Iron deficiency Anemia Vitamin A deficiency Protein deficiency Vitamin C deficiency Vitamin B12 deficiency
Falling of growth curve Muscular atrophy Slowed motor, psychologic and language developement Dry and peeling skin Fissures on face, lips Frequent respiratory tract infections Lightened hair color Tachycardia Delayed puberty
More conservative with antibiotics Clinical diagnosis of vitamin deficiencies based on risk factors and prevalence in provinces Provide vitamins to nearly all children in village Low threshold to treat for parasites
64.6% prevalence in Huancavelica Dietary deficiency Normal hemoglobin 2 points higher at altitude
Village outreach Clinical Diagnosis Provide iron supplements to nearly all children
Giardia lamblia Ascaris lumbricoides Entamoeba histolytica Taenia solium Taenia sanginata Primary biologist reports prevalence of up to 80% among children of Churcampa
Approximately 30% of O & P done positive Asymptomatic Abdominal pain Abdominal obstruction Hemoptysis Compounds problems of malnutrition
Albendazole 400mg po x 1 Mebendazole 100mg po BID x 3 days Treat family Encourage clean water Other options: Pyrantel pamoate Ivermectin
30-40% of children with stool sample positive Water supply contaminated As few as 10 cysts can cause infection
Diarrhea Abdominal cramps or tenderness. Nausea and loss of appetite. Passing more gas or having more bloating than usual. Fatigue.
Loose, soft, greasy stools (not always watery or liquid). Sometimes the stools may be foul-smelling or foamy and are often passed in small amounts. Discomfort in the abdomen or pit of the stomach that is often worse after a meal. Belly cramps, bloating, or pain. Passing more gas than usual. Persistent bad breath or belching that sometimes smells of sulfur Occasional headaches. Weight loss. General feeling of discomfort or illness (malaise), weakness, or fatigue. Web MD
Pale, foamy, foul-smelling diarrhea. Weight loss or lack of appetite. Belly pain, nausea, or vomiting. Nutritional deficiencies caused by not being able to absorb certain nutrients.
Failure to thrive Iron deficiency anemia Protein malnutrition Malabsorbtion of; Fat D-xylose Vitamin A Vitamin B12 Giardia intestinalis and nutritional status in children PARTICIPATING INTHEcomplementary nutrition program, Antioquia, Colombia, May to October 2006
Metronidazole 25mg/kg divided TID Consider treating for other parasites Side effects: nausea & vomiting Jacob’s Treatment Metronidazole 250mg po TID x 5 days Other options: Furazolidone 100mg po QID x 7-10 days Albendazole
Maternal mortality improving thanks to culturally sensitive care Infant mortality improving Malnutrition still large problem Peruvian health system making changes but much work to be done