Global child health

Question 1

What is the aim of the sustainable development goals in relation to under-five mortality?

Answer 1

The aim is to end preventable deaths in newborns and children under five years by 2030. All countries should reduce under-five mortality to at least 25 per 1 000 live births.

Question 2

What is the most vulnerable time for a child’s survival?

Answer 2

The first 28 days of life (neonatal period).

Question 3

What is the most frequent cause of death in children during the neonatal period?

Answer 3

Prematurity.

Question 4

What is the most frequent cause of death in children after the neonatal period?

Answer 4

Pneumonia.

Question 5

What is under-five mortality?

Answer 5

The risk of a child dying before completing five years of life.

Question 6

In which WHO region is the under-five mortality highest and lowest?

Answer 6

The under-five mortality is highest in the WHO African region (76 per 1 000 live births) and lowest in the WHO European region (10 per 1 000 live births).

Question 7

True of false: There is no reduction in neonatal deaths in Sub-Saharan Africa between 1990 and 2016.

Answer 7

True.

Question 8

What are WHO strategies to further reduce under-five mortality? (What causes of death are the different bullet point directed at?)

Answer 8

1) Appropriate home care and timely treatment for newborns. (Directed at birth asphyxia.)
2) Integrated management of childhood illness (IMCI) for all children under the age of years. (Directed at diarrhea, pneumonia, and malaria.)
3) Expanded programme on immunization. (Directed at vaccine preventable diseases, diarrhea, pneumonia and maybe malaria.)
4) Infant and young child feeding. (Directed at malnutrition.)

Question 9

What is a fresh stillbirth?

Answer 9

Death of the baby during labor.

Question 10

How many babies die annually during the neonatal period?

Answer 10

Nearly 2,5 million newborn babies.

Question 11

What is the overall objective of the helping babies breathe educational program?

Answer 11

Reducing number of newborn deaths due to asphyxia.

Question 12

What is the first step in the action plan of the helping babies breathe program?

Answer 12

Drying the baby thoroughly. Thereafter evaluation if the baby is crying or not.

Question 13

Which methods/tools are used in the helping babies breathe training?

Answer 13

Flip chart, simulator and learner work book.

Pair learning/teaching.

Question 14

What is it that makes the helping babies breathe program sustainable?

Answer 14

It is simple and evidence based.
It is low-cost and effective.
It is easy to integrate.

Question 15

True or false: A blood culture is a simple and safe way to detect the pathogen in the case of pneumonia.

Answer 15

False. There are no simple and safe way to detect the pathogen in pneumonia. There is a positive blood culture in only 5-20 % of cases.

Question 16

What are the most common bacterial pathogens in pneumonia? Are bacterial or viral infections the most common cause of pneumonia?

Answer 16

The most common bacterial pathogens are pneumococci, H. influenza and S. aureus.
Viral infections are the more common cause of pneumonia.

Question 17

What are the most common pathogens in HIV positive children with pneumonia?

Answer 17

P. jiroveci (fungal infection) and S. aureus (bacterial infection) are the most common.
(In fatal cases P. jiroveci and cytomegalovirus (CMV) are the most common.)

Question 18

What are indications for home care advice based on the new classification and treatment of childhood pneumonia?

Answer 18

Cold and cough - no pneumonia: Home care advice.

Fast breathing and/or chest retractions - pneumonia: Oral amoxicillin and home care advice.

Question 19

What are danger signs associated with severe pneumonia? Where should the child be treated is such signs are present?

Answer 19

Danger signs include inability to breastfeed/drink, nasal flaring, grunting, hypoxemia (SpO2 < 90 %), convulsions, abnormally sleepy or difficulty to awake, clinically severe malnutrition, severe chest retractions and/or fast breathing, and auscultatory signs.
The child should be treated in a hospital.

Question 20

The reduction of childhood pneumonia is based on prevention, protection and treatment. What does prevention and protection imply?

Answer 20

Prevention: Vaccination. Prevention of HIV. Zinc supplementation for diarrhea.
Protection: Exclusively breastfeeding. Adequate nutrition. Prevent low birth weight. Reduce indoor air pollution. Hand wash.

