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.
- Pneumonia is a major cause of death in children under 5 years old worldwide, though mortality has decreased with interventions.
- It is usually caused by viruses in young children and bacteria in older children, though over 50% of cases the pathogen is not identified.
- Clinical features include fever, cough, rapid breathing and in severe cases cyanosis and respiratory fatigue. Diagnosis is usually by chest x-ray but cannot differentiate between bacterial and viral pneumonia.
- Treatment involves antibiotics, oxygen and supportive care. The choice of antibiotic depends on the child's age and illness severity. Most children can be managed at home but some require hospital admission.
This document discusses malaria in children, including its classification, epidemiology, etiology, clinical features, complications, management, prognosis and prevention. It provides details on the life cycle and transmission of the plasmodium parasite. For diagnosis, it recommends looking for malarial parasites in blood smears or using rapid diagnostic tests. It describes the clinical features of malaria as fever, often alternating daily or every two days. Complications can include anemia, jaundice and cerebral malaria. Management involves antipyretics, hydration, nutrition and antimalarial drugs depending on the plasmodium species and local resistance patterns. Prevention methods are use of mosquito nets and chemoprophylaxis. The document also briefly discusses visceral
An 8-year-old child presents with a fever of 104°F for the past 8 days. On examination, the child has mild diarrhea, abdominal distension, hepatomegaly, and splenomegaly. The likely clinical diagnosis is typhoid fever, an infectious disease caused by Salmonella enterica serovar Typhi characterized by high fever and abdominal symptoms. Typhoid fever is transmitted through contaminated food or water and has an incubation period of 7-14 days. Common clinical features include a gradual rise in fever, abdominal symptoms, and hepatosplenomegaly. Complications can include intestinal hemorrhage or perforation. Diagnosis is confirmed through blood culture but antibody tests and culture of
This document provides information on jaundice in children. It discusses the causes of jaundice including liver diseases like hepatitis A and B, gallstones, and metabolic conditions. It outlines the approach to evaluating jaundice including assessing risk factors, laboratory tests to differentiate medical and surgical causes, and classifications. Complications of severe jaundice like kernicterus are described. Sickle cell disease is presented as another potential cause of jaundice in children.
1. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages.
2. Clinical manifestations in children vary widely and can include failure to thrive, respiratory issues, gastrointestinal diseases, and neurological problems.
3. Diagnosis is made through HIV antibody testing after 18 months or virological testing before 18 months, and management includes prophylaxis, antiretroviral therapy, treating opportunistic infections, adequate nutrition, and immunization.
The document discusses tuberculosis in children, including its epidemiology, etiology, clinical features, diagnosis, and management. It notes that tuberculosis is endemic in Pakistan, with over 200,000 new cases annually. Children under 15 account for 20% of cases. The causative agent is Mycobacterium tuberculosis. Clinical features vary depending on the site of infection, and may include cough, fever, lymph node enlargement, and meningitis. Diagnosis involves tuberculin tests, chest X-rays, and culture of fluid/tissue samples. Standard drug regimens include isoniazid and rifampin for 6-12 months. Prevention involves BCG vaccination, contact screening, and prophylactic treatment of
This document provides information on acute respiratory infections (ARIs) in children. It notes that ARIs are a major cause of morbidity and mortality worldwide, especially in developing countries. Upper respiratory infections include conditions like the common cold, sinusitis, and tonsillitis. Lower respiratory infections include bronchiolitis and pneumonia. The document outlines signs and symptoms, risk factors, diagnostic criteria and management recommendations for various ARIs like pneumonia, croup, bronchitis, and others in children. It emphasizes supportive care, oxygen supplementation, antibiotics when indicated, and referral criteria for severe or complicated cases.
This document provides statistics on the global HIV epidemic in 2018 from UNAIDS as well as information on HIV in India. Some key points:
- 37.9 million people globally were living with HIV in 2018. 1.7 million became newly infected that year while 23.3 million were accessing antiretroviral therapy.
- India has the third largest HIV epidemic in the world. In 2015, the national adult prevalence was 0.26%. Prevalence is highest in certain states like Mizoram (2.04%) and Manipur (1.43%).
- Children account for 6.54% of total PLHIV in India. Early infant diagnosis, appropriate infant feeding and prophylaxis
- Pneumonia is a major cause of death in children under 5 years old worldwide, though mortality has decreased with interventions.
- It is usually caused by viruses in young children and bacteria in older children, though over 50% of cases the pathogen is not identified.
- Clinical features include fever, cough, rapid breathing and in severe cases cyanosis and respiratory fatigue. Diagnosis is usually by chest x-ray but cannot differentiate between bacterial and viral pneumonia.
- Treatment involves antibiotics, oxygen and supportive care. The choice of antibiotic depends on the child's age and illness severity. Most children can be managed at home but some require hospital admission.
This document discusses malaria in children, including its classification, epidemiology, etiology, clinical features, complications, management, prognosis and prevention. It provides details on the life cycle and transmission of the plasmodium parasite. For diagnosis, it recommends looking for malarial parasites in blood smears or using rapid diagnostic tests. It describes the clinical features of malaria as fever, often alternating daily or every two days. Complications can include anemia, jaundice and cerebral malaria. Management involves antipyretics, hydration, nutrition and antimalarial drugs depending on the plasmodium species and local resistance patterns. Prevention methods are use of mosquito nets and chemoprophylaxis. The document also briefly discusses visceral
An 8-year-old child presents with a fever of 104°F for the past 8 days. On examination, the child has mild diarrhea, abdominal distension, hepatomegaly, and splenomegaly. The likely clinical diagnosis is typhoid fever, an infectious disease caused by Salmonella enterica serovar Typhi characterized by high fever and abdominal symptoms. Typhoid fever is transmitted through contaminated food or water and has an incubation period of 7-14 days. Common clinical features include a gradual rise in fever, abdominal symptoms, and hepatosplenomegaly. Complications can include intestinal hemorrhage or perforation. Diagnosis is confirmed through blood culture but antibody tests and culture of
This document provides information on jaundice in children. It discusses the causes of jaundice including liver diseases like hepatitis A and B, gallstones, and metabolic conditions. It outlines the approach to evaluating jaundice including assessing risk factors, laboratory tests to differentiate medical and surgical causes, and classifications. Complications of severe jaundice like kernicterus are described. Sickle cell disease is presented as another potential cause of jaundice in children.
1. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages.
2. Clinical manifestations in children vary widely and can include failure to thrive, respiratory issues, gastrointestinal diseases, and neurological problems.
3. Diagnosis is made through HIV antibody testing after 18 months or virological testing before 18 months, and management includes prophylaxis, antiretroviral therapy, treating opportunistic infections, adequate nutrition, and immunization.
The document discusses tuberculosis in children, including its epidemiology, etiology, clinical features, diagnosis, and management. It notes that tuberculosis is endemic in Pakistan, with over 200,000 new cases annually. Children under 15 account for 20% of cases. The causative agent is Mycobacterium tuberculosis. Clinical features vary depending on the site of infection, and may include cough, fever, lymph node enlargement, and meningitis. Diagnosis involves tuberculin tests, chest X-rays, and culture of fluid/tissue samples. Standard drug regimens include isoniazid and rifampin for 6-12 months. Prevention involves BCG vaccination, contact screening, and prophylactic treatment of
This document provides information on acute respiratory infections (ARIs) in children. It notes that ARIs are a major cause of morbidity and mortality worldwide, especially in developing countries. Upper respiratory infections include conditions like the common cold, sinusitis, and tonsillitis. Lower respiratory infections include bronchiolitis and pneumonia. The document outlines signs and symptoms, risk factors, diagnostic criteria and management recommendations for various ARIs like pneumonia, croup, bronchitis, and others in children. It emphasizes supportive care, oxygen supplementation, antibiotics when indicated, and referral criteria for severe or complicated cases.
This document provides statistics on the global HIV epidemic in 2018 from UNAIDS as well as information on HIV in India. Some key points:
- 37.9 million people globally were living with HIV in 2018. 1.7 million became newly infected that year while 23.3 million were accessing antiretroviral therapy.
- India has the third largest HIV epidemic in the world. In 2015, the national adult prevalence was 0.26%. Prevalence is highest in certain states like Mizoram (2.04%) and Manipur (1.43%).
- Children account for 6.54% of total PLHIV in India. Early infant diagnosis, appropriate infant feeding and prophylaxis
A 5-day-old newborn presented with generalized body stiffness, inability to suck, and fever. The baby was delivered at home by a traditional birth attendant, and the umbilical cord was cut with an unsterile instrument. On examination, the baby had generalized spasms triggered by stimuli, locked jaw, tense abdomen, and an infected umbilical cord. The diagnosis was neonatal tetanus. Neonatal tetanus results from infection of Clostridium tetani spores in the umbilical stump of newborns without protective immunity from unimmunized mothers. Management involves wound cleaning, antibiotics, antitoxin, sedation, feeding via NG tube, and supportive care
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Here are some key points regarding the feasibility of bacteriological diagnosis in children with TB:
- Sputum induction or gastric lavage are generally required to obtain specimens from children, as they typically cannot produce sputum on demand. This requires specialized equipment and trained personnel.
- Even with induced sputum or gastric lavage, specimen quality and volume may be low, reducing the sensitivity of bacteriological tests.
- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
This document discusses tuberculosis (TB) in children. It begins with an overview of the clinical spectrum of TB in children, which can include pulmonary, visceral, cutaneous, neuro, and perinatal manifestations. Pulmonary TB lesions in children typically include primary complexes and intrathoracic lymphadenopathy. Extrapulmonary TB involves sites like bone, joints, the gastrointestinal tract, and the central nervous system. The document then covers the diagnosis of TB in children, which involves clinical judgment based on exposure history and symptoms, the tuberculin skin test, chest x-ray, and bacteriological confirmation via sputum sampling or gastric aspiration. Interpretation of diagnostic tests and their limitations are also discussed.
This document discusses various worm infections that are common in children. It begins by introducing common worm infections and their symptoms. It then presents three case scenarios of children with different worm infections: 1) Ascaris lumbricoides (roundworm) infection presenting with vomiting of a worm, 2) Ancylostoma duodenale (hookworm) infection presenting with anemia, and 3) Entrobius vermicularis (pinworm) infection presenting with perianal itching. For each case, it discusses the causative worm, its life cycle, clinical features, diagnosis, treatment and prevention. It also briefly covers beef tapeworm and Echinococcus granulosus infections.
Necrotizing enterocolitis is a disease that primarily affects premature infants, causing portions of the intestine to become inflamed and die. It is one of the most serious gastrointestinal diseases in neonates. Risk factors include prematurity, low birth weight, and enteral feeding. Symptoms include abdominal distention, blood in stool, and feeding intolerance. Treatment involves stopping feedings, providing intravenous fluids and antibiotics, and potentially surgery to remove dead intestinal tissue. Complications can include intestinal perforation, stricture, or sepsis. The prognosis depends on severity but the disease has a mortality rate of around 25%.
This document discusses acute gastroenteritis (AGE), also known as infectious diarrhea, in pediatric patients. It defines AGE and different types of diarrhea such as acute, chronic, and intractable. The most common causes of AGE in children are rotavirus, Salmonella, Campylobacter, and other bacterial, viral, and parasitic pathogens. Signs and symptoms include diarrhea, vomiting, fever, and dehydration. Treatment involves oral rehydration, monitoring for dehydration, and nutritional support. Nursing care focuses on fluid and electrolyte management, preventing spread of infection, and supporting nutrition.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can be early onset (within 24 hours of birth) from bacteria passed from the mother during delivery, or late onset from bacteria acquired after birth. Risk factors include preterm birth, infections, and prolonged hospitalization. Symptoms are non-specific but may include poor feeding, lethargy, respiratory distress, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment consists of supportive care and intravenous antibiotics like ampicillin and gentamycin. Outcomes depend on the causative organism and can include neurological and respiratory complications.
Respiratory distress is a common problem in newborns. This document discusses the epidemiology, clinical features, assessment, causes and management approaches for several major causes of respiratory distress in newborns, including meconium aspiration syndrome, respiratory distress syndrome, and transient tachypnea of newborn. It provides clinical guidance on evaluating and treating newborns presenting with respiratory distress.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
This document discusses tonsillopharyngitis (acute infection of the pharynx and tonsils). It notes that the condition is usually viral but is occasionally bacterial, most commonly caused by Group A beta-hemolytic streptococcus (GABHS). Symptoms include pain with swallowing, fever, and swollen tonsils. Diagnosis involves a clinical exam plus rapid antigen test or culture. Treatment depends on the cause but may include analgesics, hydration, and antibiotics for bacterial infections like GABHS. Tonsillectomy is considered for recurrent GABHS infections.
Urinary tract infections are common in children, especially girls. The most common cause is Escherichia coli bacteria spreading from the intestines. Symptoms vary from mild cystitis to severe pyelonephritis. Diagnosis involves urinalysis and urine culture. Treatment depends on severity but commonly involves antibiotics like trimethoprim-sulfamethoxazole. Imaging with ultrasound is recommended for the first UTI in infants and children under 3, or those with fever or systemic illness, to check for anatomical abnormalities.
Croup is a respiratory illness that mainly affects young children, characterized by a barking cough and stridor. It is usually caused by viruses like parainfluenza or RSV infecting the larynx and trachea, causing inflammation and swelling that narrows the airway. Symptoms range from mild cough to severe distress. Treatment involves corticosteroids, nebulized epinephrine, humidified air, and hospitalization for children with progressive symptoms or respiratory distress. Croup has an excellent prognosis with near complete recovery in most cases.
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting and abdominal pain. It is commonly caused by viruses, bacteria, or parasites and spreads easily. Symptoms usually clear up in a few days but dehydration is a risk, especially for elderly or frail people. Treatment focuses on preventing dehydration by drinking fluids and eating lightly as tolerated. Medical care should be sought if dehydration is suspected or symptoms are severe or prolonged.
Salmonella enterica serovar Typhi causes enteric fever or typhoid fever in children. It is transmitted through ingestion of contaminated food or water. In the body, it invades the intestinal mucosa and spreads to the bloodstream and reticuloendothelial system. Clinical features include sustained high fever, abdominal discomfort, diarrhea, and complications affecting the nervous, cardiovascular or pulmonary systems. Diagnosis involves blood or stool cultures. Treatment recommended is with third generation cephalosporins like cefixime or ceftriaxone. Vaccines provide protection, especially the Vi conjugate vaccine for younger children.
A chapter on study skills from the textbook, Communication Skills, developed by the Language Communication for Development Department at the Bunda College of Agriculture, University of Malawi.
Assessing Algebra in the Senior Phase: A Practical GuideSaide OER Africa
This booklet was first developed in 2004, shortly after the introduction of the Revised National Curriculum Statement in South Africa. The intention of the booklet was to help teachers of senior phase (junior secondary) to integrate assessment into their teaching and learning.
A 5-day-old newborn presented with generalized body stiffness, inability to suck, and fever. The baby was delivered at home by a traditional birth attendant, and the umbilical cord was cut with an unsterile instrument. On examination, the baby had generalized spasms triggered by stimuli, locked jaw, tense abdomen, and an infected umbilical cord. The diagnosis was neonatal tetanus. Neonatal tetanus results from infection of Clostridium tetani spores in the umbilical stump of newborns without protective immunity from unimmunized mothers. Management involves wound cleaning, antibiotics, antitoxin, sedation, feeding via NG tube, and supportive care
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Here are some key points regarding the feasibility of bacteriological diagnosis in children with TB:
- Sputum induction or gastric lavage are generally required to obtain specimens from children, as they typically cannot produce sputum on demand. This requires specialized equipment and trained personnel.
- Even with induced sputum or gastric lavage, specimen quality and volume may be low, reducing the sensitivity of bacteriological tests.
- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
This document discusses tuberculosis (TB) in children. It begins with an overview of the clinical spectrum of TB in children, which can include pulmonary, visceral, cutaneous, neuro, and perinatal manifestations. Pulmonary TB lesions in children typically include primary complexes and intrathoracic lymphadenopathy. Extrapulmonary TB involves sites like bone, joints, the gastrointestinal tract, and the central nervous system. The document then covers the diagnosis of TB in children, which involves clinical judgment based on exposure history and symptoms, the tuberculin skin test, chest x-ray, and bacteriological confirmation via sputum sampling or gastric aspiration. Interpretation of diagnostic tests and their limitations are also discussed.
This document discusses various worm infections that are common in children. It begins by introducing common worm infections and their symptoms. It then presents three case scenarios of children with different worm infections: 1) Ascaris lumbricoides (roundworm) infection presenting with vomiting of a worm, 2) Ancylostoma duodenale (hookworm) infection presenting with anemia, and 3) Entrobius vermicularis (pinworm) infection presenting with perianal itching. For each case, it discusses the causative worm, its life cycle, clinical features, diagnosis, treatment and prevention. It also briefly covers beef tapeworm and Echinococcus granulosus infections.
Necrotizing enterocolitis is a disease that primarily affects premature infants, causing portions of the intestine to become inflamed and die. It is one of the most serious gastrointestinal diseases in neonates. Risk factors include prematurity, low birth weight, and enteral feeding. Symptoms include abdominal distention, blood in stool, and feeding intolerance. Treatment involves stopping feedings, providing intravenous fluids and antibiotics, and potentially surgery to remove dead intestinal tissue. Complications can include intestinal perforation, stricture, or sepsis. The prognosis depends on severity but the disease has a mortality rate of around 25%.
This document discusses acute gastroenteritis (AGE), also known as infectious diarrhea, in pediatric patients. It defines AGE and different types of diarrhea such as acute, chronic, and intractable. The most common causes of AGE in children are rotavirus, Salmonella, Campylobacter, and other bacterial, viral, and parasitic pathogens. Signs and symptoms include diarrhea, vomiting, fever, and dehydration. Treatment involves oral rehydration, monitoring for dehydration, and nutritional support. Nursing care focuses on fluid and electrolyte management, preventing spread of infection, and supporting nutrition.
Neonatal sepsis occurs when bacteria enter the bloodstream of infants less than 90 days old. It can be early onset (within 24 hours of birth) from bacteria passed from the mother during delivery, or late onset from bacteria acquired after birth. Risk factors include preterm birth, infections, and prolonged hospitalization. Symptoms are non-specific but may include poor feeding, lethargy, respiratory distress, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment consists of supportive care and intravenous antibiotics like ampicillin and gentamycin. Outcomes depend on the causative organism and can include neurological and respiratory complications.
Respiratory distress is a common problem in newborns. This document discusses the epidemiology, clinical features, assessment, causes and management approaches for several major causes of respiratory distress in newborns, including meconium aspiration syndrome, respiratory distress syndrome, and transient tachypnea of newborn. It provides clinical guidance on evaluating and treating newborns presenting with respiratory distress.
