Emerging infections and paediatric emergencies in Timor‐Leste · Emerging infections and...
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Emerging infections and paediatric emergencies in Timor‐Leste 13 th National Rural Health Conference Darwin 26 th May 2015 Dr Joshua Francis Paediatric Infectious Diseases Specialist, Royal Darwin Hospital
Transcript of Emerging infections and paediatric emergencies in Timor‐Leste · Emerging infections and...
EmerginginfectionsandpaediatricemergenciesinTimor‐Leste13th National Rural Health ConferenceDarwin 26th May 2015
Dr Joshua FrancisPaediatric Infectious Diseases Specialist, Royal Darwin Hospital
Whereyou’rebornmakessuchadifference
Introduction
ChildreninTimor‐Leste• More than half the population less than 18 years
• 45% children underweight• 58% children stunted
• Infant mortality 48/100,000• Under‐5 mortality 57/100,000
Introduction
Paediatricinfectionchallenges
• Dealing with the everyday things (bacteria)• Turning the tide on an epidemic (parasites)• Identifying the culprit (viruses)• Prevention is better than cure (mycobacteria)• Exposing a hidden killer (post‐infectious complications)
Introduction
DealingwiththeeverydaythingsBacteria
Acuteinfectionsinhospital• 2000 admissions per year• 6% in‐hospital mortality
• Lower respiratory tract infections (28%)• Central nervous system infections (16%)• Gastroenteritis (14%)
• Limited diagnostic microbiology capacity• Opportunities to expand immunisation strategy
Bacteria
TurningthetideonanepidemicMalaria cases in Timor‐Leste 2006‐2012
Yapabandara et al. Malaria J. 2015.
Parasites–Malaria
Findingtheculprit• Dengue is endemic and predominantly affects children• Diagnosis• Management• Prevention
Viruses–Dengue
No of dengue cases reported from 2009-2013
Findingtheculprit• Few cases of dengue so far in 2015• Apparent outbreak of dengue‐like illness
• Fever• Rash• Lymphopaenia• Thrombocytopaenia• Arthralgia uncommonly
• Diagnostic visit from an Infectious Diseases Physician
Viruses–Chikungunya
Findingtheculprit• Multiple cases of presumed encephalitis
• Fever and encephalopathy• Mild or no CSF pleocytosis• High case‐fatality rate
• Many possible causes• Viral encephalitis• Bacterial meningoencephalitis• Immune‐mediated encephalitis
Viruses–Encephalitis
Britton et al. JPCH. 2014.
Preventionisbetterthancure• 500,000 incident cases of childhood TB per year• 80,000 childhood TB deaths per year
Tuberculosis
TheglobalproblemofTB
WHO. Global tuberculosis report. 2014.
Tuberculosis
TheglobalproblemofTB
WHO. Global tuberculosis report. 2014.
Tuberculosis
TuberculosisinTimor‐LesteTuberculosis
PaediatricTBatBairoPiteClinic• 979 total TB cases between Oct 2013 – Sep 2014
• 127/979 (13%) children aged <15 years• Pulmonary TB 88/127 (69%)• Bacteriologically proven 5/127 (4%)
• Evidence of BCG 45/127 (35%)• Household contact with TB 43/127 (34%)• Malnutrition 34/127 (27%)
Tuberculosis
ImprovingTBprevention• Poor uptake of birth dose BCG
• 29% deliveries attended by skilled birth attendant• Difficult access to healthcare facilities in much of the country• BCG vaccine days limited by multi‐dose vial practicalities
• Challenges to IPT provision• Geographical isolation• Multiple households• Non‐parent index cases
Tuberculosis
Exposingahiddenkiller• Rheumatic heart disease
• Understanding the problem• Considering solutions
• Primordial factors are huge• GAS presentations are rare• ARF infrequently diagnosed• RHD presentations too late
Rheumaticheartdisease
SavingonelifeatatimeRheum
aticheartdisease
Keytoolsformakingprogress• Understanding the epidemiology
• Epidemiological research• Improving diagnostic capacity
• Implementing prevention strategies• Vaccination programs• Proven preventive therapies
• Investing in training• Postgraduate training in Timor‐Leste• Opportunities in Australia
Conclusion
Acknowledgements• David Brewster• Ingrid Bucens• Dan Murphy• Margaret Gibbons• Clare Nourse
Conclusion