Question 21

How large is the percentage of under-five deaths associated with nutrition-related factors?

Answer 21

45 %.

Question 22

What are some opportunities for preventing under-five mortality due to diarrhea?

Answer 22

Prevention of diarrhea through vaccines, e.g. rotavirus vaccine.
Improvements in case management; use of low osmolarity oral re-hydration salts (ORS) and zinc supplementation.

Question 23

In what ways can low osmolarity re-hydration salts (ORS) help decrease the number of under-five deaths due to diarrhea?

Answer 23

Fewer unscheduled IV fluids.
Fewer episodes of vomiting.
Reduced diarrheal output.

Question 24

In what ways can zinc supplementation help decrease the number of under-five deaths due to diarrhea?

Answer 24

Reduction in duration of diarrhea.
Reduction in treatment failure or death in persistent diarrhea.
Prevention of recurrence of diarrhea for 3-4 months.

Question 25

True or false: There has been a 2/3 reduction in malaria under-five mortality the last 15 years .

Answer 25

True.

Question 26

What is the main symptom of uncomplicated malaria? What are other symptoms associated with the disease?

Answer 26

The main symptom is fever.

Other symptoms include flu-like symptoms (headache, muscle ache and chills), vomiting and abdominal pain.

Question 27

What is special about plasmodium vivax and plasmodium ovale?

Answer 27

They’re the only parasites to form dormant liver stages causing relapses weeks to month after the primary malaria infection.

Question 28

What are symptoms of severe malaria? What is the name of the parasite causing severe malaria?

Answer 28

Symptoms depend on immunity and can include impaired consciousness (with coma and/or seizures), respiratory distress, severe anemia, hypoglycemia, lactacidosis, severe fever, and high peripheral parasitemia (4-5 % of erythrocytes infected).

The name of the parasite is plasmodium falciparum.

Question 29

What measures should be taken to reduce the morbidity and mortality owing to falciparum malaria?

Answer 29

Use of insecticide treated nets and indoor residual spraying.
AND
Early treatment with artemisinin-based combination therapy (ACT).

Question 30

Breastfeeding is extremely important for both mother and child. How?

Answer 30

For the baby breastfeeding is a safe (hygienic and sufficient) source of nutrition for the first 6 months.

For the mother it is inexpensive and lactation amenorrhea reduces frequent pregnancies.

Question 31

True or false: 20-23 % of children under the age of five suffer from acute malnutrition.

Answer 31

False. The statement is true for 10-13 % of children.

Question 32

What are the most common causes of acute malnutrition?

Answer 32

Severe food shortage or period of illness.

Question 33

What are the results of chronic malnutrition compared to acute malnutrition?

Answer 33

Acute malnutrition causes wasting or rapid weight loss.

Chronic malnutrition causes stunting or reduced growth in height. It may also affect cognitive development.

Question 34

How can protein-energy malnutrition be prevented?

Answer 34

Frequent meals. (Five meals per day.)
Macro-nutrients: Sufficient amounts of proteins and calories.
Micro-nutrients: Sufficient amounts of vitamin D, iron, zinc, etc.
Treatment of infections + re-feeding: Measles, worms, HIV.

Question 35

What is meant by nutrition sensitive and nutrition specific preventative interventions?

Answer 35

Nutrition specific interventions can also be referred to as direct interventions, and involve education and nutritional intervention during pregnancy and early childhood.

Nutrition sensitive interventions can also be referred to as indirect interventions, and involve female education, poverty programmes, national policies, and agriculture.

Question 36

How many of the world’s fatalities on the road occur in low and middle income countries (in percent)?

Answer 36

90 % of all fatalities on the road.

Question 37

What are the most common causes of injury-related under-five mortality?

Answer 37

Burns and road traffic injuries.

Question 38

True or false: Half of those dying on the world’s roads are “vulnerable road users”: pedestrians, cyclists and motorcyclists.

Answer 38

True.