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  1. 1

    Guideline: Updates on the management of severe acute malnutrition in infants and children.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2013. [123] p.

    This guideline provides global, evidence-informed recommendations on a number of specific issues related to the management of severe acute malnutrition in infants and children, including in the context of HIV. The guideline will help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions for severely malnourished children. It will also support Member States in their efforts to achieve global targets on the maternal, infant and young child nutrition comprehensive implementation plan, especially global target 1, which entails achieving 40% reduction by 2025 of the global number of children under 5 years who are stunted and global target 6 that aims to reduce and maintain childhood wasting to less than 5%. The guideline is intended for a wide audience, including policy-makers, their expert advisers, and technical and programme staff in organizations involved in the design, implementation and scaling-up of nutrition actions for public health. The guideline will form the basis for a revised manual on the management of severe malnutrition for physicians and other senior health workers, and a training course on the management of severe malnutrition..
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  2. 2

    Global Blood Safety Initiative. Use of plasma substitutes and plasma in developing countries, Geneva, 20-22 March 1989.

    League of Red Cross and Red Crescent Societies; World Health Organization [WHO]. Global Programme on AIDS. Health Laboratory Technology Unit

    [Unpublished] 1989. [2], 5 p. (WHO/GPA/INF/89.17; WHO/LAB/89.9)

    Health care practitioners should treat hypovolemia with plasma substitutes rather than plasma since it carries the risk of transmitting infections. They can use plasma to manage hemostasis and sometimes acute plasma protein loss, however. Crystalloid, a plasma substitute, spread swiftly from the capillaries into the interstitial fluid space. Therefore health care practitioners must administer 3 volumes of crystalloid for each volume of blood or plasma lost. This phenomenon may bring about tissue edema which is unacceptable for high risk patients. Another set of substitutes are synthetic colloids which serve to retain circulatory water and volume. They include gelatin solutions, dextran 70, and hydroxyethyl starch (HES). The gelatins function as osmotic diuretics and therefore must be supplemented with 1-2 liters of crystalloid solutions. Dextran and HES draw fluid into the intravascular areas from the surrounding extravascular spaces. Depending on the synthetic colloid, side effects consist of circulatory overload, anaphylactoid reactions, red cell aggregation, platelet and factor VIII interference, and hemostatic interference. Albumin and plasma protein fraction make up the 3rd set of substitutes. Since sophisticated manufacturing techniques and strict quality control are required, they are costly for developing countries to import. They must be pasteurized to inactivate HIV, hepatitis, and other viruses. wpossible side effects are circulatory overload, hypotension, and anaphylactoid reactions. WHO has identified >10 guidelines for managing bleeding, e.g. starting an IV if the pulse rate climbs to >100/minute or systolic blood pressure falls to <90 mm Hg. It also has addressed the need for training for nonphysicians who use plasma substitutes.
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  3. 3

    RNIS 23: report on the nutrition situation of refugees and displaced populations.

    Wallace J; Shoham J

    Geneva, Switzerland, World Health Organization [WHO], Administrative Committee on Coordination, Sub-Committee on Nutrition, 1998 Mar 25. [2], 30 p.

