niyamebbbtsmrab;efvietsþrsavrcav ... syphilis screeining.khm.pdf · (anc service). -...
TRANSCRIPT
RksYgsuxaPi)al
niyamEbbbTsMrab;eFVIetsþRsavRCav rkemeraKsVaycMeBaHRsþImanépÞeBaH
enARBHraCaNacRkkm<úCa
qñaM 2008
‐ 2 ‐
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‐ 4 ‐
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tsgeiUltIiiMld§rJ31B1Jt1H9j~ rJnUHrn~31fimrutt:lruf;~l::lUUmdl::llnsimHtMfltj}m~2ffirlt1~QUBl::l~2
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srmtmijs t~Hjrunstm~t1um~nE'!Jlmtif;tllil~utmgmmtsi!'1l::llrlgnUlllilltiliiii~mSltrlruHSlI:i~ '1 , ,
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‐ 6 ‐
HIDtHl~rum~lurrr~£h:H~EtHt:lfii nlitfiUFi BilmHtllf.'i Bil HIDH(l!Jrum~mmHmi1 Bil911Fi ftJH1YilHlliu
~llilrihillmru\ltti ihmmmFi-mnFiUUmilHnllt:lrum fUm~Fi-fUm~mlSmHmrillmr~m9fUMl1tlmr I I
utru Billtlmt1j1Ulrumm~tllf.'irnHmr!Hu'i9 BillUt:l1ITU~~~ It:lruUlSH\~Q)Hfit1HIDHUQrum~lurrr~Bil I·
~E\Ht:lfii nlitfUJFi Bilmmnf.'i. HIDHUQrum~mmrmrn Bil91rFi. 19J1tj!lSm~f1?8mt1nnl:i1rllil:. nBfi
f1?8mt1fU~H. H~mr RHAC, RACHA, FHI, PSF, PSI, MEC, Marie Stapes, US-CDC, UNFPA,
WHO, CHAI, UN ICEF Bil19j1tj!lS ITM It:lruUls~ru!Hijlllilfi\uuijBllilHluUU9MnIT\~m~lnnjlmj
1Fimtllf.'irgJmij\mgl~msl~\mm:liFiwm '1
BmlH1UUU9\Sg fimtJ fi nn r~~ t:l1 rlt:l rums nnr: M81S MnITH~ j~1 ti nn l~81ilHlhsg lUfimt:l1m~llilmt1 Bil
lUw~mt1~nl '1
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‐ 8 ‐
‐ 9 ‐
1 esckþIepþIm eTaHbICasBVéf¶enH manbec©kviTüaevC¢saRsþy:agTUlMTUlaysMrab;kareFVIeraKvinicä½y nigBüa)alkarbgáeraKsVay cMeBaHRsþImanépÞeBaHk¾eday CMgWsVayenAEtCabBaðacMbgénsuxPaBsaFarN³ CaBiessplvi)akdl;TarkeBlmun nigeRkaykMeNIt enARbeTsCaeRcInelIBiPBelak. eK)an):an;sμanfa 2PaK3énRsþImanépÞeBaHEdlmanCMgW sVaydMNak;kaldMbUgehIymin)anTTYlkarBüa)al GacnwwgvivtþeTArkkarrlUtkUn/ kUnekItmksøab; bJuk¾karbgáeraK cMeBaHkUnEdleTIbnwgekIt. tamkarGegátRsavRCavGRtaeRbv:aLg;énkarqøgemeraKsVay ¬edayeFVIetsþ RPR nigbBa¢ak;lT§pledayetsþ TPHA ¦ cMeBaHRsþImanépÞeBaHEdl)anmkBinitüsuxPaBenAesvaBinitüépÞeBaH )anbgðajfa RsþImanépÞeBaH 4>0° enAqñaM 1996 nig 0>7° enAqñaM 2001 manemeraKsVay. k¾b:uEnþrhUtmkdl;bc©úb,nñenH BMuTan;manr)aykarN_ NamYysþIBIkrNICMgWsVayBIkMeNItcMeBaHTark enAkñúgRbBn½§Bt’manénRksYgsuxaPi)alenAeLIyeT. mUlehtuenH bNþaleGaymankarlM)akkñúgkarkMNt;eGay)anc,as;fa etICMgWsVayBIkMeNItenARbeTskm<úCa CabBaðaF¶n;F¶rb:H Bal;dl;suxPaBTarkkMritNa?. eTaHbICaCMgWsVay CaCMgWEdlbgáplvi)aky:agF¶n;F¶rdl;RsþImanépÞeBaH nigTark EdleTIbnwgekItk¾eday k¾CMgWenHgayRsYlnwgbgáarNas; tamviFIsaRsþRKb;RKgEfTaMBüa)alCMgWkameraKEdlGac Gnuvtþ)anenARbeTskm<úCa. eKalneya)ay nigyuT§saRsþCatisþIBIkarbgáar nigEfTaMBüa)alkarbgáeraKtamkarrYmePT qñaM 2006-2010 ¬eKalneya)ayTI 8¦)anbB©ÚalnUvyuT§saRsþénkarykcitþTukdak;CaBiessrbs;RksYgsuxaPi)al cMeBaHsuxPaB RsþImanépÞeBaHnigTarkeTIbnwgekItEdlGacRbQmmuxnwgkarbgáeraKtamkarrYmePTnigRbdab;bnþBUC. yuT§saRsþCatisþIBIsuxPaBpøÚvePTnigsuxPaBbnþBUC/ qñaM2006-2010 k¾)ankMNt;fa CMgWenARbdab;bnþBUC ¬rYm TaMgCMgWkameraK¦ KWCaEpñkd¾sMxan;mYyénkmμviFIsuxPaBbnþBUCenARbeTskm<úCaeyIg.
2 eKalbMNgrYm eKalbMNgrYménkareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaHKW edIm,IkMcat;CMgWsVayBIkMeNItcMeBaH TarkEdleTIbnwgekItTaMgGs;enARbeTskm<úCa.
‐ 10 ‐
3 TisedAsMxan;² TisedAsMxan;KW karbgáarkarcMlgemeraKsVayBImþayeTAkUn edayepþateTAelITisedABiessmYycMnYn dUcxag eRkamenH ³
3>1 kMNt;eraKvinicä½yénetsþesr:UsaRsþ viC¢man cMeBaHRsþImanépÞeBaH 3>2 Büa)alRsþImanépÞeBaH ¬mþay¦ nigédKU edIm,Ikat;bnßykarcMlgeraK 3>3 Büa)alnigtamdansuxPaBTark
niyamEbbbTsMrab;karGnuvtþn_enH k¾manbB©ÚalpgEdrnUvkarBinitütamdanGMBIRbsiT§iPaBénkarEfTaMBüa)al cMeBaHmþaypgEdr.
4 yuT§saRsþ 4>1 kMNt;eraKvinicä½yénetsþesr:UsaRsþviC¢mancMeBaHRsþImanépÞeBaH
• Gñkpþl;esvaEfTaMsuxPaBenAEpñkBinitüépÞeBaHmuneBlsMralénmNÐlsuxPaB/ mnÞIreBTübEg¥k nigKøInik GgÁkarminEmnrdæaPi)alTaMgGs; RtUvCMrujelIkTwkcitþdl;RsþIeGayeFVIetsþRsavRCavrkemeraKsVay )an y:agticNas;k¾mYydgEdr kñúgeBlmanépÞeBaH. RsþImanépÞeBaHTaMgGs; RtUveFVIetsþRsavRCavrkemeraK sVayenAeBlmkBinitüelIkdMbUg bJueGay)ankan;Etqab;kñúgeBlmanépÞeBaH RbsinebIGaceFVIeTA)an. RbsinebIRsþIenaHmin)aneFVIetsþ kñúgeBlmanépÞeBaHeT Kat;RtUveFVIetsþenH enAeBlsMralkUn.
• etsþrh½s (Rapid test) “Bioline” sMrab;RsavRCavrkemeraKsVay (Treponema-specific rapid
diagnosis test) RtUv)ankMNt;eGayeRbIsMrab;eFVIetsþRsavRCavrkemeraKsVay cMeBaHRsþIEdlman épÞeBaH CaBiessenAeBlEdlKat;mkBinitüsuxPaBenAEpñkBinitüépÞeBaH BIeRBaHGñkpþl;esvaGaceRbI etsþenH)anrh½s nig gayRsYlCagetsþRbePTdéTeTot.
