「Child health」の版間の差分

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**22,828 infants
 
**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
  
===transmission===
 
 
===clinical features===
 
===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===
 
===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
 +
 
===treatment===
 
===treatment===
 +
 +
 
===prevention===
 
===prevention===
  

2021年5月13日 (木) 10:48時点における版

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

treatment

prevention

TB in children

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