Paediatrics Global Health Flashcards
TB treatment in a low income country
Two months of: Isoniazid, Rifampicin, Pyrazinamide +/- Ethambutol (use in an area with high resistance against isoniazid or the child is HIV positive)
The Four months of: Isoniazid and Rifampicin
Acronym: RIPE
- longer if TB meningitis, spinal or Osteo-articular disease
TB investigations in a low income country
- Acid fast bacilli (low yield in children)
- Interferon-gamma release assays
- Chest x-ray
- Mantoux (skin prick test - be careful of a false positive)
Malaria
Plasmodium parasite from female anopheles mosquito
Most severe: P.falciparum => can rapidly progress to cerebral malaria, seizures and coma (by passing the blood brain barrier)
Presentation: variable
- Fever
- Pallor
- Non-specific malaise
Investigation: blood film for microscopy or rapid diagnostic test
Malaria treatment + prevention
- Artemisinin-based combination therapy (ACT) for 3 days
For severe malaria: IM or IV artesunate until oral is tolerated
Preventative treatment should be given to all infants, including routine vaccinations in areas of high transmission
- Long lasting insecticidal nets (LLINs)
- Pilot projects for malaria vaccine
Malnutrition contributes to around — of child deaths, though rarely listed as a direct cause cause
Malnutrition contributes to around 45% of child deaths, though rarely listed as a direct cause cause
Investigations/criteria/signs (idk what to call it) of severe acute malnutrition in under 5s
- Mid-arm circumference <115mm
- weight for height < 3SD
- Oedema of both feet (and else where -> from protein malnutrition aka only being fed on carbohydrates)
Malnutrition treatment - 10 steps and 2 phases
2 phases = stabilisation and rehabilitation
- High risk of Hypoglycaemia - as soon as admitted give feed of 10% glucose and sucrose, should be fed every 2 hrs
- Hypothermia
- Dehydration - overdiagnosed. Rehydrate slowly - not with IV fluids
- Electrolytes
- Infection
- Micronutrients - no iron until rehabilitation stage
- Initiate feeding
- Catch-up feeding
- Sensory stimulation
- Prepare for follow up
— of the people with epilepsy live in low and middle income countries
(Primary/secondary) epilepsy is more common
80% of the people with epilepsy live in low and middle income countries
Secondary epilepsy is more common
Maternal education: (Primary/secondary) school education decreases chance of child dying by —
Maternal education: secondary school education decreases chance of child dying by 2/3rds!! - women make better use of health and social services available to them and better at caring for their children and sending them to school
WHO Definition of Under 5 and infant mortality rate
Under 5 Mortality rate (from WHO):
Probability of a child dying before reaching the age of 5
Infant Mortality Rate:
Probability of a child dying before reaching the age of 1
Strictly speaking, not rates but probability of death expressed as rate per 1000 live births
Live birth = any sign of life after birth irrespective of gestation
What are the top 5 causes of Under 5 mortality Globally?
- Preterm birth complications
- Pneumonia
- Intrapartum-related complications
- Congenital abnormalities
- Diarrhoea
What are the top 5 causes of Under 5 mortality in Africa?
- Diarrhoea
- Pneumonia
- Malaria
- Preterm birth complications
- Intrapartum-related complications
Pneumonia kills more than AIDS, measles, meningitis, pertussis and tetanus combined
Risk factors of pneumonia in low income countries and prevention of pneumonia
Risk factors:
- malnutrition
- over-crowding
- indoor air pollution e.g. fires
- parental smoking
Prevention:
- vaccinations
- breastfeeding then complimentary nutrition
- good hygiene
Diarrhoea: causes, prevention and treatment in low income countries
Mostly caused by: Faeces-contaminated water
Diarrhoea is a major cause of malnutrition and malnourished children are more likely to fall ill from diarrhoea
Prevention:
- safe, drinking water, good hygiene and sanitation
- breastfeeding and good nutrition
- vaccination
Treament:
- Oral rehydration solution (ORS) - water, salt and sugar => for mild to moderate dehydration it avoids IV fluids
- Zinc supplements
World Health Organization’s 6 solutions to the most preventable causes of U5’s 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 (maternal education)
- Water, sanitation, and hygiene
- Immunizations
