diff --git a/app/src/hnqisNigeriaSF/assets/CompositeScores.csv b/app/src/hnqisNigeriaSF/assets/CompositeScores.csv
index fd0d0abfb..df3144d6f 100644
--- a/app/src/hnqisNigeriaSF/assets/CompositeScores.csv
+++ b/app/src/hnqisNigeriaSF/assets/CompositeScores.csv
@@ -1,13 +1,93 @@
-69;'0';'Health Facility ICM QA score';;'jcKOyugwTMu';0
-1;'1';'ICM';69;'ienDAgkgeZw';1
-2;'1.1';'Inquiry';1;'w2L7ztygH2x';2
-3;'1.2';'Physical Examination';1;'wYD9nNnj4Iv';3
-70;'2';'Diagnosis, Treatment and Counseling';69;'kR94QfYAUUv';5
-4;'2.1';'Diagnosis, Treatment and Counseling, obs 1';70;'PpwNZ6Nm5mO';6
-5;'2.2';'Diagnosis, Treatment and Counseling, obs 2';70;'lhymcfXxSya';7
-6;'2.3';'Diagnosis, Treatment and Counseling, obs 3';70;'ZYeRLFnokBg';8
-7;'1.3';'RDT Procedure';1;'ibjI4Iy7pHS';4
-8;'3';'Work Environment';69;'aib5SagwZCJ';9
-9;'3.1';'Workplace';8;'PGAbwPDRHIW';10
-10;'3.2';'Equipment, Supplies and Consumables';8;'H8nqJR2uJtA';11
-11;'3.3';'Document and Reporting';8;'TXUdppgATOB';12
+71;'1';'FP all methods';;'S6NKChInonT';1
+72;'1.1';'Contraceptive Counseling';71;'uDyLf0FNrew';2
+73;'1.2';'Oral Contraceptive Pills';71;'vpDfPajhsvq';3
+74;'1.3';'Injectables';71;'FEbHqSkwgP5';4
+75;'1.4';'IUCD Insertion';71;'vopoZw5hw9s';5
+76;'1.5
+1.5';'IUCD Removal';71;'nYaS8nCsW4U';6
+77;'1.6';'Implant Insertion';71;'rAuizPQ1CUE';7
+78;'1.7';'Implant Removal';71;'Rqzt0hiRODU';8
+79;'0';'ICM';;'nDMuZnnpMZk';9
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+82;'1.2';'Inquiry';80;'BKMMvs8dplR';12
+83;'1.3';'Physical Examination';80;'Ul24cjDA4iQ';13
+84;'1.4';'RDT Procedure';80;'tLNrdAJwLyf';14
+85;'2';'Diagnosis, Treatment and Counseling';79;'pTUVjTP2ycy';15
+86;'2.1';'Diagnosis, Treatment and Counseling obs 1';85;'dpnxtwklH4I';16
+87;'2.2';'Diagnosis, Treatment and Counseling obs 2';85;'R4CPC77KAgU';17
+88;'2.3';'Diagnosis, Treatment and Counseling obs 3';85;'OUzzlZkwSe5';18
+89;'3';'Work Environment';79;'gY5PoUfsy5B';19
+90;'3.1';'Workplace';89;'HAKWBJItXMI';20
+91;'3.2';'Equipment, Supplies and Consumables';89;'WMblsA2KSaL';21
+92;'3.3';'Document and Reporting';89;'QnMMiaQCVVG';22
+93;'1';'Focused Antenatal Care';;'rSoMwTU9pNN';23
+94;'1.1';'Introduction';93;'vDojbapJ8uI';24
+95;'1.2';'Ask or Check';93;'Bd4trQD6YgS';25
+96;'1.3';'Care';93;'O5e2s8wepuu';26
+97;'1.4';'Client Education and counseling';93;'RQ35aiBao2q';27
+98;'1.5';'Work Environment';93;'wfXuG1qMKJQ';28
+99;'1';'Post Partum IUD';;'zQNlqxt60n3';29
+100;'1.1';'Pre-Insertion (Clinical)';99;'PvEDnqgPr1m';30
+101;'1.2';'Insertion';99;'lF8i0EuALXG';31
+102;'1.3';'Post-insertion';99;'rvUVi5ltWd9';32
+103;'1.4';'Procedure/Follow-up';99;'p6AbASLr2Kj';33
+104;'1.5';'Work Environment';99;'q32wpF66Ias';34
+105;'1';'Pregnancy and delivery complications';;'GdtcYr9yiJh';35
+106;'1.1';'Management of Pre-Eclampsia/Eclampsia';105;'amRArDAY8Hi';36
+107;'1.2';'Management of Antepartum Hemorrhage';105;'TRgoYM1wnOe';37
+108;'1.3';'Management of Post Partum Hemorrhage';105;'mb1ZJ1SONTR';38
+109;'1.4';'Work Environment';105;'z4fQzYOYHWV';39
+110;'1';'Labor and Delivery';;'viKDqRB4A2C';40
+111;'1.1';'Pre-delivery';110;'fjSrRw3Z5C6';41
+112;'1.2';'Delivery';110;'FPSo1uYQ4Wz';42
+113;'1.3';'Immediate Post-delivery';110;'dN33o086GtA';43
+114;'1.4';'Work Environment';110;'XqG9VsYWbm6';44
+115;'1';'Cervical Cancer';;'K5jl9a9pDIQ';45
+116;'1.1';'Pre-Screening';115;'hQ1GBCVK0Ix';46
+117;'1.2';'Patient screening';115;'ell3eHEJZdG';47
+118;'1.3';'Work Environment 1';115;'emCrpxAf5CU';48
+119;'1.4';'Pre-Cryotherapy Counselling';115;'lpPqqwIuYT1';48
+120;'1.5';'Cryotherapy';115;'L503YPkf0IZ';50
+121;'1.6';'Post Cryotherapy Procedures';115;'JRj7fwup3U8';51
+122;'1.7';'Work Environment 2';115;'SoLLG3GQJan';52
+123;'1';'Tuberculosis';;'pGfFCthQfmu';53
+124;'1.1';'Inquiry';123;'hO8u2Ls34aq';54
+125;'1.2';'Examination';123;'PF6FSs2KoAm';55
+126;'1.3';'Treatment';123;'orLlwKHxjiY';56
+127;'1.4';'Counseling';123;'QioOBaC3EJz';57
+128;'1.5';'Work Environment';123;'dBMh5AtGJEZ';58
+129;'1';'Newborn Resuscitation';;'q7rudlIg0O5';59
+130;'1.1';'Newborn Resuscitation';129;'cQ2aCOZ8Xbz';60
+131;'1';'HIV';;'e0rZ0YQzieW';61
+132;'1.1';'HIV Testing and Counseling';131;'Gq62ybDD3kd';62
+133;'1.2';'HIV Care and Treatment';131;'KEo4ZXyzP0R';63
+134;'1.3';'Work Environment';131;'Gc9HhmoLsZZ';64
+135;'1';'Hypertension';;'iLYk3PjdVsX';65
+136;'1.1';'HTN screening, classification and staging';135;'VENact5MkgW';66
+137;'1.2';'History taking and assessment';135;'QNci2WqSIfP';67
+138;'1.3';'Diagnosis and Management as per protocol';135;'JBLYnNm0BCz';68
+139;'1.4';'Work Environment';135;'TywBkGwgMEI';69
+140;'1';'Work Environment';;'SEP26PBMs9g';70
+141;'1.1';'Licenses';140;'sru0Y09d7DQ';71
+142;'1.2';'General Infrastructure and Equipment';140;'qZW5RPn7vYI';72
+143;'1.3';'Service delivery guidelines';140;'JEtQHhzKyyd';73
+144;'1.4';'Commodities';140;'LG8LLK8CneS';74
+145;'1.5';'Documentation';140;'lAwzwjJH8Ht';75
+146;'1';'Malaria in Adults';;'PkhLZ5aOOaw';76
+147;'1.1';'Inquiry and Physical Examination';146;'hVqGQVZfFYa';77
+155;'1.2';'RDT Procedure';146;'t7b9smZ89Rf';78
+156;'1.3';'Diagnosis, Treatment and Counseling';146;'fkeXsi7kxs7';79
+157;'1.3.1';'Diagnosis and Treatment';156;'nPQfNLn684Y';80
+158;'1.3.2';'Counseling';156;'RgUg4CHVi9A';81
+159;'1.4';'Work Environment';146;'cRoUjfZRLOY';82
+160;'1';'Post Abortion Care';;'aq3QSQV07nF';83
+161;'1.1';'Assess, Counsel, Medical Eval';160;'b08069P4Gye';84
+162;'1.2';'mPAC';160;'XQu2N2kVRSB';85
+163;'1.3';'MVA for PAC';160;'ZYc0pz6KO3M';86
+164;'1';'Sexually Transmitted Infections';;'lAHUKbH8yBg';87
+165;'1.1';'Inquiry and Physical Examination';164;'mLRjqQZj56c';88
+166;'1.2';'Diagnosis, Treatment and Counseling';164;'OOWLMKN5uEF';89
+167;'1.3';'Work Environment';164;'iAAd3QUlHMm';90
+168;'1.8';'Emergency Contraception';71;'alG1J2yq6QM';8
+169;'1.9';'IUD for Emergency Contraception';71;'FaSGYvVY8eh';9
diff --git a/app/src/hnqisNigeriaSF/assets/Headers.csv b/app/src/hnqisNigeriaSF/assets/Headers.csv
index 052d0cd6d..7484df3d8 100644
--- a/app/src/hnqisNigeriaSF/assets/Headers.csv
+++ b/app/src/hnqisNigeriaSF/assets/Headers.csv
@@ -8,3 +8,79 @@
 9;'Equip, Sup, Cons';'Equipment, Supplies and Consumables';2;4
 10;'Doc & Rept';'Document and Reporting';3;4
 59;'RDT';'RDT Procedure';4;1
+60;'Counsel';'Contraceptive Counseling';1;6
+61;'OCP';'Oral Contraceptive Pills';2;6
+62;'Inj';'Injectables';3;6
+63;'IUCD Ins';'IUCD Insertion';4;6
+64;'IUCD Rem';'IUCD Removal';5;6
+65;'Imp Ins';'Implant Insertion';6;6
+66;'Imp Rem';'Implant Removal';7;6
+67;'Intro';'Introduction';1;7
+68;'Ask or Check';'Ask or Check';2;7
+69;'Care';'Care';3;7
+70;'EC';'Client education and counseling';4;7
+71;'WE';'Work Environment';5;7
+72;'Pre-Ins';'Pre-Insertion (Clinical)';1;8
+73;'Ins';'Insertion';2;8
+74;'Post-Ins';'Post-insertion';3;8
+75;'Follow Up';'Procedure/Follow-up';4;8
+76;'WE';'Work Environment';5;8
+77;'MPE/E';'Management of Pre-Eclampsia/Eclampsia';1;9
+78;'MAH';'Management of Antepartum Hemorrhage';2;9
+79;'MPPH';'Management of Post Partum Hemorrhage';3;9
+80;'WE';'Work Environment';4;9
+81;'Pre-Del';'Pre-delivery';1;10
+82;'Del';'Delivery';2;10
+83;'Post-Del';'Immediate Post-delivery';3;10
+84;'WE';'Work Environment';4;10
+85;'Pre-Scr';'Pre-Screening';1;11
+86;'Pat scr';'Patient screening';2;11
+87;'WE1';'Work Environment 1';3;11
+88;'Pre-Cryo';'Pre-Cryotherapy Counselling';4;11
+89;'Cryo';'Cryotherapy';5;11
+90;'Inq';'Inquiry';1;12
+91;'Exam';'Examination';2;12
+92;'Treat';'Treatment';3;12
+93;'Couns';'Counseling';4;12
+94;'WE';'Work Environment';5;12
+95;'NR';'Newborn Resuscitation';1;13
+96;'HTC';'HIV Testing and Counseling';1;14
+97;'Care Tx';'HIV Care and Treatment';2;14
+98;'WE';'Work Environment';3;14
+99;'HTN';'HTN screening , classification and staging';1;15
+100;'Assess';'History taking and assessment';2;15
+101;'Diag_Mgmt';'Diagnosis and Management as per protocol';3;15
+102;'WE';'Work Environment';4;15
+103;'Licenses';'Licenses';1;16
+104;'GIE';'General Infrastructure and Equipment';2;16
+105;'SDGs';'Service delivery guidelines (job aids, algorithms etc.)';3;16
+106;'Commodities';'Commodities';4;16
+107;'Doc';'Documentation';5;16
+108;'Post Cryo';'Post Cryotherapy Procedures';6;11
+109;'WE2';'Work Environment 2';7;11
+110;;'Introduction';1;17
+111;;'Inquiry';2;17
+112;;'Physical Examination';3;17
+113;;'RDT Procedure';4;17
+114;;'Diagnosis and Treatment';5;17
+115;;'Counseling';6;17
+116;;'Work Environment';7;17
+117;;'Initial Assessment';1;18
+118;;'Counseling';2;18
+119;;'Medical evaluation';3;18
+120;;'Miso for Post Abortion Care (mPAC)';4;18
+121;;'Manual Vacuum Aspiration for Post Abortion Care';5;18
+133;;'Inquiry';1;19
+134;;'Physical Examination';2;19
+135;;'Post-examination';3;19
+136;;'Diagnosis and Treatment';4;19
+137;;'Counseling';5;19
+138;;'Work Environment';6;19
+139;;'Inquiry';7;19
+140;;'Physical Examination';8;19
+141;;'Post-examination';9;19
+142;;'Diagnosis and Treatment';10;19
+143;;'Counseling';11;19
+144;;'Work Environment';12;19
+145;;'Emergency Contraceptive Pills';8;6
+146;;'IUD for Emergency Contraception';9;6
diff --git a/app/src/hnqisNigeriaSF/assets/Matches.csv b/app/src/hnqisNigeriaSF/assets/Matches.csv
index 5eac1d4b6..ed0693429 100644
--- a/app/src/hnqisNigeriaSF/assets/Matches.csv
+++ b/app/src/hnqisNigeriaSF/assets/Matches.csv
@@ -50,3 +50,405 @@
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diff --git a/app/src/hnqisNigeriaSF/assets/OrgUnits.csv b/app/src/hnqisNigeriaSF/assets/OrgUnits.csv
index 5d3988a0f..8a0e17db6 100644
--- a/app/src/hnqisNigeriaSF/assets/OrgUnits.csv
+++ b/app/src/hnqisNigeriaSF/assets/OrgUnits.csv
@@ -363,3 +363,1050 @@
 11095;'XJiI2Q0oeQC';'LIVINUS PATENT (011A)';10745;4
 11096;'kGZYoUT8Rtm';'CHIOMA CHEMIST SHOP (011H)';10745;4
 11097;'zNXV7pF9Z8j';'ELIJAH MEDICAL SHOP (011G)';10746;4
+52601;'DkoHZcJzK6P';'ab Abia State';;1
+52602;'RopN5PFNhS0';'bo Borno State';;1
+52603;'GgB4AyJKpQT';'ad Adamawa State';;1
+52604;'OWaPVq9QIos';'ak Akwa Ibom State';;1
+52605;'DziVJPwNPcA';'an Anambra State';;1
+52606;'wKxwIF3j1Du';'be Benue State';;1
+52607;'YWwUaUtX6M7';'cr Crossriver State';;1
+52608;'rkqBOoYljDK';'de Delta State';;1
+52610;'IKTexve9Cbu';'ed Edo State';;1
+52611;'TumDLHt1jUj';'en Enugu State';;1
+52612;'FqwlNwwdyZw';'fc Federal Capital territory';;1
+52613;'T8AaWM6lsmO';'go Gombe State';;1
+52614;'XInJn2VizzD';'im Imo State';;1
+52615;'Ud0BrUFSkPm';'kd Kaduna State';;1
+52616;'c8fAF2i2wdp';'kn Kano State';;1
+52617;'Dvr73dzfrKH';'kt Katsina State';;1
+52618;'NVyFrm1xA95';'la Lagos State';;1
+52619;'bQPgOBYqfDv';'na Nassarawa State';;1
+52620;'UHS6X0LpWqt';'ni Niger State';;1
+52621;'C8Vsg9kjGMQ';'og Ogun State (SF)';;1
+52622;'S2GSbqhkxkl';'os Osun State';;1
+52623;'QjakcqkGNlK';'oy Oyo State';;1
+52624;'CG6Qr8DFhyv';'ta Taraba State';;1
+52647;'OFHQW3YhJng';'ta Jalingo Local Government Area';52624;2
+52648;'ZKuZv46XN5a';'de Oshimlli South Local Government Area';52608;2
+52649;'QR9Lz4wRBU3';'de Ughelli North Local Government Area';52608;2
+52650;'CENsCqBHRjj';'de Uvwie Local Government Area';52608;2
+52651;'Q38jHvttPg1';'de Warri South Local Government Area';52608;2
+52652;'cXtcdsMUqKi';'ed Egor Local Government Area';52610;2
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+52757;'TjllnzpVVmR';'la Surulere Local Government Area';52618;2
+52758;'zENuMnZDBYh';'be Gboko Local Government Area';52606;2
+52759;'lVGPRc844sx';'be Makurdi Local Government Area';52606;2
+52760;'ulV2QltoDx3';'be Otukpo Local Government Area';52606;2
+52761;'CMy5mUf1VS3';'be Ukum Local Government Area';52606;2
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+52775;'fSWa9J4fPkf';'ab Osisioma Local Government Area';52601;2
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+52781;'be7AO7r0YMN';'im Okigwe Local Government Area';52614;2
+52782;'vKkgUy9ielJ';'im Owerri Municipal Local Government Area';52614;2
+52783;'zL8LT5aafmE';'im Owerri North Local Government Area';52614;2
+52784;'AUiRHWLg9Pg';'ad Numan LGA';52603;2
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+52791;'wjLrcNbkR7y';'ri Muhammad Ward';52602;2
+52792;'CU7lDYhiPNc';'Ward';52602;2
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+52794;'W6G2QYDm1qA';'go Gombe Local Government Area';52613;2
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+52802;'vOPSZ1uigaC';'ad Wisdom Nursing home';52784;3
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+52810;'U5Ei50M3TAW';'an Njikoka Ward';52670;3
+52811;'sHKIDPTW989';'an Nnewi North Ward';52671;3
+52812;'n30SkuzMx60';'be Gboko Ward';52758;3
+52813;'A2gXIc7nzE7';'be Makurdi Ward';52759;3
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+52815;'RJ44ix3rIIZ';'be Ukum Ward';52761;3
+52816;'SalCBqTePq6';'cr Akamkpa Ward';52660;3
+52817;'mZG4WoNsQDs';'cr Bekware Ward';52661;3
+52818;'vdgTV5MFvu5';'cr Boki Ward';52662;3
+52819;'MPPmGXJijwl';'cr Calaba Ward';52663;3
+52820;'U8KfZ3ioZaE';'cr Calabar Municipal Ward';52664;3
+52821;'M5qDWnfzdT9';'cr Ikom Ward';52665;3
+52822;'MPxHzU67JGd';'cr Ogoja Ward';52666;3
+52823;'Ed9tOVSm3eZ';'cr Ugep Ward';52667;3
+52824;'POjR8GlFSZe';'de Oshimlli South Ward';52648;3
+52825;'CB93Pt5uC1W';'de Ughelli North Ward';52649;3
+52826;'lp9cSieyHrJ';'de Uvwie Ward';52650;3
+52827;'uZrlZdBUYhR';'de Warri South Ward';52651;3
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+52829;'D70kyuODRFT';'eb Ohaukwu Ward';52673;3
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+52831;'IJgELQvj7Tz';'ed Ikpoba Okha Ward';52653;3
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+52833;'bdnXegEYDrA';'ed Uhunmwonde Ward';52655;3
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+52835;'WwwQgYwm469';'en Enugu North Ward';52676;3
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+52837;'EYcPazZnsBQ';'en Enugu Ward';52675;3
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+52840;'bt02WNtXGQD';'en Igboeze South Ward';52680;3
+52841;'ydMCaljZkRL';'en Isi Uzo Ward';52681;3
+52842;'xMYPMEt7VdS';'en Nkanu West Ward';52682;3
+52843;'YENrO9or2v1';'en Nsukka Ward';52683;3
+52844;'cS7XNQt0rlK';'en Orji River Ward';52684;3
+52845;'nyENxcD5dPB';'en Udenu Ward';52685;3
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+52847;'SVAc2wx3kj5';'Facility 2';52786;3
+52848;'GqyP2axvv5q';'Facility D';52792;3
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+52850;'VJctXExYlKQ';'Facility F';52792;3
+52851;'Gx20dZ37caR';'Facility G';52792;3
+52852;'pI7478VFIO7';'Facility H';52792;3
+52853;'Qw1rTwsqXHI';'Facility I';52792;3
+52854;'SQ70iZoJWBW';'Facility j';52792;3
+52855;'iAAOzzyOesZ';'fc Abaji Ward';52687;3
+52856;'yo5GohfuTrf';'fc AMAC Ward';52688;3
+52857;'pRdkgAnJJNH';'fc Bwari Ward';52689;3
+52858;'O6huuevKyxz';'fc Gwagwalada Ward';52690;3
+52859;'A7e4681esSN';'fc Kuje Ward Ward';52691;3
+52860;'M4vGvHyJf8P';'fc Kwali Ward';52692;3
+52861;'XRkwYGVoLzl';'gb Ashaka cement clinic';52793;3
+52862;'Uf9qBaBA1Ub';'go Austina Facility';52787;3
+52863;'MjB4D035fbi';'go Austina Facility 2';52787;3
+52864;'ASM1GSHx26H';'go Facility A';52789;3
+52865;'PKd1T6q8Rts';'go Facility O';52788;3
+52866;'AGyNSqIK3AD';'go Gombe Ward';52794;3
+52867;'POfAfcaE4Rb';'im Ahiazu Mbaise Ward';52777;3
+52868;'F2FbOHKZf0w';'im Ngor Okpala Ward';52778;3
+52869;'qFGepnSHOIO';'im Nworiebu Ward';52779;3
+52870;'H2g9sRVwkuQ';'im Obowo Ward';52780;3
+52871;'uaQzymHGhXd';'im Okigwe Ward';52781;3
+52872;'b4nuKAkSX8L';'im Owerri Municipal Ward';52782;3
+52873;'XWvwe7Lz7Yc';'im Owerri North Ward';52783;3
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+52875;'E5bGfUGwUFo';'kd Igabi Ward';52725;3
+52876;'po8ED4qUZqn';'kd Jama''a Ward';52726;3
+52877;'Omtg2s76xAX';'kd Kachia Ward';52727;3
+52878;'SJCRLPpS7Dp';'kd Kaduna North Ward';52728;3
+52879;'uwm3ow5OGC4';'kd Kaduna South Ward';52729;3
+52880;'FdJfDHBgJcS';'kd Kaura Ward';52730;3
+52881;'Xxnig8NgmL9';'kd Lere Ward';52731;3
+52882;'NHHaaOrGiAd';'kd Saminaka Ward';52732;3
+52883;'hPeoD7hzHUV';'kd Zaria Clinic and Medical Centre';52733;3
+52884;'ALDLn3tWBFe';'kd Zaria Ward';52733;3
+52885;'Ip9LnaRzmBb';'kn Dala Ward';52734;3
+52886;'kWoLfGYAZCr';'kn Faggae Ward';52735;3
+52887;'PBWtbM88jIS';'kn Funtua Ward';52736;3
+52888;'kzuBqSRfWgy';'kn Katsina Ward';52737;3
+52889;'VLR0b5NJQLj';'kn Nassarawa Ward';52738;3
+52890;'PS0PTXduPTB';'kn Tarauni Ward';52739;3
+52891;'Z5SqIpT1MPX';'kt Funtua Ward';52740;3
+52892;'HzCvyYlPodx';'kt Katsina Ward';52741;3
+52893;'iWGPFED05Vi';'la Agege Ward';52742;3
+52894;'IvDvkdhXLSf';'la Ajeromi/Ifelodun Ward';52743;3
+52895;'FFCyZ77Z6h2';'la Alimosho Ward';52744;3
+52896;'FC0RZq3qWVY';'la Amuwo-Odofin Ward';52745;3
+52897;'ayIccYYz906';'la Apapa Ward';52746;3
+52898;'BBI2DsJy6Kp';'la Badagry Ward';52747;3
+52899;'kmQsu9hbytY';'la Ifako Ijaiye Ward';52748;3
+52900;'NDsSlkW2Y2m';'la Ikeja Ward';52749;3
+52901;'nbEM4RcbliD';'la Ikorodu Ward';52750;3
+52902;'Rpp3SXDBIVo';'la Kosofe Ward';52751;3
+52903;'vIDE6GfdOJM';'la Lagos Mainland Ward';52752;3
+52904;'Buc0zYpyx7K';'la Mushin Ward';52753;3
+52905;'biAKrqFGhos';'la Ojo Ward';52754;3
+52906;'sCqYyQN4Eur';'la Oshodi/Isolo Ward';52755;3
+52907;'EMTBC2Np4ep';'la Somolu Ward';52756;3
+52908;'FKncr8SbVJa';'la Surulere Ward';52757;3
+52909;'mbQe8hXaoEv';'na Adonai Maternity and Hospital';52694;3
+52910;'dJadrcHdeOD';'na Akwanga Ward';52693;3
+52911;'ShMkapD2LeG';'na Keffi Ward';52695;3
+52912;'g60DOKMSxp0';'na Lafia Ward';52696;3
+52913;'NXdEvDadeEm';'na Nassarawa Eggon Ward';52697;3
+52914;'NdeehInXNDl';'ni Bida Ward';52698;3
+52915;'Xbs6nKsjU4o';'ni Chanchaga Ward';52699;3
+52916;'zt8YsF2sXgR';'ni Kotangora Ward';52700;3
+52917;'gOAB6HtZzmN';'ni Mokwa Ward';52701;3
+52918;'QWhI0uvviMr';'ni Suleja Ward';52702;3
+52919;'gKz2OWYv86I';'og Abeokuta South ward';52762;3
+52920;'BOMIgfnwmA8';'og ifo ward';52764;3
+52921;'RErlGGlye0e';'og Ijebu ward';52766;3
+52922;'W6HRco0D9SP';'og Ikenne ward';52767;3
+52923;'mDaiwh7dcKM';'og Ikeola Clinic and Maternity Home';52765;3
+52924;'nSA1ojVBuRo';'og Imeko-afon';52768;3
+52925;'tenyGwq7yEH';'og Ipokia ward';52769;3
+52926;'Yi0auJxMh4t';'og Ire-ayo Hospital';52765;3
+52927;'Ew0cHvimQXN';'og Odeda ward Ogun';52770;3
+52928;'x4NLUoW61j4';'og Ododo ward';52763;3
+52929;'oZ0CDJLUygN';'og Sagamu Ward';52771;3
+52930;'re0QpOnmJxu';'og Yewa ward';52772;3
+52931;'eOKe7MUCDzj';'On Facility';52790;3
+52932;'HBiCfgPiPJn';'os Ife Central Ward';52703;3
+52933;'LuDktTbilOI';'os Ife East Ward';52704;3
+52934;'TFliqhxvVid';'os Ife Ward';52705;3
+52935;'d1yjfHmJ4nU';'os Irepodun Ward';52706;3
+52936;'CsDqJZElrg2';'os Olorunda Ward';52707;3
+52937;'PhhUk5Njyz6';'os Oshogbo Ward';52708;3
+52938;'myeCcPhxUtV';'oy Alafia Hospital';52712;3
+52939;'eK9ZIY4Dfik';'oy Atiba ward';52709;3
+52940;'BjyfS2OyjDg';'oy Dolapo Health Service';52711;3
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+53490;'uz6aceZdDba';'la Pill Box Pharmacy';52903;4
+53491;'ac7C4Ro4Tr3';'la Bristel Store';52904;4
+53492;'aVS4WX0qnlZ';'la CY Destiny Store';52904;4
+53493;'hGmvEVvgwGH';'la Eberechukwu Proprietory Patent Medicine Vendor Stores';52904;4
+53494;'EImLj6xX9xi';'la Shalom Stores';52904;4
+53495;'RB61M0JFwSb';'la De Marvel Hospital';52905;4
+53496;'F0yuiFsf9Ow';'la Kiladejo Hospital, Okoko-Maiko';52905;4
+53497;'LUK2Q2dnycJ';'la Manifel Medical Centre, Ikotun';52905;4
+53498;'IFi6NAyaOpA';'la Sabo Crown Hospital Ajangbadi';52905;4
+53499;'xqpQzp70JO0';'la Treasure Hospital, Unity Estate Iba';52905;4
+53500;'TYayziBYS1c';'la Vimek Pharmacy';52905;4
+53501;'WwvAbjvZhOc';'la Careview Pharmacy';52906;4
+53502;'f8Y3YxwnQhQ';'la Farimar Pharmacy';52906;4
+53503;'pwMUXhUuQPJ';'la PPFN Clinic Isolo and Annex';52906;4
+53504;'nNbx7UKcPV3';'la SOS Social Centre Ejigbo';52906;4
+53505;'epJa82rSyQE';'la Austin Benz Proprietory Patent Medicine Vendor Stores';52907;4
+53506;'T9fCvkEA93Z';'la Gabisco Proprietory Patent Medicine Vendor Stores';52907;4
+53507;'d5rlf6UNByW';'la Robson Pharmacy';52907;4
+53508;'iNx9u9T3ibe';'la Shallom Stores';52907;4
+53509;'aeCQRWfv9RB';'la Stanley Proprietory Patent Medicine Vendor Stores';52907;4
+53510;'Haqx6yKNlBy';'la Afro Health Pharmacy';52908;4
+53511;'xlrkJHPJLCO';'la Bee Hive Nursing Home Aguda';52908;4
+53512;'VNRs9mSgwW6';'la Frontliner Pharmacy';52908;4
+53513;'eDxTDfCX0wz';'la Mebik Pharmacy';52908;4
+53514;'ykttDscLTmH';'la Olasunkanmi Nursing Home, Ijesha- tedo';52908;4
+53515;'doHTVbZu694';'la Santus Pharmacy and Superstores';52908;4
+53516;'J6zjd8cZSKb';'be Atuna Clinic and Maternity';52812;4
+53517;'CpebUrTIRRP';'be Baki Clinic and Maternity';52812;4
+53518;'ssRwOrJXC7E';'be Fagwa Clinic and Hospital';52812;4
+53519;'HThLXA2NFiq';'be Fagwa Clinic and Maternity';52812;4
+53520;'BeGaGuGBcYu';'be Myom Clinic and Maternity';52812;4
+53521;'zs8AlfWkyIE';'be NKST Reproductive Health Mkar';52812;4
+53522;'iqZ4tyKyb7f';'be Victory Cilnic and Maternity General Hospital';52812;4
+53523;'S2VUossQgiF';'be Benue Women';52813;4
+53524;'OQz4R8OyDb7';'be Best Based Clinic and Maternity';52813;4
+53525;'wRfatFTsFEA';'be Hope Hospital Makurdi';52813;4
+53526;'ZJTroKNA5FF';'be Mulit Care Hospital Makurdi';52813;4
+53527;'AyaVwFaTKmP';'be Musab Hospital Makurdi';52813;4
+53528;'EMP9ou775gX';'be Queens Clinic Makurdi';52813;4
+53529;'Y4wBcxfjTF2';'be Shater Clinic';52813;4
+53530;'s1VgahNTNOy';'be Wuseter Clinic and Maternity';52813;4
+53531;'Y3lO0hGcprp';'be Christain Hospital and Maternity Home';52814;4
+53532;'VltqYrW3nTn';'be His Banner''s Clinic and Maternity';52814;4
+53533;'gv931npfbwN';'be Mount Zion Gate Otukpo';52814;4
+53534;'GLqkVY9h8SH';'be PPFN Clinic Otukpo';52814;4
+53535;'e7mveMUaSe0';'be St Daniel Hospital';52814;4
+53536;'rXsaliFsuK4';'be St Monica Clinic and Maternity';52814;4
+53537;'o8mkzQnKSXB';'be St Theresa Clinic And Maternity';52814;4
+53538;'hYab1FW2KjX';'be St Veronica Clinic and Maternity';52814;4
+53539;'fKcgNW40I5o';'be Akainewe Clinc and Maternity';52815;4
+53540;'Db5ZjUt3QKB';'be City Clinc and Maternity';52815;4
+53541;'IxJnhHjELbu';'be Jorda Clinic and Maternity';52815;4
+53542;'C5Nu4Iviagu';'be NKST Hospital Zaki/Biam';52815;4
+53543;'JM6vMufqqOL';'be Woma clinic and Maternity';52815;4
+53544;'U3MIChdDuwm';'og First Contact Specialist Hospital';52919;4
+53545;'psUJysb2FNL';'og Joseph and Christiana Specialist Hospital';52919;4
+53546;'JnfsB9CHgLK';'og Omotara Hospital';52919;4
+53547;'C0YgNArw2AZ';'og Yadsot Clinic';52919;4
+53548;'TTixQLUgYFO';'og Amda Hospital';52928;4
+53549;'l6LWG5GbCfx';'og Anu-olu Clinic and Maternity Home';52928;4
+53550;'hGcejsuCbkl';'og Ariset Medical Centre: Clinic and Maternity Home';52928;4
+53551;'qtA1E7Yi3Xt';'og De-Twins Clinic';52928;4
+53552;'oKFlGLIlecf';'og Kaytuns Clinic: Family Planning Unit and Maternity Home';52928;4
+53553;'ybzkyCQzPqs';'og Lifeline Medical Centre';52928;4
+53554;'EpdUwBZWxJi';'og Twins Specialist Hospital';52928;4
+53555;'Sof3WrUKW6m';'og Samsteven Hospital';52920;4
+53556;'Bn3Bwub6x8z';'og Total Health Hospital';52920;4
+53557;'fRQenLxv9y8';'og Ope-olu Clinic';52921;4
+53558;'bGvOBJUyhht';'og True vine Clinic';52921;4
+53559;'dd08su8duDL';'og Healing Spring Medical Centre';52922;4
+53560;'xzVC4pK0Aq2';'og Overcomers Specialist Hospital';52922;4
+53561;'DIXkmw57Ozi';'og Mak-Mercy Hospital';52924;4
+53562;'NksAETKDzg7';'og Otobi Clinic and Maternity Home';52924;4
+53563;'BoszGQIhNVB';'og God''s time Special Clinic and Maternity Centre';52925;4
+53564;'JBHaEGH2uxJ';'og Mayowa Hospital; Clinic and Maternity Home';52925;4
+53565;'G1MqhnAgdlb';'og Omo-arewa Health Care Foundation';52927;4
+53566;'eoQgl9qmHqs';'og Ade Maternity Home';52929;4
+53567;'HZuaqub6t9e';'og Phrontile Clinic';52929;4
+53568;'DTJ3PeMqZXJ';'og Tazan Maternity Home';52929;4
+53569;'D0Y5Dv6tGK1';'og Akinolu Faith Clinic and Maternity Home';52930;4
+53570;'ZlU9EY5Bn9f';'og Ore-ofe Clinic and Maternity Home';52930;4
+53571;'zeH5zl8qcdF';'ab Bonitas Pharmacy';52797;4
+53572;'Mwm4XQHwGJ2';'ab Chrisdom Pharmacy';52797;4
+53573;'kZNH5tpg3N6';'ab Euna Hospital';52797;4
+53574;'ywlcx9J3QZx';'ab Ezoni Pharmacy';52797;4
+53575;'p6nR2lESqlU';'ab Kelechi Hospital';52797;4
+53576;'noqKF88cFyi';'ab Melbe Proprietory Patent Medicine Vendor Stores';52797;4
+53577;'nsAXIHuCNB5';'ab Onyemaechi Maternity Home';52797;4
+53578;'SxUKqjGIpwE';'ab Promac Pharmacy';52797;4
+53579;'Rq6x5hh7QaF';'ab Rufus Obi Pharmacy';52797;4
+53580;'l3NuFRQMFvr';'ab Twiga Pharmacy';52797;4
+53581;'s2Pu5l8QJUK';'ab Ziga Pharmacy';52797;4
+53582;'Oxoio6gNmkC';'ab Chinwe Maternity Home';52798;4
+53583;'CORF1sU4O5Q';'ab Clehanson Hospital';52798;4
+53584;'sqEXmFapL7d';'ab Faith Foundation Hospital';52798;4
+53585;'x8aY64IYv2z';'ab God Gives Maternity Home';52798;4
+53586;'TvnHy0V0jkC';'ab Princess Mary Specialist Hosptial';52798;4
+53587;'dsDn5GXLLnX';'ab Rosevine Hospital';52798;4
+53588;'wfqiA9F29DE';'ab Sda Hospital and MBH';52798;4
+53589;'OxcoTnkaKCV';'ab Shammah Christian Hospital';52798;4
+53590;'OkBSvo5O99m';'ab St Anthony''s Hospital';52798;4
+53591;'WErsZuTTeIP';'ab Calvary Christian Hospital';52799;4
+53592;'tOnNSc5XfTu';'ab Calvary Cottage Hospital';52799;4
+53593;'mPNxmpIuVm3';'ab Ihunanya Specialist Hospital';52799;4
+53594;'ympA6EtgInb';'ab Simon Specialist Hospital';52799;4
+53595;'qs173udBCWZ';'ab St Andrews Maternity Home';52799;4
+53596;'zn335POAn99';'ab Yumed Pharmacy';52799;4
+53597;'KeNxAFCR4WG';'ab Anelechi Hospital';52800;4
+53598;'yx3t16d9Ehw';'ab Destiny Proprietory Patent Medicine Vendor Stores';52800;4
+53599;'EmWURb8H6Qm';'ab Divine Pharmacy';52800;4
+53600;'q4Upl33gMLf';'ab Ejike Proprietory Patent Medicine Vendor Stores';52800;4
+53601;'gRzYskfkndP';'ab Family Pharmacy';52800;4
+53602;'agQX8fz9N8Z';'ab Gods Favour Pharmacy';52800;4
+53603;'NV7muMyucGY';'ab Godwish Uche Pharmacy';52800;4
+53604;'wOwfQjPLagA';'ab Nwachinemere Hospital';52800;4
+53605;'Lry9WpbZW8R';'ab Thompson Pharmacy';52800;4
+53606;'WUJ5901cbrH';'im Ceejex Pharmacy';52867;4
+53607;'YKiSZKmduu3';'im Chinoyerem Maternity Home';52867;4
+53608;'Wh2vAniSap2';'im Crown Medical Centre';52867;4
+53609;'r1XSWfrQlmM';'im Mark of Glory Hospital and Maternity';52867;4
+53610;'SrsPPDH3RF3';'im Perpetual Hospital and MAternity Owerri';52867;4
+53611;'PEiXX43R1Og';'im St Charles Clinic Owerri';52867;4
+53612;'WhUzsQ3REFL';'im Umuowa Cottage Hospital';52868;4
+53613;'qb5ondn9yEU';'im Christian Medical Centre';52869;4
+53614;'x65R7Blj2ns';'im Longinus Proprietory Patent Medicine Vendor Stores';52870;4
+53615;'M0ASeLjs4Cp';'im Blessed Proprietory Patent Medicine Vendor Stores';52871;4
+53616;'zQ01g5LBzZB';'im Chiemeka Proprietory Patent Medicine Vendor Stores';52871;4
+53617;'BirnirxrLxs';'im Chikatony Pharmacy';52871;4
+53618;'NkI6kr2TZ2X';'im Chinwe Proprietory Patent Medicine Vendor Stores';52871;4
+53619;'iHGrhwYDMAS';'im Chi Proprietory Patent Medicine Vendor Stores';52871;4
+53620;'YYZYkEh5VBE';'im Destiny Proprietory Patent Medicine Vendor Stores';52871;4
+53621;'HVjYvgLBze0';'im Djons Pharmacy';52871;4
+53622;'rz9oFivFLGD';'im Eve Specialist Women Hospital';52871;4
+53623;'XURyVV5RurD';'im God Is Able Proprietory Patent Medicine Vendor Stores';52871;4
+53624;'nCLCqPK3Utu';'im Godwish Anyimoore Proprietory Patent Medicine Vendor Stores';52871;4
+53625;'sOfFYvDhjVs';'im Isseke Proprietory Patent Medicine Vendor Stores';52871;4
+53626;'ABa5TvqOAJB';'im Ivory Clinic';52871;4
+53627;'oxubo4YzY7x';'im Jeluke Proprietory Patent Medicine Vendor Stores';52871;4
+53628;'euOTCQBjAXP';'im Kelechukwu Proprietory Patent Medicine Vendor Stores';52871;4
+53629;'gYkNP9gVVxr';'im Natty Proprietory Patent Medicine Vendor Stores';52871;4
+53630;'wZ5Tu8ybMuR';'im Obinezu Proprietory Patent Medicine Vendor Stores';52871;4
+53631;'ZNlVt5mqo2c';'im Pinnacle Proprietory Patent Medicine Vendor Stores';52871;4
+53632;'eK5xrrGcUzc';'im Pottpouri Pharmacy';52871;4
+53633;'rpM1X9xLVO8';'im Aslem Proprietory Patent Medicine Vendor';52872;4
+53634;'CEe4iQeKVxm';'im Banax Pharmacy';52872;4
+53635;'oU6koHmqZLP';'im Belmont Specialist Hospital';52872;4
+53636;'WUwcQBAjspl';'im Cacy Pharmacy';52872;4
+53637;'g2eDqgLNOuR';'im Della Pharmacy';52872;4
+53638;'wB2tSNa4pCB';'im Drugwyse Pharmacy';52872;4
+53639;'UVrRhGbtSt7';'im Felicy Proprietory Patent Medicine Vendor Stores';52872;4
+53640;'ClLdqPSYh49';'im Mabel Proprietory Patent Medicine Vendor Stores';52872;4
+53641;'RImPzh30aY8';'im Pathway Pharmacy';52872;4
+53642;'XA31FBjoN5w';'im Pharmasense Pharmacy';52872;4
+53643;'TnRsNOo1fe8';'im Planned Parenthood Federation Of Nigeria';52872;4
+53644;'xCvPl7YZ3Wv';'im UC Golden Maternity Home';52872;4
+53645;'JnBfRqOnHCx';'im Vinedrug Pharmacy';52872;4
+53646;'A33FxE5uFJ7';'im Chadoma Pharmacy';52873;4
+53647;'anoUXIVkDPq';'im God''s Gift Maternity Home';52873;4
+53648;'Nv4ftVOKe7w';'im Jesus Redeemed People''s Hospital';52873;4
+53649;'h1bTxwxhjou';'im Ozondu Proprietory Patent Medicine Vendor Stores';52873;4
+53650;'FkWglhHTTxo';'im Prisca Proprietory Patent Medicine Vendor Stores';52873;4
+53651;'dfhPwGr6Wjo';'im Queen Jij Proprietory Patent Medicine Vendor Stores';52873;4
+53652;'F1DCZGkvi7z';'im Ricky Proprietory Patent Medicine Vendor Stores';52873;4
+53653;'O5h5TlL7VrS';'im Rosanna Medical Centre';52873;4
+53654;'ci6ZKXkMCRM';'im Ruth Proprietory Patent Medicine Vendor Stores';52873;4
+53655;'pD3cTQwdW1k';'ad Daama specialist hospital';52803;4
+53656;'GQRlhV6znsF';'ad Gal Bose Hospital';52803;4
+53657;'zy6qFrTO40e';'ad Gogo Abu Clinic and Maternity';52803;4
+53658;'dezoq5xq7xe';'ad Jimeta Clinic and Maternity';52803;4
+53659;'Fjx3DSU0MyP';'ad Luthercares Comprehensive Health Centre';52803;4
+53660;'BmySVrO95k9';'ad mercyland clinic';52803;4
+53661;'VcTzEgx8ORA';'ad NEW BOSHANG CLINIC';52803;4
+53662;'DyHOSsWJCND';'ad Peace Hospital Gombe';52803;4
+53663;'aVC8eu8Cugh';'ad Trust Medical Gombi';52803;4
+53664;'StKdCnQ5tpe';'ab Aba North Ward';52796;4
+53665;'abX67yoaOwj';'go Doma Hospital Gombe';52866;4
+53666;'RqmNyks4ScW';'go Hamdala specialist clinic and maternity';52866;4
+53667;'Gbedgc45clh';'go Jewel Specialist Hospital Gombe';52866;4
+53668;'rMnH796T2Uv';'go Miyetti Hospital';52866;4
+53669;'n8uXLM4QmX6';'go Musaba Medical Centre';52866;4
+53670;'dDDQGhEpfAO';'go PPFN Clinic Gombe';52866;4
+53671;'D9F1Ob5g2Up';'go Sabana Medical centre Gombe';52866;4
+53672;'NjG0cfECt3A';'go Yarma Hospital';52866;4
diff --git a/app/src/hnqisNigeriaSF/assets/Programs.csv b/app/src/hnqisNigeriaSF/assets/Programs.csv
index c7e4ef530..678184f6e 100644
--- a/app/src/hnqisNigeriaSF/assets/Programs.csv
+++ b/app/src/hnqisNigeriaSF/assets/Programs.csv
@@ -1 +1,15 @@
-1;'vLTSa8wPqQ8';'ICM Assessment checklist'
+2;'hug0pN6uzzA';'NG HNQIS Family Planning'
+3;'vVAUx6L0YAI';'NG HNQIS IMCI'
+4;'GHj9Yy6iyKG';'NG HNQIS Focused Antenatal Care'
+5;'O8pRU5jVlwz';'NG HNQIS Post Partum IUD'
+6;'l05C4sUJMFL';'NG HNQIS Pregnancy and Delivery Complications'
+7;'W4oCVoftkff';'NG HNQIS Labour and Delivery'
+8;'KtysP2S7Pt2';'NG HNQIS Cervical Cancer'
+9;'slp58AL4mbW';'NG HNQIS Tuberculosis'
+10;'skZiFswjqUo';'NG HNQIS Newborn Resuscitation'
+11;'D7d0KMTH5Ue';'NG HNQIS HIV'
+12;'gm7WxYPWKTn';'NG HNQIS Hypertension'
+13;'kOFrOystFsx';'NG HNQIS Work Environment'
+14;'GHan8jFY8Tu';'NG HNQIS Malaria in Adults'
+15;'Ff7ccld3wg2';'NG HNQIS Post Abortion Care'
+16;'Ldy7XN8tyHe';'NG HNQIS STIs'
diff --git a/app/src/hnqisNigeriaSF/assets/QuestionOptions.csv b/app/src/hnqisNigeriaSF/assets/QuestionOptions.csv
index 842b0b6fd..0c12f92ab 100644
--- a/app/src/hnqisNigeriaSF/assets/QuestionOptions.csv
+++ b/app/src/hnqisNigeriaSF/assets/QuestionOptions.csv
@@ -71,3 +71,405 @@
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diff --git a/app/src/hnqisNigeriaSF/assets/QuestionRelations.csv b/app/src/hnqisNigeriaSF/assets/QuestionRelations.csv
index a2f8dae6d..2c0d1d0cf 100644
--- a/app/src/hnqisNigeriaSF/assets/QuestionRelations.csv
+++ b/app/src/hnqisNigeriaSF/assets/QuestionRelations.csv
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diff --git a/app/src/hnqisNigeriaSF/assets/Questions.csv b/app/src/hnqisNigeriaSF/assets/Questions.csv
index ca227a446..67b4a41d1 100644
--- a/app/src/hnqisNigeriaSF/assets/Questions.csv
+++ b/app/src/hnqisNigeriaSF/assets/Questions.csv
@@ -1,87 +1,778 @@
-1;'HNQIS-ICM-I&PE-100';'HNQIS-ICM-I&PE-Intro-100-Provider obtains personal history (incl name, age, address, education, occupation)';;'Provider obtains personal history (incl name, age, address, education, occupation)';'<p><strong>Always ask the following in personal history:</strong></p><ul> <li><strong>Name of child: </strong>uniquely identifies the patient and ensures proper record keeping.</li> <li><strong>Age of child:</strong> some drug doses are given according to the child''s age. Age is also used for assessment of nutritional status using weight for age and for assessment of growth on the growth chart.</li> <li><strong>Address:</strong> It is important to know the locality the child comes from because some geographical locations  are high risk areas for some diseases e.g. malaria.</li> <li><strong>Education level of mother:</strong> will enable you decide how best to communicate and counsel her about how to give the medication and provide home treatment for her baby.</li> <li><strong>Occupation of mother:</strong> may determine availability of mother to provide observed home treatment.</li></ul>';'VkTeXmGEzq6';100;0.00;0.00;1;53;;2
-2;'HNQIS-ICM-I&PE-110';'HNQIS-ICM-I&PE-Intro-110-Provider asks reason for visiting health facility';;'Provider asks reason for visiting health facility';'<p><strong>Ask reason for visiting facility</strong></p><ul> <li>Ask for the child''s complaints. This will enable you to prompt for more questions related to the reason the child has been brought to hospital.</li> <li>Asking for the reason for visit will also enable you determine if this is an initial or follow-up visit. For initial visit, assess, classify and identify treatment depending on the presenting problem. For follow-up visit assess progress of the child and decide whether to advise to complete medication, change medication or refer if the child is worsening.</li></ul>';'HZL4nB1coAA';110;0.00;0.00;1;53;;2
-3;'HNQIS-ICM-I&PE-120';'HNQIS-ICM-I&PE-Intro-120-Provider checks immunization status';;'Provider checks immunization status';'<p><strong>Check immunization status of the child during each visit</strong></p><ul> <li>Immunization offers protection to the child against common potentially life-threatening childhood illnesses. You need to check if the child''s immunization is up to date. This will ensure there is no delay in giving any immunization and if there has already been a delay, the opportunity to immunize the child should not be missed again.</li> <li>Immunize if due for immunization today, if not due for immunization, give the mother a specific return date for immunization.</li></ul>';'ZJgZ0sPqrbf';120;0.00;0.00;1;53;;2
-4;'HNQIS-ICM-I&PE-130';'HNQIS-ICM-I&PE-Inq-130-Provider asks whether there are lethargy, convulsions/convulsing now';;'Provider asks whether there are lethargy, convulsions/convulsing now';'<p><strong>Ask whether there is lethargy, convulsions/convulsing now</strong><br />A child with any of these signs has a general danger sign. General danger signs include inability to drink or breastfeed, vomiting everything, history of convulsions or convulsing currently, lethargy or unconsciousness.<br />A child with any of these signs is very sick and needs urgent attention. A child currently convulsing will require diazepam immediately. Complete the rest of the assessment quickly, give any pre-referral treatment urgently and refer without delay.</p>';'vWgsPN1RPLl';130;0.10;0.10;2;53;;2
-5;'HNQIS-ICM-I&PE-140';'HNQIS-ICM-I&PE-Inq-140-Provider asks if the patient can drink or breastfeed.';;'Provider asks if the patient can drink or breastfeed.';'<p><strong>Ask if the patient can drink or breastfeed</strong><br />You need to assess if a child can drink or breastfeed to be able to determine if the child has a general danger sign. A child not able to drink or breastfeed is very sick and has a general danger sign. The other danger sings include vomiting everything, history of convulsions or convulsing currently, lethargy or unconsciousness.</p><ul><li>Confirm child''s ability to drink or breastfeed by direct observation.</li><li>Clear any nasal secretions that might be causing difficulty sucking.</li></ul><p>If still unable to breastfeed or drink, give urgent attention, complete the rest of the assessment, give any pre-refferal treatments needed and refer immediately.</p>';'m2pPvcFW7Ri';140;0.10;0.10;2;53;;2
-6;'HNQIS-ICM-I&PE-150';'HNQIS-ICM-I&PE-Inq-150-Provider asks if there is vomiting.';;'Provider asks if there is vomiting.';'<p><strong>Ask whether the child is vomiting and whether he/she is vomiting everything or retaining some food/fluid</strong></p><ul> <li>A child vomiting everything will not be able to retain food, fluids or oral drugs. Vomiting everything is a general danger sign.The other danger signs include inability to drink or breastfeed, history of convulsions or convulsing currently, lethargy or unconsciousness For such a child, complete the rest of the assessment quickly, give any pre-refferal treatment needed and refer urgently.</li> <li>If the child is vomiting but retaining some food/fluid, plan to give fluids and medication and observe if the child retains before allowing them to go home.</li></ul>';'sa0oRpuk0oh';150;0.10;0.10;2;53;;2
-7;'HNQIS-ICM-I&PE-160';'HNQIS-ICM-I&PE-Inq-160-Provider asks about frequency & Duration of cough.';;'Provider asks about frequency & Duration of cough.';'<p><strong>Ask if the child is coughing</strong><br />Cough is a main symptom and must be asked in all children. The other main symptoms are diarrhoea, fever and ear problem.<br />Cough with or without difficult breathing is the main presenting symptom of pneumonia. Alternatively, a child with cough may also be having a common cold, asthma, tuberculosis or other espiratory problem. You need to assess the respiratory system of a child with cough.<br /><strong>Ask about duration of cough</strong><br />A child with a cough more than 14 days (chronic cough) may be having tuberculosis. Screen the child for tuberculosis if you are able to, or refer the child for further assessment of the cough after stabilization.<br /><strong>Ask about frequency of cough</strong><br />A child with asthma may cough mainly at night, when exposed to cold, dust, smoke or exercise but in pneumonia, the cough may not have a particular pattern.</p>';'ON11OhbcQuL';160;0.10;0.10;2;53;;2
-8;'HNQIS-ICM-I&PE-170';'HNQIS-ICM-I&PE-Inq-170-Provider asks if there is difficulty in breathing, fast breathing, wheezing .';;'Provider asks if there is difficulty in breathing, fast breathing, wheezing .';'<p><strong>Ask for difficulty breathing: </strong>Difficult breathing with or without cough is the main presenting symptom of pneumonia. Assess the child with difficult breathing for pneumonia.<br /><strong>Ask if there if fast breathing:</strong> Fast breathing is a sign of pneumonia.<br /><strong>Ask if the child is wheezing: </strong>The commonest cause of wheezing is asthma.</p>';'cHaoGgBRQ80';170;0.10;0.10;2;53;;2
-9;'HNQIS-ICM-I&PE-180';'HNQIS-ICM-I&PE-Inq-180-Provider asks whether mother or other family or community members have cough';;'Provider asks whether mother or other family or community members have cough';'<p><strong>Ask whether there is a close contact with cough</strong><br />Air-borne transmission of Tuberculosis, pneumonia and other infectious lung diseases occur from close contact with patients with active pulmonary tuberculosis. Enquire further if the duration of coughed is more than 14 days, or if they are known to have Tuberculosis (TB) disease. Screen the child for TB if there is a contact with confirmed TB or person with chronic cough even when cough is not the primary presenting problem in the child.</p>';'bmwgoQyMRr3';180;0.10;0.10;2;53;;2
-10;'HNQIS-ICM-I&PE-190';'HNQIS-ICM-I&PE-Inq-190-Provider asks about diarrhoea';;'Provider asks about diarrhoea';'<p><strong>Ask about diarrhoea in ALL children</strong><br />Diarrhoea is presence of 3 or more loose or watery stools in a 24-hour period.<br />Diarrhoea is a main symptom and must be asked. The other main symptoms are cough or difficulty breathing, fever and ear problem.<br />A child with diarrhoea will require assessment for dehydration. A feeding history should also be sought in a child with diarrhoea.<br /><strong>Ask about duration of diarrhoea</strong><br />Diarrhoea present for more than 14 days is persistent diarrhoea. Children with persistent diarrhoea are at risk of malnutrition. Therefore, in addition to managing dehydration if present, you will have to counsel the mother how to feed the child.</p>';'qdU16BGOLDw';190;0.10;0.10;2;53;;2
-11;'HNQIS-ICM-I&PE-200';'HNQIS-ICM-I&PE-Inq-200-Provider asks whether the stool contains blood or mucus.';;'Provider asks whether the stool contains blood or mucus.';'<p><strong>Ask whether stool contains blood or mucus</strong></p><ul><li>Blood in stool with or without mucus is a sign of dysentery.</li></ul><p>A child with dysentery will require an antibiotic in addition to fluids, zinc and vitamin A. Vitamin A is indicated if the diarrhoea is persistent.</p><ul><li>Mucus in stool may be a sign of amoebiasis or giardiasis.</li></ul>';'wj7KpcVPI9N';200;0.10;0.10;2;53;;2
-12;'HNQIS-ICM-I&PE-210';'HNQIS-ICM-I&PE-Inq-210-Provider asks about fever – is there a pattern, duration, associated chills and/or rigors';;'Provider asks about fever – is there a pattern, duration, associated chills and/or rigors';'<p><strong>Ask about:</strong><br /><strong>Presence of fever:</strong> Fever is a main symptom in children and must be asked in ALL children. (The other main symptoms in children are cough or difficuty breathing, diarrhoea and ear problem.) <br />Fever maybe a sign of malaria and you need to determine the malaria risk.</p><ul><li>Decide the malaria risk whether high or low depending on the locality the child comes from.</li><li>Ask if the child has traveled to a high malaria risk area in the last 2 weeks.</li></ul><p><strong>Pattern of fever: </strong>Periodic fevers occuring every 48-72 hours may occur in malaria depending on the species, but may not always occur in <em>falciparum</em> malaria. In typhoid fever, the fever rises in a step-wise manner.<br /><strong>Duration of fever:</strong> If fever has been present more than 7 days, ask if the fever has been present everyday. A child with fever more than 7 days may have a severe illness such as typhoid fever.<br /><strong>Are there associated chills and/or rigors: </strong>The classic pattern of malaria begins with a period of chills/rigors which last for about 1-2 hours then followed by fever.</p><p>If there is history of fever, it is also important to ask for symptoms of measles in the last 3 months or if the child has had measles in the last 3 months (generalized rash <strong>and </strong>cough, runny nose or red eyes).<br />Presence or absence of fever and associated symptoms will guide you to making a diagnosis.</p>';'QEGSLxUwLEA';210;0.10;0.10;2;53;;2
-13;'HNQIS-ICM-I&PE-220';'HNQIS-ICM-I&PE-Inq-220-Provider ask for HIV positivity in mother or child';;'Provider ask for HIV positivity in mother or child';'<p><strong>Ask for HIV status of mother and child</strong><br />Ask the mother if she knows her HIV status. If she is HIV positive, determine the status of the child as per protocol.</p><ul><li>For a known HIV positive child, plan to treat, counsel and follow up for existing conditions and enrol or refer for enrolment for HIV care as per the protocols of HIV management in children if not already on ART.</li><li>If the child''s status is unknown, test the child.</li><li>If HIV exposed, offer treatment or refer for treatment as per the protocols for the HIV exposed.</li></ul>';'a0gVksA1Kcm';220;0.10;0.10;2;53;;2
-14;'HNQIS-ICM-I&PE-230';'HNQIS-ICM-I&PE-Phy Ex-230-Provider checks whether the patient is awake .If the patient is not awake, checks for consciousness/lethargy (try to wake)';;'Provider checks whether the patient is awake .If the patient is not awake, checks for consciousness/lethargy (try to wake)';'<p><strong>Check whether the patient is awake, check for consciounsness/lethargy</strong><br />Try to wake the child. A child unable to be awoken is unconscious. A lethargic child looks weak and is not interested in the surroundings. Unconsciousness or lethargy are danger signs that require urgent attention.</p><ul><li>If the child is brought in convulsing or convulses at the facility, give diazepam.</li><li>Complete the rest of the assessment and any pre-referral treatment immediately, treat to prevent low sugar, keep warm and refer urgently.</li></ul><p><a href="https://www.youtube.com/watch?v=hNhLYQeGHRo&feature=player_detailpage">Checking for danger signs</a></p>';'qgpYXcecVJM';230;0.14;0.14;3;53;;3
-15;'HNQIS-ICM-I&PE-240';'HNQIS-ICM-I&PE-Phy Ex-240-Provider checks for signs of malnutrition – visible emaciation (marasmus or kwashiorkor), pallor (anemia), oedema. Measure MUAC';;'Provider checks for signs of malnutrition – visible emaciation (marasmus or kwashiorkor), pallor (anemia), oedema. Measure MUAC';'<p><strong>Check for signs of malnutrition and anaemia in ALL children</strong><br />A child may not have specific symptoms that point to malnutrition or anaemia and a mother may not have noticed the child to be malnourished.</p><ul><li><strong>Check for visible emaciation</strong> which is a sign of marasmus</li><li><strong>Check for palmar pallor</strong> which is a sign of anaemia. Classify pallor to severe or some pallor</li><li><strong>Check for oedema</strong> of both feet which is a sign of kwashiorkor. Check for other signs of kwashiorkor which include dry, scaly skin, hair changes, puffy or moon face</li></ul><p><img src="file:///android_asset/feedback/sample.jpg"></p><ul><li><strong>Measure MUAC in a child more than 6 months.</strong> MUAC is a quick and easy way to assess nutritional status even in a very sick child <img src="file:///android_asset/feedback/sample.jpg"></li></ul><p>All the above signs are required for classification of acute malnutrition to be able to identify the appropriate treatment.</p>';'YpLXsvcPBGs';240;0.14;0.14;3;53;;3
-16;'HNQIS-ICM-I&PE-250';'HNQIS-ICM-I&PE-Phy Ex-250-Provider weighs the patient. Checks weight on a growth chart.';;'Provider weighs the patient. Checks weight on a growth chart.';'<p><strong>Weigh all children during ALL visits and chart weight on a growth chart</strong><br />Weight is important for determining the growth pattern of the child. It is also used to determine whether the child has acute malnutrition using WFH/L z scores<br />To determine the growth:</p><ul><li>Calculate age of the child in months</li><li>Find a point on the chart where the line for the child''s age meets the line for the child''s weight:<ul><li>If the point is <em>below the bottom curve</em>, the child is very low weight for age</li><li>If the point is <em>on or above the bottom curve</em>, the child is <strong>not</strong> very low weight for age</li></ul></li><li>Determine if the growth is faltering by the curve flattening/dropping for at least 2 consecutive months.</li></ul><p>For very low weight children and growth faltering, pay special attention to the feeding and treat any underlying illnesses.</p>';'CyMbNyWfZh6';250;0.14;0.14;3;53;;3
-17;'HNQIS-ICM-I&PE-260';'HNQIS-ICM-I&PE-Phy Ex-260-Provider assesses the respiratory system – counts breaths, checks for chest indrawing, stridor, wheezing, listens to breath sounds.';;'Provider assesses the respiratory system – counts breaths, checks for chest indrawing, stridor, wheezing, listens to breath sounds.';'<p><strong>In any child with cough or difficult breathing assess the respiratory system.<br />Count breaths per minute</strong></p><ul><li>Count the breaths in one minute to determine if there is fast breathing. Fast breathing is a sign of pneumonia. Count the breaths when the child is calm.</li></ul><p><em><u>Fast Breathing rates</u></em><br /><em>-From birth up to 2 months: 60 breaths per minute or more<br />-2 months up to 12 months: 50 breaths per minute or more<br />-12months up to 5 years: 40 breaths per minute or more</em></p><ul><li><strong>Check for chest in drawing</strong><ul><li>Chest in drawing is a sign of pneumonia. Observe if there is any inward movement of the lower chest wall when the baby is breathing in.</li></ul></li><li><strong>Listen to the breath sounds</strong><ul><li>Listen to breath sounds to be able to determine presence, and differentiate wheezing from stridor.Stridor (occurs during inspiration) while wheezing (occurs during expiration). Stridor in a calm child is a sign of severe pneumonia and may also indicate airway obstruction. Asthma is the commonest cause of wheezing.</li></ul></li></ul><p>If wheezing with either fast breathing or chest indrawing: Give a trial of rapid acting inhaled bronchodilator for up to three times 15-20 minutes apart. Count the breaths and look for chest indrawing again, and then classify.</p>';'tBJfygM3V5Q';260;0.14;0.14;3;53;;3
-18;'HNQIS-ICM-I&PE-270';'HNQIS-ICM-I&PE-Phy Ex-270-Provider checks for dehydration – looks for sunken eyes, pinches the skin, offers the patient water if awake.';;'Provider checks for dehydration – looks for sunken eyes, pinches the skin, offers the patient water if awake.';'<p><strong>Check for signs of dehydration in ALL childrem with diarrhoea</strong><br/>&bull;<strong>Check for sunken eyes.</strong> Sunken eyes is one of the signs of dehydration.If you are not sure whether the eyes are sunken, ask the mother if the child''s eye appear unsual. Sunken fontanel is a sign of severe dehydration.<br/>&bull;<strong>Pinch the skin of the abdomen</strong> and determine if the skin pinch returns very slowly, longer than 2 seconds (one of the signs of severe dehydration) or slowly (one of the signs of some dehydration) (picture of how to do skin pinch).<br/>&bull;<strong>Check ability to drink.</strong> Offer the child fluid and determine if the child is able to drink or not,drinking poorly or drinking eagerly/thirsty. Drinking poorly or not able to drink is one of the signs of severe dehydration. Drinking eargerly or thirsty child is one of the signs of some dehydration.<br/>Use the signs to classify dehydration to be able to identify the best rehydration plan.<br /><a href="https://www.youtube.com/watch?v=2XHpSgiE7OE&feature=player_detailpage">Assessing a child with diarrhoea</a></p>';'y2gAYUNyyrx';270;0.14;0.14;3;53;;3
-19;'HNQIS-ICM-I&PE-280';'HNQIS-ICM-I&PE-Phy Ex-280-Provider checks the temperature.';;'Provider checks the temperature.';'<p><strong>Check temperature in ALL children to determine if there is fever</strong></p><p>Axillary temperature above 37.5&deg;C is fever and below 35.5&deg;C is hypothermia.</p><ul><li>If fever is present, examine for measles, stiff neck, runny nose or other causes of fever.</li><li>Take blood sample for malaria testing if determined to have malaria risk on the inquiry.</li><li>Give paracetamol for fever above 38.5 and expose the child.</li></ul><p>Classify the illness to be able to identify treatment as per the guidelines.</p>';'PgBXw3hxzjZ';280;0.14;0.14;3;53;;3
-20;'HNQIS-ICM-I&PE-290';'HNQIS-ICM-I&PE-Phy Ex-290-Provider takes blood sample for rapid diagnostic test or microscopy in the laboratory.';;'Provider takes blood sample for rapid diagnostic test or microscopy in the laboratory.';'<p><strong>For determined high malaria risk, take a blood sample for testing for malaria.</strong><br />Malaria must be confirmed parasitologicaly using Rapid Diagnostic Testing (RDT) or microscopy in the laboratory <strong>before giving any antimalarials</strong>. Giving antimalarials without testing leads to unnecessary ACT use which is expensive, may lead to early ACT resistance and leads to delay in investigating the patient for the real cause of fever.</p>';'NodHHmDmNkE';290;0.14;0.14;3;53;;3
-21;'HNQIS-ICM-D,T&C-100';'HNQIS-ICM-D,T&C-Diag1-100-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'fz5MTTsOTA1';100;0.00;0.00;4;49;;
-22;'HNQIS-ICM-D,T&C-110';'HNQIS-ICM-D,T&C-Diag1-110-Diagnosis 1 based on supervisor''s observation';;'Diagnosis 1 based on supervisor''s observation';;'h8jxRGcOqLf';110;0.00;0.00;4;50;;
-23;'HNQIS-ICM-D,T&C-120';'HNQIS-ICM-D,T&C-Diag1-120-Treatment 1 administered';;'Treatment 1 administered';;'r1BTbbj12cu';120;0.00;0.00;4;51;;
-24;'HNQIS-ICM-D,T&C-130';'HNQIS-ICM-D,T&C-Diag1-130-Does diagnosis 1 match treatment 1?';;'Does diagnosis 1 match treatment 1?';'<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyekZKazRkVkdndWM">Diagnosis Matrix</a><br /><br />
-<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyZ1JsZ3ZZME55dTQ">Treatment Matrix</a>';'M0dwjE6TviV';130;0.25;0.25;4;89;;4
-25;'HNQIS-ICM-D,T&C-140';'HNQIS-ICM-D,T&C-Diag1-140-COUNSELING';;'COUNSELING';;'lgpaUPiyzCD';140;0.00;0.00;4;49;;
-26;'HNQIS-ICM-D,T&C-150';'HNQIS-ICM-D,T&C-Diag1-150-Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel the mother on the number of doses to give the child per day. This will ensure that she does not underdose or overdose the child.</li><li>Counsel the mother on the total number of days of treatment. If this is not explained, the mother may stop giving the medication when she sees that the child seems better. This may lead to recurrence of the illness and/or development of drug resistance.</li><li>Explain the side effects. This will ensure that the mother does not stop treatment due to an otherwise minor side effect.The mother should also be informed of the severe side effects that will require her to bring the child back hospital.</li></ul>';'ZUbFS8Sn9VK';150;0.25;0.25;4;53;;4
-27;'HNQIS-ICM-D,T&C-160';'HNQIS-ICM-D,T&C-Diag1-160-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<p><strong>Always start the first dose of oral medication on site</strong></p><ul><li>Starting the oral medication immediately will prevent worsening of the disease.</li><li>The provider is able to assess if the child retains oral drugs. If the child vomits before 30 minutes are over after giving the drug, repeat the dose.</li><li>The provider is able to demonstrate and teach the mother or caregiver how to administer the drug at home and to check her understanding.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'m1jEwtOohjp';160;0.25;0.25;4;53;;4
-28;'HNQIS-ICM-D,T&C-170';'HNQIS-ICM-D,T&C-Diag1-170-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advice the mother that the child may need referral if the child''s condition worses</strong></p><ul><li>Explain to the mother that at times sick children may worsen or not respond to the drugs even after correct treatment is given.</li><li>Discuss with the mother the various tertiary facility options in case referral is needed, calm any fears she may be having and resolve any problems.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transfered to the referral hospital.</li></ul>';'fDe9e9mBb4r';170;0.25;0.25;4;53;;4
-29;'HNQIS-ICM-D,T&C-180';'HNQIS-ICM-D,T&C-Diag2-180-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'dMmQivtqMHQ';180;0.00;0.00;5;49;;
-30;'HNQIS-ICM-D,T&C-190';'HNQIS-ICM-D,T&C-Diag2-190-Was a second diagnosis made?';;'Was a second diagnosis made?';'<p>A child may have more than 1 illness. If a second illness is present, make a second diagnosis to be able treat each illness identified correctly.</p>';'d2o7cifME4z';190;0.00;0.00;5;53;;5
-31;'HNQIS-ICM-D,T&C-200';'HNQIS-ICM-D,T&C-Diag2-200-Diagnosis 2 based on supervisor''s observation';;'Diagnosis 2 based on supervisor''s observation';;'QnFBHcybOXC';200;0.00;0.00;5;50;30;
-32;'HNQIS-ICM-D,T&C-210';'HNQIS-ICM-D,T&C-Diag2-210-Treatment 2 administered';;'Treatment 2 administered';;'fLfac9AuABJ';210;0.00;0.00;5;51;30;
-33;'HNQIS-ICM-D,T&C-220';'HNQIS-ICM-D,T&C-Diag2-220-Does diagnosis 2 match treatment 2?';;'Does diagnosis 2 match treatment 2?';'<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyekZKazRkVkdndWM">Diagnosis Matrix</a><br /><br />
-<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyZ1JsZ3ZZME55dTQ">Treatment Matrix</a>';'gWrt5jLpQHY';220;0.25;0.25;5;89;30;5
-34;'HNQIS-ICM-D,T&C-230';'HNQIS-ICM-D,T&C-Diag2-230-COUNSELING';;'COUNSELING';;'nLtnatD5p07';230;0.00;0.00;5;49;30;
-35;'HNQIS-ICM-D,T&C-240';'HNQIS-ICM-D,T&C-Diag2-240-Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel the mother that the child has 2 different illnesses. Counsel on each medication for each illness separately.</li><li>Counsel the mother on the number of doses to give the child per day. This will ensure that she does not underdose or overdose the child.</li><li>Counsel the mother on the total number of days of treatment. If this is not explained, the mother may stop giving the medication when sees that the child seems better. This may lead to recurrence of the illness and/or development of drug resistance.</li><li>Explain the side effects.This will ensure that the mother does not stop treatment due to an otherwise minor side effect. The mother should also be informed of the severe side effects that will require her to bring the child back to hospital.</li></ul>';'Nj2upW78aPs';240;0.25;0.25;5;53;30;5
-36;'HNQIS-ICM-D,T&C-250';'HNQIS-ICM-D,T&C-Diag2-250-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<p><strong>Always start the first dose of oral medication on site.</strong></p><ul><li>Starting the oral medication immediately will prevent worsening of the disease.</li><li>The provider is able to assess if the child retains oral drugs. If the child vomits before 30 minutes are over after giving the drug, repeat the dose.</li><li>The provider is able to demonstrate and teach the mother or caregiver how to administer the drug at home and to check her understanding.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'q45wkwfepMR';250;0.25;0.25;5;53;30;5
-37;'HNQIS-ICM-D,T&C-260';'HNQIS-ICM-D,T&C-Diag2-260-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advice the mother that the child may need referral if the child''s condition worsens</strong></p><ul><li>Explain to the mother that at times sick children may worsen or not respond to the drugs even after correct treatment is given.</li><li>Discuss with the mother the various tertiary facility options in case referral is needed, calm any fears she may be having and resolve any problems.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transfered to the referral hospital.</li></ul>';'AL4VpR0VjHm';260;0.25;0.25;5;53;30;5
-38;'HNQIS-ICM-D,T&C-270';'HNQIS-ICM-D,T&C-Diag3-270-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'VBba0bWJEP1';270;0.00;0.00;6;49;;
-39;'HNQIS-ICM-D,T&C-280';'HNQIS-ICM-D,T&C-Diag3-280-Was a third diagnosis made?';;'Was a third diagnosis made?';'<p>A child may have more than 2 illnesses. Identify each ot the diagnoses separately to be able to assess, classify and treat each illness correctly.</p>';'lI97dA4gYzG';280;0.00;0.00;6;53;;6
-40;'HNQIS-ICM-D,T&C-290';'HNQIS-ICM-D,T&C-Diag3-290-Diagnosis 3 based on supervisor''s observation';;'Diagnosis 3 based on supervisor''s observation';;'PGMv3dw2BYd';290;0.00;0.00;6;50;39;
-41;'HNQIS-ICM-D,T&C-300';'HNQIS-ICM-D,T&C-Diag3-300-Treatment 3 administered';;'Treatment 3 administered';;'ahTgXn992wv';300;0.00;0.00;6;51;39;
-42;'HNQIS-ICM-D,T&C-310';'HNQIS-ICM-D,T&C-Diag3-310-Does diagnosis 3 match treatment 3?';;'Does diagnosis 3 match treatment 3?';'<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyekZKazRkVkdndWM">Diagnosis Matrix</a><br /><br />
-<a href="https://drive.google.com/open?id=0BwFVG9gNmqDyZ1JsZ3ZZME55dTQ">Treatment Matrix</a>';'vgG9mXhJ8UZ';310;0.25;0.25;6;89;39;6
-43;'HNQIS-ICM-D,T&C-320';'HNQIS-ICM-D,T&C-Diag3-320-COUNSELING';;'COUNSELING';;'hZ5lgYcLuO3';320;0.00;0.00;6;49;39;
-44;'HNQIS-ICM-D,T&C-330';'HNQIS-ICM-D,T&C-Diag3-330-Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of  doses/days, side effects)';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel the mother that the child has 3 different illness. Counsel on each medication for each of the illness separately.</li><li>Counsel the mother on the number of doses to give the child per day.This will ensure that she does not underdose or overdose the child.</li><li>Counsel the mother on the total number of days of treatment. If this is not explained to the mother, she may stop giving the medication when sees that the child seems better. This may lead to recurrence of the illness and/or development of drug resistance.</li><li>Explain the side effects.This will ensure that the mother does not stop treatment due to an otherwise minor side effect.The mother should also be informed of the severe side effects that will require her to bring the child back to hospital.</li></ul>';'aiMMvuriqGI';330;0.25;0.25;6;53;39;6
-45;'HNQIS-ICM-D,T&C-340';'HNQIS-ICM-D,T&C-Diag3-340-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<p><strong>Always start the first dose of oral medication on site</strong></p><ul><li>Starting the oral medication immediately will prevent worsening of the disease.</li><li>The provider is able to assess if the child retains oral drugs. If the child vomits before 30 minutes are over after giving the drug, repeat the dose.</li><li>The provider is able to demonstrate and teach the mother or caregiver how to administer the drug at home and to check her understanding.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'NiAXMnXDbXu';340;0.25;0.25;6;53;39;6
-46;'HNQIS-ICM-D,T&C-350';'HNQIS-ICM-D,T&C-Diag3-350-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advice the mother that the child may need referral if the child''s condition worsens</strong></p><ul><li>Explain to the mother that at times sick children may worsen or not respond to the drugs even after correct treatment is given.</li><li>Discuss with the mother the various tertiary facility options in case referral is needed, calm any fears she may be having and resolve any problems.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transfered to the referral hospital.</li></ul>';'qMtzqKvfc9H';350;0.25;0.25;6;53;39;6
-48;'HNQIS-ICM-I&PE-300';'HNQIS-ICM-RDT-RDT-110-Assembles new test packet, swab, buffer, pipette, lancet and gloves';;'Assembles new test packet, swab, buffer, pipette, lancet and gloves';'<p><strong>Assemble all equipment and supplies required before starting the test procedure</strong></p><ul><li>This saves time by avoiding unnecessary movements looking for supplies after starting the procedure.</li><li>Reduces the risk of sharps injuries caused by reaching out for objects.</li><li>Ensures there is no movement during the test procedure that might prolong the time for performing the test leading to inaccurate results.</li></ul>';'IJebXactxMg';300;0.03;0.03;59;53;;7
-49;'HNQIS-ICM-I&PE-310';'HNQIS-ICM-RDT-RDT-120-Puts a new pair of gloves';;'Puts a new pair of gloves';'<p><strong>Put on a new pair of gloves for each patient</strong></p><ul><li>Gloves will protect you and the patient from contracting blood-borne diseases such as HIV, Hepatitis B among others.</li><li>A <strong>new</strong> pair of gloves will protect the second patient from exposure to infections from the first patient.</li></ul>';'eCPVti0KQtG';310;0.07;0.07;59;53;;7
-50;'HNQIS-ICM-I&PE-320';'HNQIS-ICM-RDT-RDT-130-(i) Checks expiry date on package (ii) checks dessicant satchet is still dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';;'(i) Checks expiry date on package (ii) checks dessicant satchet is still dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';'<p>(i) <strong>Always check the expiry date on the RDT package</strong>-an expired RDT kit will give incorrect results.<br/>(ii) <strong>Check if dessicant satchet is dry</strong>-A wet dessicant means the RDT has been exposed to excessive moisture and therefore is damaged. A damaged RDT will give incorrect results.<br/>(iii) <strong>Always write the patient''s name or ID on cassette</strong>- This will avoid mix up of results with other patients and prevents giving a patient incorrect results.<br/>(iv)<strong> Place cassette on a level surface</strong>- a tilted surface will interfere with the lateral flow of blood and buffer during the test and will result in incorrect results.</p>';'PZBDgiokcy5';320;0.03;0.03;59;53;;7
-51;'HNQIS-ICM-I&PE-330';'HNQIS-ICM-RDT-RDT-140-Cleans finger with antiseptic/ alcohol';;'Cleans finger with antiseptic/ alcohol';'<p><strong>Clean finger with antiseptic/alcohol before pricking</strong><br />Antiseptic/alcohol kills bacteria on the finger surface. This prevents introduction of infection into the tissues when pricking the finger to obtain a blood sample. <img src="file:///android_asset/feedback/sample.jpg"></p>';'iAKFd68uxJ2';330;0.07;0.07;59;53;;7
-52;'HNQIS-ICM-I&PE-340';'HNQIS-ICM-RDT-RDT-150-Allows finger to dry before pricking it';;'Allows finger to dry before pricking it';'<p><strong>Allow alcohol/antiseptic to dry before pricking finger</strong><br />Alcohol/antiseptic hemolyzes blood. Hemolyzed blood will not give correct results and will lead to misdiagnosis.</p>';'ckbv6XI6MkH';340;0.03;0.03;59;53;;7
-53;'HNQIS-ICM-I&PE-350';'HNQIS-ICM-RDT-RDT-160-Use a sterile lancet for finger pricking';;'Use a sterile lancet for finger pricking';'<p><strong>Use a sterile lancet for every patient</strong><br/>Prevents cross-infecting a patient with blood borne diseases such as HIV or Hepatitis B from a contaminated lancet.</p>';'TdnnCfPjvtG';350;0.07;0.07;59;53;;7
-54;'HNQIS-ICM-I&PE-360';'HNQIS-ICM-RDT-RDT-170-Puncture the side of the ball of the finger';;'Puncture the side of the ball of the finger';'<p><strong>Puncture the side of the ball of the finger NOT the tip</strong><br/>A puncture to the side of the ball of the finger is less painful than a puncture to the finger tip.</p>';'i2zxoS0DryK';360;0.03;0.03;59;53;;7
-55;'HNQIS-ICM-I&PE-370';'HNQIS-ICM-RDT-RDT-180-Provider disposes of lancent in sharps bin immediately after pricking finger';;'Provider disposes of lancent in sharps bin immediately after pricking finger';'<p><strong>Dispose off used lancet in sharps bin immediately after pricking finger</strong><br />This will prevent accidental sharps injuries to you and others which may occur if lancets are not disposed off immediately.</p>';'Yh8vdkFpFp6';370;0.07;0.07;59;53;;7
-56;'HNQIS-ICM-I&PE-380';'HNQIS-ICM-RDT-RDT-190-Collect blood with the enclosed pipette making sure to fill close to the first cross line';;'Collect blood with the enclosed pipette making sure to fill close to the first cross line';'<p><strong>Collect blood using the enclosed pipette and fill close to the first cross line</strong><br/>Using the enclosed pipette ensures the correct amount of blood is collected. Using too little or too much blood can cause the test kit to give an incorrect result.<br/><img src="file:///android_asset/feedback/sample.jpg"></p>';'Nw0FlpudQSx';380;0.03;0.03;59;53;;7
-57;'HNQIS-ICM-I&PE-390';'HNQIS-ICM-RDT-RDT-200-Using a pipette, blots blood onto the pad in the correct well';;'Using a pipette, blots blood onto the pad in the correct well';'<p><strong>Use pipette to deliver the correct amount of blood into the correct well and blot blood onto the pad</strong></p><ul><li>Putting blood into the wrong well will give in incorrect results.</li><li>The blood needs to reach and be absorbed by the pad at the bottom of the well for the test to work correctly.</li></ul>';'ZrV0L9IyAdO';390;0.07;0.07;59;53;;7
-58;'HNQIS-ICM-I&PE-400';'HNQIS-ICM-RDT-RDT-210-Disposes of pipette in sharps container immediately';;'Disposes of the used pipette in the sharps container immediately after use';'<p><strong>Dispose off used pipette into the sharps container immediately after use</strong><br/>This will prevent contamination of surfaces with blood which may lead to transmission of blood borne diseases to you or others.</p>';'EbC9h6WYDOI';400;0.03;0.03;59;53;;7
-59;'HNQIS-ICM-I&PE-410';'HNQIS-ICM-RDT-RDT-220-Dispense correct number of drops of clearing buffer into the correct well';;'Dispense correct number of drops of the buffer into the correct well';'<p><strong>Add the specified amount of buffer into the correct well</strong><br/>The test will not work correctly if too much or too little buffer is added. Adding buffer in the wrong well will also give in an invalid result.</p>';'b3qdNHErmhv';410;0.07;0.07;59;53;;7
-60;'HNQIS-ICM-I&PE-420';'HNQIS-ICM-RDT-RDT-230-Wait correct time before reading results';;'Wait correct time before reading results';'><p><strong>Read the results within the specified time</strong><br/>Reading the results before or after the recommended time will result in interpretation of incorrect results.</p>';'jV7UOCiFVOq';420;0.07;0.07;59;53;;7
-61;'HNQIS-ICM-I&PE-430';'HNQIS-ICM-RDT-RDT-240-Read the results test correctly';;'Read the test results correctly';'<p><strong>Use job aids to enable you intepret results correctly</strong><br/>If you do not read results correctly, the patient will not get the correct treatment. Understand what each line means:</p><ul><li>Line at Control Line position AND Line at Test Line position = Positive (the result is positive even if the test line is very faint)</li><li>Line at Control Line and NO LINE at Test Line position = negative</li><li>No line at Control Line position BUT line at Test Line = invalid</li><li>No line at Control Line position AND NO LINE at Test Line position = invalid</li></ul><p>A control line must be present for the result to be valid but the control line does not prove that the RDT result is accurate.<br/><img src="file:///android_asset/feedback/sample.jpg"></p>';'TOL9I9EPzYH';430;0.07;0.07;59;53;;7
