Paper Ⅹ

Community medicine

2018/19 KU
Problem- Ⅰ:
A 3 years old child is brought to your hospital with history of fever and rash all over
the body. Mother tells that the rash first appeared from hairline behind the ears.
a. What is your probable diagnosis? (1)
b. Explain clinical stages of above-mentioned disease. (3)
c. List complication of disease. (2)
d. Discuss measure for prevention and control of disease. (4)

Solution:
a.
Measles is provisional diagnosis Ⅹ
b.
There are three stages in the natural history of measles:
i) Prodromal or pre-eruptive stage
Begins 10 days after infection, and lasts until day 14
Characterized by:
-fever
-coryza with sneezing and nasal discharge
-redness of eye and photophobia
-Kolpik’s Spot
• A day or two before the appearance of the rash
• Small, bluish-white spots on a red base, smaller than the head of a pin
• Appear on the buccal mucosa opposite the first and second lower
molars
• Presence is pathognomonic of measles.
ii) Eruptive stage
• Characterized by a typical, dusky-red, macular or maculo-papular
rash

Catalyst NEPAL 1
 • Begins behind the ears and spreads rapidly in a few hours over the face
and neck, and extends down the body
• Rash and fever disappear in another 3 or 4 days
• Rash fades in the same order of appearance leaving a brownish
discoloration -hence Measles Aka Rubeola
iii) Post-measles stage
• Weight loss
• Weakness for number of days
• Increased susceptibility to other bacterial and viral infections
• Reactivation of pulmonary tuberculosis

c.
Most common complication are:
i. Measles-associated diarrhea,
ii. Pneumonia and other respiratory complications
iii. Otitis media Ⅹ
More serious complication of measles:
i. Febrile convulsions
ii. Encephalitis
iii. Subacute sclerosing pan-encephalitis (SSPE)
d.
Preventive Measures for protection of susceptible hosts are:
i. Measles vaccination
Measles is best prevented by active immunization. Only live attenuated
vaccines are recommended for use; they are both safe and effective.
The most effective when immunization as close to the age of 9 months
as possible.
ii. Immunoglobulin
Measles may be prevented by administration of immunoglobulin
(human) early in the incubation period. The person passively immunized
should be given live measles vaccine 8-12 weeks later.

Catalyst NEPAL 2
 Eradication of Measles
It is believed that measles, like smallpox, is amenable to eradication. Measles immunization has
in its favor the fact that only one dose is needed. It requires
(a) achieving an immunization coverage of at least 96 per cent of children under one year of
age, and that
(b) the cumulation in the immunity gap be prevented.

Outbreak control measures are as follows:

i. Isolation for 7 days after onset of rash,
ii. Immunization of contacts within 2 days of exposure
(if vaccine is contraindicated, immunoglobulin should be given within 3-
4 days of exposure)
iii. Prompt immunization at the beginning of an epidemic is essential to limit the
spread

Problem- Ⅱ: Ⅹ
A 2-month child is brought to health center in state of fast breathing. On
examination the child respiratory rate was 65/minute. There was presence of chest
indrawing.
a. Identify the conditions. [2]
b. Describe the component of CB-IMCI and list disease covered by it. [ 4]
c. Discuss methods of prevention and control of acute respiratory infections. [4]

Solution:
a.
Given condition is identified as Severe Pneumonia.
Most important Signs
▪ Child’s respiratory rate are increased.
▪ Chest indrawing
It may be only sign if child become too exhausted to breathe fast.

b.
There are three main components of CB-IMCI strategy

Catalyst NEPAL 3
 i. Improvement of case management skills of health staff through use of locally
adapted guidelines
ii. Improvement in overall all health system
iii. Improvements in family and community health care practices

Disease covered by CB-IMCI are:

i. Diarrhea
ii. Acute respiratory infections
iii. Measles
iv. Malnutrition
v. Malaria
vi. Other local or systemic bacterial infection,
ear infection, anemia etc.

c.
Ⅹ
Control Measures of ARI
WHO protocols for management of ARI includes three steps:

A. Case finding & Assessment

▪ Cough & difficult breathing in children < 5 years age
▪ Fever is not an efficient criterion

B. Case Classification
1. child aged 2 months up to 5 years
child should be put into one of the four classification
i. Very severe disease
ii. Severe pneumonia
iii. Pneumonia (not severe)
iv. No pneumonia; cough or cold
2. Infant less than 2 months of age
Any pneumonia in young infant is considered severe

C. Intuition of Appropriate Therapy

▪ Antibiotics

Catalyst NEPAL 4
 Prevention of ARI:
i. Immunization
It is an important measure to reduce cases of pneumonia which occur as a
complication of vaccine preventable disease, especially measles
➢ Measles vaccine
➢ HiB vaccine
➢ Pneumococcal vaccine -PCV
ii. Breastfeeding infants exclusively (no other food or drinks, not even water) for
the first six months breast milk has excellent nutritional value and it contains
the mother’s antibodies which help to protect the infant from infection.
iii. Reduction of smoke pollution and other respiratory irritant indoors.

Catalyst NEPAL 5