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

Foundations of Global Health Child Health Developed by Christy Ottendorfer. Updated by C. McGuire-Wolfe, 2012

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 2 2

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 3

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 4

Global Under 5 Deaths • Over 90% of deaths in 42 low or middle income countries • ½ of these deaths occur in 5 countries: – India – Nigeria – DRC – Pakistan – China 5 http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf

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/ 6 UNICEF_Child_mortality_for_web_0831.pdf

Under 5 Mortality Rates http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf 7

Causes Under 5 Death • Majority occur in neonatal period • Infectious diseases significant contribution to mortality 8

Risk Factors • Poverty • Rural areas • Lack of maternal education http://www.unicef.org/media/files 9 /UNICEF_Child_mortality_for_web_0831.pdf

Global Hunger Index Map http://www.ifpri.org/sites/default/files/publications/ghi11poster.pdf 10

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 11

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 12

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. 13

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 14

Preterm Birth Map, 2009 15

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 16

Perinatal Deaths & Antenatal Care 17

Antenatal Care 18

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Causes of Neonatal Deaths 20

First Month Stats • Most maternal & neonatal deaths rapidly occur – 75% of neonatal deaths occur 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 outside hospital do not receive any postnatal care 21

Neonatal Deaths http://cherg.org/main.html 22

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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 24

One Example: Human Incubators • Problem: Incubator shortage in developing countries • Solution: Kangaroo Mother Care to warm babies 25

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 26

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

US Infant Deaths Decline 28

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

Significant Progress Since 1960 • Child death rates decline due to improved basic medical care, nutrient fortification, vaccines 30

Child Mortality Rate Progress 31

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Under 5 Mortality Map 33

MDG 4 http://www.unicef.org/media/files/UNICEF_Child_mortality_for_web_0831.pdf 34

MDG 4 Progress http://www.who.int/gho/child_health/en / 35

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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 37

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 38

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 39

Common Causes • Bacterial infections with Streptococcus pneumoniae or Heamophilus influenzae typically found in developing world 40

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 41

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) 42

Tetanus Elimination • In 1988, 787,000 newborns died of 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 43

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Child Health Care Delivery 45

Table 10-5 46

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 47

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). 48