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Contents Acknowledgements iv Abbreviations vi Compendium of interventions with WHO evidence 1 References 94 iii Drafting of the guideline Mary Louisa Plummer, Child and Adolescent Health Consultant, USA and David A. Ross, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Switzerland. GRADE methodologist Nandi Siegfried, Public Health Medicine Specialist, South Africa. Steering Group (WHO staff unless otherwise noted) Coordination David Ross and Kid Kohl, Department of Maternal, Newborn, Child and Adolescent Health and Ageing. Members Jamela Al-Raiby, WHO Regional Office for the Eastern Mediterranean; Wole Ameyan, Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes; Valentina Baltag, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Faten Ben-Abdelaziz, Department of Health Promotion; Paul Bloem, Department of Immunization, Vaccines and Biologicals; Sonja Caffe, WHO Regional Office for the Americas; Marie Clem Carlos, Department of Noncommunicable Diseases; Shelly Chadha, Department of Noncommunicable Diseases; Venkatraman Chandra-Mouli, Department of Sexual and Reproductive Health and Research; Katrin Engelhardt, Department of Nutrition and Food Safety; Kaia Engesveen, Department of Nutrition and Food Safety; Regina Guthold, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Joanna Herat, United Nations Educational, Scientific and Cultural Organization (UNESCO); Symplice Mbola Mbassi, WHO Regional Office for Africa; Rajesh Mehta, WHO Regional Office for South-East Asia; Denise Mupfasoni, Department of Control of Neglected Tropical Diseases; Martina Penazzato, Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes; Marina Plesons, Department of Sexual and Reproductive Health and Research; Leanne Riley, Department of Noncommunicable Diseases; Chiara Servili, Department of Mental Health and Substance Use; Stéphanie Shendale, Department of Immunization, Vaccines and Biologicals; Marcus Stahlhofer, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Howard Sobel, WHO Regional Office for the Western Pacific; Martin Weber, WHO Regional Office for Europe; and Juana Willumsen, Department of Health Promotion. Evidence review and synthesis Systematic overview of systematic reviews of comprehensive school health services Julia Levinson, Kid Kohl, Valentina Baltag and David Ross. Systematic reviews of the effectiveness and acceptability of comprehensive school health services Paul Montgomery, University of Birmingham, United Kingdom; Jacoby Patterson, Independent Senior Research Consultant, United Kingdom; and Anders M. Bach-Mortensen, University of Oxford, United Kingdom. Review of global WHO health service interventions for 5–19-year-olds Mary Plummer, Kid Kohl and David Ross. Survey of expert opinion on school health services Mary Plummer; Ace Chan, Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC), School of Nursing, University of British Columbia, Vancouver, Canada; Kid Kohl; Ashley Taylor (SARAVYC); Elizabeth Saewyc (SARAVYC); and David Ross. Acknowledgements iv Brief exploratory review of school health services globally Mary Plummer, Kid Kohl and Valentina Baltag. Guideline Development Group Rima Afifi, University of Iowa, United States of America; Habib Benzian, New York University, United States of America; Harriet Birungi, Population Council, Kenya; Rashida Ferrand, Biomedical Research and Training Institute, Zimbabwe; Jorge Gaete, Universidad de los Andes, Chile; Najat Gharbi, Ministry of Health, Morocco; Murthy Gudlavalleti Venkata Satyanarayana, Indian Institute of Public Health, India; Henrica J. M. Fransen, University of Tunis El Manar, Tunisia; Julia Levinson, Boston University, United States of America; Erin D. Maughan, National Association of School Nurses, United States of America; Ella Cecilia Naliponguit, Department of Education, Philippines; Atif Rahman, University of Liverpool, United Kingdom; Elizabeth Saewyc (Chair), University of British Columbia, Canada; Susan Sawyer, University of Melbourne, Australia; Hui-Jing Shi, Fudan University, China; and Sharlen Vigan, World Bank, Togo. External Review Group Bruce Dick, Adolescent Health Consultant, Switzerland; Chris Kjolhede, Bassett Health Care Network, United States of America; Regina Lee, Professor of Nursing, University of Newcastle, Australia; Maziko Matemvu, Her Liberty, Malawi; Antony Morgan, Glasgow Caledonian University, United Kingdom; Blanca Pianello Castillo, International Federation of Medical Students Associations, Spain. Financial support The United Kingdom Department for International Development, the Bill and Melinda Gates Foundation and the United States Agency for International Development. v Abbreviations ADHD attention deficit hyperactivity disorder AHD adolescent health and development ART antiretroviral therapy ASD autism spectrum disorder CHD child health and development CSE comprehensive sexuality education FGM female genital mutilation GDG (WHO) Guideline Development Group GHSSSTI Global Health Sector Strategy on Sexually Transmitted Infections, 2016–2021 GRC (WHO) Guidelines Review Committee GSWCAH Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030 HEADSSS home, education/employment, eating, activity, drugs, sexuality, safety, suicidal thinking/depression iCCM integrated community case management ITU (United Nations) International Telecommunication Union IV intravenous LMIC low- and middle-income country/countries mhGAP Mental Health Gap Action Programme NCD noncommunicable disease ORS oral rehydration salts PA published global WHO health service procedure or activity for 5-to-19-year-olds PEP post-exposure prophylaxis PFA psychological first aid PrEP pre-exposure prophylaxis PTSD post-traumatic stress disorder vi RABV rabies virus SHS school health services SRH sexual and reproductive health STI sexually transmitted infection TB tuberculosis UHC universal health coverage WaSH water, sanitation and hygiene 3TC lamivudine ABC abacavir ATV/r atazanavir AZT zidovudine DRV/r darunavir DTG dolutegravir FTC emtricitabine LPV/r lopinavir RAL raltegravir TDF tenofovir disoproxil fumarate Post-exposure prophylactic agents cited in section 1-54 – PA523 A glossary of terms used throught the guidance and its web annexes is provided in the guidance document. Glossary vii Background This compendium is a supplement to the WHO guideline on school health services. It lists each of the 87 interventions that were identified by the Guideline Development Group (GDG) as essential or suitable for inclusion within school health services (SHS), either everywhere or in certain geographic areas only. Each intervention is shown with its GDG categorization, as well as its WHO source category and supporting WHO procedures or activities (PAs). The sources cited in this compendium are from a literature review of global WHO publications focused on health service procedures or activities for 5–19-year-olds. For this review, a search was conducted through online WHO search engines, department website publication lists and other compilations of WHO recommendations. In total, 342 recent global WHO publications and WHO recommendation webpages were reviewed to assess their potential relevance for SHS, of which 149 publications had content used to produce a master list of 531 health service PAs that are relevant to 5–19-year-olds. The 149 publications included global guidelines, strategies, standards for quality of care and guidance documents on adolescent health, school health and specific health conditions. The 531 PAs included formal recommendations in guidelines that had been approved by the WHO Guidelines Review Committee (GRC), and other published interventions, such as those identified as evidence-based interventions, best practice statements, good practice statements, key actions, key areas for programming, priority actions, quality areas, quality statements, recommendations and standards. Most of the compiled PAs were quoted verbatim, but some were consolidated from many lengthy and highly specific WHO recommendations to create one brief, composite PA. One unpublished global WHO report was included in the review and the resultant compendium (the February 2019 draft of the WHO universal health coverage (UHC) intervention menu).1 This draft menu was a collaborative effort between different global WHO departments. It was included here to consider the SHS interventions within the context of broader, ongoing, high-level work at WHO, but the UHC menu did not influence the WHO source of any intervention. Compendium of interventions with WHO evidence 1 A version subsequently was published in 2021 (1). WHO guideline on school health services. Web Annex A. Compendium 1 Compendium key For the 87 intervention tables in the compendium: • each intervention is shown with its GDG categorization as essential or suitable within SHS, by location, as well as its WHO source and supporting WHO PAs; • each intervention has its own table with intervention number and full wording in the top row, followed by supporting WHO PAs in subsequent rows; and • column 2 of each intervention table provides additional notes for individual PAs, such as “GRC-approved” or WHO classification as a “Quality Statement” or “Good Practice Statement”. Categorization of interventions as essential, suitable or unsuitable within SHS, by location Formatted short form Definition of category Essential everywhere Must be included in SHS everywhere Suitable everywhere Appropriate, but not essential, in SHS everywhere Essential/suitable in certain areas Essential and/or appropriate in SHS in certain geographic areas only Categorization of WHO source of interventions, including whether its publication was approved by the WHO GRC Formatted short form Definition of category Full GRC All aspects of the intervention are supported by a GRC-approved guideline Partial GRC Some – but not all – aspects of the intervention are supported by a GRC-approved guideline (in addition, some or all aspects of the intervention may be supported by “Other WHO” publications) Other WHO Some or all aspects of the intervention are supported by other (not GRC-approved) global WHO publications No WHO source identified No supporting procedures or activities have been found in global WHO publications 2 I-01. Promotion of timely care-seeking from an appropriate provider Essential everywhere Partial WHO support I-01 – WHO UHC menu (2.19 Draft). Care-seeking for signs of illness from an appropriate provider (1) I-01 – WHO UHC menu (2.19 Draft). Promotion of timely care-seeking for childhood illness (1) I-01 – PA43. Every child who requires referral receives appropriate prereferral care and the decision to refer is made without delay (2) Quality Statement 3.1 I-01 – PA44. Every child who requires referral receives seamless, coordinated care and referral according to a plan that ensures timeliness (2) Quality Statement 3.2 I-01 – PA487. Health-care providers, including those working in communities, should facilitate the timely uptake of services by children and adolescents who have experienced maltreatment and are in need of services (3) GRC-approved Good Practice Statement 9 I-02. Promotion of health literacy Essential everywhere Other WHO support I-02 – WHO UHC menu (2.19 Draft). Health promoting schools: health-promoting curriculum, comprehensive sexuality education (CSE) (1) I-02 – PA27. Adolescent-friendly health services: health care should be accessible and acceptable, promote health literacy and provide an appropriate package of services, including routine, age-appropriate appointments (such as vaccinations) (4,5) I-02 – PA50. The health facility implements systems to ensure that adolescents are knowledgeable about their own health and they know where and when to obtain health services (5) Standard 1 I-02 – PA51. All children and their carers receive appropriate counselling and health education, according to their capacity, about the current illness and promotion of the child’s health and well-being (2) Quality Statement 4.4 I-02 – PA267. Improve the nutrition literacy and skills of parents and caregivers (6) I-02 – PA434. Support teachers’ adolescent health literacy through a combination of pre- and in-service training opportunities. ... (such as) improved mental health literacy and reduced stigma (4) Key area for programming I-02 – PA436. Develop curricula to promote health literacy; address homophobic bullying and stigma related to HIV and gender-based violence; and incorporate comprehensive sexuality and life-skills based education. Promote positive development approaches to improve self-esteem through learning interventions, participatory governance approaches and broader community involvement (4) Key area for programming WHO guideline on school health services. Web Annex A. Compendium 3 I-03. Promotion of personal hygiene and handwashing with soap Essential everywhere Other WHO support I-03 – WHO UHC menu (2.19 Draft). Provision of safe drinking-water and sanitation (1) I-03 – WHO UHC menu (2.19 Draft). Promotion of personal hygiene and handwashing with soap (1) I-03 – PA34. Child-friendly water, sanitation, hand hygiene and waste disposal facilities are easily accessible, functional, reliable, safe and sufficient to meet the needs of children, their carers and staff (2) Quality Statement 8.2 I-03 – PA342. No GRC-approved diarrhoea-prevention guidelines for the general population of children. However, WHO recommends interventions on access to safe drinking-water, household water treatment and safe storage, access to improved sanitation facilities and handwashing with soap for all populations to prevent deaths due to diarrhoea (7,8) I-03 – PA513. Strategies for successful promotion of hand hygiene in health-care settings: system change (make hand hygiene possible, easy, convenient; make alcohol-based handrub available; make water and soap continuously available; install voice prompts); hand hygiene education; promote/facilitate skin care for health-care workers’ hands; routine observation and feedback; reminders in the workplace; improve institutional safety climate (general; promote active participation at individual and institutional level; avoid overcrowding, understaffing, excessive workload; institute administrative sanction/rewarding; ensure patient empowerment); combination of several of the above strategies (9) I-03 – PA526. [In the COVID-19 context] broadcast educational programmes on TV and radio during school closures. Once schools reopen and community gatherings are permissible, design tailored catch-up strategies, especially for students with particular vulnerabilities. Prepare for reopening with adequate preparations for infection prevention and control. Assess the impact of differential access to health information and education during school closures (10) I-04. Promotion of oral health care Essential everywhere Other WHO support I-04 – PA332. Schools should identify and treat oral health … problems (11) I-04 – PA517. School oral health services, part of the school health services, help screen, prevent, control and monitor oral diseases and conditions, as well as maintain good oral health. They play an important role in oral and general health promotion, supporting the efforts made by the school, teachers and students (such as providing training and expertise and supplying oral health materials) (12) I-04 – PA518. In a health-promoting school, depending on sociocultural conditions and resources, oral health promotion should target: maintaining good oral hygiene with daily toothbrushing drills supervised by teachers; the use of fluoride, including affordable fluoride toothpaste and fluoride rinsing programmes; promoting good nutrition; reducing the consumption and frequency of sugary snacks and drinks; promoting the consumption of fruit and vegetables; promoting water or milk fluoridation; promoting regular dental check-ups and care; preventing or reducing tobacco use, alcohol consumption and substance abuse; preventing accidents, violence and anti-social behaviours; and taking a wider responsibility at home and in society (12) I-04 – PA519. In a health-promoting school, oral health education should be regularly reinforced at home and further developed in school at key educational stages throughout the children’s school career (12) 4 I-05. Promotion of reduced consumption of sugar and sugar-sweetened beverages Essential everywhere Full WHO support I-05 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved Ranked “Effective” intervention I-05 – PA268. [Composite] recommendations on healthy diet (sugar, potassium and sodium intake) (7,14,15) Note: several WHO guidelines in development: on carbohydrate, non-sugar sweetener and polyunsaturated fatty acid intake in adults and children GRC-approved Not a health service recommendation: specifies healthy diet details I-05 – PA441. Establish, or critically review, school health programmes to address priorities (e.g. [noncommunicable diseases] NCDs, [sexual and reproductive health] SRH, communicable diseases and violence) in an integrated way. … [Including] b. A safe physical environment that addresses safety and the physical condition of school premises, water, sanitation and menstrual hygiene services and healthy environments to promote healthy eating and physical activity, among others (4) Key area for programming I-06. Promotion of increased physical activity and limited sedentary behaviour Essential everywhere Full WHO support I-06 – WHO UHC menu (2.19 Draft). Promotion of increased physical activity, limited sedentary behaviour and adequate sleep (1) I-06 – WHO UHC menu (2.19 Draft). Health education of adolescents, parents and caregivers regarding physical activity (1) I-06 – PA231. Promotion of healthy behaviour (e.g. nutrition, physical activity, no tobacco, alcohol or drugs) (16) Global Strategy for Women’s, Children’s and Adolescents’ Health (GSWCAH) evidence- based adolescent health and development (AHD) intervention I-06 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved Ranked “Effective” intervention I-06 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness; 2. Collect medical information from students and parents that is relevant to participation in physical activity; 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members; 4. Identify inactive students and provide them with counselling; 5. Encourage active students to maintain their current activities; 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community; 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials; 8. Collaborate with school policy-makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) WHO guideline on school health services. Web Annex A. Compendium 5 I-06. Promotion of increased physical activity and limited sedentary behaviour contd Essential everywhere Full WHO support I-06 – PA283. [Composite] recommendations on physical activity for health (5–17 years, 18–64 years) (7,14,15) GRC-approved Not a health service recommendation: specifies level/type physical activity I-06 – PA441. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] b. A safe physical environment that addresses safety and the physical condition of school premises, water, sanitation and menstrual hygiene services and healthy environments to promote healthy eating and physical activity, among others (4) Key area for programming I-07. Promotion of appropriate use of electronic devices, such as TV, Internet, games Essential everywhere Partial WHO support I-07 – WHO UHC menu (2.19 Draft). Promotion of increased physical activity, limited sedentary behaviour and adequate sleep (1) I-07 – WHO UHC menu (2.19 Draft). Child online protection (1) I-07 – PA282. Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment (6) I-07 – PA408. ITU [the United Nations International Telecommunication Union] has produced guidelines on child online protection for parents, educators and children. For example, the ITU guidelines for 8–12-year-olds address online friends, netiquette (i.e. electronic standards of conduct or procedure), playing online games, bullying and a child’s digital footprint. For children aged 13 and above, the guidelines focus on harmful and illegal content, grooming (i.e. when sexual predators contact, manipulate and gain the confidence of children for sexual purposes), cyberbullying, defending one’s privacy, respect for copyright and online commerce (18) I-07 – PA409. [As part of] Psychoeducation to promote adolescent well-being and functioning … The health-care provider should encourage and help the adolescent to get enough sleep. Promote regular bed routines and remove any TV or other electronic devices with screens from the sleeping area or bedroom (19) GRC-approved I-07 – PA410. [As part of] Parental psychoeducation for an adolescent with developmental delay or disorder … The provider should encourage the parent or guardian to … keep the environment stimulating – avoid leaving the adolescent alone for hours without someone to talk to, ensure the adolescent spends time outdoors and limit time spent watching TV and playing electronic games (19) GRC-approved I-07 – PA494. Cyberbullying (bullying, harassing or threatening a person online) harms children. Many programmes that seek to improve the whole-school culture and to teach students social and emotional skills can address cyberbullying. In settings where students have regular access to the Internet and social media, it is important to establish policies, behavioural expectations and supportive interventions around cyberbullying as part of an education and life-skills strategy. Education about responsible use of personal data and online safety can also help children protect themselves from violence or exploitation (20) 6 I-08. Promotion of adequate sleep Essential everywhere Partial WHO support I-08 – WHO UHC menu (2.19 Draft). Promotion of increased physical activity, limited sedentary behaviour and adequate sleep (1) I-08 – PA282. Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment (6) I-08 – PA409. [As part of] Psychoeducation to promote adolescent well-being and functioning … The health-care provider should encourage and help the adolescent to get enough sleep. Promote regular bed routines and remove any TV or other electronic devices with screens from the sleeping area or bedroom (20) GRC-approved I-09. Promotion of menstrual hygiene management Essential everywhere Other WHO support I-09 – WHO UHC menu (2.19 Draft). Health promoting schools: menstrual hygiene management (1) I-09 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organizations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-09 – PA64. Puberty education should be provided in the context of CSE (18) I-09 – PA71. Management of menstrual conditions: period pain; heavy bleeding; irregular periods (22) Primary care recommendation I-09 – PA404. Management of [adolescent] developmental conditions, i.e. delayed puberty for males and females (22) Primary care recommendation I-09 – PA433. Ensure adequate conditions for menstrual hygiene management, such as lockable, single-sex, private toilets with water and soap for washing, as well as a private open-air space to dry wet menstrual cloths and/or a closed bin or incinerator for used menstrual pads (4) Key area for programming I-09 – PA441. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] b. A safe physical environment that addresses safety and the physical condition of school premises, water, sanitation and menstrual hygiene services and healthy environments to promote healthy eating and physical activity, among others (4) Key area for programming I-09 – PA529. [In the COVID-19 context] for programmes that rely on school-based distribution of menstrual hygiene products, create contingency plans for their provision during school closures (10) WHO guideline on school health services. Web Annex A. Compendium 7 I-10. Promotion of responsible parenting skills for all students Suitable everywhere Other WHO support I-10 – PA437. Plan and implement a comprehensive education sector response to early and unintended pregnancy to support pregnant and parenting adolescents to continue and return to education. This includes curriculum-based interventions; eradication of policies and practices that result in the expulsion or exclusion of pregnant girls and adolescent mothers; promoting a safe school environment, free of gender-based violence, stigma, discrimination and bullying against pregnant adolescents and adolescent mothers; ensuring a supportive environment for adolescent mothers, such as parenting instructions or classes, breastfeeding space and counselling; engaging with teachers and school directors to ensure support to pregnant girls and adolescent mothers; and facilitating and promoting effective linkages between schools and adolescent-responsive health services, both within and outside the health sector (4) Key area for programming I-10 – PA449. Parenting programmes are among the most common strategies to improve parent–child relationships. Programmes can be offered to groups or individuals through home visits (home-visiting programmes) or at designated centres in communities and they can be presented to all families or targeted at vulnerable families (e.g. disadvantaged or teenage mothers). They are usually delivered by a nurse, social worker or other professional (although sometimes this is done by experienced mothers) during the first two or three years of a child’s life (some programmes begin prenatally) (23) I-11. Promotion of appropriate sun exposure for the context (e.g. prevention of sunburn or overheating; promotion of appropriate exposure for vitamin D) Essential everywhere Other WHO support I-11 – PA241. Management of skin problems (22) I-11 – PA243. One role of a SHS may be the provision of sunscreen, which should be available for all school activities. In deciding how to make sunscreen available, schools should consider five things: access, choice of sunscreen, skin reactions, management and correct use. … A further role for SHS is in the treatment of sunburn and, if necessary, referral to other agencies (24) 8 I-12. Provision and promotion of use of insecticide-treated bed nets Essential/suitable in certain areas Other WHO support I-12 – WHO UHC menu (2.19 Draft). Provision and promotion of use of insecticide treated bed nets for children (1) I-12 – PA336. Prevention and management of childhood illnesses including malaria, pneumonia, meningitis and diarrhoea (16) GSWCAH evidence-based CHD intervention I-12 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-12 – PA357. Some schools provide health services related to the control and prevention of malaria. These services commonly include: mass treatment of fever when there are malaria epidemics; mass treatment of parasitological diseases such as lymphatic filariasis, onchocerciasis; immunization combining distribution of insecticide-treated nets; screening of health problems such as anaemia and malnutrition; school feeding in underprivileged and needy areas (26) I-13. Provision of health education about nutrition Essential everywhere Full WHO support I-13 – WHO UHC menu (2.19 Draft). Health promoting schools: health-promoting curriculum, CSE (1) I-13 – PA5. Information provision to adolescents and their parents/carers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-13 – PA51. All children and their carers receive appropriate counselling and health education, according to their capacity, about the current illness and promotion of the child’s health and well-being (2) Quality Statement 4.4 I-13 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved I-13 – PA266. Require inclusion of nutrition and health education within the core curriculum of schools (6) I-13 – PA267. Improve the nutrition literacy and skills of parents and caregivers (6) I-13 – PA444. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] e. Curriculum-based interventions to develop personal health skills. Health-related education is usually and most appropriately accommodated in a health-related subject area (variously termed healthy active living; health and family living; health and physical education; personal and social skills education; health and career education; life-skills education, etc.) (4) Key area for programming WHO guideline on school health services. Web Annex A. Compendium 9 I-14. Provision of health education about physical activity Essential everywhere Full WHO support I-14 – WHO UHC menu (2.19 Draft). Health promoting schools: health-promoting curriculum, CSE (1) I-14 – WHO UHC menu (2.19 Draft). Health education of adolescents, parents and caregivers regarding physical activity (2) I-14 – PA5. Information provision to adolescents and their parents/careers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-14 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved I-14 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness; 2. Collect medical information from students and parents that is relevant to participation in physical activity; 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members; 4. Identify inactive students and provide them with counselling; 5. Encourage active students to maintain their current activities; 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community; 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials; 8. Collaborate with school policy-makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-14 – PA282. Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment (6) I-14 – PA344. [Composite] recommendations on physical activity for health (5–17 years, 18–64 years) (7,14,15) GRC-approved Not a health service recommendation: specifies level/type physical activity I-14 – PA444. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] e. Curriculum-based interventions to develop personal health skills. Health-related education is usually, and most appropriately, accommodated in a health-related subject area (variously termed healthy active living; health and family living; health and physical education; personal and social skills education; health and career education; life-skills education, etc.) (4) Key area for programming 10 I-15. Provision of sexual and reproductive health education Essential everywhere Full WHO support I-15 – WHO UHC menu (2.19 Draft). Health promoting schools: health-promoting curriculum, CSE (1) I-15 – PA63. At the school level – in collaboration with the education sector, the health sector can promote CSE by: facilitating teacher training and retraining through professional organizations; jointly reviewing the accuracy of information and the appropriateness of skills-based training in primary and secondary school curricula; providing inputs for the development of evidence-based, age-appropriate and skills-based SRH education in primary and secondary school curricula; encouraging the development, adaptation and use of standards for SRH education curricula for adolescents; and generally supporting CSE through school-based or school-linked health services and referrals (4,27) CSE is also a GSWCAH evidence-based AHD intervention I-15 – PA64. Puberty education should be provided in the context of CSE (18) I-15 – PA65. Recommend the provision of scientifically accurate and CSE programmes within and outside of schools that include information on contraceptive use and acquisition (14,28) GRC-approved I-15 – PA66. Implement interventions at scale that provide accurate information and education about contraceptives, in particular curriculum-based sexuality education, to increase contraceptive use among adolescents (14,29) GRC-approved I-15 – PA67. Offer interventions that combine curriculum-based sexuality education with contraceptive promotion to adolescents, in order to reduce pregnancy rates (14,29) GRC-approved I-15 – PA68. Target sexually transmitted infection (STI) interventions and services to populations and locations where need, risk and vulnerability are highest: include comprehensive sexual health education in school curricula for adolescents (30) Global Health Sector Strategy on Sexually Transmitted Infections, 2016–2021 (GHSSSTI) priority action for countries I-15 – PA88. [Composite] interventions to enhance adolescent girls’ abilities to resist coerced sex and to obtain support if they experience coerced sex by building their self-esteem, developing their life skills in areas such as communication and negotiation and improving their links to social networks and their ability to obtain social support, combined with interventions to create supportive social norms that do not condone coerced sex (14,29) GRC-approved I-15 – PA89. Implement interventions to engage men and boys to critically assess gender norms and normative behaviours (e.g. gender transformative approaches) that relate to sexual coercion and violence. Combine these with wider interventions to influence social norms on these issues (14,29) GRC-approved I-15 – PA108. Behavioural interventions (to reduce adolescent risk of acquiring STIs or HIV): Skills-based interactive and participatory approaches for adolescents from key populations, including online, mobile health, peer and outreach approaches, have proved acceptable to adolescents and have shown promise in some contexts (14,31) GRC-approved I-15 – PA112. [For prevention of STI transmission and acquisition] Comprehensive health information, education and health promotion programmes for adolescents (4,30) GHSSSTI priority action for countries I-15 – PA436. Develop curricula to promote health literacy; address homophobic bullying and stigma related to HIV and gender-based violence; and incorporate comprehensive sexuality and life-skills based education. Promote positive development approaches to improve self-esteem through learning interventions, participatory governance approaches and broader community involvement (4) Key area for programming WHO guideline on school health services. Web Annex A. Compendium 11 I-15. Provision of sexual and reproductive health education contd Essential everywhere Full WHO support I-15 – PA444. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] e. Curriculum-based interventions to develop personal health skills. Health-related education is usually, and most appropriately, accommodated in a health-related subject area (variously termed healthy active living; health and family living; health and physical education; personal and social skills education; health and career education; life-skills education, etc.) (4) Key area for programming I-15 – PA457. Prevent violence through curriculum based activities: Key actions: test evidence-based violence prevention strategies on a small scale e.g. in one grade or class. Strategies that have proven to be effective include: develop children’s life skills; teach children about safe behaviour and protecting themselves from abuse; challenge and transform social, cultural and gender norms that justify violence and promote equal relationship; address key risk factors for violence (alcohol, drugs, low academic achievement). If the evaluation finds that the tested violence prevention strategies were effective in reducing violence, take steps to scale it up (32) Key action at school, district or national level I-15 – PA459. An important element of a healthy psycho-social environment at school: providing a friendly, rewarding and supportive atmosphere (33). Quality area I-16. Support for a health-promoting curriculum (e.g. curriculum-based sexuality education; curriculum on nutrition and physical activity) Essential everywhere Full WHO support I-16 – WHO UHC menu (2.19 Draft). Health promoting schools: school health policies on nutrition, bullying, mental health, substance use, chronic conditions, adolescent pregnancy, hygiene (1) I-16 – WHO UHC menu (2.19 Draft). Health education of adolescents, parents and caregivers regarding physical activity (1) I-16 – WHO UHC menu (2.19 Draft). Health promoting schools: health-promoting curriculum, CSE (1) I-16 – PA62. [School] health workers could do the following: advocate for supportive school [SRH] policies and strong school programmes with policy- and decision- makers and relevant community leaders; engage and support education officials and representatives from other relevant sectors in providing information, building skills and providing counselling services in the school setting (and be actively involved in these efforts themselves); collaborate with school officials, students and teachers to mobilize school and community support for efforts that respond to reproductive health needs, for example, developing peer networks among students that promote understanding about and support for healthy sexual attitudes and behaviours, prevention programmes and care; and linking such networks to relevant programmes and networks in the school and community (21) I-16 – PA63. At the school level – in collaboration with the education sector, the health sector can promote CSE by: facilitating teacher training and retraining through professional organizations; jointly reviewing the accuracy of information and the appropriateness of skills-based training in primary and secondary school curricula; providing inputs for the development of evidence-based, age-appropriate and skills-based SRH education in primary and secondary school curricula; encouraging the development, adaptation and use of standards for SRH education curricula for adolescents; and generally supporting CSE through school-based or school-linked health services and referrals (4,27) CSE is also a GSWCAH evidence-based AHD intervention 12 I-16. Support for a health-promoting curriculum (e.g. curriculum-based sexuality education; curriculum on nutrition and physical activity) contd Essential everywhere Full WHO support I-16 – PA65. Recommend the provision of scientifically accurate and CSE programmes within and outside of schools that include information on contraceptive use and acquisition (14,28) GRC-approved I-16 – PA66. Implement interventions at scale that provide accurate information and education about contraceptives, in particular curriculum-based sexuality education, to increase contraceptive use among adolescents (15,29) GRC-approved I-16 – PA67. Offer interventions that combine curriculum-based sexuality education with contraceptive promotion to adolescents, in order to reduce pregnancy rates (15,29) GRC-approved I-16 – PA168. Non-specialized health care facilities should encourage and collaborate with school-based life skills education, if feasible, to promote mental health in children and adolescents (15,34) GRC-approved I-16 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved I-16 – PA266. Require inclusion of nutrition and health education within the core curriculum of schools (6) I-16 – PA436. Develop curricula to promote health literacy; address homophobic bullying and stigma related to HIV and gender-based violence; and incorporate comprehensive sexuality and life-skills based education. Promote positive development approaches to improve self-esteem through learning interventions, participatory governance approaches and broader community involvement (4) Key area for programming I-16 – PA444. