Paediatric global health Flashcards
Definition of infant and child mortality rate Top 5 causes of child mortality (11j) World Health Organization’s 6 solutions to preventable deaths (10e, 11e, 11h) HIV: prevention, presentation, diagnosis and treatment (8c,e) Non-health factors influencing child health (10e, 11a)
How is the probability of death expressed as?
As per 1000 live births and doesnt include still births
What do the red countries signify?
probablity of dying before the age of 5 is 1/5
top 5 causes of under 5 mortality globally
Preterm birth complications Pneumonia Intrapartum-related complications Diarrhoea Neonatal sepsis
What are causes of under 5 mortality in africa?
Diarrhoea Pneumonia Malaria Preterm birth complications Intrapartum-related complications
How common in pneumonia in causing deaths?
kills more than AIDS, measles, meningitis, pertussis and tetanus combined
has the global under 5 mortality increased or decreased?
decreased
Why do 2.7 million of babies die every year in their first month?
mpst still born
1st 24 hours –> most dangerous as either they aren’t delivered properly
in sout-east asia and sub-saharan africa
Do tetanus affect men or women?
Men more as women usually vaccinated
How to prevent neonatal syphilis attacks during death?
give them a dose of penicillin during pregnancy
If the baby is born premature what is given?
steroid to help development the resp system
What do you do if the babies is born not crying, not breathing and blue?
dont leave them like that, stimulate the baby and rub them -> baby will cry
use a bag and mask to stimulate the baby –> basic resuscitation device
What is the best option for regulating temperature when no incubators are presnt?
Kangaroo care best
- keeps the temperature warm
- stabilises the heart rate
How is bubble cpap?u
sing pumps and a tank of water - resp support
What can you do if there are no incubatal units?
“hot rooms” use heaters to incraese the heat of the room in which the baby is kept
35% of premature babies
born after 36 weeks
how to manage good feeding to the children?
Establish breastfeeding/nasogastric expressed breastmilk if possible
half of the kids who have aids die from what?
PCP/ PJP
What are the risk factors for pneumonia?
Malnutrition
Over-crowding
Indoor air pollution
Parental smoking
What leads to an increased risk of bronchiolitis in kids?
Parental smoking
What prevents the kids from pneumonia?
Vaccinations
Breastfeeding then complimentary nutrition
Good hygiene
how to treat pneumonia?
Adequate access to community health or hospital
What causes kids to die from diarrhoea?
due to faecdes-contaminated water
How to prevent diarrhoea in kids?
Safe drinking water, good hygiene and sanitation
Breastfeeding and good nutrition
Vaccination
Why is Zn important in treating diarrhoea?
Zn - helps immunity and helps to transport water across the intestine
How to treat diarrhoea?
ORS
Zn supplements
what is the importance fo ORS?
Sodium Glucose Co-transport System
Creates osmotic pull for water
Instantly absorbed in jejunum avoiding most of intestine
For mild and moderate dehydration avoids IV fluids
Only costs pennies
What are the 6 solutions to prevent the 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
- Immunizations
What is the sustanaible development goal 3 by un?
Ensure healthy lives and promote well-being for all at all ages by 2030
Target 3.2: End preventable deaths of newborns and children under 5 years of age
Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
Target 2.2: End all forms of malnutrition
Target 3.4: Reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
Where is the majority of children affected by AIDS (antenataly/ at birth/ breatfeeding)?
Sub-saharan africa
if the kids are affected by aids at birth, what are their mortality rates?
25-30% die before first birthday
50-60% die aged 3-5 years
5-25% live beyond 8 years: “long-term survivors”
What has helped to decrease the deaths of children due to AIDS?
Anti-retroviral therapy
If a mom is positive what do you do?
prophylxis for6 months
when do you keep hcecking that the baby is positive or not
?
Test child at birth, 6 weeks of age, 9 months, 18 months then 6 weeks after cessation of breastfeeding.
How does HIV usually present as?
Recurrent or severe common childhood illnesses eg otitis media, diarrhoea
Recurrent oral candidiasis not responding to treatment
Recurrent severe bacterial infections eg meningitis
Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
Persistent fever
Encephalopathy
Chronic parotitis
PJP, Kaposi sarcoma, TB, lymphocytic interstitial pneumonia….
which babies should be offered cousneling/ treating>
ALL in countries with generalized HIV epidemics (prevalence over 1% in pregnant women)
ALL exposed infants at birth
Any infant child with any suspicion of HIV
What are the diagnostic tests to check HIV in babies?
