NCDs, maternal health, mental health, child health Flashcards
What proportion of maternal and neonatal deaths are associated with anaemia
40%
Anaemia diagnostics in low resource areas
skin prick
colour chart - conjunctival pallor
common causes of anaemia in sub saharan Africa
Bacteremia (non-typhi salmonella - asymptomatic)
Malaria
Hookworm
HIV
G6PD
Vit A or B12 deficiency
What feature of sickle cell anaemia improves prognosis
High HbF = better prognosis
Clinical features of sickle cell
Bony deformities
Haemolysis
Organ damage from sickle cells
Pain crisis
Intercurrent infections → thrombi to spleen causing hyposplenism
Strokes/TIA
Acute splenic sequestration
Young children - dactylitis
Older children - pain in long bones
Adults - painful ulcers, non-healing
AVN
Sickle cell management
Do not transfuse unless Hb low
Folate
Pain Mx
Treat infection, fluids, O2.
Prophylactic penicillin
Immunisations
Hydroxyurea - increases proportion of HbF
What was the outcome of the FEAST trial?
increased mortality with bolus fluids in children with Sepsis in African setting
Outcome of sepsis protocol in Africa
‘usual care’ had a better mortality outcome than the sepsis protocol
Long term outcomes of sepsis
Increased mortality over the next 5 years even when compared to age and disease matched controls.
What are neutralizing antibodies
Antibodies which are effective in preventing infection - ie. active early when virus enters the body. Stops initial infection from taking hold. Patient never becomes unwell or infective.
What does ETAT stand for?
Emergency triage, assessment and treatment
What are the ETAT priority signs?
Trauma, Tiny, Temp
Pallor, pain, poisoning
Restless, respiratory distress, urgent referral
Malnutrition, oedema, burns
What are the ETAT emergency signs?
A- airway obstruction, central cyanosis
B - not breathing, severe resp distress
C - cold skin + cap refill >3 secs + weak and fast pulse
C - convulsing, coma
D - diarrhoea + lethargy/sunken eyes/ slow skin pinch/ not drinking
Management of child airway as per ETAT
Open the airway
<1year - neural position
>1 year - sniffing position
Management of child breathing as per ETAT
Respiratory distress:
- sit patient up
- give O2 if severe
- give ABx to all - Amoxil - add gent if severe
- maintenance fluids if severe (NO BOLUS)
- if wheeze present give salbutamol spacer
- CPAP if severe
Management of child circulation as per ETAT
Management of Shock
Give blood if Hb <6
Give Hartmans/saline over 30mins - slow to 1 hour and add glucose if malnourished.
If resolved - give maintainence fluids- add ReSoMal if malnourished
If not resolved - give blood - add ReSoMal if malnourished
Management of child dehydration as per ETAT
If not- malnourished
- ORS (mild)
- IV fluids (severe)
If malnourished
- ReSoMal
Give Zinc!
Management of child coma/convulsions as per ETAT
In first 5 mins: A TOOBAA PNB - A toobaa player named B
- open airway
- check time
- check obs
- O2
- BSL
- IV access
- ABx, Antimalarials
- Recovery position
- NG tube
- Blood tests
After 5 mins
- diazepam –> diazepam –> phenobarbitol/phenytoin
What is IMCI and what does it do
IMCI = integrated management of childhood illnesses
guidelines by WHO+UNICEF
address 5 major causes of child mortality
Pneumonia
Diarrhoea
Malaria
Measles
Malnutrition
What is a missed opportunity for vaccination?
attends clinic with no contra-indication and vaccine is not given.
What are the types of vaccine wastage?
Closed vial waste
Open vial waste
What proportion of vaccines are wasted
> 30%
What is the biggest cost in vaccine programs
the cost of the bottles!
How to know if a freeze- sensitive vaccine has been frozen
Shake test - compare with a control trial that is frozen and thawed. Compare rate of sediment
definition of Severe acute malnutrition
< 3 STD below the mean weight to length
oedema of feet
MUAC - <115
Acute malnutrition appearances
Murasmus - old man
Kwashikor - oedematous
Causes of fever + rash in children
Meningococcal, pneumococcal, scarlet fever
Measles, rubella, parvovirus B19, adenovirus, HHV6, enterovirus, parechovirus
Arbovirus
Rickettsial infections
Leptospirosis
Measles incubation, symptoms and complications
Incubation - 2 weeks
Symptoms
2-5 day prodrome
Rash - head to toe
Conjuntivitis, coryza, cough, Koplik spots
Complications - very common - occur in 40%
- pneumonia, croup, dehydration, malnutrition, encephalitis,
Prevention and follow up of measles
Prevention
- Vit A !!
- Vaccination
Follow up
- Gammaglobulin to contacts
- Chronic diarrhoea can occur post measles.
What proportion of rheumatic fever becomes rheumatic heart disease?
approx 5%
what organism causes rheumatic fever?
Group A beta haemolytic strep (strep pyogenes)
JONES criteria for rheumatic fever
J- Joint pain - migratory
O - O shaped heart - carditis, valvular disease
N - Nodules
E - Erythema marginatum
S - Syndenham chorea
(NOTE - most do not have sore throat)
Management of rheumatic fever
Aspirin
Steroids
IM Benzathine Pen
treat chorea
prophylax against relapse
Newborn danger signs
Unable to breast feed
Hypothermia
Fever
Grunting
Chest in-drawing
RR >60 or <30
Red eyes - ophthalmia neonatorum - from chlamydia and gonorrhoea
Jaundice
Skin pustules
Redness around umbilicus
Abdo distension
Floppy baby
Convulsions
most common cause of neonatal sepsis
Group B strep
Empirical treatment of neonatal sepsis
Ampicillin + Gentamycin
Management of hypoxic ischaemic encephalopathy (baby born not breathing)
If baby not breathing → stimulate and clear airway
If still not breathing → bag and mask within first minute
Can clamp and cut umbilical cord early if needing to move baby to flat surface
recommendations for use of steroids in pregnancies with high premature birth risk
Improves mortality in high resources settings but worsens mortality in low resource settings. (still recommended in LMIC if they have the resources to screen and treat infections)
Management in newborns which improves mortality
kangaroo care
bubble CPAP
breast feeding
Coma scales in children
AVPU scale
Blantyre coma scale
GCS - adapted for children
determinants of reproductive health
Family planning
Antenatal care
Treatment if infertility
Unsafe abortion issues
Reproductive tract infections
STI and HIV
Human sexuality and reproductive health
Violence against woman and harmful practices
Appropriate referrals
