Child Healthcare: Introduction


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Child Healthcare addresses all the common and important clinical problems in children, including:immunisation history and examination growth and nutrition acute and chronic infections parasites skin conditions difficulties in the home and society.

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Child Healthcare: Introduction

  1. 1. ChildHealthcareA learningprogramme forprofessionalsDavid Woods
  2. 2. ChildHealthcareA learningprogramme forprofessionalsProf. David
  3. 3. VERY IMPORTANTWe have taken every care to ensure that drugdosages and related medical advice in this bookare accurate. However, drug dosages can changeand are updated often, so always double-checkdosages and procedures against a reliable,up-to-date formulary and the given drug‘sdocumentation before administering it.Child Healthcare: A learning programmefor professionalsVersion 1.0.1 Updated 23 August 2007First published by Electric Book Works in 2007Text © Eduhealthcare 2007Getup © Electric Book Works 2007ISBN (paperback): 978-1-920218-01-0ISBN (international paperback): 978-1-920218-15-7ISBN (PDF ebook): 978-1-920218-55-3Editor: Diane AwerbuckDesigner: Arthur AttwellAll text in this book excluding the photographs,tests and answers is published under the CreativeCommons Attribution Non-Commercial NoDerivatives License. You can read up about thislicense at photographs, multiple-choice tests and answersin this publication may not be reproduced, stored ina retrieval system, or transmitted in any form or byany means without the prior permission of ElectricBook Works, 87 Station Road, Observatory, CapeTown, 7925.Visit our websites
  4. 4. 0 ContentsAcknowledgements 7 Handling vaccines 41 Case study 1 43Introduction 9 Case study 2 44 About the EBW Healthcare series 9 Case study 3 44 Why decentralised learning? 9 Case study 4 45 Books in the EBW Healthcare series 9 Case study 5 45 Format of the courses 11 Immunisation references 46 Contributors 12 Updating the course material 13 3 Growth and development 49 Contact information 13 Introduction 49 Measuring body size 491 The history and examination 14 The importance of growth monitoring 51 Introduction 14 Centile charts 52 The first meeting 14 Growth curves 54 The review of any referral information 15 Growth patterns 55 Basic information 15 Overweight and obesity 58 The history 17 The Road-to-Health Card 59 The physical examination 19 Neurodevelopment 60 Special investigations 22 Sexual development 61 The assessment 22 Case study 1 61 A plan of action 23 Case study 2 62 Writing good clinical notes 24 Case study 3 62 Case study 1 25 Case study 4 63 Case study 2 26 Case study 3 27 4 Nutrition 77 Case study 4 27 Introduction 77 Malnutrition 792 Immunisation 29 Protein energy malnutrition 80 Introduction 29 Vitamin deficiencies 86 BCG immunisation 34 Trace element and mineral deficiencies 88 Polio immunisation 36 Iron deficiency 88 Immunisation against diphtheria, Case study 1 90 pertussis and tetanus (DPT) 36 Case study 2 91 Measles immunisation 38 Case study 3 92 Immunisation against Hepatitis B 39 Case study 4 92 Immunisation against Haemophilus influenzae 40
  5. 5. 5 Diarrhoea 94 The clinical diagnosis of HIV infection Diagnosis and causes of diarrhoea 94 and AIDS 160 The complications of acute diarrhoea 97 Management of HIV-exposed infants 162 Treatment of diarrhoea 100 Management of children with Management of dehydration 103 symptomatic HIV infection 166 Prevention of diarrhoea 106 Case study 1 169 Case study 1 107 Case study 2 169 Case study 2 108 Case study 3 170 Case study 3 109 Case study 4 170 Case study 4 110 Reference: The 4 stages of HIV infection 1726 Upper respiratory tract conditions 111 Introduction 111 10 Childhood infections 173 Common cold 111 Introduction 173 Acute sinusitis 113 Measles 173 Allergic rhinitis 113 Chickenpox 175 Pharyngitis and tonsillitis 114 Mumps 175 Otitis media 115 Herpes stomatitis 176 Epiglottitis 118 Acute viral hepatitis 177 Influenza 118 Tickbite fever 178 Case study 1 119 Acute conjunctivitis 178 Case study 2 120 Case study 1 179 Case study 3 120 Case study 2 180 Case study 4 121 Case study 3 1807 Lower respiratory tract conditions 122 11 Parasites 182 Introduction 122 Introduction 182 Viral croup 123 Roundworms 182 Bronchitis 125 Whipworms 184 Bronchiolitis 125 Pinworms 184 Pneumonia 127 Hookworms 185 Asthma 129 Tapeworms 185 An approach to lower respiratory