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Dr. Jacob Meyer Veloz CCRMC Family Medicine Resident Slide 2 Perus poorest province Mining and Agriculture Spanish and Quechua spoken Slide 3 Isolated province of Huancavelica Population of approximately 30,000 Near VRAE 3262 meters above sea level Slide 4 19962006 Infant mortality43 per 100021 per 1000 Prenatal care67%91% Births attended by professionals 56%71% Maternal mortality 421/100,000185-240/100,000 Slide 5 Slide 6 Slide 7 Hemorrhage Preeclampsia Infeccion Complications of abortion Obstructed labor 27% prenatal, 26% peripartum, 46% up to 6 weeks post-partum Slide 8 Amnesty International says: Eliminate obstacles that impede or slow womens access to urgent obstetric services Barriers Geographic, economic, cultural, professional, Slide 9 Slide 10 Reduce maternal mortality to 120/100,000 Slide 11 Slide 12 Slide 13 Slide 14 Slide 15 Slide 16 Slide 17 Slide 18 Slide 19 Intercultural care Vertical birth Intermittent monitoring Health Center Care Slide 20 Slide 21 Malnutrition Iron Deficiency Parasitosis Respiratory infection Slide 22 Slide 23 Respiratory infections Perinatal disease Accidents Congenital diseases Malnutrition Slide 24 Slide 25 Slide 26 Slide 27 Slide 28 Iron deficiency Anemia Vitamin A deficiency Protein deficiency Vitamin C deficiency Vitamin B12 deficiency Slide 29 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 Slide 30 Slide 31 Slide 32 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 Slide 33 64.6% prevalence in Huancavelica Dietary deficiency Normal hemoglobin 2 points higher at altitude Slide 34 Village outreach Clinical Diagnosis Provide iron supplements to nearly all children Slide 35 Slide 36 Slide 37 Giardia lamblia Ascaris lumbricoides Entamoeba histolytica Taenia solium Taenia sanginata Primary biologist reports prevalence of up to 80% among children of Churcampa Slide 38 Approximately 30% of O & P done positive Asymptomatic Abdominal pain Abdominal obstruction Hemoptysis Compounds problems of malnutrition Slide 39 Slide 40 Albendazole 400mg po x 1 Mebendazole 100mg po BID x 3 days Treat family Encourage clean water Other options: Pyrantel pamoate Ivermectin Slide 41 30-40% of children with stool sample positive Water supply contaminated As few as 10 cysts can cause infection Slide 42 Slide 43 Diarrhea Abdominal cramps or tenderness. Nausea and loss of appetite. Passing more gas or having more bloating than usual. Fatigue. Slide 44 Slide 45 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 Slide 46 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. Slide 47 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 Slide 48 Metronidazole 25mg/kg divided TID Consider treating for other parasites Side effects: nausea & vomiting Jacobs Treatment Metronidazole 250mg po TID x 5 days Other options: Furazolidone 100mg po QID x 7-10 days Albendazole Slide 49 Slide 50 Slide 51 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 Slide 52