Dr. Hellen Mwuara

1. WID 701 – Tropical Pediatrics
and Maternal Health
Introduction with reference to NMCH situation in Kenya

2. SDG – 3 targets on pediatric and maternal health
• 3.1 By 2030, reduce the global and national MMR to less than 70 deaths and 140
deaths per 100,000 live births respectively.
• 3.2 By 2030, end preventable deaths of newborns and children under 5 years of
age, with all countries aiming to reduce neonatal mortality to at least as low as 12
per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live
births.
• 3.7 By 2030, ensure universal access to sexual and reproductive health-care
services, including for family planning, information and education, and the
integration of reproductive health into national strategies and programmes.

3. A. Overview of Tropical Pediatrics-
Definition and scope
• Tropical pediatrics is the study and management of pediatric health conditions that are
prevalent in tropical regions; characterized by unique environmental, socio-economic,
and infectious disease patterns.
• It focuses on the prevention, diagnosis, and treatment of pediatric diseases commonly
found in tropical areas.
Importance of studying tropical pediatrics in the context of infectious diseases:
• Tropical regions are affected by infectious diseases such as malaria, dengue fever, and
diarrheal diseases, which pose significant health risks to children.
• Understanding the specific challenges and considerations in managing these diseases is
crucial for healthcare professionals working in tropical areas.
Key challenges and unique aspects of tropical pediatrics:
• High burden of infectious diseases with specific epidemiological patterns.
• Limited healthcare resources and infrastructure.
• Socio-cultural factors influencing healthcare-seeking behavior and treatment adherence.

4. Neonatal mortality facts
• The first month of life is the most vulnerable period for child survival
• 2.4 million newborns died in 2020.
• In 2020, nearly half (47%) of all under-5 deaths occurred in the newborn period (the first 28 days
of life).
• Sub-Saharan Africa has the highest neonatal mortality rate in the world (43%) followed by central
and southern Asia with 36% of global newborn deaths.
• Preterm birth, intrapartum-related complications (birth asphyxia or inability to breathe at birth),
infections and birth defects are the leading causes of most neonatal deaths.
• Neonatal mortality result from lack of quality care at or immediately after birth and in the first
days of life.
• In 2021, the number of completely unvaccinated children increased by 5 million since 2019.

5. Common pediatric morbidities
1. Mosquito transmitted diseases –Malaria and Dengue fever
2. Diarrhea diseases – Rota virus, Cholera
3. HIV and other STIs ( transmission of mother to child)
4. Immunizable childhood diseases
5. Non communicable diseases
6. Accidents and poisons

6. Maternal health
• Maternal health focuses on the well-being and healthcare of women during pregnancy, childbirth, and the
postpartum period.
• It encompasses physical, mental, and social aspects of a woman's health during her reproductive journey.
Key components:
• Access to prenatal care
• Skilled attendance at birth
• Essential obstetric and neonatal care
• Postnatal care
• Family planning services
Goals:
• Ensure safe pregnancies and minimize risks for both mother and baby.
• Promote positive outcomes for maternal and child health.
Efforts include:
• Providing quality healthcare services and adequate nutrition.
• Offering antenatal care, regular check-ups, and information.
• Addressing pre-existing conditions and pregnancy-related complications.
• Emergency obstetric care.
• Promoting healthy behaviors and practices.

7. Facts on maternal health (WHO)
• Every day in 2020, almost 800 women died
from preventable causes related to pregnancy
and childbirth.
• A maternal death occurred almost every two
minutes in 2020.
• Between 2000 and 2020, the maternal
mortality ratio (MMR, number of maternal
deaths per 100 000 live births) dropped by
about 34% worldwide.
• Almost 95% of all maternal deaths occurred in
low and lower middle-income countries in
2020.
• MMR is worst in the Sub – Saharan Africa
• Care by skilled health professionals before,
during and after childbirth can save the lives
of women and newborns.

8. Key terminologies in maternal health
Maternal mortality rate: The number of maternal deaths per 100,000 live
births.
Maternal morbidity rate: The prevalence of maternal complications during
pregnancy, childbirth, and the postpartum period.
Antenatal care coverage: The proportion of pregnant women who receive
antenatal care services.
Skilled birth attendance: The percentage of deliveries attended by skilled
healthcare professionals.
Contraceptive prevalence rate: The percentage of women of reproductive
age using contraception.
Infectious diseases: HIV and other STIs

9. Maternal health in the tropics
Addressing maternal mortality and morbidity in tropical regions: -
• Tropical regions often face high maternal mortality rates due to
inadequate access to healthcare, poor infrastructure, and limited
resources.
• Key maternal health indicators in tropical settings: - Maternal
mortality rate, maternal morbidity rate, antenatal care coverage,
skilled birth attendance, and contraceptive prevalence rate.

