Rate of service fees regulation no FCTC Ratification proclamation. Guideline for Registration of Vaccine. Medicine and Medical Device Recall Directive GMP inspection directive. Guideline for Registration of Medical devices Ethiopian Medicines Formulary Cosmetics and Sanitary Items Directive.
Skip to content. Facebook Twitter Linkedin. However, production capacity, technological developments, creation of employment opportunities and investments in the healthcare sector are behind on other sectors HSTP, , while at … March 7, Strategic plan For Traceability Implementation non-categorized STG -Primary Hospital Irrational use of drugs has been one of the major problems in the Ethiopian health care system for a long time.
Irrational use of drugs has been one of the major problems in the Ethiopian health care system for a long time. These reactions manifest in different forms. It is a known fact that drugs are important for disease prevention as well … March 6, pharmacovigilance newsletter no 7 non-categorized Pharmacovigilance newsletter 16 Importance of Active surveillance and Cohort Event monitoring on ARV medicines in Ethiopia The cornerstone of any pharmacovigilance system is Spontaneous reporting system which is a passive surveillance system that uses voluntary reporting of an … March 6, Pharmacovigilance newsletter 16 non-categorized Pharmacovigilance newsletter 14 Training was given to six health centers of yeka sub city on pharmacovigilance from January 22 to the end of March Since ancient times,.
Since earliest times, herbs, roots, bark leaves and plants have been used to relieve pain and help control disease. Providing comprehensive regulation of all matters related to safety and quality of pharmaceutical products is crucial. Biotherapeutic protein products prepared by recombinant deoxyribonucleic acid … March 6, Guidelines for Registration of Biotherapeutic Proteint Products non-categorized Guideline For Drug Information Center Rational use of drugs requires access to objective drug information.
Health professionals need a good understanding of the therapeutic action, the possible hazards and the cost of drugs they prescribe; the publics need to know … March 6, Guideline For Drug Information Center non-categorized Good prescribing manual for Ethiopia new 2 Drugs are an essential component of health care delivery.
When used rationally, they produce the desired effect of improving patients ailments. Their irrational use on the hand leads to prolongation of the illness, development of … March 6, Good prescribing manual for Ethiopia new 2 non-categorized Good Dispensing manual new 2 Good dispensing of drugs and medical supplies is an important component of rational drug therapy in order to maximize the benefit and minimize the risk to recipients.
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The Authority also acknowledges … March 4, EthiopiaTobacco Control Strategic Plan non-categorized Ethiopian Pharma co-vigilance Guideline Medicines are one of the most essential components in the health care system. This indisputable fact makes rational selection, procurement, distribution, and use of medicines of paramount importance in health care. This is particularly important due to a changing disease pattern in which diseases that had … March 4, Cosmotics Importers,Distributors and Exporters Self-Inspection Check list non-categorized Clinical Trial Authorization Guideline Clinical research is necessary to establish the relative safety and effectiveness of specific health and pharmaceutical products and healthcare practices.
Several topical issues that are of current relevance and importance are hereby brought to our readers attention. This relies on the availability of safe, effective and affordable medicines with the required quality, in reasonable amount.
It was commented by a national … February 26, Ethiopian Medicines Formulary drug-formulary Cosmetics and Sanitary Items Directive Without prejudice to the definitions provided under Proclamation No. Based on economic development and the living standard of its people Ethiopia is considered to be one of the least developed countries. Although the fundamental cause for this is the backward socio-economic system which prevailed … January 8, drugPOLICY policies policies-legislation-and-regulation.
Guideline for Medical Devices Bundling for Marketing authorization application. Pharmacovigilance Directive English Traditional Medicine Clinical Trial guidance Guideline for Registration of Low-Risk Medicines. Cosmetic manufacturer Directive Food and Medicine Administration Proclamation No.
Rational Medicine Use Directive Food registration directive During the past seven decades, antimicrobial medicines have saved millions of lives, substantially reduced the burden of diseases that were previously widespread, improved the quality of life, and helped increase life expectancy.
