Infants less than 6 months - MAMA Project

fishnibblersspongyDéveloppement de logiciels

14 déc. 2013 (il y a 3 années et 7 mois)

59 vue(s)

MAMA History

Dr. Priscilla Benner MD

MAMA Director

The construction begins

The main building at the
Nutritional Center

Building the dining room

One of the first mission
teams

Dr. Benner
talking with
the people
in the
community
about the
Nutrition
Center.

Making new contacts

The moms are working in the
garden at the Nutrition Center.

The harvest is ready.

Importance of
Vitamin A

Dr. Benner

Focus on Vitamin A


Vitamin A distribution and food fortification
has become a standard part of Child Survival
efforts around the world.


Vitamin A saves children's lives, eyes and
faces.


11

Vitamin A Functions


Vision (night, day, colour)


Epithelial cell integrity against infections


Immune response


Haemopoiesis


Skeletal growth


Fertility (male and female)


Embryogenesis

12

Severe Vitamin A deficiency is a wide spread problem
in Nigeria, especially in the Northwest, and is one of
the reasons that children suffer so many infections.


13

Why do children become

vitamin A deficient?


Mothers of poor children often have Vitamin A Deficiency
and produce deficient breast
milk.


Children’s diets provide too little vitamin
A.


Children
spend a large part of their childhood being
sick.

Provitamin

A
carotenoids

in vegetables and fruits are less
readily
bio
-
available
than previously
thought.


Early
weaning is often onto foods low in vitamin
A.


Growth
velocity, and therefore vitamin A requirement, is
higher during pre
-
school age than at any other time
postnatally
.

Humphrey, Katz et al
, 2002

14



is distributed every 4
-
6 months to infants, children, and new
mothers according to established protocols


is part of child
survival
programs all
over the world



prevents
infections and
improves growth



15

Vitamin A distribution…

Vitamin A Mega
-
Dose Capsules

200,000 International Units/Capsule

Prevention & Treatment Doses

Repeat this dose as recommended for emergency indications

Age:

UNITS /Dose

Capsule

Notes:

Infants less than 6 months:

Non
-
breast
-
fed, or breast
-
fed if mother
has not received supplemental vitamin A



50,000

¼

(2 drops)


Breast milk

provides

Vitamin A

Infants 6 to 12 months:

Every 4
-
6 months



100,000


½

(4 drops)


Give eggs,
milk, greens,
fruits, colored
vegetables

Children over 12 months:

Every 4
-
6 months



200,000

1

Not safe for

girls or
women

who may

become

pregnant!

Mothers within 6 weeks
after delivery



200,000


1

16

Revised Recommendations

2002 IVACG

Population

Amount of Vitamin A to be
administered

Time of Administration

Infants

0
-
5 months

3

doses of 50,000 IU each
with at least 1 month
interval between doses

At each DTP

contact (6,10,
and 14 weeks) otherwise at
other opportunities

Infants 6
-
11 months

100,000 IU as a single dose
every 4
-
6 months

At any opportunity (e.g.,
measles immunization)

Children 12 months and
older

200,000 IU as a single dose
every 4
-
6 months

At any opportunity

Postpartum

Women

2

doses of 200,000 IU at
least 1 day apart

As soon after

delivery as
possible and not more than
6 weeks later.

17


In acute emergencies such as measles, pneumonia, TB,
malaria, meningitis, severe diarrhea, severe
malnutrition, or when signs impeding loss of vision
from nutritional blindness, or risk of mouth infection
leading to noma are detected,
-
use the


Vitamin A Emergency
Triple Dose Treatment



This will replenish acutely depleted Vitamin A sores and
can be life SAVING!


Also, use all other appropriate treatments for the
conditions. SEEK CONSULTATION!

18

Emergency Triple Dose Treatment:


For noma, malaria,
measles, pneumonia
or any life
-
threatening
infection in
malnourished children


Give the age
appropriate Vitamin A
mega dose:


One dose today


One dose tomorrow


One dose in 2 weeks



19

Vitamin A Single (Extra) Dose
Treatment for Malnourished Children
with Moderate Infections


In addition to other appropriate treatments, when a
malnourished child presents with a serious, but not
acutely life
-
threatening condition such as:


Ear infection


Diarrhea


Tonsillitis


Respiratory infection


Parasites


Worsening malnutrition


Give one extra dose of Vitamin A but do not repeat
more often than once per month in the absence of
severe infection.


See Chart.



20

Nutritional Blindness

Bitot

Spots



Very Dangerous!



Permanent blindness
may occur if Vitamin A
is not given
immediately


following
the protocol.


21

Nutritional Blindness

Keratomalacia
:

Hazy Dry Cornea

Poor Quality



Now the cornea is
becoming soft


very
critical danger!



Megadose

vitamin A
according to the
International Norms but
be given now!


22

Nutritional Blindness

Gelatinous cornea


Bulging, about ready to
rupture.


If that happens, the eye
will be permanently
blind.


There is still a chance
that this eye can be
saved by 3 doses of
Vitamin A.


23

Nutritional Blindness


Same eye, healed by
timely Vitamin A
capsules. Scar remains,
but vision is good. This
eye was saved by 3
Vitamin A capsules!


24

Nutritional Blindness:

Xerophthalmia

Dry
Eye

Bitot

Spots

Hazy dry cornea
poor

quality


Keratomalacia

Gelatinous cornea,
bulging, about ready
to rupture. If that
happens, the eye will
be permanently blind
.

