1. BY: Maria Eloisa C. Vidar, MD, MCHM, DPAFP Medical Coordinator, IHCP

2. What is National School Deworming Day? - a massive, one-day, simultaneous school- based deworming effort to approximately 16 million school-aged children enrolled in public schools this coming 29 July 2015.

3. Definitions  ALBENDAZOLE- the drug of choice for the control, prevention, and treatment of helminth infections  DEWORMING- the administration of albendazole (or mebendazole), without prior diagnosis of current infection, to control and treat intestinal helminth infecions, such as hookworm, Ascaris, and Trichuris  ELIGIBLE POPULATION- a group of individuals qualified for deworming; target population for single day deworming will be children age 5-12 years old or K- Grade VI enrolled in public elementary schools

4. Definitions  MASS DRUG ADMINISTRATION (MDA)- a strategy to provide deworming drugs to the eligible population without the requirement of prior diagnosis of current infection  MASS DRUG ADMINISTRATION PROVIDER (MDAP)- a person who administer the deworming drugs. This can be any teacher supervised by a health worker from the department of health (DOH), Department of education (DepEd), Local Government Units (LGU), or volunteer groups (with prior approval from DOH Regional Office) who have the capacity and background in health, administration of deworming drugs, and management of adverse events.

5. Rationale Target coverage: 100% Target Prevalence: < 20% 1. To improve deworming coverage 2. To maintain prevalence below 20% Parasite Survey Result Region 2004 (%) 2014/2015 I77 II50 III64 IV-A54 IV-B78 V93 VI69 VII4821 VIII82 IX5628 X8620 XI5912 XII7723 NCR53 CAR50 ARMM7538 CARAGA5221

6. Objectives General: To deworm approximately 16 million school-aged children enrolled in 38,659 public elementary schools in one (1) day through the National School Deworming Day initiative. Specific:  To increase and scale-up the MDA coverage for school- aged children (5-12 years old or Kindergarten to Grade VI) enrolled in public elementary schools  To facilitate and ensure timely reporting of deworming intervention  To promote partnership in all levels in the implementation of deworming for school-aged children enrolled in public elementary schools

7. SCOPE AND COVERAGE  The NSDD is a nationwide effort targeting all 5 to 12 years old (Kindergarten to Grade VI) children enrolled in public elementary schools.  School-aged children enrolled in private schools and children who are not enrolled are encouraged to participate. They can inform the DepEd Regional Office regarding their willingness to participate and in turn, the DepEd Regional Office can refer them to the DOH Regional Office.

8. Expected Outcome Improved and better health outcome which is among the targets in the Roadmap of the Kalusugan Pangkalahatan or Universal Health Care through High Impact Breakthrough.

9. GENERAL GUIDELINES  NSDD guidelines and protocols set by the DOH-CO in collaboration with the Department of Education (DepEd) shall provide direction and serve as a roadmap for Mass Drug Administration Providers (MDAPs) in the implementation of NSDD.

10. GENERAL GUIDELINES The NSDD shall be done simultaneously in all public elementary schools. One school in every region will serve as venue for the grand launching to be attended by key officials from the DOH-CO, DepEd-CO and DILG/LGUs-CO, as well as other stakeholders/partners. Selection of the school is based on the preference of the DOH-RO. However, priority must be given to the 43 poorest provinces. The NSDD will be replicated yearly.

11. GENERAL GUIDELINES The NSDD shall be implemented through the collaboration of different units in all levels. These units shall include representation from the health and education sectors, other government agencies, and LGUs. (Please refer to Annex A)

12. IMPLEMENTA TION  MDA in the NSDD shall be done in accordance with the MDAP Guide (Annex B)  All enrolled children in public elementary schools shall be simultaneously dewormed by MDAP assisted by Barangay and community Health Teams and supervised by Regional, Provincial and Rural Health Office Health personnel.