Pediatric urinary tract infections (UTIs) are common in children, especially girls under the age of 1. Left untreated, UTIs can cause renal scarring and long-term kidney damage. Diagnosis involves urine tests to check for white blood cells and bacteria. Treatment depends on symptoms and severity but often involves antibiotics and hydration. Follow up is important to monitor for recurrent UTIs and issues like vesicoureteral reflux, as both increase risk of permanent kidney damage if not addressed.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
This document discusses tonsillopharyngitis (acute infection of the pharynx and tonsils). It notes that the condition is usually viral but is occasionally bacterial, most commonly caused by Group A beta-hemolytic streptococcus (GABHS). Symptoms include pain with swallowing, fever, and swollen tonsils. Diagnosis involves a clinical exam plus rapid antigen test or culture. Treatment depends on the cause but may include analgesics, hydration, and antibiotics for bacterial infections like GABHS. Tonsillectomy is considered for recurrent GABHS infections.
Urinary tract infections are common in children, especially girls. The most common cause is Escherichia coli bacteria spreading from the intestines. Symptoms vary from mild cystitis to severe pyelonephritis. Diagnosis involves urinalysis and urine culture. Treatment depends on severity but commonly involves antibiotics like trimethoprim-sulfamethoxazole. Imaging with ultrasound is recommended for the first UTI in infants and children under 3, or those with fever or systemic illness, to check for anatomical abnormalities.
Croup is a respiratory illness that mainly affects young children, characterized by a barking cough and stridor. It is usually caused by viruses like parainfluenza or RSV infecting the larynx and trachea, causing inflammation and swelling that narrows the airway. Symptoms range from mild cough to severe distress. Treatment involves corticosteroids, nebulized epinephrine, humidified air, and hospitalization for children with progressive symptoms or respiratory distress. Croup has an excellent prognosis with near complete recovery in most cases.
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting and abdominal pain. It is commonly caused by viruses, bacteria, or parasites and spreads easily. Symptoms usually clear up in a few days but dehydration is a risk, especially for elderly or frail people. Treatment focuses on preventing dehydration by drinking fluids and eating lightly as tolerated. Medical care should be sought if dehydration is suspected or symptoms are severe or prolonged.
Salmonella enterica serovar Typhi causes enteric fever or typhoid fever in children. It is transmitted through ingestion of contaminated food or water. In the body, it invades the intestinal mucosa and spreads to the bloodstream and reticuloendothelial system. Clinical features include sustained high fever, abdominal discomfort, diarrhea, and complications affecting the nervous, cardiovascular or pulmonary systems. Diagnosis involves blood or stool cultures. Treatment recommended is with third generation cephalosporins like cefixime or ceftriaxone. Vaccines provide protection, especially the Vi conjugate vaccine for younger children.
A chapter on study skills from the textbook, Communication Skills, developed by the Language Communication for Development Department at the Bunda College of Agriculture, University of Malawi.
Assessing Algebra in the Senior Phase: A Practical GuideSaide OER Africa
This booklet was first developed in 2004, shortly after the introduction of the Revised National Curriculum Statement in South Africa. The intention of the booklet was to help teachers of senior phase (junior secondary) to integrate assessment into their teaching and learning.
Farmer's Agribusiness Training Course: Module 4 - ICT in Support of Farming. ...Saide OER Africa
This Farmers' Agribusiness training course has been developed to help both farmers and farmer organisations. Its intention is to provide access to provide access to additional skills and knowledge that will allow farmers to move from a 'farm' to a 'firm'. This lesson provides information on the basics of computer hardware and software systems, information on different storage devices, the importance of the role ICT can play in agricultural operations, and the importance of ICT as a communication tool in sharing farming information.
Child Healthcare: Lower respiratory tract conditionsSaide OER Africa
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.
Farmer's Agribusiness Training Course: Module 1 Lesson 2 Supplementary Readin...Saide OER Africa
The Agricultural Sector Development Strategy (ASDS) is the overall national policy document for the sector ministries and all stakeholders in Kenya. The document outlines the characteristics, challenges, opportunities, vision, mission, strategic thrusts and the various interventions that the ministries will undertake to propel the agricultural sector to the future.
Primary Maternal Care: Skills workshop examination of the abdomen in pregnancySaide OER Africa
This document provides guidance on examining the abdomen in pregnancy. It outlines how to determine gestational age by measuring the fundal height and assessing fetal presentation and position. The exam involves general inspection of the abdomen and specific palpation of the uterus and fetus to evaluate size, lie, presentation, head engagement, fetal heart rate and movements. Close monitoring of the amount of amniotic fluid and signs of uterine irritability are also described. The goal is to accurately assess fetal growth, position and well-being during routine prenatal exams.
Farmer's Agribusiness Training Course: Module 2 - Sustainable Agriculture. Le...Saide OER Africa
This Farmers’ Agribusiness training course has been developed to help both farmers and farmer organisations. Its intention is to provide access to additional skills and knowledge that will allow farmers to move from a 'farm' to a 'firm'. This lesson discusses novel technologies for adoption by farmers in their production systems and explains various options in the drive for sustainable agriculture.
Creating People Centred Schools: Cover, title and imprint pages, with content...Saide OER Africa
This document provides an overview and introduction to the Creating People-Centred Schools module. The module aims to support teachers and school managers in understanding school organizational change and development. It is comprised of four sections that progress from introducing the context and rationale, to exploring the history of school organization, to examining new policies and approaches to school effectiveness and improvement. Accompanying the learning guide are additional readings and audio/video resources that provide real-world examples and perspectives on topics covered in each section. The goal is to help improve understanding and practice of teaching by providing resources on creating more people-centered schools.
Adult HIV was developed by doctors and nurses with wide experience in the care of adults with HIV, under the auspices of the Desmond Tutu HIV Foundation at the University of Cape Town. It covers: introduction to HIV infection, management of HIV-infected adults at primary-care clinics, preparing patients for antiretroviral (ARV) treatment, ARV drugs, starting and maintaining patients on ARV treatment, opportunistic infections
Farmer's Agribusiness Training Course: Module 2 - Sustainable Agriculture. Le...Saide OER Africa
This Farmers’ Agribusiness training course has been developed to help both farmers and farmer organisations. Its intention is to provide access to additional skills and knowledge that will allow farmers to move from a 'farm' to a 'firm'. This lesson discusses factors that prevent farmers from practicing sustainable agriculture as well as the impact of land divisions on production.
OUT Institutional Policy Workshop Open University of Tanzania 12th January, 2009Saide OER Africa
Educational resources for use by educators and learners, without an accompanying need to pay royalties or licence fees. New licensing frameworks remove copying / adaptation restrictions OER hold potential for reducing the cost of accessing educational materials
Health OER Inter-Institutional Project Formative Evaluation of Health OER Des...Saide OER Africa
The project management of the Health OER Design Phase has been highly effective in enabling the realization of specified activities. A well-documented website tracks all project activities and resources. The dScribe model for converting materials to OERs is an innovative asset. There is widespread approval of the project management. While the University of Michigan plays a lead role, participants feel they are driving the project rather than being controlled. The four African universities have differing prior experiences with open learning and ICT, and academics have had varying exposure to OERs. This has resulted in the project developing differently across the varied institutional contexts.
Mother and Baby Friendly Care: Mother friendly care during pregnancySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Mother and Baby Friendly Care: Mother friendly care during labour, delivery a...Saide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
This document provides an introduction to a manual for a Train the Trainer course on health and human rights for South African health professionals. The manual was produced based on eight years of experience running the course. The course aims to train health educators ("trainers") so they can integrate human rights into their teaching at their home institutions. By training more educators, the goal is to mainstream human rights training for health professionals and address needs identified by the Truth and Reconciliation Commission. The manual is organized to mirror the five-day course structure and provides guidance for using the materials, which cover human rights content, curriculum development, institutional transformation, and leadership. The educational approach emphasizes that all participants can learn from each other's formal and informal experiences.
Childhood TB was written to enable healthcare workers to learn about the primary care of children with tuberculosis. It covers: introduction to TB infection, the clinical presentation, diagnosis, management and prevention of tuberculosis in children.
Being a Teacher: Professional Challenges and Choices.Saide OER Africa
Teachers are not just teachers. They are also people. In straddling issues of both professional and personal identity, this module comes to grips with the professional choices teachers are required to make, and do make, in developing the knowledge, skills and values of learners.
This module is suitable for both inducting novice teachers into the role of the teacher and for in-service programmes in which practising teachers could valuably compare their own experiences with this systematic overview of the role of a teacher and teaching as a profession. The contextual setting in South Africa is readily adaptable to other settings: the core issues are the same.
This document provides an overview of basic computer components and functions for Windows operating systems. It describes physical components such as the monitor, tower, keyboard, and mouse. It also covers how to power on the computer, log in, open programs, and use input devices. The document explains file systems, types of media like CDs and USB drives, printers, and basic functions such as copying and pasting. It concludes with warnings and advice that trial and error is the best way to learn to use a computer.
THESE SLIDES ARE PREPAREED TO UNDERSTAND CHILD HEALTH DISORDERS IN EASY WAY
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1. Ascaris lumbricoides is the largest roundworm that commonly infects humans, inhabiting the small intestine. It is highly prevalent in areas with poor sanitation.
2. The adult worms can cause intestinal obstruction, while migrating larvae can cause aspiration pneumonia. Symptoms range from none to severe abdominal pain.
3. Diagnosis involves finding the eggs in stool samples. Treatment involves anthelmintic drugs like albendazole or mebendazole. Maintaining good sanitation is important for prevention.
it gives information about the infection caused by the round worms which enter in the human body through dirty water,poor sanitation system,child take soil which contain feces.
