Global child mortality + malnutrition 8 - 9

Question 1

Define under-five mortality rate

Answer 1

Probability of dying between birth and exactly five years of age expressed per 1000 live births

Question 2

Define infant mortality rate

Answer 2

Probability of dying between birth and exactly one year of age expressed per 1000 live births
Most dangerous period for a child especially in developing countries

Question 3

What are the 5 most common causes of child mortality globally?

Answer 3

Preterm birth complications
Pneumonia
Birth asphyxia
Diarrhoea
Malaria

Question 4

What are the most common causes of child mortality globally linked to?

Answer 4

Lack of midwifery training, access to prenatal care and access to antibiotics

Question 5

How much more likely are children in SSA likely to die before the age of 5 than children in HICs?

Answer 5

15 times more likely

Question 6

What are the non-health determinants of infant mortality?

Answer 6

Survival of infants after 1 month mainly influenced by external environment
Poverty + household income
Sanitation
Food security
Urbanisation - urban areas do much better than rural counterparts - problem of sanitation + overcrowding
Maternal education

Question 7

What is the definition of child malnutrition?

Answer 7

Deficiency, excess or imbalance in a person’s intake of energy +/- specific nutrients in relation to their requirements (WHO)

Question 8

What are the categories of child malnutrition? x3

Answer 8

Nutrition
Specific nutrient deficiencies
Over nutrition

Question 9

What is PEM?

Answer 9

Severe protein-energy malnutrition - a leading cause of death among children < 5 years old

Question 10

What 2 classical syndromes does malnutrition go into?

Answer 10

Marasmus = wasting syndrome/severe wasting
Kwashiorkor = oedematous malnutrition (belly) from hypoalbuniaemia
Or both = marasmic-kwashiorkor

Question 11

Why is malnutrition rarely a direct cause of more than one third of all child deaths?

Answer 11

Lack of access to highly nutritious foods - particularly due to rising food prices
Poor feeding practices
Infection - undermines a child’s nutritional status
Most common cause of child deaths is communicable diseases but underlying contributor is malnutrition

Question 12

What are the proximate risk factors of high case fatality rate and poor nutritional recovery?

Answer 12

Herbal intoxication
Case severity on admission
Virological failure and advanced HIV disease stage
Constant rotation of skilled personnel + failure to sustain the quality of clinical care
Lack of specialist physicians to deal with complex presentations
Sporadic shortages of medical supplies
Shortage of the clinical personnel after normal working hours to attend to medical emergencies
Multiple infections e.g. pneumonia, HIV, diarrhoea

Question 13

What is the impact of malnutrition on childhood infections?

Answer 13

Vicious-cycle between nutrition and infection
Malnourished children are at increased risk of infection + chronic, repeat or recurrent infections often contribute to malnutrition

Question 14

What are the medical consequences of obesity in children?

Answer 14

CVD
Sleep apnoea
T2DM

Question 15

What are the 3 major micronutrient deficiencies in the developing world?

Answer 15

Iron
Iodine
Vitamin A

Question 16

What can an iodine deficiency cause?

Answer 16

Goiter (enlarged thyroid gland) –> death or mental retardation for a developing fetus

Question 17

What is the most common form of malnutrition in children?

Answer 17

Iron deficiency

Around 4 billion lack enough iron in their diet - malaria and parasitic infections are common contributing cases

Question 18

What does iodine deficiency cause?

Answer 18

Major cause of preventable mental retardation
Damaging in pregnancy and in early childhood - cretinism, stillbirth and miscarriage can cause significant loss of learning ability

Question 19

What does vitamin A deficiency cause?

Answer 19

Preventable childhood blindness and increases risk of death from common childhood illnesses e.g. diarrhoea