Child health

why child health

• children and young people are still large proportion in whole population
• large disease burden in children
  • 60% of malaria deaths, 10% of TB cases
• children are very vulnerable not only to infectious diseases but also injuries of all causes
• neonate and other children groups are still neglected and lacking epidemiological data
• children are not little adults
• preterm birth, neonatal and childhood health affect long-term health and wealth in later adulthood
• children are future

children death

• 5.9 mil. < 5 y/o died in 2015
  • 16,000 children death everyday
  • most in sub-Sahara and SE Asia
• pneumonia, malaria, diarrhea, poverty...
• the top death cause < 5 y/o is pneumonia
• 47% of <5 y/o deaths are neonates

pneumonia

framework for pneumonia control

• WHO
  • protect
    • exclusive breastfeeding for 6 months
    • adequate nutrition
    • prevent LBW
      • smoking cessation, maternal health control, prevent of young marriages
    • reduce indoor air pollution
    • handwashing
  • prevent
    • vaccine - pertussis, pneumococcal and Hib
    • prevention of child HIV
    • cotrimoxazole prevention for HIV children
    • zinc supplementation for diarrheal children
  • treat
    • appropriate medical treatment

IMCI Integrated Management of Childhood Illness

Integrated Management of Childhood Illness (IMCI)

HIV in children

epidemiology

• 2.8 mil. amongst 38 mil. LHIV are children 0-19 y/o
• DRC in 2019
  • 333,778 LHIV
  • 14,546 pregnant PMTCT
  • 22,828 infants

transmission

• 95% mother to child transmission (MTCT)
  • intrauterin 6-7%
  • prepartum 19%
  • postnatal/breastfeeding 10%
  • 35% risk in total
  • risk factor of MTCT
    • high VL, low CD4, subtype C HIV 1, cracked nipples, prematurity, ...
• sexual abuse
• sex in adolescent
• blood transfusion
• cultural actions; scarification, circumcision, tattoos by unsteriled knives

clinical features

• no symptoms at birth
• no specific symptoms after birth:
  • chronic or recurrent diarrhea
  • pneumonia (PCP)
  • oral thrush
  • poor growth
  • recurrent severe infection
  • chronic parotitis
  • bacterial infections

diagnosis

• very difficult because of passive maternal antibody up to 18 months of age
• HIV DNA, HIV RNA, P24 antigen
• 2 positive virology test means definitive HIV infection
• 1 positive virology test means presumed HIV infection
• in the absence of virology test result, based on clinical conditions
• should be confirmed by antibody test after 18 months of age
• refer diagnostic algorithm in the handout

injury, accident, disability in LMICs

epidemiology of injuries

• 5 mil. deaths (in all ages) due to injuries per year
  • 9% of global mortality
  • more than three major IDs with 3 mil. deaths
  • injuries are neglected more than infectious diseases
• proportions of injuries-caused deaths in 2012
  • road traffic 24%
  • falls 14%
  • suicide 16%
• children deaths in HICs
  • <1 y/o suffocation is the major
  • 1-4 y/o traffic accident, drowning, fall
  • 5-9 y/o traffic accident, drowning, burn

suffocation

• overlay by other person
• entrapment (wedging)
• strangulation of neck
• choking
• confinement like in fridge or laundry machine

burn

• 100,000 deaths <20 y/o per year
• girls are more suffered from burn than boys
  • possibly because girls tend to help cooking

drowning

• leading cause of children death in WPRO and South East Asian countries

poisoning

• seasoning, alcohol, fuel in kitchen
• medicine, drug

bite

• wild or strayed animal bites
• poisonous insect bites

road traffic accident

• deaths due to road traffic are increasing in LMICs contrary to HICs because of accelerated motorization without improvement of road conditions, traffic safety education and traffic legal system
• Haddon Matrix

violence

• child abuse
• human trafficking
• illegal organ trade
• sexual exploitation
• child labor
  • 158 mil. children 5-14 y/o
  • hazardous work; mines, chemical work,
• child soldier
• witch hunt

disability

• sharp decline of children deaths directly linked to increase of children in disabilities
• "impairment, disability, handicap" transformed into social model
  • disability is activity prevented by society
  • handicap is participation prevented by society
• vicious cycle of disability and poverty

neonatal health

• year to year decline rate of neonatal deaths is lesser than that of overall child death
  • another neglected health problem in LMICs

prescribing antimicrobials for children and pregnant women

children

• first line empiric antimicrobials for neonatal sepsis:
  • ampicillin and gentamycin
  • cefotaxim and gentamycin
  • ceftriaxone is not recommended because of risk of bilirubiuria
  • but in fact AMPC/GM or CTX/GM doesn't cover well neonatal sepsis pathogens now.... meropenem might be the best
• dose varies not depending on weight but also on age, especially in neonates and preterm babies, because of differences of absorption, distribution, metabolism and excretion

pregnancy

malaria in pregnancy

• risk for severe malaria
• maternal anemia
• spontaneous abortion/stillbirth
• premature birth/LBW
• treament
  • severe malaria in pregnancy - artesunate IV
  • uncomplicated falciparum malaria in pregnancy - ACT
• primaquine for vivax hypnozoite is contraindicated in pregnancy
  • should wait pregnancy termination
• chemoprophylaxis
  • doxycycline is contraindicated

TB in pregnancy

• treatment
  • first-line drugs cross placenta but seemingly not harmful
  • use same regimen as non-pregnant women, 2RHZE+4RH
    • but Z is not recommended in US