However, in the …. Ethiopia has one of the fastest growing economies in the world. However, production capacity, technological developments, creation of employment opportunities and investments in the healthcare sector are behind on other sectors HSTP, , while at …. Among the strategies devised to improve the situation, Medicine, Food and Healthcare Administration and ….
Distribution of pharmaceutical products is an important activity in the integrated supply-chain management. Feeble points in the distribution processes of pharmaceutical products provide viable ground for counterfeit, illegally imported, stolen and substandard medicines to enter …. WHEREAS, it is necessary to protect public health through regulation of small scale medicine manufacturers to operate in accordance with the required safety, quality and efficacy requirements of medicine products; WHEREAS, regulatory provisions regarding the ….
Medications are given to treat a specific disease and as they do so they can result in unwanted effects, one of which is adverse drug reaction. It is the …. The only thing that remains between an adverse drug reaction observed in a drug treatment and the help that the user of the drug gets as a result is the will and commitment of the …. Awareness creation trainings were provided to health care providers of 4 health centers of Yeka sub city ,Addis Ababa on pharmacovigilance.
PV Newsletter V2 issue 2. Medication error is one of the main causes of drug related injury or Adverse drug event. In abruptio placentae, coagulation defects have to be looked seriously. The treatment includes amniotomy to release intrauterine pressure; termination of pregnancy; and management of shock Placenta previa Placenta previa is partial or complete localization of the placenta in the lower segment of the uterus.
Factors associated include large placenta e. The first bleeding usually occurs late in pregnancy. A low lying placenta previa detected by US early in pregnancy may migrate to the upper segment of the uterus. Hence, repeat US late in pregnancy is needed before deciding on the mode of delivery. Treatment Plan Timing of delivery: Delivery is the definitive management of placenta previa.
The timing of delivery may postponed conservative management to prevent preterm delivery. Mode of delivery: The preferred mode of delivery in placenta previa is Cesarean delivery, but vaginal delivery may be considered in anterior and low lying placenta. Local causes All local causes of APH have minimal spotting or bleeding. An exception to such a presentation is the occasional profuse bleeding of ruptured vaginal varicose vein. Once placenta previa is excluded, digital and speculum examination may confirms the specific local legion.
Tentative diagnoses of abruptio placenta or placenta previa may be reached on certain clinical findings. An uncertain-US report should be seen within the context of the other clinical findings and exclusion of placenta previa by DSE. Early diagnosis of vasa previa before rupture of the membranes can be considered on palpating a band crossing the fore-water membranes and US diagnosis of placenta previa.
Pulsation on the band makes the possibility certain. The specific local cause of bleeding is identified by speculum examination. If placenta previa is more likely or the anesthetist is not well experienced, general anesthesia can be initiated before the VE. Sweep it in gently widening circle until you have examined all around as far as you can reach with your finger.
Check for vaginal bleeding while exploring. Stop when you feel any placenta or bleeding is incited or increased during the examination. Perform ARM and transfer the woman to the labor ward for close monitoring and induction with oxytocin.
Treatment Plan in APH Besides the specific cause-related interventions of the bleeding, the management of APH includes decision on time of termination immediate or conservative. Immediate termination of the pregnancy is considered if: - Gestational age is 37 weeks or above or when fetal maturity is ascertained - Bleeding is continuous with shock and maternal condition deteriorates.
Treat shock page and arrest bleeding by terminating the pregnancy - Patient is in labor - There is fetal distress - The fetus is dead - The fetus has severe congenital abnormality incompatible with life e. Rarely blood transfusion is indicated. The amount of bleeding considered to be excess is a perceived blood loss of mL or more after a vaginal delivery or mL or more after a cesarean delivery. In certain conditions such as pre-eclampsia, anemia lesser amount of blood loss leads to shock.
Providers usually underestimate blood loss. Causes - atonic uterus - genital trauma - retained placenta - coagulation failure - acute inversion of the uterus Atonic Uterus Atonic uterus is the most common cause of primary PPH.
The contraction of the uterus after delivery of the baby is the most effective mechanism that arrests bleeding from the placental bed and causes detachment and expulsion of the placenta. A hypotonic uterus leads retention of the placenta and excessive bleeding. Clinical presentation of atonic uterus mainly rests on palpating an atonic hypotonic, floppy uterus and expulsion of clots when the uterus is compressed.