    This report provides a summary of UN nutritional interventions, living conditions, and refugee situations for selected countries in sub-Saharan Africa and Asia. In 1998, conditions in Afghanistan, Angola, Liberia, and Rwanda permitted a shift, partial or country-wide, from relief efforts to development. Flooding in many East African countries (Burundi, Kenya, Somalia, and Tanzania) placed many people at risk of malnutrition. Conflicts and flooding continue to pose problems of access to large population groups in Uganda, Somalia, and Burundi and pose other problems in some areas of Rwanda, Tanzania, Congo, Sierra Leone, and Sudan. Food and non-food stocks are problematic in Burundi, Tanzania, Sierra Leone, Sudan, and Uganda, and are inadequate in some areas of the Congo. Stocks are unknown in Somalia and Rwanda. Food and non-food pipelines are not known in Uganda, and are problematic in Sudan and Somalia. Logistics are inadequate in some areas of Angola, Rwanda, Congo, Liberia, Sierra Leone, and Sudan, and are problematic in Burundi, Tanzania, Somalia, and Uganda. Camp factors are a problem in some areas of Rwanda, Congo (inadequate staff), Liberia, and Sudan, and are problematic in Burundi, Somalia, and Uganda. Rations are a problem in some camps in Rwanda, Congo, Liberia, Somalia, and Sudan, and are problematic in Burundi, Tanzania, Sierra Leone, and Uganda. Immunization is a problem in some areas of Congo, and is problematic in Burundi, Liberia, Sierra Leone, Sudan, Somalia, and Uganda. Information is problematic in Burundi, Rwanda, Sierra Leone, Somalia, and Uganda.
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  4. 4

    Detecting pre-eclampsia: a practical guide. Using and maintaining blood pressure equipment.

    Guidotti R; Jobson D

    Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. iii, 46 p. (WHO/MCH/MSM/92.3)

    WHO's Maternal Health and Safe Motherhood Programme has guidelines for health workers to detect early signs and symptoms of preeclampsia and to provide early treatment of mild preeclampsia to prevent severe preeclampsia. Health workers must take accurate blood pressure measurements, test for protein in urine, and identify substantial edema. This manual helps them determine when blood pressure equipment does not work accurately and know how to fix it. The manual covers all parts of the sphygmomanometer (blood pressure machine): the cuff, rubber bladder, the aneroid sphygmomanometer, stethoscope, and pump and control valve. Health workers should know that certain conditions elevate blood pressure in normal patients. They can alleviate them to obtain accurate blood pressure measurements. These conditions are fear, cold, full urinary bladder, exercise, tight clothes around the arm, obesity, standing up, and lying on the back. Health workers should place either the left or right arm on a table or on another object thereby allowing the muscles to relax. The upper arm needs to be at the same level of the heart. It is important that all levels of health workers be adequately trained in taking blood pressures correctly. Training should not occur in busy and noisy clinics. The trainer should use a double stethoscope to determine whether the trainees correctly identify the Korotkoff sounds. Health workers must feel pregnant women how to collect a midstream urine sample, free of vaginal secretions and discharges, so the health workers can test for protein in the urine. Its presence indicates kidney failure. Diagnosis of mild preeclampsia includes a blood pressure at least 140/90 mmHg or an increase of 30 mmHg systolic or 15 mmHg diastolic and at least 300 g/l protein in urine. In addition to these signs, sudden onset of edema of face and/or hands, severe headaches, great reduction of urine output, epigastric pain, visual disturbances, and reduced fetal movement are reliable signs of severe preeclampsia.
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  5. 5

    Hypertensive diseases of pregnancy.


    A meeting in Singapore of principal investigators from 7 countries in a WHO collaborative study on hypertensive disease of pregnancy, also called pre-eclampsia or eclampsia, pointed out women at risk, suggested management guidelines, and summarized operations research projects involving administration of aspirin or calcium supplements. Hypertensive disease of pregnancy may ultimately end in fatal seizures. It is often marked by warning signs of severe headaches and facial and peripheral edema. A survey in Jamaica found that 0.72% of a group of 10,000 pregnant women had eclamptic seizures. These were the cause of almost one-third of all obstetric deaths in the period 1981-1983. 10.4% of the pregnant women had hypertension, and half of these had proteinuria. Associated risk factors were primigravida, age >30, abnormal weight gain, edema, 1+ proteinuria. A phased program of management guidelines for identifying and treating affected women is being instituted in half of Jamaica's parishes. An operations research project involves administration of low-dose aspirin vs. placebo. Another controlled trial, in Peru, is testing calcium supplements. A third trial in Argentina will compare 2 drug regimens.
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