Page 262 – Public Health Update

Nursing: A voice to lead – Achieving the Sustainable Development Goals – International Nurses Day #VoiceToLead #IND2017

by Public Health Update May 12, 2017

12 May 2017

International Nurses Day

International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale’s birth. The theme for 2017 is Nursing: A voice to lead – Achieving the Sustainable Development Goals.

#VoiceToLead #IND2017

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people.

World Health Organization

May 12, 2017 0 comments

Fourth UN Global Road Safety Week 2017 8-14 May 2017 Save Lives: #SlowDown

by Public Health Update May 8, 2017

written by Public Health Update

The UN Road Safety Collaboration is pleased to announce that the Fourth UN Global Road Safety Week held from 8-14 May 2017. The Week will focus on speed and what can be done to address this key risk factor for road traffic deaths and injuries. Speed contributes to around one-third of all fatal road traffic crashes in high-income countries, and up to half in low- and middle-income countries.

Countries successfully reducing road traffic deaths have done so by prioritizing safety when managing speed. Among the proven strategies to address speed include:

Building or modifying roads to include features that calm traffic

Establishing speed limits to the function of each road
Enforcing speed limits
Installing in-vehicle technologies
Raising awareness about the dangers of speeding.

The Fourth UN Global Road Safety Week seeks to increase understanding of the dangers of speed and generate action on measures to address speed, thereby saving lives on the roads.

3,400 people die on the road every day.

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Research shows that a 5% cut in average speed can result in a 30% reduction in the number of fatal road traffic crashes.

May 8, 2017 0 comments

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"Midwives, Mothers and Families: Partners for Life!" International Day of the Midwife 2017

by Public Health Update May 6, 2017

written by Public Health Update

International Day of the Midwife 2017

5 May is celebrated globally as International Day of the Midwife

The theme for this year celebration is “Midwives, Mothers and Families: Partners for Life!” Midwives everywhere understand that by working in partnership with women and their families they can support them to make better decisions about what they need to have a safe and fulfilling birth. The best partnership for a pregnant woman is with a qualified midwife!

World Health Organization

READ MORE: CLICK HERE

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World Hand Hygiene Day!! SAVE LIVES: Clean Your Hands 5 May 2017 : 'Fight antibiotic resistance – it's in your hands'

by Public Health Update May 6, 2017

written by Public Health Update

5 May

SAVE LIVES: Clean Your Hands 5 May 2017 : ‘Fight antibiotic resistance – it’s in your hands’

World Hand Hygiene Day, marked globally on 5 May, highlights the importance of hand hygiene in health care. The slogan of this year’s campaign is “Fight antibiotic resistance … it’s in your hands”, illustrating the important relationship between good infection prevention and control practices like washing your hands and preventing antibiotic resistance.

World Hand Hygiene Day plays an important role in highlighting good infection prevention and control practices to change behaviours to reduce the spread of infections and therefore save the lives of millions. Without behaviour change, antibiotic resistance will remain a major threat.

Through this year’s campaign, the World Health Organization (WHO) is calling on countries and health care facilities to strengthen infection prevention and control programmes based on WHO guidelines on core components of infection prevention and control programmes. A key component of which is adequate hand hygiene, which plays a critical role in combating antimicrobial resistance.

World Health Organization

Related Links

5 moments for hand hygiene

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Photos Public Health Events

‘My Year 2074: Healthy Me, Healthy Country’ campaign photos, Pokhara 2073

by Public Health Update May 4, 2017

written by Public Health Update

‘My Year 2074: Healthy Me, Healthy Country’ campaign photos, Pokhara 2073

‘My Year 2074 BS: Healthy Me, Healthy Country’, a yearlong health campaign aims to create awareness of health among public initiated by the Ministry of Health (MoH), has launched at Pokhara with various activities. Some photos of Interaction program and mass rally were posted here;

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Objectives of Campaign by Dinesh Kumar Chapagain (Chief PHA, Kaski)

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Chief Guest remarks ( Dr Rajendra pant, DG,DoHS)

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Closing remarks RHD Taranath Poudel

May 4, 2017 0 comments

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Asthma:Better Air, Better Breathing #WorldAsthmaDay.

by Public Health Update May 2, 2017

written by Public Health Update

World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world.

