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NON COMMUNICABLE DISEASES Participants Manual NCD MODULE 13 Contents- NCD MODULE 13 Table of Contents Foreword ...................................................................................................................................... 02 Preface ........................................................................................................................................... 03 Acknowledgements ............................................................................................................. 04 Contributors............................................................................................................................... 05 UNIT 1 Diabetes Mellitus .................................................................................................................... 06 UNIT 2 Cardiovascular Diseases ..................................................................................................... 21 UNIT 3 Cancers ......................................................................................................................................... 35 UNIT 4 Epilepsy......................................................................................................................................... 45 UNIT 5 Mental Health ........................................................................................................................... 51 UNIT 6 Injuries And Disabilities Prevention And Rehabilitation ................................ 60 UNIT 7 Alcohol And Drug Abuse................................................................................................... 73 UNIT 8 Oral Health .................................................................................................................................. 83 UNIT 9 Primary Eye Care ..................................................................................................................... 98 UNIT 10 Chronic Respiratory Diseases ....................................................................................... 110 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 1 Foreword- NCD MODULE 13 Foreword Health is a major component in the socio-economic development of any community. Indeed, it society is the responsibility of all individuals, families, households, and communities. Kenya has embraced the community strategy to enable communities to improve and maintain a level of health that will enable them to participate fully in national development towards the realization of Vision 2030. Extensive consultations among various departments, divisions and stakeholders marked the development process of the CHV Curriculum which is divided into the basic and technical sections. The development of the Basic manual went through a similar process and was pre-tested in various geographic sites. Subsequently, Technical modules were also developed and pre-tested. Among these is the Non Communicable Diseases Technical Module. Strategy in achieving its strategic objectives as outlined in the Kenya Health Sector Strategic & Investment Plan (KHSS&IP) 2013-2017, and towards the attainment of SDG targets. It will be in a systematic manner through well-trained Community Health Extension Workers. In having communities to make informed choices to prevent Non communicable conditions. On behalf of the Ministry of Health, I wish to thank Kenya Red Cross (KRC), and all other contributors and reviewers who worked tirelessly to produce this module. KRC also through the Division of Non testing of this technical module for the training of Community Health Volunteers possible. I thank the Capacity Working Groups of the NCDs & DCHS, which ensured that this document the issue of equitable access to primary health services and by so doing, bring about a much Dr. Nicholas Muraguri Director of Medical Services Ministry of Health 2 NON COMMUNICABLE DISEASESParticipants Manual - NCD MODULE 13 Preface - NCD MODULE 13 Preface One of the dominant themes in health policy and planning today is the need for interventions consistent with the best available evidence must be shared between providers, policy makers and consumers of services. Community Health Volunteers (CHVs) have been major players in the implementation of primary healthcare since the 1980s, and still continue to play a critical role in mobilizing communities in taking care of their health and providing basic healthcare at community level. The Non communicable conditions, such as Heart diseases, Cancers, Diabetes and Mental health diseases provides a platform to empower community health Volunteers in identifying, screening and referring children, women, and the elderly and promoting healthy lifestyles to reduce related diseases as articulated in this module. These interventions are practical and through the advocacy by CHVs, This training module is meant to strengthen the capacity of CHVs to prevent the Non Communicable Diseases at the community level. The Government of Kenya is committed to supporting community health initiatives and accelerating the achievement of the KHSS&IP goals, Millennium Development Goals (MDGs) and providing support to Vision 2030. The training manual for CHVs is organized in Modules which should be applied incrementally training manual covers thirteen modules detailing NCD in the technical section as Module 13. It is my hope that all stakeholders in community health will utilize this module to train CHVs in order to standardize provision of healthcare to our communities. Dr. Jack Kioko Head; Department of Preventive and Promotive Health Ministry of Health NON COMMUNICABLE DISEASESParticipants Manual - NCD MODULE 13 3 Acknowledgements- NCD MODULE 13 Acknowledgements The development of this technical module on Non communicable Diseases has been through Communicable Disease Units. We acknowledge the Head, NCD, Dr Kibachio Joseph who provided technical oversight in development of this module. We also recognize those who may have not participated directly in the drafting of this module but who rendered services in support of the teams that helped in its realization. The draft module was pretested in Embu, Garissa and Nairobi Counties where the County and Sub County Community Focal Persons and level 1 workforce participated in the pre-testing exercises. Last but not least, we thank communities who shared their experiences which helped inform the development of this module. Special thanks are accorded to the CHS Capacity Working Group for initiating the training module development process. Much gratitude to the Task force Group members, Mr. Ambros Juma, -CHS, Mr.Ken Ogendo, Ms. Joyce King’ori- BNK, and Ms. Angela Ng'etich- Kenya Red Cross Society for logistical Kiogora and Sylvia Khamati, for unwavering coordination of the entire process. Dr Salim Ali Hussein Head; Community Health Services Unit Ministry of Health 4 Dr. Kibachio Joseph Mwangi Head; Division of Non-Communicable Diseases Ministry of Health NON COMMUNICABLE DISEASESParticipants Manual - NCD MODULE 13 Contributors - NCD MODULE 13 Contributors Dr Salim Hussein MOH - Head CHSU Daniel Kavoo MOH - CHSU Samuel G Kiogora MOH - CHSU Caroline Cherotich MOH - CHSU Ruth Ngechu MOH - CHSU Jane Koech MOH - CHSU Ambrose Juma MOH - CHSU Diana Kamar MOH - CHSU Charity Tauta MOH - CHSU Philip Mbithi CHSU- Intern Joyce King’ori Basic Needs Kenya Dorothy Anjuri World Vision Dr Kibachio Joseph. MOH - NCD Fransisca MOH - NCD Zachary Ndegwa MOH-NCD Dr Alfred Karagu MOH - NCD Angela Ng'etich KRCS-Kenya Red Cross Society Kenneth Ogendo MOH - CHSU - JKA Scholarstica Owondo MOH-NCD Peris Mbugua MOH-NCD Dr Muthoni Gichu MOH-NCD Dorothy Otieno AIHD NON COMMUNICABLE DISEASESParticipants Manual - NCD MODULE 13 5 UNIT 1- 1DIABETES MELLITUS UNIT DIABETES MELLITUS 6 6 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 7 7 Unit 1- DIABETES MELLITUS UNIT 1- DIABETES MELLITUS Purpose The purpose of this unit is to equip the community health volunteer with knowledge and skills to enable them to create awareness on how to recognize signs and symptoms of diabetes mellitus, prevention and appropriate referral and follow-up. Objectives By the end of this unit, the community health volunteer should be able to; 1. Define and classify diabetes mellitus 2. Identify signs and symptoms 3. List the risk factors of diabetes mellitus. 4. Facilitate the prevention and control of diabetes mellitus 5. Facilitate treatment of diabetes mellitus through referral to a health facility. 6. Identify common complications of diabetes mellitus, short-term and long-term. 8 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 1 - DIABETES MELLITUS INTRODUCTION TO DIABETES what is diabetes mellitus Diabetes is a lifelong condition characterized by high blood sugar. Causes; • Lack or insufficient production of insulin • Insulin inaction • Or both Insulin is a chemical produced by the pancreas which acts like a key that opens the body cells for sugar to enter so that it can be used for energy production. Classification of Diabetes Mellitus Simple classification of Diabetes Mellitus There are 2 main types of diabetes mellitus; type 1 and type 2 Type 1 It occurs in young children and adolescents. It results from damage to the pancreas which leads in failure of insulin production. Account for up to 10% of all cases of diabetes. Type 2 It is the commonest type of diabetes accounting for up to 90% mostly in adults .it is due to reduced insulin production or resistance of body cells to insulin, or both. Gestational diabetes mellitus Diabetes detected for the first time during pregnancy. It occurs due to failure of the body to make and use all the insulin it needs for pregnancy. Pre-diabetes state This is a state where an individual has abnormally high blood sugar that has not reached levels categorized as diabetes. People with pre diabetes are at risk of developing diabetes or getting complications before overt diabetes sets in. Fasting blood sugar levels • Hypoglycemia• Normal• Pre Diabetes state• Diabetic- <4mmols/L 4.0-5.8mmol/L 6.0-6.9mmol/L >6.9 mmol/L NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 9 Unit 1- DIABETES MELLITUS Unit 1- DIABETES MELLITUS Signs and Symptoms Diabetes Mellitus 1. 1.Signs and Symptoms of of Diabetes Mellitus Frequent urination • • Frequent urination • • Extreme hunger • Extreme hunger • • Increased fatigue • Increased fatigue • Blurry (unclear) vision • • Blurry (unclear) vision Impotencefailure sustain erection. • • Impotencefailure to to sustain anan erection. Itching private parts women • • Itching of of private parts in in women Slow healing cuts and wounds • • Slow healing of of cuts and wounds • Numbness or tingling sensation hands and feet • Numbness or tingling sensation of of thethe hands and feet • Excessive Excessive thirst thirst • Unexplained Unexplained weight loss weight loss • Irritability Irritability Ugonjwa wa Kisukari waweza kujidhihirisha kwa njia zifuatazo Ugonjwa wa Kisukari waweza kujidhihirisha kwa njia zifuatazo A person can living with diabetes without symptoms hence regular blood sugar testing NB:NB: A person can bebe living with diabetes without thethe symptoms hence regular blood sugar testing is recommended. is recommended. 10 10 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 1 - DIABETES MELLITUS Unit 1 - DIABETES MELLITUS Risk Factors diabetes mellitus Risk Factors forfor diabetes mellitus Case Study Case Study Mr.Malimoto was well respected, heavily built, very successful farmer and envy many Mr.Malimoto was well respected, heavily built, very successful farmer and thethe envy of of many Pundamilia village. Many would jokingly him mkubwa due “well-built” stature. in in Pundamilia village. Many would jokingly callcall him mkubwa due to to hishis “well-built” stature. HeHe was very welcoming and social and would have small parties and get-togethers home, was very welcoming and social and would have small parties and get-togethers in in hishis home, to to entertain his family and the villagers with nyamachoma, beer, ugali and other delicacies. entertain his family and the villagers with nyamachoma, beer, ugali and other delicacies. One evening, Mr.Malimoto suddenly and a few hours, wife realised was talking One evening, Mr.Malimoto suddenly fellfell ill ill and in in a few hours, hishis wife realised hehe was talking things they couldn’t understand and then suddenly collapsed. wife and children rushed him things they couldn’t understand and then suddenly collapsed. HisHis wife and children rushed him hospital where was admitted and unfortunately died hour after admission. The family to to hospital where hehe was admitted and unfortunately died anan hour after admission. The family sadly buried him and community members started saying that one of his business competitors sadly buried him and community members started saying that one of his business competitors had offered him sacrifice witchcraft that business could make more money than had offered him as as sacrifice in in witchcraft soso that hishis business could make more money than Mr.Malimoto’s. Mr.Malimoto’s. A couple years later, eldest son Baraka tripped their shamba was supervising A couple of of years later, hishis eldest son Baraka tripped in in their shamba as as hehe was supervising thethe farm workers and got what one would consider very minor bruise on the foot. Since it wasn’t farm workers and got what one would consider very minor bruise on the foot. Since it wasn’t serious, just it cleaned and assumed nature would take cause usual. A month soso serious, hehe just gotgot it cleaned and assumed nature would take itsits cause as as usual. A month later however, he realised the wound was far from healed and instead had pus and was even later however, he realised the wound was far from healed and instead had pus and was even enlarged. enlarged. wife this point advised him hospital, where doctor asked him several questions, HisHis wife at at this point advised him to to gogo to to hospital, where thethe doctor asked him several questions, from which realised that had recent past been taking lots water and was making from which hehe realised that hehe had in in thethe recent past been taking lots of of water and was making more frequent visits to the latrine than he earlier used to. The doctor then sent him more frequent visits to the latrine than he earlier used to. The doctor then sent him to to thethe laboratory several tests, whose results was advised pick following morning. laboratory forfor several tests, whose results hehe was advised to to pick thethe following morning. Risk factors diabetes mellitus 2. 2.Risk factors forfor diabetes mellitus Advancing age • • Advancing age • Family history diabetes • Family history of of diabetes Overweight and Obesity • • Overweight and Obesity Alcohol use • • Alcohol use • Tobacco use • Tobacco use Physical inactivity. • • Physical inactivity. • Stress. • Stress. Unhealthy diet. • • Unhealthy diet. Pregnancy • • Pregnancy • Long-term use steroids (drugs used relieve swelling and inflammation) • Long-term use of of steroids (drugs used to to relieve swelling and inflammation) NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 11 11 Unit 1- DIABETES MELLITUS Prevention and control of diabetes Prevention and control of diabetes • Promotion of healthy diets (low fat, low salt, whole grains, roots and tubers-cassava, arrowroots, sweet potatoes- avoid highly processed foods) • Promotion of physical activity • Maintenance of Healthy weight • Avoid alcohol • Avoid tobacco use • Early detection and treatment of diabetes mellitus. • Community support for people living with diabetes mellitus. Plate model A half of the plate should be vegetables, a quarter carbohydrate and a quarter protein 12 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 1 - DIABETES MELLITUS THE HEALTHY FOOD GUIDE PYRAMID The healthy food guide This is a guide on how to eat and drink to maintain good health. The guide illustrates how food should be selected and indicates food that should be eaten more (at the base), moderately or generously (at the centre), and in small amounts (at the top of the food guide). FOOD PYRAMID Promotion of physical activity Physical activity also plays an important part in preventing type 2diabetes in the following ways: » lowering blood sugar » lowering bad cholesterol and raise your good cholesterol » improving the body’s ability to use insulin » keeping the heart and bones strong » keeping the joints flexible » lowering risk of falling » helping in weight loss » reducing the body fat » giving you more energy » reducing stress NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 13 UnitUnit 1- DIABETES 1- DIABETES MELLITUS MELLITUS Examples Examples of simple of simple physical physical activities activities one one can can engage engage in: in: • • • • • • • • • Playing • Playing withwith the children the children Walking • Walking instead instead of using of using a motorbike a motorbike Working • Working in the in garden the garden Cleaning • Cleaning the house the house Take • Take the stairs the stairs instead instead of the of elevator/lift. the elevator/lift. Taking • Taking a brisk a brisk walkwalk (walk(walk at a fast at a pace) fast pace) Swimming • Swimming Dancing • Dancing Jogging • Jogging CAUTION: CAUTION: – – – – – If– you If you havehave typetype 1 diabetes, 1 diabetes, avoid avoid strenuous strenuous exercise. exercise. Carry – Carry youryour identification identification materials materials at allattimes all times Always – Always carrycarry a snack a snack or glucose or glucose tablets tablets in case in case the blood the blood sugars sugars dropdrop too low too low If– you’ll If you’ll be exercising be exercising or if or your if your physical physical activity activity will last will for lastmore for more thanthan an hour, an hour, check check youryour blood blood glucose glucose at regular at regular intervals. intervals. You You maymay needneed snacks snacks before before you you finish. finish. Do – not Do exercise not exercise if theif sugar the sugar is above is above 13 mmol/L 13 mmol/L or below or below 4 mmol/L 4 mmol/L Maintenance Maintenance of Healthy of Healthy Weight Weight Key Key Notes: Notes: Obesity Obesity is the is number the number one one contributing contributing cause cause of diabetes of diabetes today today and and it complicates it complicates the care the care of diabetes, of diabetes, which which can can make make treatment treatment withwith medications medications less less effective. effective. Being Being overweight overweight and and having having diabetes diabetes will will also also increase increase the the risk for risk diabetes for diabetes related related complications complications suchsuch as kidney as kidney failure, failure, blindness blindness and and heartheart disease. disease. A healthy A healthy weight weight will help will help you:you: • • • Lower • Lower blood blood sugar sugar and and pressure pressure if they if they are higher are higher thanthan normal. normal. Improve • Improve youryour blood blood fats iffats they if they are not are in nota healthy in a healthy range. range. Delay • Delay or prevent or prevent the onset the onset of Type of Type 2 Diabetes 2 Diabetes 14 14 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 1 - DIABETES 1 - DIABETES MELLITUS MELLITUS Normal obesity Normal obesity The The figures above are an on progression fromfrom normal healthy weight to obesity for for figures above areillustration an illustration on progression normal healthy weight to obesity bothboth menmen and and women. women. WaistWaist circumference (waist size)size) is strongly associated withwith being at risk TypeType 2 2 circumference (waist is strongly associated being at of riskdeveloping of developing Diabetes. Recommended values for the circumference (size)(size) for women should be 88cm Diabetes. Recommended values for waist the waist circumference for women should be 88cm (34 inches) or less 102cm (40 inches) or less (34 inches) or and less and 102cm (40 inches) or for lessmen. for men. Figures above are an of waist circumference (waist size) size) measurement and abdominal obesity Figures above areillustration an illustration of waist circumference (waist measurement and abdominal obesity NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 15 15 Unit 1- DIABETES MELLITUS Alcohol and tobacco use Avoidance of alcohol and tobacco use Alcohol and tobacco use increases the risk of type 2 diabetes. Heavy alcohol use Too much alcohol can cause chronic inflammation of the pancreas (pancreatitis), which can impair its ability to secrete insulin and ultimately lead to diabetes. Tobacco use Tobacco is equally harmful. Tobacco use can increase blood sugar levels and lead to insulin resistance. And the more you smoke, the greater your risk of diabetes. Those who smoke and have diabetes are also more likely to develop vision problems including eye disease and possible vision loss as well as kidney damage. It increases the chances of developing a long list of other conditions as well including: • • • • • Nerve damage that could result in the amputation of a limb Vascular disease Stroke Heart disease Foot problems Prevention, Control, Management and effective Referral of diabetes cases KEY NOTES Early detection and treatment of diabetes mellitus Early detection enables individuals who test positive for an illness to receive timely and appropriate medical treatment. Detection of diabetes is not easy without screening because many of the symptoms seem so harmless. Many diabetics are unaware that they are at high risk. Therefore, early detection of symptoms and treatment on diabetes is very important.The earlier diabetes is diagnosed, the more likely it is that it can be successfully managed. When you treat a disease early, you may be able to prevent or delay problems from the disease. Treating the disease early may also make the Diabetes easier to live with. Finding out early if you have diabetes is important because treatment can prevent or delay the complications of the disease. Community Support Systems Community support for people living with diabetes mellitus Living with type 2 diabetes for a lot of people can be a very stressful experience. It may seem that there is no clear place to turn for help on learning about healthy living. If you are living with diabetes or any other chronic illness, do not try going it alone. Yes, granted you may feel so alone and that no one gets what it is that you are dealing with. But sure-fire way to end up stressed out and depressed is to create a network with people living with a similar condition. 16 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 1 - DIABETES MELLITUS This is why it is important to build a network of people who are there to support you. The network is important by increasing prevention behaviours in persons and communities at high risk for diabetes and those with pre-diabetes. Management of diabetes mellitus The management of diabetes entails: 1. Diabetes education 2. Proper nutrition 3. Physical activity 4. Weight control 5. Cessation of smoking 6. Cessation of alcohol intake 7. Adherence to diabetes drugs intake Diabetes Education People with diabetes and their families need to know: • That diabetes is serious chronic disease, has no cure, but can be controlled • Diabetes complications are preventable • That regular medical check-ups are very important and attending diabetic clinic • When to seek medical help • That the cornerstones of diabetic treatment include: I. Individualized education and counselling II. What foods to eat, how much and how often to eat. III. How to exercise and the precautions (a light snack before and after the exercise) IV. How and when to take medications On physical exercises, it is important to stress the value of physical activity and exercises in the prevention, control and management of diabetes. Good nutrition is a key pillar of prevention, control and management of diabetes. • Eat a healthy, balanced diet with food components from all the food groups • Simple meal planning tools like plate model, the food pyramid and the Zimbabwe hand jive can be used in the community. Medication and management of diabetes Mellitus People living with type 1 disease need insulin for the management of their diabetes. People living with type 2 diabetes should be mainly managed with oral drugs. Insulin can be used when oral drugs are ineffective. Adherence to diabetes management is very important in maintaining blood sugar levels and preventing diabetic complications. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 17 UnitUnit 1- DIABETES 1- DIABETES MELLITUS MELLITUS COMMON COMMON COMPLICATIONS COMPLICATIONS OF DIABETES OF DIABETES MELLITUS MELLITUS 1. Short-term 1. Short-term complications complications LOWLOW BLOOD BLOOD SUGAR SUGAR /HYPOGLYCEMIA /HYPOGLYCEMIA 18 18 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 1 - DIABETES 1 - DIABETES MELLITUS MELLITUS HOW HOW TO PREVENT TO PREVENT LOWLOW BLOOD BLOOD SUGAR/HYPOGLYCEMIA SUGAR/HYPOGLYCEMIA NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 19 19 Unit 1- DIABETES MELLITUS 2. Long-term complications 20 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 UNIT 2- CARDIOVASCULAR DISEASES NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 21 22 22 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 2- CARDIOVASCULAR 2- CARDIOVASCULAR DISEASES DISEASES UNIT UNIT 2- CARDIOVASCULAR 2- CARDIOVASCULAR DISEASES DISEASES Purpose Purpose The The purpose purpose of this of unit this unit is to is equip to equip the community the community health health volunteers volunteers withwith knowledge knowledge and and skillsskills to enable to enable themthem to create to create awareness awareness on the on prevention the prevention of cardiovascular of cardiovascular diseases diseases withwith a special a special emphasis emphasis on hypertension on hypertension and and rheumatic rheumatic heartheart disease. disease. The The CHVCHV will will also also be able be able to recognize to recognize signssigns and and symptoms symptoms associated associated withwith common common cardiovascular cardiovascular diseases, diseases, to facilitate to facilitate appropriate appropriate referral referral and and follow-up. follow-up. Objectives Objectives By the By end the end of this of unit, this unit, the community the community health health volunteer volunteer should should be able be able to to 1. Define 1. Define and and givegive a simple a simple classification classification of CVDs of CVDs 2. Identify 2. Identify the common the common causes/risk causes/risk factors factors of CVDs of CVDs 3. Identify 3. Identify the common the common signssigns and and symptoms symptoms of CVDs of CVDs 4. Discuss 4. Discuss rheumatic rheumatic heartheart disease disease as a as CVD a CVD of community of community health health importance importance 5. Describe 5. Describe the prevention, the prevention, control control and and treatment treatment modalities modalities of CVDs of CVDs NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 23 23 Unit 2 - CARDIOVASCULAR DISEASES Understanding Cardiovascular Diseases (CVDs) Definition A cardiovascular disease (CVD) or Heart disease is any disease or condition that affects or damages the heart or blood vessels. Vascular diseases are diseases of the blood vessels; • If the blood vessels supplying blood to the heart are affected, this can lead to heart attack. • If the blood vessels supplying blood to the brain are affected, this can lead to stroke. 