13. IMPLEMENTA TION  In the occurrence of SAE, the teacher or the MDAP should report the incident to the school nurse or any health worker present in the school. If the adverse reaction persists, the MDAP shall refer the child to a nearby government hospital for further management. All government hospitals shall ensure treatment of any referrals related to mass deworming and report the case to MESU/CESU/PESU/RESU.

14. IMPLEMENTA TION The NSDD Implementers shall consist of the following:  i. Category 1: Health workers to oversee the MDA  Regional, Provincial and Municipal Health Office Staff (Rural Health Physicians, Public Health Nurses, Rural Health Midwives)  DepEd school physicians and nurses  Nurses and midwives from the Nurse Deployment Program/ Rural Health Midwife Placement Program  ii. Category 2: Front liners in the MDA  School Teachers and clinic teachers will distribute the deworming drugs  Members of the Parent Teachers Community Association (PTCA) will assist in the school deworming  Barangay Health Workers will assist in the school deworming  Community Health Teams will assist in the school deworming

15. ANNEX B. MDAP Guide 1. Pre-deworming  Prepare enrollment list  Ensure availability of deworming & supportive drugs  The Mass Drug Administration Provider must be familiar with the following information: Recommended drug for Mass Drug Administration  The DOH recommends the following drugs for mass treatment:  Albendazole 400mg chewable,flavoured tablet  Mebendazole 500mg chewable,flavoured tablet

16. ANNEX B. MDAP Guide Precautionary Measures on Mass Deworming Albendazole or Mebendazole is not recommended if the child has any of the following conditions:  Seriously ill child  Children experiencing abdominal pain  Children with diarrhea  Children who previously suffered hypersensitivity to the drug Serious Adverse Events (SAE) following deworming  MDAP shall ensure that the children will take deworming drugs on Full Stomach

17. ANNEX B. MDAP Guide 2. Deworming  Clean drinking-water should be available at the school on the treatment day  Each learner shall receive one tablet of deworming drug.  The MDA providers should ensure that each child swallows/chew the tablet.  The names of the children who are absent on NSDD should be recorded by the teacher and these children should be treated when they return to school. Children who are ill on treatment day should not receive drugs. This is not because of any danger of adverse effects, but to prevent the potential misperception that the deworming medicine caused the illness. These children should be given the anthelminthic drug later when they are well again  Ensure all RHUs and hospitals are ready for SAE referrals  Ensure that the required number of drugs is available

18. ANNEX B. MDAP Guide 3. Post Deworming  The class teachers shall make sure that all children listed in the masterlist were given deworming drugs.  NSDD point person to collate and submit report (Please see flow of reporting)

19. Procedural Guidelines: Reporting  Each school shall have one NSDD point person responsible for the collection of reports.  The prescribed forms were designed for a paper- based reporting system. Forms shall be accomplished by the designated MDAP. Annex C contains the reporting forms and instructions on how to complete them.

20. Procedural Guidelines: Reporting  Records and reports of all grade level shall be collected and submitted to the School Principal.  The principal shall submit the reports to the Division Office duly noted by the District Supervisor for consolidation.  The division superintendent shall collect reports and submit it to Department of Education Regional Office.  DepEd Regional Office shall collect all reports of school divisions and submit it to DOH-RO and DepEd-CO.  The DOH-RO shall submit the unofficial/partial report to the DOH-CO. Annex D contains the flow chart for reporting.

21. ANNEX D: Flow of recording and Reporting

22. Procedural Guidelines: Reporting  Records and reports shall be sent via text message for unofficial reports.  Unofficial and partial reports shall be submitted/sent to DOH-CO at 12:00 NN and final report at 6:00 PM on 29 July 2015.  Deadline of submission from the different levels to DepEd Regional Office is at 4:00 PM.  Final/official reports shall be submitted to DOH Regional Office at 5:00 PM and from DOH RO to DOH CO and DepEd-CO at 6:00 PM. The final report shall be released by the DOH-CO noted by DepEd- CO at 7:00 PM.

