Kutarisirwa Kwekuchengetedzwa Kwevana Vane Hurwere Hwekubereka Muzvirwere zveDengue Fever
Pendauluan
Dengue Hemorrhagic Fever (DHF) chirwere chedengue chinotapuriranwa nekurumwa kweumhutu hweAedes aegypti neAedes albopictus. Munzvimbo zhinji dzinopisa, DHF ichiri dambudziko rehutano hwevanhu rinowanzo kukonzera zviitiko zvinoshamisa, kusanganisira mumapoka asina dziviriro akadai sevakadzi vane pamuviri, vanaamai vachangobva kusununguka, nevana vacheche. Panyaya yekubatsira vana, DHF inoda kutarisirwa zvakanyanya nekuti inogona kukanganisa mamiriro eamai nemwana ari mudumbu, uye inogona kukonzera matambudziko akakomba akadai sekubuda ropa, kuvhunduka, kupera mvura mumuviri, uye kusagadzikana panguva yekusununguka.
Kutarisirwa kwevananyamukuta vane dengue fever kunoda kuti vananyamukuta vave nehunyanzvi hwekuonekwa nekukurumidza, kunyatsotarisa, kudzidzisa, kushanda pamwe nevamwe vashandi vezvehutano, uye kutumira vanhu kuchipatara nekukurumidza uye kwakakodzera. Chinyorwa chino chinokurukura misimboti nematanho ekutarisira kwevananyamukuta vane dengue fever, kunyanya kuvakadzi vane pamuviri, ukuwo vachifunga nezvekuchengetedzwa kwaamai nemwana ari mudumbu.
Kuongororwa kweDengue Fever
Dengue fivha inoratidzwa nefivha yakakwira kamwe kamwe (mazuva 2-7) inoperekedzwa nezvimwe zviratidzo zvakaita semusoro, kurwadziwa kwetsandanyama nemajoini, kuda kurutsa, kurutsa, mapundu, uye kubuda ropa (semuenzaniso, kubuda ropa mumhino, kubuda ropa mumatadza, petechiae). Muchikamu chakakosha (kazhinji mazuva 3-5), kubuda kweropa muplasma kunogona kuitika, zvichikonzera kuwanda kweropa, kudzikira kweBP, uye kuvhunduka (Dengue Shock Syndrome). Miedzo yakajairika yemurabhoritari inosanganisira thrombocytopenia, kuwedzera kwehematocrit, uye serology/dengue antigen (NS1) mhedzisiro inotsigira kuongororwa.
Mumadzimai ane pamuviri, dengue fivha inogona kuwedzera njodzi yekubvisa pamuviri, kusununguka nguva isati yakwana, kubuda ropa mushure mekusununguka uye mushure mekusununguka, uye kutambudzika kwemwana ari mudumbu nekuda kwekusabuda kweropa zvakanaka mudumbu. Saka, kutarisirwa kwevananyamukuta kunofanirwa kuitwa kwakakwana uye nguva dzose.
Zvinangwa zveKutarisira Kuchengetwa Kwevana Vakwegura
Kutarisirwa kwekuchengetedzwa kwevananyamukuta muvanhu vane DHF kune chinangwa chekuti:
1. Kuziva zviratidzo zvekutanga zvechirwere chedengue mumadzimai ane pamuviri.
2. Dzivirirai matambudziko akakomba, kunyanya kuvhunduka nekubuda ropa.
3. Chengetedza kuenzana kwemvura mumuviri uye mamiriro eropa raamai.
4. Tarisa hutano hwemwana ari mudumbu nguva dzose.
5. Kupa dzidzo nerutsigiro rwepfungwa kuna vanaamai nemhuri.
6. Itai basa pamwe chete uye tauriranai nevamwe sezvakaratidzwa.
Kuongororwa kweKubereka
Kuongorora kwekutanga idanho rakakosha kuti nyamukuta aone kuoma kwechirwere uye zvinodiwa pakurapwa. Zvinhu zvinofanirwa kuongororwa zvinosanganisira:
1. Kuverenga nhoroondo
– Zvinetso zvikuru: fivha yakanyanya, fivha yenguva refu, kurwadziwa, kuda kurutsa uye kurutsa, kushaya simba.
– Nhoroondo yekubuda ropa: kubuda ropa mumhino, kurutsa ropa, tsvina nhema, mazino anobuda ropa, mavanga paganda.
– Nhoroondo yekusangana nechirwere ichi: nzvimbo ine vanhu vane dengue fever, umhutu hwakawanda, mvura yakamira.
– Nhoroondo yekuzvitakura: zera rekuzvitakura, kufamba kwemwana ari mudumbu, nhoroondo yematambudziko epamuviri akamboitika.
– Nhoroondo yezvekurapa: anemia, matambudziko ekugwamba kweropa, zvirwere zvisingaperi.
