This document provides an overview of paediatric HIV/AIDS and challenges of management in Nigeria. It discusses the epidemiology of HIV globally and in Nigeria, where the disease burden is highest. It covers pathogenesis, transmission, clinical manifestations, diagnosis, treatment including antiretroviral therapy, and challenges in management. In Nigeria, paediatric HIV care began in 2004 and the strategic plan aims to scale up access to care, treatment and support for infected and exposed children. Management of paediatric HIV presents many challenges.
Etiopathogenesis and natural history of ca cervixNiranjan Chavan
CERVICAL CANCER , the 2nd most common cancer in India can be easily prevented with proper adequate screening and awareness.
Adequate sex education is necessary to inculcate safe sexual practices to prevent HPV infection.
CERVICAL CANCER
By
Josfeena Bashir
Lecturer,BGSBU
outline
Definition
Causes
Types
Stages
Pathophysiology
Clinical manifestations
Diagnostic investigations
Management
Complication
DEFINITION
Cervical cancer is a disease that develops quite slowly and begins with a precancerous lesion known as dysplasia .It is a malignant tumor deriving from the cells of the cervix.
incidence
Types of cervical cancer
STAGING
PATHOPHYSIOLOGY
Due to various causes
Human papilloma virus enter into cervix
HPV Exposure(million /yr)
CONDYLOMA CERVICAL
DYSPLASIA
High grade cervical dysplasia
Invasive cancer
Metastasis
Clinical manifestations
Leg pain
Edema of the extremities.
Anaemic
Hematuria
Rectal pain
Diarrhoea
Blood per rectum
Uremia in late stage
Foul smelling urine
DIAGNOSTIC INVESTIGATIONS
Medical management
Medical management
CHEMOTHERAPY
Drug: Cisplatin
RADIATION THERAPY
External beam radiation therapy
HVD BBKHT7T6TGSERTYUIJKNBCFXHG
Surgical management
Laser surgery
LEEP
Hysterectomy
Bilateral pelvic adenectomy
Pelvic exenteration
Radical trachelectomy.
complications
Early menopause
Narrowing of the vagina
Bleeding
Lymphedema
conclusion
Etiopathogenesis and natural history of ca cervixNiranjan Chavan
CERVICAL CANCER , the 2nd most common cancer in India can be easily prevented with proper adequate screening and awareness.
Adequate sex education is necessary to inculcate safe sexual practices to prevent HPV infection.
CERVICAL CANCER
By
Josfeena Bashir
Lecturer,BGSBU
outline
Definition
Causes
Types
Stages
Pathophysiology
Clinical manifestations
Diagnostic investigations
Management
Complication
DEFINITION
Cervical cancer is a disease that develops quite slowly and begins with a precancerous lesion known as dysplasia .It is a malignant tumor deriving from the cells of the cervix.
incidence
Types of cervical cancer
STAGING
PATHOPHYSIOLOGY
Due to various causes
Human papilloma virus enter into cervix
HPV Exposure(million /yr)
CONDYLOMA CERVICAL
DYSPLASIA
High grade cervical dysplasia
Invasive cancer
Metastasis
Clinical manifestations
Leg pain
Edema of the extremities.
Anaemic
Hematuria
Rectal pain
Diarrhoea
Blood per rectum
Uremia in late stage
Foul smelling urine
DIAGNOSTIC INVESTIGATIONS
Medical management
Medical management
CHEMOTHERAPY
Drug: Cisplatin
RADIATION THERAPY
External beam radiation therapy
HVD BBKHT7T6TGSERTYUIJKNBCFXHG
Surgical management
Laser surgery
LEEP
Hysterectomy
Bilateral pelvic adenectomy
Pelvic exenteration
Radical trachelectomy.
complications
Early menopause
Narrowing of the vagina
Bleeding
Lymphedema
conclusion
LSCS in Chorioamnionitis at ICCOB 2021 Ahmedabad 181221Niranjan Chavan
Chorioamnionitis in pregnancy leads to PPROM, Preterm labour, maternal and fetal sepsis. Deliver is imminent. LSCS do not improve the fetal outcome in such patients.
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
A Presentation Presented To orient about HIV, AIDS and STIs for Development of Knowledge, Attitude, and Practice for Prevention of HIV and STIs for College Students.