Ascaris lumbricoides is a parasitic roundworm that infects the small intestine of humans. It is one of the most common helminth infections worldwide, especially in tropical and subtropical areas with poor sanitation. The life cycle involves eggs being passed in feces and infecting a new host if ingested. In the small intestine, adults worms live and females can produce hundreds of thousands of eggs daily. Symptoms range from mild to blockage of the intestines. Ascariasis is treated with anthelmintic drugs and prevention relies on good sanitation and hygiene practices.
Ascariasis is an intestinal parasitic disease caused by the roundworm Ascaris lumbricoides. It is one of the most common helminthic infections worldwide, especially in tropical areas with poor sanitation. The worms live in the small intestine and lay eggs that are passed in feces. When eggs are ingested by humans, they hatch and larvae migrate through the lungs before reaching maturity in the intestine. Most infections are asymptomatic, but heavy infections can cause intestinal obstruction, pulmonary symptoms, or liver/pancreatic problems. Diagnosis involves finding eggs in stool samples. Treatment options include mebendazole, albendazole, or pyrantel pamoate. Prevention relies on improved sanitation to
SESSION 4_DISEASES CAUSED BY WORM INFESTATIONS.pptxjacob735118
1. Taenia solium, or pork tapeworm, infects people who eat undercooked pork. It can cause abdominal pain and discomfort. The larval stage, called cysticercosis, is more serious and can infect any organ or tissue.
2. Hookworm disease is caused by Necator americanus and Ancylostoma duodenale infecting humans through contaminated soil. It causes iron-deficiency anemia from blood loss in the intestines. Symptoms include fatigue and weakness.
3. Roundworm (ascariasis) infects people through eating food or water contaminated with roundworm eggs from human feces. Symptoms include coughing, abdominal pain, and diarrhea. Heavy
Worm infestations are long-term diseases caused by parasitic worms like nematodes, trematodes, and cestodes. They produce few symptoms initially but can later cause serious effects or become fatal. Common worms include Ascaris lumbricoides, Enterobius vermicularis, hookworms, Trichuris trichiura, and Wuchereria bancrofti. People become infected through contaminated food/water or contact with soil/animals. Symptoms vary by worm type but include abdominal pain, anemia, and fatigue. Diagnosis involves examining stool or blood samples microscopically. Treatment consists of anthelmintic medications like albendazole, mebendazole,
Ascaris lumbricoides is a common roundworm parasite that infects an estimated 1 billion people worldwide (1 out of 4 people), being most prevalent in underdeveloped areas with poor sanitation. It is transmitted via ingestion of eggs from contaminated food or soil and causes symptoms ranging from abdominal discomfort to pulmonary issues during larval migration. Treatment involves anthelmintic drugs like mebendazole or albendazole and prevention focuses on improved sanitation and limiting the use of human feces as fertilizer.
This document summarizes ascariasis, caused by the roundworm Ascaris lumbricoides. It describes the morphology of the worm, the life cycle involving eggs passed in feces and infective larvae. Symptoms include pulmonary symptoms during larval migration and intestinal obstruction by a mass of worms. Diagnosis involves finding eggs in stool and treatment involves anthelmintic drugs like mebendazole, albendazole, and pyrantel pamoate. Prevention relies on good sanitation to prevent fecal contamination.
This document summarizes several types of parasitic helminths (worms) that can infect humans. It describes the life cycles, geographical distribution, clinical presentation, diagnosis, and treatment of important nematode infections including hookworms, Strongyloides, ascariasis, enterobiasis, trichuriasis, and filariasis. Key points are that these soil-transmitted helminths typically have complex life cycles involving larval stages in soil that infect via skin penetration or ingestion, causing anaemia, pulmonary symptoms, or intestinal obstruction in heavy infections. Diagnosis involves finding eggs or larvae in stool or tissue samples, and treatment consists of anthelmintic medications like albendazole or me
Enterobius vermicularis by faunafondnessfaunafondness
ENTEROBIUS VERMICULARIS :- Enterobious vermicularis is a nematode and a common intestinal parasite in human.
It has a round body with cylindrical ends and a complete digestive system including mouth and anus.
It has separate sexes,the female is usually larger than a male.
It has a worldwide distribution.
E.vermicularis is a small, white round worm. Female average 10mm in length, males 3mm.
It is commonly called pinworm.
Hymenolepis nana, also known as the dwarf tapeworm, is the most common tapeworm infection in humans. It can be found worldwide but is most common in areas with poor sanitation. H. nana lives in the small intestine and can reproduce asexually inside the host, allowing infections to persist for years. Symptoms may include nausea, weakness, and diarrhea. Diagnosis is confirmed by finding H. nana eggs in stool samples. Treatment involves antiparasitic medications like praziquantel or niclosamide. Prevention focuses on good hygiene, sanitation, and eliminating rodent hosts.
Common intestinal helminths and protozoa infect millions worldwide, especially in low and middle income countries with poor sanitation. The four main soil-transmitted intestinal worms are Ascaris lumbricoides, Trichuris trichiura, Ancylostoma duodenale, and Necator americanus. A. lumbricoides is the most prevalent worm globally and causes malnutrition and obstruction. Ancylostoma duodenale and N. americanus are hookworms that infect through skin penetration and commonly cause anemia. Transmission occurs through ingestion of worm eggs from contaminated food, water, or soil. Symptoms often include abdominal pain and diarrhea. Diagnosis is via stool examination and
Ascaris lumbricoides, also known as the giant roundworm, is a parasitic nematode that infects the small intestine of humans. It is one of the most common intestinal parasites worldwide. The life cycle involves ingestion of Ascaris eggs from contaminated soil, hatching of larvae in the intestine, migration through the lungs, and maturation into adult worms in the small intestine. Most infections are asymptomatic, but some people experience abdominal pain, nausea, coughing or vomiting worms. Diagnosis is made by finding Ascaris eggs in stool samples. Treatment involves deworming medications like albendazole or mebendazole. Prevention focuses on improved sanitation and hygiene to prevent fecal contamination of soil
Virology is the scientific study of biological viruses. It is a subfield of microbiology that focuses on their detection, structure, classification and evolution, their methods of infection and exploitation of host cells for reproduction, their interaction with host organism physiology and immunity,
Hymenolepis nana, also known as the dwarf tapeworm, is the most common tapeworm infection in humans. It can be found worldwide but is most common in areas with inadequate sanitation. H. nana infects humans, mice and rats by ingesting its eggs, which can survive up to 10 days in the environment. Symptoms may include nausea, weakness, and diarrhea. Diagnosis is confirmed by finding eggs in stool samples. Treatment involves praziquantel or other anti-parasitic medications. Prevention focuses on good hygiene, sanitation, and eliminating rodent carriers.
Ascariasis is a common intestinal infection caused by the roundworm Ascaris lumbricoides. It spreads through ingestion of worm eggs from contaminated food, water, or soil. Symptoms range from mild to severe depending on worm load, and can include abdominal pain, vomiting, and malnutrition. Heavy infections can cause lung inflammation or intestinal blockages requiring medical treatment or surgery. The disease is most prevalent in areas with poor sanitation where worm eggs can survive in soil and water for years.
Asp openly licensed stories for early reading in africa mar 2015 slideshareSaide OER Africa
A recent presentation made by Tessa Welch, the African Storybook Project leader, to University of Pretoria Education students on the project and on openly licensed stories for early reading in Africa.
Quality Considerations in eLearning in South Africa. Presentation at the eLearning Summit, Indaba Hotel, 16 October 2014. Looks the the quality review process and quality criteria.
African Storybook: The First 18 Months of the ProjectSaide OER Africa
Presentation by African Storybook Initiative Leader, Tessa Welch, on the first 18 months of the initiative. Presented on 26 June at the African Storybook Summit at the University of British Columbia.
Digital Storytelling for Multilingual Literacy Development: Implications for ...Saide OER Africa
Digital Storytelling for Multilingual Literacy Development: Implications for Teachers - Presentation by Tessa Welch at the South African Basic Education Conference 31 March - 1 April 2014. Presentation explains Saide's African Storybook Initiative. Overview: Requirements for effective literacy development of young children in African countries; obstacles to achieving this goal; multi-pronged approach to overcoming obstacles; examples of digital storytelling in a school community; implications for teachers.
This document provides an overview of technology trends and outlook for African higher education. It discusses key drivers and constraints to integrating technology, including motivators like access to resources and constraints like low digital fluency of faculty. Current trends include growing social media usage, blended learning, and data-driven assessment. The document outlines different modes of educational provision from fully offline to fully online. It provides an outlook on emerging technologies like flipped classrooms, learning analytics, and 3D printing and their potential impact on higher education in both the short and long term. The talk concludes by emphasizing that technology should support, not replace, good teaching practices.
eLearning or eKnowledge - What are we offering students?Saide OER Africa
eLearning or eKnowledge - What are we offering students? A look at the convergence of elearning and eknowledge, looking at the purpose of the design - informational or instructional? Presented at the Unisa Cambridge Open and Distance eLearning Conference, Stellenbosch.
Presentation given at the Online and eLearining Conference organised by Knowledge Resources at the Forum, Bryanston, Johannesburg 28-29 August 2013. Created by Greig Krull, Sheila Drew and Brenda Mallinson.
Understand school leadership and governance in the South African context (PDF)Saide OER Africa
This module gives an overview of what management and leadership is about in a school setting. As an aspiring principal it begins a process of developing understanding about the challenges that face principals on a daily basis and allows you to also explore your own realities and decide on new and better action. In addition, you will look at some of the international trends in management and leadership and will compare what is happening in the South Africa scene to others.