23. Procedural Guidelines: Reporting  Final and duly signed records and reports, along with the documentation of program of the chosen school per division, shall be submitted to DOH-CO/IHCP Team after five (5) working days from the conduct of NSDD.

24. Procedural Guidelines: Monitoring  Monitoring shall be conducted during the pre-implementation, implementation & post- implementation phases. This will entail reviewing data received as scheduled. One of the NSDD strategies in monitoring is the use of Rapid Coverage Assessment (RCA). 

25. Procedural Guidelines: Monitoring  RCA shall be conducted during and the week after NSDD. The objective is to measure the performance of every school, specifically to:  (1) compare the total number of enrolled school-aged children and unenrolled school-aged children,  (2) identify schools where there are missed school-aged children,  (3) take immediate action to deworm missed school children.

26. Procedural Guidelines: Monitoring  The Regional, Provincial, Municipal, and City Health Office teams shall perform the monitoring.  Monitoring shall be done during the NSDD from the start of deworming until the preparation and submission of reports

27. Procedural Guidelines: Monitoring  SAEs shall also be monitored. Proper management and immediate referral to a hospital shall be carried out by the MDAP point person at the different levels. There are number of SAEs: - Those caused by the drugs themselves: e.g., an allergic reaction to the drugs - Those caused by the parasites degeneration when they are killed: e.g., intestinal blockage.

28. Procedural Guidelines: Annex C. Recording and Reporting Forms Form 1: Deworming Checklist  This form shall be accomplished by the class adviser/Teacher-in-charge and to be submitted to Grade level Supervisor for approval. Name of child and gender must be properly indicated. Essential Health Care Package: Hand washing, feeding and tooth brushing are also cited and must be carried out prior to deworming. Remarks pertain to reason for not having the child dewormed and if some adverse events occurred, management given is also included.

29. CONSENT FORM DATE Sa Kinauukulan: _____ Pinahihintulutan ko _____ Hindi ko pinahihintulutan Ang aking anak na si ______________________________ na nasa Baitang _________________ na mabigyan ng pampurga sa bulate. ___________________________ Pangalan at Lagda ng Magulang

30. NSSD Form 1 Form 1 National School Deworming Day Classroom Level Province:Division: District: School:School Address: Total Enrolment:Grade Level & Section: Name of Child EnrolmentHand washing Done Feeding Done DewormedTooth brushing Done RemarksActions Taken 4PsNon 4Ps 1. 2. Accomplished by:Noted: Class AdviserGrade Level Chairman Date:

31. Procedural Guidelines: Annex C. Recording and Reporting Forms Form 2: School Level Report  This form shall be accomplished by the school principal and submitted to the district point person. Total number of enrolled and dewormed children per grade level shall be indicated. Remarks pertain to number of children that were not dewormed and reason for such. Form 2 A: District Level Report  This form shall be accomplished by the district point person and submitted to district supervisor for approval. Total number of enrolled and dewormed children per school shall be indicated. Remarks pertain to number of schools which have children that were not dewormed and reason for such.

32. NSSD Form 2 Form 2 National School Deworming Day School Level Province:Division: District: School:School Address: Grade Level EnrolmentTotal Enrolment No. of Children Dewormed DewormedTotal No. of Children Dewormed Remarks 4PsNon 4Ps 4PsNon 4Ps Total Accomplished by:Noted: School PrincipalPSDS Date:

33. NSSD Form 3 Form 3 National School Deworming Day District Level Reporting Form RegionProvince: Division: District: Name of Schools EnrolmentTotal Enrolment No. of Children Dewormed DewormedTotal No. of Children Dewormed Remarks 4PsNon 4Ps 4PsNon 4Ps Total Accomplished by:Noted: PSDS SDS Date:

34. Roles and Responsibilities Division/District Office  Coordinates with LGUs in all phases of NSDD implementation;  Allocates deworming tablets to all public schools;  Conducts orientation to School Heads and School/ Clinic Teachers, PTAs and other partners;  Consolidates reports of district offices and submit to DEpEd Regional Offices;  Supervises the smooth conduct of the NSDD;

35. Roles and Responsibilities School  Prepares the Masterlist of children to be dewormed;  Orient and coordinates with the PTA and other stakeholders in the conduct of the NSDD;  Ensures collection of parent’s consent;  Administers the deworming drug supervised by a health worker;  Ensures referral of students to RHUs/CHOs in occurrence of common adverse events or SAEs;  Prepares & submits report.