-62;'HNQIS-ICM-I&PE-440';'HNQIS-ICM-RDT-RDT-250-Record results in the register';;'Record results in the register';'<p><strong>Record ALL results in the register immediately after reading results</strong></p><ul><li>Recording results immediately ensures they are not forgotten</li><li>Ensures records will be available for patient follow up, tracking treatment responses, forecasting and planning for commodities to be used in diagnosis and treatment of malaria, Quality assurance assessment of RDTs and for disease surveillance.</li></ul>';'EGEB9ZwANRu';440;0.03;0.03;59;53;;7
-63;'HNQIS-ICM-I&PE-450';'HNQIS-ICM-RDT-RDT-260-Dispose gloves, wrappers, alcohol swab and dessicant safely';;'Dispose gloves, wrappers, alcohol swab and dessicant safely';'<p><strong>Segregate waste at source and dispose safely</strong><br/>Proper waste segregation at source and disposal ensures infection prevention and safety to you and others.</p>';'fIDsIhGrlvf';450;0.07;0.07;59;53;;7
-64;'HNQIS-ICM-I&PE-460';'HNQIS-ICM-RDT-RDT-270-Should RDT have been undertaken based on symptoms?';;'Should RDT have been undertaken based on symptoms?';'<p><strong>Perform RDT only for suspected malaria cases</strong><br/>Undertake for:</p><ul><li>A patient with fever in a high malaria risk area.</li><li>A patient with fever and history of travel to high risk malaria area in the last 2 weeks.</li><li>A patient with fever and no other symptoms indicative of any other illness in a low risk area.</li></ul><p>Performing unnecessary RDT leads to wastage of resources and delay in reaching a correct diagnosis for a patient with non-malarial fever.</p>';'cUOQpnHePfa';460;0.03;0.03;59;53;;7
-65;'HNQIS-ICM-Work Env-100';'HNQIS-ICM-Work Env-Workplace-100-Adequate water supply (sufficient for outlet operations)';;'Adequate water supply (sufficient for outlet operations)';'<p><strong>Ensure adequate water supply</strong><br/>For infection prevention, ensure adequate water is available for:</p><ul><li>Hand washing before and after procedures</li><li>Cleaning work place</li></ul>';'rZVVWwhNeSo';100;0.20;0.20;8;53;;9
-66;'HNQIS-ICM-Work Env-110';'HNQIS-ICM-Work Env-Workplace-110-Adequate lighting (sufficient for reading test)';;'Adequate lighting (sufficient for reading test)';'<p><strong>Provide adequate lighting for RDT procedure area</strong><br/>Good light is needed to be able to read the test results correctly. In conditions of poor lighting, one may not see the test lines clearly or a faint positive may be missed.</p>';'cIcYxNH0hwI';110;0.20;0.20;8;53;;9
-67;'HNQIS-ICM-Work Env-120';'HNQIS-ICM-Work Env-Workplace-120-Space for conducting RDT (confidentiality)';;'Space for conducting RDT (confidentiality)';'<p><strong>Provide adequate space for conducting RDT</strong></p><ul><li>There should be adequate space to allow client confidentiality and respect for patients'' rights. The space should offer both visual and auditory privacy. This puts the patient at ease.</li><li>Adequate space to perform the test reduces the risk of sustaining sharps injuries.</li></ul>';'qDmVJDqkiI5';120;0.20;0.20;8;53;;9
-68;'HNQIS-ICM-Work Env-130';'HNQIS-ICM-Work Env-Workplace-130-Presence of job aids';;'Presence of job aids';'<p><strong>Have job aids and display them prominently</strong><br/>Job aids act as quick reference points when a provider is performing a test and forgets or is unsure of a step.<br/>The package instructions that come with RDT kits provided by manufacturers may be inadequate or confusing.<br/>Follow instructions on job aids to ensure standardization when performing the test procedure.</p>';'IhDWIeHoY8d';130;0.20;0.20;8;53;;9
-69;'HNQIS-ICM-Work Env-140';'HNQIS-ICM-Work Env-Workplace-140-RDTs stored in a dry place away from direct sunlight';;'RDTs stored in a dry place away from direct sunlight';'<p><strong>Store RDTs away from direct sunlight</strong><br/>RDTs are sensitive to heat. If subjected to hot conditions above those stated by the manufacturer, the RDTs will lose sensitivity before the expiry date indicated on the package.</p>';'w1IUTsrV96s';140;0.20;0.20;8;53;;9
-70;'HNQIS-ICM-Work Env-150';'HNQIS-ICM-Work Env-Equip, Sup, Cons-150-Alcohol, Lancets, Gloves';;'Alcohol, Lancets, Gloves';'<p><strong>Have alcohol, lancets and gloves</strong><br/>Needed to perform RDT procedure safely. Have:</p><ul><li>Alcohol for swabbing finger-prick sites</li><li>Sterile lancets to prevent cross-infections</li><li>Gloves to reduce risk of exposure to potentially infectious material</li></ul>';'TB6ZqZv5ywC';150;0.11;0.11;9;53;;10
-71;'HNQIS-ICM-Work Env-160';'HNQIS-ICM-Work Env-Equip, Sup, Cons-160-Timers, lead/grease pencils, marker pens';;'Timers, lead/grease pencils, marker pens';'<p><strong>Have timers, grease pencils, maker pens</strong></p><ul><li>Timers needed to set the time when test is ready for reading.</li><li>Marker pens, grease pencils needed to label the patient''s RDT kit to prevent a mix-up with other patients'' test kits.</li></ul>';'WcNmIQi4I3o';160;0.11;0.11;9;53;;10
-73;'HNQIS-ICM-Work Env-180';'HNQIS-ICM-Work Env-Equip, Sup, Cons-180-Cotton wool, Disinfectants, Soap';;'Cotton wool, Disinfectants, Soap';'<ul><li>Ensure you always have cotton wool for swabbing fingers with alcohol to supplement the alcohol swabs. This is necessary when the swabs are not adequate.</li><li>Have disinfectants for disinfecting contaminated equipment and work surfaces.</li><li>Have soap for hand washing and cleaning the work place.</li></ul><p>These are needed for infection prevention.</p>';'g30NEDD0PGa';180;0.11;0.11;9;53;;10
-74;'HNQIS-ICM-Work Env-190';'HNQIS-ICM-Work Env-Equip, Sup, Cons-190-Sharps container';;'Sharps container';'<p><strong>Have a sharps container</strong><br/>Use a sharps container to safely dispose off sharps immediately after use to avoid accidental sharps injuries to patients, health providers or cleaners that may occur when the sharps are not disposed off correctly/immediately.</p>';'TwY0fs9KXWm';190;0.11;0.11;9;53;;10
-75;'HNQIS-ICM-Work Env-200';'HNQIS-ICM-Work Env-Equip, Sup, Cons-200-Quality assured RDTs in stock on day of visit';;'Quality assured RDTs in stock on day of visit';'<p><strong>Quality assured RDTs should always be in stock</strong><br/>Quality assured RDTs should always be available so that patients suspected to have malaria can be tested immediately. ACTs should only be given to positively identified malaria cases. This will avoid wastage of ACTs, will prevent emergence of resistance to ACTs and will enable early investigation of non-malarial fever.</p>';'mIX5j7QJNr0';200;0.11;0.11;9;53;;10
-76;'HNQIS-ICM-Work Env-210';'HNQIS-ICM-Work Env-Equip, Sup, Cons-210-Expired RDTs in stock on day of visit';;'Expired RDTs in stock on day of visit';'<p><strong>Do proper stock management</strong></p><ul><li>Adhere to First-to-expire first-out (FEFO) procedures when dispatching RDTs from the store to the provider.</li><li>Establish policy and procedure to manage short-expiry RDTs.</li><li>Avoid overstocking.</li><li>Do proper forecasting to avoid wastage.</li></ul>';'ITUkdyQT0i5';210;0.11;0.11;9;74;;10
-77;'HNQIS-ICM-Work Env-220';'HNQIS-ICM-Work Env-Equip, Sup, Cons-220-RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';;'RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';'<p>Collecting and reporting the total number of days RDTs were out of stock is used to inform resupply decisions and forecast future consumption more accurately. Stock out data is critical for monitoring supply chain performance and highlighting supply gaps that may be present.</p>';'EKetcxeNIrY';220;0.11;0.11;9;74;;10
-78;'HNQIS-ICM-Work Env-230';'HNQIS-ICM-Work Env-Equip, Sup, Cons-230-Quality assured ACTs in stock';;'Quality assured ACTs in stock';'<p><strong>Quality assured ACTs should always be in stock </strong>to ensure that all confirmed cases of malaria are started on ACTs immediately. Prompt treatment of malaria is essential to prevent severe malaria and its complications from developing. Treating complicated malaria is more difficult and a patient with severe or complicated malaria is at a higher risk of dying.</p>';'faI5bhjFAol';230;0.11;0.11;9;53;;10
-79;'HNQIS-ICM-Work Env-240';'HNQIS-ICM-Work Env-Equip, Sup, Cons-240-Expired Quality Assured ACTs in stock on day of visit';;'Expired Quality Assured ACTs in stock on day of visit';'<ul><li>Never dispense an expired drug, it will not work and may cause harm to the patient.</li><li>Adhere to First-to-expire first-out (FEFO) procedures-always dispatch the first to expire ACTs from the store to the provider to avoid ACTs expiring on shelf.</li><li>Establish policy and procedure to manage short -expiry ACTs.</li><li>Order long-expiry ACTs .</li><li>Do not overstock .</li><li>Do proper forecasting to avoid wastage.</li></ul>';'lXsmWQSb6eH';240;0.11;0.11;9;74;;10
-80;'HNQIS-ICM-Work Env-250';'HNQIS-ICM-Work Env-Doc & Rept-250-Logbook/register/record book is present at the outlet';;'Logbook/register/record book is present at the outlet';'<p><strong>Have data entry tools</strong><br/>Record keeping books are essential for documentation purposes. Record books serve as reference points and are source documents for patient follow up, quality assurance visits, disease surveillance and are sources of data for report writing.</p>';'SQS5T6vuSJ0';250;0.25;0.25;10;53;;11
-81;'HNQIS-ICM-Work Env-260';'HNQIS-ICM-Work Env-Doc & Rept-260-The patients details are recorded and organised in legible manner, including date of test is recorded';;'The patients details are recorded and organised in legible manner, including date of test is recorded';'<p>Write legibly, record all patient details including full name,age and date. This will ensure validity of data when being used to inform decision making processes and for planning purposes.</p>';'oSoHZ0Vau0Z';260;0.25;0.25;10;53;;11
-82;'HNQIS-ICM-Work Env-270';'HNQIS-ICM-Work Env-Doc & Rept-270-Results of the tests are recorded/if not test action taken is recorded';;'Results of the tests are recorded/if not test action taken is recorded';'<p><strong>Record all test results regardless of the outcome</strong><br />The number of tests performed guides the estimation of stocks to be ordered for diagnosis and treatment of malaria. The results records also provide data for analysis during quality assurance assessments of RDTs.</p>';'wUY7L45SSfx';270;0.25;0.25;10;53;;11
-83;'HNQIS-ICM-Work Env-280';'HNQIS-ICM-Work Env-Doc & Rept-280-Reports for the weeks preceding the assessment have been submitted';;'Reports for the weeks preceding the assessment have been submitted';'<p><strong>Submit all reports within the specified time</strong><br/>Regular and timely submission of reports enable morbidity surveillance and procurement planning resulting in timely resupply of commodities for diagnosis and treatment.</p>';'R6xFOM433PL';280;0.25;0.25;10;53;;11
-110;'HNQIS-ICM-D,T&C-360';'HNQIS-ICM-D,T&C-Diag3-360-END OF TAB';;'END OF TAB';;;360;0.00;0.00;6;49;;
-111;'HNQIS-ICM-Work Env-290';'HNQIS-ICM-Work Env-Doc & Rept-290-END OF TAB';;'END OF TAB';;;290;0.00;0.00;10;49;;
-112;'HNQIS-ICM-I&PE-490';'HNQIS-ICM-I&PE-RDT-490-END OF TAB';;'END OF TAB';;;490;0.00;0.00;59;49;;
+1;'NG HNQIS ICM.IPE-100';'NG HNQIS ICM.IPE-100-Intro-Provider obtains personal history (incl name, age, address, education, occupation)';;'Provider obtains personal history (incl name, age, address, education, occupation)';'<ul><li><strong>Name:</strong> identification/record keeping.</li><li><strong>Age: </strong>determine drug doses, nutritional status, and growth evaluation.</li><li><strong>Address:</strong> determine if high risk area for certain diseases (e.g. Malaria).</li><li><strong>Education level:</strong> communicate according to patient/parent education level.</li><li><strong>Occupation:</strong> availability of someone to provide day/night home care.</li></ul>';'ZX6aYrcAju8';100;0.00;0.00;1;53;;81
+2;'NG HNQIS ICM.IPE-110';'NG HNQIS ICM.IPE-110-Intro-Provider asks reason for visiting health facility';;'Provider asks reason for visiting health facility';'<p><strong>Determine patient complaints</strong></p><ul><li>Initial visit or follow-up.</li><li>Initial visit: assess, classify and identify treatment.</li><li>Follow-up visit: assess and advise to complete medication, change medication or refer.</li></ul>';'XMZQ0DVJp4l';110;0.00;0.00;1;53;;81
+3;'NG HNQIS ICM.IPE-120';'NG HNQIS ICM.IPE-120-Intro-Provider checks immunization status';;'Provider checks immunization status';'<p><strong>Determine immunization status, provide immunization if necessary</strong></p><ul><li>Immunization offers protection to the child against common potentially life-threatening childhood illnesses.</li><li>Do not miss any opportunity to immunize a child.</li></ul>';'bzpftbqnIFx';120;0.00;0.00;1;53;;81
+4;'NG HNQIS ICM.IPE-130';'NG HNQIS ICM.IPE-130-Inq-Provider asks whether there are lethargy, convulsions/convulsing now';;'Provider asks whether there are lethargy, convulsions/convulsing now';'<ul><li>Convulsions and lethargy are danger signs. A child currently convulsing will require diazepam immediately.</li><li>Complete the rest of the assessment quickly, give any pre-referral treatment urgently and refer without delay.</li></ul>';'dCxDDSd36Jt';130;0.10;0.10;2;53;;82
+5;'NG HNQIS ICM.IPE-140';'NG HNQIS ICM.IPE-140-Inq-Provider asks if the patient can drink or breastfeed.';;'Provider asks if the patient can drink or breastfeed.';'<ul><li>Confirm child''s ability to drink or breastfeed by direct observation.</li><li>Inability to drink or breast feed is a danger sign and requires immediate attention.</li><li>Clear any nasal secretions that might be causing difficulty suckling.</li><li>If still unable to breastfeed or drink, complete the rest of the assessment, give any pre-referral treatments needed and refer immediately.</li></ul>';'F0JLGK4cLsw';140;0.10;0.10;2;53;;82
+6;'NG HNQIS ICM.IPE-150';'NG HNQIS ICM.IPE-150-Inq-Provider asks if there is vomiting.';;'Provider asks if there is vomiting.';'<ul><li>Vomiting everything is a danger sign.</li><li>If unable to retain food, fluids or oral drugs, complete the rest of the assessment quickly, give any pre-referral treatment needed and refer urgently.</li><li>&If vomiting but retaining some food/fluid, plan to give fluids and medication and observe if the child retains before allowing them to go home.</li></ul>';'SUln2Ks2pjQ';150;0.10;0.10;2;53;;82
+7;'NG HNQIS ICM.IPE-160';'NG HNQIS ICM.IPE-160-Inq-Provider asks about frequency & Duration of cough.';;'Provider asks about frequency & Duration of cough.';'<p><strong>Ask if the child is coughing</strong><br/>Cough with or without difficulty breathing is the main presenting symptom of pneumonia. Assess the respiratory system of a child with cough. Determine if pneumonia, common cold, asthma, tuberculosis or other respiratory problem.<br/><strong>Ask about duration of cough</strong><br/>A child with a cough more than 14 days (chronic cough) needs screening for tuberculosis.<br/><strong>Ask about frequency of cough</strong><br/>A child with asthma may cough mainly at night, when exposed to cold, dust, smoke or exercise; but in pneumonia, the cough may not have a particular pattern.</p>';'OLC5KKnsc31';160;0.10;0.10;2;53;;82
+8;'NG HNQIS ICM.IPE-170';'NG HNQIS ICM.IPE-170-Inq-Provider asks if there is difficulty in breathing, fast breathing, wheezing .';;'Provider asks if there is difficulty in breathing, fast breathing, wheezing .';'<p><strong>Ask for difficulty breathing:</strong> Difficult breathing with or without cough is the main presenting symptom of pneumonia.<br /><strong>Ask if there if fast breathing:</strong> Fast breathing is one of the signs needed to classify pneumonia.<br /><strong>Ask if the child is wheezing:</strong> The commonest cause of wheezing is asthma</p>';'DeT5KZXqvdq';170;0.10;0.10;2;53;;82
+9;'NG HNQIS ICM.IPE-180';'NG HNQIS ICM.IPE-180-Inq-Provider asks whether mother or other family or community members have cough';;'Provider asks whether mother or other family or community members have cough';'<p>Screen the child for TB if there has been contact with a person with confirmed active pulmonary TB or person with chronic cough, even when cough is not the primary presenting problem in the child.</p>';'YdVDxsii0pN';180;0.10;0.10;2;53;;82
+10;'NG HNQIS ICM.IPE-190';'NG HNQIS ICM.IPE-190-Inq-Provider asks about diarrhoea';;'Provider asks about diarrhoea';'<p><strong>Diarrhoea is presence of 3 or more loose or watery stools in a 24-hour period.</strong></p><ul><li>Assess child for dehydration.</li></ul><p><strong>Diarrhoea present for more than 14 days is persistent diarrhoea.</strong></p><ul><li>Children with persistent diarrhoea are at risk of malnutrition.</li><li>Assess feeding history.</li></ul>';'zk5eJ6qYE5k';190;0.10;0.10;2;53;;82
+11;'NG HNQIS ICM.IPE-200';'NG HNQIS ICM.IPE-200-Inq-Provider asks whether the stool contains blood or mucus.';;'Provider asks whether the stool contains blood or mucus.';'<p><strong>Blood in stool with or without mucus is a sign of dysentery.</strong></p><ul><li>A child with dysentery will require an antibiotic in addition to fluids and zinc.</li></ul>';'x3oiH0zunsK';200;0.10;0.10;2;53;;82
+12;'NG HNQIS ICM.IPE-210';'NG HNQIS ICM.IPE-210-Inq-Provider asks about fever – is there a pattern, duration, associated chills and/or rigors';;'Provider asks about fever – is there a pattern, duration, associated chills and/or rigors';'<p><strong>Fever may be a sign of malaria.</strong></p><ul><li>Determine malaria risk.</li></ul><p><strong>Pattern of fever:</strong> Periodic fevers occurring every 48-72 hours may occur in malaria depending on the species, but may not always occur in falciparum malaria. In typhoid fever, the fever rises in a step-wise manner.</p><p><strong>Duration of fever:</strong> If fever has been present more than 7 days, ask if the fever has been present everyday. A child with fever more than 7 days may have a s<strong>evere illness such as typhoid fever.</strong></p><p><strong>Are there associated chills and/or rigors: </strong>The classic pattern of malaria begins with a period of chills/rigors which last for about 1-2 hours then followed by fever.</p><p>If history of fever, ask for symptoms of measles in the last 3 months or if the child has had measles in the last 3 months (generalized rash and cough, runny nose or red eyes).</p>';'yOTgGS5SZ0N';210;0.10;0.10;2;53;;82
+13;'NG HNQIS ICM.IPE-220';'NG HNQIS ICM.IPE-220-Inq-Provider ask for HIV positivity in mother or child';;'Provider ask for HIV positivity in mother or child';'<p><strong>Ask for HIV status of mother and child</strong></p><ul><li>Ask the mother if she knows her HIV status.</li><li>If mother is HIV positive, determine the status of the child.</li><li>For a known HIV positive child, plan to treat, counsel and follow up for existing conditions and enroll or refer for enrolment for HIV care as per the protocols of HIV management in children.</li><li>If HIV exposed, offer treatment or refer for treatment as per the protocols for the HIV exposed.</li></ul>';'IRpREm9pUXI';220;0.10;0.10;2;53;;82
+14;'NG HNQIS ICM.IPE-230';'NG HNQIS ICM.IPE-230-PE-Provider checks whether the patient is awake. If the patient is not awake, checks for consciousness/lethargy (try to wake)';;'Provider checks whether the patient is awake. If the patient is not awake, checks for consciousness/lethargy (try to wake)';'<p>Try to wake the child. A child unable to be awoken is unconscious. A lethargic child looks weak and is not interested in the surroundings. Unconsciousness or lethargy are danger signs that require urgent attention.</p><ul><li>If the child is brought in convulsing or convulses at the facility, give diazepam.</li><li>Complete the rest of the assessment and any pre-referral treatment immediately, treat to prevent low sugar, keep warm and refer urgently.<br /></li></ul>';'jQsc5eqCf9H';230;0.14;0.14;3;53;;83
+15;'NG HNQIS ICM.IPE-240';'NG HNQIS ICM.IPE-240-PE-Provider checks for signs of malnutrition – visible emaciation (marasmus or kwashiorkor), pallor (anemia), oedema. Measure MUAC';;'Provider checks for signs of malnutrition – visible emaciation (marasmus or kwashiorkor), pallor (anemia), oedema. Measure MUAC';'<p>A child may not have specific symptoms that point to malnutrition or anaemia and a care giver may not have noticed the child to be malnourished.</p><ul><li><strong>Check for visible emaciation</strong> which is a sign of marasmus.</li><li><strong>Check for palmar pallor</strong> which is a sign of anaemia. Classify pallor to severe or some pallor.</li><li><strong>Check for oedema</strong> of both feet which is a sign of kwashiorkor. Check for other signs of kwashiorkor which include dry, scaly skin, hair changes, puffy or "moon" face.</li><li><strong>Measure MUAC in a child more than 6 months.</strong> MUAC is a quick and easy way to assess nutritional status even in a very sick child.</li></ul><p>All the above signs are required for classification of acute malnutrition to be able to identify the appropriate treatment</p>';'b3CjCSq9cVk';240;0.14;0.14;3;53;;83
+16;'NG HNQIS ICM.IPE-250';'NG HNQIS ICM.IPE-250-PE-Provider weighs the patient. Checks weight on a growth chart.';;'Provider weighs the patient. Checks weight on a growth chart.';'<ul><li>Weigh the child.</li><li>Calculate age of the child in months.</li><li>Find a point on the chart where the line for the child''s age meets the line for the child''s weight:<ul><li>If the point is below the bottom curve, the child is very low weight for age</li><li>If the point is on or above the bottom curve, the child is not very low weight for age</li></ul></li><li>Determine if the growth is faltering by the curve flattening/dropping for at least 2 consecutive months.</li><li>For very low weight children and growth faltering, pay special attention to the feeding and treat any underlying illnesses.</li></ul>';'guryk2hPKxE';250;0.14;0.14;3;53;;83
+17;'NG HNQIS ICM.IPE-260';'NG HNQIS ICM.IPE-260-PE-Provider assesses the respiratory system – counts breaths, checks for chest indrawing, stridor, wheezing, listens to breath sounds.';;'Provider assesses the respiratory system – counts breaths, checks for chest indrawing, stridor, wheezing, listens to breath sounds.';'<p><strong>Assess respiratory system</strong></p><ul><li>Fast breathing is a sign of pneumonia. Count the breaths when the child is calm.</li></ul><p><strong>Fast Breathing Rates:</strong></p><ul><li>From birth up to 2 months: 60 breaths per minute or more</li><li>2 months up to 12 months: 50 breaths per minute or more</li><li>12months up to 5 years: 40 breaths per minute or more</li><li>Chest in drawing is a sign of pneumonia. Observe if there is inward movement of the lower chest wall when breathing in.</li><li>Listen to breath sounds, determine if there is stridor or wheezing.</li><li>Stridor occurs during inspiration. Stridor in calm child is sign of severe pneumonia and may also indicate airway obstruction.</li><li>Wheezing occurs during expiration. Wheezing is most commonly caused by asthma.<br /></li></ul>';'INYqS1OvpLp';260;0.14;0.14;3;53;;83
+18;'NG HNQIS ICM.IPE-270';'NG HNQIS ICM.IPE-270-PE-Provider checks for dehydration – looks for sunken eyes, pinches the skin, offers the patient water if awake.';;'Provider checks for dehydration – looks for sunken eyes, pinches the skin, offers the patient water if awake.';'<p><strong>Assess for dehydration</strong></p><ul><li>Check for sunken eyes.</li><li>Pinch the skin of the abdomen. Determine if the skin pinch returns very slowly, (longer than 2 seconds) or slowly.</li><li>Check ability to drink.</li><li>Classify dehydration.<br/></li></ul>';'vvqluWcCCNa';270;0.14;0.14;3;53;;83
+19;'NG HNQIS ICM.IPE-280';'NG HNQIS ICM.IPE-280-PE-Provider checks the temperature.';;'Provider checks the temperature.';'<p><strong>Fever is axillary temperature above 37.5°C and hypothermia is below 35.5°C</strong></p><ul><li>If fever is present, examine for measles, stiff neck, runny nose or other causes of fever.</li><li>Take blood sample for malaria testing if determined to have malaria risk.</li><li>Give paracetamol for fever above 38.5 and expose the child.</li><li>Classify the illness, identify treatment as per the guidelines.</li></ul>';'zglcakmSKvF';280;0.14;0.14;3;53;;83
+20;'NG HNQIS ICM.IPE-290';'NG HNQIS ICM.IPE-290-PE-Provider takes blood sample for rapid diagnostic test or microscopy in the laboratory.';;'Provider takes blood sample for rapid diagnostic test or microscopy in the laboratory.';'<p>Parasitological diagnosis of malaria must be confirmed using Rapid Diagnostic Testing (RDT) or microscopy in the laboratory before giving any antimalarial.<br/>Giving antimalarial without testing leads to unnecessary use of ACTs which is expensive; may lead to early ACT resistance; and leads to delay in investigating the patient for the real cause of fever.</p>';'htaErlgpefN';290;0.14;0.14;3;53;;83
+21;'NG HNQIS ICM.DTC-100';'NG HNQIS ICM.DTC-100-Diag1-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'pouTteKBMeu';100;0.00;0.00;4;49;;
+22;'NG HNQIS ICM.DTC-110';'NG HNQIS ICM.DTC-110-Diag1-Diagnosis 1 based on supervisor''s observation';;'Diagnosis 1 based on supervisor''s observation';;'iUsy4tQRUJ4';110;0.00;0.00;4;50;;
+23;'NG HNQIS ICM.DTC-120';'NG HNQIS ICM.DTC-120-Diag1-Treatment 1 administered';;'Treatment 1 administered';;'eBzesW7Rtbn';120;0.00;0.00;4;51;;
+24;'NG HNQIS ICM.DTC-130';'NG HNQIS ICM.DTC-130-Diag1-Does diagnosis 1 match treatment 1?';;'Does diagnosis 1 match treatment 1?';'<a href="https://drive.google.com/open?id=0BxIl9Fv9u436NG1Va2tnNkp6aFk">Diagnosis Matrix</a><br /><br />
+<a href="https://drive.google.com/open?id=0BxIl9Fv9u436UWF5d0dLNFZUNzQ">Treatment Matrix</a>';'l5OBdIAiAm7';130;0.25;0.25;4;89;;86
+25;'NG HNQIS ICM.DTC-140';'NG HNQIS ICM.DTC-140-Diag1-COUNSELING';;'COUNSELING';;'Um9SuxaBx1f';140;0.00;0.00;4;49;;
+26;'NG HNQIS ICM.DTC-150';'NG HNQIS ICM.DTC-150-Diag1-Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel the mother on specific doses per day, total number of days, and potential side effects; including severe side effects that require a return visit to hospital.</li></ul>';'SYPBF0Vjtis';150;0.25;0.25;4;53;;86
+27;'NG HNQIS ICM.DTC-160';'NG HNQIS ICM.DTC-160-Diag1-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<ul><li>Administer first dose of oral medication on site in front of caregiver and wait 30 minutes to ensure retention of drugs. Ensure caregiver understands how to administer at home.</li><li>If patient vomits within 30 minutes, repeat the dose.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'U1WJwLFc3AB';160;0.25;0.25;4;53;;86
+28;'NG HNQIS ICM.DTC-170';'NG HNQIS ICM.DTC-170-Diag1-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advise referral if condition worsens</strong></p><ul><li>Explain to caregiver that child should be taken to tertiary facility if condition worsens.</li><li>Advise on various tertiary facility options.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transferred to the referral hospital.</li></ul>';'Wb0vJfA7swr';170;0.25;0.25;4;53;;86
+29;'NG HNQIS ICM.DTC-180';'NG HNQIS ICM.DTC-180-Diag2-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'Bw1QETTa6oQ';180;0.00;0.00;5;49;;
+30;'NG HNQIS ICM.DTC-190';'NG HNQIS ICM.DTC-190-Diag2-Was a second diagnosis made?';;'Was a second diagnosis made?';'<p>A child may have more than 1 illness. If a second illness is present, make a second diagnosis to be able treat each illness identified correctly.</p>';'HszrU1uNte7';190;0.00;0.00;5;53;;87
+31;'NG HNQIS ICM.DTC-200';'NG HNQIS ICM.DTC-200-Diag2-Diagnosis 2 based on supervisor''s observation';;'Diagnosis 2 based on supervisor''s observation';;'V8VB73kZ4tP';200;0.00;0.00;5;50;30;
+32;'NG HNQIS ICM.DTC-210';'NG HNQIS ICM.DTC-210-Diag2-Treatment 2 administered';;'Treatment 2 administered';;'XNB32M6MTm9';210;0.00;0.00;5;51;30;
+33;'NG HNQIS ICM.DTC-220';'NG HNQIS ICM.DTC-220-Diag2-Does diagnosis 2 match treatment 2?';;'Does diagnosis 2 match treatment 2?';'<a href="https://drive.google.com/open?id=0BxIl9Fv9u436NG1Va2tnNkp6aFk">Diagnosis Matrix</a><br /><br />
+<a href="https://drive.google.com/open?id=0BxIl9Fv9u436UWF5d0dLNFZUNzQ">Treatment Matrix</a>';'TzF6KeyEeP7';220;0.25;0.25;5;89;30;87
+34;'NG HNQIS ICM.DTC-230';'NG HNQIS ICM.DTC-230-Diag2-COUNSELING';;'COUNSELING';;'DNg1vKVrrXW';230;0.00;0.00;5;49;30;
+35;'NG HNQIS ICM.DTC-240';'NG HNQIS ICM.DTC-240-Diag2-Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';'<p><strong>Counsel the mother on both illnesses and medications separately:</strong></p><ul><li>Specific doses per day,</li><li>Total number of days,</li><li>Potential side effects including severe side effects that require a return visit to hospital.</li></ul>';'MCzaZRWH6sa';240;0.25;0.25;5;53;30;87
+36;'NG HNQIS ICM.DTC-250';'NG HNQIS ICM.DTC-250-Diag2-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<ul><li>Administer first dose of oral medication on site in front of caregiver and wait 30 minutes to ensure retention of drugs. Ensure caregiver understands how to administer at home.</li><li>If patient vomits within 30 minutes, repeat the dose.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'Y95mwlBuIe3';250;0.25;0.25;5;53;30;87
+37;'NG HNQIS ICM.DTC-260';'NG HNQIS ICM.DTC-260-Diag2-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advise referral if condition worsens</strong></p><ul><li>Explain to caregiver that child should be taken to tertiary facility if condition worsens.</li><li>Advise on various tertiary facility options.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transferred to the referral hospital.</li></ul>';'Yds3cQUuQs5';260;0.25;0.25;5;53;30;87
+38;'NG HNQIS ICM.DTC-270';'NG HNQIS ICM.DTC-270-Diag3-DIAGNOSIS AND TREATMENT';;'DIAGNOSIS AND TREATMENT';;'mLd9BBtZORK';270;0.00;0.00;6;49;;
+39;'NG HNQIS ICM.DTC-280';'NG HNQIS ICM.DTC-280-Diag3-Was a third diagnosis made?';;'Was a third diagnosis made?';'<p>A child may have more than 2 illnesses. Identify each of the diagnoses separately to be able to assess, classify and treat each illness correctly.</p>';'loUWHTEsDO3';280;0.00;0.00;6;53;;88
+40;'NG HNQIS ICM.DTC-290';'NG HNQIS ICM.DTC-290-Diag3-Diagnosis 3 based on supervisor''s observation';;'Diagnosis 3 based on supervisor''s observation';;'ktZYDILdaqL';290;0.00;0.00;6;50;39;
+41;'NG HNQIS ICM.DTC-300';'NG HNQIS ICM.DTC-300-Diag3-Treatment 3 administered';;'Treatment 3 administered';;'L4rXMs2WbEv';300;0.00;0.00;6;51;39;
+42;'NG HNQIS ICM.DTC-310';'NG HNQIS ICM.DTC-310-Diag3-Does diagnosis 3 match treatment 3?';;'Does diagnosis 3 match treatment 3?';'<a href="https://drive.google.com/open?id=0BxIl9Fv9u436NG1Va2tnNkp6aFk">Diagnosis Matrix</a><br /><br />
+<a href="https://drive.google.com/open?id=0BxIl9Fv9u436UWF5d0dLNFZUNzQ">Treatment Matrix</a>';'j0UJ3UU26QU';310;0.25;0.25;6;89;39;88
+43;'NG HNQIS ICM.DTC-320';'NG HNQIS ICM.DTC-320-Diag3-COUNSELING';;'COUNSELING';;'lp7JD2jZwwa';320;0.00;0.00;6;49;39;
+44;'NG HNQIS ICM.DTC-330';'NG HNQIS ICM.DTC-330-Diag3-Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';;'Provider counsels caregiver on proper dosage (no. of doses/days, side effects)';'<p><strong>Counsel the mother on three different illnesses and medications separately:</strong></p><ul><li>Specific doses per day,</li><li>Total number of days,</li><li>Potential side effects including severe side effects that require a return visit to hospital.</li></ul>';'mwLZoacHTT2';330;0.25;0.25;6;53;39;88
+45;'NG HNQIS ICM.DTC-340';'NG HNQIS ICM.DTC-340-Diag3-Provider gives first dose of oral medicine on site';;'Provider gives first dose of oral medicine on site';'<ul><li>Administer first dose of oral medication on site in front of caregiver and wait 30 minutes to ensure retention of drugs. Ensure caregiver understands how to administer at home.</li><li>If patient vomits within 30 minutes, repeat the dose.</li><li>For children with fever, advise the mother to expose the child and to tepid sponge whenever the child has fever in addition to giving paracetamol.</li></ul>';'LxzDZugMib8';340;0.25;0.25;6;53;39;88
+46;'NG HNQIS ICM.DTC-350';'NG HNQIS ICM.DTC-350-Diag3-Provider advises referral if condition worsens';;'Provider advises referral if condition worsens';'<p><strong>Advise referral if condition worsens</strong></p><ul><li>Explain to caregiver that child should be taken to tertiary facility if condition worsens.</li><li>Advise on various tertiary facility options.</li><li>If a referral is needed, write a comprehensive referral note, give supplies and instructions needed while the child is being transferred to the referral hospital.</li></ul>';'xVYdUxhOkFz';350;0.25;0.25;6;53;39;88
+48;'NG HNQIS ICM.IPE-300';'NG HNQIS ICM.IPE-300-RDT-Assembles new test packet, swab, buffer, pipette, lancet and gloves';;'Assembles new test packet, swab, buffer, pipette, lancet and gloves';'<ul><li>Saves time by avoiding unnecessary movements looking for supplies after starting the procedure.</li><li>Reduces the risk of sharps injuries caused by reaching out for objects.</li><li>Ensures there is no movement during the test procedure that might prolong the time for performing the test leading to inaccurate results.</li></ul>';'X1Iv65lckOJ';300;0.03;0.03;59;53;;84
+49;'NG HNQIS ICM.IPE-310';'NG HNQIS ICM.IPE-310-RDT-Puts a new pair of gloves';;'Puts a new pair of gloves';'<ul><li>Gloves will protect you and the patient from contracting blood-borne diseases such as HIV, Hepatitis B among others.</li><li>A new pair of gloves will protect the second patient from exposure to infections from the first patient.</li></ul>';'HmtBmdbwrKn';310;0.07;0.07;59;53;;84
+50;'NG HNQIS ICM.IPE-320';'NG HNQIS ICM.IPE-320-RDT-(i) Checks expiry date on package (ii) checks dessicant satchet is dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';;'(i) Checks expiry date on package (ii) checks dessicant satchet is dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';'<p>(i)<strong> Always check the expiry date on the RDT package</strong>-an expired RDT kit will give incorrect results.</p><p>(ii) <strong>Check if desiccant sachet is dry</strong>-A wet desiccant means the RDT has been exposed to excessive moisture and therefore is damaged. A damaged RDT will give incorrect results.</p><p>(iii) <strong>Always write the patient''s name or ID on cassette</strong>- This will avoid mix up of results with other patients and prevents giving a patient incorrect results.</p><p>(iv)<strong>Place cassette on a level surface</strong>- a tilted surface will interfere with the lateral flow of blood and buffer during the test and will result in incorrect results.</p>';'wkMQqrykhld';320;0.03;0.03;59;53;;84
+51;'NG HNQIS ICM.IPE-330';'NG HNQIS ICM.IPE-330-RDT-Cleans finger with antiseptic/ alcohol';;'Cleans finger with antiseptic/ alcohol';'<p>Antiseptic/alcohol kills bacteria on the finger surface. This prevents introduction of infection into the tissues when pricking the finger to obtain a blood sample.</p>';'lGtu8MalMSv';330;0.07;0.07;59;53;;84
+52;'NG HNQIS ICM.IPE-340';'NG HNQIS ICM.IPE-340-RDT-Allows finger to dry before pricking it';;'Allows finger to dry before pricking it';'<p>Alcohol/antiseptic hemolyses blood. Hemolysed blood will not give correct results and will lead to misdiagnosis.</p>';'paRa36Fkb0U';340;0.03;0.03;59;53;;84
+53;'NG HNQIS ICM.IPE-350';'NG HNQIS ICM.IPE-350-RDT-Use a sterile lancet for finger pricking';;'Use a sterile lancet for finger pricking';'<p>Prevents cross-infecting a patient with blood borne diseases such as HIV or Hepatitis B from a contaminated lancet.</p>';'cFe1yfFbCmz';350;0.07;0.07;59;53;;84
+54;'NG HNQIS ICM.IPE-360';'NG HNQIS ICM.IPE-360-RDT-Puncture the side of the ball of the finger';;'Puncture the side of the ball of the finger';'<p>A puncture to the side of the ball of the finger is less painful than a puncture to the finger tip.</p>';'u9hgsWuU7KW';360;0.03;0.03;59;53;;84
+55;'NG HNQIS ICM.IPE-370';'NG HNQIS ICM.IPE-370-RDT-Provider disposes of lancent in sharps bin immediately after pricking finger';;'Provider disposes of lancent in sharps bin immediately after pricking finger';'<p>Prevents accidental sharps injuries to you and others which may occur if lancets are not disposed of immediately.</p>';'Uszpq9cNj0D';370;0.07;0.07;59;53;;84
+56;'NG HNQIS ICM.IPE-380';'NG HNQIS ICM.IPE-380-RDT-Collect blood with the enclosed pipette making sure to fill close to the first cross line';;'Collect blood with the enclosed pipette making sure to fill close to the first cross line';'<p>Using the enclosed pipette ensures the correct amount of blood is collected. Using too little or too much blood can cause the test kit to give an incorrect result.</p>';'wxnjYJLh6Ei';380;0.03;0.03;59;53;;84
+57;'NG HNQIS ICM.IPE-390';'NG HNQIS ICM.IPE-390-RDT-Using a pipette, blots blood onto the pad in the correct well';;'Using a pipette, blots blood onto the pad in the correct well';'<ul><li>Putting blood into the wrong well will give incorrect results.</li><li>For test accuracy, blood needs to reach and be absorbed by the pad at the bottom of the well.</li></ul>';'PRTIMtzo4QP';390;0.07;0.07;59;53;;84
+58;'NG HNQIS ICM.IPE-400';'NG HNQIS ICM.IPE-400-RDT-Disposes of the used pipette in the sharps container immediately after use';;'Disposes of the used pipette in the sharps container immediately after use';'<p>Dispose of used pipette into the sharps container immediately after use to prevent contamination of surfaces and transmission of blood borne diseases.</p>';'l7XzFQwPVE6';400;0.03;0.03;59;53;;84
+59;'NG HNQIS ICM.IPE-410';'NG HNQIS ICM.IPE-410-RDT-Dispense correct number of drops of the buffer into the correct well';;'Dispense correct number of drops of the buffer into the correct well';'<p>The test will not work correctly if too much or too little buffer is added. Adding buffer in the wrong well will also give in an invalid result.</p>';'n78vS0IFgXA';410;0.07;0.07;59;53;;84
+60;'NG HNQIS ICM.IPE-420';'NG HNQIS ICM.IPE-420-RDT-Wait correct time before reading results';;'Wait correct time before reading results';'<p><strong>Read the results within the specified time</strong><br />Reading the results before or after the recommended time will result in interpretation of incorrect results.</p>';'abebZreBAKZ';420;0.07;0.07;59;53;;84
+61;'NG HNQIS ICM.IPE-430';'NG HNQIS ICM.IPE-430-RDT-Read the test results correctly';;'Read the test results correctly';'<p><strong>If you do not read results correctly, the patient will not get the correct treatment. Understand what each line means:</strong></p><ul><li>Line at Control Line position AND Line at Test Line position = Positive (the result is positive even if the test line is very faint)</li><li>Line at Control Line and NO LINE at Test Line position = negative</li><li>No line at Control Line position BUT line at Test Line = invalid</li><li>No line at Control Line position AND NO LINE at Test Line position = invalid</li><li>A control line must be present for the result to be valid but the control line does not prove that the RDT result is accurate.</li></ul>';'N8lieqR6DfQ';430;0.07;0.07;59;53;;84
+62;'NG HNQIS ICM.IPE-440';'NG HNQIS ICM.IPE-440-RDT-Record results in the register';;'Record results in the register';'<ul><li>Recording results immediately ensures they are not forgotten.</li><li>Ensures records will be available for patient follow up, tracking treatment responses, forecasting and planning for commodities.</li></ul>';'S3M04ToBrDE';440;0.03;0.03;59;53;;84
+63;'NG HNQIS ICM.IPE-450';'NG HNQIS ICM.IPE-450-RDT-Dispose gloves, wrappers, alcohol swab and dessicant safely';;'Dispose gloves, wrappers, alcohol swab and dessicant safely';'<p>Proper waste segregation at source and disposal ensures infection prevention and safety to you and others.</p>';'C9mhLc7JqFy';450;0.07;0.07;59;53;;84
+64;'NG HNQIS ICM.IPE-460';'NG HNQIS ICM.IPE-460-RDT-Should RDT have been undertaken based on symptoms?';;'Should RDT have been undertaken based on symptoms?';'<p><strong>Perform RDT only for suspected malaria cases to avoid wastage of resources and delayed diagnosis. Undertake for:</strong></p><ul><li>A patient with fever in a high malaria risk area.</li><li>A patient with fever and history of travel to high risk malaria area in the last 2 weeks.</li><li>A patient with fever and no other symptoms indicative of any other illness in a low risk area.</li></ul>';'AdXWpb6zFO2';460;0.03;0.03;59;53;;84
+65;'NG HNQIS ICM.WE-100';'NG HNQIS ICM.WE-100-Workplace-Adequate water supply (sufficient for outlet operations)';;'Adequate water supply (sufficient for outlet operations)';'<p><strong>For infection prevention, ensure adequate water is available for:</strong></p><ul><li>Hand washing before and after procedures</li><li>Cleaning work place</li></ul>';'B1MIrWMtG9B';100;0.20;0.20;8;53;;90
+66;'NG HNQIS ICM.WE-110';'NG HNQIS ICM.WE-110-Workplace-Adequate lighting (sufficient for reading test)';;'Adequate lighting (sufficient for reading test)';'<p><strong>Provide adequate lighting for RDT procedure area</strong><br/>Good light is needed to be able to read the test results correctly. In conditions of poor lighting, one may not see the test lines clearly or a faint positive may be missed.</p>';'XD08Le28CN9';110;0.20;0.20;8;53;;90
+67;'NG HNQIS ICM.WE-120';'NG HNQIS ICM.WE-120-Workplace-Space for conducting RDT (confidentiality)';;'Space for conducting RDT (confidentiality)';'<p><strong>Provide adequate space for conducting RDT</strong></p><ul><li>There should be adequate space to allow client confidentiality and both visual and auditory privacy.</li><li>Adequate space to perform the test reduces the risk of sustaining sharps injuries.</li></ul>';'rOaAJrhipx3';120;0.20;0.20;8;53;;90
+68;'NG HNQIS ICM.WE-130';'NG HNQIS ICM.WE-130-Workplace-Presence of job aids';;'Presence of job aids';'<p><strong>Have job aids and display them prominently</strong><br/>Job aids act as quick reference points and provide standardize procedures for the provider.</p>';'mw8ub2aFWel';130;0.20;0.20;8;53;;90
+69;'NG HNQIS ICM.WE-140';'NG HNQIS ICM.WE-140-Workplace-RDTs stored in a dry place away from direct sunlight';;'RDTs stored in a dry place away from direct sunlight';'<p><strong>RDTs are sensitive to heat</strong><br/>If subjected to hot conditions above those stated by the manufacturer, the RDTs will lose sensitivity before the expiry date indicated on the package.</p>';'uOVBWAL2cxg';140;0.20;0.20;8;53;;90
+70;'NG HNQIS ICM.WE-150';'NG HNQIS ICM.WE-150-ESC-Alcohol, Lancets, Gloves';;'Alcohol, Lancets, Gloves';'<p><strong>To perform RDT procedure safely, have:</strong></p><ul><li>Alcohol for swabbing finger-prick sites</li><li>Sterile lancets to prevent cross-infections</li><li>Gloves to reduce risk of exposure to potentially infectious material</li></ul>';'m8QOuQ7Joiz';150;0.11;0.11;9;53;;91
+71;'NG HNQIS ICM.WE-160';'NG HNQIS ICM.WE-160-ESC-Timers, lead/grease pencils, marker pens';;'Timers, lead/grease pencils, marker pens';'<p><strong>To perform RDT procedure safely, have:</strong></p><ul><li>Alcohol for swabbing finger-prick sites</li><li>Sterile lancets to prevent cross-infections</li><li>Gloves to reduce risk of exposure to potentially infectious material</li></ul>';'N5txGgPPUts';160;0.11;0.11;9;53;;91
+73;'NG HNQIS ICM.WE-170';'NG HNQIS ICM.WE-170-ESC-Cotton wool, Disinfectants, Soap';;'Cotton wool, Disinfectants, Soap';'<p>These are needed for infection prevention.</p><ul><li>Cotton wool to swab fingers with alcohol.</li><li>Disinfectants for decontaminating equipment and work surfaces.</li><li>Soap for hand washing and cleaning the work environment.</li></ul>';'MZLUywe3rQ6';180;0.11;0.11;9;53;;91
+74;'NG HNQIS ICM.WE-180';'NG HNQIS ICM.WE-180-ESC-Sharps container';;'Sharps container';'<p>To safely dispose of sharps immediately after use to avoid injuries to patients, health providers and cleaners.</p>';'xB0byFUCPMY';190;0.11;0.11;9;53;;91
+75;'NG HNQIS ICM.WE-190';'NG HNQIS ICM.WE-190-ESC-Quality assured RDTs in stock on day of visit';;'Quality assured RDTs in stock on day of visit';'<p>Quality assured RDTs should always be in stock for immediate testing and appropriate treatment.</p>';'mJKB8oKf1hG';200;0.11;0.11;9;53;;91
+76;'NG HNQIS ICM.WE-200';'NG HNQIS ICM.WE-200-ESC-Expired RDTs in stock on day of visit';;'Expired RDTs in stock on day of visit';'<ul><li>Adhere to First-to-expire first-out (FEFO) procedures when dispatching RDTs from the store to the provider.</li><li>Establish policy and procedure to manage short -expiry RDTs.</li><li>Avoid overstocking.</li><li>Do proper forecasting to avoid wastage.</li></ul>';'aESz9uxk5zm';210;0.11;0.11;9;74;;91
+77;'NG HNQIS ICM.WE-210';'NG HNQIS ICM.WE-210-ESC-RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';;'RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';'<p>Stock out data is critical for monitoring supply chain performance and highlighting supply gaps that may be present.</p>';'GsrQOI08SaI';220;0.11;0.11;9;74;;91
+78;'NG HNQIS ICM.WE-220';'NG HNQIS ICM.WE-220-ESC-Quality assured ACTs in stock';;'Quality assured ACTs in stock';'<p><strong>Quality assured ACTs should always be in stock</strong> to ensure that all confirmed cases of malaria are started on ACTs immediately, reducing risk of complications and death.</p>';'bv1JTbE2J1n';230;0.11;0.11;9;53;;91
+79;'NG HNQIS ICM.WE-230';'NG HNQIS ICM.WE-230-ESC-Expired Quality Assured ACTs in stock on day of visit';;'Expired Quality Assured ACTs in stock on day of visit';'<ul><li>Never dispense an expired drug, it will not work and may cause harm to the patient.</li><li>Adhere to First-to-expire first-out (FEFO) procedures-always dispatch the first to expire ACTs from the store to the provider to avoid ACTs expiring on shelf.</li><li>Establish policy and procedure to manage short -expiry ACTs.</li><li>Order long-expiry ACTs.</li><li>Do not overstock.</li><li>Do proper forecasting to avoid wastage.</li></ul>';'gJnWQl7afPc';240;0.11;0.11;9;74;;91
+80;'NG HNQIS ICM.WE-240';'NG HNQIS ICM.WE-240-DR-Logbook/register/record book is present at the outlet';;'Logbook/register/record book is present at the outlet';'<p>Record books serve as reference points and are source documents for patient follow up, quality assurance visits, disease surveillance and are sources of data for report writing.</p>';'AHKOsNLvIYe';250;0.25;0.25;10;53;;92
+81;'NG HNQIS ICM.WE-250';'NG HNQIS ICM.WE-250-DR-The patients details are recorded and organised in legible manner, including date of test is recorded';;'The patients details are recorded and organised in legible manner, including date of test is recorded';'<p>Write legibly, record all patient details including full name, age and date to ensure validity of data for decision making and planning purposes.</p>';'P0Ezgk3D2FY';260;0.25;0.25;10;53;;92
+82;'NG HNQIS ICM.WE-260';'NG HNQIS ICM.WE-260-DR-Results of the tests are recorded/if not test action taken is recorded';;'Results of the tests are recorded/if not test action taken is recorded';'<p>The number of tests performed and results guides the estimation of stocks to be ordered and provides data for analysis during quality assurance assessments of RDTs.</p>';'RW6Z1c1dkCJ';270;0.25;0.25;10;53;;92
+83;'NG HNQIS ICM.WE-270';'NG HNQIS ICM.WE-270-DR-Reports for the weeks preceding the assessment have been submitted';;'Reports for the weeks preceding the assessment have been submitted';'<p>Regular and timely submission of reports enables morbidity surveillance and procurement planning resulting in timely resupply of commodities for diagnosis and treatment.</p>';'ZUtmTPzmn2M';280;0.25;0.25;10;53;;92
+110;'NG HNQIS ICM.WE-280';'NG HNQIS ICM.WE-280-END-END OF TAB';;'END OF TAB';;'lnguezTBchd';360;0.00;0.00;6;49;;
+111;'NG HNQIS ICM.WE-280';'NG HNQIS ICM.WE-280-END-END OF TAB';;'END OF TAB';;'lnguezTBchd';290;0.00;0.00;10;49;;
+112;'NG HNQIS ICM.IPE-470';'NG HNQIS ICM.IPE-470-END-END OF TAB';;'END OF TAB';;'yS7ZI9fd66f';470;0.00;0.00;59;49;;
+200;'NG HNQIS FP-100';'NG HNQIS FP-100-Counsel-Does this facility offer contraceptive counseling?';;'Does this facility offer contraceptive counseling?';;'d9aqzZudmAk';100;0.00;0.00;60;53;;72
+201;'NG HNQIS FP-110';'NG HNQIS FP-110-Counsel-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Real observations are ideal for experienced providers. For providers undergoing training or who are new, a simulation can be used at the beginning.</p>';'gyZkHqMcKcz';110;0.00;0.00;60;88;;72
+202;'NG HNQIS FP-120';'NG HNQIS FP-120-Counsel-Preparation';;'Preparation';;'wIlfNrGPQsJ';120;0.00;0.00;60;49;;
+203;'NG HNQIS FP-130';'NG HNQIS FP-130-Counsel-Ensures privacy (auditory and visual)';;'Ensures privacy (auditory and visual)';'<p><strong>Confidentiality is the provider''s responsibility</strong></p><ul><li>Close the door.</li><li>Ensure others cannot hear what is being said.</li></ul>';'mqr8cxBwJDU';130;0.25;0.25;60;53;;72
+204;'NG HNQIS FP-140';'NG HNQIS FP-140-Counsel-Pre-Choice';;'Pre-Choice';;'RuYVsjkYj0k';140;0.00;0.00;60;49;;
+205;'NG HNQIS FP-150';'NG HNQIS FP-150-Counsel-Mentions all FP methods';;'Mentions all FP methods';'<p><strong>4 Stages of BCS+: 1) pre-choice, 2) method choice,3) post-choice and STI/HIV Prevention, Risk Assessment, and 4) Counseling and Testing</strong><br /><br/><strong>Pre-Choice Stage includes: creating rapport, introducing the concept of service integration (screening for HIV, sexually transmitted diseases and cervical cancer) and ruling out pregnancy</strong></p><ul><li>Mention all FP methods:By giving the range of FP methods, the client is assured of informed choice.</li><li>Set aside the cards that are not appropriate for the patient.</li><li>Follow BCS+ algorithm and continue to narrow methods for the patient.</li></ul>';'k7uuuWs0ORi';150;0.02;0.02;60;53;;72
+206;'NG HNQIS FP-160';'NG HNQIS FP-160-Counsel-Mentions RTI.STI/HIV, and CaCx services offered in the FP clinic or through referral.';;'Mentions RTI.STI/HIV, and CaCx services offered in the FP clinic or through referral.';'<p><strong>Provide holistic SRH services in the clinic or through referral</strong></p><ul><li>Discuss STI/HIV transmission and prevention.</li><li>Conduct a risk assessment.</li><li>Discuss dual protection .</li><li>Discuss and offer the patient opportunities for HIV Counselling & Testing.</li><li>Discuss STI screening.</li><li>Disclosure of STI/HIV status to partner(s) is encouraged.</li><li>Inform patient of benefits and risks of disclosure.</li><li>Discuss cervical cancer services offered and the importance of screening.</li><li>If services are not available in the facility, refer the patient.</li></ul>';'dRAh7GK8Gpf';160;0.02;0.02;60;53;;72
+207;'NG HNQIS FP-170';'NG HNQIS FP-170-Counsel-Provider rules out pregnancy using MEC check list and if indicated performs a pregnancy test';;'Provider rules out pregnancy using MEC check list and if indicated performs a pregnancy test';'<ul><li>Always use the MEC checklist to rule out pregnancy.</li><li>Pregnancy test should only be done if indicated.</li></ul>';'DizJpFLM5SZ';170;0.30;0.30;60;53;;72
+208;'NG HNQIS FP-180';'NG HNQIS FP-180-Counsel-Appropriately ensures informed choice while counseling';;'Appropriately ensures informed choice while counseling';'<ul><li>Informed choice is key in family planning.</li><li>Use the BCS+, FP Method Cards and Side effect Flip Chart to minimize errors and reduce the need for recall.</li></ul>';'gT5RqFioOD1';180;0.02;0.02;60;53;;72
+209;'NG HNQIS FP-190';'NG HNQIS FP-190-Counsel-Method Choice';;'Method Choice';;'ZUgal40KCut';190;0.00;0.00;60;49;;
+210;'NG HNQIS FP-200';'NG HNQIS FP-200-Counsel-Helps the client to choose the method that is most convenient for her/him.';;'Helps the client to choose the method that is most convenient for her/him.';'<ul><li>Allow patient to ask questions and make any clarification.</li><li>Allow patient to choose a method from the cards discussed with her.</li><li>Use probing questions and the method-specific brochure to rule out any conditions that may contraindicate the use of chosen method.</li><li>If contraindication found, explain the need to choose another method.</li><li>If patient is not able to make a choice immediately, provide her with a method (e.g. condom) until she is able to make a decision.</li></ul>';'VZmV28KkAjy';200;0.25;0.25;60;53;;72
+211;'NG HNQIS FP-210';'NG HNQIS FP-210-Counsel-Post-Choice';;'Post-Choice';;'dX0gDe2YPCF';210;0.00;0.00;60;49;;
+212;'NG HNQIS FP-220';'NG HNQIS FP-220-Counsel-Counsels appropriately on the method chosen';;'Counsels appropriately on the method chosen';'<p><strong>Use the method brochure as a counseling tool so you do not miss any key points.</strong></p><ul><li>Discuss the method chosen with the patient.</li><li>Explain that there are no contraindications with chosen method.</li><li>Give brochure to the patient to take home.</li><li>Explain key points in the brochure.</li><li>Validate the patient''s understanding of the method.</li><li>Provide the method to the patient, if available.</li><li>If the chosen method is not available, then refer to a facility that can offer the method and give an alternative method such as a condom.</li><li>Encourage partner involvement.</li></ul><p></p>';'HVVTI8z7svQ';220;0.05;0.05;60;53;;72
+213;'NG HNQIS FP-230';'NG HNQIS FP-230-Counsel-Client signs a consent form before receiving an FP method';;'Client signs a consent form before receiving an FP method';'<ul><li>Ensure patient fully understands the service being provided.</li><li>Inform patient of the procedure and acceptable alternative procedures.</li><li>Ensure patient signs a consent form before you provide the method or perform procedure.</li><li>Keep a copy of the consent form for filing in the patient''s documents.</li></ul>';'GL8z9mgcpFu';230;0.05;0.05;60;53;;72
+214;'NG HNQIS FP-240';'NG HNQIS FP-240-Counsel-Work Environment-Contraceptive Counseling';;'Work Environment-Contraceptive Counseling';;'MBc3hGRr2uj';240;0.00;0.00;60;49;;
+215;'NG HNQIS FP-250';'NG HNQIS FP-250-Counsel-Job aids are available-BCS+, MEC check list';;'Job aids are available-BCS+, MEC check list';'<p>Job aids set expectations and provide a written reference to assist in providing consistent and accurate management.</p>';'klqiq3jGNCd';250;0.02;0.02;60;53;;72
+216;'NG HNQIS FP-260';'NG HNQIS FP-260-OCP-Does this facility offer Oral Contraceptive Pills';;'Does this facility offer Oral Contraceptive Pills';;'Tc3KwL5mZ6j';260;0.00;0.00;61;53;;73
+217;'NG HNQIS FP-270';'NG HNQIS FP-270-OCP-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>An assessment on a real case is easy to plan in advance and should be the ideal.</p>';'HKLmTaWbhdy';270;0.00;0.00;61;88;;73
+218;'NG HNQIS FP-280';'NG HNQIS FP-280-OCP-Confirms method choice';;'Confirms method choice';'<p>This is especially important if counseling and service provision occur on different days or if different providers perform counseling and method provision.</p>';'y795n1H69NU';280;0.03;0.03;61;53;;73
+219;'NG HNQIS FP-290';'NG HNQIS FP-290-OCP-Confirms medical eligibility';;'Confirms medical eligibility';'<ul><li>Check if all necessary investigations and tests have been done to rule out contraindications.</li><li>If tests are pending, they must be performed before method provision.</li></ul>';'VTbydlG8a4t';290;0.03;0.03;61;53;;73
+220;'NG HNQIS FP-300';'NG HNQIS FP-300-OCP-Checks expiry date';;'Checks expiry date';'<p><strong>Always check the expiry date</strong><br/>Do not give expired oral contraceptive pills to a patient.</p>';'xG3RS5wvcDR';300;0.10;0.10;61;53;;73
+221;'NG HNQIS FP-310';'NG HNQIS FP-310-OCP-Shows client how to take pills and gives all necessary instructions';;'Shows client how to take pills and gives all necessary instructions';'<p><strong>Inform the patient that the effectiveness of the pills depend on correct use<br />For progestin only pill, explain that:</strong></p><ul><li>One packet contains 28 pills, the pills should be taken continuously without stopping between packets.</li><li>It is recommended that it is initiated on the first day of menses but can be initiated at any time in the cycle, as long as pregnancy is ruled out with a pregnancy test.</li></ul><p><strong>For combined oral contraceptive pill, explain to the patient that:</strong></p><ul><li>One packet contains 21 pills, while some brands have 7 iron tablets included to make them 28 pills, in which case the contraceptive pills are still 21.</li><li>It is recommended to start taking the first pill on the first day of a period. The pill can still be started within the first 5 days of the period.</li><li>After the 21 days of pill taking, a monthly bleed occurs. Start a new packet of pills on the first day of the period. For the 28-pack pills, take the pills continuously without stopping regardless of the monthly bleed.</li></ul><p><strong>Important information for both types of pills:</strong></p><p>The pill should be taken at the same time each day to maximize contraceptive efficacy. It can be useful to link pill taking with other activities that are part of her daily routine.</p><ul><li>The pill may be ineffective if: Taken late or missed, vomiting occurs within 2 to 3 hours of taking a pill, there is severe diarrhea, or if taken with some medications.</li><li>Give the patient a chance to ask questions and to seek clarifications.</li><li>Give a three month prescription and a return visit date.</li></ul><p>Reference-PSI Quality Assurance Manual OC & Injectable Protocols with Community‐Based Distribution Guidelines - Section 11</p>';'zTnIDmXZG1L';310;0.40;0.40;61;53;;73
+222;'NG HNQIS FP-320';'NG HNQIS FP-320-OCP-Educate the client on how to manage missed / forgotten pills';;'Educate the client on how to manage missed / forgotten pills';'<p><strong>If one pill is missed:</strong></p><ul><li>Take the pill as soon as you remember.</li><li>Take the next pill at the regular time. (It''s okay to take 2 pills on the same day).</li></ul><p><strong>If 2 pills are missed in a row in the 1st and 2nd week</strong></p><ul><li>Take two pills daily for two days.</li><li>Use back-up method for the next 7 days.</li></ul><p><strong>If 2 pills are missed in a row in 3rd week or missed 3 or more pills in a row in any week, and had unprotected intercourse:</strong></p><ul><li>Discard the rest of the pack.</li><li>Start a new pack the same day.</li><li>Use back-up method (e.g. condom) or abstain for at least next 7 days.</li><li>Visit the health facility for prescription of Emergency contraceptive pill.</li></ul><p><strong>If a patient misses any of last 7 pills in the 28-pill pack</strong></p><ul><li>You do not need a back-up method if these are the only pills that you didn''t take this cycle, but be sure to start the next pack on time.</li></ul><p>Reference-PSI Quality Assurance Manual OC & Injectable Protocols with Community‐Based Distribution Guidelines - Section 12</p>';'lWKMsWLJPnM';320;0.40;0.40;61;53;;73
+223;'NG HNQIS FP-330';'NG HNQIS FP-330-OCP-Documents service given';;'Documents service given';'<p>Document service provided in the patient file and daily activity register.</p>';'jmk0CQpKVmN';330;0.02;0.02;61;53;;73
+224;'NG HNQIS FP-340';'NG HNQIS FP-340-OCP-Work Environment - Oral Contraceptive Pills';;'Work Environment - Oral Contraceptive Pills';;'R2qMlu4EnnP';340;0.00;0.00;61;49;;
+225;'NG HNQIS FP-350';'NG HNQIS FP-350-OC-The following supplies are available: OC packs (COCs and POPs)';;'The following supplies are available: OC packs (COCs and POPs)';'<p>Ensure you have the combined and the progestin only pills so as to give the patient the appropriate pills.</p>';'fUZmkZmTmt8';350;0.02;0.02;61;53;;73
+227;'NG HNQIS FP-370';'NG HNQIS FP-370-Inj-Does this facility offer injectables?';;'Does this facility offer injectables?';;'E38ZeGEQFbc';370;0.00;0.00;62;53;;74
+228;'NG HNQIS FP-380';'NG HNQIS FP-380-Inj-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>An assessment on a real case is easy to plan in advance and should be the ideal.</p>';'dxMmHuu96hz';380;0.00;0.00;62;88;;74
+229;'NG HNQIS FP-390';'NG HNQIS FP-390-Inj-Confirms method choice';;'Confirms method choice';'<p>This is especially important if counseling and service provision occur on different days or if different providers perform counseling and method provision.</p>';'N5EN9yOYWA2';390;0.03;0.03;62;53;;74
+230;'NG HNQIS FP-400';'NG HNQIS FP-400-Inj-Confirms medical eligibility';;'Confirms medical eligibility';'<ul><li>Check if all necessary investigations and tests have been done to rule out contraindications.</li><li>If tests are pending, they must be performed before method provision.</li>';'FnHBcwb8poO';400;0.03;0.03;62;53;;74
+231;'NG HNQIS FP-410';'NG HNQIS FP-410-Inj-Checks expiry date';;'Checks expiry date';'<p>Ensure that you do not inject the patient with an expired contraceptive.</p>';'V9kwLDlkTHD';410;0.20;0.20;62;53;;74
+232;'NG HNQIS FP-420';'NG HNQIS FP-420-Inj-Appropriately cleans injection site';;'Appropriately cleans injection site';'<p><strong>Clean the injection site using alcohol swabs</strong></p><ul><li>Alcohol will kill and reduce the number of microorganisms on the skin surface. This will minimize the chances of introducing infection when giving the injection.</li><li>Aseptically clean the injection area; upper arm (deltoid muscle), the hip (ventrogluteal muscle), or the buttocks (gluteal muscle).</li></ul>';'cYmoVoGD2GS';420;0.10;0.10;62;53;;74
+233;'NG HNQIS FP-430';'NG HNQIS FP-430-Inj-DMPA: Shake the vial (if NET-EN select ''yes'')- RECOMMENDED VIGOROUSLY FOR DMPA';;'DMPA: Shake the vial (if NET-EN select ''yes'')- RECOMMENDED VIGOROUSLY FOR DMPA';'<ul><li>Shake DMPA vigorously just before use to ensure that the dose being administered represents a uniform suspension.</li></ul>';'ddIgxa8XiI8';430;0.10;0.10;62;53;;74
+234;'NG HNQIS FP-440';'NG HNQIS FP-440-Inj-Correctly administers the injectable';;'Correctly administers the injectable';'<p><strong>Correctly administer the injection</strong></p><ul><li>Warm the vial to skin temperature; remove plastic cap to expose the rubber cover; carefully open the syringe and needle packet; withdraw the drug; remove needle from bottle; move any air into the tip, and expel from the syringe gently until a drop of the solution can be seen on the tip of the needle. Care must be taken not to contaminate the needle.</li><li>Give the injection as a deep intramuscular injection in the upper arm (deltoid muscle); the hip (ventrogluteal muscle) or the buttocks (gluteal muscle).</li><li>When giving on the gluteal muscle, inject in the upper outer quadrant of the gluteus maximus muscle (buttock) to avoid injury to the sciatic nerve.</li><li>Insert needle straight- not at an angle; the skin on the injection site can be spread with fingers; hold syringe held like a dart.</li><li>Withdraw before injecting to avoid intravascular injection. Pull back slightly on the plunger to see if blood is present. If there is blood, you have injected into a blood vessel, remove the needle and syringe and start over with a new needle and syringe. If there is no blood, inject the drug emptying all the contents of the syringe.</li><li>With clean cotton wool, apply gentle pressure to the injection site to avoid bleeding and formation of a hematoma. The patient should be reminded NOT to massage the site after the injection as this can cause the drug to be absorbed more quickly and make it less effective.</li><li>Observe infection prevention principles for waste disposal.</li><li>Give a return date.</li><li>Thank the patient.</li></ul><p>Reference-PSI Quality Assurance Manual OC & Injectable Protocols with Community‐Based Distribution Guidelines - Section 5.3</p>';'GqV5bPIHgYb';440;0.35;0.35;62;53;;74
+235;'NG HNQIS FP-450';'NG HNQIS FP-450-Inj-Correctly disposes needles and sharps';;'Correctly disposes needles and sharps';'<p><strong>Dispose of needles immediately after injection into a sharps container. DO NOT recap, bend or break the needle</strong></p><ul><li>Recapping, bending or breaking needles increases the risk of needle prick injuries.</li><li>Do not disassemble the needle and syringe after use.</li><li>Discard all sharps at the point of use in an enclosed sharps container that is puncture-proof and leak-proof, placed within arm''s reach, and less than three-quarters full</li></ul>';'UtP3ywfWBch';450;0.10;0.10;62;53;;74
+236;'NG HNQIS FP-460';'NG HNQIS FP-460-Inj-Documents service given';;'Documents service given';'<ul><li>Document services given in the patient file and daily activity register.</li><li>Documentation is part of good clinical practice.</li></ul>';'uaIsPYlE5Qf';460;0.04;0.04;62;53;;74
+237;'NG HNQIS FP-470';'NG HNQIS FP-470-Inj-Work Environment-Injectables';;'Work Environment-Injectables';;'YqWg4ajK7JH';470;0.00;0.00;62;49;;
+238;'NG HNQIS FP-480';'NG HNQIS FP-480-Inj-The following are available: single‐dose vial (150 mg/dose for DMPA; 200 mg/dose for NET‐EN); syringe; intramuscular needle and calendar.';;'The following are available: single‐dose vial (150 mg/dose for DMPA; 200 mg/dose for NET‐EN); syringe; intramuscular needle and calendar.';'<ul><li>Have the correct supplies for giving the injection.</li><li>Have a calendar accessible to calculate the date of next injection.</li></ul>';'HPPQL2cQHt0';480;0.00;0.00;62;53;;74
+243;'NG HNQIS FP-530';'NG HNQIS FP-530-IUCD Ins-Does this facility offer IUCD insertion?';;'Does this facility offer IUCD insertion?';;'JcArx9mcU60';530;0.00;0.00;63;53;;75
+244;'NG HNQIS FP-540';'NG HNQIS FP-540-IUCD Ins-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>For healthcare providers who are not experienced with IUCD insertion, use of simulation at the beginning is encouraged. However, an assessment on a real case is easy to plan in advance and should be the ideal.</p>';'lgIuEqNKGb5';540;0.00;0.00;63;88;;75
+245;'NG HNQIS FP-550';'NG HNQIS FP-550-IUCD Ins-Pre-Insertion';;'Pre-Insertion';;'Wf89awttceM';550;0.00;0.00;63;49;;
+246;'NG HNQIS FP-560';'NG HNQIS FP-560-IUCD Ins-Confirms method choice';;'Confirms method choice';'<p>Important to confirm method choice especially if counseling and service provision occur on different days or if different providers perform counseling and method provision.</p>';'wgvLOzWXKDw';560;0.01;0.01;63;53;;75
+247;'NG HNQIS FP-570';'NG HNQIS FP-570-IUCD Ins-Confirms medical eligibility';;'Confirms medical eligibility';'<ul><li>Review client''s reproductive health history to ensure that client meets initial criteria for IUD.</li><li>Use the Medical Eligibility Criteria (MEC) wheel for Contraceptive Use, 2015, and Balanced Counselling Strategy plus (BCS+) brochure to review the patient''s screening checklist.</li><li>Stress that, only correct and consistent use of condoms, male or female, protect against STI/HIV. If there is a risk of STI/HIV, condom use is recommended. Do not insert an IUCD for a patient at risk of getting an STI e.g. a sex worker.</li><li>Check if all necessary investigations and tests have been done to rule out contraindications. If there are tests that are pending, perform before method provision.</li></ul>';'IIT4gdpPg2u';570;0.01;0.01;63;53;;75
+248;'NG HNQIS FP-580';'NG HNQIS FP-580-IUCD Ins-Washes hands';;'Washes hands';'<p><strong>Wash hands before and after an encounter with every patient to prevent spread of microorganisms</strong></p><ul><li>Wash hands with soap and clean running water.</li></ul>';'s9rjkbZOy0m';580;0.01;0.01;63;53;;75
+249;'NG HNQIS FP-590';'NG HNQIS FP-590-IUCD Ins-Prepares the environment';;'Prepares the environment';'<ul><li>Ensure adequate lighting and both visual and auditory privacy.</li><li>Close door and draw curtains around the patient.</li><li>Do not expose the patient until you are ready to start the procedure.</li><li>Ensure that your conversation with the patient cannot be heard by anyone else.</li><li>Have an examination lamp and position it to illuminate the perineum.</li></ul>';'lxPFWxCnZEG';590;0.02;0.02;63;53;;75
+250;'NG HNQIS FP-600';'NG HNQIS FP-600-IUCD Ins-Prepares insertion equipment and area';;'Prepares insertion equipment and area';'<p><strong>Assemble all the necessary equipment before starting</strong><br/>This is a sterile procedure.Prepare before starting the procedure to avoid movements after starting the procedure that might compromise infection prevention. Display all the requirements on a sterile surface. The following requirements should be made ready before the procedure:</p><ul><li>Examination light,</li><li>Copper T IUCD (sealed and not expired),</li><li>Bivalve speculums (several sizes),</li><li>Tenaculum,</li><li>Uterine sound,</li><li>Sponge holding forceps,</li><li>Scissors (for trimming IUD strings),</li><li>Sterile gauze,</li><li>Sterile gloves,</li><li>Sterile drapes,</li><li>Lubricant,</li><li>Antiseptic solution.</li></ul>';'t9krSydyezw';600;0.01;0.01;63;53;;75
+251;'NG HNQIS FP-610';'NG HNQIS FP-610-IUCD Ins-Prepares the client appropriately';;'Prepares the client appropriately';'<p><strong>Check that patient emptied her bladder and washed her genital area if necessary</strong></p><ul><li>Emptying the bladder makes the speculum examination more comfortable and avoids pressure on the bladder wall.</li><li>Fecal matter soiling in the perennial area should be cleaned to avoid contamination since it is a sterile procedure.</li><li>Help client onto exam table.</li></ul>';'Q2h0H5z15GR';610;0.01;0.01;63;53;;75
