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Obstetrics and Pediatrics in Rural Huancavelica, Peru

Obstetrics and Pediatrics in Rural Huancavelica, Peru. Dr. Jacob Meyer Veloz CCRMC Family Medicine Resident. Huancavelica, Peru. Peru’s poorest province Mining and Agriculture Spanish and Quechua spoken. Churcampa, Peru. Isolated province of Huancavelica

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Obstetrics and Pediatrics in Rural Huancavelica, Peru

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  1. Obstetrics and Pediatrics in Rural Huancavelica, Peru Dr. Jacob Meyer Veloz CCRMC Family Medicine Resident

  2. Huancavelica, Peru • Peru’s poorest province • Mining and Agriculture • Spanish and Quechua spoken

  3. Churcampa, Peru • Isolated province of Huancavelica • Population of approximately 30,000 • Near VRAE • 3262 meters above sea level

  4. Obstetrics in Peru600,000 births/year

  5. Maternal Mortality in 1996

  6. Prenatal Care in Peru

  7. Causes of Maternal Mortality Hemorrhage Preeclampsia Infeccion Complications of abortion Obstructed labor 27% prenatal, 26% peripartum, 46% up to 6 weeks post-partum

  8. How to reduce maternal mortality? • Amnesty International says: • Eliminate obstacles that impede or slow women’s access to urgent obstetric services • Barriers • Geographic, economic, cultural, professional,

  9. Where are babies born in 2000

  10. Millennium Goals Reduce maternal mortality to 120/100,000

  11. Gringichu en Huancavelica

  12. Intercultural care • Vertical birth • Intermittent monitoring • Health Center Care

  13. Pediatrics in Huancavelica, Peru Malnutrition Iron Deficiency Parasitosis Respiratory infection

  14. Infant Mortality

  15. Causes of Infant Mortality Respiratory infections Perinatal disease Accidents Congenital diseases Malnutrition

  16. Malnutrition in Peru

  17. Malnutrition in Huancavelica, Peru 2004

  18. Malnutrition in Peru Iron deficiency Anemia Vitamin A deficiency Protein deficiency Vitamin C deficiency Vitamin B12 deficiency

  19. Findings of Malnutrition 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

  20. Changes in Management 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

  21. Iron deficiency Anemia • 64.6% prevalence in Huancavelica • Dietary deficiency • Normal hemoglobin 2 points higher at altitude

  22. Treatment of Anemia • Village outreach • Clinical Diagnosis • Provide iron supplements to nearly all children

  23. Parasitosis in Churcampa • Giardia lamblia • Ascaris lumbricoides • Entamoeba histolytica • Taenia solium • Taenia sanginata • Primary biologist reports prevalence of up to 80% among children of Churcampa

  24. Ascaris lumbricoides • Approximately 30% of O & P done positive • Asymptomatic • Abdominal pain • Abdominal obstruction • Hemoptysis • Compounds problems of malnutrition

  25. Treatment of Ascaris lum. • Albendazole 400mg po x 1 • Mebendazole 100mg po BID x 3 days • Treat family • Encourage clean water • Other options: • Pyrantel pamoate • Ivermectin

  26. Giardia lamblia • 30-40% of children with stool sample positive • Water supply contaminated • As few as 10 cysts can cause infection

  27. Symptoms of Acute Giardiasis • Diarrhea • Abdominal cramps or tenderness. • Nausea and loss of appetite. • Passing more gas or having more bloating than usual. • Fatigue.

  28. Chronic Giardiasis • 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

  29. Giardia in Children • 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.

  30. Giardia and Nutrional Deficiency • Failure to thrive • Iron deficiency anemia • Protein malnutrition • Malabsorbtion of; • Fat • D-xylose • Vitamin A • Vitamin B12 Giardiaintestinalis and nutritional status in children PARTICIPATING INTHEcomplementary nutrition program, Antioquia, Colombia, May to October 2006

  31. Treatment of Giardia lamblia • 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

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