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] e. Curriculum-based interventions to develop personal health skills. Health-related education is usually, and most appropriately, accommodated in a health-related subject area (variously termed healthy active living; health and family living; health and physical education; personal and social skills education; health and career education; life-skills education, etc.) (4) Key area for programming I-16 – PA457. Prevent violence through curriculum based activities: Key actions: test evidence-based violence prevention strategies on a small scale e.g. in one grade or class. Strategies that have proven to be effective include: develop children’s life skills; teach children about safe behaviour and protecting themselves from abuse; challenge and transform social, cultural and gender norms that justify violence and promote equal relationship; address key risk factors for violence (alcohol, drugs, low academic achievement). If the evaluation finds that the tested violence prevention strategies were effective in reducing violence, take steps to scale it up (32) Key action at school, district or national level I-16 – PA526. [In the COVID-19 context] broadcast educational programmes on TV and radio during school closures. Once schools reopen and community gatherings are permissible, design tailored catch-up strategies, especially for students with particular vulnerabilities. Prepare for reopening with adequate preparations for infection prevention and control. Assess the impact of differential access to health information and education during school closures (10) WHO guideline on school health services. Web Annex A. Compendium 13 I-17. Support for school policies on general health promotion (e.g. related to chronic conditions, hygiene and nutrition) Essential everywhere Partial WHO support I-17 – WHO UHC menu (2.19 Draft). Health promoting schools: school health policies on nutrition, bullying, mental health, substance use, chronic conditions, adolescent pregnancy, hygiene (1) I-17 – WHO UHC menu (2.19 Draft). Promotion of personal hygiene and handwashing with soap (1) I-17 – WHO UHC menu (2.19 Draft). Promotion of increased physical activity, limited sedentary behaviour and adequate sleep (1) I-17 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health-promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health- related policy, curricula and the planning of special events (17) I-17 – PA62. [School] health workers could do the following: advocate for supportive school [SRH] policies and strong school programmes with policy- and decision- makers and relevant community leaders; engage and support education officials and representatives from other relevant sectors in providing information, building skills and providing counselling services in the school setting (and be actively involved in these efforts themselves); collaborate with school officials, students and teachers to mobilize school and community support for efforts that respond to reproductive health needs, for example, developing peer networks among students that promote understanding about and support for healthy sexual attitudes and behaviours, prevention programmes and care; and linking such networks to relevant programmes and networks in the school and community (21) I-17 – PA231. Promotion of healthy behaviour (e.g. nutrition, physical activity, no tobacco, alcohol or drugs) (16) GSWCAH evidence-based AHD intervention I-17 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved Ranked “Effective” intervention I-17 – PA266. Require inclusion of nutrition and health education within the core curriculum of schools (6) I-17 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness; 2. Collect medical information from students and parents that is relevant to participation in physical activity; 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members; 4. Identify inactive students and provide them with counselling; 5. Encourage active students to maintain their current activities; 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community; 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials; 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-17 – PA404. Ensure adequate conditions for menstrual hygiene management, such as lockable, single-sex, private toilets with water and soap for washing, as well as a private open-air space to dry wet menstrual cloths and/or a closed bin or incinerator for used menstrual pads (4) Key area for programming 14 I-17. Support for school policies on general health promotion (e.g. related to chronic conditions, hygiene and nutrition) contd Essential everywhere Partial WHO support I-17 – PA435. Address the needs of students with chronic conditions and disabilities, by adapting buildings and classrooms to their special needs; creating inclusive, learning-friendly environments; and by strengthening linkages with health services for early diagnosis and interventions (4) Key area for programming I-17 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-17 – PA526. [In the COVID-19 context] broadcast educational programmes on TV and radio during school closures. Once schools reopen and community gatherings are permissible, design tailored catch-up strategies, especially for students with particular vulnerabilities. Prepare for reopening with adequate preparations for infection prevention and control. Assess the impact of differential access to health information and education during school closures (10) SEE ALSO: I-18. Support for school policies for mental health promotion, including listening services (pre-counselling) Partial GRC support I-18. Support for school policies for mental health promotion, including listening services (pre-counselling) Essential everywhere Partial WHO support I-18 – WHO UHC menu (2.19 Draft). Health promoting schools: school health policies on nutrition, bullying, mental health, substance use, chronic conditions, adolescent pregnancy, hygiene (1) I-18 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health-promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health- related policy, curricula and the planning of special events (17) I-18 – PA59. All children and their families are given emotional support that is sensitive to their needs, with opportunities for play and learning that stimulate and strengthen their capability (2) Quality Statement 4.4 I-18 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development ] I-18 – PA168. Non-specialized health care facilities should encourage and collaborate with school-based life skills education, if feasible, to promote mental health in children and adolescents (14,34) GRC-approved I-18 – PA434. Support teachers’ adolescent health literacy through a combination of pre- and in-service training opportunities. ... [such as] improved mental health literacy and reduced stigma (4) Key area for programming I-18 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming WHO guideline on school health services. Web Annex A. Compendium 15 I-18. Support for school policies for mental health promotion, including listening services (pre-counselling) contd Essential everywhere Partial WHO support I-18 – PA442. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] c. A safe and supportive school social environment, through supportive school policies and ethos to address individual psychological vulnerabilities; and improve the classroom environment and students’ participation and connectedness (4) Key area for programming I-18 – PA528. [In the COVID-19 context] create contingency plans to provide mental health services during school closures for students who mainly rely on school- based services. Consider using digital platforms to provide psychosocial support and for early detection and management of mental health conditions. Use remote socioemotional learning programmes and strengthen the capacities of schools, mental health staff and youth champions to deliver them remotely. Intensify classroom-based socioemotional learning after schools reopen. Follow up with school drop-outs to institute support mechanisms (10) I-18 – PA529. [In the COVID-19 context] enhance engagement with governmental and [nongovernmental organization] actors to mobilize social and resources to support people with mental, neurological and substance use disorders (e.g. at home and in schools, care homes and prisons) and ensure that people with severe mental, neurological and substance use disorders have access to services that address their basic needs. Modify school mental health services to be delivered through online platforms. Consider the long-term effects of the COVID-19 response on high- risk groups (e.g. those with pre-existing mental, neurological and substance use disorders, older persons, women, young people, children); enhance cross-sectoral services (10) I-19. Support for school policies on risk reduction and disease/injury prevention (e.g. prevention of adolescent pregnancy, school violence and substance use) Essential everywhere Partial WHO support I-19 – WHO UHC menu (2.19 Draft). Health promoting schools: school health policies on nutrition, bullying, mental health, substance use, chronic conditions, adolescent pregnancy, hygiene (1) I-19 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health-promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health- related policy, curricula and the planning of special events (17) I-19 – PA62. [School] health workers could do the following: advocate for supportive school [SRH] policies and strong school programmes with policy- and decision- makers and relevant community leaders; engage and support education officials and representatives from other relevant sectors in providing information, building skills and providing counselling services in the school setting (and be actively involved in these efforts themselves); collaborate with school officials, students and teachers to mobilize school and community support for efforts that respond to reproductive health needs, for example, developing peer networks among students that promote understanding about and support for healthy sexual attitudes and behaviours, prevention programmes and care; and linking such networks to relevant programmes and networks in the school and community (21) I-19 – PA73. Advocate for adolescent pregnancy prevention among all stakeholders through interventions such as: information provision, sexuality and health education, life skills building, contraceptive counselling and service provision and the creation of supportive environments (14,29) GRC-approved 16 I-19. Support for school policies on risk reduction and disease/injury prevention (e.g. prevention of adolescent pregnancy, school violence and substance use) contd Essential everywhere Partial WHO support I-19 – PA88. [Composite] interventions to enhance adolescent girls’ abilities to resist coerced sex and to obtain support if they experience coerced sex by building their self-esteem, developing their life skills in areas such as communication and negotiation and improving their links to social networks and their ability to obtain social support, combined with interventions to create supportive social norms that do not condone coerced sex (15,29) GRC-approved I-19 – PA89. Implement interventions to engage men and boys to critically assess gender norms and normative behaviours (e.g. gender transformative approaches) that relate to sexual coercion and violence. Combine these with wider interventions to influence social norms on these issues (15,29) GRC-approved I-19 – PA110. Combination prevention is the most effective approach for the prevention of sexually transmitted infections. Evidence-based comprehensive prevention frameworks work best when there is a strategic combination of behavioural, biomedical and structural approaches. Such a combination includes an understanding of sexually transmitted infections and primary prevention methods, including condoms and a focus on working with people most affected by, and vulnerable to, sexually transmitted infections, in particular adolescents (4,30) I-19 – PA112. [For prevention of STI transmission and acquisition] Comprehensive health information, education and health promotion programmes for adolescents (4,30) GHSSSTI priority action for countries I-19 – PA116. [School] health workers could: 1. Be alert to the possibility of the presence of health problems, (such as sexually transmitted diseases) and/or unhealthy practices (such as injecting drug use) and detect them early, if and when they arise. 2. Appropriately manage STI and/or HIV-related problems, to the best of their abilities and based on the facilities available at their disposal. This could include providing medical treatment, responding to the child’s/adolescent’s psychological needs and helping them deal with the social implications of their conditions. 3. Refer students and school personnel to the next “level” of health service delivery and/or to organizations which provide relevant support services, such as counselling and social support in the areas of adolescent development, sexuality, peer pressure, identify formation, illness and death, if and when available. 4. Answer questions of students and school personnel about the need for and value of HIV-antibody testing. As necessary and if available, refer students and staff to an appropriate and confidential facility that provides pre- and post-test counseling. Counselling about HIV-antibody testing requires the services of support staff and professionals who are trained and experienced in dealing specifically with the issues involved. 5. Observe confidentiality with respect to infected students and school personnel and disclose information to staff on a need-to-know basis only. 6. Support the education and employment rights of HIV-infected students and staff by assuring concerned officials and others that HIV infected students and staff pose virtually no health threat to students and school personnel when they attend classes or work in the school (35) I-19 – PA120. Target sexually transmitted infection interventions and services to populations and locations where need, risk and vulnerability are highest: provide services appropriate for adolescents and review policies on consent to improve access (30) GHSSSTI priority action for countries I-19 – PA205. The implementation of suicide prevention programmes in school settings that include mental health awareness training and skills training can be offered to reduce suicide attempts and suicide deaths among adolescent students (14,36) GRC-approved Recommendation SUI1 I-19 – PA214. Schools should establish prevention programmes to reduce the use of tobacco, alcohol and illicit drugs and behaviour that promotes the spread of HIV infection (11) I-19 – PA231. Promotion of healthy behaviour (e.g. nutrition, physical activity, no tobacco, alcohol or drugs) (16) GSWCAH evidence-based AHD intervention WHO guideline on school health services. Web Annex A. Compendium 17 I-19. Support for school policies on risk reduction and disease/injury prevention (e.g. prevention of adolescent pregnancy, school violence and substance use) contd Essential everywhere Partial WHO support I-19 – PA295. Integrate child injury into a comprehensive approach to child health and development, e.g. existing child survival programmes need to introduce child injury prevention strategies as part of the basic package of child health services (37) GRC-approved I-19 – PA436. Develop curricula to promote health literacy; address homophobic bullying and stigma related to HIV and gender-based violence; and incorporate comprehensive sexuality and life-skills based education. Promote positive development approaches to improve self-esteem through learning interventions, participatory governance approaches and broader community involvement (4) Key area for programming I-19 – PA438. Plan and implement comprehensive education-sector responses to substance use (4) Key area for programming I-19 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-19 – PA453. Develop leadership, school policies and coordination methods [for school-based violence prevention]: Key actions: set up a school-based coordinating team. Strengthen knowledge and skills of the coordinating team. Develop a school policy that condemns violence and is enforced fairly for everyone. Develop an action plan. Make violence prevention an essential part of the day-to-day work of the school and work towards building a school culture that does not tolerate violence (32) Key action at school, district or national level I-19 – PA460. An important element of a healthy psycho-social environment at school: forbidding physical punishment and violence (33) Quality area I-19 – PA463. In suicide prevention work, teachers and other school staff face a challenge of great strategic importance, in which it is fundamental: to identify students with personality disturbances and offer them psychological support; to forge closer bonds with young people by talking to them and trying to understand and help; to alleviate mental distress; to be observant of and trained in the early recognition of suicidal communication whether through verbal statements and/ or behavioural changes; to help less skilful students with their school work; to be observant of truancy; to destigmatize mental illness and help to eliminate misuse of alcohol and drugs; to refer students for treatment of psychiatric disorders and alcohol and drug abuse; to restrict students’ access to means of suicide - toxic and lethal drugs, pesticides, firearms and other weapons, etc.; to give teachers and other school personnel on-the-spot access to means of alleviating their stress at work (38) Summary of recommendations I-19 – PA488. Health managers and policy-makers should create an enabling service-delivery environment and support health-care providers in carrying out their tasks and responsibilities related to caring for children and adolescents who have been exposed to maltreatment (3) GRC-approved Good Practice Statement 10 I-19 – PA489. There are proven ways of reducing both the likelihood and severity of all types of child and adolescent injury. Prevention programmes that use a multi- disciplinary strategy (i.e. a combination of education, environmental modification and legislation) have been shown to be particularly effective for reducing injury mortality in many high-income countries (39) I-19 – PA490. There are proven ways of reducing both the likelihood and severity of all types of child and adolescent injury. … Drownings have been reduced by limiting access to obvious hazards such as pools, installing covers on wells and teaching older children to swim (39) SEE ALSO: I-20. Support for school policies that address bullying and harassment Partial GRC support 18 I-20. Support for school policies that address bullying and harassment Essential everywhere Partial WHO support I-20 – WHO UHC menu (2.19 Draft). Health promoting schools: school health policies on nutrition, bullying, mental health, substance use, chronic conditions, adolescent pregnancy, hygiene (1) I-20 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health-promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health- related policy, curricula and the planning of special events (17) I-20 – PA6. To act in the best interest of adolescents, health services may need to prioritize their immediate health needs, while being attentive to signs of vulnerability, abuse and exploitation. Appropriate and confidential referral, if and when requested by the adolescent, can provide linkage to other services and sectors for support (14,31) GRC-approved I-20 – PA56. All children are protected from any violation of their human rights, physical or mental violence, injury, abuse, neglect or any other form of maltreatment (2) Quality Statement 5.4 I-20 – PA88. [Composite] interventions to enhance adolescent girls’ abilities to resist coerced sex and to obtain support if they experience coerced sex by building their self-esteem, developing their life skills in areas such as communication and negotiation and improving their links to social networks and their ability to obtain social support, combined with interventions to create supportive social norms that do not condone coerced sex (14,29) GRC-approved I-20 – PA89. Implement interventions to engage men and boys to critically assess gender norms and normative behaviours (e.g. gender transformative approaches) that relate to sexual coercion and violence. Combine these with wider interventions to influence social norms on these issues (14,29) GRC-approved I-20 – PA298. Assessment and management of adolescents who present with unintentional injury is necessary not only to provide appropriate medical care, but also to identify accurately the cause of the injury to ensure it does not occur again. For example, burns are one of the few forms of injury that have a higher burden in adolescent females than males, because worldwide approximately 2 billion people in low- and middle-income countries (LMIC) – the vast majority female – cook on unsafe open fires or very basic traditional stoves. … Careful assessment of the cause of adolescent injury is also important because some adolescents or their guardians may falsely state that an injury was due to an accident when in fact it was due to self-harm or interpersonal violence. In some countries, for example, so-called honour killings and death by fire account for a significant number of reported cases of familial or intimate partner violence against adolescent girls and survivors of such assaults may be compelled by the perpetrators to claim the injuries were accidental (4,40) I-20 – PA306. Strategies for young people at higher risk of or already involved in, violence: implementing therapeutic approaches for high-risk youths: therapeutic programmes last on average 10–20 weeks. They can be delivered on their own or as a component of larger programmes and most use standardized materials and therapeutic manuals. They are usually delivered by mental health specialists or social workers with a therapeutic qualification. Most programmes also involve supervisors with further extensive training, who support the programme delivery staff. The content of therapeutic approaches is usually adapted to the specific needs of the young person, although they generally combine social skills and behavioural training, anger- and self-control techniques and cognitive elements such as moral reasoning and perspective-taking to better appreciate the negative impacts of violence on victims (4,41) WHO guideline on school health services. Web Annex A. Compendium 19 I-20. Support for school policies that address bullying and harassment contd Essential everywhere Partial WHO support I-20 – PA408. ITU has produced guidelines on child online protection for parents, educators and children. For example, the ITU guidelines for 8–12-year-olds address online friends, netiquette (i.e. electronic standards of conduct or procedure), playing online games, bullying and a child’s digital footprint. For children aged 13 and above, the guidelines focus on harmful and illegal content, grooming (i.e. when sexual predators contact, manipulate and gain the confidence of children for sexual purposes), cyberbullying, defending one’s privacy, respect for copyright and online commerce (18) I-20 – PA431. School-based bullying prevention: teachers are trained to recognize and explain bullying to students, what to do when it occurs, effective relationship skills and skills for bystanders. Specialists work with students involved in bullying. School policies and procedures also may be established and parents may be trained (4) I-20 – PA436. Develop curricula to promote health literacy; address homophobic bullying and stigma related to HIV and gender-based violence; and incorporate comprehensive sexuality and life-skills based education. Promote positive development approaches to improve self-esteem through learning interventions, participatory governance approaches and broader community involvement (4) Key area for programming I-20 – PA437. Plan and implement a comprehensive education sector response to early and unintended pregnancy to support pregnant and parenting adolescents to continue and return to education. This includes curriculum-based interventions; eradication of policies and practices that result in the expulsion or exclusion of pregnant girls and adolescent mothers; promoting a safe school environment, free of gender-based violence, stigma, discrimination and bullying against pregnant adolescents and adolescent mothers; ensuring a supportive environment for adolescent mothers, such as parenting instructions or classes, breastfeeding space and counselling; engaging with teachers and school directors to ensure support to pregnant girls and adolescent mothers; and facilitating and promoting effective linkages between schools and adolescent-responsive health services, both within and outside the health sector (4) Key area for programming I-20 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] school health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-20 – PA461. An important element of a healthy psycho-social environment at school: not tolerating bullying, harassment and discrimination (33) Quality area I-20 – PA494. Cyberbullying (bullying, harassing or threatening a person online) harms children. Many programmes that seek to improve the whole-school culture and to teach students social and emotional skills can address cyberbullying. In settings where students have regular access to the Internet and social media, it is important to establish policies, behavioural expectations and supportive interventions around cyberbullying as part of an education and life skills strategy. Education about responsible use of personal data and online safety can also help children protect themselves from violence or exploitation (20) 20 I-21. Support for school policies on prevention and response to anaphylaxis Essential everywhere Partial WHO support I-21 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health-promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health- related policy, curricula and the planning of special events (17) I-21 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-21 – PA446. School policies on asthma and anaphylaxis management are useful (42) Education recommendation I-21 – PA447. [Composite] recommendations for primary, secondary and tertiary prevention and education about asthma and allergic symptoms, including anaphylaxis (42) I-21 – PA448. [Composite] recommendations for Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach to basic emergency care, including response to anaphylaxis (43) GRC-approved I-22. Support for other aspects of a health-promoting school (e.g. nutritional content of school feeding programmes; inspection of food safety; engagement with the community to make the school a healthy place) Essential everywhere Partial WHO support I-22 – WHO UHC menu (2.19 Draft). Health promoting schools: community engagement in health-promoting schools (1). I-22 – PA33. Children are cared for in a well-maintained, safe, secure physical environment with an adequate energy supply and which is appropriately designed, furnished and decorated to meet their needs, preferences and developmental age (2). Quality Statement 8.1 I-22 – PA34. Child-friendly water, sanitation, hand hygiene and waste disposal facilities are easily accessible, functional, reliable, safe and sufficient to meet the needs of children, their carers and staff (3). Quality Statement 8.2 I-22 – PA265. High-intensity school-based interventions that focus on diet and/ or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved Ranked “Effective” intervention WHO guideline on school health services. Web Annex A. Compendium 21 I-22. Support for other aspects of a health-promoting school (e.g. nutritional content of school feeding programmes; inspection of food safety; engagement with the community to make the school a healthy place) contd Essential everywhere Partial WHO support I-22 - PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-22 – PA357. Some schools provide health services related to the control and prevention of malaria. These services commonly include: mass treatment of fever when there are malaria epidemics; mass treatment of parasitological diseases such as lymphatic filariasis, onchocerciasis; immunization combining distribution of insecticide-treated nets; screening of health problems such as anaemia and malnutrition; school feeding in underprivileged and needy areas (26) I-22 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-22 – PA459. An important element of a healthy psycho-social environment at school: providing a friendly, rewarding and supportive atmosphere (33) Quality area I-22 – PA527. [In the COVID-19 context] design alternative strategies to safeguard schoolchildren’s food security and nutrition, for example, by providing micronutrient supplements, take-home rations, deworming medicines (as applicable), cash- based transfers to families with schoolchildren and food voucher assistance. Put in place alternative modalities for food collection, such as the ability to pick up meals and snacks at distribution points, including at otherwise-closed schools. Build upon existing safety-net structures to ensure vulnerable schoolchildren are cared for. Reinstate and continue the provision of essential school health and nutrition packages. Create contingency plans for the distribution of meals or food baskets during school closures (10) SEE ALSO: I-23. Training school staff on first aid, hygiene promotion, etc. Other WHO support SEE ALSO: I-24. Inspection of the physical environment of the school (e.g. prevention of injuries; water, sanitation and hygiene facilities) Other WHO support 22 I-23. Training school staff on first aid, hygiene promotion, etc. Suitable everywhere Other WHO support I-23 – PA63. At the school level – in collaboration with the education sector, the health sector can promote CSE by: facilitating teacher training and retraining through professional organizations; jointly reviewing the accuracy of information and the appropriateness of skills-based training in primary and secondary school curricula; providing inputs for the development of evidence-based, age-appropriate and skills-based SRH education in primary and secondary school curricula; encouraging the development, adaptation and use of standards for SRH education curricula for adolescents; and generally supporting CSE through school-based or school-linked health services and referrals (4,27) CSE is also a GSWCAH evidence-based AHD intervention I-23 – PA269. [SHS] can include screening for indicators of malnutrition and health status, providing treatments such as micronutrient supplements and parasite medications, referring to appropriate nutritional and other services and supplying health and nutrition information to teachers and students to help them make healthy decisions and to educate others about healthy nutrition (44) I-23 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-23 – PA301. Survival after a [road] crash: trauma response that can accommodate the needs of children is required. This ranges from training teacher and school transport drivers in safe immediate stabilization of injuries; equipping emergency vehicles with child-sized medical equipment and supplies; and improving paediatric- specific rehabilitation services for children (45) I-23 – PA333. Screening of teeth and mouth enables early detection and timely interventions towards oral diseases and conditions, leading to substantial cost savings. … Appropriate and effective efforts can be targeted at those who are at risk or in need. Signs of some general health conditions can be identified through oral health screening, such as malnutrition and diabetes. … It can be effectively carried out by trained school health nurses, school teachers or community workers. It can be incorporated into routine general health screening, surveillance programmes or other activities in schools (12) I-23 – PA434. Support teachers’ adolescent health literacy through a combination of pre- and in-service training opportunities. ... [e.g.] improved mental health literacy and reduced stigma (4) Key area for programming I-23 – PA439. Monitor quality in the implementation of health-promoting schools programmes, using available tools and resources (4) Key area for programming I-23 – PA456. Work with teachers on values and beliefs and train them in positive discipline and classroom management: Key actions: Train teachers in positive discipline and classroom management. Create mutual support mechanisms for teachers. Strengthen managerial support for teachers. Address and transform teachers’ harmful beliefs and social, cultural and gender norms. Integrate training in positive discipline and classroom management and social, cultural and gender norms in pre-service training for teachers (32) Key action at school, district or national level WHO guideline on school health services. Web Annex A. Compendium 23 I-23. Training school staff on first aid, hygiene promotion, etc. contd Suitable everywhere Other WHO support I-23 – PA457. Respond to violence when it happens: Key actions: Train teachers and school staff in recognizing violence and asking children in a responsible way about violence. Train teachers in managing situations where children tell them they have experienced violence. Deal with violent incidents immediately, using methods learned in teachers’ training, for example positive discipline and classroom management. If referral mechanisms do not exist at school level, make sure to be informed of service providers available. Train parents in recognizing and asking appropriately about violence and supporting children exposed to violence. Strengthen safe and child-friendly reporting methods. Develop and strengthen appropriate referral methods for victims of violence who need additional support. Monitor the effectiveness of reporting and referral methods (32) Key action at school, district or national level I-23 – PA517. School oral health services, part of the school health services, help screen, prevent, control and monitor oral diseases and conditions, as well as maintain good oral health. They play an important role in oral and general health promotion, supporting the efforts made by the school, teachers and students (e.g. providing training and expertise and supplying oral health materials) (12) I-24. Inspection of the physical environment of the school (e.g. prevention of injuries; water, sanitation and hygiene facilities) Suitable everywhere Other WHO support I-24 – WHO UHC menu (2.19 Draft). Health promoting schools: ensuring safe and health-promoting physical environment (1) I-24 – WHO UHC menu (2.19 Draft). Promotion of reduction in household air pollution and clean air environment (1) I-24 – WHO UHC menu (2.19 Draft). Promote use of child-resistant containers to prevent poisonings (1) I-24 – WHO UHC menu (2.19 Draft). Provision of safe drinking-water and sanitation (1) I-24 – WHO UHC menu (2.19 Draft). Environments free from lead and other neurotoxins (1) I-24 – PA33. Children are cared for in a well-maintained, safe, secure physical environment with an adequate energy supply and which is appropriately designed, furnished and decorated to meet their needs, preferences and developmental age (2) Quality Statement 8.1 I-24 – PA34. Child-friendly water, sanitation, hand hygiene and waste disposal facilities are easily accessible, functional, reliable, safe and sufficient to meet the needs of children, their carers and staff (2) Quality Statement 8.2 I-24 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) 24 I-24. Inspection of the physical environment of the school (e.g. prevention of injuries; water, sanitation and hygiene facilities) contd Suitable everywhere Other WHO support I-24 – PA342. No GRC-approved diarrhoea prevention guidelines for the general population of children. However, WHO recommends interventions on access to safe drinking-water, household water treatment and safe storage, access to improved sanitation facilities and handwashing with soap for all populations to prevent deaths due to diarrhoea (7,8) I-24 – PA432. Improve education-system facilities and reduce exposure to environmental hazards by ensuring minimum standards are met for the design of facilities (e.g. safe and sound building materials; shelter; protection from heat or cold; light; clean energy access; ventilation; sanitary facilities) and the availability of sanitation and safe water (4) Key area for programming I-24 – PA435. Address the needs of students with chronic conditions and disabilities, by adapting buildings and classrooms to their special needs; creating inclusive, learning-friendly environments; and by strengthening linkages with health services for early diagnosis and interventions (4) Key area for programming I-24 – PA439. Monitor quality in the implementation of health-promoting schools programmes, using available tools and resources (4) Key area for programming I-24 – PA440. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] a. School health policies and plans, which aim to ensure a safe, secure and healthy physical and psychosocial environment (addressing issues such as bullying, sexual harassment, substance use, school violence, nutrition and diet and mental health) (4) Key area for programming I-24 – PA441. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] b. A safe physical environment that addresses safety and the physical condition of school premises, water, sanitation and menstrual hygiene services and healthy environments to promote healthy eating and physical activity, among others (4) Key area for programming I-24 – PA458. Review and adapt school buildings and grounds: Key actions: Involve students and staff in identifying hotspots for violence (including the way to and from school) and find practical solutions in these areas. Review the appearance and features of school buildings and grounds and identify areas that could be improved. Make sure schools have clean, separate toilets for boys and girls. Ensure that the annual budget includes a budget line for improving physical infrastructure of schools with the aim to enhance safety of children (32) Key action at school, district or national level I-24 – PA489. There are proven ways of reducing both the likelihood and severity of all types of child and adolescent injury. Prevention programmes that use a multi- disciplinary strategy (i.e. a combination of education, environmental modification and legislation) have been shown to be particularly effective for reducing injury mortality in many high-income countries (39) I-24 – PA490. There are proven ways of reducing both the likelihood and severity of all types of child and adolescent injury. … Drownings have been reduced by limiting access to obvious hazards such as pools, installing covers on wells and teaching older children to swim (39) I-24 – PA492. Safe environment principles can increase the safety of school buildings and grounds and students’ routes to and from school (20) WHO guideline on school health services. Web Annex A. Compendium 25 I-25. Appropriate use of data at population level for planning school health services Essential everywhere Partial WHO support I-25 – WHO UHC menu (2.19 Draft). Adolescent responsive health care: quality improvement and interventions to increase adolescent participation in own care and quality improvement (1) I-25 – PA416. Build national and subnational (e.g. district-level) political and administrative capacity and leadership for adolescent health, through development of adolescent-centred competencies in using data for decision-making (4) Key area for programming I-25 – PA417. Use costing data to advocate for and secure resources for, adolescent health in national and sub-national plans and budgets. Ensure that resources are distributed between geographical areas in proportion to their relative needs (4) Key area for programming I-25 – PA421. Identify and respond to specific weaknesses in national data collection systems, including a review of sources and mechanisms for data collection on impact, outcome, output, process and input indicators (4) Key area for programming I-25 – PA422. Improve the capacity of national and subnational statistics agencies to report regularly on the health, development and well-being of adolescents, disaggregated by age and sex. At a bare minimum, data should be disaggregated by age and sex and wherever possible other relevant stratifiers should be included, e.g. education, rural or urban. Ensure that this information is easily accessible to constituents (4) Key area for programming I-25 – PA425. Ensure that district and national reports address adolescents (10–19 years), including cause-specific utilization of services and quality of care (4) Key area for programming I-25 – PA426. Develop national capacity to conduct standardized surveys on key adolescent behaviours and social determinants and conduct such surveys at regular intervals. Examples include the Global School-based Student Health Survey, the Global Youth Tobacco Survey and the Health Behaviour in School-age Children survey. Ensure that data-collection systems are available for out-of-school adolescents (4) Key area for programming I-25 – PA427. Develop national capacity to conduct standardized surveys to monitor inputs, processes and outputs within national school health programmes. Examples include the School Health Policies and Practices Study and surveys using the Focusing Resources on Effective School Health tools. Conduct such surveys at regular intervals (4) Key area for programming I-25 – PA428. Strengthen the availability of disaggregated data and information to expose inequities. Use data to plan remedial actions to address inequities (4) Key area for programming I-25 – PA429. Strengthen the capacity to conduct qualitative research to understand the underlying causes of trends (e.g. in health-related behaviours or use of services) (4) Key area for programming I-25 – PA430. Synthesize and disseminate the evidence base for action (4) Key area for programming I-25 – PA454. Collect data on violence and monitor changes over time: Key actions: Use data from existing surveys to increase understanding about where, when, how and by whom violence happens. Establish a record-keeping system of incidents of violence and the school’s responses to these. Make sure that data is kept confidential within the school. Include questions that measure violence in existing school surveys and an Education Management Information System. Carry out surveys to assess the extent of violence, where and when it takes place, the characteristics of those involved and perceptions of violence (32) Key action at school, district or national level 26 I-25. Appropriate use of data at population level for planning school health services contd Essential everywhere Partial WHO support I-25 – PA467. Expansion of services [for ear diseases and hearing impairment] may be required and this will depend on the numbers of persons in the population estimated and found to have remediable or avoidable ear disease and/or deafness and hearing impairment. This information will ideally be obtained from a population- based prevalence and causes survey. The primary level services would include components on prevention, basic management and referral of ear diseases and hearing impairment (46) I-25 – PA514. Effective policy-making and programme design require strategic information on the health-related behaviour of adolescents and on health services for them. … Programme input data come from administrative sources and databases including financial tracking systems, human resources, national health accounts and policy data. Programme output data come from routine facility data collection and facility assessments of services and service quality. Outcome data on health-related behaviours and services coverage come largely from nationally representative household surveys and school-based surveys. Health impact data come from vital registration statistics, disease surveillance, clinical reporting systems and household surveys. A necessary first step toward obtaining strategic information on adolescents is disaggregating the data specific to the 10–14 and 15–19 age groups I-25 – PA516. Ensure effective use of health information systems, by: building reliable births and death registration systems and, from this, developing a national system of unique patient identifiers to support quality monitoring across pathways of care; moving away from paper-based records to a unique electronic health record that can be used across multiple health care settings; developing national legislation that protects individual privacy whilst enabling the use of personal health data for research and quality improvement; supporting clinicians, managers and policy-makers in collecting and analysing service data for quality improvement and communicating effectively with the public about how these data are used; encouraging transparency when things go wrong, by building a learning culture that focuses on understanding root causes rather than assigning individual blame; at global level, agreeing on standards to enhance data quality and comparability, particularly standardized terminology to classify, analyse and prevent adverse events; including measurement of patient outcomes and experiences as a standard element in facilities’ quality assessment (47) I-26. Collection, analysis and use of data on school health service utilization and quality of care, to monitor performance and support quality improvement and for evaluation and planning Essential everywhere Partial WHO support I-26 – WHO UHC menu (2.19 Draft). Adolescent responsive health care: quality improvement and interventions to increase adolescent participation in own care and quality improvement (1) I-26 – PA32. Every health facility has managerial leadership that collectively develops, implements and monitors appropriate policies and legal entitlements that foster an environment for continuous quality improvement (2) Quality Statement 7.3 I-26 – PA38. Every child has a complete, accurate, standardized, up-to-date medical record, which is accessible throughout their care, on discharge and on follow-up (2) Quality Statement 2.1 I-26 – PA39. Every health facility has a functional mechanism for data collection, analysis and use as part of its activities for monitoring performance and quality improvement (2) Quality Statement 2.2 I-26 – PA40. The health facility collects, analyses and uses data on service utilization and quality of care, disaggregated by age and sex, to support quality improvement. Health facility staff is supported to participate in continuous quality improvement (5) Standard 7 WHO guideline on school health services. Web Annex A. Compendium 27 I-26. Collection, analysis and use of data on school health service utilization and quality of care, to monitor performance and support quality improvement and for evaluation and planning contd Essential everywhere Partial WHO support I-26 – PA41. Every health facility has a mechanism for collecting, analysing and providing feedback on the services provided and the perception of children and their families on the care received (2) Quality Statement 2.3 I-26 – PA49. Adolescents are involved in the planning, monitoring and evaluation of health services and in decisions regarding their own care, as well as in certain appropriate aspects of service provision (5) Standard 8 I-26 – PA419. Enforce a policy that in all cases – whether or not the consent of the parent or carer is required – an adolescent’s voluntary, adequately informed, non-forced and non-rushed assent for services and participation in a data- gathering activity is obtained. Adolescents should be given full, unbiased and clear information on the nature, risks and alternatives of a proposed intervention or data-gathering activity, to enable adolescents’ participation in their own care and the communication of their choices. Information about an intervention should be provided to adolescents in a manner that is appropriate to their culture, education and level of understanding. While it is important to explain clearly to adolescents the potential risks, it is also important not to frighten them (4) Key area for programming I-26 – PA420. Implement e-standards to automate the processes of data collection and analysis and to improve adolescent participation in providing feedback to facilities by using information technology (4) Key area for programming I-26 – PA423. Implement participatory monitoring approaches to engage adolescents themselves in designing monitoring and evaluation systems, to capture the user perspective (i.e. service quality and policy implementation) and to ensure that mechanisms are in place to hear the voices of young adolescents (10–14 years) (4) Key area for programming I-26 – PA424. Ensure that facility data collection and reporting forms allow for an explicit focus on adolescents (including young adolescents), cause-specific utilization of services and quality of care (4) Key area for programming I-26 – PA439. Monitor quality in the implementation of health-promoting schools programmes, using available tools and resources (4) Key area for programming I-26 – PA515. All health-care workers should commit themselves to providing and using data to demonstrate the effectiveness and safety of the care (47) I-26 – PA516. Ensure effective use of health information systems, by: building reliable births and death registration systems and, from this, developing a national system of unique patient identifiers to support quality monitoring across pathways of care; moving away from paper-based records to a unique electronic health record that can be used across multiple health care settings; developing national legislation that protects individual privacy whilst enabling the use of personal health data for research and quality improvement; supporting clinicians, managers and policy-makers in collecting and analysing service data for quality improvement and communicating effectively with the public about how these data are used; encouraging transparency when things go wrong, by building a learning culture that focuses on understanding root causes rather than assigning individual blame; at global level, agreeing on standards to enhance data quality and comparability, particularly standardized terminology to classify, analyse and prevent adverse events; including measurement of patient outcomes and experiences as a standard element in facilities’ quality assessment (47) 28 I-27. Assess and ensure compliance with school entry health requirements (e.g. medical history, comprehensive physical examination and immunization) Essential everywhere Other WHO support I-27 – PA14. All children are assessed and checked for immunization status and receive appropriate vaccinations according to the guidelines of the WHO expanded programme on immunization (2) Quality Statement 1.9 I-27 – PA377. Routine [child] immunization (including Haemophilus influenzae, pneumococcal, meningococcal and rotavirus vaccines) (16) GSWCAH evidence-based CHD intervention I-27 – PA379. Routine [adolescent] vaccinations (e.g. human papillomavirus, hepatitis B, diphtheria-tetanus, rubella, measles) (16) GSWCAH evidence-based AHD intervention I-27 – PA464. A screening programme for early detection of hearing impairment in infants and young children should be set up. … (1) It could be a component of a comprehensive screening programme for all disabilities and may be implemented through community-based rehabilitation. (2) The first screen should be during the first year of life … (3) The second screen should be about age 4 or 5 years on school entry and could be incorporated into a school health screening programme. Screening tests should include otoscopy, screening audiometry and tympanometry. The tests and equipment to be used, training required for school health teams, procedures and capacities for referral and follow-up will need to be determined (46) I-27 – PA525. [In the COVID-19 context] inform parents and adolescents about altered vaccine schedules, reassuring them about the safety of rescheduling vaccinations for adolescents. Plan for catch-up of incomplete home-based records. Once schools reopen, ensure that school-based immunization programmes implement a catch-up vaccination plan (10) SEE ALSO: I-28. Routine preventive health check-ups (e.g. at beginning of pre-school, primary and secondary school to assess physical growth, motor development, social and emotional maturation and feeding and sleep problems and to offer appropriate care or referrals), meeting WHO criteria for a screening programme Other WHO support I-28. Routine preventive health check-ups (e.g. at beginning of pre- school, primary and secondary school to assess physical growth, motor development, social and emotional maturation and feeding and sleep problems and to offer appropriate care or referrals), meeting WHO criteria for a screening programme Essential everywhere Other WHO support I-28 – WHO UHC menu (2.19 Draft). Preventive health check-ups (1) I-28 – PA14. All children are assessed and checked for immunization status and receive appropriate vaccinations according to the guidelines of the WHO expanded programme on immunization (2) Quality Statement 1.9 I-28 – PA27. Adolescent-friendly health services: health care should be accessible and acceptable, promote health literacy and provide an appropriate package of services, including routine, age-appropriate appointments (e.g. vaccinations) (5) I-28 – PA237. Pre-school, school and occupational screening for ear diseases and hearing loss is an effective tool for early identification and management of hearing loss (48) I-28 – PA334. Based on [oral] screening results, students who are in need of care should be referred to the dental team for detailed examination, treatment and follow- up monitoring. Ideally, all school children should, resource permitting, be offered a regular dental check-up (12) WHO guideline on school health services. Web Annex A. Compendium 29 I-28. Routine preventive health check-ups (e.g. at beginning of pre- school, primary and secondary school to assess physical growth, motor development, social and emotional maturation and feeding and sleep problems and to offer appropriate care or referrals), meeting WHO criteria for a screening programme contd Essential everywhere Other WHO support I-28 – PA411. Preventive care: transitions are required to create opportunities for all adolescents to make contact with primary care services for individual preventive services. Countries’ experiences suggest that actions to facilitate this might include: strengthening school health services and exploring the potential of including periodic check-ups for adolescents in primary care I-29. Conduct HEADSSS or equivalent assessments, i.e. assessments of risk behaviours related to home, education/employment, eating, activity, drugs, sexuality, safety and suicidal thinking/depression (i.e. to detect adolescent health and development problems; if their behaviour puts them at risk of negative health outcomes; and important factors in their environment that increase the likelihood of these behaviours) Essential everywhere Other WHO support I-29 – PA3. Conduct HEADSSS (home, education/employment, eating, activity, drugs, sexuality, safety, suicidal thinking/depression) assessment to: detect health and development problems that the adolescent has not presented with; detect whether the adolescent engages in behaviours that could put one at risk of negative health outcome (such as injecting drugs or having unprotected sex); and detect important factors in their environment that increase the likelihood of their engaging in these behaviours (22) Primary care recommendation I-29 – PA520. Improve primary- and referral-level care capacity to deliver integrated, adolescent-centred services (e.g. train providers in conducting a HEADSSS assessment to detect any health and development problems that the adolescent has not presented with) (4) Key area for programming I-30. Identification of developmental difficulties and disabilities Essential everywhere Other WHO support I-30 – WHO UHC menu (2.19 Draft). Identification of developmental difficulties and disabilities (1) I-30 – PA507. Primary health care services have an important role to play in early detection and facilitation of coordinated care and support [of autism spectrum disorders and other developmental disorders]. Collaborative models of care and task-sharing approaches are recommended, with multidisciplinary community- based teams assuming tasks related to assessment, management and follow up in consultation with specialists at secondary care levels (49) I-30 – PA508. Early detection of autism spectrum disorders and other developmental disorders requires the mainstreaming of child development monitoring into routine child health care services. It is important that developmental monitoring and screening are conducted in the context of early childhood development programmes along with family psycho-education and the provision of comprehensive care for children with autism spectrum disorders and other developmental disorders and their families (49) I-30 – PA509. Training materials on assessment and management of autism spectrum disorders and other developmental disorders, in line with the WHO Mental Health Gap Action Programme (mhGAP) evidence-based guidelines, are available for field testing (49) 30 I-30. Identification of developmental difficulties and disabilities contd Essential everywhere Other WHO support I-30 – PA510. Experiences from both high-income and low- and middle-income countries support the creation of collaborative, multidisciplinary, community-based teams or networks that assume and share tasks related to child development monitoring, screening, assessment, management and follow up for autism spectrum disorders and other developmental disorders, including supporting access to education, housing and employment services and leisure activities (49) I-31. Screening for eye and vision problems Essential everywhere Other WHO support I-31 – WHO UHC menu (2.19 Draft). Screening for visual problems in children (1) I-31 – PA232. Schools should identify and treat … vision … problems (11) I-31 – PA234. Comprehensive eye care aims to ensure that people have access to eye care services that meet their needs at every stage of life. This includes not only prevention and treatment services, but also vision rehabilitation. Comprehensive eye care also aims to address the full spectrum of eye diseases. ... Early diagnosis and treatment [for children] are critical in preventing vision impairment (50) I-32. Screening for ear and hearing problems Essential everywhere Other WHO support I-32 – PA235. Implement school-based hearing screening with the aim to identify, refer and manage common ear diseases and hearing loss. Integrate hearing screening into school health programmes and develop linkages for provision of suitable care: medical, surgical and rehabilitative (51,52) I-32 – PA236. For those children who develop hearing loss at a later age (> 6 months old), regular pre-school and school-based hearing screening can effectively identify hearing loss soon after its onset, thereby limiting its adverse impact (51,52) I-32 – PA237. Pre-school, school and occupational screening for ear diseases and hearing loss is an effective tool for early identification and management of hearing loss (48) I-32 – PA238. Identification and [hearing problem] assessment … includes an initial screening-type test at the primary level to identify those people who may have a hearing problem and/or other ear disease (for example chronic otitis media or otitis media with effusion). This test could be used as part of a population screening on request for any infant, child or adult who presents with suspicion of hearing loss (53) I-32 – PA239. Following identification [of a hearing problem], an assessment of hearing function is required. This assessment may take place at primary or secondary level (53) WHO guideline on school health services. Web Annex A. Compendium 31 I-32. Screening for ear and hearing problems contd Essential everywhere Other WHO support I-32 – PA464. A screening programme for early detection of hearing impairment in infants and young children should be set up. … (1) It could be a component of a comprehensive screening programme for all disabilities and may be implemented through community-based rehabilitation. (2) The first screen should be during the first year of life … (3) The second screen should be about age 4 or 5 years on school entry and could be incorporated into a school health screening programme. Screening tests should include otoscopy, screening audiometry and tympanometry. The tests and equipment to be used, training required for school health teams, procedures and capacities for referral and follow-up will need to be determined (46) I-32 – PA466. The decision whether to implement a school-wide screen of hearing impairment could await the findings of a population-based survey so the costs and benefits of implementation can be determined, especially where resources are limited. … The screening programme should not be implemented in an area until it is clear that the available services can accommodate the estimated additional numbers of cases discovered by the screening (46) I-33. Screening for oral health problems Essential everywhere Other WHO support I-33 – PA332. Schools should identify and treat oral health … problems (11) I-33 – PA333. Screening of teeth and mouth enables early detection and timely interventions towards oral diseases and conditions, leading to substantial cost savings. … Appropriate and effective efforts can be targeted at those who are at risk or in need. Signs of some general health conditions can be identified through oral health screening, such as malnutrition and diabetes. … It can be effectively carried out by trained school health nurses, school teachers or community workers. It can be incorporated into routine general health screening, surveillance programmes or other activities in schools (12) I-33 – PA334. Based on the screening results, students who are in need of care should be referred to the dental team for detailed examination, treatment and follow-up monitoring. Ideally, all school children should, resource permitting, be offered a regular dental check-up (12) I-34. Screening for nutrition problems (e.g. anaemia, malnutrition, obesity) Essential everywhere Other WHO support I-34 – PA11. All infants and young children are assessed for growth, breastfeeding and nutrition and their carers receive appropriate support and counselling, according to WHO guidelines (2) Quality Statement 1.6 I-34 – PA12. All children at risk for acute malnutrition and anaemia are correctly assessed and classified and receive appropriate care according to WHO guidelines (2) Quality Statement 1.7 I-34 – PA269. [SHS] can include screening for indicators of malnutrition and health status, providing treatments such as micronutrient supplements and parasite medications, referring to appropriate nutritional and other services and supplying health and nutrition information to teachers and students to help them make healthy decisions and to educate others about healthy nutrition (44) 32 I-34. Screening for nutrition problems (e.g. anaemia, malnutrition, obesity) contd Essential everywhere Other WHO support I-34 – PA270. [SHS] screening and diagnosis of health and nutritional status, including conditions of malnutrition, can play an important role in planning efforts to enhance health or influence unhealthy eating habits. Nutritional screening can include food consumption surveys, which are compared to food guidelines, as well as measurements of body weight and height, which are compared to a subject’s age and sex. In addition, blood tests can be used to diagnose micronutrient deficiencies, such as iron deficiency anaemia and indicators of nutrition-related chronic diseases, such as high blood cholesterol (44) I-34 – PA333. Screening of teeth and mouth enables early detection and timely interventions towards oral diseases and conditions, leading to substantial cost savings. … Appropriate and effective efforts can be targeted at those who are at risk or in need. Signs of some general health conditions can be identified through oral health screening, such as malnutrition and diabetes. … It can be effectively carried out by trained school health nurses, school teachers or community workers. It can be incorporated into routine general health screening, surveillance programmes or other activities in schools (12) I-35. Screening for type II diabetes Essential/suitable in certain areas Other WHO support I-35 – PA270. [SHS] screening and diagnosis of health and nutritional status, including conditions of malnutrition, can play an important role in planning efforts to enhance health or influence unhealthy eating habits. Nutritional screening can include food consumption surveys, which are compared to food guidelines, as well as measurements of body weight and height, which are compared to a subject’s age and sex. In addition, blood tests can be used to diagnose micronutrient deficiencies, such as iron deficiency anaemia and indicators of nutrition-related chronic diseases, such as high blood cholesterol (44) I-36. Screening for infectious diseases (e.g. tuberculosis; neglected tropical diseases, such as Chagas disease; COVID-19) Essential/suitable in certain areas Other WHO support I-36 – PA117. School-based STI service delivery … may be recommended where both STI risk among the school-going population is high and chlamydia screening is an affordable option (54) I-36 – PA118. [To achieve early diagnosis of STIs and linkage to treatment] Special efforts are required for the detection and management of asymptomatic sexually transmitted infections in specific populations, which include key populations for HIV, adolescents and young adults and pregnant women, such as case-finding or screening, with enhanced interventions for reaching sexual partners (30) I-36 – PA119. Implement strategies for detecting and managing asymptomatic [sexually transmitted] infections in specific and key populations, pregnant women and adolescents, such as regular case testing or screening, with enhanced interventions for reaching sexual partners (30) WHO guideline on school health services. Web Annex A. Compendium 33 I-36. Screening for infectious diseases (e.g. tuberculosis; neglected tropical diseases, such as Chagas disease; COVID-19) contd Essential/suitable in certain areas Other WHO support I-36 – PA531. [Composite] recommendations for schooling during the COVID-19 pandemic including those specific to: hygiene and daily practices at school (i.e. hygiene and environmental cleaning to limit exposure; screening and management of sick students, teachers and other school staff; communication with parents and students; additional school-related measures); physical distancing and tele- schooling (i.e. physical distancing at school; tele-schooling and distance learning); and monitoring of schools after re-opening (55) I-37. Screening for mental health concerns (e.g. to identify students at risk of poor mental health outcomes and/or who may need monitoring or referral) Suitable everywhere Other WHO support I-37 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-37 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-37 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-37 – PA206. For people in a position to identify whether someone may be contemplating suicide (e.g. clinicians or teachers), gatekeeper training develops knowledge, attitudes and skills for identifying adolescents at risk, determining the level of risk and referring at-risk adolescents for treatment (4,56) I-37 – PA216. Substance use generally commences during adolescence and this period can be seen as a critical milestone for substance use problems and an appropriate time to commence screening young clients. The exact age at which it is appropriate to commence regular screening for substance use will vary depending on local prevalence and patterns of use. It is important to be aware of the legal age of consent in the jurisdiction where the instrument will be used and the legal requirements relating to screening and intervention with adolescents who are under such age (57) I-37 – PA307. Training health professionals to identify possible exposure or risk of exposure to violence can help them offer a range of possible interventions sooner rather than later. … Screening for intimate partner violence combined with links to services is directly relevant to adolescent girls experiencing violence in intimate partner relationships. Such screening is also relevant for protecting younger children from indirect exposure to domestic violence, as such exposure increases the risk of becoming a victim or perpetrator of violence in later years (58) 34 I-38. Administration of immunizations recommended for all children (e.g. diphtheria-tetanus-pertussis, hepatitis B, human papillomavirus (females only), measles, rubella) Essential everywhere Full WHO support I-38 – WHO UHC menu (2.19 Draft). Immunization: hepatitis B vaccine (1) I-38 – WHO UHC menu (2.19 Draft). Immunization: diphtheria-pertussis-tetanus vaccination (1) I-38 – WHO UHC menu (2.19 Draft). Immunization: measles vaccine (1) I-38 – WHO UHC menu (2.19 Draft). Immunization: human papillomavirus vaccine (1) I-38 – PA377. Routine [child] immunization (including Haemophilus influenzae, pneumococcal, meningococcal and rotavirus vaccines) (16) GSWCAH evidence-based CHD intervention I-38 – PA379. Routine [adolescent] vaccinations (e.g. human papillomavirus, hepatitis B, diphtheria-tetanus, rubella, measles) (16) GSWCAH evidence-based AHD intervention I-38 – PA381. WHO encourages national immunization programmes to use school visits for assessment of adolescent vaccination status, administration of previously missed doses (e.g. meningococcal vaccine) and provision of boosters where there is waning immunity from infant doses (e.g. tetanus) (4,59) I-38 – PA406. Summary of WHO position papers: recommendations for routine immunization: a. recommendations for all immunization programmes: [See detailed recommendations for 5–19-year-olds for diphtheria-tetanus-pertussis, hepatitis B, human papillomavirus (females only), measles and rubella] (60–62) GRC-approved I-38 – PA521. Based upon observations and principles, ensuring privacy may, in part, reduce vaccination-associated anxiety and related events (e.g. fainting, mass