• eTaHbIy:agNak¾eday Rapid test enHminGackMNt;)anfa CMgWsVayenaHeTIbEtqøgfμ I bJuqøgyUrNas; mkehIy bJuk¾CaCMgWsVayEdl)anTTYlkarBüa)al bJuminTan;Büa)aleT. dUecñHeKRtUvykesr:UmQamGñk CMgWEdlmanlT§pl Rapid test viC¢manenaH bBa¢ÚneTAkan;mnÞIrBiesaFn_ edIm,IeFVIetsþ RPR EbbKuN PaB (qualitative test) bBa¢ak;elIlT§pl Rapid test bEnßmeTot. lT§pletsþ RPR enHGac
‐ 11 ‐
bBa¢ak;fa CMgWsVayenaHCaCMgWEdleTIbqøgfμ I² nigminTan;TTYlkarBüa)alenAeLIy dUecñHRtUvpþl;kar Büa)alCUnGñkCMgWenaH.
• RtUvGb;rMENnaMdl;RsþITaMgGs;EdlmanlT§pletsþCMgWsVayviC¢man edayetsþRbePTNak¾eday eGay eTAmNÐlpþl;RbwkSaeFVIetsþQamrkemeraKeGds_edaysμ ½RKcitþ nigrkSakarsMgat; bJubUmQamKat;Edl )ansμR½KcitþeFVIetsþQamrkemeraKeGds_ ehIybBa¢ÚnsMNakQameTAesvaeFVIetsþ HIV.
4>1>1 CMhannanasMrab;kareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaH enAesvaBinitüépÞeBaH 4>1>1>1 CMhanTI 1³
• RsþImanépÞeBaHmkTTYlesvaBinitüépÞeBaHCaelIkdMbUg • pþl;Bt’mansþIBIsar³RbeyaCn_énkareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaH • BinitürkemIldMe)AbJuBgEbkelIRbdab;bnþBUC ³
• RbsinebImandMe)A bJuBgEbkelIRbdab;bnþBUC RtUveFVIeraKvinicä½ynigBüa)alGñkCMgW eTAtamKMnUsbMRBYjéneKalkarN_ENnaMCati ¬sUmemIl]bsm<½n§TI 9 nig eKal karN_ENnaMCatisþIBIkarRKb;RKgEfTaMBüa)alkarbgáeraKtamkarrYmePT nigRbdab; bnþBUC¦
• RbsinebIKμandMe)A bJuBgEbkelIRbdab;bnþBUCeT RtUvbnþeTACMh‘anTI2 edIm,IRsav RCavrkemeraKsVayeday Rapid test .
4>1>1>2 CMhanTI 2³ • eCaHykQamBIcugRmaméd • eFVIetsþrkemeraKsVayedayeRbIetsþ Treponema-specific rapid diagnosis test
(RDT) “Bioline” ¬sUmemIl]bsm<½n§TI3¦³ • RbsinebIlT§pletsþ GviC¢man enaHbBa¢ak;faRsþIenaHKμanqøgemeraKsVayeT.
dUecñHRtUvGb;rM nigpþl;RbwkSadl;Kat; CaBiesskarGb;rMGMBIkareRbIR)as;nigpþl; eRsamGnam½yedIm,ICameFüa)ayrYmsMrab;bgáarkarqøgemeraKeGds_¼kameraK
‐ 12 ‐
nigkarmanépÞeBaH. CaTIbBa©b; RtUvpþl;Bt’manGMBIkarpþl;RbwkSanigeFVIetsþQam rkemeraKeGds_.
• RbsinebIlT§pletsþ viC¢man RtUvbnþeTACMh‘anTI3 edIm,IeFVIetsþ RPR (qualitative) sMrab;bBa¢ak;eGaydwgfa CaCMgWsVayEdleTIbnwgqøgfμ I².
• kMNt;cMNaM ³ lT§plén Rapid test RtUvkt;RtaTukenAkñúgbBa¢IBinitüépÞeBaH (Antenatal
register) ¬sUmemIl]bsm<½n§TI4¦
4>1>1>3 CMhanTI 3³ • bUmQamcMnYn 5 m>l> dak;eTAkñúgbMBg;TIb ¬Edls¶Ütnig)ansMlab;emeraK¦ bnÞab;mkyk
KMrbmkRKbeGayCit ehIybBa¢ÚneTAmnÞIrBiesaFn_edIm,IeFVIetsþ RPR (qualitative). lTVpletsþRtUvpþl;CUnGñkCMgWeGay)anqab;.
• RbsinebIlTVpletsþ GviC¢man enaHGacbBa¢ak;)anfa CMgWsVayEdl)anrkeXIj KW CaCMgWsVayEdlekItmanBImunmknig)anTTYlkarBüa)alrYcehIy. RtUvGb;rM nig pþl;RbwkSadl;Kat; CaBiesskarGb;rMGMBIkareRbIR)as;nigpþl;eRsamGnam½yedIm,I CameFüa)ayrYmsMrab;bgáarkarqøgemeraKeGds_¼kameraK nigkarmanépÞeBaH. CaTIbBa©b; RtUvpþl;Bt’manGMBIkarpþl;RbwkSanigeFVIetsþQam rkemeraKeGds_.
• RbsinebIlTVpletsþ viC¢man bBa¢ak;faCMgWsVayenaHeTIbEtqøgfμ μ I² ehIyGacmin Tan;)anTTYlkarBüa)alenAeLIy. dUecñHRtUv ³
• Büa)alCMgWsVay ¬sUmemIl]bsm<½n§TI1¦ CUnGñkCMgW nigGb;rM -pþl;RbwkSadl;Kat; CaBiesskarGb;rMGMBIkareRbIR)as;nigpþl; eRsamGnam½yedIm,I CameFüa)ayrYmsMrab;bgáarkarqøgemeraK eGds_¼kameraK nigkarmanépÞeBaH. CaTIbBa©b; RtUvpþl;Bt’man GMBIkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_.
‐ 13 ‐
• kMNt;cMNaM ³ lT§plénetsþ RPR (qualitative) RtUvkt;RtaTukenAkñúgbBa¢IBinitüépÞeBaH (Antenatal register) ¬sUmemIl]bsm<½n§TI4¦.
4>1>2 kareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaH enAesvasMralkUn • RsþImanépÞeBaHTaMgGs;RtUveFVIetsþRsavRCavrkCMgWsVayenAesvasMralkUn RbsinebIRsþIenaHminTan;)aneFVI
etsþenHkñúgkMlugeBlmanépÞeBaH ehIyKat;minTan;QWeBaHsMralkUnenAeLIy. • dMeNIrkarénkareFVIetsþRsavRCav nigBüa)alCMgWsVayenAesvasMralkUn KWdUcKñanwgdMeNIrkarenAesva
BinitüépÞeBaHmuneBlsMralEdr. 4>2 karRKb;RKgBüa)almþay nigédKUrYmePTrbs;Kat;edIm,Ikat;bnßykarcMlgemeraKsVay
4>2>1 karBüa)alcMeBaHmþay 4>2>1>1 eBlevlaénkarBüa)al ³
- RtUvBüa)almþayPøam² bnÞab;BIkarbBa¢ak;edayetsþ RPR (qualitative) bgðaj lT§pl viC¢man CaBiesskarBüa)alenH Kb,Ipþl;edaymRnþIsuxaPi)alenAEpñkBinitü épÞeBaHmuneBlsMral (ANC service).
- RtUvsaksYrGñkCMgWGMBIRbvtþiRbtikmμCamYy»sf munnwgpþl;karBüa)alCUnKat; ¬sUm emIl]bsm<½n§TI8¦
4>2>1>2 »sfsMrab;Büa)al ³ - RtUveRbI»sf Benzathine Penicillin G 2.4 million unit cak;sac;dMuEtmþgKt;
cMeBaHRsþImanépÞeBaHTaMgGs;EdlK μaneraKsBaØab:uEnþmanlT§pletsþ RPR viC¢man. cMeBaHRsþIEdlmanCMgWsVaydMNak;kaldMbUg ¬mandMe)AelIRbdab;bnþBUC¦ nigCMgWsVay dMNak;kalTIBIr RtUvBüa)altamrUbmnþdUcKñaenHEdrenH.
krNIRbtikmμCamYyBBYk»sf Penicillin ³ - RtUveRbI»sf Erythromycin 500mg elb bYndgkñúg1éf¶ ry³eBl 14 éf¶.
