The MassGeneral Hospital for Children Handbook of Pediatric Global Health. Nupur Gupta Brett D. Nelson Jennifer Kasper Patricia L.

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2 The MassGeneral Hospital for Children Handbook of Pediatric Global Health Nupur Gupta Brett D. Nelson Jennifer Kasper Patricia L. Hibberd Editors 123

3 The MassGeneral Hospital for Children Handbook of Pediatric Global Health

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5 Nupur Gupta Brett D. Nelson Jennifer Kasper Patricia L. Hibberd Editors The MassGeneral Hospital for Children Handbook of Pediatric Global Health

6 Editors Nupur Gupta, M.D., M.P.H. MassGeneral Hospital for Children Harvard Medical School Boston, MA, USA Jennifer Kasper, M.D., M.P.H. MassGeneral Hospital for Children Harvard Medical School Boston, MA, USA Brett D. Nelson, M.D., M.P.H., D.T.M.&H. MassGeneral Hospital for Children Harvard Medical School Boston, MA, USA Patricia L. Hibberd, M.D., Ph.D. MassGeneral Hospital for Children Harvard Medical School Boston, MA, USA ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

7 To Ravi and Chandra Bhandari, my parents, for always being an inspiration to me and making me who I am today; Radha Krishna and Raj Kumari Gupta, my in-laws who have always supported me in all my endeavors; Dr. Gopal Gupta, my husband and best friend, for always being there for me; Jaya and Siddharth, my children, for always believing in me; Dr. Arun Bordia and Manjula Bordia, my uncle and aunt, without whom I would never have been a doctor; and last but not the least to my patients around the world, who bring love, wisdom, and humility into my life every day. I would also like to thank our department chair, Dr. Ron Kleinman, Dr. Mark Goldstein and all the authors for sharing their time and expertise to make this handbook a reality. Nupur Gupta Brett would like to thank all of our colleagues who spent countless hours in preparing thoughtful and useful contributions to this handbook. He is also grateful for the many inspiring and deeply committed health care workers he has had the honor of working alongside and learning from in resource-limited settings. Brett D. Nelson

8 I dedicate this handbook to the following people: Dr Barry Zuckerman, who allowed me to use my call-free elective during my third year of pediatric residency at Boston City Hospital to work in Hospital Infantil in Mexico City (my life has not been the same since, for all the right reasons). Dr Lanny Smith, Dr Maruca Figueroa, and the campesinos of Estancia, El Salvador, who taught me accompaniment, liberation medicine ( the conscious and conscientious use of health to promote human dignity and social justice ), human rights, and how to amplify the voices of the marginalized, underserved, and unheard. To the board of directors and members of Doctors for Global Health who remind me to promote health and other human rights with those most in need, while educating and inspiring others to action. My parents, Bill and Kay Kasper, who gave me the confi dence and latitude to work overseas. My wife, Dr. MaryCatherine Arbour, who is my greatest inspiration. She is my staunchest supporter and reminds me to advocate for equity and social justice everywhere. Jennifer Kasper I would like to save a very special thank-you to all our authors and supporters who worked tirelessly to make their contributions to this handbook so relevant and important to a shared vision of health for children and adolescents around the world. Patricia L. Hibberd

