[PPT] - Child Health Developed by Christy Ottendorfer. Updated by C. PowerPoint Presentation

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Foundations of Global Health

Child Health

Developed by Christy Ottendorfer. Updated by C. McGuire-Wolfe, 2012

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Learning Objectives

Identify key child health measures
Understand most important causes of child

illness and death

Describe the most cost-effective interventions
Describe some examples of successful

initiatives

Discuss some challenges of further enhancing

health of children

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Importance of Child Health

7.6 million children die every

year before their fifth birthday

Many of these deaths are

preventable

Children are very vulnerable
Child health is linked with

poverty

Little progress has been made in

some parts of the world

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Child Mortality Rate

Probability that a child

born will die before reaching age 5, using current age-specific mortality rates in pop

Reflection of country’s

health care system, poverty & inadequacy of nutrition

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Global Under 5 Deaths

Over 90% of deaths

in 42 low or middle income countries

½ of these deaths
ccur in 5 countries:

– India – Nigeria – DRC – Pakistan – China

http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf

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Burden of Child Mortality

Sub-Saharan Africa
Southern Asia

As under-five mortality rates have fallen more sharply elsewhere, the disparity between Sub- Saharan Africa & S. Asia and the rest of the world has increased.

http://www.unicef.org/media/files/ UNICEF_Child_mortality_for_web_0831.pdf

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Under 5 Mortality Rates

http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf

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Causes Under 5 Death

Majority occur in

neonatal period

Infectious diseases

significant contribution to mortality

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Risk Factors

Poverty
Rural areas
Lack of maternal

education

http://www.unicef.org/media/files /UNICEF_Child_mortality_for_web_0831.pdf

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Global Hunger Index Map

http://www.ifpri.org/sites/default/files/publications/ghi11poster.pdf

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Key Terms

Perinatal – 22 weeks (gestation) to first week/life
Neonatal - first month of life
Infant - first year of life
Under-five - children 0 to 4

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Risk Factors for Neonatal, Infant & Child Deaths

Poverty
Inadequate nutrition
Educational status of mother
Poor access to safe water and sanitation,

health services, and education

Family income
Malaria
HIV

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Impact of Preterm Birth

Preterm: birth at < 37 completed weeks

– 12.9 million babies worldwide – 1 million neonatal deaths – 28% of neonatal deaths are due to preterm birth

Major determinant of neonatal mortality and

morbidity

Burden in Africa and Asia

– 85% of preterm births

Rates increasing globally, including developed

countries.

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Impact of Pre-Term Birth

Long-term adverse consequences for health

– Higher rates of cerebral palsy – Sensory deficits – Learning disabilities – Respiratory illnesses

Morbidity results with enormous

physical, psychological, economic costs – In US, medical and educational expenditure & lost productivity = >$26.2 billion

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Preterm Birth Map, 2009

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Low Birth Weight

Born less than 5 lbs, 8 oz
Increased risk for serious health

problems as newborns, lasting disabilities and even death

Poor nutritional status of

mother, teenagers that are still growing at higher risk for low birth weight babies

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Perinatal Deaths & Antenatal Care

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Antenatal Care

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Causes of Neonatal Deaths

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First Month Stats

Most maternal & neonatal

deaths rapidly occur

– 75% of neonatal deaths

ccur during first week

– 25–45% in first 24 hours

No skilled care during

birth: 47% of all mothers and newborns in developing countries

72% of all babies born
utside hospital do not

receive any postnatal care

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Neonatal Deaths

http://cherg.org/main.html

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Interventions

Basic standard of care

not universally available

Neonatal care

important factor

Educate moms to

exclusively breastfeed, keep baby warm, no baths w/in 24 hours

Simple treatments to

prevent infection

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One Example: Human Incubators

Problem: Incubator shortage in developing countries
Solution: Kangaroo Mother Care to warm babies

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Infant Mortality Rate

Number of children born in a year who die

before first birthday by total number of children born

# child deaths < 1 year x 1000 = IMR

# children born

Indicator of socioeconomic development,

hygienic conditions, overall health of population (health care conditions)