‐ 14 ‐
kMNt;cMNaM ³ - cMeBaHRsþIEdlpÞúkemeraKeGds_ ³ RKUeBTüCMnajxøH)anpþl;Gnusasn_eGayeRbI»sf
Benzathine-Penicillin G 2.4 million units cak;sac;dMu mYydgkñúgmYys)þah_ ry³eBlbIs)þah_bnþbnÞab;Kña edaymankarBinitütamdaneGay)anhμt;ct;enAesva EfTaMBüa)alCMgWeGds_. dUecñH vamansar³sMxan;Nas;EdlRtUvbBa¢ÚnRsþImanépÞeBaHpÞúk emeraKeGds_ eTATTYlkarEfTaMBüa)alenAesvaEfTaMBüa)alCMgWeGds_ ehIyRtUvCUn Bt’manGMBIlT§pletsþesrU:saRsþCMgWsVay viC¢man dl;Gñkpþl;esvaenATIenaHpg.
4>2>2 karGeBa¢IjédKUeGaymkBüa)al • RtUvBinitütamdannigGeBa¢IjédKUrYmePTrbs;RsþImanépÞeBaHehIyqøgemeraKsVayeGaymkTTYlkarEfTaM
Büa)al • RtUvBüa)alCMgWsVayCUndl;édKUrYmePTTaMgGs;enaH enAeBldMNalKñaCamYyRsþImanépÞeBaHEtmþg Rbsin
ebIGaceFVIeTA)an edayeRbI»sf Benzathine-Penicillin G 2.4 million units cak;sac;dMu EtmþgKt;. kñúgkrNIEdlGñkCMgWenaHRbtikm μCamYyBBYk Penicillin RtUveRbI»sf Erythromycin 500mg elbbYn dgkñúgmYyéf¶ ry³eBl 14éf¶ bJu »sf Doxycycline 100mg elbBIrdgkñúgmYyéf¶ ry³eBl 14éf¶.
• RtUvGb;rMdl;édKUrYmePTrbs;RsþIEdlmanlT§pletsþsVayviC¢man eGayeTATTYlesvaenAmNÐlpþl; RbwkSa nigeFVIetsþQamrkemeraKeGds_edays μR½Kcitþ nigrkSakarsMgat; (VCCT).
4>2>3 karBinitütamdancMeBaHmþay 4>2>3>1 eRkayBIlT§pl Rapid test nigetsþ RPR qualitative viC¢man ³
- eRkayBIlT§pletsþ RPR qualitative viC¢man RtUvykKMrUQamdEdlenaHeTAeFVI etsþ RPR quantitative (RPR titre). bnÞab;mk RtUvkt;RtalT§pletsþ RPR
titre enAkñúgesovePAbBa¢IBinitüépÞeBaHmuneBlsMral “ Antenatal record ” ¬sUm emIl]bsm<n§½TI5¦ nigesovePAsuxPaBmata “ Mother Health’s Record book ” ¬sUmemIl]bsm<n§½TI6¦ edIm,IrkSalT§pletsþ RPR titre enaHCaeKal (baseline)
‐ 15 ‐
sMrab;eRbobeFoblT§plBinitütamdanRbsiT§iPaBénkarBüa)al enAeBlEdlRsþICa mþaymkBinitüsuxPaBelIkeRkay²eTot.
4>2>3>2 eRkayBImþay)anTTYlkarBüa)alCMgWsVay ¬sUmemIl]bsm<n§½TI2¦ ³
- RtUvR)ab;eGayRsþIEdlmanetsþCMgWsVay viC¢man enaH RtLb;mkCYbGñkvij ry³eBlBI 6 eTA 12Ex eRkayBIKat;)anTTYlkarBüa)al edIm,IBinitütamdanRbsiT§iPaBénkar Büa)al edaykareFVIetsþ RPR quantitative (RPR titre) sareLIgvij. Cakar RbesIr mþayKb,IRtLb;mkBinitütamdaneLIgvijenAExTI9 eBlEdlKat;ykkUnmk cak;fñaMbgáarCMgWkRBa¢il.
- Kb,IeFVIetsþ RPR quantitative (RPR titre) enAmnÞIrBiesaFn_dEdl ¬mnÞIrBiesaFn_ Edlmþay)aneFVIetsþenHBIelIkmun¦. RbsinebImankarERbRbYllT§pl titre 4dg enAcenøaHl,ayetsþBIr (two dilutions) ¬]> BI 1³16 eTA 1³4 bJu BI 1³8 eTA 1³32¦ enaHGacbBa¢ak;c,as;fa mankarERbRbYllT§plrvagetsþBIr EdlrkemeraK sVay edayeRbIR)as;RbePTetsþEtmYyRbePTdUcKña ³ • RbsinebIlT§pl RPR titre fycuH 2dgbJuelIsBI2dg ¬]> BI 1³16 eTA 1³4¦
bJu lT§pletsþ RPR qualitative GviC¢man RtUvGb;rMnigpþl;RbwkSadl;Kat; Ca BiesskarGb;rMGMBIkareRbIR)as; nigpþl;eRsamGnam½yedIm,ICameFüa)ayrYmsMrab; bgáarkarqøgemeraKeGds_¼kameraK nigkarmanépÞeBaH ehIyRtUvGeBa¢IjédKUrbs; Kat;eGaymkTTYlkarBüa)al RbsinebIédKUenaHminTan;)anTTYlkarBüa)alenA eLIy nigpþl;Bt’mandl;Kat;nigédKUrbs;Kat;GMBIkarpþl;RbwkSanigeFVIetsþQamrk emeraKeGds_ RbsinebIKat;TaMgBIrnak;min)aneFVIetsþenHkalBIeBlmkBinitüépÞ eBaHmuneBlsMral bJuRbsinebIKat;mankarRbQmmuxnwgkarqøgemeraKeGds_ ebI eTaHbICalT§pletsþEdl)aneFVIBIelIkmun²GviC¢mank¾eday.
‐ 16 ‐
• RbsinebIlT§pl RPR titre KμankarfycuH4dgeT eRkayBIkarBüa)alCMgWsVay Gs;ry³eBl6Exmk ¬]> eRbobeFobCamYynwglT§pl RPR titre Edl)aneFVI kalBIelIkdMbUgenAeBlcab;epþImBüa)al¦ enaHGacbBa¢ak;)anfa karBüa)alGac braC½y bJuCMgWsVayenaHCaCMgWsVayEdl)anqøgyUrNas;mkehIy ¬qøgelIsBI 2qñaM¦ bJuk¾GacqøgCMgWsVaysarCafμ ImþgeTot. eTaHbIy:agNak¾eday lT§pletsþ esr:UsaRsþEbbenH minGacbBa¢ak;BImUlehtuNamYyEdl)anerobrab;enHeGay)an BitR)akd)aneT. dUecñH RtUvBüa)alCMgWsVayCUnGñkCMgWenHsarCafμ I nigeFVIetsþrk emeraKeGds_sarCafμ I ¬kñúgkrNIlT§pletsþelIkmun GviC¢man¦. ebIeTaHbICa karBüa)alCMgWsVayEdlqøgfμ I RtUveRbIR)as;»sf Benzathine-Penicillin G
2.4 million units cak;sac;dMuEtmþgKt;;k¾eday RKUeBTüKb,Ipþl;karBüa)alCUnGñk CMgWEdlmansßanPaBEbbenH eday»sf Benzathine-Penicillin G 2.4
million units cak;sac;dMu mYydgkñúgmYys)þah_ ry³eBlbIs)þah_bnþbnÞab;Kña edIm,IeGaykarBüa)alenHGacmanRbsiT§iPaBcMeBaHCMgWsVayEdl)anqøgyUrNas;mkehIy nigCMgWsVayEdl)anBüa)albraC½yBIelIkmun.
