Lect 11 - Global Maternal and Infant Health

Question 1

How does anemia affect maternal mortality

Answer 1

• 50-60% of women enter pregnancy with IDA
• Risk of mortality increases because of blood loss

Question 2

Causes of maternal mortality

Answer 2

• HIV, malaria
• Anemia an indirect cause
• Complications during pregnancy including: hemorrhage, infections, prolonged/obstructed labour

Question 3

What is defined as neonatal mortality

Answer 3

Mortality within the first 28 days of life

Question 4

Causes of neonatal mortality

Answer 4

Direct causes: infections, asphyxia, pre-mature birth
Indirect causes: Low birth weight which is usually a result of maternal undernutrition

Question 5

What percentage of below 5 mortality is caused by nutrition factors

Answer 5

35-50%

Question 6

Nutrition-related factors of below 5 deaths

Answer 6

• Wasting and stunting
• Reduction in intra-uterine growth
• Deficiencies: Vit A, iron, zinc, iodine
• Sub-optimal breastfeeding

Question 7

How is wasting assessed?

Answer 7

• Weight for length according to WHO growth charts (z score less than -2 is moderate, less than -3 is severe)
• bilateral edema
• mid-upper arm circumference less than 115mm

Question 8

Marasmus

Answer 8

Inadequate protein and energy intake. Results in low weight for age and low weight for length.

Question 9

Kwashiorkor

Answer 9

Sufficient energy, but insufficient protein. Causes edema with affects interpretation of weight. A result of early weening from breastmilk to poor protein quality foods (gruels).

Question 10

How is stunting determined?

Answer 10

• Length or weight for age (normal relative to each other but both are small compared to age): z score -2 is moderate, -3 is severe
• Better outcomes than wasting, but can irreversibly affect growth and development

Question 11

What is the cycle of undernutriton and immune function?

Answer 11

Undernutrition (acute or chronic in energy or micronutr) impairs the immune system (including innate and developed immune systems), which then causes increased infections. Infections raise the need for nutrition, which then causes further undernutrition when intake is already low.

Question 12

What is breastfeeding compared to sub-optimal breastfeeding?

Answer 12

Breastfeeding is exclusive breastfeeding for at least 6 months
- Leads to decreased risk of infection and mortality

Sub-optimal breasfeeding can be:
- Predominant breastfeeding: Mostly breastfeeding with some water and teas
- Partial breastfeeding: Some breastfeeding in addition to water and mixed foods
- No breastfeeding

Question 13

How does folic acid supplementation help with birth outcomes?

Answer 13

• Folic acid supplementation prior to conception can improve risk of NTDs by 72%
• Reduces prevalence of megaloblastic anemia
• Fortification of cereal foods may be more effective in reaching all women of childbearing age

Question 14

What are the effects of maternal and infant iron deficiency?

Answer 14

Maternal:
- reduced work capacity, easily fatigued
- decreased tolerance to blood loss
- low infant iron stores and birth weight

Infant:
- increased morbidity
- impaired physical cognitive development

Question 15

Maternal multiple micronutrient effects

Answer 15

Shown to reduce low birthweight and SGA births

Question 16

Effectiveness of calcium supplementation

Answer 16

In populations at risk of low calcium, calcium supplementation has been shown to reduce gestational hypertension and preeclampsia (by 52%), and preterm births

Question 17

Effectiveness of iodine supplementation and iodine needs during pregnancy

Answer 17

Iodine requirements inc during pregnancy because of increased need for T4 in 1st trimester and increased transfer to fetus later on. Iodine is essential for thyroid hormones, normal metabolism, and CNS development of fetus. Iodine deficiency shown to cause cretinism , which is reduced with iodine oil supplementation. Iodine supplementation during pregnancy also increases IQ points and psycho-motor skills. The easiest method of iodine supplementation is iodinization of salt, which requires government action.

Question 18

Zinc deficiency effects

Answer 18

• Zinc and vit A are required for proper immune function, including maintaining the integrity of the mucosal lining
• Severe zinc deficiency: delayed sexual development, growth retardation, increased rate of infection, hemolytic anemia
• Moderate zinc deficiency: rash, poor digestion and absoorption, loss of appetite and taste, hair loss, poor wound healing, decreased learning ability

Question 19

When is HIV risk increased with breastfeeding?

Answer 19

• Poor maternal nutr status
• Open sores or infection
• Low levels of maternal CD4
• Mixed feeding instead of exclusive
• Oral thrush in baby