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Clinical Cases from Resource Limited Settings: David Roesel


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Participants will be able to: recognize importance and identify resources for learning about a country and local 'disease' profile; local/regional guidelines and algorithms appropriate for the specific clinical setting; how to address limitations in clinical resources for diagnosis and management of clinical cases; and understanding health care service structure and personnel/staffing structure.

Published in: Education, Health & Medicine
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Clinical Cases from Resource Limited Settings: David Roesel

  1. 1. The Febrile Patient Clinical Essentials in Global Health: David Roesel MD, MPH, DTM&H
  2. 2. Top Ten Causes of Death in Low Income Countries WHO, Global Burden of Disease 2004 Update
  3. 3. Burden of Disease in Low Income Countries WHO, Global Burden of Disease 2004 Update 2004 Update
  4. 4. Adult Mortality by Region WHO, Global Burden of Disease 2004 Update
  5. 5. Child Mortality by Region: WHO, Global Burden of Disease 2004 Update
  6. 6. General Principles: <ul><li>Fever is one of the most common reasons for seeking medical care in developing countries-- you must become comfortable evaluating and treating it . </li></ul>
  7. 7. <ul><li>Fevers in the tropics are often due to illnesses with which North American health-workers are not familiar. </li></ul>
  8. 8. <ul><li>The febrile patient may represent an infectious disease threat to others- including you. </li></ul>
  9. 9. <ul><li>Fever can represent a life-threatening emergency or a self-limiting viral illness: triage is essential . </li></ul>
  10. 11. Do you . . . ? <ul><li>Get a head CT. </li></ul><ul><li>Draw blood cultures. </li></ul><ul><li>Perform a lumbar puncture. </li></ul><ul><li>Get a chest X-ray. </li></ul><ul><li>Send a blood smear for malaria. </li></ul><ul><li>Start empiric treatment. </li></ul>
  11. 17. Integrated Management of Childhood Illness: IMCI <ul><li>A set of clinical guidelines developed by WHO and UNICEF for low-resource settings. </li></ul><ul><li>“ Reduce death, illness and disability, and promote improved growth and development among children under five years of age.” </li></ul>
  12. 18. <ul><li>Respiratory Illness </li></ul><ul><li>Diarrhea </li></ul><ul><li>Febrile Illness </li></ul><ul><li>Ear Infection </li></ul><ul><li>Malnutrition </li></ul><ul><li>Anemia </li></ul><ul><li>HIV infection </li></ul>Integrated Management of Childhood Illness: IMCI
  13. 19. Main Causes of Child Mortality: Other Infectious & Parasitic Diseases 9% Non-communicable diseases 4% Measles 4% HIV/AIDS 2% Malaria 7% Diarrheal diseases 16% Acute Respiratory Infections 17% Injuries 4% Neonatal deaths 36% Malnutrition 35% WHO, Global Burden of Disease 2004 Update
  14. 20. Prioritize Based on Danger Signs: <ul><ul><ul><li>Persistent vomiting </li></ul></ul></ul><ul><ul><ul><li>Inability to drink/breastfeed </li></ul></ul></ul><ul><ul><ul><li>Convulsions </li></ul></ul></ul><ul><ul><ul><li>Decreased level of consciousness </li></ul></ul></ul>
  15. 21. Important Causes of Fever in Children <ul><li>Respiratory illness </li></ul><ul><li>Malaria </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Typhoid </li></ul><ul><li>Meningitis </li></ul><ul><li>Measles </li></ul>
  16. 22. IMCI Management of Fever: Give Tylenol as antipyretic. Refer if fever > 7 days Danger Signs/ Stiff Neck Broad Spectrum Antibiotics + Quinine + Glucose No Danger Signs Oral Malaria Treatment (ACT) Rash, Coryza Treat for Measles None of the above Supportive care
  17. 23. Malaria Kills
  18. 24. How should this child be managed?
  19. 25. ✓ ✓ ✓ ✓ ✓
  20. 29. General Principles: <ul><li>Explore the history, esp. exposure risks and duration of illness. </li></ul>
  21. 31. <ul><li>Know the local epidemiology. </li></ul>
  22. 32. <ul><li>Do a thorough physical exam. </li></ul>
  23. 34. <ul><li>Use wisely whatever diagnostic tests you have available. </li></ul>
  24. 38. <ul><li>Be able to read X-rays. </li></ul>
  25. 40. <ul><li>Learn to do ultrasounds. </li></ul>
  26. 42. <ul><li>Tuberculosis is a common cause of persistent fevers. </li></ul>
  27. 43. <ul><li>Hospital-acquired infections are common. </li></ul>
  28. 45. <ul><li>Know how to use a few key medications. </li></ul>
  29. 46. Essential Drugs: <ul><li>Amoxicillin </li></ul><ul><li>Ampicillin </li></ul><ul><li>Co-Artem (Artemether + lumefantrine) </li></ul><ul><li>Benzylpenicillin </li></ul><ul><li>Chloramphenicol </li></ul><ul><li>Cloxacillin </li></ul><ul><li>Co-trimoxazole </li></ul><ul><li>Doxycycline </li></ul><ul><li>Erythromycin </li></ul><ul><li>Gentamycin </li></ul><ul><li>Metronidazole </li></ul><ul><li>Praziquantel </li></ul><ul><li>Quinine </li></ul>
  30. 47. <ul><li>Show respect, compassion, humility, and patience. </li></ul>
  31. 48. Why do millions die from treatable diseases every year? A. Because they’re poor. B. Who cares? C. Ignorance. D. It is written.