World Asthma Day takes place each year on the first Tuesday in May. The aim is to improve asthma care and awareness of asthma around the world.

Key facts

Asthma is one of the major noncommunicable diseases. It is a chronic disease of the the air passages of the lungs which inflames and narrows them.
Some 235 million people currently suffer from asthma. It is a common disease among children.
Most asthma-related deaths occur in low- and lower-middle income countries.
According to the latest WHO estimates, released in December 2016, there were 383 000 deaths due to asthma in 2015.
The strongest risk factors for developing asthma are inhaled substances and particles that may provoke allergic reactions or irritate the airways.
Medication can control asthma. Avoiding asthma triggers can also reduce the severity of asthma.
Appropriate management of asthma can enable people to enjoy a good quality of life.

WHO FACT SHEET

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The causes

The fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as:

indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander)
outdoor allergens (such as pollens and moulds)
tobacco smoke
chemical irritants in the workplace
air pollution.

Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma: aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).

Urbanization has been associated with an increase in asthma. But the exact nature of this relationship is unclear.

Reducing the asthma burden

Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. Short-term medications are used to relieve symptoms. Medications such as inhaled corticosteroids are needed to control the progression of severe asthma and reduce asthma exacerbation and deaths.

People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations. Inadequate access to medicines and health services is one of the important reasons for the poor control of asthma in many settings.

Medication is not the only way to control asthma. It is also important to avoid asthma triggers – stimuli that irritate and inflame the airways. With medical support, each asthma patient must learn what triggers he or she should avoid.

Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.

World Health Organization

May 2, 2017 0 comments

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World Immunization Week 2017 #VaccinesWork

by Public Health Update April 28, 2017

written by Public Health Update

The last week of April each year is marked by WHO and partners as World Immunization Week. It aims to accelerate action to increase awareness and demand for immunization and improve vaccination delivery services so that people everywhere can be protected against deadly diseases.

In 2016, under the global slogan “Close the immunization gap”, the campaign focused on immunization for all throughout life. .More than 180 countries, territories and areas marked the week with activities including vaccination campaigns, training workshops, round-table discussions and public information campaigns. The theme for World Immunization Week 2017 is #VaccinesWork.

Theme: #VaccinesWork

World Immunization Week – celebrated in the last week of April – aims to promote the use of vaccines to protect people of all ages against disease. Immunization saves millions of lives and is widely recognized as one of the world’s most successful and cost-effective health interventions. Today, there are still 19.4 million unvaccinated and under-vaccinated children in the world.

#VaccinesWork to save lives

#VaccinesWork to fight diseases

#VaccinesWork to leave no one behind

#VaccinesWork to build a secure world

#VaccinesWork. Let’s get to work

2017 Campaign objectives

The main goal of the campaign is to raise awareness about the critical importance of full immunization throughout life, and its role in achieving the 2030 Sustainable Development Goals.

As part of the 2017 campaign, WHO and partners aim to:

Immunization prevents illness, disability and death from vaccine-preventable diseases including cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
Highlight the importance of immunization as a top global health investment priority.
Promote understanding of the action steps required to achieve the Global Vaccine Action Plan.
Showcase immunization’s role in sustainable development and global health security.

Why immunization matters now more than ever:
Expanding access to immunization is crucial to achieving the Sustainable Development Goals. Routine immunization is a building block of strong primary health care and universal health coverage—it provides a point of contact for health care at the beginning of life and offers every child the chance at a healthy life from the start.
Immunization is also a fundamental strategy in achieving other health priorities, from controlling viral hepatitis, to curbing antimicrobial resistance, to providing a platform for adolescent health and improving antenatal and newborn care.

Key facts
Global vaccination coverage is generally holding steady.
Uptake of new and underused vaccines is increasing.
Immunization currently averts an estimated 2 to 3 million deaths every year. An additional 1.5 million deaths could be avoided, however, if global vaccination coverage improves.
An estimated 19.4 million infants worldwide are still missing out on basic vaccines.

