Global Child Health Flashcards
What is the under 5 mortality rate?
Probability of a child born in a specific year or period dying before reaching the age of 5
What is the infant mortality rate?
Probability of a child born in a specific year or period dying before reaching the age of 1
What is a live birth?
Any sign of life after birth irrespective of gestation
What are under 5 and infant mortality rates useful indicators of?
The level of child health and the overall development in countries
What are infant and under 5 mortality rates used for?
Millennium and sustainable development goals = allow comparison over time
What are the top 5 causes globally of under 5 mortality?
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
Is pneumonia a massive cause of mortality in Africa?
Yes = kills more than AIDS, measles, meningitis, pertussis and tetanus combined
What is the link between under 5 mortality and income?
Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in high-income regions
Are early child deaths found to be preventable?
Yes = more than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable measures
What are 45% of all child deaths linked to?
Malnutrition
What are some simple measures that could improve neonatal survival rates?
Antenatal care = tetanus vaccine, treatment for maternal infection (HIV, syphilis)
Steroid injections for preterm labour
Skilled birth attendant present
What can skilled birth attendants help with during birth?
Provide clean delivery, dry baby and keep them warm, resuscitate asphyxiated babies
How can neonatal ICU be improved in Africa?
Hygiene = homemade hand gel for cleaning
DIY resuscitate = light, heater, clock, drawers
Skin to skin contact, hot rooms, bubble CPAP
Establish breastfeeding/nasogastric expressed breastmilk if possible
What are risk factors for pneumonia?
Malnutrition, overcrowding, indoor air pollution, parental smoking
How can pneumonia be prevented?
Vaccination, breastfeeding then complimentary nutrition, good hygiene
How is pneumonia treated?
Antibiotics, fluids, oxygen (may need ventilator)
What is diarrhoea mostly attributed to?
Contaminated water and food sources
How can diarrhoea be prevented?
Safe drinking water, good hygiene and sanitation, breastfeeding and good nutrition, vaccination
How can diarrhoea be treated?
Oral rehydration solution (ORS), zinc supplements
What is ORS?
Sodium glucose co-transport system = creates osmotic pull for water
Why is ORS beneficial?
Cheap and avoids need for IV fluids in mild/moderate dehydration = water instantly absorbed in jejunum avoiding most of intestine
What are the six solutions identified by WHO to the most preventable causes of under 5 deaths?
Immediate and exclusive breastfeeding Skilled attendant for antenatal, birth and postnatal care Access to nutrition and micronutrients Family knowledge of danger signs Water, sanitation and hygiene Immunisation
What is the SDH Goal 3?
Ensure healthy lives and promote well being for all by 2030
How is SDG Goal 3 going to be achieved?
End preventable deaths in newborns and under 5s, end all forms of malnutrition, reduce by 1/3 premature mortality from non-communicable diseases
What are some diseases the SDG goal 3 wants to eliminate and combat?
Eliminate epidemics of AIDS, TB, malaria and neglected tropical diseases
Combat hepatitis, water-borne diseases and other communicable diseases
Where are most cases of infant HIV from?
90% from sub-Saharan Africa = most cases due to mother to child transmission
What is the prognosis for children infected with HIV from birth?
25-30% die before age 1
50-60% die aged 3-5
5-25% live beyond 8 years old (long term survivors)
What has been responsible for the reduction in deaths?
ART
How many babies are infected with HIV from birth by their mother without intervention?
Between 15-45%
How is HIV transmitted from mother to child?
During pregnancy, delivery and breastfeeding (40%)
How can mother to child transmission of HIV be prevented?
Maternal lifelong antiretroviral treatment, screen and treat other STDs (especially herpes), infant prophylaxis for 6 weeks
When should children be tested for HIV when their mother is HIV positive?
At birth, 6 weeks, 9 months, 18 months then 6 weeks after mother stops breastfeeding
What infections may an HIV positive child present with?
Recurrent or severe common childhood illnesses
Recurrent oral candidiasis not responding to treatment
Recurrent severe bacterial infections (meningitis)
What are some signs and symptoms a child may have HIV?
Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
Persistent fever, encephalopathy, chronic parotitis
PJP, Kaposi sarcoma, TB, lymphocytic interstitial pneumonia
In what circumstances should HIV counselling and testing be offered?
All countries with generalised HIV epidemics
All exposed infants at birth
Any infant with suspicion of HIV
What are the diagnostic test for HIV in children <18 months old?
Virological PCR for HIV DNA or RNA
What is the diagnostic test for HIV in children >18 months old
Serological rapid antibody test
How can HIV be staged?
Clinical staging = 1-4
Immunological staging = CD4 count
Virological staging = viral load
What is given in highly active antiretrovirus therapy (HAART) for HIV?
Two NRTIs plus one NNRTI or protease inhibitor
What are some examples of drugs given in HAART for HIV treatment?
NRTI = abacavir, lamivudine
NNRTI = efavirenz for > 3 years old
Protease inhibitor = kaletra for < 3 years old
What are some complications of HIV treatment?
Compliance and side effects
Immune reconstitution inflammatory syndrome (IRIS) = NSAIDS
What are some prophylactic HIV treatments?
Co-trimoxazole, routine vaccination
How does TB present?
Chronic cough or fever >2 weeks, night sweats, weight loss, lymphadenopathy
What are the risk factors for TB?
HIV, malnutrition, household contact
What investigations are done for TB?
Acid fast bacilli = low yield in children
Interferon-gamma release assays
Chest x-ray
Mantoux
How is TB treated?
Two months of rifampicin, isoniazid, pyrazinamide +/- ethambutol
Then four months of isoniazid and rifampicin
When should treatment of TB be extended for a longer period than normal?
If there is TB meningitis, spinal or osteo-articular disease
How is TB prevented?
BCG vaccine, pre and post exposure rifampicin
What is the vector for malaria?
Plasmodium parasite is transferred by female anopheles mosquito
What form of malaria is the most severe?
That caused by P.falciparum = can rapidly progress to severe cerebral malaria, seizures and coma
How does malaria present?
Variable = fever, pallor, non-specific malaise
What investigation is done for malaria?
Blood film for microscopy or rapid diagnostic test
What age group has the most malarial deaths?
Under 5s
What is the general treatment for malaria?
Artemisinin-based combination therapy (ACT) for three days
How is severe malaria treated?
IM or IV artesunate until patient can tolerate oral
What should be given in areas of high malaria transmission?
Preventative treatment to all infants alongside routine vaccinations
How can malaria be prevented?
Long lasting insecticide nets (LLINs), pilot projects for malaria vaccine
What are some causes of malnutrition?
Lack of access, poor feeding practices, infection
What are the markers for severe acute malnutrition?
Mid arm circumference < 115mm
Weight for height <3SD
Oedema of both feet
How can malnutrition patients be managed if they have good appetite and no complications?
As an outpatient
What are some treatments for malnutrition?
Investigate cause, vitamin A, de-worm, make sure vaccinated, ready to use therapeutic food (RUTF)
What are some examples of ready to use therapeutic foods (RUTF)?
Peanut butter, dried milk, vitamins and minerals
What are the four non-communicable diseases that have the highest mortality in adults?
CV diseases, cancer, diabetes, chronic respiratory diseases
What are the four main behavioural risk factors that cause non-communicable diseases in adults?
Tobacco use, harmful use of alcohol, insufficient physical activity, unhealthy diet/obesity
Where do most people with epilepsy live?
In low and middle income countries
What is the most common type of epilepsy?
Secondary epilepsy
Is epilepsy treatable?
Yes = 70% respond to treatment, however 75% of sufferers don’t get the treatment they need
Are most deaths due to epilepsy preventable?
Yes = most are due to accidents (drowning, falls, burns, prolonged seizures)
Why do war and conflict lead to disease?
Cause over crowding = lack of food, water and shelter
Break down of health service
What does maternal education determine?
Child health
What is the association between education and child mortality?
Secondary school education decreases the chance of a child dying by 2/3
