[{"id":"f0b0d242-3dff-4470-bf52-7dd866e48fe3","slug":"cholera-dehydration-assessment","title":"Assessment and Classification of Dehydration Level","category":"Cholera","body":"TABLE 3: ASSESSMENT AND CLASSIFICATION OF THE LEVEL OF DEHYDRATION\n\nMental status:\n- No dehydration: Normal, awake\n- Some dehydration: Agitated, irritable\n- Severe dehydration: AVPU<A, Lethargic\n- Shock: Altered level of consciousness\n\nRadial pulse; temp gradient:\n- No dehydration: Easily palpable; no temp gradient\n- Some dehydration: Palpable (possibly rapid); no temp gradient\n- Severe dehydration: Difficult to palpate (weak); no temp gradient\n- Shock: Weak/absent; temp gradient\n\nEyes:\n- No dehydration: Normal\n- Some dehydration: Sunken\n- Severe dehydration: Sunken\n- Shock: Sunken\n\nSkin pinch:\n- No dehydration: Disappears rapidly\n- Some dehydration: Disappears slowly (< 2 seconds)\n- Severe dehydration: Disappears very slowly (> 2 seconds)\n- Shock: Disappears very slowly (> 2 seconds)\n\nThirst:\n- No dehydration: Drinks normally\n- Some dehydration: Thirsty, drinks avidly\n- Severe dehydration: Incapable or drinks very little\n- Shock: Incapable of drinking\n\nDiagnosis / Decision:\n- No dehydration -> Treatment plan A\n- Some dehydration -> Treatment plan B\n- Severe dehydration -> Treatment plan C\n- Shock -> Treatment for shock","source":"Cholera Management Guidelines, 2023 Edition, p. 28, Table 3","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:42:42.613Z","updatedAt":"2026-09-11T06:49:21.137Z"},{"id":"87d5c467-7442-4506-a5ad-fa937d9f334f","slug":"cholera-antibiotic-therapy","title":"Cholera — Antibiotic Therapy","category":"Cholera","body":"5.2.4 Antibiotic Treatment\n- Antibiotics can reduce the volume and duration of diarrhea.\n- Antibiotics are indicated for the following groups:\n  1. Cholera patients hospitalized with shock and severe dehydration\n  2. Patients passing at least one stool per hour during the first 4 hours of treatment \n     or treatment failure (the patient is still dehydrated after completing the initial \n     4 hours of rehydration therapy), regardless of the degree of dehydration\n  3. Patients with coexisting conditions (including pregnancy) or comorbidities (such as \n     Severe Acute Malnutrition (SAM), and HIV), regardless of the degree of dehydration\n\nNote: Antispasmodics, antidiarrheals, antiemetics, and plasma expanders are not indicated \nin the treatment of cholera and should not be used.\n\nTABLE 5: ANTIBIOTIC THERAPY\nCategory    | Antibiotic     | Children              | Adults (including Pregnancy)\nFirst line  | Doxycycline PO | 4 mg/kg single dose    | 300 mg single dose\nAlternative | Azithromycin PO| 20 mg/kg single dose   | 1 g single dose\nAlternative | Ciprofloxacin PO| 20 mg/kg single dose  | 1 g single dose\n\n*WHO recommends doxycycline to children and pregnant women as a single dose. Where \navailable, Antimicrobial Susceptibility Testing (AST) should guide antibiotic choice.","source":"Cholera Management Guidelines, 2023 Edition, pp. 31–32, Table 5","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:44:51.860Z","updatedAt":"2026-09-11T07:09:34.430Z"},{"id":"7dc98403-c678-4269-a588-a8bb8449e384","slug":"cholera-ongoing-losses-compensation","title":"Cholera — Compensation for Ongoing Fluid Losses","category":"Cholera","body":"5.2.3 Compensation for Ongoing Losses\n- During the rehydration phase, the losses from ongoing diarrhoea must be compensated \n  by ORS.\n- If the patient is incapable of drinking, ongoing losses must be compensated via the \n  intravenous route.\n- As soon as the patient can drink, replace ongoing losses with ORS.\n- Compensate for the total number of stools lost at the end of the 3-hour rehydration \n  phase over a period appropriate for the amount of volume to be replaced (do not exceed \n  25 ml/kg/hour).