NEPAL (NDHS 2016):

78% of children have received all basic vaccinations, and 38%
have received all age-appropriate vaccinations.
Ninety-eight percent of children have received BCG.
97% have received the first dose of pentavalent, and 98% have received polio 1.
Eighty-six percent and 88% of children have received the third doses of the pentavalent and polio vaccines, respectively.
Coverage of vaccination against measles rubella is 90%.
One percent of children in Nepal have not received any vaccinations.

READ MORE:

Original Links:

http://www.who.int/campaigns/immunization-week/2017/en/

April 28, 2017 0 comments

National Plan, Policy & Guidelines Public Health Public Health Notes Public Health Programs

Disease Control: Malaria (Background, Vision, Mission, Goals, Objectives & Target), Nepal

by Public Health Update April 26, 2017

written by Public Health Update

Background:

Malaria control project in Nepal was first initiated in 1954 with the support from USAID (the then USOM), with the objective of controlling malaria, mainly in plain region (Terai belt) of central Nepal.

In 1958, national malaria eradication program was launched with the objective of eradicating malaria from the country. Due to various reasons the eradication concept reverted to control program in 1978. Following the call of WHO to revamp the malaria control programs in 1998, Roll Back Malaria (RBM) initiative was launched to control malaria transmission in hard‐core forests, foot‐hills, inner‐Terai and hill river valleys, which accounted for more than 70 % of the total malaria cases in the country. The high risk of acquiring the disease is attributed to the abundance of vector mosquitoes, mobile and vulnerable population, relative inaccessibility of the area, suitable temperature, environmental and socio‐economic factors. The recent micro‐stratification, based on number of malaria cases, geo‐ecology, vector breeding and vulnerability due to migration and population movements, further narrowed down the essentials to VDC level risks as compared to earlier district as units of risks. It has clearly shown that only 54 VDC’s are at high risk, 201 VDC’s at moderate risk and 999 VDC’s at low risk. Based on the micro‐stratification report 2013, approximately 13.02 million population (47.9%) live in malaria endemic areas (VDCS); out of which ~1 million (3.62%) live in high risk VDCs, 2.66 million (9.8%) live in moderate risk VDCs, and 9.38 million(34.52%) live in low risk VDCs. A total population of 14.13 (52.1%) is estimated to live in VDCs where there is no malaria transmission. The high risk areas consist of foothills with river belts, forest fringe areas in terai, hill river valleys, inner terai areas. Low risk VDCs lie in plain cultivated outer Terai, mountain, and valleys in the mountains.

Nepal’s current National Malaria Strategic Plan (NMSP‐2014‐2025) has identified following vision, mission, goals and objectives:

Vision: Malaria‐free Nepal in 2025

Mission: To empower the health staff and the communities at risk of malaria to contribute towards the vision of malaria‐free Nepal in 2026.

Goals:

To sustain zero death due to malaria from 2012 onwards;

To reduce the incidence of indigenous malaria cases by 90% by 2018 (relative to 2012);
To reduce no. of VDCs having indigenous malaria cases by 70% by 2018 (relative to 2012);
To receive WHO certification of malaria free status by 2025.

Objective‐1: To enhance strategic information for decision making towards malaria

elimination.

Key targets / milestones:

Ward‐wise risk stratified and appropriate/rational interventions executed:

By the end of 2015, ward‐wise malaria risk micro‐stratification will be, so the intervention units could be wards in place of current VDC’s and earlier districts.

Development and roll over of SMS and web based recording and reporting system for strengthening malaria surveillance, including suspected and confirmed cases reporting.

Introduction of Case based surveillance in all districts by the end of 2014.

All malaria cases will be recorded and reported through SMS and Web‐based MDIS by the end of 2015.
Establishment and expansion of Border check posts: 2 in 2014, 2 in 2015 and 3 in 2016 and continued thereafter.

Quarterly review of the recorded data and plan interventions accordingly

Three quarterly reviews will be conducted and validation of data completed by the

end of each year.

