Child Health Flashcards
In 2010, how many children died? Majority were where?
8 million children died (1/2 of these in sub-sah Africa & 1/3 in South Asia)
How many newborns in central Africa + in South Asia don’t survive? Compare w western world?
• 1 in 5 newborns in central Africa and 1 in 13 in South Asia do not survive to 5 (is 1 in 167 in N America + 1 in 270 in W Europe)
If children are going to die, by what age does this typically happen?
5
What fraction of child deaths occur as:
1) neonates
2) infants
3) 1-5yrs
• 1/3 die as neonates, 1/3 as infants (29 days – yr), 1/3 at 1-5yrs
Leading causes of under 5 death
• neonatal complications, diarrhea, pneumonia, malaria, other infect, injuries + malnutrition
T/F Most children die of non-treatable, complex illness requiring expensive intervention.
F
Vast majority of pediatric deaths d/t treatable + preventable conditions (req low cost interventions)
• Malnutrition contributes to at least _______of child deaths
1/3
What areas of the world (in order) have the highest rates of child deaths?
in 2010, Sierra Leone > Kenya > India > China…. (Figure 5-1 p. 88)
- changes a bit based on year
Most deaths of newborns d/t
premature birth, complications during LDR that result in asphyxia or birth trauma (common when women don’t have access to HCP when giving birth) + infections
neonate deaths/year
Stillbirths?
3.5 milion
• 3 million stillbirths/yr
Where are neonatal death rates highest? (in order)
Rates 2010: Sierra Leone > India > Kenya > Brazil > China (see fig 5-4 p. 92)
Top 4 causes of under 5 deaths and % for each
1) Neonatal deaths (incl preterm brith complications, birth asphysia, sepsis) – 41%
2) Diarrheal disease – 14%
3) ARIs – 14%
4) Malaria – 8%
How does diarrhea cause death?
- Causes dehydration + lyte imbalance death
* Lyte imbalance can lead to kidney + HF
Diarrhea usually d/t?
- infection (like rotavirus) or bacteria (E Coli, Shingella, Campylobactor, Salmonella)
- Transmission via food + H2O, contact w people who have infect, contact with feces
T/F Rotavirus is vaccine preventable
T
• Lack of hygiene, sanitation (toilet or latrine) + access to safe drinking water account for _____of diarrheal deaths
90%
How many children die from diarrhea each year?
• >1 mil children die of diarrhea q year
2.5 million causes of diarrhea in U5 total
When child has diarrhea, most important method for preventing death is
• admin of oral rehydration therapy (ORT) (Is sugar, salt and clean H2O)
How do you make ORT?
How often does child with diarrhea need it?
o Can get low osmolarity formula packets in clinics
o Can make w 8tsp sugar + ½ tsp salt into 1L boiled water
o K+ can be added w fruit juice, coconut water or mashed banana
o Kid needs to drink some each time passes stool. Needs at least 1L/day. More if vomiting.
Other than ORT, what can also be taken to prevent diarrheal deaths?
Zinc supplements
What increases your chance of dying from diarrhea?
Malnutrition
Should eating stop when the child has diarrhea?
What to do w eating when diarrhea stops?
No - keep eating! If breastfeeding, keep at ‘er!
When diarrhea done, should enc to eat more than did before to make up lost weight/nutrients
Best treatment strategy for diarrhea?
Do most get this tx?
ORT w continued feeding is BEST approach to diarrhea!
<1/2 of those in developing countries get this care.
T/F Most areas of the world have enough education on ORT already
F - More education needed!!!