2. Kuongororwa Kwemuviri
– Zviratidzo zvakakosha: tembiricha, BP, kurova kwemoyo, kufema. Tarisa kurova kwemoyo nekukurumidza uye kudzikira kweBP.
– Zviratidzo zvekushaya mvura mumuviri: ganda rakaita turgor, kuoma kwemucosa.
– Zviratidzo zvekubuda ropa: petechiae, ecchymosis, kubuda ropa mucous.
– Kurwadza kwedumbu, kukura kwechiropa, kana kusagadzikana kwemudumbu (zviratidzo zvengozi).
– Kuongororwa kwepamuviri: kureba kwe fundus yemudumbu, kurova kwemoyo wemwana ari mudumbu (FHR), marwadzo emudumbu, mamiriro emuromo wechibereko kana paine zviratidzo zvekusununguka.
3. Kutsigira Bvunzo (Kushanda Pamwe Chete)
Vananyamukuta vanoita basa rekukurudzira nekutevera rutsigiro rwekuongororwa zvichienderana nechiremera chavo uye maitiro avo ebasa:
- Hematology: maplatelet, hematocrit, hemoglobin, leukocytes.
– NS1/IgM/IgG dengue zvichienderana nedanho rechirwere.
– Kushanda kwechiropa kana paine chinofungidzirwa kuti nhengo yacho yakabatana.
– Kuongororwa kwemwana asati aberekwa: USG, NST/CTG kana zviripo uye zvichiratidzwa.
Kuziva Matambudziko Epamuviri uye Kuongororwa
Vananyamukuta vanogadzira zviratidzo zvechirwere uye matambudziko ekusununguka zvichibva padata. Semuenzaniso:
– Vakadzi vane pamuviri vari mumwedzi mitatu yechipiri/yechitatu yekuzvitakura vane fivha yedengue inofungidzirwa kuti inokonzerwa nefivha yakanyanya uye thrombocytopenia.
– Njodzi yekubuda ropa ine chekuita nekudzikira kwemaplatelet.
– Njodzi yekuvhunduka kweropa nekuda kwekubuda kwemvura muropa/kushaikwa kwemvura mumuviri.
– Njodzi yekusagadzikana kwemwana ari mudumbu nekuda kwekudzikira kweropa rinobuda muchibereko.
– Kunetseka kwaamai nemhuri maererano nemamiriro ezvinhu ezvirwere uye pamuviri.
Kuronga uye Kupindira Kwekuchengetedzwa Kwevana Vachizvara
Kurapwa kwechirwere chedengue kunobatsira uye kunoda kutariswa zvakanyanya. Mukurapa kwevana vanozvara, kupindira kunosanganisira:
1. Kunyatso tarisa mamiriro emwana waamai
– Gara uchicherechedza zviratidzo zvinokosha (kazhinji panguva dzematambudziko makuru).
– Tarisa zviratidzo zveDHF: kurwadziwa kwakanyanya mudumbu, kurutsa kunoramba kuripo, kubuda ropa, kushaya simba kwakanyanya, kusagadzikana, kusaziva, kudzikira kwemvura inobuda mumuviri, kutonhora kwemuviri, kushaya mweya.
– Tarisa mvura inonwiwa uye inobuda mumuviri uye kuwanda kweweti. Kuderera kwemvura inobuda mumuviri kunogona kuratidza kushamisika kana kupera simba mumuviri.
2. Kutarisira Mvura uye Kuzorora
Vananyamukuta vanodzidzisa murwere kukosha kwekuzorora zvakakwana uye kunwa mvura. Muzviitiko zvisina zviratidzo zvekunyevera, mvura inonwiwa (mvura, mvura inonyungudutswa, muto) inogona kukurudzirwa. Zvisinei, kana paine kurutsa kakawanda, zviratidzo zvekushaya mvura mumuviri zvakanyanya, kana mamiriro acho akawedzera kuipa, kushanda pamwe chete pakurapa nemvura inopinzwa mutsinga uye kugara muchipatara kunodiwa.
3. Kudzivirira uye Kutarisira Kubuda Kweropa
– Dzidziso yekudzivirira mishonga inowedzera njodzi yekubuda ropa yakaita seaspirin neibuprofen.
– Bata pamwe nachiremba kana maplatelet ari mashoma zvikuru kana kuti ropa riri kubuda mumuviri.
- Kuongororwa kwekubuda ropa munhengo yemukadzi mumadzimai ane pamuviri, kunyanya vasati vasununguka.
4. Kutarisa Kugara Nemwana Asina Kuzvarwa
Dengue fivha inogona kukanganisa kubuda kweropa mudumbu. Mabasa aNyamukuta:
– Tarisa mafambiro emwana ari mudumbu anotaurwa naamai.
- Tarisa DJJ nguva nenguva.
– Kushanda pamwe chete neUSG/NST kuongororwa kana kufamba kwemwana ari mudumbu kwaderera kana kuti paine zviratidzo zvekusagadzikana kwemwana ari mudumbu.