tract Hydatid disease 186 conditions 133 Giardiasis 187 Case study 1 134 Amoebiasis 187 Case study 2 135 Bilharzia 188 Case study 3 135 Malaria 189 Case study 4 136 Case study 1 192 Case study 2 1938 Tuberculosis 137 Case study 3 193 Introduction 137 Case study 4 194 Tuberculosis 138 Case study 1 151 12 Skin conditions 195 Case study 2 152 Introduction 195 Case study 3 153 Local viral infection 196 Case study 4 153 Local fungal infections 198 Local bacterial infections 1999 HIV infection 155 Rashes due to systemic infections 200 Introduction 155 Local parasitic infestations 200 Transmission of hiv to children 156 Rashes due to skin irritants 202 Diagnosing HIV infection in a child 159
  6. 6. Rashes due to allergies 204 Case study 3 249 Other skin conditions in children 206 Case study 4 250 Typical presentation of rashes 207 Case study 1 207 Tests 251 Case study 2 208 Test 1: History and examination 251 Case study 3 208 Test 2: Immunisation 253 Case study 4 209 Test 3: Growth and development 255 Case study 5 209 Test 4: Nutrition 256 Test 5: Diarrhoea 25813 Serious illnesses 211 Test 6: Upper respiratory tract Introduction 211 conditions 260 Acute rheumatic fever 211 Test 7: Lower respiratory tract Acute glomerulonephritis 214 conditions 261 Septicaemia 215 Test 8: Tuberculosis 263 Meningitis 217 Test 9: HIV infection 265 Pyelonephritis 219 Test 10: Childhood infections 266 Other bacterial infections 220 Test 11: Parasites 268 Diabetes 220 Test 12: Skin conditions 270 Convulsions 220 Test 13: Serious illnesses 271 Cancer 221 Test 14: Home and society 273 Case study 1 222 Test 15: Childhood mortality 275 Case study 2 222 Case study 3 223 Answers 278 Test 1: History and examination 27814 Home and society 224 Test 2: Immunisation 278 Children’s rights 224 Test 3: Growth and development 279 Poverty 225 Test 4: Nutrition 279 Social environment 226 Test 5: Diarrhoea 279 Child abuse 227 Test 6: Upper respiratory tract Street children 229 conditions 280 Orphans 230 Test 7: Lower respiratory tract developmental screening 231 conditions 280 Neurodevelopmental disability 232 Test 8: Tuberculosis 281 Behaviour and emotional problems 233 Test 9: HIV infection 281 Case study 1 234 Test 10: Childhood infections 281 Case study 2 234 Test 11: Parasites 282 Case study 3 235 Test 12: Skin conditions 282 Case study 4 236 Test 13: Serious illnesses 282 Test 14: Home and society 28315 Childhood mortality 237 Test 15: Childhood mortality 283 Introduction 237 Collecting information on under-5 Skin conditions: illustrations 284 deaths 240 Mortality review 241 Causes of under 5 deaths 244 The analysis of mortality data 245 Ways of avoiding the common causes of under 5 deaths 246 Case study 1 248 Case study 2 249
  7. 7. 0 AcknowledgementsI wish to gratefully acknowledge the practical choice was adopted. While everycontribution of Prof Andrew Argent, Dr effort has been made to correct any errors inGerry Boon, Prof Mark Cotton, Ms Fawzia the text, the final decision and responsibilityDesai, Prof Peter Donald, Dr Teresa Edwards, were mine alone. Thanks to the Department ofProf Brian Eley, Dr Mary Hann, Prof John Dermatology at the University of Cape Town forIreland, Prof Prakash Jeena, Dr Pieter Jooste, the colour photographs of skin conditions.Prof Maurice Kibel, Dr Patricia Lawrence, My sincere thanks go to the publishers forProf Walter Loening, Dr Elmarie Malek, Dr their willingness to support this project andNeil McKerrow, Dr Mark Painter, Dr Mark for their innovative vision of presenting thePatrick, Prof David Power, Prof John Rohde, text in both book and web-based format. TheProf Haroon Saloojee, Prof Simon Schaaf, latter will be made available at no cost togetherDr Christopher Sutton, Prof Gail Todd, with an invitation to contribute in the form ofProf Gideon Tindimwebwa, Dr Hester van comments which, after review, will be added asder Walt, Prof Eugene Weinberg, and Prof extensions of the text.Dankwart Wittenberg. Royalties from the sale of this book will go toMy particular thanks to Dr Gerry Boon, Ms Eduhealthcare, a not-for-profit organisationFawzia Desai, Prof John Ireland and Prof David which has the goal of improving the healthcarePower for their support and guidance, and to of children, especially in poor countries,Dr Mary Hann for meticulously reviewing through the education of nurses and doctors.the draft. When opinions differed betweencontributing colleagues, the simplest most Prof David Woods
