May 30, 2000
ADMINISTRATIVE ORDER
No. 55 series 2000
GUIDELINES IN THE
IMPLEMENTATION OF MASS TREATMENT STRATEGY FOR SCHISTOSOMIASIS CONTROL /
ELIMINATION
The Philippines is one of
the world’s important endemic countries for Schistosomiasis. The disease occurs
in 10 regions, 25 provinces, 183 municipalities and 1112 barangays in the
country with an estimated total endemic population of 1.8 million.
Schistosomiasis has
remained a public health problem for almost 6 decades since the occurrence of
an epidemic in 1944, among American and Allied forces that landed in Leyte.
With the present national health directional goal towards disease elimination,
the Schistosomiasis Control Program of the Department of Health should
implement a more aggressive strategy to attain this end (prevalence rate of
<1%). Hence, Mass Drug Administration or Mass Treatment Strategy shall be
implemented in all schistosomiasis endemic areas.
In coordination with the
local Government Units, the Regional and Provincial Schistosomiasis
Coordinators; the Provincial Based Schistosomiasis Control Teams and the
National Center for Infectious Diseases shall cooperate with each other in
planning and conducting the activities on schistosomiasis mass treatment
strategy for the attainment of the schistosomiasis control program goal and
objectives.
I. STRATEGIES/ACTIVITIES
1. Social
Mobilization and Advocacy:
a. To generate active support and encourage collaborative
effort in the control / elimination of schistosomiasis, inter–sectoral
coordination shall be carried out thru advocacy meetings with local government
executives; school officials and teachers, various social, political and
business groups; and other government and non–government organizations.
b. Continuous IEC activities as well as development and
provision of IEC materials shall be implemented to sustain the community’s
level of awareness.
c. Orientation and skills development training shall be
conducted for service providers who will be involved in the mass chemotherapy
program.
d. Barangay assemblies for advocacy and social
preparation shall be undertaken prior to the conduct of mass treatment to
ensure support and active participation of target public/beneficiaries.
e. Health education and communication campaign activities
shall be in coordination with the Department of Education, Culture and Sports;
the Philippine Information Agency; and the Public Information and Health
Education Service of the Department of Health.
f. The local government units shall be encouraged to
adopt and integrate the schistosomiasis mass treatment strategy into their
local health program for sustainability.
2. Mass
Treatment (Mass Drug Administration):
a. Mass treatment (treatment without the benefit of stool
examination) shall be implemented country wide in all schistosomiasis endemic
barangays and the population to be covered will be age 5 years old and above.
b. Praziquantrel (generic name) the drug to be used for
schistosomiasis mass treatment, will be given at 40–50 mg/kg body weight and
shall be taken filled stomach or after ingestion of food.
c. For individuals having body weight of 31 kg and above,
praziquantrel will be applied in single dose while those with less than 31 kg
body weight, the drug will be given in 2 divided doses (split dose) at 4 – 6
hours interval.
d. Treated individuals shall be observed for a few hours
for possible side reaction, before allowing to leave the designated treatment
centers.
e. Anti–reaction drugs must be readily available during
mass treatment. Individuals with generally poor condition shall be given
supportive drugs such as Vitamins and hematinics.
f. Those with history of epileptic seizure, with high
blood pressure as well as with enlarge spleen or in the advance stage should be
referred to the hospital for treatment.
g. Although praziquantrel has not shown to be mutagenic,
teratotogenic or embryotoxic, administration of drug is not recommended for
pregnant women unless immediate intervention is essential. Nursing mothers on
the other hand shall not breastfeed their babies for 48 hours after
praziquantrel treatment.
h. Rural Heath Physician shall be encouraged in the
supervision/administration of treatment during the scheduled mass treatment.
i. Properly
trained Medical Technologists, Midwives, other health workers and paramedics
maybe allowed to administer treatment provided they are under the supervision
of a physician.
j. Setting up treatment centers and scheduling of
treatment can be done in the health centers, barangay halls, school and in
their respective houses or any convenient designated area.
k. Praziquantrel tablets should be placed in a well–closed
container protected from light.
3. Support
activities (Snail Control and Environmental Modification):
a. Partnership initiatives shall be established with the
Department of Public Works and Highways, Department of Agriculture, National
Irrigation Administration, the community and other stakeholders for Snail
Control and Environmental Modification activities, particularly infrastructure
projects such as provision of sanitary toilets and safe water supply,
construction of drainage systems and footbridges, and other related
schistosomiasis projects.
b. Whenever resources is available, application of
molluscicide will be done by the Schistosomiasis control teams in collaboration
with the community concerned in areas where eradication of snails (O. hupensis quadrasi)
is possible and where disease transmission is relatively high.
II. MONITORING
/ EVALUATION AND SURVEILLANCE SYSTEM
1. In order to adequately assess the effect of mass
treatment and guide public health for further action, monitoring/evaluation and
surveillance system shall be developed.
2. Since it is not feasible to cover the entire endemic
population sentinel sites for surveillance and monitoring shall be established /
identified in every endemic province.
3. Well defined common indicators (e.g. prevalence, incidence, egg output per gram, snail infection rate, etc.)
and comparable procedure for data collection system shall be developed, so that
effect/impact of mass treatment strategy can be drawn.
4. Masterlist of the endemic population per barangay
shall be established and maintained.
5. Mass treatment service statistics shall be recorded
and maintained by the Schistosomiasis control teams and rural health units and
shall be consolidated by the regional health offices.
6. Regional Health Offices concerned shall furnish copy
of the consolidated reports to the National Center for Infectious Diseases at
DOH central office.
7. Staff from the
Regional Health Offices concerned and from the National Center for Infectious
Diseases, shall conduct periodic monitoring and assessment on the progress of
implementation.
This
order superseded Administrative Order No. 6 series 1996 dated 27 February 1996.
ALBERTO
G. ROMUALDEZ, JR, MD
Secretary
of Health
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