LSCS in Chorioamnionitis at ICCOB 2021 Ahmedabad 181221Niranjan Chavan
Chorioamnionitis in pregnancy leads to PPROM, Preterm labour, maternal and fetal sepsis. Deliver is imminent. LSCS do not improve the fetal outcome in such patients.
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
A Presentation Presented To orient about HIV, AIDS and STIs for Development of Knowledge, Attitude, and Practice for Prevention of HIV and STIs for College Students.
At the end of the session, the students shall be able to
Describe the HIV AIDS introduction, epidemiology of HIV AIDS, diagnosis of HIV AIDS, treatment of HIV AIDS and prevention control of HIV AIDS.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. INTRODUCTION
HIV IS A RETROVIRUS WHICH BELONGS TO THE
FAMILY LENTIVIRIDAE
THE VIRUS MAINLY INFECTS HELPER T
LYMPHOCYTES,MONOCYTES AND
MACROPHAGES
AIDS RESULTS FROM PROGRESSION OF HIV
INFECTION.
4. INTRODUCTION.
HIV WAS FIRST RECOGNIZED IN THE USA IN
1981.
ISOLATED IN 1983.
DEMONSTRATED AS THE CAUSATIVE AGENT
OF AIDS IN 1984.
A SENSITIVE ELISA TEST WAS DEVELOPED
IN 1985.
5. EPIDEMIOLOGY
AT THE END OF 2007,WHO ESTIMATED THAT ABOUT
33.2MILLION PEOPLE WERE LIVING WITH HIV
GLOBALLY.
16% DROP WHEN COMPARED WITH THE 2006
ESTIMATE OF 39.5MILLION.
THE NUMBER OF PEOPLE LIVING WITH HIV IN
EASTERN EUROPE AND ASIA HAS INCREASED BY
OVER 150% FROM 630000 IN 2001 TO 1.6MIL IN 2007.
330000 CHILDREN DIED OF AIDS GLOBALLY IN 2007.
6. Global summary of the AIDS epidemic
December 2007(WHO)
Number of people living with HIV in 2007
Total 33.2 million [30.6 – 36.1 million]
Adults 30.8 million [28.2 – 33.6 million]
Women 15.4 million [13.9 – 16.6 million]
Children under 15 years 2.5 million [2.2 – 2.6 million]
People newly infected with HIV in 2007
Total 2.5 million [1.8 – 4.1 million]
Adults 2.1 million [1.4 – 3.6 million]
Children under 15 years 420 000 [350 000 – 540 000]
AIDS deaths in 2007
Total 2.1 million [1.9 – 2.4 million]
Adults 1.7 million [1.6 – 2.1 million]
Children under 15 years 330 000 [310 000 – 380 000]
7. EPIDEMIOLOGY
• SSA STILL MOST AFFECTED ,68% ADULTS AND
90% CHILDREN LIVING WITH HIV.
• SSA ACCOUNTED FOR 76% AIDS DEATHS IN 2007.
• 1.7MILLION NEW INFECTIONS IN 2007.
8. EPIDEMIOLOGY
• NGR HAS THE HIGHEST BURDEN OF MTCT
RATES AND PEADIATRIC HIV DISEASE IN THE
WORLD.
• NGR IS ESTIMATED TO HAVE 290,000
CHILDREN LIVING WITH HIV.
• ACCOUNTS FOR 14% OF THE TOTAL AFRICAN
BURDEN.
•STATE-WIDE HIV PREVALENCE IN NGR
RANGES FROM AS LOW AS 1.6% IN EKITI TO
10% IN BENUE.
10. MODE OF TRANSMISION.
• MATERNAL TO CHILD.
• USING CONTAMINATED SKIN PIERCING
INSTRUMENTS OR SHARPS.
• INJECTION OR TRANSFUSION OF CONTAMINATED
BLOOD OR BLOOD PRODUCTS.
11. MODE OF TRANSMISION.
• UNPROTECTED SEXUAL INTERCOURSE WITH AN
INFECTED PARTNER.
• WITHOUT INTERVENTION,5-10% OF TRANSMISION
WILL OCCUR DURING PREGNANCY,10-20% DURING
LABOUR AND 5-20% DURING BREASTFEEDING.
