Wednesday, September 24, 2014

New Immunization Schedule of Nepal 2014 - IPV, PCV and MR vaccines added

In 2014, September, the National Immunization Schedule was planned for an update with introduction of few new vaccines for prevalent diseases in Nepal. Nepal became the first nation to introduce Injectable Polio Vaccine (IPV) in South East Asia. IPV is recommended in addition to the Oral Polio Vaccine (OPV) and not as it's replacement.

Added Vaccines:

  1. PCV - Pneumococcal Conjugate Vaccine
  2. iPV - Injectable Polio vaccine
  3. MR - Mealsles and Rubella vaccine

The New Immunization Schedule of Nepal:

Thursday, September 4, 2014

Common Cold in children : Concerned Parents

A child may catch cold several times in a year. Common cold is a benign condition but raises a level of anxiety and concern in parents and is pretty much obvious. After all children are as delicate as they look.
Cough is a common symptom that causes a big concern in parents and commonly they are worried about their child having a chest infection - Pneumonia. Another symptom that worries parents is noisy breathing that may be a simple nasal blockade but can be due to Asthma, Croup and other conditions.

The common cold are symptoms caused by a number of different viruses. More than 100 virus cause cold but  rhinovirus, the type of virus responsible for the greatest number of colds. Other are enteroviruses (echovirus and coxsackieviruses) and coronavirus.

Common Cold common symptoms

Children under 6 years get average six to eight colds per year.

Although  colds occur during the fall and winter months,in any geographic location, it can occur though out the year. It is transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days.
Droplets containing viral particles can be exhaled into the air by breathing or coughing. Rhinoviruses are not usually transmitted as a result of contact with infected droplets, although influenza virus and coronavirus can be transmitted via small droplets. Cold viruses are not usually spread through saliva.

What are the Common Cold Symptoms?
In children, nasal congestion is the most prominent symptom.
Children can also have clear, yellow, or green-colored nasal discharge;
Fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness.
Sore throat
Decreased appetite.
Red and swollen nasal area
Neck lymph nodes may become slightly enlarged.

What are the Complications of Common Cold?
Most children who have colds do not develop complications.
However, parents should be aware of the signs and symptoms of potential complications.
Ear infection — 5 - 15 percent of children with a cold develop a bacterial or viral ear infection.
If a child develops a fever (temperature higher than 100.4ºF or 38ºC) after the first three days of cold symptoms, an ear infection may be to blame.
Asthma - noisy breathing also referred to as wheezing, called Reactive airway disease in smaller children
Pneumonia- high grade fever, lethargy, fast breathing, cough and child looks toxic.

 Symptomatic treatment —
1. Plenty of fluids - hydration
2. Warm clothing and warm environment.
3. Nasal care- Cleaning and in older children - steam inhalation with soother can be helpful. Steam inhalation in small children should be avoided as it can cause burns.
Saline nasal drops can be used in case of nasal stuffiness and blockade
4. Adequate rest - speciially children in daycare centres and school should be let to stay warm at home.
5. Antipyretics- High fever can cause discomfort and irritability. Dose of Antipyretics can be given for fever exceeding 100.4 F PRN.
6 Children may present with wheezing
   - Such children may require immediate doses of Nebulization with Salbutamol and if improves can be discharged on oral beta2 agonist

Usually Antibiotics are Not needed as Viruses don't respond to antibiotics. So requesting doctor for an antibiotic and administering over the counter antibiotics are not recommended.

When to seek Medical Help?
Refusal to drink or feed
Inconsolability and undue irritability
Lethargy (decreased responsiveness - Sick/toxic looking);
Difficulty breathing,
Fast Breathing
High grade fever greater than 101ºF (38.4ºC) lasts more than three days.

Such children need immediate medical attention regardless of time - night or day

Monday, September 1, 2014

The deadliest disease in today world

Many times we have debated on list of deadliest diseases. But if we look into the root cause, we can easily figure out the cause of most deaths in the world is poverty. More people die of hunger, starvation and poverty than wars and accidents.

In our scenario, newborns are brought in distress into our Neonatal Unit. Almost everytime the problem is same, the parents are economically broke and there isn't much they can do for their newborn, as they cannot afford NICU and medication charges. Many times we arrange Free beds but the problem is not solved with it. Even after the baby is discharged, he needs care and need to be nurtured.

The poverty is such severe that people come to Health Centres for Delivery, just to get Rs 1000 that government provides the mother under Safe Delivery program. Most of the time, we find, the parents are unprepared economically for any unexpected events at the time of delivery. If the newborn or the mother gets sick, the patients are unprepared for it. Only bearing a child is not a solution, the parents should be responsible enough and capable enough to bring up the child under atleast fair condition. A 16 year old father is in crisis after his wife delivers a preterm newborn, and this is the face of real scenario back here.

Most people here are dying of poverty. They are dying of simple diseases like Diarrhea, Pneumonia and treatable conditions like Neonatal sepsis. Malnutrition is omnipresent and is an amplifier of the risk of death and often itself is a cause of death. A small amount of saving for the time of crisis, a little aid from government can save thousand of lives of the future human resource of the nation, the children. Carelessness is even deadlier and unawareness is deadliest. Unaware of simple signs and symptoms of illness, often there is delay in seeking medical attention and such a delay can cost heavily. Health awareness and Education programs will certainly be helpful in poorer communities. A theme of Keeping a backup plan and a saving before delivering a baby should be promoted, as often people are unaware of the scenario that can arise.