Paediatric Global Health

Question 1

What is the definition of a live birth?

Answer 1

Any sign of life after birth irrespective of gestation

Question 2

What are the global top 5 causes of under 5 mortality?

Answer 2

Preterm birth complications
Pneumonia
Intrapartum related complications
Diarrhoea
Neonatal sepsis

Question 3

What antenatal care can help prevent newborn death?

Answer 3

Tetanus vaccine

Treatment of maternal infections such as HIV and syphilis

Question 4

When is kangaroo care used?

Answer 4

Regulate temperature when there are no incubators present

Question 5

What are risk factors for pneumonia?

Answer 5

Malnutrition
Over crowding
Indoor air pollution
Parental smoking

Question 6

How can pneumonia in infants be prevented?

Answer 6

Vaccinations
Breastfeeding then complimentary nutrition
Good hygiene

Question 7

What vaccinations can be given to help prevent pneumonia?

Answer 7

Hib
Pneumococcus
Measles
Whooping cough

Question 8

What commonly causes diarrhoea?

Answer 8

Contaminated water and food sources - e.coli and rotavirus

Question 9

What is oral rehydration therapy?

Answer 9

Clean water
Salt
Sugar

Question 10

How can diarrhoea be treated?

Answer 10

ORS

Zinc supplements

Question 11

Why are zinc supplements used in diarrhoea?

Answer 11

Reduce the duration of diarrhoea episodes by 25% and are associated with a 30% reduction in stool volume

Question 12

What are si solutions to the most preventable causes of under 5 death?

Answer 12

Immediate and exclusive breastfeeding
Skilled attendants for antenatal, birth and postnatal care
Access to nutrition and micronutrients
Family knowledge of danger signs in child’s health
Water, sanitation and hygiene
Immunizations

Question 13

Where is the majority of HIV found?

Answer 13

90% in subsaharan africa with 90% passed via mother to child transmission

Question 14

How is HIV transmitted MTCT (mother to child transmission)?

Answer 14

Pregnancy
Delivery
Breastfeeding

Question 15

How can MTCT be prevented?

Answer 15

Maternal lifelong antiretroviral treatment
Screen for and treat other STDs especially herpes
Infant prophylaxis for 6 weeks

Question 16

How can HIV present in infants?

Answer 16

Recurrent or severe common childhood illnesses (otitis media, diarrhoea)
Recurrent oral candidiasis not responding to treatment
REcurrent severe bacterial infections e.g. meningitis
Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
Persistent fever
Encephalopathy
Chronic parotitis
PIP
Kaposi sarcoma
TB
Lymphocytic interstitial pneumonia

Question 17

How is HIV diagnosed?

Answer 17

Less than 18 months: virological PCR for HIV DNA or RNA

More than 18 months: serological rapid antibody testing

Question 18

How is HIV staged?

Answer 18

Clinical staging 1-4
Immunological staging: CD4 count
Virological staging: viral load

Question 19

How is HIV treated?

Answer 19

2 NRTIs (abacavir and lamivudine) plus one NNRTI (efavirenz) or protease inhibitor

Question 20

What are the side effects to HIV treatment?

Answer 20

Headache
Nausea
Liver toxicity 
Hypersensitivity reactions
Strange dreams

Question 21

What is the correlation between HIV and TB?

Answer 21

Need to start TB treatment before HIV treatment as the immune recovery is brought about by a response to antiretroviral treatment due to the unmasking of latent or subclinical infection

Question 22

Why should the BCG vaccine not be given to HIV positive children?

Answer 22

Can get disseminated BCG disease

Question 23

How will TB present?

Answer 23

Chronic cough or fever for more than 2 weeks
Night sweats
Weight loss
Lymphadenopathy

Question 24

What are risk factors to TB?

Answer 24

HIV
Malnutrition
Household contact

Question 25

How is TB investigated?

Answer 25

Acid-fast bacilli Interferon gamma release assay CXR Mantoux test

Question 26

How is TB treated?

Answer 26

2 months of isoniazid, rifampicin, pyrazinamide +/- ethambutol

Question 27

When is ethambutol given in children?

Answer 27

If area of high isoniazid resistance or patient is HIV positive

Question 28

What is malaria?

Answer 28

Plasmodium parasite from female anopheles mosquito

Question 29

What is the most severe form of malaria?

Answer 29

P. falciparum which can rapidly progress to severe cerebral malaria, seizures and a coma

Question 30

What is the presentation of malaria?

Answer 30

Fever Pallor Non-specific malaise

Question 31

How is malaria treated?

Answer 31

Artemisin based combination therapy (ACT) for 3 days | Severe malaria treat with IM or IV artesunate until can tolerate oral

Question 32

How is malaria prevented?

Answer 32

Long-lasting insecticidal nets | Pilot projects for malaria vaccine which has shown to protect children against P.falciparum

Question 33

What are the definition of severe acute malnutrition?

Answer 33

Mid arm circumference less than 115 mm Weight for height less than 35D Oedema of both feet

Question 34

What are the 2 phases of treatment in malnutrition?

Answer 34

Stabilization | Rehabilitation

Question 35

What is the treatment for malnutrition?

Answer 35

10% glucose or sucrose 2 hour feeding Hypothermia treatment Rehydrate slowly either orally or by NG tube, using oral rehydration solution for malnourished children (5-10ml/kg/hr) Keep breastfeeding but also initiate feeding with F75 milk Only IV fluids in cases of shock

Question 36

How is malnutrition managed as an outpatient?

Answer 36

``` Investigate cause Vitamin A Deworm Therapeutic food - peanut butter, dried milk, vitamins and minerals Vaccinated ```

Question 37

What can cause secondary epilepsy?

Answer 37

Malaria RTA Menigitis Birth asphysia