36. Roles and Responsibilities DILG/Local Government Units E.1. Provincial /City Health Office  Coordinates with local partners and potential donors;  Disseminates IEC Materials for the implementation of NSDD;  Conducts MDAP Orientation (Level 1&2);  Monitors the delivery of drugs and supplies;  Supports the DepEd Division Office on the implementation of NSDD;  Ensures that supportive drugs are available for common adverse events and SAEs.

37. DATES TO REMEMBER JULY 29, 2015 (WEDNESDAY)NSSD Administration of Deworming Drug Accomplishment of NSSD Forms 1 and 2 Send via SMS total no. of dewormed children to PDO JULY 30, 2015 (THURSDAY) Submit Form 2 to PSDS PSDS accomplish Form 3 JULY 31, 2015 (FRIDAY) PSDS submits to SDS Form 3

38. OTHER CONCERNS  RED CROSS BISCUITS  NUTRIJUICE FEEDING PROGRAM 4 TH WAVE San Pascual ES San Juan Bautista ES San Sebastian ES Sto. Domingo ES Suizo Bliss ES Suizo Resettlement ES Sitio Dam ES List due on July 23, 2015; 2 copies  2015 NUTRITION MONTH CELEBRATION Narrative Report to be submitted on or before August 7, 2015  BREAKDOWN OF SEVERELY WASTED AND WASTED CHILDREN PER GRADE LEVEL (Based on SY 2015-2016 Nutritional Status Report) Deadline: July 23, 2015 (12:00 noon)

40. AO 2010-0023 “GUIDELINES ON MASS DRUG ADMINISTRATION AND THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) AND SERIOUS ADVERSE EVENTS (SAE)”

41. ADMINISTRATIVE ORDER 2010-0023

42. AO 2010-0023: “GUIDELINES ON MASS DRUG ADMINISTRATION AND THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) AND SERIOUS ADVERSE EVENTS (SAE)”  Revised last February 3-5,2015 with the following partners: DepEd- School Health Division Bureau of Learners Support Services UP-College of Public Health Food and Nutrition Research Institute (FNRI) Selected DOH-ROs

43. OBJECTIVES Guide health workers and providers on the ff: 1. Administering deworming drugs to different age groups 2. Management of adverse events following deworming 3. AEFD reporting and recording at different levels AO 2010-0023

44. SCOPE OF APPLICATION  This order shall apply to all national, regional and local offices and stakeholders involved in the deworming program of DOH AO 2010-0023

45. GENERAL GUIDELINES

46. I. RECOMMENDED DRUGS FOR MASS DEWORMING All individual ages 1yo and above can take the deworming tablet regardless of the schedule of their last deworming. It should not be taken on an empty stomach Albendazole 400 mg, chewable, flavored tablet Albendazole 400 mg, chewable, flavored tablet Mebendazole 500mg, chewable, flavored tablet Mebendazole 500mg, chewable, flavored tablet AO 2010-0023

47. Dosage and Estimated Effectiveness of Drugs in Current Use in Intestinal Helminth Infections (Based on Drugs Used in Parasitic Diseases, WHO) Albendazole 1 (400 mg) Levimasole 1 (2.5 mg/kg) Mebendazole 1 (500 mg) Pyrantel 1 (10 mg/kg) RoundwormWhipwormHookworm +++ + +++ ++ - +++ ++ ++ - +++ 2 +++ ++ - +++ ++ - +++ 2 ++ - +++ ++++ Highly effective +++ Effective ++ Effective in light to moderate infections to moderate infections 1 In single dose 2 The usual dose of Mebendazole is 100 mg BID for 3 days. Single dose of 500 mg Single dose of 500 mg