  8. 8. 0 IntroductionABOUT THE EBW often far away from the healthcare workers’ families and places of work, and the contentHEALTHCARE SERIES frequently fails to address the real healthcare requirements of the poor, rural communitiesEBW Healthcare publishes an innovative who face the biggest healthcare challenges.series of distance-learning books for To help solve these many problems, a self-healthcare professionals, developed by the help decentralised learning method has beenPerinatal Education Trust, Eduhealthcare, developed which addresses the needs ofthe Desmond Tutu HIV Foundation and the professional healthcare workers, especiallyDesmond Tutu TB Centre, with contributions those in poor, rural communities.from numerous experts.Our aim is to provide appropriate, affordableand up-to-date learning material for healthcare BOOKS IN THE EBWworkers in under-resourced areas, so that theycan manage their own continuing education HEALTHCARE SERIEScourses which will enable them to learn, practiseand deliver skillful, efficient patient care. Maternal Care addresses all the commonThe EBW Healthcare series is built on and important problems that occurthe experience of the Perinatal Education during pregnancy, labour, delivery and theProgramme (PEP), which has provided puerperium. It covers the antenatal andlearning opportunities to over 60 000 nurses postnatal care of healthy women with normaland doctors in South Africa since 1992. Many pregnancies, monitoring and managingof the educational methods developed by PEP the progress of labour, specific medicalare now being adopted by the World Health problems during pregnancy, labour and theOrganisation (WHO). puerperium, family planning and regionalised perinatal care. Skills workshops teach clinical examination in pregnancy and labour, routineWHY DECENTRALISED screening tests, the use of an antenatal card and partogram, measuring blood pressure,LEARNING? detecting proteinuria and performing and repairing an episiotomy.Continuing education for healthcare workers Maternal Care is aimed at healthcare workerstraditionally consists of courses and workshops in level 1 hospitals or by formal trainers at large central hospitals.These teaching courses are expensive to attend,
  9. 9. 10Primary Maternal Care addresses the Mother and Baby Friendly Care describesneeds of healthcare workers who provide gentler, kinder, evidence-based ways of caringantenatal and postnatal care, but do not for women during pregnancy, labour andconduct deliveries. It is adapted from theory delivery. It also presents improved methodschapters and skills workshops from Maternal of providing infant care with an emphasisCare. This book is ideal for midwives and on kangaroo mother care and exclusivedoctors providing primary maternal care level 1 district hospitals and clinics,and complements the national protocol of Saving Mothers and Babies was developed inantenatal care in South Africa. response to the high maternal and perinatal mortality rates found in most developingIntrapartum Care was developed for doctors countries. Learning material used in this bookand advanced midwives who care for women is based on the results of the annual confidentialwho deliver in district hospitals. It contains enquiries into maternal deaths and the Savingtheory chapters and skills workshops adapted Mothers and Saving Babies reports published infrom the labour chapters of Maternal Care. South Africa. It addresses the basic principlesParticular attention is given to the care of mortality audit, maternal mortality,of the mother, the management of labour perinatal mortality, managing mortalityand monitoring the wellbeing of the fetus. meetings and ways of reducing maternal andIntrapartum Care was written to support perinatal mortality rates. This book shouldand complement the national protocol of be used together with the Perinatal Problemintrapartum care in South Africa. Identification Programme (PPIP).Newborn Care was written for healthcare Birth Defects was written for healthcareworkers providing special care for newborn workers who look after individuals with birthinfants in regional hospitals. It covers defects, their families, and women who are atresuscitation at birth, assessing infant size and increased risk of giving birth to an infant with agestational age, routine care and feeding of both birth defect. Special attention is given to modesnormal and high-risk infants, the prevention, of inheritance, medical genetic counselling,diagnosis