The fever caused by the Chikunguya virus represents a new problem for the Ministry of Health in the Dominican Republic. Chikunguya began in February 2014, but before in December 2013, the Pan-American Health Organization, alerted the countries of the region of Americas. This disease for the first time affected the Dominican Republic, a very susceptible population, since it is transmitted by the mosquito Aedes aegypti. This type of mosquito is present in the entire country, which is the reason why a great number of cases were presented.
The origin of the word Chikunguya comes from the African language Makonde, which means: to bend by pain.
It is transmitted through the mosquito bite that can also produce dengue and yellow fever. This mosquito is easily recognized because it has a white circular stripe on the legs. When these mosquitoes bite a person with Chikunguya the transmission cycle starts.
- Sudden high fever, accompanied by multiple bilateral or symmetrical pains of variable intensity. In some cases the pain is so intense that it produces functional disability.
- After a few days, a pruritic macular rash may occur.
- Other: headache, diffuse back pain, myalgia, nausea, vomiting and conjunctivitis.
Subacute and chronic symptoms can occur from days, months or even years from the onset of symptoms. The main manifestation is arthritis.
Among the atypical manifestations of Chikunguya is neurological, ocular, cardiovascular, dermatological, renal, damage among others.
Among the complications described associated with Chikunguya:
- Respiratory failure
- Cardiovascular decompensation
- Acute hepatitis
Severe cutaneous manifestations:
- Shock and bullous lesions
The majority of these manifestations are observed in patients over 65 years of age and in children younger than one year and in patients with chronic diseases, diabetes, lupus among others.
The diagnosis is basically clinical, starting from the definition of the case suspected and family, community or work contact with other cases.
The differential diagnosis should be made with disease prevalent in the country, dengue, for the following reasons:
- They are viruses transmitted by the same vector
- Clinical manifestations are similar
Among the differential diagnoses with other diseases :
- Childhood exanthematic diseases
- HIV infection
- Infectious mononucleosis
Measures to prevent are:
- Avoid conserving water in containers outside, tanks of deposits or water for domestic use
- Avoid accumulating garbage among others
If you have symptoms, go to your nearest health center for care and treatment.
Contributed by: Dr. Maria Reyes
Family and Community Doctor, NPH Dominican Republic
The impact of NPH’s healthcare in developing countries is significant. We not only provide comprehensive care for the children living in NPH homes, but also for patients from the community and children attending NPH schools. NPH clinics support these students by providing: annual medical exams, nutrition, vision and hearing screening, dental care, immunizations, deworming twice a year, supporting and finding solutions for special cases identified during screening, health education, and therapies according to availability.
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An ear infection happens when a bacterial or viral infection affects the middle ear. Most ear infections happen when a child has previously had a cold for a few days.
Middle ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age. They are usually not serious and aren’t contagious, though can be painful because the inflammation and fluid buildup.
Ear infections can be chronic or acute. Acute ear infections are painful but don’t last more than a few days. Chronic ear infections they can recur many times. Chronic ear infections can cause permanent damage to the middle and inner ear and loss hearing.
Viruses or bacteria cause middle ear infections. Germs travel from the back of the throat when the Eustachian tube is swollen from a cold, causing infection in the middle ear. In some cases, children with an ear infection may also have fluid draining from the ear.
Some groups are more prone to have ear infections:
- Children less than 5 years old, because they have shorter Eustachian tubes.
- Children who attend daycare, because they tend to have more colds.
- Babies who are being bottle fed, especially if they swallow milk while lying too flat, it can enter the Eustachian tube and increases the risk of an ear infection.
- unexplained fever
- trouble sleeping
- tug or pull at their ears
- difficulty hearing quiet sounds.
Según la OMS en el 2015 se enfermaron 10,4 millones de personas (un millón de niños) de tuberculosis y 1,8 millones murieron por esta enfermedad. Desde el 2014 el número de las casos de tuberculosis en el mundo se ha incrementando. Más del 95% de las muertes por tuberculosis se producen en países con bajos y medianos ingresos.
La tuberculosis es una enfermedad crónica infecciosa, causada por una bacteria, llamada Mycobacterium tuberculosis. Usualmente afecta los pulmones pero puede afectar cualquier otro órgano del cuerpo. La infección se trasmite a través del aire.