Key prevention measures for diarrhea:
rotavirus + measle immunization, early + exclusive breastfeeding of infants, followed by completementary feeding; vit A suppl; improved H2O; community-wide sanitation
Leading causes of death for children 29 days – 5 yrs:
1) Diarrheal disease – 24%
2) ARIs – 23%
3) Other infections – 21%
4) Malaria – 14%
Leading causes of neonatal mortality
1) Preterm birth complications – 29%
2) Birth asphyxia – 23%
3) Sepsis – 15%
4) Pneumonia – 11%
Examples of effective interventions for neonatal health
1) Preconception:
• folic acid suppl, birth spacing
Examples of effective interventions for neonatal health
2) Antenatal/prenatal (before birth):
tetanus immunization, syphilis screening + tx, intermitted preventable treatment in preg (IPTp) of malaria, maternal supple w Fe, I, Zn, + Ca2+, maternal deworming tx, prevention of mother-to-child HIV transmission
Examples of effective interventions for neonatal health
Intranatal/Intrapartum (during delivery):
• clean delivery, detection _ management of breach births, Abx for premature rupture of membranes, corticosteroids for preterm labour, early dx of complications during labour
Examples of effective interventions for neonatal health
Postnatal:
• newborn rescus, delayed umbilical cord clamping, breastfeeding, Kangaroo mother care (skin to skin w baby’s ear near mother’s heart), prevention + management of hypothermia, nevirapine + replacement feeding for babies born to mom w HIV, pneumonia case management, neonatal vit A supplementation, bednets for malaria prev
How does this book describe pneumonia?
• Occurs when part of lung fills w fluid –> exchange at alveoli can’t occur well
Most common cause of lower resp infections (what kind of pathogen)?
Bacteria (can be lots of other pathogens too)
Most common specific bacteria that cause pneumonia? Are these vaccine preventable?
• Most common bacterial pneumonia d/t pneumococcus (Streptocuccus pneumoniae) and Haemophilus influenzaa type b (Hib). Both are vaccine preventable.
Only ____% of children w suspected pneumonia taken to HCP, only _____ receive ABx
• Only 60% of children w suspected pneumonia taken to HCP, only 1/3 receive ABx need to edu care providers so know to recognize early symptoms of pneu so can get abx tx fast
Symtpoms of Malaria?
Can you treat with antimalarials?
- Presents w fever + flu like symptoms
- In children, can deteriorate quickly into coma (cerebral malaria)
- In many cases, can be successfully tx w antimalarials but can cause weeks or motnhs of illness d/t relapses + severe anemia
T/F reinfection with Malaria is common
T
Babies of women w malaria have inc risk
• LBW, birth complicatiosn + stillbirths
• One of most effective prevention for Malaria is?
insecticide-treated bednets (ITNs)
Which disease remains one of most common causes of vaccine-preventable mortality
Measles
What is measles?
• Measles is highly contagious viral infect, spread through air or contact w secretions from nose or throat
o Symptoms: fever, runny nose, cough, sore eyes…followed by rash that starts on face + spreads to body
o May also cause diarrhea, ear infect, pneumonia, encephalitis…which can lead to severe complications + disability (esp in those who are undernourished)
Is measles treatable?
o No tx, so immunization essential
Other than measles, which vaccine-preventable diseases continue to cause many deaths in children?
includes Hib, pneumococcus, rotavirus
By what mechanisms does undernutrition lead to death?
Can cause death d/t malnutrition alone, or d/t inc risk of infection
Simple interventions that to reduce undernutrition
• exclusive breastfeeding for first 6 months, continued breastfeeding w solid food introduction, and providing vit A and zinc suppl when necessary
What does breastmilk incl?
What is particularly high in colostrum?
- all nutrients + water needed, antibodies, digestive enzymes, other immune factors
- Colostrum contains large amount of IgA Antibodies
What does “early breastfeeding” mean?
Benefit of this?
within first hour of life; inc neonatal survival rate
How long should a baby be exclusively breast fed for?
How often is this the case?
What issues does not doing this lead to?
• In ideal circumstances, infant exclusively breastfed for first 6 months (occurs in about 1/3 of children worldwide…contributing to undernutrition + diarrhea)
When do you add complementary foods? How long should breastfeeding continnue?
• Complementary foods introduced after 6 moths. Should continue breastfeeding for 2+ yrs
What is the best substitute for breast milk? When is this a challenge?
• Commercial formula is best substitute for breast milk – is challenge if lack access to clean water, have difficulty reading instruction, or limited income
Why have codes been formed around the marketing of formula?
What do these codes state?
