WK 3- Critical Diseases of Children

Question 1

What is anaemia

Answer 1

the reduced capacity of blood to transport oxygen as haem→due to decreased red cell numbers or decreased haemoglobin concentrations within cells

Question 2

Roughly how many people in developing countries does anaemia affect

Answer 2

Anaemia affects over half of pre-school children and pregnant women in developing countries and at least 30-40% in industrialized countries

Question 3

What is the most prevalent cause of anaemia

Answer 3

Iron deficiency is the most prevalent cause (around 75%)

Question 4

What complications can arise from anaemia

Answer 4

• heart failure and arrhythmia (due to decreased volume and viscosity of blood)
• reduced immunity to infection/decreased immune function
• worsen prognosis for other diseases-> ie. worsen pneumonia due to decreased oxygen
• it can impact negatively on cognitive development, reduced school attendance and educational attainment, decreased national productivity in countries with high levels of anaemia

Question 5

What are the different types of anaemia

Answer 5

Anaemia can be defined by aetiology, lab findings or cellular process

Question 6

What are the different aetiologies (causes) of anaemia

Answer 6

• Genetic-eg haemoglobinopathies
• Nutritional-eg iron deficiency, folate deficiency
• Reactive-eg anaemia of chronic disease, CKD
• Functional-eg blood loss (childbirth), cell destruction (splenomegaly)
• Infection-MALARIA, HIV/AIDS, parasitic
• Combinations-more than one cause

Question 7

What is the WHO 3 pronged approach to tackling anaemia

Answer 7

Increase iron intake
→Dietary diversification, food fortification, iron supplementation (avoid going straight to supplementation unless in high resource country where small number of people are affected→ not feasible to do in countries where majority of population is affects)
-Control infection
→Control measures for infections that contribute to iron deficiency (eg malaria, hookworm, schistosomiasis) & preventable illnesses (diarrhoea, vaccine preventable diseases)
-Improve nutritional status
→Manage and improve other nutritional deficiencies (egB12, folate, VitA)

Question 8

What are the 2 most common causes of child mortality

Answer 8

pneumonia and malaria

Question 9

How can children be PROTECTED against pneumonia

Answer 9

exclusive breast feeding for 6 months, adequate complementary feeding and preventing low birth weight
-children who are not breast fed within first 6 months are more likely to die of pneumonia

Question 10

How can pneumonia be PREVENTED in children

Answer 10

vaccinate against pneumococcal (strep causes pneumonia), HIb, pertussis and measles, hand washing, reduce household air pollution, prevent HIV in children, cotrimoxazole prophylaxis for HIV-infected children

Question 11

How can pneumonia be TREATED in children

Answer 11

→ improved care seeking and referral, case management at the health facility and community level, antibiotics/oxygen availability, continued breastfeeding

Question 12

What are some signs of pneumonia in children

Answer 12

difficult/fast breathing, cough, fever, fatigue, irritability, stop eating/feeding

Question 13

What are the abnormal resp rates of children

Answer 13

<1= ABOVE 50
2= ABOVE 40
4= ABOVE 30

Question 14

What are the effects of uncontrolled malaria

Answer 14

• LBW/stillbirth
• Child mortality
• Sick or anaemic adults
• Reduced productivity / economic activity
• Costs to health system
• Loss of productivity of a community (if large proportion of community is affected)

Question 15

What are the 2 types of transmission of malaria

Answer 15

Stable= constant high rates of transmission . Over time adults develop a level of immunity. May have parasitaemia and anaemia, but less severe illness unless pregnant/HIV. Children at risk of severe disease
Unstable= usually low transmission with epidemic outbreaks-> no immunity so severe disease results

Question 16

What is an uncomplicated presentation of malaria

Answer 16

patient who presents with symptoms of malaria and a positive parasitological test (microscopy or RDT) but with no features of severe malaria is defined as having uncomplicated malaria

Question 17

What are some early symptoms of malaria

Answer 17

headache, lassitude, fatigue, abdominal discomfort, and muscle and joint aches→Followed by fever, chills, anorexia, sweating, vomiting and worsening malaise→May also have cough or diarrhea making differential even wider

Question 18

What key factor differentiates between malaria and pneumonia

Answer 18

checking respiratory rate differentiates between malaria and pneumonia

Question 19

What investigations are conducted to test for malaria

Answer 19

• using RDT and thick/thin blood films

- Thick films to make the diagnosis –higher sensitivity, Thin films to look at parasite count and species

Question 20

What tx is available for malaria

Answer 20

Artemesinin Combination Therapy for P Falciparum→ Artemesinin plus another antimalarial –combination to reduce resistance.

Question 21

What are symptoms seen with severe malaria

Answer 21

prostration, impaired consciousness (GCS below 11), seizures, acidosis, shock, renal failure, significant bleeding, severe jaundice, hypoglycaemia, anaemia

Question 22

What are the 4 major ways that malaria can be controlled/eliminated

Answer 22

1. vector control
2. case diagnosis and effective tx
3. intermittent preventative tx in pregnancy and intimacy
4. vaccine developement

Question 23

What are the 2 main ways in which malaria vectors can be controlled

Answer 23

IRS (indoor residual spraying) and ITN (insecticide treated nets)

Question 24

How can early diagnosis aid in being an effective tx

Answer 24

takes around 10 days for gametes to be present in the blood→ if treat before 10 days can prevent spread and development

Question 25

What are the 3 stages that malaria vaccines can work at

Answer 25

pre-erythrocytic phase: short phase, stop replication and movement into RBC

• blood stage: target where the protozoa is in RBC→ stops them getting as sick
• anti-transmission: prevent gamete formation/stop spreading of the disease

Question 26

Why can developing a malaria vaccine be difficult

Answer 26

→ vaccines are difficult to maintain as the parasites mutate easily and are short lived