psychogenic illness) that can occur in large, open immunization clinics, school-based programmes and mass campaigns (63) I-38 – PA525. [In the COVID-19 context] inform parents and adolescents about altered vaccine schedules, reassuring them about the safety of rescheduling vaccinations for adolescents. Plan for catch-up of incomplete home-based records. Once schools reopen, ensure that school-based immunization programmes implement a catch-up vaccination plan (10) WHO guideline on school health services. Web Annex A. Compendium 35 I-39. Administration of immunizations recommended for children residing in certain regions (e.g. Japanese encephalitis) Essential/suitable in certain areas Full WHO support I-39 – WHO UHC menu (2.19 Draft). Immunization: yellow fever vaccine (1) I-39 – WHO UHC menu (2.19 Draft). Immunization: Japanese encephalopathy vaccine (1) I-39 – PA406. Summary of WHO position papers - recommendations for routine immunization: b. recommendations for certain regions: Japanese encephalitis: Japanese encephalitis vaccination should be integrated into national immunization schedules in all areas where Japanese encephalitis is recognized as a public health priority. The most effective immunization strategy in Japanese encephalitis endemic settings is a one-time campaign in the primary target population, as defined by local epidemiology (typically children aged < 15 years), followed by incorporation of Japanese encephalitis vaccine into the routine childhood immunization programme. Tick-borne encephalitis: in areas where the disease is highly endemic (that is, where the average prevaccination incidence of clinical disease is ≥ 5 cases/100 000 population per year), implying that there is a high individual risk of infection, WHO recommends that vaccination be offered to all age groups, including children. … Where the prevaccination incidence of the disease is moderate or low (that is, the annual average during a 5-year period is < 5/100 000) or is limited to particular geographical locations or certain outdoor activities, immunization should target individuals in the most severely affected cohorts. People travelling from non-endemic areas to endemic areas should be offered vaccination if their visits will include extensive outdoor activities. Yellow fever: preventive mass vaccination campaigns are recommended for inhabitants of areas at risk of yellow fever where there is low vaccination coverage. Vaccination should be provided to everyone aged ≥ 9 months, in any area with reported cases. … Vaccine should be offered to all unvaccinated travelers aged ≥ 9 months, travelling to and from at-risk areas, unless they belong to the group of individuals for whom yellow fever vaccination is contraindicated (62) GRC-approved I-39 – PA525. [In the COVID-19 context] inform parents and adolescents about altered vaccine schedules, reassuring them about the safety of rescheduling vaccinations for adolescents. Plan for catch-up of incomplete home-based records. Once schools reopen, ensure that school-based immunization programmes implement a catchup vaccination plan (10) 36 I-40. Administration of immunizations recommended for children in some high-risk populations (e.g. cholera, dengue, hepatitis A, meningococcal, rabies, typhoid) Essential everywhere Full WHO support I-40 – WHO UHC menu (2.19 Draft). Immunization: meningococcal vaccine (1) I-40 – PA406. Summary of WHO position papers - recommendations for routine immunization: c. recommendations for some high-risk populations: Cholera vaccination: appropriate case management, water, sanitation and hygiene (WaSH) interventions, surveillance and community mobilization remain the cornerstones of cholera control. Vaccination should be implemented in relevant settings as part of comprehensive cholera control strategies or while other activities are being developed. … Vaccination policies and strategies should be guided by an assessment of the risk of cholera and targeted to cholera hotspots. Strategies targeting specific age groups at higher risk of disease may be considered. Dengue vaccination: vaccination should be considered as part of an integrated dengue prevention and control strategy. Countries should consider introduction of the dengue vaccine CYD-TDV only if the minimization of risk among seronegative individuals can be assured. … The optimal age group to be targeted is the age before which severe dengue disease incidence is highest; this can be ascertained from national and subnational routine hospital laboratory-confirmed surveillance data. Hepatitis A vaccination: hepatitis A vaccination is recommended for inclusion in the national immunization schedule for children ≥ 1 year if indicated on the basis of incidence of acute hepatitis A, change in the endemicity from high to intermediate and consideration of cost-effectiveness. In highly endemic countries almost all persons are asymptomatically infected with hepatitis A virus in childhood, which effectively prevents clinical hepatitis A in adolescents and adults. In these countries, large-scale vaccination programmes are not recommended. Countries with improving socioeconomic status may rapidly move from high to intermediate endemicity. In these countries, a relatively large proportion of the adult population is susceptible to hepatitis A virus and large-scale hepatitis A vaccination is likely to be cost-effective and therefore is encouraged. For individual health benefit targeted vaccination of high-risk groups should be considered in low and very low endemicity settings. Those at increased risk of hepatitis A include travellers to areas of intermediate or high endemicity, those requiring life-long treatment with blood products, men who have sex with men, workers in contact with non-human primates and injecting drug users. In addition, patients with chronic liver disease are at increased risk for fulminant hepatitis A and should be vaccinated. Meningococcal vaccination: meningococcal polysaccharide vaccines can be used for those ≥ 2 years of age to control outbreaks in countries where limited economic resources or insufficient supply restrict the use of meningococcal conjugate vaccines. Polysaccharide vaccines should be administered to individuals ≥ 2 years old as one single dose. One booster 3–5 years after the primary dose may be given to persons considered to be a continued high risk of exposure, including some health workers. Rabies vaccination: there are two main immunization strategies for the prevention of human rabies: (i) post-exposure prophylaxis (PEP), which includes extensive and thorough wound washing at the rabies virus (RABV)-exposure site, together with rabies immune globulin administration if indicated and the administration of a course of several doses of rabies vaccine; (ii) pre-exposure prophylaxis (PrEP), which is the administration of several doses of rabies vaccine before exposure to RABV. PrEP is recommended for individuals at high risk of RABV exposure. These include subpopulations in highly endemic settings with limited access to timely and adequate PEP, individuals at occupational risk and travellers who may be at risk of exposure. Typhoid vaccination: typhoid vaccination programmes should be implemented in the context of other efforts to control the disease, including health education, water quality and sanitation improvements and training of health professionals in diagnosis and treatment. … Typhoid vaccination is recommended in response to confirmed outbreaks of typhoid fever and may be considered in humanitarian emergency settings depending on the risk assessment in the local setting (62) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 37 I-40. Administration of immunizations recommended for children in some high-risk populations (e.g. cholera, dengue, hepatitis A, meningococcal, rabies, typhoid) contd Essential everywhere Full WHO support I-40 – PA503. [Composite] recommendations for a meningitis outbreak in sub- Saharan Africa, including: Special situations such as mass gatherings, refugees, displaced persons or closed institutions such as schools or barracks. An immediate response, including mass vaccination, is recommended when two cases of meningococcal disease are confirmed in 1 week (64) GRC-approved I-40 – PA525. [In the COVID-19 context] inform parents and adolescents about altered vaccine schedules, reassuring them about the safety of rescheduling vaccinations for adolescents. Plan for catch-up of incomplete home-based records. Once schools reopen, ensure that school-based immunization programmes implement a catch-up vaccination plan (10) I-41. Mass drug administration (e.g. for soil-transmitted helminths, schistosomiasis, trachoma, malaria, lymphatic filariasis) Essential/suitable in certain areas Full WHO support I-41 – WHO UHC menu (2.19 Draft). Mass drug administration for prevention of schistosomiasis (1) I-41 – WHO UHC menu (2.19 Draft). Mass drug administration of azithromycin for the treatment of trachoma (2) I-41 – PA269. [SHS] can include screening for indicators of malnutrition and health status, providing treatments such as micronutrient supplements and parasite medications, referring to appropriate nutritional and other services and supplying health and nutrition information to teachers and students to help them make healthy decisions and to educate others about healthy nutrition (44) I-41 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-41 – PA339. Schools should treat when possible helminth, malarial, skin and respiratory infections, as well as other infectious diseases (10) I-41 – PA346. Preventive chemotherapy (deworming), using annual or biannual single-dose albendazole (400 mg) or mebendazole (500 mg), is recommended as a public health intervention for all young children (12–23 months), preschool (24–59 months) and school-age children living in areas where the baseline prevalence of any soil-transmitted infection is 20% or higher among children, in order to reduce the worm burden of soil-transmitted helminth infections (15,65) GRC-approved I-41 – PA347. Preventive chemotherapy (deworming), using annual or biannual single- dose albendazole (400 mg) or mebendazole (500 mg), is recommended as a public health intervention for all non-pregnant adolescent girls (10–19 years) and non- pregnant women of reproductive age (15–49 years) living in areas where the baseline prevalence of any soil-transmitted helminth infection is 20% or higher among non- pregnant adolescent girls and non-pregnant women of reproductive age, in order to reduce the worm burden of soil-transmitted helminth infection (15,65) GRC-approved 38 I-41. Mass drug administration (e.g. for soil-transmitted helminths, schistosomiasis, trachoma, malaria, lymphatic filariasis) contd Essential/suitable in certain areas Full WHO support I-41 – PA351. [Composite] recommendations on alternative mass drug administration regimens to eliminate lymphatic filariasis (66) GRC-approved I-41 – PA357. Some schools provide health services related to the control and prevention of malaria. These services commonly include: mass treatment of fever when there are malaria epidemics; mass treatment of parasitological diseases such as lymphatic filariasis, onchocerciasis; immunization combining distribution of insecticide-treated nets; screening of health problems such as anaemia and malnutrition; school feeding in underprivileged and needy areas (26) I-41 – PA358. In areas with highly seasonal malaria transmission in the sub- Sahel region of Africa, provide seasonal malaria chemoprevention with monthly amodiaquine + sulfadoxine-pyrimethamine for all children aged < 6 years during each transmission season (7,67) GRC-approved I-41 – PA527. [In the COVID-19 context] design alternative strategies to safeguard schoolchildren’s food security and nutrition, for example, by providing micronutrient supplements, take-home rations, deworming medicines (as applicable), cash- based transfers to families with schoolchildren and food voucher assistance. Put in place alternative modalities for food collection, such as the ability to pick up meals and snacks at distribution points, including at otherwise-closed schools. Build upon existing safety-net structures to ensure vulnerable schoolchildren are cared for. Reinstate and continue the provision of essential school health and nutrition packages. Create contingency plans for the distribution of meals or food baskets during school closures (10) I-42. Iron, folic acid and other micronutrient supplementation Essential/suitable in certain areas Full WHO support I-42 – WHO UHC menu (2.19 Draft). Iron, folic acid and other micronutrient supplementation (1) I-42 – PA269. [SHS] can include screening for indicators of malnutrition and health status, providing treatments such as micronutrient supplements and parasite medications, referring to appropriate nutritional and other services and supplying health and nutrition information to teachers and students to help them make healthy decisions and to educate others about healthy nutrition (44) I-42 – PA285. Daily iron supplementation is recommended as a public health intervention in school-age children aged 60 months and older, living in settings where anaemia is highly prevalent, for preventing iron deficiency and anaemia. Suggested supplementation scheme: 30–60 mg elemental iron given daily for three consecutive months in a year (68) GRC-approved I-42 – PA286. Intermittent iron supplementation is recommended as a public health intervention in preschool and school-age children to improve iron status and reduce the risk of anaemia in settings where the prevalence of anaemia in preschool or school-age children is 20% or higher (69) GRC-approved I-42 – PA287. Daily iron supplementation is recommended as a public health intervention in menstruating adult women and adolescent girls, living in settings where anaemia is highly prevalent (≥ 40% anaemia prevalence), for the prevention of anaemia and iron deficiency (69) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 39 I-42. Iron, folic acid and other micronutrient supplementation contd Essential/suitable in certain areas Full WHO support I-42 – PA288. Intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women living in settings where anaemia is highly prevalent, to improve their haemoglobin concentrations and iron status and reduce the risk of anaemia (69) GRC-approved I-42 – PA289. In populations where anaemia is a public health problem, point-of-use fortification of foods with iron-containing micronutrient powders in children aged 2–12 years is recommended, to improve iron status and reduce anaemia (70) GRC-approved I-42 – PA290. In malaria-endemic areas, the provision of iron supplementation in infants and children should be done in conjunction with public health measures to prevent, diagnose and treat malaria (68) GRC-approved I-42 – PA292. [Composite] recommendations related to nutrition and reproductive health, i.e. optimal serum and red blood cell concentrations; fortification and supplementation for pregnant women; preconception and antenatal dietary interventions (14,15) GRC-approved I-42 – PA293. [Composite] recommendations on health promotion interventions for maternal and newborn health (14,15) GRC-approved I-42 – PA527. [In the COVID-19 context] design alternative strategies to safeguard schoolchildren’s food security and nutrition, for example, by providing micronutrient supplements, take-home rations, deworming medicines (as applicable), cash- based transfers to families with schoolchildren and food voucher assistance. Put in place alternative modalities for food collection, such as the ability to pick up meals and snacks at distribution points, including at otherwise-closed schools. Build upon existing safety-net structures to ensure vulnerable schoolchildren are cared for. Reinstate and continue the provision of essential school health and nutrition packages. Create contingency plans for the distribution of meals or food baskets during school closures (10) I-43. Psychosocial intervention to promote well-being and functioning (e.g. encouraging and/or assisting a child to: get enough sleep; eat regularly; be physically active; participate in social activities; spend time with trusted friends and family; avoid the use of alcohol, drugs and nicotine; and develop interpersonal skills, emotion regulation and problem-solving and stress management skills) Suitable everywhere Full WHO support I-43 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-43 – PA167. Psychosocial support and related services for adolescent mental health and well-being (4,16) GSWCAH evidence-based AHD intervention I-43 – PA168. Non-specialized health-care facilities should encourage and collaborate with school-based life skills education, if feasible, to promote mental health in children and adolescents (14,34) GRC-approved I-43 – PA169. [Psychosocial intervention] to promote child/adolescent well-being and functioning (18,19) GRC-approved 40 I-43. Psychosocial intervention to promote well-being and functioning (e.g. encouraging and/or assisting a child to: get enough sleep; eat regularly; be physically active; participate in social activities; spend time with trusted friends and family; avoid the use of alcohol, drugs and nicotine; and develop interpersonal skills, emotion regulation and problem-solving and stress management skills) contd Suitable everywhere Full WHO support I-43 – PA528. [In the COVID-19 context] create contingency plans to provide mental health services during school closures for students who mainly rely on school- based services. Consider using digital platforms to provide psychosocial support and for early detection and management of mental health conditions. Use remote socioemotional learning programmes and strengthen the capacities of schools, mental health staff and youth champions to deliver them remotely. Intensify classroom-based socioemotional learning after schools reopen. Follow up with school drop-outs to institute support mechanisms (10) I-44. Counselling and care related to a child’s physical and psychosocial development (e.g. puberty, skin changes, body image, hygiene, child marriage) Essential everywhere Partial WHO support I-44 – WHO UHC menu (2.19 Draft). Health promoting schools: menstrual hygiene management (1) I-44 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organisations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-44 – PA71. Management of menstrual conditions, i.e. period pain; heavy bleeding; irregular periods (22) Primary care recommendation I-44 – PA72. Implement interventions to inform and empower girls, in combination with interventions to influence family and community norms, to delay the age of marriage among girls under 18 years of age (14,29) GRC-approved I-44 – PA168. Non-specialized health-care facilities should encourage and collaborate with school-based life skills education, if feasible, to promote mental health in children and adolescents (14,34) GRC-approved I-44 – PA241. Management of skin problems (22) Primary care recommendation I-44 – PA242. [Consolidated] guidance on diagnosis, treatment and management of acne, different kinds of eczema and other skin conditions, including key clinical features and treatment for severe, moderate and mild forms of these conditions (4,71) I-44 – PA273. Management of body image concerns, e.g. too thin, too fat, too short (22) Primary care recommendation I-44 – PA282. Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment (6) WHO guideline on school health services. Web Annex A. Compendium 41 I-44. Counselling and care related to a child’s physical and psychosocial development (e.g. puberty, skin changes, body image, hygiene, child marriage) contd Essential everywhere Partial WHO support I-44 – PA403. No GRC-approved recommendations currently exist [for care for 5-19-year-old development]. Guidance on this topic is in the process of being updated. Meanwhile, the guidance in Care for child development: improving the care for young children (72) may be used (7) I-44 – PA404. Management of [adolescent] developmental conditions, i.e. delayed puberty for males and females (22) Primary care recommendation I-44 – PA405. Health providers should go beyond disease management by considering the implications for the child’s overall health, development and well- being, as well as the short- and long-term effects on their lives and those of the child’s parents or carers and other considerations that are pertinent and specific to each child and family (2) I-44 – PA433. Ensure adequate conditions for menstrual hygiene management, such as lockable, single-sex, private toilets with water and soap for washing, as well as a private open-air space to dry wet menstrual cloths and/or a closed bin or incinerator for used menstrual pads (4) Key area for programming I-45. Counselling and support for a child’s caregiver related to the child’s physical and psychosocial development (e.g. nutrition, physical activity, puberty, positive development in adolescence, sexual and reproductive health) Suitable everywhere Partial WHO support I-45 – WHO UHC menu (2.19 Draft). Support for parental mental health (1) I-45 – WHO UHC menu (2.19 Draft). Health education of adolescents, parents and caregivers regarding physical activity (1) I-45 – WHO UHC menu (2.19 Draft). Caregiver counselling and support in adolescent physical and psychosocial development (1) I-45 – PA5. Information provision to adolescents and their parents/carers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-45 – PA11. All infants and young children are assessed for growth, breastfeeding and nutrition and their carers receive appropriate support and counselling, according to WHO guidelines (2) Quality Statement 1.6 I-45 – PA51. All children and their carers receive appropriate counselling and health education, according to their capacity, about the current illness and promotion of the child’s health and well-being (2) Quality Statement 4.4 I-45 – PA54. All children and their carers are made aware of and given information about children’s rights to health and health care (2) Quality Statement 5.2 42 I-45. Counselling and support for a child’s caregiver related to the child’s physical and psychosocial development (e.g. nutrition, physical activity, puberty, positive development in adolescence, sexual and reproductive health) contd Suitable everywhere Partial WHO support I-45 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organisations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-45 – PA114. [School] health workers could provide information and advice [about HIV/AID/STI] to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they may have about HIV/AIDS/STI and methods of prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about HIV/ AIDS/STI without facing ridicule or judgement; provide health products (such as contraceptives and condoms) when they are permitted to do so, by prevailing laws and policies; and identify and collaborate with organizations, which can provide appropriate non-health services when required, such as legal support for adolescents who are being abused (35) I-45 – PA153. Peer support groups and safe spaces can help improve self-esteem and address self-stigma [for HIV-positive adolescents]. Additionally, individual and family counselling can address adolescents’ mental health co-morbidities. The involvement of supportive parents or guardians can be beneficial, especially for those requiring ongoing treatment and care. It is important, however, to have the adolescent’s express permission before contacting parents or caregivers (73) GRC-approved I-45 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (18,74) I-45 – PA173. Psychoeducation to [child/adolescent] and carers and parenting advice (19) GRC-approved I-45 – PA177. Psycho-education about the negative effects of punitive responses should be given to caregivers of children with secondary non-organic enuresis in the first month after a potentially traumatic event. Parenting skills training and the use of simple behavioural interventions (i.e. star charts, toileting before sleep and rewarding having nights without wetting the bed) should be considered. In addition, where resources permit, alarms should be considered (75) GRC-approved I-45 – PA183. Parent skills training, as appropriate, for managing behavioural disorders in adolescents (4,16) GSWCAH evidence-based AHD intervention I-45 – PA189. Caregiver skills training should be provided for management of children and adolescents with developmental disorders, including intellectual disabilities and pervasive developmental disorders (including autism) (76,77) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 43 I-45. Counselling and support for a child’s caregiver related to the child’s physical and psychosocial development (e.g. nutrition, physical activity, puberty, positive development in adolescence, sexual and reproductive health) contd Suitable everywhere Partial WHO support I-45 – PA192. Management of attention-deficit hyperactivity disorder (ADHD): provide family psycho-education; consider parent skills training, when available; contact person’s teacher (if person goes to school and consent is given by the person and carer), provide advice and plan for special educational needs; anticipate major life changes (such as puberty, starting school or birth of a sibling) and arrange personal and social support; consider psychosocial interventions such as cognitive behaviour therapy and social skills; training based on availability. Assess carers regarding the impact of behavioural disorders and offer them support for their personal, social and mental health needs. DO NOT use medicines for behavioural disorders in children and adolescents (7,19,78) GRC-approved I-45 – PA198. Psychological interventions, such as cognitive behavioural therapy, interpersonal psychotherapy for children and adolescents with emotional disorders and caregiver skills training focused on their caregivers, may be offered for the treatment of emotional disorders (7,14,79) GRC-approved Recommendation CH3 I-45 – PA222. Psychosocial interventions for substance use disorder: psychoeducation; motivational interviewing; strategies for reducing and stopping use; mutual help groups; strategies for preventing harm from drug use and related conditions; and carer support (non-specialized health setting protocol) (19) GRC-approved I-45 – PA265. High-intensity school-based interventions that focus on diet and/or physical activity, are comprehensive, multi-component and include: curriculum on diet and/or physical activity taught by trained teachers; supportive school environment/policies; a physical activity programme; a parental/family component; [and/or] healthy food options available through school food services: cafeteria, vending machines, etc. (13) GRC-approved Ranked “Effective” intervention I-45 – PA267. Improve the nutrition literacy and skills of parents and caregivers (6) I-45 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-45 – PA282. Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment (6) I-45 – PA443. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] d. Engage with families and with the wider community for a safe and supportive environment beyond school premises and provide support to parents (4) 44 I-46. Counselling on nutrition, physical activity and a management plan Suitable everywhere Partial WHO support I-46 – WHO UHC menu (2.19 Draft). Healthy diet and nutrition counselling (1) I-46 – WHO UHC menu (2.19 Draft). Appropriate counselling on nutrition and physical activity and management plan for obese children (1) I-46 – PA5. Information provision to adolescents and their parents/careers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-46 – PA11. All infants and young children are assessed for growth, breastfeeding and nutrition and their carers receive appropriate support and counselling, according to WHO guidelines (2) Quality Statement 1.6 I-46 – PA272. Dietary counselling for prevention of undernutrition, overweight and obesity (16) GSWCAH evidence-based CHD intervention I-46 – PA274. Primary health care interventions targeting chronic NCD risk groups that: include persons who are inactive, consume less than five servings of fruits and vegetables daily, consume a lot of dietary fat, are overweight or have a family history of obesity, heart disease, cancer and/or type 2 diabetes (13) GRC-approved I-46 – PA275. Primary health care interventions targeting chronic NCD risk groups that include at least one session (health risk appraisal) with a health-care professional, with brief negotiation or discussion to decide on reasonable, attainable goals and a follow-up consultation with trained personnel (13) GRC-approved I-46 – PA276. Primary health care interventions targeting chronic NCD risk groups that are supported by targeted information (13) GRC-approved I-46 – PA277. Primary health care interventions targeting chronic NCD risk groups that are linked and/or coordinated with other stakeholders such as community sports organizations or ongoing mass media physical activity campaigns (13) GRC-approved I-46 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) SEE ALSO: I-66. Referral and support for overweight and obesity Full GRC support WHO guideline on school health services. Web Annex A. Compendium 45 I-47. Counselling on tobacco, alcohol and other substance use Essential everywhere Partial WHO support I-47 – WHO UHC menu (2.19 Draft). Brief interventions for substance use prevention (1) I-47 – PA5. Information provision to adolescents and their parents/careers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-47 – PA217. No GRC-approved recommendations specifically for adolescent harmful use of alcohol currently exist. The guidance in the Global strategy to reduce the harmful use of alcohol (80) and the Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders (81) may be used (14) Note also the update of the mhGAP guideline for mental, neurological and substance use disorders (76) has recommendations for “people” with alcohol and drug use disorders, i.e. ALC1, ALC2, DRU1 (cannabis), DRU2 (psychostimulant), DRU3 (opioid) I-47 – PA222. Psychosocial interventions for substance use disorder: psychoeducation; motivational interviewing; strategies for reducing and stopping use; mutual help groups; strategies for preventing harm from drug use and related conditions; and carer support (non-specialized health setting protocol) (14,19) GRC-approved I-47 – PA225. No GRC-approved recommendations specifically related to adolescents and tobacco currently exist. Guidance in the WHO Framework Convention on Tobacco Control: guidelines for implementation (82) may be used (14) I-47 – PA226. Schools and communities need to consider what preventive and treatment services are necessary for [tobacco] prevention and cessation (e.g. cessation programmes, counselling) and how these can best be provided. Health service providers know the health consequences of tobacco use … they can provide students, school personnel and parents with information on tobacco use in the community and demonstrate the effects of tobacco use on the body (83) I-47 – PA227. Clinicians should encourage all non-smokers not to start smoking; strongly advise all smokers to stop smoking and support them in their efforts; and advise individuals who use other forms of tobacco to quit (84) 46 I-48. Provision of health education to prevent common unintentional injuries (e.g. how to prevent unintentional injuries in the home, while playing or engaged in sports and on roads) Essential everywhere Partial WHO support I-48 – PA5. Information provision to adolescents and their parents/careers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-48 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-48 – PA295. Integrate child injury into a comprehensive approach to child health and development, e.g. existing child survival programmes need to introduce child injury prevention strategies as part of the basic package of child health services (37) GRC-approved I-48 – PA489. There are proven ways of reducing both the likelihood and severity of all types of child and adolescent injury. Prevention programmes that use a multi- disciplinary strategy (i.e. a combination of education, environmental modification and legislation) have been shown to be particularly effective for reducing injury mortality in many high-income countries (39) I-49. Provision of health education to prevent violence, including intimate partner violence, sexual violence, gender-based violence, bullying and gang violence (e.g. universal information provided on prevention of violence and abuse) Essential everywhere Partial WHO support I-49 – PA5. Information provision to adolescents and their parents/careers on healthy eating; physical activity; sexual activity; emotional well-being; the use of tobacco, alcohol and other substances; unintended injuries; and violence and abuse (22) I-49 – PA311. Written information on intimate partner violence should be available in health-care settings in the form of posters and pamphlets or leaflets made available in private areas such as women’s washrooms (with appropriate warnings about taking them home if an abusive partner is there) (85) GRC-approved I-49 – PA457. Prevent violence through curriculum based activities: Key actions: test evidence-based violence prevention strategies on a small scale e.g. in one grade or class. Strategies that have proven to be effective include: develop children’s life skills; teach children about safe behaviour and protecting themselves from abuse; challenge and transform social, cultural and gender norms that justify violence and promote equal relationship; address key risk factors for violence (alcohol, drugs, low academic achievement). If the evaluation finds that the tested violence prevention strategies were effective in reducing violence, take steps to scale it up (32) Key action at school, district or national level I-49 – PA471. Written information on child maltreatment should be available in health-care settings in the form of posters and pamphlets or leaflets (with appropriate warnings about taking them home in case that could compromise safety) (3) GRC-approved Recommendation 4 WHO guideline on school health services. Web Annex A. Compendium 47 I-49. Provision of health education to prevent violence, including intimate partner violence, sexual violence, gender-based violence, bullying and gang violence (e.g. universal information provided on prevention of violence and abuse) contd Essential everywhere Partial WHO support I-49 – PA491. Life skills programmes can address social and gender norms that contribute to violence (20) I-49 – PA494. Cyberbullying (bullying, harassing or threatening a person online) harms children. Many programmes that seek to improve the whole-school culture and to teach students social and emotional skills can address cyberbullying. In settings where students have regular access to the Internet and social media, it is important to establish policies, behavioural expectations and supportive interventions around cyberbullying as part of an education and life skills strategy. Education about responsible use of personal data and online safety can also help children protect themselves from violence or exploitation (20) I-49 – PA495. [Programmatic approaches within individual schools] Life and social skills training: build skills for managing emotions and anger, pro-social behaviour, respectful relationships and conflict resolution, to reduce bullying and violence among peers (20) I-49 – PA496. [Programmatic approaches within individual schools] Help children protect themselves from sexual abuse: Build awareness and teach skills to help children and adolescents understand consent, avoid and prevent sexual abuse and exploitation and to seek help and support (20) I-49 – PA497. [Programmatic approaches within individual schools] Adolescent intimate partner violence prevention programmes: Address gender norms and promote positive, respectful relationships (20) I-50. Counselling to prevent violence, including intimate partner violence, sexual violence, gender-based violence, bullying and gang violence (e.g. selected therapeutic approaches for high-risk youth) Essential everywhere Partial WHO support I-50 – PA174. Where children are exposed to intimate partner violence at home, a psychotherapeutic intervention, including sessions where they are with and sessions where they are without their mother, should be offered, although the extent to which this would apply in low- and middle-income settings is unclear (87) GRC-approved I-50 – PA306. Strategies