Same eye, healed by
timely
Vitamin A
capsules. Scar
remains, but vision
is good.

25

Essential Micronutrients


Besides Vitamin A, there are many other
essential micronutrients (vitamins and
minerals) that are found to be lacking in
children who get noma, nutritional blindness,
and other deadly infections (“Hidden
Hunger”).


Improving nutrition by better diet in
pregnancy, exclusive breast feeding early in
life, and food fortification with COMPLETE
ESSENTIAL MICRONUTRIENTS will prevent
many deaths from childhood infections.

26

INTESTINAL
PARASITES

27


Intestinal parasites
-

The Scope of the Problem



Most common infection worldwide


Prevalence rates in resource poor communities
can be over 90%.


In 2008, 3.5 billion people (mostly children) were
estimated to be infested with intestinal parasites.
From:
Tropical Medicine Institute of Sao Paulo
Brazil.


Estimated over 300 million suffer severe
impairments because of high worm burdens.




28

29


Intestinal parasites cause
illness and death from:


Anemia


Malnutrition


Impairment of physical growth
-
both
stunting and wasting


Poor intellectual development


Infections






30

WHERE DO INTESTINAL
PARASITES COME FROM?


They enter the body through food and water
that has been contaminated by human or
fecal waste, or through skin if the person
steps (or sits) in mud that contains human or
animal feces.


Many people infested with intestinal
parasites are not clinically ill but can still
spread the disease by not using latrines or
toilets.

Children with
swollen bellies
usually have:



Severe
malnutrition



A large burden
of intestinal
parasites

Parasites compete
with children for
food!


Children with heavy worm burdens may be
forced to share ¼ or more of their daily
nutrients with their parasites.


Deworming promotes child
survival.


Therefore, national level mass
deworming

campaigns
been implemented in many developing countries.


One tablet of deworming medicine, usually
Albendazole
, is given every 6 months according to
standardized protocols to everyone in the community.


This is effective in controlling the worm burden and
usually well accepted by communities.


Deworming can be integrated into Child Health Day
Events along with immunizations, vitamin A
distribution, bed net distribution and growth
monitoring.



34

Albendazole

targets the
three major intestinal
parasites:


Ascaris

lumbricoides
-
Round worm


Trichuris
-
Whipworm


Anclostoma

duodenale

(Africa)or
Necantor

americanus

(Western Hemisphere)
-
Hookworm

Other medicines that may be
used:


MEBENDAZOLE 500mg tablets can also be used
as single dose treatments of intestinal parasites


LEVAMISOLE 80mg can be used for school age
children


PYRANTEL 10mg/kg


If
Shistosomiasis

is a problem in the region,
PRAZIQUANTEL is used. Instructions may be
added to this seminar if there is need for this
medication in the target population.

36

Each parasite produces a
different set of problems:



Ascaris

is the large roundworm with a
voracious appetite for calories and vitamins.


Hookworm

is the parasite that attaches itself to
the intestinal lining and dines on the blood of
its victim.


Whipworm
is the one which attaches to the
rectum, causing
prolapse

and bleeding.


37

Notice the
size of the parasite in
centimeters.

Ascaris

Ascaris

at surgery

The entire
community
should be
dewormed
.

41

Correct Practices
of
Albendazole

Administration

42

Children over age 1 and all
adults can be
dewormed
.


Follow the recommendation of
the Ministry of Health regarding
pregnant women.


Albendazole is safe in lactation
but the woman can save her pill
to take after the first 3 months
of pregnancy.


Note: Follow norms of MOH in
country for children age 12
-
24
months and pregnant women.


43



44

Always include
the
children
not enrolled in school in
the deworming.

45

Albendazole


400mg Chewable Tablets

International Norms for
Treatment of
Intestinal
Parasites in
Community
Deworming

Campaigns

Given
with
Megadose

Vitamin A Capsules

Infants under 1 year

No treatment with Albendazole

Children
1
-
2 years


(12
-
24months)

200mg (1/2 tablet)

(Crushed and suspended in
water)


Children
over 2 years
and
Adults

400mg (1 tablet)

(Crushed and suspended in
water up to age 3, or as long as
needed)

Pregnant Woman?

Safe in pregnancy after the first
3 months

1. Wash your hands with soap and water if you
touch the child’s mouth.

46

2. Ask all mothers to help you by washing their hands
first, then you give the pill to the mother, who places it
in her child’s mouth after reassuring the child.

47

3. Never put pill in the mouth of a crying child.

48

4. Do not coerce, threaten, or unnecessarily
frighten the child. Treat him or her gently and
with patience.

49

A child that is regularly treated for worms:


is more active in school.


grows and learns better.


is more resistant to other infections.

50

Do not give
to infants
less than 1
year old.

51

For Children
F
rom 1
-
3
Years
O
ld:



Crush the tablet.


Mix with water.


Have mother help child to drink.


Give with Vitamin A capsule at the same time.


Don’t risk aspiration by forcing a child to take
the medicine until they are calm.

52

For
Chi
ldren Older
Than 3 Years Old:



Have the child chew the tablet and swallow
with water.


Ask the child to show you that he or she has
swallowed the tablet and has the residue in
his or her mouth.


Children may not want to take their medicine.


It is also okay to crush the tablet for any
child or adult and mix with water that has
been boiled and cooled.

53

Teach hygiene! The community needs to
learn to protect the water that is used
for drinking and bathing, to wear shoes,
dispose of human waste properly, keep
animals away from homes and children,
and much more! When habits change,
deworming programs will not be needed
.