Term
| Not seen a 50% reduction in child deaths |
|
Definition
| SS Africa, S Asia, Oceania |
|
|
Term
| Child mortality for: Developing, SS Africa, S Asia, Oceania |
|
Definition
|
|
Term
| Half of global child deaths in these countries |
|
Definition
| India (21%), Nigeria (10%), DR Congo, Pakistan, China |
|
|
Term
| ___% deaths in first month and ___% deaths in first year |
|
Definition
|
|
Term
| Direct Household Survery v. Indirect Household Survey |
|
Definition
Direct: ask about specific children and what happened
Indirect: ask how many children birthed and died; more basic but still a bit more detailed than a pure motality rate |
|
|
Term
| 8 categories for causes of death to under 5 mortality and percentages: |
|
Definition
| Neonatal (41%), Pneumonia (14%), Diarrhea (14%), Malaria (8%), HIV/AIDS (3%), Injuries (2%), Measles (1%), Other causes (17%) |
|
|
Term
LDC's do not have these systems __________
instead they have _________ |
|
Definition
advanced vital registration
highly professional interview |
|
|
Term
| F- Diagram: 1 --> 4 --> 1 --> 1 |
|
Definition
| Faeces to Fluids, Fields, Flies, Fingers to Food to Host |
|
|
Term
Brazil reducing at __%
Turkey reducing at __% |
|
Definition
|
|
Term
| 1990- 2000 versus 2000-2010 divide percentages |
|
Definition
90's bad decade with malaria resistance emerging, HIV emerging, etc.
1.2% decline in CMR versus 2.8% for second decade |
|
|
Term
| SS Africa as the same place? why not? |
|
Definition
| they face different problems with civil war, HIV prevalence, Malaria, etc |
|
|
Term
|
Definition
| got the Aswan damn and began to rapidly improve with electricity and diarrhea avoidance and now competing with Sweden levels |
|
|
Term
| ___% of reduced CMR attributed to __________ which has an impact _____ years later |
|
Definition
| almost 50%; female education; 15-20 years later or one full generation |
|
|
Term
| how many total child deaths? |
|
Definition
|
|
Term
| __% deaths due to malaria occur in _____ region |
|
Definition
|
|
Term
| __% deaths due to HIV occur in _____ region |
|
Definition
|
|
Term
| Malnutrition and children |
|
Definition
| 2/3 child deaths related to undernutirion or compounded by it |
|
|
Term
| __% of deaths of HIV occur in these 5 countries: |
|
Definition
| 51%; South Africa, Nigeria, Tanzania, Uganda, Mozambique (SA,N,T,U,M) |
|
|
Term
|
Definition
| edema from loss of certain protein; severe protein AND energy lack, skeletal |
|
|
Term
| _____ effects every child in world; causes death by _____ in countries like INDIA but not in those of US |
|
Definition
|
|
Term
| Sudanese Issues: 3 of them |
|
Definition
| Little infrastructure; no schooling for a generation due to war; dying from water they are drinking but dont know it and also lack of water |
|
|
Term
| Sever Diarrhea vs Dysentery |
|
Definition
| over 2 weeks long; blood in the diarrhea |
|
|
Term
Pathogens of Diarrhea:
list 2 bacteria and where they effect
list 2 viruses and where they effect |
|
Definition
E. Coli-- rural areas/communities
Cholera-- intense outbreaks usually in disaster settings
Rotavirus-- clinical settings as well as most global situations (worse than e coli)
Norovirus-- accounts for 90% of large diarrhea outbreaks |
|
|
Term
| Diarrhea ______ has stayed the same while ______ has decreased |
|
Definition
|
|
Term
| 2 Interventions for Diarrhea: |
|
Definition
| ORT/ORS; Zinc supplements |
|
|
Term
| _ to _ diarrhea episodes per child globally |
|
Definition
|
|
Term
Distribution of deaths from Diarrhea:
neonatal period
second half to 1 year
____ areas more than ____
_____ region and _____ region worst |
|
Definition
few in neonatal period
majority during this period once exclusive breastfeeding has ended
rural more than urban
SS Africa and SE Asia most |
|
|
Term
| 2 live rotavirus vaccines: |
|
Definition
Rotarix and RotaTeq
* areas with high prevalence have less efficacy with these |
|
|
Term
| WHO recommends inclusion in national immunization programs when: |
|
Definition
| diarrheal deaths >10% of under 5 deaths |
