Child Health

Malaria

Malaria is a serious disease spread through mosquito bites. Each year, there are 300 million to 500 million cases of malaria throughout the throughout the world and about 1 million child deaths. In areas where malaria is common, it can be the leading cause of death and poor growth among young children.

Malaria is also particularly dangerous for pregnant women. It causes severe anaemia, miscarriages, stillbirths, low birthweight and maternal death. Many lives can lie saved by the prevention and early treatment of malaria.

Key Messages :

What every family and community has a right to know about Malaria

  1. Malaria is transmitted through mosquito bites. Sleeping under a mosquito net treated with a recommended inseticide is the best way to prevent mosquito bites.
  2. Wherever malaria is common, children are in danger. A child with a fever should be examined immediately by a trained health worker and receive an appropriate anti-malarial treatment as soon as possible.
  3. malaria is very dangerous for pregnant women. Wherever malaria is common, pregnant women should prevent malaria by taking antimalarial tablets recommended by a health worker.
  4. A child suffering or recovering from malaria needs plenty of liquids and food.
  5. Families and communities can prevent malaria by taking action to stop mosquitoes from breeding.

Supporting Information :

  1. Malaria is transmitted through mosquito bites. Sleeping under a mosquito net treated with a recommended insecticide is the best way to prevent mosquito bites. All members of the community should be protected against mosquito bites, particularly young children and pregnant women, and especially between sunset and sunrise when mosquitos are most active.

    Mosquito nets, curtains or mats that are dipped in a recommended insecticide kill mosquitoes that land on them. Special, permanently treated mats should be used, or nets, curtains or mats that are dipped in insecticide regularly. Usually, the nets need to be re-treated when the rains begin, at least every six months, and after every third wash. Trained health workers can advise on safe insecticides and re-treatment schedules.

    Babies and other small children should sleep under a treated mosquito net. If the nets are expensive, the family should buy at least one big net, which the small children can sleep under. Breastfed babies should sleep with their mothers under a net.

    Treated mosquito nets should be used throughout the year, even during times when there are fewer mosquitoes.

    If mosquito nets cannot be used, other actions can help:

    • curtains, cloths or mats impregnated with a recommended insecticide can be hung over doors and windows
    • screens can be put on doors and windows
    • mosquito coils or other fumigants can be used

    clothing that covers the arms and legs (long sleeves and long pants or skirts) can be worn as soon as it begins to get dark. This is especially important for children and pregnant women.

  2. Wherever malaria is common, children are in danger. A child with a fever should be examined immediately by a trained health worker and receive an appropriate antimalarial treatment as soon as possible. Malaria should be suspected if anyone in the family has a fever, or if young children refuse to eat or have vomiting, drowsiness or fits.

    A child with a fever believed to be caused by malaria needs to be given immediate antimalarial treatment as recommended by a health worker. If children with a malarial fever are not treated within a day, they might die. A health worker can advise on what type of treatment is best and how long it should continue.

    A child with malaria needs to take the full course of treatment, even if the fever disappears rapidly. If the treatment is not completed, the malaria could become more severe and difficult to cure. If the malaria symptoms continue after treatment, the child should be taken to a health centre or hospital for help. The problem may be:

    • the child is not receiving enough medicine
    • the child has an illness other than malaria
    • the malaria is resistant to the medicine, and another medicine is needed.

    Children with a fever should be kept cool for as long as the fever persists by :

    • sponging or bathing with cool (not cold) water
    • covering the child with only a few clothes or one blanket.
  3. Malaria is very dangerous for pregnant women. Wherever malaria is common, pregnant women should prevent malaria by taking antimalarial tablets recommended by a health worker.

    Pregnant women are more likely to suffer from malaria than other women. The disease is more dangerous during pregnancy, especially during the first pregnancy. It can cause severe anaemia ('thin blood'), miscarriage, premature birth or stillbirth. Babies born to mothes who have had malaria during pregnancy will probably be underweight and therefore more vulnerble to infection or death during their first year.

    Pregnant women should take antimalarials during pregnancy where recommended. Not all antimalarial tablets are safe to take during pregnancy. The health worker will know which antimalarial tablets are best. Pregnant women need to sleep under mosquito nets that are regularly treated with insecticide to prevent mosquito bites. Pregnant women with signs and symptoms of malaria must be treated adequately and immediately to prevent death. Pregnant women who become ill with malarita should ask a health worker about iron and vitamin A supplements.