• kMNt;sMKal; ³ CaTUeTA etsþ RPR qualitative RtLb;eTACa GviC¢man vij eRkayBIkarBüa)alTTYl)aneCaKC½y k¾b:uEnþcMeBaHGñkCMgWxøH RPR titre Gacsßit enAkñúgkMritTabGs;ry³eBld¾yUr bJuCYnkalGs;mYyCIvit.
4>3 karBüa)al nigkarBinitütamdancMeBaHTark 4>3>1 kareFVIeraKvinicä½yCMgWsVayBIkMeNItcMeBaHTarkEdleTIbnwgekItenAesvasMralkUn
• kareFVIeraKvinicä½yCMgWsVayBIkMeNItmankarlM)aksμ úksμajNas; edaysarEtkarepÞrGgÁbdibkçR)aN BImþaymkTarktamry³suk (transplacental transfer of maternal antibodies to the
fetus) . karepÞrGgÁbdibkçR)aNBImþayeTAkUnenH eFVIeGaymankarlM)akkñúgkarbkRsaylT§pl etsþesr:UsaRsþcMeBaHCMgWsVayelITarkEdleTIbnwgekIt. eyIgk¾minRtUvykQamBITgsukTarkeTA
‐ 17 ‐
eFVIetsþEdr edaysarQamenaHGacnwgmanqøgemeraKsVayBIQamrbs;mþay. dUecñHKμanetsþNa mYysMrab;eRbIR)as;RsavRCavrkemeraKsVayBIkMeNItcMeBaHTarkenAeLIyeT. kareFVIeraKvinicä½yCMgW enHBwgEp¥keTAelIkarBinitüeraKsBaØaKøInik nigRbvtþiCMgWnigkarBüa)alrbs;mþay.
• RtUvBinitüeGay)anhμt;ct;cMeBaHTarkEdleTIbnwgekIt edIm,IrkeraKsBaØaEdlGacsgS½yfaCa CMgW sVayBIkMeNIt ³
- RbsinebImaneraKsBaØaNamYyxageRkamenH sUmbBa¢ÚnTarkeTAesvaÉkeTsEfTaMBüa)al kumar bJumnIÞreBTübEg¥kNamYy ³
• TarkekItminRKb;Ex bJuTarkekItmkmanTMgn;ticCagFm μta • manhUrsMe)ar bJuTwkrégBIRcmuHruaMér: • sm,úrelOg ¬PñasesImenAEPñkelOg¦ • eføIm/ GeNþIk bJukUnkNþúrrIkFM • knÞÜlrmas;Es,k CYnkalEs,ks¶Üt bJumanBgTwktUc² bJuEbkRska
bJuesIm² CaBiessenAéd/ eCIg bJuenAbrievNCMuvijmat; bJurn§KUf • RTg;RTayq¥wgenARcmuH bJueCIgmanlkçN³minFmμta-evoc.
- ebIeTaHbICaTarkEdleTIbnwgekItKμaneraKsBaØaNamYyxagelIenHk¾eday b:uEnþTarkenaHekIt ecjBImþayEdlmanetsþsVay viC¢man eyIgRtUvEtBüa)alCMgWsVaycMeBaHTarkeday»sf
Benzathine-Penicillin cak;sac;dMuEtmþgKt;. • bnÞab;mk RtUvbBa¢ÚnTarkeTAesvacak;fñaMbgáar nigeFVIetsþ DNA-PCR rkemeraKeGds_.
4>3>2 karBüa)alCMgWsVaycMeBaHTarkEdleTIbnwgekIt
• RtUvBüa)alCMgWsVayeday»sf Benzathine-Penicillin G 50,000 units/Kg. cak;sac;dMuEt mþgKt; cMeBaHTarkEdleTIbnwgekItecjBImþayEdlmanetsþemeraKsVay viC¢man ebIeTaHbICaTark EdleTIbnwgekItenaH K μaneraKsBaØaCMgWsVayBIkMeNItk¾eday.
‐ 18 ‐
4>3>3 karBinitütamdankumar • eTaHbICaTarkqøgemeraKsVayBImþay ehIyKμaneraKsBaØaenAeBleTIbnwgekItk¾eday k¾eraKsBaØa
KøInikénCMgWsVayBIkMeNItGacnwgelcecjenAeBleRkaymkeTot. • dUecñH ral;eBlEdlmþaynaMkumarmkTTYlkarcak;fñaMbgáar ¬s)aþh_TI 6/ 10/ 14 nigenAExTI 9¦
RKUeBTüRtUvBinitükumarrkeraKsBaØaKøInikénCMgWsVayBIkMeNItdUcCa ³ manhUrsMe)ar bJuTwkrégBIRcmuH ruaMér:/ sm,úrelOg ¬PñasesImenAEPñkelOg¦/ eføIm/ GeNþIk bJukUnkNþúrrIkFM/ knÞÜlrmas;Es,k CYnkalEs,ks¶Üt bJumanBgTwktUc² bJuEbkRska bJuesIm² CaBiessenAéd/ eCIg bJuenAbrievNCMuvij mat; bJurn§KUf. RbsinebImaneraKsBaØaNamYy RtUvbBa¢ÚnkumareTAesvaÉkeTsEfTaMBüa)alkumar bJu mnÞIreBTübEg¥kEdlenACitbMput edIm,IeFVIkarvaytMéleraKvinicä½yCabnÞan;nigTTYlkarBüa)alPøam².
• kMNt;cMNaM ³ edIm,ICYysMrYldl;karBinitütamdankumarnigmþay Gñkpþl;esvaEfTaMsuxPaBenAesva sMralkUn nigesvacak;fñaMbgáarRtUvsresrkMNt;cMNaM “mþay RPR (+) nigkumar)anTTYlkar Büa)alehIy” enAelIb½NÑcak;fñaMbgáar edIm,IeGayGñkpþl;esvaBinitütamdanrkeraKsBaØaKøInik erogral;eBlEdlkumarmkcak;fñaMbgáar nigedIm,IeFVIetsþ RPR titre cMeBaHmþayeLIgvijenAExTI 9 eBlmþaynaMkUnmkcak;fñaMbgáarCMgWkRBa¢il.
5 karpÁt;pÁg;sMPar³ brikçar nigRbtikr
sMPar³sMrab;eFVIetsþ RPR nwgRtUv)anpÁt;pÁg;CUndl;mnÞIrBiesaFn_énmnÞIreBTübEg¥k nigGtItmnÞIreBTüRsuk tam ry³mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK/ mCÄmNÐlCatiKaMBarmata nigTark nigtamry³ GgÁkarGnþrCati-GgÁkarminEmnrdæaPi)alCaédKU. RksYgsuxaPi)alnwgpÁt;pÁg;»sf brikçar nigRbtikr (Rapid
test “Bioline”, RPR test) tamry³XøaMg»sfkNþalCUndl;kariyal½ysuxaPi)alRsukRbtibtþi edIm,IEckcay bnþ. »sf brikçar nigRbtikrmYycMnYnsmRsbRtUv)anrkSaTukenAkñúgXøaMgsþúkénmCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK sMrab;karpÁt;pÁg;CabnÞan; kñúgkrNImankarekIneLIgnUvtMrUvkar bJukardac;sþúk Cayfaehtu kñúgcenøaHeBlénkarpÁt;pÁg;edayXøaMg»sfkNþal.
‐ 19 ‐
6 karpSBVpSayBt’man/ Gb;rM nigTMnak;TMng erogral;eBlBinitüCMgW Gñkpþl;esvaEfTaMRtUvGb;rMGtifiCnGMBIkarbgáarCMgWkameraK-eGds_ nigkareFVIetsþrk
emeraKeGds_/ bgðajR)ab;GMBIrebobeRbIR)as;eRsamGnam½y/ R)ab;GMBIkareRbIR)as;»sfeGay)anRtwmRtUv-eTogTat; nigCab;lab; nigR)ab;GMBIkarGeBa¢IjédKUrYmePTeGaymkTTYlkarEfTaMBüa)al.
