1. Chapter Ten Child Health

2. The Importance of Child Health • 8.8 million children under the age of 5 die each year • Many of these deaths are preventable • Children are a particularly vulnerable population • Closely linked with poverty • Insufficient progress has been made in certain parts of the world in reducing childhood morbidity and mortality

3. Key Terms • Perinatal : first week of life • Neonatal : referring to the first month of life • Infant : referring to the first year of life • Under-5 : referring to children 0-4 years old

4. Table 10.2: Selected Terms Relating to Causes of Child Illness and Death

5. The Burden of Childhood Illness Children Under 5 Years • 99% of childhood deaths are in low- and middle-income countries • Half of these deaths occur in India, Nigeria, Democratic Republic of the Congo, Pakistan, and China • 41% of under-5 child deaths occur among neonates • Rates and causes vary across and within countries • General trend is decline, but rates of decline also vary considerably by region

6. Figure 10.1: Neonatal Mortality Rate, by WHO Region, 2004

7. Figure 10.2: Infant and Under-5 Mortality

8. Figure 10.4: Causes of Neonatal Deaths, by Percentage, 2008

9. Figure 10.5: Causes of Postneonatal Deaths in Children under 5, by Percentage, 2008

10. Table 10.3: Leading Causes of Under-5 Child Death for Selected WHO Regions, by Percentage, 2008

11. Figure 10.6: Declines in Under-5 Child Mortality, by Region, 1990-2008

12. Additional Comments on Selected Causes of Morbidity and Mortality Acute Respiratory Infections • Leading cause of death in low- and middle-income countries • More severe and cause higher rates of death in low- and middle-income countries than in high-income countries • Upper respiratory tract infections include the common cold and ear infections, lower respiratory infections include bronchiolitis and pneumonia

13. Additional Comments on Selected Causes of Morbidity and Mortality Diarrhea • Caused by bacteria, viruses, protozoa, and helminths • Causes dehydration, loss of nutrition or wasting, and damage to the intestines • Infants 6-11 months are particularly vulnerable because they have been introduced to unsafe water and foods

14. Additional Comments on Selected Causes of Morbidity and Mortality Malaria • 750,000 children die from malaria each year • A child in sub-Saharan Africa is likely to have a case every 40 days • Associated with premature birth and intrauterine growth retardation, which reduce chances of survival

15. Additional Comments on Selected Causes of Morbidity and Mortality HIV/AIDS • Can be transmitted from mother to child during birth or breastfeeding • Number of HIV-infected children has grown, particularly in sub-Saharan Africa

16. Additional Comments on Selected Causes of Morbidity and Mortality Measles • Acute respiratory infection with complications including pneumonia, diarrhea, encephalitis, and blindness • Children who are vitamin A deficient or infected with HIV are more at risk of death • Extremely contagious if a population is not vaccinated

17. Additional Comments on Neonatal Mortality • 41% of children under 5 who die annually, actually die in the first month • Little progress in reducing neonatal death rate • Every day that a child lives increases the likelihood that he or she will stay alive • To reduce childhood death rates, the world needs to focus more precisely on when the deaths occur

18. Risk Factors for Neonatal, Infant and Child Deaths • Nutrition status • Household income and education of mother • Access to trained healthcare provider to attend birth and provide counseling • Water quality and sanitation

19. The Cost and Consequences of Child Morbidity and Mortality • High costs of caring for a sick child • Potential long-term disability • Poor school attendance and performance

20. Addressing Key Challenges in Child Health • Progress has been largely between 1 and 5 years; very little has been made in reducing the death rate of neonates • Insufficient progress in sub-Saharan Africa and South Asia • Low-cost, highly effective interventions are not being implemented where they are needed most

21. Addressing Key Challenges in Child Health Critical Child Health Interventions • Ensuring nutrition and health of the mother and mother-to-be • Essential newborn care, extra care for small babies, and emergency care for newborns • Preventing and managing diarrhea with hygiene, proper nutrition, measles vaccinations, and ORT • Basic vaccinations

22. Addressing Key Challenges in Child Health Community-Based Approaches to Improving Child Health • Women’s groups to raise awareness of maternal, fetal, and neonatal issues • Community-based promotion of hygiene, umbilical cord care, and keeping the baby warm

23. Addressing Key Challenges in Child Health Integrated Management of Childhood Illness • Integrated healthcare approach for children because of many interrelated factors • Healthcare workers trained at all levels, particularly home and community-based