  4. A child suffering or recovering from malaria needs plenty of liquids and food.

    Malaria burns up energy, and the child loses a lot of body fluids through sweating. The child should be offered food and drink frequently to help prevent mal-nutrition and dehydration. Frequent breastfeeding prevents dehydration and helps the child fight infections, including malaria. Children with malaria should be breastfed as often as possible. Frequent malarial infection can slow children s growth and brain development and is likely to cause anaemia. A child who has had several bouts of malaria should be checked for anaemia.

  5. Families and communities can prevent malaria by taking action to stop mosquitoes from breeding.

    Mosquitoes breed wherever there is still water - for example, in ponds, swamps, puddles, pits, drains and in the moisture on long grass and bushes. They can also breed along the edges of streams and in water containers, tanks and rice fields.

The Number of Mosquitoes Can Be Reduced By:

Malaria affects the whole community. Everyone can work together to reduce the breeding places for mosquitoes and to organize regular treatment of mosquito nets with insecticide. Communities should ask all health workers and political leaders in their regions to help them prevent and control malaria.

Sepsis

Sepsis in a newborn (sepsis neonatorum) is a seuere bacterial infection that spreads throughout the body in the first month of life.

Sepsis occurs in fewer than 1 percent of new-borns but accounts for up to 30 percent of deaths in the first few weeks of life. Bacterial infection is five times more common in newborns weighing less than 5½ pounds than in normal-weight full-term newborns. Sepsis affects twice as many boys as girls. Complications experienced during birth, such as premature rupture of the membranes or bleeding or infection in the mother, put the new-born at increased risk of sepsis.

Symptoms

Sepsis begins within 6 hours of birth in more than half the cases and within 72 hours in the great majority. Sepsis that begins 4 or more days after birth is probably an infection acquired in the hospital nursery (a nosocomial infection).

A newborn with sepsis is usually listless, doesn't suck vigorously, and has a slow heart rate and a fluctuating body temperature (low or high). Other symptoms include difficulty in breathing, seizures, jitteriness, jaundice, vomiting, diarrhea, and a swollen abdomen.

Symptoms depend on where the infection originated and where it has spread. For example, infection of the umbilical cord stump (omphalitis) may cause a discharge of pus or bleeding at the navel. Infection of the lining of the brain (meningitis) or a brain abscess may cause coma. seizures, rigid arching of the back, or bulging fontanelles (the two soft spots between the skull bones). Infection of a bone (osteomyelitis) may restrict movement in the affected arm or leg. Joint infection may cause swelling, warmth, redness, and tenderness over the joint. Infection of the inside lining of the abdomen (peritonitis) may cause a swollen abdomen and bloody diarrhea.

Diagnosis

The organism causing the infection is identified by taking blood samples and culturing any obviously infected part of the body. Antibody tests may help identify the organism. A urine sample is also examined under a microscope and cultured for bacteria. A spinal tap (lumbar puncture) is performed if the doctor suspects meningitis. Samples of fluid from the ears and from the stomach may be taken for examination under a micro-scope.

Prognosis and Treatment

Sepsis in a newborn is treated with antibiotics given intravenously. Treatment is started even before laboratory results are available: a different antibiotic may later be chosen based on the results of laboratory tests. In rare cases, the infant may also be given a preparation of purified anti-bodies or white blood cells. Despite modern antibiotics and intensive care, 25 percent or more of newborns with sepsis die. The death rate is twice as high in small, premature newborns as in normal-weight, full-term new-borns.

Pneumonia

Pneumonia is an infection of the lungs, in which the lungs fill with fluid, leading to difficulty in breathing.

Pneumonia in newborns often starts when premature rupture of the membranes leads to an infection of the amniotic fluid (amnionitis). The fetus is surrounded by the infected amniotic fluid and may inhale the fluid into its lungs. Pneumonia results, sometimes with sepsis. Pneumonia can also occur even weeks after birth, most commonly in infants whose breathing is being assisted by a ventilator.

Symptoms

Symptoms present at birth may range from rapid breathing to respiratory failure and extremely low blood pressure (septic shock). When pneumonia occurs after birth, symptoms may be-gin gradually. If the infant is breathing with the help of a ventilator, the doctor may find that an increased amount of secretions are being suctioned from the breathing tube in the windpipe and that the infant needs increasingly more help in breathing. Sometimes, however, an infant suddenly becomes ill, with fluctuating high and low temperature.

Diagnosis and Treatment

A doctor strongly suspects pneumonia if symptoms appear in an infant born after the membranes ruptured prematurely. Samples of blood and fluid from the airways are sent to the laboratory for culturing. The number of white blood cells and platelets is also determined from a blood sample. Chest x-rays may be taken, and some-times a sample of cerebrospinal fluid is taken by spinal tap (lumbar puncture) and sent for culture.