\n\nExample calculation: For a 3-year-old child, 8 stools were passed during the 3-hour \nrehydration, thus giving 800 ml (8 x 100 ml) over 3 hours at the end of rehydration is \nrequired to replace ongoing losses.\n\nTABLE 4: QUANTITY OF ORS FOR COMPENSATION OF ONGOING LOSSES\nAge (Years) | Amount of ORS after each loose stool | Quantity per day\nUnder 2     | 50-100 ml (10-20 teaspoons of 5 ml)   | 500 ml/day\n2 to 10     | 100-200 ml (½ to 1 glass of 200 ml)   | 1000 ml/day\nOver 10 & adults | at least 200-250 ml (1 glass of 200 ml) | 2000 ml/day","source":"Cholera Management Guidelines, 2023 Edition, p. 31, Table 4","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:44:07.727Z","updatedAt":"2026-09-11T07:08:58.349Z"},{"id":"79f9557f-3ead-4d8f-90be-8b2339e45390","slug":"cholera-feeding-zinc-supplementation","title":"Cholera — Feeding and Zinc Supplementation for Children","category":"Cholera","body":"5.2.5 Feeding\nPatients should be given a normal, non-restricted diet. For breastfeeding children \nincrease the frequency of feedings. Breast milk does not replace ORS, which is given \nbetween feedings.\n\n5.2.6 Zinc Supplementation for Children\n- Zinc supplementation in the management of children aged 6 months to 5 years with \n  watery diarrhea (regardless of the cause or degree of dehydration) reduces diarrhea \n  volume and duration.\n- When available, supplementation should be started immediately.\n- For children above 6 months give 20 mg p.o. zinc sulphate per day (for children less \n  than 6 months 10mg PO per day) for 10 days.\n- Zinc may reduce the absorption of some classes of antibiotics, including; \n  ciprofloxacin. For the best effect with these classes of drugs, antibiotics should be \n  administered 2 hours before zinc or 4-6 hours after zinc.\n\nNote: Children receiving therapeutic food for the treatment of SAM do not require zinc \nsupplementation, as these foods contain sufficient zinc.","source":"Cholera Management Guidelines, 2023 Edition, p. 32","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:45:40.707Z","updatedAt":"2026-09-11T07:09:43.916Z"},{"id":"1268cde1-eb72-4d66-a81d-6f5f5b461b01","slug":"cholera-principles-treatment-iv-fluids","title":"Cholera — Principles of Treatment and IV Fluid Selection","category":"Cholera","body":"5.1 Principles of Treatment\nTimely detection of cholera cases and prompt initiation of treatment is key in reducing \nmorbidity, mortality and containing disease transmission.\n1. Severe dehydration/Shock is a medical emergency. The priority is to identify and \n   correct and prevent dehydration with the appropriate rehydration fluids. Fluid \n   management is the mainstay of cholera management.\n2. Complementary therapies (antibiotics and zinc sulphate) are useful in reducing the \n   duration and severity of diarrhea but do not replace fluid therapy rehydration.\n3. Initiate oral feeding as soon as the patient can tolerate feeds.\n4. Continue breast-feeding infants and young children.\n\n5.2.1 Intravenous (IV) Fluids\n- The fluid of choice for rehydration is Ringer lactate (RL).\n- If RL is not available, 0.9% sodium chloride (Normal Saline), with or without glucose, \n  can be used.\nNB: IV fluid containing only glucose (e.g., 5% dextrose) should not be used.\n\n5.2.2 Preparing and Administering ORS\n- Ready-made sachets containing salts and minerals are available for preparing ORS.\n- ORS should be given regularly, in small amounts.\n- If a patient vomits the ORS, slow the administration of ORS and then slowly increase \n  again when vomiting stops.\n\nORS preparation steps:\n1. Wash your hands with soap and clean running water.\n2. Pour the full packet into the clean container.\n3. Measure half a liter (500ml) of pure water in the container containing ORS powder.\n4. Keep mixing until ORS is fully dissolved. If there is no dissemination, then the \n   powder is fully dissolved.\n5. Use the prepared ORS within 12 hours. Discard after 12 hours and prepare another batch.","source":"Cholera Management Guidelines, 2023 Edition, pp. 26–27","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:43:22.261Z","updatedAt":"2026-09-11T07:08:41.090Z"},{"id":"ae375cd9-6eae-45c1-9460-6809aa45a698","slug":"cholera-sam-children","title":"Cholera — Treatment in Children with Severe Acute Malnutrition (SAM)","category":"Cholera","body":"5.3.1 Treatment of Cholera in Children with Severe Acute Malnutrition (SAM)\n- Malnourished children with cholera are at risk of complications and death. Assessment \n  of the child's malnutrition status and dehydration level will determine the treatment \n  plan.\n- Immediately treat children with SAM and suspected cholera at a CTU/CTC.\n- For oral rehydration of children with SAM during an outbreak of cholera, give standard \n  ORS.\n- Do not give ReSoMal (Rehydration Solution for Malnutrition) as its sodium content is \n  not sufficient to replace that lost in cholera.\n- For severe dehydration requiring IV therapy, follow rehydration guidelines for \n  malnourished children.\n- Breastfeeding and feeding with therapeutic milk should continue throughout rehydration.","source":"Cholera Management Guidelines, 2023 Edition, p. 33","isDisaster":true,"steps":null,"createdAt":"2026-09-11T06:46:29.759Z","updatedAt":"2026-09-11T07:09:56.341Z"},{"id":"5e0df283-b260-41fc-ad8d-fee217f261a9","slug":"severe-malaria-pre-referral-treatment","title":"Severe Malaria — Pre-referral Treatment Options","category":"Malaria","body":"The risk for death from severe malaria is greatest in the first 24 h. It is recommended \nthat patients, particularly young children, be treated with a first dose of one of the \nrecommended treatments before referral (unless the referral time is <6 h).\n\nThe recommended pre-referral treatment options for children <6 years, in descending order \nof preference, are: intramuscular artesunate; rectal artesunate; intramuscular artemether; \nand intramuscular quinine.\n\nFor older children and adults, the recommended pre-referral treatment options, in \ndescending order of preference, are: intramuscular injections of artesunate; artemether; \nand quinine.\n\nRectal artesunate is recommended for use only in children aged <6 years and only when \nintramuscular artesunate is not available.\n\nWhen rectal artesunate is used, patients should be transported immediately to a \nhigher-level facility where intramuscular or intravenous treatment is available. If \nreferral is impossible, rectal treatment could be continued until the patient can tolerate \noral medication. At this point, a full course of the recommended ACT for uncomplicated \nmalaria should be administered.","source":"WHO Guidelines for Malaria, 13 August 2025, World Health Organization, p. 219","isDisaster":false,"steps":null,"createdAt":"2026-09-11T06:39:52.544Z","updatedAt":"2026-09-11T06:39:52.544Z"},{"id":"6b967d2a-0e5f-49a7-96af-08326e22073f","slug":"diarrhoea-plan-a","title":"Treat Diarrhoea at Home","category":"Diarrhoea","body":"Plan A: Treat Diarrhoea at Home\nCounsel the mother on the 4 Rules of Home Treatment:\nGive Extra Fluid, Give Zinc Supplements, Continue Feeding, When to Return\n\nGIVE EXTRA FLUID (as much as the child will take)\nTELL THE MOTHER:\n- Breastfeed frequently and for longer at each feed.\n- If the infant is exclusively breastfed, give ORS in addition to breastmilk.\n- If the child is not exclusively breastfed, give one or more of the following: ORS solution, food-based fluids (such as soup, rice water, and yoghurt drinks), or clean water.\n\nIt is especially important to give ORS at home when:\n- the child has been treated with Plan B or Plan C during this visit.\n- the child cannot return to a clinic if the diarrhoea gets worse.\n\nTEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE MOTHER 2 PACKETS OF ORS TO USE AT HOME.\n\nSHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE USUAL FLUID INTAKE:\n- Up to 2 years: 50 to 100 ml after each loose stool and between them\n- 2 years or more: 100 to 200 ml after each loose stool and between them\n\nTell the mother to:\n- Give frequent small sips from a cup.\n- If the child vomits, wait 10 minutes. Then continue, but more slowly.\n- Continue giving extra fluid until the diarrhoea stops.\n\nGIVE ZINC SUPPLEMENTS\nTELL THE MOTHER HOW MUCH ZINC TO GIVE:\n- Up to 6 months: 1/2 tablet per day for 14 days\n- 6 months or more: 1 tablet per day for 14 days\n\nSHOW THE MOTHER HOW TO GIVE ZINC SUPPLEMENTS:\n- Infants: dissolve the tablet in a small amount of expressed breastmilk, ORS or clean water, in a small cup or spoon\n- Older children: tablets can be chewed or dissolved in a small amount of clean water in a cup or spoon\n\nREMIND THE MOTHER TO GIVE THE ZINC SUPPLEMENTS FOR THE FULL 14 DAYS\nCONTINUE FEEDING\nWHEN TO RETURN","source":"Diarrhoea Treatment Guidelines (WHO/UNICEF recommendations, USAID Micronutrient Program / MOST), p. 22","isDisaster":false,"steps":null,"createdAt":"2026-09-11T06:27:39.053Z","updatedAt":"2026-09-11T06:27:39.053Z"},{"id":"bb4a76de-6e02-4e6e-97c2-e52311751975","slug":"severe-malaria-parenteral-treatment","title":"Treatment of Severe Malaria — Parenteral Artesunate (First-line)","category":"Malaria","body":"Recommendation\nTreat children and adults with severe malaria with parenteral artesunate for at least 24 h.\nStrength of recommendation: Strong for.\n\nRemarks\nParenteral artesunate is recommended as first-line treatment for adults, children, infants \nand pregnant women in all trimesters of pregnancy.\n\nDosing (children weighing < 20 kg):\nChildren weighing < 20 kg should receive a higher dose of artesunate (3 mg/kg bw per dose) \nthan larger children and adults (2.4 mg/kg bw per dose) to ensure equivalent exposure to the drug.\n\nPractical info\nArtesunate is dispensed as a powder of artesunic acid, which is dissolved in sodium \nbicarbonate (5%) to form sodium artesunate. The solution is then diluted in approximately \n5 mL of 5% dextrose and given by intravenous injection or by intramuscular injection into \nthe anterior thigh.\n\nThe solution should be prepared freshly for each administration and should not be stored.\n\nPost-treatment haemolysis warning:\nDelayed haemolysis starting >1 week after artesunate treatment of severe malaria has been \nreported in hyperparasitaemic non-immune travellers. Hyperparasitaemic patients must be \nfollowed up carefully to identify late-onset anaemia.","source":"WHO Guidelines for Malaria, 13 August 2025, World Health Organization, pp. 216–219","isDisaster":false,"steps":null,"createdAt":"2026-09-11T06:38:53.763Z","updatedAt":"2026-09-11T06:38:53.763Z"},{"id":"997bce6b-46ee-4d59-9904-3e05dd3848bb","slug":"diarrhoea-plan-c","title":"Treat Severe Dehydration Quickly","category":"Diarrhoea","body":"Plan C: Treat Severe Dehydration Quickly\nFOLLOW THE ARROWS. IF ANSWER IS \"YES\", GO ACROSS. IF \"NO\", GO DOWN.\n\nCan you give intravenous (IV) fluid immediately? YES ->\nStart IV fluid immediately. If the child can drink, give ORS by mouth while the drip is set up. Give 100 ml/kg Ringer's Lactate Solution (or, if not available, normal saline), divided as follows:\n\nAGE                              | First give 30 ml/kg in: | Then give 70 ml/kg in:\nInfants (under 12 months)        | 1 hour*                  | 5 hours\nChildren (12 months up to 5 years)| 30 minutes*             | 2 1/2 hours\n* Repeat once if radial pulse is still very weak or not detectable.