48. WHY IS ALBENDAZOLE OR MEBENDAZOLE THE DRUG OF CHOICE IN THE MASS TX OF STH? Included in the WHO model list of essential medicines for single dose treatment of STH Cheap making mass tx affordable and sustainable Excellent safety record Adverse reactions (AR) are minimal & transient AR following tx mainly due to the body’s response to the dying worm AR is highest during 1 st round of tx and decreases during subsequent rounds

49. Safe, economical and simple because it is given as a single dose Efficacy varies as a function of such factors as pre-existing diarrhoea, gastrointestinal transit time, degree of infection, and helminth strain

50. ALBENDAZOLE  DESCRIPTION: A benzimidazole carbamate based on a bicyclic ring structure in which a benzene ring is fused to the 4- and 5- positions of an imidazole ring.  PHARMACODYNAMICS: Benzimidazoles selectively bind to nematode ß-tubulin, inhibiting polymerization, thus preventing the formation of microtubules and so stopping cell division. Impaired uptake of glucose, leading to depletion of glycogen, and reduced stores of ATP has also been noted.

51. ALBENDAZOLE  PHARMACOKINETICS: Albendazole is poorly absorbed. The parent drug is undetectable in human plasma when 400 mg is taken orally. Albendazole sulphoxide is responsible for the therapeutic effect outside the gut.  INDICATIONS: Clinical studies have shown albendazole to be effective in the treatment of Enterobius vermicularis (threadworm), Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and of Ancylostoma duodenale and Necator americanus (hookworm).  CONTRAINDICATIONS: Albendazole is contraindicated in persons who have shown hypersensitivity to the drug or other benzimidazole derivatives 

52. MEBENDAZOLE  DESCRIPTION: A methyl 5-benzoyl-2-benzimidazole carbamate a synthetic benzimidazole derivative and is an off white to yellowish powder, insoluble in water and common organic solvents but freely soluble in formic acid.  PHARMACODYNAMICS: Acts locally in the lumen of the gut by interfering with cellular tubulin formation in the intestines of worms. Mebendazole binds specifically to tubulin and causes ultrastructural degenerative changes in the intestine. As a result, the glucose uptake and the digestive functions of the worm are disrupted to such an extent that an autolytic process occurs.

53. MEBENDAZOLE  PHARMACOKINETICS: Following oral administration, approximately 20% of the dose reaches the systemic circulation, due to incomplete absorption and to extensive pre-systemic metabolism (first-pass effect). Maximum plasma concentrations are generally seen 2 to 4 hours after administration. Dosing with a high fat meal leads to a modest increase in the bioavailability of mebendazole.  INDICATIONS: Clinical studies have shown mebendazole to be effective in the treatment of Enterobius vermicularis (threadworm), Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and of Ancylostoma duodenale and Necator americanus (hookworm).

54. MEBENDAZOLE  CONTRAINDICATIONS: Mebendazole is contraindicated in persons who have shown hypersensitivity to the drug or other benzimidazole derivatives

55. II. DRUG DOSAGES AND FREQUENCY OF DEWORMING BY TARGET GROUPS Target groupsDrug DosageFrequency 12—23 monthsÃlbendazole: 200 mg or ½ tablet Mebendazole: 500 mg tablet Every 6 months 2 yrs old and above (preschoolers, school children, pregnant, lactating adults, women of child bearing age, special population and special groups) Albendazole: 400mg or 1 tablet Mebendazole: 500 mg tablet Every 6 months  Pre-school aged children and unenrolled school-aged children should be given deworming drugs at the Rural Health Unit or Municipal Health Center.  Enrolled school-aged children are given deworming drugs in schools AO 2010-0023