• 15-30% OF NON-BREASTFED CHILDREN WILL BE
INFECTED OVERALL.
12. Risk Factors For Maternal To Child
Transmission
Maternal Factors
Mothers with high viral load
Severe immunosuppression and advanced disease
Rupture of membranes > 4hrs before delivery.
Cracked nipples and breast abscesses during
breastfeeding.
Maternal micronutrient deficiencies.
13. Duration of ROM and risk
of transmission
< 4 hours > 4 hours
14% 25%
14. The effect of maternal viral load on the risk of
transmission of HIV
<1000cpm 12% Transmision
>10,000cpm 29% Transmision
15. RISK FACTORS FOR MTCT
INFANT FACTORS.
– INVASIVE INFANT PROCEDURES DURING
DELIVERY
– FIRST TWIN
– PREMATURITY
– BREASTFEEDING
– ORAL THRUSH OR ORAL ULCERS WHILE
BREASTFEEDING
16. CLINICAL MANIFESTATION.
PRIMARY ACUTE INFECTION.
• I P IS 2-4WKS FOR 10
INFECTION ACQUIRED BY
ADULTS AND ADOLESCENTS.
• NON-SPECIFIC SYMPTOMS OCCUR IN 30-90% OF
NEW INFECTIONS.
• FEVER,FATIGUE,MALAISE,PHARYNGITIS,
LYMPHADENOPATHY.
17. CLINICAL MANIFESTATION.
LATE STAGE DISEASE.
• CHARACTERIZED BY IMMUNODEFICIENCY
• RESULTING IN SUSCEPTIBILITY TO
INFECTIONS,MALIGNANCIES AND
ENCEPHALOPATHY
18. CLINICAL STAGING
IMPORTANCE
• CLARIFIES THE PROGNOSIS OF INDIV PATIENTS.
• AIDS IN DIAGNOSIS IN THE ABSENCE OF LAB
TESTING.
• AFFECTS THE TYPE OF TREATMENT INTERVENTIONS
INCLUDING INDICATIONS FOR STARTING AND/OR
CHANGING ART.
19. WHO Paediatic Staging Of HIV/AIDS Disease
Stage 1 Asymptomatic
Persistent generalized lymphadenopathy
Stage 2 -Hepatosplenomegaly
-Papular pruritic eruptions
-Seborrheic dermatitis
-Fungal nail infection
- Angular chelitis
-Lineal gingival erythema
-Extensive HPV or molluscum infection (>5% of body area/face)
-Recurrent oral ulcerations (>2 episodes/6mos)
-Parotid enlargement
-Herpes zoster (>1 episode/12 mos)
-Recurrent or chronic URTI: otitis media, otorrhea, sinusitis -(>2
episodes/ 6mos)
-unexplained moderate malnutrition not responding to standard
therapy
21. •Stage 4
•Unexplained severe wasting or severe malnutrition not
responding to standard therapy.
•Pneumocystis pneumonia
•Recurrent severe presumed bacteria infections (e.g
empyema, pyomyositis, bone or joint infections,
meningitis, but excluding pneumonia).
•Chronic herpes simplex infection: (orolabial or
cutaneous of more than 1mo duration).
•Extrapulmonary TB
•Kaposis sarcoma
•Esophageal candidiasis
•CNS toxoplasmosis (outside the neonatal period).
•HIV encephalopathy.
•CMV infection (retinitis or infection of organs other
than liver, spleen or lymph nodes: onset at age 1mo or
more)
22. •Extrapulmonary crytococcosis including meningitis.
•Any disseminated endemic mycosis (e.g extrapulm histoplas
mosis, coccidiomycosis, penicilliosis)
•Cryptococcosis
•Isosporiasis
•Disseminated non-tuberculous mycobaterial infection.
•Candidiasis of the trachea, bronchi or lungs.
•Visceral herpes simplex infection
•Acquired HIV associated rectal fistula
•Cerebral or B cell non- Hodgkin lymphoma.
•Progressive multifocal leukoencephalopathy (PML).
•HIV associated cardiomyopathy or nephropathy.