7 karBinitütamdan nigr)aykarN_
7>1 bBa¢IsMrg;Bt’manGtifiCnBinitüépÞeBaHmuneBlsMral ¬ ]bsm<n§½TI4¦ • RtUveRbIR)as;bBa¢IsMrg;Bt’manGtifiCnBinitüépÞeBaHmuneBlsMral EdlkMBugeRbIR)as;enAtammNÐlsux
PaB/ mnÞIreBTübEg¥k nigKøInikGgÁkarminEmnrdæaPi)aledIm,Ikt;RtaBt’mansegçbrbs;RsþImanépÞeBaH enA ral;eBlKat;eTABinitüsuxPaB.
• cMeBaHesvasuxaPi)alenAtamRsukRbtibtþiEdlkMBugGnuvtþyuT§saRsþénkareqøIytbrYmKña cMeBaHkarbgáar nigEfTaMBüa)alCMgWeGds_-kameraK nigsuxPaBbnþBUC (Linked Response for Prevention, Care,
and Treatment of HIV/AIDS and Sexual and Reproductive Health Issues) RtUveRbIR)as; esovePAcuHbBa¢IRsþImanépÞeBaHEdlsμR½KcitþTTYlkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_ enAEpñk BinitüépÞeBaH Edl)anpþl;CUnedaymCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK.
• bBa©ÚlbEnßmxÞg; (column) cMnYnbYn ³ “eFVIetsþrkemeraKsVayeday Rapid test niglT§pletsþ”
nig “eFVIetsþrkemeraKsVayeday RPR test niglT§pletsþ” eTAkñúgbBa¢IsMrg;Bt’manGtifiCn Binitü épÞeBaHmuneBlsMral ¬sUmemIl]bsm<n§½TI4¦ edIm,IbBa¢ak;fa RsþImanépÞeBaHenaH)aneFVIetsþRsavRCavrk emeraKsVay nigbBa¢ak;BIlT§pletsþ pgEdr. RbsinebIRsþIenaH)aneFVIetsþ RtUvKUssBaØa enAkñúg
xÞg; “eFVIetsþrkemeraKsVay”. cMeBaHlT§pletsþ viC¢man bJu GviC¢man RtUvsresrenAkñúgxÞg; “lT§pl
etsþ” edayKUssBaØa (+) bJu (-). • RtUvrkSabBa¢IsMrg;Bt’manenaHenAesvaBinitüépÞeBaHmuneBlsMral edIm,IbgáarmineGay)at;bg; niggay
RsYlrkBt’manTaMgenaHeLIgvijpg.
‐ 20 ‐
7>2 snøwksMrg;Bt’manrbs;RsþIBinitüépÞeBaHmuneBlsMral ¬ ]bsm<n§½TI5¦ • RtUveRbIR)as;snøwksMrg;Bt’manrbs;RsþIBinitüépÞeBaHmuneBlsMral EdlkMBugeRbIR)as;enAtammNÐlsux
PaB nigmnÞIreBTübEg¥k edIm,Ikt;RtaTukral;Bt’manEdlTak;TgnwgRsþImanépÞeBaHenaH. • RtUvbBa©ÚlsnøwkbEnßm (additional sheet) sþIBIkarRsavRCavrkCMgWsVay P¢ab;CamYynwgsnøwksMrg;
Bt’manrbs;RsþIBinitüépÞeBaH edIm,Ikt;RtaTuknUvBt’mansþIGMBIkareFVIetsþrkemeraKsVay nigkarBüa)al CUnRsþIenaH.
• RtUvrkSasnøwksMrg;Bt’manenaHenAesvaBinitüépÞeBaHmuneBlsMral edIm,IbgáarmineGay)at;bg; niggay RsYlrkBt’manTaMgenaHeLIgvijpg.
7>3 esovePAsuxPaBmata ¬ ]bsm<n§½TI6¦ • RtUveRbIR)as; “esovePAsuxPaBmata” EdlmNÐlsuxPaB nigmnÞIreBTübEg¥k)anRbKl;CUndl;RsþI
EdlmkBinitüépÞeBaH edIm,IeGayGñkpþl;esvaEfTaMsuxPaBkt;RtaTukral;Bt’manrbs;RsþIenaHenAerog ral;eBlmanépÞeBaHmþg².
• RtUvbBa©ÚlsnøwkbEnßm (additional sheet) sþIBIkarRsavRCavrkCMgWsVay eTAkñúgesovePAsuxPaBmata edIm,Ikt;RtaTuknUvBt’mansþIGMBIkareFVIetsþrkemeraKsVay nigkarBüa)alCUnRsþIenaH.
• “esovePAsuxPaBmata” RtUvrkSaTukedayRsþIxøÜnÉgpÞal; ehIyRtUvykmkCab;nwgxøÜnKat; enAral;eBl EdlKat;mkBinitüépÞeBaHmuneBlsMralenAmNÐlsuxPaB bJumnÞIreBTübEg¥k ehIyRtUveRbIR)as;esovePA enHral;eBlEdlKat;manépÞeBaH ebIeTaHbICaenAeBlKat;QWeBaHsMralkUnk¾eday. viFIenHeFVIeGayGñk pþl;esvaEfTaMsuxPaBGacTTYl)annUvBt’manepSg²EdlTak;TgnwgépÞeBaHrbs;Kat; enAeBlEdlKat; mkBinitüsuxPaBmþg².
‐ 21 ‐
7>4 r)aykarN_ ¬ ]bsm<n§½TI7¦ • mNÐlsuxPaB/ mnÞIreBTübEg¥k/ KøIniksuxPaBRKYsar nigKøInikGgÁkarminEmnrdæaPi)al RtUvepJI
r)aykarN_sþIGMBIkareFVIetsþRsavRCavrkCMgWsVay erogral;RtImasmkEpñkRKb;RKgTinñn½yénmCÄmNÐl CatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK. bnÞab;BIkarbUksrub r)aykarN_enHnwgRtUv)anpSBVpSay CUndl;sßabn½Bak;Bn§½nana CaBiessmCÄmNÐlCatiKaMBarmatanigTark.
• RtUveRbIR)as;snøwkbEnßm (additional sheet) sþIBIr)aykarN_énkareFVIetsþRsavRCavrkCMgWsVay ¬sUm emIl]bsm<n§½TI7¦ P¢ab;mkCamYynwgr)aykarN_RbcaMRtImassþIBIkrNICMgWkameraKsMrab;mNÐlsuxPaB mnIÞreBTübEg¥k/ KøIniksuxPaBRKYsar nigKøInikGgÁkarminEmnrdæaPi)alEdlmanesvaeFVIetsþRsavRCavrk CMgWsVaycMeBaHRsþImanépÞeBaHmuneBlsMral.
‐ 22 ‐
]bsm<n§½TI1 ³ kareFVIetsþRsavRCavrkemeraKbgáCMgWsVaycMeBaHRsþImanépÞeBaH
tamdanlT§pletsþkñúgry³ eBlBI 6 eTA 12 ExeRkay. ]> enAExTI 9bnÞab;BIsMralkUn *
RsþImkBinitüépÞeBaHCaelIkdMbUg (ANC)
- Gb;rM nigpþl;RbwkSa - CMrujeGayeRbIR)as;eRsamGnam½y
nigpþl;eRsamCUnKat; - CMrujeGayeFVIetsþrkemeraKeGds_
etImandMe)AbJuBgTwk¼Ebk enARbdab;bnþBUCEdrbJueT?