+252;'NG HNQIS FP-620';'NG HNQIS FP-620-IUCD Ins-Checks for signs of severe anaemia';;'Checks for signs of severe anaemia';'<p><strong>Check for signs of severe anaemia before inserting copper-bearing IUD</strong></p><ul><li>IUCD can cause abnormal uterine bleeding the first few months. This bleeding can worsen anemia.</li><li>In case of anemia, the Levonorgestrel-releasing intrauterine device, (LNG-IUD) should be provided instead of the Copper-bearing intrauterine device, (Cu-IUD).</li></ul>';'jPHRysevFEt';620;0.05;0.05;63;53;;75
+253;'NG HNQIS FP-630';'NG HNQIS FP-630-IUCD Ins-Performs abdominal exam (Palpation)';;'Performs abdominal exam (Palpation)';'<p><strong>Perform an abdominal examination to rule out pelvic masses and pelvic inflammatory disease</strong></p><ul><li>Observe the abdomen for scars, swelling or visible lesions.</li><li>Check for swellings, bulges, masses, or other gross abnormalities.</li><li>Check for suprapubic tenderness.</li><li>If there are any abnormalities, delay insertion to evaluate client.</li><li>Give another method as evaluation and management is being carried out.</li></ul>';'OtQcR4w8n1f';630;0.01;0.01;63;53;;75
+254;'NG HNQIS FP-640';'NG HNQIS FP-640-IUCD Ins-Performs bimanual exam';;'Performs bimanual exam';'<p><strong>Perform bimanual examination checking for cervical, uterine position and adnexal or uterine abnormalities</strong></p><ul><li>After emptying the bladder, explain the procedure to the patient.</li><li>Position her in lithotomy position.</li><li>Make sure all the requirement for IUCD insertion are ready and well displayed.</li><li>Wear sterile gloves on both hands.</li><li>Clean the perineum and external genitalia using the five swab technique.</li></ul><p><br/><strong>First perform a vaginal examination.</strong></p><ul><li>Inspect the external genitalia and urethral opening for discharge, ulcers, lesions or sores?</li><li>If none, proceed with assessment.</li><li>If yes, it may indicate a current STI, and the IUD should not be inserted until current gonorrhea and chlamydia have been reliably ruled out or treated.</li><li>An ulcerative STI (e.g. herpes, syphilis, HBV) is not a contraindication for IUD insertion, but it indicates that the woman may be at high individual risk of STI''s and should be counseled accordingly.</li><li>If no problems are found, proceed to bimanual exam.</li><li>If there are potential problems (findings that suggest possible infection or other pelvic problems), perform the speculum exam first and a bimanual exam second.</li></ul><p><strong>Then perform bimanual exam</strong></p><ul><li>Lubricate your gloved fingers.</li><li>Gently insert two fingers of the one hand into the vagina. Place the other hand gently on the lower abdomen.</li><li>Gently move the cervix from side to side ("cervical rocking" test) and observe for tenderness (cervical motion tenderness). Check for cervical mobility mass or ulcer.</li><li>Palpate the uterus by pressing down on the lower part of the abdomen and moving the fingers behind the cervix to push the uterus towards your abdominal hand.</li><li>Determine the position, size, shape and consistency of the uterus. Determining size and position of the uterus is essential to ensure high fundal placement of the IUD and to minimize the risk of perforation.</li><li>Palpate the right and left adenexae gently by moving your fingers on the sides of the cervix. Gently press down with the abdominal hand. At the same time, press up with your vaginal fingers and feel for masses.</li><li>If any abnormality is found, do not insert the IUD. Refer the woman for further investigations and management.</li><li>Offer an alternative FP method.</li></ul>';'D6nswZLTVbX';640;0.05;0.05;63;53;;75
+255;'NG HNQIS FP-650';'NG HNQIS FP-650-IUCD Ins-Correctly inserts speculum';;'Correctly inserts speculum';'<p><strong>Correct insertion of the speculum ensures the cervix is well exposed and the cervical os well visualized with minimal discomfort to the patient</strong></p><ul><li>Apply lubricant to the correct size of a bivalve speculum.</li><li>Hold the speculum with blades closed with your right hand (if right handed), the opposite if left handed.</li><li>Inspect the vulva for any abnormality or atrophic changes before gently separating the labia minora to expose the vaginal orifice with your left hand (or non-dominant hand).</li><li>Align the speculum with the handle pointing towards the right side of the patient.</li><li>Slowly insert the speculum into the vagina with the tip pointing 45° downward to avoid touching the clitoris. Most of the discomfort is caused by pressure on the urethra and trigone.</li><li>Ask the patient if she feels any discomfort. Look for non-verbal cues of discomfort such as facial grimacing, clenching of fist and tense leg muscle. Encourage deep breathing and muscle relaxation.</li><li>On full insertion, turn the handle downwards (for anteverted uterus, which is more common) or upwards (for retroverted uterus) and open the speculum gently to slip the blades into the anterior and posterior fornices, thus exposing the cervix adequately.</li></ul>';'CVscrGYcZuP';650;0.02;0.02;63;53;;75
+256;'NG HNQIS FP-660';'NG HNQIS FP-660-IUCD Ins-Performs speculum exam';;'Performs speculum exam';'<p><strong>Locate the cervical os, checking for signs of infection (abnormal discharge), abnormal bleeding or masses in the vagina or cervix</strong></p><ul><li>Perform speculum examination checking for vaginal discharge, cervical or urethral discharge, and obtain discharge for laboratory assessment if indicated.</li><li>Check for cervical lacerations or narrowing of the cervical canal (stenosis), masses or ulcers. Check if the cervix bleeds easily when touched?</li><li>If these signs are present, abandon the procedure. Investigate and offer treatment or refer to a tertiary facility.</li><li>Give the woman another alternative method.</li><li>If she would still like to have an IUCD in future, reevaluate for IUCD eligibility during the future visit.</li></ul>';'qvTdrZelFcQ';660;0.05;0.05;63;53;;75
+257;'NG HNQIS FP-670';'NG HNQIS FP-670-IUCD Ins-Makes appropriate decision on whether or not to proceed and explains to the client';;'Makes appropriate decision on whether or not to proceed and explains to the client';'<p><strong>The decision to insert the IUCD depends on the examination findings</strong></p><ul><li>If there are no abnormalities proceed with IUCD insertion.</li><li>Any abnormal findings warrant investigations and management. Do not proceed with the insertion. Explain to the patient your findings.</li><li>While investigating, offer the woman an alternative method. Depending on the abnormality e.g. infection, explain to her that once the abnormality is sorted out she can be re-evaluated for IUCD.</li></ul>';'nKrr9AIxD90';670;0.01;0.01;63;53;;75
+258;'NG HNQIS FP-680';'NG HNQIS FP-680-IUCD Ins-Insertion';;'Insertion';;'gry9UWsaOew';680;0.00;0.00;63;49;;
+259;'NG HNQIS FP-690';'NG HNQIS FP-690-IUCD Ins- Swabs cervix three times with antiseptic';;'Swabs cervix three times with antiseptic';'<p><strong>IUCD insertion is a sterile procedure and swabbing the cervix three times minimizes the risk of introducing infection into the uterus.</strong></p><ul><li>Cleanse from the center of the cervical os moving outward on the cervix and into the surrounding vaginal canal.</li><li>If povidone iodine is used, allow 1 to 2 minutes before proceeding.</li><li>Do not use alcohol as it is painful for the woman; dries and damages the mucous membranes, which may support the infectious process.</li></ul><p>Reference: PSI IUD Service Delivery Protocols: Section 3.2</p>';'MJjvpSDiZmP';690;0.02;0.02;63;53;;75
+260;'NG HNQIS FP-700';'NG HNQIS FP-700-IUCD Ins-Correctly performs IUCD insertion based on protocols or guidelines';;'Correctly performs IUCD insertion based on protocols or guidelines';'<ol><li><strong>Gently grasp the cervix with tenaculum at 12 o''clock position and apply gentle traction. </strong>This is to align the uterus with the cervical opening and to stabilize the cervix for easier insertion of the IUD. Close the tenaculum only to the first notch to minimize discomfort.</li><li><strong>Sound the uterus using no-touch technique.</strong>This will ensure you insert the IUCD at the uterine fundus, by adjusting the blue flange to the corresponding uterine length as measured during sounding.<ul><li><strong>If the IUCD is inserted at the low uterine segment, pregnancy can occur because implantation takes place in the uterine fundus.</strong></li><li>Use the no-touch technique to minimize risk of infection.</li><li><strong>Steps of uterine sounding:</strong><ul><li>Gently pull the tenaculum to align the uterus and cervical opening.</li><li>Insert the uterine sound into the cervical opening.</li><li>Advance the sound into the uterine cavity until a slight resistance is felt.</li><li>Note the angle of the uterine cavity, and gently remove the sound. Do not pass the sound into the uterus more than once.</li><li>Mark length of the uterus by observing the mucus line on the tenaculum or marking with sponge holding forceps. The average uterus is between 6 and 8 cm in depth. If the uterus is less than 6 cm in depth, the woman may be at increased risk for IUD expulsion.</li><li>Slowly withdraw the sound.</li><li>On sounding the uterus, if the uterine cavity is irregular or deeper than 10 cm,do not insert IUD. Explain to the patient that with an enlarged uterus the IUD may not be as effective as normally expected and help the woman to consider another method.</li></ul></li></ul></li><li><strong>Load the IUCD</strong><ul><li>Adjust the contents of the package inside the insertion tube such that the vertical stem of the T is fully inside the insertion tube.</li><li>Set the depth-gauge (blue flange) to reflect the uterine length as measured by the uterine sound.</li><li>Open at the bottom end (where arrow says OPEN).</li><li>Insert the white rod into the insertion tube, until up to the level of the blue flange.</li><li>Load the IUCD by folding its arms and placing them inside the insertion tube while still in its sterile pack (no-touch technique) by placing the package face up on a clean surface. Place thumb and index finger on top of package on ends of the horizontal arms. Use other hand to push insertion tube against arms of, this will start bending the T arms and loading the IUCD. Do not bend the arms of copper T for more than 5 minutes before it is placed in the uterus.</li><li>Align the blue flange and the folded arms of the copper T so that they are both in a horizontal plane.</li><li>Remove the loaded IUD from the package:</li></ul></li><li><strong>Insert the IUD using withdrawal technique:</strong><ul><li>Put on a new pair of sterile gloves on both hands.</li><li>Gently grasp the tenaculum (still in place from sounding the uterus) and apply gentle traction.</li><li>Insert the loaded IUCD by holding the insertion tube, without touching vaginal walls or speculum blades, keeping the horizontal plane.</li><li>Gently advance the loaded IUCD into the uterine cavity.</li><li>STOP when the blue flange comes in contact with the cervix or light resistance is felt.</li><li>Hold the tenaculum and white plunger rod stationary, while partially withdrawing the insertion tube - this releases the arms of the IUCD.</li><li>Gently push the insertion tube until you feel a slight resistance - this step ensures placement high in the uterus.</li><li>Remove the white plunger rod, while holding the insertion tube stationary.</li><li>Gently and slowly withdraw the inserter tube from the cervical canal until strings can be seen protruding from the cervical opening.</li><li>IMPORTANT: Do not pass the loaded IUD into the uterus more than once.</li></ul></li><li><strong>Cut strings:</strong><ul><li>Use sharp Mayo scissors to cut the IUCD strings at 3-4 cm from the cervical opening before completely removing the inserter tube. (This technique ensures that the pieces of cut‐off string will stay in the insertion tube for easy disposal.)</li><li>Completely withdraw insertion tube with cut ends of strings inside.</li><li>Gently remove the tenaculum.</li><li>Observe the cervix for bleeding and remove speculum.</li><li><strong>Post Insertion</strong><ul><li>Reposition patient and make her comfortable. Observe her for 15-20 minutes before assisting her out of the bed.</li><li>If available, confirm correct insertion by use of a pelvic ultrasound.</li></ul></li></ul></li></ol><p>Reference: PSI IUD Service Delivery Protocols: Section 5</p>';'iZdfblD57Bl';700;0.50;0.50;63;53;;75
+261;'NG HNQIS FP-710';'NG HNQIS FP-710-IUCD Ins-Post-Insertion';;'Post-Insertion';;'YSOGRRXE6eB';710;0.00;0.00;63;49;;
+262;'NG HNQIS FP-720';'NG HNQIS FP-720-IUCD Ins-Post insertion IP procedures correctly performed';;'Post insertion IP procedures correctly performed';'<p><strong>Follow infection prevention procedures</strong></p><ul><li>Immediately soak ALL the instruments used for procedure or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes.</li><li>Dispose of waste material in leak proof container or plastic bag.</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution.</li><li>After soaking for 10 minutes, remove instruments from solution.</li><li>Clean instruments immediately.</li><li>Remove gloves following the glove removal procedure.</li></ul>';'JK1dM4tHToV';720;0.05;0.05;63;53;;75
+263;'NG HNQIS FP-730';'NG HNQIS FP-730-IUCD Ins-Provides post procedure counseling';;'Provides post procedure counseling';'<p><strong>Post insertion counseling should include:</strong></p><ul><li>Ensure the woman knows that she has copper T IUCD, that it should be replaced after 12 years and it is effective immediately.</li><li>Explain that it does not protect against STI/HIV.</li><li>The IUCD can be removed any time if she desires.</li><li>Inform the client that she can resume sexual activity as soon as she is comfortable.</li><li>Explain that cramping, light bleeding may occur immediately after IUCD insertion and may last for a few days. These symptoms are not harmful and do not indicate a problem. For cramping, advise her to take paracetamol or ibuprofen . If the symptoms become bothersome the woman can come back to the health facility.</li><li>The following symptoms, <strong>(PAINS)</strong> warrants immediate return to the health facility:<ul><li><strong>P</strong>eriod related or Pregnancy related problems:</li><li><strong>A</strong>bdominal pain or pain during intercourse,</li><li><strong>I</strong>nfections or unusual vaginal discharge,</li><li><strong>N</strong>ot feeling well, fever, chills,</li><li><strong>S</strong>tring problems,</li></ul></li><li>Ask her to check for strings during menses. Advice her to come back to the health facility, if the strings are missing.</li><li>Give the woman a review/reminder card and indicate the return date on the card. Remind her that she can come to the health facility whenever a complication occurs.</li></ul>';'j0HUu5EcIqK';730;0.05;0.05;63;53;;75
+264;'NG HNQIS FP-740';'NG HNQIS FP-740-IUCD Ins-Assesses client´s physical wellbeing before discharge';;'Assesses client´s physical wellbeing before discharge';'<p><strong>Post insertion assessment</strong></p><ul><li>Ask patient if she has nausea, abdominal cramping, dizziness or fainting (touching the cervix can cause neurogenic shock, though rarely).</li><li>If symptoms persist after 30 min, examine her for evidence of peritoneal signs which may indicate a perforation.</li><li>If no evidence of peritonitis, offer the woman an analgesic such as paracetamol or ibuprofen and observer for another 10‐15 minutes.</li><li>If the woman is stable she may be discharged. </li><li>If definite peritoneal signs are present, the woman should be examined by a provider who may feel that further observation or intervention are necessary.</li></ul>';'WVhvJLEYz6k';740;0.07;0.07;63;53;;75
+265;'NG HNQIS FP-750';'NG HNQIS FP-750-IUCD Ins-Records service in the client file and register / log book';;'Records service in the client file and register / log book';'<p>Document services provided in the patient file and daily activity register/log book. Documentation is part of good clinical practice.</p>';'dEMQkbsOX8O';750;0.02;0.02;63;53;;75
+266;'NG HNQIS FP-760';'NG HNQIS FP-760-IUCD Ins-Work Environment- IUCD Insertion';;'Work Environment- IUCD Insertion';;'NsgA1MEwHVM';760;0.00;0.00;63;49;;
+267;'NG HNQIS FP-770';'NG HNQIS FP-770-IUCD Ins-The following are available: tenaculum, uterine sound, bi‐valve speculums, long scissors, sponge‐holding forceps, gallipots, kidney dish.';;'The following are available: tenaculum, uterine sound, bi‐valve speculums, long scissors, sponge‐holding forceps, gallipots, kidney dish.';'<p>It is important to have all the insertion equipment to ensure you perform the procedure correctly. This will ensure safety of the patient and accurate insertion to reduce the chances of perforation, failure or expulsion of the IUD.</p>';'A7j9v8Y8RZ1';770;0.01;0.01;63;53;;75
+274;'NG HNQIS FP-840';'NG HNQIS FP-840-IUCD Ins-kidney dish (for soiled instruments)';;'kidney dish (for soiled instruments)';'<p>It is important to have all the insertion equipment to ensure you perform the procedure correctly. This will ensure safety of the patient and accurate insertion to reduce the chances of perforation, failure or expulsion of the IUD.</p>';'Her8wev1ROn';840;1.4286e-03;1.4286e-03;63;53;;75
+275;'NG HNQIS FP-850';'NG HNQIS FP-850-IUCD Rem-Does this facility offer IUCD removal?';;'Does this facility offer IUCD removal?';;'JpIwJFrUGUh';850;0.00;0.00;64;53;;76
+276;'NG HNQIS FP-860';'NG HNQIS FP-860-IUCD Rem-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>An assessment on a real case is easy to plan in advance and should be the ideal.</p>';'fdezQoZ4lZE';860;0.00;0.00;64;88;;76
+277;'NG HNQIS FP-870';'NG HNQIS FP-870-IUCD Rem-Pre-Removal';;'Pre-Removal';;'j0zKa505WTc';870;0.00;0.00;64;49;;
+278;'NG HNQIS FP-880';'NG HNQIS FP-880-IUCD Rem-Confirms removal choice';;'Confirms removal choice';'<ul><li>Ask the patient why she wants the IUCD removed</li><li>Even if the woman has no reason for removal but wants it removed, it is her right.</li><li>Ask about desire to be pregnant, limit, or space her family</li><li>Determine if it is safe to remove the IUCD during this current visit or if the woman needs further assessment or referral. (especially if removal is for medical reasons).</li><li>Removal can be done any time but it is easier during periods.</li><li>Answer her questions.</li></ul>';'nq0puZdGKaO';880;0.05;0.05;64;53;;76
+279;'NG HNQIS FP-890';'NG HNQIS FP-890-IUCD Rem-Counsels about removal procedure';;'Counsels about removal procedure';'<ul><li>Give the woman a brief overview of the procedure, encourage her to ask questions, and provide reassurance as needed.</li><li>Remind her to let you know if she feels any pain.</li></ul>';'XATRz9xvadw';890;0.05;0.05;64;53;;76
+280;'NG HNQIS FP-900';'NG HNQIS FP-900-IUCD Rem-Counsels client regarding alternative contraceptive methods';;'Counsels client regarding alternative contraceptive methods';'<p><strong>Determine if patient wants replacement IUCD or another method.</strong></p><ul><li>Ensure patient understands she can get pregnant after removal, unless the IUCD is replaced or another method is given.</li><li>No rest period is needed between removal of an IUCD and insertion of another IUCD.</li><li>If she wants another method, counsel her on other methods and help her choose.</li></ul>';'QG8p1g9W7Jl';900;0.02;0.02;64;53;;76
+281;'NG HNQIS FP-910';'NG HNQIS FP-910-IUCD Rem-Prepares removal equipment and area';;'Prepares removal equipment and area';'<p>This is a sterile procedure therefore avoid movements during the procedure by preparing the following requirements in advance of IUCD removal:</p><ul><li>Examining light</li><li>Bivalve speculum</li><li>Sponge holding forceps</li><li>Sterile gauze</li><li>Sterile gloves</li><li>Sterile drapes</li><li>Lubricant</li><li>Antiseptic solution</li></ul>';'K3s2a3dLS9O';910;0.02;0.02;64;53;;76
+282;'NG HNQIS FP-920';'NG HNQIS FP-920-IUCD Rem-Prepares the client for removal';;'Prepares the client for removal';'<ul><li>Ask about the last normal menstrual period (LMP) and rule out pregnancy.</li><li>Ask her to empty her bladder.</li><li>Ask her to clean vulva if necessary.</li><li>Get a chaperon for the procedure.</li><li>Position her in the lithotomy position.</li></ul>';'WlFAMRQzy0z';920;0.05;0.05;64;53;;76
+283;'NG HNQIS FP-930';'NG HNQIS FP-930-IUCD Rem-Removal';;'Removal';;'nPm8oH7I4K4';930;0.00;0.00;64;49;;
+284;'NG HNQIS FP-940';'NG HNQIS FP-940-IUCD Rem-Provider prepares (hand washing, gloving)';;'Provider prepares (hand washing, gloving)';'<p><strong>Wash hands and wear sterile gloves</strong><br />IUD removal is a sterile procedure. Observe infection prevention.</p>';'JnxyD7ULA1N';940;0.05;0.05;64;53;;76
+285;'NG HNQIS FP-950';'NG HNQIS FP-950-IUCD Rem-Removes IUD according to protocol';;'Removes IUD according to protocol';'<p><strong>Follow protocol when removing the IUD</strong><br />It is important to follow the IUCD removal steps for proper removal and to avoid patient discomfort.</p><p><strong>The following is the procedure for IUCD removal:</strong></p><ul><li>Make sure all the required equipment are well displayed and easily reachable</li><li>Clean the perineum and external genitalia using the five swab technique.</li><li>Conduct bimanual pelvic exam.</li><li>Insert the speculum: Look for the length and position of strings.</li><li>Swab cervix and vagina with antiseptic.</li><li>Alert the woman immediately before you remove the IUD: ask her to take slow, deep breaths and relax.</li><li>Grasp strings close to the cervix with an ovum forceps and pull gently but firmly to remove IUCD.</li><li>Insert a new IUD immediately following removal (if desired).</li><li>Remove speculum.</li><li>Reposition patient.</li></ul><p><strong>Difficult removals</strong></p><ul><li>If IUD partially removed but have difficulty drawing it through the cervical canal: attempt a gentle, slow twisting of the IUD while gently pulling. Continue as long as the woman remains comfortable.</li><li>If there seems to be a sharp angle between the uterus and cervix: place a sterile tenaculum on the cervix, and apply gentle traction downward and outward. Attempt a gentle, slow twisting of the IUD while gently pulling.</li><li>Continue as long as the woman remains comfortable.</li><li>If the IUD can still not be removed, refer the woman to a specially trained provider.</li></ul>';'QZmGsNijRnU';950;0.50;0.50;64;53;;76
+286;'NG HNQIS FP-960';'NG HNQIS FP-960-IUCD Rem-Shows client the IUCD ( if client desires) and disposes as hazardous waste';;'Shows client the IUCD ( if client desires) and disposes as hazardous waste';'<ul><li>Show the patient the removed IUCD as proof that it has been removed.</li><li>Dispose the IUD as hazardous waste.</li></ul>';'SeEmtYtMhlo';960;0.05;0.05;64;53;;76
+287;'NG HNQIS FP-970';'NG HNQIS FP-970-IUCD Rem-Post-Removal';;'Post-Removal';;'Sn1dnFV6kF4';970;0.00;0.00;64;49;;
+288;'NG HNQIS FP-980';'NG HNQIS FP-980-IUCD Rem-Post removal IP procedures correctly performed';;'Post removal IP procedures correctly performed';'<p><strong>Perform infection prevention procedures to avoid exposing health workers and patients to contaminated equipment and surfaces</strong></p><ul><li>Immediately soak ALL the instruments used during procedure or contaminated in any way in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes</li><li>Dispose of waste material in leak proof container or plastic bag</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution</li><li>After soaking for 10 minutes, remove instruments from solution</li><li>Clean instruments immediately</li><li>Remove gloves following the glove removal procedure</li></ul>';'j4EEJe2EAbl';980;0.10;0.10;64;53;;76
+289;'NG HNQIS FP-990';'NG HNQIS FP-990-IUCD Rem-Assesses client´s physical wellbeing before discharge';;'Assesses client´s physical wellbeing before discharge';'<p><strong>Asses the woman before discharge</strong></p><ul><li>Ensure she doesn''t have nausea, abdominal cramping, dizziness or fainting (touching the cervix can cause neurogenic shock, though rarely).</li><li>If any of these symptoms are present, reassure and allow her to remain on the examination table to rest until she feels better.</li><li>Review key messages. Inform her that she should come back to the health facility if she is bleeding, has an abnormal discharge or not feeling well.</li><li>If she did not get an IUCD replacement or another family planning method, ensure she understands that she has no protection against pregnancy.</li><li>Give her a review card</li></ul>';'vlJDU7MZlmR';990;0.05;0.05;64;53;;76
+290;'NG HNQIS FP-1000';'NG HNQIS FP-1000-IUCD Rem-Records in the client file and Daily Activity Register';;'Records in the client file and Daily Activity Register';'<p><strong>Document the removal in patient file and daily register</strong></p><p>Documentation is part of good clinical practice</p>';'AX5Y4rDKf0C';1000;0.02;0.02;64;53;;76
+291;'NG HNQIS FP-1010';'NG HNQIS FP-1010-IUCD Rem-Work Environment-IUCD Removal';;'Work Environment-IUCD Removal';;'lAI9xGQE8t6';1010;0.00;0.00;64;49;;
+292;'NG HNQIS FP-1020';'NG HNQIS FP-1020-IUCD Rem-The following are available: sponge‐holding forceps and IUD removal hook or alligator forceps (preferred)';;'The following are available: sponge‐holding forceps and IUD removal hook or alligator forceps (preferred)';'<p>Ensure you have the correct equipment for IUCD removal. This will make the process easy and avoid unnecessary discomfort or injury to the patient.</p>';'g1g7IDGobJh';1020;0.03;0.03;64;14;;76
+294;'NG HNQIS FP-1040';'NG HNQIS FP-1040-Imp Ins-Does this facility offer implant insertion?';;'Does this facility offer implant insertion?';;'oQilxNk3Nti';1040;0.00;0.00;65;53;;77
+295;'NG HNQIS FP-1050';'NG HNQIS FP-1050-Imp Ins-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>For healthcare providers who are not experienced with implant insertion, use of simulation at the beginning is encouraged. However, an assessment on a real case is easy to plan in advance and should be the ideal.</p>';'uNlA4oCHsrC';1050;0.00;0.00;65;88;;77
+296;'NG HNQIS FP-1060';'NG HNQIS FP-1060-Imp Ins-Pre-Insertion';;'Pre-Insertion';;'dM6OdeGcFdW';1060;0.00;0.00;65;49;;
+297;'NG HNQIS FP-1070';'NG HNQIS FP-1070-Imp Ins-Confirms method choice';;'Confirms method choice';'<p>This is especially important if counseling and service provision occur on different days or if different providers perform counseling and method provision.</p>';'Qa2km4aOQYX';1070;0.01;0.01;65;53;;77
+298;'NG HNQIS FP-1080';'NG HNQIS FP-1080-Imp Ins-Confirms medical eligibility';;'Confirms medical eligibility';'<ul><li>Ensure the client does not have contraindications for using an implant.</li><li>Check if all necessary investigations and tests have been done if necessary.</li><li>If there are tests that are pending, these need to be done before method provision.</li></ul>';'Ypsv20xNY8E';1080;0.01;0.01;65;53;;77
+299;'NG HNQIS FP-1090';'NG HNQIS FP-1090-Imp Ins-Washes hands';;'Washes hands';'<ul><li>Hand washing before and after an encounter with every patient is a very important means of preventing spread of microorganisms.</li><li>Wash hands with soap and clean running water.</li></ul>';'dOeUzZxnfAN';1090;0.01;0.01;65;53;;77
+300;'NG HNQIS FP-1100';'NG HNQIS FP-1100-Imp Ins-Preparation of the environment - Adequate lighting , Privacy (visual and auditory)';;'Preparation of the environment - Adequate lighting , Privacy (visual and auditory)';'<p><strong>Ensure adequate lighting and both visual and auditory privacy</strong></p><ul><li>Have an examination lamp and position it to illuminate the arm.</li><li>Close door and draw curtains around the patient.</li><li>Ensure that your conversation with the patient cannot be heard by anyone else.</li></ul>';'lw4K4QN2fUU';1100;0.02;0.02;65;53;;77
+301;'NG HNQIS FP-1110';'NG HNQIS FP-1110-Imp Ins-Prepares insertion equipment and area';;'Prepares insertion equipment and area';'<p><strong>Prepare equipment and area before starting the procedure</strong><br/>This is a sterile procedure. Display all the requirements on a sterile surface before the procedure:</p><ul><li>Flat couch for the patient to lie on and rest for her arm</li><li>Sterile drape with fenestration</li><li>Sterile tray for the equipment</li><li>Sterile gloves</li><li>Sterile Gauze</li><li>Antiseptic solution for the skin cleaning</li><li>Local anesthetic -1% lidocaine (if 2% dilute to 1%)</li><li>Needle gauge 21 and 5 ml syringe</li><li>Jadelle with disposable trocar and cannula or implanon or nexplanon (NXT)- (whichever implant you are going to insert). Check the expiry date</li><li>Elastoplast/adhesive bandage</li></ul>';'kVvAgLVz4Rj';1110;0.17;0.17;65;53;;77
+302;'NG HNQIS FP-1120';'NG HNQIS FP-1120-Imp Ins-Provider counsels the client on the method';;'Provider counsels the client on the method';'<p><strong>Use the method brochure to explain to the patient she has chosen the implant and that she has no contraindications</strong></p><ul><li>Give a copy of the brochure to the patient to take home.</li><li>Explain, the brochure''s key points about the implant.</li></ul><p><strong>Ensure patient''s understanding of the following about implants:</strong></p><ul><li>Changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no monthly bleeding are common.</li><li>Tell patient to come back to the health facility if bleeding is heavy or prolonged.</li></ul><p><strong>Inform patient on duration of protection against pregnancy:</strong></p><ul><li>2 rods for Jadelle--lasts five years.</li><li>1 rod for both Implanon and Nexplanon--both last for three years.</li></ul>';'qCIMrUEmvQ3';1120;0.02;0.02;65;53;;77
+303;'NG HNQIS FP-1130';'NG HNQIS FP-1130-Imp Ins-Reviews Client Screening Checklist to determine if the Implant is an appropriate choice for the client.';;'Reviews Client Screening Checklist to determine if the Implant is an appropriate choice for the client.';'<p><strong>Use the Medical Eligibility Criteria (MEC) Wheel for Contraceptive Use, 2015, and balanced Counselling Strategy plus (BCS+) brochure to review the patients screening checklist</strong></p><ul><li>In the MEC wheel:<ul><li>Category 1: Use method in any circumstance</li><li>Category 2: Generally use method</li><li>Category 3: Use of method not usually recommended unless other more appropriate methods are not available or not acceptable</li><li>Category 4: the method should not to be used</li><li>For category 2 and 3, clinical judgment is needed.</li><li>Only correct and consistent use of condoms, male or female, protect against STI/HIV.</li></ul></li><li>If there is a risk of STI/HIV, condom use is recommended.</li></ul>';'SzdQQMfggoB';1130;0.02;0.02;65;53;;77
+304;'NG HNQIS FP-1140';'NG HNQIS FP-1140-Imp Ins-Appropriate decision on whether or not to proceed and explains to the client.';;'Appropriate decision on whether or not to proceed and explains to the client.';'<ul><li>Any abnormal findings warrants investigations and management.</li><li>While investigating, offer the woman an alternative method.</li><li>If there are no abnormalities proceed with implant insertion.</li></ul>';'mtLP8mZZ5dD';1140;0.02;0.02;65;53;;77
+305;'NG HNQIS FP-1150';'NG HNQIS FP-1150-Imp Ins-Insertion';;'Insertion';;'NGb9wnYOttA';1150;0.00;0.00;65;49;;
+306;'NG HNQIS FP-1160';'NG HNQIS FP-1160-Imp Ins-Appropriately opens implant packaging';;'Appropriately opens implant packaging';'<p><strong>Open implant packaging according to instructions and drop implants untouched on sterile/HLD surface (container)</strong><br />This is to make sure that the implant does not drop outside of the sterile field.</p>';'M2KNzkw9wcH';1160;0.05;0.05;65;53;;77
+307;'NG HNQIS FP-1170';'NG HNQIS FP-1170-Imp Ins- Conducts pre-insertion preparations according to protocol';;'Conducts pre-insertion preparations according to protocol';'<p><strong>Conduct pre-insertion procedures and follow the steps of implant insertion for correct implant placement under the skin (sub dermally) </strong></p><ul><li>After counseling, explain to the patient the procedure steps and that it will be inserted in the less dominant arm (left for most people). This is because in case of injury to blood vessels or nerves (which is rare), it is not on the dominant arm.</li><li>The number of rods depend on the implant type: Jadelle has 2 rods and works for five years, while Implanon and Nexplanon each have 1 rod and work for three years each.</li><li>Check to be sure the patient has washed her entire arm with soap and water and rinsed it throroughly, being sure to remove alltraces of soap. (Residual soap decreases the effectiveness of some antiseptics.) This step is particularly important when the patient hygiene is poor.</li><li>Ask patient to lie on her back so that implant arm is turned outwards and bent at the elbow and is well supported.</li><li>Place a clean, dry cloth under her arm.</li><li>Determine the optimal insertion area: insertion area is in the inner aspect of the upper arm, between the muscles, about 8-10cm above the fold in the elbow. This is an area with few blood vessels and nerves.</li></ul><p>Reference-PSI Implant Service Delivery Protocol Section 5.2, Page 51</p>';'Ijbq6U2Q0gQ';1170;0.05;0.05;65;53;;77
+308;'NG HNQIS FP-1180';'NG HNQIS FP-1180-Imp Ins-Puts sterile or high level disinfected gloves on both hands';;'Puts sterile or high level disinfected gloves on both hands';'<p>Wear sterile gloves since this is a sterile procedure</p>';'QzkfSgDhgbq';1180;0.05;0.05;65;53;;77
+309;'NG HNQIS FP-1190';'NG HNQIS FP-1190-Imp Ins-Prepares insertion site with antiseptic solution';;'Prepares insertion site with antiseptic solution';'<p>Clean the insertion area with antiseptic solution to reduce the amount of microorganisms; this is a sterile procedure.</p>';'bjFgkGnMcPk';1190;0.05;0.05;65;53;;77
+310;'NG HNQIS FP-1200';'NG HNQIS FP-1200-Imp Ins-Correctly inserts the implant according to protocol';;'Correctly inserts the implant according to protocol';'<p><strong>Follow procedure for appropriate implant as indicated below:<br/>Jadelle</strong></p><ul><li>Prepare a clean instrument tray, open sterile instrument pack, open the implant pouch and drop the rods.</li><li>Wear sterile gloves, clean the insertion area and drape aseptically.</li><li>Infiltrate the local anesthetic (4 ml 1% lidocaine) under the skin slowly withdrawing to avoid intravascular infiltration. Start by infiltrating the needle entry point to form a small wheal, proceed to infiltrate the lidocaine in a V shape.</li><li>Introduce the trocar under the skin up to the 1st mark on the trocar with bevel facing up at an angle of about 20°.</li><li>Advance the trocar horizontally under the skin (sub dermally) until the 2nd mark on the trocar.</li><li>Remove cannula.</li><li>Insert 1st rod into the trocar and load it with the cannula by holding the cannula steady and pulling the trocar out up to the level of the 1st mark on the cannula </li><li>Repeat above and insert 2nd rod in a narrow V shape about 30° relative to the first rod</li><li>Remove trocar and cannula.</li><li>Verify the presence of the implant in the womans arm immediately after insertion by palpation.</li><li>Place a small adhesive bandage over the insertion site. Request the woman to palpate the implant.</li><li>Apply a pressure bandage with sterile gauze to minimize bruising and formation of hematoma. The woman may remove the pressure bandage in 24 hours and the small bandage over the insertion site after 3 to 5 days.</li><li>Complete the user card and give it to the woman to keep. Also, complete the chart label and affix it to the woman''s medical record</li><li>Dispose waste observing infection prevention procedures</li><li>Answer any questions the patient may have.</li><li>Give a return visit date</li></ul><p><strong>Implanon:</strong></p><ul><li>Prepare a clean instrument tray and open sterile instrument pack.</li><li>Wear sterile gloves, clean the insertion area and drape aseptically</li><li>Infiltrate the local anesthetic (4 ml 1% lidocaine) under the skin slowly withdrawing to avoid intravascular infiltration. Start by infiltrating the needle entry point to form a small wheal, proceed to infiltrate the lidocaine in a straight line at an angle of about 30°.</li><li>Remove the sterile disposable applicator carrying Implanon from its blister, ensure to keep the needle and the implant sterile. If contamination occurs, a new package with a new sterile applicator must be used.</li><li>While keeping the needle shield on the needle visually verify the presence of the implant, seen as a white body inside the needle tip. If the implant is not seen tap the top of the needle shield against a firm surface to bring the implant in to the needle tip</li><li>Following visual confirmation, the implant should be lowered back into the needle by tapping it back in to the needle tip. The needle shield can now be removed.</li><li>Please note that the implant can fall out of the needle prior to insertion. Therefore, always hold the applicator in the upward position (i.e. with the needle pointed upwards) until the time of insertion. This is to prevent the implant from dropping out</li><li>Introduce the trocar under the skin with bevel facing up at an angle of about 20°</li><li>Mark the insertion site and stretch the skin around the insertion site with thumb and index finger</li><li>Insert only the tip of the cannula slightly angled at about 20°</li><li>Lower the applicator to a horizontal position</li><li>Lift the skin with the tip of the needle, but keep the needle in the sub dermal connective tissue. Gently insert, while lifting the skin, the needle to its full length, and keep the applicator parallel to the surface of the skin</li><li>Break the seal of the applicator</li><li>Turn the obturator (the rounded end of the applicator) a quarter turn - 90°</li><li>Fix the obturator with one hand against the arm, and with the other hand slowly draw the cannula out of the arm.</li><li>Important Note: Never push against the obturator.</li><li>Verify the presence of the implant in the woman''s arm immediately after insertion by palpation.</li><li>Place a small adhesive bandage over the insertion site. Request the woman to palpate the implant.</li><li>Apply a pressure bandage with sterile gauze to minimize bruising and formation of hematoma. The woman may remove the pressure bandage in 24 hours and the small bandage over the insertion site after 3 to 5 days.</li><li>Complete the user card and give it to the woman to keep. Also, complete the chart label and affix it to the woman''s medical record</li><li>Dispose waste observing infection prevention procedures</li><li>Answer any questions the patient may have</li><li>Give a return visit date</li></ul><p><strong>Nexplanon</strong></p><ul><li>Remove the sterile preloaded disposable nexplanon applicator carrying the implant from its blister. The applicator should not be used if sterility is in question.</li><li>Hold the applicator just above the needle at the textured surface area</li><li>Remove the transparent protection cap by sliding it horizontally in the direction of the arrow away from the needle. If the cap does not come off easily, the applicator should not be used. Confirm presence of implant by checking the white colored implant by looking into the tip of the needle</li><li>Do not touch the purple slider until you have fully inserted the needle sub dermally, as it will retract the needle and prematurely release the implant from the applicator</li><li>With your free hand, stretch the skin around the insertion site with thumb and index finger</li><li>Puncture the skin with the tip of the needle angled about 20°</li><li>Lower the applicator to a horizontal position. While lifting the skin with the tip of the needle, slide the needle to its full length. You may feel slight resistance but do not exert excessive force. If the needle is not inserted to its full length, the implant will not be inserted properly</li><li>Keep the applicator in the same position with the needle inserted to its full length. If needed, you may use your free hand to keep the applicator in the same position during the following procedure</li><li>Unlock the purple slider by pushing it slightly down. Move the slider fully back until it stops</li><li>The implant is now in its final sub dermal position, and the needle is locked inside the body of the applicator.</li><li>Verify the presence of the implant in the woman''s arm immediately after insertion by palpation.</li><li>Place a small adhesive bandage over the insertion site. Request the woman to palpate the implant.</li><li>Apply a pressure bandage with sterile gauze to minimize bruising and formation of hematoma. The woman may remove the pressure bandage in 24 hours and the small bandage over the insertion site after 3 to 5 days.</li><li>Complete the user card and give it to the woman to keep. Also, complete the chart label and affix it to the woman''s medical record</li><li>Dispose waste observing infection prevention procedures</li><li>Answer any questions the patient may have</li><li>Give a return visit date</li></ul><p>Reference-PSI Implant Service Delivery Protocol Section 5.4</p>';'xIUGnB3BHDi';1200;0.35;0.35;65;53;;77
+311;'NG HNQIS FP-1210';'NG HNQIS FP-1210-Imp Ins-Post-Insertion';;'Post-Insertion';;'jU9ZraDBDTC';1210;0.00;0.00;65;49;;
+312;'NG HNQIS FP-1220';'NG HNQIS FP-1220-Imp Ins-Provides post procedure counseling';;'Provides post procedure counseling';'<p><strong>Post insertion counseling</strong><br/>Inform the patient of the following:</p><ul><li>She may feel some mild pain for which she can take a NSAID (e.g. ibuprofen).</li><li>Period of effectiveness for Jadelle is five years; Implanon and Nexplanon is three years.</li><li>Implants become effective within 24 hours after insertion</li><li>If the implant was inserted within the first 7 days of the menstrual cycle, no back up method is necessary after 24 hours.</li><li>If inserted after the 7th day, she needs to use a backup method, such as condoms, for seven days.</li><li>Implants do not protect against STI/HIV.</li><li>She may notice menstrual changes and if bleeding is heavy or prolonged she must return to health facility.</li><li>Remove the pressure bandage (the one on top) after 24 hours and the adhesive tape (Elastoplast) after three days.</li><li>If she has too much pain, reddening, hotness or bleeding on the insertion site, she must return to the health facility immediately.</li><li>Allow her to ask questions.</li><li>Give a return visit date.</li></ul>';'AxUrVQ3GIM4';1220;0.03;0.03;65;53;;77
+313;'NG HNQIS FP-1230';'NG HNQIS FP-1230-Imp Ins-Assesses client´s physical wellbeing before discharge';;'Assesses client´s physical wellbeing before discharge';'<ul><li>Observe the patient for 15-30 minutes for any complications post-insertion. Particularly, observe for bleeding.</li><li>Ask the client how she is feeling and allow her to rest on the examination table for a few minutes if needed. (Some patients may be dizzy faint after the procedure).</li><li>If the client experiences pain or soreness at the insertion site, the following measures can be taken: check that the bandage or gauze on her arm is not too tight; is tight, put a new bandage on the arm and advise her to avoid pressing on the site for a few days; give her an analgesic like paracetamol or ibuprofen.</li></ul>';'dRwHTRW98s3';1230;0.03;0.03;65;53;;77
+314;'NG HNQIS FP-1240';'NG HNQIS FP-1240-Imp Ins-Records service in the client file and register / log book';;'Records service in the client file and register / log book';'<ul><li>Document the service in the patient''s file and daily activity register.</li><li>You can draw the position of the capsule(s) to help in locating the position in future during removal.</li></ul>';'Dwmee8LFiN1';1240;0.06;0.06;65;53;;77
+315;'NG HNQIS FP-1250';'NG HNQIS FP-1250-Imp Ins-Work Environment-Implant Insertion';;'Work Environment-Implant Insertion';;'Gxz3UXvBhGo';1250;0.00;0.00;65;49;;
+316;'NG HNQIS FP-1260';'NG HNQIS FP-1260-Imp Ins-The different types of implants are available in unopened, undamaged and sterile package that is not beyond the expiration date.';;'The different types of implants are available in unopened, undamaged and sterile package that is not beyond the expiration date.';'<ul><li>It is important to have the different types of implants for the patient to choose from.</li><li>Ensure the implant packaging has not been tampered with to ensure sterility.</li><li>Ensure implants have not expired.</li></ul>';'qkoRihDEgRM';1260;0.03;0.03;65;53;;77
+317;'NG HNQIS FP-1270';'NG HNQIS FP-1270-Imp Ins-The following are available: local anaesthetic, sterile gauze, antiseptic, soap, ordinary plaster or butterfly bandage, epinephrine for anaplylaxis.';;'The following are available: local anaesthetic, sterile gauze, antiseptic, soap, ordinary plaster or butterfly bandage, epinephrine for anaplylaxis.';'<p>Have all the necessary consumables for implant insertion to ensure you perform the procedure correctly.</p>';'A61WadP5H46';1270;0.03;0.03;65;53;;77
+324;'NG HNQIS FP-1340';'NG HNQIS FP-1340-Imp Rem-Does this facility offer implant removal?';;'Does this facility offer implant removal?';;'z49O0IpFLC9';1340;0.00;0.00;66;53;;78
+325;'NG HNQIS FP-1350';'NG HNQIS FP-1350-Imp Rem-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>For healthcare providers who are not experienced with implant removal, use of simulation at the beginning is encouraged. However, an assessment on a real case is easy to plan in advance and should be the ideal.</p>';'XJAgCNnYOb5';1350;0.00;0.00;66;88;;78
+326;'NG HNQIS FP-1360';'NG HNQIS FP-1360-Imp Rem-Pre-Removal';;'Pre-Removal';;'BH9oZPqmlkz';1360;0.00;0.00;66;49;;
+327;'NG HNQIS FP-1370';'NG HNQIS FP-1370-Imp Rem-Confirms removal choice';;'Confirms removal choice';'<p><strong>Pre-removal:</strong></p><ul><li>Confirm removal choice.</li><li>Ask the woman her reasons for removal. This is to enable you decide if there is need for further assessment or referral.</li><li>Ask about desire to be pregnant, limit or space her family.</li><li>Answer her questions and review her RH goals.</li><li>Even if the woman has no reason for removal but wants it removed, it is her right.</li><li>Removal can be done any time.</li></ul>';'sjqid52SVOo';1370;0.05;0.05;66;53;;78
+328;'NG HNQIS FP-1380';'NG HNQIS FP-1380-Imp Rem-Counsels about removal procedure';;'Counsels about removal procedure';'<p><strong>Counsel the patient on procedure before removal</strong></p><ul><li>Explain the removal process and that it can take slightly longer compared to insertion but is associated with less discomfort.</li><li>Explain that she will feel some slight pain when the local anesthetic is being injected but after that, the rest of the procedure should be painless.</li></ul>';'pH7BQou5nUZ';1380;0.05;0.05;66;53;;78
+329;'NG HNQIS FP-1390';'NG HNQIS FP-1390-Imp Rem-Counsels client regarding alternative contraceptive methods';;'Counsels client regarding alternative contraceptive methods';'<p><strong>Find out if she wants a new implant to be replaced or an alternative FP method</strong></p><ul><li>Counsel and help her to choose a different method if she wants an alternative FP method.</li><li>Ensure she understands that she can get pregnant after removal unless the implant is replaced or another FP method is given.</li><li>No rest period is needed between implants if she desires implant replacement.</li><li>The new implant should be inserted in the same position at the same time of removal.</li></ul>';'nfsKSu3oLHZ';1390;0.02;0.02;66;53;;78
+330;'NG HNQIS FP-1400';'NG HNQIS FP-1400-Imp Rem-Prepares removal equipment and area';;'Prepares removal equipment and area';'<p><strong>Prepare removal equipment</strong><br/>This is a sterile procedure. Prepare the following requirements, for implant removal:</p><ul><li>Table for the patient to lie on and rest for her arm</li><li>Sterile gloves</li><li>Antiseptic solution and cotton swabs for the skin cleaning</li><li>Local anesthetic -1% lidocaine</li><li>Needle and 5 ml syringe</li><li>Scalpel 22 mm</li><li>Elastoplast</li><li>Sterile instrument pack with pack 2 mosquito forceps-curved and straight, gauze and drapes</li></ul>';'y7TUgWrWaQA';1400;0.10;0.10;66;53;;78
+331;'NG HNQIS FP-1410';'NG HNQIS FP-1410-Imp Rem-Prepares the client for removal';;'Prepares the client for removal';'<p><strong>Position the patient for removal.</strong><br />Ask the patient to lie on her back so that implant arm is turned outwards and bent at the elbow.</p>';'jUEhJitMLIP';1410;0.02;0.02;66;53;;78
+332;'NG HNQIS FP-1420';'NG HNQIS FP-1420-Imp Rem-Removal';;'Removal';;'igySyIdfvVu';1420;0.00;0.00;66;49;;
+333;'NG HNQIS FP-1430';'NG HNQIS FP-1430-Imp Rem-Provider prepares (hand washing, gloving)';;'Provider prepares (hand washing, gloving)';'<p>This is a sterile procedure, wash hands and wear sterile gloves.</p>';'kiKCSmHqa6f';1430;0.07;0.07;66;53;;78
+334;'NG HNQIS FP-1440';'NG HNQIS FP-1440-Imp Rem-Removes the Implants using the correct sterile technique.';;'Removes the Implants using the correct sterile technique.';'<p><strong>It is important to follow the implant removal steps for proper removal and to avoid patient discomfort and injury.</strong></p><p><strong>Steps for implant removal:</strong></p><ul><li>Ask her to lie on her back and position her so the implant arm is turned outwards and bent at the elbow.</li><li>Locate the implant by palpation. For Jadelle there are two rods while for Implanon and Nexplanon there is one rod.</li><li>A non-palpable implant should always first be localized by either ultrasound (USS) or magnetic resonance imaging (MRI) before removal is attempted and subsequently be removed under guidance of USS. Such a case should be referred to a gynecologist for removal.</li><li>Mark both ends of the rod(s) or capsules using a ballpoint or marking pen. If an antiseptic containing alcohol will be used to prep the arm, a pen with permanent ink must be used.</li><li>Put on sterile gloves. Do not use gloves with powder. The tiny granules (talc) may fall into the removal site and cause scarring (fibrous reaction). If gloves are powdered, wipe powder off the glove fingers with sterile gauze soaked in sterile water.</li><li>Wash the area and apply an antiseptic.</li><li>Anaesthetize the arm with 1% lidocaine (4ml for Jadelle and 2 mls for Implanon and Nexplanon) starting with the site of incision, which is just below the distal end of the implant.</li><li>The local anesthetic is applied under the implant. Application above the implant makes the skin swell, which may cause difficulties in locating the implant.</li><li>Push down the proximal tip to fix the implant; a bulge may appear indicating the distal end of the implant. Starting below the distal tip of the implant, make a longitudinal incision of 2 mm towards the distal tip of the implant.</li><li>Gently push the implant towards the incision until the tip is visible. Grasp the implant with a mosquito forceps and remove.</li><li>If the tip of the implant is not visible, there might be formation of fibrotic tissue around the implant. The fibrotic tissue can be split by continuing to cut towards the distal tip, until the tip is clearly visible. Remove the implant with a mosquito forceps.</li><li>If the tip of the implant is still not visible, gently insert a forceps into the incision and grasp the implant, and with second forceps carefully dissect the tissue around the implant. The implant can then be removed.</li><li>Ensure that for Jadelle, two rods are removed.</li><li>Close the incision with a butterfly closure.</li><li>Show the patient the implant(s).</li><li>If the woman would like to continue using an implant, a new implant may be inserted.</li><li>Apply sterile gauze with a pressure bandage to prevent bruising.</li><li>If the woman does not wish to continue using an implant and does not want to become pregnant, another contraceptive method should be recommended.</li><li>If pregnancy is desired offer preconception care.</li><li>The arm should be kept dry for about 3 days.</li><li>Answer any questions the patient may have, give a return date and thank her.</li></ul><p>Reference-PSI Implant Sevice Delivery Protocol: Section 8.4</p>';'rn43AaRx2e5';1440;0.47;0.47;66;53;;78
+335;'NG HNQIS FP-1450';'NG HNQIS FP-1450-Imp Rem-Shows client the implant and disposes as hazardous waste';;'Shows client the implant and disposes as hazardous waste';'<p><strong>Show patient the removed implant</strong></p><ul><li>Show the patient the removed implant(s), as proof that it has been removed.</li><li>Dispose the implant as hazardous waste since it has been removed from the human body and is therefore contaminated.</li></ul>';'XzzaqjC5K7M';1450;0.06;0.06;66;53;;78
+336;'NG HNQIS FP-1460';'NG HNQIS FP-1460-Imp Rem-Post-removal';;'Post-removal';;'diJqXun27IB';1460;0.00;0.00;66;49;;
+337;'NG HNQIS FP-1470';'NG HNQIS FP-1470-Imp Rem-Post removal IP procedures correctly performed';;'Post removal IP procedures correctly performed';'<p><strong>Post removal IP procedures</strong></p><ul><li>Immediately soak ALL the instruments used after respective procedure, or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes</li><li>Dispose of waste material in leak proof container or plastic bag</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution</li><li>After soaking for 10 minutes, remove instruments from solution</li><li>Clean instruments immediately</li><li>Remove gloves following the glove removal procedure</li></ul>';'JRJeUdTuDCG';1470;0.05;0.05;66;53;;78
+338;'NG HNQIS FP-1480';'NG HNQIS FP-1480-Imp Rem-Assesses client´s physical wellbeing before discharge';;'Assesses client´s physical wellbeing before discharge';'<p><strong>Assess the patient before discharge</strong><br />Observe the patient for 15-20 minutes for any complications post-removal. Particularly, observe for bleeding.</p>';'NpFbEKNImT4';1480;0.02;0.02;66;53;;78
+339;'NG HNQIS FP-1490';'NG HNQIS FP-1490-Imp Rem-Records in the client file and Daily Activity Register';;'Records in the client file and Daily Activity Register';'<ul><li>Document in the patient''s file and daily activity register. Record removal and new method chosen (if any).</li><li>Documentation is part of good clinical practice.</li></ul>';'g2vKq2KXSKP';1490;0.02;0.02;66;53;;78
+340;'NG HNQIS FP-1500';'NG HNQIS FP-1500-Imp Rem-Work Environment-Implant Removal';;'Work Environment-Implant Removal';;'wTOjJtGklqe';1500;0.00;0.00;66;49;;
+341;'NG HNQIS FP-1510';'NG HNQIS FP-1510-Imp Rem-Equipment available: scalpel with blade, 1 mosquito or crile forceps; 1 Norplant-holding forceps, straight tissue or artery forceps (optional)';;'Equipment available: scalpel with blade, 1 mosquito or crile forceps; 1 Norplant-holding forceps, straight tissue or artery forceps (optional)';'<p>Have the appropriate equipment to ensure correct and easy implant removal.</p>';'hx3vVJ5gcRW';1510;0.03;0.03;66;53;;78
+346;'NG HNQIS FP-1560';'NG HNQIS FP-1560-Imp Rem-Consumable items are available: local anaesthetic, sterile gauze, antiseptic, soap, ordinary plaster or butterfly bandage, epinephrine for anaplylaxis.';;'Consumable items are available: local anaesthetic, sterile gauze, antiseptic, soap, ordinary plaster or butterfly bandage, epinephrine for anaplylaxis.';'<ul><li>It is important to have all consumables.</li><li>Emergency medicine is critical in case of anaphylactic reaction.</li></ul>';'Nce2vFIm9Gq';1560;0.02;0.02;66;53;;78
+354;'NG HNQIS FP-2030';'NG HNQIS FP-2030-END-END OF TAB';;'END OF TAB';;'UipQzIvQNls';2030;0.00;0.00;146;49;;
+355;'NG HNQIS ANC-100';'NG HNQIS ANC-100-Intro-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<ul><li>Real cases are preferred over simulated cases</li></ul><p><strong>Main objectives of ANC visit are:</strong></p><ul><li>Early detection and treatment of complications.</li><li>Establish supportive relationship between the woman and health care provider.</li><li>Development of a birth and emergency plan.</li><li>Provision of preventative services.</li><li>Provision of advice and counseling</li></ul>';'MlunxVaBhsM';100;0.00;0.00;67;88;;94
+356;'NG HNQIS ANC-110';'NG HNQIS ANC-110-Intro-Is this the client''s first visit?';;'Is this the client''s first visit?';'<ul><li>If this is the first visit, obtain: (a) demographic data (b) medical history (c) gynecological / obstetric history (d) current state (e)medications history (f) allergies (g) contact information and next of kin including their contacts (important in case of emergencies).</li><li>Ideally, the mother should be seen by the same provider throughout her pregnancy.</li><li>Care/tests/counseling should be tailored to the stage of pregnancy.</li></ul>';'MuSddCKqIMG';110;0.00;0.00;67;53;;94
+357;'NG HNQIS ANC-120';'NG HNQIS ANC-120-Intro-Is this the client''s subsequent visit?';;'Is this the client''s subsequent visit?';'<p>If not first visit, find out if there are any:<br/>(a) New medical problems (b) Pregnancy related problems</p>';'uEivFBpcsd7';120;0.00;0.00;67;53;;94
+358;'NG HNQIS ANC-130';'NG HNQIS ANC-130-Intro-Prepares the necessary equipment.';;'Prepares the necessary equipment.';'<p><strong>Prepare equipment in advance</strong><br/>Equipment include: weight/height scale, BP machine, fetoscope or doppler, tape for fundal height, speculums, and urine dip sticks.</p>';'bzNdSegAg1f';130;0.00;0.00;67;53;;94
+359;'NG HNQIS ANC-140';'NG HNQIS ANC-140-Intro-Tells the woman what is going to be done, encourages her to ask questions, and responds supportively.';;'Tells the woman what is going to be done, encourages her to ask questions, and responds supportively.';'<p><strong>Effective communication skills</strong></p><ul><li>Communicate clearly, build trust, and keep the woman at ease</li><li>Explaining the procedure and obtaining consent helps reduce misunderstanding and helps ensure rights of patient are respected.</li></ul>';'LUeGcpMEqJX';140;0.00;0.00;67;53;;94
+360;'NG HNQIS ANC-150';'NG HNQIS ANC-150-Ask or Check-Age';;'Age';'<p><strong>Age:</strong> some age groups are at higher risk for complications (below 17 years and above 35 years).</p>';'Y3tDz4eKr1L';150;0.02;0.02;68;53;;95
+361;'NG HNQIS ANC-160';'NG HNQIS ANC-160-Ask or Check-Medical history: Previous and current';;'Medical history: Previous and current';'<p><strong>Medical History:</strong></p><ul><li>Some patients (e.g. women with history of diabetes, hypertension, epilepsy, HIV, mental illnesses etc.) will require additional interventions to minimize risk of adverse pregnancy outcomes.</li><li>Patients with pre-existing conditions beyond the provider''s capacity should be referred.</li></ul>';'xWNNwHCM7sy';160;0.02;0.02;68;53;;95
+362;'NG HNQIS ANC-170';'NG HNQIS ANC-170-Ask or Check-Medications';;'Medications';'<ul><li>Some drugs have adverse effects on the fetus (e.g. some anti-epileptic drugs).</li><li>Dosages of the medication may need to be adjusted.</li><li>Advice patients to consult a provider before taking medication during pregnancy.</li></ul>';'r2fR42zTaTt';170;0.02;0.02;68;53;;95
+363;'NG HNQIS ANC-180';'NG HNQIS ANC-180-Ask or Check-Previous Obstetric history';;'Previous Obstetric history';'<p><strong>Obstetric history</strong></p><ul><li>Experiences in previous pregnancies can influence future pregnancies. E.g., women with previous caesarian sections are at higher risk of uterine rupture or placenta accreta.</li><li>Some complications can also recur hence the need to look out for them.</li></ul>';'hUzZk89bHSs';180;0.02;0.02;68;53;;95
+364;'NG HNQIS ANC-190';'NG HNQIS ANC-190-Ask or Check-Takes information about current pregnancy: LMP, calculate EDD and any other problem';;'Takes information about current pregnancy: LMP, calculate EDD and any other problem';'<p><strong>Estimate gestational Age and EDD</strong></p><ul><li>Different methods to calculate EDD: pregnancy wheel; adding 280 days to the LMP; or add 7 to the first day of LMP and 9 to the month.</li><li>EDD is important to guide counseling and care; and scheduling ANC visits.</li><li>If a woman does not know her LMP, an early trimester ultrasound can provide the EDD. Late trimester ultrasounds are inaccurate for dating.</li></ul>';'QSkMNuaCAD7';190;0.02;0.02;68;53;;95
+365;'NG HNQIS ANC-200';'NG HNQIS ANC-200-Ask or Check-Fetal movement';;'Fetal movement';'<ul><li>Begin from 18-20 weeks (or earlier for subsequent pregnancies).</li><li>Provider should ask about this at every visit from the 2nd trimester.</li><li>A woman should visit a health facility if she experiences reduced or no fetal movements.</li></ul>';'HjPDQsyzxhW';200;0.02;0.02;68;53;;95
+366;'NG HNQIS ANC-210';'NG HNQIS ANC-210-Ask or Check-Urinary symptoms';;'Urinary symptoms';'<ul><li>Urinary tract infections are more common in pregnancy, and can trigger premature labor or cause systemic illness if untreated</li><li>Office urine dip stick can screen for a UTI; also use this as an opportunity to check for presence of proteins (can indicate pre-eclampsia) or glucose (can indicate gestational diabetes).</li></ul>';'O4qsEHec6Gj';210;0.02;0.02;68;53;;95
+367;'NG HNQIS ANC-220';'NG HNQIS ANC-220-Ask or Check-Presence of pregnancy danger signs';;'Presence of pregnancy danger signs';'<ul><li>Key danger signs include: heavy bleeding, convulsions/fits, severe headache, blurred vision, fever, difficulty breathing, severe abdominal pain, premature labor, drainage of liquor and reduced fetal movements.</li><li>Provider should ask about danger signs at each visit and manage accordingly.</li><li>Advice the woman to visit a health provider if she experiences any danger sign.</li></ul>';'WeFtIBsasrc';220;0.02;0.02;68;53;;95
+368;'NG HNQIS ANC-230';'NG HNQIS ANC-230-Ask or Check-Patient behavior: Does she sleep under net every night, what is her diet like?';;'Patient behavior: Does she sleep under net every night, what is her diet like?';'<p><strong>ITN</strong></p><ul><li>Sleeping under an insecticide treated mosquito nets reduces chances of malaria transmission.</li><li>Malaria in pregnancy can have more adverse outcomes for both mother <strong>and fetus.</strong></li></ul><p><strong>Diet</strong></p><ul><li>Nutritional status of pregnant women greatly impacts the health of the mother and newborn.</li><li>Pregnant women are at risk of micronutrient deficiencies such as iron, vitamin A, calcium and iodine.</li><li>Pregnant women should drink lots of water and stay hydrated.</li></ul>';'fT3BV8QsFHu';230;0.02;0.02;68;53;;95
+369;'NG HNQIS ANC-240';'NG HNQIS ANC-240-Ask or Check-Complete Antenatal Profile (Urinalysis, HIV, Syphilis, Hb, blood group)';;'Complete Antenatal Profile (Urinalysis, HIV, Syphilis, Hb, blood group)';'<p><strong>Antenatal profile</strong></p><ul><li>Antenatal profiles detect underlying diseases/conditions which may require interventions.</li><li>Some tests may need to be repeated more than once during the pregnancy.</li><li>Remember HIV testing is voluntary. If she declines, she should be counseled and offered the test during the next visit.</li></ul><p><strong>Routine ANC tests include:</strong></p><ul><li><em>Urinalysis:</em> detects protein in urine (can indicate pre-eclampsia), UTI, and sugar (can indicate gestational diabetes).</li><li><em>Hemoglobin levels:</em> detects anemia, which can impact fetal growth and pregnancy outcomes.</li><li><em>VDRL:</em> tests for Syphilis; if untreated can transfer from mother to newborn and cause severe problems for newborn.</li><li><em>Blood Group and rhesus factor:</em> A rhesus negative woman with a rhesus positive spouse/partner requires an indirect coombs test (ICT) at 28 weeks gestation and anti-D injection at 28 weeks gestations and within 72 hours after birth of a rhesus positive baby to prevent rhesus isoimmunization. Refer rhesus negative women to a tertiary facility.</li><li><em>HIV:</em> If a woman tests positive, interventions should be put into place to avoid transmission to child; if negative, patient should be counseled to minimize risk of infection.</li></ul>';'gJThZYrWTOx';240;0.02;0.02;68;53;;95
+370;'NG HNQIS ANC-250';'NG HNQIS ANC-250-Ask or Check-Blood pressure. Compares to previous visit';;'Blood pressure. Compares to previous visit';'<p><strong>Take the client''s blood pressure during every visit</strong></p><ul><li>Monitor for hypertensive disease in pregnancy.</li><li>Take the reading when the woman is well rested.</li><li>Compare the current BP reading with that of the previous ANC visit.</li></ul>';'BmWSLtQsUGx';250;0.02;0.02;68;53;;95
+371;'NG HNQIS ANC-260';'NG HNQIS ANC-260-Ask or Check-Pallor';;'Pallor';'<p><strong>Check for pallor during every ANC visit</strong></p><ul><li>Anaemia can develop at any stage of the pregnancy.</li><li>Check on the palms, conjunctiva or below the tongue.</li><li>A full haemogram should be done for women with pallor.</li><li>Women diagnosed with anemia should be on haemanitics and referred to a tertiary health facility as per protocol.</li></ul>';'rpLqvhdAUQB';260;0.02;0.02;68;53;;95
+372;'NG HNQIS ANC-270';'NG HNQIS ANC-270-Ask or Check-Check edema in the legs';;'Check edema in the legs';'<ul><li>Mild edema is expected in most pregnancies.</li><li>Severe pitting edema or rapidly progressing edema can be a sign of pre-elampsia, renal or cardiovascular disease and should be investigated promptly.</li><li>Women with severe edema should be referred as per protocol.</li></ul>';'EzaDN4t0Ybr';270;0.02;0.02;68;53;;95
+373;'NG HNQIS ANC-280';'NG HNQIS ANC-280-Ask or Check-Abdominal Examination';;'Abdominal Examination';'<ul><li>Abdomen should be well exposed, but the rest of the body should be covered to respect the client''s privacy.</li><li>First, inspect for previous scars, hernias or other abnormalities.</li><li>Then conduct an obstetric palpation (Leopold''s Maneuver) together with fetal heart auscultation.</li><li>Then palpate the organs; liver, spleen and kidneys.</li><li>Finally, auscultate the abdomen for bowel movements.</li></ul>';'k3aOYTsUGKn';280;0.02;0.02;68;53;;95
+374;'NG HNQIS ANC-290';'NG HNQIS ANC-290-Ask or Check-Pregnancy assessment: Fundal height. Compare to previous visit and gestation. Calculates gestational age.';;'Pregnancy assessment: Fundal height. Compare to previous visit and gestation. Calculates gestational age.';'<ul><li>Fundal height helps monitor growth of baby.</li><li>Estimate the gestational age by fundal height.</li><li>Compare the fundal height with the one for the previous visit to assess progress.</li><li>Any disparity should be investigated</li></ul>';'aJX2R0e6XxS';290;0.02;0.02;68;53;;95
+375;'NG HNQIS ANC-300';'NG HNQIS ANC-300-Ask or Check-Fetal poles/lie';;'Fetal poles/lie';'<p><strong>Asses and document the fetal poles and lie</strong></p><ul><li>These may change with every visit but become important in the 4th visit where they may influence delivery plan e.g. transverse lie in late pregnancy, should be referred for elective caesarean section.</li></ul>';'bvTOlUfdsE1';300;0.02;0.02;68;53;;95
+376;'NG HNQIS ANC-310';'NG HNQIS ANC-310-Ask or Check-Fetal presentation';;'Fetal presentation';'<p><strong>Asses the fetal presentation</strong></p><ul><li>More important in 4th visit but should be noted and documented in all visits.</li><li>Atypical presentation late in pregnancy may necessitate planning for elective caesarean section,e.g. breech presentation at 36 weeks.</li></ul>';'YkkrLW5eQbp';310;0.02;0.02;68;53;;95
+377;'NG HNQIS ANC-320';'NG HNQIS ANC-320-Ask or Check-Engagement of presenting part';;'Engagement of presenting part';'<p><strong>Asses engagement of presenting part</strong></p><ul><li>Important at 4th visit as it shows progress toward onset of labor.</li><li>Women with presentation other than cephalic at 36 weeks should be referred to a facility that can conduct a caesarean section.</li></ul>';'g3OAIs3WDtQ';320;0.02;0.02;68;53;;95
+378;'NG HNQIS ANC-330';'NG HNQIS ANC-330-Ask or Check-Fetal heart rate';;'Fetal heart rate';'<p><strong>Auscultate fetal heart rate</strong></p><ul><li>Should be checked on every visit and abnormalities investigated or referred.</li></ul>';'wqtSr9BLEyz';330;0.02;0.02;68;53;;95
+379;'NG HNQIS ANC-340';'NG HNQIS ANC-340-Ask or Check-Puts examination gloves on both hands';;'Puts examination gloves on both hands';'<ul><li>Gloves should be worn to prevent infections.</li></ul>';'tiBTHLlu2ak';340;0.02;0.02;68;53;;95
+380;'NG HNQIS ANC-350';'NG HNQIS ANC-350-Ask or Check-If appropriate proceeds with Genital Examination';;'If appropriate proceeds with Genital Examination';'<p><strong>Genital examination</strong></p><ul><li>Conduct only if indicated.</li><li>Ensure privacy, informed choice, and confidentiality.</li></ul>';'QZl3cTPy1MZ';350;0.02;0.02;68;53;;95