24 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 2- CARDIOVASCULAR DISEASES • If the blood vessels supplying the arms and legs are affected, then that can lead to death of tissues in legs due to poor blood circulation Point to Note: Hypertension (High blood pressure) is one of the commonest cardiovascular condition in our country. Persistent high blood pressure is one of the risk factors of stroke and heart attack. What is blood pressure? Blood pressure is a measure of the force of blood pushing against the walls of your blood vessels (arteries). Blood pressure is measured in millimetres of mercury (mm Hg) and is recorded as two figures. For example, 150/95 mm Hg which is said as 150 over 95. The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart contracts. The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat Hypertension or high blood pressure is said to occur when either the top number (pressure) is equals or greater than 140 mm Hg or the bottom number (pressure) is equals or greater than 90 mm Hg or both. It is a life-long condition which requires regular follow-up Impact of CVDs CVDs can affect people at any stage of life undermining the socioeconomic development, not only of affected individuals, but families and nations. They are very expensive to treat and thus prevention and control is the best option to reduce their impact. Risk Factors for CVDs Causes/Risk factors of common cardiovascular diseases There are four shared behavioral risk factors responsible for most cardiovascular diseases namely; • Unhealthy diet e.g. High salt, fat & sugar intake. • Physical inactivity leading to obesity • Alcohol use • Tobacco use Additional risk factors for hypertension include: • Family history- parents or close relatives • Race- Blacks develop high blood pressure more often than whites, and it tends to happen at an earlier age and be more severe • Age- In general, the older you get, the greater your chance of developing high blood pressure. It occurs most often in people over age 35. • Gender- Men seem to develop high blood pressure most often between age 35 and 55. Women are more likely to develop it after menopause. After age 55, high blood pressure is much more common in women than in men. • Stress • Having diabetes or kidney disease NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 25 UnitUnit 2 - CARDIOVASCULAR 2 - CARDIOVASCULAR DISEASES DISEASES Signs Signs andand symptoms symptoms of common of common cardiovascular cardiovascular diseases diseases Symptoms Symptoms of cardiovascular of cardiovascular diseases diseases Often, Often, therethere are no aresymptoms no symptoms of the of underlying the underlying disease disease of the of blood the blood vessels. vessels. A heart A heart attack attack or or stroke stroke maymay be the be first the first warning warning of the of underlying the underlying disease. disease. Symptoms Symptoms of a of heart a heart attack attack include: include: • pain • pain or discomfort or discomfort on the on left the side left side of the of chest the chest • Pain • Pain or discomfort or discomfort in the in arms, the arms, the left the shoulder, left shoulder, elbows, elbows, jaw, jaw, or back. or back. In addition In addition the person the person maymay experience: experience: • Difficulty • Difficulty in breathing in breathing or shortness or shortness of breath of breath • Feeling • Feeling sick sick or vomiting or vomiting • Feeling • Feeling light-headed light-headed or faint or faint • Breaking • Breaking into into a cold a cold sweat sweat • Becoming • Becoming pale.pale. • Pain • Pain in the in upper the upper abdomen. abdomen. Hypertension Hypertension is a common is a common CVDCVD in our in setting. our setting. The The mostmost common common symptoms symptoms include: include: • Tiredness. • Tiredness. • Confusion. • Confusion. • Nausea • Nausea or upset or upset stomach. stomach. • Vision • Vision problems problems or trouble or trouble seeing. seeing. • Nosebleeds. • Nosebleeds. • More • More thanthan normal normal sweating. sweating. • •SkinSkin that that is flushed is flushed or red, or red, or skin or skin that that is pale is pale or white. or white. • Anxiety • Anxiety or nervousness. or nervousness. • Palpitations • Palpitations (strong, (strong, fast, fast, or obviously or obviously irregular irregular heartbeat). heartbeat). • Ringing • Ringing or buzzing or buzzing in ears. in ears. • Impotence. • Impotence. • Headache. • Headache. • Dizziness. • Dizziness. It is however It is however important important to note to note that that one one could could havehave highhigh blood blood pressure pressure yet they yet they don’tdon’t feel any feel any effect effect in their in their body. body. HighHigh blood blood pressure pressure causes causes the heart the heart to work to work harder harder thanthan it normally it normally would. would. It therefore It therefore increases increases the risk the of riskheart of heart attacks, attacks, strokes, strokes, kidney kidney damage, damage, eye eye damage, damage, heartheart failure failure and and hardening hardening of of arteries. arteries. Cardiovascular Cardiovascular diseases diseases maymay also also manifest manifest themselves themselves in the in form the form of a of stroke. a stroke. The The mostmost common common symptom symptom of a of stroke a stroke is: is: • sudden • sudden weakness weakness of the of face, the face, arm,arm, or leg, or most leg, most oftenoften on one on one side side of the of body the body Other Other symptoms symptoms include include sudden sudden onset onset of: of: • Numbness • Numbness of the of face, the face, arm,arm, or leg, or especially leg, especially on one on one side side of the of body the body • Confusion • Confusion • Difficulty • Difficulty speaking speaking or understanding or understanding speech speech • Difficulty • Difficulty seeing seeing withwith one one or both or both eyeseyes 26 26 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 2- CARDIOVASCULAR 2- CARDIOVASCULAR DISEASES DISEASES • Difficulty walking • Difficulty walking • Dizziness • Dizziness • Loss of balance or coordination • Loss of balance or coordination • Severe alcohol and and drugdrug abuse withwith no known cause • Severe alcohol abuse no known cause • Fainting or unconsciousness. • Fainting or unconsciousness. PointPoint to Note: Any Any person experiencing any any of the listedlisted herehere should seekseek medical to Note: person experiencing of symptoms the symptoms should medical carecare immediately. immediately. Rheumatic Heart Disease Rheumatic Heart Disease CaseCase Study Study Makali a Standard 1 pupil in Masomo BoraBora Primary school complains to the of feeling Makali a Standard 1 pupil in Masomo Primary school complains to mother the mother of feeling painpain whilewhile swallowing foodfood and and hotness of body. The The mother goesgoes to the shopping swallowing hotness of body. mother to nearest the nearest shopping centre and and buysbuys Panadol which she gives to Makali and and tells tells him him to rest AfterAfter two two daysdays centre Panadol which she gives to Makali to at resthome. at home. Makali is feeling much better and and resumes school. Three weeks laterlater Makali becomes unwell Makali is feeling much better resumes school. Three weeks Makali becomes unwell again. He complains to the of feeling painpain in the and and kneeknee joints, has ahas fever and and again. He complains to mother the mother of feeling in ankle the ankle joints, a fever has noticed a rash developing on the The The mother takestakes Makali to the disapensary. has noticed a rash developing on skin. the skin. mother Makali to nearest the nearest disapensary. What is rheumatic fever? What is rheumatic fever? Rheumatic FeverFever is anisillness that that commonly affects children agedaged 5-155-15 years. It usually occurs Rheumatic an illness commonly affects children years. It usually occurs a few weeks afterafter the the childchild has has experienced a sore throat following an infection withwith some a few weeks experienced a sore throat following an infection some germs known as streptococcal bacteria. If such a throat infection was was untreated withwith the right germs known as streptococcal bacteria. If such a throat infection untreated the right medicines, it is possible for itfor to itprogress to rheumatic feverfever in some children. medicines, it is possible to progress to rheumatic in some children. It usually occurs a few afterafter the child It usually occurs a weeks few weeks the child has has experienced a sore throat following experienced a sore throat following an infection withwith somesome germs known as as an infection germs known streptococcal bacteria streptococcal bacteria What is Rheumatic Heart Disease What is Rheumatic Heart Disease This This is a is disease affecting the heart that that results fromfrom one one or repeated episodes of rheumatic a disease affecting the heart results or repeated episodes of rheumatic fever.fever. It occurs as a as result of damaged heartheart valves ( a one-way doordoor that that ensures that that blood It occurs a result of damaged valves ( a one-way ensures blood pumped by the flowsflows in one direction only).only). It has shown that that 40-60% of children pumped by heart the heart in one direction It been has been shown 40-60% of children withwith rheumatic feverfever will go rheumatic heartheart disease. rheumatic willon gotoondevelop to develop rheumatic disease. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 27 27 Unit 2 - CARDIOVASCULAR DISEASES Relationship between rheumatic fever and rheumatic heart disease Rheumatic fever is a type of illness that is called an auto-immune illness. This means that cells within the body that normally fight against external disease-causing germs have turned against the body’s own tissues. The germs that cause sore throats in children have been shown to resemble certain tissue that is part of the heart valves. As a result the cells within the body that fight against disease (also called antibodies) are sort of “confused”. Instead of attacking the germs, they end up attacking the tissue within the heart valves. This leads to inflammation and scarring causing permanent damage to the heart valves which contributes to rheumatic heart disease. Though rheumatic fever that leads to rheumatic heart disease mainly follows a streptococcal throat infection, it has also been shown that a skin infection caused by the same germs may also lead to rheumatic fever. Rheumatic fever and rheumatic heart disease may go undetected in many children especially where there are no health facilities nearby or where health workers are not keen to detect and treat strep sore throats. The patient may eventually present with severe heart disease, a condition that requires hospitalization and corrective surgery that is very expensive. Signs and symptoms of a sore throat • Sudden painful throat • Painful swallowing (even for saliva) • Swollen lymph nodes • Back of the mouth (tonsils) that are red and swollen • High fever • General body weakness Signs and Symptoms of Rheumatic Fever It often starts with a sore throat (a streptococcal infection). A few weeks after the “strep” throat your child may develop: • sore or swollen joints (knees, elbows, ankles and wrists) • a skin rash • a fever • abdominal pain • jerky movements 28 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 2- CARDIOVASCULAR DISEASES Signs and Symptoms of Rheumatic Heart disease This disease results from permanent damage to the heart valves that interferes with how blood flows within the heart. Damage to the valves will either cause blood that is being pumped to the rest of the body to flow back to the heart or may cause narrowing of the valves which limits the amount of blood that can be pumped by the heart. The child may therefore experience the following: • Chest pain • Shortness of breath • Tiredness/excessive fatigue • Swollen lower limbs Risk factors for Rheumatic Heart Disease Overcrowding Poor housing Poor access to treatment How to measure blood pressure. Steps in blood pressure measurements 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Introduce yourself to the community member. Explain the procedure to your client and obtain consent. Allow client to sit quietly for at least 3 minutes with the legs uncrossed Ensure upper arm is supported at heart level with palm facing upward. If the person is seated on the floor use the knee to support the arm at the heart level. Ensure that tight or restrictive clothing is removed from the arm. Check that the cuff is the correct size (arms of different sizes require different-sized cuffs). Position cuff above the elbow so that the lower band is positioned 1 – 2 cm above the elbow joint. Wrap the cuff snugly on to the arm. Switch the machine on using the “On/Off” button. The monitor will start measuring when it detects pulse and the "heart" symbol will begin to flash Systolic and diastolic blood pressures will be displayed (systolic above and diastolic below). The pulse will also be displayed. At least two measurements should be taken (participant will rest 3 min between each) Leave the cuff in place but switch monitor off and back on between readings NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 29 UnitUnit 2 - CARDIOVASCULAR 2 - CARDIOVASCULAR DISEASES DISEASES Key points Key points on blood on blood pressure pressure measurement measurement • • • • • Blood pressure measurement is quick painless. Blood pressure measurement is quick and and painless. • instrument An instrument called a blood pressure monitor is used. It typically has three the cuff, a pump An called a blood pressure monitor is used. It typically has three parts:parts: the cuff, a pump attached tocuff the by cuffa by a tube, dial or screen is also attached tocuff the by cuffa by a tube. attached to the tube, and and a diala or screen that that is also attached to the tube. • Take at least readings at least apart. A reading is higher normal should Take at least two two readings at least 3min3min apart. A reading that that is higher thanthan normal should be be referred to nearest the nearest health facility for further evaluation a health worker. referred to the health facility for further evaluation by aby health worker. • blood The blood pressure monitor recommended atcommunity the community the automatic machine. The pressure monitor recommended at the levellevel is theisautomatic machine. health worker at health the health facility however additionally a manual BP machine The The health worker at the facility maymay however additionally use ause manual BP machine to confirm the reading to confirm the reading Blood Pressure Readings Blood Pressure Readings NumberSecond Second Number First First Number Number Good for you! LessLess thanthan 120 120 LessLess thanthan 80 80 Good for you! Results/Advise Results/Advise 130-139 130-139 81-89 81-89 some changes: MakeMake some changes: eat eat less less salt, salt, lose lose weight, do more physical activity, less alcohol weight, do more physical activity, drinkdrink less alcohol , stop, stop smoking smoking 140–159 140–159 90–99 90–99 You have blood pressure. See your doctor/ You have highhigh blood pressure. See your doctor/ nursenurse if youif you are already not already being treated. you take are, take medicine are not being treated. If youIf are, youryour medicine as advised lifestyle changes above). as advised and and makemake lifestyle changes (see (see above). Tell your doctor/nurse or Community Health Tell your doctor/nurse or Community Health More More Worker immediately if your blood pressure is often at this More thanthan 159 159 More thanthan 99 99 Worker immediately if your blood pressure is often at this when check levellevel when you you check it. it. Prevention, Control Management-50 Prevention, Control andand Management-50 MinsMins 30 30 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 2- CARDIOVASCULAR 2- CARDIOVASCULAR DISEASES DISEASES Prevention, control and and Management of cardiovascular diseases Prevention, control Management of cardiovascular diseases In addition to medication prescribed by the health carecare worker, the the following lifestyle In addition to medication prescribed by the health worker, following lifestyle modifications are key and and management. modifications are in keythe in prevention the prevention management. i. Eat heart-healthy diet diet which includes dietary patterns highhigh in: in: i. aEat a heart-healthy which includes dietary patterns • Whole graingrain products e.g. posho mill mill flourflour • Whole products e.g. posho • Fruits and and vegetables that that are high in nutrients and and fiberfiber and and relatively low in calories • Fruits vegetables are high in nutrients relatively low in calories ii. Limit the amount of sodium (salt)(salt) you you eat: eat: eat no thanthan 5 g of day this this is is ii. Limit the amount of sodium eatmore no more 5 gsalt of asalt a day about a teaspoon of salt.Simply checking foodfood labels and and choosing foods withwith lower about a teaspoon of salt.Simply checking labels choosing foods lower salt options can make a biga difference. salt options can make big difference. NoteNote that:that: sodium is usually listedlisted on food labels. sodium is usually on food labels. UseUse halfhalf the the amount amount of salt of salt youyou normally normally use use when when cooking, cooking, if any. if any. Gradually Gradually reduce reduce the the amount amount of salt of salt youyou use,use, untiluntil youyou use use none. none. ask ask thatthat saltsalt not not be added be added to your to your portion, portion, especially especially withwith french french friesfries TipsTips to control to control salt intake salt intake • Read • Read the food the food labellabel to choose to choose foods foods lower lower in sodium in sodium (choose (choose “low“low sodium” sodium” items items that that havehave no more no more thanthan 140 140 milligrams milligrams of sodium of sodium per serving). per serving). • Eat • fewer Eat fewer canned canned and and processed processed foods foods that that are high are high in sodium in sodium (e.g (e.g sausage, sausage, hot hot dogs,dogs, regular regular canned canned and and instant instant soups, soups, regular regular cheese, cheese, and and chips). chips). • Eat • fresh Eat fresh fruitsfruits and and vegetables vegetables instead instead of salty of salty snacks. snacks. • Use • Use half half the the amount amount of salt of salt you you normally normally use use when when cooking, cooking, if any. if any. Gradually Gradually reduce reduce the amount the amount of salt of you salt you use, use, untiluntil you you use none. use none. • Season • Season foodfood withwith herbs herbs and and spices spices instead instead of salt. of salt. • Use • Use less salt less at saltthe at table. the table. • Eat • vegetables Eat vegetables and and fruitsfruits without without adding adding salt. salt. • When • When eating eating out, ask out,that ask that salt not saltbe notadded be added to your to your portion, portion, especially especially withwith french french fries.fries. • Taste • Taste youryour foodfood before before you you add add seasoning. seasoning. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 31 31 Unit 2 - CARDIOVASCULAR DISEASES iii. Physical activity People who are physically active have a lower risk of developing cardiovascular diseases compared with inactive people. To gain health benefits you should do at least 30 minutes of moderate physical activity, on most days (at least five days per week). • 30 minutes in a day is probably the minimum to gain health benefits. However, you do not have to do this all at once. For example, cycling to work and back 15 minutes each way adds up to the total of 30 minutes. • Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. For example, brisk walking, jogging, swimming, cycling, - particularly for preventing heart disease. • ‘On most days means’, you cannot store up the benefits of physical activity. You need to do it regularly. iv. Avoid tobacco use: Smoking narrows the blood vessels and arteries, allowing them to clog more easily; which in turn raises your blood pressure. Smoking can also increase LDL (Low density lipoproteins), or “bad” cholesterol levels while lowering HDL (High density lipoproteins), or “good” cholesterol levels a. Good cholesterol- plant sources e.g. Avacado. b. Bad cholesterol- Animal sources e.g. Red meat. v. Avoid alcohol use: Long-term excessive drinking increases your risk of developing problems with your heart. This is because drinking can: • Increase the risk of high blood pressure. Drinking excessive amounts of alcohol causes raised blood pressure which is one of the most important risk factors for having a heart attack or a stroke. Increases in your blood pressure can also be caused by weight gain from excessive drinking. • Heavy drinking weakens the heart muscle, which means the heart can’t pump blood as efficiently. It’s known as cardiomyopathy and can cause premature death, usually through heart failure, the heart may also be enlarged. vi. Manage stress levels vii. Maintain a healthy body weight:If you are overweight, you are more likely to develop cardiovascular diseases. The increased health risk of obesity is most marked when the excess fat is mainly in the tummy (abdomen) rather than on the hips and thighs. viii. Have a regular medical check-up to detect early signs and symptoms of cardiovascular diseases. 32 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 2- CARDIOVASCULAR DISEASES Facilitate treatment of hypertension through referral to a health facility. Points to note: • • • • • • It’s important for all community members to get screened for high blood pressure because most of the time people with high blood pressure do not feel sick and are not aware they have it. Community members should ask for and know their blood pressure numbers. For clients who are on treatment teach them how important it is to control their blood pressure. Encourage them to ask their doctor what their target blood pressure should be. Teach community members that uncontrolled high blood pressure will damage their eyes, kidneys, heart, and brain. Teach community members that high blood pressure will put them at high risk for heart attack, heart failure, and stroke. Help those who have diabetes understand the importance of controlling their diabetes and regularly taking their diabetes medications Support hypertension treatment compliance and adherence (20 minutes) Case Study Katana was recently diagnosed with Hypertension. His employer is aware. Katana does not want to take his tablets because he is worried what other’s will think at work and might think he has HIV. His employer asks you to talk to him? Hypertension is a life-long condition that will require you to take medication on a daily basis unless advised otherwise by your health provider. Many people with high blood pressure may take more than one medicine to keep their blood pressure under control. It’s important that they take all medicines even if they feel fine. Some medicines used to treat hypertension can cause side effects (some problems), or reactions, such as dizziness, which may bother you. If you have a bad reaction, talk to the CHW or your health provider who will advise you on what to do. It is also important to inform your CHW, nurse or doctor if you think you are pregnant and about other medicines that you are taking. Do the following to help your medicines work better: eat more fruits and vegetables, cut back on salt and sodium, lose weight, and be physically active. (Remember Lifestyle Changes) Tips for Taking Medicine for High Blood Pressure • Make sure you take your medicine every day, not only on the days when you don’t feel well. • Tell your healthcare professional the names of all other medicines, herbs, or supplements you take. Bring everything with you when you visit your clinic. • Tell the healthcare professional right away if your medicine makes you feel strange or sick. Ask them about changing the dosage or switching to another type of medicine. • Refill your medicine before you run out. • Have your blood pressure checked often to see if the medicine is working for you. • Don’t stop taking your medicine if your blood pressure is okay. Having normal blood pressure means the medicine is working and you must continue. • Get help for managing stress and depression NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 33 UnitUnit 2 - CARDIOVASCULAR 2 - CARDIOVASCULAR DISEASES DISEASES WhyWhy is treatment is treatment adherence adherence sometimes sometimes difficult? difficult? There There are several are several reasons reasons whywhy adhering adhering to a to treatment a treatment regimen regimen can be candifficult. be difficult. • Difficulty • Difficulty taking taking medications medications (such(such as trouble as trouble swallowing swallowing pills)pills) • Side • Side effects effects fromfrom medications medications (for example, (for example, being being tiredtired or diarrhoea) or diarrhoea) • Pill • loadPill loadtoo many too many medicines medicines for conditions for conditions accompanying accompanying hypertension hypertension eg diabetes, eg diabetes, highhigh cholesterol cholesterol • Daily • Daily schedule schedule issues issues (including (including a busy a busy schedule, schedule, shiftshift work,work, or travel or travel awayaway fromfrom home) home) • Being • Being sick sick or depressed or depressed • Alcohol • Alcohol or drug or drug abuse abuse TipsTips on maintaining on maintaining adherence adherence afterafter starting starting treatment? treatment? • Use • Use a 7-day a 7-day pill box. pill box. OnceOnce a week, a week, fill the fill pill thebox pill box withwith youryour medications medications for the for entire the entire week. week. • Take • Take youryour medications medications at the at same the same timetime every every day. day. • Use • Use a timer, a timer, an alarm an alarm clock, clock, or your or your cell phone cell phone alarm alarm to remind to remind you you to take to take youryour medications. medications. • Enlist • Enlist youryour family family members, members, friends, friends, or co-workers or co-workers to remind to remind you you to take to take youryour medications. medications. • Keep • Keep youryour medications medications nearby. nearby. KeepKeep a backup a backup supply supply of medications of medications in your in your briefcase briefcase or or purse purse or atorwork. at work. • Plan • Plan ahead ahead for changes for changes in your in your dailydaily routine, routine, including including weekends weekends and and holidays. holidays. If you're If you're going going away, away, packpack enough enough medications medications to last to the last entire the entire trip. trip. • Use • Use a medication a medication diarydiary to stay to stay on track. on track. WriteWrite down down the name the name of each of each medication; medication; include include the dose, the dose, number number of pills of pills to take, to take, and and when when to take to take them. them. Tick Tick off each off each medication medication as you as you taketake it. it. • Keep • Keep all your all your medical medical appointments. appointments. WriteWrite down down the date the date and and timetime of heath of heath carecare provider provider visitsvisits on your on your calendar calendar or daily or daily schedule. schedule. If you If you run low run on lowmedications on medications before before youryour nextnext visit,visit, call your call your health health carecare provider provider to renew to renew youryour prescriptions. prescriptions. What What should should I do Iifdo I forget if I forget to take to take my medications? my medications? • Unless • Unless youryour health health carecare provider provider tells tells you you otherwise, otherwise, taketake a medication a medication you you missed missed as soon as soon as you as you remember remember that that you you skipped skipped it. However, it. However, if it'sifalmost it's almost timetime for the for next the next dosedose of the of the medication, medication, don'tdon't taketake the the missed missed dosedose and and just just continue continue on your on your regular regular medication medication schedule. schedule. Don't Don't taketake a double a double dosedose of a of medication a medication to make to make up for upafor missed a missed dose.dose. What What should should I do Iifdo I have if I have problems problems adhering adhering to my to treatment my treatment regimen? regimen? • Tell • your Tell your health health carecare provider provider that that you're you're having having difficulty difficulty following following youryour regimen. regimen. Together Together you you can identify can identify the reasons the reasons whywhy you're you're skipping skipping medications. medications. • Based • Based on why on why you're you're having having problems problems withwith adherence, adherence, youryour health health carecare provider provider maymay adjust adjust or change or change youryour regimen. regimen. 34 34 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UNIT UNIT 3- 3CANCERS CANCERS NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 35 35 36 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 3- CANCERS UNIT 3- CANCERS Purpose The purpose of this unit is to equip the community health volunteer with knowledge and skills to enable them to create awareness on Prevention, control and treatment of cancers highlighting the benefits of screening early detection, and early treatment. It aims at equipping the CHV with Knowledge and skill for recognizing the common signs and symptoms associated with these cancers, for appropriate referral and follow-up. Objectives By the end of this unit, the community health volunteer should be able to; 1. Explain and classify cancer 2. List and identify different types of cancers 3. Identify the common signs and symptoms of cancers 4. Explain the risk factors for cancers 5. Describe the prevention, control and treatment of cancers NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 37 UnitUnit 3 - CANCERS 3 - CANCERS INTRODUCTION INTRODUCTION TO CANCER TO CANCER What What is cancer? is cancer? It is Itthe is the name name for diseases for diseases in which in which the the body’s body’s cellscells become become abnormal abnormal and and divide divide without without control. control. Cancer Cancer cellscells maymay invade invade nearby tissues. nearby tissues. TheyThey maymay spread spread through through the bloodstream the bloodstream and and lymphatic lymphatic system system to other to other partsparts of the of body. the body. Cancerous Cancerous cellscells havehave a tendency a tendency to proliferate to proliferate uncontrollably, uncontrollably, invading invading neighbouring neighbouring tissues tissues and and eventually, eventually, spreading spreading to other to other areasareas of the of the body. body. There There are over are over 100 100 different different types types of cancer of cancer which which maymay affect affect any regions any regions of the of body the body but but commonly commonly seenseen in the in breast, the breast, cervix, cervix, prostate, prostate, stomach, stomach, colon/rectum, colon/rectum, skin,skin, lunglung and and mouth. mouth. Similar Similar conditions conditions affecting affecting blood blood (leukaemia), (leukaemia), (bone) (bone) sarcoma, sarcoma, Hodgkin Hodgkin disease, disease, and and non-nonHodgkin Hodgkin lymphoma. lymphoma. Cancer Cancer situation situation in Kenya in Kenya Cancer Cancer is one is one of the ofleading the leading causes causes of death of death in Kenya. in Kenya. Common Common types types of cancer of cancer seenseen in Kenya in Kenya are are cancers cancers of the ofcervix, the cervix, breast, breast, oesophagus oesophagus and and prostate. prostate. Others Others include include headhead and and neck,neck, colon colon and and rectum, rectum, stomach, stomach, liverliver and and soft soft tissue tissue sarcomas. sarcomas. HIV associated HIV associated cancers cancers are also are also on the on increase the increase and and affect affect various various regions regions of the of body. the body. Terms Terms like swelling, like swelling, tumor, tumor, uvimbe, uvimbe, saratani, saratani, growth. growth. Classification Classification of cancer of cancer (tumours) (tumours) (30 min) (30 min) Story Story Pendo Pendo a mother a mother of five of was five was taking taking a shower a shower and and realized realized theythey had had a lump a lump on the onright the right side side of the of the breast. breast. She She was was scared scared and and immediately immediately wentwent to the to health the health facility. facility. A biopsy A biopsy was was taken taken to the to lab the lab for investigation. for investigation. LaterLater it was it was told told that that she was she was well well afterafter a small a small surgery. surgery. Amani Amani a prominent a prominent business business manman was was always always told told by his by friends his friends that that he ishevery is very healthy healthy and and actually actually layers layers of skin of skin werewere forming forming at the at back the back of his ofhead his head and and had had pot pot belly.belly. His community His community interpreted interpreted that that as a as wealthy a wealthy man.man. He neglected He neglected it and it and never never wentwent to hospital to hospital untiluntil one one day he day he fell illfell with ill with malaria malaria and and the doctor the doctor was was shocked shocked to see to the see size the his sizeneck. his neck. He was He was screened screened and and the the doctors doctors said said it was it was too late too late to reverse to reverse the situation. the situation. He died He died in hisinprime his prime age.age. Key Key points points Benign Benign tumors tumors aren’t aren’t cancerous. cancerous. TheyThey can can oftenoften be removed, be removed, and,and, in most in most cases, cases, theythey do not do not come come back.back. CellsCells in benign in benign tumours tumours do not do not spread spread to other to other partsparts of the of body. the body. Some Some breast breast lumps lumps are usually are usually benign benign but ifbut unattended if unattended to can to can turnturn out to outbetomalignant. be malignant. CHVsCHVs should should urgeurge communities communities to gotofor goregular for regular self-examination self-examination suspect suspect weird weird pimples pimples and and growths growths on the onbody the body and and earlyearly screening. screening. Malignant Malignant tumors tumors are cancerous are cancerous and and are made are made up ofupcells of cells that that growgrow out of outcontrol. of control. CellsCells in these in these tumours tumours can invade can invade nearby nearby tissues tissues and and spread spread to other to other partsparts of the of body. the body. Sometimes Sometimes cellscells move move awayaway fromfrom the original the original (primary) (primary) cancer cancer site and site and spread spread to other to other organs organs and and bones bones where where theythey can continue can continue to grow to grow and and formform another another tumour tumour at that at that site. site. 38 38 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 3- CANCERS 3- CANCERS Identifying Identifying common common cancers cancers Scenarios Scenarios for common for common cancers cancers A: A:Someone Someone withwith abnormal abnormal vaginal vaginal discharge discharge (pale(pale watery, watery, pink,) pink,) abnormal abnormal vaginal vaginal bleeding bleeding between between periods periods and and afterafter intercourse intercourse or menopause or menopause painpain during during intercourse intercourse B: B:Someone Someone withwith increased increased abdominal abdominal size size and and persistent persistent gloating, gloating, persistent persistent pelvic pelvic and and abdominal abdominal painpain difficult difficult eating eating and and feeling feeling full quickly, full quickly, weight weight loss loss and and frequent frequent urination urination C: C:Someone Someone withwith a lump a lump or anorarea an area of thickened of thickened tissue tissue in either in either breast, breast, nipple nipple changes changes and and cystscysts and and breast breast painpain not related not related to periods, to periods, a change a change in size in size of the of breast, the breast, D: D:Someone Someone withwith burning burning or pain or pain urination, urination, difficult difficult whilewhile urinating urinating or trouble or trouble when when starting starting or or stopping stopping urination, urination, loss of lossbladder of bladder control, control, decreased decreased flowflow of urine of urine stream, stream, blood blood in urine in urine Key Key points points Link Link the above the above to the to note the note below below A: Cervical A: Cervical cancer cancer B: Ovarian B: Ovarian cancer cancer C: Breast C: Breast Cancer Cancer D: Prostrate D: Prostrate cancer cancer Explaining Explaining the Causes the Causes of Cancer of Cancer andand risk risk factors: factors: What What Causes Causes Cancer? Cancer? Cancer Cancer is a complex is a complex group group of diseases of diseases withwith many many possible possible causes. causes. The The known known causes causes of cancers of cancers include include but not but limited not limited the following:, the following:, genetic genetic factors; factors; lifestyle lifestyle factors factors suchsuch as tobacco as tobacco use, use, diet,diet, and and physical physical activity; activity; certain certain types types of infections; of infections; and and environmental environmental exposures exposures to different to different types types of chemicals of chemicals and and radiation. radiation. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 39 39 Unit 3 - CANCERS 1. Genetics and Cancer Some types of cancer run in certain families, but most cancers are not clearly linked to the genes we inherit from our parents. 2. Tobacco and Cancer Cigarette, cigar, and smokeless tobacco use affects different groups of people both primary and secondary smokers. Tobacco has many cancer inducing substances. 3. Unhealthy diet and Physical Inactivity It is factual that unhealthy diet, physical inactivity and excess body weight may affect your risk of cancer. 40 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 3- CANCERS 4. Sun and UV Exposure There is a link between too much sun exposure and cancer especially in persons with reduced levels of melanin in their skin. 5. Radiation Exposure and Cancer Risk There are different types of radiation exposure and they might affect cancer risk. For instance, pregnant women should be careful not to expose foetus since those exposed are vulnerable to defects and cancer. 6. Other Carcinogens The environmental causes of cancer may be there in our homes, at work, in pollution, and even in some medical tests and treatments. Some types of infections are linked to cancer. These abnormal changes are caused by interactions between a person’s genetic factors and three categories of external agents which include physical carcinogens (e.g. ionizing radiation), chemical carcinogens (e.g. asbestos, components of tobacco smoke, aflatoxins) and biological carcinogens (certain viruses, bacteria or parasites. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 41 UnitUnit 3 - CANCERS 3 - CANCERS 7. Cancer 7. Cancer and and alcohol alcohol use use Alcohol Alcohol is a known is a known cause cause of cancers of cancers of the: of the: • Mouth • Mouth • Throat • Throat (pharynx) (pharynx) • Voice • Voice box box (larynx) (larynx) • Oesophagus • Oesophagus • Liver • Liver • Colon • Colon and and rectum rectum • Breast • Breast Alcohol Alcohol maymay also also increase increase the risk the of riskcancer of cancer of the pancreas. of the pancreas. For each For each of these of these cancers, cancers, the risk the increases risk increases withwith the amount the amount of alcohol of alcohol consumed. consumed. i. Cancers i. Cancers of the of mouth, the mouth, throat, throat, voice voice box,box, and and esophagus: Alcohol esophagus: Alcohol use clearly use clearly raises raises the risk the risk of these of these cancers. cancers. Drinking Drinking and and smoking smoking together together raises raises the risk the of riskthese of these cancers cancers far more far more thanthan the effects the effects of either of either drinking drinking or smoking or smoking alone. alone. This This might might be because be because alcohol alcohol can can act as acta as solvent, a solvent, helping helping harmful harmful chemicals chemicals in tobacco in tobacco to get to inside get inside the cells the cells that that line line the the digestive digestive tract.tract. Alcohol Alcohol maymay also also slowslow down down these these cells’cells’ ability ability to repair to repair damage damage to their to their DNADNA caused caused by chemicals by chemicals in tobacco. in tobacco. ii. Liver ii. Liver cancer: cancer: Long-term Long-term alcohol alcohol use use has has beenbeen linked linked to antoincreased an increased risk of riskliver of liver cancer. cancer. Regular, Regular, heavy heavy alcohol alcohol use can use damage can damage the liver, the liver, leading leading to inflammation. to inflammation. This,This, in turn, in turn, might might raiseraise the risk the of riskliver of liver cancer. cancer. iii. Colon iii. Colon and and rectal rectal cancer: Alcohol cancer: Alcohol use use has been has been linked linked withwith a higher a higher risk of riskcancers of cancers of the of the colon colon and and rectum. rectum. The The evidence evidence for such for such a linka is link generally is generally stronger stronger in men in men thanthan in women, in women, although although studies studies havehave found found the link the in linkboth in both sexes. sexes. iv. Breast iv. Breast cancer: cancer: EvenEven a few a few drinks drinks a week a week is linked is linked withwith an increased an increased risk of riskbreast of breast cancer cancer in women. in women. This This risk may risk may be especially be especially highhigh in women in women whowho do not do not get enough get enough folate folate (a B (a B vitamin) vitamin) in their in their diet diet or through or through supplements. supplements. Alcohol Alcohol can affect can affect estrogen estrogen levels levels in the in body, the body, which which maymay explain explain some some of the of increased the increased risk. risk. Drinking Drinking less less alcohol alcohol maymay be an beimportant an important way way for many for many women women to lower to lower theirtheir risk of riskbreast of breast cancer. cancer. Signs Signs andand symptoms symptoms of cancer of cancer • Fatigue • Fatigue • Unexplained • Unexplained weight weight loss/gain loss/gain • Fever • Fever • Unexplained • Unexplained painpain in body in body organs organs • Changes • Changes in appetite in appetite • Nausea • Nausea • Vomiting • Vomiting • Skin • Skin changes changes • Unexplained • Unexplained growths/pimples growths/pimples • Unexplained • Unexplained wounds wounds NB: NB: The The signssigns and and symptoms symptoms of cancer of cancer depend depend on where on where the the cancer cancer is, how is, how big itbigis, itand is, and howhow much much it affects it affects the organs the organs or tissues. or tissues. If a cancer If a cancer has spread has spread (metastasized), (metastasized), signssigns or or symptoms symptoms maymay appear appear in different in different partsparts of the of body. the body. 42 42 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 3- CANCERS 3- CANCERS Primary prevention of cancer Primary prevention of cancer Principles of cancer prevention and and control Principles of cancer prevention control These include physical activity, healthy eating and and earlyearly screening. These include physical activity, healthy eating screening. Key Key points points • Tobacco control: applies to individual, household and and community • Tobacco control: applies to individual, household community • Promotion of Healthy DietDiet and and Physical Activity: at individual levellevel one one can can taketake personal • Promotion of Healthy Physical Activity: at individual personal initiative. A parent can avoid buying junkjunk foodfood and and people engaging in sports at community initiative. A parent can avoid buying people engaging in sports at community level.level. The The community can initiate football matches and and athletics to foster activities that that helphelp community can initiate football matches athletics to foster activities themthem engage in Physical activities. engage in Physical activities. What’s a healthy weight? What’s a healthy weight? • One of the waysways to get if youif you are at a healthy weight is to ischeck youryour BodyBody MassMass • One of best the best to an getidea an idea are at a healthy weight to check Index (BMI), a score based on the between youryour height and and weight. Index (BMI), a score based on relationship the relationship between height weight. • To BMI=Weight (Kg) (Kg) divide by height ( m2)( m2) • calculate To calculate BMI=Weight divide by height • To cancer risk, risk, mostmost people needneed to keep theirtheir BMIsBMIs below 25. Ask doctor/CHEW • reduce To reduce cancer people to keep below 25. your Ask your doctor/CHEW whatwhat youryour BMI BMI number means and and whatwhat action (if any) you you should take.take. number means action (if any) should • If• you are trying to control youryour weight, a good first first stepstep is toiswatch portion sizes,sizes, especially If you are trying to control weight, a good to watch portion especially of foods highhigh in calories, fat, and added sugars. AlsoAlso try to youryour intake of high-calorie of foods in calories, fat, and added sugars. trylimit to limit intake of high-calorie foods and and drinks. Try writing down whatwhat and and howhow much you you eat and drinkdrink for afor week, thenthen foods drinks. Try writing down much eat and a week, see where you you can can cut down on portion sizes,sizes, cut back on some not-so-healthy foods and and see where cut down on portion cut back on some not-so-healthy foods drinks, or both! drinks, or both! • For whowho are overweight or obese, losing eveneven a small amount of weight has health • those For those are overweight or obese, losing a small amount of weight has health benefits and and is a good placeplace to start. benefits is a good to start. Healthy eating Healthy eating Choose foods and and drinks in amounts thatthat helphelp you you get to maintain a healthy weight. Choose foods drinks in amounts getand to and maintain a healthy weight. • Read foodfood labels to become moremore aware of portion sizessizes and and calories. Be aware that that “low-fat” • Read labels to become aware of portion calories. Be aware “low-fat” or “non-fat” doesdoes not necessarily mean “low-calorie. ” ” or “non-fat” not necessarily mean “low-calorie. • Eat portions when eating high-calorie foods. • smaller Eat smaller portions when eating high-calorie foods. • Choose vegetables, whole fruit,fruit, legumes suchsuch as peas and and beans, and and otherother low-calorie • Choose vegetables, whole legumes as peas beans, low-calorie foods instead of calorie-dense foods suchsuch as French fries,fries, potato and and otherother chips, ice cream, foods instead of calorie-dense foods as French potato chips, ice cream, donuts, and and otherother sweets. donuts, sweets. • Limit youryour intake of sugar-sweetened beverages suchsuch as soft drinks, sports drinks, and and fruit-fruit• Limit intake of sugar-sweetened beverages as soft drinks, sports drinks, flavored drinks. flavored drinks. • When you you eat away fromfrom home, be especially mindful to choose foodfood low in calories, fat, and • When eat away home, be especially mindful to choose low in calories, fat, and added sugar, and and avoid eating largelarge portion sizes.sizes. added sugar, avoid eating portion LimitLimit howhow much processed meatmeat and and red meat you you eat. eat. much processed red meat • Limit youryour intake of processed meats suchsuch as bacon, sausage, lunch meats, and and hot dogs. • Limit intake of processed meats as bacon, sausage, lunch meats, hot dogs. • Choose fish, fish, poultry, or beans instead of red (beef, pork,pork, and and lamb). • Choose poultry, or beans instead of meat red meat (beef, lamb). • If• you eat red choose leanlean cutscuts and and eat smaller portions. If you eat meat, red meat, choose eat smaller portions. • Prepare meat,meat, poultry, and fish baking, broiling, or poaching rather thanthan by frying or charbroiling. • Prepare poultry, andby fish by baking, broiling, or poaching rather by frying or charbroiling. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 43 43 Unit 3 - CANCERS Eat at least 2½ cups of vegetables and fruits each day. • Include vegetables and fruits at every meal and snack. • Eat a variety of vegetables and fruits each day. • Emphasize whole fruits and vegetables; choose 100% juice if you drink vegetable or fruit juices. • Limit your use of creamy sauces, dressings, and dips with fruits and vegetables. Choose whole grains instead of refined grain products. • Choose whole-grain breads, pasta, and cereals (such as barley and oats) instead of breads, cereals, and pasta made from refined grains, and brown rice instead of white rice. • Limit your intake of refined carbohydrate foods, including pastries, candy, sugar-sweetened breakfast cereals, and other high-sugar foods. • Control of harmful use of alcohol can be done at individual level by avoiding alcohol, at household level by parents guiding the youths and children against indulgence of alcohol. • Control of environmental exposure to carcinogens (cancer causing agents) at government and policy level. • Control of Biological agents that cause cancer-eg Human Papiloma Virus HPV that causes cancer of the cervix by circumcision at individual level by the men heading households, Role Play on Screening Mama Fatuma had pain in the breast. Her husband had listened to a radio programme and advised her on self-examination. He asked her to do it on herself. Key points 1. Early detection of cancer through screening -this ensures prompt treatment that is associated with a better outcome and prognosis. Examples of cancers whose screening programs are ongoing in Kenya include: i. Breast cancer-screening by self-breast examination and periodic examination by a health care practitioner ensures early detection and treatment. ii. Cancer of the cervix-VIA (visual inspection with acetone) and VILI (visual inspection with lugo’ls iodine) are available at MCH in our local health facilities. iii. Cancer of the prostate can be detected early by having an examination and PSA assays in our facilities. 2. Prompt diagnosis to facilitate referral for treatment. 3. Palliative care with focused pain and psychological stress management 4. Community cancer surveillance 44 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 UNIT 4- EPILEPSY NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 45 46 46 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 4- EPILEPSY 4- EPILEPSY UNIT UNIT 4- EPILEPSY 4- EPILEPSY Purpose Purpose The The purpose purpose of this of this unit unit is tois equip to equip the the community community health health volunteers volunteers withwith knowledge knowledge and and skillsskills to enable to enable themthem create create awareness, awareness, identify, identify, demystify demystify and and assistassist in management, in management, effective effective referral referral and and follow follow up ofupepilepsy of epilepsy cases. cases. Objectives Objectives By the By end the end of this of unit, this unit, the community the community health health volunteer volunteer should should be able be able to; to; 1. Identify 1. Identify epilepsy epilepsy 2. List 2. the List common the common signssigns and and symptoms symptoms of epilepsy. of epilepsy. 3. Demystify 3. Demystify the common the common myths myths associated associated withwith epilepsy. epilepsy. 4. Explain 4. Explain the risk the factors, risk factors, causes causes and and triggers triggers of epilepsy of epilepsy 5. Highlight 5. Highlight the dos the dos and and don’ts don’ts of management of management of anofepileptic an epileptic fit. fit. 6. Highlight 6. Highlight the prevention, the prevention, control, control, effective effective referral referral and and follow follow up ofupepilepsy. of epilepsy. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 47 47 Unit 4 - EPILEPSY Identifying Epilepsy Definition: Epilepsy is a chronic brain disorder characterized by repetitive, sudden onset, short lived seizures occurring more than twice in a year that may arise from many and varied causes Other commonly used terms for epilepsy: • Kifafa • Convulsions • Seizures • Fit • Attack Common myths and misconceptions associated with epilepsy 1. Epilepsy is contagious- You cannot catch epilepsy from another person 2. You can swallow your tongue during a seizure-It’s physically impossible to swallow your tongue. Do not force something into the mouth of someone having a seizure. Doing so may result in chipped teeth, injured gums, or broken jaws. 3. Epilepsy is a product of witchcraft. Epilepsy is NOT a product of witchcraft or any superstitious activity. It is a seizure disorder. 4. Epilepsy is a form of mental illness. Epilepsy is an umbrella term for many seizure disorders. It is a functional, physical problem, NOT a mental one. However, poorly controlled epilepsy may be associated with mental illnesses 5. Epilepsy is a permanent disorder. Epilepsy is NOT a permanent disorder. Most cases would manifest during childhood but seizures would stop at certain age with treatment. 6. People with epilepsy look different- People with epilepsy lead normal lives and UNLESS they are having a seizure there is no way of distinguishing a person living with epilepsy 7. Epilepsy is a curse Signs and Symptoms of epilepsy Signs and symptoms of epilepsy Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process coordinated by the brain. A seizure can thus lead to: • Temporary confusion • A staring spell • Uncontrollable jerking movements of the arms and legs • Loss of consciousness or awareness Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode. Simple classification of epilepsy Epilepsy can be classified into two major types: 1. Partial: These seizures result from abnormal activity in just one part of the brain with either impairment or retention of consciousness 2. Generalized: These are due to a widespread involvement of large parts of the brain simultaneously leading to loss of consciousness. 48 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 4- EPILEPSY Causes and triggers of epilepsy Causes of epilepsy Epilepsy has different causes. Any disease affecting the brain can cause seizure/epilepsy. Some of the common causes of epilepsy include: 1. Brain Infections • Meningitis • Cerebral malaria. • HIV-Aids –opportunistic infections. 2. Trauma • Head injury-e.g. Road Traffic Injuries, assault • Birth trauma e.g. big head of baby in a mother with a small pelvis 3. Lack of oxygen to the brain • Lack of oxygen to the baby’s brain at birth (Birth asphyxia) 4. Structural brain problems. • Accumulation of fluid in the baby’s head • Tumours/growths in the head • Abscesses- pus accumulation in the brain 5. Genetic/ Hereditary/familial causes Triggering Factors People with Epilepsy are likely to develop seizures when exposed to certain situations or conditions. These include; • Non-adherence to treatment • Sleep deprivation • Infections, • Flickering of lights. • Drug and substance intake • Drug and substance withdrawal e.g. alcohol • Hormonal imbalances e.g. seizures during menstruation • Dehydration • Emotional Stress. • Excessive physical exercise. Prevention, control, referral and follow up of epilepsy Do’s and Don’ts during an epileptic seizure During an epileptic fit it is important to note the following; What to do. • Move patient away from fire, traffic or water • Take away any objects that could harm the patient • Loosen tight clothes, remove glasses • Put something soft under the head • Turn patient on his or her left side, so that saliva and mucus can run out of the mouth • Remain with the patient until he or she regains consciousness • Let the patient rest and then resume whatever activity he was doing, if he feels like it NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 49 4 - EPILEPSY UnitUnit 4 - EPILEPSY notdo. to do. WhatWhat not to • NOT Do NOT to anything put anything the mouth • Do try totryput into into the mouth • NOT Do NOT anything to drink • Do givegive anything to drink • NOT Do NOT to stop the jerking, or restrain the movements. • Do try totrystop the jerking, or restrain the movements. recovery position The The recovery position • Unconscious patients should be placed in recovery this recovery position to minimize theof risk of them • Unconscious patients should be placed in this position to minimize the risk them chocking in case vomit chocking in case theythey vomit Principles of prevention of epilepsy Principles of prevention of epilepsy following measures should be considered in prevention the prevention of epilepsy: The The following measures should be considered in the of epilepsy: • Encourage mother to deliver in health facilities to avoid trauma • Encourage mother to deliver in health facilities to avoid birthbirth trauma • Seek treatment promptly to avoid complications of diseases like meningitis severe malaria • Seek treatment promptly to avoid complications of diseases like meningitis and and severe malaria • Prevention of malaria attacks (mosquito • Prevention of malaria attacks (mosquito nets,nets, etc.)etc.) • Encourage mothers to ensure children receive full vaccination • Encourage mothers to ensure theirtheir children receive full vaccination • prevention of road traffic accidents trauma • prevention of road traffic accidents and and otherother trauma Principles of management of epilepsy Principles of management of epilepsy 1. Community awareness to demystify epilepsy reduce stigma on epilepsy to facilitate 1. Community awareness to demystify epilepsy and and reduce stigma on epilepsy to facilitate presentation of patients for treatment. presentation of patients for treatment. 2. Teach those to patient the patient on how to react in event the event a seizure. 2. Teach those closeclose to the on how to react in the of a of seizure. 3. Prompt referral follow-up of persons of epilepsy for confirmation of diagnosis. 3. Prompt referral and and follow-up of persons withwith signssigns of epilepsy for confirmation of diagnosis. 4. Strict compliance adherence to treatment the treatment regimen prescribed. 4. Strict compliance and and adherence to the regimen prescribed. withdrawal should be considered a clinician the patient has been seizure DrugDrug withdrawal should be considered by aby clinician if theif patient has been seizure free free for atfor at years. be done in a very gradual manner within six months. In case leastleast two two years. This This mustmust be done in a very gradual manner within threethree to sixtomonths. In case the person on several drugs, the drugs should withdrawn the other. the person was was on several drugs, the drugs should withdrawn one one afterafter the other. ROLE OF CHVs IN PREVENTION MANAGEMENT OF EPILEPSY. ROLE OF CHVs IN PREVENTION ANDAND MANAGEMENT OF EPILEPSY. 1. Creating awareness on epilepsy to community the community members to reduce stigmatization 1. Creating awareness on epilepsy to the members so assotoasreduce stigmatization of persons epilepsy as well to demystify the common myths misconceptions of persons withwith epilepsy as well as toasdemystify the common myths and and misconceptions surrounding epilepsy. surrounding epilepsy. 2. Conducting regular home to identify of epilepsy in community. the community. 2. Conducting regular home visitsvisits so assotoasidentify casescases of epilepsy in the 3. Making referrals to patients epilepsy actlinkages as linkages between patients 3. Making referrals to patients withwith epilepsy and and act as between patients and and the the health facilities health facilities 4. Conducting follow up visits to patients epilepsy to monitor adherence 4. Conducting follow up visits to patients withwith epilepsy so assotoasmonitor theirtheir drugdrug adherence update records on same. the same. and and update theirtheir datadata records on the 50 50 NON COMMUNICABLE DISEASES Participants Manual NCD MODULE NON COMMUNICABLE DISEASES Participants Manual - NCD- MODULE 13 13 UNIT MENTAL HEALTH UNIT 5- 5MENTAL HEALTH NON COMMUNICABLE DISEASES Participants Manual NCD MODULE NON COMMUNICABLE DISEASES Participants Manual - NCD- MODULE 13 13 51 51 52 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 05 - MENTAL HEALTH UNIT 5- MENTAL HEALTH Purpose To equip community health volunteers with the appropriate knowledge, skills and attitudes that will enable them to respond to the mental health needs of the communities they serve. It presents key community – based mental health care concepts and practical approaches for community health volunteers to develop the competences required for community mental health care awareness, promotion, identification, referral and follow-up. Objectives By the end of this unit, the community health volunteer should be able to; 1. Know and understand basic concepts of mental health 2. Describe common mental health and mental illness signs and symptoms. 3. Describe factors that may contribute to mental illness, 4. Discuss common myths and misconceptions and services available. 5. Identify, refer and link people with mental illnesses for appropriate services. 6. Identify and support community re-integration. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 53 UnitUnit 5- MENTAL 5- MENTAL HEALTH HEALTH INTRODUCTION INTRODUCTION TO MENTAL TO MENTAL ILLNESS ILLNESS What What is Mental is Mental Health, Health, Mental Mental Illness? Illness? Definition Definition of terms: of terms: Mental Mental health: health: It is Ita isstate a state of well-being of well-being in which in which the the individual individual realizes realizes his/her his/her potentials/ potentials/ abilities, abilities, can cope can cope withwith normal normal stresses stresses of life, of can life, work can work productively productively and and fruitfully fruitfully and and is able is able to to make make a contribution a contribution to his/her to his/her community. community. Mental Mental illness: illness: Refers Refers to a to wide a wide range range of mental of mental health health conditions-disorders conditions-disorders that that affect affect youryour mood, mood, thinking thinking and and behavior. behavior. A person A person withwith a mental a mental illness illness is unable is unable to cope to cope withwith dailydaily demands demands of lifeofe.g. life work, e.g. work, personal personal upkeep, upkeep, school school or child or child care.care. Commonly Commonly seenseen mental mental illnesses illnesses in the in community the community TYPES TYPES OF MENTAL OF MENTAL ILLNESSES ILLNESSES 1. Depression 1. Depression CaseCase of Depression of Depression DanDan has just has lost just his lostparents his parents and and being being the first the first bornborn he has he six hassiblings six siblings to look to look out for outand for and fendfend for them. for them. He wakes He wakes up every up every morning morning to do tomenial do menial jobsjobs for small for small pay. pay. TheyThey all ask all him ask him basicbasic needs needs and and nownow he ishe avoiding is avoiding everyone everyone and and is withdrawn. is withdrawn. What What is Depression is Depression Depression Depression is a common is a common mental mental disorder disorder that that causes causes people people to experience to experience depressed depressed mood, mood, loss loss of interest of interest or pleasure, or pleasure, feelings feelings of guilt of guilt or low or low self-worth, self-worth, disturbed disturbed sleepsleep or appetite, or appetite, low low energy, energy, and and poorpoor concentration. concentration. Signs Signs and and symptoms symptoms of depression of depression • Tiredness • Tiredness and and loss loss of energy. of energy. • Sadness • Sadness that that doesn’t doesn’t go away. go away. • Loss • Loss of self-confidence of self-confidence and and self-esteem. self-esteem. • Difficulty • Difficulty concentrating. concentrating. • Not • Not being being ableable to enjoy to enjoy things things that that are usually are usually pleasurable pleasurable or interesting. or interesting. • Feeling • Feeling anxious anxious all the all time. the time. • Avoiding • Avoiding otherother people, people, sometimes sometimes eveneven youryour closeclose friends. friends. • Feelings • Feelings of helplessness of helplessness and and hopelessness. hopelessness. • Sleeping • Sleeping problems problems - difficulties - difficulties in getting in getting off tooffsleep to sleep or waking or waking up much up much earlier earlier thanthan usual. usual. • Very • Very strong strong feelings feelings of guilt of guilt or worthlessness. or worthlessness. • Finding • Finding it hard it hard to function to function at work/college/school. at work/college/school. • Loss • Loss of appetite. of appetite. • Loss • Loss of sex of drive sex drive and/or and/or sexual sexual problems. problems. • Physical • Physical aches aches and and pains. pains. • Thinking • Thinking about about suicide suicide and and death. death. 