and management of hypothermia, and birth defects due to chromosomalhypoglycaemia, jaundice, respiratory distress, abnormalities, single gene defects, teratogensinfection, trauma, bleeding and congenital and multifactorial inheritance. This bookabnormalities, as well as communication with is being used in the Genetics Educationparents. Skills workshops address resuscitation, Programme which trains healthcare workers insize measurement, history, examination and genetic counselling in South Africa.clinical notes, nasogastric feeds, intravenousinfusions, use of incubators, measuring blood Perinatal HIV enables midwives, nursesglucose concentration, insertion of an umbilical and doctors to care for pregnant women andvein catheter, phototherapy, apnoea monitors their infants in communities where HIVand oxygen therapy. infection is common. Special emphasis has been placed on the prevention of mother-to-Primary Newborn Care was written infant transmission of HIV. It covers the basicsspecifically for nurses and doctors who of HIV infection and screening, antenatalprovide primary care for newborn infants in and intrapartum care of women with HIVlevel 1 clinics and hospitals. Primary Newborn infection, care of HIV-exposed newbornCare addresses the care of infants at birth, care infants, and parent counselling.of normal infants, care of low-birth-weightinfants, neonatal emergencies, and common Childhood HIV enables nurses and doctorsminor problems in newborn infants. to care for children with HIV infection. It addresses an introduction to HIV in children,
  10. 10. 11the clinical and immunological diagnosis 2. Pre- and post-testsof HIV infection, management of children There is a multiple-choice test of 20 questionswith and without antiretroviral treatment, for each chapter at the end of the book.antiretroviral drugs, opportunistic infections Participants are encouraged to take a pre-testand end-of-life care. before starting each chapter, to benchmark their current knowledge, and a post-test afterChildhood TB was written to enable each chapter, to assess what they have workers to learn about the primarycare of children with tuberculosis. The book Self-assessment allows participants to monitorcovers an introduction to TB infection, their own progress through the course.and the clinical presentation, diagnosis,management and prevention of tuberculosis 3. Question-and-answer formatin children and HIV/TB co-infection.Childhood TB was developed by paediatricians Theoretical knowledge is presented in awith wide experience in the care of children question-and-answer format, which encourageswith tuberculosis, under the auspices of the the learner to actively participate in theDesmond Tutu Tuberculosis Centre at the learning process. In this way, the participantUniversity of Stellenbosch. is led step by step through the definitions, causes, diagnosis, prevention, dangers andChild Healthcare addresses all the common management of a particular problem.and important clinical problems in children, Participants should cover the answer for a fewincluding immunisation, history and minutes with a piece of paper while thinkingexamination, growth and nutrition, acute and about the correct reply to each question. Thischronic infections, parasites, skin conditions, method helps learning.and difficulties in the home and society. ChildHealthcare was developed for use in primary Simplified flow diagrams are also used, wherecare settings. necessary, to indicate the correct approach to diagnosing or managing a particular problem.Adult HIV covers an introduction to HIVinfection, management of HIV-infected adults Each question is written in bold, like this,at primary-care clinics, preparing patients for and is identified with the number of theantiretroviral (ARV) treatment, ARV drugs, chapter, followed by the number of thestarting and maintaining patients on ARV question, e.g. 5-23.treatment and an approach to opportunisticinfections. Adult HIV was developed by 4. Important lessonsdoctors and nurses with wide experience inthe care of adults with HIV, under the auspicesof the Desmond Tutu HIV Foundation at the Important practical lessons are emphasised byUniversity of Cape Town. placing them in a box like this. 5. NotesFORMAT OF THE COURSES NOTE Additional, non-essential information is provided for interest and given in notes like this. These facts are not used in the case studies or1. Objectives included in the multiple-choice questions.The learning objectives are clearly stated at thestart of each chapter. They help the participant 6. Case studiesto identify and understand the important Each chapter closes with a few caselessons to be learned. studies which encourage the participant
