UNITED REPUBLIC OF TANZANIA

Ministry of Heath, Community

Development, Gender, Elderly and
Children

PST 04102Disease
Control and
Prevention
NTA Level 4
Semester 1
Facilitator
Guide
PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
i
December 2016

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
ii
Copyright © Ministry of Health, Community Development, Gender, Elderly and Children – 2016

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Table of Contents
Background v
Acknowledgment vi
Introduction viii
Abbreviations/Acronym xi
Session 1: Concepts of Disease Control and Prevention 1
Session 2: Methods of Controlling Common Air-borne Diseases7
Session 3: Methods of Controlling Diseases Transmitted by Faecal
Contamination 12
Session 4: Methods of Controlling Vector-borne Diseases17
Session 5: Methods of Controlling Disease Transmitted by Animal Bites 22
Session 6: Measures to Improve Hygiene and Sanitation 27
Session 7: Measures for Preventing Water Contamination 32
Session 8: Water Treatment Methods 39
Session 9: Water for Pharmaceutical Use 44
Session 10: Methods for Safe Sewage Disposal 49
Session 11: Health Hazards of Poor Housing and Ventilation 55
Session 12: Air Purification in Pharmaceutical Settings 62
Session 13: Using Antiseptics and Disinfectants 67
Session 14: Introduction to Common Communicable Diseases 75
Session 15: Identification of Patients with Malaria 83
Session 16: Identification of Patients with Common Cold 94
Session 17: Identification of Patients with Tonsillitis 99
Session 18: Identification of Patients with Bronchitis 104
Session 19: Identification of Patients with Pneumonia 109
Session 20: Identification of Patients with Amoebiasis 115
Session 21: Identification of Patients with Typhoid Fever 121
Session 22: Identification of Patients with Food Poisoning 126
Session 23: Identification of Patients with Cholera 133
Session 24: Identification of Patients with Ascariasis 140
Session 25: Identification of Patients with Scabies 147
Session 26: Identification of Patients with Dermatophytes154
Session 27: Identification of Patients with HIV/AIDS 161
Session 28: Identification of Patients with Tuberculosis 172
Session 29: Identification of Patients with Leprosy 182
Session 30: Identification of Patients with Gonorrhoea 188
Session 31: Identification of Patients with Syphilis 193
Session 32: Identification of Patients with Trichomoniasis 200
Session 33: Identification of Patients with Vaginal Candidiasis 206
Session 34: Introduction to Common Non-communicable Diseases 212
Session 35: Identification of Patients with Hypertension 217
Session 36: Identification of Patients with Diabetes223
PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Session 37: Identification of Patients with Peptic Ulcers 230
Session 38: Identification of Patients with Asthma 236
Session 39: Identification of Patients with Allergic Rhinitis 243
Session 40: Prevention and Control of Contamination in Pharmaceutical
Settings 248
Session 41: Methods for Disposing Pharmaceutical Wastes 255
Session 42: Introduction to Human Nutrition270
Session 43: Managing Patients with Nutritional Deficiency Diseases 278
Session 44: Specialised Food Therapy 291

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Background
There is currently an ever increasing demand for pharmaceutical personnel in Tanzania.
This is due to expanding investment in public and private pharmaceutical sector. Shortage of
trained pharmaceutical human resource contributes to poor quality of pharmaceutical
services and low access to medicines in the country (GIZ, 2012).
Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together with
Development Partners (DPs) in Germany and Pharmaceutical Training Institutions (PTIs)
worked together to address the shortage of human resource for pharmacy by designing a
project named “Supporting Training Institutions for Improved Pharmaceutical Services in
Tanzania” in order to improve quality and capacity of PTIs in training, particularly of lower
cadre pharmaceutical personnel.
The Pharmacy Council formed a Steering committee that conducted a stakeholders workshop
from18th - 22ndAugust 2014 in Morogoro to initiate the implementation of the project.
Key activities in the implementation of this project included carrying out situational analysis,
curriculum review and harmonization, development of training manual/facilitators guide,
development of assessment plan, training of trainers and supportive supervision.

After the curricula were reviwed and harmonized, the process of developing standardised
training materials was started in August 2015 through Writer’s Workshop approach.

The approach included two workshops (of two weeks each) for developing draft documents
and a one-week workshop for reviewing, editing and formatting the sessions of the modules.

The goals of writers workshops were to build capacity of tutors in the development of
training materials and to develop high-quality, standardized teaching materials.

The training package for pharmacy cadres includes a facilitator guide, assessment plan and
practicum. There are 12 modules for NTA level 4 making 12 facilitator guides and one
practicum guide.

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Acknowledgment
The development of standardized training materials of a competence-based curriculum for
pharmaceutical sciences has been accomplished through involvement of different
stakeholders.

Special thanks go to the Pharmacy Council for spearheading the harmonization of training
materials in the pharmacy after noticing that training institutions in Tanzania were using
different curricula and train their students differently.

I would also like to extend my gratitude to St. Luke Foundation (SLF)/Kilimanjaro School of
Pharmacy –Moshi for their tireless efforts to mobilize funds from development partners.

Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale

Zusammenarbeit (GIZ), Merck Kgaa, BoehringerIngelheimGmbhand Bayer Pharma Ag and
action medeor.V for the financial and technical support.

Particular thanks are due to those who led this important process to its completion, Mrs Stella
M. Mpanda Director, Childbirth Survival Intenational, and Members from the secretariat of
National Council for Technical Education (NACTE) for facilitating the process.

Finally, I very much appreciate the contributions of the tutors and content experts
representing PTIs, hospitals, and other health training institutions. Their participation in
meetings and workshops, and their input in the development of this training
manual/facilitators guide have been invaluable.

These participants are listed with our gratitude below:

Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of Pharmacy

Mr.Samwel M. Zakayo- Pharmacy Council
Mr. Amour Idd Pharmacy Council
Mr. Selemani Majiindo NACTE
Mr. Dennis Busuguli MoHCDGEC
Mr. Amani Phillip HKMU
Mr. Karol J. Marwa CUHAS
Mr. John M. Bitoro CUHAS
Mr. Omary S. Mejjah CUHAS
Mr. Sixbert Nkwenge LZHRC
Ms. Ester A. Tuarira MUHAS
Mr. Rajabu I. Amiri MUHAS
Mr. Peter Njalale MUHAS
Ms. Tumaini H. Lyombe MUHAS
Mr. Oswald Paschal KSP
Mr. Peter Benedict KSP
PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Mr. Wensaa E. Muro KSP
Ms. Dilisi J. Makawia KSP
Mr. Nsabo J. Kihore KSP
Ms. Julieth Koimerek KSP
Rev. Baraka A.M. Kabudi MEMS
Mr. Kelvin E. Mtanililwa Royal Pharmaceutical Training Institute
Mr. George Kilimanjaro Royal Pharmaceutical Training Institute
Ms. Rose Bulilo CEDHA
Ms. Diana H. Gamuya CEDHA
Dr.Melkiory Masatu CEDHA
Dr. Benny Mboya CEDHA
Mr. Jackson Shayo CEDHA
Dr. Peter A. Sala CEDHA
Mr. Goodluck Mdugi RuCU
Mr. Gaspar Baltazary RuCU
Mr. Silvester Andrew St. Peter College
Mr. Emanuel Mayunga St. Peter College
Mr. Habel A. Habel City College of Health and Allied Sciences
Ms. Zaina Msami Meru District Council
Mr. John Paschal Mount Meru Regional Hospital
Mr. Mugisha G. Wilson JSI
Mr. Matiko M. Machage JSI
Mr. Dickson Mtalitinya SIBS
Mr. Nemes P. Uisso Moshi District Council

Dr. O. Gowele
Director of Human Resources Development
Ministry of Health, Community Development, Gender, Elderly and Children

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Introduction
Module Overview
This module content is a guide for tutors of Pharmaceutical schools for training of students.
The session contents are based on sub-enabling outcomes and their related tasks of the
curriculum for Basic Technician Course in Pharmaceutical Sciences. The module sub-
enabling outcomes and their related tasks are as indicated in the in the Basic Technician
Certificate in Pharmaceutical Sciences (NTA Level 4) Curriculum

Target Audience
This module is intended for use primarily by tutors of pharmaceutical schools. The module’s
sessions give guidance on the time, activities and provide information on how to teach the
session. The sessions include different activities which focus on increasing students’
knowledge, skills and attitudes.

Organization of the Module

The module consists of forty four (44) sessions; each session is divided into several parts as
indicated below:
 Session Title: The name of the session
 Total Session Time: The estimated time for teaching the session, indicated in minutes
 Pre-requisites: A module or session which needs to be covered before teaching the
session.
 Learning Tasks: Statements which indicate what the student is expected to learn by the
end of the session
 Resources Needed: All resources needed for the session are listed including handouts
and worksheets
 Session Overview: The session overview box lists the steps, time for each step, the
activity or method used in each step and the step title
 Session Content: All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step as shown in the overview box. Also, this section
includes instructions for the tutor and activities with their instructions to be done during
teaching of the contents
 Key Points: Key messages for concluding the session contents at the end of a session
This step summarizes the main points and ideas from the session, based on the learning
tasks of the sssion
 Evaluation: The last section of the session consists of short questions based on the
learning tasks to check the understanding of students.
 Handouts: Additional information which can be used in the classroom while teaching or
later for students’ further learning. Handouts are used to provide extra information related
to the session topic that cannot fit into the session time. Handouts can be used by the
students to study material on their own and to refer to them after the session. Sometimes,
a handout will have questions or an exercise for the participants including the answers to
the questions.

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Instructions for Use and Facilitators Preparation
 Tutors are expected to use the module as a guide to train students in the classroom and
skills laboratory
 The contents of the modules are the basis for teaching and learning Disease Control and
Prevention.
 Use the session contents as a guide
 The tutors are therefore advised to read each session and the relevant handouts and
worksheets as preparation before facilitating the session
 Tutors need to prepare all the resources, as indicated in the resource section or any other
item, for an effective teaching and learning process
 Plan a schedule (timetable) of the training activities
 Facilitators are expected to be innovative to make the teaching and learning process
effective
 Read the sessions before facilitation; make sure you understand the contents in order to
clarify points during facilitation
 Time allocated is estimated, but you are advised to follow the time as much as possible,
and adjust as needed
 Use session activities and exercises suggested in the sessions as a guide
 Always involve students in their own learning. When students are involved, they learn
more effectively
 Facilitators are encouraged to use real life examples to make learning more realistic
 Make use of appropriate reference materials and teaching resources available locally

Preparation with Handouts and Worksheets

 Go through the session and identify handouts and worksheets needed for the session
 Reproduce pages of these handouts and worksheets for student use while teaching the
session. This will enable students to refer to handouts and worksheets during the session
in the class. You can reproduce enough copies for students or for sharing
 Give clear instructions to students on the student activity in order for the students to
follow the instructions of the activity
 Refer students to the specific page in the student manual as instructed in the facilitator
guide

Using Students Manual When Teaching

 The student manual is a document which has the same content as the facilitator guide,
which excludes facilitator instructions and answersfor exercises.
 The student manual is for assisting students to learn effectively and acts as a reference
document during and after teaching the session
 Some of the activities included in facilitator guide are in the student manual without
facilitator instructions

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Abbreviations/Acronym

ACT Artimesinin Combined Therapy

AIDS Acquired Immune Deficiency Syndrome
ALU Artemether/ Lumefantrine
AMREF African Medical & Research Foundation
ART Anti-retroviral therapy
CEDHA Centre for Educational Development in Health Arusha
CUHAS Catholic University of Health and Allied Sciences
DM Diabetes Mellitus
Giz Deutsche GesellschftFür Internationale Zusammenarbeit
GoT Government of Tanzania
HIV Human Immunodeficiency Syndrome
HKMU Herbert Kairuki Memorial University
ITN Insecticides Treated Nets
JSI John Snow Inc
KSP Kilimanjaro School of Pharmacy
LCD Liquid Crystal Display
LZHRC Lake Zone Health Resource Centre
MOH Ministry of Health
MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and
Children
MOHSW Ministry of Health and Social Welfare
MUHAS Muhimbili University of Health and Allied Sciences
NACP National AIDS Control Programme
NACTE National Council for Technical Education
NCD Non-communicable diseases
NTA National Technical Award
PEM Protein Energy Malnutrition
PMTCT Prevention of Mother-to-Child-Transmission
RuCU Ruaha Catholic University
SLF Saint Luke Foundation
STIs Sexually Transmitted Infections
WHO World Health Organization

PST 04102 Disease Control and Prevention NTA Level 4 Semester 1 Facilitator Guide
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Session 1: Concepts of Disease Control and Prevention

Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites
 None

Learning Task
By the end of this session students are expected to be able to:
 Define Terms
 Explain Common Terms in Disease and Disease Control/Prevention

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Task
35 minutes Presentation Definition of Common Terms in Disease
2
Buzzing and Disease Control
3 05minutes Presentation Key Points

4 05 minutes Presentation Evaluation

5 10 minutes Presentation Assignment

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning task and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Common Terms in Disease and Disease Control (35

minutes)
1
Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the common terms in disease and disease control?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition of common terms

Disease
 A disorder with a specific cause and recognisable signs and symptoms
Or
 Any bodily abnormality or failure to function properly, except that resulting directly from
physical injury (the latter, however, may open the way for disease)

Communicable diseases
 Diseases which can be transmitted from one person to another or from animal to person
o For example, cholera, tuberculosis

Non- communicable disease

 A medical condition or disease that is non-infectious or non-transmissible which last for
long periods and progress slowly
o For example, cardiovascular diseases, chronic respiratory diseases, diabetes

Epidemic (from Greek epi- upon + demos people)

 A classification of a disease that appears as new cases in a given human population,
during a given period, at a rate that substantially exceeds what is ‘expected’, based on
recent experience. Therefore, it is unusual occurrence of a disease in the community

Endemic
 The constant presence of a disease or infectious agents within a community

Pandemic (from Greek pa? pan all + demos people)

 An epidemic that spreads across a large region (for example a continent), or worldwide

Nosocomial
 An infection developing in a patient while in a hospital or acquired in a hospital8 but
could show up after discharge

Principle of disease transmission

Transmission of a disease in human requires the following components:

2
 An agent capable of infecting man
 A source: an infected host or reservoir of infection
 A portal of exit from the source
 A suitable means of transmission
 A portal of entry into a new host
 A susceptible host

Agent
 Is an organism, mainly a microorganism but including helminthes that is capable of
causing disease

Reservoir (of infection)/ host)

 Refers to any human beings, animals, arthropods, plants, soil or inanimate matter or a
combination of these in which an infectious agent normally lives and multiplies, and on
which it primarily depends for survival and reproduction in such a manner that it can be
transmitted to a susceptible host.
o A reservoir of infection can also be termed as the natural habitat of the infectious
agent
o Disease that man is the only reservoir is called anthroponeses e.g. measles and
cholera
o Those that involve other animals reservoirs are called zoonoses e.g. plague and rabies

Portal of exit in the human host

 Include the respiratory passages, the alimentary canal, the opening in the genital urinary
system and the skin lesion

Suitable means of transmission

 Transmission of infectious agent is any mechanism by which a susceptible host is
exposed to an infectious agent. It may be either direct or indirect

Transmission Cycle of Communicable Diseases

 The transmission cycle describes how an organism grows, multiplies and spreads
 For the agent to cause a disease; it has to enter the body; routes of entry are virtually the
same as those of escape of the agent.
o The agent must enter and multiply inside the host
o The infectious organism grows and cause disease in the human body
 Different diseases have different transmission cycle
 For an agent to cause disease in an individual it must enter in the human body and
multiply

Common Communicable Diseases in Tanzania

Common communicable diseases include group of the following diseases as per mode of
transmission:
 Air-borne diseases e.g. respiratory infections, pulmonary tuberculosis
 Diseases caused by fecal contamination e.g.cholera, typhoid fever, amoebiasis
 Vector-borne diseases e.g. malaria, plague, schistosomiasis

 Diseases from animals and products e.g. tetanus, rabies, anthrax, brucellosis

3
 Contact (contagious) diseases e.g. scabies, fungal skin infections, leprosy
 Sexually transmitted infections e.g. gonorrhea, syphilis, trichomoniasis
 Helminthic diseases e.g. ascariasis, hookworm, taeniasis, trichuriasis

Prevention and Control of Communicable Diseases

The main methods of communicable disease prevention/control are:
 Attacking the source or reservoir by:
o Treatment – cases are treated with drugs that destroys the organisms
o Immunization – this increases the host resistance to disease by increasing the body‟s
immune response
o Isolation – the person with the disease is not allowed to come into close contact with
other people, except those who are providing care
o Reservoir control – in those diseases which have their main reservoir in animals, mass
treatment, chemoprophylaxis or immunization of the animal can be carried out.
o Notification – notification means that one immediately informs the local authorities
(RMO/DMO/MOI/C of the nearby health facility) of the presence or suspicion of an
infectious disease.

 Interrupting transmission by:

o Environmental sanitation
o Personal hygiene and behavior change
o Vector control
o Disinfection and sterilization
o Preventive chemotherapy through mass drug administration (MDA)

 Protecting the host by:

o Immunization – increases the host’s resistance
o Chemoprophylaxis
o Personal protection
o Better nutrition

Disease Control
 Measures designed to prevent further spread of the diseases from the infected persons and
specific treatment to minimize time for transmission and to reduce morbidity and
mortality
 Methods for disease control include:
o Preventive measures e.g. isolation, immunization
o Treatment
o Surveillance

4
STEP 3: Key Points (5 minutes)
 Diseases may be divided into 2 broad categories which are communicable and non-
communicable diseases.
 Principles of disease transmission includes agent, source, means of transmission, portal of
exit, portal of entry and susceptible host
 Disease control requires immediate preventive measures, proper treatment and continuous
surveillance to reduce morbidity and mortality

STEP 4: Evaluation (5 minutes)

 What common terms are used in disease and disease control?

STEP 5: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on the common terms used in disease and disease control (Give
examples for each term used)

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

5
References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:
Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011) (eds.),Hugo& Russell’s
Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013).National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2012).National Guidelines for Management of HIV and AIDS. (4thed) Dar es Salaam:
MOHSW/NACP

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar es salaam:
MOHSW

GoT (2007).National Guidelines for Management of Sexually Transmitted and Reproductive

Tract Infections (1st ed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable Diseases. (4thed.).
Nairobi: AMREF.

Tanzania Food and Drugs Authority (2009).Guidelines for safe disposal of unfit medicines
and cosmetic products. Dar es Salaam: MOH

6
Session 2: Methods of Controlling Common Air-borne
Diseases
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Common Airborne Diseases
 Describe Methods for Prevention and Control of Airborne Diseases + Principles of
Prevention and Control

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
35 minutes Presentation
2 Common Airborne Diseases
Buzzing
60 minutes Presentation
3 Group Prevention and Controlof Airborne Diseases
Discussion
4 05 minutes Presentation Key points

5 05minutes Presentation Evaluation

6 10 minutes Presentation Assignment

7
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Airborne Diseases (35 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the common air-borne diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Airborne diseases are diseases that are caused by pathogens and transmitted through the
air
o People spread the disease through sneezing and coughing (see figure 2.1)

Source: Slide collection, Department of Medical Microbiology, Edinburgh University

Figure 2.1: Spread of Airborne Disease

Common air-borne diseases includes:

8
 o Common cold – caused by viruses which are spread by droplets
o Sore throat – acute inflammation of the throat or pharynx
o Flu – acute respiratory tract infection of specific viral origin
o Bronchitis – acute or chronic disease, caused by bacteria or virus
o Pneumonia – acute infection of the lungs
o Measles – acute infection caused by viruses common in children
o Chickenpox – mild viral infection, very common in children
o Meningitis – inflammation of the meninges which covers the brain
o Tuberculosis – infectious chronic disease of the lung tissues

STEP 3: Prevention and Controll Airborne Diseases (60 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the control methods for air borne diseases?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Prevention and control of air borne diseases

Since the infective particles are spread by droplets from the respiratory tract of patients or
carriers, an important part of the control of these diseases is based on preventing droplets
from being inhaled by others.

Methods for Controlling Airborne Disease:

 Improved ventilation
 Avoid overcrowding
 Isolation
 Health education
 Seek treatment for any chronic cough
 Immunization
STEP 4: Key Points (5 minutes)
 Airborne diseases are of great public health importance
 Airborne diseases causes unnecessary morbidity and mortality which could be
prevented
 The control is based on preventing droplets infections spreading from one person to
another

9
STEP 5: Evaluation (5 minutes)
 What are the common airborne diseases?
 What are methods for controlling airborne diseases?

STEP 6: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on methods to control outbreak of common cold in your village

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

10
References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed). London:
Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011) (eds),Hugo& Russell’s
Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013).National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar es salaam:
MOHSW

GoT (2007).National Guidelines for Management of Sexually Transmitted and Reproductive

Tract Infections (1st ed). Dar es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable Diseases. (4thed).
Nairobi: AMREF.

11
Session 3: Methods of Controlling Diseases Transmitted by
Faecal Contamination
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Diseases Transmitted by Faecal Contamination
 Describe Methods for Controlling Diseases Transmitted by Faecal Contamination

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
25 minutes Presentation Diseases Transmitted by Faecal
2
Buzzing Contamination
60minutes Presentation
Methods for Controlling Diseases
3 Group
Transmitted by Faecal Contamination
Discussion
4 10minutes Presentation Key Points

5 10 minutes Presentation Evaluation

6 10 minutes Presentation Assignment

12
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Diseases Transmitted by Faecal Contamination (25 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair and buzz on the following question for 2 minutes

 What are the common diseases transmitted by faecal contamination?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Diseases transmitted by faecal contamination:

 Causative organisms are excreted in the stools of infected persons
 The causative organisms enter the body through the mouth
 Transmission occurs through faecal contamination of food, water and hands
 Food plays a central role in transmitting disease as it can be directly or indirectly
contaminated via polluted water, dirty hands, contaminated soil, flies and animals or
animal products
 Water can be polluted directly by faeces, or faecal material may be washed in from
polluted soil
 Hands are contaminated after defaecation or by touching contaminated objects
.
Diseases transmitted by faecal-oral contamination:
 Typhoid fever
 Cholera
 Amoebic dysentery
 Bacillary dysentery
 Staphylococcal food poisoning
 Ascariasis
 Taeniasis
 Hydatidosis

STEP 3: Methods for Controlling Diseases Transmitted by Faecal

Contamination (60 minutes)
13
Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the preventive methods for controlling diseases transmitted by faecal
contamination?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Methods for Prevention of faecal-oral diseases includes:

 Proper methods of stool disposal e.g. use of latrines
 Hand washing using soap and water after visiting toilets and before handling food
 Proper disposal of refuse
 Proper cooking of food
 Proper washing of fruits and vegetables before eating
 Boil milk and water before drinking
 Protection, purification and chlorination of public water supplies
 Health education e.g. dangers of bottle feeding

STEP 4: Key Points (10 minutes)

 Causative organisms of fecal-oral diseases are excreted in the stools of infected persons
 Transmission occurs through faecal contamination of food, water and hands
 Control of faecal-oral diseases depends on breaking the faecal –oral transmission cycle

STEP 5: Evaluation (10 minutes)

 What are the diseases transmitted by faecal contamination?
 What are the methods for controlling diseases transmitted by faecal contamination?

STEP 6: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

14
DIVIDE students in groups or individuals

ASK the students to work on the following assignment

 Prepare a presentation of at least 5 common faecal-oral transmitted diseases in their local
area and give measures how to control it.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

15
References
Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed). London:
Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011) (eds),Hugo& Russell’s
Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable Diseases. (4thed).
Nairobi: AMREF.

16
Session 4: Methods of Controlling Vector-borne Diseases
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 List Common Vector-borne Diseases
 Describe Vectors of Medical Importance
 Describe Methods of Vector Control

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 10 minutes Presentation Common Vector/borne Diseases

20 minutes Presentation
3 Vectors of Medical Importance
Buzzing
60 minutes Presentation
4 Methods of Vector Control
Group discussion
5 05 minutes Presentation Key Points

6 10 minutes Presentation Evaluation

7 10 minutes Presentation Assignment

17
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Vector-borne Diseases (10 minutes)

Common Vector borne Diseases:
 Vector is any carrier of disease (insects, mosquitos, ticks and snails) which are an essential
part of the life cycle of the disease causative organism
 Vectors acquire disease organisms by sucking blood from infected persons or animals and
pass them on by same route

Common vector borne diseases:

 Malaria
 Filariasis
 Trypanosomiasis
 Yellow fever
 Plague
 Schistosomiasis

STEP 3: Vectors of Medical Importance (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are vectors of medical importance?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

The following are Vectors of Medical importance:

18
 Table 4.1 Common vectors and the diseases they transmit
Vector Disease(s)
Mosquitoes Malaria, filariasis, yellow fever, dengue fever

Black flies River blindness

Biting flies Trypanosomiasis ( sleeping sickness)
Lice Relapsing fever ( louse-borne )
Fleas Plague
Soft ticks Relapsing fever ( tick-borne )
Hard ticks African tick-borne typhus

STEP 4: Methods of Vector Control (60 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the methods of vector control?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Methods of Vector Control:

The control may be brought about by:
 Reducing the reservoir host
o Control the vector population
o Killing adults with insecticides
o Killing larva with larvicides
o Prevention of breeding sites by environmental sanitation

 Protecting the susceptible individuals

o Use of insecticide treated nets
o Ue of chemoprophylaxis
o Use of repellents and protective clothing

STEP 5: Key Points (5 minutes)

19
  Vector is any carrier of disease
 A vector is required for the transmission of vector-borne diseases.
 Measures that reduce vector population and protect susceptible hosts are used to
control vector-borne diseases

STEP 6: Evaluation (10 minutes)

 What are the common vectors borne diseases?
 What are the vectors of medical importance?
 What are the methods of controlling vector-borne diseases?

STEP 7: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following assignment

 Prepare a presentation of at least 5 common vector-borne diseases in their local area and
give measures on how to control it

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

20
References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed). London:
Saunders Ltd.

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011) (eds),Hugo& Russell’s
Pharmaceutical Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013).National Guidelines for Diagnosis and Treatment of Malaria. Dar es salaam:
MOHSW

GoT (2013).Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999).Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008).Communicable Diseases. (4thed).
Nairobi: AMREF.

21
Session 5: Methods of Controlling Disease Transmitted by
Animal Bites
Total Session Time: 90 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Common Diseases Transmitted by Animal Bites
 Flip charts, marker pens, and masking tape Describe Methods for Controlling Diseases
Transmitted by Animal Bites

Resources Needed:

 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
30 minutes Presentation Common Diseases Transmitted by Animal
2
Buzzing Bites
30 minutes Presentation
3 Group Methods for Controlling Rabies
Discussion
4 05 minutes Presentation Key Points

5 10 minutes Presentation Evaluation

6 10 minutes Presentation Assignment

22
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Diseases Transmitted by Animal Bites (30 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What is the commonest disease transmitted by animal bites?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Common disease transmitted by animal bites

Rabies is a disease that affects wild animals such as jackals, mongooses, fox and hyaenas.
These animals may infect domestic animals such as dogs and cats. It is incidentally
transmitted to human beings by a bite of a rabid animal, commonly domestic dogs or cats.
 Rabies is an important public health problem because when no immediate action is taken
after the bite by an infectious animal, the disease is fatal.
 The virus has preference for the salivary glands and nervous tissue, finally causing
encephalitis, and resulting in death.

Clinical manifestations
 Anxiety
 Violent behavior
 Seizures
 Hallucinations
 Depression
 Paralysis of the limbs
 Spasm of pharyngeal muscles
 Fear of water (hydrophobia)

23
STEP 3: Methods for Controlling Rabies (30minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

 What are methods for controlling Rabies?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY

ASK students to discuss on the following question

SUMMARIZE by using the contents below

Methods for controlling Rabies

 Notify authority because Rabies is a notifiable disease
 Provide antirabies serum or vaccine to affected individuals
 Give health education about preventive measures, such as regular immunization of dogs
and cats (at least every 3 years) and killing of stray dogs
 Pre-exposure vaccination to high risk individuals, such as veterinary officers

STEP 4: Key Points (5 minutes)

 Rabies is the most common human disease caused by animal bite
 Death can be avoided if immediate action is taken for those who have been bitten by a
suspect dog
 Control measures include immunization of domestic dogs and individuals with high
risk of exposure

STEP 5: Evaluation (10 minutes)

 What is the common disease transmitted by animal bites?
 What are the methods for controlling Rabies?

STEP 6: Assignment (10 minutes)

24
Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on Rabies, indicating transmission, clinical manifestation and

control measures

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

25
References
Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed). London: Saunders Ltd.

Eshuis J, & Manschot, P (1992).Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Manson-Bahr PEC.,& Bell DR (2004). Manson’s Tropical Diseases (21sted). London.

Bailliere Tindall.

Nordberg, E., Kingondu T., Mugambi E., Musyoka L, & Otieno F (2007).Communicable
Diseases(4thed). Nairobi: AMREF

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF.

26
Session 6: Measures to Improve Hygiene and Sanitation

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
Differentiate Hygiene from Sanitation
Describe the Importance of Sanitation and Hygiene

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
30 minutes Presentation Hygiene and Sanitation
2
Buzzing
60 minutes Presentation
3 Small Group Importance of Sanitation and Hygiene
Discussion
4 10 minutes Presentation Key Points

5 5 minutes Presentation Evaluation

6 10 minutes Presentation Assignment

27
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Hygiene and Sanitation (30 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What is the difference between hygiene and sanitation?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Hygiene – Things that you do to keep yourself and your surrounding clean to maintain good
health. Few examples of hygiene practices are:
 Personal hygiene
 Food hygiene
 Medical hygiene practices, e.g.
o Sterilization of instruments used in surgical procedures
o Use of protective clothing and barriers, such
as masks, gowns, caps, eyewear and gloves
o Safe disposal of medical waste
o Disinfection of reusable materials such as linen, pads, uniforms
o Hand-washing before and after dispensing of medicines

Sanitation – is promotion of health through prevention of human contact with the hazards
of wastes, treatment and proper disposal of sewage or wastewater.
Few examples of sanitation are:
 Management of human faeces
 Proper handling of food (Food sanitation)
 Environmental sanitation

28
Differences between Sanitation and Hygiene
Sanitation Hygiene
Promotion of healthy living and good health Cumulative group of practices perceived by
by preventing human contact with waste and group of people to be a way towards healthy
other forms of organisms causing diseases. living
Associated with human wastes, Associated with human body
environmental wastes and other forms of
wastes

STEP 3: Importance of Sanitation and Hygiene (60 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the importance of sanitation and hygiene?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Importance of Sanitation
 Prevent variety of harmful or deadly bacteria from infecting people
 Increase lifespan and improve of quality of life
 Ensure safe living environment particularly in the rural setting
 Providing measures to control diseases

Importance of hygiene
 Protects people against disease germs that are present in the environment
 Promote health to “a state of maximum physical and mental well-being” rather than mere
absence of disease
 It promotes professional ethics

STEP 4: Key Points (10 minutes)

 Hygiene are practices done to maintain healthy living
 Sanitation is promotion of health through prevention of human contact with
wastesSanitation and hygiene are important for disease prevention

STEP 5: Evaluation (5 minutes)

 What is the difference between hygiene and sanitation?
 What are the importances of sanitation and hygiene?
STEP 6: Assignment (10 minutes)
29
Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating different hygienic measures
practiced in their households.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

30
References
Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London: Saunders
Ltd.

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed).
Nairobi: AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO

31
Session 7: Measures for Preventing Water Contamination
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session studentsare expected to be able to:
 Describe Sources of Water Supply
 Identify Sources of Water Contamination
 Describe Measures for Preventing Water Contamination

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
25 minutes Presentation Sources of Water Supply
2
Buzzing
30 minutes Presentation Sources of Water Contamination
3 Small Group
Discussion
30 minutes Presentation Measures for Preventing Water
4 Small Group Contamination
Discussion
5 10 minutes Presentation Key Points

6 10 minutes Presentation Evaluation

7 10 minutes Presentation Assignment

32
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Sources of Water Supply (25 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are sources of water supply?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Two Main Sources of Water Supply

 Surface water
 Ground water

Surface Water
 The most common source of water for most people
 Located in rivers, lakes, streams, reservoirs, oceans, dams, and rain water and snow when
it falls to the surface

Advantages of surface water

 Easily accessible
 Obtained by hand or by simple pumps
 Large lakes and rivers are permanent supplies of water throughout the year

Disadvantages of surface water

 Easily and frequently polluted as it runs over the ground where humans and animals wash
and bathe in it
 May be polluted by chemicals used in agriculture or industry
 Surface water needs to be treated before it becomes drinking water

Types of surface water

33
Rain water
 Obtained during the rainy season and collected from roofing or other collecting surfaces

Advantages of rain water

 Purest form of natural water if collected into clean, closed tanks
 Does not need treatment when collected in a clean container

Disadvantages of rain water

 Does not contain essential elements (fluoride, iodine, selenium)

Sea water
 Water from the sea contains some salts
o The water is concentrated by evaporation and become too salty for drinking

Ground Water
 Water which passes through permeable subsoil to the surface
 Ground water can be accessed through:
o Springs
o Wells (shallow well, deep well or Artesian/bore-hole wells)
 Shallow well taps water above the first impermeable stratum
 Deep wells are those derived from water bearing strata below a least one
impervious stratum
 Artesian wells are the result of ground pressure in an aquifer being released
through a natural fault, or a bore-hole, so that water is forced to the surface of the
ground

Advantages of ground water sources

o Underground water is usually clean, often plentiful and permanent
o A reliable resource, especially in dry season
o Not affected by evaporation
o Ground water doesn’t need treatment as surface water

Disadvantages of ground water sources

o Limited resources, extractable quantities are often low compared to surface water
o Ground water extraction is more expensive due to pump cost
o Water from deep wells and deep springs usually has a lot of dissolved salts and other
o Fertilizer and insecticides can get washed into aquifers via rain water and pollute
ground water

STEP 3: Sources of Water Contamination (30 minutes)

34
Activity: Brainstorming (10 minutes)

ASKstudents to brainstorm on the following question:

 What are the sources of water contamination?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Sources of Water Contamination

 Industrial and mining activities
o Industrial discharge of chemicals wastes and by products
o Spillage of petroleum products
o Acidic rain caused by industrial discharge of sulphur dioxide
o Underground storage tank leakages
o Heavy metals used in mining industries (mercury in gold mining)
o Silt in storm water runoff from construction sites or cleared land

 Agricultural activities
o Farmers use of fertilizers and pesticides
o Food processing wastes, including pathogens
o Excess nutrients added by runoff containing detergents or fertilizers

 Organic materials from human/animals/plants and other living organisms

o The collecting surface for rain water may have leaves, insects, bird and animal faces
o When water runs over the earth it may become contaminated with human or animal
excreta and solid waste
o Shallow wells may be contaminated by excreta and refuse being washed into them, if
a latrine is near
o Wells may also be contaminated by the use of dirty containers for drawing water, or
by oil from the pump
o Rivers, lakes or dams may be contaminated by bathing and/or urinating or defecating
in the water
o Even piped water may be contaminated from leaks in the pipes especially when these
pass near foul water or dirty drains
o Water may go bad if it is stored for too long in a pot or cistern
o Water from any source may become contaminated if it is drunk from dirty or
communal drinking vessel

STEP 4: Measures for Preventing Water Contamination(30 minutes)

35
Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the measures of preventing water contamination?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

The following are measures for preventing water contamination:

 Protection of springs water
o Construct concrete water-proof protection box over the spring
o Keep off sources of water from contamination e.g. fencing the source of water
 Protection of well water
o Site the well on a higher level of the source of water
o Put a concrete cover over a well
o Fence the well to keep animals away
 Protection of rain water
o Construct gutter that collects rain water from entire roof-surface and drains into an
angled pipe

STEP 5: Key Points (10 minutes)

 There are two major types of water, i.e surface water and ground water
 Water contamination can occur from industrial,mining, agricultural activities; and
materials from human, animals and plants
 Various measures can be used to protect water from contamination

STEP 6: Evaluation (10 minutes)

 What are sources of water supply?
 What are sources of water contamination?
 What are measures for preventing water contamination?

