CHAPTER 1&2: LRTI and DIARRHOEA

Question 1

How many deaths are caused by lower respiratory tract infections in X year.

Answer 1

2.6 million deaths in 2019.

Question 2

What is the common cause of bacterial pneumonia.

Answer 2

Question 3

What is the common cause of viral pneumonia

Answer 3

Respiratory syncytial virus (RSV).

Question 4

What are the five countries implicated in pneumonia deaths in (X) years.

Answer 4

Nigeria, Congo, Ethiopia, India, Pakistan in 2018 for children under age of 5 years.

Question 5

How is LRTI transmit.

Answer 5

Direct contact with respiratory droplets (airborne).

Question 6

What are social factors that increases the risk of LRTI.

Answer 6

• Exclusive breastfeeding is not commonly practice in West Africa and Central Africa.
• Cultural practice: In Nigeria, there is a belief that colostrum is ‘dirty milk’ and therefore harmful to the baby. Therefore they believe that the mother should rest and clean up and perform some rituals.
• Mother’s marital status may result in less support if they are single and also education level.

Question 7

What are the implications of not exclusively breastfeeding.

Answer 7

Increased incidence of infectious morbidity: pneumonia.

Question 8

What is the critical window for breastfeeding and what happens in this critical window.

Answer 8

Critical window for breastfeeding children for growth is the first 1000 days of child’s life where antibodies (IgA for mother who has already had rotavirus), minerals, vitamins and enzymes.

Question 9

Why do mothers not get their child to urgent care when they are presenting with LRTI symptoms.

Answer 9

Mothers in developing countries may not be aware of the symptoms presentation.

Question 10

What are economic factors that increases risk of contracting LRTI.

Answer 10

Poverty=poor living standards= inability to afford access to good healthcare service.

Question 11

What are patient factors (children) that increases the risk of contracting LRTI.

Answer 11

Malnourished children are at increased risk of dying: most deaths caused by infections due to impaired immune function: gut flora has greater gram negative bacteria compared to healthy children, reduced granulocyte chemotaxis and microbicidal activity common in these children.
Low birth weight= underdeveloped immune system.
Immunodeficiency (HIV/AIDs) that reduces T-lymphocytes. Increasing infection susceptibility.

Question 12

Give pharmacological approach to prevent LRTI (MAO)

Answer 12

Immunisation: Hib conjugate vaccine is effective for protection against capsular polysaccharide type ‘b’ and has decreased rate of Hib infections to a greater extent. For example: Israel prevaccine incidence of 34 per 100,000/yr and post vaccine incidence of 5 per 100,000/yr.
Hib vaccine activate T-cell dependent response with high levels of protective antibodies in infants from 2 months of age.

Question 13

What is the problems when it comes to delivering immunisation for LRTI.

Answer 13

Rural area e.g. Gambia is difficult to reach so accessibility to vaccination is a challenge.

Sanitation may be poor in area/temperature variation may impact the quality of vaccine and there may be an increased risk if infection at injection site.

Healthcare provider shortage or lack of education surrounding the importance of immunisation may impact the roll out.

Question 14

What are non-pharmacological approach for preventing LRTI (think patient factors)

Answer 14

Question 15

What are non-pharmacological approach for preventing LRTI (think environmental factors).

Answer 15

Question 16

What are the pharmacological treatment for pneumonia (+cost)

Answer 16

Amoxicillin cost US $0.27.

Question 17

What is the proportion of children who don’t receive antibiotic for pneumonia.

Answer 17

Only 1/3rd of children with pneumonia receive the antibiotics they need.

Question 18

What are educational points that could help reduce the severity of pneumonia incidences.

Answer 18

Provide educational program for mothers on signs and symptoms of LRTI.
o Symptom: fast breathing &chest withdrawing

Question 19

What is diarrhoea

Answer 19

Diarrhoea is an infection in the intestinal tract, caused by variety of bacterial, viral and parasitic organism.

Question 20

How does diarrhoea spread.

Answer 20

Diarrhoea is spread by the oral-faecal route. Poor sewage systems and sanitation encourages viral, bacterial or parasitic spread.
Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene.

Question 21

How many deaths are attributed to diarrhoea and at what age.

Answer 21

Question 22

What is the main pathogen involved in the cause of diarrhoea.

Answer 22

Rotavirus

Question 23

Where are most cases fo diarrhoea found.

Answer 23

Sub-Saharan Africa.

Question 24

What are the symptoms of diarrhoea.

Answer 24

Moderate dehydration: Thirst, sunken eye, decreased skin elasticity.
Severe dehydration: shock, feeble pulse, cold extremities..

Question 25

How can diarrhoea be prevented (think HAGUE)

Answer 25

Question 26

How long should you wash your hands for.

Answer 26

20seconds.

Question 27

What organisation is heavily involved in the delivery of rotavirus vaccine

Answer 27

Gavi- the vaccine alliance

Question 28

What vaccine has coverage for rotavirus.

Answer 28

Rotarix

Question 29

How would you treat CALEB who has contracted diarrhoea treated.

Answer 29

○ Antibiotics: May increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7. Bacteria resistance seen Shigella. Antibiotic-induced diarrhoea.

○ Bismuth compounds: Decrease the number of bowel movements in those with traveled diarrhoea, they don’t decrease the length of illness.

○ Loperamide (anti motility): effective at reducing the number of stools but not the duration of the disease.

○ Cholestyramine Bile acid sequestrant: indicated in chronic diarrhoea, if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention.

○ Alternative therapies: Zinc supplement only in infants over 6 months.

Question 30

What is the main stay therapy for Diarrhoea recommended by WHO.

Answer 30

Oral Rehydration Therapy.

Question 31

ORS should be withheld on the basis of potentially unsafe water. Sanitation takes precedence.
(a) True
(b) False

Answer 31

(b) False. ORS is not to be withheld on the basis of potentially unsafe water. Rehydration takes precedence.

Question 32

What is the optimal fluid for dispersing ORS.

Answer 32

Plain and clean fluid is optimal.

Question 33

What other fluids can be used to disperse ORS

Answer 33

Rice waters, yogurt, unsweetened tea, fresh fruit juice.

Question 34

How would you treat water.

Answer 34

Either add two bottle caps of of chlorine solution to container of water, shake it and then wait at least 30 minutes before drinking it (according to CDC). Or water can be boiled.

Question 35

In the first hour or two of ORS therapy what can occur and why does it occur.

Answer 35

Vomiting often occurs as result of child drinking the solution too quickly.

Question 36

Can drinks especially high in simple sugars such as soft drinks be recommended in children under the age of 5?

Answer 36

NO, because increases the dehydration.

Question 37

What is the bacteria that release Shiga toxin causing haemolytic ureimic syndrome

Answer 37

O157:H7 E.Coli

Question 38

What are the drivers for LRTI.

Answer 38

Malnutrition Pollution Overcrowding Tobacco

Question 39

Answer 39

Question 40

Answer 40

Question 41

Answer 41