23. WHO classification of HIV-associated immunodeficiency
in infants and children
Classification of HIV-
associated
immunodeficiency
Age-related CD4+ values/percentages
≤ 11 months (%) 12-35
months (%)
36-59
months (%)
≥ 5 years (cells/µl)
Not significant >35 >30 >25 >500
Mild 30-35 25-30 20-25 350-499
Advanced 25-29 20-24 15-19 200-349
Severe <25 <20 <15 <200 or <15%
*Total Lymphocyte
Count (TLC)
<4000
cells/µl
<3000
cells/µl
<2500
cells/µl
<2000
cells/µl
24. Laboratory Diagnosis
Antibody tests.
HIV rapid tests
HIV enzyme-linked immunosorbent Assay
[ELISA]
Western blot.
Antigen Detection Methods.
HIV DNA polymerase chain reaction (PCR)
HIV RNA PCR
P24 antigen detection
Viral culture.
25. INTERPRETATION OF RESULTS
HIV infection is absent if there are at least 2
negative antigen detection tests between the
age 1mo and 6mos
Loss of HIV antibody in a child with previously
negative antigen detection tests confirms that
the child is not infected.
HIV infection is present if they are 2 positive
viral tests on separate blood samples
regardless of age.
26. INTERPRETATION OF RESULTS
2 or more negative antibody tests performed
by the age of over 6mos with an interval of at
least 1mo between the tests reasonably
excludes HIV infection in exposed children.
A positive HIV antibody test at > 18mos
followed by a positive confirmatory test
definitely indicates HIV infection.
27. COUNSELLING
• A process by which a counsellor provides adequate
information and education about a situation and
helps the client to make an informed choice of
what is best to do in that situation .
• An integral component of the approach to caring for
HIV infected/affected children, their families and
caregivers.
28. COUNSELLING
• It is a continuous process that starts from the point
of contact with the facility and continues
throughout the life of the child.
29. PITC
• HIV testing and counselling which is recommended
by health care providers to persons attending
health care facilities as a standard component of
medical care.
• The major purpose is to enable specific clinical
decisions to be made and /or specific medical
services to be offered that would not be possible
without knowledge of the child’s HIV status.
30. PITC
• PITC is voluntary and the ‘’3 Cs’’- informed CONSENT,
COUNSELLING and CONFIDENTIALITY must be
observed.
• FMOH presently recommends that PITC be offered to
all children seen in paediatric health services.
31. MANAGEMENT
Maintenance of good nutrition
Vaccinations
Prophylaxis and treatment of opportunistic infections
Psychological support for the family
Anti-retroviral therapy
Management of AIDS defining illnesses
Palliative care for the terminally ill.
34. ARVs
Integrase inhibitors (Raltegravir and Elvitegravir)-
currently undergoing clinical trials.
Chemotactic cytokine Receptor (CCR5) inhibitors-
undergoing clinical trials
Maturation inhibitors-yet to undergo clinical trials
Use of biological agents - GBV- C
HIV vaccine.
35. INITIATION OF ARVs
• WHO paed stage 3 or 4 irrespective of CD4+%.
• WHO paed stage 2 or 1 with CD4+ less than 25%
(1500 cells /mic) for children less than 12 months.
Less than 20% ( less than 750 cells /mic) for
children 12 – 35 months. Less than 15%(350
cells/mic) for children 36-59 months. Less than
15% (200 cells/mic) for children more than 5
years.
36. MONITORING
• This can be either clinical or laboratory.
• Required at, 1. Base line
2. During care of patients who are not yet eligible
for ART
3. Starting ART
4. Maintaining ART
37. ADHERENCE
• A partnership between the patient, family and
health care team to ensure that medication are
taking exactly as prescribed.
• Potential barriers;
Complex medication regimens
Difficulty in measuring or administering
medications
Dietary requirements and restrictions
38. ADHERENCE
Religious, cultural and personal beliefs about taking
medications
High pill/liquid burden
Multiple caregivers who may assume that the other
has given the medication
Difficulty with transportation to the clinic for refills
and appointments
39. ADHERENCE
Travel away from home or having family members
visit
Poor palatability of ARVs
Medication refusal
Medication burn – out.
41. PEAD HIV/AIDS IN NGR
• NGR HAS A POPULATION OF 140MIL.
• ANNUAL GROWTH RATE OF 3.6%.
• 47% OF TOTAL POPULATION OF W.AFRICA.