Easy to measure
Strongly correlated with adult mortality

Source: WHO/HPR/TDR/Crump

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Infant Mortality Rates Map

27 http://data.worldbank.org/indicator/SP.DYN.IMRT.IN/countries?display=map

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US Infant Deaths Decline

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http://www.who.int/gho/child_health/mortality/neonatal_infant/en/index.html

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Significant Progress Since 1960

Child death rates decline due to improved basic

medical care, nutrient fortification, vaccines

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Child Mortality Rate Progress

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Under 5 Mortality Map

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MDG 4

http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf

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MDG 4 Progress

35 http://www.who.int/gho/child_health/en/

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Newborn Asphyxia

Failure of a newborn to initiate and

sustain breathing within 1 min at birth

Causes 20% of neonatal deaths
WHO estimates 4-9 million cases occur

each year

– Over 1 million newborns that survive develop long term problems – Cerebral palsy, mental retardation, speaking, hearing, visual & learning disabilities

Newborn resuscitation programs

now used to educate providers in developing world

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Smoking & Child Health

Smoking during pregnancy 2x more likely

to have premature rupture of membranes, placental abruption, placenta previa

Babies born to women smokers:

– 30% higher odds born prematurely – More likely born with low birth weight – Weigh less than “non-smoking” babies – Up to 3x more likely to die of Sudden Infant Death Syndrome (SIDS)

Children exposed to secondhand

smoke at increased risk for:

– Bronchitis, pneumonia – Ear infections – Severe asthma

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Pneumonia

Pneumonia kills more children

than any other infectious illness

Over 2 million children deaths

each year

– Nearly 1 in 5 under-five deaths from pneumonia

Common symptoms in children

& infants:

– Rapid or difficult breathing – Cough – Fever & chills – Headaches – Loss of appetite – Wheezing

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Common Causes

Bacterial infections with

Streptococcus pneumoniae or Heamophilus influenzae typically found in developing world

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Stop Pneumonia

Vaccination
Case management
Diagnosis by symptoms
Antibiotics

– Very inexpensive, costing less than a dollar per dose – Yet, only 1 of every 5 children with signs of pneumonia receives antibiotics

Oxygen therapy

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Tetanus

Clostridium tetani is serious bacterial disease that

produces neurotoxin

Bacterial spores ubiquitous worldwide & found in soil
When introduced into body, bacteria produces toxin
Leads to painful tightening of muscles all over body,

including jaw muscles (lock jaw), severe muscle spasms, difficulty breathing, and death

– Death in 1 out of 10 cases

Vaccine is available (DTaP, DT, Td)

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Tetanus Elimination

In 1988, 787,000 newborns died
f neonatal tetanus
By 2004, still 128,000 deaths despite

World Health Assembly attempts to prioritize this disease

Maternal & Neonatal Tetanus (MNT)

Elimination program

– Immunize pregnant women during antenatal care contacts – If not previously vaccinated, a total of five doses is recommended – Two doses one month apart in first pregnancy – One dose in every subsequent pregnancy

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Child Health Care Delivery

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Table 10-5

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Key Challenges & Interventions

Critical child health interventions
Community-based approaches to improving child

health

Integrated management of childhood illness

(IMCI)

Nutrition of women, pregnant women, and

children from conception to two years

Exclusive breastfeeding for six months
Continuum of care for newborn - keep warm,

avoid neonatal tetanus, and treat pneumonia

Immunization

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Practice Questions

Where do the majority of childhood deaths occur?
Define perinatal, neonatal, infant, under five?
Name 3 risk factors contribute to childhood illness/death.
Name 3 long term consequences of preterm or low birth

weight babies.

Name 5 interventions that can lower neonatal deaths.
What demographic factors are linked to under five mortality

rates?

What regions are on track & off-track to meet MDG4 by

2015?

Describe 3 selected childhood illnesses (asphyxia, pneumonia,

tetanus).

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In Summary…

Approximately 7.5 million children around the world die

before their fifth birthday

Many deaths are preventable
Communicable diseases are the leading cause of death among

children in developing countries

Poverty, inadequate nutrition, lack of access to safe water,

sanitation, health services, and education are important risk factors for morbidity and mortality among children

Reduce neo-natal death to make major dent in infant and

child mortality

Take family and community-based approaches
Focus on well-known cost-effective interventions and