– Gadzirira kutumira mwana nekukurumidza kana zviratidzo zvekushungurudzika kwemwana ari mudumbu zvikaonekwa.
5. Kutarisirwa Kwekusununguka kweVanaamai Vane Dengue Fiver
Kana amai vakasangana neDHF panguva yekusununguka, manejimendi anofanira kungwarira zvakanyanya:
- Kugadzirira kuendesa kunzvimbo inokwanisa kuwedzera ropa/ropa kana zvichidikanwa.
- Kutarisira kubuda ropa mushure mekusununguka (uterine atony, coagulopathy).
– Kushanda pamwe chete pakusarudza nzira yekusununguka: havasi vese vanoda kuvhiyiwa, asi sarudzo yacho inoenderana nemamiriro emuviri waamai, mwana ari mudumbu, uye mazinga eplatelet pamwe nezviratidzo zvekubuda ropa.
- Kutarisira danho rechitatu nekushingaira kudzivirira kubuda ropa mushure mekusununguka zvichienderana nemirairo.
6. Dzidzo yehutano nekudzivirira
Vananyamukuta vanoita basa guru mukusimudzira hutano:
– Kudzivirira kurumwa neumhutu: mambure eumhutu, mbatya refu, mishonga inodzinga umhutu panguva yekuzvitakura sezvinokurudzirwa, kushandisa mambure eumhutu.
– Kubvisa matendere eumhutu (PSN) 3M pamwe chete: kubvisa mvura, kufukidza, kudzokorodza/kubvisa zvinhu zvakamboshandiswa, pamwe chete nezvimwe zvekudzivirira.
– Dzidziso yekuti ungaenda riini kuchipatara, kunyanya kana fivha iri pazuva rechitatu kusvika rechishanu.
– Mazano ezvekudya: kudya zvine hutano kwakaringana kuti utsigire kupora.
Kuitwa, Kuongorora, uye Kunyora Zvinyorwa
Panguva yekushandiswa kwechirongwa ichi, nyamukuta anoshandisa hurongwa hwakagadzwa uye anoita ongororo nguva nenguva. Zvinhu zvinoumba kubudirira zvinosanganisira: kudzikira kwetembiricha, zviratidzo zvehupenyu zvakagadzikana, kusava nezviratidzo zvekuvhunduka, kunwa mvura yakakwana, kusava neropa rakawanda, kuvandudzika kwehuwandu hwemaplatelet neropa, uye hutano hwemwana ari mudumbu hwakarongedzwa zvakanaka. Kana mamiriro acho akawedzera kuipa kana zviratidzo zvengozi zvikaonekwa, nyamukuta anofanira kutanga kutumira mwana nekukurumidza uye kutaurirana zvinobudirira nechipatara chekuendesa mwana.
Magwaro anofanirwa kunge akakwana uye akarongeka: data reSOAP, rinosanganisira zvinyorwa zvekutarisa maplatelet/hematocrit, zvinobuda muropa, DJJ, uye dzidzo inopiwa.
Kushandira pamwe uye Kutumira Vamwe
Dengue fivha mumadzimai ane pamuviri inowanzoda kurapwa kwakasiyana-siyana. Vananyamukuta vanofanira kushanda pamwe chete navanachiremba, vanachiremba vezvekubereka, uye vanachiremba vezvekurapa kana zvichidikanwa. Zviratidzo zvekutumirwa nekukurumidza zvinosanganisira: zviratidzo zvekuvhunduka, kubuda ropa zvakanyanya, maplatelet akaderera, kusaziva, kufema zvishoma, kusafamba zvakanaka kwemwana ari mudumbu, kana kuvapo kwezvinetso zvepamuviri zvakaita se preeclampsia uye kubuda ropa mushure mekusununguka.
Mhedziso
Kutarisirwa kwekuchengetedzwa kwevana vanozvarwa nekuda kwechirwere chedengue kunoda kuongororwa kwakanyatsonaka, kutariswa kwakanyatsojeka panguva yakakosha, kudzivirira matambudziko ekubuda ropa uye kuvhunduka, uye kutarisirwa zvakanyanya kune hutano hwemwana ari mudumbu. Vananyamukuta vanoita basa rakakosha mukuona mwana ari mudumbu nekukurumidza, kudzidziswa, rutsigiro rwepfungwa, uye kutaurirana kwekutumira vana kuchipatara. Nekutarisirwa kwekukurumidzira, kwakakodzera, uye kwakabatana kwevananyamukuta, njodzi yematambudziko edengue mumadzimai ane pamuviri inogona kuderedzwa, nokudaro ichivimbisa kuchengetedzeka kwaamai nemwana.
Kana muchida, ndinogonawo kuunganidza chinyorwa ichi nenzira yedzidzo (nezvikamu zve "Pathway", "SOAP", kana kushandisa mareferensi emagazini uye gwara reMinistry of Health/WHO) zvichienderana nezvinodiwa nebasa.