Foci investigation rolled out by the end of 2014

At least 54 foci will be investigated in 2014, 160 in 2015 and 100 each year after.

Investigated foci will be eliminated gradually and by the end of 2016 a total of 214
foci will be eliminated, sustained thereafter and gradually increased as per above
target.

Number of operational research will be carried out generating evidence for policy making.

Objective‐2: To further reduce malaria transmission and eliminate the foci.

Key targets / milestones:

Guideline for IVM developed and rolled over by the end of 2014 for implementation.
Prevention using LLIN: Coverage of high risk VDC population through mass campaign and pregnant women in high and moderate risk VDCs through ANC visits.

471,747 LLINs in 2014; 149,969 LLINs in 2015; 252,440 LLINs in 2016; 491,112 LLINs

in 2017 and 155,851 LLINs in 2018.

Prevention using IRS: Regular annual spray covering people living in high risk every year and responsive spraying as indicated by foci investigation.

88,444 households in 2014; 60,000 households in 2015 and 30,000 households in 2016.

Foci elimination and documentation of lessons learnt for prospective activities.
54 in 2014; 160 in 2015 and 100 every year thereafter.

Objective‐3: To improve quality of and access to early diagnosis and effective treatment of malaria.

Key targets / milestones:

Update the malaria diagnosis and treatment policy, manual and roll over its application by the end of 2014
Development of training package on malaria case management: development and roll out by 2015
Training on case management of malaria by 2015

FCHVs in remote VDCs to detect malaria using RDTs,

Training on malaria case management for public & private sector health care providers

Expand and improve quality of malaria microscopy service‐continued annually

Finalize and roll over of the SOP on malaria microscopy

Establish slide banks for training and reference in malaria microscopy
Conduct internal competency assessment of malaria lab technicians and assistant
Conduct external competency assessment lab technicians and assistants
Conduct instructional skills development training for trainers in malaria microscopy
Basic and refresher training in microscopy
training in malaria microscopy
Training on preventive maintenance of microscopes
Supportive supervision and monitoring of malaria microscopists
Cross‐checking / validation of blood smears

Expand the use of RDTs and set up QA QC of combo RDTs‐ by the end of 2015

Procurement and supply of antimalarial drugs and diagnostics to avoid stock out

Regular monthly recording and reporting through FMIS/MDIS.

Annual health facility survey conducted to document no stock out of logistics.

Objective‐4: To sustain support from the political leadership and the communities

towards malaria elimination.

Key targets / milestones:

Develop and roll out of comprehensive BCC strategy by the end of 2015

Develop communication package to mobilize communities for malaria prevention

Develop specific materials (print, audio and video) to improve the following behaviors: sleep under nets every night; seek early diagnosis and treatment for malaria, and adhere to treatment on malaria.

Organize Multi‐sector advocacy meetings at national / district levels to support malaria elimination

Commemorate World Malaria Day: April 25.

Cross–border collaboration meetings annually for sharing the information and harmonizing interventions.

Objective‐5: To strengthens programmatic technical and managerial capacities towards

malaria elimination

Key targets / milestones:

Training key program staffs in malariology, case management, entomology, health informatics, GIS mapping , malaria microscopy etc.‐ annual targets in annex‐ budget sheet

Convene Malaria Technical Working Group; at least 3/yr
Periodically update the national malaria strategic plan: by the end of 2018, review and revise as necessary
Supervision, monitoring and evaluation: Annually as per M & E Plan.
Strengthen VBDRTC capacity in malaria training and research: Equipment provided and staffs deployed as necessary
Recruit and fill vacant positions at EDCD, VBDRTC, Regions and Districts: By the end of 2014, vacant positions will be filled and sustained there after
Strengthen partnership with WHO and other national/international institutions: Collaborative meetings, activities implemented

DoHS, Annual Report 2071/72 (2014/2015) Disease Control: Malaria.

April 26, 2017 0 comments

PH Important Day Public Health

End Malaria for Good – World Malaria Day 2017

by Public Health Update April 26, 2017

written by Public Health Update

April 25
World Malaria Day gives people the chance to promote or learn about the efforts made to prevent and reduce Malaria around the world. It is observed on April 25 each year.

