An evaluation of clinical indicators for severe paediatric illness

To help reduce paediatric morbidity and mortality in the developing world; WHO has developed a diagnostic and treatment algorithm that targets the principal causes of death in children; which include acute respiratory infection; malaria; measles; diarrhoeal disease; and malnutrition. With this algorithm; known as the Sick Child Charts; severely ill children are rapidly identified; through the presence of any one of 13 signs indicative of severe illness; and referred for more intensive health care. These signs are the inability to drink; abnormal mental status (abnormally spleepy); convulsions; wasting; oedema; chest wall retraction; stridor; abnormal skin turgor; repeated vomiting; stiff neck; tender swelling behind the ear; pallor of the conjunctiva; and corneal ulceration. The usefulness of these signs; both in current clinical practice and within the optimized context of the Sick Child Chart algorithm in a rural district of Western Kenya; was evaluated. We found that 27of children seen in outpatient clinics had one or more of these signs and that pallor and chest wall retraction were the signs most likely to be associated with hospital admission (odds ratio (OR) = 8.6 and 5.3; respectively). Presentation with any of these signs led to a 3.2 times increased likelihood of admission; although 54of hospitalized children had no such signs and 21of children sent home from the outpatient clinic had at least one sign. Among inpatients; 58of all children and 89of children who died had been admitted with a sign. Abnormal mental status was the sign most highly associated with death (OR = 59.6); followed by poor skin turgor (OR=5.6); pallor (OR=4.3); repeated vomiting (OR=3.6); chest wall retraction (OR=2.7); and oedema (OR=2.4). Overall; the mortality risk associated with having at least one sign was 6.5 times higher than that for children without any sign. While these signs are useful in idnetifying a subset of children at high risk of death; their validation in other settings is needed. The training and supervision of health workers to identify severely ill children should continue to be given high priority because of the benefits; such as reduction of childhood mortality

Mefloquine therapy for Plasmodium falciparum malaria in children under 5 years of age in Malawi: in vivo/in vitro efficacy and correlation of drug concentration with parasitological outcome

The in vivo and in vitro response of Plasmodium falciparum to a single oral dose of mefloquine (25 mg/kg body weight (M25) or 15 mg/kg (M15] was studied in children under 5 years of age in Malawi. Of the children who received mefloquine, 35% vomited at least once, and 10% did not tolerate the drug because of vomiting. The therapy failure rates for the M25 group on day 7, 14, and 28 were 15%, 18%, and 42%, respectively, and these did not differ significantly from those for the M15 group (4%, 18%, and 59%). In contrast, 34 in vitro microtests (17 per group) showed schizont inhibition at less than or equal to 32 pmol mefloquine per test well. On day 7, the concentration of mefloquine in samples of blood was significantly lower in both the M25 and M15 groups for children who were parasitaemic on day 7 than in samples from those who were aparasitaemic. A positive blood smear on day 7 was strongly associated with a mefloquine concentration of less than 500 ng/ml blood on day 2 or day 7 (P less than 0.0003). Vomiting was associated with a low mefloquine concentration on day 2 but not day 7. These results suggest that mefloquine is effective against P. falciparum in Malawi but that for young children the therapy appears to be complicated by frequent vomiting

Draft report on malaria and HIV infection in pregnant women in Mangochi district

Some of the findings are: 1) that on sera collected between 1987 and 1990; the seroprevalence rate among sexually active women who became pregnant was 6.9 percent; 2) there are factors associated with increased risk of HIV infection; 3) there is an association between malaria and HIV infections in pregnant women; and 4) that HIV infection in the mother during pregnancy doubles the risk of infant mortality

Syphilis-associated perinatal mortality: a quantifiable problem with an effective intervention

Presentation displays.