  11. 11. 12to consolidate and apply what was learned CONTRIBUTORSearlier in the chapter. These studies give theparticipant an opportunity to see the problem The developers of our learning materials are aas it usually presents itself in the clinic or multi-disciplinary team of nurses, midwives,hospital. The participant should attempt to obstetricians, neonatologists, and generalanswer each question in the case study before paediatricians. The development and review ofreading the correct answer. all course material is overseen by the Editor- in-Chief, emeritus Professor Dave Woods,7. Practical training a previous head of neonatal medicine at theCertain chapters contain skills workshops, University of Cape Town who now consults towhich need to be practised by the participants UNICEF and the WHO.(preferably in groups). The skills workshops,which are often illustrated with line drawings, Perinatal Education Trustlist essential equipment and present step-by- Books developed by the Perinatal Educationstep instructions on how to perform each Programme are provided as cheaply as possible.task. If participants aren’t familiar with a Writing and updating the programme is bothpractical skill, they are encouraged to ask an funded and managed on a non-profit basis byappropriate medical or nursing colleague to the Perinatal Education Trust.demonstrate the clinical skill to them. In thisway, senior personnel are encouraged to sharetheir skills with their colleagues. Eduhealthcare Eduhealthcare is a non-profit organisation8. Final examination based in South Africa. It aims to improve health and wellbeing, especially in poor communities,On completion of each course, participants through affordable education for healthcarecan take a 75-question multiple-choice workers. To this end it provides financialexamination on the EBW Healthcare website, support for the development and publishing ofwhen they are ready to. the EBW Healthcare series.All the exam questions will be taken fromthe multiple-choice tests from the book. The The Desmond Tutu HIV Foundationcontent of the skills workshops will not beincluded in the examination. The Desmond Tutu HIV Foundation at the University of Cape Town, South Africa,Participants need to achieve at least 80% is a centre of excellence in HIV medicine,in the examination in order to successfully building capacity through training andcomplete the course. Successful candidates enhancing knowledge through research.will be emailed a certificate which statesthat they have successfully completed The Desmond Tutu Tuberculosis Centrethat course. EBW Healthcare courses arenot yet accredited for nurses, but South The Desmond Tutu Tuberculosis Centre atAfrican doctors can earn CPD points on the Stellenbosch University, South Africa, strivessuccessful completion of an examination. to improve the health of vulnerable groups through the education of healthcare workersPlease contact or and community members, and by influencing+27 021 44 88 336 when you are ready to take policy based on research into the epidemiologythe exam. of childhood tuberculosis, multi-drug- resistant tuberculosis, HIV/TB co-infection and preventing the spread of TB and HIV in southern Africa.
  12. 12. 13UPDATING THE COURSE CONTACT INFORMATIONMATERIAL EBW HealthcareEBW Healthcare learning materialsare regularly updated to keep up with Website: www.ebwhealthcare.comdevelopments and changes in healthcare Email: info@ebwhealthcare.comprotocols. Course participants can makeimportant contributions to the continual Telephone: +27 021 44 88 336improvement of EBW Healthcare books Fax: +27 088 021 44 88 336by reporting factual or language errors, Post: 87 Station Road, Observatory, 7925,by identifying sections that are difficult to Cape Town, South Africaunderstand, and by suggesting additions orimprovements to the contents. Details ofalternative or better forms of management Editor-in-Chief: Professor Dave Woodswould be particularly appreciated. Please send Website: comments or suggestions to the Editor-in-Chief, Professor Dave Woods. Email: Telephone: +27 021 786 5369 Fax: +27 021 671 8030 Post: Perinatal Education Programme, PO Box 34502, Groote Schuur, Observatory, 7937, South Africa