When the uterus is extremely hypotonic, one may not feel the uterus. Bleeding due to hypotonic uterus has the tendency to recur and, hence, needs close monitoring and frequent rubbing of the uterus for two or more hours after delivery. Retained placenta The placenta is detached after the delivery of the fetus due to the contraction and retraction of the uterus and subsequent decrease in uterine implantation surface area.
The common cause of placental retention is poor uterine contraction. Constricting ring formation by the lower segment of the uterus or cervix and pathological adherence of the placenta are rare causes of placental retention. In retention of the placenta without bleeding, pathological adherence should be considered and manual removal of the placenta has to be done in the OR with all the preparation for laparotomy.
Traumatic causes Feto-pelvic disproportion, instrumental deliveries and scarred uterus are some of the predisposing factors for tears of the birth canal vaginal, cervical, uterus and bleeding. Bright red arterial bleeding with a contracted uterus suggests traumatic cause of PPH.
Coagulation defects Disseminated intravascular coagulation may develop as a consequence of abruptio placenta, amniotic fluid embolism, severe infections or massive bleeding. On physical examination, gross haemostatic failure is revealed by ecchymosis especially at injection sites , petichii, and epistaxis.
After delivery, the vaginal bleeding may not form clot or, if there is clot formation, the clot liquefies after some time. Failure of clot formation can also be demonstrated by a simple bed side clotting tests. Failure of blood kept in a test tube at body temperature to form clot within seven minutes or easy break down of initially formed soft clot, demonstrate failure of the coagulation mechanism. Acute inversion of the uterus In acute inversion of the uterus, the uterus turns inside-out during delivery.
It occurs very rarely. The immediate causes of shock are bleeding and neurogenic reflex due to pain. If not treated with antibiotics, sepsis and septic shock may develop later in the first ten days postpartum. The inversion may occur with the placenta attached to the uterus, in which case further pulling may complete the inversion. With the placenta detached the inverted uterus is described as cherry red mass. The extent of the inversion is classified into four degrees: - First degree: Fundus is within the uterus not extending beyond the cervix; on abdominal palpation, a dimple can be felt with the bleeding, pain and shock - Second degree: the inversion extends out of the cervix and is limited to within the vagina.
When the cause of the PPH is known, specific treatment is directed towards the identified cause; e. When the cause of the bleeding is not straightforward, the following management approach is taken to diagnose and treat PPH: 1.
Atonic uterus: PPH with delivered placenta and atonic uterus If the uterus is not well contracted after the placenta is delivered, management is directed to atonic uterus. The bimanual compression may arrest bleeding or provides minutes for organizing the OR team, arrange blood and treat shock. Compression of the abdominal Aorta may also be used in place of the bimanual compression especially during laparotomy. If so, perform laparotomy. For proper inspection of the cervix, a segment of the cervix held by two sponge forceps is inspected at a time.
After any normal delivery, the cervix and vagina may have small cuts that do not bleed. Such tears do not need repair. Do not waste valuable time by stitching non-bleeding tears. If there is no tear that accounts for the PPH in the vagina and cervix, check for uterine rupture. Cervical tears that extend into the uterus or their apex can not be visualized need laparotomy.
General anesthesia may be required in certain patients. The Johnson technique calls for lifting the uterus and the cervix into the abdominal cavity with the fingers in the fornix and the inverted uterine fundus on the palm. The fundus is then gently pushed back through the cervix.
If the placenta is still attached, it should not be removed until after the uterus is replaced through the cervix. But, these tocolytics are contraindicated in hypotensive patients. Magnesium sulfate g IV slowly can be used in hypertensive patients. Gentle upward traction can be used with Allis clamps placed sequentially on the round ligament. Rarely vaginal hysterectomy may be required for necrosis of the inverted uterus. After the uterus has been replaced, oxytocic agents can be used.