STEP 7: Assignment (10 minutes)

36
Activity: Take Home Assignment (10 minutes)

DIVIDE in small groups assignment

ASK the students to work individually on the following Assignment

 Prepare a list sources of water contamination
 Describe preventive measures against the list you have mentioned
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References

37
Basset W.H. (1992). Clay’s Handbook of Environmental Health (16thed). London: Chapman
and Hall.

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer Students. Kilosa,
Tanzania.

Wood C. H. (1997). Community Health (2nded). Nairobi: AMREF

38
Session 8: Water Treatment Methods
Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites
 None

Learning Task
By the end of this session students are expected to be able to:
 Explain Water Treatment Methods

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Task
40 minutes Presentation
2 Group Water Treatment Methods
Discussion
3 5 minutes Presentation Key Points

4 5 minutes Presentation Evaluation

5 5 minutes Presentation Assignment

39
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ orASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Water Treatment Methods (40 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the methods used for treatment of contaminated water?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

The following are common methods for treating contaminated water (Purification)
 Filtration
 Disinfection
 Boiling

Filtration
 Purification through sand reduces the bacterial content of the water by 85% to 90%
 The two types of filters commonly used in community water supply are:
o Slow sand filter
o Rapid (Pressure) filter

Slow filter
 Requires little operational maintenance skills
 Applicable in rural areas
 Needs attention regularly because it is liable to become a breeding place for bacteria and
water contamination

Home-made sand filter

 Filtration which is done when raw water passes through a fixed depth of arranged sand
medium
 All the suspended matter in water is dropped by the first few top layers of the sand grain
 The clean water is collected at the bottom of the medium
40
 It can be used in containers like barrels of steel or concrete or clay pots
 The home-made sand filter can be used effectively in combination with chlorination

Disinfection
 It is killing of the organisms causing diseases
o There are different methods used to disinfect water supplies, e.g. chlorination, silver
treatment, ultra-violet radiation

Water Chlorination
 It is the final safe guard of the quality of water
o The Chlorine should be applied in the water system in such a way that good mixing of
the chlorine with water is ensured

Boiling
 Simplest way to treat a small quantity of water for at least 20 minutes
 This will kill the organism and render the water harmless
 Boiled water is tasteless but it is a safe rule to follow that all drinking water should be
boiled to disinfect it

STEP 6: Key Points (5minutes)

 Water purification can be done by boiling, disinfection and filtration
 A properly constructed and carefully maintained sand filter can remove most of the
substances that cause turbidity and odour
 It is important to prevent water from contamination

STEP 7: Evaluation (5 minutes)

 What are the methods of treating contaminated water?
 Why is it important to treat contaminated water?

41
STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE individual assignment

ASK the students to work individually on the following Assignment

 Prepare a list of common methods used to treat water in their household.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

42
References

Basset W.H. (1992). Clay’s Handbook of Environmental Health (16th ed). London: Chapman
and Hall

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer Students. Kilosa,
Tanzania.

Wood, C. H. (1997). Community Health (2nded). Nairobi: AMREF

43
Session 9: Water for Pharmaceutical Use
Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites
 None

Learning Task
By the end of this session students are expected to be able to:
 Describe Types of Water for Pharmaceutical Use

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Task
Presentation
Types of Water for Pharmaceutical Use
2 40 minutes Group
Discussion
3 5 minutes Presentation Key Points

4 5 minutes Presentation Evaluation

5 5 minutes Presentation Assignment

44
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Types of Water for Pharmaceutical Use (40 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the types of water for pharmaceutical use?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

 Water is a widely used substance, raw material in the production, processing and
formulation of pharmaceutical products
 Impurities present in water may contaminate or react with intended product substances,
resulting in hazards to health
 Control of the quality of water throughout the production, storage and distribution
processes, including microbiological and chemical quality, is very important
 Assurance of quality to meet the acceptable standards of pharmaceutical products is
essential
 Microbial contamination in the production of pharmaceutical products can be minimized
by proper designing of the system, periodic sanitization and by taking appropriate
measures to prevent microbial proliferation
 Different grades of water quality are required depending on the route of administration of
the pharmaceutical products (Different grades of water can be found in pharmacopoeias
and related documents)

General principles for pharmaceutical water systems

 Pharmaceutical water production, storage and distribution systems should be designed,
installed, commissioned, qualified and maintained to ensure the reliable production of
water of an appropriate quality.
 The capacity of the system should be designed to meet the average and the peak flow
demand of the current operation.
o All systems, regardless of their size and capacity, should have appropriate recirculation
and turnover to assure the system is well controlled chemically and microbiologically.
45
 The use of the systems following initial validation (installation qualification (IQ),
operational qualification (OQ) and performance qualification (PQ)) and after any planned
and unplanned maintenance or modification work should be approved by the quality
assurance (QA) department using change control documentation.
 Water sources and treated water should be monitored regularly for chemical,
microbiological and, as appropriate, endotoxin contamination.
 There are four types of water used in pharmacy.
o Portable water
o Purified water
o Water for preparation
o Water for injection

Drinking/Portable water
 Portable water is water fleshly drawn from public mains supply
 It does not include water from local storage tank which may be heavily contaminated with
microorganisms
 Portable water is suitable for preparation of pharmaceutical preparation for internal and
external use
 Drinking-water should be supplied under continuous positive pressure in a plumbing
system free of any defects that could lead to contamination of any product
 Drinking-water is unmodified except for limited treatment of the water derived from a
natural or stored source e.g. springs, wells, rivers, lakes and the sea
o The condition of the source water will dictate the treatment required to render it safe
for human consumption (drinking)
o Treatment includes desalinization, softening, removal of specific ions, particle
reduction and antimicrobial treatment
 It is the responsibility of the pharmaceutical manufacturer to assure that the source water
supplying the purified water (PW) treatment system meets the appropriate drinking-water
requirements
 Drinking-water quality is covered by the WHO drinking-water guidelines, standards from
the International Organization for Standardization (ISO) and other regional and national
agencies.

Purified water
 This is prepared from suitable portable water by distillation or reverse osmosis system
 If allowed to stand it may gain a high content of vegetative organisms
 Water for pharmaceutical production must be freshly boiled and cooled before us

Water for preparation

 Portable or fleshly boiled and cooled purified water is recommended for preparations of
pharmaceutical
 Portable water is suitable only when it is drawn from a public supply (mains water) and is
suitable for drinking
 Water obtained from local storage tank or any other open source e.g. water from wells is
unsuitable for preparation of pharmaceuticals.
46
 Water for preparation is used for preparation of non-sterile products such as mixtures.

Water for injections

 This is pyrogen free distilled water or water produced by reverse osmosis system (ROS)
Water for injection is sterilized immediately after collection and used for parenteral
preparation and irrigation in surgical procedures

STEP 6: Key Points (5 minutes)

 Production and uses of Water for pharmaceutical use should follow the requirements
specified by Pharmacopoeias and other requirements by international and local authorities

STEP 7: Evaluation (5 minutes)

 What are the types of water for pharmaceutical use?
 What are the uses of each type of water for pharmaceutical use?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (10 minutes)

ASK the students to work individually on the following Assignment

 Prepare a list of common methods used to treat water in their household

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

47
References

Eshuis J., & Manschot, P (1992).Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Liebsch B., Nyamageni DS., Senya SS., & Steinhausen (1988). Tanzania Pharmaceutical
Handbook.Dar es Salaam: Dar es Salaam University Press

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

48
Session 10: Methods for Safe Sewage Disposal
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Define Sewage
 Describe the Importance of Safe Sewage Disposal
 Describe Methods for Safe Sewage Disposal

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction , Learning Tasks
15 minutes Presentation Definition of Sewage
2
Buzzing
30 minutes Presentation Importance of Safe Sewage Disposal
3
Brain Storming
45 minutes Presentation
5 Small Group Methods for Safe Sewage Disposal
Discussion
6 10 minutes Presentation Key Points

7 5 minutes Presentation Evaluation

8 10 minutes Presentation Assignment

SESSION CONTENTS
49
STEP1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Sewage (15 minutes)

Activity: Brainstorming (5 minutes)

ASKstudents to brainstorm on the following question:

 What is sewage?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Sewage is the mixture of liquid, faeces, toilet paper and food wastes produced by people
o The liquid in sewage includes urine and wastewater which comes from the toilet, the
kitchen, bathroom and laundry
o Sewage contains lots of disease-causing germs and parasites
o Sewage is treated to get rid of as much of the solid matter as possible
o The remaining liquid is called effluent

STEP 3: Importance of sewage disposal (30 minutes)

Activity: Brainstorming (15 minutes)

ASK students to brainstorm on the following question:

 What is the importance of sewage disposal?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Sewage disposal is the process in which sewage is transported from inhabited areas
to sewage treatment plants
o This is important to prevent people from getting infection caused by microorganisms
found in the sewage
50
Importance of safe sewage disposal
 Protects public health from diseases
 Prevent water pollution from sewage contaminants
 Remove sources of contaminants from the environment to make it safe.

STEP 4: Methods for Sewage Disposal (450 minutes)

Activity: Small Group Discussion ( 45 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

What are the methods for safe sewage disposal?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

There are main two types of sewage disposal systems which are:
 On-site systems
 Sewage or effluent systems

On-site sewage disposal systems

 It treats the sewage in a septic tank so that most of the sewage becomes effluent and is
disposed of in an area close to the house or buildings
o Example of an on-site disposal system consists of a septic tank and leach drains
o All the liquid waste from the toilet, bathroom, laundry and sink goes into pipes which
carry it to a septic tank
o The effluent from the tank is then disposed of through effluent disposal drains often
referred to as leach or French drains
o Both of these methods of disposing of liquid waste are on-site disposal systems. They
must be installed and maintained properly.
In these systems, the effluent is soaked into the surrounding soil.

51
Figure 10.1: Plan view (top) of an on-site sewage disposal system

On-site disposal systems cannot be installed in all situations. For example, they cannot be
installed:
 In areas that flood regularly
 In areas that have a high water table (that is, where the underground water is close to the
surface)
 Where the amount of wastewater to be disposed of is large
 Near to drinking water supplies

A sewage or effluent (wastewater) system

 It disposes of the effluent from a community at a central place usually called a sewage
lagoon or effluent pond
 In this method the effluent from the community is carried by large pipes to the lagoon.
 These pipes serve all the houses and other buildings in the community

Fig 10.2: Plan view of a wastewater disposal system

52
 Before disposal, the sewage is treated. This involves holding the sewage in a closed or
open space for a few days to allow fluids and solids to separate and bacterial action to
turn the sewage into safer form

 The sewage can be treated:

o In a septic tank at each building
o Just before the lagoon in a large septic tank or macerator system, or
o In the lagoon itself

STEP 6: Key Points (10 minutes)

 Sewage is a mixture of excreta, water and other materials
 Sewage disposal is important to make the environment free from pollutants and
diseases
 There are two main methods for sewage disposal; on-site and sewage system.

STEP 7: Evaluation (5 minutes)

 Why is the meaning of sewage?
 What is the importance of safesewage disposal?
 What are the methods of safe sewage disposal?

STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating different ways of safe

sewage disposal.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

53
References
Basset, W.H. (1992). Clay’s Handbook of Environmental Health (16th ed). London: Chapman
and Hall

Nyamwaya, D. (1994).A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Wood CH., Vaughan JP., &de Glanville H (1997).Community Health (2nded). Nairobi:
AMREF

54
Session 11: Health Hazards of Poor Housing and
Ventilation

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe health hazards of poor housing
 Explain types of ventilation
 Explain importance of proper ventilation in various settings

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers Projector
 Computer and LCD Projector
 Worksheet 11.1 Diseases caused by poor housing

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks

Presentation Health Hazards of Poor Housing

2 30 minutes
Brain storming
30 minutes Presentation Types of Ventilation in Various Settings
3
Buzzing
30 minutes Presentation Importance of Ventilation in Various
4 Small Group Settings
Discussion
5 10 minutes Presentation Key Points

6 5 minutes Presentation Evaluation

7 10 minutes Presentation Assignment

55
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Health Hazards of Poor Housing (30 minutes)

Activity: Brainstorming (10 minutes)

ASKstudents to brainstorm on the following question:

• What are the hazards of poor housing?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Housing conditions play a crucial role in the control of many diseases, especially in the
transmission of communicable diseases
 House can both protect and facilitate diseases

Definition of terms
 House – The usual dwelling place of the family
 Housing – The enclosed and adjoining open space and all structural components making
up those spaces
 Healthful housing – Housing which permits individuals of all ages to conduct usual
household activities without putting excessive burden upon any organ of the body

Basic requirements for a house

 Adequately shelters people from heat, cold, damp, animals, insects and invaders
 Able to be kept in good repair
 Adequate elevation, ventilation and water supply
 Adequate size and spacing for occupant(s)
 Good drainage
 Space for preparation, cooking and storage of food
 Room for fuel storage
 Adequate means to dispose of refuse and human waste
 Proximity to roads, neighbours and other centres of population
 Good natural and artificial lighting

Health hazards of poor housing

56
  A combination of dampness, lack of light, poor ventilation and overcrowding will
contribute to the spread of airborne droplet infection
 A dirt floor and walls and unscreened windows permit the entry and breeding of flies,
bedbugs and mosquitoes which contributes to the spread of vector-borne diseases
 Cooking fires placed on the floor are hazardous to small children
 A range of social problems may be associated with poor housing and living conditions
including depression and alcohol abuse
 Excessive noise and overcrowding has an influence on mental disorders
 Crowded, cramped housing conditions facilitate the spread of airborne
(communicable) infections such as measles and tuberculosis
 The use of dirty household fuels for cooking and heating can cause respiratory
problems
 Dirty water and poor sanitation are associated with numerous illnesses

STEP 3: Types of Ventilation (30 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are major types of ventilation?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition of Ventilation
 The process of removing polluted, stale, moisture laden, indoor air and replacing it with
fresh outdoor (often dryer) air

Types of Ventilation
 Natural ventilation – Natural movement of air entering and leaving openings such as
windows, doors, and roof ventilators as well as through cracks and crevices of buildings

Types of natural ventilation

o Through ventilation – Windows placed on opposite sides of house, air enters in one
window and leaves through the other window
o Cross ventilation – One window is provided and the other window is provided
adjacent, air enters and leaves through the adjacent window
o Back to back ventilation – Window is placed only on one side of the wall, Air enters
and leaves in the same window. This type of ventilation is not recommended in public
health
 Mechanical ventilation – The movement of air by mechanical means
o Wall fan and air conditioning units are examples of mechanical ventilation
57
STEP 4: Importance of Good Ventilation (30 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

• What is the importance of good ventilation?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

 Good ventilation provides enough air (oxygen) required for normal physiological function
in the body
 Proper ventilation prevents air pollutants from affecting the health of an individual
 Good ventilation helps in removing unwanted smells, such as from cooking or pets
 Ventilation controls how much moisture is lingering in a house, and helps a house stay
dry
 Moisture can cause mold to build up; which in turn can cause various diseases

STEP 6: Key Points (10 minutes)

 Poor housing contribute to diseases in humans
 There are two major types of ventilations; natural and mechanical
 Proper ventilation is important for good health

STEP 7: Evaluation (5 minutes)

 What are health hazards of poor housing?
 What are types of ventilation?
 What is the importance of proper ventilation?

STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

58
DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

• Prepare a presentation to be delivered to the class indicating different types of bad
housing and the corresponding diseases caused
REFERstudents to worksheet 11.1 Diseases caused by poor housing

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

59
References

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Salvato, J.A. (1982). Environmental Engineering and Sanitation (3rded). New

York: John Wiley and Sons

Wood C. H., Vaughan JP., & de Glanville H. (1997). Community Health (2nded).
Nairobi: AMREF

60
 Worksheet 11.1 Diseases caused by poor housing
Assignment

Instructions. Fill in column A examples of poor housing; and in column B diseases

resulting from the poor housing

Column A (Example of poor housing) Column B (Diseases)

Possible Answers

Column A (Example of poor housing) Column B (Diseases )

Poor ventilation Respiratory diseases such as Tuberculosis
Earth floors and walls Plague
Unscreened windows Malaria
Shortage of water supply Trachoma, skin diseases such as scabies
Lack of toilets Diarrhoea diseases, intestinal parasites such
as hookworm

61
Session 12: Air Purification in Pharmaceutical Settings

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Students Learning Task

By the end of this session students are expected to be able to:
 Explain process and application of air purification in pharmaceutical settings

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Task
85 minutes Presentation Process and Application of Air Purification
2 in Pharmaceutical Settings
Buzzing

3 10 minutes Presentation Key Points

4 10 minutes Presentation Evaluation

5 10 minutes Presentation Assignment

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning task and clarify

ASK students if they have any questions before continuing

62
STEP 2: The Process and Application of Air Purification in
Pharmaceutical Settings (85 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What is air purification?

 What are the methods used in the process of air purification?

ALLOW few pairs to respond and let other pair to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition of Air purification – It is a process of cleansing the air from impurities and
microorganisms
 The process of air purification involve different methods
 The methods used in the process of air purification are applied in a sterile manufacturing
room to provide sterile condition to perform sterile pharmaceutical production, as
explained below:

Sterilization by radiation
 Means energy that is radiated or transmitted in the form of rays or waves/ particles. The
ionizing radiations include Alpha, Beta, Gamma and X-ray. In a sufficient dose, these
radiations are lethal to all cells, including bacterial spores, which are generally more
resistant than vegetative cells
 Bacterial species differ in their sensitivity to ionizing radiations and the degree of
resistance varies during the growth cycle
 It is used for the commercial sterilization of large amounts of pre-packed single use items
such as plastic syringes and catheters

Laminar Air flow carbinate

 Is a system of circulating filtered air in parallel-flowing planes in hospitals or in the
health care facilities
 The system reduces the risk of airborne contamination and exposure to chemical
pollutants in hospital pharmacies
 It is also used in other areas such as surgical theatres, food preparation areas and
laboratories

Mechanical/ Forced ventilation

 Outside air is delivered indoors typically with fans, which draw air from outside and
forces it through ducts to the place where occupants are located

63
 Mechanical ventilation can exacerbate infiltration and/or exfiltration

 There are 3 types of mechanical ventilation as follows:

o Exhaust (vacuum) system: Fans draw air out of the building in openings high up in
the outside walls which is replaced by fresh air through windows and other inlets
 Local exhaust ventilation is absolutely required when the source have dust,
exhaust fumes, solvent vapors, lead fumes, and acid mist, all known as toxic or
corrosive contaminants.The fans may be placed directly in windows or outside
walls or in ducts which lead the air outside. It is a system that is useful for the
removal of dust, smoke and fumes in some factories

o Pressure (propulsion) system: Unlike the exhaust system, this forces the air into
a building and therefore control of entering air is possible, the fresh entering air
displaces the used up air. The advantage of this method is that the source of air-
entry can be controlled and its purity thereby ensured. The air can be filtered,
warmed or cooled as required

o Balanced system: This is a combination of the exhaust and pressure system.

Air is drawn in through ducts by means of a centrifugal fan and extracted at
suitable points by exhaust fan
 It facilitates good distribution of fresh air by placing supply and exhaust vents
in appropriate places
 Balanced ventilation systems are appropriate for all climates; however,
because they require two duct and fan systems, they are usually expensive
 Air conditioning is generally employed with this type of ventilation and the
temperature and humidity can be controlled
 It is suitable for factories where a control of humidity and temperature is
necessary to the processes being carried out

Reasons for using Mechanical/ Forced ventilation

o To keep flammable gases and vapours below the lower flammable limit (LFL).
o To keep the air movement at a certain level so that the air stress can be reduced
o To keep toxic contaminants at or below certain concentrations
o To reduce odours
o To control microorganisms, dusts and other particulates
o To limit carbon dioxide build-up

STEP 3: Key Points (10 minutes)

 Air purification is a process which removes contaminants from the air in a room. Air
purification methods are used in pharmaceutical setting to remove impurities such as
carbon-dioxide from air before processing
 Dust, pollen, pet dander, mold spores, mite faeces, smoke particles and volatile
organic compounds are some sources of contaminants that may affect personnel and
products in pharmaceutical setting

64
  Air purifiers are very important in capturing a greater number of bacterial and virus
particulates. They are used to reduce the concentration of these airborne contaminants

STEP 4: Evaluation (10 minutes)

 What are the reasons for air purification in pharmaceutical setting?
 What are the three methods used for air purification in pharmaceutical setting?

STEP 5: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK students to work on the following Assignment

 Visit The Hospital Pharmacy Department and prepare a presentation on the methods that
are used for Air Purification in different sections.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

65
References

Basset, W.H. (1992).Clay’s Handbook of Environmental Health (16thed). London:

Chapman and Hall
.
Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Salvato J.A. (1982). Environmental Engineering and Sanitation (3rded). New York:
John Wiley and Sons

Subi, S. (2008).Environmental Health Hand Book for Clinical Officer Students. Kilosa:
Tanzania

Wood C. H., Vaughan JP., & de Glanville H. (1997). Community Health (2nded).
Nairobi: AMREF

66
Session 13: Using Antiseptics and Disinfectants
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Differentiate Between Antisepsis and Disinfection
 Classify Agents Used for Antisepsis and Disinfection
 List Characteristics of an Ideal Disinfectant and Antiseptic
 Describe Uses of Various Antiseptics and Disinfectants

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
20 minutes Presentation Antisepsis and Disinfection
2
Buzzing
45 minutes Presentation Agents used for Antisepsis and Disinfection
3
Brain storming
20 minutes Presentation Characteristics of an Ideal Disinfectant and
4
Antiseptic
10 minutes Presentation Uses of Various Antiseptics and
5
Disinfectants
6 5 minutes Presentation Key Points

7 5 minutes Presentation Evaluation

8 10 minutes Presentation Assignment

67
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Antisepsis and Disinfection (20 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What is the difference between Antisepsis and Disinfection?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Antisepsis – Destruction or inhibition of microorganisms on living tissues, to prevent

infection

Antiseptic – A substance that counters sepsis by destroying or inhibiting the growth of

pathogenic microorganisms
 Antiseptics are generally applied to living tissues in the form of wet dressings, creams,
ointments or other substances that involve prolonged contact with the body

Disinfection – Is the process of removing microorganisms, including pathogens, from the

surfaces of inanimate objects

Disinfectant – An agent that prevents infection by destroying or removing pathogenic

microorganisms
 The term is confined to substances used for the treatment of inanimate objects
 In practice, both antiseptics and disinfectants are used to destroy or inhibit the growth of
pathogenic microorganisms in the vegetative form

68
STEP 3: Agents used for Antisepsis and Disinfection (45 minutes)

Activity: Brainstorming (10 minutes)

Ask students to brainstorm on the following question:

• What are the agents used for Antisepsis and Disinfection?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Antiseptics
Ethanol
Mode of action
 Has a bactericidal action against most vegetative organisms at a concentration of 60% and
95%, but is not effective against bacterial spores

Therapeutic uses
 Evaporating lotion used for hand and skin cleaning
 Surgical treatment for various skin lesions
 Prevention of bed sores and diminishing sweating (reduce temperature)
 Used as solvent in different pharmaceutical preparations
 A concentration of 70% either alone or with chlorohexidine or iodine for disinfection of
skin before surgical procedures

Chlorhexidine
Mode of action
 An antiseptic which is effective against a wide range of vegetative gram-positive and
gram-negative bacteria, although it has no activity against acid fast bacteria, bacterial
spores and some viruses

Therapeutic uses
 Chlorohexidine is used in disinfectant solutions, creams, gels and lozenges
 It is also used in various concentrations for disinfection in the following conditions:
o Chlorhexidine 0.5% in 70% ethanol for the preoperative disinfection of the skin
o Chlorhexidine 0.05% solution in glycerin for urethral irrigation and catheter
lubrication
o Chlorhexidine 0.02% solution for bladder irrigation
o Chlorhexidine 1% cream for use in obstetrics
o Chlorhexidine 0.01% as the diacetate for preservation of eye drops

69
Cetrimide
Mode of action
 A quaternary ammonium disinfectant that has bacterial activity against both gram-
positive and gram-negative organisms

Therapeutic uses
 Cetrimide 0.5% solution for preoperative skin disinfection
 Cetrimide 0.05% to 1% is used for the cleansing of polythene tubing and catheters, but
time of immersion should not exceed 30 minutes
 Cetrimide in higher concentrations of 15 to 35 is used in shampoos to remove scales in
seborrhea
 Cetrimide 1.5% with chlorhexidine gluconate 0.15% is often used as a general purpose
disinfectant

Povidone Iodine
Mode of action
 Acts by inhibiting enzymes essential to microbial metabolism
 It kills on contact a broad spectrum of pathogenic bacteria, viruses, fungi, protozoa and
yeasts

Therapeutic uses
 Skin antiseptics and germicidal skin cleansers
 Disinfectant for wounds, abrasions and insect bites
 Medicated spray for wounds
 Antidandruff shampoos
 Medicated adhesive plasters
 Gargles and throat lozenges
 Vaginal gels and douches

Disinfectants
Sodium Hypochlorite
 A solution 8% to about 18% of chlorine is prepared by absorption of chlorine in sodium
hydroxide solution to give sodium hypochlorite

Mode of action
 Sodium hypochlorite solutions release chlorine gas which kills most pathogenic
organisms at neutral pH

Therapeutic uses
 Rapid disinfection of hard surfaces
 Disinfection of food
 Disinfection of dairy equipment and babies’ feeding bottles
 o Solutions containing up to 0.05% of available chlorine are suitable for use on skin and
wounds
Glutaral
70
Mode of action
 Glutaral is an effective disinfectant against vegetative forms of gram-positive and gram-
negative bacteria
 It is also effective against acid-fast bacteria, bacterial spores, some fungi and viruses

Therapeutic uses
 A 2% aqueous solution of Glutaral buffered to pH 7.5-8.5 (the ambient pH for activity) is
used for the sterilization of endoscopic instruments, thermometers and rubber or plastic
equipment that cannot be sterilized by heat

Cresol and Soap Solution

 Cresol and soap solution BP (Lysol) is an old preparation which is still widely used in
East Africa as a general disinfectant for hospital and domestic use

Mode of action
 Cresol and soap solution is effective against a wide range of organisms, but its activity is
reduced in the presence of organic matter
 The bactericidal activity of cresol and soap solution varies with the soap used
 Linseed and castor oil soaps give the highest values and oleic acid the lowest
 It has further been verified that higher values are obtained with coconut oil

Therapeutic uses
 In addition to its use as a general disinfectant in hospitals, cresol and soap solution is
widely used in commercial disinfectants
 Because it is clear when diluted with water, its use is an advantage in the sterilization of
surgical instruments, since cleanliness can be identified with speed and ease
 Adverse effects
o Cresol and soap solution is irritant and corrosive to the skin and should be handled
carefully
o It is caustic to the skin and is unsuitable for skin and wound disinfection

STEP 4: Characteristics of an Ideal Disinfectant and Antiseptic (20

minutes)

Antiseptics
 Should be safe and non-toxic
 Microbial activity should be known
 Should have instructions on how to use
 Should not have residual effects
 Should be cost effective
 Should be active against a wide range of microorganisms
 Should be stable when in contact with organic matter
 Should be effective
 Should be easy to procure

71
Disinfectants
 Bactericidal or bacterial static
 Rapid activity
 Non corrosive
 Cost effectiveness
 Availability
 Stable when in contact with organic matter
 Active against a wide range of microorganisms
 Not damaging to instruments
 Easily biodegradable and less corrosive to the sewage system
 Less volatile and non toxic when it enters the atmosphere

Note
Before acquiring antiseptics and disinfectants for use, the following are things to note;
 Expiry date
 Label of container (well labeled with correct generic name of the disinfectant)
 Cover should explain the type of agent and not be torn
 Instructions on how to dilute (if not followed can damage instruments or equipment)
 Cautions of use

STEP 5: Uses of various antiseptics and disinfectants (10 minutes)

Antiseptics
Used on skin and mucous membranes to kill microorganisms
 Use on skin and mucous membranes to kill microorganisms
 Surgical hand scrub
 Skin, cervical and vaginal preparation before a clinical procedure
 Hand washing in high risk situations
 Heavy microbial contaminated area
 Before invasive procedures
 Before and after direct contact with pts with antimicrobial resistant organisms
 Before contact with immune suppressed patients
 Before handling newborns

Disinfectant
Use to kill microorganisms on inanimate objects
 Processing instruments and other items
 Non critical items/devices
 Decontaminating floors, surfaces, walls, and furniture

STEP 6: Key Points (5 minutes)

 Antiseptics are substances applied to living tissues to destroy or inhibit growth of
pathogens

72
 Disinfectants are substances applied to a non living surface for preventing infection by
destroying pathogenic microorganisms
 There are various antiseptics and disinfectants with different strengths used in different
situations in health facilities

STEP 7: Evaluation (5 minutes)

 What is a disinfectant?
 What is an antiseptic?
 What are the different types of disinfectants?
 What are the different types of antiseptics?
 What are uses of disinfectants and antiseptics?

STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating common Antiseptics and
Disinfectants used in hospitals and other health facilities

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

73
References

Nyang’hechi et al. (1992).Management of Solid and Liquid Waste. Nairobi:

AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation,

Nairobi: AMREF

MOHSW. (2004). National Infection Prevention and Control Guidelines for Health Care
Services in Tanzania. Dar es Salaam: MoHSW

MOHSW. (2006). Health Care Waste Management Monitoring Plan. Health Education
Unit. Dar es Salaam: MoHSW

MOHSW. (2006). National Standards and Procedures for Health Care Waste
Management in Tanzania.Dar es Salaam: MOHSW

Wood CH., Vaughan JP., & de Glanville H. (1997).Community Health. (2nd ed). Nairobi:
AMREF

74
Session 14: Introduction to Common Communicable
Diseases
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Define common terms used in communicable diseases
 Identify Medical Importance of Communicable Diseases
 List Common Groups of Communicable Diseases
 Describe Mode of Transmission of Communicable Diseases
 Describe the Principles of Prevention and Control of Communicable Diseases
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Common Terms used in Communicable
2 Presentation Diseases

20 minutes Presentation Medical Importance of Communicable

3 Diseases
Brainstorming

4 20 minutes Presentation Common Groups of Communicable Diseases

20 minutes Presentation Mode of Transmission of Communicable

5 Diseases
Buzzing
20 minutes Presentation Principles of Prevention and Control of
6 Communicable Diseases
Buzzing

7 10 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 10 minutes Presentation Assignment

75
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Common Terms in Communicable Diseases (10 minutes)

Communicable diseases: Are those which can be transmitted from one person to another or
from animals to person
 Epidemic – a widespread occurrence of a disease in a community at a particular time
that appears as new cases at a rate that substantially exceeds what is ‘expected’, based
on recent experience. Therefore it is the unusual occurrence of a disease in the
community

 Endemic: The constant presence of a disease or infectious agents within a community

 Pandemic (from Greek pan- all + demos- people): An epidemic that spreads across a
large region (for example a continent), or even worldwide.

 Nosocomial: An infection developing in a patient while in a hospital or acquired in a

hospital but could show up after discharge.

 Principle of disease transmission: Transmission of a disease in human requires the

following components:
o An agent capable of infecting man
o A source: an infected host or reservoir of infection
o A portal of exit from the source
o A suitable means of transmission
o A portal of entry into a new host
o A susceptible host

 Agent: An agent is an organism, mainly a microorganism but including helminthes

that is capable of causing a disease

 Reservoir (of infection): Refers to any human beings, animals, arthropods, plants,
soil or inanimate matter or a combination of these in which an infectious agent
normally lives and multiplies, and on which it primarily depends for survival and
reproduction in such a manner that it can be transmitted to a susceptible host
o A reservoir of infection can also be termed as the natural habitat of the infectious
agent

76
 o Disease that man is the only reservoir is called anthroponeses e.g. Measles and
cholera
o Those that involve other animals reservoirs are called zoonoses e.g. plague and
rabies

 Portal of exit in the human host: Include the respiratory passages, the alimentary
canal, the opening in the genital urinary system and the skin lesion

 Suitable means of transmission: Transmission of infectious agent is any mechanism

by which a susceptible host is exposed to an infectious agent. It may be either direct
or indirect

STEP 3: Medical Importance of Communicable Diseases (20 minutes)

Activity: Brainstorming (10 minutes)

Askstudents to brainstorm on the following question:

• What is the medical importance of communicable diseases?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

The following is Medical Importance of communicable diseases:

 Many of them are very common
 Some of them are serious and cause death and disabilities
 Some of them cause wide spread outbreak of disease that is epidemic
 Most of them are preventable by fairly simple means
 Many are serious particularly in infants and children

STEP 4: Common groups of Communicable Diseases (20 minutes)

Contagious Diseases
 Contagious (contact diseases) are diseases transmitted by direct or indirect contact
 Direct contact is by skin to skin e.g. touching an infected person.
 Indirect contact is by handling contaminated objects such as clothing, bedding materials,
dressing and utensils. Example scabies, pediculosis, fungal skin infections, trachoma and
acute bacterial conjunctivitis

Sexually Transmitted Infections and HIV/AIDS

77
 These are diseases or infections whose predominant mode of transmission is through
sexual contact, be heterosexual or homosexual
o Sexually transmitted infection includes the stage of preclinical illness (i.e. the
typical symptoms and signs have not yet appeared) for example HIV
o Sexually transmitted disease is the stage of clinical illness (i.e. the typical
symptoms and signs are present) for example AIDS and gonorrhea

Vector-Borne Diseases
 Vectors are invertebrate hosts (insects, ticks and snails) which are an essential part of the
life cycle of the disease causative organism
 Therefore a vector-borne disease is a disease whose transmission requires a vector (i.e.
part of the life cycle of the causative organism takes place within the vector)
 Vectors acquire disease organisms by sucking blood from infected persons or animals and
pass them on by same route
 Examples are yellow fever, trypanosomiasis, schistosomiasis and malaria

Diseases Caused by Fecal Contamination

 These are diseases whose causative organisms are excreted in the stools of infected
persons or animals. For example acute gastro-enteritis, amoebiasis, and cholera
 The portal of entry for these organisms is the mouth
 The organisms have to pass through the environment from the faeces of an infected
person or animal to the gastrointestinal tract of a susceptible person (fecal – oral
transmission route)

Helminthic diseases
 These are diseases caused by parasitic worms. For example; ascariasis, enterobiasis,
trichuriasis, hookworm, strongyloidiasis, taeniasis and hydatidosis

Airborne diseases
 These are diseases caused by pathogens transmitted through air. For example; acute
respiratory infections, meningitis, tuberculosis and leprosy

Zoonotic diseases
 These are diseases that can be passed between animals and humans. This can be through
contact with animals or animal products. For example; anthrax, brucellosis, rabies,
hydatidosis and tetanus

78
STEP 5: Mode of Transmission of Communicable Diseases (20 minutes)
Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What is the mode of transmission of communicable diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

The following are the Modes of Transmission of Common Communicable Diseases:

 Direct or indirect contact
 Sexual Contact
 Vector bite, crushed or infection enter skin cracks/abrasions from infected insect
 Faecal-oral route
 Penetration through intact skin
 Ingestion of infected animal products
 Inhalation (droplet infection)

STEP 6: Principles of Prevention and Control of CommunicableDisease(20

minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the principles of prevention and control of communicable

diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Communicable diseases transmission can be controlled by three main ways namely:

 pting transmission
 Protecting tAttacking the source
 Interruhe host
The components of each of the ways are summarized in Table 1 below:

79
Table 1: Principles of communicable diseases control

Attacking the source Interrupting transmission Protecting the host

Treatment Environmental sanitation Immunisation
Isolation Personal hygiene Chemoprophylaxis
Reservoir isolation Behaviour change Personal protection
Vector control Better nutrition
Disinfection and sterilisation

Level of Prevention
 Primary prevention: These refer to prevention of healthy people from becoming infected
and or develop a disease. The measures include:
o Immunization
o Health education
o Promotion of nutrition
o Vector control
o Provision of adequate housing
o Hand washing

 Secondary prevention: This refers to detection of people who already have a given
disease at the earliest possible stage in order to stop the disease from developing further
and or prevent complications i.e. early detection and prompt treatment

 Tertiary prevention: This refers to prevention of disease disability and death in a patient
who has already developed the disease, and has complications or cannot be cured. It
includes rehabilitation

STEP 6: Key Points (10minutes)

 Communicable diseases are transmitted from one person to another or from animals to a
person
 There are various ways through which communicable diseases are transmitted
 Prevention and control include measures that attack the source, interrupt transmission and
protect the host

STEP 7: Evaluation (5minutes)

 What are the common terms used in communicable diseases?
 What is medical importance of communicable diseases?
 What are the common groups of communicable diseases?
 What are the modes of transmission of communicable diseases?
 What are the principles of prevention and control of communicable diseases?

80
STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class explaining most common type of
communicable diseases from their home and recommend the most effective control
methods.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

81
References

Cook G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd

Eshuis J., & Manschot, P. (1992).Communicable diseases.(1sted). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th
ed.)Nairobi: AMREF

82
Session 15: Identification of Patients with Malaria
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session studentsare expected to be able to:
 Describe Causes of Malaria,
 Describe Mode of Transmission of Malaria
 Describe Major Signs and Symptoms of Malaria
 Explain Treatment of Malaria
 Explain Prevention and Control of Malaria

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD projector
 Handout 15.1; Life cycle of malaria parasite
 Handout 15.2; Treatment of uncomplicated malaria

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks

2 5 minutes Presentation Cause(s) of Malaria

3 30 minutes Presentation Mode of Transmission of Malaria

15 minutes Presentation Major Signs and Symptoms of Malaria

4
Brainstorming
5 30 minutes Presentation Treatment of Malaria

20 minutes Presentation Prevention and Control of Malaria

6
Buzzing
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

83
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Malaria (5 minutes)

Malaria
 An acute infection of the blood caused by protozoa of genus Plasmodium
 Malaria is the most common disease in the tropical Africa

Causative Agents of Malaria

There are 4 different species of Malaria parasite which infect human beings:
 Plasmodium falciparum (commonest cause of Malaria in Tanzania)
 Plasmodium Malariae
 Plasmodium vivax
 Plasmodium ovale

STEP 3: Mode of Transmission of Malaria (30 minutes)

 Malaria is transmitted by the female Anopheles mosquito which requires human blood for
the development of eggs.
 The male mosquito does not suck human blood.
 Major Anopheles species of importance in Africa include:
o Anopheles Gambiae -Most important vector in Africa.
o Anopheles Funestus - Breeds in permanent vegetation e.g. swamps.

84
Figure 15.1 Spread of malaria

85
Life cycle of malaria parasite
 Divided into two phases
o Asexual cycle occurring in human
o Sexual or sporogony cycle occurring in female Anopheles (mosquito)

Life Cycle of Malaria Parasites in Man (Asexual Cycle)

 Sporozoites in the mosquito salivary glands are injected into the host via the proboscis of
the mosquito
 They quickly migrate to the liver

 The hepatic (Liver) stage

o The Sporozoites is taken up by the Kupffer cells of the liver and then passes through
into the hepatocytes or liver cells
o There, it develops into hepatic Schizont, releasing thousands of Merozoites into the
general circulation

 Hypnozoites
o This stage of the parasites only occurs in Plasmodium Ovale and Plasmodium Vivax
o The Hypnozoites mature unpredictably and releases new Merozoites responsible for
recurrent infections up to 18 months after primary infection, even though earlier blood
stages may have been cured
o Without treatment (specific) using primaquine, it is thought that this stage may remain
in the liver for life

 Erythrocytic or Blood Stage

o The merozoites released from the liver invade individual red blood cells (RBCs) and
then develop within the RBCs from “rings” into blood schizonts
o The schizonts then rupture the RBCs releasing numerous merozoites which invade
new RBCs
o It is this part of the cycle that causes clinical illness, and then Length of time for each
RBC cycle gives the periodicity of the symptoms

 Gametocytes
o At unknown stage or time in the RBCs cycle, ‘sexual’ forms develop and are in turn
responsible for the survival and transmission of the parasite
o Male and female gametocytes circulate for a few weeks and are taken up by the
feeding mosquito

Life Cycle of Malaria Parasites in Mosquito (Sexual Cycle of Malaria Parasites)

 Sexual reproduction, the male and female gametocytes develop into gametes and then
fuse in the stomach of mosquito to form a zygote
 This develops into a mobile ookinete which immigrates through the wall of the stomach
to form an oocyst
 Oocyst matures and releases sprorozoites

86
 Sporozoites migrate to the salivary glands ready for delivery with the mosquito’s next
meal

Refer to handout 15.1: Life Cycle of Malaria Parasite

STEP 4: Major Signs and Symptoms of Malaria (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question

• What are the major signs and symptoms of Malaria?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Signs and symptoms of Malaria

The signs and symptoms of Malaria are non–specific and can mimic symptoms of systemic
viral illnesses or other disease condition. The occurrence of Malaria signs and symptoms may
differ in children and adults

Signs and symptoms of uncomplicated Malaria

 Fever
 Headache
 Malaise
 Joint pains
 Vomiting /diarrhoea
 Body ache
 Poor appetite
 Body weakness
 Pallor
 Enlarged spleen

Signs and symptoms of Severe Malaria

 Extreme weakness
 Impaired consciousness
 Change of behaviour ( hallucinations, delusions, agitation, and acute state of confusion)
 Respiratory distress
 Bleeding tendency
 Jaundice
 Circulatory collapse/ shock
 Vomiting everything

87
 Inability to drink or breastfeed

STEP 5: Treatment of Malaria (30 minutes)

Treatment of Uncomplicated Malaria with First Line Drugs
 Artemether/ Lumefantrine (ALU) an oral fixed combination tablet of 20 mg Artemether
(a derivative of artemisinin) and 120 mg Lumefantrine

 A simple dosage regimen is recommended to improve compliance:

o The first dose should be given as Direct Observation Treatment (DOT)
o The second dose should strictly be given after 8 hours
o Subsequent doses could be given twice daily (morning-evening) until completion of 6
doses
Refer to Handout 15.2: Treatment Schedule of uncomplicated Malaria using ALU

Contra-indications of ALU
 Hypersensitivity to either Artemether or Lumefantrine
 First trimester in Pregnancy

Side Effects of ALU

 Sleep disorders
 Headache
 Dizziness
 Nausea
 Anorexia
 Abdominal pain
 Itching and skin rash
 Joint and muscle pain
 Palpitation

Other Artimesinin Combined Therapy (ACT) options Treatment of Uncomplicated

Malaria
 Recommended ACTs options for the treatment of uncomplicated Malaria are those with
minimum 3-day course which include:
o Dihydroartemesinin-Piperaquine (DPQ) –Oral
o Artesunate-Amodiaquine-oral
o Artesunate-Mefloquine-oral

Treatment of Severe Malaria

 The medicine of choice for treatment of severe Malaria is injectable Artesunate
 Injectable Quinine is to be used when Artesunate is contraindicated such as allergy,
medicine interaction, non-response or when it is not available.

Artesunate Injection

88
 Give injectable antiMalarial for minimum of 24 hours even if the patient can tolerate oral
medication earlier before 24 hours, and thereafter, complete treatment by giving a
complete course of Artemether-Lumefantrine
 Available formulations are: 30mg, 60mg and 120mg of Artesunate for injection.
The recommended formulation for public sector is 60mg

Injectable Quinine
 Injectable Quinine is the alternative treatment for severe Malaria. Formulated as Injection
600mg in 2mls

 Indications
o Acceptable alternative choice for treatment of severe Malaria
o Medicine of choice for treatment of severe Malaria in first trimester of pregnancy

 Contraindications
o Hypersensitivity to quinine
o Optic neuritis
o Myasthenia gravis

 Adverse effects
o Cinconism (Tinnitus, Vertigo and Dizziness)
o Hypotension
o Hypoglycaemia
o Injection site abscess

 Administration
o Quinine dihydrochloride injection 10mg/kg is given by intravenous infusion Where
 Diluted in 10 ml/kg. body weight of 5% dextrose or dextrose – saline
 Infused over 4 hours and repeated every 8 hours.
 Nine doses then continue with ALU
STEP 6: Prevention and Control of Malaria (20 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the methods for preventing and controlling Malaria?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Reducing the host reservoir

89
 o This is done by prompt diagnosis and appropriate treatment of infected individuals
o Controlling the vector population by:
 Killing adult mosquito with insecticides
 Killing larvae with larvicides
 Prevention of breeding by environmental sanitation
 Using pre intermittent preventive treatment in pregnancy
 Use of insecticides treated nets (ITN)
 Use of chemoprophylaxis for example Mefloquine, Proguanil Hydrochloride and
Doxycycline

STEP 6: Key Points (5 minutes)

 Malaria is an acute infection of the blood with plasmodia, characterized by fever, joint
pains headache and resulting in anaemia because of haemolysis
 Route of transmission is mostly by the bite of infective female Anopheles mosquito
 ALu-ACT based combinations are recommended for first line treatment of Malaria.
 Prevention and control of sources of Malaria is important in reducing Malaria

STEP 7: Evaluation (5 minutes)

 What are the species that cause Malaria?
 What is the mode of transmission of Malaria?
 What are major signs and symptoms of Malaria?
 What is treatment of Malaria?
 What are methods prevention and control of Malaria?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating prevention and control
methods of Malaria you use in your house hold

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

90
References

Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London: Saunders Ltd

Denyer, S. P., Hodges, N. A., & Gorman, S. P (2011) (Ed).Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J.& Manschot, P. (1992).Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) National Guidelines for Diagnosis and Treatment of Malaria. Dar es salaam:
MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed).
Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

91
Handout 15.1 Life Cycle of Malaria Parasite

92
 Handout 15.2 Dosage Schedule for Artemether-Lumefantrine

Day 1 Day 2 Day 3

Dose 1st nd
2 3rd 4th 5th 6th
Kg
Hours 0 (*) 8 24 36 48 60
Age (years) tablets tablets tablets tablets tablets tablets
up to 15 0 to 3 1 1 1 1 1 1
15 up to 25 3 up to 8 2 2 2 2 2 2
25 up to 35 8 up to 12 3 3 3 3 3 3
35 and 12 and 4 4 4 4 4 4
above above
(*) 0 hours means the time of starting medication
Source: National Guidelines for Malaria Diagnosis and Treatment, 2013

93
Session 16: Identification of Patients with Common Cold
Total Session Time: 60 minutes + 1 hour Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause of Common Cold,
 Describe Mode of Transmission of Common Cold
 Describe Major Signs and Symptoms of Common Cold
 Explain Treatment of Common Cold
 Explain Prevention and Control of Common Cold

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Causes of Common Cold
2
Buzzing
3 5 minutes Presentation Mode of Transmission of Common Cold

5 minutes Presentation Major Signs and Symptoms of Common

4 Cold

10 minutes Presentation Treatment of Common Cold

5
Brainstorming
6 10 minutes Presentation Prevention and Control of Common Cold

7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

94
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Common Cold (10 minutes)

An introduction to URTI
 Respiratory tract infection: A term used to describe infection of all the parts of the body
that are involved in helping a person to breathe
 Upper Respiratory Tract include the nose, sinuses, pharynx and trachea
 Respiratory tract infection can be divided into:
o Upper respiratory tract infection
o Lower respiratory tract infection
 Common upper respiratory tract infections (URTIs) include:
o Common cold
o Sore throat - usually due to an infection of the pharynx (pharyngitis)
o Tonsillitis - infection of the tonsils
o Sinusitis - infection of the sinuses
o Laryngitis - infection of the larynx

This session will deal with Common cold

Common cold (Coryza)

Cause: Is caused by a number of viruses which are spread by droplets and by indirect
transmission such as through freshly infected articles (handkerchiefs)

STEP 3: Mode of Transmission of Common Cold (5 minutes)

 Droplet infection through talks, coughs, laughs, or sneeze discharges
 Causative microorganisms is carried in droplets from infected person to another via
respiratory tract
 Airborne disease spread more easily when there is overcrowding

STEP 4: Major Signs and Symptoms of Common Cold (5 minutes)

 Running nose and sneezing
 Fever
 Malaise
 Headache
 Running eye
 Nasal congestion

95
 Sore throat
 Cough

STEP 5: Treatment of Common Cold (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What is the treatment of common cold?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 No effective treatment is available.Headache may be relieved by analgesics

 Nasal congestion may temporarily be relieved by Ephedrine nose drop

STEP 6: Prevention and Control of Common Cold (10 minutes)

 Prevent droplet infection from being inhaled by others
 Improve ventilation for example building houses with adequate window to allow natural
air flow
 Avoid overcrowding e.g. building houses with enough space
 Isolation may be required for some conditions
 Health education about personal hygiene, such as:
o To cover the mouth when coughing and sneezing
o Use handkerchief or paper for disposal of nasal secretion and sputum
o Avoid to spit on the ground or outside the house
o Avoid sharing cigarettes, drinking bowels, or eating utensils
 Wearing of masks in the hospitals
 Immunization

STEP 6: Key Points (5 minutes)

 Among the common Upper Respiratory Tract infections includes Common cold
 Common cold is caused by viruses
 Treatment is symptomatic in most cases
 Prevention and control include improved ventilation, avoiding overcrowding, personal
hygiene and immunization

STEP 7: Evaluation (5 minutes)

96
 What is the cause of common cold?
 What is the mode of transmission for common cold?
 What are major signs and symptoms of common cold?
 What is the treatment for common cold?
 What are the prevention and control measures of common cold?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE individual assignment

ASK the students to work individually on the following Assignment

• Prepare a presentation on how to prevent common cold in their location
ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

97
References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London: Saunders Ltd

Denyer, S. P., Hodges, N. A., Gorman, S. P., & Gilmore BF (2011) (Eds.).Hugo & Russell’s
Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis J., & Manschot, P (1992). Communicable Diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4 ed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF

98
Session 17: Identification of Patients with Tonsillitis
Total Session Time: 60 minutes + 1 hour Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Tonsillitis
 Describe Mode of tansmission of Tonsillitis
 Describe Major Signs and Symptoms of Tonsillitis
 Explain Treatment of Tonsillitis
 Explain Prevention and Control of Tonsillitis
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks

2 5 minutes Presentation Cause(s) of Tonsillitis,

3 5 minutes Presentation Mode of Transmission of Tonsillitis

10 minutes Presentation Major Signs and Symptoms of Tonsillitis

4
Brainstorming
5 5 minutes Presentation Treatment of Tonsillitis

15 minutes Presentation Prevention and Control of Tonsillitis

6
Buzzing
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

99
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Tonsillitis (5 minutes)

Tonsillitis
At the back of throat, two masses of tissue called tonsils act as filters, trapping germs that
could otherwise enter the airways and cause infection. They also produce antibodies to fight
infection. But sometimes the tonsils themselves become infected, they swell and become
inflamed, a condition known as tonsillitis

Causes
 Streptococcal bacteria
 Viruses can also cause acute tonsillitis

STEP 3: Mode of Transmission of Tonsillitis (5 minutes)

 Droplet infection through talks, coughs, laughs, or sneezes discharges
 Causative microorganism is carried in droplets from infected person to another via
respiratory tract
 Airborne disease spread more easily when there is overcrowding

STEP 4: Major Signs and Symptoms of Tonsillitis (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the major signs and symptoms of Tonsillitis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Major signs and symptoms of Tonsillitis

 Sudden onset with general malaise
 Fever
 Headache

100
 Sore throat and difficult in swallowing
 Signs of inflammation e.g. redness of tonsils and white spots

STEP 5: Treatment of Tonsillitis (5 minutes)

 Symptomatic treatment
 Bed rest is advised
 Light diet with plenty of hot drinks
 Analgesics such as paracetamol to reduce pain and fever

STEP 6: Prevention and Control of Tonsillitis (15 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the methods for preventing and controlling Tonsillitis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Prevent droplet infection from being inhaled by others

 Improve ventilation such as building houses with adequate window to allow natural air
flow
 Avoid overcrowding for example building houses with enough space
 Isolation may be required for some conditions
 Health education about personal hygiene e.g.
o To cover the mouth when coughing and sneezing
o Use handkerchief or paper for disposal of nasal secretion and sputum
o Avoid to spit on the ground or outside the house
o Avoid sharing cigarettes, drinking bowels, or eating utensils
 Wearing of masks in the hospitals
 Immunization

STEP 6: Key Points (5 minutes)

 Tonsillitis is caused by bacteria and also viruses transmitted by droplets
 Treatment is symptomatic in most cases
 Prevention and control include improved ventilation, avoiding overcrowding, personal
hygiene and immunization

101
STEP 7: Evaluation (5 minutes)
 What are causes of Tonsillitis?
 What is the mode of transmission for Tonsillitis?
 What are major signs and symptoms of Tonsillitis?
 What is the treatment for common Tonsillitis?
 What are the prevention and control measures of Tonsillitis?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

• Prepare a presentation on how to prevent Tonsillitis in their location
ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

102
References

Cook, G&. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwel publishing

Eshuis, J.& Manschot,P (1992). Communicable diseases,1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-

Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

103
Session 18: Identification of Patients with Bronchitis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause(s) of Bronchitis
 Describe Mode of Transmission of Bronchitis
 Describe Major Signs and Symptoms of Bronchitis
 Explain Treatment of Bronchitis
 Explain Prevention and Control of Bronchitis
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
05 minutes Cause(s) of Bronchitis
2 Presentation

10 minutes Mode of Transmission of Bronchitis

3 Presentation

20 minutes Presentation Major Signs and Symptoms of Bronchitis

4
Buzzing
30 minutes Presentation Treatment of Bronchitis
5
Brainstorming
30 minutes Presentation Prevention and Control of Bronchitis
6
Buzzing
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 10 minutes Presentation Assignment

104
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Bronchitis (5 minutes)

Lower respiratory tract infections include infectious processes of the lungs and bronchi,
for example, Pneumonia and Bronchitis

This session will deal with Bronchitis

Bronchitis
 Bronchitis refers to an inflammatory condition of the large elements of the trachea-
bronchial tree that is usually associated with a generalized respiratory infection
 The disease entity is frequently classified as either acute or chronic
 Common condition often caused by viral infections of upper respiratory with secondary
bacterial infection
 Common in children with infectious fever e.g. measles, influenza and whooping cough
 It is also common in smokers, the elderly and people with chronic chest disorders

Causes
 Bacteria: Mycoplasma pneumonia, streptococcal bacteria, haemophillus influenza
 Viruses: The common cold viruses, rhinovirus, coronavirus, influenza virus, adenovirus,
and respiratory syncytial virus, account for the majority of cases

STEP 3: Mode of transmission of Bronchitis (5 minutes)

 Usually airborne transmitted from upper respiratory tract infection

STEP 4: Signs and Symptoms of Bronchitis (20 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the signs and symptoms of Bronchitis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

105
 Cough
o Cough is the hallmark of acute bronchitis
o Frequently, the cough is initially non-productive but progresses, yielding
mucopurulent sputum
 Fever with malaise, headache and loss of appetite
 Dyspnea
 Crepitation in the lungs
 Wheezing
 The patient typically has nonspecific complaints such as malaise and headache, coryza,
and sore throat

STEP 5: Treatment of Bronchitis (30 minutes)

Activity: Brainstorming (5 minutes)

ASKstudents to brainstorm on the following question:

• What is the treatment of bronchitis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Bed rest and mild analgesic-antipyretic therapy are often helpful in relieving the
associated lethargy, malaise, and fever
 Bronchitis is primarily a self-limiting illness and rarely a cause of death
 Patients should be encouraged to drink fluids to prevent dehydration and possibly
decrease the viscosity of respiratory secretions
 Non-steroidal anti-inflammatory drugs such as aspirin or acetaminophen or ibuprofen is
administered every 4 to 6 hours
o In children, aspirin should be avoided and acetaminophen used as the preferred agent
because of the possible association between aspirin use and the development of
Reye’s syndrome
 Persistent, mild cough, may be treated with dextromethorphan;
o more severe coughs may require intermittent codeine or other similar agents
 When possible, antibiotic therapy is directed toward anticipated respiratory pathogen(s)
for example penicillin

106
STEP 6: Prevention and Control of Bronchitis (30 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the methods for prevention and control of Bronchitis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 A complete occupational/environmental history for the determination of exposure to

noxious, irritating gases, as well as cigarette smoking, must be assessed.
 Exposure to bronchial irritants should be reduced.
 Attempts should be made with the patient to reduce or eliminate cigarette smoking
 Control measures of lower respiratory tract infections are based on general principles
governing control of airborne diseases

STEP 7: Key Points (5 minutes)

 Bronchitis means the bronchial tubes are inflamed and irritated.
 Bronchitis is characterized by cough, fever and difficulty in breathing
 When antibiotic is needed, penicillins is highly recommended
 Control depends on the control of primary diseases
 Mortality can be reduced by early diagnosis and treatment

STEP 8: Evaluation (5 minutes)

 What causes bronchitis?
 What is the mode of transmission for common bronchitis?
 What are the major signs and symptoms of bronchitis?
 What is the treatment of common bronchitis?
 What are the prevention and control measures of bronchitis?

STEP 9: Assignment (10 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

 Explain preventive measures that you will take to control Bronchitis
ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

References
107
Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd.

Denyer, S. P. Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J,& Manschot,P (1992). Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T.,& Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

108
Session 19: Identification of Patients with Pneumonia
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe cause of pneumonia,
 Describe Mode of Transmission of Pneumonia
 Describe Major Signs and Symptoms of Pneumonia
 Explain Treatment of Pneumonia
 Explain Prevention and Control of Pneumonia
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Cause(s) of Pneumonia

10 minutes Presentation Mode of Transmission of Pneumonia

3
Brainstorming
10 minutes Presentation Major Signs and Symptoms of Pneumonia
4
Buzzing
5 20 minutes Presentation Treatment of Pneumonia

55 minutes Presentation Prevention and Control of Pneumonia

6
Buzzing
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

109
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Task (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Pneumonia (5 minutes)

Lower respiratory tract infections include infectious processes of the lungs and bronchi,
for example pneumonia and bronchitis

Pneumonia
 Inflammatory condition of the lung caused by infection

Causes
 Virus
 Bacteria: Pneumococci, Streptococci, Staphylococci, Klebsiellae species and
Haemophillus influenzae

STEP 3: Mode of Transmission of Pneumonia (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What are the modes of transmission of Pneumonia?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Airborne from upper respiratory tract infection, especially influenza in the elderly,
HIV/AIDS, immunocompromised and measles and whooping cough in children. These
infections cause damage to the epithelium of the lungs and so clear the way for bacterial
superinfection
 Transmission is by droplet spread, direct oral contact or indirectly through freshly
infected articles

110
STEP 4: Signs and Symptoms of Pneumonia (10minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the signs and symptoms of Pneumonia?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Signs and Symptoms

 Dry or productive Cough
 High Fever with malaise, headache and loss of appetite
 Chest pain
 Dyspnoea (difficult breathing)
 Respiratory distress
 Crepitation in the lungs
 Wheezing

STEP 5: Treatment of Pneumonia (20 minutes)

 Supportive care: Lower temperature by using analgesics, if wheezing use bronchodilators,
daily fluid maintenance(encourage breastfeeding for children)
 Medicines
o Non-severe pneumonia: Cotrimoxazole, Amoxycillin
o Severe pneumonia: Benzyl-penicillin, Chloramphenicol, Gentamycin, Ceftriaxone,
Erythromycin and Azithromycin

111
STEP 6: Prevention and Control of Pneumonia (55 minutes)

Activity: Group Discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the prevention and control measures of Pneumonia?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Control measures of lower respiratory tract infections are based on general principles
governing control of airborne diseases
 Immunisation to prevent diseases complicated by pneumonia such as measles and
whooping cough is important
 Mortality can be reduced by early diagnosis and treatment especially in children and
elderly
 Prompt adequate therapy started.

STEP 7: Key Points (5 minutes)

 Pneumonia is characterized by cough, fever and difficulty in breathing
 It occurs as a complication of upper respiratory infections
 Treatment will depend if it is a non-severe or severe condition
 Control depends on the control of primary diseases and on general principles governing
control of airborne diseases
 Mortality can be reduced by early diagnosis and treatment

STEP 8: Evaluation (5 minutes)

 What causes Pneumonia?
 What is the mode of transmission for pneumonia?
 What are the major signs and symptoms of pneumonia?
 What is the treatment of pneumonia?
 What are the prevention and control measures of pneumonia?

112
STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE individual assignment

ASK the students to work individually on the following Assignment

 Explain preventive measures that you will take to control Pneumonia in children
and adults
ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

113
References

Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. &Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, &Manschot,P (1992). Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed).
Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-

Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

114
Session 20: Identification of Patients with Amoebiasis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causeof Amoebiasis,
 Describe Mode of Transmission of Amoebiasis
 Describe Major Signs and Symptoms of Amoebiasis
 Explain Treatment of Amoebiasis
 Explain Prevention and Control of Amoebiasis
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 10 minutes Presentation Cause(s) of Amoebiasis

10 minutes Presentation Mode of Transmission of Amoebiasis

3
Brainstorm
4 25 minutes Presentation Major Signs and Symptoms of Amoebiasis

5 05 minutes Presentation Treatment of Amoebiasis

50 minutes Presentation Prevention and Control of Amoebiasis

6 Group
Discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

115
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Amoebiasis (5 minutes)

 Amoebiasis:
o An infection caused by the amoeba Entamoeba histolytica which is a single-celled
organism
o E. histolytica is often found in food or water contaminated with human faeces.
 The main reservoir of E. histolytica is man
 A pathogenic intestinal amoeba is spread between humans by its cysts, characterized by
diarrhoea
 This infection can be fatal in infant and to older people with low resistance

STEP 3: Mode of Transmission of Amoebiasis (10 minutes)

Activity: Brainstorming (5 minutes)

ASKstudents to brainstorm on the following question:

• What is the mode of transmission of Amoebiasis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 The only infective form of E. histolytica is the cyst

 It is acquired by ingestion of cysts which is resistant to gastric acid
 Cysts are passed from person-to-person by the faecal oral route, by fingers soiled with
faeces either directly into the mouth or via food
 There have been cases of transmission through sexual contact
 The incubation period ranges from two weeks to many years

116
STEP 4: Signs and Symptoms of Amoebiasis (20 minutes)
 Infection with amoebae in most cases is asymptomatic
 The presenting features may be gradual, severe or fulminating, and include:
o Gradual onset colitis
o Severe acute amoebic dysentery

Gradual Onset Colitis

 Present with:
o Mild intermittent diarrhoea
o Abdominal discomfort, usually progressing to bloody diarrhoea with mucous.
o nausea,
o headache
o low grade fever
o Anorexia

Severe Acute Amoebic Dysentery

 Amoebic dysentery is a severe form of Amoebiasis
 The symptoms of amoebic dysentery include:
o Severe diarrhoea that contains blood or mucus
o Severe stomach pain
o loss of appetite
o Loss of weight
o Fever
o Chills
 Occasionally, the infection can spread through the bloodstream to other parts of the body
causing an amoebic abscess

STEP 5: Treatment of Amoebiasis (10minutes)

 Asymptomatic patients normally do not need treatment because in time they clear the
infection
 Drug of choice: Metronidazole
 Alternative drugs of choice: Tinidazole, Secnidazole

117
STEP 6: Prevention and Control of Amoebiasis (50 minutes)

Activity: Group Discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the prevention and control measures of Amoebiasis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Prvention and control measures

 Early diagnosis and treatment
 Food handlers may need to be screened periodically during employment
 Drinking water should be boiled to kill the cysts
 Proper faecal and refuse disposal
 Washing hands after visiting the toilet, before eating and before preparing food
 Foods should be well cooked and covered
 Health education on how the disease is transmitted
 Improvement of living standards
 Amoebiasis can be prevented by good hygiene and sanitary conditions
 Improve water supply and proper disposal of faeces
 Do not eat fresh fruit or vegetables which cannot be peeled before eating
 Make sure raw vegetables are washed thoroughly and cooked properly

STEP 7: Key Points (5 minutes)

 Amoebiasis is an infection caused by potentially pathogenic amoeba E. histolytica
 Infection occurs through the faecal-oral transmission route
 In severe cases, the onset is more sudden, the patient is ill and toxic with fever and signs
of dehydration
 Treatment should cover both tissue parasites and parasites in the bowel lumen
 Drug of choice for treatment of Amoebiasis is Metronidazole

STEP 8: Evaluation (5 minutes)

 What is the infective form of entamoeba histolytica?
 What are the clinical features of amoebiasis?
 What are the drugs used in treatment of amoebiasis?
 How can Amoebiasis be prevented and controlled?
STEP 9: Assignment (5 minutes)
118
Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

• Write a presentation on how to handle the following so as to prevent and control
Amoebiasis:
o Drinking Water
o Food handlers
o Sewage disposal
• Write a presentation on transmission cycle of Amoebiasis

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

119
References
Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed.Hugo & Russell’s Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis ,J, & Manschot, P. (1992). Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed).
Dar es Salaam: MOHSW

Nordberg, E. R. (1999): Communicable Diseases, A Manual for Health Workers in Sub-

Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF.