• Horrible companies like Nestle have hired “milk nurses” to promote use of formula + not provide breastfeeding training… Are now codes for marketing around this. Fucking capitalists.
o Code states that formula must be presented as the second option and risks of using it and other breastfeeding substitutes must be explained (Social + financial implications, health hazards)
o Marketing personell are not to contact mothers directly, health facilities should not promote formula use + samples of formula should not be distributed at hospitals
What sort of eating practices can change to inc chance of children getting all the needed nutrients?
give own bowl (so not competing), ensure not left to eat after men of household have (often causes them to not get enough protein)
what are the 4 main global child health initiatives that the book outlines?
1) Primary Health Care
2) Expanded Program of Immunization (EPI)
3) GOBI
4) Integrated Management of Childhood Illness (IMCI)
Where was primary health care developed?
Developed in Alma Ata 1978 (where they developed “Health for All by 2000” through reduction of barriers to HC access)
What does PHC prioritize?
o PHC prioritizes prevention of locally common infection disease, promotion of nutriton, provision of essential drugs and treatments for common diseases + injuries, coordination of health services with traditional health practitioners, and programming for maternal and child health
Does PHC take a horizontal or verticle approach?
o PHC is “horizontal” approach that emphasizes routine access to comprehensives primary care rather than “verticle” approach that targets selected iseases with specific interventions (eg: special vaccination days) that are managed outside the public healthcare system
Hallmark of PHC is:
regularly scheduled health clinics for children U5 to monitor growth + provide immunizations up to 5th birthday. Regular check-ups means detect serious illness early
Expanded Program of Immunication (EPI)
What is it?
when was it started and by whom?
o Started by WHO in mid 1970s
o Expanded type + # of vaccinations given to children
o Successfully got more children immunized
What is GOBI?
Started when and by who/
o Started in 1980s by UNICEF
o Focussed on inc child survival by: growth monitoring, oral hydration for diarrhea, breastfeeding, and immunization
What did GOBI evolve into?
o Later, UNICEF, WHO + World Bank added family planning, food production + female education (now called GOBI/FFF)
• Integrated Management of Childhood Illness (IMCI)
Developed by? When?
o Dev’d in 1990s by UNICEF + WHO
What does the “Integrated” part of Integrated Management of Childhood Illness (IMCI) refer to?
o refers to interrelatedness of children’s health conditions, families and communities working together + outpatient staff knowing where to refer children
What is the purpose of Integrated Management of Childhood Illness (IMCI)?
o A package of simple, affordable, effective interventiosn for major childhood illnesses + undernutrition
o Aim is to improve family + community health practices + improve case management skills of healthcare staff
o Provides home healthcare guidelines for families w young children (See chart 5-7 p. 103) and evidence-based decision charts for clinicians when assessing children + treating common illnesses
Convention on the Rights of the Child
Adopted by who? When?
What do the rights include?
1989 UN
Rights include adequate standard of living, freedom from all forms of exploitation, protection from violence, access to edu + approp info, right to be heard, right to rest, leisure + play
o Reality is that many are denied these
• International Labour Organization (ILO) makes distinction b/t children participating in economic activity (working or doing chores) and “child labour” . What the differnce?
o Permissible for 12+ to spend few hours/wk doing light work that is not hazardous
o Becomes child labour when long hours, high intensity, hazardous…anything that could harm the child physically or emotionally essentially
ILO estimates >300million children 5-17 engaged in labour in 2008, of whom 115 million conducted hazardous work
In what ways are Girls particularly vulnerable to abuse + neglect?
o Infanticide, heavy domestic responsibilities, FGM, violence, sexual abuse\
o If limited resources in parents, may face discrimination in food allocation, forced into early marriage, not allowed to go to school
1995 UN adopted Beijing Declaration
What does this do?
In what area have significant gains been made for equality with girls?
o affirms several strategiec objects for achieving rights of the “girl-child”
Have made progress in school enrollment but significant inequities remain in many areas
What is the most prominent organization for child’s health?
What do they do?
UNICEF
• Advocate for protection of children’s rights, to help meet their basic needs, and expand opportunities for children to reach their full potential.
o Advocates for children by promoting prenatal care, girls’ edu, immunizations, nutrition, HIV/AIDS prevention amoung young people, protective enviros free of violence, abuse + exploitation
o Also respond to emergencies
How does UNICEF get their funding?
o 2/3 of funding from governemnts, 1/3 from NGOs, partnerships, private donations