If the tissue is very adherent, suspect placenta accreta and proceed to laparotomy and possible subtotal hysterectomy. If any Placental lobe or tissue is missing, explore the uterine cavity to remove it. Usually sub-involution of the uterus, intrauterine infection and retained pieces of placental tissue are considered as a triad of causes for bleeding in the first two weeks especially from the 5th to 10th day postpartum. When reliable US is available, the decision to evacuate the uterus or not can be made based on US finding.
Incase of breakdown of the uterine wound after Cesarean delivery or ruptured uterus, laparotomy is done to re-suture the wound or hysterectomy. Sloughing of dead tissue of the vaginal wall is treated by removing dead tissue under light anesthesia; and packing the bleeding areas tightly for hours 4. When bleeding occurs late in the postpartum period, 3rd - 6th week , pregnancy test has to be performed to role out choriocarcinoma.
Specimen of uterine evacuation must be submitted for histological examination. In non-breast feeding woman, it may be the first menstrual bleeding postpartum. Local legion of the vagina or cervix are excluded by speculum examination.
Evaluation: Many women are unable to accurately recall either the date of their last menstrual period or the regularity of their cycles. Therefore a through revision of history, physical examination and earlier ultrasound evaluation are helpful in ascertaining the duration of gestation and also diagnosis and management.
The expected date of delivery EDD should be adjusted by number of days that the cycle varied from the usual 28 days. Diagnostic tests Positive pregnancy test in urine by 6 weeks from LNMP Ultrasound is most useful when performed before the 20th week of gestation. Gestational sac, crown rump lengh. Femur length, Biparietal diameter. Cesarean section if contraindication for induction or vaginal delivery exists Cervical Ripening Most parturient with documented post-term pregnancy have a low Bishop score.
Cervical ripening techniques may help to attain a safe vaginal delivery. Method used includes membrane stripping, Prostaglandin E2 administration and Foley catheter traction. Once the cervical priming is complete, amniotomy or oxytocin administration may be used to stimulate labor. Antenatal Surveillance Testing Methods Ante partum surveillance generally begins at 41 weeks, or days from the first day of the last menstrual period, because the perinatal morbidity and mortality begin to rise before 42 weeks of amenorrhea.
Terminate pregnancy if test is positive. Note that parallel testing for fetal well-being should be preferred than branched testing to avoid loss of mature fetus.
Therefore a single abnormal test is satisfactory to consider termination of the pregnancy. Refer the induction and labor management protocol. Patients are scheduled for induction from outpatient unless otherwise induction on emergency ground or admission for other obstetrical risk factors is indicated. First stage of labor: close follow up of the fetal well being by CTG monitoring or intermittent auscultation every 15 minutes in relations to contraction.
Second stage of labor: anticipate the following maternal and fetal complications. Third stage should be managed actively. PROM is less likely if fluid volume is normal. The information now available, from the "Term PROM Trial", showed no difference in any major outcome measure whether the chosen management was immediate induction, using oxytocin or vaginal prostaglandin, or expectant Management.
Therefore, our management approaches, in term PROM should be: Expedite delivery with out delay; in presence of suspected or evident intrauterine infection, abruption placenta, or evidence of fetal compromise.
NB: - It is important to re-emphasize here again that, there is almost a universal agreement that delivery should be expeditiously undertaken regardless of the GA, when clinical Chorioamnionitis is diagnosed. Expectant management Expectant management, when chosen at any gestational age, consists of the following Principles. Onset of labor 2. Evidence for fetal distress 4. Evidence for intra uterine infection. It is a high risk pregnancy associated with significantly higher rates of maternal and perinatal morbidity and mortality.
Type of twin pregnancy Dizygotic twins fraternal twins : results from fertilization of two separate ova by two spermatozoa. They are always diamniotic-dichorionic. The sex of the fetuse may be same or different. The blood group is usually different Monozygotic twin identical twin : results from the division of a single zygote. Placentation depending on time of division can be diamniotic dichorionic, diamniotic mono chorionic or mono amniotic mono chorionic.
The fetuses have always the same sex and The blood group is always the same. Diagnosis of a twin gestation Diagnosis require a high index of suspicion if a routine ultrasound is not performed for all pregnant women. In all other situations, the following history, physical findings and diagnostic tests provide useful clues. Education: Birth preparedness and on the need for Hospital delivery with Cesarean Section facility and in the presence of a health worker skilled in intrauterine manipulation and neonatal resuscitation.
