Child health Flashcards by Joe Delahunty

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

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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

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NAMES of ACTs available for children:

Artemether-Lumifantrine
Artesunate Amodiaquine
Artesunate Mefloquine
Dihydroartemisinin Piperaquine
NOT SP in children/1st trimester

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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

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UN SDGs 2030: 4 key things

universal
indivisible
sustainable
ambitious

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highest burden of u5 deaths (time and place?)

day 1 of life
SSA/SA

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common causes of childhood mortality:

prematurity
RTIs
birth asphyxia/trauma
malaria
all 44%

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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

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WHO IMCI guidelines address commonest cause of deaths 1 week-5 years of life, these are:

pneumonia
diarrhoea
malaria
measles
malnutrition
>70%

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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

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what does IMCI aim to do?

comprehensive intervention
strengthen HS
prevent and treat common diseases
engage the community

checks all children for danger signs

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Fever and rash Ddx:
child

Bacterial: meningococcus, pneumococcus, scarlet fever
Viral (most cases): measles, rubella, parvovirus, adenovirus, HHV6, enterovirus, parechovirus

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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

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1st disease:

Measles

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2nd disease:

scarlet fever (strep pyogenes)

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3rd disease:

Rubella (German measles)

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4th disease:

Duke’s disease, Filatov-Duke/ scarlet fever…

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5th disease:

erythema infectiosum
Slapped cheek syndrome
-Parvorvirus B19

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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