|
|
Term
| cost of rotavirus vaccines is ____ and saves ____ per life year saved |
|
Definition
|
|
Term
Egypt: _____________ partnership with ______
Use ______ to distribute; reduced diarrheal deaths by _%
program in _____(year)
4 components:
Outcome of ___% using ____
IMR decreased by __% and child mortality overall by __% |
|
Definition
public-private; USAID
Mothers; 45%
1981
Product designed/branded; uninterrupted supply; private sectors to sell ORT; thousands health workers trained in use
60%; ORT
35%; 43% |
|
|
Term
Madagascar: ___/___ campaign; "Safe Water Saves Lives"
diluted _____ solution
characteristics: 3 aspects |
|
Definition
CDC/PSI
chlorine
small/economical family size bottles; subsidized price so itd be bought; 60% through retail and 40% sold in schools/community |
|
|
Term
|
Definition
fluid replacement to prevent dehydration;
zinc treatment;
rotavirus and measles vaccines;
early/exclusive breastfeeding;
hand washing;
improved water supply;
community sanitation promotion |
|
|
Term
Leading cause of death in children world wide:
___% in ____ and ____ |
|
Definition
Pneumonia
50% in S Asia and SS Africa |
|
|
Term
Causes of Pneumonia--
_____, _ _ _, ______ (common in HIV patients) |
|
Definition
| streptococcus pneumonia, HIB, pneumocystis jiroveci |
|
|
Term
| Transmission of pneumonia: |
|
Definition
| airborne and through blood or shortly after birth |
|
|
Term
|
Definition
| immune compromised; environmental factors (pollution, etc) |
|
|
Term
Immunizations for pneumonia: 4 exist
treatment: |
|
Definition
HIB, pneumococcus, measles, pertusis
antiobiotics: amoxicillin and hospitalization for over 2 weeks in severe cases |
|
|
Term
| what is the "Gold Standard" of testing? |
|
Definition
| randomized control trials |
|
|
Term
| Cost of pneumonia vaccines problems |
|
Definition
| adding just a few dollars to the amount makes it even more difficult for people and their governments to pay for these vaccines to be distributed; ex. gambia total for all vaccines is $37 but a HIB vaccine would add an entire $3 when the gov only can provide $6 per person |
|
|
Term
|
Definition
1) recognize sick child
2) seek appropriate care
3) treat with antibiotics |
|
|
Term
| Problem with recognizing pneumonia: |
|
Definition
| few caregivers recognize key danger signs; 21% recognize difficulty breathing and 17% recognize fast breathing |
|
|
Term
| problem with seeking appropriate care: |
|
Definition
| only have of children with pneumonia taken to appropriate provider |
|
|
Term
problem with treating pneumonia with antibiotics:
Ex. Uganda delayed care- explain |
|
Definition
only about 19% received antibiotics they needed; urban/rural divide
however: egypy increased from 25% to 75%
ex. delayed care in Uganda: review of case histories found children often misdiagnosed with malaria and had a huge delay to seeking help |
|
|
Term
IMCI Strategy for Pneumonia:
signs of severe pneumonia: 3
non severe: 1 |
|
Definition
fast breathing, chest wall indrawing, stridor
fast breathing |
|
|
Term
|
Definition
| Community Care Management (of diseases) |
|
|
Term
| CCM decreased overall mortality in children by 24% and penumonia specific mortality by __% |
|
Definition
|
|
Term
|
Definition
| trust of allowing CHW to use meds/vaccines; drug resistance developing; drug timing and dosage |
|
|
Term
| Marsh Et. All reading on CCM- explain the type of study |
|
Definition
| sent out surveys to MOH of countries in asia and africa mostly and also to NGOs working in these countries to have them evaluate whether countyr policies or programs existed for CCM |
|
|
Term
|
Definition
| amount of diagnosed vs. number treated |
|
|
Term
|
Definition
| delivered by unpaid, women workers; game them a status |
|
|
Term
| Pneumonia and HIV are related: |
|
Definition
| of african children with severe pneumonia, 60% have HIV; 7 times higher CFR for child with HIV; high treatment failure with severe infections |
|
|
Term
|
Definition
| prevent mother to child transmission |
|
|
Term
|
Definition