Se calcula que una tercera parte de la población mundial tiene tuberculosis latente. Se trata de personas que están infectadas pero no enfermas y tampoco trasmiten la infección. Sin embargo a lo largo de su vida tienen un riesgo de enfermarse de la tuberculosis activa de 10%. Si tienen condiciones como VIH, diabetes, malnutrición el riesgo es mucho mayor. Los síntomas de la enfermedad activa más comunes son tos productiva, pérdida de peso, fiebre y debilidad. La enfermedad es prevenible y curable, aunque el tratamiento es largo. Usualmente la tuberculosis activa se trata con una combinación de 4 antibióticos durante 6 meses. Últimamente se han registrado más resistencias a los medicamentos antituberculosos que significa un reto para los médicos.
En los países de Latinoamerica la mayoría de los bebes recibe la vacuna de Tuberculosis, pero lamentablemente el efecto de esa vacuna es limitado y no puede prevenir una infección al largo plazo.
Cuando un niño llega como nuevo ingreso a NPH, en clínica se hace una prueba cutanea de tuberculosis, que puede detectar si el niño ha tenido contacto con el Mycobacterium Tuberculosis. Junto con una exploración exacta y una historia clínica detallada, el doctor determina si es necesario dar tratamiento o si hace falta hacer más diagnóstico o llevar el niño al especialista.
En NPH hemos tenido pocos casos de Tuberculosis activa. Ya que esta condición es contagiosa se tiene que aislar a los pacientes en clínica hasta que el medicamento ha tenido su efecto. Al mismo tiempo se tiene que hacer un cribado en toda la población por síntomas.
World Tuberculosis Day 2017
Tuberculosis is a chronic infectious disease caused by a bacterium called Mycobacterium tuberculosis. Usually the lungs are affected but any other part of the body can be affected, too. Infection is transmitted through the air.
It is estimated that one-third of the world’s population has latent tuberculosis. These are people who are infected but not sick and do not transmit the infection. However throughout their life they have a risk of becoming sick of active tuberculosis of 10%. If they have conditions like HIV, diabetes, malnutrition the risk is much bigger. The most common symptoms of active disease are productive cough, weight loss, fever, and weakness. The disease is preventable and curable, although the treatment is long. Usually active tuberculosis is treated with a combination of 4 antibiotics for 6 months. Recently more resistance to antitubercular drugs has been reported and implies a challenge for doctors.
Tuberculosis is one of the 10 leading causes of mortality in the world and together with HIV it is the leading cause of death among infectious diseases.
According to the WHO in 2015, 10.4 million people (one million children) got affected by tuberculosis and 1.8 million died from tuberculosis. Since 2014 the number of tuberculosis notifications in the world is increasing. More than 95% of tuberculosis deaths occur in low- and middle-income countries.
In Latin American countries most babies receive the Tuberculosis vaccine, but unfortunately the effect of that vaccine is limited and cannot prevent infection in the long term.
When a child newly arrives at NPH, a skin test for tuberculosis is performed in our own clinics, which can detect if the child has had contact with the Mycobacterium tuberculosis. Combined with an exact examination and a detailed medical history, the doctor determines if treatment is necessary or if more diagnosis or an appointment with a specialist is needed.
We have had few cases of active tuberculosis in NPH. Since this condition is contagious it is necessary to isolate those patients in clinic until the medicine has had its effect. At the same time, the whole population must be screened for symptoms.
This disease is very contagious and therefore the treatment must be prescribed to all the people who live in the same house. In young adults, sexually transmitted infection is common. Overcrowding conditions increase their prevalence in the population, and can even occur epidemic in institutions. It is more frequent in winter, probably by the greater agglomeration of people and survival of the mite in cold temperatures with high humidity.
Symptoms are severe stinging and lesions in generalized excoriations with small pruriginous vesicles, pustules and “galleries” (short and irregular mark, perhaps of 2-3 mm length and the width of a hair) to the sides of the fingers and in the eminences of the palms of the hands, wrists, elbows and around the armpits. The characteristic lesions can be manifested in nipples of women and as pruritic papules in the scrotum or penis of the male.
A diagnosis is confirmed under the microscope when the mites eggs and brown spots of excrement are observed.
- Lindane 1% cream, applying it from the neck to the feet.
- Permethrin 5% cream, one application during 8 to 12 hr.
- Crotamiton cream; apply at night, for 4 nights.
- Benzyl benzoate emulsion, apply from the shoulders to the feet an application per week (two doses).
- Triamcinolone cream, for dermatitis.
PREVENTIVE MEASURES: The mite can live up to thirty hours on clothing and hair.
- Disinfect objects (combs, brushes, etc.).
- Those objects that cannot be disinfected, seal them in a plastic bag for 72 hours.
- All bedding must be soaked in water with detergent for one hour and then washed; Expose it to the sun all day long.
- Avoid promiscuity and overcrowding.