for young people at higher risk of or already involved in, violence: implementing therapeutic approaches for high-risk youths: therapeutic programmes last on average 10–20 weeks. They can be delivered on their own or as a component of larger programmes and most use standardized materials and therapeutic manuals. They are usually delivered by mental health specialists or social workers with a therapeutic qualification. Most programmes also involve supervisors with further extensive training, who support the programme delivery staff. The content of therapeutic approaches is usually adapted to the specific needs of the young person, although they generally combine social skills and behavioural training, anger- and self-control techniques and cognitive elements such as moral reasoning and perspective-taking to better appreciate the negative impacts of violence on victims (41) I-50 – PA307. Training health professionals to identify possible exposure or risk of exposure to violence can help them offer a range of possible interventions sooner rather than later. … Screening for intimate partner violence combined with links to services is directly relevant to adolescent girls experiencing violence in intimate partner relationships. Such screening is also relevant for protecting younger children from indirect exposure to domestic violence, as such exposure increases the risk of becoming a victim or perpetrator of violence in later years (58) 48 I-50. Counselling to prevent violence, including intimate partner violence, sexual violence, gender-based violence, bullying and gang violence (e.g. selected therapeutic approaches for high-risk youth) contd Essential everywhere Partial WHO support I-50 – PA313. Women who disclose any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator should be offered immediate support. Health-care providers should, as a minimum, offer first-line support when women disclose violence. First-line support includes: being non- judgmental and supportive and validating what the woman is saying; providing practical care and support that responds to her concerns, but does not intrude; asking about her history of violence, listening carefully, but not pressuring her to talk (care should be taken when discussing sensitive topics when interpreters are involved); helping her access information about resources, including legal and other services that she might think helpful; assisting her to increase safety for herself and her children, where needed; providing or mobilizing social support. ... If health- care providers are unable to provide first-line support, they should ensure that someone else (within their health-care setting or another that is easily accessible) is immediately available to do so (85) GRC-approved I-50 – PA474. [Related to child maltreatment] Health-care providers should seek informed consent for all decisions and actions to be taken as appropriate to the child’s or adolescent’s age and evolving capacity and the legal age of consent for obtaining clinical care. Where the child or adolescent is below the legal age of consent, it may still be in the child´s or adolescent´s best interests to seek informed consent. Moreover, in accordance with evolving capacities, children and adolescents have the right to access confidential counselling or advice and information without the consent of their parents or legal guardians. In situations where it is assessed to be in the best interests of the adolescents who are in need of care and based on their preferences, health-care providers may consider whether to involve the parents or legal guardians (3) GRC-approved Good Practice Statement 3 I-50 – PA486. Treatment of perpetrators [of child abuse] to prevent recurrence: no recommendation can be made because evidence on the effectiveness (or harms) of psychosocial and/or pharmacological intervention for the reduction of recurrence of child maltreatment was not identified (3) GRC-approved Recommendation 11 I-51. Contraceptive counselling (e.g. brief sexuality-related communication; counselling on contraception to enable a voluntary, informed choice; referral or provision of contraception if requested post-counselling and legal) Essential everywhere Full WHO support I-51 – PA62. [School] health workers could do the following: advocate for supportive school [SRH] policies and strong school programmes with policy- and decision- makers and relevant community leaders; engage and support education officials and representatives from other relevant sectors in providing information, building skills and providing counselling services in the school setting (and be actively involved in these efforts themselves); collaborate with school officials, students and teachers to mobilize school and community support for efforts that respond to reproductive health needs, for example, developing peer networks among students that promote understanding about and support for healthy sexual attitudes and behaviours, prevention programmes and care; and linking such networks to relevant programmes and networks in the school and community (21) I-51 – PA69. Training of health-care providers in sexual health knowledge and in the skills of brief sexuality-related communication is recommended (86) GRC-approved I-51 – PA73. Advocate for adolescent pregnancy prevention among all stakeholders through interventions such as: information provision, sexuality and health education, life skills building, contraceptive counselling and service provision and the creation of supportive environments (29) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 49 I-51. Contraceptive counselling (e.g. brief sexuality-related communication; counselling on contraception to enable a voluntary, informed choice; referral or provision of contraception if requested post-counselling and legal) contd Essential everywhere Full WHO support I-51 – PA76. Information, counselling and services for comprehensive sexual and reproductive health including contraception (16) GSWCAH evidence-based AHD intervention I-51 – PA109. Brief sexuality-related communication is recommended for the prevention of sexually transmitted infections among adults and adolescents in primary health services (14,86) GRC-approved I-52. Counselling on HIV/STI prevention methods (e.g. brief sexuality-related communication; counselling on correct condom use to enable a voluntary, informed choice; referral or provision of condoms if requested post- counselling and legal) Essential everywhere Partial WHO support I-52 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organisations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-52 – PA69. Training of health-care providers in sexual health knowledge and in the skills of brief sexuality-related communication is recommended (86) GRC-approved I-52 – PA109. Brief sexuality-related communication is recommended for the prevention of sexually transmitted infections among adults and adolescents in primary health services (14,86) GRC-approved I-52 – PA110. Combination prevention is the most effective approach for the prevention of sexually transmitted infections. Evidence-based comprehensive prevention frameworks work best when there is a strategic combination of behavioural, biomedical and structural approaches. Such a combination includes an understanding of sexually transmitted infections and primary prevention methods, including condoms and a focus on working with people most affected by, and vulnerable to, sexually transmitted infections, in particular adolescents (4,30) I-52 – PA111. Effective [STI transmission and acquisition] prevention requires ensuring access to vital information, commodities (such as condoms) and services (such as vaccination, voluntary medical male circumcision, testing, treatment and care) within a human rights framework. Alongside that, behaviour interventions are critically important for sexually transmitted infection prevention including HIV and include: the promotion of consistent use of male and female condoms; education including a focus on increasing awareness of sexually transmitted infections; reduction in the number of sexual partners; increased uptake of testing for sexually transmitted infections, including HIV; delayed sexual debut; as well as the promotion of sexual well-being. Many such interventions have the dual advantage of preventing sexually transmitted infections, including HIV and unintended pregnancies, in particular through the use of condoms by adolescents. Focusing the interventions appropriately for specific populations (including key populations for HIV), adolescents and pregnant women is a priority (4,30) 50 I-52. Counselling on HIV/STI prevention methods (e.g. brief sexuality-related communication; counselling on correct condom use to enable a voluntary, informed choice; referral or provision of condoms if requested post- counselling and legal) contd Essential everywhere Partial WHO support I-52 – PA113. [For prevention of STI transmission and acquisition] Male and female condom programming for dual protection against sexually transmitted infections and unintended pregnancy, in particular for adolescents and distributed through communities and through outreach services for specific populations (4,30) GHSSSTI priority action for countries I-52 – PA114. [School] health workers could provide information and advice [about HIV/AID/STI] to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they may have about HIV/AIDS/STI and methods of prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about HIV/ AIDS/STI without facing ridicule or judgement; provide health products (such as contraceptives and condoms) when they are permitted to do so, by prevailing laws and policies; and identify and collaborate with organizations, which can provide appropriate non-health services when required, such as legal support for adolescents who are being abused (35) I-52 – PA132. Adolescents’ emotional, intellectual and social capacities are continuously evolving. Young people from key populations, perhaps more so than their peers in the general population, experience power imbalances in sexual relationships that limit their ability to use condoms. Peer-led and outreach approaches may help to distribute condoms and lubricants, increase knowledge, develop skills and empower adolescents from key populations to use condoms and lubricants correctly and consistently (14,31) GRC-approved I-53. Referral and support for voluntary medical male circumcision Essential/suitable in certain areas Full WHO support I-53 – PA111. Effective [STI transmission and acquisition] prevention requires ensuring access to vital information, commodities (such as condoms) and services (such as vaccination, voluntary medical male circumcision, testing, treatment and care) within a human rights framework. Alongside that, behaviour interventions are critically important for sexually transmitted infection prevention including HIV and include: the promotion of consistent use of male and female condoms; education including a focus on increasing awareness of sexually transmitted infections; reduction in the number of sexual partners; increased uptake of testing for sexually transmitted infections, including HIV; delayed sexual debut; as well as the promotion of sexual well-being. Many such interventions have the dual advantage of preventing sexually transmitted infections, including HIV and unintended pregnancies, in particular through the use of condoms by adolescents. Focusing the interventions appropriately for specific populations (including key populations for HIV), adolescents and pregnant women is a priority (4,30) I-53 – PA129. Voluntary medical male circumcision in countries with HIV generalized epidemics (16) GSWCAH evidence-based AHD intervention I-53 – PA130. Countries with hyperendemic and generalized HIV epidemics and low prevalence of male circumcision should increase access to male circumcision services as a priority for adolescents and young men (14,31) GRC-approved I-53 – PA131. [WHO guidelines on updated recommendations on safe male circumcision for HIV prevention and related service delivery for adolescent boys and men in generalized HIV epidemics in development] WHO guideline on school health services. Web Annex A. Compendium 51 I-54. Referral and support for HIV pre-exposure and/or post-exposure prophylaxis (PEP)a Essential everywhere Partial WHO support I-54 – PA324. [After sexual assault] Offer HIV PEP, as appropriate, to children and adolescents who have been raped involving oral, vaginal or anal penetration with a penis and who present within 72 hours of the incident (87) GRC-approved I-54 – PA325. [After sexual assault] Provide a 28-day prescription of antiretroviral medicines for HIV PEP, following initial risk assessment. Ideally offer a triple-therapy antiretroviral regimen, but a two-medicine regimen is also effective. Incorporate adherence counselling as an important element in the provision of HIV postexposure prophylaxis to survivors of sexual assault or rape (87) GRC-approved I-54 – PA522. PrEP delivery sites for adolescents and young people should ensure that they can provide services that are integrated, efficient, ensure privacy and are non-judgemental. … Ideally, PrEP should be introduced as part of the package of combination HIV prevention and sexual and reproductive health care for adolescents. While PrEP can prevent HIV infection when used consistently, it cannot prevent other sexually transmitted infections or pregnancy. Young people who are seeking or using PrEP to prevent sexual acquisition of HIV are also at risk for STIs and unplanned pregnancy. Thus, these services should ideally be delivered as part of an integrated package of sexual and reproductive health services. Thus, potential areas to locate PrEP services include family planning clinics, reproductive health clinics, youth clinics, STI clinics, school and university health clinics, clinics serving key populations and mobile outreach services (88) GRC-approved I-54 – PA523. Adults and adolescents: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) (or emtricitabine (FTC)) is recommended as the preferred backbone regimen for HIV PEP (strong recommendation, low-certainty evidence). Dolutegravir (DTG) is recommended as the preferred third drug for HIV PEP for children for whom an approved DTG dosing is available (strong recommendation, low-certainty evidence). When available, atazanavir (ATV/r), darunavir (DRV/r), lopinavir (LPV/r) and raltegravir (RAL) may be considered as alternative third drug options for PEP (conditional recommendation, low-certainty evidence). Consider potential safety issues for women and adolescent girls of childbearing potential using DTG (89) GRC-approved I-54 – PA524. Children: zidovudine (AZT) + 3TC is recommended as the preferred backbone regimen for HIV PEP for children. Abacavir (ABC) + 3TC or TDF + 3TC (or FTC) can be considered as alternative regimens (strong recommendation, low-certainty evidence). DTG is recommended as the preferred third drug for HIV PEP for children for whom an approved DTG dosing is available (strong recommendation, low- certainty evidence). When available, ATV/r, DRV/r, LPV/r and RAL may be considered as alternative third drug options for PEP (conditional recommendation, low- certainty evidence). The choice of antiretroviral drugs for children will depend on the availability of approved dosing and age-appropriate formulations for children. Use of DTG applies to all infants and children for whom an approved DTG dosing is available (89) GRC-approved a Cotrimoxazole prophylaxis for HIV-infected or HIV-exposed children is addressed under: I-64. Referral and support for chronic care of HIV-infected children. 52 I-55. Referral and support for HIV testing services Essential everywhere Full WHO support I-55 – WHO UHC menu (2.19 Draft). Voluntary counselling and testing for HIV (1) I-55 – PA13. All children at risk for tuberculosis (TB) and/or HIV infection are correctly assessed and investigated and receive appropriate management according to WHO guidelines (2) Quality Statement 1.8 I-55 – PA111. Effective [STI transmission and acquisition] prevention requires ensuring access to vital information, commodities (such as condoms) and services (such as vaccination, voluntary medical male circumcision, testing, treatment and care) within a human rights framework. Alongside that, behaviour interventions are critically important for sexually transmitted infection prevention including HIV and include: the promotion of consistent use of male and female condoms; education including a focus on increasing awareness of sexually transmitted infections; reduction in the number of sexual partners; increased uptake of testing for sexually transmitted infections, including HIV; delayed sexual debut; as well as the promotion of sexual well-being. Many such interventions have the dual advantage of preventing sexually transmitted infections, including HIV and unintended pregnancies, in particular through the use of condoms by adolescents. Focusing the interventions appropriately for specific populations (including key populations for HIV), adolescents and pregnant women is a priority (4,30) I-55 – PA116. [School] health workers could: 1. Be alert to the possibility of the presence of health problems, (such as sexually transmitted diseases) and/or unhealthy practices (such as injecting drug use) and detect them early, if and when they arise. 2. Appropriately manage STI and/or HIV-related problems, to the best of their abilities and based on the facilities available at their disposal. This could include providing medical treatment, responding to the child’s/adolescent’s psychological needs and helping them deal with the social implications of their conditions. 3. Refer students and school personnel to the next “level” of health service delivery and/or to organizations which provide relevant support services, such as counselling and social support in the areas of adolescent development, sexuality, peer pressure, identify formation, illness and death, if and when available. 4. Answer questions of students and school personnel about the need for and value of HIV-antibody testing. As necessary and if available, refer students and staff to an appropriate and confidential facility that provides pre- and post-test counseling. Counselling about HIV-antibody testing requires the services of support staff and professionals who are trained and experienced in dealing specifically with the issues involved. 5. Observe confidentiality with respect to infected students and school personnel and disclose information to staff on a need-to-know basis only. 6. Support the education and employment rights of HIV-infected students and staff by assuring concerned officials and others that HIV infected students and staff pose virtually no health threat to students and school personnel when they attend classes or work in the school (35) I-55 – PA133. Generalized HIV epidemic: HIV testing services with linkage to prevention, treatment and care should be offered to all adolescents [children] in generalized epidemics (73) GRC-approved I-55 – PA134. Concentrated HIV epidemic: HIV testing services with linkage to prevention, treatment and care should be accessible to adolescents [children] in low-level and concentrated epidemics (73) GRC-approved I-55 – PA136. In generalized epidemic settings, infants and children with unknown HIV status who are admitted for inpatient care or attending malnutrition clinics should be routinely tested for HIV (73) GRC-approved I-55 – PA137. In generalized epidemic settings, infants and children with unknown HIV status should be offered HIV testing in outpatient or immunization clinics (73) GRC-approved I-55 – PA140. HIV testing and counselling, with linkages to prevention, treatment and care, is recommended for adolescents from key populations in all settings (generalized, low and concentrated epidemics) (31) GRC-approved I-55 – PA142. [WHO consolidated guidelines on HIV testing services in development.] WHO guideline on school health services. Web Annex A. Compendium 53 I-56. Provision of first aid, i.e. identification and prioritization of problems, provision of immediate care and referral for full medical treatment, if required (e.g. acute conditions such as asthma, diabetes, seizures; bleeding or injury; mental health concerns, including self-harm; life-threatening allergy; poisoning and envenoming; substance abuse) Essential everywhere Full WHO support I-56 – PA7. All children are triaged and promptly assessed for emergency and priority signs to determine whether they require resuscitation and receive appropriate care according to WHO guidelines (2) Quality Statement 1.1 I-56 – PA8. All children with cough or difficult breathing are correctly assessed, classified and investigated and receive appropriate care and/or antibiotics for pneumonia, according to WHO guidelines (2) Quality Statement 1.3 I-56 – PA9. All children with diarrhoea are correctly assessed and classified and receive appropriate rehydration and care, including continued feeding, according to WHO guidelines (2) Quality Statement 1.4 I-56 – PA10. All children with fever are correctly assessed, classified and investigated and receive appropriate care according to WHO guidelines (2) Quality Statement 1.5 I-56 – PA17. All children with surgical conditions are screened for surgical emergencies and injury and receive appropriate surgical care (2) Quality Statement 1.12 I-56 – PA18. All sick children, especially those who are most seriously ill, are adequately monitored, reassessed periodically and receive supportive care according to WHO guidelines (2) Quality Statement 1.13 I-56 – PA220. People likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose (90) GRC-approved I-56 – PA257. [Composite] recommendations for management of exacerbation of asthma (91) GRC-approved I-56 – PA259. When intravenous (IV) access is not available for the control of acute seizures in children, nonparenteral routes of administration of benzodiazepines should be used. Options include rectal diazepam, oral or intranasal midazolam and rectal or intranasal lorazepam. Some benzodiazepines (lorazepam and midazolam) may be given intramuscularly; this requires additional expertise and expense. The preference may be guided by availability, expertise and social preference (7,92) GRC-approved Recommendation 3.1 I-56 – PA260. For children presenting with acute seizures where IV administration is available, IV diazepam or IV lorazepam should be used to terminate the seizure (7,92) GRC-approved Recommendation 3.2 I-56- PA261. [Composite] recommendations for second-line anticonvulsant medicines for children with established status epilepticus resistant to first-line benzodiazepines (92) GRC-approved Recommendations 3.3-3.8 I-56 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) 54 I-56. Provision of first aid, i.e. identification and prioritization of problems, provision of immediate care and referral for full medical treatment, if required (e.g. acute conditions such as asthma, diabetes, seizures; bleeding or injury; mental health concerns, including self-harm; life-threatening allergy; poisoning and envenoming; substance abuse) contd Essential everywhere Full WHO support I-56 – PA296. Implement specific actions to prevent and control child injuries, e.g. immediate resuscitation in response to drowning; appropriate paediatric acute care in response to a fall (37) GRC-approved I-56 – PA297. Assessment and management of adolescents who present with unintentional injury, including alcohol-related injury (16) GSWCAH evidence-based AHD intervention I-56 – PA299. Strengthen health systems to address child injuries, e.g. the development and maintenance of an efficient system of pre-hospital care (37) GRC-approved I-56 – PA300. Pre-hospital care [after road injury]: standardize formal emergency medical services, including equipping vehicles with supplies and devices for children as well as adults. Where no pre-hospital trauma care system exists: teach interested community members basic first aid techniques; build on existing, informal systems of pre-hospital care and transport; and initiate emergency services on busy roads with high-frequency crash sites (4) I-56 – PA301. Survival after a [road] crash: trauma response that can accommodate the needs of children is required. This ranges from training teacher and school transport drivers in safe immediate stabilization of injuries; equipping emergency vehicles with child-sized medical equipment and supplies; and improving paediatric- specific rehabilitation services for children (45) I-56 – PA302. Develop trauma care skills of medical personnel at the primary, district and tertiary health-care levels (93) I-56 – PA303. Several easily performed first aid measures can decrease the pain and risk of death and disability for burn victims, … [e.g.] immediate application of cool water to burns should be promoted widely as an effective first aid treatment with emphasis on the fact that the water should be cool (e.g. tap water temperature, 15–25 ºC) and not ice-cold (94) I-56 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-56 – PA365. Children with acute wheeze/asthma and bronchoconstriction should be treated with inhaled salbutamol using a metered dose inhaler with spacer devices to relieve bronchoconstriction. Oral salbutamol should not be used for treatment of acute or persistent wheeze except where inhaled salbutamol is not available. Oral salbutamol is not useful in testing response to bronchodilators (7,95) GRC-approved I-56 – PA448. [Composite] recommendations for Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach to basic emergency care, including response to anaphylaxis (43) GRC-approved I-56 – PA462. Health service delivery: develop capacity to provide fundamental emergency medical care within each school (25) SEE ALSO: I-82. Referral and support for management of suicide risk/self-harm Full GRC support SEE ALSO: I-85. Referral and support for management of harmful use of a substance (e.g. alcohol, illicit drugs) Full GRC support WHO guideline on school health services. Web Annex A. Compendium 55 I-57. Administration of over-the-counter and prescribed medications by a school health professional Essential everywhere Partial WHO support I-57 – WHO UHC menu (2.19 Draft). Chronic and palliative pain control and management (1) I-57– PA20. We recommend the use of syringes with a sharps injury protection feature, as opposed to syringes without a sharps injury protection feature, by health- care workers delivering intramuscular, subcutaneous or intradermal injectable medications to patients. We recommend the use of syringes with a reuse prevention feature (RUP devices), as opposed to devices without, by health-care workers delivering intramuscular, subcutaneous or intradermal injectable medications to patients (96) GRC-approved I-57 – PA24. It is recommended to use the analgesic treatment in two steps according to the child’s level of pain severity. Paracetamol and ibuprofen are the medicines of choice in the first step (mild pain). Both paracetamol and ibuprofen need to be made available for treatment in the first step (97) GRC-approved I-57 – PA25. The use of strong opioid analgesics is recommended for the relief of moderate to severe persisting pain in children with medical illnesses (97) GRC-approved I-57 – PA26. [Composite] recommendations for firstline opioid and possible adjuvant medicines in treatment of persisting moderate to severe pain (7) I-57 – PA28. The health facility has convenient operating hours, a welcoming and clean environment and maintains privacy and confidentiality. It has the equipment, medicines, supplies and technology needed to ensure effective service provision to adolescents (5) I-57 – PA36. Adequate stocks of child-friendly medicines and medical supplies are available for the routine care and management of acute and chronic childhood illnesses and conditions (2) Quality Statement 8.4 I-57 – PA193. Non-specialized health-care providers at the secondary level should consider initiating parent education/training before starting medication for a child who has been diagnosed as suffering from ADHD. Initial interventions may include cognitive behaviour therapy and social skills training if feasible (98) GRC-approved I-57 – PA230. In adolescents with psychotic disorders (including schizophrenia and bipolar disorder), certain second-generation antipsychotic medications (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone) can be offered as a treatment option under supervision of a specialist. If treatment with one of the above agents is not feasible, first-generation antipsychotics (haloperidol, chlorpromazine, perphenazine, molindone) may be used under supervision of a specialist (76) GRC-approved I-57 – PA252. [Composite] recommendations for type 2 diabetes medication and blood pressure (91) GRC-approved I-57 – PA258. Interventions to improve clinical care of adolescents with asthma prioritize increasing access to medicines and other cost-effective interventions and upgrading standards and accessibility of care at different levels of the health-care system (99) I-57 – PA269. [SHS] can include screening for indicators of malnutrition and health status, providing treatments such as micronutrient supplements and parasite medications, referring to appropriate nutritional and other services and supplying health and nutrition information to teachers and students to help them make healthy decisions and to educate others about healthy nutrition (44) I-57 – PA341. [Composite] recommendations to treat ear problems (acute otitis media and chronic suppurative otitis media) with antibiotics, antiseptics or steroids (95) GRC-approved 56 I-58. Referral and support for pain control and management, e.g. headache Essential everywhere Full WHO support I-58 – WHO UHC menu (2.19 Draft). Chronic and palliative pain control and management (1) I-58 – PA4. Management of other common conditions [in adolescents], e.g. abdominal pain, suspected anaemia, tiredness, headache (22) Primary care recommendation I-58 – PA23. Every child is assessed routinely for pain or symptoms of distress and receives appropriate management according to WHO guidelines (2) Quality Statement 6.3 I-58 – PA24. It is recommended to use the analgesic treatment in two steps according to the child’s level of pain severity. Paracetamol and ibuprofen are the medicines of choice in the first step (mild pain). Both paracetamol and ibuprofen need to be made available for treatment in the first step (97) GRC-approved I-58 – PA25. The use of strong opioid analgesics is recommended for the relief of moderate to severe persisting pain in children with medical illnesses (97) GRC-approved I-58 – PA26. [Composite] recommendations for first-line opioid and possible adjuvant medicines in treatment of persisting moderate to severe pain (7) I-58 – PA71. Management of menstrual conditions, i.e. period pain; heavy bleeding; irregular periods (22) Primary care recommendation I-58 – PA115. Management of genital conditions, i.e. foreskin problems; acute scrotal pain; penis discharge/pain on urination; genital ulcer; inguinal swelling; vaginal itching, burning or abnormal discharge (22) Primary care recommendation I-58 – PA207. The 2016 WHO mhGAP intervention guide recommends assessing comprehensively everyone presenting with thoughts, plans or acts of self-harm. The guide recommends asking any person over 10 years of age who is experiencing a priority mental, neurological or substance-use disorder – or chronic pain or acute emotional distress – about his or her thoughts, plans or acts related to self-harm and suicide (19) GRC-approved I-58 – PA303. Several easily performed first aid measures can decrease the pain and risk of death and disability for burn victims, … [e.g.] immediate application of cool water to burns should be promoted widely as an effective first aid treatment with emphasis on the fact that the water should be cool (e.g. tap water temperature, 15–25 ºC) and not ice-cold (94) I-59. Referral and support for management of non-specific symptoms (e.g. diarrhoea, fever) Essential everywhere Partial WHO support I-59 – WHO UHC menu (2.19 Draft). Case management of acute and persistent watery diarrhoea (1) I-59 – PA9. All children with diarrhoea are correctly assessed and classified and receive appropriate rehydration and care, including continued feeding, according to WHO guidelines (2) Quality Statement 1.4 I-59 – PA10. All children with fever are correctly assessed, classified and investigated and receive appropriate care according to WHO guidelines (2) Quality Statement 1.5 I-59 – PA336. Prevention and management of childhood illnesses including malaria, pneumonia, meningitis and diarrhoea (4,16) GSWCAH evidence-based CHD intervention WHO guideline on school health services. Web Annex A. Compendium 57 I-59. Referral and support for management of non-specific symptoms (e.g. diarrhoea, fever) contd Essential everywhere Partial WHO support I-59 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-59 – PA343. Low-osmolarity oral rehydration salts (ORS) is recommended for the treatment of dehydration or intravenous electrolyte solution in cases of severe dehydration, in HIV-infected and -exposed infants and children with diarrhoea. This recommendation is the same for all children (100) GRC-approved I-59 – PA344. Elemental zinc supplementation for 10–14 days is recommended, with increased fluids and continued feeding, for all HIV-infected and -exposed children with diarrhoea, at 10 mg/day for infants 2–6 months of age and 20 mg/day for infants and children > 6 months. This recommendation is the same for all children (100) GRC-approved I-59 – PA345. Children with diarrhoea and blood in stool (i.e. dysentery) should be treated with ciprofloxacin as a first line treatment. Ceftriaxone should be given as a second line treatment in severely ill children where local antimicrobial sensitivity is not known. ... Where local antimicrobial sensitivity is known, local guidelines should be followed (95) GRC-approved I-59 – PA357. Some schools provide health services related to the control and prevention of malaria. These services commonly include: mass treatment of fever when there are malaria epidemics; mass treatment of parasitological diseases such as lymphatic filariasis, onchocerciasis; immunization combining distribution of insecticide-treated nets; screening of health problems such as anaemia and malnutrition; school feeding in underprivileged and needy areas (26) I-60. Implementation of, and support for, a health-facility risk management plan linked with primary, secondary and tertiary care systems (e.g. protocol if school health services should provide essential services during complex emergencies) Essential everywhere Other WHO support I-60 – WHO UHC menu (2.19 Draft). Health promoting schools: school-based and school linked services (1) I-60 – WHO UHC menu (2.19 Draft). Health promoting schools: ensuring safe and health-promoting physical environment (1) I-60 – PA1. School health services help foster health and well-being as well as prevent, reduce, monitor, treat and refer health problems or conditions. In health- promoting schools, health services provide services, as possible, and make referrals, as needed. Health service providers should be included in the development or review of health-related policy, curricula and the planning of special events (17) I-60 – PA7. All children are triaged and promptly assessed for emergency and priority signs to determine whether they require resuscitation and receive appropriate care according to WHO guidelines (2) 58 I-60. Implementation of, and support for, a health-facility risk management plan linked with primary, secondary and tertiary care systems (e.g. protocol if school health services should provide essential services during complex emergencies) contd Essential everywhere Other WHO support I-60 – PA264. During a radiological or nuclear emergency, provision of iodine thyroid blocking to people who are at risk of being exposed to radioiodine should be implemented as an urgent protective action, within the frame of a justified and optimized protection strategy (101) I-60 – PA300. Pre-hospital care: standardize formal emergency medical services, including equipping vehicles with supplies and devices for children as well as adults. Where no pre-hospital trauma care system exists: teach interested community members basic first aid techniques; build on existing, informal systems of pre- hospital care and transport; and initiate emergency services on busy