Toolkit: Unit 8 - Developing a school-based care and support plan.Saide OER Africa
The document provides guidance to school management teams on developing a school-based care and support plan. It includes tools to help schools analyze the needs of vulnerable learners, create a vision statement, conduct a SWOT analysis, and identify strategic goals. The tools would help schools understand the challenges they face in supporting vulnerable students, develop a plan to address these challenges, and establish goals and objectives in key areas like nutrition, aftercare, counseling, and HIV/AIDS education.
Toolkit: Unit 7 - Counselling support for vulnerable learners.Saide OER Africa
The purpose of this toolkit is to conduct a situational analysis or assessment that will help you to understand the size of the challenge and the current capacity of your school to set up a counselling service. To assist you to decide on the most suitable options for implementing counselling support in your school context.
The purpose of this toolkit is to use a brainstorming technique to come up with creative ideas respond to the challenge of providing aftercare support for vulnerable learners. To use the ideas from the brainstorming session to inform the development of a draft set of ideas for an aftercare strategy.
There are different ways of combating discrimination and creating a safe and nonthreatening environment at school. An important contribution can be made by implementing an Anti-Bullying Policy
The guidelines and the five priority areas identified by Department of Education offer a framework that supports the development of a school HIV and AIDS policy. The guidelines and priorities can also be used to review your school's existing HIV and AIDS policy and determine how adequate it is and what changes may be necessary
Toolkit: Unit 1 - How responsive are schools to the socio-economic challenges...Saide OER Africa
The purpose of this toolkit is to understand what threatens the quality of education in your school so that you can take informed action to remedy the situation.
Reading: Understanding Intrapersonal Characteristics (Word)Saide OER Africa
Here are a few key points about Joseph based on the description:
- He struggles to focus, follow instructions, and complete work. This suggests difficulties with attention, executive functioning, and/or self-regulation.
- He is easily distracted and fidgety. This could indicate an attention issue like ADHD.
- He has quick temper outbursts. This points to potential difficulties with emotional regulation.
- The water spill incident triggered an extreme reaction, rather than a calm response like Martha's. This reinforces the idea of challenges with emotional control.
Overall, Joseph seems to exhibit signs of difficulties with attention, self-control, and emotional regulation - all of which could interfere with his ability to function
Reading: Understanding Intrapersonal Characteristics (pdf)Saide OER Africa
The impact of intrapersonal characteristics on school performance and learner development - A reading to accompany Unit Six of the module: Teaching and Learning Mathematics in Diverse Classrooms. This reading is useful because it summaraizes the various theoretical perspectives for understanding inclusive education, and because it uses case studies of typical learners to illustrate how teaching and learning activities need to be adapted to ensure that all children, no matter what their background or intrapersonal characteristics do learn mathematics.
Reading: Guidelines for Inclusive Learning Programmes (word)Saide OER Africa
A reading to accompany Unit Six of the module: Teaching and Learning Mathematics in Diverse Classrooms. This Reading consists of two extracts from a document "Guidelines for Inclusive Education Learning Programmes" produced by the Department of Education in June 2005.
Reading: Guidelines for Inclusive Learning Programmes (pdf)Saide OER Africa
A reading to accompany Unit Six of the module: Teaching and Learning Mathematics in Diverse Classrooms. This Reading consists of two extracts from a document "Guidelines for Inclusive Education Learning Programmes" produced by the Department of Education in June 2005.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
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How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
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1. 11
Parasites
Children with AIDS may be infected with
Objectives unusual parasites not normally seen in healthy
children (e.g. Toxoplasmosis).
When you have completed this unit you
should be able to: 11-2 Which are the common intestinal
• Diagnose and manage children with parasites?
intestinal worms. In Southern Africa the common intestinal
• Diagnose and treat giardiasis. parasites are:
• Diagnose and treat amoebiasis.
• Diagnose and treat bilharzia. • Roundworms
• Diagnose and manage children with • Whipworms
malaria. • Pinworms
• Hookworms
• Giardia
INTRODUCTION •
•
Tapeworms
Amoebae
11-1 What are parasites?
ROUNDWORMS
These are small creatures (animals) which
invade and infect (infest) the body. They may
be either: 11-3 What is a roundworm?
• External parasites which live on or in the Roundworms are the most common parasites
skin, e.g. scabies and sandworms. found in the gut of children. The worms are
• Internal parasites which live in the body. pink and smooth and measure about 25 cm
Many internal parasites live in the bowel long. They look like pale garden earth worms.
(i.e. intestinal parasites such as worms).
Other parasites live in the blood (e.g. Roundworms produce thousands of eggs a day
malaria) or other organs such as the which are passed in the child’s stool (faeces).
bladder wall (e.g. bilharzia). The eggs have a very characteristic shape and
can be easily recognised if a sample of stool is
examined under a microscope.
2. PARASITES 183
Roundworms are common in children (undernutrition). Roundworms also
between the ages of 1 and 5 years. decrease the child’s appetite.
• A large bunch (bolus) of worms can cause
colic (cramping abdominal pain) and even
Roundworms are the most common bowel total small bowel obstruction. The mass
parasite in many poor countries. of worms may be palpable on abdominal
examination.
NOTE The roundworm is Ascaris lumbricoides. • Migrating worms can get stuck in the bile
Infection with roundworms is called ascariasis. duct, resulting in acute, severe pain over
the liver (biliary colic).
11-4 How do children get roundworms?
NOTE Roundworms can also cause bowel
If human faeces are not disposed of in a perforation, volvulus, intussusception, colangitis
hygienic way, or if sewerage sludge is used as and pancreatic duct obstruction. With heavy
a garden fertiliser, children can swallow and infections, bunches of roundworms can be
get infected by roundworm eggs. Roundworm seen in a plain abdominal X-ray. Do not give
mebendazole or albendazole if acute abdominal
eggs can survive in soil for years. Playing or
pain is present as treatment increases the worms’
crawling in contaminated soil or eating raw tendency to migrate and may precipitate bowel
vegetables that have not been washed may obstruction. Surgery must be considered if there
result in infection. High prevalence rates are are signs of obstruction.
common in communities with poor sanitation.
This is a major public health problem in many 11-6 How can roundworms cause chest
parts of South Africa. problems?
Roundworm eggs hatch in the child’s small The larvae (which hatch out of the eggs in the
bowel, and the newly hatched larvae then pass gut) can causes respiratory symptoms and signs
through the bowel wall into the bloodstream during the time that they are migrating through
and are carried to the alveoli of the lungs. the lungs. Children with roundworm larvae in
From here they make their way up the bronchi the lungs present with a dry cough or wheeze.
and trachea then get swallowed. In the small
bowel the roundworm larvae mature into adult NOTE A high eosinophil count in the peripheral
blood (10% or more) is typical. Chest X-ray may
worms where they can live for 2 years.
show a pneumonitis.
11-5 Do roundworms in the gut cause
11-7 How are roundworms treated?
clinical problems?
Roundworm infection can be treated with
Many children with roundworms appear
either:
healthy and have no symptoms. Often the
only way the parents know that their children • Mebendazole orally 100 mg (i.e. 1 tablet)
have roundworms, is when worms are seen in twice a day for 3 days if below 5 years and
the stool. Sometimes worms can be vomited. 500 mg as a single dose if 5 years or older.
When the child is ill with a fever, roundworms • Albendazole as a single dose 200 mg (2
may make their way up the child’s oesophagus tablets) for children below 2 years and 400
and come out of the nose. mg for children of 2 years or more.
Large numbers of worms in the bowel can
cause problems: 11-8 How can infection with roundworms
be prevented?
• Vague abdominal pain or discomfort
• The amount of food they use • By safely disposing of human faeces
can contribute to malnutrition (adequate sanitation), e.g. water borne
sewerage or correctly built pit latrines
3. 184 PARASITES
• By washing raw vegetables before they are 11-11 What are the clinical features of
eaten whipworm infection?
• By washing hands before preparing or
Whipworms usually infect children over 5
eating meals
years of age. If the infection is light there are
• By preventing children from eating soil
usually no symptoms or signs. Heavy infection
• By routinely deworming children
can cause:
11-9 When is deworming recommended? • Loose stools containing blood.
Deworming every 6 months is recommended • Rectal prolapse may occur with very heavy
for children between the ages of 2 and 5 infections. With prolapse, the worms may
years in communities with poor hygiene and be seen attached to the rectal mucosa.
inadequate sanitation (poor toilet facilities). • Iron deficiency anaemia due to chronic
This should be done even if there is no history blood loss in the stool. This may be severe.
of roundworms in the stool. Medication is • Malnutrition
usually given at the local primary care clinic
or in schools. Deworming has been found to Whipworm infection can cause iron deficiency
improve the learning capacity and growth of
anaemia.
school children.
Mebendazole is the drug of choice. 11-12 What is the treatment of whipworm
Albendazole is more expensive. The dose infection?
for deworming is the same as for treating
roundworms. Both these drugs are highly 1. Prevention through good hand hygiene,
effective for roundworms. washing raw vegetables and the correct
disposal of human faeces (as with
prevention of roundworms)
Regular deworming of young children is 2. Mebendazole or albendazole, as given for
recommended in communities where roundworms roundworms
are common. 3. Treat iron deficiency anaemia with oral iron.
PINWORMS
WHIPWORMS
11-13 What are pinworms?
11-10 What are whipworms?
Pinworm infection is very common. They are
Whipworms commonly infect the bowel small, thin worms (about 4 cm long). Pinworms
of children in Southern Africa. They are are especially common where children sleep
short, thin worms (about 4 cm) that attach or play together in crowded conditions. Adult
themselves to the mucosa of the large bowel female worms pass out the anus at night to lay
where they cause bleeding. It is rare to see the eggs on the perineum. Eggs are swallowed from
worms in the stool. contaminated fingers, clothing or bed linen.