RPR titre (quantitative) edIm,IrkSa lT§pletsþenaH CaeKal (baseline)
eRbIKMnUsbMRBYjsþIBIkarEfTaMBüa)aldMe)AelIRbdab;bnþBUC
Büa)alCMgWsVay - Benzathine-Penicillin G 2.4 lan units cak;sac;dMuEtmþgKt; - Gb;rM nigpþl;RbwkSa - CMrujeGayeRbIR)as;eRsamGnam½y nigpþl;eRsamCUnKat; - RKb;RKg nigEfTaMBüa)alédKUrYmePT - CMrujeGayeFVIetsþrkemeraKeGds_
viC¢man
Rapid test
GviC¢man
RPR test GviC¢man
viC¢man
lT§pletsþ RPR titre Føak;cuHes μ I bJuelIsBI 2 titres (≥ 2 titres)**
lT§pletsþ RPR titre ekIneLIg bJuminERbRbYl bJuFøak;cuHticCag 2 titres (≤ 2 titres)
- Gb;rM nigpþl;RbwkSa - CMrujeGayeRbIR)as;eRsamGnam½y nigpþl;eRsamCUnKat; - CMrujeGayeFVIetsþrkemeraKeGds_ ¬RbsinebIminTan;eFVI¦ - RtUvBüa)alCMgWsVayCUnédKUrYmePTrbs;Kat; RbsinebI
édKUenaHminTan;)anTTYlkarBüa)alenAeLIy.
karBüa)alGacbraC½y bJuRsþIGacqøgCMgWsVayCaf μI bJuk¾CaCMgW sVayEdl)anqøgyUrNas;mkehIy. RtUv Büa)alCMgWsVay sarCaf μ IeLIgvij ry³eBlbIs)þah_ ³ - Benzathine-Penicillin G 2.4 lan units
cak;sac;dMumYydgkñúg 1s)þah_ ry³eBlbIs)þah_ - RtUvelIkTwkcitþeGayRsþIeFVIetsþrkemeraKeGds_ - RtUvBüa)alCMgWsVayCUnédKUrYmePTrbs;Kat; - CMrujeGayeRbIR)as;eRsamGnam½y nigpþl;eRsamCUnKat;
* mþaynaMkUnmkmNÐlsuxPaBbJumnÞIreBTübEg¥k edIm,Icak; v:ak;saMgkarBarCMgWkRBa¢il.
** ]> Føak;cuHBI 1:16 mkenARtwm 1:4
Kμan
man
‐ 23 ‐
]bsm<n§½TI2 ³ karEfTaMBüa)alTarkEdlekItecjBImþaymanqøgCMgWsVay
TarkekItecjBImþaymanCMgWsVay
etImaneraKsBaØaEdlsgS½yfaCaCMgWsVayBIkMeNItEdrbJueT?
bBa¢Ún
eT
Binitütamdan
Büa)alCMgWsVayBenzathine-Penicillin
cak;sac;dMuEtmþgKt;
man esvacak;v:ak;saMgbgáareraK
eraKsBaØaKøInikEdlnaMeGaysgS½yfaGacCaCMgWsVayBIkMeNIt ¬enAeBlTarkekItPøam bJuenAeBlBinitütamdan¦ ³ - TarkekItminRKb;Ex bJuTarkekItmkmanTMgn;ticCagFmμta - manhUrsMe)ar bJuTwkrégBIRcmuHruaMér: - sm,úrelOg ¬PñasesImenAEPñkelOg¦ - eføIm/ GeNþIk bJukUnkNþúrrIkFM - knÞÜlrmas;Es,k CYnkalEs,ks¶Üt bJumanBgTwktUc² bJuEbkRska bJuesIm² CaBiessenAéd/ eCIg
bJuenAbrievNCMuvijmat; bJurn§KUf - RTg;RTayq¥wgenARcmuH bJueCIgmanlkçN³minFm μta-evoc.
eFVIetsþ DNA PCR
rkemeraKeGds_
ral;eBlkumarmk TTYlkarcak;v:ak; saMgbgáareraK ¬s)aþh_TI 6-10-14 nigExTI 9¦ RtUvBinitürkemIl eraKsBaØaKøInikénCMgWsVayBIkMeNIt
bBa¢ÚneTAesvaÉkeTsCMgW kumar bJueTAmnÞIreBTübEg¥k
man
‐ 24 ‐
]bsm<n§½TI3 ³ etsþ Standard SD Bioline Syphilis 3.0
sMPar³EdlRtUvkarsMrab;eFVIetsþenHKW Micropipette nig Tips EdlmancMNuH 10ul . karGnuvtþn_ ³
• dkykbnÞHetsþecjBIkBa©b; ehIydak;elIkEnøgEdlmanépÞrabesμ I • bnþk;esr:UmQam bJuQamsuT§ cMnYn 10ul edayyWt²eTAelIkEnøgsMrab;dak;vtßúviPaKrbs;bnÞHetsþ • bnþk;l,ayetsþ bI dMNk; eTAelIkEnøgsMrab;dak;vtßúviPaKrbs;bnÞHetsþ • BinitüemIllT§pletsþry³eBl 5 eTA 20 naTIeRkay
lT§pl GviC¢man RbsinebImanelcecjbnÞHqñÚtEtmYy enaHbBa¢ak;fa lT§pletsþ “GviC¢man” lT§pl viC¢man RbsinebImanelcecjbnÞHqñÚtcMnYn BIr ¬C nig T¦ enaHbBa¢ak;fa lT§pletsþ “viC¢man” lT§pl minGackMNt;)an RbsinebIKμanelcecjbnÞHqñÚtNamYyeT bnÞab;BIeFVIetsþ enaHbBa¢ak;fa lT§pletsþ “minGackMNt;)an”
‐ 25 ‐
]bsm<n§½TI4 ³ xÞg;bEnßmsMrab;bBa¢IsMrg;Bt’manBinitüépÞeBaHmuneBlsMral (Additional columns to Antenatal Register) kMNt;cMNaM ³ - cMeBaHesvasuxaPi)alenAtamRsukRbtibtþiEdlkMBugGnuvtþyuT§saRsþénkareqøIytbrYmKña cMeBaHkarbgáar nig
EfTaMBüa)alCMgWeGds_-kameraK nigsuxPaBbnþBUC (Linked Response for Prevention, Care, and
Treatment of HIV/AIDS and Sexual and Reproductive Health Issues) RtUveRbIR)as; esovePA cuHbBa¢IRsþImanépÞeBaHEdlsμR½KcitþTTYlkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_ enAEpñkBinitüépÞeBaH Edl)anpþl;CUnedaymCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK.
- RtUvBinitürkeraKsBaØadMe)AelIRbdab;bnþBUC nigeFVIetsþRsavRCavrkemeraKsVay eday “ Rapid test ”
(Treponemal test) cMeBaHRsþImanépÞeBaHTaMgGs;Edl)anmkBinitüsuxPaBenAesvaBinitüépÞeBaHmuneBl sMral. RbsinebIlT§ pl Rapid test viC¢man RtUveFVIetsþbBa¢ak;eday “ RPR test ” (Non-treponemal
test) . kareFVIetsþRsavRCavrkemeraKsVay Rapid test RPR test
(+) (-) (+) (-)
‐ 26 ‐
]bsm<n§½TI5 ³ snøwkbEnßmsMrab;sMrg;Bt’manBinitüépÞeBaHmuneBlsMral (Additional sheet to Antenatal Record) kMNt;cMNaM ³ RtUvBinitürkeraKsBaØadMe)AelIRbdab;bnþBUC nigeFVIetsþRsavRCavrkemeraKsVay eday “ Rapid test ”
(Treponemal test) cMeBaHRsþImanépÞeBaHTaMgGs;Edl)anmkBinitüsuxPaBenAesvaBinitüépÞeBaHmuneBlsMral.
4 kareFVIetsþRsavrkemeraKsVay kalbriecäT>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• BgTwk¼dMe)AelIRbdab;bnþBUC man K μan min)anBinitü kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Rapid test rkemeraKsVay (+) (-) min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• RPR test rkemeraKsVay (+) (-) min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Rbtikm μCamYy»sf Penicillin man K μan mindwgc,as; kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Büa)alCMgWsVay man Kμan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• RPR titre Baseline………………… min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Follow-up……………… ………………
• GeBa¢IjédKUrYmePTeGaymkBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• édKUrYmePT)anTTYlkarBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Tark)anTTYlkarBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• bBa¢ÚneTAesva PMTCTRbsinebI man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> minTan;)aneFVIetsþrkemeraKeGds_
kalbriecäTNat;CYbelIkeRkayeTot ¬RbsinebIcaM)ac;¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> kMNt;cMNaM ³
RbsinebIdwgc,as;fa lT§pl Rapid test viC¢man cab;BIeBlmanépÞeBaHelIkmunmk eKmincaM)ac;eFVIetsþenHsarCafμ I eLIgvijeT. cUreFVIetsþ “ RPR test ” (qualitative nig quantitative) kñgeBldMNalKñaEtmþg.