- Personal grooming (hand washing, clean and cut nails).
- Washing and exposing clothes to heat / sun, otherwise ironing clothes.
- Avoiding the exchange of personal clothing.
- Ventilate rooms, clean sheets, pillows, and covers.
- Put mattress in the sun.
Source: Diagnostico Clínico y Tratamiento, Manual Moderno, 36 a Edición, Lawrence M Tierney, Stephen McPhee, Maxine Papadakis. Wikipedia, org.
Dr. Azucena Hernández
Clinic, NPH Mexico
A child who benefits from appropriate medical care generally enjoys a better state of health during childhood and becomes a healthier adult. The right to children’s health also includes pre and postnatal care for mothers.
Following the framework from the United Nations and the World Health Organization on human development, the NPHI Medical Services Department used the Millennium Development Goals (MDGs) as our guidelines in 2016; complementing, but not replacing other goals that each NPH home may have individually.
During 2016, we decided to focus on sanitation and safe water, nutrition, immunization and mosquito-transmitted diseases as our main goals.
SANITATION AND SAFE WATER
Development and good health begins with having clean and safe water as well as access to health services, food and education. NPH homes monitor water with biannual microbiological and chemical testing and by reviewing their water infrastructure from the pipes to the water tanks. Also homes have added a second barrier to the water purification process with UV light. We are continuously working on improving the water collection process as well.
Across NPH homes we have seen improvements in the daily food menus, such as including more fruit and vegetables. This has led to a significant decrease in children with anemia and other deficiencies. Most of the countries have additional nutritional programs as well. NPH clinics monitor growth, development and anemia through biannual screening.
In some of our countries, we are facing a new epidemic that has spread throughout the rest of the world as well: overweight and obesity. Malnutrition is not just low weight but also overweight, as both are signs of not receiving adequate quality intake. NPH ensures adequate management to medical protocols and early detection.
VACCINATIONS AND HEALTH CAMPAIGNS
Vaccinations are fairly inexpensive when considering the benefits. They protect children against the risk of death and handicaps caused by the most common children’s diseases in poor countries: tuberculosis, diphtheria, tetanus, leprosy, polio, whooping cough and measles. At NPH we vaccinate our children, as well as offer awareness and health education campaigns, which can prompt a significant reduction in health risks. All homes have had done a great job at least once a month for children and caregivers, offering health education discussions that are age appropriate.
In 2016, we administered 3,662 doses of vaccines across all countries. Applying vaccines doesn’t mean the population is well vaccinated according to the age, though it is a good step to reach the goal. The average ratio of vaccination in NPH is 78-80% in most of the basic vaccines, but boosters are needed every year to maintain the protection. Our goal is to be at least 90%. Furthermore, we provide deworming to our entire child population and provide Vitamin A to children under 5 to prevent blindness. Funds from international NGOs and foundations for immunization completion and nutrition have been a key to continue to work and make improvements in the children’s health, as well as receiving advanced medication for children with HIV.
Countries where NPH works have a high prevalence of high-impact diseases, especially during the rainy season. Cleaning surroundings in our community is important to prevent the breeding sites of mosquitoes. Any collection of water is a threat for disease incubation. Fumigation and mosquito nets are necessary to prevent infectious, transmitted diseases such as Zika, chikungunya, dengue or malaria.
The impact of NPH’s work in developing countries is significant. We work not only for the children living in NPH homes, but also for patients from the community and children attending NPH schools. NPH clinics support these students by providing: annual medical exams, nutrition screening, vision, hearing, dental care, immunization campaigns, one nutritious meal, deworming twice a year, supporting/finding a solution for special cases identified during screening, health education, and therapies according to availability. The most common daily clinic visits are: upper respiratory infections, traumas (from small wounds to broken arms or concussions), skin problems, parasites and gastrointestinal issues (stomachache, diarrhea).
• Restoration and remodeling of outdated clinics in Honduras and Haiti homes
• Preparing and coordination of three children traveling abroad for specialist treatment
• Implementation of psychology and therapy services in electronic medical records
• Comprehensive care with teams for children with severe disabilities
• Professional development: International NPHI medical workshop and training abroad on mental health care
The Medical Services team and local clinics work hard to apply our mission statement to our daily work: striving to reach an optimum health and wellbeing for children to live as healthy as possible. The success relies on the close cooperation between the Medical Services team and local staff, and establishing collaborative partnerships with local public health facilities and other NGOs.
On behalf of all the children, medical staff and NPHI Medical Services we want to thank all the supporters.
Pilar Silverman, MD, NPHI Medical Services Director
NPHI Medical Services Team members are: