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Edit Comment Close Premium member Presentation Transcript Department of Education Deworming Program: Department of Education Deworming ProgramHelminthiasis : Helminthiasis Infestation with or disease caused by parasitic worms. Organisms that live in the Intestines of Human Beings and are Harmful to human host.Intestinal Nematodes: Intestinal Nematodes Worms “ Lugay ”Helminthiasis or Intestinal Nematode Infestation: Helminthiasis or Intestinal Nematode Infestation Affects more than 1 billion people worldwide. Most Common in Tropical Countries with Poor Fecal Sanitation.Helminthiasis or Intestinal Nematode Infestation: Helminthiasis or Intestinal Nematode Infestation Contributes greatly to Malnutrition and Poor Academic Performance in School Children. Poor Physical Development. Diminished Working Capacity.Three Most Common Intestinal Nematodes: Three Most Common Intestinal Nematodes Ascaris lumbricoides Hookworm Trichuris trichuraAscaris lumbricoides: Ascaris lumbricoidesAscaris lumbricoides: Ascaris lumbricoides The Largest Intestinal Nematode parasite of Humans Adult Male 10 to 31 cms in length Adult Female 22 to 40 cms in lengthAscaris lumbricoides: Ascaris lumbricoides 2 -3 Months elapse before initial infection and egg production. Lifespan of 1 to 2 years. Female produce 240,000 eggs/dayAscaris lumbricoides: Ascaris lumbricoides Most Common Roundworm affecting Human Beings Endemic Worlwide Very Common in South East Asia – Philippines.Ascaris lumbricoides epidemiology: Ascaris lumbricoides epidemiology Egg in the soil is infective stage. Eggs are transmitted via hand to mouth Eggs are resistant to chemical disinfectants and can withstand temporary immersion in strong chemicals.Ascaris lumbricoides: Ascaris lumbricoides Adult Worm location in the Lumen of Jejunum. Infection is most Common in 5 to 9 year old age group. Pre – school and young school children harbor the most infection.Ascaris lumbricoides: Ascaris lumbricoides Usual infection consists of 5 to 10 adult worms Most frequent complaint is vague abdominal painAscaris lumbricoides: Ascaris lumbricoides Children affected with Ascariasis do not gain weight normally Food is consumed by the worms. Adverse effect upon nutritional state and mental development of school children.Ascariasis Signs and Symptoms: Ascariasis Signs and Symptoms Lung Stage of Larval migration non - productive cough, burning substernal pain aggravated by coughing or deep inspiration .Ascaris lumbricoides: Ascaris lumbricoides Blood Streaked Sputum Hemorrhagic PneumonitisAscaris lumbricoides: Ascaris lumbricoides FeverAscaris lumbricoides complications: Ascaris lumbricoides complications Intestines Usually Asymptomatic Large Infections – Bolus Intestinal Obstruction PerforationAscaris lumbricoides: Ascaris lumbricoidesAscaris lumbricoides: Ascaris lumbricoidesAscaris lumbricoides complications: Ascaris lumbricoides complications Migration of adult worm to aberrant sites Liver Hepato – biliary tree Pancreas Esophagus – Passage of Worms through the Mouth or NoseAscaris lumbricoides: Ascaris lumbricoidesSlide 27: Photo courtesy of Dr. BD Cabrera Photo courtesy of Dr. BD CabreraHookworm: HookwormHookworm: Hookworm 2 Hookworm species infective to humans Ancyclostoma doudenale Necator americanus Most infected humans are Asymptomatic Heavy worm burden, prolonged infection, malnutrition causes Iron Deficiency AnemiaHookworm: Hookworm Ancyclostoma doudenale produce 20,000 eggs/day Necator americanus produce 10,000 eggs/day Eggs are deposited in soil. Eggs hatch and Develop to Rhabditiform larvae After 1 week Develop to Filariform larvae – Infective StageHookworm: Hookworm Penetrate through skin. Reach the lungs Penetrate the alveoli Invade the Upper airways Coughed and Swallowed Develop in Small intestine Time Period: 6 