‐ 27 ‐
]bsm<n§½TI6 ³ snøwkbEnßmsMrab;esovePABinitüsuxPaBmata (Additional sheet to Mother Health Record’s Book) kMNt;cMNaM ³ TMrg;sMrg;Bt’manenHKWCasnøwkbEnßmeTAkñúgesovePAsuxPaBmata.
kareFVIetsþRsavRCavrkemeraKsVay kalbriecäT>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• BgTwk¼dMe)AelIRbdab;bnþBUC man K μan min)anBinitü kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Rapid test rkemeraKsVay (+) (-) min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• RPR test rkemeraKsVay (+) (-) min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Rbtikm μCamYy»sf Penicillin man K μan mindwgc,as; kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Büa)alCMgWsVay man Kμan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• RPR titre Baseline………………… min)aneFVI kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Follow-up……………… ………………
• GeBa¢IjédKUrYmePTeGaymkBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• édKUrYmePT)anTTYlkarBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• Tark)anTTYlkarBüa)al man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
• bBa¢ÚneTAesva PMTCTRbsinebI man K μan kMNt;cMNaM>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> minTan;)aneFVIetsþrkemeraKeGds_
kalbriecäTNat;CYbelIkeRkayeTot ¬RbsinebIcaM)ac;¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> kMNt;cMNaM ³
RbsinebIdwgc,as;fa lT§pl Rapid test viC¢man cab;BIeBlmanépÞeBaHelIkmunmk eKmincaM)ac;eFVIetsþenHsarCafμ I eLIgvijeT. cUreFVIetsþ “ RPR test ” (qualitative nig quantitative) kñgeBldMNalKñaEtmþg.
‐ 28 ‐
]bsm<n§½TI7 ³ r)aykarN_RbcaMRtImassþIBIkrNICMgWkameraK kMNt;cMNaM ³ TMrg;sMrg;Bt’manenHKWCasnøwkbEnßmsþIGMBIkareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaH EdlP¢ab;CamYynwgr)aykarN_RbcaMRtImassþIBIkrNICMgWkameraKEdlbBa¢ÚnmkBIKøIniksuxPaBRKYsar bJumNÐlsuxPaB EdlmanesvaenH.
kareFVIetsþRsavRCavrkemeraKsVaycMeBaHRsþImanépÞeBaH Ex>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> RtImasTI>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> qñaM 20>>>>>>>>>>> eQμaHKøIniksuxPaBRKYsar bJumnÞIreBTübEg¥k bJumNÐlsuxPaB>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> RsukRbtibtþi>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> extþ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> karEbgEcktamGayu
srub kareFVIetsþrkemeraKsVay ticCag 15 qñaM 15-49 qñaM elIsBI 50qñaM
cMnYnRsþITaMgGs;EdlmkBinitüépÞeBaHelIkTI1 enAesvaBinitüépÞeBaHmuneBlsMral
cMnYnRsþITaMgGs;Edl)aneFVI Rapid test
cMnYn Rapid test (+)
cMnYnRsþITaMgGs;Edl)aneFVI RPR qualitative test
cMnYn RPR test (+)
cMnYnRsþImkBinitüépÞeBaH Edl)anBüa)alCMgWsVay
cMnYnRsþImanCMgWsVayEdl)aneFVI RPR quantitative test (titre)
cMnYnRsþIeFVIetsþ RPR- Titre - baseline
cMnYnRsþIeFVIetsþ RPR- Titre - follow up
cMnYnsrub édKUEdl)anTTYlkarBüa)alCMgWsVay
cMnYnsrub TarkEdl)anTTYlkarBüa)alCMgWsVay
‐ 29 ‐
]bsm<n§½TI8 ³ karRKb;RKgEfTaMGñkCMgWEdlmanRbtikm μCamYy»sf (Management of anaphylaxis) RbtikmμCamYynwg»sf (Anaphylaxis) GacekItmaneLIgCayfaehtu enAKøInikeBlEdlGñkCMgWTTYlkarBüa)al. RKUeBTüRtUveFVIkarseRgÁaHGñkCMgWCabnÞan;Pøam² enAeBlEdlKat;manRbtikmμCamYynwg»sfBüa)al. dUecñH RtUvEtman»sf Adrenaline sMrab;eRbIR)as;Pøam² RbsinebIkrNIenHekItmaneLIg enAeBlNaEdlRKUeBTü cak;v:ak;saMg bJueRbI»sfcak;CUnGñkCMgW.
1- eraKsBaØaénkarmanRbtikmμCamYynwg»sf GñkCMgWGacdwgfaxøÜnmanRbtikmμCamYynwg»sf enAeBlEdlKat;maneraKsBaØadUcteTA ³
- cab;epþImtwg-fb;degðImPøam² (wheeze) - Bi)akdkdegðIm - ehIm-ehImmux/ bbUrmat; nigGNþat - eLIgsVay-sVaybbUrmat; nigRmaméd - CIBcredIrjab; - sMBaFQamcuHTab - eLIgknÞÜl-rmas; EdlekIteLIgy:agqab;rh½sCamYyeraKsBaØaxagelI.
2- karRKb;RKgEfTaMCabnÞan;cMeBaHGñkCMgWEdlmanRbtikmμCamYy»sf
- dak;GñkCMgWeGayedksNþÚkep¥ógmkxageqVg - erobcMsMrYleGaymanxül;dkdegðIm RbsinebIGñkCMgWQb;dkdegðIm bJuCIBcrenAsésrbMBg;k
(Carotide pulse) minGacsÞabeXIj RtUvcab;epþImCYyseRgÁaHdl;ebHdUg-sYt CabnÞan;Pøam edIm,IeGaysrIragÁenHdMeNIrkareLIgvij
- esñIsMuCMnYyseRgÁaHbnÞan;Pøam².
3- kareRbIR)as;»sf Adrenaline - RtUvcak;»sf cUlkñuúgsac;dMueGayeRCA edayeRbIsWruaMgcMNuH 1 m>l> nigm¢úlelx 23 G .
‐ 30 ‐
Dose of Adrenaline = 0.01ml/kg*
AGE/WEIGHT DOSE OF ADRENALINE (ml of 1:1000) 1-2 years (approx 3 - 10 kg) 0.03 - 0.1 ml 2-3 years (approx 10 kg) 0.1 ml 4-6 years (approx 15 kg) 0.15 ml 7-10 years (approx 20 kg) 0.2 ml 11-12 years (approx 25 - 30 kg) 0.25 - 0.3 ml 12 - 14 years (approximately 40 kg) 0.4 ml Adult 0.5 ml
- RKUeBTüRtUvføwgkumar bJuBinitüemIlTMgn;kumarkalBIelIkmun enAkñuúgesovePAkt;RtaBt’manrbs;GñkCMgW
k¾bu:EnþminRtUveFVIeGaymankaryWty:avdl;karseRgÁÁaHTarkeT. - RtUveRbI»sf Adrenaline CabnþbnÞab;ry³eBl 5 naTImþg cMeBaHmnusSeBjv½y bJu 10 eTA 15
naTImþg cMeBaHkumarrhUtTal;EtmansPaBFUrRsaleLIgvij.
4- karEfTaMbEnßmeRkayBIkarcab;epþImcak;»sf Adrenaline - cab;epþImcak;bBa©Úlesr:UméRbPøam² - dak;xül;GuksIuEsn 100° edayBak;m:as;elImuxGñkCMgW (face-mask) kñúgcMNuH 8 lIRtkñúg 1 naTI
ehIyrkSaeGayxül;GacecjcUltampøÚvdkdegðIm)anl¥ - bBa¢ÚnGñkCMgWtamrfynþseRgÁaHbnÞan; RbsinebIGaceFVIeTA)an. dak;GñkCMgWeGaysMrakBüa)alenAkñúg
mnÞIreBTü edIm,IBinitütamdanbnþ nigpþl;karEfTaMBüa)al - BinitütamdankarBüa)al nigsBaØaepSg² dUcCa sm<aFQam/ cgVak;ebHdUg/ sItNðPaB/
cgVak;degðIm/ kMhab;GuksIuEsn .l. erogral;ry³eBl 10-15 naTImþg nigkt;RtalT§plTuk.