9 Preface Welcome to the MassGeneral Hospital for Children Handbook of Pediatric Global Health. This Handbook is intended for the ever-increasing number of health professionals who are becoming involved in global health and spending a few weeks to months or even years providing medical care in resource-poor countries. Clinicians trained in the United States, Europe, Australia, and other resource-rich countries may take for granted ready access to tools for diagnosing and treating illness. Insufficient diagnostic services, treatment options, and health care infrastructure in resource-limited settings may prove challenging. This Handbook provides practical, evidence-based, hands-on guidance for managing and preventing childhood illnesses when resources are limited. It is not meant solely for pediatricians; it is designed for generalists, specialists, doctors, nurses, other health care workers, and those in training. The reality in many resource-limited settings is that the majority of the patients needing care will be young infants and children. Therefore, all providers need to be prepared to provide quality, evidence-based, compassionate pediatric care. The Handbook may also be a useful addition and resource for academic centers and universities in developed countries that are creating courses for trainees who will do clinical electives abroad during their training. A focus on prevention and treatment of childhood illness for everyone providing care in developing countries remains highly relevant today. The United Nations Millennium Development Goal 4 is to reduce the under-age-five mortality rate by two-thirds between 1990 and We are quickly approaching this target date. Overall there has been some progress: several countries in South America and China will achieve the 2015 goal. However, progress has been slower than desired in many countries in sub-saharan Africa and parts of South Asia: they are not projected to reach the 2015 goal until after In 2013, nearly seven million children under age five will die, and almost half will be neonates (less than 1 month old), and the most common causes of death in those greater than 2 months of age will be pneumonia and diarrhea. This Handbook provides setting-specific understanding and management approaches to the major causes of childhood mortality, including pneumonia, diarrhea, birth asphyxia, complications of preterm birth, and neonatal sepsis. vii

10 viii Preface The first part of the Handbook provides an overview of childhood mortality, health systems, and the various stakeholders that play a role in the global health arena. The Handbook also contains chapters on adolescent health, which is increasingly recognized as important as focus shifts towards health preconception in order to improve health of neonates and young infants. Also targeting the unique health concerns of this age group will maintain gains made in childhood and help prevent the onset of adult illnesses. Finally, key topics in non-communicable diseases are covered, including trauma and injuries, pediatric mental health, child and adolescent rights, and oral health. The Handbook is a collaborative effort of residents, fellows, and faculty from MassGeneral Hospital for Children, paired with internationally recognized content experts from all over the globe. The Handbook focuses on the equipment, laboratory resources, and medicines that are likely to be available in developing settings and deliberately does not include options that are not typically available. It provides practical, field-based suggestions for utilizing local resources for optimal clinical care. For many of the authors, working in developing countries during both short- and long-term assignments has changed their lives and career goals. Global health providers will experience exhilarating moments when a baby s life is saved, as well as tragedies when simple, cheap, life-saving equipment or medicines are just not available. The goal of global health experiences is to help serve communities around the world. They also provide an opportunity for us to learn from our overseas colleagues and are a tremendous way to expand our own clinical understanding. Our hope is that respect for cultural issues, gratitude towards the people and providers from whom we learn, as well as the knowledge we bring will help all of us become competent and compassionate global health providers. This is the essence of the Handbook. Boston, MA Patricia L. Hibberd, M.D., Ph.D. Nupur Gupta, M.D., M.P.H. Brett D. Nelson, M.D., M.P.H., D.T.M.&H. Jennifer Kasper, M.D., M.P.H.

11 Contents Part I Overview of Pediatric Global Health 1 Child Mortality in Developing Countries... 3 Norman Miles Farr and Brett D. Nelson 2 Stakeholders and Approaches to Address Pediatric Global Health Jennifer Kasper and Nancy Ringel 3 Global Health Systems Matthew Tobey and Patrick T. Lee 4 Vulnerability of Children in Developing Countries and Disrupted Settings Sylvia Veronica Romm, Iyah K. Romm, and Brett D. Nelson 5 Fundamentals of Pediatric Care in Resource- Limited Settings Julia Elisabeth von Oettingen, Roseda E. Marshall, and Jennifer Kasper Part II Newborn Health 6 Maternal Health Ariel Wagner, Veronica Maria Pimentel, and Melody J. Eckardt 7 Preventive Newborn Care Rebecca Cook and Gopal K. Gupta 8 Newborn Resuscitation Jonathan Reisman, Jonathan M. Spector, and Linda L. Wright 9 Neonatal Infections Hasan S. Merali, Anita K.M. Zaidi, and Brett D. Nelson ix

