3: Global Child Health

Question 1

Rather than “developing / developed” or first/second/third-world, what terms are used to describe countries now?

Answer 1

Low / middle / high income countries

Question 2

What is infant mortality rate?

Answer 2

Probability of dying before the age of 1

Question 3

Are stillbirths / miscarriages included in infant mortality rates?

Answer 3

No, live births only

Question 4

Countries where the infant mortality rate is high tend to have less ___.

Answer 4

doctors

Question 5

What parts of the world have the highest infant mortality rates?

Answer 5

Africa

SE Asia

Question 6

Neonatal mortality describes the death of a child in what period of life?

Answer 6

First 28 days

Question 7

What simple measures taken at birth reduce the infant mortality rate?

Answer 7

Skilled attendant > clean deliver

Vaccination

Treatment for infection

Question 8

What is the most common respiratory cause of infant mortality?

Answer 8

Pneumonia

Question 9

What is the most common GI cause of infant mortality?

Answer 9

Diarrhoea

secondary to gastroenteritis caused by contaminated water and food

Question 10

How can pneumonia be prevented?

Answer 10

Vaccination

Good hygiene

Nutrition support

Question 11

How is diarrhoea prevented?

Answer 11

Safe drinking water and food

Good hygiene and sanitation

Vaccination

Question 12

How is infant diarrhoea treated?

Answer 12

Oral rehydration solution (relearn SGLT2)

Zinc supplements - micronutrient replacement

Question 13

How does SGLT work?

Answer 13

Cotransporter for Na⁺ and Glucose INTO small bowel / kidneys (1/2)

Water follows sodium so effectively rehydrates

(Oral rehydration solutions contain water, sodium and glucose to take advantage of SGLT and rehydrate quicker)

Question 14

What is a viral infection which causes a large proportion of paed deaths in Africa?

Answer 14

HIV

Question 15

How can babies contract HIV?

Answer 15

Transmission from mother

across placenta, during delivery or via breastfeeding

Question 16

How is mother-child HIV transmission prevented?

Answer 16

Put mother on anti-retrovirals

Screening

Give infant anti-retrovirals prophylactically after birth

Question 17

In a child with recurrent widespread infections, what should be suspected?

Answer 17

HIV infection

Question 18

As with many viruses, how is HIV tested for?

Answer 18

Viral PCR

Question 19

Why can’t the blood of breastfeeding babies be tested for HIV?

Answer 19

If mother is on anti-retrovirals then the baby will receive remnants from breast milk - not a representative of baby w/o antibodies

Question 20

Why is compliance for anti-retrovirals poor?

Answer 20

Disgusting medication

Question 21

How does HIV cause immune suppression?

Answer 21

Attacks CD4+ T cells, inhibiting body’s ability to produce an immune response

Question 22

What distinctive tumour(s) are associated with HIV infection?

Answer 22

Kaposi sarcomas

Question 23

Which type of pneumonia is associated with HIV?

Answer 23

Pneumocystis jirovecci

Question 24

What sort of vaccines should be avoided in people with HIV?

Answer 24

Live attenuated

weakened immune system so can cause actual infection

Question 25

What infection commonly accompanies HIV in infected children?

Answer 25

**Tuberculosis** chronic cough, fever, weight loss, night sweats, lymphadenopathy... so treatments are often given together

Question 26

How is suspected childhood TB investigated?

Answer 26

**Ziehl-Neelson test** for **Acid-fast bacilli** in **sputum** (not common in kids) **CXR** (for cavitating lesions) **Mantoux test**

Question 27

How is tuberculosis treated?

Answer 27

**2 RIPE 4 RI** 2 months of rifampicin, isoniazid, pyrazinamide and ethambutol then 4 months of rifampicin and isoniazid only

Question 28

What immunisation are people with HIV commonly given?

Answer 28

**BCG** for TB

Question 29

What is a common parasitic infection causing child mortality?

Answer 29

**Malaria**

Question 30

Which organism causes malaria?

Answer 30

*Plasmodium falciparum*

Question 31

What are the common symptoms of malaria?

Answer 31

**Prodromal headache** (migraine-y) **Myalgia** **Anorexia** progressing to fever and reduced conscious level

Question 32

Any child in a low income country with a fever, pallor and malaise should be tested for what?

Answer 32

**Malaria**

Question 33

Is malaria immunity life-long?

Answer 33

**No**, must be immunised before travel

Question 34

How is malaria prevented?

Answer 34

**Mosquito nets** **Intermittent vaccination**

Question 35

What is a dietary cause of child mortality?

Answer 35

**Malnutrition**

Question 36

What is a common neuro problem in children of low income countries?

Answer 36

**Epilepsy**

Question 37

What disrupts healthcare delivery in middle/low income countries?

Answer 37

**Conflict**