+381;'NG HNQIS ANC-360';'NG HNQIS ANC-360-Ask or Check-Remove contaminated gloves carefully';;'Remove contaminated gloves carefully';'<ul><li>Carefully remove contaminated gloves and immediately dispose in segregated waste container to minimize risk of infection.</li></ul>';'WsMMmHs8BkS';360;0.02;0.02;68;53;;95
+382;'NG HNQIS ANC-370';'NG HNQIS ANC-370-Care-Iron/folate.';;'Iron/folate.';'<p><strong>Give Iron and Folate</strong></p><ul><li>All pregnant should receive iron (60mg) and folate (400mcg) daily to minimize risk of anemia.</li><li>In addition, folic in the first trimester reduces the risk of neural tube defects in the fetus.</li><li>Encourage intake of Vitamin C to aid in absorption of iron.</li></ul>';'wVuosy6q4Mj';370;0.03;0.03;69;53;;96
+383;'NG HNQIS ANC-380';'NG HNQIS ANC-380-Care-Antimalarial: Intermittent Preventive Treatment (IPTp1), Sulfadoxine-Pyrimethamine (SP), give 3 tablets by directly observed treatment (DOT).';;'Antimalarial: Intermittent Preventive Treatment (IPTp1), Sulfadoxine-Pyrimethamine (SP), give 3 tablets by directly observed treatment (DOT).';'<p><strong>Intermittent Preventive Treatment (IPTp-SP)</strong></p><ul><li>Should be given to women in moderate to high malaria transmission zones.</li><li>Give starting from 16 weeks then, during every visit, provided that the doses are given at least one month apart.</li><li>Administer as directly observed therapy (DOT).</li><li>Can be given on empty stomach.</li><li>Avoid folic dose (above .6 mg) when giving SP.</li><li>Women receiving cotrimoxazole prophylaxis should not be given IPTp-SP.</li></ul>';'hkGIZlM70PT';380;0.03;0.03;69;53;;96
+384;'NG HNQIS ANC-390';'NG HNQIS ANC-390-Care-Antihelminthics: Mebendazole 500 mg (in areas where hookworm is greater than 20%). Does not give in 1st trimester';;'Antihelminthics: Mebendazole 500 mg (in areas where hookworm is greater than 20%). Does not give in 1st trimester';'<p><strong>Check if the woman has been dewormed</strong></p><ul><li>Hookworms and other intestinal parasites may lead to anemia.</li><li>Mebendazole should be given in second or third trimester in areas with high hookworm prevalence.</li></ul>';'q0aFQaIkFPL';390;0.03;0.03;69;53;;96
+385;'NG HNQIS ANC-400';'NG HNQIS ANC-400-Care-Tetanus toxoid: Gives 2 times during pregnancy (if not immune).';;'Tetanus toxoid: Gives 2 times during pregnancy (if not immune).';'<p><strong>Check if she has received TT</strong></p><ul><li>Tetanus is life threatening in newborns with close to 100% mortality.</li><li>Two TT injections given 4 weeks apart in the first pregnancy; and one injection in subsequent pregnancies, reduces risk of neonatal tetanus.</li><li>After a total of 5 injections, a woman is considered immune and does not need further injections.</li></ul>';'qoJZxcB9JCg';400;0.03;0.03;69;53;;96
+386;'NG HNQIS ANC-410';'NG HNQIS ANC-410-Care-Vitamin A (in areas of Vitamin A deficiency)';;'Vitamin A (in areas of Vitamin A deficiency)';'<ul><li>Supplementation should be given in Vitamin A deficient areas.</li><li>All pregnant women should eat foods rich in Vitamin A such as liver.</li></ul>';'V7SS3qwpIs2';410;0.03;0.03;69;53;;96
+387;'NG HNQIS ANC-420';'NG HNQIS ANC-420-Care-Iodine (in areas of iodine deficiency)';;'Iodine (in areas of iodine deficiency)';'<ul><li>In iodine deficient areas, supplementation should be given (unless salt is adequately iodized in country).</li></ul>';'rXKxIlllxUE';420;0.03;0.03;69;53;;96
+388;'NG HNQIS ANC-430';'NG HNQIS ANC-430-Care-In case issues were identified, were they managed / treated correctly ?';;'In case issues were identified, were they managed / treated correctly ?';'<ul><li>Problems identified (e.g. UTI, hypertension, vaginal candidiasis, etc.) should be managed accordingly</li><li>Providers should be attentive to individual clients needs and should provide care in a non-judgmental and appropriate manner</li></ul>';'N3AdnbJX8Lv';430;0.03;0.03;69;53;;96
+389;'NG HNQIS ANC-440';'NG HNQIS ANC-440-EC-Provides client education and counseling on: Diet and nutrition.';;'Provides client education and counseling on: Diet and nutrition.';'<ul><li>Pregnant mothers need balanced and nutritious diet to support fetal development.</li><li>Providers should counsel mothers on appropriate diet that is affordable and available locally.</li></ul>';'WoUk25MvDnh';440;0.03;0.03;70;53;;97
+390;'NG HNQIS ANC-450';'NG HNQIS ANC-450-EC-Prevent anemia';;'Prevent anemia';'<p><strong>Counsel on anaemia prevention</strong></p><ul><li>Women should take foods rich in iron, folic acid and other micro-nutrients to prevent anemia.</li><li>Iron rich foods: fish, liver, whole grains, dark green leafy vegetables, poultry, and dried fruits.</li><li>Folate rich foods: beans, spinach, citrus fruits, mangoes, and green leafy vegetables.</li></ul>';'onRN56nvYV2';450;0.03;0.03;70;53;;97
+391;'NG HNQIS ANC-460';'NG HNQIS ANC-460-EC-Prevent malaria';;'Prevent malaria';'<p><strong>Educate about malaria prevention</strong></p><ul><li>Malaria in pregnancy can cause severe complications e.g. pre-mature birth, low birth weight, intra-uterine death severe disease in woman etc.</li><li>Women should sleep under an insecticide treated net on all nights; take intermittent prophylaxis (SP) from 2nd trimester; and seek prompt treatment for any fever from a qualified provider.</li></ul>';'E6bCwBXlJon';460;0.03;0.03;70;53;;97
+392;'NG HNQIS ANC-470';'NG HNQIS ANC-470-EC-Correct preparation for breastfeeding';;'Correct preparation for breastfeeding';'<p><strong>Educate on exclusive breastfeeding</strong></p><ul><li>1st visit: counsel women on benefits of breastfeeding.</li><li>2nd visit: counsel on when to initiate breastfeeding and how to breastfeed.</li><li>3rd visit: counsel on exclusive breastfeeding.</li><li>4th visit: repeat all previous messages.</li><li>Many health benefits of breastfeeding for mother and newborn.</li><li>HIV positive women should be counseled based on local protocol.</li></ul>';'YTxjJbRt5ua';470;0.03;0.03;70;53;;97
+393;'NG HNQIS ANC-480';'NG HNQIS ANC-480-EC-Provides appropriate counseling on Birth preparation and planning';;'Provides appropriate counseling on Birth preparation and planning';'<p><strong>Discuss and assist in preparation of a Birth plan</strong></p><ul><li>Pregnant women should develop a birth plan including: where to deliver, transport plan to health facility, mode of delivery, birth companion and personal effects.</li><li>Birth plan helps the woman and her family be ready to seek and access care when labor begins.</li></ul>';'DCKYKBe1GZf';480;0.03;0.03;70;53;;97
+394;'NG HNQIS ANC-490';'NG HNQIS ANC-490-EC-Danger signs in pregnancy, labor and postpartum (woman and newborn)';;'Danger signs in pregnancy, labor and postpartum (woman and newborn)';'<p><strong>Educate on danger signs</strong></p><ul><li>A pregnant woman and her family should be able to identify danger signs and respond promptly.</li><li><strong>Danger signs in pregnancy: </strong>vaginal bleeding, convulsions, severe headache, blurred vision, fever, difficulty breathing, severe abdominal pain, premature labor, drainage of liquor and reduced fetal movements.</li><li><strong>Danger signs during labor:</strong> excessive bleeding, labor for more than 12 hours, premature rupture of membranes, convulsions, loss of consciousness and cord/arm/leg prolapse.</li><li><strong>Postpartum danger signs:</strong> excessive bleeding, fever, foul smelling discharge, abdominal pains, painful breasts, mental disturbance, excessive fatigue, headaches, convulsions, facial/hand swelling and painful calf muscles.</li><li><strong>Newborn danger signs:</strong> breathing problems, bleeding/pus discharge from umbilicus, floppy/stiff, fever, convulsions, > 10 skin pustules.</li></ul>';'EeKPyTCHJFi';490;0.04;0.04;70;53;;97
+395;'NG HNQIS ANC-500';'NG HNQIS ANC-500-EC-Counsels about post partum Family planning';;'Counsels about post partum Family planning';'<p><strong>Discuss family planning options</strong></p><ul><li>Provider should discuss FP options during the 3rd trimester.</li><li>After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes.</li><li>Provider should respect rights of patients and ensure informed choice when discussing FP options and clearly address any questions raised.</li></ul>';'DvHIWnAS6rs';500;0.03;0.03;70;53;;97
+396;'NG HNQIS ANC-510';'NG HNQIS ANC-510-EC-Other complaints or problems All visits.';;'Other complaints or problems All visits.';'<p><strong>Other complaints</strong></p><ul><li>Provider should encourage patients to raise any concerns/questions during all visits and should listen in a caring non-judgmental manner.</li><li>Verbal and non-verbal cues should be keenly observed and an atmosphere of understanding and support created at all times.</li></ul>';'UtQKb74HuJK';510;0.03;0.03;70;53;;97
+397;'NG HNQIS ANC-520';'NG HNQIS ANC-520-WE-Is there a functioning weighing scale?';;'Is there a functioning weighing scale?';'<ul><li>All women should be weighed at each ANC visit</li></ul>';'NQHFex1FilW';520;0.03;0.03;71;53;;98
+398;'NG HNQIS ANC-530';'NG HNQIS ANC-530-WE-Is there a functioning BP machine?';;'Is there a functioning BP machine?';'<ul><li>BP should be taken at each visit for prompt identification of hypertensive diseases</li></ul>';'OB2AXxwUHXI';530;0.03;0.03;71;53;;98
+399;'NG HNQIS ANC-540';'NG HNQIS ANC-540-WE-Availability of Fetoscope or doppler, tape measure';;'Availability of Fetoscope or doppler, tape measure';'<ul><li>Necessary for antenatal examination</li></ul>';'pYrSvV9vynL';540;0.03;0.03;71;53;;98
+400;'NG HNQIS ANC-550';'NG HNQIS ANC-550-WE-Are LLITNs available?';;'Are LLITNs available?';'<ul><li>Pregnant women attending antenatal clinic should be provided with a LLITN to avoid malaria transmission.</li></ul>';'curz8emYiRx';550;0.03;0.03;71;53;;98
+401;'NG HNQIS ANC-560';'NG HNQIS ANC-560-WE-Availability of Iron tablets, folic acid, antimalarials, antihelminthics (mebendazole), Tetanus Toxoid, Vitamin A (in areas of deficiency), Iodine (in areas of deficiency).';;'Availability of Iron tablets, folic acid, antimalarials, antihelminthics (mebendazole), Tetanus Toxoid, Vitamin A (in areas of deficiency), Iodine (in areas of deficiency).';'<ul><li>These essential drugs should be available for treatment and prophylaxis.</li></ul>';'BthJoOyWjh1';560;0.03;0.03;71;53;;98
+402;'NG HNQIS ANC-570';'NG HNQIS ANC-570-WE-Are there ANC booklets, ANC register?';;'Are there ANC booklets, ANC register?';'<ul><li>Each woman should have an ANC booklet which is filled during each visit.</li></ul><p>Patient data should be entered into an ANC register.</p>';'iBBRg2Oh8GG';570;0.03;0.03;71;53;;98
+403;'NG HNQIS ANC-580';'NG HNQIS ANC-580-END-END OF TAB';;'END OF TAB';;'HY3aVC5FANy';580;0.00;0.00;71;49;;98
+404;'NG HNQIS PPIUD-100';'NG HNQIS PPIUD-100-Pre-Ins-Is this a real or simulated observation?';;'Is this a real or simulated observation?';;'XnqEXkVNwUo';100;0.00;0.00;72;88;;100
+405;'NG HNQIS PPIUD-110';'NG HNQIS PPIUD-110-Pre-Ins- Review client record and verifies eligibility for PPIUD insertion';;'Review client record and verifies eligibility for PPIUD insertion';'<p><strong>The following are types PPIUD insertion:</strong><br /><strong>a.Post placental insertion:</strong> IUD insertion is performed within 15 minutes of expulsion of the placenta following a vaginal delivery.<br /><strong>b.Immediate postpartum insertion: </strong>IUD insertion performed after the post placental period but within 48 hours of a vaginal delivery.<br /><strong>c.Transcaesarean insertion:</strong> IUD is inserted following a cesarean delivery, before the uterus incision is sutured.<br /><strong>d.Post abortion:</strong> general term for IUD insertion that follows a spontaneous or induced abortion.</p><ul><li>Note: Insertion of the IUD between 48 hours and 4 weeks postpartum is NOT recommended because of increased risk of expulsion.</li><li>If 48 hours have elapsed, advice the woman to come back at 6 weeks postpartum for interval insertion.</li></ul><p><strong>In preparation for insertion of the IUD, confirm the following information about the woman and her clinical situation:</strong></p><ul><li>Ask the woman whether she still desires the IUD for Immediate PPFP.</li><li>Review her antenatal record and be certain that:<ul><li>Her antenatal screening shows that an IUD is an appropriate method for her,</li><li>She has had FP counseling while not in active labor and there is evidence of consent in her chart,</li><li>OR she is being counseled in the post-partum period.</li></ul></li><li>Review the course of her labor and delivery and ensure that none of the following conditions are present:</li><li><strong><em>For Immediate post placental insertion:</em></strong><ul><li>Chorioamnionitis (during labor)</li><li>More than 18 hours from rupture of membranes to delivery of baby</li><li>Unresolved postpartum hemorrhage</li></ul></li><li><em><strong>For Immediate postpartum insertion:</strong></em><ul><li>Puerperal sepsis</li><li>Postpartum endometritis/metritis</li><li>Continued excessive postpartum bleeding</li><li>Extensive genital trauma where the repair would be disrupted by immediate postpartum placement of an IUD</li></ul></li><li>Confirm that sterile instruments are available.</li><li>Confirm that IUDs are available and accessible on the labor ward.</li></ul><p>If these conditions are present, reevaluate for IUD at 6 weeks postpartum. If the patient is eligible prepare requirements and the patient.</p><p>Prepare requirements:</p><ul><li>A procedure room suitable for IUD insertion is needed</li><li>Examining light</li><li>2 Ring forceps/ Sponge holding forceps</li><li>Copper T IUCD or levonorgestrel IUD</li><li>Sims speculum</li><li>Uterine sound</li><li>Sterile gauze</li><li>Sterile gloves</li><li>Sterile drapes</li><li>Lubricant</li><li>Antiseptic solution</li></ul><p>Prepare patient:</p><ul><li>Ensure that active management of third stage of labor (AMTSL) procedures are complete.</li><li>Empty bladder.</li><li>Chaperon needed.</li><li>Put the patient in the lithotomy position.</li></ul>';'eHCUPSOfG0q';110;0.05;0.05;72;53;;100
+406;'NG HNQIS PPIUD-120';'NG HNQIS PPIUD-120-Pre-Ins-Performs abdominal exam and assesses the uterus';;'Performs abdominal exam and assesses the uterus';'<ul><li>Palpate the uterus and ensure that it is well contracted, consistent with a post placental or post partum state. Note the size in corresponding weeks of gestation. The uterus should be at least 20 weeks in size.</li><li>There should be no suprapubic tenderness.</li><li>Ensure that active management of third stage of labor (AMTSL) procedures are complete.</li><li>If there are any abdominal masses/abnormalities or significant tenderness inconsistent with a normal post placental or postpartum state then insertion may need to be delayed and the client should be referred for evaluation.</li></ul>';'jtZRj1M3y7p';120;0.05;0.05;72;53;;100
+407;'NG HNQIS PPIUD-130';'NG HNQIS PPIUD-130-Pre-Ins-Tells the client what is going to be done and answers any questions she may have';;'Tells the client what is going to be done and answers any questions she may have';'<p>Explain to the patient the procedure.</p>';'fy7zGbYGzCC';130;0.05;0.05;72;53;;100
+408;'NG HNQIS PPIUD-140';'NG HNQIS PPIUD-140-Pre-Ins-Performs speculum exam, locates cervix checking for any signs of cervical or vaginal problems that might preclude insertion at this time';;'Performs speculum exam, locates cervix checking for any signs of cervical or vaginal problems that might preclude insertion at this time';'<p><strong>Speculum examination</strong></p><ul><li>At speculum examination, if there is active bleeding, assess and manage the bleeding first before insertion.</li><li>If there are tears, lacerations or episiotomy that is not activity bleeding, insert the IUD first then do the repairs after.</li></ul>';'eBtIb28xu2P';140;0.05;0.05;72;53;;100
+409;'NG HNQIS PPIUD-150';'NG HNQIS PPIUD-150-Pre-Ins-Takes appropriate decision on whether or not to proceed and explains to the client. If proceeding with insertion, confirms consent has been given.';;'Takes appropriate decision on whether or not to proceed and explains to the client. If proceeding with insertion, confirms consent has been given.';'<ul><li>If there are reasons not to provide the IUD at the time, explain to the woman.</li><li>Offer another method, and let her know she can come for another assessment for IUD at 6 weeks postpartum.</li></ul><p><strong>Obtaining consent</strong></p><ul><li>Consent is sought before delivery or after delivery, but not during second stage of labor. During second stage of labor, the woman may not be in the right state of mind to give informed consent.</li></ul>';'nGJbptDgy0S';150;0.05;0.05;72;53;;100
+410;'NG HNQIS PPIUD-160';'NG HNQIS PPIUD-160-Ins-Grasp the anterior lip of the cervix with a ring forceps';;'Grasp the anterior lip of the cervix with a ring forceps';'<ul><li>Gently grasp the anterior lip of the cervix with ring forceps, pull the forceps very gently to align the uterus with the cervix.</li></ul><p>PSI PPIUD Service Delivery Protocols: Section 5</p>';'VXsFlHRhjCf';160;0.05;0.05;73;53;;101
+411;'NG HNQIS PPIUD-170';'NG HNQIS PPIUD-170-Ins-Does not use a toothed tenaculum, because it may tear the cervix. Closes the forceps one notch only';;'Does not use a toothed tenaculum, because it may tear the cervix. Closes the forceps one notch only';'<ul><li>A tenaculum has sharp teeth that can tear the cervix, which is very friable immediately after delivery.</li><li>Close the forceps one notch only to avoid tearing cervical tissue.</li></ul>';'ff51hX8pUIe';170;0.05;0.05;73;53;;101
+412;'NG HNQIS PPIUD-180';'NG HNQIS PPIUD-180-Ins-Opens the IUD package half way using the ‘No-Touch’ technique for you to load the forceps.';;'Opens the IUD package half way using the ‘No-Touch’ technique for you to load the forceps.';'<p>The no-touch technique assures sterility for infection prevention.</p>';'q5e2lb45u7w';180;0.05;0.05;73;53;;101
+413;'NG HNQIS PPIUD-190';'NG HNQIS PPIUD-190-Ins-Grasps the IUD with the standard ringed/Kelly’s forceps.';;'Grasps the IUD with the standard ringed/Kelly’s forceps.';'<p><strong>A forceps insertion is recommended because:</strong></p><ul><li>Compared to manual insertion by hand, it is less painful for the client, easier to insert in a contracted uterus and better infection prevention procedures will be observed.</li><li>In addition, with manual insertion there is a risk of pulling the strings, inevitably inserting the IUD in the lower uterine segment instead of the fundus.</li></ul>';'NnpwVrne6fE';190;0.05;0.05;73;53;;101
+414;'NG HNQIS PPIUD-200';'NG HNQIS PPIUD-200-Ins-Inserts forceps, passing through the cervix, following a plane that is perpendicular to the plane of the woman’s back and into the lower uterine cavity. Avoids touching the walls of the vagina with the IUD';;'Inserts forceps, passing through the cervix, following a plane that is perpendicular to the plane of the woman’s back and into the lower uterine cavity. Avoids touching the walls of the vagina with the IUD';'<ul><li>This is the best way to direct the IUD to the uterine fundus.</li><li>Not touching the vaginal wall with the IUD assures sterility.</li></ul>';'jAn20FhOPPb';200;0.05;0.05;73;53;;101
+415;'NG HNQIS PPIUD-210';'NG HNQIS PPIUD-210-Ins-Note: Performs IUD insertion while seated.';;'Note: Performs IUD insertion while seated.';'<ul><li>Sit while performing insertion</li><li>Standing tends to make you direct the IUD-holding forceps too posteriorly</li></ul>';'JtsbNZPnZLi';210;0.05;0.05;73;53;;101
+416;'NG HNQIS PPIUD-220';'NG HNQIS PPIUD-220-Ins-Releases the hand that is holding the cervix-holding forceps; moves the hand to the abdomen, placing it on top of the uterine fundus';;'Releases the hand that is holding the cervix-holding forceps; moves the hand to the abdomen, placing it on top of the uterine fundus';'<p>This helps to direct the IUD placement to the fundus of the uterus.</p>';'VNhF9VQEu4f';220;0.05;0.05;73;53;;101
+417;'NG HNQIS PPIUD-230';'NG HNQIS PPIUD-230-Ins-With the abdominal hand, stabilizes the uterine fundus through the abdominal wall';;'With the abdominal hand, stabilizes the uterine fundus through the abdominal wall';'<p>This helps to direct the IUD placement to the fundus of the uterus.</p>';'jJwobvBfMFT';230;0.05;0.05;73;53;;101
+418;'NG HNQIS PPIUD-240';'NG HNQIS PPIUD-240-Post-Ins-Gently removes all instruments used and places them in 0.5% chlorine decontamination solution.';;'Gently removes all instruments used and places them in 0.5% chlorine decontamination solution.';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>Immediately soak ALL the instruments used after respective procedure, or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes.</li><li>Dispose of waste material in leak proof container or plastic bag.</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution.</li><li>After soaking for 10 minutes, remove instruments from solution.</li><li>Clean instruments immediately.</li><li>Remove gloves following the glove removal procedure.</li></ul>';'HEuYUFSGO66';240;0.05;0.05;74;53;;102
+419;'NG HNQIS PPIUD-250';'NG HNQIS PPIUD-250-Post-Ins-Before discharge, checks that expulsion has not occurred and that the client is comfortable.';;'Before discharge, checks that expulsion has not occurred and that the client is comfortable.';'<ul><li>Expulsion is likely to occur in the first few days and weeks, hence the need to check.</li><li>Ensure the client is comfortable.</li></ul>';'shlvj5oLcj3';250;0.05;0.05;74;53;;102
+420;'NG HNQIS PPIUD-260';'NG HNQIS PPIUD-260-Post-Ins-Schedules a follow-up appointment with client for 3-6 weeks after insertion';;'Schedules a follow-up appointment with client for 3-6 weeks after insertion';'<ul><li>The schedules can follow the recommended three to six weeks postpartum.</li><li>A follow up visit is important to assess the woman''s satisfaction with the IUD, to check for problems and manage, and to reinforce key messages regarding the IUD.</li></ul>';'n97s88d0wfN';260;0.05;0.05;74;53;;102
+421;'NG HNQIS PPIUD-270';'NG HNQIS PPIUD-270-Post-Ins-Reviews key messages for women who have just had an IUD inserted from the reminder card';;'Reviews key messages for women who have just had an IUD inserted from the reminder card';'<ul><li>Inform the woman that the IUD has been successfully placed; reassure her and answers any questions she may have.</li><li>Review IUD side effects and normal postpartum symptoms.</li><li>Tell her when to return for PPIUD/postpartum and newborn check-ups</li></ul>';'ncrWATaJUCF';270;0.05;0.05;74;53;;102
+422;'NG HNQIS PPIUD-280';'NG HNQIS PPIUD-280-Post-Ins-Assesses client to make sure that she feels well and preferably observes her for 15 minutes before sending her home';;'Assesses client to make sure that she feels well and preferably observes her for 15 minutes before sending her home';'<p><strong>Assess the client to make sure she is well before sending her home</strong></p><ul><li>Asses the client, specifically for bleeding, ensure that there is minimum lochia loss before sending her home.</li><li>This ensures you don''t send the client home with potential complications.</li></ul>';'i3qSbHZaFCZ';280;0.05;0.05;74;53;;102
+423;'NG HNQIS PPIUD-290';'NG HNQIS PPIUD-290-Follow Up-Assesses for common side effects';;'Assesses for common side effects';'<p><strong>Assess for common side effects</strong></p><ul><li>Cramping, light bleeding immediately after IUCD insertion may occur and may last for a few days . These symptoms are not harmful and do not indicate a problem.</li><li>For cramping, advise her to use paracetamol or ibuprofen. If the symptoms become bothersome the woman can come back to the health facility.</li><li>Additionally, review the postpartum warning signs:<ul><li>>Bright red bleeding for which the client needs to change her pad more than six times a day,</li><li>>Unusual abdominal or pelvic pain (not after-birth pain),</li><li>>Unusual vaginal discharge or pain, or fever.</li></ul></li></ul>';'CuwghMESL9e';290;0.05;0.05;75;53;;103
+424;'NG HNQIS PPIUD-300';'NG HNQIS PPIUD-300-Follow Up-Screens for warning signs (PAINS) as mentioned on reminder card';;'Screens for warning signs (PAINS) as mentioned on reminder card';'<p><strong>Screen and inform the client that following symptoms, (PAINS) warrant immediate return to the health facility:</strong></p><ul><li><strong>P</strong>eriod related or pregnancy related problems</li><li><strong>A</strong>bdominal pain or pain during intercourse</li><li><strong>I</strong>nfections or unusual vaginal discharge</li><li><strong>N</strong>ot feeling well, fever, chills</li><li><strong>S</strong>tring problems</li></ul>';'to5HccPaKi2';300;0.05;0.05;75;53;;103
+425;'NG HNQIS PPIUD-310';'NG HNQIS PPIUD-310-WE-The following equipment are available for Post partum IUD insertion:';;'The following equipment are available for Post partum IUD insertion:';;'p9nbK3obcJp';310;0.00;0.00;76;49;;
+426;'NG HNQIS PPIUD-320';'NG HNQIS PPIUD-320-WE-GRAVES speculum (if being inserted > 30 minutes post placenta)';;'GRAVES speculum (if being inserted > 30 minutes post placenta)';'<p>Have the correct equipment for Post partum IUD insertion</p>';'oGSw3z8bKBQ';320;0.01;0.01;76;53;;104
+427;'NG HNQIS PPIUD-330';'NG HNQIS PPIUD-330-WE-Vaginal retractor (valve) or sims speculum; (the Cusco speculum is NOT appropriate for PPIUD insertion)';;'Vaginal retractor (valve) or sims speculum; (the Cusco speculum is NOT appropriate for PPIUD insertion)';'<p>Have the correct equipment for Post partum IUD insertion</p>';'NhokQvmh8Fw';330;0.01;0.01;76;53;;104
+428;'NG HNQIS PPIUD-340';'NG HNQIS PPIUD-340-WE-Long ringed/sponge forceps to grasp the cervix (>9 inches), preferably curved (not the tenaculum used for interval insertion)';;'Long ringed/sponge forceps to grasp the cervix (>9 inches), preferably curved (not the tenaculum used for interval insertion)';'<p>Have the correct equipment for Post partum IUD insertion</p>';'bDbCFIz0nS1';340;0.01;0.01;76;53;;104
+429;'NG HNQIS PPIUD-350';'NG HNQIS PPIUD-350-WE-Long (>9 inches) Ringed/Sponge-holding or Kelly placental forceps';;'Long (>9 inches) Ringed/Sponge-holding or Kelly placental forceps';'<p>Have the correct equipment for Post partum IUD insertion</p>';'mbGxlfJLCOq';350;0.01;0.01;76;53;;104
+430;'NG HNQIS PPIUD-360';'NG HNQIS PPIUD-360-END-END OF TAB';;'END OF TAB';;'RDlmQ0zJgC1';360;0.00;0.00;76;49;;
+431;'NG HNQIS PDC-100';'NG HNQIS PDC-100-MPE/E-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Observation of real cases with eclampsia may be hard to plan but file reviews together with case studies may help in assessment of the provider. Assessments should in no way interfere with patient management during emergencies.</p>';'Y8IZrxKNpgK';100;0.00;0.00;77;88;;106
+432;'NG HNQIS PDC-110';'NG HNQIS PDC-110-MPE/E-Confirms diagnosis and classifies appropriately:pre-eclampsia (moderate or severe) or eclampsia';;'Confirms diagnosis and classifies appropriately:pre-eclampsia (moderate or severe) or eclampsia';'<p><strong>Conduct a rapid assessment, confirm diagnosis and classify hypertensive disease in pregnancy</strong><br/>It is important to quickly identify and classify women with hypertensive disorder in pregnancy due to the poor outcomes associated with these disorders.</p><p><strong>The Essentials for diagnosis include:</strong></p><ul><li>Hypertension is Blood Pressure (BP) of 140/90mmHg or more on two occasions six hours apart OR diastolic BP of 110mg or more on a single occasion OR in a woman with pre-existing hypertension, an increase of more than 30/15mmHg</li><li>Proteinuria (proteins in urine) of 0.3g/l or more in at least 2 random samples collected six hours apart OR urine dipstick finding of ''trace'',''1''; or more proteins</li><li><strong>Pre-eclampsia is classified as:</strong><ul><li>Mild/moderate-Diastolic BP is between 90-100mmHg and trace or 1+ proteinuria</li><li>Severe-Diastolic BP >100mmHG, proteinuria 2+ or greater and persistent edema with any of the following-headache, visual disturbance, oliguria, diminished fetal movement and upper abdominal pain.</li></ul></li><li><strong>Eclampsia</strong> is signs/symptoms of severe pre-eclampsia plus eclamptic fits/convulsions. The convulsions are generally tonic-clonic, occur in rapid sequence and are often followed by a coma lasting from a few minutes to hours.</li></ul>';'gemlNZ8Q0bo';110;0.14;0.14;77;53;;106
+433;'NG HNQIS PDC-120';'NG HNQIS PDC-120-MPE/E-Commences appropriate treatment as indicated';;'Commences appropriate treatment as indicated';'<p><strong>The key objectives of management of severe pre-eclampsia/eclampsia is to control the blood pressure, control seizures and facilitate delivery as soon as feasible. Delivery is the definitive management.</strong></p><p>For severe pre-eclampsia or eclampsia, the patient should be managed in a tertiary facility with a theatre, renal unit and intensive care unit.</p><p><strong>The following emergency treatment should be commenced while referral arrangements are being undertaken for patients in a facility that is not well equipped to manage severe pre-eclampsia/eclampsia:</strong></p><ul><li>If unconscious, call for help and perform maternal resuscitation</li><li>Secure two intravenous access and collect blood samples for Grouping and cross match, urea/electrolytes/creatinine, Liver function tests and Full blood count</li><li>Start magnesium sulphate</li><li>>Loading dose: IV 4 g of 20% magnesium sulphate over 15 minutes or if unable to secure an intravenous access: IM 5g in each buttock (total 10g) with 1 ml 1% lidocaine</li><li>Insert a foley''s catheter for monitoring urine output</li><li>Check vital signs every 15-30 minutes</li><li>Give antihypertensives to reduce blood pressure, usually hydralazine or labetalol</li><li>Restrict fluids to 1ml/kg/hr or 80ml/hour</li><li>Expedite delivery: Do a bishop score, and if the cervix is favorable in eclampsia - rupture membranes as you plan referral or induce labor with 25µg of misoprostol</li><li>Refer patients with severe pre-eclampsia and eclampsia to a tertiary facility</li><li>Call the referral facility</li><li>Accompany the patient to the referral facility</li></ul>';'Cb3hY9PXWWp';120;0.14;0.14;77;53;;106
+434;'NG HNQIS PDC-130';'NG HNQIS PDC-130-MPE/E-Monitors blood pressure per protocol';;'Monitors blood pressure per protocol';'<p><strong>Monitor blood pressure hourly and adjust medication appropriately</strong></p><ul><li>It is important to maintain diastolic blood pressure between 90-100mmHg to reduce risk of cerebrovascular accidents e.g. stroke as well as to ensure adequate placental blood supply that is important for fetal well being.</li><li>It is important to note that anti-hypertensive treatment does not alter the progression of pre-eclampsia.</li></ul>';'dcsEJNbW5Fy';130;0.14;0.14;77;53;;106
+435;'NG HNQIS PDC-140';'NG HNQIS PDC-140-MPE/E-Maintains woman on appropriate dose of anticonvulsant (MgSO4, first line) and anti-hypertensive medication';;'Maintains woman on appropriate dose of anticonvulsant (MgSO4, first line) and anti-hypertensive medication';'<p><strong>Give maintenance dose of magnesium sulphate</strong></p><ul><li>IV 1g of 20% magnesium sulphate per hour or if IM 5g (50% solution) + 1ml lignocaine 4 hourly. The maintenance dose should be continued for 24 hours after delivery or he last convulsion.</li></ul><p><strong>Reduce high blood pressure</strong></p><ul><li>If the diastolic blood pressure is more than 110mmHg, give hydralazine 5mg slow IV every 5 minutes until blood pressure is lowered. Alternative anti-hypertensive are labetalol or nifedipine</li></ul>';'mjl15xoAA0w';140;0.14;0.14;77;53;;106
+436;'NG HNQIS PDC-150';'NG HNQIS PDC-150-MPE/E-Correctly inserts a urinary catheter and aims to maintain urine output at 30ml/hour or more. Withholds MgSO4 if urine output is lower than this';;'Correctly inserts a urinary catheter and aims to maintain urine output at 30ml/hour or more. Withholds MgSO4 if urine output is lower than this';'<p><strong>Monitor urine output and keep an input- output chart</strong></p><ul><li>Patients with severe pre-eclampsia or eclampsia need to be catheterized so as to enable monitoring of urine output.</li><li>Despite the peripheral edema, patients with pre-eclampsia have intravascular volume depletion with high peripheral vascular resistance and thus diuretics should be avoided.</li><li>Aggressive volume resuscitation may lead to pulmonary edema that is a common cause of mortality and morbidity especially in the post-partum period. Fluid should be limited to 80mls/hr or 1ml/kg/hr of Ringers lactate or Normal Saline with a careful monitoring of urine output.</li><li>If urine output is less than 30mls/hour in preceding 4 hours, do not repeat dose of MgSO4 as this may increase risk of toxicity with subsequent respiratory failure.</li><li>Renal failure and cerebral edema are common complications of severe pre-eclampsia and eclampsia hence the importance of referring these patients to a facility with a renal unit and intensive care unit.</li></ul>';'d0yXGZOFmHA';150;0.14;0.14;77;53;;106
+437;'NG HNQIS PDC-160';'NG HNQIS PDC-160-MPE/E-Checks tendon reflexes. Withholds MgSO4 if tendon reflexes are reduced or absent';;'Checks tendon reflexes. Withholds MgSO4 if tendon reflexes are reduced or absent';'<p><strong>Prior to repeating MgSO4 dose, the following should be checked:</strong></p><ul><li>Every 4 hours before the next magnesium sulphate dose, check:<ul><li>Consciousness level, Patella reflex, urine output and respiratory rate.</li></ul></li><li>Do not give the next dose if: there is absent or reduced patella reflex ;or urine output less than 100ml in last 4 hours; or respiratory rate less than 16 breaths per minute, in which case give 10% calcium gluconate 1g IV over 10 minutes.</li></ul>';'MQF6NXYqD6r';160;0.14;0.14;77;53;;106
+438;'NG HNQIS PDC-170';'NG HNQIS PDC-170-MPE/E-If undelivered, manages delivery or referral for delivery appropriately';;'If undelivered, manages delivery or referral for delivery appropriately';'<p><strong>Delivery is the definitive management for pre-eclampsia and eclampsia</strong></p><ul><li>Patients with mild pre-eclampsia are often induced after 37 weeks gestation.</li><li>In severe pre-eclampsia, induction of delivery may be considered at 34 weeks or earlier depending on maternal condition, fetal lung maturity can be achieved with use of corticosteroids.</li><li>In eclampsia, delivery should occur regardless of gestational age. The route of delivery depends on the bishop score.</li></ul><p><u><strong><em>NOTE:</em></strong></u> Refer patients with severe pre-eclampsia and eclampsia to a tertiary facility with Specialists, renal unit, operation theatre and intensive care unit. Only undertake emergency measures as you refer.</p></body>';'ldF8yRPKBcV';170;0.14;0.14;77;53;;106
+439;'NG HNQIS PDC-180';'NG HNQIS PDC-180-MAH-Patient correctly assessed for cause of bleeding : Apruptio placenta, placenta previa and ruptured uterus. Refers patient appropriately for further investigation and management';;'Patient correctly assessed for cause of bleeding : Apruptio placenta, placenta previa and ruptured uterus. Refers patient appropriately for further investigation and management';'<p><strong>APH is vaginal bleeding during pregnancy usually presenting in the last trimester of pregnancy (after 28 weeks). Causes include:</strong></p><p><strong>Placenta praevia</strong>- is when implantation of the placenta occurs at or near the cervix. It may be partial or complete praevia. The signs and symptoms are: shock, bleeding may be precipitated by intercourse, the uterus is relaxed, fetal presentation not in lower uterine pole- feels empty, normal fetal condition.</p><p><strong>Abruption placenta</strong>- is premature detachment of a normally situated placenta before the fetus is delivered. The resultant retro- placental bleeding may be revealed, concealed or mixed type. The signs and symptoms are: shock, tense and tender uterus, decreased or no fetal movements, fetal distress or absent fetal heart sounds.</p><p><strong>Ruptured uterus</strong>. Bleeding may be intra -abdominal and/or vaginal. If the woman was in labor, the contractions stop. Risk factors include; previous caesarean delivery, grand multiparity. Other signs and symptoms include: shock, abdominal distension, free fluid in abdomen, abnormal uterine contour, tender abdomen, easily palpable fetal parts, absent fetal movements and heart sounds and rapid maternal pulse.</p><p><strong>General management:</strong></p><ul><li>Shout for help.</li><li>Urgently mobilize all available personnel</li><li>Make a rapid evaluation of the general condition of the woman including vital signs (pulse, blood pressure, respiration, temperature). <strong>DO NOT do vaginal examination at this stage.</strong></li><li>If you suspect shock, begin treatment immediately.</li><li>Start a rapid IV infusion (Normal saline or ringers solution). Take blood for grouping and cross match</li><li>Even if signs of shock are not present, keep shock in mind as you evaluate the woman further because her status may worsen rapidly.</li><li>Refer to tertiary facility with obstetrician for further investigation and management. The patient should be accompanied by a health care personnel.</li></ul>';'VOZpedRBKmY';180;1.00;1.00;78;53;;107
+440;'NG HNQIS PDC-190';'NG HNQIS PDC-190-MPPH-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Observation of real cases with post partum hemorrhage may be hard to plan but file reviews together with case studies may help in assessment of the provider. Assessments should in no way interfere with patient management during emergencies.</p>';'xrrYxr4VJQm';190;0.00;0.00;79;88;;108
+441;'NG HNQIS PDC-200';'NG HNQIS PDC-200-MPPH-Confirms diagnosis and cause of bleeding';;'Confirms diagnosis and cause of bleeding';'<p><strong>Identify the cause of the bleeding. There are 4 major causes of PPH (4Ts)</strong></p><ul><li><strong>Atonic uterus in 70% of the cases</strong><strong>(</strong>a<strong>T</strong>ony<strong>)</strong> this is when the uterus fails to contract adequately, resulting in excessive blood loss. Causes include: retained placenta, placental fragments, tissue/membranes, blood clots, over distention of the uterus due to multiple gestation, excess amniotic fluid or a large baby, high parity, prolonged labor Induction or augmentation of labor, precipitous labor (labor lasting less than 3 hours) and a full bladder.</li><li><strong>Genital trauma in 20% of cases</strong><strong>(T</strong>rauma/<strong>T</strong>ears<strong>)</strong>-Cervical, vaginal and perineal laceration, vulvar / pelvic hematoma, uterine inversion and ruptured uterus are classified as genital trauma .Tears may co-exist with atonic uterus. One should always suspect a cervical or a vaginal tear whenever there is postpartum bleeding with a contracted uterus. Unrepaired or poorly repaired episiotomies or tears can also cause severe bleeding.</li><li><strong>Retained tissue/membranes, retained placenta in 10% of cases</strong><strong>(T</strong>issue<strong>)</strong>. This is defined as failure to deliver the placenta within 30 minutes of childbirth. This interferes with uterine contractility. Retained placental fragments, as well as retained membranes also result in PPH by predisposing to uterine atony. Predisposing factors include : previous C/S, previous history of retained placenta, previous dilatation and curettage, previous placenta praevia.</li><li><strong>Coagulopathies (blood clotting disorders) in 1% of cases(T</strong>hrombin<strong>)</strong>. Coagulation disorders are rare causes of PPH. When the blood fails to clot despite the routine interventions, a coagulation disorder should be suspected. Predisposing factors include: severe pre-eclampsia, placenta abruption, intrauterine fetal death, amniotic fluid embolism, excessive bleeding which can deplete coagulation factors and promote further bleeding, infection and genetic factors.</li></ul>';'TW9qyzSefHK';200;0.20;0.20;79;53;;108
+442;'NG HNQIS PDC-210';'NG HNQIS PDC-210-MPPH-Initiates appropriate treatment (depending on cause of bleeding )';;'Initiates appropriate treatment (depending on cause of bleeding )';'<p><strong>Initiate Treatment for PPH depending on the identified cause</strong></p><ul><li>Call for help, you need more than one person</li><li>Empty the bladder</li><li>Give oxytocin IM</li><li>Massage uterine fundus</li><li>Fix 2 large bore needles, take samples for blood group and cross match, start intravenous fluids-normal saline. Anticipate need for transfusion.</li></ul><p><strong>Specific management guided by the cause of PPH:</strong><br /><em><strong>Placenta:</strong></em> Check to see if the placenta has been expelled, and examine the placenta to be certain it is complete. If placenta is still inside, ensure bladder is empty, massage uterus, do Controlled cord traction (CCT), if it fails to come out by CCT, repeat oxytocin, do manual removal. If placenta was out, massage uterine fundus, expel clots. If part of the membranes or placenta are retained, do manual removal of the fragments by hand or ovum forceps.<br /><em><strong>Lacerations:</strong></em> Inspect genital tract for tears and lacerations, repair lacerations, if unskilled, clamp and refer.<br /><em><strong>Uterine atony:</strong></em> massage uterine fundus, expel clots, repeat uterotonics, bimanual compression of uterus. If still bleeding, aortic compression as you refer to a facility with a theatre and obstetrician for exploration (see next question for more details on management of uterine atony).<br /><em><strong>Coagulopathy:</strong></em> Transfuse with fresh plasma/blood /platelets as you refer to a facility with specialists. Infuse 40 IU oxytocin in 500ml normal saline to run at 60 drops per minute . If you do not have blood products for transfusion, refer to a tertiary facility as the oxytocin in saline infusion is running. Note if blood is clotting.</p>';'Bfx5bPVl0xd';210;0.20;0.20;79;53;;108
+443;'NG HNQIS PDC-220';'NG HNQIS PDC-220-MPPH-If atony: initiates treatment cascade';;'If atony: initiates treatment cascade';'<p>An atonic uterus fails to contract after delivery. Any condition that interferes with uterine contractions will predispose to an atonic uterus. The result is excessive blood loss that can result in maternal death. If the bleeding is ascertained to be due to uterine atony, do the following:</p><ul><li>Call for help, you need more than one person</li><li>Empty the bladder</li><li>Give oxytocin by intramuscular route</li><li>Fix 2 large bore intravenous access as you draw blood for grouping and cross match. Anticipate the need to transfuse. Start intravenous fluids in the meantime to prevent shock.</li><li>Massage uterine fundus</li><li>Expel clots</li><li>If bleeding continues, repeat oxytocin then apply <strong>bimanual uterine compression:</strong> Wear sterile glove; introduce the right hand into the vagina, clenched fist, with the back of the hand directed posteriorly and the knuckles in the anterior fornix; place the other hand on the abdomen behind the uterus and squeeze the uterus firmly between the two hands; Continue compression until bleeding stops (no bleeding if the compression is released).</li><li>If bleeding persists despite bimanual compression apply <strong>aortic compression</strong> and transport woman to tertiary facility/or take her to theatre for exploration by an obstetrician. How to apply aortic compression: feel for femoral pulse, apply pressure above the umbilicus to stop bleeding, apply sufficient pressure until femoral pulse is not felt, after finding correct site, show assistant how to apply pressure, if necessary, as you transfer to theatre/refer. Refer with an oxytocin infusion running.</li></ul>';'x6MeAuPCuSM';220;0.20;0.20;79;53;;108
+444;'NG HNQIS PDC-230';'NG HNQIS PDC-230-MPPH-Stabilize patient';;'Stabilize patient';'<p><strong>Resuscitate and stabilize a patient with postpartum hemorrhage</strong></p><ul><li>Establish diagnosis, of postpartum hemorrhage and the cause which is either: uterine atony, retained placenta, trauma, coagulopathy</li><li>Call for HELP</li><li>Carry out maternal resuscitation if needed</li><li>If the patient is in shock: Make sure that the airway is open; Check vital signs; Do not give fluids by mouth as the woman may vomit and inhale or aspirate the vomitus; Keep the woman warm but do not over heat; Maintain circulation to vital organs by elevating the legs (either by placing pillows under feet, elevating foot of the bed or placing the patient in a Trendelenburg position). Remember if you elevate the foot of the bed too much, the blood may collect in the uterus rather than be expelled.</li><li>Fix two large bore cannulas and collect blood for grouping and cross match</li><li>Start intravenous fluids</li><li>Blood transfusion as required</li><li>Give oxygen</li><li>Empty bladder by inserting an indwelling foley''s catheter</li><li>Massage the uterus</li><li>Give uterotonics</li><li>Oxytocin 40 units in 500ml normal saline to run at 60 drops per minute</li></ul><p>Note: a high dose of oxytocin is need for management of PPH</p><ul><li>Misoprostol 1000 µg per rectal</li><li>Inspect placenta for completeness</li><li>Inspect vulva, vagina and cervix for tears and repair any tears</li><li>Perform a bimanual uterine compression</li><li>If bleeding does not stopping consider tranexamic acid 1 gram IV slowly</li><li>If bleeding does not stop, consider aortic compression, use of the Bakri balloon tamponade (if unavailable modify a condom), pack the uterus with gauze and call a specialist if theatre facilities are available or refer</li><li>Once bleeding controlled and all observations normal, observe every 15 minutes until stable</li><li>Refer appropriately.</li></ul>';'EQGP3WCUtGu';230;0.20;0.20;79;53;;108
+445;'NG HNQIS PDC-240';'NG HNQIS PDC-240-MPPH-If bleeding is not controlled, prepares/refers woman for surgical intervention';;'If bleeding is not controlled, prepares/refers woman for surgical intervention';'<p><strong>If bleeding does not stop in a woman with PPH refer to a tertiary facility</strong>y</p><ul><li>If bleeding does not stop in spite of treatment with uterotonics, and other conservative interventions, surgical interventions should be initiated in a facility with specialists and operating theatre.</li><li>As you refer stabilize the patient, fix 2 large bore cannulas, collect blood for grouping and cross match, start intravenous fluids, continue mechanical methods of stopping bleeding including uterine packing or balloon tamponade if available.</li><li>Call the referral facility.</li><li>Accompany the patient to the referral facility.</li></ul>';'Sl0r9Jq9xF5';240;0.20;0.20;79;53;;108
+446;'NG HNQIS PDC-250';'NG HNQIS PDC-250-WE-Is a functioning BP machine available?';;'Is a functioning BP machine available?';'<p>A BP machine is essential in management of emergencies including hypertensive disease in pregnancy and haemorrhage.</p>';'P65PtiqV4pF';250;0.10;0.10;80;53;;109
+447;'NG HNQIS PDC-260';'NG HNQIS PDC-260-WE-Are there job aids or algorithms for management of each of the pregnancy complications i.e. preeclampsia/eclampsia, antepartum haemorrhage and post partum haemorrhage?';;'Are there job aids or algorithms for management of each of the pregnancy complications i.e. preeclampsia/eclampsia, antepartum haemorrhage and post partum haemorrhage?';'<ul><li>They set the expectations for staff and provide a written reference to assist staff in providing consistent and accurate management.</li><li>They reduce reliance on memory and enable a provider to perform optimally.</li></ul>';'dtdHe3scoqb';260;0.10;0.10;80;53;;109
+448;'NG HNQIS PDC-270';'NG HNQIS PDC-270-WE-Are intravenous fluids available?';;'Are intravenous fluids available?';'<p>Intravenous fluids are essential to have when managing complications related to pregnancy and delivery.</p>';'FRaUR6iHTtA';270;0.20;0.20;80;53;;109
+449;'NG HNQIS PDC-280';'NG HNQIS PDC-280-WE-Catheters, Urine bottles and urine dip sticks for testing for protein?';;'Catheters, Urine bottles and urine dip sticks for testing for protein?';'<p>These are needed when investigating or managing preeclampsia/eclampsia.</p>';'XQPyAyvCSQI';280;0.20;0.20;80;53;;109
+450;'NG HNQIS PDC-290';'NG HNQIS PDC-290-WE-Are the required drugs available?- antihypertensives (hydralazine or labetalol and Nifedipine), MgSO4, calcium gluconate, oxytocin, misoprostol';;'Are the required drugs available?- antihypertensives (hydralazine or labetalol and Nifedipine), MgSO4, calcium gluconate, oxytocin, misoprostol';'<ul><li>These are emergency life- saving drugs and should always be available and easily accessible.</li><li>Keep them labeled and routinely check for the expiry dates.</li></ul>';'ixtpSI44hzJ';290;0.40;0.40;80;53;;109
+451;'NG HNQIS PDC-300';'NG HNQIS PDC-300-END-END OF TAB';;'END OF TAB';;'LOk8guWACPU';300;0.00;0.00;80;49;;
+452;'NG HNQIS LD-100';'NG HNQIS LD-100-Pre-Del-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Real cases should be observed if possible. This will be easy to do in busy hospitals. Providers with sporadic deliveries may need to be assessed in a facility with more deliveries or from review of client records.</p>';'dWLD0HITnEg';100;0.00;0.00;81;88;;111
+453;'NG HNQIS LD-110';'NG HNQIS LD-110-Pre-Del-Conducts initial assessment of the patient and fetus';;'Conducts initial assessment of the patient and fetus';'<ul><li>General examination: blood pressure; pulse; temperature</li><li>Abdominal examination for fundal height, lie, presentation; check uterine contractions; urine output; fetal heart sounds; and cervical dilatation using aseptic techniques.</li></ul>';'yxID4Kohnjj';110;0.10;0.10;81;53;;111
+454;'NG HNQIS LD-120';'NG HNQIS LD-120-Pre-Del-Uses partogram to monitor progress of labor';;'Uses partogram to monitor progress of labor';'<p><strong>Use a partograph to monitor labor</strong></p><ul><li>Graphic presentation of progress in active labor including the fetal and maternal condition; can detect abnormal progress of labor.</li><li>The events of active labor are plotted against time in hours. All entries are recorded in relation to the time at which the observations are made.</li></ul><p><strong>Start the partograph when the woman is in active phase of labor, that is cervical dilatation of 4cm.</strong><br/>The partograph contains:</p><ol><li><strong>Patient information</strong><ul><li>Full name, age, gravidity, parity, hospital number, date and time of admission and time of rupture of the membranes in hours.</li></ul></li><li><strong>Foetal condition</strong><ul><li>The Fetal heart rate is observed ½ hourly .The normal fetal heart rate is between 120 - 160 beats per minute. If at level 2-3, refer to higher level if 3 consecutive readings 15 minutes apart reveal FHR < 110 or > 170 mm hg.</li></ul></li><li><strong>Amniotic Fluid and membranes</strong><ul><li>At every vaginal exam, the state of the membranes and/or amniotic fluid /liquor is noted and recorded noting whether membranes are ruptured, color and presence of liqour, meconium/blood stained liquor as well as smell. This is important as it helps to identify fetal distress, any infections, abnormal blood loss and pre-mature rupture of membranes that may warrant change in management of the delivery. e.g. If there is thick meconium at any time or absent liquor at the time of membrane rupture, rule out other signs of fetal distress and take appropriate action.</li></ul></li><li><strong>Moulding of the fetal skull bones</strong><ul><li>This is an important indication of how adequately the pelvis can accommodate the fetal head. Increasing molding with the head high in the pelvis is a sign of cephalopelvic disproportion.</li><li>Molding is observed 4 hourly.</li></ul></li><li><strong>Cervical dilation</strong><ul><li>The cervical dilation is assessed at every vaginal examination and plotted accordingly. The charting commences only when the cervical dilatation is 4cm and above.</li><li>The Alert line starts at 4cm of cervical dilatation to the point of full dilatation at a rate of 1cm per hour.</li><li>The Action line is a parallel line draw 4 hours to the right of the alert line.</li><li>When the cervical dilatation moves to the right of the alert line, this indicates prolonged Active Phase. In this instance, the woman must be referred to a comprehensive Emergency Obstetric Care facility.</li><li>The 4 hours between the alert and action lines allows time for the woman to be assessed and appropriate intervention taken including referral.</li><li>If during labor, the cervical dilatation reaches the action line a decision must be taken about the course of the progress and appropriate action taken. Under no circumstance should the cervical dilatation be allowed to cross the action line.</li></ul></li><li><strong>Descent of the fetal head</strong><ul><li>For labor to progress well, dilatation of the cervix should be accompanied by descent of the head. Descent of the head is measured by abdominal palpation and is expressed in terms of fifths palpable above the pelvic brim. Abdominal palpation has been found to be a more reliable way of gauging descent than vaginal examination where large caput formation often leads inexperienced health providers to confuse scalp descent with skull descent.</li></ul></li><li><strong>Uterine Contractions</strong><ul><li>In normal labor the uterine contractions increase in frequency and intensity. The number of the uterine contractions is assessed and recorded every half-hour in the active phase of labor.</li><li>When charting the contractions, two important observations must be recorded:<ul><li>The frequency: How often are they felt</li><li>The duration: How long do they last (in seconds); the duration must also be palpated not just estimated by observation.</li></ul></li><li>The frequency of the contractions is assessed over a ten-minute period.</li><li>The duration of the contractions is from the time the contraction is felt abdominally to the time the contraction passes off.</li></ul></li><li><strong>Maternal Condition</strong><ul><li>Documentation of any drugs and IV fluids given include oxytocin, pulse rate, blood pressure, temperature and urine output is important to identify on going needs of the mother, detect any complications e.g. dehydration, excess blood loss, infections etc. that may necessitate change in plan of care.</li></ul></li></ol><p></p></body></html>';'OCO1OUJjUez';120;0.12;0.12;81;53;;111
+455;'NG HNQIS LD-130';'NG HNQIS LD-130-Del-Prepares delivery equipment and area';;'Prepares delivery equipment and area';'<p><strong>Prepare delivery equipment and area</strong></p><ul><li>Ensures that the provider is able to focus fully on conducting the delivery with minimal distractions and can quickly respond to any situation that needs prompt intervention.</li></ul>';'T1bnCuIhJyK';130;0.04;0.04;82;53;;112
+456;'NG HNQIS LD-140';'NG HNQIS LD-140-Del-Puts on gloves, gown and eye protection to prepare for the delivery.';;'Puts on gloves, gown and eye protection to prepare for the delivery.';'<p><strong>Put on gloves, gown and eye protection and observe infection prevention standards</strong></p><ul><li>Key for infection prevention.</li></ul>';'mgA0T75FDu5';140;0.04;0.04;82;53;;112
+457;'NG HNQIS LD-150';'NG HNQIS LD-150-Del-Confirm full dilation of cervix and decent of fetus';;'Confirm full dilation of cervix and decent of fetus';'<p><strong>Confirm full dilatation and decent of the fetus and determine if the woman is able to deliver vaginally</strong></p><p>Confirmation of full cervical dilatation (10cm dilatation) is performed by digital vaginal examination (VE).</p><p>Other signs of readiness for vaginal delivery include:</p><ul><li>Uterine contractions becoming strong and more frequent (4-5 per 10 minutes).</li><li>The woman grunts or gets the urge to bear down.</li><li>The woman may retch or vomit.</li><li>The fetal head further descending into the pelvis.</li><li>The perineum bulging and the skin becoming tense and glistening.</li><li>The anus may gape and may pass fecal matter.</li></ul><p>Note:</p><ul><li>Pushing should only be after above conditions have been met. Pre-mature pushing often leads to poor progress of labor, fetal distress and maternal exhaustion.</li><li>Look out for complications and signs that will make vaginal delivery impossible and take appropriate actione.g referral if the facility is not equipped with an operation theatre in women who may require C/S.</li></ul>';'nOeqHrOM4sz';150;0.04;0.04;82;53;;112
+458;'NG HNQIS LD-160';'NG HNQIS LD-160-Del-Cleanses the perineum with an antiseptic solution (performs episiotomy only if needed)';;'Cleanses the perineum with an antiseptic solution (performs episiotomy only if needed)';'<p><strong>Clean the perineum with antiseptic and perform episiotomy only for women who require</strong></p><ul><li>Clean the perineum to reduce amount of vulvovaginal pathogens that may cause infection to both the baby and the mother.</li><li>Episiotomy should only be done when necessary due to its association with increased third and fourth degree tears, and subsequent anal sphincter muscle dysfunction.</li><li>Consider episiotomy only on selected cases such as: shoulder dystocia, vacuum delivery, scarring from previous female genital cutting or poorly healed perineal tears among others.</li><li>Whenever episiotomy is given, administer local anesthesia.</li></ul>';'wpd7k8xPAK9';160;0.04;0.04;82;53;;112
+459;'NG HNQIS LD-170';'NG HNQIS LD-170-Del-Assists and encourages the woman to push effectively';;'Assists and encourages the woman to push effectively';'<p><strong>Encourage and guide the woman</strong></p><ul><li>The client should be encouraged to bear down only during contractions and relax in between so as to maximize on the natural rhythm of labor.</li></ul>';'B2h5hB6YPzw';170;0.04;0.04;82;53;;112
+460;'NG HNQIS LD-180';'NG HNQIS LD-180-Del-Appropriate assessment and management of crowning';;'Appropriate assessment and management of crowning';'<p><strong>Carry out the following procedures after crowning of the head</strong></p><ul><li>At crowning, the perineum should be supported with a pad firmly held to prevent perineal tears.</li><li>Avoid obstructing the presenting part and allow fetal head to extend the perineum.</li><li>The baby''s head should be kept flexed gently with support to the perineum until its delivered.</li><li>Remember to check for the cord around the neck. If present but loose, slip it over the baby''s head. If the cord is tight around the neck doubly clamp and cut it before unwinding it from the head.</li><li>A cord around the neck can delay/prevent descent of fetus during delivery; may lead to early separation of placenta causing fetal hypoxia.</li></ul>';'CVBcVVPkwzl';180;0.10;0.10;82;53;;112
+461;'NG HNQIS LD-190';'NG HNQIS LD-190-Del-Manages the delivery of head and body appropriately';;'Manages the delivery of head and body appropriately';'<p><strong>Allow for restitution and external rotation</strong></p><ul><li>Allow the baby''s head to turn spontaneously.</li><li>Once the head is delivered ask the patient not to push.</li><li>Clear the airway of the newborn gently with sterile swab.</li><li>Restitution and external rotation to a transverse position allows the shoulders to correctly engage the pelvis for delivery. This should not be rushed as it may cause injuries to both mother and fetus.</li></ul><p><strong>Complete the delivery as follows</strong></p><ul><li>Reduce the likelihood of tears by delivering one shoulder at a time. With a hand on each side of the baby''s head, move the head posteriorly to deliver the anterior shoulder and vice versa.</li><li>If there is difficulty in delivering the shoulders suspect shoulder dystocia and carry out manoeuvres of delivering shoulder dystocia.Use the HELPERR pneumonic if shoulder dystocia is suspected:<ul><li>H:Call for HELP-team</li><li>E: Evaluate for EPISOTOMY</li><li>L: LEGS, McRoberts Maneuver - knee chest position</li><li>P: External PRESSURE (suprapubic)-to dislodge the anterior shoulder</li><li>E: ENTER - Rotational maneuvers<ul><li>>Wood''s Screw: push on posterior aspect of anterior shoulder and on anterior aspect of posterior shoulder and try to rotate shoulders to oblique</li><li>>Reverse Wood''s Screw: push on anterior aspect of posterior shoulder and try to rotate shoulders to oblique</li></ul></li><li>R: REMOVE Posterior arm - grasp fetal elbow, not shoulder</li><li>R: ROLL the patient to her hands and knee,</li><p>Note: If HELPERR doesn''t work- Intentional fracture of the clavicle OR Replacement of fetal head, abdominal rescue in a facility with a theatre (Zavanelli maneuver)</p></ul></li><li>Support the baby''s body as it slides out and place the baby on the mother''s abdomen.</li></ul>';'UbUxZrEArs8';190;0.04;0.04;82;53;;112
+462;'NG HNQIS LD-200';'NG HNQIS LD-200-Del-Places the baby on mother’s abdomen,then clamps, cuts and ties the cord';;'Places the baby on mother’s abdomen,then clamps, cuts and ties the cord';'<p><strong>Place the baby on mother''s abdomen</strong></p><ul><li>This is important to ensure the baby is warm(thermoregulation) after delivery through direct skin contact with the mother.</li><li>It also helps to reduce physiologic stress, enhances breastfeeding and creates a bond between mother and newborn.</li></ul><p><strong>Clamp or tie the umbilical cord correctly to avoid bleeding and to allow administration of drugs to the baby if required.</strong></p><ul><li>Place 2 clamps or ties around the cord. The first clamp is placed about 2 finger breadths from the baby''s abdomen while the second clamp is put 5 finger breadths from the abdomen.</li><li>Cut between the clamps/ ties with a sterile scissors or blade. If bleeding occurs, place a second clamp between the first one and the baby''s skin.</li><li>Leave the cut end of the umbilical cord open to the air to dry.</li><li>It is recommended that as part of routine care, the provider waits at least 1 minute and up to 3 minutes to clamp/tie and cut the cord (delayed cord clamping). This allows about 80 ml of blood to flow into the baby''s circulation, and have shown to prevent iron deficiency in the first year of life.</li></ul>';'KORHWgJ9Qsn';200;0.04;0.04;82;53;;112
+463;'NG HNQIS LD-210';'NG HNQIS LD-210-Del-Assess APGAR score';;'Assess APGAR score';'<p><strong>Perform an APGAR score, indicate time of delivery</strong></p><ul><li>The Apgar score is a quick assessment of cardiovascular, circulatory, respiratory and neurological functions and allows for quick decision making on initiation as well as progress of resuscitation.</li><li>It is done at 1 minute and 5 minutes after birth (or every 5 minutes during resuscitation) and is scored out of 10 with a maximum of 2 points for each of the following<ul><li>A=appearance</li><li>P=pulse</li><li>G=grimace</li><li>A=Activity</li><li>R=Respiration</li></ul></li><li>Low Apgar score may indicate neurological depression/brain damage, laryngeal obstruction, maternal medication and or prematurity.</li></ul><p>Document the APGAR score in the client''s file.</p><p><strong>Indicate the time of delivery in patients case record</strong></p><ul><li>Noting the time of delivery is important as it allows the proper subsequent management and tracking of baby e.g. Apgar scores, initiation of breastfeeding among others.</li></ul>';'xydP9s3sUeu';210;0.04;0.04;82;53;;112
+464;'NG HNQIS LD-220';'NG HNQIS LD-220-Post-Del-Dry baby with a clean, dry towel.';;'Dry baby with a clean, dry towel.';'<p><strong>Dry the baby</strong></p><ul><li>Thoroughly but gently dry the baby. Drying helps to keep the baby warm and stimulates breathing.</li><li>A newly born baby wet with amniotic fluid can become cold even in a warm room.</li><li>After drying, remove the wet cloth and wrap in a dry cloth, keep the baby warm, check breathing (Baby should be crying or breathing quietly and easily), encourage breastfeeding and routine newborn care.</li><li>Anticipate the need for neonatal resuscitation and prepare in advance for it.</li></ul>';'EVoscQV7ASI';220;0.02;0.02;83;53;;113
+465;'NG HNQIS LD-230';'NG HNQIS LD-230-Post-Del-Where necessary, provides prophylactic eye care for the newborn within one hour of delivery.';;'Where necessary, provides prophylactic eye care for the newborn within one hour of delivery.';'<p><strong>Eye care include wiping the baby''s eyes with a piece of cloth and prophylactic tetracycline or erythromycin if indicated</strong></p><ul><li>This is important to minimize risk of ophthalmia neonatorum where there is suspicion of either gonorrhea or chlamydial infection in the mother.</li><li>Prophylactic eye ointment with tetracycline or erythromycin eye ointment is given within one hour of delivery if indicated.</li></ul>';'b9ASsvXEpRu';230;0.02;0.02;83;53;;113
+466;'NG HNQIS LD-240';'NG HNQIS LD-240-Post-Del-Performs active management of the third stage of labor as per guidelines.';;'Performs active management of the third stage of labor as per guidelines.';'<p><strong>Perform active management of the third stage of labor (AMTSL)</strong></p><ul><li>This prevents occurrence of post partum hemorrhage (PPH).</li></ul><p><strong>The following are the 3 steps of AMTSL:</strong></p><ol><li><strong>Prophylactic use of oxytocin</strong><ul><li>Within one minute of delivery of the baby, palpate the abdomen to rule out the presence of additional baby/babies.</li><li><strong>Give oxytocin 10 IU intramuscular (IM)</strong></li><li>Oxytocin is preferred because it is effective 2-3minutes after injection, has minimal adverse effects and can be used in all women</li><li>If oxytocin is not available, ergometrin can be used as 0.25mg given IM</li><li>Note: ergometrin is contraindicated in women with pre-eclampsia/eclampsia, high blood pressure and cardiac disease because it increases blood pressure by peripheral vasoconstriction, and may increase the risk of convulsions and cerebrovascular accidents</li></ul></li><li><strong>Controlled cord traction for delivery of the placenta</strong><ul><li>Within one minute of delivery, clamp the cord close to the perineum using sponge forceps. Hold the clamped cord and the end of the forceps with one hand.</li><li>Place the other hand just above the woman''s pubic bone and stabilize the uterus by applying counter traction during controlled cord traction. This helps prevent uterine inversion.</li><li>Keep slight tension on the cord and await a strong uterine contraction (2-3 minutes). When the uterus becomes rounded or the cord lengthens very gently pull downwards on the cord to deliver the placenta</li><li>If the placenta does not descend during 30-40 seconds of controlled cord traction (i.e. there are no signs of placental separation). DO NOT continue to pull on the cord. Gently hold the cord and wait until the uterus is well contracted again. If necessary, roll the cord on the forceps or clamp the cord closer to the perineum as it lengthens</li><li>With the next contraction, repeat controlled cord traction with counter traction</li><li>Never apply cord traction without applying counter traction above the pubic bone with the other hand</li><li>To reduce the risk of the thin membranes tearing off as the placenta delivers, hold the placenta in two hands and gently turn it until the membranes are twisted. Slowly complete delivery of the placenta.</li><li>Inspect the maternal surface of the placental lobes for completeness and remove any retained fragments</li><li>Maintain infection prevention protocols at all times</li></ul></li><li><strong>Uterine massage</strong><ul><li>Immediately after delivery of the placenta, massage the fundus of the uterus through the woman''s abdomen until the uterus is contracted.</li><li>Repeat uterine massage every 15 minutes for the first 1-hour.</li><li>Ensure that the uterus does not become relaxed after you stop uterine massage.</li><li>Ensure the urinary bladder is empty.</li></ul></li></ol>';'n6YJHWLo2Gf';240;0.10;0.10;83;53;;113
+467;'NG HNQIS LD-250';'NG HNQIS LD-250-Post-Del-Examines the placenta and membranes';;'Examines the placenta and membranes';'<p><strong>Examine the delivered placenta</strong></p><ul><li>Carefully examine the placenta to ensure completeness and that no lobe is missing.</li><li>If a portion of the maternal surface is missing or there are torn membranes, suspect retained placental fragments.</li><li>In such cases examine the upper vagina and cervix and use a sponge forceps to remove any pieces of membranes that are present.</li><li>Also examine for infarcts, presence of a retro placental clot and any other abnormalities e.g. extra lobes.</li><li>Examine the blood vessels in the cord. Normally it has two arteries and one vein. The absence of one artery may be associated with congenital abnormality, particularly renal agenesis.</li><li>Weigh the placenta.</li></ul>';'e4PVFmI4SmF';250;0.02;0.02;83;53;;113