56. III. ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) Common Adverse EffectsHow to Manage* Local sensitivity or allergyGive antihistamine Mild abdominal painGive antispasmodic DiarrheaGive oral rehydration solution plus Zinc Erratic worm migrationPull out the worms from mouth/nose and dispose worm properly  Parents/caregivers are allowed to manage the adverse reactions, but if these reactions persist, a doctor shall be consulted and any of the AEFD team shall be informed AO 2010-0023

57. WHY DO WE SAY THAT ADVERSE EFFECTS ARE RELATIVELY MILD?  Poorly absorbed  Primary metabolite, sulfoxide, is rapidly metabolized to sulfone  Negligible or undetectable in the plasma 24 hours after ingestion  Half life of the sulfoxide is about 8.5 hours  No treatment is necessary if the child experienced any of the adverse reactions since they are mild and transient

58. RECOMMENDED DRUGS FOR THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) DrugDose DiphenhydramineFor oral dosage forms: Syrup 12.5mg/5ml Children younger than 6 years of age: ½ tsp to 1 tsp every 6 – 8 hours until symptoms subside Children 6 to 12 years of age: 1tsp to 2 tsp every 6 – 8 hours until symptoms subside For local hypersensitivity and allergy:

59. RECOMMENDED DRUGS FOR THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) DrugDose DicycloverineGI spasm: For oral dosage forms: Syrup 10 mg/5ml Children 6 months – 2 years old: ½ tsp to 1 tsp every 6 – 8 hours. Children 2 – 12 years old: 1 tsp every 6 – 8 hours. * Dicycloverine: May be taken with or without food. (May be taken before or after meals.) For abdominal pain:

60. RECOMMENDED DRUGS FOR THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) DrugDose Hyoscine N- butylbromide Acute attacks of colicky pain: For oral dosage forms: Syrup 5 mg/5ml or Tablet 10mg Children ≥ 6 years: I tablet every 6 – 8 hours or 2 tsp every 6 – 8 hours. For abdominal pain:

61. RECOMMENDED DRUGS FOR THE MANAGEMENT OF ADVERSE EVENTS FOLLOWING DEWORMING (AEFD) DrugDose Reformulated Oral Rehydration Salt To prevent dehydration: give after each loose stool 50 – 100 ml (¼ to ½ cup) ORS for children under 2 years old 100 – 200 ml (½ cup to 2 cups) ORS for children 2 – 10 years old For older children and adults: as much fluid as they want Refer to health center if child develop dehydration Zinc supplementation See Administrative Order No. 2007-0045 dated December 17, 2007 For diarrhea:

62. IV. PRECAUTIONARY MEASURES ON MASS DEWORMING CategoryResponse  Seriously ill child  Children experiencing abdominal pain  Children with diarrhea  Children who previously suffered hypersensitivity to the drug Manage existing condition prior to administration of deworming drug  Severely malnourished children Assess for presence or absence of medical complication and edema of both feet. If present, manage medical complications before deworming. (Source: Community-based Management of Acute Malnutrition) For uncomplicated severe malnutrition, (absence of medical complication and edema) children may be dewormed. AO 2010-0023

63. REMEMBER!  Target clients or caregivers should be adequately informed of the possible adverse reaction to the drug and how to manage it in case it occurs  Adverse reactions should be accurately recorded and proper authorities (AEFD team) informed  Health personnel at the community level should be informed of the on-going deworming activity. Support drugs should be available at the nearest health facility

64. WHEN TO REPORT SAE?  Any Serious Adverse Event (SAE) experienced by the client within 8-10 hours after ingestion of the drug should be reported immediately to the appropriate authority.  Any AEFD or non-serious adverse event shall also be recorded for reference.  Any AEFD or non-serious adverse event reported after 10 hours since the administration of the drug should be investigated and managed appropriately.