54 54 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 5- MENTAL 5- MENTAL HEALTH HEALTH 2. Psychotic 2. Psychotic Disorders Disorders RoleRole playplay FaithFaith has has beenbeen chewing chewing miraa miraa for aforlong a long time;time; recently recently she she has has started started smoking smoking bhang. bhang. Nowalcohol Nowalcohol and and drugdrug abuseys abuseys she talks she talks to herself to herself and and is theis talk the of talktown. of town. What What illness illness is this? is this? Psychotic Psychotic disorders disorders involve involve uncoordinated uncoordinated awareness awareness and and thinking. thinking. TwoTwo of the of most the most common common symptoms symptoms of psychotic of psychotic disorders disorders are hallucinations are hallucinations -- the -- experience the experience of images of images or sounds or sounds that that are not are real, not real, suchsuch as hearing as hearing voices voices -- and -- and delusions, delusions, which which are false are false beliefs beliefs by the by ill the person. ill person. 3. Post-traumatic 3. Post-traumatic stress stress disorder disorder (PTSD): (PTSD): Story Story Hekima Hekima was was raped raped by her by own her own biological biological father. father. SinceSince then,then, life has life never has never beenbeen the same the same again; again; her performance her performance at school at school is poor. is poor. Key Key notenote This This is a is condition a condition that that can can develop develop following following a traumatic a traumatic and/or and/or terrifying terrifying event, event, suchsuch as a as a sexual sexual or physical or physical assault, assault, the unexpected the unexpected death death of a loved of a loved one,one, or a natural or a natural disaster. disaster. People People withwith PTSDPTSD oftenoften havehave lasting lasting and and frightening frightening thoughts thoughts and and memories memories of the of event, the event, and and tendtend to beto be emotionally emotionally numb. numb. Post-traumatic Post-traumatic stress stress disorder disorder occurs occurs afterafter events events suchsuch as deliberate as deliberate acts acts of interpersonal of interpersonal violence, violence, severe severe accidents, accidents, disasters disasters or military or military action. action. Those Those at; at; 1. Risk 1. Risk of PTSD of PTSD includes includes survivors survivors of war of war and and torture, torture, of accidents of accidents and and disasters, disasters, and and of violent of violent crime crime (for example, (for example, physical physical and and sexual sexual assaults, assaults, sexual sexual abuse, abuse, bombings bombings and and riots).riots). 2. Refugees, 2. Refugees, women women whowho havehave experienced experienced traumatic traumatic childbirth, childbirth, people people diagnosed diagnosed withwith a life-threatening a life-threatening illness, illness, and and members members of the of armed the armed forces, forces, police police and and otherother emergency emergency personnel personnel (Foa(Foa et al.,et2008). al., 2008). Symptoms Symptoms include; include; 1. Flashbacks 1. Flashbacks in which in which the the person person acts acts or feels or feels as ifas theif the event event is recurring, is recurring, nightmares nightmares and and repetitive repetitive images images or other or other sensory sensory impressions impressions fromfrom the event. the event. 2. Reminders 2. Reminders of the oftraumatic the traumatic event event arouse arouse intense intense distress distress and/or and/or physiological physiological reactions; reactions; thesethese include include inability inability to have to have any feelings, any feelings, feeling feeling detached detached fromfrom otherother people, people, giving giving up previously up previously significant significant activities activities and and amnesia amnesia for significant for significant partsparts of common of common Mental Mental Health Health Disorders Disorders 4. Suicidal 4. Suicidal tendencies tendencies HaveHave you you everever felt like feltrunning like running awayaway from,from, home, home, youryour country country or your or your life due life due to problems? to problems? WhoWho has ever has ever lost alost loved a loved one one or a or joba important job important to them, to them, or have or have you you heard heard of people of people withwith suicidal suicidal tendencies? tendencies? Share Share youryour stories stories Suicide Suicide is the is act the of actdeliberately of deliberately killing killing oneself. oneself. Self-harm Self-harm by poisoning by poisoning or injury, or injury, which which maymay or or maymay not have not have a fatal a fatal intent intent or outcome. or outcome. Any Any person person overover 10 years 10 years of age of age experiencing experiencing any any of the of following the following conditions conditions should should be asked be asked about about thoughts thoughts or plans or plans of self-harm of self-harm in the inlast themonth last month and and about about acts acts of self-harm of self-harm in the inlast theyear: last year: NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 55 55 Unit 5- MENTAL HEALTH Signs & symptoms; • Severe emotional distress • Hopelessness • Extreme agitation • Violence • Uncommunicative behavior • Social isolation 5. Behavioral disorders: Behavioral disorders” is an umbrella term that includes more specific disorders, such as attention deficit hyperactivity (ADHD) or over activity and excessive restlessness, especially in situations requiring relative calm or other behavioral disorders. Behavioral symptoms of varying levels of severity are very common in the population. Signs and symptoms Impaired attention and over activity; impaired attention shows itself as breaking off from tasks and leaving activities unfinished. The child or adolescent shifts frequently from one activity to another.It may involve the child or adolescent running and jumping around, getting up from a seat when he or she was supposed to remain seated, excessive talkativeness and noisiness, or fidgeting and wriggling. The characteristic behavioral problems should be of early onset (before age 6 years) and long duration (> 6 months), and not limited to only one setting. 6. Developmental disorders Developmental disorder is a term covering disorders such as Intellectual disability / mental retardation as well as autism. These disorders usually affect children, impairment or delay in functions related to the back bone. Despite a childhood onset, the developmental disorders tend to persist into adulthood. People with developmental disorders are more vulnerable to physical illness. Signs and symptoms; Impairment of developmental areas such as cognitive, language and social skills during the growth period. Lower intelligence diminishes the ability to alcohol and drug abusept to the daily demands of life. The features are impaired social behavior, communication and language, 7. Dementia Dementia is a condition due to illness of the brain, which is usually progressive in nature. The conditions that cause dementia produce changes in a person’s mental ability, personality and behavior. People with dementia commonly experience problems with memory and skills to carry out everyday activities. Dementia is not part of normal ageing. Although it can occur at any age, it’s more common in older people. Signs and symptoms • People with dementia often present with complaints of forgetfulness or feeling depressed. • Deterioration in emotional control and social behavior. 56 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 5- MENTAL HEALTH • • • People with dementia may be totally unaware of these changes and may not seek help. Memory problems, change in personality or behavior, Confusion, wandering or incontinence Mental illness, how big is the problem? In Kenya, on average, 25% of those who attend general outpatient clinics in all our health care facilities suffer from mental disorders and the vast majority suffer from minor mental disorders such as anxiety and depression. Signs and symptoms of mental illness NOTE: Signs are those that are observable (Objective) e.g. low mood, un-kept, disconnected, restlessness , disturbed behavior, loss of memory, forgetfulness, lack of insight (time, place, name, relatives) disturbance in the flow of thought NOTE: Symptoms: are those that one feels (Subjective) e.g. abnormal beliefs, abnormal perceptions, hearing voices, suicidal ideas/desire for death Factors that contribute to mental illnesses • Biological: genetics, infections, injuries, nutrition • Psychological: loss, psychological trauma, neglect, poor inter personal relationships • Environmental/social: harmful traditional/cultural practices, dysfunction in the family, discrimination, stigma Myths and Misconceptions Myth: Mental illness only affects a few people. Fact: Mental illness is common. It affects people of all ages, educational and income levels and cultures Myth: Mental illness is caused by a personal weakness. Fact: A mental illness is not a character flaw. It is caused by genetic, biological, social and environmental factors. Seeking and accepting help is a sign of strength. Myth: People with a mental illness never get better. Fact: With the right kind of help, most people do recover and lead healthy, productive and satisfying lives. Myth: People with a mental illness can “pull themselves out of it”. Fact: A mental illness is not caused by personal weakness and is not “cured” by personal strength. Myth: People with a mental illness are violent. Fact: People with a mental illness are no more violent or dangerous than the rest of the population. People with a mental illness are more likely to harm themselves – or to be harmed – than they are to hurt other people. Myth: People with a mental illness should be kept in hospital. Fact: With appropriate treatment and support, people with mental illness can live successfully in the community. In fact, the majority of people with a mental illness live independently in the community. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 57 UnitUnit 5- MENTAL 5- MENTAL HEALTH HEALTH RoleRole of CHVSs of CHVSs Roles Roles of Community of Community health health volunteers volunteers in Mental in Mental Health Health 9 Promotion 9 Promotion of mental of mental health: health: RolesRoles include include awareness awareness creation creation about about risk factors, risk factors, promotion promotion of lifestyles of lifestyles supportive supportive to good to good mental mental health health 9 Identification 9 Identification and and referral: referral: Household Household visits,visits, create create awareness awareness on signs on signs and and symptoms, symptoms, encourage encourage families families to visit to visit health health facilities, facilities, accompany accompany patients patients where where appropriate appropriate and and create create awareness awareness about about the mental the mental health health and and psychosocial psychosocial services services in the in community; the community; Fill Fill the referral the referral formform to the to facility the facility and and referral referral backback fromfrom the community. the community. 9 Advocacy: 9 Advocacy: Create Create awareness awareness about about the rights the rights of persons of persons withwith mental mental illness illness in community in community forums. forums. TakeTake notenote of human of human rights rights abuses abuses to persons to persons withwith mental mental disorders disorders and and report report to to relevant relevant authorities, authorities, speak speak about about the needs the needs of people of people withwith mental mental disorders disorders in strategic in strategic forums forums 9 Community 9 Community CareCare and and support; support; Conduct Conduct home home visitsvisits to persons to persons withwith mental mental illness illness and and taketake notenote of their of their adherence adherence to medication, to medication, side side effects, effects, clinicclinic return return dates, dates, resumption resumption for for functional functional capacities, capacities, family family reintegration reintegration and and acceptance, acceptance, community community acceptance. acceptance. Support Support Persons Persons withwith mental mental illnesses illnesses to regain to regain theirtheir jobs,jobs, and and occupational occupational activities. activities. Community Community Re-integration Re-integration RoleRole play;play; A man A man and and his wife, his wife, havehave just received just received newsnews that that theirtheir first born first born son has son been has been a drunkard, a drunkard, chews chews miraa miraa and and has has beenbeen operating operating as a as tout a tout in town in town for several for several years. years. He has He has decided decided to come to come backback home home because because of hisofhealth his health that that is deteriorating is deteriorating eacheach day. day. As he Asishe seated is seated withwith his parents his parents discussing discussing about about his coming his coming back,back, his younger his younger brother brother arrives arrives fromfrom the the fieldfield where where he was he was looking looking afterafter the cattle. the cattle. When When he realized he realized his brother his brother has come has come and and given given attention, attention, he vowed he vowed not to notallow to allow him him in since in since he wasted he wasted his life hiswhile life while drinking. drinking. FromFrom this scene, this scene, • Is• it common Is it common in your in your community? community? • How • How do you do you dealdeal withwith suchsuch cases? cases? HowHow can the can following the following mentally mentally ill person ill person be re-integrated be re-integrated and and support support him/her him/her to cope to cope 1. A1. 50Ayear 50 year old woman old woman livingliving in village in village x is recovering x is recovering fromfrom severe severe depression depression .She.She is living is living withwith her parents her parents sincesince her husband her husband ran away ran away fromfrom her. her. She She has 2has children 2 children agedaged 14 and 14 and 20 20 years. years. She She doesdoes not have not have landland or a or job.a What job. What stepssteps would would you you taketake to reintegrate to reintegrate her back her back to to normal normal life inlifethe in community the community 2. A2.34Ayear 34 year old man old man is living is living in Garissa in Garissa recovering recovering fromfrom a schizophrenia. a schizophrenia. He has He ahas wife a wife and and 4 4 children. children. He burn He burn down down his house his house during during one one of the of acute the acute episodes episodes .His family .His family soldsold all the all the livestock livestock to take to take him him to hospital. to hospital. He has He has a pending a pending casecase of destruction of destruction of his of neighbors’ his neighbors’ property. property. 3. A3.17Ayear 17 year old girl old living girl living in Kibera in Kibera has been has been diagnosed diagnosed withwith suicidal suicidal ideation. ideation. She She has had has had 2 2 58 58 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 5- MENTAL 5- MENTAL HEALTH HEALTH of abortion teachers refused to accept her back to school. Her mother casescases of abortion .The.The teachers havehave refused to accept her back to school. Her mother a 32a 32 old single mother not have means of livelihood to support her and 3 other yearyear old single mother doesdoes not have means of livelihood to support her and her 3her other siblings are also outschool. of school. siblings whowho are also out of 4. 4. A 9 year old boy a village in Kilifi has been diagnosed a mild developmental A 9 year old boy livingliving in a in village in Kilifi has been diagnosed withwith a mild developmental disorder. Although of age he not has joined not joined school yet. The mother 27 year disorder. Although he ishe of isage he has school yet. The mother whowho is 27isyear old old is alcoholic. father a small business where he sells charcoal is also suffering is alcoholic. The The father has ahas small business where he sells charcoal .He is.He also suffering fromfrom depression. 2 other children. would a CHW to support this family depression. TheyThey havehave 2 other children. WhatWhat would a CHW do todosupport this family Different activities in community the community for re-integration the re-integration of persons mental illness. Different activities in the for the of persons withwith mental illness. • Encourage people to form support groups • Encourage people to form support groups • Support groups to registered get registered where appropriate • Support groups to get where appropriate • Identify individual needs make appropriate referrals linkages • Identify individual needs and and make appropriate referrals and and linkages • Support groups to map our resources within communities • Support groups to map our resources within theirtheir communities • Support group trainings therapies • Support group trainings and and therapies • Lobby for community Participation in Mental Health • Lobby for community Participation in Mental Health CareCare • Promote the role of Families in social re-integration • Promote the role of Families in social re-integration • Promote anti-stigma campaigns • Promote anti-stigma campaigns • Advocacy for other organizations to meet needs of individuals families • Advocacy for other organizations to meet needs of individuals and and families NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 59 59 UNIT 6- INJURIES AND DISABILITIES PREVENTION AND REHABILITATION 60 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 61 UnitUnit 6- INJURIES 6- INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION UNIT UNIT 6: 6:INJURIES INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION Purpose Purpose The The purpose purpose of this of this unit unit is tois equip to equip the the community community health health volunteers volunteers withwith knowledge knowledge and and skillsskills to enable to enable themthem to create to create awareness awareness on the on prevention the prevention and and earlyearly management management of common of common injuries injuries and and disabilities disabilities in the in the community, community, for for appropriate appropriate referral, referral, follow-up follow-up and and rehabilitation. rehabilitation. Objectives Objectives By the By end the end of the of unit, the unit, the participants the participants will be willable be able to; to; • Explain • Explain whatwhat is injuries is injuries and and disability disability • Discuss • Discuss the common the common causes causes and and types types of injuries of injuries and and disability disability • Describe • Describe howhow to prevent, to prevent, provide provide basicbasic treatment treatment and and referrefer injuries injuries • Differentiate • Differentiate between between impairment impairment and and disability disability • Discussion • Discussion on appropriate on appropriate and and acceptable acceptable language language to be toused be used when when talking talking about about disability disability and/or and/or addressing addressing persons persons withwith disabilities disabilities • Demystify • Demystify common common myths myths and and misconceptions misconceptions about about disabilities disabilities • Explain • Explain howhow you you can support can support community community rehabilitation rehabilitation in your in your catchment catchment areaarea 62 62 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 6 - INJURIES 6 - INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION INTRODUCTION INTRODUCTION TO INJURIES TO INJURIES ANDAND DISABILITIES DISABILITIES What What is Injury is Injury and and disability disability Injury Injury is defined is defined as “the as “the physical physical damage damage that that results results when when a human a human bodybody is subjected is subjected to to excessive excessive forceforce or results or results in lack in lack of one of one or more or more vital vital elements, elements, suchsuch as oxygen. as oxygen. Previously Previously injuries injuries werewere known known as ‘accidents’ as ‘accidents’ depicting depicting that that theythey are beyond are beyond our control our control but nowadays but nowadays we refer we refer to to themthem as injuries as injuries sincesince it is now it is now understood understood that that many many factors factors cause cause harmful harmful incidents incidents to happen, to happen, and and many many measures measures can be cantaken be taken to prevent to prevent them. them. Disability Disability and and impairment impairment Disability Disability is a physical is a physical or mental or mental condition condition that that limitslimits a person’s a person’s movements, movements, senses, senses, or activities. or activities. It is the exclusion of It is the exclusion of people people withwith impairments impairments due due to attitudinal to attitudinal and and environmental environmental barriers barriers that that limitslimits theirtheir full and full and equal equal participation participation in the in life theoflifethe of community the community and and society society at large. at large. Impairment Impairment refers refers to the tophysical, the physical, intellectual, intellectual, mental mental and/or and/or sensory sensory characteristics characteristics or conditions or conditions that that limitlimit a person’s a person’s individual individual or social or social functioning, functioning, in comparison in comparison withwith someone someone without without these these impairments. impairments. Causes Causes andand types types of injuries of injuries Causes Causes of Injuries of Injuries based based on aon simple a simple classification classification Injuries Injuries are categorized are categorized as being as being either either “unintentional” “unintentional” or “intentional. or “intentional. 1. Unintentional 1. Unintentional injuries injuries resultresult fromfrom unintended unintended or “accidental” or “accidental” incidents incidents suchsuch as burns, as burns, drowning, drowning, choking. choking. 2. Intentional 2. Intentional injuries injuries are caused are caused by one by one person person inflicting inflicting harmharm on another on another person person or toorself, to self, suchsuch as physical as physical assault, assault, sexual sexual violence violence and and suicide. suicide. Types Types of injuries of injuries • Falls • Falls • Assault • Assault e.g. gunshot e.g. gunshot wounds, wounds, bluntblunt trauma trauma and and penetrating penetrating injuries injuries • Road • Road traffic traffic crashes crashes • Poisoning • Poisoning • Burns • Burns • Airway • Airway obstruction: obstruction: choking, choking, suffocation, suffocation, strangulation strangulation • Drowning • Drowning • Suicide • Suicide • Electrocution • Electrocution • Animal • Animal bitesbites Injuries Injuries can be canunderstood be understood according according to the to model the model of diseases. of diseases. TheyThey result result fromfrom the interaction the interaction of three of three factors: factors: the person, the person, the cause the cause (or agent), (or agent), and and the environment the environment NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 63 63 Unit 6- INJURIES AND DISABILITIES PREVENTION AND REHABILITATION Injury Person Cause Environment Analyzing the interactions among the person, the cause, and the environment can help to identify the specific factors that lead to an injury Person factors • Lack of awareness of the dangers or hazards • Lack of concentration • In children, high physical activity, agility and curiosity • Mobility problems due to muscle weakness or balance problems e.g. in older persons • Visual Problems • Stress and other mental disorders Cause factors • Equipment e.g. motor vehicles, farming, house hold • Driving when drunk • Speeding • Physical abuse • Gender based violence Environment • Places and facilities: bodies of water, roads, cliffs, playgrounds, kitchens, bathrooms, open windows, garages, and construction sites. • Weather conditions: extreme cold or heat. • Natural disasters: floods, earthquakes, lightening • Inadequate adult supervision for children, lack of knowledge of child development and safety • Lack of enough light Common causes of disabilities • Disease • Poverty • Wars • Drought/ famine • Harmful traditional practices • Household and work place accidents • Traffic accidents (road, air and water). • Ageing 64 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 6 - INJURIES AND DISABILITIES PREVENTION AND REHABILITATION Prevention and management Prevention, provision of basic management and referral of injuries Different scenes of Injuries i. Fall- A young child climbs up a tall mango tree, slips and falls from it. ii. Poisoning –It is night, 3 young children are warming themselves near a jiko in a cold kitchen with the door closed. iii. Burns- House help leaves a sufuria of boiling hot water on the floor as she picks something from the sitting room. Baby crawls quickly past the sufuria as she follows the house help. iv. Choking and Suffocation- Children are playing outside the house, one child puts a 10/= coin in the mouth and chases others as he runs about. v. Drowning- 3 teenage boys dare each other to swim across a seasonal river. Two reach the other side. vi. Road traffic crashes – A drunkard suddenly crosses the road without checking on traffic. Key notes: Prevention and Management of Injuries Injury Prevention Management • • • • Falls • • • • Remove obstructions that will result to falls e.g rugs, electrical cords Make the bathroom floor not to be slippery Safety-proof stairs to prevent child fall Adequate lighting of inside and outside areas Make windows safe by putting metal reinforcement Education of (especially older) people on the risk and prevention of falls NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Make sure there are no serious and obvious injuries- no broken bones, heavy bleeding, seizures, and that the person is conscious Seek medical treatment if the following symptoms are observed: • Unconsciousness- even if it is very brief (concussion) • Becomes very sleepy or is difficult to wake up (concussion) • Walking in an abnormal fashion- off balance, dizzy (concussion) • Difficulty breathing • Clear fluid or bleeding coming from nose, ears or mouth • Complains of intense or increasing pain • Vomiting • Deep or large wounds • Irritable and oddly moody, nonstop crying • Trouble focusing eyesight, distorted vision • Odd behavior or symptoms 65 UnitUnit 6- INJURIES 6- INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION InjuryInjury Prevention Prevention Management Management • • Poisoning Poisoning • • • • • • Burns/ Burns/ ScaldsScalds • • • Swallowed • Swallowed poison: Take poison: Take the item the away item away from from the the person, person, and have and have themthem spit out spitany outremaining any remaining Have • Have child child proofproof containers containers for for substance. substance. Do not Domake not make the person the person vomitvomit medication medication and hazardous and hazardous components components • Skin • poison: Remove Skin poison: Remove clothes clothes and rinse and rinse the skin the skin Safe • storage Safe storage of hazardous of hazardous materials materials with lukewarm with lukewarm waterwater for atfor least at least 15 minutes 15 minutes Keep • Keep sources sources of carbon of carbon monoxide monoxide • Poisonous • Poisonous fumes: Take fumes: Take the person the person outside outside or or outside/ outside/ in well in well ventilated ventilated rooms rooms eg. eg. into fresh into fresh air immediately. air immediately. If theIfperson the person is notis not Jikos Jikos breathing breathing , do cardiopulmonary , do cardiopulmonary resuscitation resuscitation (CPR)(CPR) Blow • Blow out out candles candles and and otherother openopen sources sources of light of light whenwhen your your leaveleave a a • Run • cool Run cool waterwater over over the burned the burned area, area, soak soak it it roomroom in cool in water cool water (not ice (notwater), ice water), or cover or cover it with it with a a Do • not Dolet notchildren let children play near play near the stove the stove clean,clean, cold, cold, wet towel. wet towel. or help or help you cook you cook at theatstove the stove • Cover • Cover the burn the burn with with a sterile a sterile bandage bandage or a or a Turn • Turn pot handles pot handles toward toward the back the back or or cleanclean clothcloth center center of theofstove the stove to avoid to avoid hitting hitting it it • Protect • Protect the burn the burn from from pressure pressure and friction. and friction. Avoid • Avoid smoking smoking in theinhouse the house • Do • not Doapply not apply butter, butter, ice, fluffy ice, fluffy cotton cotton dressing, dressing, Have • Have the electrical the electrical wiring wiring in your in your homehome adhesive adhesive bandages, bandages, cream, cream, oil spray, oil spray, or any or any checked checked by a professional by a professional electrician electrician at at household household remedy remedy to a burn to a burn least least onceonce everyevery 10 years 10 years • If• a burn If a burn appears appears to betosevere be severe or you or develop you develop Ensure • Ensure you you buy buy gas cylinders gas cylinders from from signssigns of infection, of infection, take take the person the person to the to the authorized authorized dealers dealers and and fastenfasten all all nearest nearest facility facility connections connections • If• theIffire theisfire overwhelming is overwhelming kindlykindly keep keep off off Don’t • Don’t keep keep flammables flammables in theinhouses the houses e. e. g. Kerosene, g. Kerosene, • Take • Take the object the object out of out hisofmouth his mouth only only if youif you • Keep • Keep tiny objects tiny objects awayaway from from the reach the reach can see canitsee it of children of children • Give • Give up toup5 to blows 5 blows between between the shoulder the shoulder • Watch • Watch your your children children at mealtime at mealtime e.g. e.g. blades blades with the withheel the of heel your of your handhand teachteach children children to chew to chew and and swallow swallow • Perform • Perform thrusts: thrusts: their their food food before before talking, talking, laughing, laughing, or • or Stand • Stand behind behind the person the person and wrap and wrap your your arms arms Choking Choking and and getting getting up toup move to move around, around, give food give food around around the waist. the waist. Suffocation Suffocation pieces pieces for the forappropriate the appropriate age age • Place • Place your clenched your clenched fist just fistabove just above the person’s the person’s • Always • Always placeplace babies babies to sleep to sleep on their on their navel.navel. Grab Grab your your fist with fist your with your otherother hand.hand. backsbacks • Quickly • Quickly pull inward pull inward and upward. and upward. • Keep • Keep plastic plastic bags bags awayaway from from children children • Continue • Continue cyclescycles of 5 ofback 5 back blowsblows and and 5 5 • Mothers • Mothers to breastfeed to breastfeed the babies the babies in anin an abdominal abdominal thrusts thrusts until until the object the object is coughed is coughed upright upright position position up orup theorperson the person startsstarts to breathe to breathe or cough. or cough. • Refer • Refer to health to health facility facility 66 66 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 6 - INJURIES 6 - INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION InjuryInjury Prevention Prevention • • Drowning Drowning • • • Management Management Never leaveleave a child unattended near near a • Never a child unattended a waterwater source e.g water in bucket, pool pool source e.g water in bucket, Keep bathrooms and toilets locked out ofout theofwater • Keep bathrooms and toilets locked Take the Takeperson the person the water Fence areasareas around swimming poolspools • Fence around swimming and dams CheckCheck for Breathing if notifbreathing start CPR( and dams for Breathing not breathing start CPR( Learn to swim • Learn to swim Avoid swimming whilewhile intoxicated • Avoid swimming intoxicated Wearing of seat Wearing of belts seat belts Wearing of helmets Wearing of helmets AvoidAvoid driving whenwhen drunkdrunk driving AssesAsses the area of fireoforfire another road road the for areapossibility for possibility or another traffictraffic crashcrash Do not casualties: You may causecause further Do move not move casualties: You may further injuryinjury RoadRoad traffictraffic AvoidAvoid entering an overloaded vehicle for breathing: if notifbreathing perform CPR CPR entering an overloaded vehicle CheckCheck for breathing: not breathing perform crashes crashes Observe rules rules of crossing roadsroads eg. zebra Observe of crossing eg. zebra Stop Stop bleeding by applying pressure on wound bleeding by applying pressure on wound crossing crossing MakeMake arrangements to transfer casualties to a to a arrangements to transfer casualties health facility health facility Below Below are pictures are pictures showing showing management management of infant of infant chocking chocking NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 67 67 Unit 6- INJURIES AND DISABILITIES PREVENTION AND REHABILITATION Impairment and disabilities The differences between impairment and disability Impairment is a problem in body function or structure. There are many types of impairments, the most common types are physical, visual, hearing, intellectual and multiple. Disability is the consequence of an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person’s lifetime. Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives. (WHO). Different ways in which the community views and handles persons with disabilities. 1. Persons with disabilities perceived as dependent and helpless. This is a traditional way of viewing persons with disabilities as being dependent and helpless. They are seen as: • Objects of charity • Having nothing to give, only to receive • Always poor, needy and fully dependent on charity or welfare for their survival. 2. Persons with disabilities perceived as patients. This focuses primarily on the medical problems of persons with disabilities and emphasizes medical solutions. It assumes that: • The problem of disability is due entirely to the individual’s condition or impairment. • People with disabilities are — first and foremost — ‘patients’. • The problem of disability requires a purely medical solution. 3. Persons with disability perceived as a social problem People with disabilities are viewed as a social burden and the society should do something to alleviate their suffering. It assumes that: • Disability is best thought of as a social problem. • The problem is not the person with disabilities or their impairment, but the unequal and discriminatory way they are treated by society. • The solution lies in removing the barriers that restrict the inclusion and participation of people with disabilities in the social life of the community. 4. Persons with disability are perceived to have no human rights,however: • All human beings are equal and have rights that should be respected without distinction of any kind. • People with disabilities are citizens and, as such, have the same rights as those without impairments. • All actions to support people with disabilities should be ‘rights based’; for example, the demand for equal access to services and opportunities as a human right. 68 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 6 - INJURIES AND DISABILITIES PREVENTION AND REHABILITATION Appropriate and inappropriate terms when discussing disability Inappropriate terms Appropriate terms The disabled, the handicapped People with disabilities Cripple, physically handicapped or wheelchair bound. A person with a physical disability/impairment or wheelchair user Deaf and dumb A person with hearing and speech impairments The blind People who are blind, or partially sighted, or visually impaired people The deaf People who are deaf, or hearing-impaired people Demystifying common myths and misconceptions about disabilities (20 Mins) Common myths about disability: Myth 1: People with disabilities are brave and courageous. Fact: Adjusting to impairment requires adapting to particular circumstances and lifestyle, not bravery and courage. Myth 2: Wheelchair use is confining; people who use wheelchairs are ‘wheelchair-bound’. Fact: A wheelchair, like a bicycle or an automobile, is a personal mobility assistive device that enables someone to move around. Myth 3: All persons with hearing disabilities can read lips. Fact: Lip-reading skills vary among people and are never entirely reliable. Myth 4: People who are blind acquire a ‘sixth sense’. Fact: Although most people who are blind develop their remaining senses more fully, they do not have a ‘sixth sense’. Myth 5: Most people with disabilities cannot have sexual relationships. Fact: Anyone can have a sexual relationship by adapting the sexual activity. People with disabilities can have children naturally or through adoption. People with disabilities, like other people, are sexual beings. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 69 UnitUnit 6- INJURIES 6- INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION As a As community a community health health volunteer, volunteer, you you can help can help remove remove barriers barriers by encouraging by encouraging participation participation of of people people withwith disabilities disabilities in your in your community community through: through: • using • using accessible accessible sitessites for meetings for meetings and and events events • advocating • advocating for afor barrier-free a barrier-free environment environment • speaking • speaking up when up when negative negative words words or phrases or phrases are used are used about about persons persons withwith disabilities disabilities • accepting • accepting persons persons withwith disabilities disabilities as individuals as individuals withwith the same the same needs, needs, feelings feelings and rights and rights as yourself. as yourself. HowHow to support to support Community Community Based Based Rehabilitation Rehabilitation in Our in Our Catchment Catchment Areas Areas Story; Story; Edi isEdi anis11 anyear 11 year old boy old boy whowho was was bornborn withwith a disease a disease that that made made his head his head to grow to grow too large too large for for his body. his body. It is so It isheavy so heavy that that he cannot he cannot lift itlift byithimself. by himself. He also He also has very has very poorpoor eyesight eyesight and and is a is a slowslow learner. learner. All ofAllhisoflife hisEdi lifehas Edi lain has on lainthe on floor the floor or inorbed. in bed. His parents His parents are quite are quite poorpoor but have but have bought bought a television a television so that so that Edi can Edi have can have something something to dotoduring do during the day. the day. Key Key notes; notes; OneOne of the of most the most important important principles principles in Community in Community based based rehabilitation rehabilitation is that is that the community the community is a is resource a resource for people for people withwith disability. disability. The The storystory of Edi of shows Edi shows many many different different waysways that that the the community community can help. can help. • • • • • • The workman can his useskills his skills to build a special for Edi. The locallocal workman can use to build a special chairchair for Edi. • The owner of wood can donate the materials a chair or give a discount. The owner of wood shopshop can donate the materials for afor chair or give a discount. • The school teacher a volunteer can give informal education Edi sit canup. sit up. The school teacher or a or volunteer can give informal education nownow that that Edi can • The leader of youth group can arrange a volunteer to read toevery Edi every week. The leader of youth group can arrange for afor volunteer to read to Edi week. • The neighbor can help special exercises to give parents a break doing them. The neighbor can help withwith special exercises to give Edi’sEdi’s parents a break fromfrom doing them. 70 70 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 6 - INJURIES 6 - INJURIES AND AND DISABILITIES DISABILITIES PREVENTION PREVENTION AND AND REHABILITATION REHABILITATION Another important principle is that by doing CBR CBR the community learns and and develops itself.itself. So So Another important principle is that by doing the community learns develops the community also also benefits. the community benefits. HowHow has the developed by helping Edi? Edi? has community the community developed by helping • The community can can see that something simple can can improve Edi’sEdi’s life and make his parents • The community see that something simple improve life and make his parents happy. TheyThey can see people withwith disability can change and and grow. happy. can that see that people disability can change grow. • The community nownow has skills to make special equipment for persons withwith disability. EvenEven • The community has skills to make special equipment for persons disability. though it is itunlikely that that another childchild would be born withwith that that disease, the community though is unlikely another would be born disease, the community members nownow know that that special equipment can can be used, and and havehave learnt some basicbasic members know special equipment be used, learnt some principles. principles. • Children get get to know children withwith disability and and learnlearn that that theythey are not different fromfrom • Children to know children disability are not different themselves. Learning these positive attitudes earlyearly will make themthem moremore accommodative themselves. Learning these positive attitudes will make accommodative community members in the community members in future. the future. • By a disability problem, the community is more motivated to solve otherother problems • solving By solving a disability problem, the community is more motivated to solve problems in the Success at solving one one problem leadsleads to confidence and and motivation to to in community. the community. Success at solving problem to confidence motivation solvesolve others. others. • People withwith disability and and theirtheir family members are also key community resources. Not Not onlyonly • People disability family members are also key community resources. are they experts on the of disability (what it is like whatwhat is needed) but they are they experts on experience the experience of disability (what it is and like and is needed) but they are often experts on how to help. are often experts on how to help. SUMMARY SUMMARY Rehabilitation Rehabilitation • Rehabilitation includes all measures aimed at reducing the the impact of disability for an • Rehabilitation includes all measures aimed at reducing impact of disability for an individual, enabling him him or her independence, social integration, a better quality individual, enabling or to herachieve to achieve independence, social integration, a better quality of lifeofand self –self actualization. life and – actualization. • Rehabilitation should be offered as a process in which all participants are actively and closely involved. • Rehabilitation should be offered as a process in which all participants are actively and closely involved. Community Based Rehabilitation (CBR) Community Based Rehabilitation (CBR) • This is a isstrategy within the the general community development for the rehabilitation, • This a strategy within general community development for the rehabilitation, equalization of opportunities and and social inclusion of allofpeople withwith disabilities. equalization of opportunities social inclusion all people disabilities. • It• involves working withwith people withwith all forms of impairment, focusing on networking withwith It involves working people all forms of impairment, focusing on networking existing health, education, livelihood and and social services so that theythey include the needs and and existing health, education, livelihood social services so that include the needs potentials of persons withwith disabilities. potentials of persons disabilities. • The primary objective of CBR is the improvement of the quality of life withwith • The primary objective of CBR is the improvement of the quality of of lifepeople of people disability/marginalized persons. disability/marginalized persons. RoleRole of CHVs in Community Based Rehabilitation of CHVs in Community Based Rehabilitation • Act advocates on behalf of people withwith disabilities and and theirtheir families withwith the health • as Actlocal as local advocates on behalf of people disabilities families the health services personnel services personnel • Provide liaison and and continuity of care in the on behalf of professionals e.g. Home • Provide liaison continuity of care in community the community on behalf of professionals e.g. Home visitsvisits • Act of community initiatives to remove social and and physical barriers that that affect • as Actdirectors as directors of community initiatives to remove social physical barriers affect exclusion exclusion • Provide a positive role role model for service usersusers if they themselves havehave a disability • Provide a positive model for service if they themselves a disability NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 71 71 Unit 6- INJURIES AND DISABILITIES PREVENTION AND REHABILITATION • • • • • 72 Learn to accept people with disabilities and give them opportunities to join in community life. Learn and practice behaviors that prevent disability. Find people living with disabilities in the community and initiate them into a community based rehabilitation program Work as community based rehabilitation volunteers. They can donate their time to many community based rehabilitation activities, for example helping a disabled person in the home, or visiting schools to help students with disability. Help with fund raising e.g. by organizing a community fair to raise money and community awareness. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 UNIT 7- ALCOHOL AND DRUG ABUSE NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 73 74 74 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 07 - 07 ALCOHOL - ALCOHOL AND AND DRUGDRUG ABUSE ABUSE UNIT UNIT 7: ALCOHOL 7: ALCOHOL AND AND DRUG DRUG ABUSE ABUSE Purpose Purpose To enhance To enhance the capacity the capacity of Community of Community health health volunteers volunteers withwith knowledge knowledge and and skillsskills to campaign to campaign against against Alcohol Alcohol AndAnd DrugDrug Abuse Abuse as well as well as toasmonitor, to monitor, manage manage and and support support persons persons withwith substance substance use disorders, use disorders, theirtheir families families and and community. community. Objectives Objectives By the By end the end of this of unit this unit the Community the Community health health volunteer volunteer should should be able be able to: to: 1. Define 1. Define and and understand understand basicbasic concepts concepts of Alcohol of Alcohol AndAnd DrugDrug Abuse Abuse and and identify identify the types the types of substances of substances commonly commonly abused abused at community at community levellevel 2. Understand 2. Understand the signs the signs and and symptoms symptoms of Alcohol of Alcohol AndAnd DrugDrug Abuse. Abuse. 3. Educate 3. Educate the community the community on prevention on prevention and and effects effects of Alcohol of Alcohol AndAnd DrugDrug Abuse Abuse 4. Identify 4. Identify and and referrefer persons persons withwith substance substance use use disorders disorders to the to nearest the nearest health health facility/rehabilitation facility/rehabilitation centre. centre. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 75 75 Unit 7- ALCOHOL AND DRUG ABUSE INTRODUCTION TO DRUGS AND DRUG ABUSE Definitions of Basic concepts Drug: Any chemical substance, natural or man-made, that changes a person’s mental state and that may be used repeatedly by a person for that effect. The term ‘drug’ includes legal and illegal substances such as alcohol, caffeine, tobacco, petrol, heroin, steroids, marijuana (Commonwealth Department of Human Services and Health 1994:7). Drug use: This term means taking drugs. The term does not necessarily mean that the drug taking is harmful or ongoing. Tolerance: Physiological state in which increased dose is needed to produce a specific effect Drug abuse: This term is often used to describe drug use that causes harm. The problem with using this term is that it can create negative feelings or attitudes toward the user and is not a recommended term to use Addiction: Addiction to a drug means that the person: • Has a strong desire or compulsion to use the drug (cannot think about anything else) • Finds it difficult to control the drug using behaviour • Is uncomfortable or distressed if the drug taking is prevented or stops (withdrawal symptoms) • Keeps using the drug, even when it is causing problem Dependency: Drug dependence occurs when a drug becomes central to a person’s thoughts, emotions and activities. Using the drug takes on a higher priority than many other things in life and the person may neglect other responsibilities. Being dependent makes it hard for people to stop or even cut down on the drug. Withdrawal: When a person stops taking the drug, he or she may experience certain unpleasant physical and mental effects. This group of effects is referred to as ‘withdrawal symptoms’. They are different for each drug. Classification of drugs Types of drugs i. Stimulants • What is stimulation? • How do you feel when you are stimulated? • Do you have stimulants in your community? • Note their contribution on a flip chart. • Summarize by the following facts. Increase the activity of the central nervous system which speed up the functioning of the brain, and are often used for leisure, but also with the objective of remaining alert or increasing courage. E.g.Tobacco, Cocaine, Miraa, Shisha (emerging menace) 76 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 7 - ALCOHOL AND DRUG ABUSE ii. Depressants Ask the participant volunteer to act as a depressed person. How can you help a depressed person? Summarize with the following key notes Decrease the activity of the central nervous system. They reduce tension and cheer up a depressed mood. Many are used as sedatives and tranquillizers. E.g. – Alcohol, Heroine, morphine, bhang, iii. Hallucinogens • Ask a volunteer to demonstrate how people hallucinate. • Are they common in your community? • What causes hallucinations? Cause pronounced alteration of perception. It is the state of fantasy or illusion, being lost in the world of dreams E.g. cannabis and hashish iv. Steroids • What are steroids? • Are they commonly used in your community? Foster the formation of living tissue, increases muscular mass. They are used as body building substances especially by athletes and body builders Signs and Symptoms of Drug and Substance Abuse; • • • • • • • • • • • • • • • • • • Unhealthy appearance, indifference to hygiene or marked deterioration in physical hygiene and grooming Poor physical co-ordination, slurred or incoherent speech Blood shot eyes or red eyes, dilated pupils, drooping eyelids Burnt or stained thumb nails or finger tips, burnt holes on clothing Injection marks as evidence of using needles Unexplained skin rash Watering eyes and nose (itching eyes) Dark circles under the eyes and a blank facial expression Memory lapses or blackouts, short attention span, difficulty in concentration Sexual problems which include lack of , function and promiscuity Insomnia (lack of sleep), moodiness, fatigue, restlessness, shakes, agitation,, nausea, vomiting, sweating, hallucinations and convulsions Suicidal behavior Migraine healcohol and drug abuseches Increased absenteeism or tardiness (slow in arrival), lethargy (lack of energy) Inattentiveness, lack of concentration, loss of interest Increased job related accidents. Quarrelsome Chronic dishonesty (Lying, stealing, trouble with law enforcers) NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 77 UnitUnit 7- ALCOHOL AND AND DRUGDRUG ABUSE 7- ALCOHOL ABUSE Factors contributing to alcohol andand drugdrug abuse Factors contributing to alcohol abuse Individual factors Individual factors • Control of Anxiety. (Anxiety is a mental mechanism that that compels us touscater for our • Control of Anxiety. (Anxiety is a mental mechanism compels to cater for most our most basicbasic needs: Food, shelter, and and love.love. needs: Food, shelter, • Control of emotions • Control of emotions • •Dismiss fear. fear. Dismiss • Evade boredom. • Evade boredom. • Stress - occurs when therethere is anisimbalance between, the demands of lifeofand our inability to to • Stress - occurs when an imbalance between, the demands life and our inability copecope withwith them. them. • Too much workload. • Too much workload. • Low achievement. • Low achievement. • Overbearing spouses. • Overbearing spouses. • Sheer Curiosity. • Sheer Curiosity. • Lack of Education or information about effects of drugs • Lack of Education or information about effects of drugs • Looking for pleasure, (feeling good, greatgreat happy. Drugs will temporarily givegive happiness but but • Looking for pleasure, (feeling good, happy. Drugs will temporarily happiness • •LackLack of Purpose in Life. Purpose givesgives direction, or something to live for. Iffor. you havehave no no of Purpose in Life. Purpose direction, or something to live If you purpose in lifeinyou are called a Shifting shadow “(You“(You follow anything that that moves)” this this will will purpose life you are called a Shifting shadow follow anything moves)” leadlead to everlasting pain.pain. to everlasting • Peer/Social Pressure. , Reduces him/her to mediocrity, affects his/her spirituality, controls the the • Peer/Social Pressure. , Reduces him/her to mediocrity, affects his/her spirituality, controls way way he/she dresses, his/her manners,. It is like magnet that that attracts withwith powerful strength. he/she dresses, his/her manners,. It is alike a magnet attracts powerful strength. It attracts you you to drugs and and you you will certainly not say It attracts to drugs will certainly not no”. say no”. • Social/peer pressure is theis worst enemy of human beings. It urges themthem to dotowhat theythey do do • Social/peer pressure the worst enemy of human beings. It urges do what not want to do. not want to do. Family factors. Family factors. a. Poor childchild upbringing. a. Poor upbringing. RoleRole play;play; Ask Volunteers to demonstrate a drunkard, smoking father whowho advices his children Ask Volunteers to demonstrate a drunkard, smoking father advices his children to betogood in school and and never smoke or drink. be good in school never smoke or drink. • Are suchsuch people in your community? • there Are there people in your community? • What should the community members do todosolve this?this? • What should the community members to solve Adults usually disapprove drugdrug consumption among teens. Hypocrisy is inismany parents, Adults usually disapprove consumption among teens. Hypocrisy in many parents, teachers, and and opinion leaders because theythey taketake drugs when teens are watching (do as teachers, opinion leaders because drugs when teens are watching (doI say as Iand say and not as notI do as Irule). do rule). b. Parenting styles. b. Parenting styles. Different types of leadership styles Different types of leadership styles Authoritarian/Autocratic/dictatorial styles breed rebellion. Authoritarian/Autocratic/dictatorial styles breed rebellion. Lasses Fair Style – Children growgrow without direction – This leadsleads to carefree lifestyle Lasses Fair Style – Children without direction – This to carefree lifestyle c. Marital conflicts andand breakdown c. Marital conflicts breakdown Is theIs life predictable? Do they feel protected? theoflifethe of children the children predictable? Do they feel protected? Is there family support when needed? Is there family support when needed? d. Loss of a of significant one.one. d. Loss a significant e. Overprotection by family. Assumption that that everyone else else maymay be wrong except my own e. Overprotection by family. Assumption everyone be wrong except my own f. Family rulesrules - roles-fixed, rigidrigid f. Family - roles-fixed, 78 78 NON COMMUNICABLE DISEASES Participants Manual - NCD- MODULE 13 13 NON COMMUNICABLE DISEASES Participants Manual NCD MODULE UnitUnit 7 - ALCOHOL AND AND DRUGDRUG ABUSE 7 - ALCOHOL ABUSE g. g. Ambitious andand overover expecting parents Ambitious expecting parents h. Genetic reasonsSome people havehave a greater genetic predisposition thanthan others to be h. Genetic reasonsSome people a greater genetic predisposition others to be victims of alcoholic beverages i.e.It i.e.It runsruns in some families. victims of alcoholic beverages in some families. Societal factors Societal factors a. Information resulting fromfrom of media, Music, Internet e.t.c.e.t.c. a. Information resulting of media, Music, Internet b. Culture. Many cultural activities are associated withwith drugs e.g. marriage, harvest, funeral e.t.c.e.t.c. b. Culture. Many cultural activities are associated drugs e.g. marriage, harvest, funeral c. Availability/Accessibility-Lax lawslaws resulting in ability to reduce supply. c. Availability/Accessibility-Lax resulting in ability to reduce supply. d. Socio economic and and cultural changes which fosters:Loneliness, isolation, depression and and d. Socio economic cultural changes which fosters:Loneliness, isolation, depression anxiety anxiety Work place factors Work place factors What is stress? What is stress? RoleRole play;play; A mother withwith several things to dotoatdohome whowho is quarreled by her husband. A mother several things at home is quarreled by drunkard her drunkard husband. a. Stress. a. Stress. WorkWork overload. overload. PoorPoor timetime management management b. Frustration. b. Frustration. Failure to grow professionally, get recognition or promotion. Failure to grow professionally, get recognition or promotion. c. Entropy – Same workstation, samesame duties, samesame people, no new challenges. c. Entropy – Same workstation, duties, people, no new challenges. d. Conflicts. People havehave conflict within themselves; theythey transfer the same to others. d. Conflicts. People conflict within themselves; transfer the same to others. e. Work structure and and policies e. Work structure policies EFFECTS OF ALCOHOL ANDAND DRUG ABUSE EFFECTS OF ALCOHOL DRUG ABUSE a. • • • • • • • • • • • Individual a. Individual Personal neglect • Personal neglect Lack of self-respect • Lack of self-respect Immorality • Immorality Poor performance at any • Poor performance at task any task Poor health • Poor health Accidents • Accidents Very emotional • Very emotional Absenteeism fromfrom workwork or school • Absenteeism or school Addiction could leadlead to suicidal thoughts • Addiction could to suicidal thoughts Poor self esteem • Poor self esteem Death • Death b. • • • • • • Family b. Family Bad role role model to the family members • Bad model to other the other family members Depression to the family members • Depression to other the other family members Domestic violence especially husband abusing wifewife and and children • Domestic violence especially husband abusing children Abuse to the and and siblings when children abuse drugs • Abuse to parents the parents siblings when children abuse drugs Insecurity at home • Insecurity at home Broken marriages and and families • Broken marriages families NON COMMUNICABLE DISEASES Participants Manual - NCD- MODULE 13 13 NON COMMUNICABLE DISEASES Participants Manual NCD MODULE 79 79 Unit 7- ALCOHOL AND DRUG ABUSE • • • Accidents and loss of family property Embarrassment to the family/stigma Poverty - very expensive to treat drug illnesses c. • • • • • • • Community National poverty due to poor productivity and poor use of money Insecurity (drug abusers are rapists, incest, violent robbers, carjackers etc) Accidents on the roads, in place of work etc Drug abuse promotes spread of HIV/AIDS especially among IDUs, alcohol abusers Poor culture spread to the youth Strikes in schools Political unrest (post-election violence) SPECIFIC HEALTH AND SOCIAL EFFECTS OF DRUGS ALCOHOL It causes;• Brain and nerve damage • Impaired visual ability – don’t see clearly. • Altered sense of time and space • Not able to walk strait - hence staggering • Loss of pain perception – drunkards realizes they were injured after sobering up • Unclear hearing- that’s why people shout when they are drunk because they cannot hear well. • Slow reaction time – making one vulnerable to accidents • To the liver – Enlargement, hardening, Cancer (cirrhosis) and liver failure • To the heart, causes enlargement, damages the valves, causes high blood pressure and heart failure • To the stomach – cause ulcers , stomach cancer and other gastrointestinal tract cancers (e.g. mouth, throat, duodenum, intestines) • Causes poor re-absorption of water causing dehydration, frequent passing out of urine, leads to early death • In reproductive organs, it causes - poor quality sperm or ova (deformed or lacking important parts like tail or nuclear), lack of sexual arousal in the long term (impotence or frigidity) TOBACCO Cigarettes Tobacco contains some 4700 ingredients. Out of these, 400 are known to be very harmful to human life and health by way of causing cancer. The following are the harmful effects of tobacco that can be seen in various organs of the body: i. 80 Mouth • Smokers experience dulling of their taste buds, • Irritation in the mouth, • Gum diseases, • Bad breath and numbness, • Staining of teeth and even falling off, • Increases chances of cancer of the mouth. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 7 - ALCOHOL AND DRUG ABUSE ii. Throat Tobacco causes cancer of throat. It irritates the membranes of the throat causing it to become sore. iii. Heart Tobacco increases heart rate and blood pressure, which increases a person’s risk of heart attack and stroke iv. Liver Smoking causes liver to harden v. Lungs Smoking progressively limits the amount of air flow into and out of the lungs. Tar and other constituents cause lung cancer vi. Reproductive system Smoking reduces sex drive and increases risk of impotence in men. In women, there is increased risk of cervical cancer, increased risk of miscarriage and pregnancy complication. BHANG The use of bhang may lead to the following: • Deformed babies • False confidence • Spontaneous laughter • Short memory loss • Confusion of past, present and future • Hallucinations and paranoid feelings • Poor quality sperm in men • Painful periods in women • Loss of sexual drive NB: Effects of bhang are felt many years after stopping its use. MIRAA • Major memory loss (brain crash or amnesia), personality disorders, depression • Mouth sores and ulcers, tongue, lip which predisposes an individual to HIV/AIDS • Oral cancer • Nerve damage leading to numbness • Hallucinations – disorganized, paranoid • Excessive irritability • Chronic constipation-slow passage of food through the stomach and intestines • Painful intercourse • Impotence in men and frigidity in women-lowering of happiness during sex INHALANTS • Dizziness, vomiting and tremors • First phase of euphoria and hallucinations. • Slurred speech • Irregular heartbeat • Violent behavior • Damage to soft tissue in nose and mouth resulting in loss of ability to smell • Loss of appetite NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 81 UnitUnit 7- ALCOHOL 7- ALCOHOL AND AND DRUGDRUG ABUSE ABUSE SHISHA SHISHA This This is anis emerging an emerging drugdrug which which is a isflavored a flavored formform of tobacco of tobacco that that is made is made to appear to appear less less harmful harmful thanthan otherother types types of tobacco. of tobacco. It is usually It is usually smoked smoked using using a shared a shared pipepipe hence hence it can it can leadlead to transmission to transmission of communicable of communicable diseases diseases suchsuch as TB. asIn TB.some In some instances instances otherother drugs drugs suchsuch as as heroine, heroine, cocaine cocaine and and bangbang are added are added to this to this mixture. mixture. A puff A puff of shisha of shisha is equivalent is equivalent to smoking to smoking 20 cigarettes. 20 cigarettes. Key Key notes notes • Prevention • Prevention of alcohol of alcohol and and drugdrug abuse; abuse; awareness awareness creation creation and and Education, Education, • identification • identification and and referral referral of persons of persons withwith alcohol alcohol and and drugdrug abuse abuse disorders disorders • Linking • Linking individuals individuals withwith alcohol alcohol and and drugdrug abuse abuse disorders disorders and and theirtheir families families to the to the otherother relevant relevant services services • Support • Support re-integration re-integration of persons of persons withwith alcohol alcohol and and drugdrug abuse abuse disorders disorders 82 82 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UNIT UNIT 8- 8ORAL ORAL HEALTH HEALTH NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 83 83 84 84 NON COMMUNICABLE DISEASESDISEASES Participants Manual Manual - NCD MODULE 13 NON COMMUNICABLE Participants - NCD MODULE 13 Unit 8 Unit - ORAL 8 -HEALTH ORAL HEALTH UNITUNIT 8: ORAL HEALTH 8: ORAL HEALTH Purpose Purpose The purpose of this of unit is to equip community healthhealth volunteers with knowledge The purpose this unit is to the equip the community volunteers with knowledge and skills promotion of oralof health care and prevention of common oral diseases. andfor skills for promotion oral health care and prevention of common oral diseases. This will them to foster publicpublic awareness on theon importance of good Thisenable will enable them to foster awareness the importance of oral good oral healthhealth and establish the relationship between oral health and general health.health. and establish the relationship between oral health and general Objectives Objectives By theBy end this of unit, healthhealth volunteer shouldshould be ablebeto:able to: theofend thiseach unit,community each community volunteer • Understand importance of oralofhealth • Understand importance oral health • Establish relationship between oral health and general healthhealth • Establish relationship between oral health and general • Identify the common oral diseases and conditions • Identify the common oral diseases and conditions • Demonstrate good oral health practices • Demonstrate good oral health practices • List• theList causes, prevention and treatment methods of oralof health diseases the causes, prevention and treatment methods oral health diseases • Refer oralof diseases for management to the to nearest healthhealth facilityfacility • cases Refer of cases oral diseases for management the nearest • Build with stakeholders for oralfor health care promotion and disease • partnerships Build partnerships with stakeholders oral health care promotion and disease prevention prevention NON COMMUNICABLE DISEASESDISEASES Participants Manual Manual - NCD MODULE 13 NON COMMUNICABLE Participants - NCD MODULE 13 85 85 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH INTRODUCTION INTRODUCTION TO ORAL TO ORAL HEALTH HEALTH OralOral health health • Oral • Oral health health describes describes the absence the absence of disease of disease and and optimal optimal functioning functioning of the of mouth the mouth and and its its tissues, tissues, in a manner in a manner which which preserves preserves the highest the highest levellevel of self of esteem. self esteem. • It• describes It describes a standard a standard of health of health for oral for oral and and related related tissues tissues which which enable enable an individual an individual to to eat, eat, speak speak and and socialize socialize without without active active disease, disease, discomfort discomfort or embarrassment or embarrassment and and which which contribute contribute to antoindividuals’ an individuals’ well-being. well-being. • These • These include include the teeth, the teeth, the gums, the gums, the tongue the tongue and and otherother tissues tissues in the in mouth. the mouth. • The • health The health of the ofteeth the teeth and and gums gums is related is related to the tohealth the health of the ofwhole the whole person, person, just as justthe aswell the well being being of a of person a person relates relates to the to health the health of the of entire the entire community. community. • Basic • Basic carecare of the of teeth the teeth and and gums gums - both - both preventive preventive and and curative curative - should - should be part be part of the of the “know-how” “know-how” of allofprimary all primary healthcare healthcare workers. workers. While While dental dental disease disease is decreasing is decreasing in richer in richer countries, countries, it is on it isthe onincrease the increase in most in most poorpoor countries. countries. OneOne reason reason for this for is this that is that people people are eating are eating fewer fewer traditional traditional (unrefined) (unrefined) foods foods and and moremore pre-prepackaged, packaged, commercial commercial foods foods oftenoften softened softened by refined by refined sugars sugars Below Below are the are parts the parts of a of tooth a tooth • Crown • Crown (above (above the gum) the gum) • Enamel • Enamel • Dentine • Dentine • Pulp • Pulp • Root • Root (in the (in gum) the gum) • Nerves • Nerves • Ligaments • Ligaments • Jaw • Jaw bonebone 86 86 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH SetsSets of teeth of teeth These These are: are: • Milk • Milk & Permanent & Permanent Types Types of teeth of teeth • Incisors • Incisors • Canines • Canines • Premolars • Premolars • Molars • Molars Importance Importance of teeth of teeth 1. Appearance 1. Appearance • To • Look To Look Good Good • To • Look To Look Happy Happy • To • Look To Look Beautiful: Beautiful: boost boost self esteem self esteem • To • Have To Have a good a good Smile Smile 2. For 2. speaking For speaking properly properly 3. Milk 3. Milk teethteeth guide guide permanent permanent teethteeth into into correct correct positions positions 4. Milk 4. Milk teethteeth provide provide the right the right space space for permanent for permanent teeth. teeth. 5. Chewing 5. Chewing general poorpoor general PoorPoor Oral Oral PoorPoor nutrition nutrition low low immunity immunity health leading health leading loss loss of teeth. of teeth. health health leadsleads to to leading leading to to leading leading to to to to ORAL ORAL DISEASES DISEASES Common Common oral oral Diseases Diseases and and Conditions Conditions Diseases Diseases 1. Tooth 1. Tooth Decay Decay 2. Gum 2. Gum Disease Disease 3. Oral 3. Oral Cancer. Cancer. Conditions Conditions 1. Crowding 1. Crowding 2. Brown 2. Brown Teeth Teeth ( Fluorosis) ( Fluorosis) 3. Toothlessness 3. Toothlessness 4. Dental 4. Dental Trauma Trauma 5. Cleft 5. Cleft lip/cleft lip/cleft palate. palate. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 87 87 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH Tooth Tooth Decay Decay » » » » » This » This is theis destruction the destruction of a tooth of a tooth Structure Structure that that involves involves the outer the outer and and sometimes sometimes innerinner partsparts of a of tooth. a tooth. It» occurs It occurs when when foodfood containing containing sugars sugars and and starch starch are left are on leftaon tooth a tooth surface surface for afor long a long timetime Bacteria » Bacteria that that live in livethe in mouth the mouth digest digest these these sugars sugars turning turning themthem into into acidsacids which which dissolve dissolve a a tooth, tooth, creating creating holesholes or cavities. or cavities. Bacteria » Bacteria + Sugary + Sugary foods foods and and salivasaliva = Plaque = Plaque (White (White Film)Film) that that produce produce acidsacids that that dissolve dissolve a a tooth tooth creating creating holesholes or cavities. or cavities. When » When cavities cavities startstart there’s there’s no pain no pain Foods Foods thatthat cause cause Tooth Tooth Decay. Decay. These These are generally are generally sugary sugary foods foods and and drinks. drinks. Examples Examples • •Biscuits. Biscuits. • Sodas. • Sodas. • Cakes. • Cakes. • Sweets. • Sweets. • Chocolates. • Chocolates. • Ice • Cream. Ice Cream. HowHow do you do you know know you you havehave tooth tooth decay? decay? • Sensitivity • Sensitivity to hot to or hotcold or cold foods foods or drinks or drinks • Discolored • Discolored spotsspots on aon tooth, a tooth, white white or black or black • Hole • Hole in a tooth in a tooth • Pain • Pain • Swelling • Swelling • Bad • Bad breath breath HowHow to prevent to prevent tooth tooth decay? decay? • Brushing • Brushing youryour teethteeth at least at least twice twice a daya after day after eating, eating, morning morning and and evening. evening. • Use • Use dental dental flossfloss to clean to clean between between teethteeth and and hardhard to reach to reach places places withwith a tooth a tooth brush. brush. • Eat • nutritious Eat nutritious andaanda balanced balanced diet.diet. • Limit • Limit snacks snacks and and sticky sticky foods foods and and if eaten if eaten brush brush youryour teethteeth immediately immediately • Visit • Visit youryour Dentist Dentist or any or any another another dental dental personal personal twice twice a year a year eveneven if your if your teethteeth havehave no no problems problems or pain. or pain. • In • case In case of pain of pain or a or problem, a problem, havehave it treated. it treated. GumGum disease disease What What is Gum is Gum Disease Disease or Gingivitis or Gingivitis This This is anisirritation an irritation of gums of gums or gum or gum caused caused by Plaque/Tatar by Plaque/Tatar which which comes comes fromfrom foodfood remains remains and and bacteria bacteria in the in mouth. the mouth. HowHow do you do you know know you you havehave a gum a gum disease? disease? By; By; • Having • Having bleeding bleeding gums/gum. gums/gum. 88 88 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH • Red • Red gum/gums. gum/gums. • Swollen • Swollen gum/gums. gum/gums. • Pus • oozing Pus oozing fromfrom gum/gums. gum/gums. • Gum/ • Gum/ gums gums moving moving awayaway downward downward or upward. or upward. • Misalignment • Misalignment of teeth. of teeth. • Bad • Bad breath. breath. • Pain • Pain on gum/gums. on gum/gums. If gum If gum diseases diseases is not is treated not treated this this leads leads to: to: • Shaking • Shaking of teeth. of teeth. • Shifting • Shifting of teeth. of teeth. • Eventually • Eventually tooth tooth loss.loss. HowHow do you do you prevent prevent gumgum disease? disease? By; By; • Brushing • Brushing youryour teethteeth at least at least twice twice a day, a day, afterafter breakfast breakfast and and supper. supper. • Having • Having a regular a regular check-up check-up by your by your dentist. dentist. • Have • Have youryour teethteeth professionally professionally cleaned cleaned by aby dentist. a dentist. Leaning Leaning about about OralOral cancer. cancer. RoleRole Play:Play: Zawadi Zawadi was was introduced introduced to smoking to smoking and and drinking drinking by his byfather his father at young at young age.age. NowNow he ishe a chain is a chain smoker smoker and and his mouth his mouth has ahas bad a bad stench stench fromfrom a wound a wound on lips. on lips. Everybody Everybody avoids avoids him.A him.A CHVCHV was was concerned concerned about about his situation. his situation. Key Key points points Oral Oral cancer cancer is part is part of a group of a group of cancers of cancers called called headhead and and neckneck cancers. cancers. It is any It is cancerous any cancerous growth growth located located in the in oral the oral cavity. cavity. MostMost oral oral cancers cancers begin begin on the on tongue the tongue in the in floor the floor of the of mouth. the mouth. Signs Signs and and symptoms symptoms • Skin • Skin lesion, lesion, lumplump or ulcer or ulcer that that doesdoes not resolve not resolve in 14indays: 14 days: • Located • Located on the on tongue, the tongue, lip, or lip,other or other mouth mouth areas. areas. • Usually • Usually small. small. • often • often palepale colored, colored, but may but may be dark be dark or discolored or discolored • Early • Early signsign maymay be abe white a white patch patch or a or reda patch red patch on the on soft the soft tissues tissues of the of mouth. the mouth. • Usually • Usually painless painless initially initially • May • May develop develop a burning a burning sensation sensation or pain or pain when when tumor tumor is advanced. is advanced. Additional Additional symptoms symptoms thatthat maymay be associated be associated withwith the disease: the disease: • Tongue • Tongue problems problems • Swallowing • Swallowing difficult difficult • Mouth • Mouth sores, sores, painpain and and parasthesia parasthesia are late are late symptoms symptoms The The following following are key are risk key factors risk factors thatthat are associated are associated withwith oral oral cancers: cancers: • Smoking • Smoking and and otherother tobacco tobacco use are use associated are associated withwith about about 75 per 75 cent per cent of oral of oral cancer cancer casescases caused caused by the by irritation the irritation of the of mucous the mucous membranes membranes of the of mouth the mouth fromfrom smoke smoke and and heatheat of of cigarettes, cigarettes, cigars cigars and and pipes. pipes. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 89 89 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH • • Alcohol • Alcohol use isuse another is another highhigh risk activity risk activity associated associated withwith oral cancer. oral cancer. There There is known is known to betoabe very a very strong strong synergistic synergistic effect effect or oral or cancer oral cancer risk when risk when a person a person is both is both a heavy a heavy smoker smoker and and drinker. drinker. Infection • Infection withwith the human the human papilloma papilloma virusvirus (type(type 16) is16) a known is a known risk factor risk factor and and independent independent causative causative factor factor of oral of oral cancer(Gilson cancer(Gilson et al.etJohn al. John Hopkins) Hopkins) COMMON COMMON DENTAL DENTAL CONDITIONS CONDITIONS Understanding Understanding Toothlessness Toothlessness Key Key point point LossLoss of some of some teethteeth results results in partial in partial loss loss whilewhile loss loss of allofteeth all teeth results results in complete in complete loss.loss. For people, For people, the relevance the relevance and and functionality functionality of teeth of teeth can can easilyeasily be taken be taken for granted, for granted, but abut closer a closer examination examination of their of their considerable considerable significance significance will demonstrate will demonstrate howhow theythey are actually are actually very very important. important. Among Among otherother things, things, teethteeth serveserve to; to; • • • Support • Support the lips the and lips and cheeks, cheeks, providing providing for fuller, for fuller, moremore aesthetically aesthetically pleasing pleasing appearance. appearance. Along • Along withwith the tongue the tongue and and the lips, the lips, allowallow for proper for proper pronunciation pronunciation of various of various sounds. sounds. Cut, • Cut, grindgrind and and otherwise otherwise chew chew food.food. The The cause cause of tooth of tooth loss loss can can be multifaceted. be multifaceted. Tooth Tooth loss loss resultresult fromfrom toothtooth decay, decay, gumgum disease disease or or accidents. accidents. The predominant The predominant cause cause of tooth of tooth loss in loss adults in adults is periodontal is periodontal (gum) (gum) disease. disease. When When you think you think of your of your teeth, teeth, thinkthink of your of your gums. gums. Gums Gums are important are important in holding in holding eacheach toothtooth in place. in place. 90 90 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH Dental Dental fluorosis fluorosis (browning (browning of teeth) of teeth) Key Key Points Points • •It’s important It’s important to note to note that that fluoride fluoride is a mineral is a mineral goodgood for the for body the body and and repairs repairs or heals or heals tooth tooth decay. decay. However However highhigh levels levels of it of can it be canharmful be harmful to both to both teethteeth and and bones. bones. • Dental • Dental fluorosis fluorosis is a health is a health condition condition caused caused by aby person a person taking taking too much too much fluoride fluoride during during tooth tooth development. development. This This condition condition mainly mainly occurs occurs during during development development of teeth of teeth when when children children are in arethe in mother’s the mother’s womb. womb. Critical Critical period period of exposure of exposure is between is between 1 and 1 and 4 years. 4 years. • In • itsInmild its mild form,form, fluorosis fluorosis appears appears as tiny as tiny white white streaks streaks or specks or specks that that are often are often unnoticeable. unnoticeable. • The • The spotsspots and and stains stains left by leftfluorosis by fluorosis are permanent. are permanent. TheyThey maymay darken darken overover time.time. In itsInmost its most severe severe form,form, which which is also is also called called mottling mottling of dental of dental enamel; enamel; it is it characterized is characterized by black by black or or brown brown stains stains as well as well as cracking as cracking or pitting or pitting of teeth. of teeth. • The • severity The severity depends depends on the onamount the amount of fluoride of fluoride exposure, exposure, the age theof age theofchild the child and individual and individual response. response. NB: NB: Where Where therethere is excessive is excessive fluoride fluoride in the in environment the environment especially especially in drinking in drinking water,causing water,causing dental dental or skeletal or skeletal fluorosis fluorosis de-fluoridation de-fluoridation measures measures to remove to remove the excess the excess are recommended. are recommended. AlsoAlso notenote that that fluorides fluorides havehave a proven a proven caries caries reducing reducing effect effect especially especially on smooth on smooth surfaces surfaces if if administered administered properly properly delivery delivery waysways can be: can be: 1. Salt 1. Salt 2. Water, 2. Water, 3. Toothpaste, 3. Toothpaste, 4. Fluoride 4. Fluoride mouth mouth rinserinse 5. Topical 5. Topical application application of solutions of solutions or varnishes or varnishes NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 91 91 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH Management Management of fluorosis of fluorosis 1. De-fluoridation 1. De-fluoridation of available of available drinking drinking water water in small in small communities communities 2. In 2. cases In cases where where fluorosis fluorosis is endemic is endemic identify identify alternative alternative water water supply supply for drinking for drinking water. water. The The CHEW CHEW and and CHVCHV to teach to teach the community. the community. 3. Develop 3. Develop appropriate appropriate education education programmes. programmes. The CHV The CHV can advice can advice the community the community members members livingliving highhigh fluoride fluoride areasareas to supervise to supervise children’ children’ s brushing s brushing of teeth of teeth so that so they that they don’tdon’t swallow/ingest swallow/ingest toothtooth pastepaste withwith fluoride.CHV fluoride.CHV to advice to advice themthem swallowing swallowing increases increases risk ofrisk developing of developing fluorosis fluorosis 4. For 4. those For those whowho can afford, can afford, appropriate appropriate restoration restoration of affected of affected teethteeth can be candone be done cosmetically cosmetically by aby dentist a dentist e.g. tooth e.g. tooth bleaching. bleaching. Dental Dental trauma. trauma. RoleRole PlayPlay Macho Macho had had an accident an accident whilewhile on bodaboda. on bodaboda. He was He was heavily heavily bleeding bleeding fromfrom his mouth his mouth and and two two teethteeth werewere strewn strewn on the on road; the road; facilitator facilitator to get to several get several volunteers volunteers to play-out to play-out the various the various partsparts of the of story. the story. OneOne volunteer volunteer can can put put blackblack tapetape on the on tooth the tooth to pose to pose as if as heiflost he lost the tooth the tooth to to create create an image an image for learning. for learning. Key Key points points Dental Dental trauma trauma is anisinjury an injury to the toteeth, the teeth, gums, gums, and and jaw bones. jaw bones. The most The most common common dental dental trauma trauma is is a broken a broken or displaced or displaced tooth. tooth. Traumatic Traumatic dental dental injuries injuries oftenoften occur occur in accidents in accidents or sports-related or sports-related injuries. injuries. Chipped Chipped teeth teeth account account for the for the majority majority of allofdental all dental injuries. injuries. Dislodged Dislodged or knockedor knockedout teeth out teeth are examples are examples of less of frequent, less frequent, but more but more severe severe injuries. injuries. Trauma Trauma of CHV in Prevention management of trauma RoleRole of CHV in Prevention and and management of trauma • CHV to Advice the community members to wear protective e.g mouth guard, reflector • CHV to Advice the community members to wear protective geargear e.g mouth guard, reflector jackets when riding or engaging in contact sports like boxing ,hockey jackets when riding or engaging in contact sports like boxing ,hockey • CHV to teach community on importance of Safety helmets to avoid impact on the • CHV to teach community on importance of Safety beltsbelts and and helmets to avoid impact on the especially on matatu bodaboda headhead especially on matatu and and bodaboda • CHV to refer the victims to nearest the nearest health facility • CHV to refer the victims to the health facility 92 92 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH CleftCleft lip and lip and palate palate Key Key Notes Notes These are birth defects that that affect either the upper lip alone or upper lip and the roof of the These are birth defects affect either the upper lip alone or upper lip and the roof of the mouth (Palate). mouth (Palate). Causes, incidence and and risk factors Causes, incidence risk factors • Genetic passed down fromfrom one one or both parents, drugs viruses or other toxins can can cause • Genetic passed down or both parents, drugs viruses or other toxins cause these defects. these defects. • Cleft lip orlippalate maymay occur along withwith otherother syndromes or birth defects. • Cleft or palate occur along syndromes or birth defects. A cleft lip and palate can:can: A cleft lip and palate • Affect the appearance of the • Affect the appearance of face the face • Lead to problems withwith feeding and and speech • Lead to problems feeding speech • Lead to ear • Lead toinfections ear infections Risk Risk factors include a family history of cleft lip orlippalate and and otherother birthbirth defects. factors include a family history of cleft or palate defects. Key Key features of clefts features of clefts • A• child maymay havehave one one or more birthbirth defects A child or more defects • A• cleft lip may be just small notch in the A cleft lip may be ajust a small notch in lip the lip • It• may be abe complete splitsplit in the goesgoes all the to the of the It may a complete in lip thethat lip that all way the way to base the base of nose. the nose. • A• cleft palate can can be on or both sidessides of roof of the It may go the of of A cleft palate beone on one or both of roof of mouth. the mouth. It may go full thelength full length the palate. the palate. Other symptoms include: Other symptoms include: • Change in the shape • Change in nose the nose shape • Poorly aligned teethteeth • Poorly aligned NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 93 93 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH Problems Problems thatthat maymay be present be present because because of cleft of cleft lip orlippalate: or palate: • Failure • Failure to gain to gain weight weight • Feeding • Feeding problems problems - flow - flow of milk of milk through through nasalnasal passages passages during during feeding feeding • Poor • Poor growth growth • Repeated • Repeated ear infections ear infections • Speech • Speech difficulties difficulties Prevention Prevention and and Management Management of Cleft of Cleft Palate: Palate: The The CHVCHV should should referrefer suchsuch children children to the to the health health facility facility for immediate for immediate action action because because the the outcome outcome afterafter surgery surgery in a child in a child is better is better thanthan in adulthood. in adulthood. Surgery Surgery to close to close the cleft the cleft lip and lip and palate palate is done is done preferably preferably when when the child the child is between is between 6 weeks 6 weeks and and 9 months. 9 months. CleftCleft palate palate is usually is usually closed closed within within the the first first yearyear of life of so lifethat so that the the child’s child’s speech speech develops develops normally. normally. A prosthetic A prosthetic device device is temporarily is temporarily usedused to close to close the palate the palate so that so that the baby the baby can can feedfeed and and growgrow untiluntil surgery surgery is done. is done. Teeth Teeth crowding crowding Causes Causes of Tooth of Tooth Crowding Crowding • Habits; • Habits; (Thumb (Thumb sucking, sucking, nail Biting nail Biting etc) etc) • Hereditary • Hereditary e.g. Smaller e.g. Smaller JawsJaws and and Big Teeth Big Teeth • Early • Early loss loss of milk of milk teethteeth Prevention Prevention CHVCHV to teach to teach families families or household or household on changing on changing habits habits that that can lead can lead to tooth to tooth crowding crowding Correction of crowded teeth Correction of crowded teeth • Braces are used • Braces are used • It’s to see dentist • advisable It’s advisable to your see your dentist 94 94 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH PREVENTION PREVENTION OF ORAL OF ORAL DISEASES DISEASES ANDAND CONDITIONS CONDITIONS Key Key Notes Notes • Cleaning • Cleaning teethteeth • Chewing • Chewing gumgum • Dental • Dental check check up up • Eating • Eating well well Cleaning Cleaning teeth teeth HowHow to clean to clean youryour teeth teeth properly properly and and effectively effectively • Wash • Wash youryour hands hands before before you you washwash youryour teeth. teeth. • Proper • Proper and and effective effective tooth tooth brushing brushing should should taketake at least at least 3 minutes. 3 minutes. • Use • Use a softa soft bristled bristled toothbrush. toothbrush. • Use • Use shortshort gentle gentle strokes. strokes. • Pay • attention Pay attention to the to gum the gum line line and and hardhard to reach to reach areasareas suchsuch as surfaces as surfaces of back of back teeth, teeth, fillings fillings and and braces. braces. Concentrate Concentrate on each on each section section of each of each tooth tooth as follows: as follows: • • • • • • • Clean the outer surface of your upper leftright to right lower teeth. Clean the outer surface of your upper teethteeth left to thenthen lower teeth. • Clean surface of upper lower. Clean innerinner surface of upper teethteeth thenthen lower. • Clean chewing surfaces. Clean chewing surfaces. • Brush tongue Brush youryour tongue too. too. • Rinse mouth water. Rinse youryour mouth withwith cleanclean water. • Wash toothbrush. Wash youryour toothbrush. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 95 95 UnitUnit 08- ORAL 08- ORAL HEALTH HEALTH What What are common are common tooth tooth brushing brushing mistakes? mistakes? • Not • Not using using the right the right brush brush size!size! Too Too big or bigtoo or small too small • A• toothbrush A toothbrush should should be comfortable be comfortable to use. to use. • Not • Not picking picking the right the right bristled bristled brush. brush. A hard A hard bristled bristled brush brush will hurt will hurt youryour gums gums and and hence hence discourages discourages effective effective tooth tooth brushing. brushing. • Brushing • Brushing too often too often or too or hard too hard • Excessive • Excessive brushing brushing could could expose expose the root the root of the of tooth the tooth and and also also hurthurt gums. gums. NOTE; NOTE; not brushing not brushing oftenoften enough enough withwith much much timetime between between brushings brushings plaque plaque will build will build up and up and risk gum risk gum inflammation inflammation and and tooth tooth decay decay What What typetype of toothbrush of toothbrush do you do you need? need? Soft Soft or medium or medium Bristled Bristled Maybe Maybe a commercial a commercial toothbrush toothbrush or a or chew a chew stickstick ( Mswaki) ( Mswaki) HowHow often often should should you you replace replace youryour brush? brush? • When • When youryour toothbrush toothbrush shows shows wearwear and and tear tear or atorleast at least afterafter 3 months 3 months Chewing Chewing GumGum You You lovelove to chew to chew gumgum because because it tastes it tastes greatgreat and and freshens freshens youryour breath, breath, but but DID DID YOUYOU KNOW KNOW therethere maymay be additional be additional benefits benefits to chewing to chewing gumgum suchsuch as: as: • Oral • Oral health health • Weight • Weight management management • Increased • Increased alertness, alertness, focusfocus and and concentration concentration • Stress • Stress reliefrelief Chewing Chewing GumGum Helps Helps Improve Improve OralOral Health Health • Chewing • Chewing sugar sugar free free gumgum can impact can impact oral oral health health in many in many ways:ways: • Stimulates • Stimulates flowflow of saliva of saliva in the in mouth the mouth • Cleans • Cleans teethteeth between between brushings brushings • Relieves • Relieves dry mouth dry mouth discomfort discomfort • Neutralizes • Neutralizes plaque plaque acidsacids that that formform in the in mouth the mouth afterafter eating eating fermentable fermentable carbohydrates carbohydrates • Helps • Helps re-mineralize re-mineralize enamel enamel to strengthen to strengthen teethteeth • Helps • Helps reduce reduce plaque plaque • Helps • Helps reduce reduce the risk the of riskdental of dental caries caries • Helps • Helps whiten whiten teethteeth by reducing by reducing and and preventing preventing stains stains Chewing Chewing sugar-free sugar-free gumgum afterafter eating eating is clinically is clinically proven proven to betoan beimportant an important part part of good of good oral oral health. health. It stimulates It stimulates salivasaliva flowflow in the in mouth, the mouth, which which in turn in turn helpshelps fightfight cavities, cavities, putsputs a stop a stop to to plaque plaque formation, formation, rebuilds rebuilds tooth tooth enamel enamel and and washes washes awayaway foodfood particles. particles. 96 96 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 08 - 08 ORAL - ORAL HEALTH HEALTH Summary: Summary: You You needneed strong strong teethteeth to eat to different eat different kindskinds of foods. of foods. Different Different kindskinds of foods of foods are important are important for for health. health. To have To have strong strong teethteeth and and healthy healthy gums gums you you needneed to: to: 1. Eat 1. only Eat only goodgood healthy healthy foods foods –Traditional –Traditional foodfood is usually is usually goodgood food.food. Sweet Sweet foods foods especially especially the ones the ones bought bought fromfrom the stores, the stores, made made of refined of refined sugars sugars are not are good not good for teeth. for teeth. 2. Clean 2. Clean youryour teethteeth everyday everyday (at least (at least twice twice a day): a day): morning morning afterafter breakfast breakfast and and at night at night before before bed.bed. If you If you do not do clean not clean properly properly the food the food that that is leftis on leftyour on your teethteeth as well as well as the as gums the gums nearnear themthem maymay be abe source a source of dental of dental problems. problems. 3. If3.youIf you see asee cavity a cavity starting starting in your in your mouth mouth or feel or afeel tooth a tooth hurting, hurting, get help get help rightright away. away. A dental A dental professional professional knows knows howhow to manage to manage the problem. the problem. 4. To 4. make To make youryour gums gums stronger stronger and and ableable to fight to fight infection: infection: • Eat • ore Eat fresh ore fresh fruitsfruits and and green green leafyleafy vegetables vegetables and and fewer fewer soft soft sticky sticky foods foods fromfrom the store the store • Even • Even if your if your gums gums are sore are sore and and theythey bleed bleed you you mustmust still clean still clean the teeth the teeth beside beside them. them. If If moremore foodfood collects collects on the on teeth, the teeth, the gum the gum infection infection will only will only get worse. get worse. Get aGet softa soft brush brush and and use ituse gently. it gently. • Painful • Painful gums gums that that bleed bleed at slightest at slightest touch touch needneed special special treatment. treatment. A dental A dental professional professional can explain can explain whatwhat is happening is happening and and whatwhat needs needs to betodone. be done. Roles Roles of CHV of CHV 1. Identification 1. Identification of oral of oral conditions conditions and and disease disease 2. Referral 2. Referral of community of community members members withwith any oral any oral disease disease or condition or condition 3. Health 3. Health education education and and promotion promotion on oral on oral health health 4. Advice 4. Advice community community on importance on importance of check of check ups ups NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 97 97 UNIT UNIT 09-09PRIMARY PRIMARY EYEEYE CARE CARE 98 98 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 99 99 UnitUnit 9- PRIMARY 9- PRIMARY EYE CARE EYE CARE Unit Unit 9: PRIMARY 9: PRIMARY EYEEYE CARE CARE Purpose Purpose The The purpose purpose of this of unit this unit is to isequip to equip the community the community health health volunteers volunteers withwith basicbasic skillsskills and and knowledge knowledge so that so that theythey can identify can identify a normal a normal eye and eye and an eye an problem eye problem and and taketake appropriate appropriate action action Objectives Objectives • By • the By end the end of the of unit, the unit, the participants the participants will be willable be able to; to; • Describe • Describe a normal a normal eye eye • Discuss • Discuss the effects the effects poorpoor vision vision and blindness and blindness on the onindividual the individual and the andcommunity the community • Understand • Understand howhow to take to take visual visual Acuity Acuity and and conduct conduct basicbasic eye examination eye examination • Discuss • Discuss howhow to take to take appropriate appropriate action action and and referral referral for an foreye an problem eye problem • Provide • Provide first first aid for aideye for injury eye injury • Demonstrate • Demonstrate howhow to instill to instill Tetracycline Tetracycline eye ointment eye ointment in newborn in newborn eyeseyes • Discuss • Discuss key messages key messages on eye on health eye health • Understand • Understand the role the role of community of community health health volunteers volunteers in eye in care eye care 100 100 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 9 - PRIMARY 9 - PRIMARY EYE CARE EYE CARE INTRODUCTION INTRODUCTION TO EYE TO EYE CARE CARE Normal Normal eye eye Some Some of the of parts the parts of the of eye the can eye can be seen be seen by looking by looking at a at person’s a person’s faceface like in likethe in picture the picture below below whilewhile others others can only can only be seen be seen withwith the help the help of some of some special special instruments instruments and and equipments equipments The eyelids The eyelids should should openopen and close and close properly properly ® no ®lumps no lumps on the onlids the lids ® lashes ® lashes should should not turn not in turn in The The colored colored part part of the of eye the should eye should be be smooth smooth and shiny. and shiny. It should It should have have no white no white marksmarks or blood or blood vessels. vessels. The The whitewhite of the of eye the should eye should be white, be white, except except for a few for ablood few blood vessels. vessels. It should It should not not be red. be red. Major Major partsparts of the of Eye the Eye • Pupil • Pupil • Cornea • Cornea • Eye • lids Eye lids • Eye • lashes Eye lashes • Conjuctiva • Conjuctiva • Retina • Retina NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 101 101 UnitUnit 9- PRIMARY 9- PRIMARY EYE CARE EYE CARE Effects Effects of Poor of Poor Vision Vision AndAnd Blindness Blindness On The On The Individual Individual AndAnd The The Community Community • • Reducing • Reducing unnecessary unnecessary blindness blindness in their in their communities communities and and support support those those incurably incurably blind. blind. Reaffirm • Reaffirm theirtheir role role is to isidentify to identify all blind all blind people people and and sendsend to the to eye the care eye care worker worker within within theirtheir areaarea to either to either be treated be treated or rehabilitated. or rehabilitated. points Key Key points • Poor vision or blindness affect the way a person life: they not be • Poor vision or blindness can can affect the way a person liveslives theirtheir life: they maymay not be to take of themselves; cannot do activities to help around the house ableable to take carecare of themselves; theythey cannot do activities to help around the house or or to make money. Socially be excluded in daily community activities e.g. don’t to make money. Socially theythey maymay be excluded in daily community activities e.g. don’t to farm. the farm. go togothe • People are incurably rehabilitation services to help to well, live well, • People whowho are incurably blindblind needneed rehabilitation services to help themthem to live - identify the nearest referral centre for rehabilitation in area the area - identify the nearest referral centre for rehabilitation in the • Blind people be referred an care eye care provider to check if anything • Blind people needneed to betoreferred to antoeye provider to check if anything can can be be to restore donedone to restore theirtheir sightsight • Blind person’s needs be part of community the community • Blind person’s needs to betopart of the DEMONSTRATION FIRST DEMONSTRATION ANDAND FIRST AID AID Demonstration practice on measuring (vision Acuity) basic Demonstration andand practice on measuring eye eye sightsight (vision Acuity) andand basic eye eye examination examination the chart for vision screening (tumbling of 6/60 Use Use the chart for vision screening (tumbling E of E6/60 andand 6/126/12 size)size) • Find a space where is good too dark, bright or looking the sun) • Find a space where therethere is good lightlight (not(not too dark, bright or looking into into the sun) • Stand to person the person explain to person the person to their use their to show • Stand nextnext to the and and explain to the howhow to use handhand to show you you the the direction of Ethe E direction of the • • • • Ask Please use the of your handhand to cover youryour left eye and and showshow me the • the Ask person: the person: Please use palm the palm of your to cover left eye me the direction of the to to direction of Es theI am Es I pointing am pointing Stand 6 meters away. HoldHold the chart for vision screening (tumbling E of E6/60 and and 6/126/12 size)size) • Stand 6 meters away. the chart for vision screening (tumbling of 6/60 Point to antoEan and ask the to show you you the direction of the and of the Es. Es. • Point E and ask person the person to show the direction of big the Ebig E and of little the little Now ask the Please use the of your handhand to cover youryour rightright eye and showshow me me • Now ask person the person Please use palm the palm of your to cover eye and the direction of the to to the direction of Es theI am Es I pointing am pointing 102 102 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 9 - PRIMARY 9 - PRIMARY EYE CARE EYE CARE Make a decision about to do Make a decision about whatwhat to do If a person cannot see big the Ebig or fingers the fingers are holding up they big problem. • If• a person cannot see the or Ethe you you are holding up they havehave a biga problem. If they cannot see small the small E they a smaller problem If they cannot see the E they havehave a smaller problem It does not matter if you cannot measure vision, make a referral decision based • It• does not matter if you cannot measure vision, you you can can make a referral decision based on on the person whatwhat the person says:says: » person The person needs non-urgent referral the decrease in vision has been gradual, or if one » The needs non-urgent referral if theifdecrease in vision has been gradual, or if one eye sees worse the other eye sees worse thanthan the other » The person needs be referred immediately if vision has become suddenly worse » The person needs to betoreferred immediately if vision has become suddenly worse Providing aideye for eye injury Providing firstfirst aid for injury = Script (Vision) 1a =1a Script (Vision) Catherine, 45 years old lady cannot her bible normal distance to put Catherine, a 45ayears old lady cannot readread her bible fromfrom normal distance and and has has to put it it further for writings the writings be clear. CHV’s name is James. further awayaway for the to betoclear. The The CHV’s name is James. Catherine, welcome, I help CHV:CHV: Catherine, welcome, howhow can Ican help you?you? Patient: Thank I have noticed I have problem in reading my bible as I used Patient: Thank you,you, I have noticed that that I have problem in reading my bible as I used to doto do before. before. when? CHV:CHV: SinceSince when? Patient: about six months Patient: about six months Did problem the problem suddenly or over CHV:CHV: Did the startstart suddenly or over timetime Patient: but now canlonger no longer seeall,atbut all, Ibut see far. Patient: overover time,time, but now I canI no see at seeI far. Do you any other problems CHV:CHV: Do you havehave any other problems Patient: I have onback my back Patient: Yes IYes have painpain on my any medication CHV:CHV: HaveHave you you usedused any medication Patient: I used breast but not has helped not helped Patient: Yes, Yes, I used breast milkmilk but has we shall see what CHV:CHV: OkayOkay we shall see what to doto do 1b. Script (Diabetes) for vision 1b. Script (Diabetes) for vision loss loss A diabetic patient 5 years comes to clinic the clinic itching A diabetic patient for 5for years comes to the withwith itching eyes.eyes. Exchange pleasantries ask what dothe for client/patient? the client/patient? HW:HW: Exchange pleasantries and and ask what to dotofor Patient: My eyes are itching Patient: My eyes are itching when H/W:H/W: SinceSince when Patient: Patient: one one weekweek put medicines any medicines H/W:H/W: HaveHave you you put any Patient: Patient: No No Is there H/W:H/W: Is there painpain Patient: Patient: No No Is there history of Injury H/W:H/W: Is there history of Injury Patient: Patient: No No Is there of vision H/W:H/W: Is there loss loss of vision Patient: A little Patient: A little Do you any chronic condition? H/W:H/W: Do you havehave any chronic condition? Patient: I have diabetes Patient: Yes, Yes, I have diabetes For how known? H/W:H/W: For how longlong havehave you you known? Patient: Patient: Five Five yearsyears foreye an check eye check HW:HW: HaveHave you you everever gonegone for an Patient: No, why I need go while can see still very see very Patient: No, why do I do need to gotowhile I canI still well well NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 103 103 UnitUnit 9- PRIMARY 9- PRIMARY EYE CARE EYE CARE 2. Script 2. Script (Pain) (Pain) The The patient patient walks walks in bending in bending and and holding holding theirtheir head, head, maybe maybe eveneven tied tied firmly firmly withwith a cloth. a cloth. H/W:H/W: Exchange Exchange pleasantries, pleasantries, and and thenthen ask what ask what the problem the problem is is Patient: Patient: My eyes My eyes and and headhead hurthurt reallyreally badly badly H/W:H/W: SinceSince when when Patient: Patient: Last Last nightnight H/W:H/W: HowHow did itdid start? it start? Patient: Patient: I justI woke just woke up inupthe in night the night withwith the pain the pain H/W:H/W: HaveHave you you usedused any medications any medications Patient: Patient: No. No. 3. Script 3. Script (Injury) (Injury) A patient A patient comes comes to the to clinic the clinic withwith an injury an injury H/W:H/W: Exchange Exchange pleasantries pleasantries and and ask how ask how (s) he(s)can he help can help Patient: Patient: I wasI was pricked pricked by aby thorn a thorn in the in eye the eye H/W:H/W: When When did itdid happen? it happen? Patient: Patient: Three Three daysdays ago ago H/W:H/W: whywhy havehave you you not come not come to the to clinic the clinic earlier? earlier? Patient: Patient: I didI not did have not have money money and and I wasI was waiting waiting for afor market a market day so daythat so that I canI get can transport. get transport. H/W:H/W: HaveHave you you put any put medications any medications in the in eye the eye Patient: Patient: Yes, Yes, my neighbor my neighbor brought brought for me for an meeye an cream eye cream which which he was he was given given at the at hospital the hospital when when he went he went to seek to seek eye treatment. eye treatment. H/W:H/W: Can Can I seeI the see medication the medication Patient: Patient: HereHere it is -itproduces is - produces TEO TEO H/W:H/W: OkayOkay we shall we shall discuss discuss this later this later The The decision decision making making chart chart to decide to decide on the on action the action to take to take for the for patient the patient in the in role the role playsplaysLookLook at the at person the person as they as they come come closer closer and and pick pick up on upany on signs any signs which which maymay include: include: • Age • Age (generally (generally referral referral is more is more urgent urgent for children, for children, theirtheir eyeseyes are still aredeveloping; still developing; olderolder people people are more are more at risk at of riskdeveloping of developing blinding blinding eye diseases) eye diseases) • how • how the person the person moves moves around, around, do they do they needneed someone someone to lead to lead themthem (this(this can can givegive you you an an ideaidea howhow well well theythey see) see) • obvious • obvious injury injury / pain / pain behavior: behavior: bodybody language, language, facialfacial expression, expression, behavior, behavior, like holding like holding theirtheir eye eye • Pain? • Pain? If pain If pain is soissevere so severe that that it makes it makes it difficult it difficult per the per person the person to dotonormal do normal activities activities - refer - refer immediately immediately • Injury? • Injury? If injury, If injury, do first do first aid and aid and if it isif aitsevere is a severe injury injury or vision or vision is worse is worse referrefer immediately immediately • Vision? • Vision? If theIf vision the vision has become has become bad bad suddenly suddenly – refer – refer immediately immediately If vision If vision has has gradually gradually become become worse worse at distance at distance or near or near referrefer non-urgently. non-urgently. You You can use can ause chart a chart or your or your fingers fingers to measure to measure vision vision to check to check • Systemic • Systemic conditions? conditions? If a person If a person has diabetes, has diabetes, theythey needneed an eye an check eye check at least at least onceonce every every year.year. 104 104 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 9 - PRIMARY 9 - PRIMARY EYE CARE EYE CARE Pictures of injuries eye injuries in eye the and eye and eye lid Pictures of eye in the eye lid • • • • Demonstrate to wash or rinse the eyes a chemical injury Demonstrate howhow to wash or rinse the eyes afterafter a chemical injury • Demonstrate 3 options for removal of foreign Demonstrate 3 options for removal of foreign bodybody • What techniques do participants the participants know for removing something What otherother techniques do the know of forofremoving something smallsmall fromfrom the the eye?eye? points Key Key points WhatWhat entered entered the eye the eye Action Action • • A chemical A chemical ThereThere is likely is likely to be:to be: • severe • severe pain pain • redness • redness of theofwhite the white of eyeof eye • • • Something Something quitequite big, like big, alike stick a stick • or thorn or thorn • • • • Very small Very small particle particle like dust like dust • • • • This • isThis an is emergency an emergency • Immediately Immediatelystart startto torinse rinseor orwashwashthe theeye. eye. Use Use preferably preferably cleanclean water.water. (Pour(Pour the water the water from from the nose the nose outwards outwards so that sonone that none of theofliquid the liquid runs out runs out from from one eye oneinto eyethe intoother. the other. Change Change from from one eye onetoeye thetoother the other alternately). alternately). Do this Dofor this10for - 15 10minutes. - 15 minutes. Refer • Refer if vision if vision is badisafter bad after rinsing rinsing Refer • Refer urgently urgently Do • not Dotouch not touch the eye thetoeye examine to examine or to or clean to clean the eye the eye Do • not Doremove not remove anything anything that isthat stuck is stuck in theineye the eye Do • not Doput notany putdrops any drops or ointment or ointment in theineye the eye Do • not Dopad notthe padeye the eye Refer • Refer for tetanus for tetanus toxoid toxoid injection, injection, oral antibiotic oral antibiotic and oral andanalgesic oral analgesic Rinse • Rinse eye(s)eye(s) 2 minutes 2 minutes or until or until it is washed it is washed out, or out, open or open eye ineye a cup in a of cup of waterwater Use • cold Use clean cold clean waterwater or water or water that has thatbeen has been boiled boiled If• youIfsee yousomething see something like alike speck a speck of sand of sand or wood or wood that isthat lying is lying on top onoftop of the white the white of theofeye, theuse eye,the usecorner the corner of a clean of a clean clothcloth to remove to remove Refer • Refer - If you - If cannot you cannot remove remove it / the it / person the person still says still says they they can feel can feel something something in their in their eye eye Refer • Refer if vision if vision is reduced is reduced NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 105 105 UnitUnit 9- PRIMARY 9- PRIMARY EYE CARE EYE CARE MANAGEMENT MANAGEMENT ANDAND REFERRAL REFERRAL HowHow to take to take appropriate appropriate action action andand referral referral for an foreye an eye problem problem ASK: ASK: The right The right questions questions to find toout findabout out about an eye anproblem eye problem -Measure -Measure sightsight (first (first right right then then ASSESS ASSESS - If you - Ifcannot you cannot measure measure sightsight ask a ask person a person how how they see they see Examine Examine how how the eyes the look eyes (black look (black and white and white parts)parts) left left eye). eye). Depending Depending on the onhistory, the history, OR the ORvision the vision OR how OR the howeyes the look, eyes look, decide decide on What on What to action to action to to ACTION: ACTION: take: take: is referral is referral needed? needed? Is it necessary Is it necessary for immediate for immediate referral referral or nonor nonurgent urgent referral? referral? If people If people are referred are referred give them give them advice advice aboutabout the referral, the referral, or what or what they need they need to doto todo keep to keep ADVICE: ADVICE: their their eyes healthy eyes healthy and/or and/or prevent prevent further further problems problems HowHow to wipe to wipe the eyes the eyes of a of new a new bornborn baby baby andand to instill to instill Tetracycline Tetracycline eye eye ointment ointment Key Key points points • Prevent diseases fromfrom the the birthbirth canalcanal getting into into a baby’s eyes.eyes. These can can cause • Prevent diseases getting a baby’s These cause serious infection and and eveneven blindness serious infection blindness • Use a clean cotton woolwool or cloth for wiping eacheach eye. eye. • Use a clean cotton or cloth for wiping • Immediately afterafter birth,birth, wipewipe the baby’s eyeseyes fromfrom inside to outside lid. lid. • Immediately the baby’s inside to outside • Hold the lids and and put 1% ointment under the lower lid aslidsoon as as • Hold the apart lids apart put tetracycline 1% tetracycline ointment under the lower as soon possible afterafter birthbirth but within 72 hours (3 days). possible but within 72 hours (3 days). • Keep medication sterile: • Keep medication sterile: • Do the tip / bottle withwith anything. • not Do touch not touch theoftipthe of tube the tube / bottle anything. • Do touch the eye • not Do let notthe let tip theoftipthe of tube the tube touch the eye • Put afterafter use. use. • on Putthe on cover the cover • Store in a cool placeplace if possible. • Store in a cool if possible. • Throw awayaway the bottle / tube one one month afterafter opening. (confirm withwith Pharmacist) • Throw the bottle / tube month opening. (confirm Pharmacist) Rehabilitation for the persons Rehabilitation for blind the blind persons • Which activities can acan blind person do? do? • Which activities a blind person • What waysways can acan blind person be helped?. • What a blind person be helped?. • what are the services for adults and and children that that are available?. • what are rehabilitative the rehabilitative services for adults children are available?. 