As with roundworms, eggs are ingested Pinworms are common even where hygiene
(swallowed) with soil. The eggs hatch in the and sanitation are of a high standard. They are
child’s gut and the larvae attach to the bowel also known as threadworms.
wall. Unlike roundworms, the larvae do not NOTE The pinworm is Enterobius vermicularis.
migrate through the lungs.
NOTE The whipworm is Trichuris trichura. The eggs
in the stool have a typical ‘tea tray’ appearance.
4. PARASITES 185
11-14 What are the clinical features of 11-18 What are the clinical features of
pinworm infection? hookworm infection?
Perianal itching and scratching at night. This Usually, there are no symptoms unless there
may cause loss of sleep. Secondary infection is heavy infection. The child may have an
of the scratched skin is common. In girls the unusually large appetite and want to eat sand.
worms may enter the vulva causing irritation In severe cases there may be signs of iron
and vaginal discharge (vaginitis). deficiency anaemia.
Pinworm infection presents with perianal itching 11-19 How is hookworm infection
diagnosed?
and scratching, especially at night.
Worms and their eggs may be found in the
stools.
11-15 How is pinworm infection
diagnosed?
11-20 What is the treatment of hookworm
The clinical diagnosis can be confirmed by the infection?
parent finding the small worms on the skin
around the anus at night. A piece of sticky tape Mebendazole or albendazole, as for
(Sellotape) should be placed against the anus roundworm infection.
and surrounding skin during the night and then NOTE Pyrantel (Combantrin) orally 10 mg/kg as a
immediately removed. In this way eggs can be single dose may also be used.
collected and identified under a microscope.
11-16 What is the treatment of pinworms? TAPEWORMS
Mebendazole or albendazole, as used for
roundworms 11-21 What are tapeworms?
The common tapeworms that infect the
HOOKWORMS human gut are the pork and, to a lesser degree,
the beef tapeworm. They are very long (up
to 5 metres) segmented worms that grow
11-17 What are hookworms? in the small bowel of humans after eating
uncooked or partially cooked meat, which is
Hookworms commonly occur in warm, contaminated with tapeworm cysts. Tapeworm
moist climates such as northern KwaZulu- segments filled with eggs are excreted in
Natal and the Mozambique coast. With human stools and later may be swallowed
poor sanitation, hookworm eggs in the stool by animals (pigs or cows). The eggs hatch
contaminate the soil and hatch rapidly. They in the animal’s gut and are carried in the
then infect the feet of barefoot children. Once bloodstream to the muscles of the animals
the skin is penetrated, hookworms behave like where they become tapeworm cysts. Eating
roundworms as they enter the bloodstream infected, uncooked meat of these animals
and travel via the lungs to get into the small completes the life cycle of the tapeworm when
bowel. The worms attach to the bowel mucosa the eggs hatch, resulting in adult worms living
and cause bleeding. in the human gut.
NOTE There are two types of hookworm,
Ancylostoma duodenale and Necator americanus.
Most tapeworms result from eating poorly cooked
pork which is infected with tapeworm cysts.
5. 186 PARASITES
NOTE The pork tapeworm is Taenia solium and the are a common cause of fits in children that live
beef tapeworm is Taenia saginata. in rural areas where toilets are not available.
Good sanitation, safe water, hand-washing
11-22 How is tapeworm infection and washed vegetables will reduce the risk of
diagnosed? neurocycticercosis.
Small segments of the worm are seen in the
stool or may be found in the bed. Often there Swallowed pork tapeworm eggs from human
are no other symptoms. However, tapeworms faeces result in tapeworm cysts in the brain.
can cause abdominal discomfort, failure to
thrive and loss of appetite. NOTE The tapeworm cysts (cysticerci) are best
identified in the brain by MRI or CT scanning.
11-23 What is the treatment of tapeworm With time they become calcified and can be
infection? seen on X-ray. Cysts may also occur in muscles.
Antibody tests are of little help. Treatment of
Mebendazole orally 100 mg twice daily for 7 neurocysticercosis in hospital is with steroids and
days. Praziquantel.
11-24 How can tapeworm infection be
prevented? HYDATID DISEASE
If possible, animals should be slaughtered in a
registered abattoir where all meat is inspected 11-26 What is hydatid disease?
to ensure that it is not infected by tapeworm
cysts. Cooking meat well kills the cysts. This is caused by the dog tapeworm which
Therefore, avoid eating raw or partially cooked can occur in the gut of dogs. Eggs, which are
meat. Meat lightly cooked on an open fire may passed in the dog’s stool, may be swallowed
still contain live tapeworm cysts. by sheep and goats, resulting in tapeworm
cysts in their muscles. Other dogs can then
Human stools must be disposed of safely be infected with tapeworms by eating the raw
so that it cannot be eaten by pigs. This will meat of these sheep or goats.
prevent the pigs from becoming infected
with tapeworm cysts. Parts of the Eastern If eggs of the dog tapeworm are swallowed by
Cape of South Africa are particularly heavily humans instead, the eggs hatch in the human
contaminated with tapeworm eggs. gut and are carried by the bloodstream to
the liver or lung where they form large cysts
(hydatid cysts). These large cysts may cause
In villages, pigs must be prevented from eating clinical problems (hydatid disease) and will
human faeces. have to be removed surgically.
Dogs should be dewormed regularly and
11-25 Can tapeworm cysts enter the brain? they should not be allowed to eat raw meat,
Yes. Sometimes the eggs of the pork tapeworm, especially mutton or goat meat which is
which have been passed in human faeces, are infected with the cysts of the dog tapeworm.
swallowed by other humans (instead of by pigs) Prevent children eating soil as it may be
in food or water contaminated by infected contaminated with dog tapeworm eggs.
human faeces. The eggs hatch in the child’s Always wash hands before eating. Also wash
gut and are then carried by the bloodstream vegetables well.
into all parts of the body including the brain.
In the brain they form many small tape worm Hydatid disease results when children swallow
cysts (neurocysticercosis) which cause fits
the eggs of the dog tapeworm.
(convulsions). Tapeworm cysts in the brain
6. PARASITES 187
Treatment is with mebendazole or albendazole 11-29 What is the treatment of giardia
daily for 6 weeks. infection?
NOTE The dog tapeworm is Echinococcus Metronidazole (Flagyl) 500 mg (under 4 years)
granulosus. or 800 mg (4 years or older) daily for 3 days.
The prevention, diagnosis and treatment of It is best to avoid infection with giardia by
sandworm infection is discussed in Unit 12. not drinking contaminated water or eating
unwashed vegetables or salad.
GIARDIASIS AMOEBIASIS
11-27 What is giardiasis?
11-30 What is amoebiasis?
Giardiasis is an infection with a single-celled
Amoebiasis is an infection caused by a single-
organism (protozoa) called giardia. The cysts
celled organism (protozoa) called an amoeba
of giardia are swallowed in contaminated food
which infects the large bowel. Amoebae
or water. Giardia lives in the small bowel and
are passed in the stool from where they can
cysts are passed in the stool. The cysts in human
contaminate food or water causing infection in
stools contaminate the soil and nearby water.
others. Therefore, the provision of toilets and
NOTE Giardia lamblia is the cause of giardiasis. a safe water supply are important to prevent
amoebiasis.
11-28 What are the clinical features of NOTE Entamoeba histolytica is the amoeba which
giardia infection? causes amoebiasis.
Giardiasis is usually asymptomatic. However,
with heavy infection the child develops loose, 11-31 What are the clinical features of
foul-smelling, watery stools. Abdominal amoebiasis?
cramps and vomiting are common. Usually Mild infection is asymptomatic. However,
the infection resolves in a few days but it may heavy infection causes abdominal discomfort
become chronic. Chronic giardiasis may cause and dysentery with blood and mucus in the
chronic diarrhoea with malabsorption leading stools. Amoebae can also cause abscesses in
to failure to thrive and malnutrition. the liver. This presents with an enlarged tender
It is difficult to confirm the diagnosis by liver. Severe bowel infection can result in
finding cysts in the stool. Therefore, diagnosis perforation and peritonitis.
is usually suspected from the clinical history Amoebae can be seen microscopically in
and confirmed when the symptoms and signs warm stool. A blood test for antibodies against
disappear after treatment. amoebae is useful in identifying patients with
amoebiasis.
Giardiasis can cause chronic diarrhoea and failure
to thrive. 11-32 What is the treatment of amoebiasis?
Metronidazole (Flagyl) 200 mg 3 times daily
NOTE Giardia is a common cause of ‘travellers’ for 5 days. All children with severe dysentery
diarrhoea’.
or suspected liver abscess must be referred
urgently. A large liver abscess may need to be
aspirated.
7. 188 PARASITES
Clean water, washing hands before eating, parasites in communities where they are
avoiding unwashed vegetables and salads, and common.
the safe disposal of human faeces prevents
It is important that parents are aware of the
amoebiasis.
clinical features of infection with intestinal
parasites and can recognise the worms if they
11-33 How can infection with many types are seen.
of intestinal parasite be prevented?
The same basic steps are needed to prevent
most intestinal parasites: BILHARZIA
1. The safe disposal of faeces is most
important, e.g. water flush toilets or 11-35 What is bilharzia?
correctly-made pit toilets (VIP toilets).
Never pass urine or stool near a stream or Bilharzia (schistosomiasis) is a disease caused
dam. by the bilharzia parasite. About 2 million people
2. Hands should always be washed before are infected with bilharzia in South Africa.
preparing and eating food. They should There are 2 forms of bilharzia. One affects
also be washed before eating. the bowel while the other affects the bladder.
3. Always use a clean, safe source of water for Bilharzia of the bladder is the most common
drinking and washing. form of bilharzia in children in South Africa.
4. Always wash raw vegetables or salads Eggs of the bladder parasite are passed in the
before eating. urine. If the urine reaches a source of water,
5. Avoid eating meat which has not been the parasite can infect and multiply in a special
thoroughly cooked. snail often found in pools, dams, reservoirs,
6. Prevent pigs from eating human faeces. canals or slow flowing streams. Parasites
7. Do not leave dog faeces lying around. released from the snail can penetrate the skin
Public awareness campaigns are an important of humans. From here the parasites enter the
method of reducing the number of infected bloodstream and are carried to the bladder.
children. Methods of preventing infection Sometimes they may also reach other organs.
with intestinal parasites should be taught and In the bladder wall the parasites cause
practised at schools. inflammation, bleeding and eventually
scarring. Damage can extend to the rest of the
Safe toilets and clean water will prevent infection urinary tract, resulting in urinary obstruction
with most intestinal parasites. with chronic renal failure.
NOTE Bilharzia (schistosomiasis) is caused by either
Schistosoma haemotobium (bladder parasite) or
11-34 What is the treatment of intestinal Schistosoma mansoni (bowel parasite).
parasites?
Most intestinal parasites can be effectively
Bilharzia of the bladder is common in South
treated with oral mebendazole or albendazole.
Some require a single dose (roundworms, Africa.
whipworms and pinworms) but others need a
daily dose for a number of days (tapeworms). 11-36 What are the clinical features of
Giardia and Amoeba infections should be bilharzia of the bladder?
treated with metronidazole (Flagyl).
At the time of infection an itchy, papular rash
Regular treatment of children (e.g. deworming may occur at the site where the parasites enter
for roundworms) is advised for some intestinal the skin (called ‘swimmers’ itch’). This may be
followed a few weeks later by a flu-like illness.
8. PARASITES 189
Mild bladder infection with bilharzia MALARIA
parasites is often asymptomatic. With more
severe infection, the classical sign is terminal
haematuria (blood seen in the urine towards 11-40 What is malaria?
the end of micturition).
Malaria is a serious illness caused by a malaria
parasite which is transmitted to humans by a
Bilharzia of the bladder usually presents with special type of mosquito. When a mosquito
terminal haematuria. bites an infected person, human blood
containing malaria parasites is taken in by the
NOTE Bilharzia of the bowel may cause dysentery. mosquito. The mosquito becomes infected
(but not ill) and can then bite and infect other
11-37 How is the diagnosis of bilharzia of humans. In the human, the malaria parasite
the bladder confirmed? infects both red cells and the liver. Infection
of the red cells causes haemolysis, resulting
By finding the typical bilharzia eggs in the in anaemia. It also causes the red cells to stick
urine under a microscope. It is best to collect together which obstructs small blood vessels.
urine around midday when most eggs are Malaria is a common cause of chronic illness
released. A blood test for antibodies to the and death in many low lying regions where
parasite is also available. malaria mosquitoes occur.
NOTE Eosiniphilia in the blood is usually present
with bilharzia.
Malaria is an important cause of death in many
parts of southern Africa.
11-38 What is the treatment of bilharzia?
Praziquantel 40 mg/kg orally as a single As falciparum malaria is by far the most
dose. This treatment can be given at a clinic. common form of malaria in South Africa, other
Unfortunately, children who live in a bilharzia rarer forms of malaria will not be considered.
region may have to be treated repeatedly for
NOTE Almost all malaria in Southern Africa is
bilharzia.
caused by Plasmodium falciparum which is
transmitted by female Anopheles mosquitoes
11-39 How can bilharzia be prevented? (the vector of malaria).
Every effort must be made to prevent bilharzia
infection. Never pass urine into a stream or 11-41 What are the clinical signs of
pool of water. Standing or slow-moving water malaria?
such as farm dams and irrigation furrows are The patient develops an acute illness with
the home of the bilharzias snail, especially fever, shivering rigors and flu-like symptoms
in the eastern areas of South Africa and in 1 to 2 weeks after being bitten by an infected
Zimbabwe. Fast-moving streams are usually mosquito. Headache, nausea and body pains
safe. Swimming or bathing in infected water are common in uncomplicated (mild) malaria.
must be avoided as this is the common way of The symptoms and signs of malaria are very
getting bilharzias. Efforts are being made to non-specific, making the clinical diagnosis
kill the snails in high risk areas. difficult to confirm or exclude.
Severe headache, repeated vomiting and
Do not swim in standing water where there are drowsiness suggest the development of severe
bilharzia snails. malaria. Mild malaria may become severe and
even fatal within hours.
NOTE Infection of other organs such as the liver
(jaundice), gut (diarrhoea), lungs (respiratory
9. 190 PARASITES
distress) and kidneys (oliguria with renal failure) • Is passing urine
may occur. Massive haemolysis (blackwater fever) • Is not vomiting repeatedly, and is able to
causes anaemia, with dark urine. take oral medication
Anyone who develops fever in a malaria • Has no signs of organ failure
area, or within 2 weeks of leaving a malaria NOTE In uncomplicated malaria the parasite count
area, must be suspected of having malaria. on a thin blood smear is less than 5%, i.e. less
Thinking of malaria is the most important than 5% of red cells containing malaria parasites.
step in the clinical diagnosis. As the clinical In severe malaria the patient may have any of
symptoms and signs of malaria are very varied, the following:
it is always important to confirm the clinical
suspicion. There are often no clinical signs at • Signs of cerebral malaria
presentation. • Breathing difficulty
• Hypoglycaemia, jaundice or severe
anaemia (Hb less than 5 g/dl)
Suspect malaria in anyone with a flu-like illness • Repeated vomiting, apparent dehydration
who lives in or has recently visited a malaria or little urine passed
region. • A shocked appearance
NOTE In severe malaria the parasite count is well
11-42 How is the diagnosis of malaria over 5% (hyperparasitaemia). The higher the
confirmed? count, the more severe the malaria. Metabolic
acidosis may occur.
1. Seeing the malaria parasites within red
cells in a stained thick blood smear is
11-44 What is cerebral malaria?
the traditional ways of confirming the
diagnosis. Repeated smears may be needed This is the most dangerous complication of
before malaria is excluded as the smear severe malaria as the brain is affected and can
may be negative early in the infection. lead to rapid death. Young children, pregnant
2. A blood test to detect malaria proteins women and people who are HIV infected are
(rapid antigen test) is also useful in making particularly susceptible to cerebral malaria.
a rapid diagnosis. It is very reliable and Each year many children die of cerebral
available at primary care facilities in malaria in Africa.
malarial areas of South Africa.
Signs of cerebral malaria must always be
3. It is very important to confirm the
viewed with great concern:
diagnosis of malaria as soon as possible.
• Depressed level of consciousness, i.e.
drowsy, unable to stand, confused or
Most deaths due to malaria are caused by delayed unconscious
diagnosis or late treatment. • Convulsions
Remember that many other serious conditions
may present with the same symptoms and signs Confusion is an important sign of potentially fatal
as malaria, e.g. bacterial meningitis. Children cerebral malaria.
may also have malaria plus another infection.
NOTE In cerebral malaria the large numbers of
parasites obstruct the normal blood flow to the
11-43 How can you tell whether malaria is brain.
uncomplicated or severe?
In uncomplicated malaria the patient:
• Has mild symptoms
• Is fully alert and able to stand and walk
10. PARASITES 191
11-45 How is uncomplicated malaria In future intravenous artesunate will probably
treated? replace quinine as it is safer. Rectal artesunate
is also an effective emergency treatment.
Early and accurate diagnosis with urgent
treatment using the correct drugs is the key NOTE A loading dose of quinine 20 mg/kg diluted
to successful management. It is important in 5% dextrose water (10 ml/kg) must always be
to differentiate uncomplicated from severe given as a slow infusion over 4 hours and never
as a bolus. This is followed by 10 mg/kg 8 hourly
malaria. If possible all patients with malaria are
intravenously. Change to oral quinine as soon as
referred to a hospital or clinic where the staff possible.
are experience in treating malaria. They must
be closely followed up for the first few days. Using a combination of drugs for both
Patients with confirmed malaria are usually uncomplicated and severe malaria is more
treated with coartemether (Coartem). Coartem effective and less likely to result in resistance in
is a combination of two potent, rapidly acting the community than monotherapy (one drug
anti-malarial drugs which are well tolerated. only). The patient should improve clinically
within 48 hours and the fever should settle
For uncomplicated malaria, one dose of within 5 days.
Coartem should be taken immediately, then
again after 8 hours, followed by a twice daily
11-47 How is malaria prevented?
dose for the next 2 days. Each dose is 1 tablet
if 10–14 kg, 2 tablets if 15–24 kg, 3 tablets if 1. Pregnant women and young children should
25–34 kg and 4 tablets if 35 kg or more. Best not enter a malaria areas if at all possible.
taken with food. 2. Mosquitoes usually bite in the early
evening and early morning. Therefore, stay
Drug resistance is a major problem with
indoors with screens over windows and
malarial treatment. Most strains of malaria
doors or wear light coloured clothes, long
are now resistant to chloroquine alone or in
sleeves and trousers with shoes and socks
combination with other drugs. Paracetamol
in the evenings and early mornings.
is best for reducing the fever. Make sure the
3. Use a bed net impregnated with insecticide
patient is taking enough fluids.
