Child Mortality Improvements Flashcards
Learning Objectives
- Describe current levels and trends in child mortality
worldwide. - Describe the sources data used to measure child mortality and their availability worldwide.
- Discuss the role of the health systems in reducing child
mortality
What’s the biggest risk factor for death?
Question to think about
What are the efforts being made for child mortality?
- MDG 4 target: To reduce the under 5 mortality rate by two thirds in the period between 1990 and 2015
- SDG 3 target: To reduce under 5 mortality to at least as low as 25 per 1000 by 2030
What is the need to track child mortality?
- Measure of child health and overall developmental progress
- Setting priorities & directing resources
- Demonstrate effectiveness
- Resource mobilisation
- Accountability
List the different types of mortalities
- Neonatal mortality: The probability of dying within the 1st month of life
- Infant mortality: The probability of dying before the 1st birthday
- Post-neonatal mortality: The difference between infant and neonatal mortality
- Under-five mortality: The probability of dying before the fifth birthday
- Child mortality: The probability of dying between the 1st and 5th birthdays
Which data sources are used to track mortality rates?
- Civil Registration & Vital Statistics systems
- Surveys
- Censuses
What are the pros and cons of using Civil Registration & Vital Statistics systems?
Pros:
- Almost real time information
- Full population coverage
- Detailed information: cause, timing, location,
demographics
Cons:
- Expensive
- Administratively demanding
- Limited availability
List the pros and cons of using surveys
Pros:
- e.g. Demographic Health Surveys
- Often include information on timing of death (called
Complete Birth History data)
- Conducted every few years
Cons:
- Limited geographical information
- Sample of the population
List the pros and cons of using a consensus
Pros:
- Capture entire populations
- Higher resolution geographical information
Cons:
- Infrequent
- No information of timing of births/deaths (Known as summary birth history data)
What is the key goals linked with health systems & child systems?
- Globally, over 80% of the under-five deaths are due to neonatal conditions and infectious diseases like pneumonia, diarrhoea, malaria, measles and
meningitis, often compounded by malnutrition. - Most childhood deaths can be prevented with effective interventions that are feasible for implementation, even in resource constrained settings.
- The decline in child mortality over the past few decades can be attributed to a combination of factors within health systems, policies, and broader
social determinants of health
How do we Improve Access to Healthcare and Disease
Prevention & Control
- Improved Access to Skilled Birth Attendance: The presence of skilled healthcare providers during childbirth has helped reduce maternal and neonatal deaths, leading to improved survival rates for infants.
- Expansion of Primary Healthcare: Increased access to primary healthcare services, especially in rural and underserved areas, community health worker
programs. - Antibiotics and Antiretroviral Therapy: Access to antibiotics for bacterial infections, as well as antiretroviral therapy for HIV-positive mothers and children to prevent mother-to-child transmission.
- Expanded Immunization Programs: Widespread immunization against diseases like measles, diphtheria and polio.
- Malaria prevention & control programs: Insecticide-treated bed net distribution,
anti-malarials, combination therapies (ACTs).
How do we focus on maternal health?
- Better Maternal Health Care: Enhanced maternal healthcare, including prenatal care, safe delivery practices, and postpartum care, has led to fewer complications during pregnancy and childbirth, which indirectly reduces child mortality.
- Family Planning and Birth Spacing: Access to family planning services has allowed for safer and more planned pregnancies, leading to better health outcomes for both mothers and their children.
How can better nutrition be provided?
- Promotion of Breastfeeding: Initiatives to promote exclusive breast feeding for the first six months of life.
- Micronutrient Supplementation: Programs to address vitamin A deficiency and anaemia and other nutritional gaps have helped reduce mortality from malnutrition-related causes like stunting and weakened immune systems.
What are the public health measures that can be taken?
- Improved sanitation and clean water: Investment in WASH infrastructure reduces water-borne infections e.g., cholera.
- Education: education of girls more broadly and public health campaigns to promote vaccination, proper hygiene and nutrition.
What does a focus on preterm birth consist of?
- Target audience is healthcare professionals
- 10 recommendations (17 additional sub recommendations)
- Preventions (maternal interventions)
- Risk reductions (maternal and child interventions)
Describe the National Health Insurance Scheme (NHIS)
- Free healthcare to participants
- 2008, enrolment was made free of charge for pregnant women and children under 18 years of age
- Antenatal and postnatal visits, facility delivery (including emergency obstetric care) and neonatal care are all included under the scheme
- Ghana’s 2007–2015 Child Health Policy
- User Fees Exemption for Delivery Care was scaled up in 2005: exempts pregnant women who are not enrolled in NHIS from paying delivery fees.
What was the Ghana’s 2007–2015 Child Health Policy?
- Aimed to unify fragmented programme delivery under a recommended continuum of care for mothers and children,
- Scaling up of interventions with proven efficacy to prevent child deaths, e.g., oral rehydration therapy and zinc for treatment of diarrhoea, vitamin A supplementation and antibiotic treatment for
pneumonia
What are the challenges that remain with inequities?
- Large inequalities between regions (north-south divide): colonial legacy.
- Large within city-inequalities.
- Declines in continued care post birth: e.g.,
- 90% in Greater Accra take place in a health facility in the presence of a skilled health professional
- 76% of children aged one year have all age appropriate vaccines
- 48% of children aged 2–3 years have all age-appropriate vaccines
Conclusions
- Much progress has been made to reduce child mortality worldwide, but large inequalities remain.
- CVRS systems, surveys and censuses all provide data that can be used to measure child mortality.
- Countries with the highest burden of child mortality typically lack complete birth and death registration.
- Most child deaths are preventable and/or treatable.
- WHO recommends holistic care through pregnancy and early childhood
- Continued monitoring and surveillance is needed to identify vulnerable children