12 x Contents Part III Adolescent Health 10 Adolescent Global Health Karen Sadler and Nupur Gupta 11 Adolescent Preventative and Clinical Care: A Checklist Nupur Gupta and Karen Sadler 12 Sexually Transmitted Infections in Adolescents Mark A. Goldstein and Nupur Gupta 13 Contraceptive Options for Adolescents Nupur Gupta Part IV Communicable Diseases 14 Acute Respiratory Infections David A. Lyczkowski, Peter P. Moschovis, and Shamim Qazi 15 Diarrheal Illnesses A. Kaytee Welsh and Archana Patel 16 Malaria Paul J. Krezanoski and Davidson H. Hamer 17 Measles Elizabeth R. Wolf and Elisa Margolis 18 HIV/AIDS Kathleen M. Powis and Aura M. Obando 19 Tuberculosis Rinn Song and Kristian R. Olson 20 Parasitic Diseases Amanda P. Garcia and LeAnne M. Fox 21 Vaccine-Preventable Diseases Michele S. Duke and Vandana L. Madhavan Part V Non-Communicable Diseases 22 Malnutrition Pornthep Tanpowpong, Sarah Messmer, Jennifer Kasper, and Ronald E. Kleinman 23 Micronutrient Deficiencies Jyoti Ramakrishna and Jay Thiagarajah

13 Contents xi 24 Emergency Pediatric Care in Resource- Limited Settings Sylvia Veronica Romm, Daniel P. Ryan, and Linda T. Wang 25 Child and Adolescent Mental Health Giuseppe Raviola and Sarabeth Broder-Fingert 26 Child and Adolescent Health and Human Rights Ashkon Shaahinfar and Theresa S. Betancourt 27 Pediatric Preventive and Clinical Oral Health Care Brittany Seymour, Michele Martin, and Grace Kim 28 Neurological Issues and Epilepsy in Children and Adolescents in the Developing World Amy C. Lee 29 Care of the Child Immigrant Jennifer Kasper, Nupur Gupta, Andrea J. Hunter, and Brett D. Nelson Appendix A: WHO Integrated Management of Childhood Illness for High HIV Settings Appendix B: WHO Growth Charts Head Circumference Boys Appendix C: WHO Growth Charts Head Circumference for Girls Appendix D: WHO Growth Charts Weight for Age Boys Appendix E: WHO Growth Charts Weight for Age Girls Appendix F: WHO Growth Charts Weight for Height Boys Appendix G: WHO Growth Charts Weight for Height Girls Appendix H: WHO Growth Charts Weight for Length Boys Appendix I: WHO Growth Charts Weight for Length Girls Appendix J: Essential Medications for RLS Appendix K: GAPS Monograph Appendix L: GAPS Periodic Questionnaire Appendix M: WHO Immunization Routine LifeSpan Vaccinations Appendix N: WHO Routine Immunization Children Appendix O: WHO Delayed Routine Immunization Index

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15 Contributors Theresa S. Betancourt, Sc.D., M.A. Department of Global Health and Population, Francois- Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA Sarabeth Broder-Fingert, M.D., M.A. Department of Pediatrics, Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA Rebecca Cook, M.D., M.Sc. Medicine Department, Harvard University, Boston, MA, USA MassGeneral Hospital for Children, Boston, MA, USA Michele S. Duke, M.D. Division of Global Health, MassGeneral Hospital for Children, Boston, MA, USA Melody J. Eckardt, M.D., M.P.H. Emergency Medicine, Global Health and Human Rights, Obstetrics and Gynecology, Boston Medical Center, Massachusetts General Hospital, Boston, MA, USA Norman Miles Farr, M.D., M.P.H. Medicine-Pediatrics Department, MassGeneral Hospital for Children, Boston, MA, USA LeAnne M. Fox, M.D., M.P.H., D.T.M.&H. Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA Amanda P. Garcia, M.P.H. Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA Mark A. Goldstein, M.D. Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA xiii