• FIRST CASE DIAGNOSED IN A 13YR-OLD GIRL IN
1986.
42. PEAD HIV/AIDS IN NGR
• FMOH IDENTIFIES AIDS AS ONE OF THE IMPORTANT
CAUSES OF DEATHS IN ADULTS AGED 15-49YRS.
• FMOH PLANNED TO PROVIDE ART IN 2001.
• IMPLIMENTATION STARTED FOR ADULTS IN 2002.
• TREATMENT FOR CHILDREN DID NOT BEGIN UNTIL
2004.
43. PEAD HIV/AIDS IN NGR
STRATEGIC PLAN
• FMOH COMMITTED TO SCALING UP PEAD HIV CARE
TO ENSURE THAT AT LEAST 80% OF INFECTED AND
EXPOSED CHILDREN HAVE ACCESS TO
CARE,TREATMENT AND SUPPORT.
44. PEAD HIV/AIDS IN NIGERIA
STRATEGIC OBJECTIVES
• PROMOTE NATIONAL COORDINATION
• STRENGTHEN THE SYSTEM OF IDENTIFICATION AND
TESTING OF NEW HIV POSITIVE CHILDREN
• ENHANCE CARE FOR HIV INFECTED AND EXPOSED
CHILDREN
• EXPAND HUMAN RESOURCES
45. PEAD HIV/AIDS IN NGR
STRATEGIC OBJECTIVES
• IMPROVE COMMUNITY INTEGRATION
• IMPROVE MONITORING AND EVALUATION
• INITIATE A SURVEILLANCE PROGRAM TO ASSESS THE
NATURE OF PEAD HIV/AIDS.
46. CHALLENGES
CHALLENGES TO THE HEALTH SYSTEM
• INCREASED BURDEN ON ALREADY OVERSTRETCHED
HEALTH CARE SYSTEM
• LACK OF ACCESS TO AND POOR UPTAKE OF PMTCT
SERVICES
• INADEQUATE FACILITIES FOR EARLY INFANT DIAGNOSIS
• LIMITED HUMAN RESOURCE CAPACITY TO MANAGE PEAD
HIV/AIDS
47. CHALLENGES
CHALLENGES TO THE HEALTH SYSTEM
• ISSUES AROUND INFANT FEEDING AND COUNSELLING
• LACK OF INTEGRATION,POOR LINKAGES AND WEAK
REFERRAL SYSTEM
• WEAK LOGISTIC MANAGEMENT INFORMATION SYSTEM
LMIS
• LACK OF REGULAR MONITORING AND EVALUATION OF
SERVICES.
48. CHALLENGES
SOCIETAL
• LOSS OF PRODUCTIVE AGE GROUP
• INCREASING NUMBER OF OVC
• STIGMA,DISCRIMINATION AND CULTURAL BARRIERS
TO EFFECTIVE CARE AND TREATMENT.
49. STRENGTHS AND OPPORTUNITIES
• POLITICAL COMMITMENT BY GOVT
• WELL SPREAD HEALTH INFRASTRUCTURE
• MANY TRAINABLE HEALTH PERSONNEL AND EXPERTS
• INCREASED DEMAND FOR HIV/AIDS TREATMENT,CARE
AND SUPPORT SERVICES
51. CONCLUSION
• HIV/AIDS HAS BECOME A SIGNIFICANT CAUSE OF INFANT AND
CHILDHOOD MORTALITY AND MORBIDITY IN NIGERIA AND SERIOUS
ATTENTION BY BOTH THE GOVERNMENT AND POPULACE SHOULD
BE PAID TO ITS PREVENTION AND MANAGEMENT.
• ALL HANDS MUST BE ON DECK TO ENSURE THAT THE FMOH’S GOAL
OF PROVIDING CARE,TREATMENT AND SUPPORT TO AT LEAST 80%
OF THE CHILDREN EXPOSED TO AND INFECTED WITH HIV IS
ACHIEVED.
53. REFERENCES
• UNAIDS,WHO;Aids epidemic update.Dec,2007.
• Hoffman,Rockstroh,Kamps;HIV Medicine 2007.
• WHO;Guidelines on PITC 2007.
• William W Hay Jr,et al;Current pediatric Diagnosis
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