<18 months of age: virological PCR for HIV DNA or RNA
>18 months: serological rapid antibody test
What are the clinical stagings of HIV?
Clinical staging 1-4
Immunological staging: CD4 count
** Virological staging: viral load ** - number of viruses detectable in the body
which testing is the fastes?
Rapid antibody test
Who all should be given HIV treatment?
ALL children living with HIV, regardless of WHO clinical stage or at any CD4 cell count.
What happens oif a kid has a tb and HIV?
treat Tb for 2 weeks before starting HIV
what is the routine prophylaxis for tb in those with hIV?
co-trimoxazole
risk factors for tb
HIV, malnutrition, household contact
how can you test for HIV?
adults - acid fast bacilli kids - AFC low yield hence not useful IFG release assays (not useful as it cant tell the diff btw latent and active and in africa most have latent) chest x-ray mantoux
What are the treatments for tb?
Two months of : Isoniazid, Rifampicin, Pyrazinamide +/- Ethambutol
Then four months of isoniazid and rifampicin
Would you give BCG vaccine in kis with HIV?
no
mosrt serious form of malaria caused by which organim?
P.Falciparun crosses BBB and causes serious seizures
other causes of organism?
P.ovale, P.vivax, P. malariae
What are the rapid malaria test?
best to check if malaria is there or not
What if a person comes from malaria endemic areas with fever?
check and treatment
what are the treatments for malaria?
Treatment with artemisinin-based combination therapy (ACT) for 3 days
Severe malaria treat with IM or IV artesunate until can tolerate oral
What is the cause of most child deaths globally? (45%)
malnutrition
What are the causes of malnutrition?
Lack of access
Poor feeding practices
Infection
What are the causes of malnutrition?
older siblings prioritised
Is kwashiorkar and marasmus distinguished?
no, as the treatment for the both is the same
kwashiorkar - protein-loss in diet
How do you diagnose severe acute malnutrition?
Mid-arm circumference <115mm
Weight for height
How do you treat malnutrition?
10-step plan
- give them sugar (hypoglycaemia)
- give antibiotics (if they come in with hypothermia as they are cold and have hypoglycaemia)
- Rehydrate orally and slowly - every 2 hrs or so, IV - only if the child in shocl Don’t give too much fluid at the same time (as too much fluid can cause heart failure)
- Electrolytes (breast feeding)
- sensory stimulation
- prepare for follow up
- micronutrients
8
how do you test malnutrition?
Good appetite or not, and if no complication - manage as OP
Investigate cause Vitamin A De-worm Ready to use therapeutc food (RUTF) – peanut butter, dried milk, vitamins & minerals Make sure vaccinated
What are the 4 major non-communicable diseases that cause the majority of the deaths?
Cardiovascular diseases
Cancers
Diabetes
Chronic respiratory diseases
What are the 4 behavioural risk factors?
Tobacco use
Harmful use of alcohol
Insufficient physical activity
Unhealthy diet/obesity
What are the causes of seconary epilepsy?
malaria, road traffic accidents, meningitis, birth asphysia etc
What is the importance of treatment in epilepsy?
70% respond to the treatment (but most dont have it)
Which country did polio resurface in are 14 years with no cases?
Syria (as immunication decreased by 43%)
Which areas have the highest newborn mortality rates?
Areas affected by humanitarian emergencies
What is a major determinant of child health and prevents child death by 2/3rds?
secondary school education for moms
What is the average weight of a newborn born in the UK?
3.4 kg
What is meant by under 5 mortality rate?
Probability of a child born at a specific period or year dying before reaching the age of 5/ 1000 live births per year.
What is meant by the infant mortality rate?
Probability of a child born in a specific year or period dying before reaching the age of 1/ 1000 live births per year.
What is meant by the neonatal mortality rate?
Probability of a child born in a specifc year or age dying before reaching the age of 1 month/ 1000 live births per year.
What is a leading indicator of the level of child health and the overall development in a country?
Under 5 mortality rate
What is the most common cause for child death?
malnutrition
