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Management of the Child with a Serious Infection or Severe Malnutrition
  1. P Eunson

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It is a pleasure to review a paediatric text book for developing countries which indicates in a foreword its intended audience without trying to be all things to all men and women. This manual is intended for health workers who will be diagnosing and treating children at the first referral level. This will mean hospitals or large health centres which have access to basic investigations and to the essential drugs. The basic principles of treatment have been taken from the Integrated Management of Childhood Illness programme produced by WHO and others. This has the advantage that these health workers will be using the same principles of diagnosis and treatment as health workers in smaller establishments.

The quality of the text is high, and well interspersed with the diagrams, charts, bold type, and bullet points. In particular the quality of the black and white drawings of children, investigation techniques, and physical signs is superb without being patronising. I was particularly impressed by a page of drawings of typical chest x ray findings which are so much better than the usual poor quality copies seen in paediatric text books.

The first chapter deals with emergency triage assessment and treatment and includes 11 charts on practical tasks such as how to position the unconscious child, how to give IV fluids for shock, and how to give diazepam rectally for convulsions. A set of these charts on laminated cards would be ideal for casualty department walls.

The second chapter makes for harder reading as it looks at assessment and diagnosis. There are 14 long tables in this chapter on differential diagnosis of particular signs and symptoms. The use of these tables would presume a considerable medical knowledge and may take them beyond what a nurse or paramedical worker may be able to use. Many children would initially be seen by somebody in these circumstances who does not have a medical degree.

It is an immensely practical text book written by health workers who must have had experience in developing countries. When the possibility of a rare diagnosis is entertained the authors advise the reader to consult standard paediatric text books. They refrain from discussing possibilities of intensive treatment such as mechanical ventilation or expensive antibiotics. Their first line recommendation for treatment of meningitis is chloramphenicol and ampicillin or benzylpenicillin. However, they acknowledge that third generation cephalosporins may be part of some national guidelines.

The appendices cover practical procedures and information and doses of essential drugs. The section on recipes for refeeding malnourished children would benefit from having a table of nutritional contents of some basic foodstuffs. The growth section needs a chart on normal head circumference.

The authors have included a short appendix on play and toys for severely malnourished children, which does tend to get ignored by the sheer volume of pathology in malnutrition units.

It is difficult to find fault with the contents of the book. Regular users will quickly get to the sections they want, although I suspect the charts in the first chapter will be well thumbed. I trust that the book will be translated into other languages and that the quality of the drawings would not suffer adversely in those countries where depiction of the human body is not culturally acceptable. My only real criticism is that after a few days thumbing through this book, the binding has already come apart and it will not stand up to the hard wear which it deserves.

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