to 8 Weeks Note: Larvae of Ancyclostoma doudenale can develop directly if swallowedHookworms: Hookworms Adult Hookworms grow up to 1 cm long Attach to mucosa of small intestine Ancyclostoma doudenale Suck up to 0.2 ml of blood per day Necator americanus suck up to 0.03 ml of blood per dayHookworms: Hookworms Lifespan up to 10 years Ancyclostoma doudenale : 6 to 8 years Necator americanus : 2 to 5 yearsHookworm: Hookworm Female hookworm can produce eggs within 5 to 6 weeks after initial infectionHookworm epidemiology: Hookworm epidemiology Ancylostoma doudenale prevalent in southern Europe, North Asia N. americanus is the predominant species in the western hemisphere and equatorial Africa. The two species overlap in many tropical regions, particularly Southeast Asia.Hookworm epidemiology: Hookworm epidemiology Older children have the highest incidence and greatest intensity of hookworm infection. In rural areas where fields are fertilized with human feces, older working adults also may be heavily affected.Clinical Features: Clinical Features Most hookworm infections are asymptomatic. Infective larvae may provoke pruritic maculopapular dermatitis ("ground itch")Clinical Features: Clinical Features The major consequence of chronic hookworm infection is iron deficiency. weakness shortness of breath.Clinical Features: Clinical Features Larvae migrating through the lungs occasionally cause mild transient pneumonitis .Clinical features: Clinical features In the early intestinal phase, infected persons may develop epigastric pain Diarrhea Abdominal painTrichuris trichura: Trichuris trichuraTrichuriasis: Trichuriasis Most infections with the Trichuris trichiura are asymptomatic. Whipworm is distributed globally in the tropics and subtropics Most common among poor children from resource-poor regions of the world.Trichuriasis: Trichuriasis heavy infections may cause gastrointestinal symptoms. Like the other soil-transmitted helminthsLife Cycle : Life Cycle Adult Trichuris worms reside in the colon and cecum Embed in the superficial mucosa. Thousands of eggs laid daily by adult female worms pass with the feces and mature in the soil.Life Cycle: Life Cycle Eggs are ingested Eggs hatch in the duodenum, Larvae mature in the small intestine. Migrate to the large bowel. The entire cycle takes ~3 months. Adult worms may live for several years.In Summary: In SummarySigns and Symptoms of Intestinal Parasitism: Signs and Symptoms of Intestinal Parasitism Abdominal pain and enlargement Weight loss Anemia Malnutrition Loss of appetiteEffects of Intestinal Parasitism: Effects of Intestinal Parasitism Impaired cognitive processes Poor physical development Decreased physical activityPrevention: Prevention Prevent open DefecationPrevention: Prevention HandwashingPrevention: Prevention Wear Slippers Avoid Walking BarefootPrevention: Prevention Hygienic Food PreparationDep Ed Memos that support the Deworming Program: Dep Ed Memos that support the Deworming Program DepEd Memorandum # 28 S. 2007 – Implementation of the Mass Deworming Program In All Public Elem. School Nationwide. DepEd Order #65 S. 2009- Implementation of Essential Health Care Program (EHCP) for the School Children ( Bi-annual Deworming of school children) Regional Memorandun #60 S. 2011- Implementation of Essential Health Care Program (EHCP) for the School Children (a record of deworming activities per class should be kept by the Classroom Adviser for easy monitoring)Target Population: Target Population All Public Elementary School Children 6 to 12 years oldSchedule: Schedule July January WHO Recommendation Deworming 3 to 4 times a year in Highly Endemic AreasSchedule: Schedule All Teachers Must Deworm on the Friday of the Following week Time: 8 to 9 am Within School Premises Secure Parent’s PermitMebendazole: Mebendazole 500 mg Tablet 1 Tablet as Single DoseQualitative and Quantitative Composition: Qualitative and Quantitative Composition Each tablet Contains 500 mg Mebendazole with Inactive ingredients of Lactose, methylcellulose, sodium starch glycolate , microcrystalline cellulose, corn starch, magnesium stereate , colloidal silicone dioxide.Therapeutic Indications: Therapeutic Indications Indicated for mass treatment of single or mixed GI infestations of: Ascaris Lumbricoides (Large Roundworm), Trichuris trichura (Whipworm), Ancyclostoma doudenale , Necator Americanus (Hookworm) Enterobius Vermicularis (Pinworm),Slide 68: In Patients Living in Heavily Endemic Areas , regular treatment with Mebendazole 500 mg 3 to 4 times a year. (every 3 to 4 months) will substantially reduce the overall wormload and keep it well below the level of clinical significance.Method of Administration: Method of Administration 1 single TABLET of MEBENDAZOLE 500 mg for ADULTS and CHILDREN (12 months and above) NO SPECIAL PROCEDURES, such as diet or use of laxatives are required. Mebendazole may be taken with or without food, it may be crushed, chewed, swallowed whole, mixed with food or taken with water.CONTRAINDICATIONS: CONTRAINDICATIONS SHOULD NOT BE GIVEN to children BELOW 12 MONTHS of age! SHOULD NOT BE GIVEN TO PATIENTS WITH KNOWN and WELL DOCUMENTED CASES OF HYPERSENSITIVITY!Special Warning and Precautions: Special Warning and Precautions Rare reports of Convulsions in patients below 1 year of age. Reversible Liver Function Disturbance, hepatitis, and neutropenia . In prolonged use. Avoid prolonged concomitant use with Metronidazole .Drug Interaction: Drug Interaction CIMETIDINE (H2 Receptor Antagonist) anti ulcer drug. Used in treating PUD and Heartburn. Brand name: TAGAMET Inhibits metabolism of Mebendazole in the LIVER causing increased plasma comcentrations .Pregnancy and Lactation: Pregnancy and Lactation AVOID GIVING in first Trimester of pregnancy. Risk must be weighed against the expected therapeutic benefits. Not known if excreted in human breast milk exercise caution in nursing women.Effects on Driving and Use of Machines: Effects on Driving and Use of Machines MEBENDAZOLE 500 mg DOES NOT AFFECT Mental Alertness or Driving AbilityAdverse Reactions: Adverse Reactions Mebendazole is well tolerated. In patients with High Parasitic Burden may present with Diarrhea and/or Abdominal Pain (VERY RARE AS IT MAY BE CAUSED BY THE WORM INFESTATION ITSELF) VERY RARE Hypersensitivity Reactions ( ALLERGY ) ( LESS THAN 1 case in every 10,000 persons taking Mebendazole 500 mg)ACTION (HOW DOES MEBENDAZOLE KILL THE WORM?) : ACTION (HOW DOES MEBENDAZOLE KILL THE WORM?) Once ingested by the WORM, Mebendazole interferes with cellular tubulin formation in the WORM INTESTINE by specifically binding to the TUBULIN and causing ultrastructural degenerative changes in the intestine. Disrupts GLUCOSE UPTAKE and other Nutrients in worm intestine STOPS the DIGESTIVE FUNCTIONS OF THE WORMPharmacokinetics: Pharmacokinetics Oral administration 20% absorbed to systemic circulation. Maximum Plasma concentrations 2 to 4 hours after Oral administartion 90% to 95% bound to protien indicating adequate distribution Metabolism occurs in the LIVER – check LIVER function Elimination – URINE Elimination half-life 3 to 6 hoursPre Clinical SAFETY DATA: Pre Clinical SAFETY DATA MEBENDAZOLE Is well tolerated Large Margin of Safety Extensive testing in Laboratory animals using high dose chronic administration causes LIVER and TESTICULAR Damage in RATS – NO CARCINOGENIC or MUTAGENIC ACTIVITYACCIDENTAL OVERDOSE: ACCIDENTAL OVERDOSE ABDOMINAL CRAMPS NAUSEA VOMITING DIARRHEATREATMENT: TREATMENT NO SPECIFIC ANTIDOTE WITHIN FIRST HOUR AFTER INGESTION GASTRIC LAVAGE may be performed ACTIVATED CHARCOAL may be given if considered appropriate You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.