Session 4.7. Other important infections and conditions

It is important to know a little bit about some other infections that we have not yet mentioned. These infections do not cause epidemics that happen very rapidly or at certain periods, like diarrhoeas or respiratory infections. But they affect many millions of people around the world and cause a lot of sickness and death. For this reason, we need to know about them.

Part 4.7.1. HIV infection

The human immunodeficiency virus (HIV) is a germ that causes infection in humans only. It attacks the immune system (the body’s defence against diseases) and gradually destroys it. HIV is present in blood, breast milk, semen and vaginal fluids in amounts sufficient to cause infection. When people are infected with HIV, they are known as “people living with HIV” (PLHIV).

An individual can live with HIV without symptoms for years. When people with HIV are no longer able to resist infection because they have lower immunity, a group of serious illnesses can affect them and lead to their death. If the HIV infection is diagnosed early, treatment can preserve the person’s defence system. For most of the people living with HIV who are taking medication, HIV is a chronic infection and they continue to live as healthy people, as long as they take the medication.

Ways in which HIV is transmitted: 

• Unprotected sexual contact. People most commonly contract HIV through having unprotected sex.
• Blood contact. HIV can be transmitted through unsafe blood transfusions, or by sharing needles and syringes or other sharp objects contaminated with infected blood. 
• Mother-to-child transmission. Mothers can pass HIV to their babies during pregnancy, childbirth or breastfeeding.

Ways in which HIV is NOT transmitted:

• Social contact. HIV is not transmitted by hugging, kissing, shaking hands, breathing the same air, coughing, sneezing, sweat, tears or contact through sport. 
• Shared use of objects. HIV is not transmitted by toilet seats, food utensils, drinking cups, clothes, public baths or swimming pools.
• Insect bites. HIV is not transmitted by mosquitoes, bed bugs or other insects.

Ways to prevent HIV transmission:

• Safer sex. This can be achieved in a range of ways (including abstinence, being faithful to your partner, avoiding casual sex, having non-penetrative sex, using condoms every time, etc.). 
• Preventing mother-to-child transmission. Specific treatments are recommended during pregnancy, childbirth and breastfeeding. 
• Harm reduction. This strategy involves stopping risky or harmful behaviours that increase the likelihood that individuals will get HIV.
• Testing for HIV. Taking an HIV test permits early diagnosis and treatment. This reduces the risk of HIV transmission (including for people living with HIV and people who take medications as a prophylaxis). 
• “Universal precautions”. A carer takes precautions against infection by ensuring that he or she has no contact with blood or body fluids during caring activities.

It is important to know about HIV infection because people living with HIV are more likely to get sick and to die during an epidemic. Because people living with HIV are more vulnerable, it is important to help them in epidemic situations; however, they may be reluctant to disclose their status, so every precaution should be taken to protect their privacy.

Part 4.7.2. Tuberculosis

Tuberculosis (TB) is a disease that mainly affects the lungs but can also affect other organs. In some respects it is similar to the respiratory infections we discussed earlier, but it is transmitted and heals much more slowly.

TB is a serious disease, but curable. Infection occurs when TB germs are coughed into the air by people who have TB and then breathed in by people who do not have TB.

People who are in close contact with a person who has TB are more at risk. A person infected with TB should cover his or her mouth and nose with a handkerchief when coughing or sneezing to avoid spreading the germs until treatment has controlled the disease. TB develops easily and becomes serious when the body is weak. For example, people who smoke, are malnourished, are infected with HIV, or have an alcohol or drug abuse problem are more vulnerable to TB infection.

TB is suspected when someone has a cough for more than two weeks, is coughing up blood, has a fever, night sweats, chest pain, or pain when breathing or coughing, suffers from loss of appetite and weight and is tired. Anyone who has some of these symptoms should go to the local health facility or TB clinic for an examination.

TB germs take a very long time to control so treatment is very long. A person with TB must take a combination of several drugs for no less than six months. Most TB cases can be cured with the right treatment, but it is very important to take the medication regularly and to complete the full course of treatment. This said, some kinds of TB germ are resistant to current medication and are much harder and sometimes impossible to cure.

People living with HIV are at greater risk of developing TB, which can be life-threatening.

Participate

In your group, discuss how the presence of high rates of TB or HIV in your community might affect your epidemic response plan. What actions could you take to reduce the risk that people with HIV or TB will contract other epidemic diseases?

More information about HIV and TB, and what volunteers can do to prevent their spread and support people who have been infected, can be found in the CBHFA manuals.

Part 4.7.3. Malnutrition

The importance of nutrition in emergencies

Emergencies can exacerbate many of the causes of malnutrition by reducing access to food and safe water, health services, social care, and sanitation, and so raise rates of illness and death. In particular, the incidence of acute malnutrition (wasting) may increase after a sudden fall in the availability of adequate food and the spread of disease. The management of acute malnutrition often becomes a priority in emergencies because it is life-saving. Chronic malnutrition (stunting) and micronutrient deficiencies may also worsen, because emergencies tend to undermine infant and young child feeding practices. Emergency nutrition interventions should target children under five years old (6-59 months) and pregnant and lactating women (PLWs), who are particularly vulnerable.