\n\n- Reassess the child every 1-2 hours. If hydration status is not improving, give the IV drip more rapidly.\n- Also give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after 3-4 hours (infants) or 1-2 hours (children).\n- Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment.\n\nCan you give IV fluid immediately? NO -> Is IV treatment available nearby (within 30 minutes)? YES ->\n- Refer URGENTLY to hospital for IV treatment.\n- If the child can drink, provide the mother with ORS solution and show her how to give frequent sips during the trip.\n\nIs IV treatment available nearby (within 30 minutes)? NO -> Are you trained to use a naso-gastric (NG) tube for rehydration? YES ->\n- Start rehydration by tube (or mouth) with ORS solution: give 20 ml/kg/hour for 6 hours (total of 120 ml/kg).\n- Reassess the child every 1-2 hours:\n  - If there is repeated vomiting or increasing abdominal distension, give the fluid more slowly.\n  - If hydration status is not improving after 3 hours, send the child for IV therapy.\n- After 6 hours, reassess the child. Classify dehydration. Then choose the appropriate plan (A, B, or C) to continue treatment.\n\nAre you trained to use NG tube? NO -> Can the child drink? YES ->\nRefer URGENTLY to hospital for IV or NG treatment\n\nCan the child drink? NO -> Refer URGENTLY to hospital for IV or NG treatment\n\nNOTE:\n- If possible, observe the child at least 6 hours after rehydration to be sure the mother can maintain hydration giving the child ORS solution by mouth.\n\nIMMUNIZE EVERY SICK CHILD, AS NEEDED","source":"Diarrhoea Treatment Guidelines (WHO/UNICEF recommendations, USAID Micronutrient Program / MOST), p. 24","isDisaster":false,"steps":null,"createdAt":"2026-09-11T06:29:43.264Z","updatedAt":"2026-09-11T06:29:43.264Z"},{"id":"d4a7fa58-d226-4a67-909b-cfa101ded970","slug":"diarrhoea-plan-b","title":"Treat Some Dehydration with ORS","category":"Diarrhoea","body":"Plan B: Treat Some Dehydration with ORS\nGive in clinic recommended amount of ORS over 4-hour period\n\nDETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS.\n\nAGE:      Up to 4 months | 4 months up to 12 months | 12 months up to 2 years | 2 years up to 5 years\nWEIGHT:   < 6 kg          | 6 - < 10 kg               | 10 - < 12 kg            | 12 - 19 kg\nIn ml:    200 - 400       | 400 - 700                 | 700 - 900               | 900 - 1400\n\n* Use the child's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child's weight (in kg) times 75.\n\nIf the child wants more ORS than shown, give more.\nFor infants under 6 months who are not breastfed, also give 100-200 ml clean water during this period.\n\nSHOW THE MOTHER HOW TO GIVE ORS SOLUTION.\n- Give frequent small sips from a cup.\n- If the child vomits, wait 10 minutes. Then continue, but more slowly.\n- Continue breastfeeding whenever the child wants.\n\nAFTER 4 HOURS:\n- Reassess the child and classify the child for dehydration.\n- Select the appropriate plan to continue treatment.\n- Begin feeding the child in clinic.\n\nIF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:\n- Show her how to prepare ORS solution at home.\n- Show her how much ORS to give to finish 4-hour treatment at home.\n- Give her enough ORS packets to complete rehydration. Also give her 2 packets as recommended in Plan A.\n- Explain the 4 Rules of Home Treatment:\n  1) GIVE EXTRA FLUID (see Plan A for recommended fluids)\n  2) GIVE ZINC SUPPLEMENTS\n  3) CONTINUE FEEDING\n  4) WHEN TO RETURN","source":"Diarrhoea Treatment Guidelines (WHO/UNICEF recommendations, USAID Micronutrient Program / MOST), p. 23","isDisaster":false,"steps":null,"createdAt":"2026-09-11T06:28:53.795Z","updatedAt":"2026-09-11T06:28:53.795Z"}]