| Highly active anti-retroviral therapy |
|
|
Term
| Pneumonia and ____ supplements as well as ______ |
|
Definition
| Zinc; some think it can help prevent; breastfeeding is also helpful for nutritional status |
|
|
Term
Measles: spread
signs/symptoms: 4
complications: name 2
treatment? |
|
Definition
airborne virus
fever, runny nose, cough, red eyes, small white spots inside cheeks, rash erupts after several days
blindness, encephalitis (story of that girl on the horse), severe diarrhea, ear infections, resp. infections
no treatment- only vaccination |
|
|
Term
|
Definition
| less than $1 a child; resulted in a 78% measles cause of death drop in 8 years; 95% show up today in developing countries |
|
|
Term
| WHO/UNICEF Measles strategy: 4 parts |
|
Definition
1) child gets one dose vaccine at 9 mo
2) give child second opp. mass vacc campaign
3) effective surveillance
4) care for those and include vit A provision |
|
|
Term
|
Definition
| was better under the Soviets; instead now re-emerging diseases and new need to vaccinate; disposal of waste is also problematic |
|
|
Term
|
Definition
| quintessential to Measles; developing new ways to measure whether the cold chain has been broken before administering the dose; |
|
|
Term
| Alternatives to syrringes for measles: |
|
Definition
| oral vaccine by a a vaporizor |
|
|
Term
|
Definition
|
|
Term
|
Definition
| reduce infection or disease to specific geo area but interventions required to avoid its re-establishment |
|
|
Term
|
Definition
|
|
Term
| Innovative Finance with _ _ _ _ |
|
Definition
| GAVI; raise funds by selling bonds to capital markets and then taking raised funds to use for immunization campaigns; GAVI also promises they will purchase X-vaccine doses if an industry make if for a specific disease and at a specific price |
|
|
Term
| Interventions for drowning: |
|
Definition
| drowning-safe homes, community creches, environmental modification, water safety skills |
|
|
Term
| __% drownings in daylight, 1/3 child was alone and 2/3 of those that were accompanied were only those when with other child under 10 |
|
Definition
|
|
Term
Bangladesh Drowning study setup:
age group was biggest: |
|
Definition
face to face interviews with respondents; ellicit deaths of children as well as causes of death and more detailed questions if the child was revealed to have drowned
ages 1-4 was most at risk |
|
|
Term
| 3 major risks in Bangladesh for drowning: |
|
Definition
Inadaquate supervision, lack of awarenes on risk/prevention, lack of first response skills
also- male involvement important |
|
|
Term
|
Definition
| train healthworkers to recognize signs of major childhood diseases; packaged specifically to the country and integrates many different programs to simplify the process of analysis |
|
|
Term
|
Definition
| Assess child (wholistic approach to find any disease problems); classify illness (3 color triage); ID treatment; Treat Child; Counsel the Mother (breastfeeding and when to return, etc.); Follow up |
|
|
Term
|
Definition
| health worker skills; health system issues (location, availability drugs, superviison); community and family practices |
|
|
Term
|
Definition
| reduce significantly global morbidity and mortality associated with major causes of disease under 5; to contribute to the healthy growth and development of children |
|
|
Term
| IMCI v. Vertical programs |
|
Definition
| IMCI collaborates to create one booklet and an integrated training course as opposed to vertical programs where must learn about each disease individually |
|
|
Term
|
Definition
| Health workers, family and community, community practices |
|
|
Term
| Golden Pediatric standard v. IMCI approach (4 steps) |
|
Definition
golden standard has very elaborate and multiple steps
IMCI is 4 steps: focussed assessment, quick classification, treatment, counsel/followup |
|
|
Term
|
Definition
| physical harm by an acute, thermal, or chemical force |
|
|
Term
| Unintentional injury v. intentional |
|
Definition
| no KNOWN intentional cause v. act of violence |