120
Session 21: Identification of Patients with Typhoid Fever
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause of Typhoid Fever
 Describe Mode of Transmission of Typhoid Fever
 Describe Major Signs and Symptoms of Common Typhoid Fever
 Explain Treatment of Common Typhoid Fever
 Explain Prevention and Control of Typhoid Fever
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Cause of Typhoid Fever

20 minutes Presentation Mode of Transmission of Typhoid Fever

3
Brainstorming
15 minutes Presentation Major Signs and Symptoms of Typhoid
4 Fever

5 15 minutes Presentation Treatment of Typhoid Fever

35 minutes Presentation Prevention and Control of Typhoid Fever

6
Buzzing
7 05 minutes Presentation Key Points

8 10 minutes Presentation Evaluation

9 10 minutes Presentation Assignment

121
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Typhoid Fever (5 minutes)

 Typhoid fever is a systemic infectious disease, caused by bacteria Salmonella typhi and
Salmonella paratyphi

STEP 3: Mode of Transmission of Typhoid Fever (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What is the mode of transmission of typhoid fever?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Mode of transmission
 The organisms that are responsible for infection are transmitted through foods or water
contaminated with faeces or urine of a patient or carrier
 It is more common in areas where there is insufficient water for washing hands
 Typhoid is an exclusively human disease
 It is transmitted through the ingestion of food or drink contaminated by the faeces or
urine of infected people
 A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms,
but capable of infecting others

STEP 4: Signs and Symptoms of Typhoid Fever (15 minutes)

 Typhoid fever is characterized by:
o Fever as high as 40 °C (104 °F)
o Profuse sweating
o Drowsiness
o Muscle pain
o Severe headache
o Non-bloody diarrhea although it can sometimes have bloody diarrhea too
122
 o The incubation period of typhoid fever varies with the size of the infecting dose, and
averages from 10 to 20 days
o The onset is gradual

STEP 5: Treatment of Typhoid Fever (15 minutes)

Drug of choice
 Ciprofloxacin
o Contraindication : Pregnancy and Children below 15 years

Alternatively
 Chloramphenicol
o Contraindication: Third trimester of pregnancy

STEP 6: Prevention and Control of Typhoid Fever (35 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the measures for prevention and control of Typhoid?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Measures of prevention and control

 Early diagnosis and treatment of cases is important
 General prevention is as for faecal-oral diseases:
o Cook food thoroughly
o Boil drinking water
o Wash hands before preparing food, after preparing food and before eating
 It is important to identify carriers who work as food handlers as they are especially likely
to transmit the infection (although searching for carriers is impracticable in endemic
areas)
 Immunization

STEP 7: Key Points (5 minutes)

 Typhoid fever is a systemic bacterial infection caused by Salmonella typhi, in areas where
sanitation is poor
 Drug of choice for treatment of typhoid fever is ciprofloxacin
 Delayed treatment may lead the severe complications such as bleeding from bowel, bowel
perforation and peritonitis

123
 Safe water, supply and food hygiene will prevent the population from infection
STEP 8: Evaluation (10 minutes)
 What is the cause of typhoid fever?
 What is the mode of transmission of typhoid fever?
 What are signs and symptoms of typhoid fever?
 What is the treatment of typhoid fever?
 How is typhoid fever prevented?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individual assignment

ASK the students to work individually on the following Assignment

 Prepare a presentation explaining how to differentiate a patient suffering Typhoid
fever from the one having Amoebiasis
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

124
References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J, Manschot, P (1992). Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed).
Dar es Salaam: MOHSW

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-

Saharan Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF

125
Session 22: Identification of Patients with Food Poisoning

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause of Food Poisoning
 Describe Mode of Transmission of Food Poisoning
 Describe Major Signs and Symptoms of Food Poisoning
 Explain Treatment of Food Poisoning
 Explain Prevention and Control of Food Poisoning
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
15 minutes Presentation Cause of Food Poisoning
2
Buzzing
15 minutes Presentation Mode of Transmission of Food Poisoning
3
Brainstorming
15 minutes Presentation Major Signs and Symptoms of Food
4 Poisoning

5 15 minutes Presentation Treatment of Food Poisoning

40 minutes Presentation Prevention and Control of Food Poisoning

6 Small group
Discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

126
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Food Poisoning (15 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What causes food poisoning?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition
Food poisoning is an acute intestinal disease acquired by consumption of contaminated food
or water

Causes
Food poisoning can be divided into two categories:
 Chemical (heavy metals, fluoride and others)
 Infectious: Toxins produced by microorganism present in natural food or bacteria
contaminating food or water
o Infectious agents include viruses, bacteria, and parasites
o Toxic agents include poisonous mushrooms, improperly prepared exotic foods

Bacteria
 Bacteria can cause food poisoning in two different ways
o Some bacteria infect the intestines, causing inflammation and difficulty absorbing
nutrients and water, leading to diarrhoea
o Other bacteria produce chemicals in foods (known as toxins) that are poisonous to the
human digestive system
 When eaten, these bacterial toxins can lead to nausea, vomiting, kidney failure,
and even death
 The common bacteria causing food poisoning are:
 Salmonellae,
 Campylobacter,
 Staphylococcus aureus
 Escherichia coli
127
  Clostridium botulinum
 Vibrio cholerae

Pesticides
 In food and naturally toxic substances like poisonous mushrooms or reef fish

Viruses
 These viruses include:
o Noroviruses
o Rotavirus
o Enteroviruses
o Hepatitis A

Parasites
 They are usually in contaminated or untreated water and cause long-lasting but mild
symptoms
o Examples of parasites which can cause illness are Giardia and Cryptosporidium

Note: Toxic agents are the least common cause of food poisoning

STEP 3: Mode of Transmission of Food Poisoning (15 minutes)

Activity: Brainstorming (15 minutes)

ASK students to brainstorm on the following question:

 How is food poisoning transmitted?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Illness is often isolated episode caused by poor food preparation or selection

o Eating wild toxic mushrooms,
o Eating fish and other seafood that contains toxins
o Eating food which has been contaminated with pesticides
 Food poisoning illness usually arises from improper handling, preparation, or food
storage
 The illness is transmitted by undercooked foods such as eggs, potato, salads poultry, raw
milk, dairy products, fish and other sea foods

128
STEP 4: Signs and Symptoms of Food Poisoning (15 minutes)
 Symptoms of food poisoning depend on the type of contaminant and the amount eaten
 The symptoms can develop rapidly, within 30 minutes, or slowly, worsening over days to
weeks
 Most of the common signs and symptoms are:
o Nausea,
o Vomiting
o Diarrhoea
o Abdominal cramping
 The incubation period is short depending on the cause of food poisoning:
o Staphylococcal food poisoning takes 1 – 6 hours
o Salmonella food poisoning takes 12 – 14 hours
o Anthrax gastrointestinal poisoning take 2 – 5 days
 There is acute onset of vomiting and diarrhoea after ingestion of contaminated food
 Gastrointestinal anthrax presents with vomiting, abdominal pain, haematemesis, bloody
diarrhoea and toxaemia
 Staphylococcus aureus: Causes moderate to severe illness with rapid onset of nausea,
severe vomiting, dizziness, and abdominal cramping
 Clostridium botulinum (botulism): Causes severe illness affecting the nervous system
o Symptoms start as blurred vision
o The person then develops problems of talking and overall weakness
o Symptoms then progress to difficulty breathing and inability to move arms or legs
o Botulism has the 4 D’s: diplopia (double vision), dysphagia (difficulty swallowing),
dysarthria/dysphonia (difficulty speaking) and diarrhoea
 Neurological symptoms suggest insecticides e.g. organophosphorous or mushroom
poisoning and seafood poisoning

STEP 5: Treatment of Food Poisoning (15 minutes)

 Symptomatic treatment to correct dehydration by ORS or intravenous fluid.
o Helps to correct electrolyte imbalance that might arise from diarrhoea and vomiting
o The patient may need to be admitted to the hospital
 This depends on the severity of the dehydration, response to therapy, and ability to
drink fluids without vomiting
 Antibiotics are usually not indicated except for anthrax food poisoning where large dose
of benzyl penicillin together with streptomycin may be needed
 Atropine is useful in case of organophosphate poisoning
 Antidote in case of eating food contaminated with pesticides
 Aggressive treatment may include pumping the stomach (lavage)

129
STEP 6: Prevention and Control of Food Poisoning (40 minutes)

Activity: Group discussion (30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the prevention and control measures of food poisoning?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Serve meals immediately after preparation to avoid growth of staphylococci

 Thorough cooking of food will prevent most cases of food borne poisoning
 Exclude people with pyogenic skin infection from food handling
 Preserve and protect food from being contaminated
 Health education to food handlers about necessity of proper food preservation, washing
hands and maintaining a clean kitchen
 Educating communities to avoid eating animals that have died after illness
 If food poisoning is suspected, trace all the persons who ate the infected meal and treat
them if possible
 Safe steps in food handling, cooking, and storage are essential to avoid food-borne illness
 Use cooked leftovers within four days if stored in the refrigerator and make sure to heat
them thoroughly before eating

STEP 6: Key Points (5 minutes)

 Food poisoning is common and is due to contaminated food product
 Causes are intoxication or infection by bacteria
 Treatment of food poisoning is mainly symptomatic and antibiotics are rarely needed
 Food should be served as soon as it is prepared and the remaining should be kept properly
 Food preservation should follow aseptic procedures
 Hand washing is important to reduce the risk of contaminating food

STEP 7: Evaluation (5 minutes)

 What is food poisoning?
 How is food poisoning transmitted?
 What are the clinical features of food poisoning?
 What is the treatment of food poisoning?
 What are the prevention and control measures of food poisoning?
STEP 8: Assignment (5 minutes)

130
Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on common causes of food poisoning in their area.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

131
References
Burton, B. T. & Foster W. R. (1988) Human Nutrition; A textbook of nutrition in health and
disease (4thed). New York: McGraw-Hill Book Company

Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed). Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar es Salaam:
MOHSW/NACP

GoT (2013) National Guidelines for Diagnosis and Treatment of Malaria. Dar es Salaam:
MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF.

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

Tanzania Food and Drugs Authority (2009), Guidelines for safe disposal of unfit medicines
and cosmetic products. Dar es Salaam: MOH

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO
132
Session 23: Identification of Patients with Cholera
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause of Cholera
 Describe Mode of Transmission of Cholera
 Describe major Signs and Symptoms of Cholera
 Explain Treatment of Common Cholera
 Explain Prevention and Control of Cholera
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Causes of Cholera
2
Buzzing
40 minutes Presentation Mode of Transmission of Cholera
3 Small group
Discussion
10 minutes Presentation Major Signs and Symptoms of Cholera
4
Brainstorming
5 10 minutes Presentation Treatment of Cholera

30 minutes Presentation Prevention and Control of Cholera

6 Small group
Discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

133
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Cholera (10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What causes cholera?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition
 Cholera is acute diarrheal infection of the intestine caused by vibrio cholerae
 The infection is often mild or without symptoms, but sometimes can be severe and fatal

STEP 3: Mode of Transmission of Cholera (40 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 How is cholera transmitted?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Transmission is through faecal –oral route but almost all cholera infections are water-
borne (see figure 1).
o Vibrio cholera can live in water for 2 weeks and prefer salty water
o Vibrio may survive for longer period and multiply in shellfish
134
The reservoir of infection is formed mainly by carriers excrete vibrio in small numbers
posing danger to the community

STEP 4: Signs and Symptoms of Cholera (10 minutes)

Activity: Brainstorming (15 minutes)

Ask students to brainstorm on the following question:

 What are the signs and symptoms of cholera?

ALLOW few students to respond?

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 The incubation period is 2-3 days

 The clinical presentation of cholera is caused by water and electrolyte loss and develop in
3 stages described below:

First stage (last for 3-12 hours)

 Characterized by passage of profuse watery stool
 The stool comprises of clear fluid with flakes of mucous (rice water appearance)
 vomiting
 Severe cramps in the abdomen and limbs develop from loss of electrolytes

135
Second stage:
 There is collapse from dehydration
 The body becomes cold, the skin dry and inelastic
 The blood pressure is low and the pulse is rapid and feeble
 Urine production stops and the patient may die of shock

Third stage:
 Stage of recovery, either spontaneously or with treatment
 Diarrhoea decreases
 Patient is able to take fluids and general condition improves

STEP 5: Treatment of Cholera (10 minutes)

 Patients should be hospitalised

Rehydration
 Cholera is cured by appropriate and timely rehydration
o Patients of all ages who are strong enough to drink will take a lot of
glucose/electrolyte solution needed for rehydration and maintenance
 It is essential to use oral rehydration solution (ORS) or appropriate intravenous (IV)
fluids to replace the necessary electrolytes.
 Patients in shock or who are too weak to drink require intravenous fluids until they can
take in oral fluids.

Antimicrobials
 Antimicrobial agents have been shown to shorten the period of diarrhoea and the amount
of fluid loss
o Tetracycline or doxycycline are the drugs of choice
o Erythromycin is an effective alternative both in children and adults
o Cotrimoxazole is also another alternative
 Strict isolation is not necessary as only vomitus and stool are infectious
 Patients are treated on ‘Cholera bed’ (beds with central hole) through which the
continuous stool can pass into a bucket and fluid loss be measured

136
STEP 6: Prevention and Control of Cholera (30minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What are the prevention and control measures of cholera?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Prvention and control measures

 Improve quality of public water supply by chlorination in large scale
 Encourage individuals to boil drinking water
 Milk products should be pasteurized
 Avoid eating half cooked food
 Leftovers should be protected against contamination by flies
 Markets and food premises should be free from contamination
 Improvement of sanitation facilities e.g. proper excreta and refuse disposal
 Give health education to public on how cholera is spread, clinical features, preventive
measures, ways of making water safer (e.g. by boiling), proper food handling, sanitation
and hand washing
 The vomitus and stool should be properly deposited in pit latrine or a septic tank system
 Hospital equipment should be cleaned with disinfectant such as 5% lysol

STEP 6: Key Points (5 minutes)

137
 Cholera is acute intestinal disease caused by vibrio cholerae
 Patients present with profuse watery diarrhoea, vomiting and rapid dehydration
 The disease is spread by faecal-oral route
 Rehydration can prevent death
 Cholera can be prevented by improving sanitation, water supply, refuse dispersal and
personal hygiene

STEP 7: Evaluation (5 minutes)

 What causes cholera?
 How does cholera spread?
 What are signs and symptoms of cholera?
 What is the treatment of cholera?
 What are the preventive and control measures of cholera?

STEP 8: Assignment (5 hours)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on control measures in the outbreak of cholera in their area.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

138
References
Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London: Saunders Ltd

Denyer, S. P. Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J,& Manschot, P (1992).Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF

Nyamwaya, D. (1994): A Guide to Health Promotion through Water and Sanitation, Nairobi:
AMREF

139
Session 24: Identification of Patients with Ascariasis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Ascariasis
 Describe Mode of Transmission of Ascariasis
 Describe Major Signs and Symptoms of Ascariasis
 Explain Treatment of Ascariasis
 Explain Prevention and Control of Ascariasis
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Cause(s) of Ascariasis
2
Buzzing
30 minutes Presentation Mode of Transmission of Ascariasis
3 Small group
Discussion
4 10 minutes Presentation Major Signs and Symptoms of Ascariasis

5 10 minutes Presentation Treatment of Ascariasis

40 minutes Presentation Prevention and Control of Ascariasis

6 Small group
Discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

140
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASKstudents to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Ascariasis (10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What causes Ascariasis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Ascariasis: is one of the commonest infections of the small intestine

 Caused by a nematode called Ascaris lumbricoides ( round worm)

STEP 3: Mode of Transmission of Ascariasis (30 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What is the mode of transmission of Ascariasis?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Common ways of acquiring Ascariasis include failure to adhere to hygienic practices such
as washing hands before food preparation and proper storage of food
 Therefore the disease is related to poor sanitation and hygiene
 Infection is acquired from ingestion of food contaminated with mature eggs
 The usual vehicles are fruits and other raw food
141
 Children are more frequently infected and have higher worm burden than adults because
they like putting contaminated objects into their mouths
 Heavy infection in children can contribute to under-nutrition
 Adults have much lighter infections, although re-infection can occur throughout life

Refer students to Handout 24:1 Life cycle of ascaris lumbricoides for further
reading

STEP 4: Signs and Symptoms of Ascariasis (10 minutes)

 Fever
 Cough
 Abdominal discomfort, restlessness and insomnia (sleeplessness)
 Eosinophilia due to allergic reaction
 Intestinal obstruction
 Passing adult worm in the stool or vomitus
 Obstructive jaundice

STEP 5: Treatment of Ascariasis (10 minutes)

 Treatment is effective only against the adult worms
 The drugs of choice are as follows:
o Albendazole: for children 2-5 years a single dose of 200mg and for older children and
adults, one dose of 400mg is given
o Mebendazole: a single dose 500mg
o Levamisole: a single of 2.5mg/kg body weight
o Piperazine (antepar): syrup at a dose of 150mg/kg body weight (to a maximum of 4g)
as a single dose
 Note that these drugs are given between meals
 They should be avoided during the first tree monthsr of pregnancy

STEP 6: Prevention and Control of Ascariasis (40 minutes)

142
 Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 How is Ascariasis transmitted?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Environmental measures such as provision of adequate and safe water supplies.

 Proper disposal of faeces
 prevention of faecal contamination of food and water
 Discourage use of fresh human faeces as manure
 Health education on:
o Proper use of latrines
o Personal hygiene e.g. washing hands after using toilet or before handling food
o Washing fruits and vegetables before eating
o Use of dry racks for utensils so that they are above the soil and dust

STEP 7: Key Points (5 minutes)

 Ascariasis is a common nematode infection.
 The prevalence of Ascariasis is related to poor sanitation and hygiene
 Control is mainly by improving faeces disposal
 A heavy infection in a child can contribute to malnutrition

STEP 8: Evaluation (5 minutes)

 What is Ascariasis?
 How does a person acquire Ascariasis infection?
 What are the signs and symptoms of Ascariasis?
 What is the treatment of Ascariasis?
 What are preventive and control measures of Ascariasis?

STEP 9: Assignment (5 minutes)

143
Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following assignment

 Prepare a presentation on common causes of food poisoning in their area.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

References

144
Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd.

Denyer, S. P. Hodges, N. A. Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical

Microbiology (8th ed). Oxford: Willey-Blackwell Publishing

Eshuis J, Manschot, P (1992). Communicable diseases, (1sted). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

145
Handout 24.1: Life cycle of Ascaris lumbricoides

146
Session 25: Identification of Patients with Scabies
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause(s) of Scabies
 Describe Mode of Transmission of Scabies
 Describe Major Signs and Symptoms of Scabies
 Explain Treatment of Scabies
 Explain Prevention and Control of Scabies

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Cause(s) of Scabies
2
Buzzing
3 10 minutes Presentation Mode of Transmission of Scabies

30 minutes Presentation Major Signs and Symptoms of Scabies

4
Brainstorming
5 20 minutes Presentation Treatment of Scabies

30 minutes Presentation Prevention and Control of Scabies

6 Small group
discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

147
SESSION CONTENTS

STEP1: Presentation of Session Titles and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Scabies(10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What causes scabies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Scabies: A parasitic infection of the skin characterised by an intense itching with typical
distribution caused by the mite Sarcoptes scabies
 Prevalence is high in areas with shortage of water
 Common in people who do not take bath regularly
 Low socio-economic conditions favour the spread of the disease

STEP 3: Mode of Transmission of Scabies (10 minutes)

 Transmission is by direct close body contact from infected person and indirectly through
bed clothes and sharing clothing
 The female mite enters the skin and makes a small tunnel or burrow
 The burrow is always superficial
 The skin selected for burrow is always thin and wrinkled giving scabies rash a typical
distribution
 In the burrows, eggs and faeces are produced
 The eggs hatch in 4-5 days
 The larvae leave the parent tunnel and bury in the skin in other places, but do not make
tunnels

148
STEP 4: Signs and Symptoms of Scabies (30 minutes)

Activity: Brainstorming (10 minutes)

Ask students to brainstorm on the following question:

 What are the signs and symptoms of scabies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Intensive itching, especially at night

 Eczema-like signs
o The itching leading to scratching
o Secondary bacterial infection
 In case of immune suppression such as HIV and AIDS, infestation can be extensive
 Typical distribution of severe itch and rash are:
o Anterior axillary fold
o Nipples, lower abdomen in women
o Belt line (umbilicus)
o Front side of wrist and elbows
o External genitalia
o Thighs and buttocks
o Sides of fingers and toes
o Sides and webs of fingers
o Scalp and feet (infants under 1 year)
 Patients with leprosy or other diseases which interfere with normal sensation may not feel
the itching caused by scabies. In these cases, scabies can be very extensive and thick
crusts can form

149
STEP 5: Treatment of Scabies (30 minutes)
 The drug of choice is 10% Benzyl benzoate emulsion (BBE)
 Administration information
o After the patient has taken a warm bath, the drug is applied over the whole body
except the face
o After 24 hours of first treatment, the patient should bath again and put on clean
clothes
o The drug has no effect on the eggs, therefore repeat BBE after 4 – 7 days to kill larvae
which have hatched after the first treatment
 Other drugs which can be used in the absence of BBE include:
o Tetmosol solution or soap
o Permethrin cream 5% (applied to areas of the body from neck downward and washed
off after 8-14 hours)
o Ivermectin 200µg/kg orally and repeated after 2 weeks or Lindane (1%) lotion or
cream
o Antibiotics are used only when there is a secondary infection (preferably Penicillin)

150
STEP 6: Prevention and Control of Scabies (30 minutes)

Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are the measures of preventing scabies?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Prevention and control of scabies

 Regular bathing with soap
 Washing clothes regularly
 Give health education to stress the use of soap and personal hygiene
 Treat the whole family
 Decontamination of bedding materials and clothing
 Improve water supply

STEP 7: Key Points (5 minutes)

 Scabies is characterized by severe itching
 It is treated with BBE, Tetmosol, Ivermectin or Lindane.
 Treatment of scabies should include all family members
 Control is by regular bathing using water and soap

STEP 8: Evaluation (5 minutes)

 What is the cause of scabies?
 What is the mode of transmission of scabies?
 What are signs and symptoms of scabies?
 What is the treatment of scabies?
 What are control measures for scabies?

151
STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDEstudents into small groups assignment

ASK the students to work individually on the following Assignment

• Prepare a presentation on how to control scabies at home.
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

152
References

Cook, G. & Zumla, A. (2003).Manson’s Tropical Diseases. (21sted.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed.Hugo & Russell’s Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis,J, & Manschot,P (1992). Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

153
Session 26: Identification of Patients with Dermatophytes
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause(s) of Dermatophytes
 Describe Mode of Transmission of Dermatophytes
 Describe Major Signs and Symptoms of Dermatophytes
 Explain Treatment of Dermatophytes
 Explain Prevention and Control of Dermatophytes
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Cause(s) of Dermatophytes
2
Buzzing
30 minutes Presentation Mode of Transmission of Dermatophytes
3 Small group
discussion
15 minutes Presentation Major Signs and Symptoms of
4 Buzzing Dermatophytes

5 15 minutes Presentation Treatment of Dermatophytes

30 minutes Presentation Prevention and Control of Dermatophytes

6 Small group
discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

154
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Dermatophytes (10 minutes)

Definition
 Dermatomycosis is a term applied to fungal infection of the skin and its appendages i.e.
hair and nails
o Different types are identified according to causative organism, site and clinical
appearance
o They are sometimes indicators of immune suppression as occurs in AIDS, cancer,
diabetes and tuberculosis.

Types of dermatomycosis
 Tinea capitis (ringworm of the scalp)
 Tinea corporis (ringworm of the body)
 Tinea pedis (ringworm of the foot or ‘athlete’s foot’)
 Tinea unguium (ringworm of the nails)
 Tinea versicolor or pityriasis

STEP 3: Mode of Transmission of Dermatophytes (30 minutes)

Activity: Group discussion (20 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What is the mode of transmission of dermatophytes?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 All fungi may be transmitted to humans by direct skin contact from their habitat in the
soil, vegetation, animals or other individuals

155
 Genital infection (balanitis and vulvo-vaginitis) may spread during sexual intercourse but
most candida infections are not sexually transmitted
 Local conditions on the skin such as moist and hot environment are predisposing factors

STEP 4: Signs and Symptoms of Dermatophytes (15 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the signs and symptoms of dermatomycosis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Tinea Capitis (Ringworm of the scalp)

 Begins as a small papule which spreads to involve a larger area
 Hairs in the affected skin become brittle and break off easily
 Occurs mainly in children under 10 years and often disappears after puberty

Tinea Corporis (Ringworm of the body)

 Characterized by flat ring shaped spreading lesions
 The ring lesions are reddish, vesicular or pastula, and may be dry and scaly, or moist and
crusted
 The central area often clears leaving apparently normal skin

Tinea Pedis (Ringworm of the foot or athlete’s foot)

 Characterized by scaling and cracking of the skin between the toes, particularly the fourth
and fifth toes

Tinea Unguium (Ringworm of the nails)

 Characterized by a thickening, discolouration and brittleness of the nails
 There is accumulation of caseous materials beneath the nail which becomes chalky and
disintegrates

Tinea Versicolor or Pityriasis

 This is a very superficial infection
 Skin on side of face, neck and chest show many irregular, round and light-coloured areas

STEP 5: Treatment of Dermatophytes (15 minutes)

156
Tinea Capitis
 Griseofulvin is the drug of choice, although oral therapy with itraconazole and terbinafine
are effective alternatives.
 Oral fluconazole seems to have similar efficacy to Griseofulvin
 Give Griseofulvin at a dosage of 250 mg twice a day or 500mg once a day in adults and
20-25mg/kg for children for 6-12 weeks
 Whitefield’s ointment applied twice daily for 3 – 6 weeks has also been used in areas
where the above drugs are not available.

Tinea Corporis
 This responds well with application of topical antifungal such as Clotrimazole 1% cream,
lotion or solution (use twice daily), and ketoconazole 2% cream (used once daily)
 Severe disease and disease in immune compromised patients should be treated with
systemic agents

Tinea Cruris
 Topical antifungal treatment should be used (just as in Tinea corporis)
 Resistant lesions can be treated with griseofulvin or other systemic agents
 Patients should be advised to dry the area completely after bath and not to wear tight
clothing

Tinea Pedis
 Topical agents applied for duration of 4 weeks are usually effective
 Chronic or extensive disease may require
o Griseofulvin 250 – 500mg twice daily for 6 – 12 weeks, or
o Terbinafine 250 mg daily or itraconazole 200 mg daily

Tinea Unguium
 Systemic antifungal are indicated
 Terbinafine and itraconazole are more effective than other agent

STEP 6: Prevention and Control of Dermatophytes (30 minutes)

157
 Activity: Group discussion (15 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What are the prevention and control measures of dermatophytes?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Dermatomycosis Prevention and Control

 Early diagnosis and treatment of infected person
 Improve personal hygiene – regular bathing with water and soap
 Dry skin well (especially feet)

STEP 7: Key Points (5 minutes)

 Dermatomycosis is a fungal infection of the skin
 Four types of dermetomycosis are common i.e. tinea capitis, corporis, pedis, unguim and
vesicolor
 Fungal infections are mostly transmitted through body contact
 Signs and symptoms depends on the area affected
 Treatment depends on the site of infection
 Prevention is through improved personal hygiene

STEP 8: Evaluation (5 minutes)

 What causes of dermatophytes?
 What is the mode of transmission of dermatophytes?
 What are major signs and symptoms of dermatophytes?
 What is the treatment of dermatophytes?
 What are the prevention and control measures of dermatophytes?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

158
ASK the students to work individually on the following Assignment
• Explain preventive measures that you will take to control Bronchitis
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

159
References

Cook, G. & Zumla, A. (2003).Manson’s Tropical Diseases. (21st ed.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

160
Session 27: Identification of Patients with HIV/AIDS
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of HIV/AIDS
 Describe Mode of Transmission of HIV/AIDS
 Describe Major Signs and Symptoms of HIV/AIDS
 Explain Treatment of HIV/AIDS
 Explain prevention and control of HIV/AIDS

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Causes of HIV/AIDS
2
Buzzing
30 minutes Presentation Mode of Transmission of HIV/AIDS
3 Small group
discussion
10 minutes Presentation Major Signs and Symptoms of HIV/AIDS
4
Brainstorming
5 10 minutes Presentation Treatment of HIV/AIDS

40 minutes Presentation Prevention and Control of HIV/AIDS

6 Small group
discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

161
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of HIV/AIDS (10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What causes HIV/AIDS?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Human Immunodeficiency Virus (HIV) infection:

 State of being infected with the Human Immunodeficiency Virus without showing signs
and symptoms

Acquired Immunodeficiency Syndrome (AIDS)

 A state of being HIV infected with presentation of signs and symptoms

STEP 3: Mode of Transmission of HIV/AIDS (30 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What is the mode of transmission of HIV?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Unprotected sexual intercourse with infected partner

162
 Vertical transmission:
o During pregnancy
o During delivery
o During breast feeding
 Contact with infected blood products
 Transfused with infected blood
 Injection drug use (IDU) through needle-sharing, needle stick accidents, unsterilized
needles.

