Maternal and Child Health Flashcards
What is the three point agenda from McCoy et al. 2024 about colonialism
Three-part agenda
1. Power asymmetries between global health actors from high-income and historically privileged countries and their counterparts in low-inccome and marginalized settings
- Colonization of structures and systems of global health governance
- Colonialism occurs through global health system. Need political and economic anticolonialism as well as social decolonization
What is the largest cause of preventable global deaths each year?
NCDs are greatest cause among >30 years and greatest cause overall. Deaths among 30-69 years are largely preventable.
What is the Under-Five Mortality Rate?
- the most commonly-used child health indicator
- It’s the probability of dying between birth and exactly five years of age per 1,000 live births (up to, but not including, fifth birthday)
How has the U5 mortality rate changed from 1990 to 2020?
Declined dramatically from 90.6/1000 live births to 37/1000 live births
What % of child mortality is linked to malnutrition?
45%
Where do the majority of U5 deaths occur in the world?
75% of deaths occur in 2 regions, Sub-Saharan Africa and South Asia
How does the U5 Mortality Rate compare to maternal and neonatal deaths
There is a similar distribution across the three
What is the infant mortality rate in the US for non-hispanic Blacks and whites
10.4 for Non-Hispanic Black
4.4 for Non-Hispanic White
What is the leading cause of death in children from 1-59 months?
Pneumonia
What are the principal causes if neonatal mortality?
- Preterm birth complications
- Pneumonia
- Intrapartum complications
- Sepsis or meningitis
What are the principal causes of postneonatal and child mortality?
- Pneumonia
- Diarrhea
- Malaria
What are risk factors for pneumonia in <5 children
Suboptimal breastfeeding
Undernutrition
Zinc deficiency
Crowding & indoor air pollution
What proportion of pneumonia deaths do vaccine preventable causes account for?
Account for at least 1/3 of the severe episodes and 2/3 of the deaths due to pneumonia
Name some interventions to reduce mortality of pneumonia.
Protection:
- nutritional counseling to improve breastfeeding practices
- reduce air pollution: cooking with charcoal, wood, dung
- reduce outdoor air pollution: trash burning, vehicles, industry
Prevention of pneumonia through:
- Hib vaccine, Pneumococcal conjugate vaccine
Case management of pneumonia:
- Oral and/or injectable antibiotics (potential for simplified antibiotic therapy)
- Oxygen therapy can be important for reducing mortality
How many under-five deaths every year are attributable to enteric diseases
500,000 U5 deaths every year
What are two pathways to mortality from enteric diseases?
Acute watery diarrhea –> dehydration
Undernutrition –> growth faltering –> eventual death, sometimes during bouts of pneumonia or malaria
What are two pathways to malnutrition from enteric diseases?
Chronic/recurrent diarrhea –> malnutrition
Environmental enteropathy –> reduced surface area of intestinal villae –> malabsorption –> malnutrition
What are some preventions for diarrheal diseases?
- improved sanitation, clean water
- separation of poultry from children
- vaccines
Describe case management for diarrhea episodes.
- Oral rehydration solution to prevent dehydration from loss of fluid and electrolytes
- Zinc supplementation especially where zinc deficiency is high
- Antibiotics for invasive diarrhea
Why is the discovery of oral rehydration solution (ORS) a really big deal?
- An inexpensive solution to a huge source of morbidity and mortality
- Estimated to reduce mortality from diarrhea by 93%
Why do salt and sugar treat diarrhea well?
Normal state: intestinal cells secrete and absorb sodium
Diarrheal state: normal mechanism of sodium absorption is impaired
What if you give water + saline? Causes more secretion of water, which is passed as stool
What if you give water + saline + glucose? Glucose-linked sodium absorption, accompanied by increased absorption of water & other electrolytes
What are some key interventions for malaria control?
- Long lasting insecticide-treated mosquito nets (LLINs)
- Indoor residual spraying
- Drain or manage larval habitats –> effectiveness depends on the local malaria vector. Sometimes it is not possible.
