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Writer: Dr Daniel Njai
Cover design: Bruce Kynes
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UNIT 21: OTHER CONDITIONS
INTRODUCTION Congratulations for coming this far! You are now in the last unit of this course on child health. In the last two units, you learnt how to diagnose, manage and rehabilitate children with various types of disabilities. In this unit, you will learn about other conditions which affect children. Although these conditions are not very common, they have serious consequences on the health and normal growth and development of the children. These other conditions are:
If these conditions are not recognized early and treated promptly, they can cause very high mortalities or serious complications in those who survive. That is why you need to equip yourself with the necessary knowledge and skills so that you can effectively contribute towards the reduction of deaths and complications associated with these conditions. Unfortunately, as you will discover, some of the above conditions do not have a cure. However, they can be prevented. And as you know, prevention is better than cure! So it is worth learning how to recognize all them.
Describe the causes, mode of transmission or contributing factors of each of the above conditions;
Describe the clinical manifestations and how to diagnose each of the above conditions;
Outline the management of each of the above conditions;
Explain the prevention and control, where available, of some of these diseases.
21.1 BACTERIAL MENINGITIS
What is Bacterial Meningitis?
Bacterial meningitis is the infection of the meninges, the membranes enclosing the brain and the spinal cord, by bacteria. Bacterial meningitis is among the most common and the most important causes of disturbed consciousness and coma in children. If meningitis is not recognized early and promptly treated, it is associated with high morbidity and mortality.
Before you proceed do the following activity. It should take you 5 minutes to complete.
Think of the ways by which the bacteria reach the meninges and write them down:
These last four signs show that the intracranial pressure is raised. Meningism means occurrence of neck stiffness without cerebrospinal fluid changes. Meningism is often seen in children with pneumonia, tonsillitis, retropharyngeal abscess, and severe otitis media and less commonly in children with hepatitis and urinary tract infection.
(a) Unequal pupil size
b) Rigid Posture
Figure. 1 Signs of meningitis
When there are no signs of raised intracranial pressure, a lumbar puncture is done to obtain cerebrospinal fluid. A cloudy cerebrospinal fluid suggests meningitis. Microscopy shows more than 1000 leukocytes / mm3. Biochemistry shows more than 100mg of protein per deciliter. The glucose is less than 40% of the blood sugar which should be measured simultaneously. The culture of the cerebrospinal fluid shows the type of bacteria causing the meningitis.
A child with meningitis should be urgently referred to the hospital. In the hospital, meningitis is treated with chloramphenicol 25 mg/kg intramuscularly or intravenously every 6 hours and benzyl penicillin 100,000/kg units intramuscularly or intravenously every 6 hours for a total duration of 10 days.
Complication of meningitis include the following:
cerebral palsy and
syndrome of inappropriate ADH secretion.
The syndrome of inappropriate ADH secretion is characterized by low level of sodium in the blood (hyponatraemia) with excess water. This syndrome presents with restlessness, irritability, and convulsions. The treatment of a child with this syndrome consists of water restriction.