Factors influencing transmission of HIV/AIDS

 Risky sexual behaviour e.g. unsafe sex with infected partner and multiple sexual partners
 Social economic e.g. commercial sex
 Cultural practices e.g. female genital mutilation
 Biological e.g. young age and early sexual indulgence
 Political e.g. war and political instability
 Unsterile procedures e.g. sharing instruments for circumcision
 Peer pressure towards involvement into sexual intercourse
 Substance abuse e.g. cocaine, bhang, heroine and alcohol

Handout 27.1: Life cycle of HIV for further reading

STEP 4: Signs and Symptoms of HIV/AIDS (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

 What is the signs and symptoms of HIV/AIDS?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Signs and symptoms of HIV infection:

 Fever
 Headache
 Cough
 Lymphadenopathy
 Skin rashes, which resolve spontaneously
 Mental illness (dementia)

The natural history of HIV can be explained in different stages or clinical presentation
163
 Acute HIV infection (window period): can present as any acute viral illness
o HIV antibodies take time to be produced and show up on a blood test
o Window period is the period between time of infection and hen initial detection of
HIV antibodies is possible by laboratory tests
o People who test HIV negative must be tested again after 3 months, when antibodies
should have developed
o DNA/RNA testing can be used to diagnose HIV infection before antibodies are
formed

 Latent HIV infection

o This is a period when the patient has no symptoms at all
o The body is still able to fight against most of the diseases just as in HIV negative
individuals
o Patient may have generalized lymphadenopathy

 Late stages of HIV infection

o The immunity of the patient falls and severe life threatening infections occur e.g.
cryptococcal meningitis, toxoplasmosis and pneumocystis pneumonia

STEP 5: Treatment of HIV/AIDS: (10 minutes)

 Not all HIV positive patients are eligible for treatment withARVs
 Two classes of patients eligible to begin treatment:
o All patients in WHO stage 3 and 4 clinical criteria, regardless of CD4 cell count.
o All adolescences and adults including pregnant women with a CD4 count <
350cells/mm3, regardless of clinical symptoms

 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

o Zidovudine (AZT)
o Lamivudine (3TC)
o Abacavir (ABC)
o Emtricitabine (FTC)
o Stavudine (d4T)

 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

o Nevirapine (NVP)
o Efavirenz (EFV)

 Nucleotide Reverse Transcriptase Inhibitors (Nucleotide Analogues)

o An example of this relatively new class of antiretroviral drugs is Tenofovir (TDF)

 Protease Inhibitors (PIs)

o Lopinavir (LPV)
o Atazanavir (ATV)

164
 Antiretroviral therapy involves the use of a combination of 3 drugs (triple therapy) e.g.
o 2 NRTI + 1 NNRTI, OR
o 2 NRTI + 1 PI, OR
o 3 NRTI’s

STEP 6: Prevention and Control of HIV/AIDS: 40 minutes

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What are the preventive and control measures of HIV/AIDS?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Development/Empowerment Interventions
 Development/empowerment interventions improve general living conditions through:
o Poverty-alleviation and income-generation programmes e.g. MKUKUTA
o Improvements to infrastructure
o Workshops and training to address gender inequality or to empower youth

Health-Services Interventions
 Improve health-services issues:
 Provider-initiated testing and counseling (PITC) or voluntary counseling and testing
(VCT)
 Provision of ART and care of People Living with HIV (PLHIV)
 Strengthening management of STIs
 Strengthening prevention of mother-to-child-transmission services (PMTCT) and
provision of ART
 Strengthening training for health-care providers
 Integrating HIV prevention into care and treatment services
 Safe medical practices such as use of sterile syringes and needles
 Post exposure prophylaxis (PEP) to health workers

165
Management of STIs
 All patients should be assessed by clinicians for STIs because:
o STIs share similar risk factors with HIV infection
o STIs increase the risk of HIV acquisition or HIV transmission
o STIs can often be treated and cured
 Abstinence
o Encourage delaying sexual activity for young people
 Sexual and reproductive health education to young people in and out of school
 Faithfulness (have one faithful uninfected partner)
 Using condoms correctly and consistently
o Correcting myths and misconceptions about condoms
 Screening and effective treatment of asymptomatic cases
 Male circumcision

STEP 6: Key Points (5 minutes)

 HIV/AIDS is a viral infection affecting all age groups
 Mode of transmission is mainly through unprotected sexual intercourse
 Infection may be asymptomatic in early stages
 Not all HIV positive patients are eligible for treatment with ARVs
 Antiretroviral therapy involves the use of a combination of 3 drugs (triple therapy)
 Prevention of HIV/AIDS includes developmental or empowerment initiatives; health
service interventions and management of STIs

STEP 7: Evaluation (5 minutes)

 What causes HIV/AIDS?
 How is HIV/AIDS transmitted?
 What are the major signs and symptoms of HIV/AIDS?
 What is the treatment of HIV/AIDS?
 What are the preventive and control measures of HIV/AIDS?

STEP 8: Assignment (5 hours)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on common causes of food poisoning in their area.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

166
References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:
Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J. &Manschot, P. (1992).Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar es Salaam:
MOHSW/NACP

GoT. (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., &Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

167
 Handout 27.1: Life Cycle of HIV

Life cycle of HIV is divided into seven (7) main steps as described below
 Attachment of HIV virus through the interaction between viral glycoprotein and CD4
receptors and co-receptors:
o The spikes on HIV virus attach to special areas on the surface of T-cells called
receptors

 Fusion and release of RNA into the cytoplasm of the cell:

o After attachment the envelope and capsid fuse with cell membrane of the human cell
thus releasing the RNA into the cytoplasm of the human white blood cell

 Reverse transcription to produce viral DNA

o Using other components from the T- cell, the viral enzyme, reverse transcriptase
produces a DNA copy of viral RNA; this DNA copy is called a pro-viral DNA

 Integration of pro-viral DNA to host DNA using other components from the T- cell.
o The viral enzyme (integrase) integrates the proviral DNA into the T-cell DNA.

 Synthesis of viral proteins:

o Using other cellular components from T. cell, the viral enzyme (protease) synthesises
viral protein necessary for a completion of virion.

 Assembly and release of a complete virion.

o Virions are distributed to infect other more T-helper cell: virion are released from T-
cells and can infect more T-cell

168
 Handout 27.2: Life Cycle of HIV

 An opportunistic infection (OI): An infection caused by an organism that does not

usually cause disease in a healthy person with a normal immune system
 When the immune system is compromised such as through HIV infection, the
pathogen then gets an opportunity ‘to infect and cause disease’
 Other examples of people with suppressed immunity include very young children and
very old people, patient with advanced cancer and/or on chemotherapy, patients
taking steroids for a long time, and those on immunosuppressive therapy following
organ transplantation

 Opportunitistic Infections affecting gastrointestinal system include:

o Oral-oesophageal candidiasis (thrush)
o Herpes Simplex Virus
o Kaposis sarcoma as well as diarrhoeal illnesses
o Cytomegalo Virus

 Opportunistic Infections affecting Respiratory System includes:

o Pneumocystis carinii pneumonia (PCP), currently is also known as
pneumocystis jirovecii pneumonia (PJP)
o Recurrent respiratory tract infection (RTI), bacterial pneumonias
o Pulmonary tuberculosis (PTB) and pleura infusion

 OIs in the cardiovascular system can lead to the following include;

o Pericarditis
o Cardiomyopathy

 OIs affecting Skeletal Muscular System include:

o Herpes zoster and herpes simplex
o Kaposi’s sarcoma o Pyomyositis and Abscesses

 OIs affecting Central Nervous System include:

o Cryptococcus Meningitis
o Toxoplasmosis

169
 Handout 27.3: WHO Clinical Staging of HIV/AIDS in
adults

 The WHO Clinical staging system is based on clinical features believed to have
prognostic significance resulting in four stages of disease progression
 WHO staging is done where HIV infection is confirmed by HIV antibody or
virological markers
 Staging determines eligibility for ART
 WHO staging looks at the clinical presentation of the client or patient
 WHO clinical staging can be used effectively without access to CD4 or other
laboratory testing

WHO Clinical Stage I: Asymptomatic

 A person with Stage I infection:
o Feels well and can do all his or her normal activities
o Has no signs or symptoms of any illness
o May experience Persistent Generalized Lymphadenopathy (PGL)

WHO Clinical Stage II: Minor Symptoms

 A person in this stage may feel
o Ill at times, but still can perform all of his or her activities
o Moderate unexplained weight loss (<10% body weight)
o Recurrent respiratory tract infections
o Minor mucocutaneous manifestations
o Herpes zoster

WHO Clinical Stage III: Moderate Symptoms

 People in this stage
o Often cannot do their usual activities, but are in bed less than half the time
o Severe unexplained weight loss (<10% of presumed or measured body weight)
o Unexplained chronic diarrhoea for >1 month
o Unexplained persistent fever above 37.6C intermittent or constant for >1 month
o Persistent oral candidiasis
o Oral hairy leukoplakia
o Pulmonary tuberculosis (current)
o Severe bacterial infections
o Acute necrotising ulcerative stomatitis, gingivitis or periodontitis

WHO Clinical Stage IV: AIDS-Defining Conditions

 A person in this stage is ill often and may stay in bed more than 50% of the time
o Wasting can take place in this stage: weight loss >10% of body weight
 Involved organ systems:
o Cutaneous and oral

170
 o Respiratory
o Gastrointestinal
o Neurological and ocular
o Generalised

 Main infections include:

o Kaposi sarcoma
o Cryptococcal meningitis
o CNS toxoplasmosis
o Pneumocystis pneumonia

171
Session 28: Identification of Patients with Tuberculosis

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Tuberculosis
 Describe mode of Transmission of Tuberculosis
 Describe Major Signs and Symptoms of Tuberculosis
 Explain Treatment of Tuberculosis
 Explain Prevention and Control of Tuberculosis
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Causes of Tuberculosis
2
Buzzing
30 minutes Presentation Mode of Transmission ofTuberculosis
3 Small group
Discussion
10 minutes Presentation Major signs and Symptoms of Tuberculosis
4
Brainstorming
5 10 minutes Presentation Treatment of Tuberculosis

40 minutes Presentation Prevention and Control of Tuberculosis

6 Small group
Discussion
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

172
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Tuberculosis (10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What causes tuberculosis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition
 Tuberculosis (TB) is a chronic infectious disease caused mainly by mycobacterium
tuberculosis (M. tuberculosis) and occasionally by mycobacterium bovis or
mycobacterium africanum.

Tuberculosis can be grouped into two main types:

Pulmonary tuberculosis (PTB)
 Affects the lungs
 Most common and accounts for 80% of all cases of TB

Extra-pulmonary (EPTB)
 Affects organs other than the lungs
 Non-infectious
 Accounts for 20% of all cases of TB
 The most common types of extra-pulmonary tuberculosis are:
o TB lymphadenitis
o TB of the bones and joints
o TB meningitis
 Tuberculosis is on the increase, especially in countries with high prevalence of HIV
 Tuberculosis can kill or render the patient disabled for life if untreated or inadequately
treated

173
STEP 3: Mode of Transmission of Tuberculosis (30 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What is the mode of transmission of tuberculosis?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 The transmission of tubercle bacilli occurs by airborne spread of infectious droplets

 TB is transmitted from one person to another through inhalation of droplets during:
o Coughing
o Laughing
o Talking
o Sneezing
o Spitting
o Singing
 Coughing is the common means of transmission
 The risk of acquiring the infection is higher for individuals close to the patient
 Direct sunlight kills tubercle bacilli within minutes, but they can survive in the dark for
many hours (24-48 hours)

Note: The majority (90%) of people without HIV infected with mycobacterium tuberculosis
do not develop tuberculosis because their immune system is strong enough to prevent the
development of tuberculosis

STEP 4: Signs and Symptoms of Tuberculosis (10 minutes)

The most common symptoms of pulmonary tuberculosis are:
 Persistent cough for 2 weeks or more
 Blood stained sputum (haemoptysis)
 Shortness of breath
 Chest pain
 Fatigue (tiredness)
 General malaise
 Loss of appetite

 Loss of weight
174
 Night sweats
 Fever

The symptoms for extra-pulmonary tuberculosis depend on the organs involved, for example:
 Chest pain in Tb pleurisy
 Swelling of lymph nodes in Tb lymphadenitis
 Pain and swelling of joints in Tb arthritis
 Deformity of the spine (Pott’s disease)
 Headache, fever, stiffness of the neck and mental confusion in Tb meningitis

STEP 5: Treatment of Tuberculosis (10 minutes)

Treatment is divided into three groups:
 New patients who have no history of TB treatment or who have received less than one
month of anti-TB drugs regardless of their smear or culture results
 Previously treated patients who have received anti-TB drugs for one month or more in
the past with a second episode
 Drug-resistant patients with tubercle bacilli that are resistant to rifampicin and isoniazid

Direct observation treatment (DOT) strategy

 Direct observation treatment means that a trained health care provider or other designated
individual, including family members, observe the patient swallow all tablets
 Ensures that a TB patient takes the right drugs, in the right doses, at the right intervals and
finishes treatment within the required duration,

There are five essential first-line anti-TB drugs for adults and children in Tanzania, as
recommended by the MOHSW and WHO.
 Drugs are formulated in fixed drug combinations (FDCs)
o Isoniazid (H)
o Rifampicin (R)
o Pyrazinamide (Z)
o Ethambutol (E)
o Streptomycin (S)

 Treatment of TB requires multiple drugs for effectiveness

o This is called Multi-Drug Treatment (MDT)
o If one or two drugs are used alone, other organisms will not be killed and resistance
will develop

 Treatment of TB is divided into two phases as described below;

Initial (intensive) phase

 At least 4 drugs are used in this phase:
175
 o Isoniazid
o Rifampicin
o Pyrazinamide
o Ethambutol
 Majority of TB bacilli are rapidly killed and patients become non- infectious within two
weeks
 The duration of treatment for initial phase is at least two (2) months

Continuation phase
 There are always bacilli that remain metabolic inactive, hiding in tissue or macrophages
even after the initial phase of treatment
 These are called persisters or semi-dormant and they need much longer treatment before
they are killed
 Two drugs are used
o Isoniazid
o Rifampicin
 The duration for this phase is at least four (4) months to make a total duration of at least
six (6) months to complete treatment

Handout 28.1: Mode of Action, Potency and Recommended dose of Anti-TB drugs
for further reading

Handout 28.1: Adverse Reactions of Anti-TB Drugs for further reading

STEP 6: Prevention and Control of Tuberculosis (40 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

 What are the preventive prevention and control measures of tuberculosis?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 The control of TB depends on success of treatment of registered TB patients and contact

tracing.

176
 o Emphasis must be placed on those who are sputum smear-positive (open TB) to make
them smear-negative
o All patients with open TB must be put on treatment as early as possible to prevent
them from infecting others
o Early case finding is an important aspect of TB control
 Passive case finding – all health care workers should know the early symptoms of
TB and diagnose it whenever patients reports to facilities
 Active contact tracing/case finding – community health workers to visit the homes
of all TB cases to look for other cases
 Appropriate health education should be given to patients and relatives so that
symptomatic contacts can be brought to the health facility for investigation
 Case holding – those who are put on treatment, should be maintained on treatment until
they finish the whole course of treatment
 Strengthen the efficiency and reliability of the health services
o Advertise the routine methods of TB treatment in health facility
o Having special day in a week/month where TB patients are seen
 The role of BCG immunization
o Provides partial active immunity against TB
 Other important measures are:
o TB patients should be advised not to spit anywhere carelessly
o A sputum mug should be provided in which to spit and disposed carefully
o Overcrowding and poor ventilation at homes should be avoided
o Patients should cough into a piece of cloth to reduce distribution of particles b in the
air
o Hand washing after coughing

STEP 7: Key Points (5minutes)

 TB is transmitted from one person to another through inhalation of droplets
 Treatment of TB requires multiple drugs for effectiveness
 Majority of TB bacilli are rapidly killed and infectious patients become non- infectious
within two weeks
 There are five essential, first-line anti-TB drugs which are Isoniazid, Rifampicin,
Pyrazinamide, Ethambutol and Streptomycin
 The control of TB depends on successful treatment of registered TB patients and contact
tracing
 Early case finding is an important aspect of TB control

STEP 8: Evaluation (5 minutes)

 What causes of tuberculosis?
177
 What is the mode of transmission of tuberculosis?
 What are major signs and symptoms of tuberculosis?
 What is the treatment of tuberculosis?
 What are the preventive prevention and control measures of tuberculosis?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

• Explain preventive measures that you will take to control Tuberculosis in your area
ALLOCATE time for students to do the assignments and submit
REFER students to recommended references

178
References
Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:
Saunders Ltd.

Eshuis, J. Manschot, P. (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

179
Handout 28.1: Mode of Action, Potency and Recommended
dose of Anti-TB drugs

180
Handout 28.2: Adverse Reactions of Anti-TB Drugs

181
Session 29: Identification of Patients with Leprosy
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause(S) of Leprosy
 Describe Mode of Transmission of Leprosy
 Describe Major Signs and Symptoms of Leprosy
 Explain Treatment of Leprosy
 Explain Prevention and Control of Leprosy

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks

2 15 minutes Presentation Cause(s) of Leprosy

20 minutes Presentation Mode of Transmission of Leprosy

3
Brainstorming
30 minutes Presentation Major Signs and Symptoms of Leprosy
4 Small group
discussion
5 15 minutes Presentation Treatment of Leprosy

20 minutes Presentation Prevention and Control of Leprosy

6
Brainstorming
7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

182
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Leprosy (15minutes)

 Leprosy is a chronic infectious disease caused by mycobacterium leprae (M. leprae)
 Mainly affects the skin, peripheral nerves, and mucous membranes
 The disease affects people of all ages and sexes

STEP 3: Mode of Transmission of Leprosy (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

 What is the mode of transmission of leprosy?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Leprosy bacilli are mainly transmitted through infectious droplets that are spread by an
infectious individual through coughing and sneezing
 Patients carrying many leprosy bacilli are called multibacillary (MB) patients
o They are the main source of infection
 Individuals with few bacilli in their body are called paucibacillary (PB)
o They are not a significant source of infection
 Healthy carriers are people carrying the bacilli without developing the disease
o They are not a significant source of infection
 Skin contact with leprosy patients not a means of transmitting leprosy infection
 Leprosy has a very long incubation period of 3-30 years, with an average of five years

STEP 4: Sign and Symptoms of Leprosy (20minutes)

183
Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the signs and symptoms of leprosy?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 One or more pale or reddish, hypo-pigmented patch(es) on the skin with diminished or
loss of sensation
 Painless swelling or lumps in the face and/or earlobes
 Enlarged and/or tender nerves
 Burning sensation of the skin
 Numbness or tingling of hands and/or feet
 Weakness of eyelids, hands, and/or feet
 Painless wounds or burns on the hands and/or feet
 The skin lesion can be single or multiple and in many cases less pigmented than the
surrounding skin. Sometimes lesion is reddish or copper-coloured
 The skin lesion may show loss of sensation on light touch, a key feature in leprosy
 Lesions can present in different ways, but macules (flat), papules (raised) or sometimes
nodules are the most common

STEP 5: Treatment of Leprosy (30 minutes)

 The aim of leprosy control is to:
o Cure patients
o Detect and treat leprosy reactions
o Prevent further damage to nerves and other tissue in patients with an already existing
disability
o Prevent further transmission to other community members

 Multi Drug Treatment (MDT) is the only adequate chemotherapy that will kill bacilli
 MDT is a combination of a minimum of two anti-leprosy drugs, prescribed in the correct
dosage, taken regularly for a period of 6-12 months
 Multi bacillary (MB) patients are treated for a period of 12 months
 Paucibacillary (PB) patients are treated for 6 months
 Treatment of leprosy with only one drug will result in development of drug-resistance
 Treatment is given according to WHO recommended MDT regimens based on the
 classification of Multibacillary or Paucibacillary
 The patient receives a combination of rifampicin, dapsone and clofazimin in case of MB
or rifampicin and dapsone in case of PB

 The patient should thus attend the nearest clinic where she/he is registered to collect
 blister pack and for clinical assessment.

184
 The patient takes the first dose under direct observation of a health worker
 In the following 27 days the patient then takes the medicine without being supervised by
the health worker

STEP 6: Prevention and Control of Leprosy ( 15 minutes)

 Early diagnosis and prompt treatment with Multi Drug Therapy
o Case holding and patient compliance
o Early detection of leprosy reactions and prompt treatment with prednisolone to
prevent disabilities

STEP 6: Key Points (20 minutes)

 Leprosy is a chronic infectious disease caused by Mycobacterium leprae
 The cardinal signs are skin lesion with loss of sensation, one or more enlarged peripheral
nerves and a positive skin smear.
 Treatment is given according to WHO recommended MDT regimens based on the
classification of Multibacillary or Paucibacillary.
 Early detection and prompt treatment are important measures

STEP 7: Evaluation (5 minutes)

 What causes leprosy?
185
 How is leprosy transmitted?
 What are the major signs and symptoms of leprosy?
 Hat is the treatment of leprosy?
 Explain prevention and control of leprosy
 What are the preventive and control measures of leprosy?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

 Explain preventive measures that you will take to control leprosy
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References

186
Cook, G., & Zumla, A. (2003), Manson’s Tropical Diseases. (21st ed.). London: Saunders

Eshuis, J. & Manschot, P (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004).National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the management of
tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

Kingondu, T. et al. (2007), Communicable Disease, Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4th ed.).
Nairobi: AMREF

187
Session 30: Identification of Patients with Gonorrhoea
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Gonorrhoea
 Describe Mode of Transmission of Gonorrhoea
 Describe Major Signs and Symptoms of Gonorrhoea
 Explain Treatment of Gonorrhoea
 Explain Prevention and Control of Gonorrhoea
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks
15 minutes Presentation Causes of Gonorrhoea
2
Brainstorming
3 15 minutes Presentation Mode of Transmission of Gonorrhoea

30 minutes Presentation Major Signs and Symptoms of Gonorrhoea

4 Small group
discussion
5 20 minutes Presentation Treatment of Gonorrhoea

6 20 minutes Presentation Prevention and Control of Gonorrhoea

7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

188
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Gonorrhoea (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What is Gonorrhoea?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Gonorrhea is an acute or chronic purulent infection of the urogenital tract caused by

gonococcus is known as Neisseria gonorrhoeae
 Gonorrhea is by far the commonest of so called ‘classical STIs’ known before the
 emergence of HIV and AIDS all over the world
 Gonorrhea can cause sterility in both males and females and accounts for a serious
 decline in birth rate in some communities
 The Gonococcus is not able to penetrate intact skin or squamous epithelium but prefers
columnar epithelium such as in the urethra, endocervix, rectum and conjunctiva

STEP 3: Mode of Transmission of Gonorrhoea (15 minutes)

 Gonorrhoea is mainly transmitted through sexual intercourse,
o However, there are exceptions e.g. gonorrheal ophthalmia neonatorum is an acute
inflammation of the conjunctiva of the new born, contacted during passage through
the birth canal of an infected mother

189
STEP 4: Signs and Symptoms of Gonorrhoea (30 minutes)

Activity: Group discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are the signs and symptoms of gonorrhoea?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

The signs and symptoms may differ between men to females as follows;

In males
 The earliest symptom is irritation at the urinary meatus
o After an incubation period of 2 – 10 days, symptoms of urethritis develop in majority
of infected men
 A burning sensation when passing urine
 A purulent yellow and profuse discharge soon follow
 Dysuria (difficult in passing urine) may be slight or very severe
 Severe dysuria is often accompanied by urgency and frequency and occasionally
 Terminal haematuria (blood in urine)
 In untreated cases, the discharge which was purulent and profuse gradually become
o Scant and less purulent discharges may present only in the mornings

In females
 About 50 -80% of infected women have no symptoms
 Urethritis and discharge often may go unnoticed
 Cervicitis may cause a discharge
 Most of symptoms in females are due to complications of gonorrhoea
 The risk of infection after a single exposure to an infected partner ranges from 20 to 35%
in male and from 60 to 90% in females

STEP 5: Treatment of Gonorrhoea (20 minutes)

 The recommended first line drugs for treatment of Gonorrhoea include the following:
o Ceftriaxone
o Norfloxacin
o Ciprofloxacin
 The recommended alternative or second line drugs for treatment of Gonorrhoea include
the following:
o Cefixime

190
 o Cefoxitin
o Cefotaxime
o Spectinomycin (Togamycin)
o Azithromycin
o Cotrimoxazole

 Treatment of Ophthalmia neonatorum include:

o Gentamycin and Kanamycin
o Gentamicin can be available in form of eye drops
o Zinnat syrup (oral cephalosporin-cefuroxime)
o The eyes should be washed with saline 2 hourly for the first 12 hours and
subsequently every 4 hours

STEP 6: Prevention and Control of Gonorrhoea (20 minutes)

 Abstinence
 Avoid multiple partners and stick to one uninfected partner
 Proper and consistent use of condom
 Early diagnosis and treatment is important to reduce/prevent complications and further
spread of infection among the community
 Partners must be treated regardless of their symptoms or test results
 Health education on public awareness and specific knowledge of STIs in the target groups

STEP 7: Key Points (5 minutes)

 Gonorrhoea is a common STI in the community which needs prompt diagnosis and
treatment

STEP 8: Evaluation (5 minutes)

 What is Gonorrhoea?
 What are signs and symptoms of gonorrhea?
 What is mode of transmission of gonorrhea?
 What is the treatment of gonorrhea?
 How can you prevent Gonorrhoea in the community?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

 Explain preventive measures that you will take to control Gonorrhoea
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

191
References

Cook, G. Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London:

Saunders Ltd

Denyer, S. P. Hodges, N. A. &Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical

Microbiology (8thed). Oxford: Willey-Blackwell Publishing

Eshuis, J, & Manschot,P (1992).Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1st ed). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

192
Session 31: Identification of Patients with Syphilis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Syphilis
 Describe Mode of Transmission of Syphilis
 Describe Major Signs and Symptoms of Syphilis
 Explain Treatment of Syphilis
 Explain Prevention and Control of Syphilis
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 5 minutes Presentation Introduction, Learning Tasks

2 5 minutes Presentation Cause(s) of Syphilis

15 minutes Presentation Mode of Transmission of Syphilis

3
Buzzing
40 minutes Presentation Major Signs and Symptoms of Syphilis
4 Small group
discussion
5 10 minutes Presentation Treatment of Syphilis

6 30 minutes Presentation Prevention and control of Syphilis

7 5 minutes Presentation Key Points

8 5 minutes Presentation Evaluation

9 5 minutes Presentation Assignment

193
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Syphilis (5minutes)

 Syphilis: A chronic multi-systemic disease caused by the bacteria spirochetal bacterium

Treponema pallidum.

STEP 3: Mode of Transmission of Syphilis (15 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What is the mode of transmission of Syphilis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 The spirochaete Treponema pallidum enters the body through mucous membranes and
skin.
 The route of transmission of syphilis is almost always through sexual contact, although
there are other routes such as:
o Congenital Syphilis via transmission from mother to child in utero.
o Transfusion of unscreened blood.
o A patient with secondary syphilis who has mucosal or cutaneous lesion may transmit
the disease through physical contact.
o Unusual but possible transmission is accidental contact with infective tissue.

194
STEP 4: Signs and Symptoms of Syphilis (40 minutes)

Activity: Group discussion (20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are the signs and symptoms of Syphilis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

There are 3 main stages of the disease namely:

 Primary Syphilis
 Secondary Syphilis
 Tertiary Syphilis

Note: Different manifestations occur depending on the stage of the disease; as outlined
below:

Primary Syphilis
 Primary syphilis is typically acquired via direct sexual contact with the
infectious lesions of a person with syphilis.
 Approximately 10-90 days after the initial exposure (average 21 days), a skin lesion
appears at the point of contact, which is usually the genitalia, but can be anywhere on the
body
o This lesion, called a chancre which is a firm, painless skin ulceration localized at the
point of initial exposure to the spirochete, often on the penis, vagina, rectum or
elsewhere like lips, tongue, breast etc.
 The lesion may persist for 4 to 6 weeks and usually heals spontaneously.
 Local lymph node swelling can occur.

195
Secondary Syphilis
• Secondary syphilis occurs approximately 1–6 months (commonly 6 to 8 weeks) after the
primary infection.
• There are many different manifestations of secondary disease.
• A patient with syphilis is most contagious when he or she has secondary syphilis.
• There may be a symmetrical reddish pink non-itchy rash on the trunk and extremities.
• This is accompanied with mild constitutional systems, often described as flu-like.
• These rashes tend to be symmetrical can involve the palms of the hands and the soles of
the feet.
• In moist areas of the body such as anus, vulva, perineum, mouth, and axilla the rash
becomes flat, broad, whitish lesions known as condylomata lata.
• All of these lesions are infectious and harbor active treponema organisms.

Tertiary Syphilis
 Tertiary syphilis usually occurs 1–10 years after the initial infection, though in some
 Cases it can take up to 50 years.
 This stage is characterized by the formation of gummas which are soft, tumor-like lesions
of inflammation known as granulomas.
 They may appear almost anywhere in the body including the skeleton and brain.
 The more severe manifestations include neurosyphilis and cardiovascular syphilis
 The incubation period of syphilis varies from 10 days to 10 weeks with average of 3
weeks.

STEP 5: Treatment of Syphilis (10 minutes)

 The drug of choice is intramuscular Benzathine benzylpenicillin
 Doxycycline
 Erythromycin

196
STEP 6: Prevention and Control of Syphilis (30 minutes)

Activity: Group discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are the prevention and control measures of Syphilis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Abstinence
o Encourage delaying sexual activity for young people
 Sexual and reproductive health education to young people in and out of school
 Faithfulness (have one faithful uninfected partner)
 Using condoms correctly and consistently
o myths and misconceptions about condoms
 Screening and effective treatment of asymptomatic cases
 Effective treatment of STIs/RTIs
 Voluntary counseling and testing (VCT)
 Screening of blood for transfusion
 All pregnant women should be screened for syphilis routinely to prevent
congenital syphilis

STEP 7: Key Points (5minutes)

 Syphilis is sexually transmitted diseases cause by Treponema pallidum
• Syphilis is a disease characterized by a primary lesion, a later secondary eruption and
tertiary manifestation.
• Syphilis can also be transmitted from mother to the newborn leading to congenital
Syphilis.
• Syphilis can be prevented by proper and consistent condom use.

197
STEP 8: Evaluation (5minutes)
 What causes Syphilis?
 What is the mode of transmission of Syphilis?
 What are the signs and symptoms of Syphilis?
 What is the treatment of Syphilis?
 What are preventive and control measure of Syphilis?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating prevention and control
methods of Syphilis.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

References
198
Cook, G, & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.). London: Saunders
Ltd.

Denyer, S. P. Hodges, N. A., & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8th ed). Oxford: Willey-Blackwell publishing

Eshuis, J, & Manschot, P. (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1sted). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E., Kingondu, T., & Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF.

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

199
Session 32: Identification of Patients with Trichomoniasis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Trichomoniasis
 Describe Mode of Transmission of Trichomoniasis
 Describe Major Signs and Symptoms of Trichomoniasis
 Explain Treatment of Trichomoniasis
 Explain Prevention and Control of Trichomoniasis
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Causes of Trichomoniasis

15 minutes Presentation Mode of transmission of Trichomoniasis

3
Brainstorming
30 minutes Presentation Major Signs and Symptoms of
4 Small group Trichomoniasis
discussion
5 20 minutes Presentation Treatment of Trichomoniasis

30 minutes Presentation Prevention and Control of Trichomoniasis

6 Small group
discussion
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 05 minutes Presentation Assignment

200
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Trichomoniasis (5 minutes)

Definition
 Trichomoniasis: A highly transmissible protozoal infection of the genital tract of males
and females caused by Trichomonas vaginalis

STEP 3: Mode of Transmission of Trichomoniasis (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

 What is the mode of transmission of Trichomoniasis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Trichomoniasis is a very common infection of the female genital tract, affecting about
10% of all women
 Transmission is by sexual intercourse or by indirect contact through contaminated clothes
and other articles
 Susceptibility is general for both male and females but common in females
 The parasite survive in acidic environment (pH 4) found in the vagina of adult women
during the reproductive years
 The period of communicability spans from months to years if left untreated
 No protective immunity occurs in an individual infected with trichomoniasis

STEP 4: Signs and Symptoms of Trichomoniasis (30 minutes)

201
 Activity: Group discussion (15 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

o What are the signs and symptoms of Trichomoniasis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 The incubation period is 5 to 28 days

 Trichomonas vaginalis infection in women is frequently symptomatic presenting with
o Itching vaginitis
o Vulvar and cervical lesions
o Lower abdominal pain
o Dysuria and dyspareunia
o Increased vaginal foamy greenish yellow discharge

 In most males, the infection is frequently asymptomatic occasionally, urethritis,

epididymitis, and prostatitis can occur

STEP 5: Treatment of Trichomoniasis (30 minutes)

 The treatment of choice is a single dose of metronidazole
o Metronidazole is incompatible with alcohol and must not be given to women in
first trimester of pregnancy
 Tinidazole can also be used
 Clotrimazole pessaries in women with Trichomonas vaginalis (TV) who are pregnant
 Encourage the patient to bring the sexual partner for treatment.

STEP 6: Prevention and Control of Trichomoniasis (30 minutes)

202
 Activity: Group discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are the prevention and control measures of Trichomoniasis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Abstinence
 Encourage delaying sexual activity for young people
 Sexual and reproductive health education to young people in and out of school
 Faithfulness (have one faithful uninfected partner)
 Use of condoms correctly and consistently
o Correct myths and misconceptions about condoms
 Screening and effective treatment of asymptomatic cases e.g. partners of the patients
 Effective treatment of STIs

STEP 7: Key Points (5 minutes)

 Trichomoniasis is a protozoal infection of the genital tract of males and females
 Transmission is by sexual intercourse or by indirect contact through contaminated clothes
 Treatment of as well as their partners is important even if the partner is asymptomatic
 Prevention and control measures of Trichomoniasis are just like other STIs

STEP 8: Evaluation (5 minutes)

 What is Trichomoniasis?
 What is the mode of transmission of Trichomoniasis?
 What are signs and symptoms of Trichomoniasis?
 What is the drug of choice for treatment of Trichomoniasis?
 What are control and preventive measures of Trichomoniasis?