+468;'NG HNQIS LD-260';'NG HNQIS LD-260-Post-Del-Inspects vagina and perineum and manages accordingly for lacerations/tears and repairs lacerations/tears/episiotomy) if necessary.';;'Inspects vagina and perineum and manages accordingly for lacerations/tears and repairs lacerations/tears/episiotomy) if necessary.';'<p><strong>Examine the genital tract</strong></p><ul><li>Carefully examine the cervix, vagina and perineum and repair any tears present as appropriate.</li><li>Repair the episiotomy, if it had been performed.</li></ul>';'IU4HIy1uhO5';260;0.02;0.02;83;53;;113
+469;'NG HNQIS LD-270';'NG HNQIS LD-270-Post-Del-Disposes of the placenta in a leak-proof container';;'Disposes of the placenta in a leak-proof container';'<p><strong>Dispose the placenta</strong></p><ul><li>The placenta contains blood and other body fluids that can transmit infection and should be stored in leak proof containers to prevent possibility of the fluids leaking to other surfaces.</li></ul>';'vGCD4dPCAZB';270;0.02;0.02;83;53;;113
+470;'NG HNQIS LD-280';'NG HNQIS LD-280-Post-Del-Correctly processes instruments.';;'Correctly processes instruments.';'<p><strong>Following infection prevention procedures, process instruments</strong></p><ul><li>Correct processing of instruments as per protocols helps to minimize transmission of infections.</li></ul>';'qmfQRR4nzCy';280;0.02;0.02;83;53;;113
+471;'NG HNQIS LD-290';'NG HNQIS LD-290-Post-Del-Assists with post delivery cleanliness and comfort';;'Assists with post delivery cleanliness and comfort';'<ul><li>Clean the woman''s perineum with suitable antiseptic, use an appropriate sanitary towel and transfer her to a clean comfortable post delivery bed.</li><li>Cleaning the perineum helps to minimize risk of infections. The sanitary towel also helps to monitor ongoing blood loss after delivery.</li></ul>';'uY1aO82guoC';290;0.02;0.02;83;53;;113
+472;'NG HNQIS LD-300';'NG HNQIS LD-300-Post-Del-Assists with initiation of breastfeeding.';;'Assists with initiation of breastfeeding.';'<p><strong>Assist the mother to initiate breastfeeding as soon as possible</strong></p><ul><li>Immediate breastfeeding is important because it promotes uterine contraction, allows for transfer of immunoglobulins to the baby from mother as well as fostering an emotional and physical bond among other benefits.</li></ul>';'jeLxDvQW9Jy';300;0.02;0.02;83;53;;113
+473;'NG HNQIS LD-310';'NG HNQIS LD-310-Post-Del-Monitors post partum vital signs and uterine status per protocol';;'Monitors post partum vital signs and uterine status per protocol';'<p><strong>Monitor woman''s vital signs and the contraction of the uterus</strong></p><ul><li>Complications can be picked up early. Measure and record blood pressure, pulse rate, respiratory rate and temperature.</li><li>Key Complications to consider when vital signs are abnormal are postpartum hemorrhage, hypotension, hypoglycemia, infection.</li></ul><p><strong>Differential diagnosis for abnormal vital signs</strong><br /><strong>Pulse rate:</strong> Elevated pulse may indicate hypotension, infection, blood loss/anemia. In hypovolemic shock the pulse may be weak.<br /><strong>Blood Pressure:</strong> Increasing blood pressure should trigger an alert for possible hypertensive disease, about half the cases of hypertensive disease occur in the postpartum period. Other causes of elevated BP include infection, dehydration and blood loss. Low blood pressure may indicate hypovolemia due to blood loss.<br /><strong>Temperature:</strong> infection<br /><strong>Respiration: </strong>Dehydration, blood loss, infection and rarely pulmonary embolism are key factors to consider when the respiratory rate begins to change.<br /><strong>Uterine status:</strong> Proper uterine contraction helps to avert post partum hemorrhage (PPH). Atony should be investigated and managed as per protocols.</p>';'qACvIGiGLDJ';310;0.02;0.02;83;53;;113
+474;'NG HNQIS LD-320';'NG HNQIS LD-320-Post-Del-Before discharge counsels the woman and her support person on postpartum danger signs and management';;'Before discharge counsels the woman and her support person on postpartum danger signs and management';'<p><strong>Counsel the mother and support person on postpartum danger signs</strong><br/>Mothers should be advised to return to the health facility in case of any of the following danger signs:</p><ul><li>Fever</li><li>Foul smelling vaginal discharge</li><li>Excessive vaginal discharge</li><li>Edema of limbs or face</li><li>Bright red/fresh vaginal bleeding</li><li>Urinary symptoms: pain, blood stained, smelly urine</li><li>Breast symptoms: pain, swelling, discharge</li><li>Perineal/pelvic pain</li></ul>';'hnz3fYEM9dz';320;0.02;0.02;83;53;;113
+475;'NG HNQIS LD-330';'NG HNQIS LD-330-WE-Fully equiped delivery kits available-Artery forceps, cord ligature, cord scissors, episiotomy scissors, needle holder, toothed dissecting forceps, gullipot, kidney dish';;'Fully equiped delivery kits available-Artery forceps, cord ligature, cord scissors, episiotomy scissors, needle holder, toothed dissecting forceps, gullipot, kidney dish';'<p>Full delivery kits should always be available to ensure deliveries are conducted safely and to avoid wasting time looking for missing supplies or equipment.</p>';'cjy0CE6qeXX';330;0.01;0.01;84;53;;114
+476;'NG HNQIS LD-340';'NG HNQIS LD-340-WE-Equiment for assisted vaginal delivery available';;'Equiment for assisted vaginal delivery available';'<p>Necessary for difficult deliveries.</p>';'zABrwsWrwje';340;0.01;0.01;84;53;;114
+477;'NG HNQIS LD-350';'NG HNQIS LD-350-WE-Drugs are available: tetracyline or erythromycin eye ointment, oxytocin, lignocaine';;'Drugs are available: tetracyline or erythromycin eye ointment, oxytocin, lignocaine';'<p>These must be available in a delivery room.</p>';'miGfao28mAG';350;0.01;0.01;84;53;;114
+478;'NG HNQIS LD-360';'NG HNQIS LD-360-WE-Baby weighing scale, thermometer available';;'Baby weighing scale, thermometer available';'<p>Needed for initial assessment of the newborn baby.</p>';'Ckt31RHVUk4';360;0.01;0.01;84;53;;114
+479;'NG HNQIS LD-370';'NG HNQIS LD-370-WE-Job aids for labour and delivery available';;'Job aids for labour and delivery available';'<ul><li>Written reference to assist staff in providing consistent and accurate management.</li><li>They reduce reliance on memory and enable a provider to perform optimally.</li></ul>';'CHi2t55gri3';370;0.01;0.01;84;53;;114
+480;'NG HNQIS LD-380';'NG HNQIS LD-380-END-END OF TAB';;'END OF TAB';;'hTZt1xzsRs1';380;0.00;0.00;84;49;;
+481;'NG HNQIS CC-100';'NG HNQIS CC-100-Pre-Scr-Is this a real or simulated observation?';;'Is this a real or simulated observation?';;'RvSfeDV1dee';100;0.00;0.00;85;88;;116
+482;'NG HNQIS CC-110';'NG HNQIS CC-110-Pre-Scr-Obtains client''s demographic information';;'Obtains client''s demographic information';'<p><strong>Obtain clients bio-data, these include:</strong></p><ul><li>Patient identifier''s are: patient''s name and hospital number. These will help in retrieving patient information and to facilitate continuum of care during follow up visits.</li><li>Contact details include: physical address and phone numbers, these will be useful for patient follow up especially if there is an abnormal cervical screening result that needs follow up.</li><li>Women 30-49 years are the ideal target group for cervical cancer screening. PSI global guidelines target this group, though individual countries should defer to national screening guidelines. Postmenopausal women are not eligible for VIA/VILI because the SCJ may not be visible. These women should be offered the Pap smear test, if available.</li></ul>';'qCjZYL6ZDMn';110;0.07;0.07;85;53;;116
+483;'NG HNQIS CC-120';'NG HNQIS CC-120-Pre-Scr-Provides detailed information about Cervical Cancer prevention and treatment';;'Provides detailed information about Cervical Cancer prevention and treatment';'<p><strong>Provide detailed information about cervical cancer prevention and treatment during counselling</strong></p><ul><li>This will make the woman comply with screening and reduce lost to follow up when treatment or referral is required.</li></ul><p><strong>The following should be included in the information:</strong></p><ul><li>Cervical cancer is caused by infection with a virus called HPV. This virus is passed during sexual relations and is very common among both men and women. Almost all men and women will be exposed to HPV in their lifetime.</li><li>Most HPV infections go away in a short time without treatment. In some women, HPV infection continues and can slowly change the cells on the cervix. These changes are called pre-cancer. If not treated, they can develop into cancer of the cervix.</li><li>The screening test being performed today (VIA/VILI or Pap) can detect these early changes of the cervix (pre-cancer). After screening, the results will be one of the following: normal screen, abnormal screen with abnormal cells suitable for treatment, or abnormal cells that require further examination.</li><li>The next steps depend on the screening test used (VIA/VILI or Pap smear).</li><li>The provider must offer clear instructions for each woman, based on the test outcome. If cryotherapy is available onsite, it should be offered immediately.</li></ul>';'iaARtOLvpTU';120;0.07;0.07;85;53;;116
+484;'NG HNQIS CC-130';'NG HNQIS CC-130-Pre-Scr-Counsels on HIV and FP';;'Counsels on HIV and FP';'<p><strong>During the counselling process, counsel also on HIV testing and FP options</strong></p><ul><li>Women living with HIV are at higher risk for cervical cancer. Screening for cervical precancer and cancer should be done in women and girls who have initiated sexual activity as soon as she has tested positive for HIV, regardless of age; women/girls with HIV should be re-screened 12 months after treatment for pre-cancer, or within three years after negative screening results. Refer to national guidelines, if screening intervals for HIV+ women are shorter.</li><li>All women screened for cervical cancer should be counseled and offered FP and HIV screening, where available, as part of the integrated and holistic approach.</li></ul>';'SDXPJ074UBm';130;0.07;0.07;85;53;;116
+485;'NG HNQIS CC-140';'NG HNQIS CC-140-Pat scr-Ensures HLD instrument pan, supplies, swab sticks and white light source are available';;'Ensures HLD instrument pan, supplies, swab sticks and white light source are available';'<p><strong>Prepare equipment and supplies and make them ready for the procedure</strong></p><ul><li>Soap and water for hand-washing</li><li>Bright light source to examine the cervix (standing lamp with flexible arm, headlamp, or flashlight)</li><li>Cusco''s or Grave''s speculum (preferred), high-level disinfected (it need not be sterile)</li><li>Disposable or high-level disinfected examination gloves (need not be sterile)</li><li>Examination table covered by clean paper or cloth</li><li>Cotton-tipped swabs, or cotton wool (formed into balls) and forceps</li><li>Dilute acetic acid solution (3-5%) or white vinegar</li><li>0.5% chlorine solution for decontaminating instruments and gloves</li><li>Wooden spatula or tongue depressor (used to hold back vaginal walls which can obscure view of cervix)</li><li>Timer or clock to ensure 1 minute following application of acetic acid or Lugol''s iodine</li><li>Form to document findings/results</li></ul>';'IYFFRyCdaVb';140;0.04;0.04;86;53;;117
+486;'NG HNQIS CC-150';'NG HNQIS CC-150-Pat scr-Ensures freshly prepared 5% acetic acid solution/lugols iodine solution (well covered) is available and ready to be used.';;'Ensures freshly prepared 5% acetic acid solution/lugols iodine solution (well covered) is available and ready to be used.';'<p><strong>Prepare a fresh 3-5% acetic acid and lugols iodine for each patient when ready to examine</strong></p><ul><li>To maintain infection prevention standards.</li><li>Lugols iodine evaporates and gets destroyed by light, hence should not be exposed to light unnecessarily.</li></ul>';'s1DffSs7Lx2';150;0.04;0.04;86;53;;117
+487;'NG HNQIS CC-160';'NG HNQIS CC-160-Pat scr-Performs speculum exam, locates cervix checking for any signs of cervical or vaginal problems or discharges';;'Performs speculum exam, locates cervix checking for any signs of cervical or vaginal problems or discharges';'<p><strong>Once the woman has emptied her bladder, position her in the lithotomy position then perform a speculum examination</strong></p><ul><li>Speculum examination exposes the cervix and allows for the VIA/VILI procedure and to be able to rule out infections.</li><li>Emptying the bladder ensures that the woman is comfortable and the speculum does not press on a full bladder.</li><li>Lithotomy position helps in the adequate exposure of the cervix.</li></ul>';'V49UKNe8mil';160;0.15;0.15;86;53;;117
+488;'NG HNQIS CC-170';'NG HNQIS CC-170-Pat scr-If appropriate proceeds with the VIA screening.';;'If appropriate proceeds with the VIA screening.';'<p><strong>Do not proceed with the VIA/VILI procedure and treat or refer appropriately if the following are observed during speculum examination</strong></p><ul><li>Signs of infection such as discharge: in this case treat for infection first then give a return visit for screening.</li><li>Active menstruation, as it may interfere with the ability to visualize a lesion.</li><li>Obvious cervical mass: refer for biopsy and further management.</li></ul>';'qWyEAINkexe';170;0.04;0.04;86;53;;117
+489;'NG HNQIS CC-180';'NG HNQIS CC-180-Pat scr-Identify the cervical os and the transformation zone (TZ)';;'Identify the cervical os and the transformation zone (TZ)';'<p><strong>Identify the cervical anatomy: the os, SCJ and TZ</strong></p><ul><li>Abnormal lesions start on or near the SCJ and extend to the Transformation Zone. Identifying these make it easy to locate lesions.</li><li>If the SCJ and TZ are in the endocervix, this is inadequate for VIA/VILI and the woman is not eligible for VIA/VILI and should be screened using the Pap smear test, if available.</li></ul>';'Hucu51LwrYV';180;0.20;0.20;86;53;;117
+490;'NG HNQIS CC-190';'NG HNQIS CC-190-Pat scr-Appropriately applies acetic acid and waits 1 min prior to assessing cervix';;'Appropriately applies acetic acid and waits 1 min prior to assessing cervix';'<p><strong>After application of acetic acid, time between 1 and 3 minutes to read the findings</strong></p><ul><li>Abnormal cervical lesions (dysplastic lesions), remain acetowhite after 1 minute of application of acetic acid, but not more than 3 minutes.</li><li>Acetowhite lesions due to squamous metaplasia (a normal physiological process where the columnar epithelium is converted to squamous epithelium), disappear before 1 minute.</li><li>After the VIA procedure the VILI procedure follows if the protocol in the institution uses both VIA/VILI.</li></ul>';'QQTfQa2ihtw';190;0.15;0.15;86;53;;117
+491;'NG HNQIS CC-200';'NG HNQIS CC-200-Pat scr-Discusses the result with the woman and counsels appropriately about next steps';;'Discusses the result with the woman and counsels appropriately about next steps';'<p><strong>Carry out post screen counselling</strong><br/>Post screen counselling strengthens compliance to future screens and treatment. Counsel the client on the VIA/VILI result:</p><ul><li><strong><em>If normal:</em></strong> next routine screen after three years, but if HIV positive every year.</li><li><strong><em>If positive:</em></strong> if cryotherapy is available offer cryotherapy if eligible. Refer those with cryotherapy ineligible lesions or when cryotherapy is not available.</li><li><strong><em>If Suspicious for cancer or is otherwise ineligible (i.e., lesion is >75% of cervix or extends into endocervical canal or other):</em></strong> refer for appropriate follow up. Women suspicious for cancer should be referred for further evaluation.</li></ul>';'dVVbXACeNpa';200;0.04;0.04;86;53;;117
+492;'NG HNQIS CC-210';'NG HNQIS CC-210-Pat scr-Refers client appropriately';;'Refers client appropriately';'<p><strong>Referral</strong></p><ul><li>Refer patients for continuum of care for procedures and services that are not available in the facility. Give a comprehensive referral letter, as well as verbal instructions, to the patient. She should be given a contact number of whom to call in case of any questions related to the screening or treatment procedure(s).</li></ul>';'DNWT1mS7pcw';210;0.04;0.04;86;53;;117
+493;'NG HNQIS CC-220';'NG HNQIS CC-220-Pat scr-Records observations and test result. Draws a map of any abnormal findings on the record form.';;'Records observations and test result. Draws a map of any abnormal findings on the record form.';'<p><strong>Document your findings</strong></p><ul><li>Documentation is part of good clinical practice</li></ul>';'VkDnSBKvGvk';220;0.04;0.04;86;53;;117
+494;'NG HNQIS CC-230';'NG HNQIS CC-230-WE1-Acetic acid, swab sticks, antiseptic available, white light source';;'Acetic acid, swab sticks, antiseptic available, white light source';'<p>These are essential for performing cervical cancer screening using visual inspection.</p>';'lEBIwEhH3p6';230;0.01;0.01;87;53;;118
+495;'NG HNQIS CC-240';'NG HNQIS CC-240-WE1-Speculums of different sizes available';;'Speculums of different sizes available';'<p>It is important to have different sizes of speculums. Ensure you use the right size of speculum to avoid causing unnecessary pain and discomfort to the woman.</p>';'dXEeSudRUNr';240;0.01;0.01;87;53;;118
+496;'NG HNQIS CC-250';'NG HNQIS CC-250-WE1-Job aids available-cervicograms';;'Job aids available-cervicograms';'<p>Provide a guide making a diagnosis of cervical lesions. These have been developed by Jphiego and WHO/IARC.</p>';'PmzKuXDApuZ';250;0.02;0.02;87;53;;118
+497;'NG HNQIS CC-260';'NG HNQIS CC-260-Pre-Cryo-Does this facility offer cryotherapy services?';;'Does this facility offer cryotherapy services?';;'KD2sq1gTY0k';260;0.00;0.00;88;53;;119
+498;'NG HNQIS CC-270';'NG HNQIS CC-270-Pre-Cryo-Confirms eligibility for cryotherapy';;'Confirms eligibility for cryotherapy';'<p><strong>Confirm eligibility for cryotherapy if the screening and the cryotherapy procedure are not being performed at the same sitting</strong></p><p><strong>The following are eligible for cryotherapy</strong></p><ul><li>VIA Positive, VILI positive and HSIL on pap smear.</li><li>Entire lesion should be located on the ectocervix without extension to vagina or endocervix.</li><li>Lesion should be visible in its entire extent including the entire transformation zone.</li><li>Lesion should not cover >75% of cervix (3 quadrants).</li><li>Lesion should be adequately covered by the largest available cryotip- preferably the 19mm.</li><li>There should be no evidence of PID or cervicitis.</li><li>The woman should not be menstruating. If menstruating, she should be advised to return after her menses.</li><li>The woman should not be pregnant.</li></ul><p><strong>Rule out pregnancy</strong></p><ul><li>Cryotherapy is contraindicated in pregnancy.</li><li>If the woman is pregnant and has a cervical lesion refer her to a tertiary facility for review by an Obstetrician Gynecologist.</li></ul>';'zdCJSuVTf2E';270;0.03;0.03;88;53;;119
+499;'NG HNQIS CC-280';'NG HNQIS CC-280-Pre-Cryo-Explains the steps of procedure and possible side effects';;'Explains the steps of procedure and possible side effects';'<p><strong>Counsel the woman on the cryotherapy procedure.</strong></p><ul><li>Counseling well will help the woman cooperate during the procedure. Use a language that the woman understands. Allow the woman to ask questions.</li></ul><p><strong>Include the following aspects during counselling:</strong></p><ul><li>That cryotherapy is a treatment for cervical dysplasia that freezes the abnormal cervical cells. It can be done immediately after VIA/VILI.</li><li>It is an office procedure that does not require anesthesia.</li><li><strong>Post cryotherapy side effects are mild and may include:</strong><ul><li>Mild cramping: this usually resolves with analgesic</li><li>Profuse, watery vaginal discharge for about 1 month</li><li>Spotting, light bleeding for 1-2 weeks</li></ul></li><li><strong>Post cryotherapy instructions include:</strong><ul><li>Give a broad spectrum antibiotic and analgesic.</li><li>No sex for 2 weeks (if unlikely give condoms).</li><li>No douching, no tampons or other intravaginal products.</li><li>Come back if heavy bleeding or signs of infection.</li></ul></li><li><strong>Follow up instructions:</strong><ul><li>Immediately in case of complication: fever, foul smelling discharge, heavy bleeding and severe abdominal pain.</li><li>1 month if no complications.</li><li>Repeat screening after 6 months (test-for-cure examination).</li><li>Yearly follow up screening.</li></ul></li></ul>';'DaU5HUP7Oro';280;0.03;0.03;88;53;;119
+500;'NG HNQIS CC-290';'NG HNQIS CC-290-Pre-Cryo-Discuss about FP and HIV Screening';;'Discuss about FP and HIV Screening';'<p><strong>If the screening and cryotherapy are not being done at the same sitting, counsel for FP and HIV testing </strong>(otherwise it is covered above under the counseling section of patient screening)</p><ul><li>Counsel and offer FP to women as part of the integrated and holistic approach.</li><li>HIV infection is one of the key risk factors for cervical dysplasia. Cancer of the cervix is an AIDS defining illness. Women who are HIV positive are more likely to have infections with oncogenic HPV strains, are more likely to get persistent HPV infections and progress faster to invasive cancer of the cervix.</li><li>Screening for cervical precancer and cancer should be done in women and girls who have initiated sexual activity as soon as she has tested positive for HIV, regardless of age; women/girls with HIV should be re-screened 12 months after treatment for pre-cancer, or within three years after negative screening results. Refer to national guidelines, if screening intervals for HIV+ women are shorter.</li></ul>';'ErehwFqe3wH';290;0.03;0.03;88;53;;119
+501;'NG HNQIS CC-300';'NG HNQIS CC-300-Pre-Cryo-Obtain consent for the procedure.';;'Obtain consent for the procedure.';'<p><strong>Obtain informed consent for cryotherapy</strong></p><ul><li>Informed consent is a patient''s right. If the patient does not consent for the procedure, continue counseling and offer the procedure only after informed consent.</li><li>It is recommended to obtain cryotherapy consent during counselling for VIA/VILI if the see-and-treat approach is being used.</li></ul>';'qXHd0HfM1VD';300;0.03;0.03;88;53;;119
+502;'NG HNQIS CC-310';'NG HNQIS CC-310-Cryo-Check that all supplies are available and ready to use. Instrument tray, speculums, gloves, 0.5% chlorine, dilute acetic acid or lugols solution, wooden spatula/condom, cotton swabs and forceps';;'Check that all supplies are available and ready to use. Instrument tray, speculums, gloves, 0.5% chlorine, dilute acetic acid or lugols solution, wooden spatula/condom, cotton swabs and forceps';'<p><strong>Prepare equipment and supplies and make them ready for the procedure </strong></p><ul><li>Soap and water for hand-washing</li><li>Bright light source to examine the cervix (standing lamp with flexible arm, headlamp, or flashlight)</li><li>Cusco''s or Grave''s speculum (preferred), high-level disinfected (it need not be sterile)-</li><li>Disposable or high-level disinfected examination gloves (need not be sterile)</li><li>Examination table covered by clean paper or cloth</li><li>Cotton-tipped swabs, or cotton wool (formed into balls) and forceps</li><li>Dilute acetic acid solution (3-5%) or white vinegar</li><li>0.5% chlorine solution for decontaminating instruments and gloves</li><li>Wooden spatula or tongue depressor (used to hold back vaginal walls which can obscure view of cervix)</li><li>Timer or clock to ensure 1 minute following application of acetic acid or Lugol''s iodine</li><li>Form to document findings/results</li></ul>';'uLhNTrzl1gF';310;0.02;0.02;89;53;;120
+503;'NG HNQIS CC-320';'NG HNQIS CC-320-Cryo-Ensures white Light Source and Timer are available';;'Ensures white Light Source and Timer are available';'<p><strong>Have a white light source and timer</strong></p><ul><li>The light must be white to ensure that acetowhite lesions are identified with the use of acetic acid.</li></ul><p><strong>Timing is important so that lesions can be identified as follows:</strong></p><ul><li>Abnormal cervical lesions (dysplastic lesions), remain acetowhite after 1 minute of application of acetic acid, but not more than 3 minutes.</li><li>Acetowhite lesions due to squamous metaplasia (a normal physiological process, that columnar epithelium is converted to squamous epithelium), disappear before 1 minute.</li></ul>';'PfmSDGqS8TU';320;0.02;0.02;89;53;;120
+504;'NG HNQIS CC-330';'NG HNQIS CC-330-Cryo-Check that cryotherapy instrument and gas are ready to use. Gas pressure OK.';;'Check that cryotherapy instrument and gas are ready to use. Gas pressure OK.';'<p><strong>Test the machine before starting the procedure to make sure it is functional</strong></p><ul><li>Connect the manometer to the tank and make sure it is securely fastened.</li><li>Make sure the arrow on the manometer is turned off first.</li><li>Turn the valve on the tank 360 degrees, one complete turn, and make sure the gauge indicates there is enough gas (pressure) in the tank; the indicator should be in the blue area.</li><li>Test freezing and defrosting by pointing probe at ceiling. Freeze for 1 second and then defrost for 1 second. Screw cryotip with sleeve onto end of probe.</li><li>Make sure different sizes of cryotips are available.</li></ul>';'AtXerS0Y00a';330;0.02;0.02;89;53;;120
+505;'NG HNQIS CC-340';'NG HNQIS CC-340-Cryo-Explains the steps of procedure and possible side effects';;'Explains the steps of procedure and possible side effects';'<p><strong>Before starting the procedure, confirm if the woman is ready for the procedure as explained to her in the counselling step before</strong></p><ul><li>This is to check again if the woman still consents for the procedure. If at this point the woman doesn''t want the procedure, respect her option and continue counseling or refer.</li><li>Answer any concerns the woman may have.</li></ul>';'O9jm6yXN7fI';340;0.02;0.02;89;53;;120
+506;'NG HNQIS CC-350';'NG HNQIS CC-350-Cryo-Ask her to empty the bladder, help her get to the examination couch and drape to ensure modesty if possible';;'Ask her to empty the bladder, help her get to the examination couch and drape to ensure modesty if possible';'<p><strong>Ask the woman to empty her bladder and position her in the lithotomy position</strong></p><ul><li>Emptying the bladder ensures that the woman is comfortable and the speculum does not press on a full bladder.</li><li>Help her onto the couch and position her in lithotomy position.</li><li>Lithotomy position helps in the adequate exposure of the cervix.</li><li>Respect her privacy and drape her until when you are ready to start the procedure.</li></ul>';'Ql2Ty0XNpq2';350;0.02;0.02;89;53;;120
+507;'NG HNQIS CC-360';'NG HNQIS CC-360-Cryo-Wash hands thoroughly and dry them';;'Wash hands thoroughly and dry them';'<p><strong>Wash hands and dry them</strong></p><ul><li>It is part of infection prevention procedures.</li><li>Dry hands to make wearing gloves easy.</li></ul>';'fAHlkrDBlNA';360;0.02;0.02;89;53;;120
+508;'NG HNQIS CC-370';'NG HNQIS CC-370-Cryo-Put on pair of examination gloves on both hands.';;'Put on pair of examination gloves on both hands.';'<p><strong>Put on sterile gloves on both hands</strong></p><ul><li>It part of infection prevention procedures.</li><li>It is a sterile procedure.</li></ul>';'Ll2WLkeiHOI';370;0.02;0.02;89;53;;120
+509;'NG HNQIS CC-380';'NG HNQIS CC-380-Cryo-Arrange instruments and supplies on high- level disinfected tray or container.';;'Arrange instruments and supplies on high- level disinfected tray or container.';'<p><strong>Arrange instruments in a high-level disinfected tray/container</strong></p><ul><li>It is a sterile procedure.</li><li>Arranging everything needed in a high-disinfected tray/container maintains sterility and ensures that the procedure is carried out without interruption.</li></ul>';'sSCsD2mYxPC';380;0.02;0.02;89;53;;120
+510;'NG HNQIS CC-390';'NG HNQIS CC-390-Cryo-Insert speculum and fix blades so that the entire cervix can be seen and accessed';;'Insert speculum and fix blades so that the entire cervix can be seen and accessed';'<p><strong>Insert the speculum</strong></p><ul><li>The speculum exposes the cervix and makes it accessible for cryotherapy.</li><li>Fix the speculum blades in a way that allows you to see and access the entire cervix.</li></ul>';'YAilX1lY9Bd';390;0.02;0.02;89;53;;120
+511;'NG HNQIS CC-400';'NG HNQIS CC-400-Cryo-Move light source so cervix can be seen clearly';;'Move light source so cervix can be seen clearly';'<p><strong>Move the light source to visualize the cervix</strong></p><ul><li>Visualization of the cervix specifically the transformation zone is important to ensure the cryotip can be placed correctly over the lesion.</li><li>Ensure that other tissues such as the vaginal wall are not part of the cryotherapy, as it can result in fistula formation.</li></ul>';'YgJWl4CM47h';400;0.03;0.03;89;53;;120
+512;'NG HNQIS CC-410';'NG HNQIS CC-410-Cryo-Clean cervix with swab and identify the cervical os, the SCJ and the site and size of lesion (repeat VIA/VILI if necessary).';;'Clean cervix with swab and identify the cervical os, the SCJ and the site and size of lesion (repeat VIA/VILI if necessary).';'<p><strong>Pre-cryotherapy procedure after visualization of the cervix</strong></p><ul><li><strong>Clean the cervix with a swab and identify the cervical os and SCJ:</strong> abnormal lesions start on or near the SCJ and extend to the TZ. Identifying the anatomy makes it easy to locate lesions.</li></ul><p><strong>Repeat VIA/VILI if it is a referral and VIA/VILI was done in another facility or by a different health care provider.</strong></p><ul><li>Repeat the VIA/VILI to be able to identify the size and site of the lesion and determine eligibility for cryotherapy.</li></ul><p><strong>The following are eligible for cryotherapy</strong></p><ul><li>VIA Positive, VILI positive and HSIL on pap smear.</li><li>Entire lesion should be located on the ectocervix without extension to vagina or endocervix.</li><li>Lesion should be visible in its entire extent including the entire transformation zone.</li><li>Lesion should not cover >75% of cervix (3 quadrants).</li><li>Lesion should be adequately covered by the largest available cryotip- preferably the 19mm.</li><li>Woman should NOT be pregnant.</li><li>There should be no evidence of PID or cervicitis.</li><li>The woman should not be actively menstruating.</li></ul>';'sjInqJo1mRl';410;0.05;0.05;89;53;;120
+513;'NG HNQIS CC-420';'NG HNQIS CC-420-Cryo-Apply cryotip to the cervix, ensuring that the nipple is centered and securely placed';;'Apply cryotip to the cervix, ensuring that the nipple is centered and securely placed';'<p><strong>Apply cryotip to the cervix, ensuring that the nipple is centered on and placed securely on the os for freezing, squeeze freeze trigger until it latches with no continuous pressure on trigger</strong></p><ul><li>This ensures that the lesion and transformation zone is covered by the cryotip completely.</li></ul>';'F7hCc8IBLdG';420;0.07;0.07;89;53;;120
+514;'NG HNQIS CC-430';'NG HNQIS CC-430-Cryo-Ensure cryotip is held perpendicular to the plane of the cervix and protect vaginal walls';;'Ensure cryotip is held perpendicular to the plane of the cervix and protect vaginal walls';'<p><strong>Ensure cryotip is held perpendicular to the plane of the cervix and neither the cryoprobe or cryotip touches the vaginal walls by using a plastic sheath or wooden spatula between probe and vaginal walls</strong></p><ul><li>This ensures protection of adjacent tissues such as vaginal wall, bladder and rectum. If these tissues are included in the cryotherapy treatment, a complication of fistula formation could occur post cryotherapy.</li></ul>';'GoBSH6wnUOb';430;0.07;0.07;89;53;;120
+515;'NG HNQIS CC-440';'NG HNQIS CC-440-Cryo-Initiates freezing by squeezing freeze trigger per instructions';;'Initiates freezing by squeezing freeze trigger per instructions';'<p>Squeeze the trigger until it latches with no continuous pressure on trigger</p>';'tiygL26chYp';440;0.07;0.07;89;53;;120
+516;'NG HNQIS CC-450';'NG HNQIS CC-450-Cryo-Times duration of freeze appropriately';;'Times duration of freeze appropriately';'<p><strong>Time the freezing procedure. Using double freeze technique, freeze the cervix for 3 minutes, defreeze for 5 minutes, don''t remove tip until it thaws and repeat freeze procedure for 3 minutes and wait for the tip to detach from the cervix</strong></p><ul><li>This has been shown to offer effective treatment.</li><li>Not removing the cryotip until it thaws avoids injury to the cervix.</li></ul>';'YLnhcZ6r5Ns';450;0.04;0.04;89;53;;120
+517;'NG HNQIS CC-460';'NG HNQIS CC-460-Cryo-Defrosts appropriately and cervix inspected to ensure an adequate ice ball is present';;'Defrosts appropriately and cervix inspected to ensure an adequate ice ball is present';'<ul><li><strong>Do not remove the cryotip until it thaws to avoid injury to the cervix</strong></li><li><strong>Inspect the cervix for a hard, white frozen ice ball.</strong> This is evidence of adequate freezing.</li></ul>';'JNpnv5MSJTG';460;0.04;0.04;89;53;;120
+518;'NG HNQIS CC-470';'NG HNQIS CC-470-Cryo-Cervix inspected and managed if bleeding';;'Cervix inspected and managed if bleeding';'<p><strong>Inspect cervix for bleeding after the procedure</strong></p><ul><li>If there is bleeding, apply pressure.</li><li>If bleeding does not stop, apply a vaginal pack, fix two large bore cannulas, collect a blood sample for grouping and cross match and refer to a tertiary facility.</li></ul>';'lWJFIvmUY2L';470;0.03;0.03;89;53;;120
+519;'NG HNQIS CC-480';'NG HNQIS CC-480-Post Cryo-Provides client with a sanitary pads ( and underwear if possible)';;'Provides client with a sanitary pads ( and underwear if possible)';'<p><strong>Provide the client with a sanitary pad</strong></p><ul><li>After cryotherapy, the woman may have some light bleeding or vaginal discharge.</li><li>Provide sanitary towels as the client may not have carried her own.</li></ul><p><strong>Let her dress up</strong><br/>Respect her privacy : explain the procedure findings after she is dressed.</p>';'STcsQnKCFWl';480;0.05;0.05;108;53;;121
+520;'NG HNQIS CC-490';'NG HNQIS CC-490-Post Cryo-Checks if the client experiences a side effect and manages if appropriately';;'Checks if the client experiences a side effect and manages if appropriately';'<p><strong>Observe the patient for 15 minutes</strong></p><ul><li>Observe for immediate post cryotherapy complications like bleeding and cramping.</li><li>Very rarely neurogenic shock can occur.</li><li>Manage any side effects present.</li><li>The commonest side effect is cramping for which you can give oral analgesics.</li></ul>';'STZElAFsafu';490;0.02;0.02;108;53;;121
+521;'NG HNQIS CC-500';'NG HNQIS CC-500-Post Cryo-Advise woman about post - treatment care and follow up instructions';;'Advise woman about post - treatment care and follow up instructions';'<p><strong>Advice on post-treatment care and follow up instructions</strong></p><ul><li><strong>Post cryotherapy instructions include:</strong><ul><li>Give a broad spectrum antibiotic and analgesic.</li><li>No sex for 2 weeks (if unlikely give condoms).</li><li>No douching, No tampons or other intravaginal products.</li><li>Come back if heavy bleeding or signs of infection.</li></ul></li><li><strong>Follow up instructions:</strong><ul><li>Immediately in case of complication: fever, foul smelling discharge, heavy bleeding and severe abdominal pain.</li><li>1 month if no complications.</li><li>Repeat screening after 6 months (test-for-cure examination).</li><li>Yearly follow up screening.</li></ul></li></ul>';'zxJUFnM1Uz4';500;0.02;0.02;108;53;;121
+522;'NG HNQIS CC-510';'NG HNQIS CC-510-Post Cryo-Wipe light source with 0.5% chlorine solution or alcohol';;'Wipe light source with 0.5% chlorine solution or alcohol';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>In all the steps during the procedure, observe infection prevention procedures to minimize risk of spreading infections.</li></ul>';'gMTrUhax0no';510;0.05;0.05;108;53;;121
+523;'NG HNQIS CC-520';'NG HNQIS CC-520-Post Cryo-Decontamination: All used instruments disassembled and fully immersed in decontamination solution (0.5% chlorine solution). Cryotip processed as per manufacturer’s instructions';;'Decontamination: All used instruments disassembled and fully immersed in decontamination solution (0.5% chlorine solution). Cryotip processed as per manufacturer’s instructions';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>In all the steps during the procedure, observe infection prevention procedures to minimize risk of spreading infections.</li></ul>';'y1HAhDReUPf';520;0.05;0.05;108;53;;121
+524;'NG HNQIS CC-530';'NG HNQIS CC-530-Post Cryo-Cryotherapy unit, hose and regulator decontaminated by wiping with alcohol 70 - 90%';;'Cryotherapy unit, hose and regulator decontaminated by wiping with alcohol 70 - 90%';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>In all the steps during the procedure, observe infection prevention procedures to minimize risk of spreading infections.</li></ul>';'dDWzoKfPbxL';530;0.05;0.05;108;53;;121
+525;'NG HNQIS CC-540';'NG HNQIS CC-540-Post Cryo-Findings documented and record treatment and follow up plan in woman’s record.';;'Findings documented and record treatment and follow up plan in woman’s record.';'<p><strong>Document your findings</strong></p><ul><li>Documentation is part of good clinical practice</li></ul>';'eSqXiHkz29U';540;0.02;0.02;108;53;;121
+526;'NG HNQIS CC-550';'NG HNQIS CC-550-Post Cryo-Discharge instructions provided orally and in written form, including reasons for immediate return';;'Discharge instructions provided orally and in written form, including reasons for immediate return';'<p><strong>Discharge instructions</strong></p><ul><li>Provide both oral and written instructions and ensure the woman understands them.</li><li>Ensure the woman understands when to return immediately to the health facility.</li><li>Ensure the woman has contact information for the health facility to enable her ask any questions or seek advice.</li></ul>';'eKoSdKaCqLS';550;0.02;0.02;108;53;;121
+527;'NG HNQIS CC-560';'NG HNQIS CC-560-Post Cryo-Assess women´s wellbeing before discharge';;'Assess women´s wellbeing before discharge';'<p>Ensure the woman is stable before discharge</p>';'UIlcQQxCzno';560;0.00;0.00;108;53;;121
+528;'NG HNQIS CC-570';'NG HNQIS CC-570-WE2-Job aids for cryotherapy available';;'Job aids for cryotherapy available';'<p>Provide guidelines when performing the procedure and act as a quick reference point.</p>';'NbQNS8dh5e5';570;0.03;0.03;109;53;;122
+529;'NG HNQIS CC-580';'NG HNQIS CC-580-END-END OF TAB';;'END OF TAB';;'uzM24DrHFTk';580;0.00;0.00;109;49;;122
+530;'NG HNQIS TB-100';'NG HNQIS TB-100-Inq-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Due to risk of infection to health care workers, possible real cases should be assessed in well ventilated rooms and if possible in an open space. Simulated cases can be complemented with record reviews.</p>';'Z3Al2uJbBEH';100;0.00;0.00;90;88;;124
+531;'NG HNQIS TB-110';'NG HNQIS TB-110-Inq-Ask about cough for more than 2 weeks';;'Ask about cough for more than 2 weeks';'<p><strong>In patients presenting with a cough, always ask duration of the cough</strong></p><ul><li>Any patient with a cough lasting more than 2 weeks should be screened for TB.</li></ul>';'CVoGkRGBZo7';110;0.06;0.06;90;53;;124
+532;'NG HNQIS TB-120';'NG HNQIS TB-120-Inq-Other complaints or problems (weight loss, night sweats & fever)';;'Other complaints or problems (weight loss, night sweats & fever)';'<p><strong>If cough present more than 2 weeks, screen for TB related symptoms:</strong></p><ul><li>Due to its systemic nature, TB typically presents with characteristic accompanying symptoms of:<ul><li>Weight loss</li><li>Night sweats</li><li>Fever</li></ul></li><li>However, absence of these symptoms does not rule out TB.</li></ul>';'YKuVMEWBVqN';120;0.06;0.06;90;53;;124
+533;'NG HNQIS TB-130';'NG HNQIS TB-130-Inq-History of TB contacts';;'History of TB contacts';'<p><strong>Ask the patient whether (s)he has been in close contact with a person known to have TB or with a chronic cough</strong></p><ul><li>TB is an infectious disease transmitted from one person to another through air by coughing or sneezing.</li><li>Close contact with a known TB case increases likelihood of being infected with TB.</li><li>Only people with active pulmonary TB can transmit TB to other people.</li></ul>';'eN2iazycLqJ';130;0.03;0.03;90;53;;124
+534;'NG HNQIS TB-140';'NG HNQIS TB-140-Inq-Diet history';;'Diet history';'<p><strong>If patient has weight loss, inquire further:</strong></p><ul><li>Ask if they have sufficient and nutritional food.</li><li>Ask if patient is vomiting or has diarrhea.</li><li>Poor/Insufficient diet may occasionally lead to wasting that may be misdiagnosed as TB.</li><li>Poor diet also contributes to low immunity that may predispose one to TB infection especially in children.</li><li>Diarrhea and vomiting may also lead to weight loss unrelated to TB.</li></ul>';'PrwUShYFmiZ';140;0.03;0.03;90;53;;124
+535;'NG HNQIS TB-150';'NG HNQIS TB-150-Inq-Has client seen another provider for the same or similar problem and when';;'Has client seen another provider for the same or similar problem and when';'<p><strong>Treatment history is important for diagnosing and initiating treatment</strong></p><ul><li>Ask if patient has been treated for similar symptoms in the past and what the outcome was.</li><li>Cases of failed treatment and TB relapse usually require different drug and follow-up regimen.</li><li>In addition, chronic cough may be due to other illness (e.g. asthma, bronchitis) which may have resolved with appropriate treatment in the past.</li><li>Past history of asthma or bronchitis does not rule out TB.</li></ul>';'APuP38KIa9g';150;0.03;0.03;90;53;;124
+536;'NG HNQIS TB-160';'NG HNQIS TB-160-Exam-Conducts general and systemic examination';;'Conducts general and systemic examination';'<p><strong>Conduct a proper physical exam in suspected TB case:</strong></p><ul><li>A proper respiratory exam includes palpation, percussion and auscultation which can help refine the diagnosis prior to lab testing.</li><li>TB can affect multiple organs and proper examination helps to diagnose cases of extra pulmonary TB (e.g. TB adenitis) which are common in HIV positive individuals and malnourished children.</li><li>Examination allows the clinician to detect other signs of immuno-suppression that may be the underlying cause of TB including generalized lymphadenopathy.</li></ul>';'IFNKZzJN000';160;0.05;0.05;91;53;;125
+537;'NG HNQIS TB-170';'NG HNQIS TB-170-Exam-Takes/refers for sputum microscopy for acid fast bacilli (AFB)';;'Takes/refers for sputum microscopy for acid fast bacilli (AFB)';'<p><strong>Patient should give a sputum sample for lab confirmation of TB through microscopy or referred if test not available.</strong></p><ul><li>Sputum should be collected in a well ventilated area, preferably outside, to minimize risk of transmission to others.</li><li>Sputum microscopy (ZN staining) should be done for all patients prior to initiating treatment.</li><li>Sputum should be collected at least twice: spot and morning sample.</li><li>Follow up sputum is collected at end of intensive phase (2 months); at 4/5 months; and at end of treatment.</li></ul>';'rI4IgUoLvpq';170;0.10;0.10;91;53;;125
+538;'NG HNQIS TB-180';'NG HNQIS TB-180-Exam-Offers HIV testing for all newly diagnosed TB patients or old patients of unknown HIV status';;'Offers HIV testing for all newly diagnosed TB patients or old patients of unknown HIV status';'<p><strong>Offer and conduct a HIV test for all TB patients</strong>.</p><ul><li>The most common risk factor for TB is being HIV positive.</li><li>HIV testing offers an opportunity for further treatment, care and support to those who are HIV positive.</li><li>TB is among the leading causes of mortality in HIV positive patients and worsens progression of HIV.</li><li>Prompt diagnosis of HIV allows proper treatment of HIV to minimize mortality due to HIV/TB co-infection.</li><li>For those who are HIV negative it offers them an opportunity to know their HIV status and practice risk reduction.</li></ul>';'DZ3PrvBL1VC';180;0.05;0.05;91;53;;125
+539;'NG HNQIS TB-190';'NG HNQIS TB-190-Exam-Offers or refers treatment based on clinical condition of client using national guidelines for TB management including directly observed therapy (DOT)';;'Offers or refers treatment based on clinical condition of client using national guidelines for TB management including directly observed therapy (DOT)';'<p><strong>Treatment should be offered in line with national guidelines including direct observation of treatment (DOT)</strong></p><ul><li>Drug regimen and duration of treatment varies depending on the classification of TB (new, retreatment, extra pulmonary).</li><li>Due to challenges associated with stigma, pill burden and long duration of treatment, DOT is recommended to improve medication compliance for good treatment outcomes.</li><li>DOT may take place at home, workplace, health facility or other convenient place agreeable with the patient, the treatment supporter and the health care system.</li></ul>';'Gyugc4R5Khq';190;0.25;0.25;92;53;;126
+540;'NG HNQIS TB-200';'NG HNQIS TB-200-Couns-Importance of compliance with treatment and follow-up appointments';;'Importance of compliance with treatment and follow-up appointments';'<p><strong>Counsel the patient on importance of compliance with treatment and follow up appointments</strong></p><ul><li>Symptoms of TB disappear quickly upon initiation of treatment but the drugs still need to be continued daily until the end of the prescribed treatment period.</li><li>Failure to comply may cause relapse and possibly drug resistance. Both these, pose a risk of transmission.</li><li>Follow up appointments are important to monitor progress of the patient and if necessary modify treatment based on response.</li></ul>';'eMPOHauaBMa';200;0.10;0.10;93;53;;127
+541;'NG HNQIS TB-210';'NG HNQIS TB-210-Couns-Need for treatment supporter';;'Need for treatment supporter';'<p><strong>Discuss and identify a treatment supporter for the patient</strong></p><ul><li>Due to the long duration of treatment and risk of non-compliance with medication, often due to psycho-social challenges, it is recommended to identify and link each TB patient with a treatment supporter. This ensures adherence to treatment thus averting potential cases of drug resistance due to poor compliance.</li><li>A treatment supporter could be a health care worker, a family member or a community volunteer who is acceptable and accountable to the patient and the health system.</li></ul>';'MoRgGH9eaWG';210;0.02;0.02;93;53;;127
+542;'NG HNQIS TB-220';'NG HNQIS TB-220-Couns-Possible side effects of medications and what to do if they occur';;'Possible side effects of medications and what to do if they occur';'<p><strong>Discuss possible side effects and what to do when they occur</strong></p><ul><li>Informing patients of side effects is important to ensure adherence to medication and to monitor/manage life threatening adverse events.</li><li>Possible side effects may include urine discoloration, skin reactions, nausea/vomiting, pins & needles sensation, blurring of vision etc.</li><li>Patients should be informed of transient nature of most side effects but advised to come to hospital in case of jaundice, blurring of vision or worsening of any of the other side effects.</li></ul>';'iXIIIJMfL2X';220;0.02;0.02;93;53;;127
+543;'NG HNQIS TB-230';'NG HNQIS TB-230-Couns-How to get resupplies of medications and how often to do so';;'How to get resupplies of medications and how often to do so';'<p><strong>Discuss where to get medication refills, how often and for how long</strong></p><ul><li>Adherence to medication is important to ensure effective cure of the disease, thus avoiding treatment failure and emergence of drug resistant pathogens.</li><li>Often if patients are not counselled on getting refills, they may stop treatment once they finish the given dose more so if the symptoms have resolved.</li><li>Providers should ensure patients are initiated on treatment at a place that is easily accessible to the patient with a guaranteed supply of drugs to optimize adherence.</li></ul>';'G3GJ9dnj2ED';230;0.05;0.05;93;53;;127
+544;'NG HNQIS TB-240';'NG HNQIS TB-240-Couns-Counseling on nutrition';;'Counseling on nutrition';'<p><strong>Counsel patient on need for sufficient and nutritious food during and after treatment</strong></p><ul><li>TB patients have increased nutritional requirements especially energy, proteins and micro-nutrients to help rebuild the body and enable them to cope with the medication.</li><li>Nutritious foods do not need to be expensive and providers should strive to have individualized diet plans for the patients in context with what is easy accessible to them.</li></ul>';'F8UrdIh6tK6';240;0.05;0.05;93;53;;127
+545;'NG HNQIS TB-250';'NG HNQIS TB-250-Couns-Need to inform clinic if client decides to relocate (for linkage to treatment sites in new area of domicile)';;'Need to inform clinic if client decides to relocate (for linkage to treatment sites in new area of domicile)';'<p><strong>Find out about patients place of residence, any plans on changing residence during the course of treatment and discuss importance of communicating the same</strong></p><ul><li>It is important for patients to inform the staff at the clinic when they intend to travel to ensure an adequate supply of drugs are given to cater for the period they are away from their local area thereby minimizing risk of missed dosages.</li><li>In addition, patients need to inform the staff at the clinic when they intend to move to another area to facilitate writing of a transfer letter and advice as to where they can continue treatment.</li></ul>';'YnGOnNcLVkl';250;0.02;0.02;93;53;;127
+546;'NG HNQIS TB-260';'NG HNQIS TB-260-Couns-Importance of testing (and possible treatment) of contacts';;'Importance of testing (and possible treatment) of contacts';'<p><strong>Discuss and plan to screen contacts for TB</strong></p><ul><li>TB is an infectious disease transmitted from one person to another through the air by coughing or sneezing and the patient may have infected other people with TB.</li><li>He/she should therefore, be asked to encourage other people with whom he/ she has been in close contact with, to undergo screening for TB.</li></ul>';'lUrKC7relgL';260;0.02;0.02;93;53;;127
+547;'NG HNQIS TB-270';'NG HNQIS TB-270-Couns-Provides follow-up appointment or arrange home visit if possible.';;'Provides follow-up appointment or arrange home visit if possible.';'<p><strong>Schedule and agree on a follow up appointment and home visit as is feasible</strong></p><ul><li>Follow up appointments are important to monitor progress of patients and provide on going psycho-social support.</li><li>Where feasible, home visits offer opportunity to provide health education to family members thereby ensuring support for the patient at home and reducing risk of infecting contacts.</li></ul>';'sM3VJzCnPVV';270;0.01;0.01;93;53;;127
+548;'NG HNQIS TB-280';'NG HNQIS TB-280-WE-Availability of SOPs and Protocols/National guidelines for Tuberculosis';;'Availability of SOPs and Protocols/National guidelines for Tuberculosis';'<p><strong>National guidelines and SOPs should be available for service providers</strong></p><ul><li>National guidelines are evidence-based criteria which ensures that the highest possible quality of care is given to a patient.</li><li>SOPs provide a comprehensive set of criteria outlining the management steps for Tuberculosis.</li></ul>';'wz2vRD3OH2j';280;0.02;0.02;94;53;;128
+549;'NG HNQIS TB-290';'NG HNQIS TB-290-WE-Availability of Anti-TB drugs if the facility offers treatment';;'Availability of Anti-TB drugs if the facility offers treatment';'<p><strong>Maintain Anti-TB drugs in stock at all times</strong></p><ul><li>It is critical that patients on TB treatment do not miss any dose; otherwise there is risk of developing drug resistant TB.</li><li>Patient compliance is also enhanced when there is consistency of service provision and supply of medicine.</li></ul>';'QICinw0TocV';290;0.02;0.02;94;53;;128
+550;'NG HNQIS TB-300';'NG HNQIS TB-300-END-END OF TAB';;'END OF TAB';;'uhd58nej9NN';300;0.00;0.00;94;49;;
+551;'NG HNQIS NR-100';'NG HNQIS NR-100-NR-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Real life emergency cases will typically be difficult to assess due to the overriding objective of ensuring the safety/well being of the new born is achieved. Simulated cases should be tailored to mimic real life situations and variations as much as possible.</p>';'yRFQ6W5v0c7';100;0.00;0.00;95;88;;130
+552;'NG HNQIS NR-110';'NG HNQIS NR-110-NR-Checks to make sure all supplies are available And that emergency equipment is working, while preparing for delivery.';;'Checks to make sure all supplies are available And that emergency equipment is working, while preparing for delivery.';'<p><strong>Before beginning delivery, ensure that all the required equipment and supplies are available. Confirm that the emergency tray is also complete and close by.</strong></p><ul><li>Maintain regular records of emergency supplies and equipment including service repairs.</li></ul><p><strong>Required equipment:</strong></p><ul><li>Radiant warmer or pre-warmed towels and an extra blanket-for warming the baby</li><li>Newborn-size self-inflating resuscitation bag</li><li>2 face masks-(for normal and small newborn)</li><li>Suctioning equipment</li><li>Oxygen cylinder</li><li>Clock</li></ul><p><strong>Always anticipate a resuscitation of a newborn. Refresh your skills frequently.</strong><br/>Be alert for high risk maternal and fetal conditions that may lead to a need for neonatal resuscitation. (Malaria, STDs, maternal chronic disease, difficult pregnancy, history of infant death or traumatic delivery, APH etc.)</p>';'qi7IqUhvDdD';110;0.20;0.20;95;53;;130
+553;'NG HNQIS NR-120';'NG HNQIS NR-120-NR-Keep baby warm (place baby under radiant warmer if available)';;'Keep baby warm (place baby under radiant warmer if available)';'<p><strong>Immediately after delivery, ensure baby is warm by drying with a warm towel</strong></p><ul><li>If baby has poor Apgar score and is being resuscitated, ensure warmth by keeping under a radiant warmer during the procedure.</li><li>The ideal body temperature 36.5-37.5C is largely influenced by the baby''s environment.</li></ul>';'Cahajc5Zxfo';120;0.16;0.16;95;53;;130
+554;'NG HNQIS NR-130';'NG HNQIS NR-130-NR-Clears the airway, if necessary suctions the mouth and nose.';;'Clears the airway, if necessary suctions the mouth and nose.';'<p><strong>Clear the airway by suctioning the mouth and nose gently, only if indicated</strong></p><ul><li>Airway obstruction may be the cause of poor clinical state of new born.</li><li>Suctioning removes secretions/particles that may be obstructing air flow.</li><li>Often times suctioning alone is enough to allow natural breathing in the new born.</li></ul>';'QiDvCRnmUQg';130;0.16;0.16;95;53;;130
+555;'NG HNQIS NR-140';'NG HNQIS NR-140-NR- Places the mask on the baby’s face so that it covers the chin, mouth and nose.';;'Places the mask on the baby’s face so that it covers the chin, mouth and nose.';'<p><strong>Once the airway is clear, place the correct size mask on baby''s face</strong></p><ul><li>A properly fitting mask that covers the chin, mouth and nose provides a tight seal that ensures adequate amount of oxygen.</li><li>Ensure new born''s head is in a neutral position.</li><li>Continue clearing secretions as necessary.</li></ul>';'BOENe3mTQGa';140;0.16;0.16;95;53;;130
+556;'NG HNQIS NR-150';'NG HNQIS NR-150-NR-Ventilates at a rate of 40 breaths per minute for 1 minute.';;'Ventilates at a rate of 40 breaths per minute for 1 minute.';'<p><strong>The new born should be ventilated at 40 breaths per minute, counted out loudly</strong></p><ul><li>Ventilation at 30-60 bpm mimics the natural respiratory rate.</li><li>Higher rates may lead to pneumomediastinum, pneumothorax or pneumopericardium; while lower rates may lead to inadequate ventilation.</li></ul>';'EgwAY1il9oH';150;0.16;0.16;95;53;;130
+557;'NG HNQIS NR-160';'NG HNQIS NR-160-NR-If baby is not breathing, or breathing is less than 30 breaths per minute or severe chest indrawing is present, continues ventilating. Gives oxygen if available and arranges immediate transfer for special care';;'If baby is not breathing, or breathing is less than 30 breaths per minute or severe chest indrawing is present, continues ventilating. Gives oxygen if available and arranges immediate transfer for special care';'<p><strong>Continue ventilating, give oxygen and arrange for transfer if respiratory rate remains below 30 breaths/minute</strong></p><ul><li>Poor response to assisted ventilation by bag and mask often indicates need for intubation and mechanical ventilation.</li><li>Where this is not available, continuous steady bagging with suctioning as necessary helps to keep new born alive until reaching appropriate facility.</li><li>Remember to keep baby warm and monitor other vital signs that may require additional intervention specifically slow heart rate(bradycardia), dehydration and hypoglycemia.</li></ul>';'W1O2tSQB4bt';160;0.16;0.16;95;53;;130
+558;'NG HNQIS NR-170';'NG HNQIS NR-170-END-END OF TAB';;'END OF TAB';;'V36Vlse37wx';170;0.00;0.00;95;49;;
+559;'NG HNQIS HIV-100';'NG HNQIS HIV-100-HTC-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>While a real case observation is ideal, it is important to respect patients'' right to privacy and confidentiality during HIV testing due to the sensitive nature of a positive result.</p>';'W9jDjDNOZDf';100;0.00;0.00;96;88;;132
+560;'NG HNQIS HIV-110';'NG HNQIS HIV-110-HTC-PRE-TEST';;'PRE-TEST';;'i8kxVMfbbP3';110;0.00;0.00;96;49;;
+561;'NG HNQIS HIV-120';'NG HNQIS HIV-120-HTC-Provider describes test';;'Provider describes test';'<p><strong>Explain and ensure patient understanding of the following:</strong></p><ul><li>Test requires a blood sample drawn using a needle prick.</li><li>Blood is tested for HIV antibodies which if present indicate HIV infection.</li><li>The test will be conducted in front of the patient.</li><li>Test results are available within a few minutes.</li><li>Patient must provide written consent to perform test.</li></ul><p><strong>Provide information on benefits of knowing one''s HIV status, sexual partner testing</strong></p><ul><li>Counsel on partner testing. A patient may test HIV negative, but risks getting infected if the partner is HIV positive and remains untested.</li><li>The patient''s status does not reflect the status of his/her sexual partner(s).</li></ul>';'Z9IRrxcV2mP';120;0.05;0.05;96;53;;132
+562;'NG HNQIS HIV-130';'NG HNQIS HIV-130-HTC-Explains window period (HIV -ve clients < 3 months exposure) and need for partner testing';;'Explains window period (HIV -ve clients < 3 months exposure) and need for partner testing';'<p><strong>Explain the following important information:</strong></p><ul><li>Due to differences in immune response, it may take up to 3 months before an infected individual has the requisite antibodies to be detected by the test kit (the window period).</li><li>During the window period a test can be negative, therefore a retest is recommended after 3 months depending on the risk.</li><li>Reiterate, a patient may test HIV negative, but risks getting infected if the partner is HIV positive and remains untested. It is important for the patient''s partner(s) to also be tested.</li></ul>';'Hm7QjsE7gpo';130;0.05;0.05;96;53;;132
+563;'NG HNQIS HIV-140';'NG HNQIS HIV-140-HTC-Explores support networks available';;'Explores support networks available';'<p><strong>Discuss availability of support networks for the patient in case of a positive result</strong></p><ul><li>Post testing support networks are vital to treatment adherence and the psychological well-being of an individual.</li></ul>';'sDtlws4Xuse';140;0.05;0.05;96;53;;132
+564;'NG HNQIS HIV-150';'NG HNQIS HIV-150-HTC-Explains result interpretation';;'Explains result interpretation';'<p><strong>Use the ''display cards'' to explain how to interpret the test results</strong></p><ul><li>Two bands for a positive test (control band & test band).</li><li>One band for a negative test (control band only).</li><li>Explain a positive result will be followed by a confirmatory test using a different test kit that will be interpreted in the same way.</li><li>Ensure patient understands result interpretation prior to testing so he is able to read the result for him/herself and accept the outcome.</li></ul>';'wzUIVyZ8HHJ';150;0.05;0.05;96;53;;132
+565;'NG HNQIS HIV-160';'NG HNQIS HIV-160-HTC-Seek clarification and obtains verbal or written consent ( if the client decides to test)';;'Seek clarification and obtains verbal or written consent ( if the client decides to test)';'<ul><li>Ask the patient if they have concerns and address them before conducting the test.</li><li>Consent must be voluntary and not coercive.</li><li>If patient wants to test, obtain verbal or written consent before conducting the test.</li><li>If a patient is unwilling to take the test, encourage the him/her to come later when he/she is ready and give prevention messages and condoms as necessary.</li></ul><p><strong>Children and Disabled persons</strong></p><ul><li>Children may be tested with the consent of a parent or guardian, or may give their own if they are symptomatic, pregnant, married, a parent, or engaged in behavior that puts them at risk of contracting HIV.</li><li>A person with a disability that prevents them from giving consent may be tested with the consent of the guardian, parent, partner or family of the person being tested, or other caregiver.</li></ul><p><strong>The only circumstances where consent for a HIV test is not a requirement are:</strong></p><ul><li>When a person is required to be tested for HIV under the provisions of a written law; and</li><li>When a person is unconscious and unable to give consent, and the test is medically necessary for a clinical diagnosis.</li></ul><p><strong>Under no circumstances may persons be required to have an HIV test for purposes of employment, marriage, education, travel, or for the provision of health care, insurance cover, or any other service.</strong></p>';'m1ptLsY9jtW';160;0.10;0.10;96;53;;132
+566;'NG HNQIS HIV-170';'NG HNQIS HIV-170-HTC-PERFORM TEST';;'PERFORM TEST';;'zt7VjSQLqIK';170;0.00;0.00;96;49;;
+567;'NG HNQIS HIV-180';'NG HNQIS HIV-180-HTC-Prepares client for testing';;'Prepares client for testing';'<p><strong>Ensure the patient is ready for the test, comfortably seated and the environment is conducive for testing</strong></p><ul><li>Ensure the room is private and confidential (close the door), well lit, and the testing surface is clean.</li></ul>';'ouOhGbE40HW';180;0.05;0.05;96;53;;132
+568;'NG HNQIS HIV-190';'NG HNQIS HIV-190-HTC-Prepares the testing kit';;'Prepares the testing kit';'<p><strong>Make sure testing kits, consumables and other required supplies are ready and in good condition</strong></p><ul><li>Ensure all the sets of recommended test kits required to conduct a HIV test are available. If any are lacking, do not proceed with the test.</li><li>Check the expiry date and overall condition (sealed, dry ) of the test kits and confirm this with the patient.</li><li>Ensure the lancet, swabs, assay diluents and disposable specimen droppers are available and in good condition.</li></ul><p><em><strong>Note:</strong></em> Test kits must be stored correctly as per the manufacturer''s specifications to ensure they give the correct results.</p>';'jskVCLnqQV9';190;0.05;0.05;96;53;;132
+569;'NG HNQIS HIV-200';'NG HNQIS HIV-200-HTC-Collects blood samples based on protocols';;'Collects blood samples based on protocols';'<p>Correct amount of blood should be collected from the finger as per protocol.</p><ul><li>Ensure the provider follows the steps as outlined in the SOPs/job aids because poor specimen collection may give false results</li><li>Observe if the provider labels the test device with patient code, swabs the finger, collects the required amount of specimen and puts it in the sample well, uses the right amount of diluent and allows the recommended time before reading results.</li></ul>';'vMSXRKLJOb5';200;0.10;0.10;96;53;;132
+570;'NG HNQIS HIV-210';'NG HNQIS HIV-210-HTC-Runs the test (and confirmatory test if positive) based on protocols';;'Runs the test (and confirmatory test if positive) based on protocols';'<p><strong>Provider must do the following according to protocol in order to obtain accurate results:</strong></p><ul><li>Collect the recommended volume of blood.</li><li>Use the right amount of diluent.</li><li>Allow the recommended time to elapse before reading the test.</li><li>Conduct a second confirmatory test if first is positive.</li><li>Conduct a third test if first two are discrepant.</li></ul>';'qqY7QmOHQs3';210;0.10;0.10;96;53;;132
+571;'NG HNQIS HIV-220';'NG HNQIS HIV-220-HTC-POST-TEST';;'POST-TEST';;'vAXfGB4EVCU';220;0.00;0.00;96;49;;
+572;'NG HNQIS HIV-230';'NG HNQIS HIV-230-HTC-Post-test IP procedures correctly performed';;'Post-test IP procedures correctly performed';'<p><strong>To minimize risk of infection, ensure infection prevention procedures for biologic waste are followed.</strong></p><ul><li>The testing area should not be cluttered and the provider should put the hazardous waste on a tray within clear visibility as he conducts the test.</li><li>The recommended waste disposal containers should be within easy reach and dispose of the swabs, lancet, specimen delivery capillary tubes as soon as possible to minimize risk of accidents during testing. This can be done as the provider waits for the recommended time to elapse before reading the results.</li></ul><p><strong>Note:</strong> Every HTC facility must have and adhere to procedures for the safe handling of bio hazardous material including instructions on use of gloves, closed footwear, hand washing, handling and disposing of sharps, how to clean up a spill and disinfect HIV testing areas, and proper disposal of used test kits.</p><ul><li>Generally, there should be no eating, drinking or smoking in the same place where HIV testing is conducted, and unauthorized persons should not be allowed in the HIV testing area.</li><li>There must also be procedures in place for how to respond in the case of an accidental exposure to bio hazardous material.</li></ul><p>Lreference-SOP on Waste management, handling of sharps and needles</p>';'Bh3NMUfyU8Y';230;0.05;0.05;96;53;;132
+573;'NG HNQIS HIV-240';'NG HNQIS HIV-240-HTC-Relays/gives results according to protocols';;'Relays/gives results according to protocols';'<p>Results should only be given after the correct time has elapsed and with involvement of the client.</p><ul><li>Ensure the provider waits for the recommended time prior to giving results.</li><li>The patient should be encouraged to read the results themselves from the testing device and refer to the result chart if necessary.</li><li>Providers should respect patient rights when giving results and offer the necessary support and counselling especially after a positive result.</li></ul>';'DDvCek37B8x';240;0.10;0.10;96;53;;132
+574;'NG HNQIS HIV-250';'NG HNQIS HIV-250-HTC-Post-test counselling based on protocols';;'Post-test counselling based on protocols';'<p>Counsel all tested patients in accordance with protocols.</p><ul><li><strong>The following counseling services should be offered to HIV negative patients:</strong><ul><li>Window period(re-testing)</li><li>Prevention counseling/risk reduction plan</li><li>Partner testing</li><li>Referral to additional prevention services as needed e.g. Male circumcision</li><li>Needle exchange for injecting drug users (IDUs)</li><li>Condoms education and distribution. Demonstrate correct condom use and provide condoms to the client</li><li>Post-exposure prophylaxis (PEP)</li></ul></li><li><strong>For those testing positive, counselling should address:</strong><ul><li>Immediate emotions after the test</li><li>Exploring support networks</li><li>Partner testing and disclosure including risks and benefits of disclosure</li><li>Referral to additional prevention services as needed e.g. Male circumcision, cervical cancer screening</li><li>Needle exchange for injecting drug users (IDUs)</li><li>Follow up services including care & treatment and linkage to care</li><li>Prevention with positives</li><li>Stress on dual protection</li><li>Condoms education and distribution. Demonstrate correct condom use and provide condoms to the patient</li><li>Healthy lifestyles and linkages to care</li></ul></li><li>Other topics that may be discussed during the post-test session for either HIV positive or HIV negative patients, depending on their needs and the setting, include:<ul><li>Supported disclosure</li><li>Family member testing</li><li>Maternal and child health services</li><li>Family planning services</li></ul></li></ul>';'hCGBl5XPxof';250;0.20;0.20;96;53;;132
