B7_Anaemia_R4_final in under-five children

Anemia in children

1. 1 Anaemia

2. 2 The graph below illustrates proportion of anaemia cases in all consultations from the ALMANACH implementing clinics. Except for Gubadley, the rest of the clinics conitnue to report low cases Anaemia- ALMANACH Data

3. 3 Anaemia Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal Haemoglobin is needed to carry oxygen this results in symptoms such as fatigue, weakness, dizziness and shortness of breath WHO estimates prevalence of anaemia in children aged between 6 and 59 months to up to 40% worldwide Common causes are: Iron deficiency (malnutrition) Infections Parasites (i.e. hookworm or whipworm that can cause blood loss from the gut) Malaria (which can destroy red cells rapidly)

4. 4 Anaemia Pallor is a typical clinical sign and refers to an unusual paleness of the skin Look at the skin of the child’s palm do not stretch fingers backwards, this may cause pallor by blocking the blood supply compare the colour of the child’s palm with your own the palms of the parent To check conjunctivae also help to identify pallor If colour of skin is very pale or close to white -> classify as severe pallor

5. 5 With Haemoglobin ≤ 6g/dl the child may need an urgent blood transfusion Anaemia- Classification

6. 6 Case 1a-Anaemia Start a new consultation : 2 years, 12 kg, T 36° NO to all incl conjunctiva and jaundice assessment until anaemia assessment Conjuntivae OR palms pale: YES Severe eye OR palm pallor: YES Malaria RDT available: YES Follow instructions and open in after lab Result Malaria RDT: positive Diagnosis No Malnutrition, Severe Malaria, Severe Anaemia Treatment Severe Malaria and severe Anaemia Follow instructions End of ALMANACH: click on confirm and finish Questions?

7. 7 Case 1a-Anaemia NOTE: No Hemocue requested when clinically classified as severe pallor If unsure, click no for severe palm pallor and do Hemoglobin testing With all anaemia symptoms Malaria RDT requested, even without fever Malaria classifies as severe when a severe anaemia is present Only in case of fever and severe anaemia : pre-referral antibiotic treatment (infection as cause) Close follow up after discharge

8. 8 Case 1b-Anaemia Start a new consultation : 1 year, 6 months, 10 kg, T 37° NO to all incl conjunctiva and jaundice assessment until anaemia assessment Conjuntivae OR palms pale: YES Severe eye OR palm pallor: NO Hemaglobin testing available: NO All other questions: NO Prevention: Vit A and Deworming: YES Did the child receive RUTF: NO Vaccines: select all but no measles Diagnosis No Malnutrition, Anaemia Treatment Anaemia Follow instructions, check on which vaccines still needed to give End of ALMANACH: click on confirm and finish Questions?

9. 9 Case 1b-Anaemia NOTE: If no Haemoglobin testing available but pallor yes --> moderate Anaemia Why asking for RUTF? Counselling of the caretaker is very important Need to understand length of treatment (2 months!) Need to come back for follow up and more iron tablets after 2 weeks(Anemia planned follow up algorithm) Understand feeding recommendations for good diet ensure regular deworming Ensure no malnutrition (MAM) underlying and if so --> good counselling! Iron treatment only initiate once fever subsides 1x/ day, every day for 2 months Does have side effects like nausea, constipation Stool can turn black --> good counselling… If child still pale after 2 months --> refer for assessment No Hb testing every 2 weeks, change needs more time

10. 10 Case 1c-Anaemia Start a new consultation : 3 years, 16 kg, T 37°, MUAC: YELLOW NO to all incl conjunctiva and jaundice assessment until anaemia assessment Conjunctivae OR palms pale: YES Severe eye OR palm pallor: NO Haemaglobin testing available: YES Malaria RDT available: YES All other questions: NO Prevention: Vit A and Deworming: YES Vaccines: select all but no IPV 2 Do lab tests and open case in after lab Haemoglobin between 7-<11 g/dl, Malaria RDT: Negative Diagnosis?

11. 11 Case 1c-Anaemia Diagnosis Moderate Acute Malnutrition Anaemia Treatment Anaemia Follow instructions check on which vaccines still needed to give End of ALMANACH: click on confirm and finish Questions?

12. 12 Case 1c-Anaemia NOTE: Remember: no fever but anaemia symptoms --> Malaria RDT Why asking for Measles past 3 months Measles induce many times severe malnutrition Close follow up on complications Close follow up of malnutrition status Close follow up on anaemia --> Documentation on health card! Taking RUTF no extra iron while taking RUTF If no more RUTF: start iron Parents need to understand: good counselling

13. 13 Take home Message Anaemia is much more frequent than we think can increase severity of other diseases check each child for clinical signs like palm of eye pallor Anaemia treatment takes long time good counselling needed from the start Don’t give iron while child taking RUTF Any Questions?