STEP 9: Assignment (5 minutes)

203
Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating prevention and control
methods of Trichomoniasis.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended reference

References

204
 Cook, G.& Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd.

Denyer, S. P. , Hodges, N. A.& Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, &Manschot, P (1992).Communicable diseases,(1st ed). Nairobi: AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

GoT (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1sted). Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF. Nordberg, E. (1999): Communicable Diseases, A Manual for Health
Workers in Sub-Saharan Africa, Nairobi: AMREF

205
Session 33: Identification of Patients with Vaginal
Candidiasis
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Cause(S) of Vaginal Candidiasis
 Describe Mode of Transmission of Vaginal Candidiasis
 Describe Major Signs And Symptoms of Vaginal Candidiasis
 Explain Treatment of Vaginal Candidiasis
 Explain Prevention and Control of Vaginal Candidiasis
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
10 minutes Presentation Cause(s) of Viginal Candidiasis
2
Buzzing
20 minutes Mode of Transmission of Viginal
3 Presentation Candidiasis
20 minutes Presentation Major Signs and Symptoms of Vaginal
4 Brainstorming Candidiasis

5 20 minutes Presentation Treatment of Vaginal Candidiasis

30 minutes Presentation Prevention and Control of Vaginal

6 Small group Candidiasis
discussion
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 05 minutes Presentation Assignment

206
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Vaginal Candidiasis (10 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What causes vaginal candidiasis?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Candidiasis: A fungal infection, caused by yeast called candida albicans

 Candidiasis usually affects people with impaired body immunity e.g.
o Skin or mucosal membranes, including:
 oral cavity (thrush; seen around the mouth as white patches)
 pharynx or esophagus
 gastrointestinal tract
 urinary bladder
 Candida can be isolated from the vagina in a high proportion of women of child bearing
age, many of whom will have no symptoms
 Infection in the vagina, it is known as vulvo-vaginal candidiasis.

STEP 3: Mode of Transmission of Vaginal Candidiasis (20 minutes)

 Candidiasis is not sexually transmitted, although occasionally can be spread from one
sexual partner to the other
o Partner of someone who has a yeast infection does not need treatment
 Candida can overgrow for many reasons including;
o Stress
o Pregnancy
o illnesses that affect the immune system may allow yeast to multiply
o Long term use of antibiotics and steroids.
 Women who have diabetes or HIV that is not controlled are at a higher risk for
candidiasis
 Recurrent yeast infections is a common complaint in women with HIV infection

207
 STEP 4: Signs and Symptoms of Vaginal Candidiasis (20 minutes)
Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What are the major signs and symptoms of vaginal candidiasis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Common signs and symptoms of Candida infections in women include:

o Itching and irritation in the vagina
o Redness, swelling, or itching of the vulva (the folds of skin outside the vagina)
o A thick, white discharge that can look like cheese-like discharge (curd-like
o Appearance) and is usually odourless, although it might smell like bread or yeast.
o Pain or burning when urinating
o Pain or discomfort during sexual intercourse

STEP 5: Treatment of Vaginal Candidiasis (20 minutes)

 Topical; pessaries or creams containing one of the antifungal such as clotrimazole,
miconazole and nystatin
 The following medicines are often used;
o Clotrimazole
o 1% cream
o 100 mg vaginal tablet at
o Miconazole
 2% cream 5 gm intra-vaginally
 vaginal pessaries ,
o Nystatin 100,000-unit vaginal tablet, one per day
 Fluconazole for involvement of systemic or recurrent infection

208
STEP 6: Prevention and Control of Candidiasis (30 minutes)
Activity: Group discussion (15 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

o What are the prevention and control measures of vaginal candidiasis?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Keep the external genital area clean and dry

 Avoid irritating soaps, vaginal sprays and douches
 Change tampons and sanitary napkins frequently
 Wear loose cotton (rather than nylon) underwear that does not trap moisture.
 Avoid prolonged use of antibiotics
 Control of diabetes mellitus minimizes the occurrence of candidiasis in diabetic patients

STEP 7: Key Points (5 minutes)

 Candidiasis is a fungal infection, caused by yeast called candida albicans
 The organism is also responsible for balanitis in men
 Women who have diabetes or HIV that isn't controlled are at a higher risk for candidiasis
 Control of diabetes mellitus minimizes the occurrence of candidiasis in diabetic patients

STEP 8: Evaluation (5 minutes)

 What is vaginal candidiasis?
 What are clinical features of vaginal candidiasis?
 What is the treatment is of vaginal candidiasis?
 What are the control and preventive measures of vaginal candidiasis?

STEP 9: Assignment (5 minutes)

209
Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating prevention and control of
vaginal candidiasis.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References
210
Cook, G. & Zumla, A. (2003). Manson’s Tropical Diseases. (21sted.). London:
Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s Pharmaceutical
Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis J, Manschot, P (1992). Communicable diseases, (1st ed). Nairobi: AMREF

GoT (2004) National Infection Prevention and Control (IPC) Guidelines for Healthcare
Workers. Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., Mugambi, E., et al. (2008) Communicable Diseases. (4thed.).
Nairobi: AMREF.

GoT (2013) Standard Treatment Guidelines & National Essential Medicines List (4thed). Dar
es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar es Salaam:
MOHSW/NACP

GoT (2007) National Guidelines for Management of Sexually Transmitted and Reproductive
Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E. (1999) Communicable Diseases, A Manual for Health Workers in Sub-Saharan

Africa, Nairobi: AMREF

211
Session 34: Introduction to Common Non-communicable
Diseases
Total Session Time: 60 minutes + 2 hours Assignment

Prerequisites
 None

Learning Task
By the end of this session students are expected to be able to:
 Describe Non-communicable Diseases
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Task
10 minutes Presentation Types of Non-communicable Diseases
2
Brainstorming
3 10 minutes Presentation Risk factors for Non-communicable Diseases
20 minutes Presentation
4 Prevention of Non-communicable Diseases
Buzzing
5 05 minutes Presentation Key points

6 05 minutes Presentation Evaluation

7 05 minutes Presentation Assignment

212
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Types of Communicable Disease (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What are the types of non-communicable diseases?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below:

Non-communicable diseases (NCD) are medical conditions or diseases which are not
infectious and cannot be transferred from person to person
o Diseases last for long periods of time and progress slowly

Common groups of non-communicable diseases include:

 Cardiovascular diseases (CVDs) - e.g. heart failure, hypertension
 Cancers - e.g. lung cancer, breast cancer, cervical cancer
 Gastrointestinal disorders- e.g. peptic ulcers
 Chronic respiratory diseases - e.g. chronic pulmonary diseases (COPDs), asthma
 Diabetes

STEP 3: Risk factors for Non-Communicable Diseases (10 minutes)

Risk factors for NCD are divided into two groups:
 Biological risk factors:
o Hypertension
o High cholesterol in the blood
o Glucose
o Obesity

 Behavioral risk factors:

o Tobacco use
o Unhealthy diet
o Harmful use of alcohol
o Physical inactivity

213
STEP 4: Prevention and Control of Common Non-Communicable Diseases
(20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are preventive measures of non-communicable diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Early detection and treatment is important to reduce morbidity and mortality for NCD related
disorders
 Advise people to stop smoking tobacco to minimize chance of acquiring chronic
respiratory, cardiovascular and other pathological disorders
 Encourage balanced diet and regular physical exercise to avoid
being overweight or obesity
 Encourage people to stop or reduce alcohol intake
 Focus on behavioural change as the core component of all clinical programmes for the
prevention and management of NCDs
 Establish centers to improve preventive programmes for NCDs in local areas

STEP 5: Key Points (5 minutes)

 NCDs are chronic diseases which last for long periods and progress slowly.
 Common groups of non-communicable diseases include diabetes, cardiovascular diseases
and cancer
 Biological and behavioral risks factors are of medical importance in NCDs.
 Majority of NCDs are preventable that requires environmental and lifestyle modifications

STEP 6: Evaluation (5minutes)

 What are non-communicable diseases?
 What are risk factors for non-communicable diseases?
 What are preventive measures for non-communicable diseases?

214
STEP 7: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

• Explain preventive measures that you will take to control non-communicable diseases
in your area
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

215
References

Braunwald, E. & Fauci, A.N. (2008) Harrison’s Principles of Internal Medicine (17thed.).
Oxford: McGraw Hill.

Davidson, S. (2006) Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006) Textbook of Clinical Medicine. Churchill: Livingstone.

216
Session 35: Identification of Patients with Hypertension
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Hypertension
 Describe Types of Hypertension
 Describe Major Signs and Symptoms of Hypertension
 Explain Treatment Of Hypertension
 Explain Prevention and Control of Hypertension

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Cause of Hypertension

20 minutes Presentation Types of Hypertension

3
Buzzing
4 15 minutes Presentation Major Signs and Symptoms of Hypertension

5 20 minutes Presentation Treatment of Common Hypertension

40 minutes Presentation Prevention and Control of Hypertension

6 Small group
discussion
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 05 minutes Presentation Assignment

217
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Hypertension (5 minutes)

 Hypertension or high blood pressure is a chronic medical condition in which the blood
pressure in the arteries is persistently raised
 Blood pressure is expressed by two measurements:
o The systolic pressure occurs when the left ventricle contract
o The diastolic pressure occurs when the left ventricle relaxes before the next
contraction
 Normal blood pressure at rest is within the range of 100–140 millimeters
mercury (mmHg) systolic and 60–90 mmHg diastolic.
 Hypertension is present if the blood pressure is persistently at or above 140/90 mmHg for
most adults

STEP 3: Types of Hypertension (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the types of hypertension?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Hypertension is classified as either:

 Primary (essential) hypertension defined as high blood pressure with no obvious
underlying cause.
o About 90–95% of cases are categorized as primary hypertension
 Secondary hypertension; defined as hypertension due to an identifiable cause
o Accounts for remaining 5–10% of cases of hypertension,
o Causes of secondary hypertension;
 chronic kidney disease,
 pregnancy
 alcohol
 narrowing of the aorta or kidney arteries
218
  Endocrine disorder e.g. excessive aldosterone, cortisol, or catecholamines
 Drugs such as corticosteroids, non-steroidal anti-inflammatory drugs

STEP 4: Signs and Symptoms of Hypertension (15 minutes)

 Hypertension usually does not cause symptoms initially
 Some patients report;
o Headaches (particularly at the back of the head and in the morning)
o Vertigo,
o Tinnitus (buzzing or hissing in the ears)
o Altered vision or fainting episodes
 Sustained hypertension over time is a major risk factor for:
o Heart disease
o Coronary artery disease
o Stroke
o Aortic aneurysm
o Peripheral artery disease
o Chronic kidney disease

STEP 5: Treatment of Hypertension (20 minutes)

 Refer patients to the hospital for investigations and initial treatment and follow up may be
even done at dispensary or health centre
 Antihypertensive medications are available for treating hypertension
 First line medications for hypertension include:
o Tthiazide - diuretics e.g. hydrochlorothiazide
o Calcium channel blockers, e.g. diltiazem
o Angiotensin converting enzyme inhibitors e.g. captopril
o Angiotensin receptor blockers e.g. losartan
 These drugs may be used alone or in combination
 The majority of people require more than one medication to control their
hypertension.

219
STEP 6: Prevention and Control of Hypertension (40 minutes)

Activity: Group discussion (30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are preventive and control measures of hypertension?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Lifestyle changes are recommended to lower blood pressure, before starting drug therapy.
o Maintain normal body weight for adults (e.g. Body mass index 20 – 25 kg/m2)
o Reduce dietary sodium intake
o Engage in regular physical activity e.g. Walking
o Limit alcohol consumption
 consume a diet rich in fruit and vegetables
 Stop smoking and reduce intake of dietary saturated fat and cholesterol
 Lifestyle modification may lower blood pressure as much as antihypertensive drug
 Patient education
o Hypertension is a lifelong disorder
 Long-term commitment to lifestyle modifications and pharmacological therapy is
required.
 Repeated in-depth patient education and counselling improve compliance and
reduce cardiovascular risk factors.

STEP 7: Key Points (5 minutes)

 Hypertension is diagnosed by properly measuring elevated blood pressure at three or
more separate occasions based on 2 or more readings.
 Treatment approach in hypertension is based upon its severity by classification ranging
from non pharmacological to pharmacological.
 Patient’s education repeatedly carries a great role for optimal control of hypertension by
lifelong commitment to lifestyle modification and drug therapy.

STEP 8: Evaluation (5 minutes)

 What is hypertension?
 How is hypertension classified?
 What is the pharmacological treatment of hypertension?
 What are preventive measures of hypertension?

220
STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

ASK the students to work individually on the following Assignment

• Explain preventive measures for hypertension
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

221
References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal Medicine (17thed.).

Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill: Livingstone.

MOHSW (2005).Tanzania National Formulary. Dar es Salaam: MoHSW

222
Session 36: Identification of Patients with Diabetes
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Diabetes
 Describe Types of Diabetes
 Describe Major Signs and Symptoms of Diabetes
 Explain Treatment of Common Diabetes
 Explain Prevention and Control of Diabetes

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

Presentation Causes of Diabetes

2 10 minutes
Brainstorming
3 10 minutes Presentation Types of Diabetes

30 minutes Presentation Major Signs and symptoms of Diabetes

4
Buzzing
5 20 minutes Presentation Treatment of Diabetes

30 minutes Presentation Prevention and Control of Diabetes

6 Small group
discussion
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 05 minutes Presentation Assignment

223
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Diabetes (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What causes diabetes?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Diabetes mellitus (DM) comprises Hyperglycemia is a cardinal manifestation due to;

o Insulin deficiency or
o Insulin resistance
 Several distinct types of DM exist and are caused by a complex interaction of genetics,
environmental factors and life-style choices
 Factors contributing to hyperglycemia may include:
o Reduced insulin secretion
o Decreased glucose usage, and
o Increased glucose production

STEP 3: Types of Diabetes (10 minutes)

There are three main types of diabetes mellitus:

 Type 1 DM results from failure of pancreases to produce enough insulin
o This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM)
or "juvenile diabetes".
o The cause is unknown
 Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to
insulin properly.
o As the disease progresses a lack of insulin may develop
o This form was previously referred to as "non insulin-dependent diabetes mellitus"
(NIDDM) or "adult-onset diabetes"
o The primary cause is excessive body weight

224
 o Risk Factors for Type 2 Diabetes Mellitus
 Family history of diabetes (i.e. parent or sibling with type 2 diabetes)
 Obesity i.e. body mass index (BMI) >27kg/m2
 Age >45 years
 History of gestational diabetes mellitus
 Hypertension
 High density lipoprotein (HDL) cholesterol <0.90 mmol/l (35mg/dl)
 In HIV patients, the HAART therapy can increase risk of diabetes
 Gestational diabetes, is the third main form and occurs when pregnant women without
a previous history of diabetes develop a high blood sugar level.

STEP 4: Signs and Symptoms of Diabetes (30 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the signs and symptoms of diabetes?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Clinical features of DM depend on the severity of disease and its complications. They
include:
 Polyuria
 Polydipsia
 Polyphagia
 Hyperglycaemia
 Glycosuria
 Keto acidosis
 Coma
 Weight loss
 Fatigue
 Weakness
 Blurred vision
 Frequent superficial infections e.g. vaginitis, fungal skin infections
 Slow healing of skin lesions after minor trauma

225
Figure 36.1: Main symptoms of diabetes

STEP 5: Treatment of Diabetes (20 minutes)

 Treatment of DM should be initiated at hospital after thorough evaluation
 Follow up may be done in the health centre when patients are stable

Type I Diabetes Mellitus

Insulin is required
 The commonly used types of insulin are:
o Fast-acting: Includes the insulin analogues aspart, lispro, and glulisine.
 These begin to work within 5 to 15 minutes and are active for 3 to 4 hours.
o Short-acting: Includes regular insulin
 Begins working within 30 minutes and is active about 5 to 8 hours.
o Intermediate-acting: Includes NPH insulin
 Begins working in 1 to 3 hours and is active 16 to 24 hours.
o Long acting: Includes the analogues glargine and detemir,
o Begins working within 1 to 2 hours and continue to be active, without major peaks or
dips, for about 24 hours, although this varies in many individuals.
o Ultra-long acting: Currently only includes the analogue degludec,
 Begins working within 30–90 minutes, and continues to be active for greater than
24 hours
o Combination insulin products – Includes a combination
 of either fast-acting or short-acting insulin

226
Type 2 Diabetes Mellitus
 There are several classes of anti-diabetic medications available such as:
o Biguanides; e.g. Metformin
o Sulfonylureas,
 First generation e.g. Chlorpropamide, Tolbutamide
 Second generation e.g. Glipizide, Gliclazide, Glibenclamide, Glyburide
 Third generation e.g. Glimepiride, Gliclazide MR (DIAMICRON MR 60)
o Thiazolidinediones e.g Rosiglitazone

STEP 6: Prevention of Diabetes (30 minutes)

Activity: Group discussion (30 minutes)

DIVIDEstudents into small manageable groups

ASK students to discuss on the following question

• What are the preventive measures of diabetes?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Regular daily exercise is important; recommendation is 20-30 minutes of exercise daily

(this can be walking).
 Educated patients about long term consequences of uncontrolled diabetes such as:
o Renal impairment
o Higher risk of ocular damage
o Increased risk of heart attack
o Neuropathy
 Patient education allows individuals with DM to assume greater responsibility for their
care including compliance with medications

STEP 7: Key Points (5 minutes)

 Diabetes mellitus is a group of common metabolic disorders that present with
hyperglycemia
 Diabetes mellitus is caused by insulin deficiency or insulin resistance
 Types of diabetes mellitus includes type I, type II and gestational diabetes
 Signs and symptoms are Polyuria, hyperglycemia, Glycosuria, weight loss and blurred
vision
 Treatment depends on the type of diabetes mellitus; type I requires insulin where as type
II requires ant-diabetic medicine
227
 Preventive measures include regular daily exercise and patient education about long term
consequences of uncontrolled diabetes

STEP 8: Evaluation (5 minutes)

 What is diabetes mellitus?
 What are the causes of diabetes mellitus
 What are the types of diabetes?
 What are the signs and symptoms of diabetes mellitus?
 What is the treatment of diabetes mellitus?
 What are the preventive measures of diabetes mellitus?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work individually on the following Assignment

• Explain preventive measures that you will take to control diabetes
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

228
References
Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal Medicine (17thed.).
Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill: Livingstone.

229
 Session 37: Identification of Patients with Peptic Ulcers
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Peptic Ulcers
 Describe Types of Peptic Ulcers
 Describe Major Signs and Symptoms of Peptic Ulcers
 Explain Treatment of Common Peptic Ulcers
 Explain Prevention and Control of Peptic Ulcers

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Causes of Peptic Ulcers

15 minutes Presentation Types of Peptic Ulcers

3
Brainstorming
30 minutes Presentation Major Signs and Symptoms of Peptic Ulcers
4
Buzzing
5 20 minutes Presentation Treatment of Peptic Ulcers

30 minutes Presentation Prevention and Control of Peptic Ulcers

6 Small group
discussion
7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 05 minutes Presentation Assignment

230
SESSION CONTENTS

STEP1: Presentation of Session Title and Related Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Peptic Ulcers (5 minutes)

 Definition : An ulcers is a break in the mucosal surface >5 mm in size, with depth to the
submucosa
 Common causes include;
o The bacteria, helicobacter pylori
o non-steroidal anti-inflammatory drugs
o tobacco smoking
o Alcohol
o Psychological stress
o Diet: certain foods can cause dyspepsia, but no convincing studies indicate an
association between ulcer formation and a specific diet.

STEP 3: Types of Peptic Ulcers (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

• What are the types of peptic ulcers?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 PUD encompasses:
o Gastric ulcers (GU) which is an ulcer in the stomach
o Duodenal ulcers (DU) which is an ulcer in the first part of the small intestines
(duodenum)
 Duodenal and gastric ulcers share common features in terms of pathogenesis, diagnosis,
and treatment, but several factors distinguish them from one another.

231
STEP 4: Signs and Symptoms of Peptic Ulcers (30 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are signs and symptoms of peptic ulcers?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Signs and symptoms of peptic ulcer can include one or more of the following:
 Epigastric pains associated with mealtimes
o pain appears about three hours after taking a meal in duodenal ulcers
 Bloating and abdominal fullness
 Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric
ulcer, or from damage to the esophagus from severe/continuing vomiting.
 Melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin);
 Nausea, and copious vomiting;
 Loss of appetite
 Weight loss
 Dyspepsia that becomes constant not relieved by food or antacids, radiating to the back
may indicate a penetrating ulcer

STEP 5: Treatment of Peptic Ulcers (20 minutes)

 Treatment is initiated at the hospital
 The clinician's goal in treating PUD is to:
o Provide relief of symptoms (pain or dyspepsia)
o Promote ulcer healing
o Prevent ulcer recurrence and complications

 Therapy for H. Pylori Eradication

o H. pylori should be eradicated in patients with documented PUD
o The agents used with the greatest frequency include:
 Amoxicillin
 Metronidazole
 Tetracycline
 Clarithromycin
 Bismuth compounds
o Triple Therapy Regimes include:
 Amoxicillin, Metronidazole and omeprazole
 Lansoprazole, clarithromycin, and amoxicillin

232
  Bismuth subsalicylate, tetracycline, and metronidazole etc.
 Antacids e.g. Magnesium Trisilicate - offer symptomatic relief by neutralizing stomach
acidity
 Acid inhibitory agents - decrease the amount of acid in the stomach helping with healing
of ulcers.
o Histamine 2 receptors blockers (H2 blockers) e.g. Ranitidine, fomatidine
o Proton Pump Inhibitors (PPIs)e.g. Omeprazole, Lansoprazole
 Prostaglandin analogue (misoprostol) for prevention of NSAID-induced ulceration

STEP 6: Prevention and Control of Peptic Ulcers (30 minutes)

Activity: Group discussion (20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

o What are preventive and control measures of peptic ulcers?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Personal hygiene - It's not clear how H. pylori spread, but there's some evidence that it could
be transmitted from person to person or through food and water.
o Wash hands with soap and water before handling
o Eat foods properly cooked
 Use NSAIDs with caution.
o Avoid taking aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs
o Take medication with meals
 Avoid drinking or drink alcohol in small amounts
o Avoid drinking alcohol when taking medication
 Don't smoke. Smokers are much more likely to get ulcers

STEP 7: Key Points (5 minutes)

 Peptic ulcer is caused by bacterial infection, drugs, alcohol and stress
 Types of peptic ulcer includes duodenal and gastric ulcers
 Signs and symptoms are epigastric pains, abdominal fullness, loss of weight, nausea and
vomiting
 Treatment is mainly with antacids and antibiotics may be required
 Prevention strategies includes avoid alcohol, smoking and stress

233
STEP 8: Evaluation (5 minutes)
 What causes peptic ulcer?
 What are the types of peptic ulcers
 What are signs and symptoms of peptic ulcers?
 What is the treatment of peptic ulcers?
 What are preventive measures of peptic ulcers?

STEP 9: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE individual assignment

ASK the students to work individually on the following Assignment

• Explain preventive measures that you will take to control peptic ulcers
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

234
References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal Medicine (15thed.).

Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill: Livingstone

MOHSW (2005).National Formulary. Dar es Salaam: Ministry of Health and Social Welfare.

Swash, M. & Glynn, M. (2007). Hutchison’s Clinical Methods (22nded.). London: Harcourt
Publishers Ltd.

235
Session 38: Identification of Patients with Asthma
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Asthma
 Describe Major Signs and Symptoms of Asthma
 Explain Treatment of Asthma
 Describe Prevention and Control of Asthma
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 38.1: Bronchial Asthma - Precipitating or Aggravating Factors

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

Presentation Causes of Asthma

2 20 minutes
Brainstorming
3 10 minutes Presentation Major Signs and Symptoms of Asthma

4 10 minutes Presentation Treatment of Asthma

50 minutes Presentation Prevention and Control of Asthma

5
Group discussion
6 05 minutes Presentation Key Points

7 10 minutes Presentation Evaluation

8 10minutes Presentation Assignment

236
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Cause(s) of Asthma (20 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

 What are the causes of asthma?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

 Asthma is a respiratory tract disorder characterized by chronic inflammatory reversible

airways obstruction.
 Involves the respiratory system constricting the airway
 Bronchial asthma may be either episodic (the patient has no respiratory symptoms
between episodes, or signs of asthma.
 Paroxysm of wheeze and dyspnoea may occur at any time and can be of sudden onset
 May be extrinsic (this occurs to young people due to allergy) or intrinsic (occurs in older
people)

Causes
 The symptoms are caused by constriction of bronchial smooth muscle (bronchospasm),
oedema of bronchial mucous membrane and blockage of the smaller bronchi with plug of
mucous
 It can also be triggered by factors like allergens, infections, exercise, tobacco smoke
inhaled chemicals and drugs for example aspirin
 High risk jobs such as farming, painting, janitorial work and plastic manufacturing
 Generally it can be caused by a complex interaction of environmental and genetic factors

Handout 38.1: Bronchial Asthma - Precipitating or Aggravating Factors

237
STEP 3: Major Signs and Symptoms of Asthma (10 minutes)
 Signs and Symptoms of Asthma:
o Wheezing
o Productive cough
o Shortness of breath (dyspnoea)
o Chest tightness
o Increased respiratory rate
o Increased heart rate
o Diaphoresis (excessive sweating)
o Decreased exercise tolerance
Cough and wheeze are common during the night and may disturb sleep

STEP 4: Treatment of Asthma (10 minutes)

 Acute severe asthma and life threatening asthma in adult
o Perform pre-referral treatment:
 Nebulized salbutamol or inhaled salbutamol (if available)
 Hydrocortisone 200mg i.v slowly (if available)
 Aminophylline 250mg i.v slowly or tabs
 Monitor vital signs
o Refer to hospital immediately

 Treatment at the hospital

o Oxygen 40-60% via nasal prongs or face mask if available
o Nebulized salbutamol or inhaled salbutamol delivered by a spacer
o Hydrocortisone 200mg i.v slowly then oral prednisolone 30-60mg for 5-7 days
o Aminophylline 250mg i.v slowly or tabs when therapy above fails

STEP 5: Prevention and Control of Asthma (50 minutes)

Activity: Small Group Discussion ( 10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the measures for the prevention and control of asthma?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

238
 Patient Education
 Should begin at the time of diagnosis and be revisited in every subsequent consultation.
 Education involves the patient understanding the nature of asthma, the practical skills
necessary to manage asthma successfully for example using inhaler devices and monitor
the effect of treatment
 Patients should appreciate the differences between the reliever medication
(bronchodilator) and the controller medication (anti-inflammatory)

Prevention of Asthmatic Attack

 Avoidance of exposure to allergen to which patients are sensitive to:
o Animal dander: Avoid contact with dogs, cats, horses or other animals.
o Feathers in pillows or quilts: Substitute latex foam pillows and terylene quilts.
o Avoid all preparations of relevant drugs for example beta-blockers, aspirin and other
nonsteroidal anti-inflammatory drugs if the patient is sensitive.
o Food: Identify and eliminate from diet.
o Industrial chemicals e.g. isocyanates, epoxy resins, perfumes: Avoid exposure to
chemical or change occupation.
o Do not smoke and avoid environmental smoke.
o Pollens: Try to avoid exposure to flowering vegetation and keep the bedroom
windows closed.
o Avoid exertion during high levels of pollution.

STEP 6: Key Points (5 minutes)

 Asthma can either be caused by a complex interaction of environmental and genetic
factors.
 Major signs and symptoms includes wheezing, shortness of breath (dyspnoea) and chest
tightness
 Severe bronchial asthma is an emergency which need urgent attention.
 Educating patients with bronchial asthma should start early when diagnosis is established
in order to carry out necessary precautions.

STEP 7: Evaluation (10minutes)

 What are the cause(s) of asthma?
 What are the major signs and symptoms of asthma?
 What is the treatment of asthma?
 What are the measures for prevention of asthma?

239
STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation on how environmental and genetic factors cause Asthma?
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

240
References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal Medicine (17thed.).

Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine (6thed.). Churchill: Livingstone

MoHSW. (2013). Standard Treatment Guidelines & National Essential MedicinesList

(4thed.). Dar es Salaam: MoHSW

Wikipedia. (2010). Asthma Before-After.Retrieved

fromhttp://en.wikipedia.org/wiki/File:Asthma_before-after.png

241
Handout 38.1: Bronchial Asthma - Precipitating or
Aggravating Factors

242
Session 39: Identification of Patients with Allergic Rhinitis
Total Session Time: 60 minutes + 1 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Causes of Allergic Rhinitis
 Describe Mode of Transmission of Allergic Rhinitis
 Describe Major Signs and Symptoms of Allergic Rhinitis
 Explain Treatment Allergic Rhinitis
 Explain Prevention and Control Allergic Rhinitis
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD Projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

2 05 minutes Presentation Causes of Allergic Reactions

15 minutes Presentation Major Signs and Symptoms Allergic

3 Reactions
Brainstorming

4 10 minutes Presentation Treatment of Allergic Reactions

10 minutes Presentation Prevention and Control of Allergic

5 Reactions

6 05 minutes Presentation Key Points

7 05 minutes Presentation Evaluation

8 05 minutes Presentation Assignment

243
SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Allergic Rhinitis (5 minutes)

Definition
 Allergic rhinitis is inflammation of the nasal membranes characterized by a combination
of the following symptoms:
o Sneezing
o Nasal congestion
o Conjunctival irritation
o Nasal and pharyngeal itching
o Lacrimation (rhinorrhea)
 Rhinitis is present if sneezing attacks, nasal discharge or blockage occur for more than an
hour on most days for:
o A limited period of the year (seasonal rhinitis-often called hay fever)
o Throughout the whole year (perennial rhinitis)

Causes of Allergic Rhinitis

 Allergic rhinitis is caused by things that trigger allergies (allergens)
 These allergens can be found both outdoors and indoors
 When allergic rhinitis is caused by common outdoor allergens such as mold or trees, grass
and weed pollens
 Allergic rhinitis may also be triggered by allergens that are in your house, such as animal
dander (tiny skin flakes and saliva), indoor mold, or the droppings of cockroaches or
house dust mites.

STEP 3: Signs and Symptoms of Allergic Rhinitis (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

 What are the major signs and symptoms of allergic rhinitis?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

244
 Symptoms of Allergic Rhinitis
o Sneezing
o Itching (of nose, eyes, ears, and Palate)
o Rhinorrhea
o Postnasal drip
o Congestion
o Anosmia
o Headache
o Ear ache
o Tearing
o Red eyes
o Eye swelling
o Fatigue
o Drowsiness
o Malaise

STEP 4: Treatment of Allergic Rhinitis (10 minutes)

Antihistamines
 Antihistamines work well for treating allergy symptoms, especially when symptoms do
not happen very often or do not last very long.
 Antihistamines taken by mouth can relieve mild to moderate symptoms, but can cause
sleepiness e.g. Citerizine
 Azelastine is a nasal spray used to treat allergic rhinitis

Corticosteroids
 Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis.
 They work best when used for long term, but they can also be helpful when used for
shorter periods

Decongestants
 Decongestants may also be helpful in reducing symptoms such as nasal congestion.
 Nasal spray decongestants should not be used for more than 3 days.

STEP 5: Prevention and Control of Allergic Rhinitis (10 minutes)

Identify and avoid all triggers of allergic symptoms

245
STEP 6: Key Points (5 minutes)
 Allergic rhinitis is inflammation of the nasal membranes
 Allergic rhinitis is caused by allergens common in childhood, adolescence and early adult
hood
 Treatment depends on the type and severity of symptoms, age, and whether
there are other medical conditions (such as asthma)
 Prevention involves avoiding all triggering factors of your symptoms

STEP 7: Evaluation (5minutes)

 What is allergic rhinitis?
 What are signs and symptoms of allergic rhinitis?
 What is the treatment of allergic rhinitis?
 What is preventive and control measures of allergic rhinitis?

STEP 8: Assignment (5 minutes)

Activity: Take Home Assignment (5 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Prepare a presentation to be delivered to the class indicating prevention and control of
allergic rhinitis

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

246
References
Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal Medicine (17thed)
Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.). Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine (6th ed.). Churchill:
Livingstone

Swash, M. & Glynn, M. (2007). Hutchison’s Clinical Methods (22nded.). London:

Harcourt Publishers Ltd.

247
Session 40: Prevention and Control of Contamination in
Pharmaceutical Settings
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Explain Sources of Contamination in Pharmaceutical Settings
 Explain The Consequences of Contamination on Pharmaceutical Products
 Describe Measures for Preventing and Controlling Contamination in Pharmaceutical
Settings

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

20 minutes Presentation Sources of Contamination in Pharmaceutical

2
Brainstorm Settings
20 minutes Presentation Consequences of Contamination on
3
Buzzing Pharmaceutical Products
50 minutes Presentation Measures for Preventing and Controlling
4 Small group Contamination in Pharmaceutical Settings
discussion
5 05 minutes Presentation Key Points

6 10 minutes Presentation Evaluation

7 10 minutes Presentation Assignment

248
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Sources of Contamination in Pharmaceutical Settings (20 minutes)

Activity: Brainstorming (10 minutes)

Ask students to brainstorm on the following question:

 What are sources of contamination in pharmaceutical setting?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Microbiological contamination
Refers to non- intended or accidental introduction of infectious material like bacteria, yeast,
mould, fungi, virus, prions, protozoa or their toxins and by-products

Sources of contamination in pharmaceutical settings

In manufacture/ compounding
 Regardless of whether manufacture takes place in industry or on a smaller scale in the
hospital pharmacy, the microbiological quality of the finished product will be determined
by:
o Formulation components used
o Environment in which they are manufactured
o Manufacturing process itself.