- Rapid diagnostic testing (RDT) –> early and appropriate treatment of malaria with artemisinin-based combinations (ACT), especially in U5
- Prevention and control of malaria in pregnancy (2-3 doses of intermittent preventative therapy after quickening
- Seasonal malaria chemoprevention –> areas of seasonal transmission (treat children monthly during 3-4 months of rainy seasons)
What is the double burden of malnutrition?
The simultaneous presence of both undernutrition and overnutrition within individuals, households, and populations.
What is undernutrition?
insufficient food intake and repeated infectious diseases
What is overnutrition?
Energy consumed in excess of needs, resulting in weight gain and associated metabolic issues
How many deaths is undernutrition responsible for globally in the U5 population?
undernutrition is an underlying cause of 45% of deaths in children U5
How does infectious disease affect undernutrition?
Infectious disease –> more likely to become undernourished (decreased appetite and poor absorption of nutrients)
What are the two types of undernutrition?
- Impaired physiological growth: Due to low intake of energy and other nutrients, or poor absorption/utilization. It is assessed by measuring body size: Stunting, wasting, underweight, mid-upper arm circumference (MUAC)
- Micronutrient deficiency (hidden hunger): Due to low intake of micronutrients, or poor absorption/utilization. It is assessed through biochemical indicators, clinical symptoms, and diet
What are the two main types of nutrients?
Macronutrients: Provides energy (protein, fat, carbohydrates)
Micronutrients: Do not provide energy, but are essential in small amounts for cellular functions (signaling, respiration, growth). Vitamins and minerals.
What are key micronutrients for public health?
Vitamin A: cell differentiation and growth, especially mucosal and immunological cells; eyesight
Iron: oxygen transport and cellular respiration, cognitive and motor development
Iodine: A component of thyroid hormone, which controls cellular metabolism, growth
Zinc: supports mucosal and immunological cells, wound healing
Folate: development of neural tube, assists with oxygen transport
What are some clinical symptoms of micronutrient deficiency?
- clinical symptoms of specific deficiencies indicate severe deficiency
other consequences: impaired immune system functioning, cognitive development, and physiological growth
What are the ABCDs of measuring nutritional status?
What are some forms of childhood nutrition?
What is the definition of stunting?
More than 2 deviations below the mean height for age of reference population, indicates chronic/long-term undernutrition
Caused by long term deficiency (or poor utilization/absorption) of calories, macronutrients, and/or micronutrients, leading to suboptimal linear growth over the long term
What is wasting?
More than 2 standard deviations below the mean weight for height of the reference population, indicates acute/short-term undernutrition.
Caused by short-term decrease in food intake, could be due to seasonal fluctuations in food supply
Why does stunting matter?
Maternal stunting associated with: difficult/obstructed labor, poor perinatal outcomes
Childhood stunting associated with: higher rates of morbidity and mortality and poor cognitive development
Stunting in general associated with: reduced human capital: less schooling, less economic productivity
What is Kwashiokor?
- Protein deficiency with adequate calorie intake
- Edema due to lack of albumin. Albumin is a protein that draws water out of intercellular spaces through osmosis.
- Primarily in children > 18 months
How do different stakeholders use anthropometric data?
Researchers: What do the indicators really tell us about health?
Donors: Where is the greatest need?
Technical organizations: Has progress been made as a result of implementing programs?
During the early stages of famine, which would you expect to see?
Increased rates of wasting
How do maternal and child care practices lead to undernutrition?
- Lack of exclusive breastfeeding, or infrequent breastfeeding due to parental work
- passive feeding
- intrahousehold food allocation
- care by siblings, grandparents
What is environmental enterpathy?
Reduced nutrient absorption due to chronic diarrhea (intestinal villi become blunted)
Name some nutrition-specific interventions for undernutrition.
Exclusive breastfeeding
Knowledge about complementary foods
Feeding style (i.e. responsive feeding)
Micronutrient supplementation
Fortification of the food supply
Special focus on first 1000 days of life, when nutritional deficiencies have disproportionately large impact
