The Importance of Child Health 63 million children under the age of 5 die each year Many of these deaths are preventable Children are a particularly vulnerable population Closely linked with poverty ID: 741201
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Slide1
Child Health
Chapter 10 Slide2
The Importance of Child Health
6.3 million children under the age of 5 die each year.
Many of these deaths are preventable.
Children are a particularly vulnerable population.Closely linked with poverty.Insufficient progress has been made in certain parts of the world in reducing childhood morbidity and mortality.Slide3Slide4
Source: UNICEF
http://www.childmortality.org/files_v20/download/IGME%20report%202015%20child%20mortality%20final.pdf
Accessed Jan 17, 2016Slide5
Key Terms
Perinatal : first week of life Neonatal : referring to the first month of life
Infant : referring to the first year of life Under-5 : referring to children 0-4 years oldSlide6
Selected Terms Relating to Causes of Child Illness and Death Slide7
The Burden of Childhood Illness
Children Under 5 Years
99% of childhood deaths are in low- and middle-income countries.
Half of these deaths occur in India, Nigeria, Democratic Republic of the Congo, Pakistan, and China.
44% of under-5 child deaths occur among neonates.Rates and causes vary across and within countries.General trend is decline, but rates of decline also vary considerably by region.Slide8
Underlying Causes/Determinants of Disease and Malnutrition
Poverty
Inadequate/Relative Poverty
Lack of access to careLack of maternal educationConflict/War/DisasterSlide9
Neonatal Mortality Rate, by WHO Region, 2010 Slide10
Neonatal, infant, and Under-5 Mortality
Source: UNICEF www.data.unicef.orgSlide11
Causes of Neonatal Deaths, by Percentage, 2008
Every year nearly 45% of all under 5 child deaths are among newborn infants, babies in their first 28 days of life or the neonatal period.
Three quarters of all newborn deaths occur in the first week of life.
In developing countries nearly half of all mothers and newborns do not receive skilled care during and immediately after birth.
Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life.
Source: WHO www.who.int Slide12
Leading causes of death in post-neonatal children: risk factors and responseSlide13
Declines in Under-5 Child Mortality, by Region, 2015Slide14
Additional Comments on Selected Causes
of Morbidity and Mortality
Acute Respiratory Infections
Leading cause of death in low- and middle-income countries.
More severe and cause higher rates of death in low- and middle-income countries than in high-income countries.Upper respiratory tract infections include the common cold and ear infections, lower respiratory infections include bronchiolitis and pneumonia.Pneumonia is the leading cause of infectious death globally in children under 5 years. Nutrition (exclusive breastfeeding, Vit A, and Zinc supplement) avoidance of indoor pollution, early recognition of symptoms
and appropriate administration of full course antibiotic could reduce ARI death significantly.Slide15
Diarrhea
Caused by bacteria, viruses, protozoa, and helminths.
Causes dehydration, loss of nutrition or wasting, and damage to the intestines.
Infants 6-11 months are particularly vulnerable because they have been introduced to unsafe water and foods.
Death occurs due to DehydrationElectrolyte imbalanceInterventions like adequate supply of water, sanitation and access to clean water could reduce mortality.Slide16
Diarrhea Treatment Interventions
ORT
Continued breastfeeding
It is estimated that ORT is saving 1 million lives/year.Zinc supplement
Question:
How much does a sachet of ORS cost?
Answer: 5-10 centsSlide17
Malaria
600,000 children die from malaria each year.
Malaria is the leading cause of death in children under 5 years of age in sub-Saharan Africa.
People in endemic areas of sub-Saharan Africa will have almost five episodes of malaria a year.
Associated with premature birth and intrauterine growth retardation, which reduce chances of survival.Malaria prevention interventions include vector control. Insecticide treated nets can reduce overall under five mortality rates about 20% in malaria endemic countries.Slide18
HIV/AIDS
Can be transmitted from mother to child during birth or breastfeeding.