(pyrethroid) at night.
Uncomplicated malaria can also be treated with 4. Use insect repellent on the skin and clothes
oral quinine. However, there are some serious or burn repellent coils or pads or sprays at
side effects of quinine, e.g. myocardial toxicity. night.
NOTE The dose of oral quinine is 10 mg/kg 8 hourly
5. Antimalarial drug prophylaxis is
for 7 days PLUS clindamycin 5 mg/kg 8 hourly for 7 recommended for short visits to a malaria
days or doxycycline (if over 8 years of age) 4 mg/kg area.
immediately then 2 mg/kg daily for 7 days. 6. By reducing the number of mosquitoes.
The quinine tablets are very bitter but can be Preventing mosquito bites is more effective
crushed and taken with jam, or mashed banana. than prophylaxis. Usually both are needed.
11-46 How is severe malaria treated? Preventing mosquito bites is the most effective
Severe malaria is usually treated with way of avoiding malaria.
intravenous quinine PLUS oral doxycycline
(if over 8 years) or clindamycin (oral,
11-48 What malaria prophylaxis is
intramuscular or intravenous in younger
recommended?
children). Intravenous drugs must be
started immediately and the patient urgently Malaria prophylaxis is needed by all who enter
referred to hospital. Look for and manage a malaria area (a region where malaria occurs),
hypoglycaemia, shock or convulsions. even if it is only a one day visit. The risk of
11. 192 PARASITES
becoming infected by malaria is particularly CASE STUDY 1
high in the rainy season when mosquitoes are
common. Full compliance is very important.
A mother brings her 5-year-old son to the
However, prophylaxis is never 100% effective.
clinic because he has passed 2 roundworms
1. Malanil or malarone (atovaquone plus with his stool. He is generally well but the
proguanil) for children of 10 kg or more. It mother complains that he scratches his anus at
is well tolerated but expensive. night which keeps him awake.
2. Mefloquine (Larium) for children of 5 kg
or more. 1. How do children get roundworms?
3. Doxycycline for older children (over 8
years). They ingest the roundworm eggs after playing
in sand or soil. If human faeces are not
It is best for all children under 5 years, disposed of correctly they can contaminate
especially children under 5 kg, not to enter a soil in the village, garden or playground. Eggs
malaria area as they are at high risk for severe can survive for years in soil and may also
infection. Chloroquine alone, chloroquine contaminate pools of water or raw vegetables.
with proguanil, and Coartem should not be This is a common public health problem.
used for prophylaxis.
NOTE Malanil daily ¼ tablet if 5–20 kg, ½ tablet 2. Can roundworms cause clinical
if 21–30 kg, ¾ tablet if 31–45 kg and 1 tablet if problems?
over 45 kg starting one day before entering and
stopping one week after leaving a malaria area. Usually not. However, with heavy infections
Mefloquine weekly ¼ tablet if 5–20 kg, ½ tablet children may complain of abdominal
if 21–30 kg, ¾ tablet if 31–45 kg and 1 tablet if pain or discomfort and lose their appetite.
over 45 kg starting one week before entering and Roundworms can cause bowel obstruction or
stopping 4 weeks after leaving a malaria area. block a bile duct. The larvae of roundworms
Doxycycline 100 mg daily starting 1 day before pass through the lungs and can cause
entering and stopping 4 weeks after leaving a coughing and wheezing.
malaria area.
Seasonal Intermittent Treatment of children 3. How should this child be treated?
in malaria regions decreases the incidence of
clinical malaria. With a single oral dose of mebendazole or
albendazole. The mother should be told how
to avoid reinfection.
11-49 How can the number of mosquitoes
be reduced?
4. Is routine deworming recommended for
1. By reducing the mosquito population all children?
with the use of controlled spraying around
homes with insecticides. This is done by A deworming programme is recommended in
state-employed teams. regions where roundworms are common.
2. By reducing pools of water where
mosquitoes can breed. 5. What is a common cause of perianal itch
at night in children?
NOTE Malarial mosquitoes have become resistant
to many insecticides. The controlled use of DDT Pinworms. These are short worms that infect
is very effective but remains controversial due to the gut and leave the anus at night, causing
the risk of environmental pollution and dangers irritation to the skin around the anus. They
to other animals and possibly the newborn infant. can also cause a vaginal discharge in girls.
12. PARASITES 193
6. How can the diagnosis be confirmed? 5. Can tapeworms affect the brain?
A strip of Sellotape should be stuck onto the Yes. If eggs of the pork tapeworm are passed
child’s skin over and next to the anus and then in human faeces and then later get swallowed
immediately removed. Pinworm eggs will stick by another human rather than a pig, they
to the Sellotape. These can then be seen under can hatch in the gut of that person and then
a microscope. The treatment is the same as for travel in the bloodstream to the brain where
roundworms. they form many small cysts. This is called
neurocysticercosis and usually presents with
convulsions. Neurocysticercosis is common in
CASE STUDY 2 communities where there are pigs and human
faeces are not disposed of safely.
A malnourished child from a rural village
presents at the local clinic after passing a piece 6. What problems can be caused by the dog
of tapeworm in her stool. Pigs run free and eat tapeworm?
human faeces. There are also a number of dogs If eggs of the dog tapeworm are ingested
in the village. by humans they hatch in the gut, enter the
bloodstream and are carried to organs such as
1. What are the common types of the liver and lungs where they grow into large
tapeworms in children? (hydatid) cysts. Therefore it is important that
The pork or beef tapeworms. Pig tapeworms children do not play in areas where dog faeces
are more common. are left to mix with the soil or pools of water.
Hydatid disease can be treated with oral daily
2. What is the clinical presentation of mebendazole or albendazole for 6 weeks.
tapeworms? Large cysts may have to be removed surgically.
Infected children are often asymptomatic.
However, tapeworms can cause poor appetite,
abdominal discomfort and weight loss. This CASE STUDY 3
child’s malnutrition may be partly explained
by the tapeworm. A month after returning from holiday on a
farm in the Eastern Cape, a 14-year-old child
3. How did this child get infected with a presents with a 3-week story of loose stools,
tapeworm? and terminal haematuria for 2 days. While on
holiday he swam in a farm dam.
Probably by eating uncooked or partially
cooked pork. Tapeworm eggs get passed in the 1. What is the common cause of terminal
stool and then may be eaten by pigs if toilets haematuria?
are not available. The eggs hatch in the pig’s
gut and then travel in the bloodstream to the Blood in the urine towards the end of
muscles where they form cysts. If these cysts in micturition is typical of bilharzia. The bilharzia
the meat are eaten by humans, they hatch out parasite settles in the wall of the bladder where
in the gut to form a tapeworm. it causes inflammation and bleeding.
4. What is used to treat intestinal 2. When did the infection probably occur?
tapeworms? When he swam in the farm dam. The special
Oral mebendazole twice daily for 7 days. bilharzia snail is common in the eastern parts
of South Africa where it lives in standing or
slow-moving water such as farm dams or
13. 194 PARASITES
irrigation furrows. If someone with bilharzia indicates severe, probably cerebral malaria.
passes urine into the water the snails can Malaria can progress from uncomplicated to
become infected. The parasites released from severe within hours if not treated.
the snails can then penetrate the skin of
anyone walking or playing in the water. 3. How can the diagnosis be confirmed?
By examining a blood smear or performing a
3. Can bilharzia be treated?
malaria rapid antigen test.
Yes. It can be treated very effectively with
praziquantel. It is best to first confirm the 4. What is the correct treatment?
diagnosis by seeing bilharzia parasites in
a urine sample collected around midday. She must be admitted to hospital urgently as
Chronic bilharzia infection can lead to damage cerebral malaria can be fatal. She needs to be
of the urinary system causing renal failure. treated with intravenous quinine plus either
doxycycline or clindamycin. Uncomplicated
malaria can be adequately treated with oral
4. What is the probable cause of the
Coartem provided the clinical diagnosis has
diarrhoea for the past 3 weeks?
been confirmed.
The child may have a bowel infection with
giardia, which causes diarrhoea. Although it 5. How can malaria be prevented while on
is often acute it may last for weeks or months. holiday?
Giardia is common where a safe water supply
and adequate toilets are not present. The only way to confidently avoid malaria is
not to enter a malaria area. However, malaria
can usually be avoided by making efforts not
5. Which drug is used to treat giardiasis?
to be bitten by mosquitoes and by taking
Metronidazole (Flagyl). malaria prophylaxis. Insecticide impregnated
bed nets are very effective. Also keeping
indoors after sunset with mosquito screens on
CASE STUDY 4 the door and windows. Wear long trousers and
sleeves, and shoes and socks if going out in the
Two weeks after returning from a malaria area, evening or early morning, when mosquitoes
a 10-year-old child presents with headache, are most active.
shivering and vomiting. The mother gave her
some paracetamol for the fever. A few hours 6. What malaria prophylaxis should be
later the child becomes confused and cannot taken?
stand up. The family did not take malarial The choice is atovaquone and proguanil
prophylaxis because they planned to be in the (Malanil) for children of 10kg or more, or
area for 2 days only. mefloquine (Larium) for children of 5 kg
or more. Children over 8 years can also use
1. Do you think this child has malaria? doxycycline. The medication must be taken
Yes. Malaria has an incubation period of 1 to correctly, including for the correct period after
2 weeks and presents with fever and a flu-like leaving the malaria area. Prophylaxis must be
illness. taken even for a one day visit.
2. How severe is the infection?
At presentation it was uncomplicated, with
fever and vomiting. However, within hours
she was confused and could not stand. This