Pneumonia is treated with antibiotics given intravenously. Treatment is started as quickly as possible. The choice of antibiotic may be changed after the specific type of bacteria responsible for the pneumonia is determined by laboratory tests.

Hepatitis

Hepatitis is an infection of the liver, nearly always with the hepatitis B virus.

In the United States, an infected mother is the usual source of hepatitis B infection in a newborn. The baby is infected during delivery, not usually during pregnancy, because the virus doesn't easily cross into the placenta. Infection from the mother after delivery is rare.

Symptoms and Diagnosis

Most newborns infected with the hepatitis B virus develop a chronic liver infection (chronic hepatitis) that usually doesn't produce symptoms until young adulthood. However, the infection is serious; one fourth of those infected eventually die of liver disease. Occasionally, the liver may enlarge in a child, fluid may accumulate in the abdomen (a condition called ascites), and blood levels of bilirubin may be high, leading to jaundice.

Prognosis and Treatment

The long-term prognosis is unknown. Being infected with the hepatitis B virus from infancy in-creases the risk of liver disease, such as chronic active hepatitis, cirrhosis, and liver cancer, later in life.

Pregnant women are routinely tested for hepatitis B virus infection. Because the baby usually isn't infected until delivery, a baby born to an infected mother can be given an injection of hepatitis B immune globulin within 24 hours of delivery, before the infection has become established. This treatment temporarily protects the baby. At the same time, the baby is immunized with hepatitis B vaccine for long-term protection.

Breastfeeding doesn't appear to significantly increase the risk of hepatitis B, particularly if the infant received both immune globulin and the vaccine. However, if a mother has cracked nipples or another breast disorder, breastfeeding could possibly transmit the hepatitis B virus. No treatment is given to newborns with chronic hepatitis without symptoms. Supportive care is given to infants with symptoms of hepatitis.

Acute Infectious Diarrhea

Infectious diarrhea is the frequent passing of loose and unformed stools as the result of an infection. Infection by bacteria or viruses is by far the most common cause of acute diarrhea in infants, although diarrhea can have a number of causes. A baby may be infected if it swallows organisms while passing through a contaminated birth canal or if it's touched by contaminated hands. Other less common sources are infected household articles-and contaminated food or bottles. Occasionally, infection may be caused by inhaling or-ganisms floating in the air, especially during viral outbreaks. Overcrowded hospital nurseries are subject to outbreaks of infectious diarrhea. Diarrhea is more likely when hygiene is poor or when a poor family lives in crowded conditions. Infectious diarrhea is also quite common in day care centers.

Symptoms and Diagnosis

Infection may cause sudden diarrhea, vomiting, bloody stools, fever, poor appetite, or listless-ness. Diarrhea is frequently accompanied by de-hydration. Mild dehydration merely makes the infant's mouth dry. Moderate dehydration causes the skin to lose its firmness. The eyes and a fontanelle (the soft spot on top of the head) may be sunken. Severe dehydration, which can develop rapidly, is life threatening, usually causing a considerable fall in blood pressure (shock).

Diarrhea may lead to the loss of fluid and electrolytes, such as sodium and potassium which may make the infant drowsy or irritable or, more rarely, cause abnormal heart rhythms or bleeding in the brain. Electrolyte levels and the number of white blood cells, which is high during a bacterial infection, are measured in a blood sample. The doctor tries to identify the organism that is causing the diarrhea by examining a stool sample under a microscope and sending stool samples to a laboratory for culture.

Treatment

Replacing fluid and electrolytes lost by diarrhea and vomiting is the first and most important step in treating the infant. If the infant is very ill, fluids are usually given intravenously in the hospital. Otherwise, the infant can drink any of several commercial preparations that contain electrolytes. Very careful hand washing by anyone handling the infant is important to prevent the spread of infection to others.

Breastfeeding is continued to avoid malnutrition and maintain the mother's milk supply. An infant not being breastfed should be offered a lactose-free formula as soon as the dehydration has been corrected. The usual formula can be offered gradually a few days later, but if diarrhea recurs, the lactose-free formula may be substituted for several weeks.

Although acute infectious diarrhea may be caused by bacteria, antibiotics usually aren't needed, because the infection usually clears without treatment. However, some infections are treated with antibiotics to prevent the infection from spreading beyond the intestine. Nevertheless, giving drugs to stop the diarrhea may actually harm the infant because they prevent the body from flushing out the infectious organisms with the stools.

Submitted By
Dr g. G. Newaz, Md
The author is a practicing paediatrician in New Jersey, USA.

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