|
|
Term
|
Definition
| road traffic accidents and then drowning-- about 40% of all injuries |
|
|
Term
| 31% of all child injury deaths are: |
|
Definition
| unintentional like suffocation, choking, animals, venum, thermias, and natural disasters |
|
|
Term
| Gender and injuries: 1 exception and general rule |
|
Definition
| with exception of burns which girls are most likely to be subjected to, boys are more likely than girls in every category to die from injury of any cause |
|
|
Term
|
Definition
| shared place-- for labor, travel, and playing; also leading cause of disability |
|
|
Term
| Burns: two most at risk regions and why |
|
Definition
| Africa and SE Asia; highly associated with families cooking over open fires and smoke inhalation |
|
|
Term
| Falls: pyramid explained (5 levels starting with for every 1 death) |
|
Definition
| 4 permanent dissabilities, 13 hospitalized over 10 days, 24 hopsitalized up to 9 days, and 690 missed work or school or sought treatment |
|
|
Term
| Poisoning: what ages? why? developing v. developed causes |
|
Definition
ages under one year due to new exploration and then repeak after 15 with substance abuse
HIC: pharma, cleaning, pesticides, plants/bites
LIC: fuels, pharma, cleaning agents |
|
|
Term
| 3 E's of injury prevention: |
|
Definition
| Education, environment, enforcement of legislation/regulations |
|
|
Term
|
Definition
| recognizing individual worth of child v. using power over child |
|
|
Term
| WHO definition of child maltreatment: |
|
Definition
physical, emotional, sexual, neglectful, and commercial exploitation
actual or POTENTIAL harm to child in context of child-adult relationship |
|
|
Term
| Convention on the rights of the child: |
|
Definition
| signed by all countries except US and Somalia; 54 articles on the rights of the child; |
|
|
Term
Children receive Hollistic care diagram from IMCI
(4 sources influencing) |
|
Definition
health facilties: support and essential resources
families/communities: appropriate home care/safe environ
MOH- diff. departments all work together
Healthcare providers: 1 training course and provice integrated care |
|
|
Term
| what age group highest risk for road accidents? |
|
Definition
|
|
Term
| drowning is worst in _____ region due to _____ |
|
Definition
| LMIC in Western pacific region due to geography (rice, wet, etc) |
|
|
Term
| drowning highet in ages____ |
|
Definition
| 1-4 because age at which begin to explore and lack supervision that they may need |
|
|
Term
| 6 factors that contribute to Africa's heaviest burden of Malaria: |
|
Definition
anopheles gambia (most virulent mosquito)
P falciparum is most popular kind and most deadly
ITN coverage remains low (<20%)
drug resistance due to over-perscribed treatments
complex terrain, weak economies, inadequate health services
severe climate instabilities
HIB increased susceptibility
insecticide resistance |
|
|
Term
| 5 consequences of malarial infection in children and pregnant women: |
|
Definition
Anemia (malaria causes hemolysis although not really sure how it causes anemia)
Malarial kidney damage
enlarged spleen
lost work due to sickness
Intrauterine growth retardation
maternal anemia
placental parasitemia
preterm birth
low birth weight |
|
|
Term
| Integrated management- what is it? talk also about HIV/AIDS and malaria |
|
Definition
cooperation between initiatives under the common banner of maternal health (even though both may be addressing different sub-problems)
lowering the rate of malaria will also decrease the amount of Deaths from HIV because malaria will not be around to compound AIDS |
|
|
Term
|
Definition
| atemisinin based combination therapy: combination of artemisinin based or conjugate which is associated with rapidly killing the malaria parasite and another slower-acting drug that kills malaria by an entirely different means; both drugs must be independently capable |
|
|
Term
|
Definition
| rapid substantial reduction of parasite load and symptoms; effective against p falciparum (even MDR); may reduce transmission to others; shortened duration of 3 day treatment |
