Global Child Health Flashcards
What terms are now to be used instead of “developing” or “third world” countries?
Low/middle/ income countries
What is meant by the “infant mortality rate”?
Number of children dying before the age of 1 year
What is the neonatal mortality rate?
Number of children dying before 1 month of age
What are the top 5 causes of under 5 mortality globally?
- Preterm birth complications
- Pneumonia
- Intrapartum-related complications
- Diarrhoea
- Neonatal sepsis
What are the top 5 causes of under 5 mortality in africa?
- Diarrhoea
- Pneumonia
- Malaria
- Preterm birth complications
- Intrapartum-related complications
European infant mortality is mainly due to neonatal causes. TRUE/FALSE?
TRUE
Why is there a smaller percentage of neonatal mortality in africa compared to europe?
There are more communicable diseases in africa, therefore children are more likely to die of infection
What simple measures can be put in place for newborns in order to minimise neonatal deaths?
Antenatal care for mother
=>Tetanus vaccine
=> Tx of infections including HIV & syphilis
Steroids for preterm labour (to aid baby’s lungs)
Skilled birth attendant present
Antibiotics for sepsis and pneumonia
How do low income countries in Africa provide services such as an NICU?
- homemade hand gel
- DIY resuscitare
- Kangaroo care (held close to mother)
- “Hot rooms”
- potential NG tube for breastmilk
- Bubble CPAP (for infant resp. distress syndrome)
What are the benefits of “Kangaroo care” from the mother?
Regulates baby’s RR as they can feel the mother breathe
Synchronises mother and baby’s HR
Regulates temperature of the baby
What are the main causes of pneumonia in low income countries
Strep pneumoniae
Haemophilus influenza
RSV
Pneumocystis jiroveci
What pneumonia is most prevalent in HIV infected infants
Pneumocystis jiroveci
What are the main causes of pneumonia in low income countries?
Malnutrition
Over-crowding
Indoor air pollution
Parental smoking
How is diarrhoea prevented in low income countries?
- Safe drinking water
- good hygiene and sanitation
- Breastfeeding and good nutrition
- Vaccination
What can be used to treat diarrhoea in low income countries
Oral rehydration solution (ORS) Zinc supplements (aid water transport across intestine)
How can HIV be transmitted from mother to child?
Transmitted during:
Pregnancy
Delivery
Breastfeeding
How can HIV transmission from mother to child be prevented?
- Maternal lifelong antiretroviral treatment
- Screen for and treat other STDs, especially herpes
- Infant prophylaxis for 6 weeks
What diagnostic tests can be used for children with suspected HIV infection?
<18 months of age: virological PCR for HIV DNA or RNA
> 18 months: serological rapid antibody test
What is used to stage HIV?
Viral Load
What treatment did WHO recommend for ALL children living with HIV, regardless of their clinical staging?
2 NRTIs + one NRTI OR protease inhibitor
NRTI = Nucleoside reverse transcriptase inhibitors
eg abacavir and lamivudine
NNRTI = Non-nucleoside reverse transcriptase inhibitors eg efavirenz for >3yr olds
Protease inhibitor eg kaletra for <3yr olds
How does TB usually present in children?
Chronic cough or fever >2 weeks
night sweats
weight loss
lymphadenopathy
What risk factors can increase a child’s chance of TB infection?
HIV
malnutrition
household contact
What investigations can be used if TB is suspected in children?
Acid-fast bacilli (**BUT low yield in children)
Interferon-Gamma Release Assays (can pick up latent TB which is common)
Chest Xray (for intrathoracic lymph node enlargement)
Mantoux (difficult if child has had BCG vaccine)
The BCG vaccination cant be given to children who are HIV positive. TRUE/FALSE?
TRUE
How is malaria usually treated?
Treatment with artemisinin-based combination therapy (ACT) for 3 days
Severe malaria treat with IM or IV artesunate until can tolerate oral
Why is P. falciparum the most severe form of malaria?
Crosses the blood-brain barrier
=> can rapidly progress to severe cerebral malaria, seizures and coma
What are the most common causes of malnutrition?
Lack of access
Poor feeding practices (younger children get less food than older siblings. Mothers who cook the food also get less)
Infection
What is used to diagnose severe acute malnutrition?
Mid-arm circumference <115mm
Weight for height
If children are severely malnourished, what is the first step of treatment?
at risk of hypoglycaemia
given a feed on admission
=> 10% glucose or sucrose
If a child presents in hypothermia due to malnourishment, how should they be treated?
treated routinely for hypoglycaemia and infection
=> glucose and antibiotics
If children need rehydrated, this should be achieved IV. TRUE/FALSE?
FALSE
IV route is not for rehydration, except in cases of shock.
Rehydrate slowly, either orally or by nasogastric tube
An appetite test can determine whether a child needs admitted or can be managed as an outpatient. TRUE/FALSE?
TRUE
If good appetite & no complications can be managed as outpatient
What should be ensured when managing malnourishment as an outpatient?
- Investigate cause
- Vitamin A
- De-worm (remove worms from intestines as these are using up all nutrients)
- Ready to use therapeutic food (RUTF) – peanut butter, dried milk, vitamins & minerals
- Make sure vaccinated
Why do the majority of epilepsy sufferers live in low/middle income countires?
They have developed secondary epilepsy due to:
- malaria
- road traffic accidents
- meningitis
- birth asphysia
These are more common in these types of country
War and conflict can reduce immunisation in certain countries. TRUE/FALSE?
TRUE
e.g. Syria 2010 pre-conflict = 80% immunised
Syria 2014 = 43% immunised
=> causing resurface of polio
Maternal education has no effect on their children’s health. TRUE/FALSE?
FALSE
even going to the equivalent of primary school can decrease their childs death risk by 2/3