Key nutrition interventions in emergencies

a. Prevent and manage acute malnutrition.

b. Protect and promote appropriate infant and young child feeding practices.

c. Manage micronutrient deficiencies.

d. Make multi-sectoral interventions to prevent further deterioration in nutritional status.

Malnutrition emergencies

Malnutrition can become an emergency of its own. If many more children than normal become malnourished, it is a malnutrition emergency. You can think of this in a similar way to the other epidemic diseases we have discussed. Malnutrition is preventable, predictable, can tend to occur in certain seasons, and can increase suddenly due to a change in risk factors. When more children than normal are affected by malnutrition, you should respond as you do to an epidemic. Mobilize volunteers and communities to prevent it, detect and refer cases, and support families who are affected, until the situation returns to normal.

What are the symptoms of a-cute malnutrition?

There are two types of acute -malnutrition: marasmus and kwashiorkor. They look different and have different symptoms.

Participate

List the signs and symptoms of malnutrition below:

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Now, discuss the signs and symptoms with your facilitator. How many symptoms did you get right?

How to prevent acute malnutrition?

Preventing malnutrition requires a multi-sectoral response. The aim should be to:

• Improve access to water and sanitation. 
• Improve access to nutritious and appropriate food, through distribution of food or cash. 
• Improve care practices, including exclusive breastfeeding, complementary feeding and hygiene. 
• Promote vaccinations. 
• Detect and refer malnutrition cases at an early stage.

How to deal with cases of acute malnutrition?

Unlike many of the other diseases in this toolkit, that require care in a health facility, the best way to treat children and adults with malnutrition is at home, supported by regular visits to a health facility, usually over a six to eight week period. Especially in remote areas, volunteers can play a vital role in treating malnutrition.

All children under five years of age who are identified as being acutely malnourished need to be referred to a health facility. There, the nurses or health workers will check for other illnesses and decide whether the child is moderately or severely malnourished. If the child is sick or has no appetite, he or she will be admitted to hospital for specialist care. If well and hungry, the child will receive antibiotics, medicine to treat worms, sometimes vaccinations, and will be given a special food that is specifically and only for children who have malnutrition.

Children with moderate acute malnutrition (MAM) may be given different food. This may be a flour known as corn soya blend (CBS) that can be made into porridge, or packets of a food that resembles peanut butter with added vitamins and minerals.

Children with severe acute malnutrition (SAM) are given a very dense, peanut paste (in some non-African countries it may be different) that is very high in calories and contains extra vitamins and minerals. This special food is easy to eat and digest and helps children to put on weight quickly. Children should continue to breastfeed and eat other foods if they are available.

Volunteers can encourage mothers to give the special food at home, ensure that mothers return to the clinic for follow up and support, and promote recommended health and hygiene practices. In remote locations, volunteers may be trained to distribute the special food.

How to detect malnutrition?

Children with malnutrition can be detected in several ways. To prevent malnutrition emergencies and stop children from dying, it is vital to identify cases in the community quickly and refer them for treatment to the health facility.

If you see children with symptoms of malnutrition, you should refer them immediately to the health centre to be checked.

If you have been trained and have equipment, you can also check children by weighing and measuring them. This is called “weight for height”. Checking children against the normal weight and height range shows whether they are growing properly or are malnourished. See Action tool 16.

You can check for malnutrition more easily and quickly by measuring the circumference of the upper arm of children under five years old. This test is called the middle upper arm circumference test, or MUAC. If they have been trained, volunteers can do the MUAC test. You measure the upper arm of children, using a special tape with red, yellow and green colour sections. If the circumference falls in the tape’s red or yellow sections, the child is likely to be malnourished and should be referred to a health facility. See Action tool 17.

How a malnutrition emergency is declared?

A malnutrition emergency is declared when more children under five are underweight than normal. This can be assessed on the basis of surveys that count how many children are malnourished. A malnutrition emergency is normally declared if more than 10 per cent of all children under five years old are malnourished.

How to deal with an epidemic?

Technically, malnutrition crises are not “epidemics”; however, the response to them is similar. Malnutrition can occur in seasons, just like malaria or influenza, and can affect many children at once because of drought or food insecurity. When there is a large increase in the number of children with acute malnutrition, we should react as we do when there is a steep increase in illnesses due to an infectious disease.

As volunteers, you should: 

• Familiarize yourself with the culture of the community, especially its feeding and care practices. 
• Build trust with community members. 
• Involve members of the community in efforts to improve nutrition and care practices.
• Take steps to detect and refer malnourished children and pregnant and lactating women quickly. 
• Promote recommended hand and food hygiene practices.

What can volunteers do?

Volunteers can greatly assist efforts to prevent and treat malnutrition. By promoting recommended health practices and identifying cases and referring them to health facilities, you can help children to recover quickly.

You can:

• Make house-to-house visits to measure children’s MUAC. See Action tool 16. 
• Refer malnourished children, and pregnant and lactating women, to health centres or hospitals. 
• Ensure children have access to safe food and water.
• Give families psychosocial support. 
• Assist with food distributions. 
• Follow up patients admitted to community-based management of acute malnutrition (CMAM) programmes.
• Mobilize members of the community and encourage the adoption of recommended health and hygiene practices (using BCC). In this area, you can advise the community on:

1. The importance of exclusive breastfeeding. 
2. Feeding practices.
3. Hygiene promotion. 
4. Vaccination.