Child health Flashcards
bedside tests for severe malaria child:
Prostration – cannot stand up unaided
Blantyre scoring for conscious level assessment
Hypoglycaemia – finger prick testing <2.2
Haemocue ?bedside
Severe anaemia – conjuncitva, palmar pallor comparing hand to mother’s hand
RR – observations/vital signs
2 seizures in 24h
Mx CM in child: initial
A-E including airway management
IV artesunate or quinine if not available
Anticonvulsants – Benzos
Oxygen +- CPAP +- mechanical ventilation
CRO IV cover bacterial sepsis
Treat hypos
Benzos
Antipyretics
NAMES of ACTs available for children:
Artemether-Lumifantrine
Artesunate Amodiaquine
Artesunate Mefloquine
Dihydroartemisinin Piperaquine
NOT SP in children/1st trimester
Rationale behind each of the 2 drugs in ACT?
Artesunate works fast, short half life, effective, affects gametocytes – rapid parasite killing, genetic barrier high to resistance in artesunate -> low resistance
Other drug protects artesunate from resistance, longer half-life, resistance unlikely due to combination
UN SDGs 2030: 4 key things
universal
indivisible
sustainable
ambitious
highest burden of u5 deaths (time and place?)
day 1 of life
SSA/SA
common causes of childhood mortality:
prematurity
RTIs
birth asphyxia/trauma
malaria
all 44%
key interventions to prevent childhood deaths:
skilled delivery attendant
exclusive breast feed 6/12
ANC/PNC
Vaccination
Iron, Vit C, Zinc supplements
ORS
Deworming
Improved diagnostics
WHO IMCI guidelines address commonest cause of deaths 1 week-5 years of life, these are:
pneumonia
diarrhoea
malaria
measles
malnutrition
>70%
challenges to improving global health for children:
lack political will, prioritisation
resource unavailability
HS challenges - infrastructure, services
Poor community engagement
Poor levels of women empowerment
fragile settings
corruption
what does IMCI aim to do?
comprehensive intervention
strengthen HS
prevent and treat common diseases
engage the community
checks all children for danger signs
Fever and rash Ddx:
child
Bacterial: meningococcus, pneumococcus, scarlet fever
Viral (most cases): measles, rubella, parvovirus, adenovirus, HHV6, enterovirus, parechovirus
FEAST Trial NEJM - Clinical Risk score in African children
Children who had aggressive fluid resuscitation had higher mortality rates
?third spacing, pulmonary oedema
Diluting the circulation of an already anaemic patient
PET score and PETaL score
PET uses 8 values all of which involve bedside clinical exam
PETaL includes lab values
1st disease:
Measles
2nd disease:
scarlet fever (strep pyogenes)
3rd disease:
Rubella (German measles)
4th disease:
Duke’s disease, Filatov-Duke/ scarlet fever…
5th disease:
erythema infectiosum
Slapped cheek syndrome
-Parvorvirus B19
6th disease:
roseola infantum
(3 day fever THEN rash)
HHV 6>7
other (DTMH) causes of fever + rash:
Arboviruses (Dengue, Chik, YF)
Rickettsial infections (Spotted fever, Typhus group, scrub typhus)
Leptospirosis
SEROCONVERSION
Dengue warning signs:
Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation
Mucosal bleed
Lethargy or restlessness
Liver enlargement >2cm
Inc Hct concurrent with rapid decrease in Plt count
R0 Measles:
12-18
why is eradication feasible in measles:
no animal reservoir
no chronic infection
Safe and effective vaccine available
measles incubation period:
1-2 weeks
up to 21 days
clinical features of measles:
prodrome - fever, loss appetite, 3C’s (cough, coryza, conjunctivitis), Koplik spotst
rash - morbiliform head, trunk, extremities
widespread mp rash
Diagnostics measles:
IgM 4 days after rash onset (blood, saliva)
RNA PCR throat swab, saliva, blood, urine
WHO clinical Dx - mp rash widespread + one of 3 Cs
Cx measles:
1-3/1000 die (respiratory or neurological complications)
Acute encephalitis
Subacute sclerosing panencephalitis
Contagiousness measles:
4 days before rash to 4 days after
Usually coryzal during this period
Respiratory spread (not touching rash)
Mx mild measles:
Vitamin A supplementation
supportive care, Rx Cx
Mx severe measles:
IV Abx
o2
nebulised oxygen for croup
treat severe acute malnutrition
susceptible contacts measles <1 years old Rx:
gammaglobulin
measles prevention:
vaccination
overcrowded areas
refugee classes
immunocompromise
Rheumatic fever pathogen:
Group A B-haemolytic streptococcus
also scarlet fever, impetigo
Rheumatic heart disease pathology:
cross-reactivity between bacteria and cardiac connective tissue
carditis then either resolves or -> RhHD
Dx RhF:
Jones Criteria:
2 major/1 major + 2 minor:
MAJOR:
carditis, polyarthritis, chorea, Erythema marginatum, SC nodules
MINOR:
arthralgia, fever, raised CRP/ESR, prolonged PR
social determinants of health RhF:
reduction poverty, inequality, crowded living conditions
improved access to HC
primary prevention RhF:
treating Strep A with appropriate Abx
development of GAS vaccine
secondary prevention RhF:
improve awareness, Dx of ARF, registers of people with ARF, prophylactic abx for people at risk for ARF recurrence
gold standard dx GAS:
throat culture
can use RDTs
other serology tests
abx for 2ndry prevention of ARF:
IV benpen
Pen V oral
Erythromycin
sulphanomide
salicylates have dramatic effect
The three delays in care:
Seeking care
Reaching care
Receiving care - ETAT
What is ETAT
Triage and management of critically ill children in LMICs
Developed in Malawi
ETAT = manage a child with an emergency sign as soon as the sign is recognised
Standardised treatment with clear algorithms
Professional structures
Preparedness
Visualisation of protocols
Changes in the physical environment
Improvement of patient flow
Allocation of staff (keep paeds in paeds)
Regular training
Adapted to APLS concept
WHO guideline linked to reducing u5 mortality
when can you use ETAT:
severe respiratory distress
severely impaired circulation
severe dehydration
Severe acute malnutrition
(SAM)
weight-for-height z score
<-3 or MUAC <11.5 cms or
pedal oedema (age 6m – 5
y)
Kwashiorkor:
oedema (pitting, bilateral;
limb, periorbital)
* flaky-paint dermatitis
* dry, thin, depigmented hair
* hepatomegaly
* apathy, misery, lethargy
inappropriate adaptation
Marasmus
thin, flaccid skin: “little
old man” appearance
* reduced fat and muscle
* alert, irritable
Appropriate adaptation to
malnutrition
EPI - Missed opportunities for vaccination
causes:
Can be due to
* Fear of vaccine wastage/cost; negative health workers attitude
* Not screening for vaccines; schedule of vaccination clinics
* Fear of side effects; misconception of contraindications