 Quality must be built into the product at all stages of the process and not inspected at the
end of manufacture or compounding. The following are sources of contamination:
o Raw materials: particularly water and ingredients
o Processing equipment
o Cleaning equipment: Premises/environment
o Staff
o Packaging

249
In use
 Pharmaceutical manufacturers may argue that their responsibility ends with the supply of
a well- preserved product of high microbiological standard in a suitable pack and that the
subsequent use, or abuse, of the product is of little concern to them.

 Products such as multi-dose may acquire contamination on their continued use or if

subjected in a contaminated state, particularly in hospitals where it could result in the
spread of cross - infection.

 Human sources:
o During normal usage, patients may contaminate their medicine with their own
microbial flora; subsequent use of such products may or may not result in self –
infection.
o Topical products are considered to be most at risk, as the product will probably be
applied by hand, thus introducing contaminants from the resident skin flora of
staphylococci,
o Micrococcus species and diphtheroids but also perhaps transient contaminants, such
as pseudomonas or coliforms, which would normally be removed with effective hand-
washing.
o A further potential source of contamination in hospitals is the nursing staff
responsible for medicament administration.

 Environmental sources:
o Small numbers of airborne contaminants may settle in products left open to the
atmosphere.
 Equipment sources:
o Patients and nursing staff may use a range of applicators (pads, sponges, brushes and
spatulas) during medicament administration, particularly for topical products
o If reused, these easily become contaminated and may be responsible for perpetuating
contamination between fresh stocks of product, as has indeed been shown in studies
of cosmetic products.

250
STEP 3: Consequences of Contamination on Pharmaceutical Products (20
minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the consequences of contamination on pharmaceutical products?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

 Initiating infections
o Cross-contamination of medicines contributes to most of the nosocomial infections
occurring in hospitals
o It also accounts for most of the postsurgical infections and deaths occurring in
hospitals.
o Cross-contaminated medicines weaken the relationship between patients and
healthcare givers.
o This occurs mostly in the event of drug resistance and treatment failure, but also
infections due to contaminated medicines make patients lose trust in their health care
givers.

 Medicines spoilage
o This occurs by microorganisms chemically decomposing the active
ingredient or the excipients. This may lead to:
 The product being under- strength,
 Physically or chemically unstable, or possibly
 Contaminated with toxic materials.
 Financial loss
o Contaminated products have financial implications in terms of:
 additional treatment costs
 product recalls
 possible litigation/ legal action
 damage to the reputation of the manufacturer or compounder

251
STEP 4: Measures for Preventing and Controlling Contamination in
Pharmaceutical Settings (50 minutes)

Activity: Small Group Discussion (10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the measures for preventing and controlling contamination in
pharmaceutical settings?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

 Raw materials, particularly water and those ingredients of natural origin, must be of a
high microbiological standard.
 Water for pharmaceutical manufacture requires some further treatment, usually by
distillation, reverse osmosis or deionization
 Processing and compounding equipment should be subjected to planned preventive
maintenance and should be properly cleaned after use to prevent cross - contamination
between batches
 Cleaning equipment should be appropriate for the task in hand and should be thoroughly
cleaned and properly maintained.
o These are responsible for distributing organisms around the pharmacy area.
o For example mops, buckets, cleaning cloths and scrubbing machines if stored wet
they provide a convenient niche for microbial growth.
 Manufacture should take place in suitable premises, supplied with filtered air, for which
the environmental requirements vary according to the type of product being made.
 Free - living opportunist pathogens, such as pseudomonas aeruginosa, can normally be
found in wet sites, such as drains, sinks and taps.
o This may be minimized by observing good manufacturing practices (GMP), by
installing heating traps in sink U - bends, thus destroying one of the main reservoirs of
contaminants
 Patients and nurses use a range of applicators (pads, sponges, brushes, spatulas and
spoons) during medicament administration, particularly for topical and oral products.
 These should be made as disposable so as to minimise contamination.
 In busy wards:
o Hand - washing between attending to patients may be overlooked and
o Contaminants may subsequently be transferred to medicaments during administration
o Emphasize use of non - touch techniques for medicament administration

252
 Staff involved in manufacture or compounding should not only have good health but also
a sound knowledge of the importance of personal and production hygiene.
 They should dress appropriately and use protective gears such as boots, coats, caps,
gloves and masks in controlling contamination
 The end - products requires suitable packaging which will protect it from contamination
during its shelf- life and is itself free from contamination.
 Sacking, cardboard, card liners, corks and paper are unsuitable for packaging
pharmaceuticals, as they are heavily contaminated.
o These have now been replaced by non -biodegradable plastic materials.
o Re-use of packaging materials should be discouraged.
o Effective control method includes the supply of products in individual patient’s packs.

STEP 5: Key Points (5 minutes)

 Contamination of pharmaceutical products may occur during manufacturing/compounding
and use
 Consequences of medicine contamination include; initiation of infections, products
spoilage and financial loss
 It is important to use different preventive measures for controlling contamination in
pharmaceutical settings in order to minimize the risks of contamination.

STEP 6: Evaluation (10 minutes)

 What are the sources of contamination in pharmaceutical settings?
 What are the consequences of contamination on pharmaceutical products?
 What are the measures for preventing and controlling contamination in pharmaceutical
settings?

STEP 7: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Visit a hospital pharmacy department, basing on its design/set up; write a presentation on
factors responsible for contamination of pharmaceutical products and give suggestions on
what should be done to avoid the consequences of contamination.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

253
References

Denyer, P. D, Hodges, N. Gorman, S. P. & Gilmore, B. F. (2011). Hugo &

Russell’sPharmaceutical Microbiology. (8thed.). West Sussex:Blackwell Publishing Ltd,

Gabriel J (2008). Infusion therapy: Prevention and management of complications. Nurs

Stand.; 22(32): 41-48

Senya, S., Mwasha, C.Y.S, Muyinga, A.M, Amir, R.I, & Mauga, E.A.S.K, (2011) Tanzania
Pharmaceutical Handbook. (2nded.). Dar es Salaam: ARU Printing Unit

254
Session 41: Methods for Disposing Pharmaceutical Wastes
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Define Terminologies Applied in Disposal of Pharmaceutical Wastes
 Describe Categories of Healthcare Wastes
 Describe Principles of Waste Management
 Describe Methods for Disposal of Pharmaceutical Wastes
 Explain Consequences of Improper Disposal of Pharmaceutical Wastes
 Describe Procedure for Safe Disposal of Unfit Medicines as per Tanzania Foods, Drugs
and Cosmetics Act, 2003

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Handout 41.1: Categories of Health Care Wastes
 Handout 41.2: Category of products and their recommended disposal methods

255
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks

Terminologies Applied in Disposal of

2 05 minutes Presentation
Pharmaceutical Wastes
20 minutes Presentation Categories of Healthcare Wastes
3
Brainstorming
4 10 minutes Presentation Principles of Waste Management

30 minutes Presentation Methods for Disposal of Pharmaceutical

5
Buzzing Wastes
15 minutes Presentation Consequences of Improper Disposal of
6
buzzing Pharmaceutical Wastes
10 minutes Procedure for Safe Disposal of Unfit
7 Presentation Medicines as Per Tanzania Foods, Drugs and
Cosmetics Act, 2003
8 05 minutes Presentation Key Point

9 10 minutes Presentation Evaluation

10 10 minutes Presentation Assignment

SESSION CONTENTS
256
STEP1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Terminologies Applied in Disposal of Pharmaceutical Wastes (5

minutes)
 Pharmaceutical waste includes expired, unused, spilt, and contaminated pharmaceutical
products, drugs, vaccines, and sera that are no longer required and need to be disposed of
appropriately.
 The category also includes discarded items used in the handling of pharmaceuticals, such
as bottles or boxes with residues, gloves, masks, connecting tubing, and drug vials.
 Also medicines and cosmetic products are considered as unfit when they are:
o Improperly sealed
o Damaged
o Unexpired and improperly stored
o Improperly labelled
o Counterfeit
o Substandard and adulterated
o Prohibited and unauthorized

STEP 3: Categories of Health Care Wastes (20 minutes)

Activity: Brainstorming (10 minutes)

Ask students to brainstorm on the following question:

 What are the categories of healthcare wastes?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

257
Classification of HCW

Source: WHO. National Health-Care Waste Management Plans in Sub-Saharan Countries. Guidance
Manual (1999).

Refer students to Handout 41.1: Categories of Health Care Wastes for further
reading

STEP 4: Principles of Waste Management (10 minutes)

Pharmaceutical waste
 Pharmacy department stores in each health care facility should be rigorously managed to
reduce the generation of pharmaceutical waste. Especially, stocks of pharmaceuticals
should be inspected periodically and checked for their durability (expiration date). Stock
positions should be recorded on a regular basis.

Pharmaceutical waste
 Pharmacy department stores in each health care facility should be rigorously managed to
reduce the generation of pharmaceutical waste. Especially, stocks of pharmaceuticals
should be inspected periodically and checked for their durability (expiration date). Stock
positions should be recorded on a regular basis.

258
 These wastes usually arise at central locations, i.e. in pharmacies and laboratories and
they are also often found at places where the ready-to-use cytotoxic solutions are
prepared.

 The precautions taken during the use of cytotoxic pharmaceuticals must also be applied
on their journey outside the respective establishment, as releases of these products can
have adverse environmental impacts. The management of these wastes, in covered and
impermeable containers, must be strictly controlled. Solid containers must be used for
collection. The use of coded containers is recommended. For reasons of occupational
safety, cytotoxic pharmaceutical wastes must be collected separately from pharmaceutical
waste and disposed in a hazardous waste incineration plant.

STEP 5: Methods for Disposal of Pharmaceutical Wastes (30 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the methods for disposal of pharmaceutical wastes?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Disposal Methods
 Landfill
o Involves placing unfit medicines and cosmetic products directly into a land disposal
site without prior treatment.
o The method is used in disposing off solid waste.
o Small quantities of unfit medicines and cosmetic products produced on a daily basis
may be land filled provided that they are dispersed in large quantities of general
waste.
o Cytotoxic, narcotic drugs and cosmetic products containing heavy metals such as
mercury should not be land filled, even in small quantities.

Types of landfill methods

 There are three types recognized as outlined below:
o Landfill for untreated unfit medicines and cosmetic products
o The method is applicable to small quantities of unfit medicine and cosmetic products.
It involves placing untreated waste medicine and cosmetic into an uncontrolled, non-
engineered open dump. The unfit medicine and cosmetic products should be covered
immediately with large quantities of other type of waste or soil/sand to prevent
scavenging by unscrupulous people.

259
  Discarding of untreated unfit medicine and cosmetics into such a site is not
recommended except as a last resort. They should preferably be discharged after
immobilization by encapsulation or inertization.
o Discarding in open uncontrolled dump with insufficient isolation from the aquifer or
other watercourses can lead to pollution, with the risk of drinking water
contamination in the worst cases.

o The disposal exercise should be done amid tight security by Police and be supervised
by technical personnel. This method is applicable to solids, semi-solids, powders,
medicines, waste dosage forms and cosmetics.

 Engineered landfill
Such landfill has some features to protect from loss of chemicals into the aquifer. Direct
deposit of medicines and cosmetics is second best to discharging immobilized unfit
medicines and cosmetic products into such a landfill.

 Highly engineered sanitary landfill

Properly constructed and operated landfill sites offer relative safe disposal route for unfit
medicines and cosmetic products. An appropriate landfill consists of an evacuated pit isolated
from watercourses and which is above water table. Once unfit medicine and cosmetic
products are thrown into the pit, they are compacted and covered with soil to maintain
sanitary environment.

 Landfill for treated unfit medicines and cosmetics (medicines and cosmetics waste
immobilization)

Immobilization of unfit medicine and cosmetics can be done in the following ways:

2. Encapsulation
In this process waste medicines and cosmetics are immobilized in a solid block within a
plastic or steel drum. The drum should be cleaned before using them and they should not
have contained explosive or hazardous materials previously.
The exercise starts by filling the drum to 75% of their capacity with solid and semi-solid
waste medicines and cosmetics. The remaining space is filled by pouring in a medium such as
cement or cement-lime mixture, plastic foam or bituminous sand.
For ease and speed of filling, the drum lids should be cut open and bent back. Once the drums
are filled to 75% capacity, the mixture of lime, cement and water in the proportions 15:15: 5
(by weight) is added and drum filled to capacity.
Steel drum lids should then be bent back and sealed by seam or spot welding. The sealed
drum lids should be placed at the base of a landfill site and covered with fresh municipal
solid waste. The method is applicable to solids waste, semi-solids, powders, and liquids

260
3. Inertization
The method involves removing the packaging materials (inner and outer container). The unfit
medicines and cosmetics are then ground and a mix of water, cement and lime added to form
a homogenous paste. The paste is then transported in liquid state by concrete mixer truck to a
landfill site and decanted into a normal municipal waste. The paste then sets as a solid mass
dispersed within the municipal solid waste.

The main tools required for the operation are a grinder or road roller to crush the
medicines/cosmetics, concrete mixer, cement, lime and water.

Medicines or cosmetics waste, lime, cement and water are mixed in the following ratios by
weight 65%, 15%, 15% and 5% respectively. Water can be added more than the required
amount when need arises to have satisfactory liquid consistency.

The method is applicable to solids, semi-solids, powders, antineoplastics controlled drugs of

that nature and cosmetics containing heavy metals (e.g. mercury).

4. Sewer
This is a method used whereby waste medicines and cosmetic products in liquid form e.g.
syrups, lotions and intravenous fluids are diluted with water and flushed into a proper
functioning sewerage system/sewers in small quantities over a period of time without causing
serious public health or environmental effect. Fast flowing watercourses may likewise be
used to flush small quantities of well-diluted liquid medicines/cosmetics or antiseptics.

5. Medium temperature incineration

This method involves the use of medium temperature incinerators. Unwanted solid
pharmaceuticals may be destructed by using a two-chamber incinerator that operates at the
minimum temperature of 8500C, with a combustion retention time of at least two seconds in
the second chamber. It is recommended that prior to destruction; pharmaceutical waste
should be diluted with large quantities of municipal waste (approximately 1:1000).
Medium temperature furnaces may be used in absence of medium temperature incinerators.
This type of incinerator is not suitable for incineration of halogenated compounds, as they
need a more high temperature incinerator. The method is applicable to solids, semi-solids,
powders and controlled drugs of that nature.

6. High temperature incineration

This involves the use high temperature incinerator, which operates at a temperature well in
excess of 8500C. Our country does not possess such expensive and sophisticated incinerators
so the uses of industrial plant such as cement kilns serve the purpose. Cement kilns can reach
temperatures of 14500C – 20000C that is suitable for total destruction of organic waste
component. These have long combustion retention times and disperse exhaust gases via tall
chimneys, often to high altitudes thus reducing the risk of environmental effect.
It may be necessary prior to incineration to remove packaging materials to avoid clogging
and blockage of incinerator or kiln.

261
7. Burning in open containers
Paper and cardboard packaging materials, if they are not to be recycled, may be burnt.
Polyvinyl Chloride (PVC) plastic however must not be burnt. Unfit medicines and cosmetics
should not be destroyed by burning at low temperatures in open containers, as toxic
pollutants may be released into the air. It is strongly recommended that only very small
quantities of unfit medicines and cosmetics be disposed of in this way.

8. Return to donor or manufacturer

Wherever practical the possibility of returning unfit medicines and cosmetic products for safe
disposal by the manufacturer should be explored; particularly medicines and cosmetics which
present problems, such as antineoplastics and heavy metals. For unwanted, unrequested
donations, especially that arrive with past or unreasonably expiry dates, it may be possible to
return them to the donor for disposal.

Refer students to Handout 41.2: Category of products and their recommended

disposal methods for further reading.

STEP 6: Consequences of Improper Disposal of Pharmaceutical Wastes (15

minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the consequences of improper disposal of pharmaceutical wastes?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

In general, improper disposal of pharmaceutical wastes and unfit medicines and cosmetics
presents a serious threat to public health. Some of the health risks are;
 Contamination of drinking water.
 Non-biodegradable antibiotics, antineoplastics and disinfectants may kill bacteria
necessary for the treatment of sewage.
 Burning medicines and cosmetics at low temperatures or in open containers results in
release of toxic pollutants into the air which should ideally be avoided.
 Inefficient and insecure sorting and disposal may allow medicines and cosmetics beyond
their expiry dates to be diverted for resale to the general public.
 In the absence of suitable disposal sites, if stored in their original packing there is a risk of
diversion.

262
STEP 7: Procedure for Safe Disposal of Unfit Medicines as per Tanzania
Foods, Drugs and Cosmetics Act, 2003 (10 minutes)

Disposal of unfit medicines and cosmetic products shall involve the following procedures:
1. A Drug Inspector, Health Officer, Environmental Officer and Policeman shall supervise
the transport of consignment from the owner’s premises to the disposal site for destruction
exercise.
2. The destruction exercise shall be supervised by Health Officer, Environmental Officer,
Policeman and Drug Inspector.
3. Unfit medicines and cosmetic products shall be transported in a closed motor vehicle to
avoid pilferage.
4. Supervisors shall wear protective gears such as overalls, gloves, masks, caps and boots
during the exercise.
5. Upon completion of the exercise, a Drug Disposal Form shall be duly filled in and signed
by the supervisors and owner/owner’s representative.
6. Drug Disposal Form shall be sent to TFDA headquarter offices.
7. Once TFDA has received the form, a certificate of destruction of unfit medicines and
cosmetic products shall be prepared and sent to the consignee.
8. Particular care shall be taken while handling anti- cancer drugs, narcotic drugs and
penicillins to avoid associated hazards.

STEP 8: Key Points (5 minutes)

• Pharmaceutical waste includes expired, unused, spilt, and contaminated pharmaceutical
products and drugs that are no longer required and need to be disposed of appropriately
• Stocks of pharmaceuticals should be inspected periodically and checked for their
durability (expiration date) in order to minimize amount of wastes.
• Improper disposal of pharmaceutical wastes and unfit medicines and cosmetics presents a
serious threat to public health.
• Procedure for safe disposal of unfit medicines as per Tanzania Foods, Drugs and
Cosmetics Act, 2003 should be adhered in order to get away from consequences involved.

STEP 9: Evaluation (10 minutes)

• What is the pharmaceutical wastes?
• What are the categories of healthcare wastes?
• What are the principles of waste management?
• What are the methods for disposal of pharmaceutical wastes?
• What are the consequences of improper disposal of pharmaceutical wastes?
• What is the procedure for safe disposal of unfit medicines as per Tanzania Foods, Drugs
and Cosmetics Act, 2003?

263
STEP 10: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

 Basing on Handout 41.1, prepare a presentation on pharmaceutical wastes, giving specific
examples of wastes on each category that is found in their pharmaceutical setting.

ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

264
References

TFDA. (2009). Guidelines for safe disposal of unfit medicines and cosmetic products(1sted).
Dar-es- salaam: MoHSW

WHO (1999).National Health-Care Waste Management Plans in Sub-Saharan Countries

Guidance Manual. Geneva.WHO

World Health Organization (1999), Guidelines for safe disposal of unwanted

pharmaceuticals in and after emergencies. Geneva: WHO

265
 Handout 41.1: Categories of Health Care Wastes

A. Non-risk HCW: includes all the waste that has not been infected like general office
waste, packaging or left over food. They are similar to normal household or municipal
waste and can be managed by the municipal waste services. Three groups can be
established:
A1. Recyclable waste: It includes paper, cardboard, non-contaminated plastic or
metal, cans or glass that can be recycled if any recycling industry exists in the country.
A2. Biodegradable waste: This category comprises for instance, left over food or
garden waste that can be composted.
A3. Other non-risk waste: all the non-risk waste that do not belong to categories A1
and A2.
B. Biomedical and health-care waste requiring special attention:
B1. Human anatomical waste: This category comprises non-infectious human body
parts, organs and tissues and blood bags. Examples of such wastes: tissue waste,
removed organs, amputated body parts and placentas
B2. Waste sharps: Sharps are all objects and materials that are closely linked with
health-care activities and pose a potential risk of injury and infection due to their
puncture or cut property. For this reason, sharps are considered as one of the most
hazardous waste generated and they must be managed with the utmost care. Examples
of such wastes: all types of needles, broken glassware, ampoules, scalpel blades,
lancets, vials without content
B3. Pharmaceutical waste: This category comprises expired pharmaceuticals or
pharmaceuticals that are unusable for other reasons. They are divided into three
classes:
B3.1 Non-hazardous pharmaceutical waste: This class includes pharmaceuticals
such as chamomile tea or cough syrup that pose no hazard during collection,
intermediate storage and waste management. They are not considered hazardous
wastes and should be managed jointly with municipal waste.
B3.2 Potentially hazardous pharmaceutical waste: This class embraces
pharmaceuticals that pose a potential hazard when used improperly by unauthorized
persons. They are considered as hazardous wastes and their management must take
place in an appropriate waste disposal facility.
B3.3 Hazardous pharmaceutical waste: This comprises heavy metal containing
and unidentifiable pharmaceuticals as well as heavy metal containing disinfectants,
which owing to their composition require special management. They must be
considered as hazardous wastes and their management must take place in an
appropriate waste disposal facility.
B4. Cytotoxic pharmaceutical waste: these can arise by use (administration to
patients), manufacture and preparation of pharmaceuticals with a cytotoxic
(antineoplastic) effect. These chemical substances can be subdivided into six main
groups: alkylated substances, antimetabolites, antibiotics, plant alkaloids, hormones,
and others. A potential health risk to persons who handle cytotoxic pharmaceuticals
266
 results above all from the mutagenic, carcinogenic and teratogenic properties of these
substances. Consequently, these wastes pose a hazard, and the measures to be taken
must also include those required by occupational health and safety provisions.
Examples of such wastes: Discernible liquid residues of cytotoxic concentrates, post-
expiration-date cytotoxic pharmaceuticals and materials proven to be visibly
contaminated by cytotoxic pharmaceuticals must be disposed of as cytotoxic
pharmaceutical waste.
B5. Blood and body fluids waste: these are wastes that are not categorized as
infectious waste but are contaminated with human or animal blood, secretions and
excretions. It is warranted to assume that these wastes might be contaminated with
pathogens. Examples of such wastes: Dressing material, swabs, syringes without
needle, infusion equipment without spike, bandages
C. Infectious and highly infectious waste: Special requirements regarding the
management of infectious wastes must be imposed whenever waste is known or –
based on medical experience – expected to be contaminated by causative agents of
diseases and when this contamination gives cause for concern that the disease might
spread. In this category two groups can be considered depending on the degree of
infectiousness that is expected.
C. 1 Infectious waste: This class comprises all biomedical and health-care waste
known or clinically assessed by a medical practitioner or veterinary surgeon to have
the potential of transmitting infectious agents to humans or animals. Waste of this
kind is typically generated in the following places: isolation wards of hospitals;
dialysis wards or centers caring for patients infected with hepatitis viruses (yellow
dialysis); pathology departments; operating theatres; medical practices and
laboratories which mainly treat patients suffering from the diseases specified above. It
includes: Discarded materials or equipment contaminated with blood and its
derivatives, other body fluids or excreta from clinically confirmed infected patients or
animals with hazardous communicable diseases. Contaminated waste from patients
known to have blood-borne infections undergoing haemodialysis (e.g. dialysis
equipment such as tubing and filters, disposable sheets, linen, aprons, gloves or
laboratory coats contaminated with blood); Carcasses as well as litter and animal
faeces from animal test laboratories, if transmission of the above-mentioned diseases
is to be expected. Examples of such wastes: Blood from patients contaminated with
HIV, viral hepatitis, brucellosis, Q fever. Faeces from patients infected with typhoid
fever, enteritis and cholera.
C2. Highly infectious waste: It includes all microbiological cultures in which a
multiplication of pathogens of any kind has occurred. They are generated in institutes
working in the fields of hygiene, microbiology and virology as well as in medical
laboratories, medical practices and similar establishments; laboratories. Examples of
such wastes: Sputum cultures of TB laboratories, contaminated blood clots and
glassware material generated in the medical analysis laboratories, high concentrated
microbiological cultures carried out in medical analysis laboratories.
D. Other hazardous waste: This category of waste is not exclusive to the health-care
sector. They include: gaseous, liquid and solid chemicals, waste with high contents of
heavy metals such as batteries and pressurized containers. Chemical waste consists of
267
 discarded chemicals that are generated during disinfecting procedures or cleaning
processes. Not all of them are hazardous but some have toxic, corrosive, flammable,
reactive, explosive, shock sensitive, cyto- or genotoxic properties. Examples of such
wastes: thermometers, blood-pressure gauges, photographic fixing and developing
solutions in X-ray departments, halogenated or non-halogenated solvents, organic and
in-organic chemicals.
E. Radioactive health-care waste: this includes liquids, gases and solids contaminated
with radionuclides whose ionizing radiations have genotoxic effects. The ionizing
radiations of interest in medicine include X and γ-rays as well as α- and β- particles

268
 Handout 41.2: Category of products and their recommended
disposal methods

S/N Category Disposal methods

1. Solids, semi-solids and powders Landfill, incineration and waste
immobilization
2. Liquids Sewer, high temperature incineration and
treated waste
3. Antineoplastics Treated waste and landfill, high
temperature incineration and return to
manufacturer
4. Controlled Drugs Treated waste and landfill, high
temperature incineration
5. Aerosols and inhalers Landfill without waste inertization
6. Disinfectants Sewer or fast-flowing watercourse
7. PVC plastics, glass (ampoules, bottles Landfill and re-cycling
and vials)
8. Paper, cardboard Recycle, burn, landfill

269
Session 42: Introduction to Human Nutrition
Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Sources of Different Food Substances
 Describe the Composition of each Class of Food (Carbohydrates, Proteins, Fats And Oils,
Vitamins And Minerals)
 Define Balanced Diet and Explain its Importance to Human Health
 Differentiate Between Fat Soluble and Water Soluble Vitamins

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD projector

SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
15 minutes Presentation
2 Sources 0f Different Food Substances
Brainstorming
30 minutes The Composition of each Class 0f Food
Presentation
3 (Carbohydrates, Proteins, Fats and Oils,
Buzzing
Vitamins and Minerals)
40 minutes Presentation Balanced Diet and its Importance to Human
4
Group discussion Health
5 10 minutes Presentation Fat Soluble and Water Soluble Vitamins

6 05 minutes Presentation Key Points

7 05 minutes Presentation Evaluation

8 10 minutes Presentation Assignment

270
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Sources of Different Food Substances (15 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:
 What are sources and classes of different food substances?
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below

Important terms
 Food: is what is eaten or taken into the body by parenteral routes for the purpose of
nourishing the body.
o Foods contain elements called nutrients.
 Nutrients: are a variety of chemical substances that, in nature, form part of food.
Nutrients are not the same, they can be quite be different from one another.
 Nutrition: is the term standing for the sum of all processes involved in food intake,
assimilation and utilization by the body.
o Food must be available and accessible for consumption
o Body ingests, rearranges, assimilates and utilizes the nutrients consumed in food, for
the purpose of:
 Production of energy
 Growth
 Functioning of organs and systems
 Maintenance of life.
 Nutritional status: is the result of the body’s nutrient intake and utilization, which may
be good or bad.
 Malnutrition: literally means ‘bad nutrition’.
o It means any deviation from normal nutrition.
o Can be either under-nutrition or over-nutrition

Sources of different food substances

The main sources of different food substances are:
 Cereals: For example maize, rice, millet, wheat and sorghum
 Pulses: For example lentils, beans, soya beans and peas
 Nuts: groundnuts and cashew nuts
 Vegetables:
o Green leafy vegetables: cabbage, cauliflower, spinach and lettuce
271
 o Roots and tubers: yams, cassava, potatoes, sweet potatoes, carrots and beetroots
o Other vegetables: ladiesfingers, brinjals, pumpkins, green peas
 Fruits: pawpaws, mangoes, oranges, banana, tangerines, pineapples as well as wild fruits
such as baobab fruits and tamarind
 Foods of animal origin: meat, fish, eggs, milk and milk products
 Sugar, Honey, Fats and Oils
o Examples of fats and oils are:
 Ghee
 Butter
 Coconut oil
 Margarine
 Sunflower
 Palm oil

STEP 3: The Composition of each Class of Food (30 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What is the composition of classes of food?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Carbohydrates
 These are organic compounds composed of the elements carbon, hydrogen and oxygen.
 Carbohydrates provide the main source of energy for the body.
 Carbohydrates are classified as:
o Monosaccharide (glucose, fructose, galactose and mannose) are the simplest
carbohydrates.
o For their absorption they can pass through the wall of the alimentary tract without
being changed by digestive enzymes.
o Disaccharides (sucrose, maltose and lactose) and oligosaccharides are also simple
carbohydrates.
 These have to be converted by the body into monosaccharides before they can be
absorbed from the alimentary tract.
o Polysaccharides, also called complex carbohydrates, are chemically the most
complicated carbohydrates. Examples are starch, cellulose and glycogen.
 These are long chain molecules in which a large number of monosaccharides are
combined.

272
Lipids
 These are organic compounds made of the elements carbon, hydrogen and oxygen but in
different proportions and different structural arrangements
 Fats and oils provide the body with fuel with very high efficiency
 Dietary lipids transport the fat-soluble vitamins (vitamin A, D, E and K)
 Absorption of these vitamins does not take place very efficiently in the absence of fat
 Lipids that are solid at room temperature (butter, beef fat) are referred to as ‘fats’
 Lipids that are in liquid at room temperature are referred to as ‘Oils’

Proteins
 Proteins are organic molecules that contain the elements carbon, hydrogen, oxygen and
nitrogen.
 Frequently proteins contain sulphur and phosphorus and less frequently, other elements
such as iron, copper and iodine
 Nitrogen is the element characteristic of all amino acids and therefore of proteins
 Amino acids are classified into two groups:
o Those amino acids which cannot be synthesized in the human body (or synthesized in
inadequate amounts) are termed essential.
o Those which can be synthesized in the body are non-essential amino acids.

Importance of Protein in Nutrition

 Necessary for growth, development and repair of the body.
 Main structural constituents of the cells and tissues making up the greater proportion
muscles and organs.
 For producing metabolic and digestive enzymes
 Constituent of certain hormones such as thyroid hormones and insulin.
 Amount exceeding the requirement for growth, cell and fluid replacement and other
metabolic functions is used to provide energy
 The body obtains this energy by changing the protein into carbohydrate

Vitamins
 Vitamins are organic compounds that perform specific metabolic functions in the body
Most of them are not synthesized in the body, must be provided by dietary sources
 Vitamins, unlike carbohydrates, lipids and proteins, do not produce energy.
 Vitamins differ widely from one another in terms of chemical structure and biological
functions

Minerals
 Minerals are naturally occurring, inorganic, homogenous substances.
 These substances are very important to keep the human body in a balancing working
order
 Minerals are constituents of the bones, teeth, soft tissue, muscle, blood, and nerve cells.
 Minerals act as catalysts for many biological reactions within the body
 Mineral classification:
273
 o Major minerals includes:
 Calcium
 Iron
 Sodium
 Potassium
 Magnesium
 Phosphorus
 Sulfur
o Trace minerals are:
 Zinc
 Copper
 Cobalt
 Manganese
 Iodine
 Chromium
 Chloride
 Fluoride

Water
 This is an essential component of healthy diet. About 60-70% of the total body weight of
a person is water
 It is important for transport of nutrients, removal of waste and assists in metabolic
activities of all cells and provides lubrication to moving parts of the body and assist in
regulating body temperature.
 Clean and safe water is essential for avoiding water-borne and water related diseases.
 Water requirement of a person varies with climate, age, activity, dietetics habits and body
build.

STEP 4: Balanced Diet and Explain its Importance to Human Health (40 minutes)
Activity: Small Group Discussion (10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What is balanced diet?
 What is the importance of balanced diet to human health?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Balanced diet

274
 A diet that contains the proper proportions of carbohydrates, fats, proteins, vitamins,
minerals, and water necessary to maintain good health.
 A balanced meal should contain at least one food from each of the food groups
 Balanced diet is important for growth and development

Figure 1: Nutrition and Diseases: Vicious Cycle

STEP 5: Fat Soluble and Water Soluble Vitamins (10 minutes)

Classification of Vitamins
 Fat soluble vitamins are vitamins A, D, E and K.
 They are soluble in fats and fat solvents
 They are utilized only if there is enough fat in the body.
 They have the following general properties:
o Consist of carbon, hydrogen and oxygen
o They are relatively stable during:
 Processing,
 Preservation
 Preparation
o They are stored in the liver and fatty deposits of the body therefore do not have to be consumed on
daily basis
o If consumed in excess can produce toxicity

 Water-soluble vitamins are vitamins C, folic acid and the B vitamins.