|
|
Term
|
Definition
| affordibility, proliferation, MDR developing, oversight |
|
|
Term
Challenges of community delivery of malaria treatment:
7 causes (list at least a few) |
|
Definition
limitation of outreach capacity (esp. nomads)
inability efficiently use resources
full community acceptance is hard
lack of understanding of problem
potential ineffectiveness of curative drug/dose
side-effects |
|
|
Term
|
Definition
| Home Management of Malaria; supported by WHO; educating many people about symptoms and then how to treat with appropriate drugs |
|
|
Term
|
Definition
ensure access to drugs at community level
ensure community drug provider has necc. skills/education
effective communication strategy
good mechanism of supervision/monitoring with state |
|
|
Term
| 6 factors contributing to worsening malaria: |
|
Definition
global warming
civil disturbances and unrest
drug-resistance evolving
changes and increase of traveling
HIV increased susceptibility
insecticide resistance to DDT |
|
|
Term
|
Definition
| partnership between WHO and many different agences/agents; reduce morb. and mort. by 1/2 by 2010; organized effort not a new method |
|
|
Term
| Roll Back Malaria strategy: |
|
Definition
| integration essentially: early diagnosis, treatment, preventive measures, prevent epidemics, focused research |
|
|
Term
| why malaria plans have failed in past: |
|
Definition
| political will, integration, community participation, resource mobilization |
|
|
Term
| Organization working to address problems of malaria in children/mothers |
|
Definition
| CORE group-- general collaborative action with many member organizations; share and creat knowledge, cross-cutting comm. health program strategies, catalyzes and supports global health intiatives at country level, advocates |
|
|
Term
| ____ peaked while ____ is on the rise for HIV |
|
Definition
| prevalence peaked; incidence rising |
|
|
Term
| _____ has most infections at 18.3% of adults |
|
Definition
|
|
Term
| almost ___% of women infected with HIV are in Africa |
|
Definition
|
|
Term
| 7 factors increasing risk of HIV: |
|
Definition
| biological, social, political, economical, cultural, access to health services, reproductive health services |
|
|
Term
| young women at greater risk biologically because: |
|
Definition
| immature cervix, less vaginal secretions |
|
|
Term
| economic effects on women more likely for HIV: |
|
Definition
| poverty and food insecutiry; transactional sex or older partner for economic support |
|
|
Term
|
Definition
| Prevention of Mother to Child Transmission |
|
|
Term
PMTCT: feeding problems
WHO recommendation: |
|
Definition
total avoidance of breastfeeding with effective formula and lots of careful planning is generally not feasible; exclusive breast feeding recommended where replacement feeding not an option;
AZT and single dose of dNVP to prevent transmission from mother to child |
|
|
Term
| Population group with largest infected persons HIV: |
|
Definition
|
|
Term
| WHy is it good to target HIV interventions at adolescents? |
|
Definition
not established rooted behavioral patterns; interventions can be tailored to their characteristics
most have not been succesful |
|
|
Term
|
Definition
| abstinence, be faithful, condom use |
|
|
Term
| 3 modes of mother to child transmission: |
|
Definition
| during pregnancy, delivery, post-natally from breast feeding |
|
|
Term
| children v. child HIV/AIDS |
|
Definition
| adult clinical features present about 9-10 years later; in children many will die before 5th birthday- more rapid |
|
|
Term
| 2 reasons women dont seek HIV care |
|
Definition
| fatalism and non-caring attitudes |
|
|
Term
|
Definition
| voluntary counseling and testing (for HIV/AIDS); often inadequately supplied |
|
|
Term
| interventions for HIV proven to work: 2 |
|
Definition
| condoms, promotion of safe sexual behaviors |
|
|
Term
| interventions potential to work: 4 |
|
Definition
