Week 8: Maternal and Infant

What is maternal mortality?

Woman dies during pregnancy, childbirth or soon after ( about 30 days)

What is Infant Mortality?

Deaths during the first year of life

What is neonatal mortality?

Stillbirths, death to 30 days 

What are the main causes of infant death?

Congenital problems, prematurity, low birthweight, and Sudden Infant death syndrome ( SIDS). Infections, accidents, and maternal complications

What do the cause in question 4 highlight?

Good prenatal care, safe delivery services, and proper newborn care 

How is a child’s growth measured?

Measured using growth curves and Z-scores, show how far a child’s weight or height is from the average for their age and sex

What are the two main references for growth curves?

NCHS: Old Standard U.S 1978

WHO: New standard: 2008

What do “Z scores” represent?

Z-scores help health workers decide wether a child is growing normally or showing signs of undernutrition

Grummer-Strawn (2010) is used for?

CDC use of standards for individual growth trajectories and WHO for population level health measures 

Why Z scores and percentiles?

• Age and sex contribute to differences in expected weights and heights for kids

• Z-scores and percentiles allow direct comparisons by converting measurements to comparable units by age and sex that allow for comparison across groups

What is wasting? 

Low weight for age or weight for height 

• Usually a measure of acute malnutrition 

• Can occur at any age 

• Recovery possible 

• Classified by severity: 

Moderate acute malnutrition: WHZ ←2 ← 3

Severe acute malnutrition: WHZ ← 3 with additional symptoms 

What is stunting?

Low height for age

• Usually measure of chronic malnutrition 

• Often occurs by age 2 

• Catch-up growth possible, height deficits persist  
  A Z score of 3 or lower = severe malnutrition

What is micronutrient malnutrition?

Micronutrients are nutrients needed in very small amounts compared to macronutrients ( fat, carbohydrates, protein)

Why is vitamin important and what does it mean if deficiency occurs?

Important for vision and its deficiency leads to night blindness and retinal defects ( congenital)

Why is Iodine important and what does it mean if deficiency occurs?

Needed for thyroid hormones and deficiency causes goiter and in pregnancy it can cause cretinism ( serious growth and mental problems)

Why is Iron important and what does it mean if deficiency occurs?

Most common micronutrient issue → causes anemia which leads to tiredness, weakness, poor concentration, and can affect children’'s development

Can have long term impact on growth and cognitive function

Vitamin C deficiency ( Scurvy) is?

• Found in emergency situations or in displaced persons w/ a lack of fresh fruits and vegetables 

• Lack of vitamin c leads to increase in bruising and bleeding, loss of teeth, fatigue 

Thiamine deficiency ( beriberi) is?

Thiamine involved in the breakdown of glucose, neurons

Loss of motor control, difficulty walking, overall muscle weakness, GI and cardiovascular issue

Associated w/ rice based diet — modern commercial rice commonly fortified

Niacin deficiency ( Pellagra) is?

• Extremely common in corn/maize consuming populations

• Symptoms: diarrhea, dermatitis, dementia and death

• Treatment of corn with lime ( and consumption of beans) makes the niacin in the corn available

What causes malnutrition? 

Infection → fever, viral/bacterial, helminthic, vector born ( malaria), communicable ( pneumonia, measles )

Marginal nutrition → sex based priorities of feeding, difficulties accessing food, seasonality in food supply 

poor diet 

poor feeding practices

Improperly prepared foods, contaminated foods 

How does infections cause malnutrition?

Infection is associated with increase in metabolic needs, wasting, stunting

Marginal nutritional status contributes to morbidity and mortality

What is helminths and its impact? 

Intestinal parasites ( worms) 

Extremely common in children 

infections start at 6- months 

Weight loss, growth stunting even if caloric intake adequate 

What is malaria and its impact?

Mosquito born illness

Once infected — can have later cycles of malaria w/o reinfection

Significant <5 year old mortality

665,000 deaths in 2010

What is marginal nutrition and its impact?

Acute: disruption due to natural disaster, conflict, displacement 

Chronic: low nutrient intake reflecting larger social, political and economic forces ( structural violence) 

Inappropriate waning practices  

What is the impact of seasons?

Seasonality affects food availability and disease levels, leading to period when children are more likely to lose weight