Children to be treated first as ministry lists new guidelines

Anyone with a respiratory illness visiting the hospital will have to get tested for Covid-19. 

New guidelines issued by the Ministry of Health state that the tests will include children with pneumonia, who will be prioritised for the coronavirus test.

These tests, the ministry cautions, should not delay the patient from being attended to.

These new measures are contained in the Interim Guidance on Continuity of Essential Health Services during the Covid-19 pandemic, which should guide resumption of normal services in hospitals as the country recovers from the pandemic.

High risk

The guidelines signed by Health Director General Patrick Amoth covers children services, maternal and reproductive health services, non-communicable diseases, cancer care and respiratory illness, HIV, cardiovascular patients, immunisation services, mental health, persons living with disabilities and surgery.

While Covid-19 has not been a threat as such among children with fatalities almost at zero per cent, the guidelines state that the high risk facing this population is lack of access to routine services.

“Children with chronic health conditions such as heart disease, asthma and sickle cell disease should be closely monitored and followed up routinely,” says the ministry.

Child health services such as immunisation will continue through this period, while immunisation campaigns will be organised after the pandemic.

“A fully vaccinated child is also more likely to be protected from vaccine preventable diseases and possible complications of Covid-19,” the ministry notes in the guidelines.

Children with indrawing pneumonia as per Integrated Management of Childhood Illness (IMCI) should be prioritised for Covid-19 testing.

“This should not delay the management of the indrawing pneumonia,” the guidelines read.

While routine paediatric outpatient clinics may be postponed, hospitals should ensure those who can get refills for medications of chronic illnesses are well covered.

“Where possible, a designated caregiver should refill the prescription of the child without going with them to the health facility,” the ministry advises, insisting that the contact time with the child should be as minimal as possible but adequate for quality service provision.

Where the child is unwell, one designated caregiver should bring the child to hospital.

Risk factors

“Preparation for possible catch-up immunisation activities upon the end of Covid-19 pandemic should be done,” it adds.

While there are no studies for Covid-19 among patients infected with tuberclosis, the ministry notes that chronic respiratory illnesses which may be caused by delay in treatment of TB are a known risk factor for morbidity and mortality from the coronavirus.

“All patients being evaluated for respiratory illnesses such as pneumonia, asthma, chronic obstructive pulmonary disease and tuberculosis should also be evaluated for Covid-19,” the guidelines direct.

Persons living with HIV will be taken care of through phone and other non-contact models or community antiretroviral therapy delivery groups. The virtual services should also be encouraged among adolescents and pregnant women.

The ministry noted that persons with underlying health conditions who are at high risk of Covid-19 deaths should continue to access regular medications and essential health services.

“It is recommended that persons living with non-communicable disease (NCDs) who are in stable condition have longer periods between their clinic appointments and hence bigger drug refills,” the ministry recommends.

For those with cancer, the ministry suggests cancellation of all elective procedures (those procedures where a delay of six-eight weeks will not lead to a detrimental effect on the health of the patient).

However, emergency surgical procedures (those that absolutely need to be performed in 24-48 hours) should be prioritised.

The guidelines state that patients should be encouraged not to arrive too early for their appointments and doctors should also consider alternative regimens or different locations where the medicine can be administered.