106 106 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 9 - PRIMARY 9 - PRIMARY EYE CARE EYE CARE HEALTH PROMOTION EYE EYE HEALTH PROMOTION Messages on eye health promotionMessages on eye health promotion• What is the relationship between immunization for measles or vitamin • What is the relationship between the the eyeseyes and and immunization for measles or vitamin A A supplementation supplementation • What the usefulness of doing an yearly eye check by people 40 years or diabetic persons • What is theisusefulness of doing an yearly eye check by people overover 40 years or diabetic persons points on eye health promotion Key Key points on eye health promotion can make teach people in community the community to have the knowledge CHVsCHVs can make suresure that that theythey teach people in the to have bothboth the knowledge and and to Promote eye health service seeking behavior. skillsskills to Promote earlyearly eye health service seeking behavior. • Yearly eye check uppersons for persons suffering diabetes to avoid blindness. • Yearly eye check up for suffering fromfrom diabetes to avoid blindness. • Yearly eye check upall forpersons all persons 40 years of age. • Yearly eye check up for overover 40 years of age. • Know the closest where a specialist eye care worker canseen. be seen. • Know the closest placeplace where a specialist eye care worker can be • not Do delay not delay seeking eye treatment • Do seeking eye treatment : : • Anyone an problem eye problem should as soon as possible someone • Anyone withwith an eye should seekseek helphelp as soon as possible fromfrom someone whowho has been trained to provide eye care. has been trained to provide eye care. • Using a traditional medicine a medicine has prescribed not prescribed a delay • Using a traditional medicine or a or medicine that that has not maymay leadlead to a to delay in treatment a worse outcome in treatment and and a worse outcome points on rehabilitation. Key Key points on rehabilitation. • Identify people are blind or have make • Identify people whowho are blind or have poorpoor eye eye sightsight and and make suresure theythey havehave seenseen a a specialized eye care provider to check if their canimproved be improved specialized eye care provider to check if their sightsight can be • People are blind or have eye sight receive training to most of their • People whowho are blind or have poorpoor eye sight can can receive training to most of their skillsskills and and of remaining of remaining sightsight • Help people are blind or have be included in society • Help people whowho are blind or have poorpoor sightsight to betoincluded in society Prevention of eye problems Prevention of eye problems • Wash every • Wash faceface and and eyeseyes every day day • Protect injuries • Protect eyeseyes fromfrom injuries • Support strategies to prevent eye injuries common to area. the area. • Support strategies to prevent eye injuries common to the • Observe safety precautions to prevent work, sports home accidents. • Observe safety precautions to prevent work, sports and and home accidents. • Rinsing for chemical burns. • Rinsing eyeseyes for chemical burns. health promotion for children Eye Eye health promotion for children • Think about to integrate midwives services, school services, environmental • Think about howhow to integrate withwith midwives MCHMCH services, school services, environmental sanitation services to provide eye health to children and and sanitation services to provide eye health carecare to children in face, the face, FliesFlies in the mouth mouth and and eyes;eyes; NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 107 107 UnitUnit 9- PRIMARY 9- PRIMARY EYE CARE EYE CARE Key Key points points of preventive of preventive measures measures for children for children eyeseyes • Immunization • Immunization and and Vitamin Vitamin A supplementation A supplementation children children also also helpshelps to protect to protect the eyes the eyes • Instilling • Instilling tetracycline tetracycline eye ointment eye ointment protects protects babies’ babies’ eyeseyes fromfrom getting getting infected infected in the in the eyeseyes if theif mother the mother had had a sexually a sexually transmitted transmitted infection infection in pregnancy. in pregnancy. • To• prevent To prevent spread spread of eye ofdisease, eye disease, washwash the face the regularly face regularly and do andnot doshare not share cloths cloths to wipe to wipe facesfaces • Immediate/ • Immediate/ Urgent Urgent referral referral is required is required if: if: • A• young A young babybaby has swollen has swollen eyeseyes withwith pus pus • A• baby A baby or child or child whowho have;have; • White • White appearance appearance on the on black the black part part of the of eye the eye • One • One eye is eye bigger is bigger thanthan the other the other or both or both eyeseyes are bigger are bigger thanthan usualusual • Eyes • Eyes do not do look not look straight straight ahead ahead (crossed (crossed eyes)eyes) • Poor • Poor vision vision and and havehave to fold to fold the face the face to see to what see what the teacher the teacher has written has written on on the blackboard the blackboard or have or have to sittoInsitfront In front of the of class the class to see to see • Eye • injury Eye injury • For • school For school children: children: poorpoor performance, performance, screwing screwing up eyes up eyes to see to the see board the board / copy / copy fromfrom others others • To• prevent To prevent eye injuries: eye injuries: identify identify things things that that cause cause eye injuries eye injuries in the in community the community (e.g. (e.g. put sharp put sharp objects objects out of outthe of reach the reach of children, of children, counsel counsel against against dangerous dangerous games) games) Children’s Children’s eyeseyes are still are growing still growing and and therefore therefore it is very it is very important important to take to take carecare of them. of them. RoleRole of CHV of CHV in eye in eye carecare PaulPaul is a CHV is a CHV at CHU at CHU 1. There 1. There is a blind is a blind old man old man in hisincommunity. his community. The The old man old man started started having having the problem the problem overover 4 years 4 years ago ago and and nownow he cannot he cannot walkwalk without without the help the help of hisofgrandson his grandson whowho has had has had to stop to stop going going to school to school in order in order to lead to lead him him around. around. The The old man old man says says it is normal it is normal to to go blind go blind in old in age old age just like just itlike happened it happened to his toancestors. his ancestors. PaulPaul met met him him at hisatHH his when HH when he had he had gonegone to register to register themthem as part as part of hisofCHU. his CHU. He counseled He counseled the old the man old man to know to know that that therethere are eye are care eye care services services for cohort for cohort 5 and 5 and can benefit can benefit fromfrom the serthe servicesvices at the at nearby the nearby eye clinic eye clinic where where therethere is a specialized is a specialized eye care eye care worker. worker. The The old man old man decided decided to heed to heed the advice the advice and and visited visited the clinic the clinic where where he was he was told told his condition his condition can be cantreated be treated by aby a simple simple operation operation but he butneeded he needed to pay to apay small a small fee. He fee.was He was operated operated a fewa few daysdays laterlater and and was was ableable to see to afterwards. see afterwards. He was He was so happy so happy withwith the help the help PaulPaul had had given given him him and and his grandson his grandson could could also also go togoschool to school nownow that that his grandpa his grandpa did not did need not need a guide a guide to walk to walk around. around. 108 108 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 Pictures Pictures of children of children withwith Cataracts Cataracts in both in both eyeseyes points: Key Key points: arethe in very the very position to help individuals, households communities CHVCHV are in bestbest position to help individuals, households and and communities to: to: • Realize everyone, people, a right to sight • Realize that that everyone, eveneven olderolder people, has ahas right to sight • Include people are blind or have eye sight in society and help full life • Include people whowho are blind or have very very poorpoor eye sight in society and help themthem live alive fullalife • Help people are blind or with eye sight • Help people whowho are blind or with veryvery poorpoor eye sight • keep e.g. keep a register for blind persons, • e.g. a register for blind persons, • make referred to specialist eye care to ifsee if anything candone be done • make suresure theythey havehave beenbeen referred to specialist eye care to see anything can be • access get access to rehabilitation services • get to rehabilitation services • Provide aidinjuries for injuries • Provide first first aid for • Recognize when people conditions indicate referral to specialized • Recognize when people havehave conditions that that indicate theythey needneed referral to specialized eye care services for further eye care services for further help.help. • history e.g. history of severe or injury, vision white appearance of eye; the eye; • e.g. of severe painpain or injury, poorpoor vision and and white appearance of the • support get support goreferral for referral (know where tohow go, how tothere, get there, a referral note); • get to gotofor (know where to go, to get havehave a referral note); • Follow of client the client referral to feedback get feedback • Follow up ofupthe afterafter referral to get NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 109 109 UNIT UNIT 10-10CHRONIC CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES 110 110 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 111 111 UnitUnit 10 - 10 CHRONIC - CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES UNIT UNIT 10:10: CHRONIC CHRONIC RESPIRATORY RESPIRATORY DISEASESDISEASESPurpose Purpose The purpose The purpose of this of unit this unit is to is equip to equip the community the community health health volunteers volunteers withwith knowledge knowledge and and skillsskills to enable to enable themthem to create to create awareness, awareness, identify identify and and assistassist in treatment, in treatment, referral referral and and follow follow up ofupcommon of common chronic chronic respiratory respiratory diseases. diseases. Objectives Objectives • By • the By end the end of this of unit, this unit, the community the community health health volunteer volunteer should should be able be able to; to; • Define • Define and and givegive examples examples of chronic of chronic respiratory respiratory diseases diseases • List • the List common the common signssigns and and symptoms symptoms of asthma. of asthma. • Explain • Explain the causes the causes and and triggers triggers of asthma of asthma • Highlight • Highlight the prevention, the prevention, management management and and follow follow up ofupasthma of asthma 112 112 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 10- CHRONIC 10- CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES INTRODUCTION INTRODUCTION TO CHRONIC TO CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES What What are chronic are chronic respiratory respiratory diseases? diseases? Chronic Chronic respiratory respiratory diseases diseases are diseases are diseases of the of airways the airways and and otherother structures structures of the of lung the lung that that are are characterised characterised by poor by poor air flow air flow in the in lungs the lungs and and shortness shortness of breath of breath that that worsens worsens overover time.time. The The mostmost common common include include asthma asthma and and chronic chronic obstructive obstructive airway airway disease. disease. Asthma Asthma is a long is a long standing standing disease disease characterised characterised by recurrent by recurrent attacks attacks of breathlessness, of breathlessness, tightness tightness of the of chest the chest and and wheezing, wheezing, which which varies varies in severity in severity and and frequency frequency fromfrom person person to person. to person. Signs Signs andand symptoms symptoms of an ofasthmatic an asthmatic attack attack An asthma An asthma attack attack maymay include include coughing, coughing, chestchest tightness, tightness, wheezing, wheezing, breathlessness breathlessness and and trouble trouble breathing. breathing. The The attack attack happens happens in your in your body’s body’s airways, airways, which which are the are pipes the pipes that that carrycarry air toairyour to your lungs. lungs. As As the air themoves air moves through through youryour lungs, lungs, the airways the airways become become smaller, smaller, like the like branches the branches of a of tree a tree are are smaller smaller thanthan the tree the tree trunk. trunk. During During an asthma an asthma attack, attack, the sides the sides of the of airways the airways in your in your lungs lungs swellswell and and the airways the airways shrink. shrink. LessLess air gets air gets in and in and out of outyour of your lungs, lungs, and and mucous mucous that that youryour bodybody makes makes clogsclogs up the up airways the airways eveneven more. more. Causes Causes andand triggers triggers of asthma of asthma The The real real causes causes of asthma of asthma are not are not completely completely understood. understood. However, However, the strongest the strongest risk factors risk factors for developing for developing asthma asthma are aare combination a combination of genetic of genetic and and environmental environmental exposure exposure to inhaled to inhaled substances substances and and particles particles that that maymay provoke provoke allergic allergic reactions reactions or irritate or irritate the airways the airways suchsuch as: as: • indoor • indoor allergens allergens (for example (for example house house dustdust mites mites in bedding, in bedding, carpets carpets and and stuffed stuffed furniture, furniture, pollution pollution and and pet dander) pet dander) • outdoor • outdoor allergens allergens (such(such as pollens as pollens and and moulds) moulds) • tobacco • tobacco smoke smoke • chemical • chemical irritants irritants in the in workplace the workplace • polluted • polluted air air Other Other triggers triggers of asthmatic of asthmatic attacks attacks maymay include include being being in a cold in a cold environment, environment, extreme extreme emotional emotional arousal arousal suchsuch as anger as anger or fear, or fear, and and extreme extreme physical physical activity. activity. Prevention, Prevention, management management andand follow follow up of upasthma-15 of asthma-15 Minutes Minutes Preventing Preventing asthma asthma attack attack Asthma Asthma can be canprevented be prevented by knowing by knowing the early the early warning warning signssigns of anofasthma an asthma attack, attack, staying staying awayaway fromfrom things things that that cause cause an attack, an attack, and and following following youryour doctor’s doctor’s advice. advice. NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 113 113 UnitUnit 10 - 10 CHRONIC - CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES Managing Managing asthma asthma • Your • Your aimsaims during during an asthma an asthma attack attack are to areease to ease the breathing the breathing and and if necessary if necessary get medical get medical help.help. • You • You needneed to keep to keep the patient the patient calmcalm and and reassure reassure themthem • Follow • Follow the person’s the person’s asthma asthma planplan if possible. if possible. This This includes includes finding finding out out if theif person the person has an has an individualized individualized asthma asthma action action planplan fromfrom a health a health carecare provider. provider. If so,Iffollow so, follow its directions its directions for for giving giving asthma asthma medication medication and and seeking seeking medical medical helphelp for an foracute an acute asthma asthma attack. attack. • If• theIf person the person doesn’t doesn’t havehave an asthma an asthma plan,plan, sit them sit them upright upright comfortably comfortably and and loosen loosen tighttight clothing. clothing. • • • • If• theIf person has asthma medication, suchsuch as anasinhaler, assistassist in using it. It should relieve the the the person has asthma medication, an inhaler, in using it. It should relieve attack within a fewa few minutes. attack within minutes. Encourage the patient to breathe slowly and and deeply. • Encourage the patient to breathe slowly deeply. Encourage the casualty to sittoinsita in position that that theythey find find mostmost comfortable. Do not • Encourage the casualty a position comfortable. Do lie notthe lie the casualty down. casualty down. Monitor the patient and and if theif situation worsens seekseek immediate medical attention • Monitor the patient the situation worsens immediate medical attention Note: Note: • Do drowsiness as a as sign of improvement; it could mean asthma is worsening. • not Do mistake not mistake drowsiness a sign of improvement; it could mean asthma is worsening. • Do the person’s asthma is improving if you no longer hearhear wheezing. • not Do assume not assume the person’s asthma is improving if you no longer wheezing. Follow Up Up Follow Ensure the patient adheres to the medication Ensure the patient adheres to prescribed the prescribed medication 114 114 NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 UnitUnit 10- CHRONIC 10- CHRONIC RESPIRATORY RESPIRATORY DISEASES DISEASES ROLE OF CHVs ROLE OF CHVs 1. Creating awareness on chronic respiratory diseases to community the community members 1. Creating awareness on chronic respiratory diseases to the members 2. Conducting regular home to identify of chronic respiratory diseases in the 2. Conducting regular home visitsvisits so assotoasidentify casescases of chronic respiratory diseases in the community. community. 3. Making referrals to patients chronic respiratory diseases actlinkages as linkages between 3. Making referrals to patients withwith chronic respiratory diseases and and act as between the patients the health facilities the patients and and the health facilities 4. Conducting follow up visits to patients chronic respiratory diseases to monitor 4. Conducting follow up visits to patients withwith chronic respiratory diseases so assotoasmonitor adherence update records on same. the same. theirtheir drugdrug adherence and and update theirtheir datadata records on the REFERENCES REFERENCES 1. Republic of Kenya (2011).Guidelines for asthma management in Kenya. Ministry of Public 1. Republic of Kenya (2011).Guidelines for asthma management in Kenya. Ministry of Public Health Sanitation Health and and Sanitation 2. John’s St John’s Ambulance (2012). Asthma. St John’s Ambulance. accessed on 27th 2. St Ambulance (2012). Asthma. St John’s Ambulance. LastLast accessed on 27th JuneJune 20142014 www.sja.org.uk/sja/first-aid-advice/breathing-problems/asthma.aspx fromfrom www.sja.org.uk/sja/first-aid-advice/breathing-problems/asthma.aspx 3. WHO (2007). Global surveillance, prevention control of chronic respiratory diseases: 3. WHO (2007). Global surveillance, prevention and and control of chronic respiratory diseases: A A comprehensive Approach. Geneva, WHO. accessed on 27th www.who. comprehensive Approach. Geneva, WHO. LastLast accessed on 27th JuneJune 20142014 fromfrom www.who. int/respiratory/publications/globa-surveillance/en/ int/respiratory/publications/globa-surveillance/en/ NON COMMUNICABLE NON COMMUNICABLE DISEASES DISEASES Participants Participants Manual Manual - NCD- MODULE NCD MODULE 13 13 115 115 UNIT 11- Community Based Palliative Care FACILITATORS MANUAL | COMMUNITY HEALTH VOLUNTEERS | MODULE NO. 13 | NON COMMUNICABLE DISEASES 167 Unit 11 - Community Based Palliative Care UNIT 11- Community Based Palliative Care Purpose The purpose of this unit is to equip Community Health Volunteers with the appropriate knowledge, skills and attitude that will enable them to provide compassionate care to the communities they serve. The CHV will also be able to identify persons within the community who are in need of palliative care and link them to appropriate care. Objectives By the end of this unit, the Community Health Volunteer (CHVs) should be able to: 1. 2. Describe who needs palliative care 3. Discuss common myths regarding palliative/hospice care 4. Support patients in their homes with basic interventions 5. Identify, refer and link palliative patients to appropriate services Duration: 4 hours Methodologies Materials: Lecture, Group work, Role play, Case studies, Brain storming t Pen t Marker pens t Writing papers t Audio visual t Training manual and curriculum NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 117 Unit 11 - Community Based Palliative Care Unit Session Plan Duration 3 hours Topics 60 min Methodology Materials Buzzing, discussions Flip Charts Markers, pens principals of palliative care 30 min Who needs palliative care Buzzing/ discussions Flip Charts Markers, pens 30 min Discuss common myths regarding palliative/ hospice care Buzzing/ discussions Flip Charts Markers, pens 30 min How can you support patients in their homes with basic palliative care interventions Role Play 30 min How can you Identify, refer Buzzing/ brain storming/ discussions and link palliative patients to appropriate services Flip Charts Markers, pens. Videos, photos ACTIVITY 1: DEFINING AND PRINCIPALS OF PALLIATIVE CARE- 60 MINUTES Facilitation Steps 1. Ask participants in groups of 3-4 to discuss the terms palliative care/ hospice care and end of life care 2. Ask the participants to present this in a plenary and paste their answers on the wall 3. 4. What is Palliative Care? Palliative care is an approach which improves the quality of life of patients and their families facing lifethreatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems (WHO 2012). It starts when a diagnosis is made and continues throughout the entire course of the disease. 118 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 11 - Community Based Palliative Care Palliative care therefore: t t t t t t t Provides relief from pain and other distressing symptoms; Intends neither to hasten nor postpone death; Integrates the psychological and spiritual aspects of patient care; in their own bereavement; Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; t Pediatric Palliative Care Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family. It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease. Health providers must evaluate and alleviate a child’s physical, includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited. It can be provided in tertiary care facilities, in community health centres and even in children’s homes (WHO 1998). Why is Palliative care Important Palliative care is an essential component of a comprehensive package of care for people living a life threatening/ life limiting or terminal illness because of the variety of symptoms they can experience, such as pain, diarrhoea, cough, shortness of breath, nausea, weakness, fatigue, fever, and confusion. to the hospital or clinic. Lack of palliative care results in untreated symptoms that hamper an individual’s ability to continue his or her activities of daily life. At the community level, lack of palliative care places an unnecessary burden on hospital or clinic resources. Principles of palliative care Deciding who is to provide palliative care CHVs can provide the prescribed medications and other physical and psychological support that may be needed and ensure that the patient is comfortable. Medical attention from health facility workers (home visits to support the patient and to assist the caregiver) should be available as needed. Families and friends should be provided support even after the death of the patient. Bereavement counselling is an opportunity Deciding where palliative care can be provided Palliative care should be part of a comprehensive care and support package, which can be provided in hospitals and clinics or at home by CHVs and relatives. In many settings, patients with chronic illnesses prefer to receive care at home. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 119 Unit 11 - Community Based Palliative Care Hospice care rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. The philosophy of hospice is to provide support for the patient’s emotional, social, and spiritual needs as well as medical symptoms as part of treating the whole person, using a multidisciplinary team approach, including the services of a nurse, doctor, social worker and clergy in providing care. End of Life care well as possible until they die. Both Hospice and End of Life Care are part of palliative care. ACTIVITY 2: WHO NEEDS PALLIATIVE CARE? - 30 MINUTES Facilitation Steps 1. care 2. Ask the participants to present this in a plenary and paste their answers on the wall 3. 4. Who needs palliative care? Palliative care is appropriate at any stage for both adults and children living with a life limiting/ life threatening or terminal illnesses and can be provided together with curative treatment. It is not designed to replace treatment; rather it complements the treatment received. Patients with uncontrolled symptoms; moderateto-severe distress related to their diagnosis and treatment, serious physical and psychosocial conditions; concerns about their course of disease and/or their treatment options should receive palliative care. Examples of patients requiring palliative care: t t t t t t t 120 Cancer Advanced and complicated diabetes Hypertension Heart and lung diseases, HIV/AIDS Tuberculosis Neurological diseases NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 11 - Community Based Palliative Care ACTIVITY 3: WHAT ARE THE COMMON MYTHS REGARDING PALLIATIVE/ HOSPICE CARE - 30 MINUTES Facilitation Steps 1. Ask participants in groups of 3-4 to discuss any myths/ misconception they may have about palliative care 2. Ask the participants to present this in a plenary and paste their answers on the wall 3. Past a list of common myths/ misconceptions about palliative care on the wall / power point 4. Have a short discussion on common myths/ misconceptions about palliative care Common myths/ misconceptions about palliative care Myth Fact 1. Palliative care hastens death Palliative care does not hasten death. It provides comfort and the best quality of life from diagnosis of an advanced illness until end of life. 2. Palliative care is only for people dying of cancer ilies from the time of diagnosis of any illness that may shorten life. 3. People in palliative care who stop eating die of starvation People with advanced illnesses don’t experience hunger or thirst as healthy people do. People who stop eating die of their illness, not starvation 4. Palliative care is only provided in a hospital. Palliative care can be provided wherever the patient lives – home, long-term care facility, hospice or hospital. 5. We need to protect children from being exposed to death and dying. Allowing children to talk about death and dying can help them develop health attitudes that can need time to say goodbye to people who are important to them 6. Pain is a part of dying. Pain is not always a part of dying. If pain is experienced near end of life, there are many ways it can be alleviated. 7. Taking pain medications in palliative care leads to addiction Keeping people comfortable often requires increased doses of pain medication. This is a result of tolerance to medication as the body adjusts, not addiction 8. Morphine is administered to hasten death Appropriate doses of morphine keep patients comfortable but do not hasten death. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 121 Unit 11 - Community Based Palliative Care 9. Palliative care means my doctor has given up and there is no hope for me Palliative care ensures the best quality of life for those who have been diagnosed with an advanced illness. Hope becomes less about cure and more about living life as fully as possible. 10. I’ve let my family member down because he/ she didn’t die at home Sometimes the needs of the patient exceed what Ensuring that the best care is delivered, regardless of setting, is not a failure ACTIVITY 4: HOW CAN YOU SUPPORT PATIENTS IN THEIR HOMES WITH BASIC PALLIATIVE CARE INTERVENTIONS? - 30 MINUTES Facilitation Steps Role play Njeri is a patient with a wound as a result of her diabetes condition. She is living with her granddaughter aged 12. Njeri is in pain and her wound has a bad smell. She has not been taking her medications for her diabetes. You have gone to visit Njeri. 1. What will you say to Njeri? 2. What will you do to assist her? Community Health Volunteers can play a vital role in supporting patients requiring palliative care. They may provide most of the care for the patients at home. Volunteers are included in hospice and palliative care teams with the aim of assisting health-care professionals to provide the optimal quality of life for patients and families. Volunteers can help identify those who need palliative care and provide some basic care and work closely with health workers in palliative care. The following are key roles of the CHV in palliative care: t Teach patients in self administration of pain medications and other drugs; t Help clean a patient’s wound t Feed a patient t Turn a patient who is bed-ridden to prevent sores t Bath a patient t Talk to the patient t Reassure the patient and their family that they will be there for them t Incase the patient dies, support the family in bereavement. 122 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 11 - Community Based Palliative Care ACTIVITY 5 : HOW CAN YOU IDENTIFY, REFER AND LINK PALLIATIVE PATIENTS TO APPROPRIATE SERVICES - 30 MINUTES Facilitation Steps 1. 2. 3. Ask participants in groups of 3-4 to discuss they can identify, link and refer patients to appropriate services. Ask the participants to present this in a plenary and paste their answers on the wall. Have a short discussion on how can they Identify, refer and link palliative patients to appropriate services Volunteers often provide a link between health-care institutions and patients. Incorporating volunteers in a palliative care team brings in a dimension of community support and community expertise. With the appropriate training and support, volunteers can provide direct service to patients and families, help with administrative tasks, or even work as counsellors. They can also take on several other roles, such as raising awareness, providing health education, generating funds, helping with rehabilitation, or even delivering some types of medical care. NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 123 Unit 11 - Community Based Palliative Care REFERENCES: 1. Government of Kenya (2012). Community health volunteers (CHVs): Non-communicable Diseases Manual. Nairobi, Ministry of Public Health and Sanitation. 2. The Kenya National Diabetes Educator’s Manual. 3. National Clinical Guidelines for Management of Diabetes Mellitus 4. Government of Kenya (2012). Community health volunteers (CHVs): Non-communicable Diseases Manual. Nairobi, Ministry of Public Health and Sanitation. 5. Government of Kenya (2014). Kenya National Guidelines for the Management of Epilepsy: A Practical Guide for Healthcare Workers. Nairobi, Ministry of Health. 6. http://www.dentaltraumaguide.org/Permanent_Avulsion_Description.aspx 7. WHO information series on school health document 11 8. www.google.com/search?q=teeth+crowding& 9. Republic of Kenya (2011).Guidelines for asthma management in Kenya. Ministry of Public Health and Sanitation 10. St John’s Ambulance (2012). Asthma. St John’s Ambulance. Last accessed on 27th June 2014 from 11. WHO (2007). Global surveillance, prevention and control of chronic respiratory diseases: A comprehensive Approach. Geneva, WHO. Last accessed on 27th June 2014 from www.who.int/ respiratory/publications/globa-surveillance/en/ 12. Fact sheets on HIV/AIDS for nurses and midwives. WHO/EIP/OSD/2000.5. 13. AIDS Palliative Care. UNAIDS Technical Update, October 2000. 14. Cancer pain relief, 2nd Edition. WHO, 1996. 15. Symptom relief in terminal illness. WHO, 1998. 16. Caring for carers, managing stress in those who care for PLWHA. UNAIDS case study, 2000. 17. AIDS Home Care Handbook. WHO/GPA/IDS/HCS/P3.2. 18. Home-based and long-term care, annotated bibliography. WHO/HSC/LTH/99.1. 19. Home-based long-term care. WHO TRS 898. WHO 2000. 20. Suggested essential WHO drug list for palliative care: consultation on HIV patients with cancer: December 2000. 21. Clinical AIDS Care Guidelines for Resource-poor Settings, MSF, Belgium-Luxembourg, March 2001. 22. Confronting AIDS: Public Priorities in a Global Epidemic. Oxford University Press for the World Bank, 1997 124 NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 Unit 11 - Community Based Palliative Care Notes NON COMMUNICABLE DISEASES Participants Manual - NCD MODULE 13 125 Design and Production funded by: KENYA RED CROSS SOCIETY Other Partners © April 2015
