Paediatric Global Health

Question 1

Definition of under 5 mortality rate?

Answer 1

Probability of a child born in a specific year/period dying before reaching 5 years of age

Question 2

Definition of infant mortality rate?

Answer 2

Probability of a child born in a specific year/period dying before reaching 1 year of age

Question 3

Definition of newborn mortality rate?

Answer 3

Probability of a child born in a specific year/period dying before reaching 1 month of age

Question 4

How are these probabilities of death expressed?

Answer 4

Rate per 1000 LIVE births (i.e: any sign of life after birth irrespective of gestation, so it does not inc. stillbirths)

Question 5

Top 5 causes of under 5 mortality globally?

Answer 5

1. Preterm birth complications
2. Pneumonia
3. Intrapartum-related complications
4. Diarrhoea
5. Congenital abnormalities

Question 6

Top 5 causes of under 5 mortality in Sub-Saharan Africa?

Answer 6

1. Pneumonia
2. Preterm birth complications
3. Intrapartum-related complications
4. Diarrhoea
5. Malaria

Question 7

Simple healthcare measures that are effective for newborns?

Answer 7

Antenatal care:
• Tetanus vaccine
• Treatment of maternal infections, inc. HIV

Steroids for preterm labour

Skilled birth attendant present to provide:
• Clean delivery
• Dry the baby and keep them warm
• Resuscitate asphyxiated babies
• Recognise warning signs for referral

Antibiotics for sepsis and pneumonia

Question 8

Risk factors for pneumonia?

Answer 8

Malnutrition, over-crowding, indoor air pollution and parental smoking (increases risk of bronchiolitis)

Question 9

Prevention of pneumonia?

Answer 9

Vaccinations

Breastfeeding and then complementary feeding

Good hygiene

Question 10

Treatment of pneumonia?

Answer 10

Adequate access to community health/hospital

Question 11

What is ORS?

Answer 11

Oral rehydration salts - utilise the sodium glucose co-transport system

It creates an osmotic pull for the water, which is instantly absorbed in the jejunum (avoiding most of the intestine)

Question 12

Benefits of ORS?

Answer 12

Useful for mild/moderate dehydration

Avoids IV fluids

Inexpensive

Question 13

6 solutions for preventable causes of under 5 deaths?

Answer 13

1. Immediate and exclusive breastfeeding
2. Skilled attendants for antenatal, birth, and postnatal care
3. Access to nutrition and micronutrients
4. Family knowledge of danger signs in a child’s health
5. Water, sanitation, and hygiene
6. Immunisations

Question 14

Method of HIV transmission to children?

Answer 14

Majority mother to child transmission, during pregnancy, delivery or breastfeeding

Question 15

Outcomes of HIV infection at birth?

Answer 15

• Die before their 1st birthday
• Die aged 3-5 years
• Live beyond 8 years of age (“long-term survivors”)

Question 16

Prevention of mother to child transmission of HIV?

Answer 16

Maternal lifelong anti-retroviral treatment

Screen for and treat other STDs, esp. Herpes

Infant prophylaxis for 6 weeks OR throughout breastfeeding

Question 17

Diagnosis of HIV in children?

Answer 17

Test child at birth, 6 weeks of age and then 6 weeks after cessation of breastfeeding

If <18 months of age:
• Virological PCR (for HIV DNA/RNA)

If >18 months of age:
• Serological rapid Ab test

Question 18

Presentation of HIV in childhood?

Answer 18

Recurrent/severe childhood illness, e.g: otitis media, diarrhoea

Recurrent oral candidiasis with no response to treatment

Recurrent/severe bacterial infections, e.g: meningitis

Failure to thrive/growth failure

Generalised lymphadenopathy, hepatosplenomegaly

Persistent fever

Encephalopathy

PCP, Kaposi Sarcoma, TB, etc

Question 19

To whom should counselling/treatment be offered to?

Answer 19

ALL in countries with generalised HIV epidemics

ALL exposed infants at birth

Any infant child with any suspicion of HIV

Question 20

Treatment of HIV?

Answer 20

Recommend for all children with HIV, HAART (2 NRTIs + 1 NNRTI or protease inhibitor)

Co-trimoxazole prophylaxis and routine vaccinations

Question 21

Examples of NRTIs?

Answer 21

Nucleoside reverse transcriptase inhibitors, e.g: abacavir and lamivudine

Question 22

Examples of NNRTIs?

Answer 22

Non-nucleoside reverse transcriptase inhibitors, e.g: efavirenz for those >3 years old

Question 23

Examples of protease inhibitors?

Answer 23

Kaletra for those <3 years old

Question 24

Complications of HAART?

Answer 24

Compliance

Side effects

Immune reconstitution inflammatory syndrome (IRIS) - treated with NSAIDs

Question 25

Risk factors for TB?

Answer 25

HIV, malnutrition and household contact

Question 26

Presentation of TB?

Answer 26

Chronic cough OR fever for >2 weeks

Night sweats

Weight loss

Lymphadenopathy

Question 27

Ix for TB?

Answer 27

Acid-fast bacilli (low yield in children)

Interferon-Gamma

Release Assays

Chest X-ray

Mantoux

Question 28

Treatment of TB?

Answer 28

2 RIPE 4 RI

Question 29

Prevention of TB?

Answer 29

BCG (not in a HIV +ve patient)

Question 30

Cause of malaria?

Answer 30

Plasmodium parasite from female anopheles mosquito; the most severe is P. falciparum

Question 31

Presentation of malaria?

Answer 31

Very variable but can be with:
• Fever
• Pallor
• Non-specific malaise

Question 32

Diagnosis of malaria?

Answer 32

Blood film for microscopy or rapid diagnostic test

Question 33

Treatment of malaria?

Answer 33

Artermisinin-based combination therapy (ACT) for 3 days; if severe, treat with IM/IV artesunate until they can tolerate oral

Question 34

Prevention of malaria?

Answer 34

Long-lasting insecticidial nets (LLINs)

Question 35

Diagnosing severe acute malnutrition?

Answer 35

Mid-arm circumference <115 cm

Weight for height

Question 36

Treatment of malnutrition?

Answer 36

If good appetite & no complications, manage as outpatient and Ix cause:
• Vitamin A
• De-worm
• Ready to use therapeutic food (RUTF) – peanut butter, dried milk, vitamins & minerals
• Ensure vaccinated

Question 37

Complications of epilepsy?

Answer 37

Stigma and discrimination

Many preventable deaths, e.g: falls, drowning, burns and prolonged seizures