CONJUNCTIVAL DISORDERS

Apart from primary lesions, conjunctiva being a transparent mucus membrane, is also a window to detect underlying scleral or vascular abnormalities.

Acute conjunctivitis may be infective or non-infective in origin (Table 26.3), characterized by conjunctival hyperemia, edema, exudation and ocular discomfort or pain.

Neonatal conjunctivitis (Ophthalmia neonatorum) is a potentially blinding condition in newborns, caused by organisms from maternal birth canal, e.g. N. gonorrhoeae or C. trachomatis, or hospital flora, e.g. Pseudomonas or Staphylococci (Nosocomial).

Gonococcal conjunctivitis usually presents at birth or within first 5 days of life, while Chalmydia conjunctivitis typically develops after 5-7th day. Severity of disease may vary from superficial conjunctivitis to secon­dary complications, e.g. keratitis, iridocyclitis and panophthalmitis.

Early diagnosis by direct gram staining and culture of the discharge as well as microscopic examination of epithelial cell scrapping from tarsal conjunctiva (for chlamydial inclusion bodies) is essential for rational antibiotic therapy.

While regular eye wash with warm saline and topical antibiotics are enough for very mild and non-gonococcal conjunctivitis, other cases need systemic antibiotic therapy with ceftriaxone (gonococci), erythromycin (chlamydia), aminoglycoside (pseudomonas) and cloxacillin (staphylococci).

TABLE 26.3: Common causes of conjunctivitis

• Ophthalamia neonatorum

• Infections:

- Bact: Staph. aureus, H. influenzae, S. pneumoniae

- Viral: Adenovirus, Enterovirus, Measles

• Allergic:

- Exogenous allergens: Seasonal, vernal

- Endogenous allergens: Phlyctenules

• Immunological: Reiter's disease* *

• Chemical: Topical eye drops, smoke, sprays

• Others: Stevens-Johnson syndrome

* with arthritis and urethritis

Navjaat Shishu Suraksha Karyakram (NSSK), launched in 2009, aims to train health personnel in the Basic Newborn Care and Resuscitation with updated algorithms and technology, to improve neonatal survival.

Objective of this program is to ensure presence of a trained health person at every delivery point, in simple life-saving issues, e.g. prevention of hypothermia, prevention of infection, early initiation of breastfeeding and basic newborn resuscitation. NSSK aimed to train all health workers and doctors involved in delivery and newborn care.

Implementation: Presently, NSSK is a training package with two days classroom and hands-on training,

Adolescents, generally considered as healthy, are actually at higher risk for many nutritional, life-style, sexual and mental health as well as violence and injuries.

Rashtriya Kishor Swasthya Karyakram (RKSK) was launched on 7^th January, 2014 to enable all adolescents to realize their full potential by making informed and responsible decisions related to their health and well­being and by accessing the services and support they need to do so.

Key strength of this program is its health promotion approach—a paradigm shift from the existing clinic-based

¹Safe home remedies to sooth the throat, e.g. honey, tulsi, ginger, etc.

thread pulse, (b) severe abdominal pain, (c) bleeding, and (d) positive tourniquet test.

A Rapid diagnostic test (RDT) for malaria is advised to all fever cases in endemic area or in a fever case with no other cause in non-endemic area.

Accordingly, fever cases are classified in eight categories for severity and treatment purpose as follows: (a) very severe febrile illness, (b) malaria/ suspected malaria, (c) fever, malaria unlikely, (d) severe dengue/dengue with warning signs, (e) dengue fever, (f) severe complicated measles, (e) measles with eye or mouth complications, and (f) measles (Table 29.3).

d. Children with ear complaints are assessed for— (a) ear pain, (b) pus discharge from ears and its duration (c) tenderness behind the ears.

Accordingly, these cases are classified in four categories for severity and treatment purpose as follows: (a) mastoiditis, (b) acute ear infection, (c) chronic ear infection and (d) no ear infection (Table 29.4).

Step III. General assessment: After assessment for general danger signals and major symptoms, children must be assessed for—(a) nutrition, (b) anemia, and (c) immunization status, and (d) feeding problems.

a. Nutrition is assessed by—(a) weight for length/height (WFL), (b) presence of bilateral feet edema, (c) mid upper­arm circumference (MUAC) above 6 months, and (d) any medical complication, e.g. general danger sign, any severe classification, pneumonia, diarrhea with dehydration and poor appetite.

Signs: Diarrhea gt;14 days with dehydration

Treatment:

• Refer urgently (if has another severe classification)

• Treat dehydration, before referral (if no other severe classifi­cation)

Persistent Diarrhea

Signs: Diarrhea gt;14 days without dehydration

Treatment:

• Advice on feeding

• Give oral vitamin A (single dose)

• Give oral zinc and multivitamins for 14 days

• Follow-up after 2 days

Dysentery

Signs: Blood in stool

Treatment:

• Give oral Cefixime for 5 days

• Give oral Zinc for 14 days

• Follow-up after 2 days

Accordingly, the child is classified into four nutritional categories for severity and treatment purpose—(a) severe acute malnutrition (SAM) with medical complications, (b) SAM without medical complications, (c) moderate acute malnutrition, and

(d) no acute malnutrition (Table 29.5).

b. Anemia is assessed according to the color of child's palm and comparing it with examiner's palm, though haemoglobin should be tested, if possible.

Signs: (a) WFL gt; -2SDS, (b) MUAC gt; 12.5 cm, (c) No edema

Treatment:

• Dietary assessment and counseling

• Follow-up after 2 day or SOS

WFL: Weight for length; MUAC: Mid-upper arm circumference (not applicable lt;6 mo age)