PHLT Ch 11- The health of young children

The importance of child health

• 5.4 million children under 5 years of age die each year

• almost all of these deaths are preventable

• children are a particularly vulnerable population

• child health closely linked with poverty

• insufficient progress in certain parts of the world in reducing childhood morbidity and mortality

Key terms

• perinatal: first week of life

• neonatal: the first month of life

• infant: the first year of life

• under-5: children 0-4 years old

Mortality and the burden of disease

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

• 46% of under-5 child deaths among neonates

• general trend is decline, but rates of decline vary considerably by region

Pneumonia/ lower respiratory infections

• children under-5 in low and middle income countries average 3-6 acute respiratory infections per year

• more severe and causes higher rates of death in low and middle income countries

• leading infectious cause of death globally in children under 5

• upper respiratory tract infections include common cold and ear infections and lower respiratory infections include bronchiolitis and pneumonia

Diarrhea

• second leading infectious cause of young child death

• causes dehydration, loss and damage to the intestines

• children under 5 in low and middle income countriese have around 3-4 cases per year; those aged 6-11 months have almost double that

Malaria

• leading cause of death in children under 5 in sub saharan africa

• extremely high morbidity; estimate some people in sub saharan africa have about 5 episodes per year

Mortality and the burden of disease cont.

HIV/AIDS

• in so17 there were 180000 newborns infected with HIV and mroe than 90% of them were in sub saharan africa

• causes 1.2% of deaths in children under 5

• a newborn has a 15-45% chance of being infected from an HIV positive woman who is not receiving antiretroviral therapy

Measles

• children under 5 years and vitamin A deficient or HIV nfected are more vulnerable to complications

• deaths decreased by 80% globally 2000-2016

• still a leading cause of death of children under 5

• causes 1.3% of deaths in children under 5

Soil transmitted helminths

• roundworm, hookworm, and whipworm

• 270 million preschool children and 560 million school aged children live in intense helminth transmissions areas

• infections can lead to severe morbidity such as iron deficiency anemia

• burden of several worms highest for 6 or 7 years old

additional comments on neonatal mortality

• 46% of annual under 5 deaths occur within the first month of life

• 73% of deaths in first month occur in first week

• insufficient progress in reducing neonatal death rate

• every day that a child lives increases the likelihood that he or she will stay alive

The cost and consequences of child morbidity and mortality

• cannot measure direct losses in productivity

• high costs of caring for a sick child

• potential long term disability

• growth restriction and restriction of mental dvelopment can result in poor school attendance and performance

• high fertility to compensate for deaths

addressing key challenges in child health

• most progress for 1 and 5 year olds; less progress reducing neonatal death rates

• insufficient progress in subsaharan africa and south asia

• low-cost highly effective interventions are not implemented at the scale needed to prevent 2/3 of child deaths

Critical child health interventions

• life course approach interventions

• ensuring a healthy and well nourished mother

• prenatal care and micronutrient supplementation for the mother-to-be

• prevnetion of mother-to-child transmission of HIV

• attendance at delivery by a skilled birth attendant and referral for emergency obstetric care if needed

• appropriate care of the newborn and referral if needed

• kangaroo mother care

• early and exclusive breastfeeding for six months

• hygienic introduction of diverse complementary foods

• managing pneumonia and diarrhea

• immunixation

• bednets for malaria and regular drug administration for worms

Immunization: a best buy in global health

• one of the most successful and cost effective child health interventions available

• each year, routine immunizations prevents 2-3 million deaths and protects up to 100million people against illness and disability

• immunization reduces health costs of illness and prevents loss of productivity from illness

• when population health improves and fertility rates drop, the age distribution becomes more favorable to economic growth

• global partnerships are working in development and implementation of more efficient immunization procurement mechanisms

• there remail critical gaps in achieving universal immunization coverage

addressing key challenges in child health cont

Community based approaches to improving child health

• womens groups to raise awareness of maternal, fetal, and neonatal issues

• community-based promotion of hygiene, umbilical cord care, keeping the newborn warm, and exclusive breastfeeding can reduce neonatal mortality 10-40%