+575;'NG HNQIS HIV-260';'NG HNQIS HIV-260-HTC-Records in the client file and Daily Activity Register';;'Records in the client file and Daily Activity Register';'<p><strong>Ensure details of patient and test are recorded in appropriate register</strong></p><ul><li>Immediately after completing the test, provider should record the test in a systematic manner.</li><li>HTC service providers should be aware of and use appropriate data collection tools.</li><li>It is highly recommended that they use one standardized patient form with standardized variables and harmonized data reporting tools with the same indicators.</li></ul>';'Jzkl79cRamZ';260;0.05;0.05;96;53;;132
+576;'NG HNQIS HIV-270';'NG HNQIS HIV-270-Care Tx-POSITIVE CASES ONLY (ART)';;'POSITIVE CASES ONLY (ART)';;'IxZYs1aUBzw';270;0.00;0.00;97;49;;133
+577;'NG HNQIS HIV-280';'NG HNQIS HIV-280-Care Tx-Proper history taking and staging of the patient';;'Proper history taking and staging of the patient';'<p><strong>Conduct proper history taking in a structured manner while respecting the patients rights and dignity. After history taking, conduct physical exam and stage as per protocol</strong></p><ul><li>The goal of clinical assessment is to identify patients who need ART and ensure they are medically ready to commence therapy.</li><li>The assessment involves a thorough history, screening for and treating/stabilizing any opportunistic infections (OIs), starting preventive therapy against OIs, addressing any pre-existing medical problems, WHO clinical staging and determining if ART is required.</li></ul><p><strong>Clinical staging provides clinicians and patients with important information about HIV disease severity and guides clinical management. It is useful:</strong></p><ul><li>For providing guidance as to when to start or review ARV drug therapy,</li><li>In assessing clinical response to therapy in the absence of appropriate laboratory tests,</li><li>For determining prognosis and monitoring patients'' clinical progress.</li></ul>';'b716uABa259';280;0.15;0.15;97;53;;133
+578;'NG HNQIS HIV-290';'NG HNQIS HIV-290-Care Tx-Proper Counselling on adherence and disclosure';;'Proper Counselling on adherence and disclosure';'<p><strong>Discuss with the patient the importance of adherence to medication and role of disclosure in management of disease</strong></p><ul><li>Adherence to medication including ART is the cornerstone of successful management of HIV and should be done at every visit. Poor adherence accounts for most of treatment failure and other poor outcomes and should be discussed at each visit.</li><li>Disclosure counselling helps patients to gain confidence to share their status with the partner, a close relative/friend whom they can rely on for psychosocial support.</li><li>Disclosure is also useful as it offers an opportunity for testing of partners and where necessary, children of the positive individual.</li></ul>';'tfttGc2YrRB';290;0.20;0.20;97;53;;133
+579;'NG HNQIS HIV-300';'NG HNQIS HIV-300-Care Tx-Use of screening tools for TB using the yellow card & pink card for children';;'Use of screening tools for TB using the yellow card & pink card for children';'<p><strong>Screen for TB during all visits using the recommended screening tools</strong></p><ul><li>All HIV positive patients should be screened for TB at every visit using the appropriate cards.</li><li>This is because TB is the leading cause of mortality in HIV positive patients and hastens the progression of HIV disease if not treated on time.</li><li>Using the recommended cards ensures standardization and documentation of screening by all providers.</li></ul>';'Rs55gnyeELb';300;0.05;0.05;97;53;;133
+580;'NG HNQIS HIV-310';'NG HNQIS HIV-310-Care Tx-Screening for opportunistic infections and proper administration of correct treatment';;'Screening for opportunistic infections and proper administration of correct treatment';'<p><strong>Use appropriate history taking, physical examination and laboratory tests to screen for opportunistic infections (OIs) and manage accordingly</strong></p><ul><li>Screening for opportunistic infections (including TB) should be done at every visit by utilizing the clinical assessment approach of thorough history taking and physical examination.</li><li>OIs should be managed according to the recommended protocols.</li><li>If OIs are not treated on time may hasten progression of HIV with poor outcomes.</li></ul>';'q7zuVvTXOO6';310;0.15;0.15;97;53;;133
+581;'NG HNQIS HIV-320';'NG HNQIS HIV-320-Care Tx-Patient given cotrimoxazole and correct return date';;'Patient given cotrimoxazole and correct return date';'<p><strong>Ensure patient has enough Cotrimoxazole for prophylaxis and agree on return date.</strong></p><ul><li>All HIV positive patients should be put on daily Cotrimoxazole prophylaxis, unless contra-indicated/allergic to prevent opportunistic infections. Patients allergic to cotrimoxazole should be put on dapsone.</li><li>Proper adherence counselling should be provided prior to initiation of Cotrimoxazole prophylaxis.</li><li>Follow up dates should be given in accordance with the recommended guidelines/SOPs.</li></ul>';'rWv5a0HlpQ9';320;0.15;0.15;97;53;;133
+582;'NG HNQIS HIV-330';'NG HNQIS HIV-330-Care Tx-Correct filling of the data tools- ANC booklet (PMCTC only), Blue card, pre- ART and ART registers';;'Correct filling of the data tools- ANC booklet (PMCTC only), Blue card, pre- ART and ART registers';'<p><strong>Fill in required information in appropriate standardized data collection tools</strong></p><ul><li>Providers should have and use standardized data collection tools for HIV care and treatment</li><li>Proper data collection and utilization is important for chronic care management of HIV.</li><li>Ascertain availability of tools, understanding of indicators, quality of data (accuracy, completeness, timeliness, consistency) as well as evidence of report submission to relevant MOH/oversight persons.</li><li>For PMTCT, record in ANC booklet. This ensures that HIV care is not overlooked during routine antenatal care visits. It also ensures that the service providers delivering the mother have the information needed for continuity of care for the mother and to prevent HIV infection to the newborn baby.</li></ul>';'g0HBhDzbd3A';330;0.05;0.05;97;53;;133
+583;'NG HNQIS HIV-340';'NG HNQIS HIV-340-Care Tx-Was patient offered correct ART drugs as per the national guidelines';;'Was patient offered correct ART drugs as per the national guidelines';'<ul><li>Ensure providers offer ART as per national guidelines and protocols. This is important to ensure optimal response to treatment, standardize care as well as minimize risk of emergence of resistant strains.</li></ul>';'WrVQU69FRQt';340;0.15;0.15;97;53;;133
+584;'NG HNQIS HIV-350';'NG HNQIS HIV-350-Care Tx-Screening for pregnancy at every visit (Female patients )';;'Screening for pregnancy at every visit (Female patients )';'<p><strong>Rule out pregnancy in female patients during each visit</strong></p><ul><li>Providers should take proper reproductive history including screening for pregnancy in HIV positive women so as not to miss interventions targeting prevention of mother to child transmission of HIV.</li><li>HIV positive women should be offered and supported to use dual protection (condoms and an FP method) to avoid any unplanned pregnancies.</li></ul>';'Ounr3yvEMsB';350;0.10;0.10;97;53;;133
+585;'NG HNQIS HIV-360';'NG HNQIS HIV-360-Care Tx-RECORD REVIEW - POSITIVE CASES';;'RECORD REVIEW - POSITIVE CASES';;'Hk90adsjuFw';360;0.00;0.00;97;49;;133
+586;'NG HNQIS HIV-370';'NG HNQIS HIV-370-Care Tx-Vital signs- weight and height taken and BMI calculated at every visit correctly charted';;'Vital signs- weight and height taken and BMI calculated at every visit correctly charted';'<p><strong>At every visit, measure weight, height, blood pressure, temperature and calculate BMI</strong></p><ul><li>Check if vital signs are taken at every visit and documented in the patient records. These include-temperature, weight, height, blood pressure and pulse rate.</li><li>It is important to take vital signs at every visit in order to promptly detect any subtle co-morbidities that may need to be managed accordingly like high temperature that may indicate an underlying infection.</li><li>BMI is additionally useful in monitoring progress of patient on treatment. Patients who are initially underweight should gain weight when treatment is working and patients whose BMI starts to drop could be having treatment failure or opportunistic infections.</li></ul>';'PBH3itQC0mX';370;0.17;0.17;97;53;;133
+587;'NG HNQIS HIV-380';'NG HNQIS HIV-380-Care Tx- Screening and treatment of TB and /or any presenting OI';;'Screening and treatment of TB and /or any presenting OI';'<p><strong>Screen for TB and other OIs and document at every visit</strong></p><ul><li>Check if the provider has filled the TB screening cards at every visit as well as documented screening for other OIs with appropriate management where necessary.</li></ul>';'dFpzIZN2bRH';380;0.17;0.17;97;53;;133
+588;'NG HNQIS HIV-390';'NG HNQIS HIV-390-Care Tx- Correct ART regimen given';;'Correct ART regimen given';'<p><strong>ART regimen and dosage should be appropriate for the individual patient</strong></p><ul><li>For each patient on ART, check whether the regimen is in line with recommended national guidelines taking into consideration age, co-morbidities, other medication and or response to treatment.</li><li>Following guidelines helps to optimize on proven and effective regimen as well as reducing risk of drug resistance and treatment failure.</li><li>Providers should have within quick reach SOPs on nationally recommended ART regimen for different circumstances and refer to these as often as necessary.</li></ul>';'GuDOjHukmuW';390;0.17;0.17;97;53;;133
+589;'NG HNQIS HIV-400';'NG HNQIS HIV-400-Care Tx- Correct schedule for CD4 or VL testing';;'Correct schedule for CD4 or VL testing';'<p><strong>Send for CD4 and VL testing as per schedule and document results</strong></p><ul><li>Check whether the recommended guidelines for CD4 count and VL testing have been adhered to and results documented in file.</li><li>CD4 count is currently recommended for all new patients and to determine eligibility for ART (except in children under 10 and pregnant women).</li><li>VL is recommended for monitoring response to ART.</li></ul>';'xvmJhJ6vKos';400;0.17;0.17;97;53;;133
+590;'NG HNQIS HIV-410';'NG HNQIS HIV-410-Care Tx-Proper clinical management of patients including identification of treatment failure';;'Proper clinical management of patients including identification of treatment failure';'<p><strong>Manage patients as per guidelines with proper decisions made at each visit based on guidelines and documented</strong></p><ul><li>Check for documentation that proper history taking, physical exam, clinical & laboratory monitoring, screening for OIs and other recommended support services including sexual reproductive health, adherence counselling, nutrition and psychosocial assessment are provided as per guidelines.</li><li>Look for evidence of clinical staging and laboratory monitoring for treatment failure at recommended intervals.</li></ul>';'lQfhZMaGD4G';410;0.17;0.17;97;53;;133
+591;'NG HNQIS HIV-420';'NG HNQIS HIV-420-Care Tx-Available referral directory Pre- ART lab work-up, CD4 and VL samples';;'Available referral directory Pre- ART lab work-up, CD4 and VL samples';'<p><strong>Referrals should be documented and feedback mechanism in place for various components of care and treatment</strong></p><ul><li>All facilities offering only HTC should have clear referral systems for follow up of HIV positive patients with documented evidence of the same including feedback.</li><li>Where feasible, linkages that minimize patient movement (specimen/sample networking) should be put in place to ensure point of care services are offered to the patients.</li><li>Providers without clear referral systems should be discouraged from offering HTC and instead advised to refer patients for testing until they have the systems in place.</li><li>Prior to referral or where care and treatment is available, document all lab results clearly in the patient''s file. These are important for follow up to ensure that complications or treatment failure is detected early by making comparisons with previous lab results.</li></ul>';'fmOLhaYAyk8';420;0.17;0.17;97;53;;133
+592;'NG HNQIS HIV-430';'NG HNQIS HIV-430-Care Tx-RECORD REVIEW - POSITIVE CASES - PMCTC';;'RECORD REVIEW - POSITIVE CASES - PMCTC';;'TrbZD4i2edJ';430;0.00;0.00;97;49;;
+593;'NG HNQIS HIV-440';'NG HNQIS HIV-440-Care Tx-Check HTC for all mothers in the ANC register';;'Check HTC for all mothers in the ANC register';'<p><strong>HTC should be offered to all pregnant mothers and documented in appropriate registers</strong></p><ul><li>Check in the ANC register whether all pregnant women have HTC results in the relevant column and discuss with provider any discrepancies.</li><li>HTC should be offered to all pregnant women and noted in the appropriate documents.</li><li>Women who decline testing should be encouraged during subsequent visits with appropriate counselling and support messages taking into consideration principle of informed consent prior to HIV testing.</li><li>Where a woman has not been tested, offer counseling and testing. There should never be a missed opportunity to test a pregnant woman.</li></ul>';'s1qc1mCQRiM';440;0.17;0.17;97;53;;133
+594;'NG HNQIS HIV-450';'NG HNQIS HIV-450-Care Tx-Review referral and linkages for positive mothers';;'Review referral and linkages for positive mothers';'<p><strong>Proper referral for further care and treatment should be documented and feedback mechanism put in place for HIV positive pregnant women</strong></p><ul><li>All facilities offering only HTC to pregnant women should have clear referral systems for follow up of those testing HIV positive with documented evidence of the same including feedback.</li><li>Providers without clear referral systems should be discouraged from offering HTC and instead advised to refer patients until they have the systems in place.</li></ul>';'fAaWzwx9DTI';450;0.17;0.17;97;53;;133
+595;'NG HNQIS HIV-460';'NG HNQIS HIV-460-Care Tx-Check documented counselling on birth plan';;'Check documented counselling on birth plan';'<p><strong>Develop and follow individualized birth plans for HIV positive pregnant women</strong><br />This is important to ensure best outcomes for mother and new born by covering key aspects of the delivery process.</p>';'mo2ByJ8DIf3';460;0.17;0.17;97;53;;133
+596;'NG HNQIS HIV-470';'NG HNQIS HIV-470-Care Tx-Proper clinical management of patients including identification of treatment failure';;'Proper clinical management of patients including identification of treatment failure';'<p><strong>Patients should be managed as per guidelines with proper decisions made at each visit based on guidelines and documented</strong></p><ul><li>Check for documentation that proper history taking, physical exam, clinical & laboratory monitoring, screening for OIs and other recommended support services including adherence counselling, nutrition and psychosocial assessment are provided as per guidelines.</li><li>Look for evidence of clinical staging and laboratory monitoring for treatment failure at recommended intervals.</li><li>All pregnant women should be on ART irrespective of their CD4 count.</li></ul>';'kKQTLLRus4u';470;0.17;0.17;97;53;;133
+597;'NG HNQIS HIV-480';'NG HNQIS HIV-480-Care Tx- Check the 4 completion / scheduling of the 4 ANC visits';;'Check the 4 completion / scheduling of the 4 ANC visits';'<p><strong>HIV positive pregnant women need to follow ANC appointments as per standard guidelines</strong></p><ul><li>Check the ANC register and mother child booklet where available for the implementation of at least 4 ANC visits for pregnant women and discuss any gaps with the provider</li></ul>';'V01w6D2n7iH';480;0.17;0.17;97;53;;133
+598;'NG HNQIS HIV-490';'NG HNQIS HIV-490-Care Tx-Available referral directory Pre- ART lab work-up, CD4 and VL samples';;'Available referral directory Pre- ART lab work-up, CD4 and VL samples';'<p><strong>Referrals should be documented and feedback mechanism in place for various components of care and treatment</strong></p><ul><li>All facilities offering only HTC to pregnant women should have clear referral systems for follow up of HIV positive patients with documented evidence of the same including feedback.</li><li>Where feasible, linkages that minimize patient movement (specimen/sample networking) should be put in place to ensure point of care services are offered to the patients.</li><li>Providers without clear referral systems should be discouraged from offering HTC and instead advised to refer patients until they have the systems in place.</li><li>Prior to referral or where care and treatment is available, document all lab results clearly in the patient''s file. These are important for follow up to ensure that complications or treatment failure is detected early by making comparisons with previous lab results.</li></ul>';'WbdnRzH2eTQ';490;0.17;0.17;97;53;;133
+599;'NG HNQIS HIV-500';'NG HNQIS HIV-500-WE-Availability of recommended Testing Kits';;'Availability of recommended Testing Kits';'<p>You should only use the test kits recommended on the National guidelines. Standardization keeps errors to a minimum.</p>';'YzlzKX4aTBR';500;0.40;0.40;98;53;;134
+600;'NG HNQIS HIV-510';'NG HNQIS HIV-510-WE-Availability of SOPs and Protocols/National guidelines';;'Availability of SOPs and Protocols/National guidelines';'<p>Have SOPs and National guidelines for HIV accessible to staff for use.</p>';'fLvY2mJP2eC';510;0.15;0.15;98;53;;134
+601;'NG HNQIS HIV-520';'NG HNQIS HIV-520-WE-Availability of job aids or algorithm for HIV testing';;'Availability of job aids or algorithm for HIV testing';'<p>Job aids and algorithms provide a quick reference point and ensure standardization when performing the HIV test.</p>';'ZYTXOy5Xyv5';520;0.15;0.15;98;53;;134
+602;'NG HNQIS HIV-530';'NG HNQIS HIV-530-WE-Are there screening tools for TB and opportunistic infections?';;'Are there screening tools for TB and opportunistic infections?';'<p>These are essential. All HIV patients should be routinely screened for Tuberculosis and other opportunistic infections.</p>';'i7laa8APqV3';530;0.15;0.15;98;53;;134
+603;'NG HNQIS HIV-540';'NG HNQIS HIV-540-WE-Are drugs available-ARVs, cotrimoxazole and dapsone';;'Are drugs available-ARVs, cotrimoxazole and dapsone';'<p>ARVs and cotrimoxazole should always be in stock. Dapsone should be available for patients allergic to sulphur based drugs.</p>';'O445JbTjbdH';540;0.15;0.15;98;53;;134
+604;'NG HNQIS HIV-550';'NG HNQIS HIV-550-END-END OF TAB';;'END OF TAB';;'uPnkg1mUsLC';550;0.00;0.00;98;49;;
+605;'NG HNQIS HYP-100';'NG HNQIS HYP-100-HTN-Is this a real or simulated observation?';;'Is this a real or simulated observation?';'<p>Simulated observations often limit assessments to knowledge component only and therefore, real life cases should be utilized as often as possible to ascertain attitudes and practices (problem solving skills) of the providers more so in complex real life scenarios.</p>';'hZVKgc8C25T';100;0.00;0.00;99;88;;136
+606;'NG HNQIS HYP-110';'NG HNQIS HYP-110-HTN-Digital BP Machine';;'Digital BP Machine';;'FzwnrIKp3td';110;0.00;0.00;99;49;;
+607;'NG HNQIS HYP-120';'NG HNQIS HYP-120-HTN-Provider introduces him/herself and obtains consent and explains the procedure';;'Provider introduces him/herself and obtains consent and explains the procedure';'<p><strong>Introduce oneself and explain the procedure with client prior to taking BP measurement</strong></p><ul><li>Proper introduction taking into consideration verbal and non verbal cues helps to create rapport and keep patient calm.</li><li>Explaining the procedure and obtaining consent not only ensure we respect the patients rights but also helps to reduce misunderstanding and make the patient comfortable before the procedure.</li></ul>';'Sn16uU8iAKW';120;0.01;0.01;99;53;;136
+608;'NG HNQIS HYP-130';'NG HNQIS HYP-130-HTN-Allows patient to rest for 3 to 5 minutes before measurement';;'Allows patient to rest for 3 to 5 minutes before measurement';'<p><strong>Patient should sit and relax for about 5 minutes before taking BP</strong></p><ul><li>Any physical activity, mood change and positioning can affect BP readings by between 5-40mmHg.</li><li>Allowing the patient to rest helps to ensure correct BP readings are obtained.</li></ul>';'cp2jmvwSoHQ';130;0.03;0.03;99;53;;136
+609;'NG HNQIS HYP-140';'NG HNQIS HYP-140-HTN-BP reading taken according to protocols';;'BP reading taken according to protocols';'<p><strong>Use the BP machine to take the reading as per protocol</strong><br/>The following help to get an accurate BP reading:</p><ul><li>Use of correct cuff size</li><li>Complete exposure of the upper arm</li><li>Proper positioning of patient seated (arm, back, feet supported and not crossed)</li><li>Minimal talking and patient comfort</li></ul>';'FnDbIvdvgKp';140;0.10;0.10;99;53;;136
+610;'NG HNQIS HYP-150';'NG HNQIS HYP-150-HTN-Take 2 measurements at least 2 to 3 minutes apart in the same sitting.';;'Take 2 measurements at least 2 to 3 minutes apart in the same sitting.';'<p><strong>If first reading is high (>140/90), repeat measurement after 2-3 minutes</strong></p><ul><li>Taking two readings allows us to confirm the first reading and ensure proper management of the patient. Two readings should be taken. if the average is 140/90 mmHg or more, an additional reading should be taken at the end of the consultation for confirmation.</li><li>Blood pressure should be measured in both arms initially, and the arm with the higher reading used for future measurements. If the difference between the two arms is more than 20 mmHg for systolic pressure or 10 mmHg for diastolic pressure, the patient should be referred to the next level of care for examination for vascular stenosis. Patients with accelerated (malignant) hypertension (blood pressure ≥ 180/110 mmHg with papilloedema or retinal haemorrhages) or suspected secondary hypertension should be referred to the next level immediately.</li></ul>';'DYrwDtNVcLn';150;0.03;0.03;99;53;;136
+611;'NG HNQIS HYP-160';'NG HNQIS HYP-160-HTN-BP recording done on relevant form';;'BP recording done on relevant form';'<p><strong>Document measurement(s) in correct data capture tool</strong></p><ul><li>Record keeping is primarily important in ensuring proper management of the patient.</li><li>Lack of proper records may affect decision making and follow up of the patient during subsequent visits.</li></ul>';'u0K8gmNnfya';160;0.03;0.03;99;53;;136
+612;'NG HNQIS HYP-170';'NG HNQIS HYP-170-HTN-Is the classification and staging of HTN correctly done?';;'Is the classification and staging of HTN correctly done?';'<p><strong>If BP is elevated, classify and stage hypertension as below:</strong><br /><strong>Optimum: </strong>Blood pressure <120/80mmHg<br /><strong>Prehypertension:</strong> BP 120/80 mmHg- 139/89mmHg<br /><strong>Stage 1 (mild): </strong>BP 140/90mmHg -159/99mmHg<br /><strong>Stage 2(Moderate):</strong> BP 160/100mmHg -179/109mmHg<br /><strong>Stage 3 (severe):</strong> BP >180/110mmHg</p><ul><li>Correct classification ensures proper patient management.</li><li>Management may include non-pharmacological interventions mostly around diet and exercise as well as pharmacological management with one or more drugs.</li><li>Incorrect classification may thus affect the choice of treatment including number and dosage of anti-hypertensive drugs.</li></ul>';'cV2pKP46nOQ';170;0.10;0.10;99;53;;136
+613;'NG HNQIS HYP-180';'NG HNQIS HYP-180-HTN-Is the patient informed of his/her blood pressure level?';;'Is the patient informed of his/her blood pressure level?';'<p><strong>Discuss with patient BP findings immediately</strong></p><ul><li>Informing patient of his/her blood pressure not only ensures that we respect the patients right to information but enables us to obtain informed consent for further examination and management of the patient.</li><li>It also improves future compliance to medication and follow up.</li></ul>';'Wc5QqtR76V3';180;0.01;0.01;99;53;;136
+614;'NG HNQIS HYP-190';'NG HNQIS HYP-190-Assess-Asks for signs and symptoms of hypertension (headache, fatigue, palpitations, chest pains, blurred vision, irregular heart beat)';;'Asks for signs and symptoms of hypertension (headache, fatigue, palpitations, chest pains, blurred vision, irregular heart beat)';'<p><strong>Take proper history of other signs and symptoms of hypertension including recurrent headache, fatigue, palpitations, chest pains and blurred vision. Symptoms will depend on the organ affected</strong></p><ul><li>More often hypertension is asymptomatic but presence of signs and symptoms helps in correct classification/staging of the disease and influences management decision.</li><li>Hypertension affects multiple organs and presence of additional signs/symptoms of organ damage indicates severity of illness and influences treatment options.</li></ul>';'gDwMpdLZdbX';190;0.04;0.04;100;53;;137
+615;'NG HNQIS HYP-200';'NG HNQIS HYP-200-Assess-Asks for family history, lifestyle, occupation and any other relevant history.';;'Asks for family history, lifestyle, occupation and any other relevant history.';'<p><strong>Ask about family history of hypertension, lifestyle (diet & exercise) and occupation</strong></p><ul><li>Evidence shows that hypertension is associated with other risk factors like family history of hypertension, sedentary lifestyles, smoking, poor stress management, and poor diet.</li><li>Getting history on these risk factors is necessary in ensuring that part of the patient management includes modification of the risk factors amenable to change at individual level.</li></ul>';'UJ91dnUFfGa';200;0.04;0.04;100;53;;137
+616;'NG HNQIS HYP-210';'NG HNQIS HYP-210-Assess-Calculates Body Mass Index- BMI';;'Calculates Body Mass Index- BMI';'<p><strong>Take height and weight measurement and calculate Body Mass Index (BMI)</strong></p><ul><li>BMI=weight (kg)/height (m2)</li><li>BMI is a useful epidemiological measure of obesity. Obesity is a risk factor for hypertension and individuals with BMI higher than 25 have been shown to have an increased risk of hypertension.</li><li>Calculating the BMI helps to incorporate non-pharmacological management including dietary and lifestyle modifications into the treatment plan of hypertensive patients.</li></ul>';'QJSt83QCfG3';210;0.03;0.03;100;53;;137
+617;'NG HNQIS HYP-220';'NG HNQIS HYP-220-Assess-Physical examination and assessment of presence of target organ damage';;'Physical examination and assessment of presence of target organ damage';'<p><strong>Obtain consent and conduct full physical exam taking note of any end organ damage.</strong></p><ul><li>Hypertension affects multiple organs including kidneys, brain, heart and eyes.</li><li>Proper physical examination ensures we are able to detect organ involvement/damage and manage as appropriate; ascertain whether patient is at risk for heart disease and stroke; and rule out secondary causes of hypertension.</li><li>A physical examination should include:<ul><li>Examination of the cardiovascular system, particularly for heart size, evidence of heart failure, evidence of disease in the carotid, renal and peripheral arteries, and physical signs suggestive of coarctation of the aorta, particularly in young people with hypertension;</li><li>Examination for features of secondary hypertension (phaeochromocytoma, Cushing syndrome,etc.)</li><li>Examination of the lungs for congestion;</li><li>Examination of the abdomen for bruits, enlarged kidneys and other masses;</li><li>Examination of the optic fundi.</li></ul></li></ul>';'nbV31dngJ7z';220;0.04;0.04;100;53;;137
+618;'NG HNQIS HYP-230';'NG HNQIS HYP-230-Assess-Conduct baseline investigations- urine dipstick, blood glucose, FBC, Others';;'Conduct baseline investigations- urine dipstick, blood glucose, FBC, Others';'<p><strong>Discuss with the client, obtain consent and collect blood and urine for the relevant baseline tests, depending on available resources</strong></p><ul><li>Baseline investigations help us to confirm end organ involvement that has an impact on patient treatment</li><li><strong>The baseline investigations include:</strong><ul><li>Urea/electrolyte and creatinine</li><li>Lipid profiles</li><li>Electrocardiograph (ECG)</li><li>Chest X ray</li><li>Urine dipstick</li><li>Fasting Blood Sugar</li></ul></li></ul><p>Impaired renal function for example may influence choice of antihypertensive drugs and dosages. Other baseline investigations help to rule out co-morbidities like diabetes that need to be concurrently managed; and also help in patient follow up.</p>';'Euf52LBs4BC';230;0.04;0.04;100;53;;137
+619;'NG HNQIS HYP-240';'NG HNQIS HYP-240-Assess-Do proper risk profiling- average, low added, moderately added, high added or very high added)';;'Do proper risk profiling- average, low added, moderately added, high added or very high added)';'<p><strong>Conduct risk profile based on additional history/clinical findings</strong></p><ul><li>Risk profiling help to make a decisions on how to individualize treatment and follow up. WHO/ISH risk profiles are available by geographic area and should be used in determining risk of 10-year future cardiac event based patient history, risk factors and clinical profile.</li></ul>';'TrZLYTi3zbS';240;0.10;0.10;100;53;;137
+620;'NG HNQIS HYP-250';'NG HNQIS HYP-250-Diag_Mgmt-Proper diagnosis made based on BP readings and risk profiling';;'Proper diagnosis made based on BP readings and risk profiling';'<p><strong>Based on BP readings and risk profile, make diagnosis and classify hypertension</strong></p><ul><li>Proper diagnosis helps to ensure the correct mix of interventions will have the desired outcome for the patient.</li></ul>';'yNo4mUpdVoO';250;0.05;0.05;101;53;;138
+621;'NG HNQIS HYP-260';'NG HNQIS HYP-260-Diag_Mgmt-Correct drug therapy as per diagnosis and guidelines';;'Correct drug therapy as per diagnosis and guidelines';'<p><strong>Prescribe medication according to classification and in line with national guidelines and consistent supply of prescribed medication</strong><br />Correct drug therapy ensures that the blood pressure is brought under control within a reasonable time frame and with minimal side effects to the patient.</p><ul><li>Use of low dose combination therapy helps to minimize drug toxicities while ensuring optimal blood pressure control.</li></ul><p><strong>Recommended drug regimen is as below:</strong></p><ul><li>Low dose aspirin 75mg once daily if aged more than 50 years and aspirin is not contraindicated</li><li>Counsel on lifestyle modification including diet, importance of regular cardiovascular exercise, cessation of smoking, moderation of alcohol etc.</li></ul><p><strong>Stage 1 (mild):</strong> BP 140/90mmHg -159/99mmHg</p><ul><li>Monotherapy:</li><li>Preferably with hydrochlorothiazide</li><li>For diabetics an Angiotensin Converting Enzyme(ACE) Inhibitor such as enalapril is preferred</li></ul><p><strong>Stage 2 (Moderate):</strong> BP 160/100mmHg -179/109mmHg</p><ul><li>Use Combination therapy with</li><li>with hydrochlorothiazide + beta blocker or ACE inhibitor</li><li>Beta blockers are contraindicated in patients with asthma or Chronic Obstructive Pulmonary Disease (COPD)</li><li>Specialist review</li></ul><p><strong>Stage 3 (severe):</strong> BP >180/110mmHg</p><ul><li>Admit in a tertiary facility</li><li>Emergency measures: Nifedipine 20mg orally repeated after one hour OR Hydralazine 10mg IV every 15 minutes.</li></ul>';'PkCS6gWtqzL';260;0.10;0.10;101;53;;138
+622;'NG HNQIS HYP-270';'NG HNQIS HYP-270-Diag_Mgmt-Counsels client on lifestyle modification instructions and treatment adherence and follow up date based on clients BP levels and condition';;'Counsels client on lifestyle modification instructions and treatment adherence and follow up date based on clients BP levels and condition';'<p><strong>Discuss and counsel client on treatment plan including lifestyle modification, adherence to medication and follow up appointments</strong></p><ul><li>Risk factors for hypertension include poor diet, sedentary lifestyles, smoking and highly stressful jobs. Modification of these risk factors on its own leads to reduction in blood pressure and augments pharmacological intervention in hypertensive patients.</li><li>Adherence to treatment ensures that the medication can reach steady concentrations in the blood that are able to lower the blood pressure.</li><li>Giving follow up dates dependent on assessment of patient allows us to closely monitor effect of treatment and adjust accordingly.</li></ul>';'jHkP7Z971Me';270;0.10;0.10;101;53;;138
+623;'NG HNQIS HYP-280';'NG HNQIS HYP-280-Diag_Mgmt-Client referral- right client referred according to protocol and well documented';;'Client referral- right client referred according to protocol and well documented';'<p><strong>Discuss with patient the need for a multi-disciplinary approach to management including nutritionists, clinicians and refer accordingly</strong></p><ul><li>Hypertension is a progressive disease so prompt referral based on individual assessment helps to minimize delays in diagnosis and treatment thus ensuring better outcomes.</li><li>Patients with co-morbidities/higher risk profiles may require referrals due to complex nature of their treatment.</li><li>Good documentation helps the receiving site to appropriately manage the patient and ensures proper follow up at primary site.</li></ul>';'u5qbHVY2TJu';280;0.05;0.05;101;53;;138
+624;'NG HNQIS HYP-290';'NG HNQIS HYP-290-WE-Is there a functioning BP machine?';;'Is there a functioning BP machine?';'<p>A BP machine is the most important equipment for diagnosis and follow -up of hypertension. Take BP readings for hypertensive patients during all visits.</p>';'UwX3OfbB3O9';290;0.02;0.02;102;53;;139
+625;'NG HNQIS HYP-300';'NG HNQIS HYP-300-WE-Is there a functioning weighing scale?';;'Is there a functioning weighing scale?';'<p>A functioning weighing scale is needed to take weight of hypertensive patients and calculate the BMI.</p>';'bMX1wlI8jgD';300;0.02;0.02;102;53;;139
+626;'NG HNQIS HYP-310';'NG HNQIS HYP-310-WE-Are antihypertensive drugs available?';;'Are antihypertensive drugs available?';'<p>Always have antihypertensive drugs for proper management of patients with hypertension.</p>';'yU3YTeChmXq';310;0.02;0.02;102;53;;139
+627;'NG HNQIS HYP-320';'NG HNQIS HYP-320-WE-Are urine dip sticks, blood glucose strips available?';;'Are urine dip sticks, blood glucose strips available?';'<p>These are necessary for testing for presence of diabetes and kidney damage which frequently occur with hypertension.</p>';'dnP8WeL67eU';320;0.02;0.02;102;53;;139
+628;'NG HNQIS HYP-330';'NG HNQIS HYP-330-END-END OF TAB';;'END OF TAB';;'yHvYvsBKH6m';330;0.00;0.00;102;49;;
+629;'NG HNQIS WE-100';'NG HNQIS WE-100-Licenses-Facility registration';;'Facility registration';'<p><strong>Register and display the facility registration</strong><br />It is illegal to run an unlicensed health facility. Comply with your country''s regulator requirements. The license should also be renewed on time and should be displayed prominently.</p>';'UXBOSsHPZUh';100;0.05;0.05;103;53;;141
+630;'NG HNQIS WE-110';'NG HNQIS WE-110-Licenses-Professional license (doctors, nurses/midwives, Chews etc.)';;'Professional license (doctors, nurses/midwives, Chews etc.)';'<p><strong>Ensure all clinical service providers are licensed</strong><br/>Only licensed staff are allowed to attend to patients or perform clinical procedures. This is to ensure safety of the patients.</p>';'nMZDQPTo7br';110;0.05;0.05;103;53;;141
+631;'NG HNQIS WE-120';'NG HNQIS WE-120-GIE-Clean and hygienic surfaces (walls, floors etc.)';;'Clean and hygienic surfaces (walls, floors etc.)';'<p><strong>The facility should be cleaned as needed on daily basis</strong><br/>Management needs to provide cleaning supplies that enable staff to routinely clean surfaces to ensure the health-care environment is visibly clean and free from dust and soil. The workers tasked with this duty should perform it thoroughly and their supervisor should ensure so.</p>';'w0WO6dYe9Ah';120;0.02;0.02;104;53;;142
+632;'NG HNQIS WE-130';'NG HNQIS WE-130-GIE-Running water and soap in critical points (toilet, examination room, lab, patient waiting area)';;'Running water and soap in critical points (toilet, examination room, lab, patient waiting area)';'<p><strong>Avail clean running water and soap at critical points</strong></p><ul><li>Frequent hand-washing is the most effective means of reducing the spread of organisms.</li><li>When running water and soap are far from patient care areas, staff and patients are less likely to wash their hands as required.</li><li>Drying hands on reusable towels is a means of transmitting germs, therefore disposable or non-reusable towels should be used.</li></ul>';'DEaLsHekFwU';130;0.02;0.02;104;53;;142
+633;'NG HNQIS WE-140';'NG HNQIS WE-140-GIE-Adequate lighting';;'Adequate lighting';'<p><strong>The hospital design should allow for as much natural light as possible</strong></p><ul><li>Electricity should also be available if possible to enable use of examination or operating lights to illuminate the area of on the patient''s body during a procedure.</li><li>If operating critical services like an operating theatre, then a functional back up generator must be available to power machines and to provide lighting.</li></ul>';'ubyzwTXCwv0';140;0.02;0.02;104;53;;142
+634;'NG HNQIS WE-150';'NG HNQIS WE-150-GIE-Adequate storage for drugs, consumables and commodities';;'Adequate storage for drugs, consumables and commodities';'<p><strong>Create/build adequate storage area</strong></p><p>The facility should have adequate storage space for supplies and equipment. Apart from adequate storage, the following are other general principles when creating and organizing a storage area.</p><ul><li>It should be secure to prevent theft : burglar proofing windows, security locks on doors etc.</li><li>Access should be restricted to authorized personnel only.</li><li>Storage areas should be of sufficient capacity to allow the orderly storage of the various categories of materials and products.</li><li>Temperature should be controlled and the store should be protected from excessive humidity.</li><li>Should have adequate lighting.</li><li>Should be clean and free from pests.</li><li>Should allow for separate section for hazardous or flammable supplies.</li><li>Should be well organized to allow easy access or commodities.</li><li>Items should be arranged to enable dispatch to users based on FEFO principle.</li><li>Good documentation and record keeping.</li></ul>';'Y4As7W7l8Lk';150;0.02;0.02;104;53;;142
+635;'NG HNQIS WE-160';'NG HNQIS WE-160-GIE-Functional Internal and/or external toilets';;'Functional Internal and/or external toilets';'<p><strong>Adequate and functional latrines/toilets</strong></p><ul><li>Have separate facilities for male, female and children.</li><li>Have separate toilets/latrines for staff and patients.</li><li>Have adequate number of toilets depending on the number of patients served.</li><li>They should be clean.</li><li>Have a clear sign for ease of access.</li><li>Toilets should have water for flushing while latrines should have covers.</li><li>Design to respond to local cultural or social conditions (e.g. provide water for anal washing)</li><li>Equip them to enable ease of use by disabled people, the elderly, pregnant women and the very sick.</li><li>Provide running water and soap at the exit.</li><li>Minimize risk of potential violence (including sexual violence) e.g. by having locks inside and having lights for use at night.</li></ul>';'XtL55c8bjC2';160;0.02;0.02;104;53;;142
+636;'NG HNQIS WE-170';'NG HNQIS WE-170-GIE-Are services offered in a confidential space?';;'Are services offered in a confidential space?';'<p><strong>Service provision areas should provide visual and auditory privacy</strong><br/>Confidentiality is every patient''s right and it is the duty of the service provider to ensure the space for service provision offers the patient confidentiality.</p>';'EvN3aa8bZkn';170;0.02;0.02;104;53;;142
+637;'NG HNQIS WE-180';'NG HNQIS WE-180-GIE-Approved waste collection and disposal method';;'Approved waste collection and disposal method';'<p><strong>Have a waste management plan for waste collection and disposal</strong><br/>Hospital waste is a reservoir of pathogenic micro-organisms and requires appropriate, safe and reliable handling. Approved waste management systems and disposal sites is a requirement for licensing of health facilities. This is essential for infection prevention and ensuring safety to you and others.<br /><strong>Ensure you:</strong></p><ul><li>Establish systems and infrastructure for waste management.</li><li>Develop and disseminate standards and guidelines on waste management.</li><li>Promote continuous professional development for health workers on waste management.</li><li>Train waste handlers on proper waste management.</li><li>Promote segregation, storage, collection, pre-treatment, transportation and proper disposal of waste.</li><li>Provide adequate resources to increase efficiency in waste management.</li></ul>';'Ms12qVT55jU';180;0.02;0.02;104;53;;142
+638;'NG HNQIS WE-190';'NG HNQIS WE-190-GIE-An established inventory management system in use';;'An established inventory management system in use';'<p><strong>Have an inventory management system</strong><br/>The purpose of an inventory system is to:</p><ul><li>Allow preparation of effective orders</li><li>Maintain sufficient stock levels within the budget limits</li><li>Maintain records according to local requirements</li><li>Enable adjustment of stock levels depending on morbidity trends</li><li>Prevent expiry of medicines</li><li>Provide appropriate, safe and secure storage</li></ul><p><strong>Benefits of inventory management system:</strong></p><ul><li>Prevents Stock Outs--Sufficient stock levels ensures supplies are available for patient care.</li><li>Ensures supplies are delivered at intervals which saves on administrative time and costs.</li><li>Increase patients'' confidence when they know hospital has supplies.</li><li>Ensures there is accountability for commodities.</li></ul>';'GEzz2ezUj69';190;0.02;0.02;104;53;;142
+639;'NG HNQIS WE-200';'NG HNQIS WE-200-GIE-Infection prevention equipments';;'Infection prevention equipments';'<p><strong>For infection prevention in a hospital the following commodities should be available:</strong></p><ul><li>Soap</li><li>Clean running water</li><li>Different colors of waste bags for proper waste segregation</li><li>Sharps containers</li><li>Cotton wool/alcohol swabs</li><li>Sodium hypochlorite</li><li>Sterilization equipment etc.</li></ul>';'nh9gLMyKaU5';200;0.02;0.02;104;53;;142
+640;'NG HNQIS WE-210';'NG HNQIS WE-210-GIE-Availability of Designated room for services';;'Availability of Designated room for services';'<p><strong>Allocate rooms for services</strong></p><ul><li>To ensure easy patient flow, rooms should be designated for specific services.</li><li>Designating rooms also helps infection prevention (e.g. surgical procedures should be done in a minor theatre/procedure room rather than the consultation room).</li><li>Patient confidentiality can be maintained.</li></ul>';'yWimcXIEZJg';210;0.02;0.02;104;53;;142
+641;'NG HNQIS WE-220';'NG HNQIS WE-220-GIE-Availability of referral network and identified referral site';;'Availability of referral network and identified referral site';'<p><strong>An effective referral system ensures a close relationship between all levels of the health system and helps patients receive the best possible care.</strong></p><ul><li>Referral protocols should be developed and made available to all service providers.</li><li>The referral system must be open to revision based on practical experience, and in order to meet the goals of the health system overall.</li><li>Periodically review functionality of the referral system.</li><li>Ensure feedback mechanisms to track outcomes of the referred patients.</li></ul>';'p0EuZNj0S18';220;0.02;0.02;104;53;;142
+642;'NG HNQIS WE-230';'NG HNQIS WE-230-GIE-Patient record cards and forms';;'Patient record cards and forms';'<p>Patient record cards /forms are important for documenting a patient''s notes. This is critical for follow up, continuity of care and for data audits.</p>';'uqCD0eyxhoR';230;0.02;0.02;104;53;;142
+643;'NG HNQIS WE-240';'NG HNQIS WE-240-GIE-Registers';;'Registers';'<p>Have all the required registers to capture data. Data forms the basis of all decision making processes.</p>';'NTojsvYshRF';240;0.02;0.02;104;53;;142
+644;'NG HNQIS WE-250';'NG HNQIS WE-250-GIE-Availability of IEC materials';;'Availability of IEC materials';'<p><strong>IEC materials are aimed at changing or reinforcing health-related behaviors in a target audience through information, education, and communication.</strong><br/>The IEC materials should:</p><ul><li>Have a clear objective to change or reinforce a specific behavior.</li><li>Target a specific audience (e.g., mothers of children below five years old).</li><li>Address a specific problem rather than multiple problems at one time.(e.g., offering increased fluids and continuing feeding a child with diarrhea.)</li><li>Set a timeframe within which the behavior change is expected to occur.</li></ul>';'EhLvEu8Rbg1';250;0.02;0.02;104;53;;142
+645;'NG HNQIS WE-260';'NG HNQIS WE-260-GIE-Evidence of Demand generation activities';;'Evidence of Demand generation activities';'<p><strong>Plan demand creating activities</strong></p><ul><li>Community mobilization activities and advertising campaigns should target specific groups.</li><li>Inform the target population of the services offered at the clinic.</li><li>Specific efforts should be made to overcome barriers between community members and uptake of services.</li></ul>';'WYewrt3cBuP';260;0.02;0.02;104;53;;142
+646;'NG HNQIS WE-270';'NG HNQIS WE-270-GIE-Availability of SOPs and Protocols/National guidelines';;'Availability of SOPs and Protocols/National guidelines';'<p><strong>National guidelines and SOPs should be available for service providers</strong></p><ul><li>National guidelines are rigorously developed using evidence-based medicine criteria and consist of detailed instructions for the application of that evidence to patient care, ensuring the highest possible quality of care is given to a patient.</li><li>SOPs are systematically developed statements that assist decisions about appropriate health care for specific circumstances. They are more specific than guidelines and are defined in greater detail. They provide a comprehensive set of rigid criteria outlining the management steps for a single clinical condition or aspects of the health facility.</li></ul>';'Db6O0bHMfom';270;0.02;0.02;104;53;;142
+647;'NG HNQIS WE-280';'NG HNQIS WE-280-SDGs-Infection Prevention Protocol';;'Infection Prevention Protocol';'<p><strong>Have documented infection prevention protocol</strong><br/>This should be available to all staff as each individual is responsible for infection prevention.</p>';'JA8f4OLTwXY';280;0.05;0.05;105;53;;143
+648;'NG HNQIS WE-290';'NG HNQIS WE-290-Commodities-Antibiotics – parenteral and oral';;'Antibiotics – parenteral and oral';'<p><strong>Have parenteral and oral antibiotics</strong><br/>Antibiotics are some of the most essential drugs in a health facility. Availability of antibiotics is part of the assessment of a health facility''s readiness for operation.</p>';'vuD7gWBBA39';290;0.13;0.13;106;53;;144
+649;'NG HNQIS WE-300';'NG HNQIS WE-300-Commodities-Intravenous fluids';;'Intravenous fluids';'<p>Intravenous fluids are essential for management of various conditions, including dehydration, hemorrhage, shock. However, they should only be given providers allowed to administer intravenous injections.</p>';'qGJoiVpWFNB';300;0.13;0.13;106;53;;144
+650;'NG HNQIS WE-310';'NG HNQIS WE-310-Commodities-Are the commodities properly secured and stored according to guidelines';;'Are the commodities properly secured and stored according to guidelines';'<p>Commodities should be kept in a store to ensure safety, control and availability when needed.</p>';'LV1IucsVsJ5';310;0.13;0.13;106;53;;144
+651;'NG HNQIS WE-320';'NG HNQIS WE-320-Doc-Data quality assurance checks';;'Data quality assurance checks';'<p><strong>Data quality assurance should be done periodically</strong></p><ul><li>The hospital data should be available for internal and external quality assurance.</li><li>Areas of weakness should be identified for improvement.</li><li>Feedback should be given to the staff to ensure there is improvement in quality of care.</li></ul>';'IF0ceXtI11v';320;0.05;0.05;107;53;;145
+652;'NG HNQIS WE-330';'NG HNQIS WE-330-END-END OF TAB';;'END OF TAB';;'FtI49D7JFEw';330;0.00;0.00;107;49;;
+653;'NG HNQIS MA-100';'NG HNQIS MA-100-Intro-Is this a real or simulated observation?';'NG HNQIS MA-100-Intro-Is this a real or simul';'Is this a real or simulated observation?';;'a3uhwB8l9AU';100;0.00;0.00;110;88;;
+654;'NG HNQIS MA-110';'NG HNQIS MA-110-Intro-Provider obtains personal history (incl name, age)';'NG HNQIS MA-110-Intro-Provider obtains person';'Provider obtains personal history (incl name, age)';'<ul><li><strong>Name:</strong> identification/record keeping.</li><li><strong>Age:</strong> determine drug doses, nutritional status, and growth evaluation.</li><li><strong>Address: </strong>determine if high risk area for certain diseases (e.g. Malaria).</li></ul>';'sWMLiLsMHrV';110;0.00;0.00;110;53;;
+655;'NG HNQIS MA-120';'NG HNQIS MA-120-Intro-Provider asks reason for visiting health facility';'NG HNQIS MA-120-Intro-Provider asks reason fo';'Provider asks reason for visiting health facility';'<p><strong>Determine patient complaints</strong></p><ul><li>Initial visit or follow-up.</li><li>Initial visit: assess and treat.</li><li>Follow-up visit: assess and advise to complete medication, change medication or refer.</li></ul>';'sKHP4tpVGEI';120;0.00;0.00;110;53;;
+656;'NG HNQIS MA-130';'NG HNQIS MA-130-Inq-Provider asks for duration and pattern of fever.';'NG HNQIS MA-130-Inq-Provider asks for duratio';'Provider asks for duration and pattern of fever.';'<p>The most common cause of fever is an infection which may be localized or systemic; other causes include malignancy, allergic reaction, and inflammatory disorders. In malaria endemic areas, fever without focal signs is commonly due to malaria.<br /><strong>Determine duration of fever:</strong> ask when the fever started.<br /><strong>Pattern of fever: </strong>Periodic fevers occurring every 48-72 hours may occur in malaria depending on the species, but may not always occur in falciparum malaria. In typhoid fever, the fever rises in a step-wise manner.</p>';'hbJ1at8WJpG';130;0.08;0.08;111;53;;147
+657;'NG HNQIS MA-140';'NG HNQIS MA-140-Inq-Asks for associated symptoms: chills/rigors, headache, joint pains, loss of appetite, nausea';'NG HNQIS MA-140-Inq-Asks for associated sympt';'Asks for associated symptoms: chills/rigors, headache, joint pains, loss of appetite, nausea';'<p><strong>Ask for associated symptoms</strong></p><ul><li>Chills and/or rigors: The classic pattern of malaria begins with a period of chills/rigors which last for about 1-2 hours then followed by fever.</li><li>Some of the other symptoms of malaria include headaches, muscle aches, joint pains, loss of appetite, nausea, vomiting and abdominal pains.</li></ul>';'PCbitvxLTHg';140;0.08;0.08;111;53;;147
+658;'NG HNQIS MA-150';'NG HNQIS MA-150-Inq-Asks for danger signs and symptoms of severe malaria';'NG HNQIS MA-150-Inq-Asks for danger signs and symp';'Asks for danger signs and symptoms of severe malaria';'<p><strong>Danger signs and signs of severe malaria include:</strong></p><ul><li>Impaired consciousness (including unarousable coma), change in behaviour;</li><li>Prostration, i.e. generalized weakness so that the patient is unable to sit, stand or walk without assistance;</li><li>Convulsions;</li><li>Deep breathing;</li><li>Clinical jaundice (yellowness of eyes);</li><li>Pale hands</li><li>Vomiting everything/inability to drink;</li><li>Reduced amount of urine or not passing urine;</li><li>Dark colored urine;</li><li>Abnormal bleeding/spontaneous bleeding.</li></ul>';'t1AGLCsoNN3';150;0.10;0.10;111;53;;147
+659;'NG HNQIS MA-160';'NG HNQIS MA-160-Inq-Asks for other symptoms that could indicate other focus of infection: cough, painful urination, painful ear, stiff neck, diarrhoea';'NG HNQIS MA-160-Inq-Asks for other symptoms t';'Asks for other symptoms that could indicate other focus of infection: cough, painful urination, painful ear, stiff neck, diarrhoea';'<p><strong>Ask for other symptoms that could indicate other focus of infection:</strong></p><ul><li>Cough, difficult breathing;</li><li>Painful swallowing;</li><li>Ear pain, ear discharge;</li><li>Headaches, neck stiffness, photophobia;</li><li>Diarrhoea, vomiting, abdominal pains;</li><li>Painful urination, flank pains;</li><li>Swollen and painful limb, etc.</li></ul>';'Ufa2V9o1zvD';160;0.08;0.08;111;53;;147
+660;'NG HNQIS MA-170';'NG HNQIS MA-170-Inq-Provider asks for medication history including antimalarials for this illness';'NG HNQIS MA-170-Inq-Provider asks for medicat';'Provider asks for medication history including antimalarials for this illness';'<p><strong>Medication history</strong></p><ul><li>Determine if patient has received any treatment for this illness, including antimalarials.</li><li>Consider possibility of incompletely treated disease or drug resistance.</li><li>Find out if the patient is on any other medication for other illness, whether long term or short term.</li></ul>';'nEUOW37cxEl';170;0.05;0.05;111;53;;147
+661;'NG HNQIS MA-180';'NG HNQIS MA-180-Inq-Provider asks about prior testing for malaria during this illness';'NG HNQIS MA-180-Inq-Provider asks about prior';'Provider asks about prior testing for malaria during this illness';'<p>Determine if the patient has been tested for malaria during this illness and what the results were. This will help in identification of a correct treatment plan.</p>';'pB2mjDAzlkr';180;0.05;0.05;111;53;;147
+662;'NG HNQIS MA-190';'NG HNQIS MA-190-Inq-Provider asks about the patient''s HIV status';'NG HNQIS MA-190-Inq-Provider asks about the p';'Provider asks about the patient''s HIV status';'<p>HIV-infected adults are at increased risk of severe malaria and death.</p>';'rHClvg896km';190;0.05;0.05;111;53;;147
+663;'NG HNQIS MA-200';'NG HNQIS MA-200-PE-Provider checks for danger signs/signs of severe malaria';'NG HNQIS MA-200-PE-Provider checks for danger';'Provider checks for danger signs/signs of severe malaria';'<p><strong>Check for danger signs/signs of severe malaria</strong></p><ul><li>Impaired consciousness: Glasgow coma scale < 11;</li><li>Prostration;</li><li>Respiratory distress-rapid, deep laboured breathing;</li><li>Shock-prolonged capillary refill and cold peripheries;</li><li>Abnormal or prolonged bleeding;</li><li>Reduced renal output.</li></ul>';'ezQ8HPit6Mt';200;0.08;0.08;112;53;;147
+664;'NG HNQIS MA-210';'NG HNQIS MA-210-PE-Provider determines the patient''s temperature';'NG HNQIS MA-210-PE-Provider determines the pa';'Provider determines the patient''s temperature';'<ul><li>Measure the patient''s temperature to determine presence of fever.</li><li>Fever is elevated body temperature of more than 38°C if measured centrally (ear, rectal, or oral) or 37.5°C axillary.</li><li>Remember that the temperature might be normal at that particular moment if the patient has taken antipyretics.</li></ul>';'Ugc1T8M47uq';210;0.08;0.08;112;53;;147
+665;'NG HNQIS MA-220';'NG HNQIS MA-220-PE-Takes vital signs: Blood pressure, pulse rate and respiratory rate';'NG HNQIS MA-220-PE-Takes vital signs: Blood p';'Takes vital signs: Blood pressure, pulse rate and respiratory rate';'<p><strong>Take other vital signs to determine patient stability</strong></p><ul><li>Blood pressure</li><li>Respiratory rate</li><li>Pulse rate</li></ul>';'V0WZaIwTIGP';220;0.08;0.08;112;53;;147
+666;'NG HNQIS MA-230';'NG HNQIS MA-230-PE-Checks for pallor, jaundice';'NG HNQIS MA-230-PE-Checks for pallor, jaundic';'Checks for pallor, jaundice';'<p><strong>Severe malaria causes anaemia and jaundice due to hemolysis of red blood cells</strong></p><ul><li>Check for pallor on the conjunctiva, palms or tongue.</li><li>Check for jaundice on the sclera (white part of eye) using natural light.</li></ul>';'N16e8D0Kyn4';230;0.08;0.08;112;53;;147
+667;'NG HNQIS MA-240';'NG HNQIS MA-240-PE-Performs physical examination of all systems';'NG HNQIS MA-240-PE-Performs physical examinat';'Performs physical examination of all systems';'<p><strong>Examine the patient thoroughly paying attention to sites of possible infection:</strong><br /><strong>General examination: </strong>skin lesions, including rash; insect or animal bites; nutritional status (wasting).<br /><strong>Head and neck:</strong> neck pain or stiffness; throat, tonsils, ears for inflammation and discharge; sinus tenderness; mouth (Koplik''s spots, ulcers or lesions).<br /><strong>Chest:</strong> difficult breathing; fast breathing; crackles; bronchial breathing; absent breath sounds; murmurs,<br /><strong>Abdominal or genitourinary:</strong> enlarged liver or spleen; abdominal tenderness or mass; pain over kidneys (flank pain); pelvic tenderness or mass; rectal and vaginal examination for pain, discharge, ulcers, mass.<br /><strong>Muscles and joints:</strong> red, hot, swollen, painful joint(s) with reduced mobility; swollen, painful limb (deep venous thrombosis, cellulitis); open wounds.</p>';'qvNLN4hv3J8';240;0.08;0.08;112;53;;147
+668;'NG HNQIS MA-250';'NG HNQIS MA-250-PE-Provider takes blood sample for malaria rapid diagnostic test or microscopy in the lab';'NG HNQIS MA-250-PE-Provider takes blood sampl';'Provider takes blood sample for malaria rapid diagnostic test or microscopy in the lab';'<ul><li>Parasitological diagnosis of malaria must be confirmed using Rapid Diagnostic Testing (RDT) or microscopy in the laboratory before giving any antimalarial.</li><li>Giving antimalarial without testing leads to unnecessary use of ACTs which is expensive; may lead to early ACT resistance; and leads to delay in investigating the patient for the real cause of fever.</li></ul>';'zqiRX7PCnB8';250;0.08;0.08;112;53;;147
+669;'NG HNQIS MA-260';'NG HNQIS MA-260-RDT-Is this a real or simulated observation?';'NG HNQIS MA-260-RDT-Is this a real or simulat';'Is this a real or simulated observation?';;'YkjoK4qEji5';260;0.00;0.00;113;88;;
+670;'NG HNQIS MA-270';'NG HNQIS MA-270-RDT-Assembles new test packet, swab, buffer, pipette, lancet and gloves';'NG HNQIS MA-270-RDT-Assembles new test packet';'Assembles new test packet, swab, buffer, pipette, lancet and gloves';'<ul><li>Saves time by avoiding unnecessary movements looking for supplies after starting the procedure.</li><li>Reduces the risk of sharps injuries caused by reaching out for objects.</li><li>Ensures there is no movement during the test procedure that might prolong the time for performing the test leading to inaccurate results.</li></ul>';'AvmIP1GO1Ca';270;0.04;0.04;113;53;;155
+671;'NG HNQIS MA-280';'NG HNQIS MA-280-RDT-Puts a new pair of gloves';'NG HNQIS MA-280-RDT-Puts a new pair of gloves';'Puts a new pair of gloves';'<ul><li>Gloves will protect you and the patient from contracting blood-borne diseases such as HIV, Hepatitis B among others.</li><li>A new pair of gloves will protect the second patient from exposure to infections from the first patient.</li></ul>';'x6Oqa6g7e3v';280;0.08;0.08;113;53;;155
+672;'NG HNQIS MA-290';'NG HNQIS MA-290-RDT-(i) Checks expiry date on package (ii) checks desiccant sachet is still dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';'NG HNQIS MA-290-RDT-(i) Checks expiry date on';'(i) Checks expiry date on package (ii) checks desiccant sachet is still dry (iii) Write''s patient''s name or ID on cassette (iv) Places cassette on a level surface';'<p>(i) Always check the expiry date on the RDT package-an expired RDT kit will give incorrect results.</p><p>(ii) Check if desiccant sachet is dry-A wet desiccant means the RDT has been exposed to excessive moisture and therefore is damaged. A damaged RDT will give incorrect results.</p><p>(iii) Always write the patient''s name or ID on cassette- This will avoid mix up of results with other patients'' and prevents giving a patient incorrect results.</p><p>(iv) Place cassette on a level surface- a tilted surface will interfere with the lateral flow of blood and buffer during the test and will result in incorrect results.</p>';'y27ABDWIGz2';290;0.04;0.04;113;53;;155
+673;'NG HNQIS MA-300';'NG HNQIS MA-300-RDT-Cleans finger with antiseptic/ alcohol';'NG HNQIS MA-300-RDT-Cleans finger with antise';'Cleans finger with antiseptic/ alcohol';'<p>Antiseptic/alcohol kills bacteria on the finger surface. This prevents introduction of infection into the tissues when pricking the finger to obtain a blood sample.</p>';'vQhE18ghlZc';300;0.08;0.08;113;53;;155
+674;'NG HNQIS MA-310';'NG HNQIS MA-310-RDT-Allows finger to dry before pricking it';'NG HNQIS MA-310-RDT-Allows finger to dry befo';'Allows finger to dry before pricking it';'<p>Alcohol/antiseptic hemolyses blood. Hemolysed blood will not give correct results and will lead to misdiagnosis.</p>';'br2RJoxSI3K';310;0.04;0.04;113;53;;155
+675;'NG HNQIS MA-320';'NG HNQIS MA-320-RDT-Use a sterile lancet for finger pricking';'NG HNQIS MA-320-RDT-Use a sterile lancet for';'Use a sterile lancet for finger pricking';'<p>Prevents cross-infecting a patient with blood borne diseases such as HIV or Hepatitis B from a contaminated lancet.</p>';'GkwEvP6VF7u';320;0.08;0.08;113;53;;155
+676;'NG HNQIS MA-330';'NG HNQIS MA-330-RDT-Puncture the side of the ball of the finger';'NG HNQIS MA-330-RDT-Puncture the side of the';'Puncture the side of the ball of the finger';'<p>A puncture to the side of the ball of the finger is less painful than a puncture to the finger tip. </p>';'mYB1E4RDB7n';330;0.04;0.04;113;53;;155
+677;'NG HNQIS MA-340';'NG HNQIS MA-340-RDT-Provider disposes of lancet in sharps bin immediately after pricking finger';'NG HNQIS MA-340-RDT-Provider disposes of lanc';'Provider disposes of lancet in sharps bin immediately after pricking finger';'<p>Prevents accidental sharps injuries to you and others which may occur if lancets are not disposed of immediately.</p>';'nIlB0BvQjZ1';340;0.08;0.08;113;53;;155
+678;'NG HNQIS MA-350';'NG HNQIS MA-350-RDT-Collect blood with the enclosed pipette making sure to fill close to the first cross line';'NG HNQIS MA-350-RDT-Collect blood with the en';'Collect blood with the enclosed pipette making sure to fill close to the first cross line';'<p>Using the enclosed pipette ensures the correct amount of blood is collected. Using too little or too much blood can cause the test kit to give an incorrect result. </p>';'ljFFRmPDCOD';350;0.04;0.04;113;53;;155
+679;'NG HNQIS MA-360';'NG HNQIS MA-360-RDT-Using a pipette, blots blood onto the pad in the correct well';'NG HNQIS MA-360-RDT-Using a pipette, blots bl';'Using a pipette, blots blood onto the pad in the correct well';'<ul><li>Putting blood into the wrong well will give incorrect results.</li><li>For test accuracy, blood needs to reach and be absorbed by the pad at the bottom of the well.</li></ul>';'I8iI1vKHguU';360;0.08;0.08;113;53;;155
+680;'NG HNQIS MA-370';'NG HNQIS MA-370-RDT-Disposes of the used pipette in the sharps container immediately after use';'NG HNQIS MA-370-RDT-Disposes of the used pipe';'Disposes of the used pipette in the sharps container immediately after use';'<p>Dispose of used pipette into the sharps container immediately after use to prevent contamination of surfaces and transmission of blood borne diseases.</p>';'FiFxvujVdCf';370;0.04;0.04;113;53;;155
+681;'NG HNQIS MA-380';'NG HNQIS MA-380-RDT-Dispense correct number of drops of the buffer into the correct well';'NG HNQIS MA-380-RDT-Dispense correct number o';'Dispense correct number of drops of the buffer into the correct well';'<p>The test will not work correctly if too much or too little buffer is added. Adding buffer in the wrong well will also give in an invalid result.</p>';'U1hurxjqO8w';380;0.06;0.06;113;53;;155
+682;'NG HNQIS MA-390';'NG HNQIS MA-390-RDT-Wait correct time before reading results';'NG HNQIS MA-390-RDT-Wait correct time before';'Wait correct time before reading results';'<p><strong>Read the results within the specified time</strong><br/>Reading the results before or after the recommended time will result in interpretation of incorrect results.</p>';'gbl4UDup933';390;0.08;0.08;113;53;;155
+683;'NG HNQIS MA-400';'NG HNQIS MA-400-RDT-Read the test results correctly';'NG HNQIS MA-400-RDT-Read the test results cor';'Read the test results correctly';'<p><strong>If you do not read results correctly, the patient will not get the correct treatment. Understand what each line means:</strong></p><ul><li>Line at Control Line position AND Line at Test Line position = <strong>Positive</strong> (the result is positive even if the test line is very faint)</li><li>Line at Control Line and NO LINE at Test Line position = <strong>negative</strong></li><li>No line at Control Line position BUT line at Test Line = <strong>invalid</strong></li><li>No line at Control Line position AND NO LINE at Test Line position = <strong>invalid</strong></li></ul><p>A control line must be present for the result to be valid but the control line does not prove that the RDT result is accurate.</p>';'BwW6SXinXmZ';400;0.08;0.08;113;53;;155
+684;'NG HNQIS MA-410';'NG HNQIS MA-410-RDT-Record results in the register';'NG HNQIS MA-410-RDT-Record results in the reg';'Record results in the register';'<ul><li>Recording results immediately ensures they are not forgotten.</li><li>Ensures records will be available for patient follow up, tracking treatment responses, forecasting and planning for commodities.</li></ul>';'jQ9bhKpOo8V';410;0.02;0.02;113;53;;155
+685;'NG HNQIS MA-420';'NG HNQIS MA-420-RDT-Dispose gloves, wrappers, alcohol swab and desiccant safely';'NG HNQIS MA-420-RDT-Dispose gloves, wrappers,';'Dispose gloves, wrappers, alcohol swab and desiccant safely';'<p>Proper waste segregation at source and disposal ensures infection prevention and safety to you and others.</p>';'RK0iM0AYbkW';420;0.08;0.08;113;53;;155
+686;'NG HNQIS MA-430';'NG HNQIS MA-430-RDT-Explains the results to the patient';'NG HNQIS MA-430-RDT-Explains the results to t';'Explains the results to the patient';'<p><strong>Explain the test results to the patient</strong><br/>An informed patient is more likely to adhere to treatment and to take preventive measures to reduce risks of getting malaria again.</p>';'kbJN5vtiNWq';430;0.04;0.04;113;53;;155
+687;'NG HNQIS MA-440';'NG HNQIS MA-440-RDT-Should RDT have been undertaken based on symptoms';'NG HNQIS MA-440-RDT-Should RDT have been unde';'Should RDT have been undertaken based on symptoms';'<p><strong>Perform RDT only for suspected malaria cases to avoid wastage of resources and delayed diagnosis. Undertake for:</strong></p><ul><li>A patient with fever in a high malaria risk area.</li><li>A patient with fever and history of travel to high risk malaria area in the last 2 weeks.</li><li>A patient with fever and no other symptoms indicative of any other illness in a low risk area.</li></ul>';'zXBI8P8n4U7';440;0.04;0.04;113;53;;155
+688;'NG HNQIS MA-450';'NG HNQIS MA-450-DxTx-Does the provider diagnose the illness correctly?';'NG HNQIS MA-450-DxTx-Does the provider diagno';'Does the provider diagnose the illness correctly?';'<a href="https://drive.google.com/file/d/0BxIl9Fv9u436T3FxdGxCemd0TFk/view">Fever in Adults: Diagnosis and Treatment Matrix</a>';'M0F4XxUPBsr';450;0.30;0.30;114;53;;157
+689;'NG HNQIS MA-460';'NG HNQIS MA-460-DxTx-Does the provider administer the correct treatment?';'NG HNQIS MA-460-DxTx-Does the provider admini';'Does the provider administer the correct treatment?';'<a href="https://drive.google.com/file/d/0BxIl9Fv9u436T3FxdGxCemd0TFk/view">Fever in Adults: Diagnosis and Treatment Matrix</a>';'M2qWWU3TzgQ';460;0.70;0.70;114;53;;157
+690;'NG HNQIS MA-470';'NG HNQIS MA-470-Counseling-Provider explains the treatment to be given';'NG HNQIS MA-470-Counseling-Provider explains';'Provider explains the treatment to be given';'<p>Explain the treatment to the patient to improve compliance.</p>';'cpB321VUtz3';470;0.33;0.33;115;53;;158
+691;'NG HNQIS MA-480';'NG HNQIS MA-480-Counseling-Provider counsels on proper dosage (no. of doses/days, side effects)';'NG HNQIS MA-480-Counseling-Provider counsels';'Provider counsels on proper dosage (no. of doses/days, side effects)';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel on specific doses per day, total number of days of treatment, and potential side effects; including severe side effects that require a return visit to hospital.</li></ul>';'Yc4gjsrwNOT';480;0.33;0.33;115;53;;158
