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Child Health > Global Child Health > Flashcards

Global Child Health Flashcards

1
Q

What is the under 5 mortality rate?

A

Probability of a child born in a specific year or period dying before reaching the age of 5

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2
Q

What is the infant mortality rate?

A

Probability of a child born in a specific year or period dying before reaching the age of 1

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3
Q

What is a live birth?

A

Any sign of life after birth irrespective of gestation

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4
Q

What are under 5 and infant mortality rates useful indicators of?

A

The level of child health and the overall development in countries

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5
Q

What are infant and under 5 mortality rates used for?

A

Millennium and sustainable development goals = allow comparison over time

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6
Q

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

A

Preterm birth complications, pneumonia, intrapartum-related complications, diarrhoea, neonatal sepsis

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7
Q

What are the top 5 causes of under 5 mortality in Africa?

A

Diarrhoea, pneumonia, malaria, preterm birth complications, intrapartum-related complications

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8
Q

Is pneumonia a massive cause of mortality in Africa?

A

Yes = kills more than AIDS, measles, meningitis, pertussis and tetanus combined

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9
Q

What is the link between under 5 mortality and income?

A

Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in high-income regions

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10
Q

Are early child deaths found to be preventable?

A

Yes = more than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable measures

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11
Q

What are 45% of all child deaths linked to?

A

Malnutrition

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12
Q

What are some simple measures that could improve neonatal survival rates?

A

Antenatal care = tetanus vaccine, treatment for maternal infection (HIV, syphilis)
Steroid injections for preterm labour
Skilled birth attendant present

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13
Q

What can skilled birth attendants help with during birth?

A

Provide clean delivery, dry baby and keep them warm, resuscitate asphyxiated babies

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14
Q

How can neonatal ICU be improved in Africa?

A

Hygiene = homemade hand gel for cleaning
DIY resuscitate = light, heater, clock, drawers
Skin to skin contact, hot rooms, bubble CPAP
Establish breastfeeding/nasogastric expressed breastmilk if possible

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15
Q

What are risk factors for pneumonia?

A

Malnutrition, overcrowding, indoor air pollution, parental smoking

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16
Q

How can pneumonia be prevented?

A

Vaccination, breastfeeding then complimentary nutrition, good hygiene

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17
Q

How is pneumonia treated?

A

Antibiotics, fluids, oxygen (may need ventilator)

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18
Q

What is diarrhoea mostly attributed to?

A

Contaminated water and food sources

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19
Q

How can diarrhoea be prevented?

A

Safe drinking water, good hygiene and sanitation, breastfeeding and good nutrition, vaccination

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20
Q

How can diarrhoea be treated?

A

Oral rehydration solution (ORS), zinc supplements

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21
Q

What is ORS?

A

Sodium glucose co-transport system = creates osmotic pull for water

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22
Q

Why is ORS beneficial?

A

Cheap and avoids need for IV fluids in mild/moderate dehydration = water instantly absorbed in jejunum avoiding most of intestine

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23
Q

What are the six solutions identified by WHO to the most preventable causes of under 5 deaths?

A 
Immediate and exclusive breastfeeding
Skilled attendant for antenatal, birth and postnatal care
Access to nutrition and micronutrients
Family knowledge of danger signs 
Water, sanitation and hygiene 
Immunisation
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24
Q

What is the SDH Goal 3?

A

Ensure healthy lives and promote well being for all by 2030

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25
Q

How is SDG Goal 3 going to be achieved?

A

End preventable deaths in newborns and under 5s, end all forms of malnutrition, reduce by 1/3 premature mortality from non-communicable diseases

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26
Q

What are some diseases the SDG goal 3 wants to eliminate and combat?

A

Eliminate epidemics of AIDS, TB, malaria and neglected tropical diseases
Combat hepatitis, water-borne diseases and other communicable diseases

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27
Q

Where are most cases of infant HIV from?

A

90% from sub-Saharan Africa = most cases due to mother to child transmission

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28
Q

What is the prognosis for children infected with HIV from birth?

A

25-30% die before age 1
50-60% die aged 3-5
5-25% live beyond 8 years old (long term survivors)

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29
Q

What has been responsible for the reduction in deaths?

A

ART

30
Q

How many babies are infected with HIV from birth by their mother without intervention?

A

Between 15-45%

31
Q

How is HIV transmitted from mother to child?

A

During pregnancy, delivery and breastfeeding (40%)

32
Q

How can mother to child transmission of HIV be prevented?

A

Maternal lifelong antiretroviral treatment, screen and treat other STDs (especially herpes), infant prophylaxis for 6 weeks

33
Q

When should children be tested for HIV when their mother is HIV positive?

A

At birth, 6 weeks, 9 months, 18 months then 6 weeks after mother stops breastfeeding

34
Q

What infections may an HIV positive child present with?

