements (volume of fluid/kg/day)

Additional allowance:

1. Increase insensible water loss:

a. Radiant warmer 20 m1/kg/day
b. Photo therapy 20 m1/kg/day
c. Increase body temperature 10-20 m1/kg/day

2. Increase loss water from other roots:

Example: neonatal entrocolitis, GI aspirates, diarrhea. The loss in the above conditions are variable, they should be replaced volume for volume.

Stomach contents should be replaced with half saline with KCL loss small intestinal contents is replaced with normal saline and KCL.

ANNEX 4: THE KANGAROO MOTHER CARE

Kangaroo Mother Care (KMC), is defined as early, prolonged and continuous skin to skin contact between a mother and her low birth weight infants (LBWI), both in hospital and after early discharge until at least the 40^th week of postnatal gestational age. KMC does not need sophisticated equipment, and for its simplicity it can be applied almost everywhere including peripheral hospitals. Kangaroo Mother Care also contributes to the humanization of neonatal care and the containment of cost, for these features, it may also be attractive for neonatal units in high-income countries.

Kangaroo care a program of skin-to-skin contact between mother (any family members) and a LBWI, is part of the revolution in the care of premature infants. Since its first description in 1983 in Bogota, Colombia, KMC has drawn the attention of international agencies and the scientific community leading to a publication of more than 200 papers and abstracts.

The Multi center study including the neonatal unit of Addis Ababa, Ethiopia showed that LBWI in KMC had better growth, early discharge from hospital, lower cost, acceptable by both hospital staff and mothers when compared to the conventional method of care. KMC is not only feasible but also easily grasped by the hospital staff and accepted by the community. The feasibility of the KMC is also testified by the growing number of reported experiences and by its inclusion in national guidelines for perinatal care. The neonatal unit of Tikur Anbessa hospital also uses KMC as a routine care for all babies weighing less than 2000 grams since 1997.

The benefits of Kangaroo Mother Care: Many studies showed that Kangaroo Mother Care offers the preterm infants many physical and emotional benefits, which includes:

• A stable heart rate

• More regular breathing

• Improve dispersion of oxygen throughout the body

• Prevention of cold stress and also warming babies who are already in cold stress, Kangaroo transportation where transport incubators are not there to keep the warm chain

• Longer period of sleep (during which the brain matures)

• More rapid weight gain and earlier discharge from hospital

• Reduction of purposeless activity which simply burns calories at the expense of infants growth and health

• Decreased crying

• Opportunities to breast feed and enjoy all the healthful benefits of breast milk

• Earlier bonding

The KMC works so beautifully because of three factors affecting the infant:

1. It creates conditions similar to those with which the infant had become familiar in Utero, such as the proximity of the mother’s heart beat sounds and her voice couples with the gentle rhythmic rocking of her breathing

2. It provides containment and allows for flexion and prevent heat loss and provides heat from the skin to skin contact

3. Protects the infant and offers him a re-prieve from the stressful elements of NICU

When to Discharge from Kangaroo position:

The decision of discharging from Kangaroo position is made by the baby it self (at about the 40^th week of postnatal gestational age and weight of about 2000 grams). The baby will be restless and the mother could not maintain the Kangaroo position any more then this is the time to go out of the kangaroo "pouch"

ANNEX 5: THE ETHIOPIAN AIDS CASE DEFINITION FOR SURVEILLANCE IN PEDIATRICS [REVISED FEBRUARY 2002]

I. AIDS in a child <12 years of age is defined with evidence of positive HIV test in the presence of 3 major signs alone in the absence of other known causers of immunosuppression.

II. AIDS in a child <12 years of age is defined without laboratory evidence of HIV infection in the presence of: 2 major and 2 minor signs or 3 major and 1 minor sign in the absence of other known causes of immunosuppression

III. AIDS in a child < 12 years of age is defined if patient fulfills the 1987CDC surveillance case definition

Major signs/disease

1. Failure to thrive
2. Repeated/persistent lower respiratory tract infection (LRTI)
3. Chronic recurrent diarrhea for more than 1 month (continuous/intermittent).
4. Unexplained prolonged fever.1month (continuous/intermittent). Fever should not be counted as a major sign in the presence of lower respiratory tract infection {LRTI).

Minor signs/disease

1. Generalized lymphadenopathy
2. Repeated or persistent common infections
3. Unexplained neurological disorders or developmental delay and/or microcephaly.
4. Hepatosplenomegally/or splenomegally
5. Extensive varicella infections or molluscum contagiousum.
6. Confirmed maternal HIV infection

ANNEX 6: WHO RECOMMENDATIONS ON MULTIPLE DRUG THERAPY FOR LEPROSY (TABLE 1-4)

The basic WHO recommendations on multiple drug therapy for leprosy, using adult doses (Technical report series 675, 1982)

Table 1. Multibacillary leprosy (adult dosage)

Note: Ethionamide/prothionamide, in a daily self-administered dose of 250-375mg, may be used if the skin pigmentation or other side effects of clofazimine render this drug totally unacceptable.

Table 2. Paucibacillary leprosy (adult dosage)

Dosages based on age for children

Table 3. Multibacillary leprosy (3 drugs - Dapsone, Rifampicin Clofizimine)

Table 4. Paucibacillary Leprosy (2 drugs-Dapsone and Rifampicin)

ANNEX 7: PERCENTAGE OF ADULT DOSE REQUIRED AT VARIOUS AGES AND BODY WEIGHT

Note: The percentage method is derived from the surface area formula for children. This table is to be used only for drugs with a high therapeutic index. The clinical response of the child, age- or disease-related changes in drug clearance and any adverse effects that might present should be given due consideration when calculating doses.

ANNEX 8: GUIDELINES FOR THE MANAGEMENT OF PAIN (INCLUDING POST-OPERATIVE PAIN)

Pain score should be assessed after asking the patient to take a deep breath, cough and move.

ANNEX 9: GUIDELINES FOR USING NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

ANNEX 10. SYMPTOMS AND FINDINGS WHEN POISONED WITH SOME COMMON DRUGS

AST=aspartate aminotransferase; ALT=alanine aminotransferase; CNS=central nervous system; ECG=electrocardiogram.