L10 Global Maternal and Infant Health

Question 1

What are some current goals of the WHO?

Answer 1

• end poverty
• no hunger
• good health and well being
• quality education
• gender equality
• clean water and sanitation

Question 2

How much higher is the infant mortality rate in indigenous women?

Answer 2

2.2 X’s

Question 3

What are some common direct and indirect causes of maternal mortality?

Answer 3

direct: severe bleeding, high B.P., unsafe abortion, infections like HIV and malaria
Indirect: anemia, low calcium

Question 4

What are some nutritional related causes under five mortality?

Answer 4

30-50% directly related or indirectly related to nutrition?
Neonatal preterm birth, lower respiratory infections, diarrhea diseases, protein energy malnutrition, measles, whooping cough, intestinal infections, iron deficiency anemia

Question 5

Why is maternal under nutrition associated with infant and early childhood mortality in pregnancy?

Answer 5

pregnancy - inadequate fetal growth

low birth weight, and low infant nutrient stores

Question 6

Why is iron deficiency associated with infant mortality?

Answer 6

most prevalent nutrient deficiency world wide

• low dietary sources
• increase iron losses to parasites
• less time between pregnancies
• maternal stores low = infant stores low

Question 7

Iodine and infant mortality?

Answer 7

• component or hormones from thyroid gland (thyroxine)
• requirements increase in pregnancy by 50%
• important in neurodevelopment (cretinism: stunted physical and mental growth)

Question 8

Why are folate and calcium contribute to infant mortality?

Answer 8

Folate - NTD’s and megaloblastic anemia

Calcium - hypertension during pregnancy and preterm birth

Question 9

What are the nutrition related factors that contribute to infant mortality in pregnancy?

Answer 9

under nutrition, iron, iodine, folate and calcium

Question 10

What are the nutrition related factors that contribute to infant mortality in infancy and childhood?

Answer 10

Undernutrition, iron, vitamin A, zinc, sub optimal breastfeeding

Question 11

Explain acute undernutirtion

Answer 11

Early childhood - weight for length by the WHO standards is low. Wasted = < 3rd percentile, severely wasted = <0.1 percentile
mid-upper arm circumference < 115mm
bilateral edema

Question 12

Severe Acute undernutrition

Answer 12

Marasmus

• “skin and bones”
• inadequate energy and protein intake
• low weight for age and weight-for-length

Kwashiorkor

• edema -interpretation of weight
• inadequate protein
• “first second” (seen in the 1st infant when the 2nd infant is born)
• early weaning from breastmilk to poor protein quality foods

Question 13

Signs for stunting or chronic undernutrition

Answer 13

Length-for-age using
WHO Growth Standards
- Stunted: < 3rd percentile (z score

Question 14

How to prevent undernutrition?

Answer 14

• improve water supply
• nutritious food security for poor houses
• adequate nutrition for mothers and children
• promote early initiation and exclusive breast feeding for 6 months

Question 15

what are the results of infant iron deficiency?

Answer 15

Infant iron deficiency:
 delayed physical and cognitive development
 increased mortality and morbidity

Question 16

What role do vitamin A and Zinc deficiency play in infant mortality?

Answer 16

They are required for immune function
 maintain the integrity of mucosal lining and function of immune cells
Deficiency common: rich sources are animal products
 fruits and vegetables high in beta-carotene
need more water to grow

Question 17

What are some adverse results of suboptimal breast feeding?

Answer 17

 increases all-cause mortality

 increases the incidence and death from diarrhea

Question 18

Diarrhea is a major cause of infant death. What are the modes of transmission and the treatments?

Answer 18

• Water contaminated with feces, person to person contact (personal hygeine), and poor food safety preparations
• zinc supplements, nutrient-rich foods, and rehydration

Question 19

If a mother has HIV or aids, what is the recommendation for breast feeding?

Answer 19

• exclusive b.f. for 6 months with maternal antiviral drugs

- Formula only recommended if acceptable, feasible, affordable, sustainable and safe

Question 20

How is the transmission of HIV increased through breast milk?

Answer 20

 lower maternal CD4 counts
 poor maternal nutritional status
 breast conditions
 oral thrush in infants
 mixed feeding as opposed to exclusive breastfeeding in first six months

Question 21

How can exclusive breast feeding lower transmission of HIV infection compared to mixed feeding?

Answer 21

 maintains integrity of infant GI tract
 promotes beneficial infant microbiota
 maintains integrity of mammary cell permeability
 immunological factors in breastmilk