Paediatric Global Health Flashcards
Definition of under 5 mortality rate?
Probability of a child born in a specific year/period dying before reaching 5 years of age
Definition of infant mortality rate?
Probability of a child born in a specific year/period dying before reaching 1 year of age
Definition of newborn mortality rate?
Probability of a child born in a specific year/period dying before reaching 1 month of age
How are these probabilities of death expressed?
Rate per 1000 LIVE births (i.e: any sign of life after birth irrespective of gestation, so it does not inc. stillbirths)
Top 5 causes of under 5 mortality globally?
- Preterm birth complications
- Pneumonia
- Intrapartum-related complications
- Diarrhoea
- Congenital abnormalities
Top 5 causes of under 5 mortality in Sub-Saharan Africa?
- Pneumonia
- Preterm birth complications
- Intrapartum-related complications
- Diarrhoea
- Malaria
Simple healthcare measures that are effective for newborns?
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
Risk factors for pneumonia?
Malnutrition, over-crowding, indoor air pollution and parental smoking (increases risk of bronchiolitis)
Prevention of pneumonia?
Vaccinations
Breastfeeding and then complementary feeding
Good hygiene
Treatment of pneumonia?
Adequate access to community health/hospital
What is ORS?
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)
Benefits of ORS?
Useful for mild/moderate dehydration
Avoids IV fluids
Inexpensive
6 solutions for 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
Method of HIV transmission to children?
Majority mother to child transmission, during pregnancy, delivery or breastfeeding
Outcomes of HIV infection at birth?
- Die before their 1st birthday
- Die aged 3-5 years
- Live beyond 8 years of age (“long-term survivors”)
Prevention of mother to child transmission of HIV?
Maternal lifelong anti-retroviral treatment
Screen for and treat other STDs, esp. Herpes
Infant prophylaxis for 6 weeks OR throughout breastfeeding
Diagnosis of HIV in children?
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
Presentation of HIV in childhood?
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
To whom should counselling/treatment be offered to?
ALL in countries with generalised HIV epidemics
ALL exposed infants at birth
Any infant child with any suspicion of HIV
Treatment of HIV?
Recommend for all children with HIV, HAART (2 NRTIs + 1 NNRTI or protease inhibitor)
Co-trimoxazole prophylaxis and routine vaccinations
Examples of NRTIs?
Nucleoside reverse transcriptase inhibitors, e.g: abacavir and lamivudine
Examples of NNRTIs?
Non-nucleoside reverse transcriptase inhibitors, e.g: efavirenz for those >3 years old
Examples of protease inhibitors?
Kaletra for those <3 years old
Complications of HAART?
Compliance
Side effects
Immune reconstitution inflammatory syndrome (IRIS) - treated with NSAIDs
Risk factors for TB?
HIV, malnutrition and household contact
Presentation of TB?
Chronic cough OR fever for >2 weeks
Night sweats
Weight loss
Lymphadenopathy
Ix for TB?
Acid-fast bacilli (low yield in children)
Interferon-Gamma
Release Assays
Chest X-ray
Mantoux
Treatment of TB?
2 RIPE 4 RI
Prevention of TB?
BCG (not in a HIV +ve patient)
Cause of malaria?
Plasmodium parasite from female anopheles mosquito; the most severe is P. falciparum
Presentation of malaria?
Very variable but can be with:
• Fever
• Pallor
• Non-specific malaise
Diagnosis of malaria?
Blood film for microscopy or rapid diagnostic test
Treatment of malaria?
Artermisinin-based combination therapy (ACT) for 3 days; if severe, treat with IM/IV artesunate until they can tolerate oral
Prevention of malaria?
Long-lasting insecticidial nets (LLINs)
Diagnosing severe acute malnutrition?
Mid-arm circumference <115 cm
Weight for height
Treatment of malnutrition?
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
Complications of epilepsy?
Stigma and discrimination
Many preventable deaths, e.g: falls, drowning, burns and prolonged seizures