A

Recurrent or severe common childhood illnesses
Recurrent oral candidiasis not responding to treatment
Recurrent severe bacterial infections (meningitis)

35
Q

What are some signs and symptoms a child may have HIV?

A

Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
Persistent fever, encephalopathy, chronic parotitis
PJP, Kaposi sarcoma, TB, lymphocytic interstitial pneumonia

36
Q

In what circumstances should HIV counselling and testing be offered?

A

All countries with generalised HIV epidemics
All exposed infants at birth
Any infant with suspicion of HIV

37
Q

What are the diagnostic test for HIV in children <18 months old?

A

Virological PCR for HIV DNA or RNA

38
Q

What is the diagnostic test for HIV in children >18 months old

A

Serological rapid antibody test

39
Q

How can HIV be staged?

A

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

40
Q

What is given in highly active antiretrovirus therapy (HAART) for HIV?

A

Two NRTIs plus one NNRTI or protease inhibitor

41
Q

What are some examples of drugs given in HAART for HIV treatment?

A

NRTI = abacavir, lamivudine
NNRTI = efavirenz for > 3 years old
Protease inhibitor = kaletra for < 3 years old

42
Q

What are some complications of HIV treatment?

A

Compliance and side effects

Immune reconstitution inflammatory syndrome (IRIS) = NSAIDS

43
Q

What are some prophylactic HIV treatments?

A

Co-trimoxazole, routine vaccination

44
Q

How does TB present?

A

Chronic cough or fever >2 weeks, night sweats, weight loss, lymphadenopathy

45
Q

What are the risk factors for TB?

A

HIV, malnutrition, household contact

46
Q

What investigations are done for TB?

A

Acid fast bacilli = low yield in children
Interferon-gamma release assays
Chest x-ray
Mantoux

47
Q

How is TB treated?

A

Two months of rifampicin, isoniazid, pyrazinamide +/- ethambutol
Then four months of isoniazid and rifampicin

48
Q

When should treatment of TB be extended for a longer period than normal?

A

If there is TB meningitis, spinal or osteo-articular disease

49
Q

How is TB prevented?

A

BCG vaccine, pre and post exposure rifampicin

50
Q

What is the vector for malaria?

A

Plasmodium parasite is transferred by female anopheles mosquito

51
Q

What form of malaria is the most severe?

A

That caused by P.falciparum = can rapidly progress to severe cerebral malaria, seizures and coma

52
Q

How does malaria present?

A

Variable = fever, pallor, non-specific malaise

53
Q

What investigation is done for malaria?

A

Blood film for microscopy or rapid diagnostic test

54
Q

What age group has the most malarial deaths?

A

Under 5s

55
Q

What is the general treatment for malaria?

A

Artemisinin-based combination therapy (ACT) for three days

56
Q

How is severe malaria treated?

A

IM or IV artesunate until patient can tolerate oral

57
Q

What should be given in areas of high malaria transmission?

A

Preventative treatment to all infants alongside routine vaccinations

58
Q

How can malaria be prevented?

A

Long lasting insecticide nets (LLINs), pilot projects for malaria vaccine

59
Q

What are some causes of malnutrition?

A

Lack of access, poor feeding practices, infection

60
Q

What are the markers for severe acute malnutrition?

A

Mid arm circumference < 115mm
Weight for height <3SD
Oedema of both feet

61
Q

How can malnutrition patients be managed if they have good appetite and no complications?

A

As an outpatient

62
Q

What are some treatments for malnutrition?

A

Investigate cause, vitamin A, de-worm, make sure vaccinated, ready to use therapeutic food (RUTF)

63
Q

What are some examples of ready to use therapeutic foods (RUTF)?

A

Peanut butter, dried milk, vitamins and minerals

64
Q

What are the four non-communicable diseases that have the highest mortality in adults?

A

CV diseases, cancer, diabetes, chronic respiratory diseases

65
Q

What are the four main behavioural risk factors that cause non-communicable diseases in adults?

A

Tobacco use, harmful use of alcohol, insufficient physical activity, unhealthy diet/obesity

66
Q

Where do most people with epilepsy live?

A

In low and middle income countries

67
Q

What is the most common type of epilepsy?

A

Secondary epilepsy

68
Q

Is epilepsy treatable?

A

Yes = 70% respond to treatment, however 75% of sufferers don’t get the treatment they need

69
Q

Are most deaths due to epilepsy preventable?

A

Yes = most are due to accidents (drowning, falls, burns, prolonged seizures)

70
Q

Why do war and conflict lead to disease?

A

Cause over crowding = lack of food, water and shelter

Break down of health service

71
Q

What does maternal education determine?

A

Child health

72
Q

What is the association between education and child mortality?

A

Secondary school education decreases the chance of a child dying by 2/3

Child Health (27 decks)

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