+692;'NG HNQIS MA-490';'NG HNQIS MA-490-Counseling-Provider advises referral if condition worsens or refers in case of severe illness';'NG HNQIS MA-490-Counseling-Provider advises r';'Provider advises referral if condition worsens or refers in case of severe illness';'<ul><li>A patient with severe illness should be admitted/referred after stabilization and administration of pre-referral treatment.</li><li>Advice the patient on referral in case he/she worsens.</li></ul>';'AFbdxFDUlRe';490;0.33;0.33;115;53;;158
+693;'NG HNQIS MA-500';'NG HNQIS MA-500-WE-Adequate water supply (sufficient for outlet operations)';'NG HNQIS MA-500-WE-Adequate water supply (suf';'Adequate water supply (sufficient for outlet operations)';'<p><strong>For infection prevention, ensure adequate water is available for:</strong></p><ul><li>Hand washing before and after procedures</li><li>Cleaning work place</li></ul>';'HhrhCDqWYOb';500;0.05;0.05;116;53;;159
+694;'NG HNQIS MA-510';'NG HNQIS MA-510-WE-Adequate lighting (sufficient for reading test)';'NG HNQIS MA-510-WE-Adequate lighting (suffici';'Adequate lighting (sufficient for reading test)';'<p><strong>Provide adequate lighting for RDT procedure area</strong><br/>Good light is needed to be able to read the test results correctly. In conditions of poor lighting, one may not see the test lines clearly or a faint positive may be missed.</p>';'NJWlnkOuMe2';510;0.05;0.05;116;53;;159
+695;'NG HNQIS MA-520';'NG HNQIS MA-520-WE-Space for conducting RDT (confidentiality)';'NG HNQIS MA-520-WE-Space for conducting RDT (';'Space for conducting RDT (confidentiality)';'<p><strong>Provide adequate space for conducting RDT</strong></p><ul><li>There should be adequate space to allow client confidentiality and both visual and auditory privacy.</li><li>Adequate space to perform the test reduces the risk of sustaining sharps injuries.</li></ul>';'BRtJoWLYCAE';520;0.05;0.05;116;53;;159
+696;'NG HNQIS MA-530';'NG HNQIS MA-530-WE-Presence of job aids';'NG HNQIS MA-530-WE-Presence of job aids';'Presence of job aids';'<p><strong>Have job aids and display them prominently</strong><br/>Job aids act as quick reference points and provide standardize procedures for the provider.</p>';'YBoXhCyJLiG';530;0.05;0.05;116;53;;159
+697;'NG HNQIS MA-540';'NG HNQIS MA-540-WE-RDTs stored in a dry place away from direct sunlight';'NG HNQIS MA-540-WE-RDTs stored in a dry place';'RDTs stored in a dry place away from direct sunlight';'<p><strong>RDTs are sensitive to heat</strong><br/>If subjected to hot conditions above those stated by the manufacturer, the RDTs will lose sensitivity before the expiry date indicated on the package.</p>';'KTWll9qP9Fa';540;0.05;0.05;116;53;;159
+698;'NG HNQIS MA-550';'NG HNQIS MA-550-WE-Alcohol, Lancets, Gloves';'NG HNQIS MA-550-WE-Alcohol, Lancets, Gloves';'Alcohol, Lancets, Gloves';'<p><strong>To perform RDT procedure safely, have:</strong></p><ul><li>Alcohol for swabbing finger-prick sites</li><li>Sterile lancets to prevent cross-infections</li><li>Gloves to reduce risk of exposure to potentially infectious material</li></ul>';'Kq0oWlA2Gc4';550;0.05;0.05;116;53;;159
+699;'NG HNQIS MA-560';'NG HNQIS MA-560-WE-Timers, lead/grease pencils, marker pens';'NG HNQIS MA-560-WE-Timers, lead/grease pencil';'Timers, lead/grease pencils, marker pens';'<p><strong>Have timers and a pen that can write on the RDT cassette</strong></p><ul><li>Timers needed to set the time when test is ready for reading.</li><li>Marker pens or grease pencils needed to label the patient''s RDT kit to prevent a mix-up with other patients'' test kits.</li></ul>';'aawyJO3UrBx';560;0.05;0.05;116;53;;159
+700;'NG HNQIS MA-570';'NG HNQIS MA-570-WE-Biohazard waste bags';'NG HNQIS MA-570-WE-Biohazard waste bags';'Biohazard waste bags';'<p>Needed for proper waste disposal for infection prevention</p>';'jnwAejWBE8j';570;0.05;0.05;116;53;;159
+701;'NG HNQIS MA-580';'NG HNQIS MA-580-WE-Cotton wool, Disinfectants, Soap';'NG HNQIS MA-580-WE-Cotton wool, Disinfectants';'Cotton wool, Disinfectants, Soap';'<p>These are needed for infection prevention.</p><ul><li>Cotton wool to swab fingers with alcohol</li><li>Disinfectants for decontaminating equipment and work surfaces.</li><li>Soap for hand washing and cleaning the work environment.</li></ul>';'OnwjAmn4IQ2';580;0.05;0.05;116;53;;159
+702;'NG HNQIS MA-590';'NG HNQIS MA-590-WE-Sharps container';'NG HNQIS MA-590-WE-Sharps container';'Sharps container';'<p>To safely dispose of sharps immediately after use to avoid injuries to patients, health providers and cleaners.</p>';'fKiTffml62z';590;0.05;0.05;116;53;;159
+703;'NG HNQIS MA-600';'NG HNQIS MA-600-WE-Quality assured RDTs in stock on day of visit';'NG HNQIS MA-600-WE-Quality assured RDTs in st';'Quality assured RDTs in stock on day of visit';'<p>Quality assured RDTs should always be in stock for immediate testing and appropriate treatment.</p>';'i1zS4ibterc';600;0.05;0.05;116;53;;159
+704;'NG HNQIS MA-610';'NG HNQIS MA-610-WE-Expired RDTs in stock on day of visit';'NG HNQIS MA-610-WE-Expired RDTs in stock on d';'Expired RDTs in stock on day of visit';'<ul><li>Adhere to First-to-expire first-out (FEFO) procedures when dispatching RDTs from the store to the provider.</li><li>Establish policy and procedure to manage short -expiry RDTs.</li><li>Avoid overstocking.</li><li>Do proper forecasting to avoid wastage.</li></ul>';'QbKx2nucjO9';610;0.05;0.05;116;74;;159
+705;'NG HNQIS MA-620';'NG HNQIS MA-620-WE-RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';'NG HNQIS MA-620-WE-RDTs stock out for MORE TH';'RDTs stock out for MORE THAN 1 WEEK / 7 days in the past 3 months';'<p>Stock out data is critical for monitoring supply chain performance and highlighting supply gaps that may be present.</p>';'pu79OKXfu07';620;0.05;0.05;116;74;;159
+706;'NG HNQIS MA-630';'NG HNQIS MA-630-WE-Quality assured ACTs in stock';'NG HNQIS MA-630-WE-Quality assured ACTs in st';'Quality assured ACTs in stock';'<p><strong>Quality assured ACTs should always be in stock</strong> to ensure that all confirmed cases of malaria are started on ACTs immediately, reducing risk of complications and death.</p>';'yHcOB9fyk2m';630;0.05;0.05;116;53;;159
+707;'NG HNQIS MA-640';'NG HNQIS MA-640-WE-Expired Quality Assured ACTs in stock on day of visit';'NG HNQIS MA-640-WE-Expired Quality Assured AC';'Expired Quality Assured ACTs in stock on day of visit';'<ul><li>Never dispense an expired drug, it will not work and may cause harm to the patient.</li><li>Adhere to First-to-expire first-out (FEFO) procedures-always dispatch the first to expire ACTs from the store to the provider to avoid ACTs expiring on shelf.</li><li>Establish policy and procedure to manage short -expiry ACTs.</li><li>Order long-expiry ACTs.</li><li>Do not overstock.</li><li>Do proper forecasting to avoid wastage.</li></ul>';'HWm3VcsEXL8';640;0.05;0.05;116;74;;159
+708;'NG HNQIS MA-650';'NG HNQIS MA-650-WE-Logbook/register/record book is present at the outlet';'NG HNQIS MA-650-WE-Logbook/register/record bo';'Logbook/register/record book is present at the outlet';'<p>Record books serve as reference points and are source documents for patient follow up, quality assurance visits, disease surveillance and are sources of data for report writing.</p>';'ZGbduSjKtGN';650;0.05;0.05;116;53;;159
+709;'NG HNQIS MA-660';'NG HNQIS MA-660-WE-The patients details are recorded and organised in legible manner, including date of test is recorded';'NG HNQIS MA-660-WE-The patients details are r';'The patients details are recorded and organised in legible manner, including date of test is recorded';'<p>Write legibly, record all patient details including full name, age and date to ensure validity of data for decision making and planning purposes.</p>';'B36bko2ynQ8';660;0.05;0.05;116;53;;159
+710;'NG HNQIS MA-670';'NG HNQIS MA-670-WE-Results of the tests are recorded/if not test action taken is recorded';'NG HNQIS MA-670-WE-Results of the tests are r';'Results of the tests are recorded/if not test action taken is recorded';'<p>The number of tests performed and results guides the estimation of stocks to be ordered and provides data for analysis during quality assurance assessments of RDTs.</p>';'BzgpPXtuMBJ';670;0.05;0.05;116;53;;159
+711;'NG HNQIS MA-680';'NG HNQIS MA-680-WE-Reports for the weeks preceding the assessment have been submitted';'NG HNQIS MA-680-WE-Reports for the weeks prec';'Reports for the weeks preceding the assessment have been submitted';'<p>Regular and timely submission of reports enables morbidity surveillance and procurement planning resulting in timely resupply of commodities for diagnosis and treatment.</p>';'ZukJTInD7yy';680;0.05;0.05;116;53;;159
+712;'NG HNQIS MA-690';'NG HNQIS MA-690-END-END OF TAB';'NG HNQIS MA-690-END-END OF TAB';'END OF TAB';;'wniXP34a8ty';690;0.00;0.00;116;49;;
+713;'NG HNQIS PAC-100';'NG HNQIS PAC-100-Assess-Assess patient for shock and other life-threatening conditions';'NG HNQIS PAC-100-Assess-Assess patient for sh';'Assess patient for shock and other life-threatening conditions';'<p>Before performing uterine evacuation, any serious medical conditions that are present should be addressed immediately. Assess the woman for life threatening conditions. These include:</p><ul><li>shock,</li><li>acute abdomen,</li><li>sepsis,</li><li>cervical or pelvic infection,</li><li>hemorrhage,</li><li>signs of manipulation (uterine perforation, vaginal or cervical laceration, abdominal injury)</li></ul><p>Some of these complications may occur with incomplete or clandestine abortions. Uterine evacuation is often an important component of definitive management in these cases and once the patient is stabilized, the procedure should not be delayed.</p>';'xvl1y2Zx9V8';100;0.05;0.05;117;53;;161
+714;'NG HNQIS PAC-110';'NG HNQIS PAC-110-Assess-If any complications are identified, stabilizes patient and refers if necessary';'NG HNQIS PAC-110-Assess-If any complications';'If any complications are identified, stabilizes patient and refers if necessary';'<p><u><strong>Sepsis/Shock- Emergency Assessment</strong></u></p><ol><li><strong>Rapid initial assessment for shock if woman appears to be frankly hemorrhagic, losing consciousness, near collapse, septic, etc.</strong></li><li><strong>Call for help</strong></li><li><strong>Check vital signs (blood pressure, pulse, temperature, respiratory rate)</strong></li><li><strong>Evaluate for the following signs of shock:</strong><ul><li>Fast, weak pulse (rate > 110 beats per minute)</li><li>Low blood pressure (diastolic < 60)</li><li>Pallor (generally very pale, pallor of palms or around the mouth)</li><li>Sweatiness</li><li>Rapid breathing (respiration > 30 per minute)</li><li>Anxiousness, confusion or unconsciousness</li><li>Frank, profuse hemorrhage</li></ul></li><li><strong>If the woman is in shock or clinically unstable:</strong><strong></strong><ul><li>If woman is conscious or family member is present, find out: current medications, serious health condition, known allergies, if she ingested any substance to induce abortion other than misoprostol or attempted mechanical dilation with unsafe provider.</li><li>Proceed immediately to stabilize the woman:<ul><li>IV fluid volume replacement with 2 large-bore IV catheter</li><li>Oxygen by mask if available</li><li>If sepsis is suspected, obtain blood and cervical cultures if possible and start broad-spectrum IV antibiotics if indicated: Ampicillin, gentamicin and metronidazole</li><li>Obtain hemoglobin/hematocrit, blood type, and type and cross for blood transfusion if indicated</li></ul></li><li>Determine underlying etiology of shock- e.g., ruptured ectopic pregnancy requires emergency surgery. > If etiology is from retained products of conception proceed with uterine evacuation ASAP</li></ul></li><li><strong>Transfer to acute-care facility</strong><ul><li>If woman requires transfer to facility that can provide higher-acuity care, she may need stabilization and volume replacement with IV fluids before/during transport.</li><li>Notify referral facility and PSI that woman is being transported and give report on her diagnosis and condition.</li></ul></li></ol>';'ASbj4pVO1Go';110;0.05;0.05;117;53;;161
+715;'NG HNQIS PAC-120';'NG HNQIS PAC-120-Counseling-Interacts with client in a respectful manner';'NG HNQIS PAC-120-Counseling-Interacts with cl';'Interacts with client in a respectful manner';'<p>Interact with the client in a respectful manner. You must not create undue barriers or otherwise unnecessarily delay a client''s access to the service.</p>';'kVbDWFpMJxz';120;0.01;0.01;118;53;;161
+716;'NG HNQIS PAC-130';'NG HNQIS PAC-130-Counseling-Explains misoprostol, MVA and expectant management; how each method works; potential side effects; complications and eligibility for each method';'NG HNQIS PAC-130-Counseling-Explains misopros';'Explains misoprostol, MVA and expectant management; how each method works; potential side effects; complications and eligibility for each method';'<ul><li>Counsel on both medical and surgical abortion in detail. Explain how they are performed, the benefits of each, indications and contraindications for each method.</li><li>Consider that in certain cases expectant management is also possible.</li></ul>';'ThbcbtJVwst';130;0.02;0.02;118;53;;161
+717;'NG HNQIS PAC-140';'NG HNQIS PAC-140-Counseling-Provider asks the woman to choose the method she prefers';'NG HNQIS PAC-140-Counseling-Provider asks the';'Provider asks the woman to choose the method she prefers';'<p>Allow the woman to choose among available methods that are appropriate, based on the duration of pregnancy and her medical condition. If she is not yet able to make a decision:</p><ul><li>Ask if she has any questions</li><li>Review the benefits and limitations.</li></ul>';'NZKD3HDRXgS';140;0.01;0.01;118;53;;161
+718;'NG HNQIS PAC-150';'NG HNQIS PAC-150-Counseling-Explains the rapid return to fertility and the need to start contraception, and what methods are available';'NG HNQIS PAC-150-Counseling-Explains the rapi';'Explains the rapid return to fertility and the need to start contraception, and what methods are available';'<p><strong>Offer contraceptive counseling</strong></p><ul><li>Ensure the woman understands that ovulation returns 10-12 days after abortion, which could quickly lead to another pregnancy if she resumes sexual intercourse without using a modern contraceptive method.</li><li>If a woman desires contraception, provide it or refer for appropriate contraceptive services.</li></ul>';'a5Ixqmx2LK3';150;0.03;0.03;118;53;;161
+719;'NG HNQIS PAC-160';'NG HNQIS PAC-160-Counseling-Provides the woman with information about risk factors for STIs and HIV';'NG HNQIS PAC-160-Counseling-Provides the woma';'Provides the woman with information about risk factors for STIs and HIV';'<p>Discuss how to prevent infection, and provide condoms if she wants them. If the woman has not been tested recently and would like to be, explain what that will involve and arrange for testing. If it is not available at your site, provide a referral.<br/>Note: an HIV test is not a prerequisite for post abortion care.</p>';'JDQZXVVnoAS';160;0.03;0.03;118;53;;161
+720;'NG HNQIS PAC-170';'NG HNQIS PAC-170-Counseling-Encourages the woman to ask any questions';'NG HNQIS PAC-170-Counseling-Encourages the wo';'Encourages the woman to ask any questions';'<p>Give the woman a chance to ask questions and seek clarifications.</p>';'od7hTRxIkPS';170;0.01;0.01;118;53;;161
+721;'NG HNQIS PAC-180';'NG HNQIS PAC-180-Counseling-Check to make sure that client understands key messages conveyed';'NG HNQIS PAC-180-Counseling-Check to make sur';'Check to make sure that client understands key messages conveyed';'<p>Check to ensure the client understands key messages. You can ask her to tell you in her own words what she has understood.</p>';'abFZNpj7fJD';180;0.01;0.01;118;53;;161
+722;'NG HNQIS PAC-190';'NG HNQIS PAC-190-Counseling-Provides the woman with emergency contact information for the clinic or referral information for emergency care';'NG HNQIS PAC-190-Counseling-Provides the woma';'Provides the woman with emergency contact information for the clinic or referral information for emergency care';'<p>If is important for the woman to have emergency contact information incase she develops complications such as excessive bleeding.</p>';'IP2VtlsEIEh';190;0.03;0.03;118;53;;161
+723;'NG HNQIS PAC-200';'NG HNQIS PAC-200-Counseling-Provider obtains and documents informed consent';'NG HNQIS PAC-200-Counseling-Provider obtains';'Provider obtains and documents informed consent';'<ul><li>Informed consent assures that the woman''s decision is voluntary and informed.</li><li>Give accurate information regarding the risks, benefits, and possible complications of the method chosen.</li><li>There must be documentation that the woman understands the procedure and its alternatives; the potential risks, benefits and complications; that her decision is not coerced; and that she is firm in her decision to have an abortion.</li></ul>';'x6jqUgVWpY5';200;0.05;0.05;118;53;;161
+724;'NG HNQIS PAC-210';'NG HNQIS PAC-210-Med Eval-Asks about her current pregnancy history, RH, surgical and medical history';'NG HNQIS PAC-210-Med Eval-Asks about her curr';'Asks about her current pregnancy history, RH, surgical and medical history';'<p>Obtain the following in medical history:</p><ol><li>Current medicines used</li><li>Any known allergies</li><li>Acute or chronic illnesses or conditions</li><li>Brief obstetric and contraceptive history</li><li>History of current pregnancy<ul><li>Last Menstrual Period (LMP)</li><li>Gestational Age (GA)</li><li>Pregnancy symptoms</li><li>When bleeding began, bleeding patterns and amount of bleeding</li><li>Any agents used for induction of abortion? (i.e. misoprostol, tea, herbs, other tablets or substances, mechanical dilation, etc.)</li><li>Obtain history of tetanus vaccinations and assess risk for tetanus (i.e. sticks or other foreign objects inserted into uterus) and administer tetanus vaccine as per national protocols</li><li>Pelvic pain/ cramping -pattern and severity</li></ul></li></ol>';'YSY04HYja2H';210;0.10;0.10;119;53;;161
+725;'NG HNQIS PAC-220';'NG HNQIS PAC-220-Med Eval-Asks woman to empty her bladder before the examination';'NG HNQIS PAC-220-Med Eval-Asks woman to empty';'Asks woman to empty her bladder before the examination';'<p>This will avoid discomfort for the woman during abdominal, pelvic and speculum examinations.</p>';'roiVbdYh3WM';220;0.05;0.05;119;53;;161
+726;'NG HNQIS PAC-230';'NG HNQIS PAC-230-Med Eval-Provider washes hands and puts on gloves';'NG HNQIS PAC-230-Med Eval-Provider washes han';'Provider washes hands and puts on gloves';'<p>Wash hands before and after examining a patient to avoid transfer of infections.</p>';'tUcpjEKEKpU';230;0.03;0.03;119;53;;161
+727;'NG HNQIS PAC-240';'NG HNQIS PAC-240-Med Eval-General health assessment';'NG HNQIS PAC-240-Med Eval-General health asse';'General health assessment';'<p><strong>Proceed with general examination and note the following:</strong></p><ul><li>General appearance.</li><li>Vital signs.</li><li>Signs of weakness, lethargy, anaemia or malnourishment.</li><li>Signs or marks of physical violence.</li><li>General physical examination (as indicated).</li></ul>';'XdKmLZM0xn6';240;0.08;0.08;119;53;;161
+728;'NG HNQIS PAC-250';'NG HNQIS PAC-250-Med Eval-Performs an abdominal examination';'NG HNQIS PAC-250-Med Eval-Performs an abdomin';'Performs an abdominal examination';'<p><strong>When performing an abdominal examination:</strong></p><ul><li>Palpate abdomen and check for suprapubic or pelvic tenderness and adnexal abnormalities.</li><li>Check if uterus is palpable abdominally to approximate gestational age.</li></ul>';'x4B0BP1Qfm8';250;0.08;0.08;119;53;;161
+729;'NG HNQIS PAC-260';'NG HNQIS PAC-260-Med Eval-Uses a towel or sheet to ensure the client''s privacy is protected';'NG HNQIS PAC-260-Med Eval-Uses a towel or she';'Uses a towel or sheet to ensure the client''s privacy is protected';'<p>Ensure you always respect a client''s privacy and dignity.</p>';'FBRvdj0c3f1';260;0.05;0.05;119;53;;161
+730;'NG HNQIS PAC-270';'NG HNQIS PAC-270-Med Eval-Provider discusses each step of exam with client as he/she proceeds';'NG HNQIS PAC-270-Med Eval-Provider discusses';'Provider discusses each step of exam with client as he/she proceeds';'<p>Ensure the client is informed about the examination so as to allay anxiety and make her more co-operative during the examination.</p>';'rtHp33Suf2N';270;0.03;0.03;119;53;;161
+731;'NG HNQIS PAC-280';'NG HNQIS PAC-280-Med Eval-Appropriately performs a speculum examination';'NG HNQIS PAC-280-Med Eval-Appropriately perfo';'Appropriately performs a speculum examination';'<ul><li>Position her in lithotomy position.</li><li>Put on new exam (disposable) or HLD or sterile (reusable) gloves on both hands.</li><li>Clean the perineum and external genitalia</li><li>Inspect the external genitalia for ulcers or any abnormalities or signs of disease or infection.</li><li>Gently insert a warm appropriate size speculum and:<ul><li>Check amount and source of any vaginal bleeding;</li><li>Note any pus, discharge, lesions of the cervical os;</li><li>Gently remove any visible products of conception from the os using a ring forceps;</li><li>Identify traumatic injuries and remove any foreign bodies if present;</li><li>Take samples for culture if you suspect infection.</li></ul></li></ul>';'pX3hxvur5we';280;0.08;0.08;119;53;;161
+732;'NG HNQIS PAC-290';'NG HNQIS PAC-290-Med Eval-Performs a bimanual exam';'NG HNQIS PAC-290-Med Eval-Performs a bimanual';'Performs a bimanual exam';'<p><strong>Next, perform Bimanual examination:</strong></p><ul><li>Assess the size, consistency and position of the uterus and adnexa;</li><li>Note any uterine or adnexal masses or tenderness;</li><li>Compare the size of the uterus with the history of amenorrhoea;</li><li>Note whether the cervical os is open or closed;</li><li>If uncertain about the uterine size, ask another provider to assess or send the patient for an ultrasound scan.</li></ul>';'x9HYcR52kAV';290;0.08;0.08;119;53;;161
+733;'NG HNQIS PAC-300';'NG HNQIS PAC-300-Med Eval-Rules out ectopic pregnancy';'NG HNQIS PAC-300-Med Eval-Rules out ectopic p';'Rules out ectopic pregnancy';'<p><strong>Risk factors for Ectopic Pregnancy include:</strong></p><ul><li>History of Prior Ectopic Pregnancy</li><li>History of tubal surgery (i.e. tubal ligation)</li><li>IUD in place</li><li>Adnexal mass or pain on physical examination.</li></ul><p>However, an ectopic pregnancy can occur in a woman without risk factors. Suspect ectopic pregnancy if:<br /><strong>Positive risk factors + Concerning physical exam</strong><br/>Signs and symptoms concerning for an ectopic pregnancy include: adnexal mass or adnexal pain on exam, hemodynamic instability, or peritoneal signs. If any of these signs are present, the woman should be treated as soon as possible or transferred immediately to a facility that can manage ectopic pregnancy.</p><p><em><strong>NOTE: Findings on physical exam consistent with an ectopic pregnancy may be similar to findings present in the setting of a septic or unsafe abortion, in particular if the woman underwent a surgical procedure by an unskilled provider.</strong></em></p><p>Refer suspected ectopic pregnancy for ultrasound then to a qualified provider for surgical management.</p>';'j0w2yZkTr2c';300;0.10;0.10;119;53;;161
+734;'NG HNQIS PAC-310';'NG HNQIS PAC-310-Med Eval-Makes appropriate decision whether to proceed with the client''s chosen method and informs her appropriately';'NG HNQIS PAC-310-Med Eval-Makes appropriate d';'Makes appropriate decision whether to proceed with the client''s chosen method and informs her appropriately';'<p>The final decision on the management plan depends of physical examination findings. It is important to discuss with the patient your examination findings and the next course of actions depending of the findings. If there are contraindications to offering either medical or surgical management, refer the woman appropriately.</p>';'g1u4DFIpwJZ';310;0.05;0.05;119;53;;161
+735;'NG HNQIS PAC-320';'NG HNQIS PAC-320-mPAC-Is the client receiving Misoprostol for Post Abortion Care? (mPAC)';'NG HNQIS PAC-320-mPAC-Is the client receiving';'Is the client receiving Misoprostol for Post Abortion Care? (mPAC)';;'EZEkpWNySJm';320;0.00;0.00;120;53;;162
+736;'NG HNQIS PAC-330';'NG HNQIS PAC-330-mPAC-Confirms eligibility for misoprostol for post abortion care (mPAC)';'NG HNQIS PAC-330-mPAC-Confirms eligibility fo';'Confirms eligibility for misoprostol for post abortion care (mPAC)';'<p><strong>Eligibility for misoprostol for treatment of incomplete abortion include:</strong></p><ul><li>Open cervical os</li><li>Vaginal bleeding or history of vaginal bleeding during this pregnancy</li><li>Uterine size of less than or equal to 12 weeks</li><li>Woman medically stable</li></ul><p><strong>Notes:</strong></p><ul><li>Women who are breastfeeding are eligible for misoprostol.</li><li>Women who have a history of a prior cesarean section are eligible for misoprostol in the first and second trimester.</li></ul><p><strong>Contraindications to misoprostol treatment of incomplete abortion include:</strong></p><ul><li>Known allergy to misoprostol or to other prostaglandins (very rare)</li><li>Confirmed or suspected ectopic pregnancy</li><li>Signs of sepsis</li><li>Hemodynamic instability or shock</li></ul>';'RPomyzHtcAB';330;0.25;0.25;120;53;;162
+737;'NG HNQIS PAC-340';'NG HNQIS PAC-340-mPAC-Explains to the woman what to expect';'NG HNQIS PAC-340-mPAC-Explains to the woman w';'Explains to the woman what to expect';'<p><strong>Explain the following:</strong></p><ul><li>Effectiveness of treatment.</li><li>Range of normal experience.</li><li>Potential side effects and complications.</li><li>Warning signs to seek help and access to emergency care if needed.</li><li>Provide information where to get help - including emergency phone number.</li></ul>';'JkSA72wxGnN';340;0.10;0.10;120;53;;162
+738;'NG HNQIS PAC-350';'NG HNQIS PAC-350-mPAC-Provides misoprostol and observes the woman in the clinic for several hours. If the woman is stable and prefers home treatment, allows her to take medicine and go home but counsels on when to return';'NG HNQIS PAC-350-mPAC-Provides misoprostol an';'Provides misoprostol and observes the woman in the clinic for several hours. If the woman is stable and prefers home treatment, allows her to take medicine and go home but counsels on when to return';'<p>Depending on the facility space, the woman''s condition and her preference, she can take the medicines at the clinic and then return home, she can take the misoprostol once she is at home, or she can remain in the clinic for several hours for observation if facilities permit and this is the woman''s preference.</p>';'DIg8r8HDXTc';350;0.08;0.08;120;53;;162
+739;'NG HNQIS PAC-360';'NG HNQIS PAC-360-mPAC-Provider gives the recommended regimen/dose';'NG HNQIS PAC-360-mPAC-Provider gives the reco';'Provider gives the recommended regimen/dose';'<p><strong>Give either:</strong></p><ul><li>Oral misoprostol: 600mcg OR</li><li>Sublingual misoprostol: 400 mcg</li></ul><p>For incomplete abortion in the first trimester, these doses are equally effective. Thus, the choice in regimens may depend on cultural/social attitudes concerning route of administration or cost.</p>';'CufjauOr0rG';360;0.20;0.20;120;53;;162
+740;'NG HNQIS PAC-370';'NG HNQIS PAC-370-mPAC-Explains instructions for administration/ administers the drugs';'NG HNQIS PAC-370-mPAC-Explains instructions f';'Explains instructions for administration/ administers the drugs';'<p><strong>Describe how the pills should be taken</strong></p><ul><li>For sublingual, instruct women to place both misoprostol pills under the tongue and allow it to dissolve. Do not swallow. If fragments remain after 30 minutes, it is okay to swallow at that point.</li><li>For oral, instruct the woman to swallow all 3 pills at the same time.</li></ul>';'BBhGsWhhbkj';370;0.08;0.08;120;53;;162
+741;'NG HNQIS PAC-380';'NG HNQIS PAC-380-mPAC-Provides information on expected bleeding pattern and accompanying symptoms';'NG HNQIS PAC-380-mPAC-Provides information on';'Provides information on expected bleeding pattern and accompanying symptoms';'<p><strong>Explain the expected symptoms after taking misoprostol. They include:</strong></p><ul><li>Cramping and bleeding may begin as soon as 30 minutes after taking misoprostol.</li><li>Heavy bleeding may last for a few hours, but should not exceed soaking 2 pads per hour for 2 consecutive hours (see warning signs below).</li><li>This initial heavy bleeding is often associated with passage of tissue and/or clots.</li><li>Total bleeding time is typically 5-8 days, but the majority of this is light to moderate.</li><li>Woman may experience chills, nausea, diarrhea, fever associated with the medication but these symptoms usual resolve on their own with 24 hours and do not require further treatment or care.</li></ul><p>NOTE: Women can be counseled that should she experience the above symptoms, the pregnancy has likely passed and provided she has no other questions or concerns may not require a follow-up visit.</p>';'uhQWmORrnUQ';380;0.10;0.10;120;53;;162
+742;'NG HNQIS PAC-390';'NG HNQIS PAC-390-mPAC-Counsels on warning signs';'NG HNQIS PAC-390-mPAC-Counsels on warning sig';'Counsels on warning signs';'<p><strong>Warning signs for which the woman should seek immediate medical care:</strong></p><ul><li>Heavy bleeding.<ul><li>Soaking 2 full-thickness sanitary pads per hour for more than 2 consecutive hours.</li><li>Heavy bleeding that occurs after bleeding had slowed down or stopped.</li><li>Feeling light-headed, dizzy or weak as bleeding continues.</li></ul></li><li>Fever that lasts more than a day or starts a day after the misoprostol is taken.</li><li>Severe pain, even on the day of misoprostol, that does not get better with medication, rest or a heating pad.</li><li>Severe nausea, vomiting or diarrhea or nausea, vomiting or diarrhea lasting more than 24 hours.</li></ul>';'dM9BSr2M38P';390;0.08;0.08;120;53;;162
+743;'NG HNQIS PAC-400';'NG HNQIS PAC-400-mPAC-Provides additional medicines: analgesics, antiemetics';'NG HNQIS PAC-400-mPAC-Provides additional med';'Provides additional medicines: analgesics, antiemetics';'<ul><li>For pain: NSAIDs such as ibuprofen 400-600 mg orally every 6 hours as needed.</li></ul><p style="margin-left: 40px;">Note: Paracetamol is no longer recommended for pain control for PAC as studies have shown it to be less effective than NSAIDs (WHO, 2012).</p><ul><li>Other medicines (e.g., anti-emetics) can be advised or prescribed as needed.</li></ul>';'cpcuRMfOBGS';400;0.05;0.05;120;53;;162
+744;'NG HNQIS PAC-410';'NG HNQIS PAC-410-mPAC-Assists the woman in identifying an appropriate support person';'NG HNQIS PAC-410-mPAC-Assists the woman in id';'Assists the woman in identifying an appropriate support person';'<p>A partner or support person present during home administration is encouraged.</p>';'MoA94s2bbFN';410;0.03;0.03;120;53;;162
+745;'NG HNQIS PAC-420';'NG HNQIS PAC-420-mPAC-Advises follow-up (if needed) and gives a follow up date';'NG HNQIS PAC-420-mPAC-Advises follow-up (if n';'Advises follow-up (if needed) and gives a follow up date';'<ul><li>Follow-up visit is not mandatory and women can be counseled that if they experienced the expected symptoms following misoprostol administration and they have no other questions or concerns they do not need to return to the clinic.</li><li>If you choose to schedule a routine follow-up visit, it is advisable to do so one to two weeks following misoprostol administration. At least 95% of women will be successful by 7 days post misoprostol administration.</li></ul>';'p5Vau6teXdv';420;0.03;0.03;120;53;;162
+746;'NG HNQIS PAC-430';'NG HNQIS PAC-430-mPAC-Records in the client file and Daily Activity Register';'NG HNQIS PAC-430-mPAC-Records in the client f';'Records in the client file and Daily Activity Register';'<p>Documentation is important after every procedure.</p>';'umc7T9XoUT4';430;0.03;0.03;120;53;;162
+747;'NG HNQIS PAC-440';'NG HNQIS PAC-440-MVA-Is the client having an MVA procedure for Post abortion care?';'NG HNQIS PAC-440-MVA-Is the client having an';'Is the client having an MVA procedure for Post abortion care?';;'vLyCMxFPyMT';440;0.00;0.00;121;53;;163
+748;'NG HNQIS PAC-450';'NG HNQIS PAC-450-MVA-PRE-PROCEDURE';'NG HNQIS PAC-450-MVA-PRE-PROCEDURE';'PRE-PROCEDURE';;'DhPt6VZ5ERm';450;0.00;0.00;121;49;;163
+749;'NG HNQIS PAC-460';'NG HNQIS PAC-460-MVA-Confirms eligibility for MVA';'NG HNQIS PAC-460-MVA-Confirms eligibility for';'Confirms eligibility for MVA';'<p>There are very few absolute contraindications to MVA procedures; however, the following cases may require a higher level facility for care or the procedure should be performed by a more experienced provider.</p><ul><li>Uterine anomaly</li><li>Fibroids > 16 weeks or obstructing cervical canal</li><li>Severe anemia (Hb < 7)</li><li>Uncontrolled seizure disorder</li><li>Known or suspected molar pregnancy > 12 weeks</li><li>Uncontrolled diabetes</li><li>Significant cardiopulmonary disease</li><li>Uncontrolled hypertension</li><li>Severe infection requiring IV antibiotics</li></ul>';'S0x0CBLgFw4';460;0.10;0.10;121;53;;163
+750;'NG HNQIS PAC-470';'NG HNQIS PAC-470-MVA-Determines a pain management plan and provides it';'NG HNQIS PAC-470-MVA-Determines a pain manage';'Determines a pain management plan and provides it';'<p><strong>Decide on a pain management plan</strong><br/>Most women undergoing first-trimester vacuum aspiration will experience some pain. Generally a combination of pharmacologic pain medications, including local anesthesia (in the form of a paracervical block) and non-pharmacologic measures provide pain relief for most women.</p><ul><li>Non-pharmacologic pain management: medications should be supplemented with supportive techniques to decrease pain and anxiety.</li><li>Pharmacologic pain management:<ul><li>Include NSAIDS, analgesics, narcotics and anxiolytics. At a minimum, premedication with an NSAID should be given. <strong>Recommendation: Give Ibuprofen 400-800mg orally one hour prior to MVA procedure.</strong></li><li>Paracetamol is no longer recommended as a first line pain medication, but may be used as an antipyretic if needed.</li><li>Paracervical block: a paracervical block with up to 20mL of lidocaine (one percent) given several minutes before dilating the cervix has been shown to decrease pain with dilation and aspiration.</li><li>Intravenous sedation is also effective. However, providing intravenous sedation increases the expense, complexity and potential risks of the procedure.</li></ul></li></ul>';'QxNPaBXG5o2';470;0.05;0.05;121;53;;163
+751;'NG HNQIS PAC-480';'NG HNQIS PAC-480-MVA-Provides necessary antibiotics';'NG HNQIS PAC-480-MVA-Provides necessary antib';'Provides necessary antibiotics';'<ul><li>Prophylactic antibiotics are recommended for all women prior to vacuum aspiration. However, where antibiotics are unavailable uterine aspiration may still be offered.</li><li>Therapeutic antibiotics should be administered to all women who are suspected of or who have been diagnosed with an infection.<ul><li>Women at high risk should be screened and treated for sexually transmitted infections in addition to receiving prophylactic antibiotics.</li><li>Women who have signs and symptoms of active infection should still receive the MVA service without delay but should simultaneously be started on appropriate therapeutic antibiotics.</li></ul></li></ul>';'RQg1XqNxkjj';480;0.03;0.03;121;53;;163
+752;'NG HNQIS PAC-490';'NG HNQIS PAC-490-MVA-Explains the procedure and encourages the client to ask questions';'NG HNQIS PAC-490-MVA-Explains the procedure a';'Explains the procedure and encourages the client to ask questions';'<p>Explain to the patient the procedure. She has a right to receive information. This will also allay anxiety in her.</p>';'mFiO8iBc1Iq';490;0.03;0.03;121;53;;163
+753;'NG HNQIS PAC-500';'NG HNQIS PAC-500-MVA-Explains that some procedure steps may be uncomfortable but reassures the client';'NG HNQIS PAC-500-MVA-Explains that some proce';'Explains that some procedure steps may be uncomfortable but reassures the client';'<p>This will help the woman tolerate the pain and discomfort better.</p>';'tSLxTXPLCUo';500;0.03;0.03;121;53;;163
+754;'NG HNQIS PAC-510';'NG HNQIS PAC-510-MVA-Confirms all equipment is available';'NG HNQIS PAC-510-MVA-Confirms all equipment i';'Confirms all equipment is available';'<p>Ensure you have all the equipment before starting. MVA is a sterile procedure hence once you start, you should not touch anything outside the sterile field.</p>';'iEiVsgSleze';510;0.02;0.02;121;53;;163
+755;'NG HNQIS PAC-520';'NG HNQIS PAC-520-MVA-Ensures appropriate size of cannulae and adapters are available';'NG HNQIS PAC-520-MVA-Ensures appropriate size';'Ensures appropriate size of cannulae and adapters are available';'<p>Do not proceed with an MVA if you do not have appropriate sizes of cannulae and adapters; you may not be able to achieve a vacuum for the process to be effective.</p>';'I7mcQNMITen';520;0.02;0.02;121;53;;163
+756;'NG HNQIS PAC-530';'NG HNQIS PAC-530-MVA-Checks the MVA syringe and charges it (to establish vacuum)';'NG HNQIS PAC-530-MVA-Checks the MVA syringe a';'Checks the MVA syringe and charges it (to establish vacuum)';'<ul><li>Check that you have a vacuum. If vacuum is not retained, check the O-ring and lubricate if necessary.</li><li>If vacuum is still not retained, discard and use another aspirator. Discard aspirators with visible cracks or defects.</li></ul>';'gpW1k3XVRyS';530;0.02;0.02;121;53;;163
+757;'NG HNQIS PAC-540';'NG HNQIS PAC-540-MVA-Checks that patient has recently emptied her bladder';'NG HNQIS PAC-540-MVA-Checks that patient has';'Checks that patient has recently emptied her bladder';'<p>A full bladder will cause discomfort for the woman during the procedure.</p>';'c6WHxdY16zE';540;0.03;0.03;121;53;;163
+758;'NG HNQIS PAC-550';'NG HNQIS PAC-550-MVA-Checks that patient has thoroughly washed and rinsed her perineal area';'NG HNQIS PAC-550-MVA-Checks that patient has';'Checks that patient has thoroughly washed and rinsed her perineal area';'<ul><li>Fecal matter soiling in the perennial area should be cleaned to avoid contamination since it is a sterile procedure.</li></ul>';'Z17mUidbnVH';550;0.03;0.03;121;53;;163
+759;'NG HNQIS PAC-560';'NG HNQIS PAC-560-MVA-Washes hands and dries them';'NG HNQIS PAC-560-MVA-Washes hands and dries t';'Washes hands and dries them';'<ul><li>Wash hands routinely to avoid spreading infections.</li><li>Dry hands to make gloving easy.</li></ul>';'sydumhUjQNg';560;0.03;0.03;121;53;;163
+760;'NG HNQIS PAC-570';'NG HNQIS PAC-570-MVA-Puts on new sterile gloves on both hands';'NG HNQIS PAC-570-MVA-Puts on new sterile glov';'Puts on new sterile gloves on both hands';'<p>MVA is a sterile procedure, observe infection prevention protocol.</p>';'Ov70IU5dxUT';570;0.03;0.03;121;53;;163
+761;'NG HNQIS PAC-580';'NG HNQIS PAC-580-MVA-Arranges sterile instruments on sterile tray';'NG HNQIS PAC-580-MVA-Arranges sterile instrum';'Arranges sterile instruments on sterile tray';'<p><strong>Arrange the necessary equipment on a sterile before starting. These include:</strong></p><ul><li>MVA instruments: aspirator, cannulae of various sizes, and silicone or other suitable lubricant</li><li>Tenaculum</li><li>Speculum</li><li>Sponge forceps or uterine-packing forceps</li><li>Mechanical dilators (if not using cannulae for this purpose)</li><li>Betadine or other nonalcoholic antiseptic</li><li>Paracervical block supplies: anesthetic (0.5% or 1.0% Lidocaine) without epinephrine and a 5, 10 or 20ml syringe with 21- or 22-gauge (or finer) regular or spinal needle</li><li>Tissue inspection supplies: strainer, clear bowl, light source, forceps and water</li></ul>';'fgyLHffugwg';580;0.03;0.03;121;53;;163
+762;'NG HNQIS PAC-590';'NG HNQIS PAC-590-MVA-MVA PROCEDURE';'NG HNQIS PAC-590-MVA-MVA PROCEDURE';'MVA PROCEDURE';;'QFI4daqygDc';590;0.00;0.00;121;49;;163
+763;'NG HNQIS PAC-600';'NG HNQIS PAC-600-MVA-Performs bimanual pelvic examination to confirm uterine size, position and degree of cervical dilation (only if patient returns on different day of primary examination)';'NG HNQIS PAC-600-MVA-Performs bimanual pelvic';'Performs bimanual pelvic examination to confirm uterine size, position and degree of cervical dilation (only if patient returns on different day of primary examination)';'<ul><li>Bimanual pelvic examination needs to be performed again if the MVA is not done immediately with the medical evaluation.</li><li>Note the degree of cervical dilation to be able to pick the appropriate size of cannula.</li></ul>';'gCM0WAMpqdB';600;0.02;0.02;121;53;;163
+764;'NG HNQIS PAC-610';'NG HNQIS PAC-610-MVA-Inserts the speculum and removes blood or tissue from vagina using sponge holding forceps and sterile gauze';'NG HNQIS PAC-610-MVA-Inserts the speculum and';'Inserts the speculum and removes blood or tissue from vagina using sponge holding forceps and sterile gauze';'<p>This will enable you visualize the cervix and os clearly.</p>';'T2tFWpn1DZm';610;0.02;0.02;121;53;;163
+765;'NG HNQIS PAC-620';'NG HNQIS PAC-620-MVA-Removes any products of conception protruding from the cervical os and checks the cervix for tears';'NG HNQIS PAC-620-MVA-Removes any products of';'Removes any products of conception protruding from the cervical os and checks the cervix for tears';'<ul><li>POCs protruding from the os can be removed with forceps gently. These may be large and will obstruct insertion of the cannula.</li><li>Check for tears which may have been as a result of attempted abortion by an unskilled provider.</li></ul>';'xKD9NFHV7Ne';620;0.02;0.02;121;53;;163
+766;'NG HNQIS PAC-630';'NG HNQIS PAC-630-MVA-Applies appropriate antiseptic to cervix and vagina three times.';'NG HNQIS PAC-630-MVA-Applies appropriate anti';'Applies appropriate antiseptic to cervix and vagina three times.';'<p><strong>MVA is a sterile procedure and swabbing the cervix three times minimizes the risk of introducing infection into the uterus.</strong></p><ul><li>Cleanse from the center of the cervical os moving outward on the cervix and into the surrounding vaginal canal.</li><li>If povidone iodine is used, allow 1 to 2 minutes before proceeding.</li><li>Do not use alcohol as it is painful for the woman; dries and damages the mucous membranes, which may support the infectious process.</li></ul>';'XuEVmI9t1RS';630;0.03;0.03;121;53;;163
+767;'NG HNQIS PAC-640';'NG HNQIS PAC-640-MVA-Puts single tooth tenaculum or vulsellum forceps on lower lip of cervix (5 or 7 o’clock).';'NG HNQIS PAC-640-MVA-Puts single tooth tenacu';'Puts single tooth tenaculum or vulsellum forceps on lower lip of cervix (5 or 7 o’clock).';'<p>The tenaculum is used to align the uterus with the cervical opening and to stabilize the cervix for easier insertion of the cannula.</p>';'Mb0E6tSgl13';640;0.02;0.02;121;53;;163
+768;'NG HNQIS PAC-650';'NG HNQIS PAC-650-MVA-Correctly administers paracervical block (if necessary) as per protocol';'NG HNQIS PAC-650-MVA-Correctly administers pa';'Correctly administers paracervical block (if necessary) as per protocol';'<p><strong>Administer paracervical block as follows:</strong></p><ul><li>Load a 20mL syringe with 12mL of lidocaine (one percent) (If sodium bicarbonate solution is available a buffered solution may be prepared: Load 20mL syringe with 18mL of 1% lidocaine and load 2mL sodium bicarbonate (8.4 percent))</li><li>Attach syringe to a 20-gauge spinal needle (or use a 20-gauge needle with a "needle extender").</li><li>Infiltrate 2mL into the cervix superficially at the tenaculum site (12 o''clock or 6 o''clock).</li><li>Grasp the cervix at the site of the previously injected local with the single-tooth or atraumatic vulsellum tenaculum.</li><li>Inject the remaining lidocaine in equal amounts at the cervicovaginal junction at the locations of four and eight o''clock just above the uterosacral ligament. (Some clinicians also prefer to inject at 2, 4, 8 and 10 o''clock).</li><li>The injection should be continuous from superficial to a depth of one to three centimeters.</li><li>Pull back on the plunger before injecting anesthesia to prevent intravascular injection.</li><li>Inspect the injection sites for bleeding (may need to hold pressure if bleeding).</li><li>Begin procedure at least three minutes after the paracervical block is complete.</li></ul>';'RrGQ2MYrAVu';650;0.05;0.05;121;53;;163
+769;'NG HNQIS PAC-660';'NG HNQIS PAC-660-MVA-Gently applies traction on the cervix to straighten the cervical canal and uterine cavity';'NG HNQIS PAC-660-MVA-Gently applies traction';'Gently applies traction on the cervix to straighten the cervical canal and uterine cavity';'<p>Apply gentle traction to avoid tearing the cervix.</p>';'GsPwKnVpZXx';660;0.01;0.01;121;53;;163
+770;'NG HNQIS PAC-670';'NG HNQIS PAC-670-MVA-Dilates the cervix (if needed)/proceeds if not needed';'NG HNQIS PAC-670-MVA-Dilates the cervix (if n';'Dilates the cervix (if needed)/proceeds if not needed';'<ul><li>Cervical dilatation is necessary when the cervical canal will not allow passage of a cannula appropriate to the uterine size.</li><li>When required, dilatation should be done gently with progressively larger cannulae or tapered mechanical dilators, taking care not to traumatize the cervix.</li><li>Misoprostol can also be used to ripen the cervix.</li></ul>';'aCZCC8oLPEw';670;0.02;0.02;121;53;;163
+771;'NG HNQIS PAC-680';'NG HNQIS PAC-680-MVA-While holding the cervix steady, pushes the selected cannula gently and slowly into the uterine cavity until it just touches the fundus (not >10 cm). Then withdraws the cannula slightly away from the fundus';'NG HNQIS PAC-680-MVA-While holding the cervix';'While holding the cervix steady, pushes the selected cannula gently and slowly into the uterine cavity until it just touches the fundus (not >10 cm). Then withdraws the cannula slightly away from the fundus';'<ul><li>Do not insert the cannula forcefully, as forceful movements may cause uterine perforation or damage to the cervix, pelvic organs or blood vessels. Rotate the cannula with gentle pressure to help ease insertion.</li><li>Remain alert to signals that may indicate perforation throughout the procedure and stop suction immediately if they appear.</li></ul>';'VR837gQxumn';680;0.03;0.03;121;53;;163
+772;'NG HNQIS PAC-690';'NG HNQIS PAC-690-MVA-Performs suction as per protocol using the no-touch technique.';'NG HNQIS PAC-690-MVA-Performs suction as per';'Performs suction as per protocol using the no-touch technique.';'<p><strong>Perform suction as follows:</strong></p><ul><li>Attach cannula to aspirator, holding the tenaculum and end of the cannula in one hand and the aspirator in the other. Take care not to push the cannula further into the uterus.</li><li>Release vacuum by pressing the buttons in; suction will begin immediately.</li><li>Evacuate by slowly and gently rotating cannula and aspirator 180 degrees in each direction while using an in-and-out motion. Take care not to withdraw the aperture of the cannula beyond the cervical os, as this will cause a loss of vacuum.</li><li>If the syringe becomes half full before the procedure is complete, detach the cannula from the syringe. Remove only the syringe, leaving the cannula in place. <strong>Never push aspirated contents through the cannula into the uterus.</strong></li><li>Push the plunger to empty POC into the strainer.</li><li>Recharge syringe, attach to cannula and release buttons.</li></ul>';'ukZZV4z3Lct';690;0.10;0.10;121;53;;163
+773;'NG HNQIS PAC-700';'NG HNQIS PAC-700-MVA-Checks for signs of completion';'NG HNQIS PAC-700-MVA-Checks for signs of comp';'Checks for signs of completion';'<p><strong>The following signs indicate completion:</strong></p><ul><li>Red or pink foam without tissue passes through the cannula;</li><li>Gritty sensation as the cannula passes over the surface of the evacuated uterus;</li><li>The uterus contracts around the cannula;</li><li>The woman feels increased cramping when the uterus is empty, indicating contraction.</li></ul>';'DnHSqMkVCOx';700;0.03;0.03;121;53;;163
+774;'NG HNQIS PAC-710';'NG HNQIS PAC-710-MVA-Removes cannula from the MVA syringe and pushes the plunger to empty contents into the strainer';'NG HNQIS PAC-710-MVA-Removes cannula from the';'Removes cannula from the MVA syringe and pushes the plunger to empty contents into the strainer';'<ul><li>When the procedure is finished, depress the buttons and disconnect the cannula from the aspirator.</li><li>Alternatively, withdraw the cannula and aspirator together. Without depressing the buttons, empty contents into strainer.</li></ul>';'OyvPXzQXJ5o';710;0.02;0.02;121;53;;163
+775;'NG HNQIS PAC-720';'NG HNQIS PAC-720-MVA-Quickly inspects the tissue removed from the uterus to be sure the uterus is completely evacuated';'NG HNQIS PAC-720-MVA-Quickly inspects the tis';'Quickly inspects the tissue removed from the uterus to be sure the uterus is completely evacuated';'<ul><li>Inspect aspirated tissue for quantity and presence or absence of products of conception (POC).</li><li>You can rinse the tissues with water or saline to enable better visualization.</li><li>This is extremely important since it indicates whether the evacuation was complete or whether there is the possibility of an ectopic or molar pregnancy.</li></ul>';'bSOYOUFv7GB';720;0.02;0.02;121;53;;163
+776;'NG HNQIS PAC-730';'NG HNQIS PAC-730-MVA-If no products of conception are seen, reassess situation to be sure it is not an ectopic pregnancy';'NG HNQIS PAC-730-MVA-If no products of concep';'If no products of conception are seen, reassess situation to be sure it is not an ectopic pregnancy';'<p>If no products of conception (POCs) are seen, the possibility of ectopic pregnancy, incomplete abortion or a complete spontaneous abortion should be considered.</p>';'EF0gyYxNUcl';730;0.03;0.03;121;53;;163
+777;'NG HNQIS PAC-740';'NG HNQIS PAC-740-MVA-Determines the procedure is complete';'NG HNQIS PAC-740-MVA-Determines the procedure';'Determines the procedure is complete';'<p><strong>Determine completion:</strong></p><ul><li>Wipe away excess blood from the os and assess the quantity still coming from the uterus or elsewhere. Ensure that bleeding is minimal.</li><li>Remove the speculum.</li><li>Perform bimanual examination to check size and firmness of the uterus.</li><li>If suspected remained products of conception, repeat the MVA procedure.</li></ul>';'PB4WfMm6YTz';740;0.03;0.03;121;53;;163
+778;'NG HNQIS PAC-750';'NG HNQIS PAC-750-MVA-Cleans the woman and provides her with a pad.';'NG HNQIS PAC-750-MVA-Cleans the woman and pro';'Cleans the woman and provides her with a pad.';'<p>After completing the evacuation, clean the woman; provide her with a sanitary pad; and position her in a recovery position; or help her to a recovery bed.</p>';'JQ7UyANBA98';750;0.01;0.01;121;53;;163
+779;'NG HNQIS PAC-760';'NG HNQIS PAC-760-MVA-POST-MVA TASKS';'NG HNQIS PAC-760-MVA-POST-MVA TASKS';'POST-MVA TASKS';;'FYMwkRveY0H';760;0.00;0.00;121;49;;163
+780;'NG HNQIS PAC-770';'NG HNQIS PAC-770-MVA-Post MVA Infection Prevention procedures correctly performed';'NG HNQIS PAC-770-MVA-Post MVA Infection Preve';'Post MVA Infection Prevention procedures correctly performed';'<ul><li>Before removing gloves, dispose of waste materials in a leak-proof container or plastic bag.</li><li>Place speculum and metal instruments in 0.5% chlorine solution for 10 minutes for decontamination.</li><li>If reusing needle or syringe, fill syringe (with needle attached) with 0.5% chlorine solution and submerge in solution for 10 minutes for decontamination. If disposing of needle and syringe, flush needle and syringe with 0.5% chlorine solution three times, then place in puncture proof container.</li><li>Attach used cannula to MVA syringe and flush both with 0.5% chlorine solution.</li><li>Detach cannulae from syringe and soak them in 0.5% chlorine solution for 10 minutes for decontamination.</li><li>Empty POC into utility sink, flushable toilet, latrine or container with tightfitting lid.</li><li>Appropriately removes and disposes gloves.</li><li>Wash hands thoroughly with soap and water and dry with clean, dry cloth or air dry.</li></ul>';'PYOCaxRKjZz';770;0.03;0.03;121;53;;163
+781;'NG HNQIS PAC-780';'NG HNQIS PAC-780-MVA-Allows the patient to rest comfortably for at least 30 minutes where her recovery can be monitored';'NG HNQIS PAC-780-MVA-Allows the patient to re';'Allows the patient to rest comfortably for at least 30 minutes where her recovery can be monitored';'<p><strong>Monitor the woman''s recovery</strong><br/>Have the woman rest in a comfortable position. Assess and respond sensitively to her emotional state. Monitor her until she has:</p><ul><li>pulse and blood pressure that is normal for her;</li><li>the ability to walk and drink fluids;</li><li>normal bleeding and cramping.</li></ul>';'ay0ZjebFRiu';780;0.03;0.03;121;53;;163
+782;'NG HNQIS PAC-790';'NG HNQIS PAC-790-MVA-Checks for bleeding at least once and ensure that cramping has decreased before discharge';'NG HNQIS PAC-790-MVA-Checks for bleeding at l';'Checks for bleeding at least once and ensure that cramping has decreased before discharge';'<ul><li>Check the sanitary pad for signs of heavy bleeding.</li><li>Ask her whether the cramping has reduced.</li></ul>';'eJ4Pc2wb2VG';790;0.03;0.03;121;53;;163
+783;'NG HNQIS PAC-800';'NG HNQIS PAC-800-MVA-Instructs patient regarding post abortion care';'NG HNQIS PAC-800-MVA-Instructs patient regard';'Instructs patient regarding post abortion care';'<p><strong>Give instructions on:</strong></p><ul><li>instructions for taking medications</li><li>information about routine hygiene</li><li>information about resumption of sexual activity and contraception</li><li>signs and symptoms requiring emergency attention</li><li>where to seek emergency care, if needed</li><li>list of counseling and other available services</li><li>date, time and location of follow-up visit</li></ul>';'XqIw23yrwhT';800;0.03;0.03;121;53;;163
+784;'NG HNQIS PAC-810';'NG HNQIS PAC-810-MVA-Counsels on warning signs and signs of a normal recovery';'NG HNQIS PAC-810-MVA-Counsels on warning sign';'Counsels on warning signs and signs of a normal recovery';'<p><strong>Warning signs include:</strong></p><ul><li>fever, chills, nausea or vomiting for more than 24 hours</li><li>cramping for more than a few days</li><li>tenderness, pain or distention of the abdomen</li><li>heavy bleeding (more than normal menstrual bleeding)</li><li>foul-smelling vaginal discharge</li><li>delay in resumption of menstrual period by more than eight weeks</li><li>fainting or dizziness.</li></ul><p><strong>Signs of a normal recovery include:</strong></p><ul><li>Some uterine cramping can be expected over the next few days, similar to that of a normal menstrual period.</li><li>Discomfort may be eased by mild analgesics, warm compress or bath.</li><li>Spotting and bleeding should not exceed normal menses.</li><li>A normal period should begin within four to eight weeks.</li></ul>';'IW1d9q0V2ny';810;0.03;0.03;121;53;;163
+785;'NG HNQIS PAC-820';'NG HNQIS PAC-820-MVA-Tells her when to return if follow-up is needed and that she can return anytime or call if she has concerns.';'NG HNQIS PAC-820-MVA-Tells her when to return';'Tells her when to return if follow-up is needed and that she can return anytime or call if she has concerns.';'<ul><li>Give the patient a follow up date.</li><li>Tell her that she can return to the facility anytime she has concerns.</li></ul>';'DiWsa8wXsen';820;0.03;0.03;121;53;;163
+786;'NG HNQIS PAC-830';'NG HNQIS PAC-830-MVA-Discusses reproductive goals and, as appropriate, provides/counsels on family planning.';'NG HNQIS PAC-830-MVA-Discusses reproductive g';'Discusses reproductive goals and, as appropriate, provides/counsels on family planning.';'<p><strong>Review her reproductive health goals. Women should be given detailed information regarding the following</strong></p><ul><li><strong>Post abortion contraception</strong><ul><li>Women can become pregnant as soon as 10 days after the procedure.</li><li>Contraception can help prevent pregnancy.</li><li>Contraceptive counseling and the woman''s method of choice should ideally be provided before she leaves the clinic.</li></ul></li><li><strong>HIV</strong><ul><li>Unprotected sex may have exposed her to HIV infection.</li><li>The earlier a woman knows her HIV status the better; if a woman is HIV-positive, she could access care and support services that can prolong and increase the quality of her life.</li><li>Safer sexual practices, such as condom use, may reduce the risk of receiving or transmitting HIV as well as other sexually transmitted infections.</li><li>Offer voluntary HIV counseling and testing, as well as referrals to local HIV/AIDS support groups.</li></ul></li></ul>';'bsrU0h21Bg8';830;0.03;0.03;121;53;;163
+787;'NG HNQIS PAC-840';'NG HNQIS PAC-840-MVA-Records in the client file and Daily Activity Register';'NG HNQIS PAC-840-MVA-Records in the client fi';'Records in the client file and Daily Activity Register';'<p>Documentation is important after every procedure.</p>';'C2VJO8RiUnf';840;0.03;0.03;121;53;;163
+788;'NG HNQIS STI-100';'NG HNQIS STI-100-Inq-Is this a female client?';'NG HNQIS STI-100-Inq-Is this a female client?';'Is this a female client?';;'VmUpj1hsOLz';100;0.00;0.00;133;53;;
+789;'NG HNQIS STI-110';'NG HNQIS STI-110-Inq-Ensures privacy (Visual and auditory)';'NG HNQIS STI-110-Inq-Ensures privacy (Visual';'Ensures privacy (Visual and auditory)';'<ul><li>Ensure the room provides privacy. Patients are often embarrassed and may withhold important information if they think their condition will become known to others.</li><li>Reassure the patient that confidentiality will be maintained and explain the reason for asking certain questions.</li></ul>';'jLIAiGOW5FG';110;0.01;0.01;133;53;;165
+790;'NG HNQIS STI-120';'NG HNQIS STI-120-Inq-Provider is polite and non-judgmental';'NG HNQIS STI-120-Inq-Provider is polite and n';'Provider is polite and non-judgmental';'<ul><li>Create rapport with the patient.</li><li>Do not create undue barriers to a client seeking STI services.</li><li>Effective interviewing and counseling skills characterized by respect, compassion, and a nonjudgmental attitude toward all patients are essential to obtaining a thorough sexual history and delivering effective prevention messages.</li></ul>';'v6l2gD1P0y1';120;0.01;0.01;133;53;;165
+791;'NG HNQIS STI-130';'NG HNQIS STI-130-Inq-Asks about onset and history of current problem relating to the genital area and associated symptoms';'NG HNQIS STI-130-Inq-Asks about onset and his';'Asks about onset and history of current problem relating to the genital area and associated symptoms';'<p><strong>Take detailed history</strong></p><ul><li>Find out the symptoms and their duration. The symptoms to look out for are: genital ulcer/sore, vaginal discharge, pain passing urine, lower abdominal pains.</li><li>Presumed source and time of infection.</li><li>Medication, self administered or prescribed.</li><li>Ask about associated symptoms: fever, intermenstrual bleeding, post-coital bleeding.</li></ul>';'ROnzX8K8oz6';130;0.12;0.12;133;53;;165
+792;'NG HNQIS STI-140';'NG HNQIS STI-140-Inq-Takes sexual history: type of partner (spouse or casual), date of last encounter, type of exposure (oral, vaginal, anal) regularity of condom use';'NG HNQIS STI-140-Inq-Takes sexual history: ty';'Takes sexual history: type of partner (spouse or casual), date of last encounter, type of exposure (oral, vaginal, anal) regularity of condom use';'<p><strong>Sexual history</strong></p><ul><li>Important in determining which STI the patient could be having.</li><li>Provides the ground for counseling on behaviour change.</li></ul>';'UpzDOHOI6yR';140;0.10;0.10;133;53;;165
+793;'NG HNQIS STI-150';'NG HNQIS STI-150-Inq-Ask if sexual partner has symptoms';'NG HNQIS STI-150-Inq-Ask if sexual partner ha';'Ask if sexual partner has symptoms';'<p><strong>Ask if partner has any symptoms</strong></p><ul><li>This may help in confirmation of presence of an STI.</li><li>Introducing discussion on the partner provides an opportunity to counsel on partner tracing and treatment, and to prevent re-infection. However, remember the partner(s) may well be asymptomatic.</li></ul>';'nK5ItdTQxQH';150;0.02;0.02;133;53;;165
+794;'NG HNQIS STI-160';'NG HNQIS STI-160-Inq-Asks for history of STI in the past, including genital herpes';'NG HNQIS STI-160-Inq-Asks for history of STI';'Asks for history of STI in the past, including genital herpes';'<p><strong>Ask for history of previous STI infection</strong></p><ul><li>This may indicate repeated risky behaviour; repeated exposure from partner or persistence of symptoms from the previous episode.</li><li>Determine the treatment that was given for the previous STI, if there is history of previous STI.</li><li>Determine if the sexual partner(s) was treated during the last episode, as the client could be presenting with a re-infection from the same partner.</li><li>In such a client, emphasize risk reduction. Spend time helping the client to identify a risk reduction plan.</li><li>Emphasize contact tracing and treatment and have a follow up plan for the client.</li></ul>';'cM0wIikFlAl';160;0.02;0.02;133;53;;165
+795;'NG HNQIS STI-170';'NG HNQIS STI-170-Inq-Provider asks about HIV status';'NG HNQIS STI-170-Inq-Provider asks about HIV';'Provider asks about HIV status';'<p><strong>Ask about the client''s HIV status</strong></p><ul><li>A client seeking STI services provides an opportunity for HIV counseling and testing.</li><li>A client coming for STI screening within 72 hours of sexual exposure and agrees to HIV testing will benefit from HIV post-exposure prophylaxis if the HIV test result turns negative.</li><li>Behaviors that put someone at risk of STI (not using condoms, multiple partners, anonymous partners) are the same risk factors for HIV infection to oneself and partner.</li><li>A sore or inflammation from an STD increases the risk of HIV infection.</li></ul>';'Ugizo95OpVW';170;0.02;0.02;133;53;;165
+796;'NG HNQIS STI-180';'NG HNQIS STI-180-Inq-Obtains consent before proceeding with examination (verbal) without coercion';'NG HNQIS STI-180-Inq-Obtains consent before p';'Obtains consent before proceeding with examination (verbal) without coercion';'<ul><li>Before undertaking any physical examination, seek client or guardian consent.</li><li>A client has a right to make choices concerning their body/health. As a provider, give all the information required concerning the illness,importance of examination and the procedure to be done to ensure the consent is informed.</li></ul>';'WZZbAuvlsnp';180;0.01;0.01;133;53;;165
+797;'NG HNQIS STI-190';'NG HNQIS STI-190-PE-Explains the examination procedure and its importance';'NG HNQIS STI-190-PE-Explains the examination';'Explains the examination procedure and its importance';'<p><strong>Explain the examination procedure</strong></p><ul><li>A client has a right to information regarding their health.</li><li>Explaining the procedure will allay anxiety and enhance client co-operation during examination especially because genital examinations are embarrassing to most people.</li></ul>';'lkHlGkWkscn';190;0.02;0.02;134;53;;165
+798;'NG HNQIS STI-200';'NG HNQIS STI-200-PE-Provider gets a chaperone if the client is not of the same sex';'NG HNQIS STI-200-PE-Provider gets a chaperone';'Provider gets a chaperone if the client is not of the same sex';'<p><strong>Have a chaperone during the physical examination</strong></p><ul><li>This may be another health worker or the partner if they came for treatment together.</li><li>This will make the client more comfortable.</li><li>It also helps prevent potential medico-legal complaints regarding sexual/indecent assault against the provider/client.</li></ul>';'NUwnvEVwM1B';200;0.04;0.04;134;53;;165
+799;'NG HNQIS STI-210';'NG HNQIS STI-210-PE-Prepares equipment and area';'NG HNQIS STI-210-PE-Prepares equipment and ar';'Prepares equipment and area';'<p><strong>Prepare equipment and area prior to starting an examination. Have the following supplies/equipment:</strong></p><ul><li>Examination lamp</li><li>Examination couch</li><li>Bi-valved speculums (different sizes)</li><li>Antiseptic</li><li>Gloves</li><li>Lubricant</li></ul>';'mI00BJeLuE5';210;0.02;0.02;134;53;;165
+800;'NG HNQIS STI-220';'NG HNQIS STI-220-PE-Prepares the client adequately';'NG HNQIS STI-220-PE-Prepares the client adequ';'Prepares the client adequately';'<p><strong>Prepare patient adequately</strong></p><ul><li>Ask the client to empty her bladder for the examination to be more comfortable.</li><li>Ask her to clean the perineal area if it is soiled.</li></ul>';'aM8DBLVUhHU';220;0.02;0.02;134;53;;165
+801;'NG HNQIS STI-230';'NG HNQIS STI-230-PE-Ensures privacy during examination';'NG HNQIS STI-230-PE-Ensures privacy during ex';'Ensures privacy during examination';'<p>Ensure the door is closed during the examination and draw the curtains around the examination couch.</p>';'T4MUpOo5zNM';230;0.04;0.04;134;53;;165
+802;'NG HNQIS STI-240';'NG HNQIS STI-240-PE-Washes hands before examination';'NG HNQIS STI-240-PE-Washes hands before exami';'Washes hands before examination';'<p><strong>Wash hands before and after an encounter with every patient to prevent spread of microorganisms</strong></p><ul><li>Wash hands with soap and clean running water.</li></ul>';'hRaEDatf715';240;0.03;0.03;134;53;;165
+803;'NG HNQIS STI-250';'NG HNQIS STI-250-PE-Puts on new gloves';'NG HNQIS STI-250-PE-Puts on new gloves';'Puts on new gloves';'<ul><li>Gloves are important for infection prevention.</li></ul>';'of56WGL3evU';250;0.03;0.03;134;53;;165
+804;'NG HNQIS STI-260';'NG HNQIS STI-260-PE-Positions the client for examination';'NG HNQIS STI-260-PE-Positions the client for';'Positions the client for examination';'<ul><li>Help the woman onto the examination couch.</li><li>Ask the woman to loosen her clothing. Use a sheet or clothing to cover her.</li><li>Have her lie on her back, with her heels close to her bottom and her knees up.</li></ul>';'mz01sS0KetH';260;0.02;0.02;134;53;;165
+805;'NG HNQIS STI-270';'NG HNQIS STI-270-PE-Performs a general examination';'NG HNQIS STI-270-PE-Performs a general examin';'Performs a general examination';'<p>All examinations should begin with a general assessment, including vital signs and inspection of the skin, to detect signs of systemic disease.</p>';'JFIrXLrPZkj';270;0.03;0.03;134;53;;165
+806;'NG HNQIS STI-280';'NG HNQIS STI-280-PE-Performs abdominal examination by palpation';'NG HNQIS STI-280-PE-Performs abdominal examin';'Performs abdominal examination by palpation';'<ul><li>All sexually active women presenting with lower abdominal pain should be carefully evaluated for pelvic inflammatory disease (PID).</li><li>In addition, routine abdominal examination should be carried out on all women with a presumptive STI since some women with PID or endometritis will not complain of lower abdominal pain.</li></ul>';'WnIFC4Lq9VF';280;0.05;0.05;134;53;;165
+807;'NG HNQIS STI-290';'NG HNQIS STI-290-PE-Palpates for inguinal lymph nodes';'NG HNQIS STI-290-PE-Palpates for inguinal lym';'Palpates for inguinal lymph nodes';'<p><strong>Examine inguinal lymph nodes checking for enlargement, tenderness, consistency and whether they are ,matted or not</strong></p><ul><li>Inguinal and femoral buboes are localised enlargements of the lymph nodes in the groin area, which are painful and may be fluctuant. They are frequently associated with LGV and chancroid. In many cases of chancroid an associated genital ulcer is visible.</li><li>However, remember that Non-sexually transmitted local and systemic infections (e.g. infections of the lower limb or tuberculous lymphadenopathy) can also cause swelling of inguinal lymph nodes.</li></ul>';'GgSKkpWhYph';290;0.03;0.03;134;53;;165
+808;'NG HNQIS STI-300';'NG HNQIS STI-300-PE-Examines external genitalia looking for ulcers and separates the labia while inspecting';'NG HNQIS STI-300-PE-Examines external genital';'Examines external genitalia looking for ulcers and separates the labia while inspecting';'<ul><li>Carry out the examination in good light.</li><li>Examine the external genitalia.</li><li>Using the gloved hand, gently look for lumps, swelling, sores, vesicles.</li><li>Separate the labia to look to examine the inner aspects of the vulva.</li></ul>';'EBvoe758MmH';300;0.05;0.05;134;53;;165
+809;'NG HNQIS STI-310';'NG HNQIS STI-310-PE-Performs vaginal examination as per protocol';'NG HNQIS STI-310-PE-Performs vaginal examinat';'Performs vaginal examination as per protocol';'<p>Check the vaginal opening for any discharge, the colour, consistency and smell of the discharge.</p>';'LBihPEtCaat';310;0.06;0.06;134;53;;165