World Malaria Day is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control.

Chief PHA Dinesh Kumar Chapagain, DPHO Kaski

RHD, Dr. Taranath Poudel, WRHD

A push for prevention

This year’s global theme for World Malaria Day is End Malaria for Good. In the lead-up to 25 April, WHO is shining a spotlight on prevention, a critical strategy for reducing the toll of a disease that continues to kill more than 400 000 people annually.

Since 2000, malaria prevention has played an important role in reducing cases and deaths, primarily through the scale up of insecticide-treated nets and indoor spraying with insecticides.

The World Health Organization Regional Office for Africa (WHO/AFRO) announced that Ghana, Kenya, and Malawi will take part in a WHO-coordinated pilot implementation programme that will make the world’s first malaria vaccine available in selected areas, beginning in 2018.
The injectable vaccine, RTS,S, was developed to protect young children from the most deadly form of malaria caused by Plasmodium falciparum. RTS,S will be assessed in the pilot programme as a complementary malaria control tool that could potentially be added to the core package of WHO-recommended measures for malaria prevention. WHO

Key facts

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.

In 2015, 91 countries and areas had ongoing malaria transmission.
Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places.
Between 2010 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 21% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.
The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.

NEPAL:

Nepal has surpassed the Millennium Development Goal #6 by reducing malaria morbidity and mortality rates by more than 50% in 2010 as compared to 2000. Therefore, Government of Nepal has set a vision of Malaria free Nepal in 2025. Confirmed cases dropped from 2092 in FY 2069/70 to 1,352 in 2071/72. The proportion of P. falciparum infections has sharply increased and reached 20.26% in reporting year. There is a decreasing trend of confirmed case, case severity with sustaining zero death due to scaling up access to RDT and ACT to public health facilities, high coverage of LLINs in endemic districts and increased socio‐economic status of community people. There is rapid decreasing trend of indigenous PF, whereas slow decreasing trend of indigenous Plasmodium vivax cases indicates that P vivax may remain a challenge for malaria elimination in Nepal. (DoHS, Annual Report 2071/72 (2014/2015)
Read Also:
Disease Control: Malaria (Background, Vision, Mission, Goals, Objectives & Target), Nepal

Further reading:

April 26, 2017 0 comments

National Plan, Policy & Guidelines PH Important Day Public Health Events Research & Publication

Standard Treatment Protocol for mental health services into the Primary Health Care System

by Public Health Update April 6, 2017

written by Public Health Update

Depression

There are many types of disorders of mood (emotion) like unipolar depression, bipolar affective disorder, etc. Among them, unipolar depression is a very common presentation in primary health care set-up. For the sake of simplicity, unipolar depression will be referred as depression from this point on.

Cover Page : Standard Treatment Protocol (STP) for Mental Health Services into the Primary Health Care System

Core symptoms:

1. Depressed mood for most time of the day for most of the days

2. Loss of interest or pleasure in previously pleasurable activities

3. Easy fatigue or decreased energy

Other features:

1. Feelings of guilt

2. Feelings of worthlessness

3. Poor attention and concentration

4. Low confidence and self-esteem

5. Negative view of the future

6. Ideas or attempts of suicide

7. Poor sleep

8. Poor appetite

To diagnose a case of depression: At least 2 core symptoms and at least 3 other symptoms need to be present for at least 2 weeks.

Rule out other physical conditions that can mimic symptoms like depression, such as anemia, malnutrition, thyroid disorders, and medication reaction (steroids, Oral Contraceptive Pills, statins, some anti-hypertensives). If any of these are present, manage them first before starting medication for depression. Refer when management for this condition is not possible from the health center.

Rule out the presence of manic episode in the past. If there are symptoms like extremely expansive, elated or irritable mood, increased activity and extreme talkativeness, flight of ideas, decreased need for sleep, grandiosity, extreme distractibility or reckless behavior for a duration of at least a week, mania should be suspected and the patient should be referred for further management.