Rest: Limited physical activities, Early work leave. Antepartum surveillance starting from 32 weeks of gestation weekly is indicated in complicated multifetal gestation. Techniques-Modified biophysical profile, Fetal movement counting Cardiff's count to ten method Timing of delivery All twin gestations should be delivered by 40 weeks of gestation. Fetal lung maturity should be assessed if elective delivery is considered before 38 wks of gestation.
Cesarean section should only be performed for the same indications as in singleton pregnancy. If twin B is a breech and the estimated weight greater than gm but less than gram vaginal delivery could be allowed. Alternative management for twin B transverse or Breech is to perform External cephalic. Twin A-Non-vertex In all cases of twin gestation where the first tin is non-vertex, delivery should be effected by cesarean section.
This mode of delivery has to be done irrespective of the presentation of the second twin. Third stage of labor Third stage of labor should be managed actively after the delivery the last fetus. Complications 1. Delayed delivery of the second twin In the absence of infection late second-trimester or early third-trimester rupture of the membranes and delivery of one fetus need not always be followed by efforts to deliver the second fetus.
There will be Hydraminos in the larger twin recipient , oligohydraminos in a growth restricted fetus donor. Conjoined twins This is one of the rarest complication of a twin pregnancy, which if not recognized can lead to obstructed labor. The possible causes of hypertension in pregnancy are classified as: Preeclampsia: refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman.
Gestational hypertension: refers to hypertension usually mild without proteinuria or other signs of preeclampsia developing after the 20th week of pregnancy in a previously normotensive pregnant woman.
Chronic hypertension: is defined as hypertension that antedates pregnancy; is present before the 20th week of pregnancy; or persists after 12 weeks postpartum. Superimposed preeclampsia: is diagnosed when a woman with chronic hypertension develops new onset proteinuria after 20 weeks of gestation.
Women with chronic hypertension and preexisting proteinuria before 20 weeks are considered preeclamptic if there is an exacerbation of blood pressure to the severe range systolic mmHg or diastolic mm Hg in the last half of pregnancy, especially if accompanied by symptoms or a sudden increase in proteinuria.
Eclampsia: describes the development of grand mal seizures or coma in a woman with preeclampsia. Urgently mobilize all available personnel. If there are symptoms or signs of imminent eclampsia such as headache, blurred vision, vomiting, right upper quadrant pain, oliguria, exaggerated DTR manage as in eclampsia. If it is less, run fluids more rapidly if no still improved, consider renal failure.. Then continue as mg PO every 6 hours. Methyldopa is the drug of choice for maintenance therapy.
Methyldopa has a long history of safe use in pregnancy, well tolerated. General measures 2. General Measures in the Mx of Eclampsia 1. Give oxygen by mask at 6 liters per minute 5. An attendant must be always beside the patient.
Ensure that aseptic technique is practiced when giving magnesium sulfate deepIM injection. Warn the woman that a feeling of warmth will be felt when magnesium sulfate is given. If vaginal delivery is not anticipated within this time limit, delivery should be by cesarean section. Severe pre-eclampsia remote from term «28 or 30 wks GA 4.
NB Eclampsia is not a contraindication to such trial of induction. In fact it is usually successful with short induction delivery interval. Definition Gestational Diabetes Mellitus GDM is any degree of glucose intolerance with onset or first recognition during pregnancy. Pre-pregnancy diabetes is diagnosed prior to onset of pregnancy. This can be type 1 or type 2. Random is defined as any time of day without regard to time since last meal.
Fasting is defined as no caloric intake for at least 8 hours. The test should be performed as described by the World Health Organization using a glucose load containing the equivalent of g anhydrous glucose dissolved in water.
Whole blood glucose values are lower than plasma levels due to glucose uptake by hemoglobin. The recommended time of screening 1-hour challenge test is administered between 24 and 26 weeks of gestation. Classically, screening has consisted of a blood glucose determination 1 hour after the ingestion of a g glucose load. Components to the treatment of diabetes in pregnant women. Blood glucose concentration is lowered by exercise resulting in lowering the need for insulin.