+810;'NG HNQIS STI-320';'NG HNQIS STI-320-PE-Performs speculum examination';'NG HNQIS STI-320-PE-Performs speculum examina';'Performs speculum examination';'<ul><li>Clean the perineum and external genitalia using the five swab technique.</li><li>Gently insert a warm appropriate size speculum.</li><li>Be careful not to press on the urethra or clitoris because these areas are very sensitive.</li><li>Fix the blades to visualize the cervix.</li><li>Check for vaginal discharge.</li><li>Look for signs of cervical infection by checking for yellowish discharge or easy bleeding when the cervix is touched with a swab.</li><li>Note any abnormal growths or sores on the cervix.</li><li>Notice if the cervical os is open or closed, and whether there is any bleeding.</li><li>Take samples for culture (if required and resources are available).</li></ul>';'TPJykWMDxXQ';320;0.06;0.06;134;53;;165
+811;'NG HNQIS STI-330';'NG HNQIS STI-330-PE-Performs bimanual palpation';'NG HNQIS STI-330-PE-Performs bimanual palpati';'Performs bimanual palpation';'<p><strong>Perform bimanual exam</strong></p><ul><li>Lubricate your gloved fingers.</li><li>Gently insert two fingers into the vagina. Place the other hand gently on the lower abdomen.</li><li>Gently move the cervix from side to side ("cervical rocking" test) and observe for tenderness (cervical motion tenderness) which is a sign of PID.</li><li>Check for cervical mobility.</li><li>Palpate the uterus by pressing down on the lower part of the abdomen and moving the fingers behind the cervix to push the uterus towards your abdominal hand. Feel for its size and shape.<ul><li>If it feels soft and large, she is probably pregnant</li><li>If it feels lumpy and hard, she may have a fibroid or other growth</li><li>If it tender, she may have PID</li><li>If it is not freely mobile, she could have adhesions from an old infection.</li></ul></li><li>Palpate the right and left adenexae gently by moving your fingers on the sides of the cervix. Gently press down with the abdominal hand. At the same time, press up with your vaginal fingers and feel for masses.</li></ul>';'NhS0gLg2Nrd';330;0.06;0.06;134;53;;165
+812;'NG HNQIS STI-340';'NG HNQIS STI-340-PE-Examines perianal area';'NG HNQIS STI-340-PE-Examines perianal area';'Examines perianal area';'<p><strong>Examine the anal area</strong></p><ul><li>Ask the patient to lie on her side with the top leg flexed up towards the chest.</li><li>Examine the anus for ulcers, warts, rashes, or discharge.</li></ul>';'zaWwX77Gi60';340;0.05;0.05;134;53;;165
+813;'NG HNQIS STI-350';'NG HNQIS STI-350-Post Exam-Post -examination IP procedures correctly performed';'NG HNQIS STI-350-Post Exam-Post -examination';'Post -examination IP procedures correctly performed';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>Immediately soak ALL the instruments used after procedure, or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes.</li><li>Dispose of waste material in leak proof container or plastic bag.</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution.</li><li>After soaking for 10 minutes, remove instruments from solution.</li><li>Clean instruments immediately.</li><li>Remove gloves following the glove removal procedure.</li></ul>';'URYu8r9VvX1';350;0.05;0.05;135;53;;165
+814;'NG HNQIS STI-360';'NG HNQIS STI-360-Post Exam-Washes hands after examination';'NG HNQIS STI-360-Post Exam-Washes hands after';'Washes hands after examination';'<p>Wash hands with soap and running water after examining a patient or performing a procedure to prevent spread of microorganisms.</p>';'DMdjkVhPDZK';360;0.05;0.05;135;53;;165
+815;'NG HNQIS STI-370';'NG HNQIS STI-370-DxTx-Makes a correct diagnosis';'NG HNQIS STI-370-DxTx-Makes a correct diagnos';'Makes a correct diagnosis';'<p>Make a diagnosis following the flow charts/algorithms.</p>';'Z6rB3QZJzxd';370;0.20;0.20;136;53;;166
+816;'NG HNQIS STI-380';'NG HNQIS STI-380-DxTx-Gives the correct treatment using the standard flow charts/algorithms';'NG HNQIS STI-380-DxTx-Gives the correct treat';'Gives the correct treatment using the standard flow charts/algorithms';'<p>Identify treatment using the flow charts/algorithms</p>';'I5VbQ3zM3mL';380;0.20;0.20;136;53;;166
+817;'NG HNQIS STI-390';'NG HNQIS STI-390-Counseling-Provider uses education material during counseling';'NG HNQIS STI-390-Counseling-Provider uses edu';'Provider uses education material during counseling';'<p><strong>It is important to use education material to enhance understanding during counseling. The material should cover the critical areas which include:</strong></p><ul><li>Counseling</li><li>Compliance to recommended treatment</li><li>Condoms</li><li>Contact treatment</li></ul>';'MhM5wCJhQML';390;0.03;0.03;137;53;;166
+818;'NG HNQIS STI-400';'NG HNQIS STI-400-Counseling-Provides information about the current STI, including transmission and prevention';'NG HNQIS STI-400-Counseling-Provides informat';'Provides information about the current STI, including transmission and prevention';'<ul><li>Inform the client what STI they have.</li><li>Discuss mechanisms of transmission.</li><li>Discuss potential health complications that can arise if the STI is not treated e.g. Pelvic infections; tubal blockage causing infertility; risk of ectopic pregnancy; pregnancy complications such as miscarriage; transmission of infection to the new born baby among others.</li><li>Discuss risky sexual behaviour that increases the risk of getting an STI.</li><li>Discuss ways of preventing infection with STIs including:<ul><li>delaying sexual activity (for adolescents);</li><li>decreasing the number of sex partners;</li><li>using condoms correctly and consistently.</li><li>early treatment of STI to prevent infection to others.</li></ul></li></ul>';'HZN7MstMwKK';400;0.03;0.03;137;53;;166
+819;'NG HNQIS STI-410';'NG HNQIS STI-410-Counseling-Counsels on drug dosage, duration of treatment including side effects';'NG HNQIS STI-410-Counseling-Counsels on drug';'Counsels on drug dosage, duration of treatment including side effects';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel on specific doses per day, total number of days of treatment, and potential side effects; including severe side effects that require a return visit to hospital.</li></ul>';'Qsi53Z2mCoF';410;0.06;0.06;137;53;;166
+820;'NG HNQIS STI-420';'NG HNQIS STI-420-Counseling-Provider explores barriers to treatment adherence';'NG HNQIS STI-420-Counseling-Provider explores';'Provider explores barriers to treatment adherence';'<ul><li>Adherence to treatment and completion of the dose is essential to break the STI transmission cycle and to prevent complications.</li><li>Explore issues that might hinder treatment such as: fear of spouse/partner discovering they are on treatment for an STI.</li><li>Discuss with the client ways of tackling the barriers.</li></ul>';'Ya3KVVbkUJf';420;0.06;0.06;137;53;;166
+821;'NG HNQIS STI-430';'NG HNQIS STI-430-Counseling-DOT for single dose drugs offered on site/first dose given on site';'NG HNQIS STI-430-Counseling-DOT for single do';'DOT for single dose drugs offered on site/first dose given on site';'<ul><li>WHO recommends that, where possible, single-dose therapy be used.</li><li>It is also preferred to initiate treatment as soon as possible.</li></ul>';'jnCEfqd5zEM';430;0.03;0.03;137;53;;166
+822;'NG HNQIS STI-440';'NG HNQIS STI-440-Counseling-Counsels on risk reduction';'NG HNQIS STI-440-Counseling-Counsels on risk';'Counsels on risk reduction';'<p><strong>Counsel the client on risk reduction to prevent re-infection</strong></p><ul><li>Abstinence/reduction of number of sexual partners.</li><li>Correct and consistent condom use.</li><li>Delaying sexual activity for adolescents and young people.</li><li>Remaining faithful to one uninfected partner.</li></ul>';'myNHhF4hWgE';440;0.06;0.06;137;53;;166
+823;'NG HNQIS STI-450';'NG HNQIS STI-450-Counseling-Counsels on HIV testing and offers the test/refers for the test if the client is willing.';'NG HNQIS STI-450-Counseling-Counsels on HIV t';'Counsels on HIV testing and offers the test/refers for the test if the client is willing.';'<ul><li>Both ulcerative and non-ulcerative STIs increase the risk of sexual transmission of HIV.</li><li>A client at risk of STI is also at risk of HIV.</li></ul>';'iUZ4bgveINq';450;0.06;0.06;137;53;;166
+824;'NG HNQIS STI-460';'NG HNQIS STI-460-Counseling-Counsels and demonstrates condom use and provides the client with condoms';'NG HNQIS STI-460-Counseling-Counsels and demo';'Counsels and demonstrates condom use and provides the client with condoms';'<p><strong>Condom use</strong></p><ul><li>Correct and consistent condom use is the most reliable method available method of protecting oneself or their partner from any risk of STIs.</li><li>STIs can still occur despite condom use: genital ulcers or warts can be transmitted through contact with parts of the body not covered by the condom.</li><li>Condoms may fail if: handled or stored incorrectly e.g. in wallets or in a hot place; or if used with oil-based lubricants.</li><li>Condom breakage is usually due to incorrect use, not due to defects in the device.</li><li>When used correctly during every act of intercourse, condoms can greatly reduce the risks of both pregnancy and STI (dual protection), including HIV infection.</li><li>Demonstrate condom use, do not make an assumption that the patient knows how to use condoms.</li><li>Provide the client with condom supply/ advice client to buy if not available for free distribution.</li></ul>';'qSUxX2xZ8vM';460;0.06;0.06;137;53;;166
+825;'NG HNQIS STI-470';'NG HNQIS STI-470-Counseling-Counsels on contact tracing, partner notification and treatment';'NG HNQIS STI-470-Counseling-Counsels on conta';'Counsels on contact tracing, partner notification and treatment';'<p><strong>Ask the client to bring partner(s) for treatment/advice partner to come for treatment</strong></p><ul><li>The sexual partner(s) of STI patients are likely to be infected and should be offered treatment.</li><li>Further transmission of STIs and reinfection can be prevented by referral of sexual partners for diagnosis and treatment.</li><li>Partner notification and management offers an opportunity to identify and treat people who otherwise would not receive treatment.</li><li>In case the source of infection was from a casual sexual encounter and there has been no sexual contact with the regular partner/spouse, counsel on importance of preventing transmission to the partner.</li><li>These actions, however, should be carried out with sensitivity and consideration of social and cultural factors to avoid ethical and practical problems such as rejection and violence, against the woman.</li></ul>';'waqp9HmBuXh';470;0.06;0.06;137;53;;166
+826;'NG HNQIS STI-480';'NG HNQIS STI-480-Counseling-Explains re-infection in case the partner is not treated';'NG HNQIS STI-480-Counseling-Explains re-infec';'Explains re-infection in case the partner is not treated';'<p>Emphasize that re-infection will occur if the sexual partner is not treated, regardless of whether the partner is symptomatic or not.</p>';'KQe1Cp119fd';480;0.06;0.06;137;53;;166
+827;'NG HNQIS STI-490';'NG HNQIS STI-490-Counseling-Explains where and when to seek follow up care, and gives a follow up visit date';'NG HNQIS STI-490-Counseling-Explains where an';'Explains where and when to seek follow up care, and gives a follow up visit date';'<ul><li>For continuity of care, it is better for the client to return to the same facility if they have problems.</li><li>Give the client a number for the facility they can call to ask any question.</li><li>Give the client a follow up visit if required.</li></ul>';'BYWN9AjRqiv';490;0.03;0.03;137;53;;166
+828;'NG HNQIS STI-500';'NG HNQIS STI-500-Counseling-Allows the client to ask questions';'NG HNQIS STI-500-Counseling-Allows the client';'Allows the client to ask questions';'<p>Always give the client an opportunity to ask questions and to seek clarifications. If you do not give them a chance, they may feel embarrassed to ask and may end up leaving the clinic with a problem or without understanding your instructions.</p>';'jEUZdC5BuR2';500;0.03;0.03;137;53;;166
+829;'NG HNQIS STI-510';'NG HNQIS STI-510-Counseling-Documents services given';'NG HNQIS STI-510-Counseling-Documents service';'Documents services given';'<ul><li>Documentation is part of good clinical practice.</li><li>Patient follow up is easy when previous records are available.</li></ul>';'K4It7WEsMnC';510;0.03;0.03;137;53;;166
+830;'NG HNQIS STI-520';'NG HNQIS STI-520-WE-All supplies available';'NG HNQIS STI-520-WE-All supplies available';'All supplies available';'<p>Have the necessary supplies including speculums of different sizes, gloves, antiseptic etc.</p>';'AAstCNR7veb';520;0.20;0.20;138;53;;167
+831;'NG HNQIS STI-530';'NG HNQIS STI-530-WE-Light source for genital and speculum examination';'NG HNQIS STI-530-WE-Light source for genital';'Light source for genital and speculum examination';'<p>Have a light source for genital examination so as not to miss a pathology.</p>';'lKCme8yi7T4';530;0.20;0.20;138;53;;167
+832;'NG HNQIS STI-540';'NG HNQIS STI-540-WE-STI algorithms and SOPs available';'NG HNQIS STI-540-WE-STI algorithms and SOPs a';'STI algorithms and SOPs available';'<ul><li>SOPs/flow charts/algorithms represent a combination of practical and scientific information necessary for decision making.</li><li>These are required for syndromic management of STIs which does not require equipment, are easy to use and ensure immediate provision of services to all clients.</li><li>SOPs and algorithms need to be followed to provide standardized care and to reduce chances of errors in diagnosis and treatment.</li></ul>';'nv2r1AtZWIF';540;0.20;0.20;138;53;;167
+833;'NG HNQIS STI-550';'NG HNQIS STI-550-WE-IEC materials';'NG HNQIS STI-550-WE-IEC materials';'IEC materials';'<p><strong>Have STI IEC materials for distribution</strong></p><ul><li>Use IEC materials to help change risky sexual health-related behaviors and to reinforce safe practices.</li><li>The IEC materials should:<ul><li>Have a clear objective to change or reinforce sexual behavior.</li><li>Target a specific audience e.g. married couples or adolescents</li><li>Address a specific problems</li><li>Set a timeframe within which the behavior change is expected to occur.</li></ul></li></ul>';'gXXAyrkeX5x';550;0.20;0.20;138;53;;167
+834;'NG HNQIS STI-560';'NG HNQIS STI-560-WE-Condoms';'NG HNQIS STI-560-WE-Condoms';'Condoms';'<p>Important to provide condoms to the client to avoid transmitting the STI to partner(s) and to prevent new infection with another STI/HIV.</p>';'rOVzs4jdp1o';560;0.20;0.20;138;53;;167
+835;'NG HNQIS STI-600';'NG HNQIS STI-600-Inq-Is this a male client?';'NG HNQIS STI-600-Inq-Is this a male client?';'Is this a male client?';;'ThbwvXfIPqc';600;0.00;0.00;139;53;;
+836;'NG HNQIS STI-610';'NG HNQIS STI-610-Inq-Ensures privacy (Visual and auditory)';'NG HNQIS STI-610-Inq-Ensures privacy (Visual';'Ensures privacy (Visual and auditory)';'<ul><li>Ensure the room provides privacy. Patients are often embarrassed and may withhold important information if they think their condition will become known to others.</li><li>Reassure the patient that confidentiality will be maintained and explain the reason for asking certain questions.</li></ul>';'jHwXX0ey1Cx';610;0.01;0.01;139;53;;165
+837;'NG HNQIS STI-620';'NG HNQIS STI-620-Inq-Provider is polite and non-judgmental';'NG HNQIS STI-620-Inq-Provider is polite and n';'Provider is polite and non-judgmental';'<ul><li>Create rapport with the patient.</li><li>Do not create undue barriers to a client seeking STI services.</li><li>Effective interviewing and counseling skills characterized by respect, compassion, and a nonjudgmental attitude toward all patients are essential to obtaining a thorough sexual history and delivering effective prevention messages.</li></ul>';'fnoBRZAg2Kf';620;0.01;0.01;139;53;;165
+838;'NG HNQIS STI-630';'NG HNQIS STI-630-Inq-Asks about onset and history of current problem relating to the genital area and associated symptoms';'NG HNQIS STI-630-Inq-Asks about onset and his';'Asks about onset and history of current problem relating to the genital area and associated symptoms';'<p><strong>Take detailed history</strong></p><ul><li>Find out the symptoms and their duration. The symptoms to look out for are: genital ulcer/sore, vaginal discharge, pain passing urine, lower abdominal pains.</li><li>Presumed source and time of infection.</li><li>Medication, self administered or prescribed.</li><li>Ask about associated symptoms: fever, intermenstrual bleeding, post-coital bleeding.</li></ul>';'gik9Zlrmx1p';630;0.12;0.12;139;53;;165
+839;'NG HNQIS STI-640';'NG HNQIS STI-640-Inq-Takes sexual history: type of partner (spouse or casual), date of last encounter, type of exposure (oral, vaginal,anal) regularity of condom use';'NG HNQIS STI-640-Inq-Takes sexual history: ty';'Takes sexual history: type of partner (spouse or casual), date of last encounter, type of exposure (oral, vaginal,anal) regularity of condom use';'<p><strong>Sexual history</strong></p><ul><li>Important in determining which STI the patient could be having.</li><li>Provides the ground for counseling on behaviour change.</li></ul>';'PbVLJr3humb';640;0.10;0.10;139;53;;165
+840;'NG HNQIS STI-650';'NG HNQIS STI-650-Inq-Ask if sexual partner has symptoms';'NG HNQIS STI-650-Inq-Ask if sexual partner ha';'Ask if sexual partner has symptoms';'<p><strong>Ask if partner has any symptoms</strong></p><ul><li>This may help in confirmation of presence of an STI.</li><li>Introducing discussion on the partner provides an opportunity to counsel on partner tracing and treatment, and to prevent re-infection. However, remember the partner(s) may well be asymptomatic.</li></ul>';'B8L4lHVDyZX';650;0.02;0.02;139;53;;165
+841;'NG HNQIS STI-660';'NG HNQIS STI-660-Inq-Asks for history of STI in the past, including genital herpes';'NG HNQIS STI-660-Inq-Asks for history of STI';'Asks for history of STI in the past, including genital herpes';'<p><strong>Ask for history of previous STI infection</strong></p><ul><li>This may indicate repeated risky behaviour; repeated exposure from partner or persistence of symptoms from the previous episode.</li><li>Determine the treatment that was given for the previous STI, if there is history of previous STI.</li><li>Determine if the sexual partner(s) was treated during the last episode, as the client could be presenting with a re-infection from the same partner.</li><li>In such a client, emphasize risk reduction. Spend time helping the client to identify a risk reduction plan.</li><li>Emphasize contact tracing and treatment and have a follow up plan for the client.</li></ul>';'bt9bCOEnMED';660;0.02;0.02;139;53;;165
+842;'NG HNQIS STI-670';'NG HNQIS STI-670-Inq-Provider asks about HIV status';'NG HNQIS STI-670-Inq-Provider asks about HIV';'Provider asks about HIV status';'<p><strong>Ask about the client''s HIV status</strong></p><ul><li>A client seeking STI services provides an opportunity for HIV counseling and testing.</li><li>A client coming for STI screening within 72 hours of sexual exposure and agrees to HIV testing will benefit from HIV post-exposure prophylaxis if the HIV test result turns negative.</li><li>Behaviors that put someone at risk of STI (not using condoms, multiple partners, anonymous partners) are the same risk factors for HIV infection to oneself and partner.</li><li>A sore or inflammation from an STD increases the risk of HIV infection.</li></ul>';'Uz8cKfLPtfI';670;0.02;0.02;139;53;;165
+843;'NG HNQIS STI-680';'NG HNQIS STI-680-Inq-Obtains consent before proceeding with examination (verbal) without coercion';'NG HNQIS STI-680-Inq-Obtains consent before p';'Obtains consent before proceeding with examination (verbal) without coercion';'<ul><li>Before undertaking any physical examination, seek client or guardian consent.</li><li>A client has a right to make choices concerning their body/health. As a provider, give all the information required concerning the illness,importance of examination and the procedure to be done to ensure the consent is informed.</li></ul>';'Gj5Okf2HybE';680;0.01;0.01;139;53;;165
+844;'NG HNQIS STI-690';'NG HNQIS STI-690-PE-Explains the examination procedure and its importance';'NG HNQIS STI-690-PE-Explains the examination';'Explains the examination procedure and its importance';'<p><strong>Explain the examination procedure</strong></p><ul><li>A client has a right to information regarding their health.</li><li>Explaining the procedure will allay anxiety and enhance client co-operation during examination especially because genital examinations are embarrassing to most people.</li></ul>';'SxlPKBThQ7R';690;0.02;0.02;140;53;;165
+845;'NG HNQIS STI-700';'NG HNQIS STI-700-PE-Provider gets a chaperone if the client is not of the same sex';'NG HNQIS STI-700-PE-Provider gets a chaperone';'Provider gets a chaperone if the client is not of the same sex';'<p><strong>Have a chaperone during the physical examination</strong></p><ul><li>This may be another health worker or the partner if they came for treatment together.</li><li>This will make the client more comfortable.</li><li>It also helps prevent potential medico-legal complaints regarding sexual/indecent assault against the provider/client.</li></ul>';'en6TUHNLSbe';700;0.04;0.04;140;53;;165
+846;'NG HNQIS STI-710';'NG HNQIS STI-710-PE-Prepares equipment and area';'NG HNQIS STI-710-PE-Prepares equipment and ar';'Prepares equipment and area';'<p><strong>Prepare equipment and area prior to starting an examination. Have the following supplies/equipment:</strong></p><ul><li>Examination lamp</li><li>Examination couch</li><li>Bi-valved speculums (different sizes)</li><li>Antiseptic</li><li>Gloves</li><li>Lubricant</li></ul>';'hYUwadVp0AW';710;0.02;0.02;140;53;;165
+847;'NG HNQIS STI-720';'NG HNQIS STI-720-PE-Prepares the client adequately';'NG HNQIS STI-720-PE-Prepares the client adequ';'Prepares the client adequately';'<p><strong>Prepare patient adequately</strong></p><ul><li>Ask the client to empty her bladder for the examination to be more comfortable.</li><li>Ask her to clean the perineal area if it is soiled.</li></ul>';'bKIYVJAhlzc';720;0.02;0.02;140;53;;165
+848;'NG HNQIS STI-730';'NG HNQIS STI-730-PE-Ensures privacy during examination';'NG HNQIS STI-730-PE-Ensures privacy during ex';'Ensures privacy during examination';'<p>Ensure the door is closed during the examination and draw the curtains around the examination couch.</p>';'Gc1vHIZYj9A';730;0.04;0.04;140;53;;165
+849;'NG HNQIS STI-740';'NG HNQIS STI-740-PE-Washes hands before examination';'NG HNQIS STI-740-PE-Washes hands before exami';'Washes hands before examination';'<p><strong>Wash hands before and after an encounter with every patient to prevent spread of microorganisms</strong></p><ul><li>Wash hands with soap and clean running water.</li></ul>';'rSzbdWAsMoN';740;0.03;0.03;140;53;;165
+850;'NG HNQIS STI-750';'NG HNQIS STI-750-PE-Puts on new gloves';'NG HNQIS STI-750-PE-Puts on new gloves';'Puts on new gloves';'<ul><li>Gloves are important for infection prevention.</li></ul>';'bTRjwrCFrri';750;0.03;0.03;140;53;;165
+851;'NG HNQIS STI-760';'NG HNQIS STI-760-PE-Positions the client for examination';'NG HNQIS STI-760-PE-Positions the client for';'Positions the client for examination';'<ul><li>Help the woman onto the examination couch.</li><li>Ask the woman to loosen her clothing. Use a sheet or clothing to cover her.</li><li>Have her lie on her back, with her heels close to her bottom and her knees up.</li></ul>';'E99yV1KriXa';760;0.02;0.02;140;53;;165
+852;'NG HNQIS STI-770';'NG HNQIS STI-770-PE-Performs a general examination';'NG HNQIS STI-770-PE-Performs a general examin';'Performs a general examination';'<p>All examinations should begin with a general assessment, including vital signs and inspection of the skin, to detect signs of systemic disease.</p>';'WAX5o2vCMXE';770;0.03;0.03;140;53;;165
+853;'NG HNQIS STI-780';'NG HNQIS STI-780-PE-Palpates for inguinal lymph nodes';'NG HNQIS STI-780-PE-Palpates for inguinal lym';'Palpates for inguinal lymph nodes';'<p><strong>Examine inguinal lymph nodes checking for enlargement, tenderness, consistency and whether they are ,matted or not</strong></p><ul><li>Inguinal and femoral buboes are localised enlargements of the lymph nodes in the groin area, which are painful and may be fluctuant. They are frequently associated with LGV and chancroid. In many cases of chancroid an associated genital ulcer is visible.</li><li>However, remember that Non-sexually transmitted local and systemic infections (e.g. infections of the lower limb or tuberculous lymphadenopathy) can also cause swelling of inguinal lymph nodes.</li></ul>';'w8QhA7CvztF';780;0.03;0.03;140;53;;165
+854;'NG HNQIS STI-790';'NG HNQIS STI-790-PE-Inspects external genitalia for ulcers, vesicles or urethral discharge; retracts foreskin in uncircumcised clients';'NG HNQIS STI-790-PE-Inspects external genital';'Inspects external genitalia for ulcers, vesicles or urethral discharge; retracts foreskin in uncircumcised clients';'<ul><li>Inspect for ulcers, sores and vesicles on the genitalia.</li><li>Check for urethral discharge:<ul><li>Most commonly, urethral discharge and dysuria in men are caused by infection with gonorrhea or chlamydia. Occasionally other bacteria are the cause.</li><li>Scanty clear discharge is more characteristic of chlamydia, and more copious yellow purulent discharge is characteristic of gonorrhea. However, they frequently occur together.</li></ul></li><li>In uncircumcised men, discharge from the glans or foreskin may appear to come from the meatus, hence the need to retract the foreskin to determine the source of the discharge.</li></ul>';'XrSKmlZ1xSx';790;0.09;0.09;140;53;;165
+855;'NG HNQIS STI-800';'NG HNQIS STI-800-PE-"Milks" the urethra';'NG HNQIS STI-800-PE-"Milks" the urethra';'"Milks" the urethra';'<ul><li>If you cannot see an obvious urethral discharge, milk the urethra or ask the patient to milk the urethra gently in order to express any discharge.</li><li>This is done by applying gentle pressure to the penis.</li><li>It may be necessary to milk the urethra, starting at the base of the penis. Place one finger or the palm of the hand beneath the penis and one or two fingers on top at the base. Applying gentle pressure, move the hands outward towards the tip of the penis. Repeat the process if necessary.</li><li>If a discharge is present, wipe it with a swab and dispose of it in a leak-proof container.</li></ul>';'hrjMoqjkthe';800;0.09;0.09;140;53;;165
+856;'NG HNQIS STI-810';'NG HNQIS STI-810-PE-Palpates the scrotum, feeling for the testis, epididymis, and spermatic cord on each side';'NG HNQIS STI-810-PE-Palpates the scrotum, fee';'Palpates the scrotum, feeling for the testis, epididymis, and spermatic cord on each side';'<ul><li>Palpate the scrotum, feeling for the testis, epididymis, and spermatic cord on each side checking for tenderness.<ul><li>Epididymitis usually manifests itself by acute onset of unilateral testicular pain and swelling, often with tenderness of the epididymis and vas deferens, and occasionally with erythema and oedema of the overlying skin.</li><li>In men under 35 years this is more frequently caused by sexually transmitted organisms than in those over 35 years.</li><li>When the epididymitis is accompanied by urethral discharge, it should be presumed to be of sexually transmitted origin, commonly gonococcal and/or chlamydial in nature.</li><li>The adjacent testis is often also inflamed (orchitis), giving rise to epididymo-orchitis.</li><li>If not effectively treated, STI-related epididymitis may lead to infertility.</li></ul></li><li>It is important to consider other non-infectious causes of scrotal swelling, such as trauma, testicular torsion and tumour.</li></ul>';'lTU14n9Bbo2';810;0.09;0.09;140;53;;165
+857;'NG HNQIS STI-820';'NG HNQIS STI-820-PE-Examines perianal area';'NG HNQIS STI-820-PE-Examines perianal area';'Examines perianal area';'<p><strong>Examine the anal area</strong></p><ul><li>Ask the patient to lie on her side with the top leg flexed up towards the chest.</li><li>Examine the anus for ulcers, warts, rashes, or discharge.</li></ul>';'KyEsdFCgAYN';820;0.05;0.05;140;53;;165
+858;'NG HNQIS STI-830';'NG HNQIS STI-830-Post Exam-Post -examination IP procedures correctly performed';'NG HNQIS STI-830-Post Exam-Post -examination';'Post -examination IP procedures correctly performed';'<p><strong>Observe infection prevention procedures</strong></p><ul><li>Immediately soak ALL the instruments used after procedure, or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes.</li><li>Dispose of waste material in leak proof container or plastic bag.</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution.</li><li>After soaking for 10 minutes, remove instruments from solution.</li><li>Clean instruments immediately.</li><li>Remove gloves following the glove removal procedure.</li></ul>';'VaQYnfCQ2qP';830;0.05;0.05;141;53;;165
+859;'NG HNQIS STI-840';'NG HNQIS STI-840-Post Exam-Washes hands after examination';'NG HNQIS STI-840-Post Exam-Washes hands after';'Washes hands after examination';'<p>Wash hands with soap and running water after examining a patient or performing a procedure to prevent spread of microorganisms.</p>';'bP2mAZlCOIz';840;0.05;0.05;141;53;;165
+860;'NG HNQIS STI-850';'NG HNQIS STI-850-DxTx-Makes a correct diagnosis';'NG HNQIS STI-850-DxTx-Makes a correct diagnos';'Makes a correct diagnosis';'<p>Identify treatment using the flow charts/algorithms in the <a href="https://drive.google.com/file/d/0BxIl9Fv9u436bmQtclg5TkZMWVE/view">STI Diagnosis and Treatment Table</a></p>';'V78qolC3TG7';850;0.20;0.20;142;53;;166
+861;'NG HNQIS STI-860';'NG HNQIS STI-860-DxTx-Gives the correct treatment using the standard flow charts/algorithms';'NG HNQIS STI-860-DxTx-Gives the correct treat';'Gives the correct treatment using the standard flow charts/algorithms';'<p>Make a diagnosis following the flow charts/algorithms in the <a href="https://drive.google.com/file/d/0BxIl9Fv9u436bmQtclg5TkZMWVE/view">STI Diagnosis and Treatment Table</a></p>';'cireoVZFaxv';860;0.20;0.20;142;53;;166
+862;'NG HNQIS STI-870';'NG HNQIS STI-870-Counseling-Provider uses education material during counseling';'NG HNQIS STI-870-Counseling-Provider uses edu';'Provider uses education material during counseling';'<p><strong>It is important to use education material to enhance understanding during counseling. The material should cover the critical areas which include:</strong></p><ul><li>Counseling</li><li>Compliance to recommended treatment</li><li>Condoms</li><li>Contact treatment</li></ul>';'JJx9OENRHoQ';870;0.03;0.03;143;53;;166
+863;'NG HNQIS STI-880';'NG HNQIS STI-880-Counseling-Provides information about the current STI, including transmission and prevention';'NG HNQIS STI-880-Counseling-Provides informat';'Provides information about the current STI, including transmission and prevention';'<ul><li>Inform the client what STI they have.</li><li>Discuss mechanisms of transmission.</li><li>Discuss potential health complications that can arise if the STI is not treated e.g. Pelvic infections; tubal blockage causing infertility; risk of ectopic pregnancy; pregnancy complications such as miscarriage; transmission of infection to the new born baby among others.</li><li>Discuss risky sexual behaviour that increases the risk of getting an STI.</li><li>Discuss ways of preventing infection with STIs including:<ul><li>delaying sexual activity (for adolescents);</li><li>decreasing the number of sex partners;</li><li>using condoms correctly and consistently.</li><li>early treatment of STI to prevent infection to others.</li></ul></li></ul>';'CoxhWPfFYO5';880;0.03;0.03;143;53;;166
+864;'NG HNQIS STI-890';'NG HNQIS STI-890-Counseling-Counsels on drug dosage, duration of treatment including side effects';'NG HNQIS STI-890-Counseling-Counsels on drug';'Counsels on drug dosage, duration of treatment including side effects';'<p><strong>Counsel on proper dosage</strong></p><ul><li>Counsel on specific doses per day, total number of days of treatment, and potential side effects; including severe side effects that require a return visit to hospital.</li></ul>';'hFAYkfTgjKC';890;0.06;0.06;143;53;;166
+865;'NG HNQIS STI-900';'NG HNQIS STI-900-Counseling-Provider explores barriers to treatment adherence';'NG HNQIS STI-900-Counseling-Provider explores';'Provider explores barriers to treatment adherence';'<ul><li>Adherence to treatment and completion of the dose is essential to break the STI transmission cycle and to prevent complications.</li><li>Explore issues that might hinder treatment such as: fear of spouse/partner discovering they are on treatment for an STI.</li><li>Discuss with the client ways of tackling the barriers.</li></ul>';'PLy2mJT6c2t';900;0.06;0.06;143;53;;166
+866;'NG HNQIS STI-910';'NG HNQIS STI-910-Counseling-DOT for single dose drugs offered on site/first dose given on site';'NG HNQIS STI-910-Counseling-DOT for single do';'DOT for single dose drugs offered on site/first dose given on site';'<ul><li>WHO recommends that, where possible, single-dose therapy be used.</li><li>It is also preferred to initiate treatment as soon as possible.</li></ul>';'oEi3kpKKV3q';910;0.03;0.03;143;53;;166
+867;'NG HNQIS STI-920';'NG HNQIS STI-920-Counseling-Counsels on risk reduction';'NG HNQIS STI-920-Counseling-Counsels on risk';'Counsels on risk reduction';'<p><strong>Counsel the client on risk reduction to prevent re-infection</strong></p><ul><li>Abstinence/reduction of number of sexual partners.</li><li>Correct and consistent condom use.</li><li>Delaying sexual activity for adolescents and young people.</li><li>Remaining faithful to one uninfected partner.</li></ul>';'ZBPHyAphRoY';920;0.06;0.06;143;53;;166
+868;'NG HNQIS STI-930';'NG HNQIS STI-930-Counseling-Counsels on HIV testing and offers the test/refers for the test if the client is willing.';'NG HNQIS STI-930-Counseling-Counsels on HIV t';'Counsels on HIV testing and offers the test/refers for the test if the client is willing.';'<ul><li>Both ulcerative and non-ulcerative STIs increase the risk of sexual transmission of HIV.</li><li>A client at risk of STI is also at risk of HIV.</li></ul>';'drjExSrTXaM';930;0.06;0.06;143;53;;166
+869;'NG HNQIS STI-940';'NG HNQIS STI-940-Counseling-Counsels and demonstrates condom use and provides the client with condoms';'NG HNQIS STI-940-Counseling-Counsels and demo';'Counsels and demonstrates condom use and provides the client with condoms';'<p><strong>Condom use</strong></p><ul><li>Correct and consistent condom use is the most reliable method available method of protecting oneself or their partner from any risk of STIs.</li><li>STIs can still occur despite condom use: genital ulcers or warts can be transmitted through contact with parts of the body not covered by the condom.</li><li>Condoms may fail if: handled or stored incorrectly e.g. in wallets or in a hot place; or if used with oil-based lubricants.</li><li>Condom breakage is usually due to incorrect use, not due to defects in the device.</li><li>When used correctly during every act of intercourse, condoms can greatly reduce the risks of both pregnancy and STI (dual protection), including HIV infection.</li><li>Demonstrate condom use, do not make an assumption that the patient knows how to use condoms.</li><li>Provide the client with condom supply/ advice client to buy if not available for free distribution.</li></ul>';'EwnfHasdHpY';940;0.06;0.06;143;53;;166
+870;'NG HNQIS STI-950';'NG HNQIS STI-950-Counseling-Counsels on contact tracing, partner notification and treatment';'NG HNQIS STI-950-Counseling-Counsels on conta';'Counsels on contact tracing, partner notification and treatment';'<p><strong>Ask the client to bring partner(s) for treatment/advice partner to come for treatment</strong></p><ul><li>The sexual partner(s) of STI patients are likely to be infected and should be offered treatment.</li><li>Further transmission of STIs and reinfection can be prevented by referral of sexual partners for diagnosis and treatment.</li><li>Partner notification and management offers an opportunity to identify and treat people who otherwise would not receive treatment.</li><li>In case the source of infection was from a casual sexual encounter and there has been no sexual contact with the regular partner/spouse, counsel on importance of preventing transmission to the partner.</li><li>These actions, however, should be carried out with sensitivity and consideration of social and cultural factors to avoid ethical and practical problems such as rejection and violence, against the woman.</li></ul>';'tUDk7okn4F1';950;0.06;0.06;143;53;;166
+871;'NG HNQIS STI-960';'NG HNQIS STI-960-Counseling-Explains re-infection in case the partner is not treated';'NG HNQIS STI-960-Counseling-Explains re-infec';'Explains re-infection in case the partner is not treated';'<p>Emphasize that re-infection will occur if the sexual partner is not treated, regardless of whether the partner is symptomatic or not.</p>';'H7zdVBXY3Pt';960;0.06;0.06;143;53;;166
+872;'NG HNQIS STI-970';'NG HNQIS STI-970-Counseling-Explains where and when to seek follow up care, and gives a follow up visit date';'NG HNQIS STI-970-Counseling-Explains where an';'Explains where and when to seek follow up care, and gives a follow up visit date';'<ul><li>For continuity of care, it is better for the client to return to the same facility if they have problems.</li><li>Give the client a number for the facility they can call to ask any question.</li><li>Give the client a follow up visit if required.</li></ul>';'Rich9lceplf';970;0.03;0.03;143;53;;166
+873;'NG HNQIS STI-980';'NG HNQIS STI-980-Counseling-Allows the client to ask questions';'NG HNQIS STI-980-Counseling-Allows the client';'Allows the client to ask questions';'<p>Always give the client an opportunity to ask questions and to seek clarifications. If you do not give them a chance, they may feel embarrassed to ask and may end up leaving the clinic with a problem or without understanding your instructions.</p>';'SeJlmszRh6d';980;0.03;0.03;143;53;;166
+874;'NG HNQIS STI-990';'NG HNQIS STI-990-Counseling-Documents services given';'NG HNQIS STI-990-Counseling-Documents service';'Documents services given';'<ul><li>Documentation is part of good clinical practice.</li><li>Patient follow up is easy when previous records are available.</li></ul>';'TVUZy1HBsPW';990;0.03;0.03;143;53;;166
+875;'NG HNQIS STI-1000';'NG HNQIS STI-1000-WE-All supplies available';'NG HNQIS STI-1000-WE-All supplies available';'All supplies available';'<p>Have the necessary supplies including speculums of different sizes, gloves, antiseptic etc.</p>';'AF2KSno4ru5';1000;0.20;0.20;144;53;;167
+876;'NG HNQIS STI-1010';'NG HNQIS STI-1010-WE-Light source for genital and speculum examination';'NG HNQIS STI-1010-WE-Light source for genital';'Light source for genital and speculum examination';'<p>Have a light source for genital examination so as not to miss a pathology.</p>';'wVe8VSrZThj';1010;0.20;0.20;144;53;;167
+877;'NG HNQIS STI-1020';'NG HNQIS STI-1020-WE-STI algorithms and SOPs available';'NG HNQIS STI-1020-WE-STI algorithms and SOPs';'STI algorithms and SOPs available';'<ul><li>SOPs/flow charts/algorithms represent a combination of practical and scientific information necessary for decision making.</li><li>These are required for syndromic management of STIs which does not require equipment, are easy to use and ensure immediate provision of services to all clients.</li><li>SOPs and algorithms need to be followed to provide standardized care and to reduce chances of errors in diagnosis and treatment.</li></ul>';'c8eHwNa1MS1';1020;0.20;0.20;144;53;;167
+878;'NG HNQIS STI-1030';'NG HNQIS STI-1030-WE-IEC materials';'NG HNQIS STI-1030-WE-IEC materials';'IEC materials';'<p><strong>Have STI IEC materials for distribution</strong></p><ul><li>Use IEC materials to help change risky sexual health-related behaviors and to reinforce safe practices.</li><li>The IEC materials should:<ul><li>Have a clear objective to change or reinforce sexual behavior.</li><li>Target a specific audience e.g. married couples or adolescents</li><li>Address a specific problems</li><li>Set a timeframe within which the behavior change is expected to occur.</li></ul></li></ul>';'DXxHThQghko';1030;0.20;0.20;144;53;;167
+879;'NG HNQIS STI-1040';'NG HNQIS STI-1040-WE-Condoms';'NG HNQIS STI-1040-WE-Condoms';'Condoms';'<p>Important to provide condoms to the client to avoid transmitting the STI to partner(s) and to prevent new infection with another STI/HIV.</p>';'G8hrkPoN6f9';1040;0.20;0.20;144;53;;167
+880;'NG HNQIS STI-1050';'NG HNQIS STI-1050-END-END OF TAB';'NG HNQIS STI-1050-END-END OF TAB';'END OF TAB';;'TaRZQFuJIGX';1050;0.00;0.00;144;49;;
+881;'NG HNQIS FP-1650';'NG HNQIS FP-1650-EC-Does this facility offer Emergency Contraceptive Pills (ECPs)?';'NG HNQIS FP-1650-EC-Does this facility offer';'Does this facility offer Emergency Contraceptive Pills (ECPs)?';;'sBngdAgNriX';1650;0.00;0.00;145;53;;168
+882;'NG HNQIS FP-1660';'NG HNQIS FP-1660-EC-Is this a real or simulated observation?';'NG HNQIS FP-1660-EC-Is this a real or simulat';'Is this a real or simulated observation?';'<p>Real observations are preferred</p>';'Hbqzha7ARVx';1660;0.00;0.00;145;88;;168
+883;'NG HNQIS FP-1670';'NG HNQIS FP-1670-EC-Confirms eligibility for ECPs';'NG HNQIS FP-1670-EC-Confirms eligibility for';'Confirms eligibility for ECPs';'<ul><li>Confirm to the woman that all women can use ECPs safely and effectively, including women who cannot use ongoing hormonal contraceptive methods.</li><li>Because of the short-term nature of their use, there are no medical conditions that make ECPs unsafe for any woman.</li></ul>';'EMIduWBgzYU';1670;0.10;0.10;145;53;;168
+884;'NG HNQIS FP-1680';'NG HNQIS FP-1680-EC-Tells the client about ECPs, how they work, effectiveness and possible side effects';'NG HNQIS FP-1680-EC-Tells the client about EC';'Tells the client about ECPs, how they work, effectiveness and possible side effects';'<ul><li>ECPs work primarily by preventing or delaying ovulation.</li><li>Effective when taken within 5 days of having unprotected sex; the sooner they are taken, the more effective.</li><li>Do not disrupt an existing pregnancy.</li><li>Side effects include: changes in bleeding pattern; nausea; abdominal pain; fatigue; headaches; breast tenderness; dizziness and vomiting.</li></ul>';'o4va25Tih2g';1680;0.20;0.20;145;53;;168
+885;'NG HNQIS FP-1690';'NG HNQIS FP-1690-EC-Checks expiry date';'NG HNQIS FP-1690-EC-Checks expiry date';'Checks expiry date';'<p><strong>Always check the expiry date</strong><br/>Do not give expired pills to a patient.</p>';'Br0qqvI0ocJ';1690;0.03;0.03;145;53;;168
+886;'NG HNQIS FP-1700';'NG HNQIS FP-1700-EC-Gives/explains to the client the correct number of pills and how to take them';'NG HNQIS FP-1700-EC-Gives/explains to the cli';'Gives/explains to the client the correct number of pills and how to take them';'<p><strong>Explain the number of pills and the dosing schedule. This depends on the type of ECP</strong></p><ul><li><em><strong>Levonorgestrel-only dedicated product:</strong></em> 1.5 mg of levonorgestrel in a single dose.</li><li><em><strong>Estrogen-progestin dedicated product:</strong></em> 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel. Follow with same dose 12 hours later.</li><li><em><strong>Progestin-only pills with levonorgestrel:</strong></em> levonorgestrel pills: 1.5 mg levonorgestrel in a single dose.</li><li><em><strong>Progestin-only pills with norgestrel:</strong></em> 3 mg norgestrel in a single dose.</li><li><em><strong>Combined (estrogen-progestin) oral contraceptives containing levonorgestrel:</strong></em> Estrogen and levonorgestrel pills: 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel. Follow with same dose 12 hours later.</li><li><em><strong>Combined (estrogen-progestin) oral contraceptives containing norgestrel:</strong></em> Estrogen and norgestrel pills: 0.1 mg ethinyl estradiol + 1 mg norgestrel. Follow with same dose 12 hours later.</li><li><em><strong>Combined (estrogen-progestin) oral contraceptives containing norethindrone:</strong></em> Estrogen and norethindrone pills: 0.1 mg ethinyl estradiol + 2 mg norethindrone. Follow with same dose 12 hours later.</li><li><em><strong>Ulipristal acetate dedicated product:</strong></em> 30 mg of ulipristal acetate in a single dose.</li></ul>';'wSgPdTWyuhN';1700;0.25;0.25;145;53;;168
+887;'NG HNQIS FP-1710';'NG HNQIS FP-1710-EC-Provider explains how to manage possible side effects';'NG HNQIS FP-1710-EC-Provider explains how to';'Provider explains how to manage possible side effects';'<p><strong>Explain what to do about side effects</strong></p><ul><li><strong>Nausea:</strong> routine use of anti-nausea medications is not recommended. Women who have had nausea with previous ECP use or with the first dose of a 2-dose regimen can take anti-nausea medication one-half to one hour before taking ECPs.</li><li><strong>Vomiting:</strong> if vomiting occurs within 2 hours of taking ECPs, the dose should be repeated. (She can use anti-nausea medication with this repeat dose, as above.) If vomiting continues, she can take the repeat dose by placing the pills high in her vagina. If vomiting occurs more than 2 hours after taking ECPs, she does not need to take any extra pills.</li><li><strong>Change in bleeding pattern:</strong> will eventually regularize without treatment. Not a problem unless irregular bleeding is due to a pregnancy if the ECPs fail.</li><li>The rest of the side effects should pass without requiring treatment.</li></ul>';'krsM0NsI4i2';1710;0.10;0.10;145;53;;168
+888;'NG HNQIS FP-1720';'NG HNQIS FP-1720-EC-Explains that the next menstrual period may start earlier or later';'NG HNQIS FP-1720-EC-Explains that the next me';'Explains that the next menstrual period may start earlier or later';'<ul><li>Monthly bleeding may start earlier or later than expected.</li><li>This is not a sign of illness or pregnancy.</li></ul>';'BgFoqRIFPmS';1720;0.05;0.05;145;53;;168
+889;'NG HNQIS FP-1730';'NG HNQIS FP-1730-EC-Informs client to return for a pregnancy test if her menses are more than one week late';'NG HNQIS FP-1730-EC-Informs client to return';'Informs client to return for a pregnancy test if her menses are more than one week late';'<ul><li>If her next monthly bleeding is more than one week later than expected after taking ECPs, assess for pregnancy.</li><li>There are no known risks to a fetus conceived if ECPs fail to prevent pregnancy.</li></ul>';'sbDpvj08kRY';1730;0.10;0.10;145;53;;168
+890;'NG HNQIS FP-1740';'NG HNQIS FP-1740-EC-Allows the client to ask questions and checks clients'' understanding';'NG HNQIS FP-1740-EC-Allows the client to ask';'Allows the client to ask questions and checks clients'' understanding';'<p><strong>Confirm understanding and allow the client to ask questions</strong></p><ul><li>Will ensure she takes the medicine the correct way.</li><li>Any other issues can be addressed.</li></ul>';'UvzYcaYpo8v';1740;0.03;0.03;145;53;;168
+891;'NG HNQIS FP-1750';'NG HNQIS FP-1750-EC-Informs client to return, or call if she has any questions or concerns';'NG HNQIS FP-1750-EC-Informs client to return,';'Informs client to return, or call if she has any questions or concerns';'<p>Ensure you inform her to return or call in case of any problems/questions.</p>';'fui055mEXel';1750;0.10;0.10;145;53;;168
+892;'NG HNQIS FP-1760';'NG HNQIS FP-1760-EC-Patient records completed';'NG HNQIS FP-1760-EC-Patient records completed';'Patient records completed';'<p>Record in the patient''s file and register.</p>';'nNtonT2ynFf';1760;0.03;0.03;145;53;;168
+893;'NG HNQIS FP-1770';'NG HNQIS FP-1770-EC-Work Environment-Emergency Contraceptive Pills';'NG HNQIS FP-1770-EC-Work Environment-Emergenc';'Work Environment-Emergency Contraceptive Pills';;'DGaZBzl7Lil';1770;0.00;0.00;145;49;;168
+894;'NG HNQIS FP-1780';'NG HNQIS FP-1780-EC-Non expired emergency contraceptive pills are available';'NG HNQIS FP-1780-EC-Non expired emergency con';'Non expired emergency contraceptive pills are available';'<p>Have non-expired ECPs in stock.</p>';'MAg6W9D4b9E';1780;0.02;0.02;145;53;;168
+895;'NG HNQIS FP-1790';'NG HNQIS FP-1790-IUD for EC-Does this facility offer IUD for Emergency Contraception?';'NG HNQIS FP-1790-IUD for EC-Does this facilit';'Does this facility offer IUD for Emergency Contraception?';;'TLtRnnG1TQn';1790;0.00;0.00;146;53;;169
+896;'NG HNQIS FP-1800';'NG HNQIS FP-1800-IUD for EC-Is this a real or simulated observation?';'NG HNQIS FP-1800-IUD for EC-Is this a real or';'Is this a real or simulated observation?';'<p>Real observations are preferred</p>';'He8a1OAvFP5';1800;0.00;0.00;146;88;;169
+897;'NG HNQIS FP-1810';'NG HNQIS FP-1810-IUD for EC-Screening';'NG HNQIS FP-1810-IUD for EC-Screening';'Screening';;'UHiqmeKvGKY';1810;0.00;0.00;146;49;;169
+898;'NG HNQIS FP-1820';'NG HNQIS FP-1820-IUD for EC-Provider uses the "Checklist for Screening a Client Who Wants to Initiate Use of the Copper IUD as Emergency Contraception"';'NG HNQIS FP-1820-IUD for EC-Provider uses the';'Provider uses the "Checklist for Screening a Client Who Wants to Initiate Use of the Copper IUD as Emergency Contraception"';'<ul><li>This tool is intended to be used by providers who are screening women that are seeking emergency contraception (EC) to prevent an unintended pregnancy.</li><li>It will enable accurate determination as to which client may receive an IUD an emergency contraception.</li></ul>';'zZpVpOmAGeS';1820;0.10;0.10;146;53;;169
+899;'NG HNQIS FP-1830';'NG HNQIS FP-1830-IUD for EC-Provider confirms Medical Eligibility for the IUD';'NG HNQIS FP-1830-IUD for EC-Provider confirms';'Provider confirms Medical Eligibility for the IUD';'<p><strong>The following are contraindications to IUD insertion</strong></p><ul><li>Unexplained vaginal bleeding: may be a sign of an underlying pathological condition, such as genital malignancy or a pregnancy-related problem.</li><li>Any type of cancer in the genital organs, trophoblastic disease, or pelvic tuberculosis.</li><li>Multiple sexual partners/partner with multiple sexual partners: more than one sexual partner in the last 3 months. Clients who have multiple sexual partners are at high risk of contracting STIs.</li><li>Diagnosis of STI in the last 3 months: there is a possibility that these clients currently have chlamydia and/or gonorrhea infection. Unless these STIs can be reliably ruled out, do not insert IUD.</li><li>Partner has had an STI in the last 3 months, or if he has had any symptoms - for example, penile discharge.</li><li>Patient with AIDS and not on ARVs: HIV-positive clients who have developed AIDS and are not taking ARVs may be at increased risk of STIs and PID because of a suppressed immune system. IUD use may further increase that risk. If the woman is HIV-positive but has not developed AIDS, the IUD may generally be used.</li></ul>';'Eml4KwnIIik';1830;0.10;0.10;146;53;;169
+900;'NG HNQIS FP-1840';'NG HNQIS FP-1840-IUD for EC-Pre-insertion';'NG HNQIS FP-1840-IUD for EC-Pre-insertion';'Pre-insertion';;'yd4b9sZtpHg';1840;0.00;0.00;146;49;;169
+901;'NG HNQIS FP-1850';'NG HNQIS FP-1850-IUD for EC-Provider washes hands';'NG HNQIS FP-1850-IUD for EC-Provider washes h';'Provider washes hands';'<p><strong>Wash hands before and after an encounter with every patient to prevent spread of microorganisms</strong></p><ul><li>Wash hands with soap and clean running water.</li></ul>';'QA9jtLwVCJ1';1850;0.02;0.02;146;53;;169
+902;'NG HNQIS FP-1860';'NG HNQIS FP-1860-IUD for EC-Prepares the environment';'NG HNQIS FP-1860-IUD for EC-Prepares the envi';'Prepares the environment';'<ul><li>Ensure adequate lighting and both visual and auditory privacy.</li><li>Close door and draw curtains around the patient.</li><li>Do not expose the patient until you are ready to start the procedure.</li><li>Ensure that your conversation with the patient cannot be heard by anyone else.</li><li>Have an examination lamp and position it to illuminate the perineum.</li></ul>';'JgCNdgv9uTY';1860;0.02;0.02;146;53;;169
+903;'NG HNQIS FP-1870';'NG HNQIS FP-1870-IUD for EC-Prepares insertion equipment and area';'NG HNQIS FP-1870-IUD for EC-Prepares insertio';'Prepares insertion equipment and area';'<p><strong>Assemble all the necessary equipment before starting</strong><br/>This is a sterile procedure. Prepare before starting the procedure to avoid movements after starting the procedure that might compromise infection prevention. Display all the requirements on a sterile surface. The following requirements should be made ready before the procedure:</p><ul><li>Examination light,</li><li>Copper T IUCD (sealed and not expired),</li><li>Bivalve speculums (several sizes),</li><li>Tenaculum,</li><li>Uterine sound,</li><li>Sponge holding forceps,</li><li>Scissors (for trimming IUD strings),</li><li>Sterile gauze,</li><li>Sterile gloves,</li><li>Sterile drapes,</li><li>Lubricant,</li><li>Antiseptic solution.</li></ul>';'LXX8Gh03gYf';1870;0.01;0.01;146;53;;169
+904;'NG HNQIS FP-1880';'NG HNQIS FP-1880-IUD for EC-Prepares the client appropriately';'NG HNQIS FP-1880-IUD for EC-Prepares the clie';'Prepares the client appropriately';'<p><strong>Check that patient emptied her bladder and washed her genital area if necessary</strong></p><ul><li>Emptying the bladder makes the speculum examination more comfortable and avoids pressure on the bladder wall.</li><li>Fecal matter soiling in the perennial area should be cleaned to avoid contamination since it is a sterile procedure.</li><li>Help client onto exam table.</li></ul>';'fWGDgFfDeke';1880;0.01;0.01;146;53;;169
+905;'NG HNQIS FP-1890';'NG HNQIS FP-1890-IUD for EC-Performs abdominal exam (Palpation)';'NG HNQIS FP-1890-IUD for EC-Performs abdomina';'Performs abdominal exam (Palpation)';'<p><strong>Perform an abdominal examination to rule out pelvic masses and pelvic inflammatory disease</strong></p><ul><li>Observe the abdomen for scars, swelling or visible lesions.</li><li>Check for swellings, bulges, masses, or other gross abnormalities.</li><li>Check for suprapubic tenderness.</li><li>If there are any abnormalities, do not insert the IUD. Give her the option of emergency contraceptive pills and investigate and manage for the abnormality found.</li></ul>';'cTdvEPPJ9Yu';1890;0.03;0.03;146;53;;169
+906;'NG HNQIS FP-1900';'NG HNQIS FP-1900-IUD for EC-Appropriately performs a speculum examination';'NG HNQIS FP-1900-IUD for EC-Appropriately per';'Appropriately performs a speculum examination';'<ul><li>Position her in lithotomy position.</li><li>Wear sterile gloves on both hands.</li><li>Clean the perineum and external genitalia .</li><li>Inspect the external genitalia for any ulcers.</li><li>Insert the speculum and:<ul><li>Inspect the cervix and vaginal canal for ulcers-may indicate a current STI;</li><li>Check for purulent cervical discharge- may be a sign of cervicitis and possibly PID;</li><li>Check if cervix bleeds easily to touch-may indicate cervicitis or cervical cancer;</li><li>Any anatomical abnormality of the cervix that may prevent insertion of IUD.</li></ul></li></ul>';'RAJ8IRsDAMq';1900;0.03;0.03;146;53;;169
+907;'NG HNQIS FP-1910';'NG HNQIS FP-1910-IUD for EC-Performs a bimanual exam';'NG HNQIS FP-1910-IUD for EC-Performs a bimanu';'Performs a bimanual exam';'<p><strong>Perform Bimanual examination:</strong></p><ul><li>Note the size, shape, position and mobility of the uterus.</li><li>Assess for adnexal tenderness or masses-Adnexa tenderness or/and adnexa mass is a sign of a malignancy or PID.</li><li>Assess for cervical motion tenderness- a sign of PID.</li><li>Is there an anatomical abnormality of the uterine cavity that distorts the uterine cavity?</li></ul>';'tL3VCTN7hjw';1910;0.03;0.03;146;53;;169
+908;'NG HNQIS FP-1920';'NG HNQIS FP-1920-IUD for EC-Appropriately makes decision whether woman is eligible for IUD as EC and informs her.';'NG HNQIS FP-1920-IUD for EC-Appropriately mak';'Appropriately makes decision whether woman is eligible for IUD as EC and informs her.';'<ul><li>The decision to insert the IUD as EC depends on the screening checklist and examination findings.</li><li>If the woman is not eligible, counsel appropriately and you may offer emergency contraceptive pills if she is eligible.</li><li>If she is eligible, counsel her on the next steps of insertion.</li></ul>';'hsu7vYCBhra';1920;0.02;0.02;146;53;;169
+909;'NG HNQIS FP-1930';'NG HNQIS FP-1930-IUD for EC-Insertion';'NG HNQIS FP-1930-IUD for EC-Insertion';'Insertion';;'miqHQa9cmOU';1930;0.00;0.00;146;49;;169
+910;'NG HNQIS FP-1940';'NG HNQIS FP-1940-IUD for EC-Swabs cervix three times with antiseptic';'NG HNQIS FP-1940-IUD for EC-Swabs cervix thre';'Swabs cervix three times with antiseptic';'<p><strong>IUCD insertion is a sterile procedure and swabbing the cervix three times minimizes the risk of introducing infection into the uterus.</strong></p><ul><li>Cleanse from the center of the cervical os moving outward on the cervix and into the surrounding vaginal canal.</li><li>If povidone iodine is used, allow 1 to 2 minutes before proceeding.</li><li>Do not use alcohol as it is painful for the woman; dries and damages the mucous membranes, which may support the infectious process.</li></ul>';'rPTWQq1FeWE';1940;0.01;0.01;146;53;;169
+911;'NG HNQIS FP-1950';'NG HNQIS FP-1950-IUD for EC-Correctly performs IUCD insertion based on protocols or guidelines';'NG HNQIS FP-1950-IUD for EC-Correctly perform';'Correctly performs IUCD insertion based on protocols or guidelines';'<ol><li><strong>Gently grasp the cervix with tenaculum at 12 o''clock position and apply gentle traction. </strong>This is to align the uterus with the cervical opening and to stabilize the cervix for easier insertion of the IUD. Close the tenaculum only to the first notch to minimize discomfort.</li><li><strong>Sound the uterus using no-touch technique.</strong>This will ensure you insert the IUCD at the uterine fundus, by adjusting the blue flange to the corresponding uterine length as measured during sounding.<ul><li><strong>If the IUCD is inserted at the low uterine segment, pregnancy can occur because implantation takes place in the uterine fundus.</strong></li><li>Use the no-touch technique to minimize risk of infection.</li><li><strong>Steps of uterine sounding:</strong><ul><li>Gently pull the tenaculum to align the uterus and cervical opening.</li><li>Insert the uterine sound into the cervical opening.</li><li>Advance the sound into the uterine cavity until a slight resistance is felt.</li><li>Note the angle of the uterine cavity, and gently remove the sound. Do not pass the sound into the uterus more than once.</li><li>Mark length of the uterus by observing the mucus line on the tenaculum or marking with sponge holding forceps. The average uterus is between 6 and 8 cm in depth. If the uterus is less than 6 cm in depth, the woman may be at increased risk for IUD expulsion.</li><li>Slowly withdraw the sound.</li><li>On sounding the uterus, if the uterine cavity is irregular or deeper than 10 cm,do not insert IUD. Explain to the patient that with an enlarged uterus the IUD may not be as effective as normally expected and help the woman to consider another method.</li></ul></li></ul></li><li><strong>Load the IUCD</strong><ul><li>Adjust the contents of the package inside the insertion tube such that the vertical stem of the T is fully inside the insertion tube.</li><li>Set the depth-gauge (blue flange) to reflect the uterine length as measured by the uterine sound.</li><li>Open at the bottom end (where arrow says OPEN).</li><li>Insert the white rod into the insertion tube, until up to the level of the blue flange.</li><li>Load the IUCD by folding its arms and placing them inside the insertion tube while still in its sterile pack (no-touch technique) by placing the package face up on a clean surface. Place thumb and index finger on top of package on ends of the horizontal arms. Use other hand to push insertion tube against arms of, this will start bending the T arms and loading the IUCD. Do not bend the arms of copper T for more than 5 minutes before it is placed in the uterus.</li><li>Align the blue flange and the folded arms of the copper T so that they are both in a horizontal plane.</li><li>Remove the loaded IUD from the package:</li></ul></li><li><strong>Insert the IUD using withdrawal technique:</strong><ul><li>Put on a new pair of sterile gloves on both hands.</li><li>Gently grasp the tenaculum (still in place from sounding the uterus) and apply gentle traction.</li><li>Insert the loaded IUCD by holding the insertion tube, without touching vaginal walls or speculum blades, keeping the horizontal plane.</li><li>Gently advance the loaded IUCD into the uterine cavity.</li><li>STOP when the blue flange comes in contact with the cervix or light resistance is felt.</li><li>Hold the tenaculum and white plunger rod stationary, while partially withdrawing the insertion tube - this releases the arms of the IUCD.</li><li>Gently push the insertion tube until you feel a slight resistance - this step ensures placement high in the uterus.</li><li>Remove the white plunger rod, while holding the insertion tube stationary.</li><li>Gently and slowly withdraw the inserter tube from the cervical canal until strings can be seen protruding from the cervical opening.</li><li>IMPORTANT: Do not pass the loaded IUD into the uterus more than once.</li></ul></li><li><strong>Cut strings:</strong><ul><li>Use sharp Mayo scissors to cut the IUCD strings at 3-4 cm from the cervical opening before completely removing the inserter tube. (This technique ensures that the pieces of cut‐off string will stay in the insertion tube for easy disposal.)</li><li>Completely withdraw insertion tube with cut ends of strings inside.</li><li>Gently remove the tenaculum.</li><li>Observe the cervix for bleeding and remove speculum.</li></ul></li></ol><p style="margin-left: 40px;"><strong>Post Insertion</strong></p><ul style="margin-left: 40px;"><li>Reposition patient and make her comfortable. Observe her for 15-20 minutes before assisting her out of the bed.</li></ul>';'RESbZFLeS8E';1950;0.40;0.40;146;53;;169
+912;'NG HNQIS FP-1960';'NG HNQIS FP-1960-IUD for EC-Post insertion';'NG HNQIS FP-1960-IUD for EC-Post insertion';'Post insertion';;'G1fwQlvfciH';1960;0.00;0.00;146;49;;169
+913;'NG HNQIS FP-1970';'NG HNQIS FP-1970-IUD for EC-Post insertion IP procedures correctly performed';'NG HNQIS FP-1970-IUD for EC-Post insertion IP';'Post insertion IP procedures correctly performed';'<p><strong>Follow infection prevention procedures</strong></p><ul><li>Immediately soak ALL the instruments used for procedure or contaminated in any way, in a plastic bucket with 0.5% sodium hypochlorite (chlorine) solution for 10 minutes.</li><li>Dispose of waste material in leak proof container or plastic bag.</li><li>Decontaminate couch or other surfaces contaminated during the procedure by wiping with 5% chlorine solution.</li><li>After soaking for 10 minutes, remove instruments from solution.</li><li>Clean instruments immediately.</li><li>Remove gloves following the glove removal procedure.</li></ul>';'pXVDqm9Sh4m';1970;0.05;0.05;146;53;;169
+914;'NG HNQIS FP-1980';'NG HNQIS FP-1980-IUD for EC-Provider offers post-insertion counseling';'NG HNQIS FP-1980-IUD for EC-Provider offers p';'Provider offers post-insertion counseling';'<p><strong>Counseling points</strong></p><ul><li><strong>If next menses come when expected. Then she may not be pregnant.</strong></li><li>She can consider keeping the IUD for regular contraception.<ul><li>If she chooses to keep it, she should come for a follow-up 3-6 weeks after insertion.</li><li>If she doesn''t want to continue using an IUD, she can have it removed any time after the start of her menses. She will then need another contraceptive method to prevent pregnancy.</li></ul></li><li><strong>If next menses do not come when expected</strong></li><li>She is most likely pregnant. Advice her to return for a pregnancy test one week after expected menses.<ul><li>If pregnancy test positive, advice her on options available.</li><li>If pregnancy test negative, she may chose to keep it or remove it. Offer alternative FP method if she choses to remove.</li></ul></li><li>Explain that the IUD does not protect against STI/HIV.</li><li>The IUCD can be removed any time if she desires.</li><li>Explain that cramping, light bleeding may occur immediately after IUCD insertion and may last for a few days. These symptoms are not harmful and do not indicate a problem. For cramping, advise her to take paracetamol or ibuprofen . If the symptoms become bothersome the woman can come back to the health facility.</li><li>The following symptoms, (<strong>PAINS</strong>) warrants immediate return to the health facility:<ul><li><strong>P</strong>eriod related or Pregnancy related problems:</li><li><strong>A</strong>bdominal pain or pain during intercourse,</li><li><strong>I</strong>nfections or unusual vaginal discharge,</li><li><strong>N</strong>ot feeling well, fever, chills,</li><li><strong>S</strong>tring problems,</li></ul></li><li>If she chooses to keep the IUD as an ongoing contraceptive method, ask her to check for strings during menses. Advice her to come back to the health facility, if the strings are missing.</li><li>Give the woman a review/reminder card and indicate the return date on the card. Remind her that she can come to the health facility whenever a complication occurs.</li></ul>';'lAsWu8hjYGT';1980;0.03;0.03;146;53;;169
+915;'NG HNQIS FP-1990';'NG HNQIS FP-1990-IUD for EC-Assesses client´s physical wellbeing before discharge';'NG HNQIS FP-1990-IUD for EC-Assesses client´s';'Assesses client´s physical wellbeing before discharge';'<p><strong>Post insertion assessment</strong></p><ul><li>Ask patient if she has nausea, abdominal cramping, dizziness or fainting (touching the cervix can cause neurogenic shock, though rarely).</li><li>If symptoms persist after 30 min, examine her for evidence of peritoneal signs which may indicate a perforation.</li><li>If no evidence of peritonitis, offer the woman an analgesic such as paracetamol or ibuprofen and observer for another 10‐15 minutes.</li><li>If the woman is stable she may be discharged.</li><li>If definite peritoneal signs are present, the woman should be examined by a provider who may feel that further observation or intervention are necessary.</li></ul>';'bAZB1D5Mzxo';1990;0.08;0.08;146;53;;169
+916;'NG HNQIS FP-2000';'NG HNQIS FP-2000-IUD for EC-Records service in the client file and register / log book';'NG HNQIS FP-2000-IUD for EC-Records service i';'Records service in the client file and register / log book';'<p>Record services provided in the patient file and daily activity register/log book. Documentation is part of good clinical practice.</p>';'eZkj8C1npp0';2000;0.01;0.01;146;53;;169
+917;'NG HNQIS FP-2010';'NG HNQIS FP-2010-IUD for EC-Work Environment- IUD for Emergency Contraception';'NG HNQIS FP-2010-IUD for EC-Work Environment-';'Work Environment- IUD for Emergency Contraception';;'rpSZPbvQp2t';2010;0.00;0.00;146;49;;169
+918;'NG HNQIS FP-2020';'NG HNQIS FP-2020-IUD for EC-The following are available: tenaculum, uterine sound, bi‐valve speculums, long scissors, sponge‐holding forceps, gallipots, kidney dish.';'NG HNQIS FP-2020-IUD for EC-The following equ';'The following are available: tenaculum, uterine sound, bi‐valve speculums, long scissors, sponge‐holding forceps, gallipots, kidney dish.';'<p>It is important to have all the insertion equipment to ensure you perform the procedure correctly. This will ensure safety of the patient and accurate insertion to reduce the chances of perforation, failure or expulsion of the IUD.</p>';'aQwORbWjp72';2020;0.05;0.05;146;53;;169
+919;'NG HNQIS HIV-269';'NG HNQIS HIV-269-Care Tx-Does this facility offer HIV Care and Treatment?';'NG HNQIS HIV-269-Care Tx-Does this facility o';'Does this facility offer HIV Care and Treatment?';;'O9fT18jF4oA';269;0.00;0.00;97;53;;133
diff --git a/app/src/hnqisNigeriaSF/assets/TabGroups.csv b/app/src/hnqisNigeriaSF/assets/TabGroups.csv
index 4aced9bf3..e669fc726 100644
--- a/app/src/hnqisNigeriaSF/assets/TabGroups.csv
+++ b/app/src/hnqisNigeriaSF/assets/TabGroups.csv
@@ -1 +1,15 @@
-1;'ICM Checklist TabGroup';1
+1;;3
+2;;2
+3;;4
+4;;5
+5;;6
+6;;7
+7;;8
+8;;9
+9;;10
+10;;11
+11;;12
+12;;13
+13;;14
+14;;15
+15;;16
diff --git a/app/src/hnqisNigeriaSF/assets/Tabs.csv b/app/src/hnqisNigeriaSF/assets/Tabs.csv
index ef76ffcb8..e82c9775a 100644
--- a/app/src/hnqisNigeriaSF/assets/Tabs.csv
+++ b/app/src/hnqisNigeriaSF/assets/Tabs.csv
@@ -1,3 +1,17 @@
 1;'Inquiry and Physical Examination';1;1;0
 2;'Diagnosis, Treatment and Counseling';2;1;0
 4;'Work Environment Assessment';4;1;0
+6;'FP all methods';1;2;0
+7;'Focused Antenatal Care';1;3;0
+8;'Post Partum IUD';1;4;0
+9;'Pregnancy and delivery complications';1;5;0
+10;'Labor and Delivery';1;6;0
+11;'Cervical Cancer';1;7;0
+12;'Tuberculosis';1;8;0
+13;'Newborn Resuscitation';1;9;0
+14;'HIV';1;10;0
+15;'Hypertension';1;11;0
+16;'Licenses';1;12;0
+17;'Malaria in Adults';1;13;0
+18;'Post Abortion Care';1;14;0
+19;'Sexually Transmitted Infections';1;15;0