| male circumcision, combination ARV's, preexposure prophylaxis, HIV vaccines |
|
|
Term
|
Definition
|
|
Term
| recs regarding PMTCT of HIV using ART |
|
Definition
WHO: earlier initiation of ART for adults and adolescents; phase out current drug and replace with AZT or TDF (less toxic and as effective)
provide ARVs to HIV positive women in 3rd trimester |
|
|
Term
| Reccs regarding Breastfeeding and PMTCT |
|
Definition
| WHO- 2009; HIV positive mothers take ARVs while breastfeeding should continue until infant is 12 months as long as mother or child is taking ARVs during this period |
|
|
Term
| Impact of HIV on children: name 6-7 effects |
|
Definition
| loss of family/identity; depression; reduced well being; increased malnutrition; starvation; failure to be immunized; decreased healthcare access; loss of schooling; loss of inheritence; forced migration; homelessness; vagrancy/crime; street living; exposure to HIV infection |
|
|
Term
| Factors that increase TB: 4 |
|
Definition
| over crowding, lots of immigration, decreased surveillance, MDR emergence |
|
|
Term
| __-__% were in developing countries (TB) |
|
Definition
|
|
Term
| Limitations of existing data: |
|
Definition
| global burden is unclear due to limited data; few studies in children and data limited by reporting delays |
|
|
Term
| ___% TB meningitis reported in SS Africa |
|
Definition
|
|
Term
|
Definition
industrialized seen a declin
developing seen an increasing rate of publishing |
|
|
Term
| TB interventions in Peru, Russia, Latvia: |
|
Definition
| DOTS program and BCG vaccine parallels these falling rates |
|
|
Term
| TB increase transmission risk factors: 4 |
|
Definition
number of cases, duration of infection
delayed treatment/diagnosis
exposure
crowding |
|
|
Term
| TB causes of increased susceptibility: |
|
Definition
| age 5-14 (immature immune system); malnutrition; immunocompromised (HIV); age; genetics; substance abuse; immunization; poverty |
|
|
Term
| TB Infection vs. TB Disease |
|
Definition
Infection= latent= bacteria spreads to lung, positive blood test but no disease, not infectious, lifetime risk of developing disease is higher
disease= active= clinical manifestation/chest radiograph; TB implies disease not infection generally |
|
|
Term
|
Definition
| must spread to bronchial tree to be trasmitted through air; transmitted through blood in children; Pulmonary TB can be smear pos/neg; those with extra-pulmonary TB rarely infectious |
|
|
Term
| clinical presentation of TB: |
|
Definition
| develops within 12 mo of exposure; reactivated by dormant mechanisms; children often have minimal symptoms |
|
|
Term
TB diagnosis:
developed vs. developing |
|
Definition
D-ed: skin test, chest radiograph, history, culture GI, sputum
D-ing: symptoms, history, diagnosis often confused with asthma or pneumonia
|
|
|
Term
|
Definition
TST: exposure if it is positive
lots of false positives, BCG can cause a false positive |
|
|
Term
| TB golden standard for diagnosis: |
|
Definition
bacterial diagnosis; in resource poor areas sputum is tested and then those people are targeted for DOTS;
even when sputum tested, only 10-15% children test positively |
|
|
Term
|
Definition
| microscopic-observation drug-susceptibility assay |
|
|
Term
MODS benefits:
country ex. |
|
Definition
new possible cheap technique for detections of m TB;
ex in Peru: more sensitive and rapid than traditional sputum test |
|
|
Term
|
Definition
| most efficient way of finding children newly infected; even if they have no physical signs |
|
|
Term
|
Definition
| TB rates increased twice as fast in countries with high HIV; HIV can complicate diagnostic tests (interferes with chest xrays) |
|
|
Term
|
Definition
increase in vaccination but still increase in TB rates
BCG is not effective and plays narrow role in prevention
great variation in BCG efficacy depending on region |
|
|
Term
|
Definition
| 2 mo, intensive, 3-4 drugs; curable if drugs followed; DOTS encouraged by WHO to ensure treatment |
|
|
Term
|
Definition
| pregnancy does NOT increase risk of TB |
|
|