 They cannot be stored in the body therefore, a day to day supply is essential
275
STEP 6: Key Points (5 minutes)
 The main sources of different food substances are: cereals, nuts, pulses and vegetables
 The major nutrients in the bodies are carbohydrates, proteins, lipids, vitamins and
minerals.
 Balanced diet is important for growth and development
 Balanced diet contains the proper proportions of carbohydrates, fats, proteins, vitamins,
minerals, and water
 Water soluble vitamins are soluble in water whereas fat soluble are not.

STEP 7: Evaluation (5 minutes)

 What are sources and classes of different food substances?
 What is the composition of each class of food?
 What is balanced diet?
 What is the importance of balanced diet to human health?
 What is the difference between fat soluble and water soluble vitamins?

STEP 8: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

• Explain how water requirement of a person varies with climate, age, activity, dietetics
habit and body build
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References

276
Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva: WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries.(2nded.) Oxford: Felicity
Oxford University Press.

Kumar, P. & Clark, M. (2006).Clinical Medicine.(6thed.) Phidalephia: Elsevier Limited.

Latham, M. C (1997).Human Nutrition in the Developing World.David Lubin Memorial

Library.

McLaren, S. (1992).A Colour Atlas and Text of Diet-Related Disorders.(2nded.) Aylesbury:

BPCC Hazells Ltd

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd. Rev.ed.) New

Delhi: Sterling Publishers Private Ltd

Tanzania Food and Nutrition Centre.(2009). National Guidelines for Nutrition Care and
Support for People Living with HIV.(2nded.) Dar es Salaam: TFNC

277
Session 43: Managing Patients with Nutritional Deficiency
Diseases

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Describe Common Nutritional Deficiency Diseases
 Describe Management of Nutritional Deficiency Diseases

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD projector
 Handout 43.1

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
50 minutes Presentation
2 Common Nutritional Deficiency Diseases
Buzzing
40minutes Presentation Management of Common Nutritional
3
Group discussion Deficiency Diseases
4 05 minutes Presentation Key Points

5 10 minutes Presentation Evaluation

6 10 minutes Presentation Assignment

278
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Common Nutritional Deficiency Diseases (50 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the common nutritional deficiency diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Malnutrition
 Can occur at any time in the life cycle
 When it occurs early in life, irreversible damages can be done to the body and brain
 Affects a significant proportion of populations, presenting as macro and or micronutrient
deficiency disorders
 Nutrition disorder means any kind of disorder caused by eating too little or too much of
one or more different nutrients

Classification of Malnutrition
 Can be classified in different ways but most commonly as under nutrition or over
nutrition
o Under Nutrition occurs when nutrients intake does not meet nutrients needs
o Many nutrients are in high demand due to the constant state of cell lose and later
regeneration in the body
o Over nutrition is prolonged consumption of more nutrients than the body needs

Protein Energy Malnutrition (PEM)

 A deficiency of energy and protein which results in body wasting,
 Occurs more frequently in infants and young children but is also observed in adolescents
and adults
 Severe forms of PEM are Kwashiorkor and Marasmus

Kwashiorkor
279
 Caused by failure to provide an adequate dietary sources of protein to substitute for the
protein
 Signs and symptoms includes:
o failure of growth but the child is not severely wasted,
o swollen abdomen,
o hair changes (hair becomes brown, straight and soft)
o skin rashes,
o child becomes inactive, apathetic, irritable and is difficult to feed,
o oedema of lower limbs

Marasmus
 Causes: severe loss or chronic waste of fat, muscles and other tissues of the body. The
disease occurs due to shortage of basic nutrition, proteins, vitamins and calories to the
body. It is inadequate energy intake in all forms, including protein.

 Signs and Symptoms of Marasmus: remarkable failure of growth, severe muscle wasting
with flaccid, wrinkled skin and bony prominence, the child looks awake and hungry and
displays what is referred to as ‘old person’s face and oedema is absent

Prevention of PEM
 The different strategies may include:
o Incorporating nutrition objectives into development of policies and programmes
o Improving household food security
o Protection and promotion of good health
o Improving the quality and safety of foods
o Protect and promote breastfeeding and complementary feeding
o Early treatment of common diseases
o Immunization
o Growth monitoring
o Promoting appropriate diets and healthy lifestyles

Vitamins and Minerals Nutritional Deficiencies

Vitamin A Deficiency
 It plays important roles in the body including vision, maintenance of epithelial tissue, and
synthesis of mucous secretion, growth, reproduction and immunity.
 The organ that is most readily affected is the eye

Symptoms and Signs:

 Night blindness (Reduced ability to see in dim light)
 Conjunctival xerosis/ drying
 Corneal xerosis/drying,
 Xerophthalmic fundus (retina has white dots).
 Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of ocular contents and
perhaps destruction of the eye.

280
Vitamin B1 Deficiency (Beriberi):
 Occurs when people consume highly milled polished rice or maize, and starchy roots such
as cassava, which are deprived of thiamine content

Signs and Symptoms:

 Heart palpitation, chest pain.
 Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and distended neck veins
with visible pulsations
 The heart is found to be enlarged
 Cyanosis
 Increased oedema
 Severe dyspnoea
 Acute circulatory failure and death
 The patient is thin with weak, wasted muscles Anaesthesia and ‘pins-and-needles’
feelings in the feet and arms may increase, eventually causing difficulty in walking
 Foot drop and wrist drop commonly occur

Vitamin B2 (Riboflavin) Deficiency (Beriberi)

Sign and symptoms:
 Angular stomatitis
 Glossitis
 Skin changes
 Seborrheic dermatitis
 Vascularization of the cornea

Vitamin B3 (Niacin) Deficiency (Pellagra):

 It is generally associated with maize diet
 Early Symptoms of Pellagra: A person appears poorly malnourished, often weak and
underweight. A person may also have diminished sensitivity to gentle touch and
sometimes some muscular weakness and tremor. Untreated cases of pellagra may die of
the disease
 The disease is later characterized by the three ‘Ds’:
o Dermatitis: deepening of the pigmentation, dry skin, scaly and eventual cracked,
desquamation, occasionally the skin may blister, the tongue and other parts of the
mouth are often sore, red, smooth and raw-looking
o Diarrhoea: a patient with pellagra may frequently have bouts of abdominal pain,
diarrhoea and other digestive upsets. The upsets include nausea, excessive salivation,
and a burning sensation in the epigastrium.
o Dementia: this involves the effect of pellagra in nervous system which brings about
Irritability, loss of memory, anxiety and insomnia

Vitamin C Deficiency (Scurvy):

 Ascorbic acid is essential for the formation of intercellular collagen and hence for the
development of cartilage, bone and teeth and for the healing of fractures and wounds.

Symptoms and Signs:

281
 The walls of blood vessels lack solidity and become fragile and bleeding or haemorrhage
from various sites results. Other haemorrhages include nosebleeds, blood in the urine or
faeces
 Moderate deficiency of vitamin C may result in poor healing of wounds. People who do
not eat enough vitamin C may not absorb enough iron and may develop iron deficiency
anaemia especially in pregnancy
 Tiredness and weakness
 Swollen gums which bleed easily at the base of the teeth
 In the skin - follicular hyperkeratosis, skin bruising haemorrhages and broken coiled hair
 Swollen painful joints particularly of the knees, hip and elbow also pain in all muscles
 Loss of secretion of lachrymal and salivary glands, loss of hair, dryness of the skin and
loss of dental fillings.
 Beading of the ribs

Vitamin D Deficiency (Rickets and Osteomalacia)

 The main feature of both rickets and osteomalacia is lack of calcium in the bones.
 Rickets occurs in children whose bones are still growing. Often children are plump and
appear well fed
 Osteomalacia occurs in adults who have formed bones. Both conditions are caused
mainly by a deficiency of vitamin D, and not by a dietary lack of calcium.

Symptoms and Signs of Rickets:

 Child tends to be miserable
 Flabby (toneless state of muscles that causes a pot-belly)
 Impairment of normal development
 Gastro-intestinal upset and excessive sweating of the head
 The main signs of the disease are bone deformation

Vitamin E Deficiency
 It is not common among human beings as it is widely distributed in foods.

Signs and symptoms:

 Muscular dystrophy
 Paralysis
 Impaired fat absorption
 Haemolytic anaemia in babies after delivery
 Liver necrosis, erythrocyte haemolysis and anaemia in adults

Vitamin K Deficiency (haemorrhagic disease)

 Dietary deficiency is not common. Deficiency occurs due to deficient production of it by
the gut, with prolonged antibiotic therapy, due to poor absorption of vitamin K, in
malabsorption of fat and due to low prothrombin synthesis in liver disease

Signs and symptoms:

 Tendency to bleed from skin and mucous membranes

282
Anaemia
 Anaemia is a pathological condition arising as a result of low level of haemoglobin which
impairs oxygen transport to the tissues. There are various types of Anaemia such
Haemorrhagic, haemolytic and nutritional Anaemia.
 Nutritional anaemia is due to deficiency of nutrients that are needed for the synthesis of
red blood cells: iron, folic acid and vitamin B12.
 Thus nutritional anaemia includes: Iron deficiency anaemia, Folic acid deficiency
anaemia and Vitamin B12 deficiency anaemia.

Iron Deficiency Anaemia (IDA)

Symptoms and Signs
 Tiredness and fatigue
 Dizziness and/or headaches
 Palpitations
 Difficulty in breathing on exertion
 Inadequate temperature regulations
 Mild degree of splenomegaly
 Brittle finger nail

Folate and vitamin B12 (Megaloblastic anaemia) Deficiency

Symptoms and Signs:
 Glossitis, sometimes stomatitis, hyper pigmentation of skin and mucosa, peripheral
neuropathy and dementia
o In children, severe Vitamin B12 deficiency may produce mental regression,
convulsions, coma and ultimate death
Note: The symptoms are quite variable, and they can be caused by other conditions. The only
sign you can look for is paleness, which is not very reliable. So to know whether a person is
anaemic or not, you need to measure the amount of haemoglobin in the blood.

Iodine Deficiency
 Deficiency of iodine in the body leads to conditions termed iodine deficiency disorders
(IDD)
 Iodine is found in the soil and is picked up by different foods (plants, animals, water)
obtainable in the area
 The major cause of iodine deficiency is its loss from the soil through leaching. Iodine
deficiency manifests as goitre as well as a variety of conditions termed hypothyroidism.

Symptoms and Signs of Iodine Deficiency Disorders:

Goitre
 A person who is hypothyroid: Feels cold easily, moves slowly and lacks energy, think
slowly and appear unconcerned, may be sleepy, has a dry skin and may be constipated
 A child who is hypothyroid: Also grows slowly, may be very short and may not do well
in school
 Women who are hypothyroid during pregnancy may also have; Miscarriage or still birth,
Low birth weight babies, Babies with congenital deformities and Babies with cretinism
STEP 3: Management of Nutritional Deficiency Diseases (40 minutes)

283
Activity: Small Group Discussion ( 10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 How are nutritional deficiency diseases managed?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Vitamin A
 Promotion of horticultural foods (fruits and vegetables such as carrots, cabbage and sweet
potatoes)
 Promotion of production and use of red palm oil and other cooking oils
 Improvement of appropriate child feeding: Breastfeeding and Improved complementary foods
 Use of milk and milk products
 Early treatment of diseases (measles, respiratory tract infections, diarrhea)
 Promotion of immunization coverage
 Vitamin A supplementation (to children, lactating women)
 Fortification of foods with Vitamin A

Vitamin B1 (Thiamine)
 Consumption of diet containing adequate quantities of vitamin B
 If highly milled white rice is the staple food, diet should be supplemented with foods rich in
thiamine: nuts, beans, peas and other pulses, whole grain cereals and yeast based products
 Nutrition education to stress cause of diseases, foods that should be consumed, and ways to
minimize vitamin loss

Vitamin B2 (Riboflavin)
 Consumption of diet containing adequate quantities of vitamin B2 such as eggs, milk and
milk products, meat, fish, whole cereals, oil seeds, nuts and leafy vegetables

Vitamin B3 (Niacin)
 Diversity in the diet
 Production and consumption of food known to prevent pellagra i.e. those rich in niacin
such us nuts and tryptophan such as eggs, milk, lean meat and fish should be increased
 Enrich milled maize meal with niacin
 Niacin tablets are administered as prophylaxis in prisons, refugee camps and institutions
in areas where pellagra is endemic.
 Nutrition education

Vitamin C
 Increased production and consumption of vitamin C rich foods: fruits and vegetables.
Encourage the use of wild edible fruits and vegetables
 Provision of vegetable fruits and fruits juices to all community members (including
children beginning at six months)
284
 Nutrition education in consumption of vitamin C rich foods, minimizing vitamin C loss in
cooking and food preparation

Vitamin D
 All children get adequate amount of sunlight
 Children, pregnant women and lactating women should have adequate calcium and
vitamin D in their diet
 Attend clinic regularly
 Fish- liver oils, egg yolk, milk, butter, cheese and ghee
 Establish allowing supplementation of cod-liver oil or other vitamin D supplements
 Nutrition education (including child spacing)

Vitamin E
 It is widely distributed in nature that it is difficulty to prepare a diet deficient in vitamin E
 Human milk is enough for the infants
 Cereal especially wheat germ oils are the richest source. Vegetable fats from corn, soya
bean, peanuts and coconut or cotton seeds are good sources followed by cereals, eggs and
meat and green leaves such as spinach.

Vitamin K
 Bacteria in the intestine normally produce it in adequate amount
 Fresh dark green vegetables especially spinach, kale and cauliflower
 Plant oils, rice bran oil and wheat germ oil, soya bean and cotton seed oils are best
sources

Iodine
 Various medicinal preparations are administered, such as:
o Injectable iodized oil
o Iodinated oil capsules
o Salt iodation: emphasis should be on salt iodation only because currently other strategies
are less commonly usedControl of Iodine Deficiency
Iron
 Promotion of consumption of iron- and vitamin-rich foods
 Prevention and treatment of anemia-related diseases (malaria, worm infestation)
 Iron and folic acid supplementation to the most at risk groups (children, pregnant women,
sickle cell disease patients)
 Fortification of foods with relevant nutrients (iron, folic acid)
 Prevention and treatment of anaemia-related diseases (malaria, worm infestation)

Handout 43.1: Nutrition Supplements and Associated Nutrient Disorders

Handout 41.2: Nutrition Supplements and Associated Nutrient Disorders

Handout 41.3: Nutrition Supplements

STEP 4: Key points (5 minutes)

285
 Common nutritional deficiency diseases are Protein Energy Malnutrition and Vitamins
and Minerals Nutritional Deficiencies
 Management of nutritional deficiency diseases depends much on handling their signs and
symptoms

STEP 5: Evaluation (10 minutes)

 What are the common nutritional deficiency diseases?
 How are nutritional deficiency diseases managed?

STEP 6: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

• Prepare a presentation about different types of Anaemia and how they can be
managed
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva: WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries. (2nded.). New York:
Felicity Oxford University Press

286
Kumar P. & Clark, M. (2006).Clinical Medicine.(6thed.) New York: Elsevier Limited.

Latham M. C (1997). Human Nutrition in the Developing World.David Lubin Memorial

Library.

McLaren.S. (1992).A Colour Atlas and Text of Diet-Related Disorders.(2nded.)BPCC Hazells

Ltd, Aylesbury, England.

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd Rev.ed.). New

Delhi: Sterling Publishers Private Ltd,.

Tanzania Food and Nutrition Centre.(2009). National Guidelines for Nutrition Care and
Support for People Living with HIV.(2nded.) Dar es Salaam: TFNC

Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights. (4thed.) Phidalephia: Mc
GrawHill,

287
Handout 43.1: Nutrition Supplements and Associated
Nutrient Disorders

288
Handout 43.2: Nutrition Supplements and Associated
Nutrient Disorders

289
Handout 43.3: Nutrition Supplements

290
Session 44: Specialised Food Therapy

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites
 None

Learning Tasks
By the end of this session students are expected to be able to:
 Define Specialised Food Therapy
 Explain Nutrients Required for Different Groups
 Explain Entry and Exist Criteria for Specialised Food Products
 Describe Different Types of Specialised Food Products
 Describe the Importance of Nutritional Therapy for Acute Malnourished Clients

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Computer and LCD projector
 Handout 44.1

SESSION OVERVIEW

Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
50 minutes Presentation
2 Common Nutritional Deficiency Diseases
Buzzing
40minutes Presentation Management of Common Nutritional
3
Group discussion Deficiency Diseases
4 05 minutes Presentation Key Points

5 10 minutes Presentation Evaluation

6 10 minutes Presentation Assignment

291
SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Common Nutritional Deficiency Diseases (50 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

 What are the common nutritional deficiency diseases?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Malnutrition
 Can occur at any time in the life cycle.
 When it occurs early in life, irreversible damages can be done to the body and brain
 Affects a significant proportion of populations, presenting as macro and or micronutrient
deficiency disorders.
 Nutrition disorder means any kind of disorder caused by eating too little or too much of
one or more different nutrients.

Classification of Malnutrition
 Can be classified in different ways but most commonly as under nutrition or over
nutrition.
o Under Nutrition occurs when nutrients intake does not meet nutrients needs.
o Many nutrients are in high demand due to the constant state of cell lose and later
regeneration in the body.
o Over nutrition is prolonged consumption of more nutrients than the body needs

Protein Energy Malnutrition (PEM)

 A deficiency of energy and protein which results in body wasting,
 Occurs more frequently in infants and young children but is also observed in adolescents
and adults
 Severe forms of PEM are Kwashiorkor and Marasmus

Kwashiorkor
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 Caused by failure to provide an adequate dietary sources of protein to substitute for the
protein
 Signs and symptoms includes:
o failure of growth but the child is not severely wasted,
o swollen abdomen,
o hair changes (hair becomes brown, straight and soft)
o skin rashes,
o child becomes inactive, apathetic, irritable and is difficult to feed,
o oedema of lower limbs

Marasmus
 Causes: severe loss or chronic waste of fat, muscles and other tissues of the body. The
disease occurs due to shortage of basic nutrition, proteins, vitamins and calories to the
body. It is inadequate energy intake in all forms, including protein.

 Signs and Symptoms of Marasmus: remarkable failure of growth, severe muscle wasting
with flaccid, wrinkled skin and bony prominence, the child looks awake and hungry and
displays what is referred to as ‘old person’s face and Oedema is absent

Prevention of PEM
 The different strategies may include:
 Incorporating nutrition objectives into development of policies and programmes
 Improving household food security
 Protection and promotion of good health
 Improving the quality and safety of foods
 Protect and promote breastfeeding and complementary feeding
 Early treatment of common diseases
 Immunization
 Growth monitoring
 Promoting appropriate diets and healthy lifestyles

Vitamins and Minerals Nutritional Deficiencies

Vitamin A Deficiency
 It plays important roles in the body including vision, maintenance of epithelial tissue, and
synthesis of mucous secretion, growth, reproduction and immunity.
 The organ that is most readily affected is the eye.

Symptoms and Signs:

 Night blindness (Reduced ability to see in dim light)
 Conjunctival xerosis/ drying
 Corneal xerosis/drying,
 Xerophthalmic fundus (retina has white dots)
 Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of ocular contents and
perhaps destruction of the eye
o All of these may lead to complete blindness
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Vitamin B1 Deficiency (Beriberi):
 It occurs when people consume highly milled polished rice or maize, and starchy roots
such as cassava, which are deprived of thiamine content.
 Signs and Symptoms:
o Heart palpitation, chest pain.
o Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and distended neck
veins with visible pulsations
o The heart is found to be enlarged
o Cyanosis
o Increased oedema
o Severe dyspnoea
o Acute circulatory failure and death
o The patient is thin with weak, wasted muscles Anaesthesia and ‘pins-and-needles’
feelings in the feet and arms may increase, eventually causing difficulty in walking
o Foot drop and wrist drop commonly occur

Vitamin B2 (Riboflavin) Deficiency (Beriberi)

Sign and symptoms:
 Angular stomatitis
 Glossitis
 Skin changes
 Seborrheic dermatitis
 Vascularization of the cornea

Vitamin B3 (Niacin) Deficiency (Pellagra):

 It is generally associated with maize diet.
 Early Symptoms of Pellagra: A person appears poorly malnourished, often weak and
underweight. A person may also have diminished sensitivity to gentle touch and
sometimes some muscular weakness and tremor. Untreated cases of pellagra may die of
the disease
 The disease is later characterized by the three ‘Ds’:
o Dermatitis: deepening of the pigmentation, dry skin, scaly and eventual cracked,
desquamation, occasionally the skin may blister, the tongue and other parts of the
mouth are often sore, red, smooth and raw-looking
o Diarrhoea: a patient with pellagra may frequently have bouts of abdominal pain,
diarrhoea and other digestive upsets. The upsets include nausea, excessive salivation,
and a burning sensation in the epigastrium.
o Dementia: this involves the effect of pellagra in nervous system which brings about
Irritability, loss of memory, anxiety and insomnia

Vitamin C Deficiency (Scurvy):

 Ascorbic acid is essential for the formation of intercellular collagen and hence for the
development of cartilage, bone and teeth and for the healing of fractures and wounds.
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Symptoms and Signs:
 The walls of blood vessels lack solidity and become fragile and bleeding or haemorrhage
from various sites results. Other haemorrhages include nosebleeds, blood in the urine or
faeces
 Moderate deficiency of vitamin C may result in poor healing of wounds. People who do
not eat enough vitamin C may not absorb enough iron and may develop iron deficiency
anaemia especially in pregnancy
 Tiredness and weakness
 Swollen gums which bleed easily at the base of the teeth
 In the skin - follicular hyperkeratosis, skin bruising haemorrhages and broken coiled hair
 Swollen painful joints particularly of the knees, hip and elbow also pain in all muscles
 Loss of secretion of lachrymal and salivary glands, loss of hair, dryness of the skin and
loss of dental fillings.
 Beading of the ribs

Vitamin D Deficiency (Rickets and Osteomalacia)

 The main feature of both rickets and osteomalacia is lack of calcium in the bones.
 Rickets occurs in children whose bones are still growing. Often children are plump and
appear well fed
 Osteomalacia occurs in adults who have formed bones. Both conditions are caused
mainly by a deficiency of vitamin D, and not by a dietary lack of calcium.

Symptoms and Signs of Rickets:

 Child tends to be miserable
 Flabby (toneless state of muscles that causes a pot-belly),
 Impairment of normal development
 Gastro-intestinal upset and excessive sweating of the head.
 The main signs of the disease are bone deformation.

Vitamin E Deficiency
 It is not common among human beings as it is widely distributed in foods.

Signs and symptoms:

 Muscular dystrophy
 Paralysis
 Impaired fat absorption
 Haemolytic anaemia in babies after delivery
 Liver necrosis, erythrocyte haemolysis and anaemia in adults

Vitamin K Deficiency (haemorrhagic disease)

 Dietary deficiency is not common. Deficiency occurs due to deficient production of it by
the gut, with prolonged antibiotic therapy, due to poor absorption of vitamin K, in
malabsorption of fat and due to low prothrombin synthesis in liver disease.

Signs and symptoms:

 Tendency to bleed from skin and mucous membranes

Anaemia

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 Anaemia is a pathological condition arising as a result of low level of haemoglobin which
impairs oxygen transport to the tissues. There are various types of Anaemia such
Haemorrhagic, haemolytic and nutritional Anaemia.
 Nutritional anaemia is due to deficiency of nutrients that are needed for the synthesis of
red blood cells: iron, folic acid and vitamin B12.
 Thus nutritional anaemia includes: Iron deficiency anaemia, Folic acid deficiency
anaemia and Vitamin B12 deficiency anaemia.

Iron Deficiency Anaemia (IDA)

Symptoms and Signs Iron Deficiency Anaemia (IDA)
 Tiredness and fatigue
 Dizziness and/or headaches
 Palpitations
 Difficulty in breathing on exertion
 Inadequate temperature regulations
 Mild degree of splenomegaly
 Brittle finger nail

Folate and vitamin B12 (Megaloblastic anaemia) Deficiency

Symptoms and Signs:
 Glossitis, sometimes stomatitis, hyper pigmentation of skin and mucosa, peripheral
neuropathy and dementia
o In children, severe Vitamin B12 deficiency may produce mental regression,
convulsions, coma and ultimate death
Note: The symptoms are quite variable, and they can be caused by other conditions. The only
sign you can look for is paleness, which is not very reliable. So to know whether a person is
anaemic or not, you need to measure the amount of haemoglobin in the blood.

Iodine Deficiency
 Deficiency of iodine in the body leads to conditions termed iodine deficiency disorders
(IDD).
 Iodine is found in the soil and is picked up by different foods (plants, animals, water)
obtainable in the area.
 The major cause of iodine deficiency is its loss from the soil through leaching. Iodine
deficiency manifests as goitre as well as a variety of conditions termed hypothyroidism.
 Symptoms and Signs of Iodine Deficiency Disorders:

Goitre
 A person who is hypothyroid: Feels cold easily, moves slowly and lacks energy, think
slowly and appear unconcerned, may be sleepy, has a dry skin and may be constipated
 A child who is hypothyroid: Also grows slowly, may be very short and may not do well
in school

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 Women who are hypothyroid during pregnancy may also have; Miscarriage or still birth,
Low birth weight babies, Babies with congenital deformities and Babies with cretinism
STEP 3: Management of Nutritional Deficiency Diseases (40 minutes)

Activity: Small Group Discussion ( 10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 How are nutritional deficiency diseases managed?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

Vitamin A
 Promotion of horticultural foods (fruits and vegetables such as carrots, cabbage and sweet
potatoes)
 Promotion of production and use of red palm oil and other cooking oils
 Improvement of appropriate child feeding: Breastfeeding and Improved complementary
foods
 Use of milk and milk products
 Early treatment of diseases (measles, respiratory tract infections, diarrhea)
 Promotion of immunization coverage
 Vitamin A supplementation (to children, lactating women)
 Fortification of foods with Vitamin A

Vitamin B1 (Thiamine)
 Consumption of diet containing adequate quantities of vitamin B
 If highly milled white rice is the staple food, diet should be supplemented with foods rich in
thiamine: nuts, beans, peas and other pulses, whole grain cereals and yeast based products
 Nutrition education to stress cause of diseases, foods that should be consumed, and ways to
minimize vitamin loss

Vitamin B2 (Riboflavin)
 Consumption of diet containing adequate quantities of vitamin B2 such as eggs, milk and
milk products, meat, fish, whole cereals, oil seeds, nuts and leafy vegetables

Vitamin B3 (Niacin)
 Diversity in the diet
 Production and consumption of food known to prevent pellagra i.e. those rich in niacin
such us nuts and tryptophan such as eggs, milk, lean meat and fish should be increased
 Enrich milled maize meal with niacin
 Niacin tablets are administered as prophylaxis in prisons, refugee camps and institutions
in areas where pellagra is endemic.
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 Nutrition education

Vitamin C
 Increased production and consumption of vitamin C rich foods: fruits and vegetables.
Encourage the use of wild edible fruits and vegetables
 Provision of vegetable fruits and fruits juices to all community members (including
children beginning at six months)
 Nutrition education in consumption of vitamin C rich foods, minimizing vitamin C loss in
cooking and food preparation

Vitamin D
 All children get adequate amount of sunlight
 Children, pregnant women and lactating women should have adequate calcium and
vitamin D in their diet
 Attend clinic regularly
 Fish- liver oils, egg yolk, milk, butter, cheese and ghee
 Establish allowing supplementation of cod-liver oil or other vitamin D supplements
 Nutrition education (including child spacing)

Vitamin E
 It is widely distributed in nature that it is difficulty to prepare a diet deficient in vitamin E
 Human milk is enough for the infants
 Cereal especially wheat germ oils are the richest source. Vegetable fats from corn, soya
bean, peanuts and coconut or cotton seeds are good sources followed by cereals, eggs and
meat and green leaves such as spinach.

Vitamin K
 Bacteria in the intestine normally produce it in adequate amount
 Fresh dark green vegetables especially spinach, kale and cauliflower
 Plant oils, rice bran oil and wheat germ oil, soya bean and cotton seed oils are best
sources

Iodine
 Various medicinal preparations are administered, such as:
o Injectable iodized oil
o Iodinated oil capsules
o Salt iodation: emphasis should be on salt iodation only because currently other strategies
are less commonly usedControl of Iodine Deficiency

Iron
 Promotion of consumption of iron- and vitamin-rich foods
 Prevention and treatment of anemia-related diseases (malaria, worm infestation)
 Iron and folic acid supplementation to the most at risk groups (children, pregnant women,
sickle cell disease patients)
 Fortification of foods with relevant nutrients (iron, folic acid)
 Prevention and treatment of anaemia-related diseases (malaria, worm infestation)

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 Handout 43.1: Nutrition Supplements and Associated Nutrient Disorders

Handout 41.2: Nutrition Supplements and Associated Nutrient Disorders

Handout 41.3: Nutrition Supplements

STEP 4: Key points (5 minutes)

 Common nutritional deficiency diseases are Protein Energy Malnutrition and Vitamins
and Minerals Nutritional Deficiencies
 Management of nutritional deficiency diseases depends much on handling their signs and
symptoms

STEP 5: Evaluation (10 minutes)

 What are the common nutritional deficiency diseases?
 How are nutritional deficiency diseases managed?

STEP 6: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)

DIVIDE students in groups or individuals

ASK the students to work on the following Assignment

• Prepare a presentation about different types of Anaemia and how they can be
managed
ALLOCATE time for students to do the assignments and submit

REFER students to recommended references

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva: WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries. (2nded.). New York:
Felicity Oxford University Press

Kumar P. & Clark, M. (2006).Clinical Medicine. (6thed.) New York: Elsevier Limited
299
Latham M. C (1997). Human Nutrition in the Developing World.David Lubin Memorial
Library

McLaren.S. (1992).A Colour Atlas and Text of Diet-Related Disorders. (2nded.) BPCC
Hazells Ltd, Aylesbury, England

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd Rev.ed.). New

Delhi: Sterling Publishers Private Ltd

Tanzania Food and Nutrition Centre.(2009). National Guidelines for Nutrition Care and
Support for People Living with HIV. (2nded.) Dar es Salaam: TFNC

Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights. (4thed.) Phidalephia: Mc
GrawHill,

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Handout 43.1: Nutrition Supplements and Associated
Nutrient Disorders

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Handout 43.2: Nutrition Supplements and Associated
Nutrient Disorders

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Handout 43.3: Nutrition Supplements

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Hand Out 44.1: Specialised Food Products Used in Tanzania

a) F 75 and F 100

F-100 composition F-75 Composition

No. Ingredient Contents/100g of dry Contents/100g of dry product
product
1 Energy 520 kcal 446 kcal
2 Protein 10% de 5% de
3 Lipids 45% de 31% de
4 Vit.A 800 ug 0.9 mg
5 Vit.D 15 ug 18 ug
6 Vit.E 20 mg 20 mg
7 Vit.C 50 mg 59 mg
8 Vit.B1 0.5mg 0.5 mg
9 Vit.B2 1.6 mg 1.2 mg
10 Niacin 5 mg 5 mg
11 Vit.B6 0.6 mg 0.6 mg
12 Folic acid 200 ug 200 ug
13 Vit.B12 1.6 ug 1.6 ug
14 Biotin 60 ug 60 ug
15 Pantothenic acid 3 mg 3 mg
16 Vit.K 16 ug 24 ug
17 Sodium <290 mg <87 mg
18 Calcium 300 mg 560 mg
19 Phosphorus 300 mg 330 mg
20 Magnesium 80 mg 50 mg
21 Zinc 11 mg 12.2 ug
22 Iodine 70 ug 100 ug
23 Potasium 1100 mg 775 mg
24 Copper 1.4 mg 1.7 mg
25 Selenium 20 ug 30 ug
26 Iron <0.2 mg <0.3 mg

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 b) READY TO USE THERAPETIC FOOD ‘Plumpy'Nut.

It is a paste of groundnut composed of vegetable fat, peanut butter, skimmed milk powder,
lactoserum, maltodextrin, sugar, mineral and vitamin complex

Nutrient Per sachet of 92 g Nutrient Per sachet of 92 g

Energy 500 kcal Vitamin A 840 mcg

Proteins 12.5 g Vitamin D 15 mcg

Lipids 32.86 g Vitamin E 18.4 mg
Calcium 276 mg Vitamin C 49 mg
Phosphorus 276 mg Vitamin B1 0.55 mg
Potassium 1 022 mg Vitamin B2 1.66 mg
Magnesium 84.6 mg Vitamin B6 0.55 mg
Zinc 12.9 mg Vitamin B12 1.7 mcg
Copper 1.6 mg Vitamin K 19.3 mcg
Iron 10.6 mg Biotin B5 60 mcg
Iodine 92 mcg Folic acid 193 mcg
Selenium 27.6 mcg Pantothenic acid 2.85 mg
Sodium < 267 mg Niacin B3 4.88 mg

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 c) FORTIFIED BLENDED FOOD (FBF)

High Energy Pre-cooked Porridge Flour, Fortified with Vitamins & Minerals

Composition Table of Fortified Blended Flour (Fbf)

Foundation Plus+- (Corn Soy Blend ) Frominsta Health Builder

Maize 64.4%,
Soybeans 25%
Sugar 5%,
Palm Olein Oil 5%,
Vitamins & Minerals 0.6%

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