global health paediatrics Flashcards
what is the under 5 mortality rate?
-probability of a child dying before reaching age of 5
what is infant mortality rate?
-probability of a child dying before reaching the age of 1
what is a live birth?
-any sign of life after birth irrespective of gestation
what globally are the top 5 causes of under 5 mortality?
- preterm birth complications
- pneumonia
- intrapartum related complications
- congenital abnormalities
- diarrhoea
in Africa what are the top 5 causes of under 5 mortality?
- diarrhoea
- pneumonia
- malaria
- preterm birth complications
- intrapartum related complications
what causes pneumonia?
- strep pneumoniae
- haemophilus influenza
- RSV
- pneumocystis jiroveci (PCP)
what increases risk of getting pneumonia?
- malnutrition
- over crowded
- indoor air population
- parental smoking
what prevents pneumonia?
- vaccinations
- breastfeeding then complimentary nutrition
- good hygiene
what is one of the most common causes of diarrhoea in developing countries?
faeces contained water
what does diarrhoea cuse?
- malnutrition
- malnourished children
how can diarrhoea be prevented?
- safe drinking water
- good hygiene
- sanitation
- breastfeeding and good nutrition
- vaccination
what is treatment for diarrhoea?
-oral rehydration solution (ORS)
what are 6 solutions to the most preventable causes of under 5 deaths?
- Immediate and exclusive breastfeeding
- Skilled attendants for antenatal, birth and postnatal care
- Access to nutrition and micronutrients
- Family knowledge of danger signs in a child’s health
- Water, sanitation and hygiene
- Immunisations
can HIV be transferred from mother to child?
yes
how can HIV be transmitted from mother to child?
- pregnancy
- delivery
- breastfeeding
how is maternal to child transmission of HIV prevented?
- maternal lifelong antiretroviral treatment
- screen for and treat other STDs
- infant prophylaxis for 6 weeks
test child at birth, 6 weeks of age, 9 months, 18 months and then 6 weeks after cessation of breastfeeding
how does HIV present in a baby?
- recurrent of severe common childhood illnesses
- recurrent orl candidiasis not responding to treatment
- recurrent severe bacterial infections (e.g. meningitis)
- failure to thrive or growth failure
- generalised lymphadenopathy, hepatosplenomegly
- persistent fever
- encephalopthy
- chronic parotitis
- PJP Kaposi sarcoma, TB, lymphocytic interstitial pneumonia…
who do you offer HIV counselling and testing to?
- all in countries with generalised HIV epidemics
- all exposed infants at birth
- any infant child with ant suspicion of HIV
what is the diagnostic test for HIV for a neonate of <18 months?
-virological PCR for HIV DNA or RNA
what is the diagnostic test for HIV for a neonate of >18 months?
-serology rapid antibody test
what does staging do?
-determines the degree of damage the illness has done to your immune system (there are stage 1-4)
why is serology test for HIV in a baby <18 months unreliable?
-due to maternal antibodies if. mother is breastfeeding
what is HIV treatment in neonates?
HAART (highly active antiretroviral therapy): 2 NRTIs (abacavir and lamivudine) plus one NNRTI (efavirenz for >3 years old) or protease inhibitor (kaletra for <3years)
how does TB present?
- chronic cough or fever >2 weeks
- night sweats
- weight loss
- lymphadenopathy
True or false
Most children infected with M. tubercolosis develop TB
False- most do not develop TB
what are investigations for TB?
- acid fast bacili
- interferon gamma release assays
- chest Xray
- mantoux
what test for TB is not used in under 5 years old?
interferon gamma release assay
what is the treatment for TB?
two months of: Isoniazid, Rifampicin, Pyrazinamide +/- Ethambutol (RIPE)
4 monnths of: Rifampicin and Isoniazid (RI)
what causes malaria?
Plasmodium parasite from females anopheles mosquite
which is the most severe type of malaria and why?
P, falciparum
it crosses the BBB and can rapidly progress to severe cerebral malaria, seizure and coma
how does malaria present?
- fever
- pallor
- non specific malaise
what is treatment for malaria?
- artemisinin-based combination therapy (ACT) for 3 days
- severe malaria treat with IM or IV artesunate until can tolerate oral
- in high transmission areas give preventative treatment to all infants alongside routing vaccines (lon lasting insecticidal nests and/or pilot projects for malaria vaccine)
what causes malnutrition?
- lack of access
- poor feeding practice
- infection
how may a child with severe acute malnutrition present?
mid-arm circumference <115mm
Weight for height
how is malnutrition treated?
involves 10 steps in 2 phases: initial stabilisation and rehabilitation