Desirable perinatal outcomes are affected to an important degree by nutrient intakes sufficient to meet pregnancy requirements. It is well established that energy is the most important nutrient determinant of weight gain during pregnancy. Extra energy is required during pregnancy, and it has been recommended that between to kcal per day be added to non-pregnant requirements.
Insulin Principles There is no universal formula, and treatment must be individualized. The desired dosage schedule should be one that resembles insulin production in the normal patient as closely as is technically possible.
The preferred regimen is multiple injections consisting of rapid-acting insulin before each meal and at bedtime, with the latter mixed with intermediate-acting insulin. A typical insulin dose is 0. New cases need Hospitalization for the skill and education on insulin therapy. Short and intermediate acting insulin pre breakfast and pre dinner. From the total dose two-thirds before breakfast NPH or Lente and regular insulin in a mixture one-third before dinner NPH or Lente and regular insulin and as mixture.
Shot acting insulin before each meal plus intermediate insulin at bed time. In addition, 5—10 units of NPH or Lente is given at bedtime. Pre-meal doses 30min. Togather with weight estimate ,the ratio of head circumference to the abdominal circumference may help in predicting shoulder dystocia.
Route of delivery Cesarean section is indicated only upon obstetric indications. Intrapartum glycemic management 1-Insulin infusion method Withhold the morning insulin injection. Begin infusion of regular insulin at 0.
Adjust insulin infusion as follows. Begin oxytocin if needed Monitor maternal glucose hourly. If the need arises, use of oral hypoglycemic agents can normalize the blood glucose concentration.
Medical follow-up of these patients must be more intense as they are more likely to remain or progress to overt diabetes. To ensure adequate follow-up, these patients need to be referred to an endocrinology program with extensive experience in intensive management of diabetic patients.
HIV primarily affects women in the reproductive age group, years. However, if pregnancy occurs in late stage AIDS the rate of maternal mortality, particularly in developing countries is increased. In the developing countries there is also an increase in stillbirth rate, perinatal mortality and infant mortality. HIV does not have direct influence on rate of congenital malformation. MTCT is the predominant mode of transmission in children under 15 years of age. The factors are categorized in to viral factors, maternal factors, obstetric factors and fetal factors.
If the woman is infected with HIV during pregnancy or breast feeding the viral load is high. If instrumental delivery is required it is better to use forceps. If the mother chooses to breastfeed exclusive breastfeeding for six months should be recommended. Encourage the consumption of foods rich in iron e. Routine provider-initiated counseling and testing of all pregnant women for HIV results in greater acceptability, increased opportunity to prevent MTCT, and minimized stigma.
Testing and counseling is voluntary and this should be communicated to all pregnant women. The pregnant woman should be given the results of rapid HIV tests within one hour whenever possible. Information about HIV testing and counseling must maintain privacy and confidentiality. Knowledge of HIV status is crucial in providing appropriate recommendations and treatment for HIV positive women if indicated. Parentral iron treatment and blood transfusion should be based on severity of the anemia, the gestational age and presence of other conditions associated with ongoing blood loss.
All HIV positive pregnant women living in malaria endemic area should receive prophylaxis and treatment for malaria according to the national guideline. Prophylaxis against candida and CMV is not indicated. English is the most …. There are some attributes of democratic citizens in developing democratic cultures. They are: Knowing and respecting the human and ….
The redesign, printing, and distribution of this student textbook aim to improve the quality of primary education. This report is also similar to previous study Daka et al.
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Potential of mobile Phones to serve finding that a large number of S. Online J. Is your phone bugged? The incidence of bacteria known to cause thus our view that the results obtained in this study do not nosocomial infection on healthcare workers' mobile phones. We cannot explain this phenomenon.
Brook I, Frazier E Clinical features and aerobic and anaerobic The MAR phenotypes Table 3 obtained in the study microbiological characteristics of cellulites. Arch Surg. Brouillette E, Malouin F The pathogenesis and control of correlated with the percentage of antibiotic resistance. Staphylococcus aureus-induced mastitis: Study models in the mouse. Although the development of resistance to a particular Microbes Infect.
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