65. WHOM TO REPORT SAE? Municipal LevelProvincial LevelRegional LevelNational Level a.Municipal Health Officer b. Municipal Epidemiology Surveillance Officer (if available) c. IHCP Coordinator d. DOH Rep e. School Health Coordinator a.Provincial Health Officer b. Provincial Epidemiology Surveillance Officer (if available) c. IHCP Coordinator d. DOH representative e. School Health Coordinator (for school based deworming) a.Regional IHCP Coordinator b. Regional Epidemiology Surveillance Officer c. Food and Drug Administration Officer d. School Health Coordinator (for school based deworming) a.Disease Prevention and Control Bureau b. Epidemiology Bureau c. Food and Drug Administration d. Department of Education (for school based deworming)

66. DOH/DFA/DepEd  Recommend appropriate action DOH/DFA/DepEd  Recommend appropriate action RESU / Regional Coordinator/DepEd School Governance and Operations Division  Confirms and validate investigation findings  Assist in investigation if needed  Recommends appropriate action Municipal/ Provincial/ City Health Office/ DepEd Division Office  Conducts and confirms initial investigation using adverse reaction reporting form and submits to next level  Recommends appropriate action Health Worker/ Parent/Teacher  Reports any SAE in the area to higher level Flow of SAE Report and Investigation

67. INTEGRATED HELMINTH CONTROL PROGRAM Adverse Events Following deworming REPORTING FORM To be filled in by the Physician/Midwife/Barangay Health Worker or Teacher as needed during every mass deworming campaign Region: ______________________ Province: ________Municipality: _______________________ Service outlet: (Please check and indicate name of RHU, School, Daycare ______ Barangay Health Station/RHU: ________________ School:_________________ ______ Day Care Center: _____________________ Date of deworming: ___________Time of Deworming _____ Name of patientAge Complete AddressChief ComplaintAction REMARKS and time of onset of signs and symptomsTaken Accomplished by: _______________________________ Print name and signature Date: ________________________

68. SUPPORT TO DOH REGIONAL OFFICES FOR AEFD AND SAE  The Integrated Helminth Control Program shall sub-allot the amount of Fifty Thousand Pesos (PhP 50,000) to each DOH Regional Office annually to help defray the expenses incurred related to the occurrence of AEFD or SAE during the conduct of deworming activity. AO 2010-0023

69. ROLES AND RESPONSIBILITIES

70. DISEASE PREVENTION AND CONTROL BUREAU (DPCB)  Establishes a pool of experts or designates collaborating centers which shall provide experts at the national level to provide technical assistance in the management of severe adverse drug reactions  Develops and updates policies and guidelines on the management of AEFD for schools, RHUs and hospitals and other government agencies involved in mass deworming campaign  Allocates fund for the management of AEFD AO 2010-0023

71. EPIDEMIOLOGY BUREAU  Conducts an in-depth investigation of any serious adverse experience which may be life-threatening or requires hospitalization  Establishes and maintains a database in coordination with DPCB  Analyzes data provided by RESU  Recommends appropriate action if necessary  Provides feedback to concerned offices/LGUs or schools as necessary AO 2010-0023

72. DOH REGIONAL OFFICES / REGIONAL EPIDEMIOLOGY SURVEILLANCE UNIT (RESU)  Confirms reported occurrence of AEFD  Conducts investigation in collaboration with LGUs  Analyzes data gathered and recommends appropriate action  Allocates fund to augment national funds in the management of AEFD AO 2010-0023

73. MUNICIPAL /PROVINCIAL / CITY HEALTH OFFICES (MHO / PHO / CHO)  Oversee the implementation of mass deworming  Conducts initial investigation and confirms reported AEFD through the PESU/MESU  Recommends appropriate action if necessary  Augments fund for the management of AEFD  Reports to DOH Regional Office or refers to next higher level if further investigation is required AO 2010-0023

74. GOVERNMENT HOSPITALS  Ensure treatment of any referrals related to mass deworming AEFD  Report cases of SAEs to MESU/PESU/RESU AO 2010-0023

75. PARENTS / HEALTH WORKERS / TEACHERS  Report cases of SAEs to proper authority, e.g. PESU/MESU  Report cases of SAEs to nearest health facility or proper authority e.g. MHO/PHN/PESU/MESU AO 2010-0023

76. THANK YOU.