‐ 31 ‐
]bsm<n§½TI9 ³ KMnUsbMRBYjsþIBIdMe)AenAelIRbdab;bnþBUC (Genital Ulcer Management)
karEfTaMBüa)aledayBwgEp¥kelIcegáameraKsBaØa ¬ KμanmnÞIrBiesaFn_¦
GñkCMgWt¥ÚjEt¥rfamanBgTwkbJudMe)AenAelIRbdab;bnþBUC
etImandMe)A BitR)akEdrb¤eT?
man
etImanBgTwk¼Ebk Edr b¤eT?
eT eT
man
Rsg;RbvtþinigBinitüGñkCMgW
- Gb;rMGñkCMgWeGaypøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as; nig
pþl;eRsamGnam½y - pþl;RbwkSaeFVIetsþQam
rkemeraKeGds_
- Büa)alCMgWBgTwk¼Ebk - Gb;rMedIm,IeGayGñkCMgWpøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as; nigpþl;eRsamGnam½y - RKb;RKgEfTaMBüa)alédKUrYmePT - pþl;RbwkSaeFVIetsþQam rkemeraKeGds_
- Büa)alCMgWsVay nigCMgW Chancroid - Gb;rMedIm,IeGayGñkCMgWpøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as; nigpþl;eRsamGnam½y - RKb;RKgEfTaMBüa)lédKUrYmePT - pþl;RbwkSaeFVIetsþQam rkemeraKeGds_ - Büa)alCMgWehImRKelon edayEp¥kelIlkçN³eGBIedmIsaRsþ RbsinebI
GñkCMgWminFUrRsalkñúgeBlmktamdan b¤karmkBinitüelIkdMbUg - R)ab;GñkCMgWeGayvilRtLb;mkCYbvij ebIcaM)ac; .
‐ 32 ‐
karEfTaMBüa)aledayBwgEp¥kelIetsþmnÞIrBiesaFn _
GñkCMgWt¥ÚjEt¥rfamanBgTwkbJudMe)AenAelIRbdab;bnþBUC
etImandMe)A BitR)akEdrb¤eT?
eT eT
man
Rsg;RbvtþinigBinitüGñkCMgW - Gb;rMGñkCMgWeGaypøas; bþÚrkarRbRBwtþ
- CMrujkareRbIR)as; nig pþl;eRsamGnam½y
- pþl;RbwkSaeFVIetsþQam rkemeraKeGds_
Büa)alCMgWBgTwk¼Ebk - Gb;rMedIm,IeGayGñkCMgW
pøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as;
nigpþl;eRsamGnam½y - RKb;RKgEfTaMBüa)al
édKUrYmePT - pþl;RbwkSaeFVIetsþQam
rkemeraKeGds_
(-)
TPPA test
Büa)alCMgWsVay nigCMgWBgTwk¼Ebk - Gb;rMedIm,IeGayGñkCMgWpøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as; nigpþl;eRsamGnam½y - RKb;RKgEfTaMBüa)alédKUrYmePT - pþl;RbwkSaeFVIetsþQam rkemeraKeGds_
RPR test
(+)
etImanBgTwk¼Ebk Edr b¤eT?
Büa)alCMgWsVay nigCMgW Chancroid - Gb;rMedIm,IeGayGñkCMgWpøas;bþÚrkarRbRBwtþ - CMrujkareRbIR)as; nigpþl;eRsamGnam½y - RKb;RKgEfTaMBüa)alédKUrYmePT - pþl;RbwkSaeFVIetsþQam rkemeraKeGds_ - Büa)alCMgWehImRKelon edayEp¥kelIlkçN³
eGBIedmIsaRsþ RbsinebIGñkCMgWminFUrRsal kñúgeBlmktamdan b¤karmkBinitüelIkdMbUg
- R)ab;GñkCMgWeGayvilRtLb;mkCYbvij ebIcaM)ac; .
man
(-)
(+)
‐ 33 ‐
]bsm<n§½TI10 ³ TIkEnøgEdl)andMeNIrkaresvaeFVIetsþQamrkemeraKsVaycMeBaHRsþImanépÞeBaH enAkñúgqñaM 2008 enH manesvaEfTaMsuxPaBcMnYn 34 Edl)aneGaycab;epþImdMeNIrkaresvaeFVIetsþQamrkemeraK sVaycMeBaHRsþImanépÞeBaH edaykareFVI “RAPID TEST” ³ esvaEfTaMsuxPaBEdlkMBugdMeNIrkareFVIetsþQamrkemeraKsVay ¬bnþskm μPaBenAkñúgqñaM 2008¦³
1- mCÄmNÐlCatiKaMBarmata nigTark 2- mNÐlsuxPaB ³
extþ-Rkug RsukRbtibtþi mNÐlsuxPaB ]btßmÖKaMRTeday ³
esomrab esomrab 2 bnÞayRsI GgÁkar RACHA 3 kRnÞaMg GgÁkar RACHA 4 mNÐl 1 GgÁkar RACHA
5 esomrab GgÁkar RACHA GgÁrCMu 6 BYk GgÁkar RACHA
7 ssrsþm GgÁkar RACHA RkLaj; 8 kMBg;fáÚv GgÁkar RACHA
eBaFisat; sMeBAmas 9 keNþóg GgÁkar RACHA
10 RkKr GgÁkar RACHA 11 BalEjk GgÁkar RACHA 12 PñMRkvaj GgÁkar RACHA
)akan 13 bwgxñar GgÁkar RACHA kMBt GgÁrC½y 14 tanI GgÁkar RACHA
kMBt 15 RkaMgGMBil GgÁkar RACHA QUk 16 QUk GgÁkar RACHA kMBg;Rtac 17 kMBg;Rtac GgÁkar RACHA
‐ 34 ‐
3- KøInikGgÁkarminEmnrdæaPi)al ³
extþ-Rkug RsukRbtibtþi KøIniksuxPaB ]btßmÖKaMRTeday ³PñMeBj 18 sÞwgmanC½y GgÁkar RHAC
19 cak;GERg GgÁkar RHAC 20 TYlsEgá GgÁkar RHAC
21 Twkføa GgÁkar RHAC 22 TMnb;fμ I GgÁkar RHAC
23 pSaredb:U GgÁkar RHAC 24 TYlTMBUg GgÁkar RHAC
RkugRBHsIhnu RkugRBHsIhnu 25 RkugRBHsIhnu GgÁkar RHAC
)at;dMbg )at;dMbg 26 )at;dMbg GgÁkar RHAC kMBg;cam kMBg;cam 27 kMBg;cam GgÁkar RHAC
eCIgéRB 28 p¥av GgÁkar RHAC
t,ÚgX μ Mú 29 sYg GgÁkar RHAC taEkv dUnEkv 30 taEkv GgÁkar RHAC
esomrab esomrab 31 esomrab GgÁkar RHAC RkLaj; 32 BYk GgÁkar RHAC
kMBg;s<W kMBg;s<W 33 kMBg;s<W GgÁkar RHAC
sVayerog CIPU 34 )avit GgÁkar RHAC
‐ 35 ‐
esvaEfTaMsuxPaBEdlnwgerobcMeGaydMeNIrkareFVIetsþQamrkemeraKsVay ¬enAkñúgqñaM 2009¦³ 1- mNÐlsuxPaB ³
extþ-Rkug RsukRbtibtþi mNÐlsuxPaB ]btßmÖKaMRTeday ³
bnÞaymanC½y e):ayEb:t 35 e):ayEb:t US-CDC mgÁlbUrI 36 esrIesaP½N US-CDC
)at;dMbg )at;dMbg 37 sVaye):a US-CDC sMeBAlUn 38 mnÞIreBTübEg¥ksMeBAlUn US-CDC
éRBEvg éRBEvg 39 HC Sub-satellites CHAI (?) GñkelOg 40 HC Sub-satellites CHAI (?) RBHesþc 41 HC Sub-satellites CHAI (?) kMBg;RtEbk 42 HC Sub-satellites CHAI (?) emsag 43 HC Sub-satellites CHAI (?)
taEkv KIrIvgS 44 HC Sub-satellites EU/ITM
2- KøInikGgÁkarminEmnrdæaPi)al ³
extþ-Rkug RsukRbtibtþi KøIniksuxPaB ]btßmÖKaMRTeday ³ PñMeBj 45 c,arGMeBA Marie Stopes
kNþal taexμA 46 taexμA Marie Stopes
ekaHkug s μac;manC½y 47 ekaHkug Marie Stopes