roads with high-frequency crash sites (4,40) I-60 – PA301. Survival after a [road] crash: trauma response that can accommodate the needs of children is required. This ranges from training teacher and school transport drivers in safe immediate stabilization of injuries; equipping emergency vehicles with child-sized medical equipment and supplies; and improving paediatric- specific rehabilitation services for children (45) I-60 – PA412. Develop and use a health and humanitarian risk assessments approach to identify priority needs and focus interventions (14,16) I-60 – PA413. In the event of humanitarian emergency, ensure deployment of essential health interventions. Adapt, implement and coordinate use of the minimum initial service package (14,16) I-60 – PA414. Public health, pre-hospital and facility-based clinical services must be well prepared to respond effectively in the event of an emergency with health consequences. They should have the capacity to scale up service delivery to meet increased health needs (e.g. through increasing bed capacity, establishing temporary facilities or mobile clinics, vaccination campaigns) and to take specific measures related to certain hazards (e.g. isolation of infectious cases). A range of health-care disciplines contribute to health emergency and disaster risk management and to building resilience of communities and countries, including preventing and mitigating risk, preparedness, response and recovery. As far as possible, representatives from the various disciplines should contribute to risk and capacity assessments, planning, implementation and monitoring and evaluation (102) I-60 – PA415. Every child with condition(s) that cannot be managed effectively with the available resources receives appropriate, timely referral, with seamless continuity of care (2) I-60 – PA445. Establish, or critically review, school health programmes to address priorities (e.g. NCDs, SRH, communicable diseases and violence) in an integrated way. … [Including] f. School health services (school-based or school-linked) to provide a continuum of health promotion, prevention and early detection and referral services, either within school premises or by linking with services elsewhere in the community. School health services should be mandated by a formal arrangement between the educational institution and the provider health-care organization (4) Key area for programming I-60 – PA462. Health service delivery: develop capacity to provide fundamental emergency medical care within each school (25) WHO guideline on school health services. Web Annex A. Compendium 59 I-60. Implementation of, and support for, a health-facility risk management plan linked with primary, secondary and tertiary care systems (e.g. protocol if school health services should provide essential services during complex emergencies) contd Essential everywhere Other WHO support I-60 – PA527. [In the COVID-19 context] design alternative strategies to safeguard schoolchildren’s food security and nutrition, for example, by providing micronutrient supplements, take-home rations, deworming medicines (as applicable), cash- based transfers to families with schoolchildren and food voucher assistance. Put in place alternative modalities for food collection, such as the ability to pick up meals and snacks at distribution points, including at otherwise-closed schools. Build upon existing safety-net structures to ensure vulnerable schoolchildren are cared for. Reinstate and continue the provision of essential school health and nutrition packages. Create contingency plans for the distribution of meals or food baskets during school closures (10) I-60 – PA528. [In the COVID-19 context] create contingency plans to provide mental health services during school closures for students who mainly rely on school- based services. Consider using digital platforms to provide psychosocial support and for early detection and management of mental health conditions. Use remote socioemotional learning programmes and strengthen the capacities of schools, mental health staff and youth champions to deliver them remotely. Intensify classroom-based socioemotional learning after schools reopen. Follow up with school drop-outs to institute support mechanisms (10) I-60 – PA530. [In the COVID-19 context] enhance engagement with governmental and NGO [nongovernmental organization] actors to mobilize social and resources to support people with mental, neurological and substance use disorders (e.g. at home and in schools, care homes and prisons) and ensure that people with severe mental, neurological and substance use disorders have access to services that address their basic needs. Modify school mental health services to be delivered through online platforms. Consider the long-term effects of the COVID-19 response on high-risk groups (e.g. those with pre-existing mental, neurological and substance use disorders, older persons, women, young people, children); enhance cross-sectoral services (10) I-60 – PA531. [Composite] recommendations for schooling during the COVID-19 pandemic including those specific to: hygiene and daily practices at school (i.e. hygiene and environmental cleaning to limit exposure; screening and management of sick students, teachers and other school staff; communication with parents and students; additional school-related measures); physical distancing and tele- schooling (i.e. physical distancing at school; tele-schooling and distance learning); and monitoring of schools after re-opening (55) I-61. Referral and support for management of common infections (e.g. ear, eye oral/dental, skin, throat, urinary tract) Essential everywhere Partial WHO support I-61 – WHO UHC menu (2.19 Draft). Case management of ear infections (1) I-61 – WHO UHC menu (2.19 Draft). Case management of urinary tract infection (1) I-61 – WHO UHC menu (2.19 Draft). Case management of throat infection (tonsillitis) (1) I-61 – WHO UHC menu (2.19 Draft). Case management of eye infections (1) I-61 – WHO UHC menu (2.19 Draft). Treatment of common skin infections in children (1) I-61 – PA18. All sick children, especially those who are most seriously ill, are adequately monitored, reassessed periodically and receive supportive care according to WHO guidelines (2) Quality Statement 1.13 60 I-61. Referral and support for management of common infections (e.g. ear, eye oral/dental, skin, throat, urinary tract) contd Essential everywhere Partial WHO support I-61 – PA19. All children receive care with standard precautions to prevent health- care-associated infections (2) Quality Statement 1.14 I-61 – PA233. Management of vision problems (22) Primary care recommendation I-61 – PA234. Comprehensive eye care aims to ensure that people have access to eye care services that meet their needs at every stage of life. This includes not only prevention and treatment services, but also vision rehabilitation. Comprehensive eye care also aims to address the full spectrum of eye diseases. ... Early diagnosis and treatment [for children] are critical in preventing vision impairment (50) I-61 – PA241. Management of skin problems (22) Primary care recommendation I-61 – PA242. [Consolidated] guidance on diagnosis, treatment and management of acne, different kinds of eczema and other skin conditions, including key clinical features and treatment for severe, moderate and mild forms of these conditions (4,71) I-61 – PA341. [Composite] recommendations to treat ear problems (acute otitis media and chronic suppurative otitis media) with antibiotics, antiseptics or steroids (95) GRC-approved I-62. Referral and support for management of less common infectious diseases (e.g. bone infections, cholera, dengue, dysentery, helminths, joint infections, malaria, meningitis, other neglected tropical diseases, pertussis, pneumonia, rheumatic fever, septicaemia, typhoid fever, tuberculosis, viral encephalitis) Essential everywhere Partial WHO support I-62 – WHO UHC menu (2.19 Draft). Case management of bone infections (1) I-62 – WHO UHC menu (2.19 Draft). Case management of joint infections (1) I-62 – WHO UHC menu (2.19 Draft). Case management of dengue (1) I-62 – WHO UHC menu (2.19 Draft). Case management of rheumatic fever (1) I-62 – WHO UHC menu (2.19 Draft). Management of common helminths (1) I-62 – WHO UHC menu (2.19 Draft). Anthelmintic treatment (1) I-62 – PA18. All sick children, especially those who are most seriously ill, are adequately monitored, reassessed periodically and receive supportive care according to WHO guidelines (2) Quality Statement 1.13 I-62 – PA19. All children receive care with standard precautions to prevent health- care-associated infections (2) Quality Statement 1.14 I-62 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) WHO guideline on school health services. Web Annex A. Compendium 61 I-62. Referral and support for management of less common infectious diseases (e.g. bone infections, cholera, dengue, dysentery, helminths, joint infections, malaria, meningitis, other neglected tropical diseases, pertussis, pneumonia, rheumatic fever, septicaemia, typhoid fever, tuberculosis, viral encephalitis) contd Essential everywhere Partial WHO support I-62 - PA339. Schools should treat when possible helminth, malarial, skin and respiratory infections, as well as other infectious diseases (11) I-62 – PA340. [WHO guideline update on nonpharmaceutical interventions for influenza and standard guideline for the clinical management of severe influenza virus infection in development] I-62 – PA350. [WHO guidelines on diagnosis and treatment guidelines for Taenia solium neurocysticercosis in development] I-62 – PA352. Recognize neglected tropical diseases through changes on the skin (103) I-62 – PA353. Recommendations on diagnosis, treatment and chemoprophylaxis of leprosy (104) GRC-approved I-62 - PA354. [WHO guidelines on the diagnosis, treatment and prevention of leprosy in development] I-62 - PA355. [To treat yaws] WHO recommends a single dose of oral azithromycin (30 mg/kg body weight), which is to be used in the new treatment policies, during the initial campaign of total community treatment, followed by total targeted treatment (105) I-62 - PA356. No GRC-approved recommendations currently exist related to dengue and children. Guidance on this topic is in the process of being updated. Meanwhile, the guidance in Dengue: guidelines for diagnosis, treatment, prevention and control (106) may be used (7) I-62 – PA359. All cases of suspected malaria should have a parasitological test (microscopy or malaria rapid diagnostic test) to confirm the diagnosis. Both microscopy and malaria rapid diagnostic tests should be supported by a quality assurance programme (7,67) GRC-approved I-62 – PA360. Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the recommended artemisinin-based combination therapies (7,14,67) GRC-approved I-62 – PA361. [Composite] recommendations for reducing transmissibility, treating special risk groups, treatment of other forms of uncomplicated malaria and preventing relapse (7,14) GRC-approved I-62 – PA362. [Composite] recommendations for treatment of severe malaria, including pre-referral treatment (7,14) GRC-approved I-62 – PA363. Diagnostic testing and treatment for malaria should be deployed as part of programmes promoting the integrated management of febrile childhood and adult illnesses. Evidence and lessons learnt from implementation should be taken into account in scaling-up integrated community case management (iCCM) at community level and integrated management of childhood illness and integrated management of adolescent and adult illness at health facility level. The essential elements of the generic iCCM algorithm should remain unchanged in country adaptations (14,107) GRC-approved I-62 – PA364. Children with non-severe pneumonia (i.e. fast breathing with no chest indrawing or danger sign) should be treated with oral amoxicillin. The exception is in patients with HIV. … Children with non-severe pneumonia who fail on the first line treatment with amoxicillin should have the option of referral to a facility where there is appropriate second line treatment (7,95) GRC-approved 62 I-62. Referral and support for management of less common infectious diseases (e.g. bone infections, cholera, dengue, dysentery, helminths, joint infections, malaria, meningitis, other neglected tropical diseases, pertussis, pneumonia, rheumatic fever, septicaemia, typhoid fever, tuberculosis, viral encephalitis) contd Essential everywhere Partial WHO support I-62 – PA365. Children with acute wheeze/asthma and bronchoconstriction should be treated with inhaled salbutamol using a metered dose inhaler with spacer devices to relieve bronchoconstriction. Oral salbutamol should not be used for treatment of acute or persistent wheeze except where inhaled salbutamol is not available. Oral salbutamol is not useful in testing response to bronchodilators (7,95) GRC-approved I-62 – PA366. Other [composite] recommendations for management of pneumonia and other respiratory illnesses (e.g. non-severe with wheeze; severe; very severe) (7) GRC-approved I-62 – PA367. [Composite] recommendations for treatment of TB in children (7,108) GRC-approved I-62 – PA368. [Composite] recommendations for diagnosis of pulmonary TB, rifampicin resistance and extrapulmonary TB in children (7,108) [WHO guidelines on infection prevention and control for pulmonary TB are in development] GRC-approved I-62 – PA369. Other [composite] recommendations for TB management (e.g. in children living with HIV; drug-resistant TB; and nutritional and care support) (7,15) GRC-approved I-62 – PA372. No GRC-approved recommendations related to treatment of measles currently exist. Guidance on this topic is in the process of being updated. Meanwhile, the guidance on treating measles in children (109) may be used (7) I-62 – PA373. [Composite] recommendations for treatment of acute bacterial meningitis (7,95) GRC-approved I-62 – PA374. No GRC-approved recommendations for septicaemia currently exist. Guidance on this topic is in the process of being updated (7) I-62 - PA375. [Composite] recommendations for treatment of typhoid fever (7,95) GRC-approved I-63. Management of infectious disease outbreaks in school, including surveillance, reporting suspected outbreaks to health authorities and following isolation or quarantine protocols (e.g. cholera; conjunctivitis; coronaviruses; dysentery; hand, foot and mouth disease; influenza; meningococcal disease; rubella; scabies; scarlet fever; tuberculosis; typhoid; varicella) Essential everywhere Partial WHO support I-63 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-63 – PA370. [Composite] recommendations for investigating household and close contacts of an index case for active TB (7) GRC-approved I-63 – PA376. [Composite] recommendations to prevent virus exposure among health workers providing clinical care to patients with known or suspected filovirus disease (110) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 63 I-63. Management of infectious disease outbreaks in school, including surveillance, reporting suspected outbreaks to health authorities and following isolation or quarantine protocols (e.g. cholera; conjunctivitis; coronaviruses; dysentery; hand, foot and mouth disease; influenza; meningococcal disease; rubella; scabies; scarlet fever; tuberculosis; typhoid; varicella) contd Essential everywhere Partial WHO support I-63 – PA498. [Composite] recommendations for managing epidemics (i.e. ebola virus disease, lassa fever, Crimean-Congo haemorrhagic fever, yellow fever, zika, chikungunya, avian and other zoonotic influenza, seasonal influenza, pandemic influenza, Middle East respiratory syndrome , cholera, monkeypox, plague, leptospirosis, meningococcal meningitis) (111) I-63 – PA499. During [a seasonal influenza] epidemic, to reduce transmission: school closures have the greatest benefit when applied early in the course of the outbreak. The benefit has to be weighed against the cost of disruption (111) I-63 – PA500. Public health, pre-hospital and facility-based clinical services must be well prepared to respond effectively in the event of an emergency with health consequences. They should have the capacity to scale up service delivery to meet increased health needs (e.g. through increasing bed capacity, establishing temporary facilities or mobile clinics, vaccination campaigns) and to take specific measures related to certain hazards (e.g. isolation of infectious cases) (102) I-63 – PA501. Health and related services (before, during and after emergencies, including routine, emergency and surge): public health measures: societal measures, e.g. quarantine, school closures, cancellation of mass gatherings (102) I-63 – PA502. [Composite] recommendations for surveillance, investigation and control measures for food-borne disease outbreaks (112) I-63 – PA503. [In response to a meningitis outbreak in sub-Saharan Africa] Special situations such as mass gatherings, refugees, displaced persons or closed institutions such as schools or barracks. An immediate response, including mass vaccination, is recommended when two cases of meningococcal disease are confirmed in one week (54) GRC-approved I-63 – PA504. [Composite] recommendations for a measles outbreak, including: [when an outbreak is suspected] at the health-facility level, measles surveillance should be intensified to actively seek additional cases (113) I-63 – PA505. [Composite] recommendations for a cholera outbreak, including: when the case-fatality is high (> 1%), it indicates … that people arrive too late at health care centres (establish community cholera treatment units, e.g. in schools, promote early use of ORS) (114) I-63 – PA506. [Composite] recommendations for a possible outbreak of acute diarrhoea, including: protecting the community, treating the patient, informing and asking for help (115) I-63 – PA526. [In the COVID-19 context] broadcast educational programmes on TV and radio during school closures. Once schools reopen and community gatherings are permissible, design tailored catch-up strategies, especially for students with particular vulnerabilities. Prepare for reopening with adequate preparations for infection prevention and control. Assess the impact of differential access to health information and education during school closures (10) I-63 – PA531. [Composite] recommendations for schooling during the COVID-19 pandemic including those specific to: hygiene and daily practices at school (i.e. hygiene and environmental cleaning to limit exposure; screening and management of sick students, teachers and other school staff; communication with parents and students; additional school-related measures); physical distancing and tele- schooling (i.e. physical distancing at school; tele-schooling and distance learning); and monitoring of schools after re-opening (55) 64 I-64. Referral and support for chronic care of HIV-infected children Essential everywhere Full WHO support I-64 – WHO UHC menu (2.19 Draft). Antiretroviral therapy (ART) and comprehensive care of HIV exposed or infected children (1) I-64 – WHO UHC menu (2.19 Draft). Management of opportunistic infections associated with HIV/AIDS (1) I-64 – WHO UHC menu (2.19 Draft). Chronic care for HIV-infected children (1) I-64 – WHO UHC menu (2.19 Draft). Cotrimoxazole prophylaxis for HIV-infected and exposed children (1) I-64 – PA100. All adult and adolescent women from key populations who are living with HIV and are pregnant should receive appropriate HIV treatment and care, in line with WHO guidance, to prevent HIV transmission from mother to child (31) GRC-approved I-64 – PA111. Effective [STI transmission and acquisition] prevention requires ensuring access to vital information, commodities (such as condoms) and services (such as vaccination, voluntary medical male circumcision, testing, treatment and care) within a human rights framework. Alongside that, behaviour interventions are critically important for sexually transmitted infection prevention including HIV and include: the promotion of consistent use of male and female condoms; education including a focus on increasing awareness of sexually transmitted infections; reduction in the number of sexual partners; increased uptake of testing for sexually transmitted infections, including HIV; delayed sexual debut; as well as the promotion of sexual well-being. Many such interventions have the dual advantage of preventing sexually transmitted infections, including HIV and unintended pregnancies, in particular through the use of condoms by adolescents. Focusing the interventions appropriately for specific populations (including key populations for HIV), adolescents and pregnant women is a priority (4,30) I-64 – PA116. [School] health workers could: 1. Be alert to the possibility of the presence of health problems, (such as sexually transmitted diseases) and/or unhealthy practices (such as injecting drug use) and detect them early, if and when they arise. 2. Appropriately manage STI and/or HIV-related problems, to the best of their abilities and based on the facilities available at their disposal. This could include providing medical treatment, responding to the child’s/adolescent’s psychological needs and helping them deal with the social implications of their conditions. 3. Refer students and school personnel to the next “level” of health service delivery and/or to organizations which provide relevant support services, such as counselling and social support in the areas of adolescent development, sexuality, peer pressure, identify formation, illness and death, if and when available. 4. Answer questions of students and school personnel about the need for and value of HIV-antibody testing. As necessary and if available, refer students and staff to an appropriate and confidential facility that provides pre- and post-test counselling. Counselling about HIV-antibody testing requires the services of support staff and professionals who are trained and experienced in dealing specifically with the issues involved. 5. Observe confidentiality with respect to infected students and school personnel and disclose information to staff on a need-to-know basis only. 6. Support the education and employment rights of HIV-infected students and staff by assuring concerned officials and others that HIV infected students and staff pose virtually no health threat to students and school personnel when they attend classes or work in the school (35) I-64 – PA143. Children of school age should be told their HIV-positive status and their parents or caregiver’s status (73) GRC-approved I-64 – PA144. Adolescents with HIV should be counselled about the potential benefits and risks of disclosure of their HIV status and empowered and supported to determine if, when, how and to whom to disclose (73) GRC-approved I-64 – PA146. [Composite] recommendations of interventions to ensure linkage from diagnosis to care; CD4 cell counting at point of care; and laboratory connectivity (73) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 65 I-64. Referral and support for chronic care of HIV-infected children contd Essential everywhere Full WHO support I-64 – PA147. REC A.7: trained and supervised lay providers can distribute ART to adults, adolescents and children living with HIV (116) GRC-approved I-64 – PA148. [Composite] recommendations on when to start ART in children [adolescents] and first-line, second-line and third-line ART (< 3 years, 3–10 years, 10–19 years) (73) GRC-approved I-64 – PA150. Training of health-care workers can contribute to treatment adherence and retention in care of [children] adolescents living with HIV. Health-care providers can support adherence among adolescents by: assisting them in exploring factors influencing their adherence; improving their understanding of HIV, ART and adherence; recognizing developmental needs while supporting their emerging independence; assisting them in integrating ART into daily life; offering simplified ART regimes; encouraging participation in peer support groups and community-based interventions (31) GRC-approved I-64 – PA151. Current WHO guidance on the use of ART for treatment of HIV infection in adults and adolescents applies to people living with HIV who inject drugs (31) GRC-approved I-64 – PA152. REC A.1: adolescent-friendly health services should be implemented in HIV services to ensure engagement and improved outcomes (116) GRC-approved I-64 – PA153. Peer support groups and safe spaces can help improve self-esteem and address self-stigma. Additionally, individual and family counselling can address adolescents’ mental health co-morbidities. The involvement of supportive parents or guardians can be beneficial, especially for those requiring ongoing treatment and care. It is important, however, to have the adolescent’s express permission before contacting parents or caregivers (73) GRC-approved I-64 – PA154-PA164 (inclusive) and PA294, PA343, PA364, PA369, PA387, PA392, PA395, PA401. [Composite] recommendations related to HIV care and treatment for children and adolescents living with HIV related to: human papillomavirus screening, skin and oral HIV-associated conditions, TB, poor weight gain, fever, cough, malnutrition, nutrition assessment and care, epilepsy, diarrhoea and immunizations (7,15,73,95,100,117–121) GRC-approved I-65. Referral and support for management of anaemia (e.g. iron supplementation) Essential everywhere Partial WHO support I-65 – WHO UHC menu (2.19 Draft). Case management of severe and moderate anaemia (1) I-65 – PA4. Management of other common conditions [in adolescents], e.g. abdominal pain, suspected anaemia, tiredness, headache (22) Primary Care Recommendation I-65 – PA12. All children at risk for acute malnutrition and anaemia are correctly assessed and classified and receive appropriate care according to WHO guidelines (2) Quality Statement 1.7 66 I-65. Referral and support for management of anaemia (e.g. iron supplementation) contd Essential everywhere Partial WHO support I-65 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-65 – PA285. Daily iron supplementation is recommended as a public health intervention in school-age children aged 60 months and older, living in settings where anaemia is highly prevalent, for preventing iron deficiency and anaemia. Suggested supplementation scheme: 30–60 mg elemental iron given daily for 3 consecutive months in a year (68) GRC-approved I-65 – PA286. Intermittent iron supplementation is recommended as a public health intervention in preschool and school-age children to improve iron status and reduce the risk of anaemia in settings where the prevalence of anaemia in preschool or school-age children is 20% or higher (69) GRC-approved I-65 – PA287. Daily iron supplementation is recommended as a public health intervention in menstruating adult women and adolescent girls, living in settings where anaemia is highly prevalent (≥ 40% anaemia prevalence), for the prevention of anaemia and iron deficiency (69) GRC-approved I-65 – PA288. Intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women living in settings where anaemia is highly prevalent, to improve their haemoglobin concentrations and iron status and reduce the risk of anaemia (69) GRC-approved I-65 – PA289. In populations where anaemia is a public health problem, point-of-use fortification of foods with iron-containing micronutrient powders in children aged 2–12 years is recommended, to improve iron status and reduce anaemia (70) GRC-approved I-65 – PA290. In malaria-endemic areas, the provision of iron supplementation in infants and children should be done in conjunction with public health measures to prevent, diagnose and treat malaria (68) GRC-approved I-65 – PA357. Some schools provide health services related to the control and prevention of malaria. These services commonly include: mass treatment of fever when there are malaria epidemics; mass treatment of parasitological diseases such as lymphatic filariasis, onchocerciasis; immunization combining distribution of insecticide-treated nets; screening of health problems such as anaemia and malnutrition; school feeding in underprivileged and needy areas (26) I-65 – PA527. [In the COVID-19 context] design alternative strategies to safeguard schoolchildren’s food security and nutrition, for example, by providing micronutrient supplements, take-home rations, deworming medicines (as applicable), cash- based transfers to families with schoolchildren and food voucher assistance. Put in place alternative modalities for food collection, such as the ability to pick up meals and snacks at distribution points, including at otherwise-closed schools. Build upon existing safety-net structures to ensure vulnerable schoolchildren are cared for. Reinstate and continue the provision of essential school health and nutrition packages. Create contingency plans for the distribution of meals or food baskets during school closures (10) WHO guideline on school health services. Web Annex A. Compendium 67 I-66. Referral and support for overweight and obesity Essential everywhere Full WHO support I-66 – WHO UHC menu (2.19 Draft). Appropriate counselling on nutrition and physical activity and management plan for obese children (1) I-66 – PA251. [Composite] recommendations for type 2 diabetes behaviour change, i.e. advise overweight patients to reduce weight by reducing their food intake; advise all patients to give preference to low glycaemic-index foods (beans, lentils, oats and unsweetened fruit) as the source of carbohydrates in their diet; advise all patients to practice regular daily physical activity appropriate for their physical capabilities (e.g. walking) (91) GRC-approved I-66 – PA274. Primary health care interventions targeting chronic NCD risk groups that: include persons who are inactive, consume less than five servings of fruits and vegetables daily, consume a lot of dietary fat, are overweight or have a family history of obesity, heart disease, cancer and/or type 2 diabetes (13) GRC-approved I-66 – PA275. Primary health care interventions targeting chronic NCD risk groups that include at least one session (health risk appraisal) with a health-care professional, with brief negotiation or discussion to decide on reasonable, attainable goals and a follow-up consultation with trained personnel (13) GRC-approved I-66 – PA276. Primary health care interventions targeting chronic NCD risk groups that are supported by targeted information (13) GRC-approved I-66 – PA277. Primary health care interventions targeting chronic NCD risk groups that are linked and/or coordinated with other stakeholders such as community sports organizations or ongoing mass media physical activity campaigns (13) GRC-approved I-66 – PA278. Primary health care cholesterol screening programmes that provide clients with their results and follow up education, ideally in person (13) GRC-approved I-66 – PA279. Primary health care weight loss programmes using health professionals with personal or telephone/Internet consultations over a period of at least four weeks and, a self-help programme that includes self-monitoring (13) GRC-approved I-66 – PA280. Develop and support appropriate weight management services for children and adolescents who are overweight or obese that are family-based, multi- component (including nutrition, physical activity and psychosocial support) and delivered by multi-professional teams with appropriate training and resources, as part of UHC (6) I-66 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) 68 I-67. Referral and support for management of asthma Essential everywhere Full WHO support I-67 – WHO UHC menu (2.19 Draft). Case management of acute and chronic asthma (1) I-67 – PA256. [Composite] recommendations for management of stable asthma (91) GRC-approved I-67 – PA257. [Composite] recommendations for management of exacerbation of asthma (91) GRC-approved I-67 – PA258. Interventions to improve clinical care of adolescents with asthma prioritize increasing access to medicines and other cost-effective interventions and upgrading standards and accessibility of care at different levels of the health-care system (99) I-67 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-67 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-67 – PA365. Children with acute wheeze/asthma and bronchoconstriction should be treated with inhaled salbutamol using a metered dose inhaler with spacer devices to relieve bronchoconstriction. Oral salbutamol should not be used for treatment of acute or persistent wheeze except where inhaled salbutamol is not available. Oral salbutamol is not useful in testing response to bronchodilators (7,95) GRC-approved I-68. Referral and support for management of other chronic conditions (e.g. developmental disabilities/delay, diabetes, heart disease, seizures, sickle cell disease) Essential everywhere Partial WHO support I-68 – WHO UHC menu (2.19 Draft). Case management of rheumatic heart disease (1) I-68 – WHO UHC menu (2.19 Draft). Case management of congenital heart disease (1) I-68 – WHO UHC menu (2.19 Draft). Case management of acute and chronic seizures in children (1) I-68 – WHO UHC menu (2.19 Draft). Case management of sickle cell disease (1) WHO guideline on school health services. Web Annex A. Compendium 69 I-68. Referral and support for management of other chronic conditions (e.g. developmental disabilities/delay, diabetes, heart disease, seizures, sickle cell disease) contd Essential everywhere Partial WHO support I-68 – WHO UHC menu (2.19 Draft). Case management of diabetes in children (1) I-68 – WHO UHC menu (2.19 Draft). Treatment and rehabilitative care for children with congenital abnormalities and disabilities (1) I-68 – PA15. All children with chronic conditions receive appropriate care and they and their families are sufficiently informed about their condition(s) and are supported to optimize their health, development and quality of life (2) Quality Statement 1.10 I-68 – PA186. Psychoeducation for developmental delay/disorder (19) GRC-approved I-68 – PA187. Management of child/adolescent developmental delay/disorder (non- specialized health setting protocol) (19) GRC-approved I-68 – PA188. Care for children with developmental delays (16) GSWCAH evidence-based CHD intervention I-68 – PA189. Caregiver skills training should be provided for management of children and adolescents with developmental disorders, including intellectual disabilities and pervasive developmental disorders (including autism) (77) GRC-approved I-68 – PA190. No GRC-approved recommendations specific to children currently exist for development disorders. Guidance on this topic is in the process of being updated (7) I-68 – PA250. Point of care devices can be used in diagnosing [type 2] diabetes if laboratory services are not available (93) GRC-approved I-68 – PA251. [Composite] recommendations for type 2 diabetes behaviour change, i.e. advise overweight patients to reduce weight by reducing their food intake; advise all patients to give preference to low glycaemic-index foods (beans, lentils, oats and unsweetened fruit) as the source of carbohydrates in their diet; advise all patients to practice regular daily physical activity appropriate for their physical capabilities (e.g. walking) (91) GRC-approved I-68 – PA252. [Composite] recommendations for type 2 diabetes medication and blood pressure (91) GRC-approved I-68 – PA253. [Composite] recommendations for additional assessments for people with type 2 diabetes (e.g. feet at risk of ulcers; diabetic retinopathy) (91) GRC-approved I-68 – PA254. [WHO guidelines on classification and diagnostic criteria for diabetes mellitus and intermediate hyperglycaemia in development] I-68 – PA259. When IV access is not available for the control of acute seizures in children, nonparenteral routes of administration of benzodiazepines should be used. Options include rectal diazepam oral or intranasal midazolam and rectal or intranasal lorazepam. Some benzodiazepines (lorazepam and midazolam) may be given intramuscularly; this requires additional expertise and expense. The preference may be guided by availability, expertise and social preference (7,92) GRC-approved Recommendation 3.1 I-68 – PA260. For children presenting with acute seizures where IV administration is available, IV diazepam or IV lorazepam should be used to terminate the seizure (7,92) GRC-approved Recommendation 3.2 I-68 – PA261. [Composite] recommendations for second-line anticonvulsant medicines for children with established status epilepticus resistant to first-line benzodiazepines (92) GRC-approved Recommendations 3.3–3.8 I-68 – PA262. [No current WHO guidance on health promotion, prevention or treatment for children affected by sickle cell disease] 70 I-68. Referral and support for management of other chronic conditions (e.g. developmental disabilities/delay, diabetes, heart disease, seizures, sickle cell disease) contd Essential everywhere Partial WHO support I-68 - PA274. Primary health-care interventions targeting chronic NCD risk groups that: include persons who are inactive, consume less than five servings of fruits and vegetables daily, consume a lot of dietary fat, are overweight or have a family history of obesity, heart disease, cancer and/or type 2 diabetes (13) GRC-approved I-68 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-68 – PA410. [As part of] parental psychoeducation for an adolescent with developmental delay or disorder … Keep the environment stimulating – avoid leaving the adolescent alone for hours without someone to talk to, ensure the adolescent spends time outdoors and limit time spent watching TV and playing electronic games (19) GRC-approved I-68 – PA435. Address the needs of students with chronic conditions and disabilities, by adapting buildings and classrooms to their special needs; creating inclusive, learning-friendly environments; and by strengthening linkages with health services for early diagnosis and interventions (4) Key area for programming I-68 – PA507. Primary health care services have an important role to play in early detection and facilitation of coordinated care and support [of autism spectrum disorders and other developmental disorders]. Collaborative models of care and task-sharing approaches are recommended, with multidisciplinary community- based teams assuming tasks related to assessment, management and follow up in consultation with specialists at secondary care levels (49) I-68 – PA511. Holistic and intersectoral approaches to health promotion, care and rehabilitation that facilitate optimal functioning and psychosocial well-being of people with autism spectrum disorders (ASDs), with the involvement of multiple public sectors, including health, education, social welfare and labour, are recommended (49) I-68 – PA512. Individualized management plans should be the norm, based on assessment and monitoring of evolving needs and functioning, with involvement of people with ASDs and their carers, as appropriate, following procedures of informed decision-making (49) I-69. Referral and support for rehabilitation, habilitation, assistive technology, assistance and support services for injured or disabled individuals (e.g. those who are visually or hearing impaired or have eye/ear problems, who have physical disabilities or motor disorders, who have experienced female genital mutilation (FGM) or who have sports injuries) Essential everywhere Partial WHO support I-69 – WHO UHC menu (2.19 Draft). Case management of common childhood injuries (wounds, fractures, head, chest and abdominal injuries) (1) WHO guideline on school health services. Web Annex A. Compendium 71 I-69. Referral and support for rehabilitation, habilitation, assistive technology, assistance and support services for injured or disabled individuals (e.g. those who are visually or hearing impaired or have eye/ear problems, who have physical disabilities or motor disorders, who have experienced female genital mutilation (FGM) or who have sports injuries) contd Essential everywhere Partial WHO support I-69 – WHO UHC menu (2.19 Draft). Treatment and rehabilitative care for children with congenital abnormalities and disabilities (1) I-69 – PA103. Information regarding different types of FGM and the associated respective immediate and long-term health risks should be provided to health-care providers who care for girls and women living with FGM (122) GRC-approved Best Practice Statement 7 I-69 – PA105. Offer deinfibulation for preventing and treating urological complications, specifically recurrent urinary tract infections and urinary retention, in girls and women living with type III FGM (122) GRC-approved Recommendation 3 I-69 – PA106. Consider cognitive behavioural therapy for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression or post-traumatic stress disorder (PTSD) (122) GRC-approved Recommendation 4 I-69 – PA107. [Composite] recommendations for preventing and treating obstetric complications and sexual dysfunction in women living with FGM (122) GRC-approved Recommendations 1, 2 and 5 I-69 – PA234. Comprehensive eye care aims to ensure that people have access to eye care services that meet their needs at every stage of life. This includes not only prevention and treatment services, but also vision rehabilitation. Comprehensive eye care also aims to address the full spectrum of eye diseases. ... Early diagnosis and treatment [for children] are critical in preventing vision impairment (50) I-69 – PA235. Implement school-based hearing screening with the aim to identify, refer and manage common ear diseases and hearing loss. Integrate hearing screening into school health programmes and develop linkages for provision of suitable care: medical, surgical and rehabilitative (51,52) I-69 – PA240. The guidelines recommend that priority for hearing aids and services should be given to children with an average hearing impairment in the range of 31 to 80 dBHL in the better ear in the frequency range 500 Hz to 4 kHz, followed by adults (53) I-69 – PA244. Treatment and rehabilitation of children with congenital abnormalities and disabilities (16) GSWCAH evidence-based CHD intervention I-69 – PA246. Invest in specific programmes and services for people with disabilities (e.g. In addition to mainstream services, some people with disabilities may require access to specific measures, such as rehabilitation, support services or training. Rehabilitation – including assistive technologies such as wheelchairs, hearing aids and white canes – improves functioning and independence. A range of well- regulated assistance and support services in the community can meet needs for care, enabling people to live independently and to participate in the economic, social and cultural lives of their communities. … While there is a need for more services, there is also a need for better, more accessible, flexible, integrated and well-coordinated multidisciplinary services, particularly at times of transition such as between child and adult services) (123) GRC-approved I-69 – PA249. Actions to remove barriers and improve access to health services and to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services and community-based rehabilitation for all people with disabilities, including adolescents (124) I-69 – PA301. Survival after a [road] crash: trauma response that can accommodate the needs of children is required. This ranges from training teacher and school transport drivers in safe immediate stabilization of injuries; equipping emergency vehicles with child-sized medical equipment and supplies; and improving paediatric- specific rehabilitation services for children (45) 72 I-69. Referral and support for rehabilitation, habilitation, assistive technology, assistance and support services for injured or disabled individuals (e.g. those who are visually or hearing impaired or have eye/ear problems, who have physical disabilities or motor disorders, who have experienced female genital mutilation (FGM) or who have sports injuries) contd Essential everywhere Partial WHO support I-69 – PA331. Adolescents with disabilities are more likely than other adolescents to experience abuse, including sexual abuse, so clinicians should be aware of the signs and symptoms and assess this possibility (4,123) GRC-approved I-69 – PA435. Address the needs of students with chronic conditions and disabilities, by adapting buildings and classrooms to their special needs; creating inclusive, learning-friendly environments; and by strengthening linkages with health services for early diagnosis and interventions (4) Key area for programming I-69 – PA465. Even if screen-positive children with mild to moderate levels of hearing impairment are not referred, they can at least be targeted for simple classroom measures to improve school progress, so that the level of awareness generally in the school and community will also be raised (46) I-69 – PA467. Expansion of services [for ear diseases and hearing impairment] may be required and this will depend on the numbers of persons in the population estimated and found to have remediable or avoidable ear disease and/or deafness and hearing impairment. This information will ideally be obtained from a population- based prevalence and causes survey. The primary level services would include components on prevention, basic management and referral of ear diseases and hearing impairment (46) I-70. Referral and support for management of common childhood injuries (e.g. head, chest and abdominal injuries; fractures; wounds) Essential everywhere Full WHO support I-70 – PA281. School health services should: 1. Collaborate with the physical education component of the school to regularly assess physical activity levels and fitness. 2. Collect medical information from students and parents that is relevant to participation in physical activity. 3. Provide such information (when necessary and in accordance with parental or guardian permission) to the physical education teachers and other appropriate staff members. 4. Identify inactive students and provide them with counselling. 5. Encourage active students to maintain their current activities. 6. Make recommendations about physical activity for students with disorders and conditions such as anaemia, diabetes, asthma, obesity and heart diseases and refer them, as necessary, to appropriate health services providers within the community. 7. Promote physical activity to students and their families through individual counselling, small group discussions and by distributing educational materials. 8. Collaborate with school policy makers, teachers and administrators to develop safety standards and ensure that first aid is available for injuries that might result from physical activity (17) I-70 – PA295. Integrate child injury into a comprehensive approach to child health and development, e.g. existing child survival programmes need to introduce child injury prevention strategies as part of the basic package of child health services (37) GRC-approved I-70 – PA296. Implement specific actions to prevent and control child injuries, e.g. immediate resuscitation in response to drowning; appropriate paediatric acute care in response to a fall (37) GRC-approved I-70 – PA297. Assessment and management of adolescents who present with unintentional injury, including alcohol-related injury (16) GSWCAH evidence-based AHD intervention WHO guideline on school health services. Web Annex A. Compendium 73 I-70. Referral and support for management of common childhood injuries (e.g. head, chest and abdominal injuries; fractures; wounds) contd Essential everywhere Full WHO support I-70 – PA298. Assessment and management of adolescents who present with unintentional injury is necessary not only to provide appropriate medical care, but also to identify accurately the cause of the injury to ensure it does not occur again. For example, burns are one of the few forms of injury that have a higher burden in adolescent females than males, because worldwide approximately 2 billion people in LMIC – the vast majority female – cook on unsafe open fires or very basic traditional stoves. … Careful assessment of the cause of adolescent injury is also important because some adolescents or their guardians may falsely state that an injury was due to an accident when in fact it was due to self-harm or interpersonal violence. In some countries, for example, so-called honour killings and death by fire account for a significant number of reported cases of familial or intimate partner violence against adolescent girls and survivors of such assaults may be compelled by the perpetrators to claim the injuries were accidental (4,40) I-70 – PA299. Strengthen health systems to address child injuries, e.g. the development and maintenance of an efficient system of pre-hospital care (37) GRC-approved I-70 – PA300. Pre-hospital care: standardize formal emergency medical services, including equipping vehicles with supplies and devices for children as well as adults. Where no pre-hospital trauma care system exists: teach interested community members basic first aid techniques; build on existing, informal systems of pre- hospital care and transport; and initiate emergency services on busy roads with high-frequency crash sites (4,40) I-70 – PA301. Survival after a [road] crash: trauma response that can accommodate the needs of children is required. This ranges from training teacher and school transport drivers in safe immediate stabilization of injuries; equipping emergency vehicles with child-sized medical equipment and supplies; and improving paediatric- specific rehabilitation services for children (45) I-70 – PA302. Develop trauma care skills of medical personnel at the primary, district and tertiary health care levels (93) I-70 – PA338. School nurses can help raise awareness of health problems among students, teachers and staff and play an important role in referring students to specialists. They are responsible for de-worming at regular intervals, managing health outcomes such as an asthma attack or injury and recognizing severe diseases such as malaria, severe diarrhoea and respiratory infections for correct referral. Ideally, they should receive training in environmental health issues prevalent in their community. School nurses should be responsible for tracking illnesses among students to help identify potential environmental health problems within the school (25) I-71. Referral and support for management of burns Essential everywhere Other WHO support I-71 – WHO UHC menu (2.19 Draft). Case management of burns in children (1) I-71 – PA243. One role of a school health service may be the provision of sunscreen, which should be available for all school activities. In deciding how to make sunscreen available, schools should consider five things: access, choice of sunscreen, skin reactions, management and correct use. … A further role for school health services is in the treatment of sunburn and, if necessary, referral to other agencies (24) I-71 – PA297. Assessment and management of adolescents who present with unintentional injury, including alcohol-related injury (16) GSWCAH evidence-based AHD intervention 74 I-71. Referral and support for management of burns contd Essential everywhere Other WHO support I-71 – PA298. Assessment and management of adolescents who present with unintentional injury is necessary not only to provide appropriate medical care, but also to identify accurately the cause of the injury to ensure it does not occur again. For example, burns are one of the few forms of injury that have a higher burden in adolescent females than males, because worldwide approximately 2 billion people in LMIC – the vast majority female – cook on unsafe open fires or very basic traditional stoves. … Careful assessment of the cause of adolescent injury is also important because some adolescents or their guardians may falsely state that an injury was due to an accident when in fact it was due to self-harm or interpersonal violence. In some countries, for example, so-called honour killings and death by fire account for a significant number of reported cases of familial or intimate partner violence against adolescent girls and survivors of such assaults may be compelled by the perpetrators to claim the injuries were accidental (4,40) I-71 – PA303. Several easily performed first aid measures can decrease the pain and risk of death and disability for burn victims, … [e.g.] immediate application of cool water to burns should be promoted widely as an effective first aid treatment with emphasis on the fact that the water should be cool (e.g. tap water temperature, 15–25 ºC) and not ice-cold (94) I-72. Referral and support for management of non-fatal drowning and related complications (e.g. respiratory impairment, long-term disability) Essential everywhere Partial WHO support I-72 – WHO UHC menu (2.19 Draft). Management of drowning in children (1) I-72 – PA296. Implement specific actions to prevent and control child injuries, e.g. immediate resuscitation in response to drowning; appropriate paediatric acute care in response to a fall (37) GRC-approved I-73. Referral and support for victims of violence (e.g. child abuse and neglect by parents or other caregivers; collective violence; gender-based or sexual violence; harmful cultural practices, such as FGM, child marriage and forced marriage; violence among adolescents; and violence by intimate partners) Essential everywhere Full WHO support I-73 – WHO UHC menu (2.19 Draft). Injury care due to intimate partner violence (1) I-73 – PA6. To act in the best interest of adolescents, health services may need to prioritize their immediate health needs, while being attentive to signs of vulnerability, abuse and exploitation. Appropriate and confidential referral, if and when requested by the adolescent, can provide linkage to other services and sectors for support (14,31) GRC-approved I-73 – PA56. All children are protected from any violation of their human rights, physical or mental violence, injury, abuse, neglect or any other form of maltreatment (2) Quality Statement 5.4 WHO guideline on school health services. Web Annex A. Compendium 75 I-73. Referral and support for victims of violence (e.g. child abuse and neglect by parents or other caregivers; collective violence; gender-based or sexual violence; harmful cultural practices, such as FGM, child marriage and forced marriage; violence among adolescents; and violence by intimate partners) contd Essential everywhere Full WHO support I-73 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organisations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-73 – PA103. Information regarding different types of FGM and the associated respective immediate and long-term health risks should be provided to health-care providers who care for girls and women living with FGM (122) GRC-approved Best Practice Statement 7 I-73 – PA105. Offer deinfibulation for preventing and treating urological complications, specifically recurrent urinary tract infections and urinary retention, in girls and women living with type III FGM (122) GRC-approved Recommendation 3 I-73 – PA106. Consider cognitive behavioural therapy for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression or PTSD (122) GRC-approved Recommendation 4 I-73 – PA107. [Composite] recommendations for preventing and treating obstetric complications and sexual dysfunction in women living with FGM (122) GRC-approved Recommendations 1, 2 and 5 I-73 – PA114. [School] health workers could provide information and advice [about HIV/AID/STI] to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they may have about HIV/AIDS/STI and methods of prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about HIV/ AIDS/STI without facing ridicule or judgement; provide health products (such as contraceptives and condoms) when they are permitted to do so, by prevailing laws and policies; and identify and collaborate with organizations, which can provide appropriate non-health services when required, such as legal support for adolescents who are being abused (35) I-73 – PA174. Where children are exposed to intimate partner violence at home, a psychotherapeutic intervention, including sessions where they are with and sessions where they are without their mother, should be offered, although the extent to which this would apply in low- and middle-income settings is unclear (7,85) GRC-approved I-73 – PA298. Assessment and management of adolescents who present with unintentional injury is necessary not only to provide appropriate medical care, but also to identify accurately the cause of the injury to ensure it does not occur again. For example, burns are one of the few forms of injury that have a higher burden in adolescent females than males, because worldwide approximately 2 billion people in LMIC – the vast majority female – cook on unsafe open fires or very basic traditional stoves. … Careful assessment of the cause of adolescent injury is also important because some adolescents or their guardians may falsely state that an injury was due to an accident when in fact it was due to self-harm or interpersonal violence. In some countries, for example, so-called honour killings and death by fire account for a significant number of reported cases of familial or intimate partner violence against adolescent girls and survivors of such assaults may be compelled by the perpetrators to claim the injuries were accidental (4,40) 76 I-73. Referral and support for victims of violence (e.g. child abuse and neglect by parents or other caregivers; collective violence; gender-based or sexual violence; harmful cultural practices, such as FGM, child marriage and forced marriage; violence among adolescents; and violence by intimate partners) contd Essential everywhere Full WHO support I-73 – PA308. Management of violence and assault in adolescents, including violence among adolescents, child abuse and neglect by parents and other caregivers, violence by intimate partners, sexual violence, self-directed violence and collective violence (22) Primary care recommendation I-73 – PA309. Child maltreatment and life-threatening incidents must be reported to the relevant authorities by the health-care provider, where there is a legal requirement to do so (14,85) GRC-approved I-73 – PA310. Prevention of and response to sexual and other forms of gender-based violence (16) GSWCAH evidence-based AHD intervention I-73 - PA312. “Universal screening” or “routine enquiry” (i.e. asking women in all health-care encounters) should not be implemented. Health-care providers should ask about exposure to intimate partner violence when assessing conditions that may be caused or complicated by intimate partner violence in order to improve diagnosis/identification and subsequent care (14,85) GRC-approved I-73 – PA313. Women who disclose any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator should be offered immediate support. Health-care providers should, as a minimum, offer first-line support when women disclose violence. First-line support includes: being non- judgmental and supportive and validating what the woman is saying; providing practical care and support that responds to her concerns, but does not intrude; asking about her history of violence, listening carefully, but not pressuring her to talk (care should be taken when discussing sensitive topics when interpreters are involved); helping her access information about resources, including legal and other services that she might think helpful; assisting her to increase safety for herself and her children, where needed; providing or mobilizing social support. ... If health- care providers are unable to provide first-line support, they should ensure that someone else (within their health-care setting or another that is easily accessible) is immediately available to do so (14,85) GRC-approved I-73 – PA314. [Composite] recommendations for other care for survivors of intimate partner violence, e.g. cognitive behavioural therapy; or care specifically for women who have mental disorder, are in a shelter or are pregnant or psychotherapeutic intervention for exposed children (7) GRC-approved I-73 – PA315. Care for women experiencing intimate partner violence and sexual assault should, as much as possible, be integrated into existing health services rather than as a stand-alone service. A country needs multiple models of care for survivors of intimate partner violence and sexual assault, for different levels of the health system. However, priority should be given to providing training and service delivery at the primary level of care (14,85) GRC-approved I-73 – PA316. Mandatory reporting of intimate partner violence to the police by the health-care provider is not recommended. However, health-care providers should offer to report the incident to the appropriate authorities (including the police) if the woman wants this and is aware of her rights (14,85) GRC-approved I-73 – PA317. Offer first-line support to women survivors of sexual assault by any perpetrator, which includes: providing practical care and support, which responds to her concerns, but does not intrude on her autonomy; listening without pressuring her to respond or disclose information; offering comfort and help to alleviate or reduce her anxiety; offering information and helping her to connect to services and social supports (81) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 77 I-73. Referral and support for victims of violence (e.g. child abuse and neglect by parents or other caregivers; collective violence; gender-based or sexual violence; harmful cultural practices, such as FGM, child marriage and forced marriage; violence among adolescents; and violence by intimate partners) contd Essential everywhere Full WHO support I-73 – PA318. [After sexual assault] Take a complete history, recording events to determine what interventions are appropriate and conduct a complete physical examination (head-to-toe including genitalia). The history should include: the time since assault and type of assault; risk of pregnancy risk of HIV and other STIs; mental health status (85) GRC-approved I-73 – PA319–PA330 (inclusive). [Composite] clinical recommendations for responding to children and adolescents who have been sexually abused (87) GRC-approved I-73 – PA457. Respond to violence when it happens: Key actions: Train teachers and school staff in recognizing violence and asking children in a responsible way about violence. Train teachers in managing situations where children tell them they have experienced violence. Deal with violent incidents immediately, using methods learned in teachers’ training, for example positive discipline and classroom management. If referral mechanisms do not exist at school level, make sure to be informed of service providers available Train parents in recognizing and asking appropriately about violence and supporting children exposed to violence. Strengthen safe and child- friendly reporting methods. Develop and strengthen appropriate referral methods for victims of violence who need additional support. Monitor the effectiveness of reporting and referral methods (32) Key action at school, district or national level I-73 – PA468. Health-care providers should be alert to the clinical features associated with child maltreatment and associated risk factors and assess for child maltreatment without putting the child at increased risk (3) GRC-approved Recommendation 1 I-73 – PA470. Health-care providers should consider exposure to child maltreatment when assessing children with conditions that may be caused or complicated by maltreatment, in order to improve diagnosis/identification and subsequent care, without putting the child at increased risk (3) GRC-approved Recommendation 3 I-73 – PA472. Health-care providers should seek explanations for any injuries or symptoms that may be caused by physical, sexual, emotional abuse or neglect from both the parent or the carer and the child or adolescent in an open and non- judgemental manner (3) GRC-approved Good Practice Statement 1 I-73 – PA473. Before starting to obtain the medical history or forensic interview, any urgent medical and/or safety needs must be addressed. In line with the principle of “do no harm”, when the medical history is being obtained and, if needed, a forensic interview is being conducted, health-care providers should seek to minimize additional trauma and distress for children and adolescents (3) GRC-approved Good Practice Statement 2 I-73 – PA474. Health-care providers should seek informed consent for all decisions and actions to be taken as appropriate to the child’s or adolescent’s age and evolving capacity and the legal age of consent for obtaining clinical care. Where the child or adolescent is below the legal age of consent, it may still be in the child´s or adolescent´s best interests to seek informed consent. Moreover, in accordance with evolving capacities, children and adolescents have the right to access confidential counselling or advice and information without the consent of their parents or legal guardians. In situations where it is assessed to be in the best interests of the adolescents who are in need of care and based on their preferences, health-care providers may consider whether to involve the parents or legal guardians (3) GRC-approved Good Practice Statement 3 I-73 – PA475. In conducting physical examinations and, where needed, forensic investigations, health-care providers should seek to minimize additional harms including trauma, fear and distress and respect the autonomy and wishes of children or adolescents (3) GRC-approved Good Practice Statement 4 78 I-73. Referral and support for victims of violence (e.g. child abuse and neglect by parents or other caregivers; collective violence; gender-based or sexual violence; harmful cultural practices, such as FGM, child marriage and forced marriage; violence among adolescents; and violence by intimate partners) contd Essential everywhere Full WHO support I-73 – PA476. Health-care providers should accurately and completely document findings of the medical history, physical examination and forensic tests and any other relevant information, for the purposes of appropriate follow-up and supporting children and adolescents in accessing police and legal services, while at the same time protecting confidentiality and minimizing distress for children or adolescents and their caregivers (3) GRC-approved Good Practice Statement 5 I-73 – PA477. Promoting and protecting the physical and emotional safety of the child or adolescent must be the primary consideration throughout the course of care. This means that, with the participation from the child and adolescent (and their non- offending caregivers, as appropriate,) health-care providers need to consider all potential harms and take actions that will minimize the negative consequences to the child or adolescent, including the likelihood of the maltreatment continuing (3) GRC-approved Good Practice Statement 6 I-73 – PA478. The interaction with caregivers when child maltreatment is suspected is complicated by the fact that the caregiver might be the perpetrator or may have allowed the maltreatment or felt powerless to stop it or may also be victim of violence in the home. Good interaction will influence outcomes for and safety of the child or adolescent (3) GRC-approved Good Practice Statement 7 I-73 – PA479. Psychological debriefing should not be used in an attempt to reduce the risk of post-traumatic stress, anxiety or depressive symptoms (3) GRC-approved Recommendation 5 I-73 – PA480. Cognitive behavioural therapy including with a trauma focus may be offered for children and adolescents who have been exposed to maltreatment and are diagnosed with PTSD (3) GRC-approved Recommendation 6 I-73 – PA481. Evidence-based psychological interventions, such as cognitive behavioural therapy and interpersonal psychotherapy, may be offered to children and adolescents who have been exposed to maltreatment and are experiencing emotional disorders and caregiver-skills training to their non-offending caregivers (3) GRC-approved Recommendation 7 I-73 – PA482. Evidence-based psychological interventions, such as cognitive behavioural therapy, may be offered to children and adolescents who have been exposed to maltreatment and are experiencing behavioural disorders (3) GRC-approved Recommendation 8 I-73 – PA483. Caregiver interventions that promote nurturing caregiver–child relationships, including through improved communication skills and direct coaching of parents while they are interacting with their children, may be considered (3) GRC-approved Recommendation 9 I-73 – PA484. Pharmacological interventions should not be considered in children and adolescents exposed to child maltreatment with anxiety disorders, depressive episodes/disorders or behavioural disorders in non-specialist settings (3) GRC-approved Recommendation 10 I-73 – PA485. Whether health-care providers have to comply with a legal or policy requirement or are guided by an ethical duty to report known or suspected child or adolescent maltreatment, they should balance the need to take into account the best interests of that child or adolescent and their evolving capacity to make autonomous decisions (3) GRC-approved Good Practice Statement 8 I-73 – PA493. Schools and educators are part of referral networks and first-line response. … Educators can recognize and refer children who experience violence for services (20) WHO guideline on school health services. Web Annex A. Compendium 79 I-74. Referral and support for management of pregnancy Essential everywhere Full WHO support I-74 – PA60. [School] health workers could do the following: provide information and advice to students and school personnel; provide opportunities for school personnel, students and parents to ask questions and clarify any doubts or concerns they have about development during puberty, menstruation, pregnancy and methods of menstrual care and pregnancy prevention; serve as a confidant to whom students and school personnel can express fear and anxiety about physical and emotional changes during puberty or pregnancy without facing ridicule or judgement; provide health products (such as contraceptives or condoms) when they are permitted to do so by prevailing laws and practices or refer students and school personnel to an easily available source; identify and collaborate with organisations that can provide appropriate non-health services when required, such as legal or social support for children and adolescents who are being abused or neglected (21) I-74 – PA91. [Composite] recommendations to enable adolescents to obtain safe abortion services by informing them and other stakeholders: of the dangers of unsafe methods of interrupting a pregnancy; of safe abortion services that are legally available; and under what circumstances these services can be obtained legally (14,29) GRC-approved I-74 – PA95. If adolescent presents asking if she could be pregnant, assess and respond as outlined in the adolescent job aid (22) Primary care recommendation I-74 – PA96. If adolescent is pregnant, follow flow chart for the care of pregnant adolescents, i.e. general principles and special considerations; quick check, rapid assessment, management and emergency treatment; antenatal care (22) I-74 – PA97. [Composite] recommendations to provide information to all pregnant adolescents and other stakeholders about the importance of utilizing skilled antenatal and childbirth care (14,29) GRC-approved I-74 – PA98. Promote birth and emergency preparedness in antenatal care strategies for pregnant adolescents (in household, community and health facility settings) (14,29,125) GRC-approved I-74 – PA99. Expand the availability and access to basic emergency obstetric care and comprehensive emergency obstetric care to all populations, including adolescents (14,29,125) GRC-approved I-74 – PA100. All adult and adolescent women from key populations who are living with HIV and are pregnant should receive appropriate HIV treatment and care, in line with WHO guidance, to prevent HIV transmission from mother to child (14,31) GRC-approved I-74 – PA101. [Composite] recommendations for antenatal care (e.g. dietary, supplements) (14,126) GRC-approved I-74 – PA102. [Composite] recommendations for maternal and newborn health (e.g. birth preparedness, childbirth/intrapartum care, male involvement, traditional birth attendant) (14,127) GRC-approved I-74 – PA437. Plan and implement a comprehensive education sector response to early and unintended pregnancy to support pregnant and parenting adolescents to continue and return to education. This includes curriculum-based interventions; eradication of policies and practices that result in the expulsion or exclusion of pregnant girls and adolescent mothers; promoting a safe school environment, free of gender-based violence, stigma, discrimination and bullying against pregnant adolescents and adolescent mothers; ensuring a supportive environment for adolescent mothers, such as parenting instructions or classes, breastfeeding space and counselling; engaging with teachers and school directors to ensure support to pregnant girls and adolescent mothers; and facilitating and promoting effective linkages between schools and adolescent-responsive health services, both within and outside the health sector (4) Key area for programming 80 I-75. Referral and support for management of sexually transmitted infection Essential everywhere Full WHO support I-75 – PA111. Effective [STI transmission and acquisition] prevention requires ensuring access to vital information, commodities (such as condoms) and services (such as vaccination, voluntary medical male circumcision, testing, treatment and care) within a human rights framework. Alongside that, behaviour interventions are critically important for sexually transmitted infection prevention including HIV and include: the promotion of consistent use of male and female condoms; education including a focus on increasing awareness of sexually transmitted infections; reduction in the number of sexual partners; increased uptake of testing for sexually transmitted infections, including HIV; delayed sexual debut; as well as the promotion of sexual well-being. Many such interventions have the dual advantage of preventing sexually transmitted infections, including HIV and unintended pregnancies, in particular through the use of condoms by adolescents. Focusing the interventions appropriately for specific populations (including key populations for HIV), adolescents and pregnant women is a priority (4,30) I-75 – PA115. Management of genital conditions, i.e. foreskin problems; acute scrotal pain; penis discharge/pain on urination; genital ulcer; inguinal swelling; vaginal itching, burning or abnormal discharge (22) Primary care recommendation I-75 – PA116. [School] health workers could: 1. Be alert to the possibility of the presence of health problems, (such as sexually transmitted diseases) and/or unhealthy practices (such as injecting drug use) and detect them early, if and when they arise. 2. Appropriately manage STI and/or HIV-related problems, to the best of their abilities and based on the facilities available at their disposal. This could include providing medical treatment, responding to the child’s/adolescent’s psychological needs and helping them deal with the social implications of their conditions. 3. Refer students and school personnel to the next “level” of health service delivery and/or to organizations which provide relevant support services, such as counselling and social support in the areas of adolescent development, sexuality, peer pressure, identify formation, illness and death, if and when available. 4. Answer questions of students and school personnel about the need for and value of HIV-antibody testing. As necessary and if available, refer students and staff to an appropriate and confidential facility that provides pre- and post-test counselling. Counselling about HIV-antibody testing requires the services of support staff and professionals who are trained and experienced in dealing specifically with the issues involved. 5. Observe confidentiality with respect to infected students and school personnel and disclose information to staff on a need-to-know basis only. 6. Support the education and employment rights of HIV-infected students and staff by assuring concerned officials and others that HIV infected students and staff pose virtually no health threat to students and school personnel when they attend classes or work in the school (35) I-75 – PA117. School-based STI service delivery … may be recommended where both STI risk among the school-going population is high and chlamydia screening is an affordable option (54) I-75 – PA118. [To achieve early diagnosis of STIs and linkage to treatment] Special efforts are required for the detection and management of asymptomatic sexually transmitted infections in specific populations, which include key populations for HIV, adolescents and young adults and pregnant women, such as case-finding or screening, with enhanced interventions for reaching sexual partners (30) I-75 – PA119. Implement strategies for detecting and managing asymptomatic infections in specific and key populations, pregnant women and adolescents, such as regular case testing or screening, with enhanced interventions for reaching sexual partners (30) GHSSSTI priority action for countries WHO guideline on school health services. Web Annex A. Compendium 81 I-75. Referral and support for management of sexually transmitted infection contd Essential everywhere Full WHO support I-75 – PA120. Target sexually transmitted infection interventions and services to populations and locations where need, risk and vulnerability are highest: provide services appropriate for adolescents and review policies on consent to improve access (30) GHSSSTI priority action for countries I-75 – PA121. Strengthen links, collaboration and integration, including between sexually transmitted infection programmes and those with responsibilities for … adolescent health: support further integration through primary health care services; … ensure adequate communication and coordination between the different levels of the health system and the public and private sectors (30) GHSSSTI priority action for countries I-75 – PA122. [Composite] recommendations for treatment of Treponema pallidum (syphilis), including for infected adolescents (128) GRC-approved I-75 – PA123. [Composite] recommendations for treatment of genital herpes simplex virus, including for infected adolescents (129) GRC-approved I-75 – PA124. [Composite] recommendations for treatment of Chlamydia trachomatis (130) GRC-approved I-75 – PA125. [Composite] recommendations for treatment of Neisseria gonorrhoeae, including for infected adolescents (131) GRC-approved I-75 – PA126. [Composite] recommendations for hepatitis B and C testing and prevention, screening, care and treatment of chronic hepatitis B or C (125) GRC-approved I-75 – PA128. [WHO guidelines on STI case management in development] I-75 – PA318. [After sexual assault] Take a complete history, recording events to determine what interventions are appropriate and conduct a complete physical examination (head-to-toe including genitalia). The history should include: the time since assault and type of assault; risk of pregnancy risk of HIV and other STIs; mental health status (85) GRC-approved I-75 – PA320. Offer presumptive or prophylactic treatment for gonorrhoea, chlamydia and syphilis for children and adolescents who have been sexually abused involving oral, genital or anal contact with a penis or oral sex, particularly in settings where laboratory testing is not feasible (87) GRC-approved I-75 – PA321. Offer syndromic case management for children and adolescents who have been sexually abused and who present with clinical symptoms (vaginal/urethral discharge – gonorrhoea, chlamydia, trichomoniasis; genital ulcers – herpes simplex virus, syphilis, chancroid), particularly in settings where laboratory testing is not feasible (87) GRC-approved I-75 – PA337. Prevention, detection and treatment of communicable and non- communicable diseases and sexually transmitted and reproductive tract infections, including HIV, TB and syphilis (16) GSWCAH evidence-based AHD intervention 82 I-76. Provide short-term counselling or crisis intervention focused on mental health or situational concerns (e.g. grief, difficult transitions) Essential everywhere Partial WHO support I-76 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-76 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-76 – PA167. Psychosocial support and related services for adolescent mental health and well-being (4) Also a GSWCAH evidence- based AHD intervention I-76 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-76 – PA178. [Composite] recommendations for assessment and management of conditions specifically related to stress in the first month after a potentially traumatic event. E.g. no specific recommendation can be made for children and adolescents with (a) acute traumatic stress symptoms; or (b) acute (secondary) insomnia or (c) dissociative (conversion) disorders, but benzodiazepines and antidepressants should not be offered. Additional remark: there is already a WHO (2010) mhGAP recommendation to offer access to psychological first aid to people who have been recently exposed to potentially traumatic events. Therefore, as no further specific recommendation can be made, psychological first aid should be considered in children and adolescents with acute traumatic stress symptoms associated with significant impairment in daily functioning/acute (secondary) insomnia in the first month after a potentially traumatic event (75,132) GRC-approved I-76 – PA179. Rebreathing into a paper bag should not be considered for children with hyperventilation in the first month after a potentially traumatic event. No specific recommendation can be made on the basis of available evidence on rebreathing into a paper bag for adolescents and adults with hyperventilation in the first month after exposure to a potentially traumatic event (75) GRC-approved I-76 – PA180. [Composite] recommendations for PTSD and bereavement (75) GRC-approved I-76 – PA452. The mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (78) … describe[s] psychological debriefing as promoting ventilation by asking a person to briefly but systematically recount their perceptions, thoughts and emotional reactions during a recent stressful event. This intervention is not recommended (132) I-76 – PA499. Psychological first aid (PFA) describes a humane, supportive response to a fellow human being who is suffering and who may need support. PFA involves the following themes: providing practical care and support, which does not intrude; assessing needs and concerns; helping people to address basic needs (for example, food and water, information); listening to people, but not pressuring them to talk; comforting people and helping them to feel calm; helping people connect to information, services and social supports; protecting people from further harm. It is also important to understand what PFA is not. It is not something that only professionals can do. It is not professional counselling. It is not “psychological debriefing” in that PFA does not necessarily involve a detailed discussion of the event that caused the distress. It is not asking someone to analyse what happened to them or to put time and events in order. Although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event (132) WHO guideline on school health services. Web Annex A. Compendium 83 I-76. Provide short-term counselling or crisis intervention focused on mental health or situational concerns (e.g. grief, difficult transitions) contd Essential everywhere Partial WHO support I-76 – PA500. PFA is for distressed people who have been recently exposed to a serious crisis event. You can provide help to both children and adults. However, not everyone who experiences a crisis event will need or want PFA. People who need more immediate advanced support: people with serious, life-threatening injuries who need emergency medical care; people who are so upset that they cannot care for themselves or their children; people who may hurt themselves; people who may hurt others (132) I-76 – PA501. [Composite] recommendations related to psychological first aid, e.g. ask about people’s needs and concerns; listen to people and help them feel calm; encourage positive coping strategies and discourage negative coping strategies (133) I-77. Referral and support for child carers (e.g. students who provide unpaid support to a parent who could not manage without this help) Suitable everywhere No WHO source identified I-77. [None] I-78. Referral and support for management of common behavioural disorders in children (e.g. attention deficit hyperactivity disorder) Essential everywhere Full WHO support I-78 – Draft UHC menu. Case management of common behavioural disorders in children, e.g. ADHD (1) I-78 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-78 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-78 – PA170. Assessment of common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-78 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-78 – PA172. Follow-up on common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-78 – PA181. [Psychosocial intervention] for improving [child/adolescent] behaviour (18,19) GRC-approved I-78 – PA182. Management of child/adolescent problems with behaviour (non- specialized health setting protocol) (19) GRC-approved 84 I-78. Referral and support for management of common behavioural disorders in children (e.g. attention deficit hyperactivity disorder) contd Essential everywhere Full WHO support I-78 – PA183. Parent skills training, as appropriate, for managing behavioural disorders in adolescents (4,16) GSWCAH evidence-based AHD intervention I-78 – PA184. Behavioural interventions for children and adolescents and caregiver skills training may be offered for the treatment of behavioural disorders (133) GRC-approved Recommendation CH2 I-78 – PA191. Management of child/adolescent ADHD (non-specialized health setting protocol) (19) GRC-approved I-78 – PA192. Management of ADHD: provide family psycho-education; consider parent skills training, when available; contact person’s teacher (if person goes to school and consent is given by the person and carer), provide advice and plan for special educational needs; anticipate major life changes (such as puberty, starting school or birth of a sibling) and arrange personal and social support; consider psychosocial interventions such as cognitive behaviour therapy and social skills; training based on availability. Assess carers regarding the impact of behavioural disorders and offer them support for their personal, social and mental health needs. DO NOT use medicines for behavioural disorders in children and adolescents (7,19,78) GRC-approved I-78 – PA193. Non-specialized health-care providers at the secondary level should consider initiating parent education/training before starting medication for a child who has been diagnosed as suffering from ADHD. Initial interventions may include cognitive behaviour therapy and social skills training if feasible (98) GRC-approved I-78 – PA194. [For ADHD] Methylphenidate may be considered, when available, after a careful assessment of the child, preferably in consultation with relevant specialist and taking into consideration, the preferences of parents and children. Children receiving methylphenidate should be maintained under close clinical monitoring for improvement in symptoms and prevention of adverse effects. Care and support should be provided for the parents, if needed (98) GRC-approved I-79. Referral and support for management of emotional, anxiety and depressive disorders Essential everywhere Full WHO support I-79 – PA106. Consider cognitive behavioural therapy for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression or PTSD (120) GRC-approved Recommendation 4 I-79 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-79 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-79 – PA170. Assessment of common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 85 I-79. Referral and support for management of emotional, anxiety and depressive disorders contd Essential everywhere Full WHO support I-79 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-79 – PA172. Follow-up on common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-79 – PA196. Psychoeducation for emotional problems/disorders including depression in adolescents (18,19) GRC-approved I-79 – PA197. Management of child/adolescent problems with emotions (non- specialized health setting protocol) (19) GRC-approved I-79 – PA198. Psychological interventions, such as cognitive behavioural therapy, interpersonal psychotherapy for children and adolescents with emotional disorders and caregiver skills training focused on their caregivers, may be offered for the treatment of emotional disorders (7,14,79) GRC-approved Recommendation CH3 I-79 – PA199. Pharmacological interventions should not be considered in children and adolescents with anxiety disorders in non-specialist settings (19,87,134) GRC-approved I-79 – PA200. Management of child/adolescent emotional disorder or depression (non-specialized health setting protocol) (19) GRC-approved I-79 – PA201. Health-care providers can offer different treatment formats of WHO’s recommended, structured psychological interventions for adults and older adolescents with depressive disorder. These include behavioural activation, cognitive behavioural therapy, interpersonal psychotherapy, problem-solving treatment as an adjunct treatment (e.g. in combination with antidepressants). Different treatment formats for consideration include (a) individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists, as well as (b) self-help psychological treatment. While face-to-face psychological treatment or guided self-help psychological treatment are likely to have better outcomes than unguided self-help, the latter may be suitable for those people who either (a) do not have access to face-to-face psychological treatment or guided self- help psychological treatment or (b) are not willing to access such treatments (76) GRC-approved Recommendation DEP2 I-79 – PA202. When psychosocial interventions prove ineffective, fluoxetine (but not other selective serotonin reuptake inhibitors or tricyclic antidepressants) may be offered in adolescents with moderate-severe depressive episode/disorder. The intervention should only be offered under supervision of a specialist (19,87,135) GRC-approved Recommendation CH4 I-79 – PA203. Antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors) should not be used for the treatment of children 6–12 years of age with depressive episode/disorder in non-specialist settings (4,136) GRC-approved I-79 – PA326. [After sexual assault] Do not use psychological debriefing in an attempt to reduce the risk of post-traumatic stress, anxiety or depressive symptoms (87) GRC-approved 86 I-80. Referral and support for management of eating disorders (e.g. anorexia, bulimia) Essential everywhere Other WHO support I-80 – WHO UHC menu (2.19 Draft). Management of eating disorders (1) I-80 - PA3. Conduct HEADSSS assessment to: detect health and development problems that the adolescent has not presented with; detect whether the adolescent engages in behaviours that could put one at risk of negative health outcome (such as injecting drugs or having unprotected sex); and detect important factors in their environment that increase the likelihood of their engaging in these behaviours (22) Primary care recommendation I-80 – PA273. Management of body image concerns, e.g. too thin, too fat, too short (22) Primary care recommendation I-80 – PA407. Multidimensional programmes that integrate traditional health education approaches within broader mental health promotion strategies appear to have promising outcomes [in preventing/reducing eating disorders] (15,18) I-81. Referral and support for management of stress Essential everywhere Partial WHO support I-81 – PA106. Consider cognitive behavioural therapy for girls and women living with FGM who are experiencing symptoms consistent with anxiety disorders, depression or PTSD (122) GRC-approved Recommendation 4 I-81 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-81 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-81 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-81 – PA178. [Composite] recommendations for assessment and management of conditions specifically related to stress in the first month after a potentially traumatic event. E.g. no specific recommendation can be made for children and adolescents with (a) acute traumatic stress symptoms; or (b) acute (secondary) insomnia or (c) dissociative (conversion) disorders, but benzodiazepines and antidepressants should not be offered. Additional remark: there is already a WHO (2010) mhGAP recommendation to offer access to psychological first aid to people who have been recently exposed to potentially traumatic events. Therefore, as no further specific recommendation can be made, psychological first aid should be considered in children and adolescents with acute traumatic stress symptoms associated with significant impairment in daily functioning/acute (secondary) insomnia in the first month after a potentially traumatic event (75) GRC-approved I-81 – PA326. [After sexual assault] Do not use psychological debriefing in an attempt to reduce the risk of post-traumatic stress, anxiety or depressive symptoms (87) GRC-approved I-81 – PA327. [After sexual assault] Consider cognitive behavioural therapy with a trauma focus for children and adolescents who have been sexually abused and are experiencing symptoms of PTSD (87) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 87 I-81. Referral and support for management of stress contd Essential everywhere Partial WHO support I-81 – PA328. [After sexual assault] Consider cognitive behavioural therapy with a trauma focus, when safe and appropriate, to involve at least one non-offending caregiver, for children and adolescents who have been sexually abused and are experiencing symptoms of PTSD and for their non-offending caregiver(s) (87) GRC-approved I-81 – PA452. The mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings” (78) … describe[s] psychological debriefing as promoting ventilation by asking a person to briefly but systematically recount their perceptions, thoughts and emotional reactions during a recent stressful event. This intervention is not recommended (132) I-81 – PA499. PFA describes a humane, supportive response to a fellow human being who is suffering and who may need support. PFA involves the following themes: providing practical care and support, which does not intrude; assessing needs and concerns; helping people to address basic needs (for example, food and water, information); listening to people, but not pressuring them to talk; comforting people and helping them to feel calm; helping people connect to information, services and social supports; protecting people from further harm. It is also important to understand what PFA is not. It is not something that only professionals can do. It is not professional counselling. It is not “psychological debriefing” in that PFA does not necessarily involve a detailed discussion of the event that caused the distress. It is not asking someone to analyse what happened to them or to put time and events in order. Although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event (132) I-81 – PA500. Psychological first aid (PFA) is for distressed people who have been recently exposed to a serious crisis event. You can provide help to both children and adults. However, not everyone who experiences a crisis event will need or want PFA. People who need more immediate advanced support: people with serious, life- threatening injuries who need emergency medical care; people who are so upset that they cannot care for themselves or their children; people who may hurt themselves; people who may hurt others (132) I-81 – PA501. [Composite] recommendations related to psychological first aid, e.g. ask about people’s needs and concerns; listen to people and help them feel calm; encourage positive coping strategies and discourage negative coping strategies (132) I-82. Referral and support for management of suicide risk/self-harm Essential everywhere Full WHO support I-82 – PA206. For people in a position to identify whether someone may be contemplating suicide (e.g. clinicians or teachers), gatekeeper training develops knowledge, attitudes and skills for identifying adolescents at risk, determining the level of risk and referring at-risk adolescents for treatment (4,56) I-82 – PA207. The 2016 WHO mhGAP intervention guide recommends assessing comprehensively everyone presenting with thoughts, plans or acts of self-harm. The guide recommends asking any person over 10 years of age who is experiencing a priority mental, neurological or substance-use disorder – or chronic pain or acute emotional distress – about his or her thoughts, plans or acts related to self-harm and suicide (4,19) GRC-approved I-82 – PA208. Assessment of self-harm/suicide (non-specialized health setting protocol) (4,19) GRC-approved I-82 – PA209. Management of medically serious act of self-harm (non-specialized health setting protocol) (4,19) GRC-approved 88 I-82. Referral and support for management of suicide risk/self-harm contd Essential everywhere Full WHO support I-82 – PA210. Management of imminent risk of self-harm/suicide (non-specialized health setting protocol) (4,19) GRC-approved I-82 – PA211. Management of risk of self-harm/suicide (non-specialized health setting protocol) (4,19) GRC-approved I-82 – PA212. Follow-up on risk of self-harm/suicide (non-specialized health setting protocol) (4,19) GRC-approved I-82 – PA213. Repeated follow-up by health workers for patients discharged after suicide attempts and community support, are low-cost, effective interventions that are easy to implement. Follow-up can include postcards, telephone calls or brief in- person visits (4,56) I-82 – PA298. Assessment and management of adolescents who present with unintentional injury is necessary not only to provide appropriate medical care, but also to identify accurately the cause of the injury to ensure it does not occur again. For example, burns are one of the few forms of injury that have a higher burden in adolescent females than males, because worldwide approximately 2 billion people in LMIC – the vast majority female – cook on unsafe open fires or very basic traditional stoves. … Careful assessment of the cause of adolescent injury is also important because some adolescents or their guardians may falsely state that an injury was due to an accident when in fact it was due to self-harm or interpersonal violence. In some countries, for example, so-called honour killings and death by fire account for a significant number of reported cases of familial or intimate partner violence against adolescent girls and survivors of such assaults may be compelled by the perpetrators to claim the injuries were accidental (4,40) I-83. Referral and support for management of somatoform disorders (i.e. physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition or by the direct effect of a substance) and other psychosomatic conditions Essential everywhere Full WHO support I-83 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-83 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-83 – PA170. Assessment of common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-83 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-83 – PA172. Follow-up on common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 89 I-83. Referral and support for management of somatoform disorders (i.e. physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition or by the direct effect of a substance) and other psychosomatic conditions contd Essential everywhere Full WHO support I-83 – PA228. Brief psychological interventions, including cognitive-behavioural therapy should be considered to treat somatoform disorders in children, if adequate training and supervision by specialists can be made available. Active consultation with a mental health specialist should be considered in managing these conditions, when possible (137) GRC-approved I-83 – PA229. Pharmacological interventions to treat somatoform disorders in children and adolescents should not be considered by non-specialized health-care providers (137) GRC-approved I-84. Referral and support for management of psychotic disorders Essential everywhere Full WHO support I-84 – PA165. [WHO guidelines on mental health promotion and prevention in adolescents in development] I-84 – PA166. Child and adolescent mental health services across different levels of a health system include: informal community care by non-health workers at schools focused on promotion of mental health and primary prevention of mental disorders; and primary health care by health workers in clinics, including parental and youth education, screening for mental health problems (including suicidal tendencies), identification of young people at risk of mental health problems, short-term counselling services for young people and their families and basic management of behavioural disorders and follow-up and support for young people with chronic conditions (16,18) GSWCAH evidence-based AHD intervention I-84 – PA170. Assessment of common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-84 – PA171. Schools should identify psychological problems and refer those affected for appropriate treatment (11) I-84 – PA172. Follow-up on common presentations of child and adolescent mental and behavioural disorders (non-specialized health setting protocol) (19) GRC-approved I-84 – PA230. In adolescents with psychotic disorders (including schizophrenia and bipolar disorder), certain second-generation antipsychotic medications (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone) can be offered as a treatment option under supervision of a specialist. If treatment with one of the above agents is not feasible, first-generation antipsychotics (haloperidol, chlorpromazine, perphenazine, molindone) may be used under supervision of a specialist (76) GRC-approved 90 I-85. Referral and support for management of harmful use of a substance (e.g. alcohol, illicit drugs) Essential everywhere Full WHO support I-85 – PA215. Detection and management of hazardous and harmful substance use (4,16) GSWCAH evidence-based AHD intervention I-85 – PA217. No GRC-approved recommendations specifically for adolescent harmful use of alcohol currently exist. The guidance in the Global strategy to reduce the harmful use of alcohol (80) and the Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders report (81) may be used (14) Note also the Update of the Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders (76) has recommendations for “people” with alcohol and drug use disorders, i.e. ALC1, ALC2, DRU1 (cannabis), DRU2 (psychostimulant), DRU3 (opioid) I-85 – PA218. Assessment of emergency presentations of disorders due to substance use (non-specialized health setting protocol) (14,19) GRC-approved I-85 – PA219. Assessment of common presentations of disorders due to substance use (non-specialized health setting protocol) (14,19) GRC-approved I-85 – PA220. People likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose (90) GRC-approved I-85 – PA221. Management of: harmful use of a substance; dependence on a substance; and alcohol, opioid and benzodiazipine withdrawal (non-specialized health setting protocol) (14,19) GRC-approved I-85 – PA222. Psychosocial interventions for substance use disorder: psychoeducation; motivational interviewing; strategies for reducing and stopping use; mutual help groups; strategies for preventing harm from drug use and related conditions; and carer support (non-specialized health setting protocol) (14,19) GRC-approved I-85 – PA223. Pharmacological interventions for substance use disorder (non- specialized health setting protocol) (14,19) GRC-approved I-85 – PA224. Follow-up of substance use disorder (non-specialized health setting protocol) (14,19) GRC-approved I-86. Referral and support for management of dependence on a substance (e.g. alcohol, illicit drugs) Essential everywhere Full WHO support I-86 – PA217. No GRC-approved recommendations specifically for adolescent harmful use of alcohol currently exist. The guidance in the Global strategy to reduce the harmful use of alcohol (80) and the Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders (81) may be used (14) Note also the Update of the Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders (76) has recommendations for “people” with alcohol and drug use disorders, i.e. ALC1, ALC2, DRU1 (cannabis), DRU2 (psychostimulant), DRU3 (opioid). I-86 – PA219. Assessment of common presentations of disorders due to substance use (non-specialized health setting protocol) (14,19) GRC-approved I-86 – PA221. Management of: harmful use of a substance; dependence on a substance; and alcohol, opioid and benzodiazepine withdrawal (non-specialized health setting protocol) (14,19) GRC-approved WHO guideline on school health services. Web Annex A. Compendium 91 I-86. Referral and support for management of dependence on a substance (e.g. alcohol, illicit drugs) contd Essential everywhere Full WHO support I-86 – PA222. Psychosocial interventions for substance use disorder: psychoeducation; motivational interviewing; strategies for reducing and stopping use; mutual help groups; strategies for preventing harm from drug use and related conditions; and carer support (non-specialized health setting protocol) (14,19) GRC-approved I-86 – PA223. Pharmacological interventions for substance use disorder (non- specialized health setting protocol) (14,19) GRC-approved I-86 – PA224. Follow-up of substance use disorder (non-specialized health setting protocol) (14,19) GRC-approved I-86 – PA225. No GRC-approved recommendations specifically related to adolescents and tobacco currently exist. Guidance in the WHO Framework Convention on Tobacco Control: guidelines for implementation (82) may be used (14) I-86 – PA226. Schools and communities need to consider what preventive and treatment services are necessary for [tobacco] prevention and cessation (e.g. cessation programmes, counselling) and how these can best be provided. Health service providers know the health consequences of tobacco use … they can provide students, school personnel and parents with information on tobacco use in the community and demonstrate the effects of tobacco use on the body (83) I-86 – PA227. Clinicians should encourage all non-smokers not to start smoking; strongly advise all smokers to stop smoking and support them in their efforts; and advise individuals who use other forms of tobacco to quit (4,84) I-87. Referral and support for management of substance withdrawal Essential everywhere Full WHO support I-87 – PA217. No GRC-approved recommendations specifically for adolescent harmful use of alcohol currently exist. The guidance in the Global strategy to reduce the harmful use of alcohol (80) and the Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders (81) may be used (14) Note also the Update of the Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders (76) has recommendations for “people” with alcohol and drug use disorders, i.e. ALC1, ALC2, DRU1 (cannabis), DRU2 (psychostimulant), DRU3 (opioid). I-87 – PA219. Assessment of common presentations of disorders due to substance use (non-specialized health setting protocol) (14,19) GRC-approved I-87 – PA221. Management of: harmful use of a substance; dependence on a substance; and alcohol, opioid and benzodiazipine withdrawal (non-specialized health setting protocol) (14,19) GRC-approved I-87 – PA222. Psychosocial interventions for substance use disorder: psychoeducation; motivational interviewing; strategies for reducing and stopping use; mutual help groups; strategies for preventing harm from drug use and related conditions; and carer support (non-specialized health setting protocol) (14,19) GRC-approved I-87 – PA223. Pharmacological interventions for substance use disorder (non- specialized health setting protocol) (14,19) GRC-approved 92 I-87. Referral and support for management of substance withdrawal contd Essential everywhere Full WHO support I-87 – PA224. Follow-up of substance use disorder (non-specialized health setting protocol) (14,19) GRC-approved I-87 – PA225. No GRC-approved recommendations specifically related to adolescents and tobacco currently exist. Guidance in WHO Framework Convention on Tobacco Control: guidelines for implementation (82) may be used (14) I-87 – PA226. Schools and communities need to consider what preventive and treatment services are necessary for [tobacco] prevention and cessation (e.g. cessation programmes, counselling) and how these can best be provided. Health service providers know the health consequences of tobacco use … they can provide students, school personnel and parents with information on tobacco use in the community and demonstrate the effects of tobacco use on the body (83) I-87 – PA227. Clinicians should encourage all non-smokers not to start smoking; strongly advise all smokers to stop smoking and support them in their efforts; and advise individuals who use other forms of tobacco to quit (4,84) WHO guideline on school health services. Web Annex A. Compendium 93 References1 1. UHC compendium. Health interventions for universal health coverage. In: World Health Organization [website]. 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WHO guideline on school health services: web annex A: compendium
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