Special considerations:

It is very common in general health clinics for patient with depression to present with multiple physical complaints like non-specific aches and pains, dizziness, tingling (jhamjham) sensation of body. Prescription of multi-vitamins without elaborate history taking is not fruitful for the patient.

Depression can also be seen in children and old age population. These cases need to be referred whenever possible as special considerations need to be taken during management. If the symptoms of depression start during pregnancy, within a month of delivery of a child (post-partum depression) or in a lactating mother, they need to be referred for further management. When people are currently exposed to severe adversity (eg. grief), symptoms may be similar to depression, there should be impairment in daily functioning to make a diagnosis of depression.

Risk of suicide:

Risk of suicide needs to be assessed in every person suspected of having mental health issues. It should always be asked when depression is suspected as a large portion of suicide is caused due to underlying depression. It is not true that asking about suicide initiates a person to commit suicide. Always ask about suicidal ideas/thoughts, plan or previous suicide attempts. Inform family members about risk of suicide and ask for close monitoring of the patient, including removal of harmful objects. Serious risk of suicide is an indication for admission, so refer to a hospital with psychiatric care.

Management of depression:

Note: Re-confirm that there is no past history of mania before starting antidepressants Management with antidepressants (SSRI- Selective Serotonin Reuptake inhibitor):

Capsule Fluoxetine 10 mg should be started in the morning, after food and increased to 20 mg after a week. Evaluate after 6 weeks and continue same dose if symptom of depression start decreasing. If there is no change in the symptoms even after 6 weeks, patient should be referred.

For MBBS doctors:

Dose of Fluoxetine can be gradually increased by 10 mg every 6 weeks for a maximum up to 40 mg. It is important to wait for 6 weeks at every dose to assess the effectiveness of the dose. Refer if treatment seems ineffective even at 40 mg/day.

When insomnia or severe restlessness is present: Add Tab. Diazepam 5mg PO HS along with fluoxetine. Decrease the dose to 2.5mg after 1 week and then stop Diazepam within 2 weeks. Do not give diazepam for more than 2 weeks.

Stop the medication and refer whenever there are symptoms of mania.

Total duration of treatment: Medication should be given for 9 more months after the symptoms improve significantly. Decrease the dose by 10 mg every 4 weeks and stop the medication. If symptoms restart, refer.

Side effects of Fluoxetine:

Common Side effects Restlessness, nervousness, insomnia, anorexia gastrointestinal disturbances, headache, sexual dysfunction

Serious side –effects marked / prolonged akathisia , bleeding abnormalities in those who regularly use aspirin and other non-steroidal anti-inflammatory drug Refer in case of prolonged or serious side-effects.

Psychosocial management:

If symptoms are present but not enough to make a diagnosis of depression, psychosocial support itself may be enough for treatment. Even when medications are started, psychosocial support needs to be provided to the patient. Advice to patient and family members relating to depression:

1. Symptoms of depression are not a result of patient’s laziness or lack of effort. It is a disease and the symptoms cannot be controlled by patient’s will-power.

2. Mention of suicidal ideation should always be taken seriously and immediately followed up.

3. Patient should be encouraged to continue regular sleep routine and physical activity routine.

4. Patient should also be encouraged to take part in activities that they used to enjoy even if they do not currently do so.

5. Treatment is effective in most of the patients, but will take a few weeks to show the desired effects.

6. Ensure the intake of medications

Addressing the current psychosocial stressors:

1. Provide the opportunity for the patient to talk about their current stressors. Ask them about their understanding of the cause of the stressors.

2. If there are issues of abuse, contact local centers/ resources to try to manage it.

3. Help the patient to cope with the current stressors. Involve the support system that the patient already has, such as- friends, family or local groups.

4. Encourage moderate physical activity (Example: 45 minute walk, 3 times a week). Find out the daily activity of the patient and advice physical activity accordingly. It can be started with shorter duration of activity which can gradually be increased.

Source: Standard Treatment Protocol (STP) for Mental Health Services into the Primary Health Care System

Depression: let’s talk – 7 April 2017 | World Health Day
Depression: let’s talk – 7 April 2017 | World Health Day
Depression: let’s talk – 7 April 2017 | World Health Day

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