Number of HIV-infected children has generally declined with the use of antiretroviral drugs.
There are 200,000 newborns infected with HIV and more than 90%of them were in sub-Saharan Africa.
About 2% of deaths of children under 5 globally are a result of HIV infection. Video: WHO strategy on HIV/AIDS for 2011-2015:http://www.youtube.com/watch?v=n61IAf07VAQ&feature=plcp Question: Has anything changed since then?Slide19
Measles
Acute respiratory infection with complications including pneumonia, diarrhea, encephalitis, and blindness.
Measles is a leading cause of vaccine preventable disease.
Children who are vitamin A deficient or infected with HIV are more at risk of death.
Extremely contagious if a population is not vaccinated.Deaths from measles has decreased by 75% globally between 2000 and 2013. Still accounts for about 2% of deaths of children under 5 years.Video : The last Measlehttp://www.measlesrubellainitiative.org/videoalbums/the-last-measle-2/Slide20
Helminths
880 million children were t risk of infectious from soil-transmitted helminths.
Only 305 of these children receive appropriate treatment.
Infections can lead to severe morbidity, such as iron deficiency anemia.The burden of several species of worms is highest in children around 6 or 7 years old.Slide21
Additional Comments on Neonatal Mortality
44% of children under 5 who die annually, actually die in the first month.
Little progress in reducing neonatal death rate.
Every day that a child lives increases the likelihood that he or she will stay alive.
To reduce childhood death rates, the world needs to focus more precisely on when the deaths occur.
Figure: The share of neonatal deaths among under-five deaths has increased in all regions Proportion of under-five deaths occur in neonatal period (percent), by UNICEF region, 1990 and 2011Slide22
Risk Factors for Neonatal, Infant and Child Deaths
Nutrition status.
Household income and education of mother.
Access to trained healthcare provider to attend birth and provide counseling.Water quality and sanitation.Slide23
The Cost and Consequences of Child Morbidity and Mortality
High costs of caring for a sick child.
Potential long-term disability.
Poor school attendance and performance.Slide24
Future Challenges
Seven countries reduced the rate of under-5 child mortality by more than two-thirds between 1990 and 2012.
Either other countries have decreased the rate of under-5 child mortality by more than 50%, but less than 66% at the same time.
However, challenges to improving health in children remain. Two thirds of childhood deaths that occur every year could be prevented by effective implementation of simple technology (e.g. ORT,
bednets, etc). Slide25
Progress in Child Health
The global polio eradication initiative (Polio is now only endemic in three countries.)
Progress against measles (548,000 deaths in 2000 to 158,000 in 2011).
Progress towards universal immunization of children (in 2013, 111 million infants, or 84% of children, were vaccinated).Slide26
Addressing Key Challenges in Child Health
Critical Child Health Interventions
Ensuring nutrition and health of the mother and mother-to-be.
Essential newborn care, extra care for small babies, and emergency care for newborns.
Preventing and managing diarrhea with hygiene, proper nutrition, measles vaccinations, and ORT.Basic vaccinations.Health care worker should inform the parents about:Necessary immunizations and the schedule to followHow to avoid anemia and parasitic disease in children over 6 months of ageWhy deworming is importantWays to ensure enough nutrient consumption such as iron and vitamin A.Slide27
Addressing Key Challenges in Child Health
Community-Based Approaches to Improving Child Health
Women’s groups to raise awareness of maternal, fetal, and neonatal issues.
Community-based promotion of hygiene, umbilical cord care, and keeping the baby warm
Video: Community project: Mothers helping mothers fight HIV (18:30)http://www.ted.com/talks/mitchell_besser_mothers_helping_mothers_fight_hiv.htmlSlide28
Addressing Key Challenges in Child Health
Integrated Management of Childhood Illness
Integrated healthcare approach for children because of many interrelated factors.
Healthcare workers trained at all levels, particularly home and community-based .