10. Objectives and Targets of WHO
1. To reduce maternal morbidity and mortality due to pregnancy and child birth
2. To reduce morbidity and mortality due to unsafe abortion
3. To reduce perinatal and neonatal morbidity and mortality
4. To promote reproductive health awareness for young children
5. To increase knowledge of reproductive biology and promote responsible behaviour of
adolescents regarding contraception, safe sex and prevention of sexually transmitted
infections.
6. To reduce the levels of unwanted pregnancies in all women of reproductive age.
7. To reduce the incidence and prevalence of sexually transmitted infections, in order to reduce
the transmission of HIV infection.
8. To reduce the incidence and prevalence of cervical cancer
9. To reduce female genital mutilation and provide approparaite care for females who have
already undergone genital mutilation
10. To reduce domestic and sexual violence and ensure proper mananagment of the victims.

11. Scope of maternal health in this study
• STIs
• HIV and PMTCT in the tropics
• Malaria in Pregnancy
• Schistosomiasis and related infections
• Non- communicable diseases
• Breastfeeding and mal-nutrition
• One- Health approach on maternal health.

12. MNCH situation in Kenya
• There is a slow decline in maternal,
neonatal and child mortality rates.
• The rate of decline is sub-optimal for
attainment of SDG targets.

13. Barriers to utilization of MNC health services
in kenya
3 broad categories
1. Personal
2. Community
3. Health facility

14. Major causes of maternal mortality in Kenya
1. Haemorrhage
2. sepsis,
3. eclampsia,
4. obstructed labour
5. Raptured uterus
6. unsafe abortion
Note : Unsafe abortion practices alone cause at least a third of all
maternal deaths.

15. Indicators of pediatric and maternal health
Classification Indicator
1.Direct indicators (infectious diseases) · Malaria
· TB
· HIV
2. Indirect indicators · Distance to a health facility
· Delivery by skilled professional
· Health facility delivery
· Attendance to ANC clinic
· Attendance to PNC clinic
· Birth intervals
· Total fertility
3. Social demographic indicators- · Education
· Religion
· Residence
4. Traditional/cultural indicator · FGM
· Autonomy of women
· Gender-based violence
· Teenage mothers

16. MMR and heath facility services in Kenya

17. Social demographic indicators in Kenya
• Disparities in distribution of
wealth and education in Kenya.
• This distribution is associated with
differentiated maternal mortality
rates
• Wealth and Education attainment
impede on uptake of health
facility services
• Also affects parity and
contraception uptake

18. Cultural/traditional indicators in kenya
• Heterogeneous distribution
across provinces
• Largest MMR in North Eastern,
• FGM prevalence is highest in NE
and Nyanza provinces.
• Teenage mothers are most
prevalent in marginalized
communities, and Modern cities
• Compromised autonomy calls for
male-partner involvement in ANC
and other interventions

19. Pediatric health interventions in kenya
1. Expanded Program on Immunization (EPI): provides routine immunizations, including vaccines for
diseases such as measles, polio, tuberculosis, and diphtheria.
2. Integrated Management of Childhood Illness (IMCI): ntegrating the prevention, diagnosis, and
management of common childhood illnesses.
3. Prevention of Mother-to-Child Transmission of HIV (PMTCT): This includes providing antiretroviral therapy
to HIV-positive pregnant women, HIV testing for infants, and support for HIV-exposed children.
4. Community-based Nutrition Programs: provide nutritional counseling, supplementation, and support to
mothers and caregivers to ensure adequate nutrition for children.
5. Integrated Early Childhood Development (ECD): promote holistic development in children, focusing on
health, nutrition, early learning, and social-emotional well-being. These programs provide age-
appropriate stimulation, nutrition support, and parenting education.
6. Prevention and Treatment of Malaria: the distribution of insecticide-treated bed nets, indoor residual
spraying, and prompt diagnosis and treatment of malaria cases.
7. School Health Programs: including deworming campaigns, health education, and provision of sanitary
facilities.
8. Child Injury Prevention: including road safety campaigns, childproofing homes, and raising awareness
about hazards such as burns, drowning, and falls.
9. Integrated Management of Acute Malnutrition (IMAM): These programs include screening, therapeutic
feeding, and counseling for caregivers.
10. Child Welfare Services: - child protection, foster care, and adoption programs, to ensure the well-being
and safety of vulnerable children.

20. Maternal health interventions in kenya
1. Free Maternal Healthcare Policy (2013):
2. Strengthening of Health Systems:.
3. Expansion of Maternity Waiting Homes:
4. Promotion of Skilled Birth Attendance:
5. Community Health Workers:
6. Mobile Health (mHealth) Initiatives:
7. Family Planning Services:.
8. Maternal Death Surveillance and Response (MDSR) System.
9. Integration of HIV and Maternal Health Services:

21. Conclusion
• Kenya is still far from achieving SDG targets
• Sub-optimal improvement besides the many interventions
• A call for targeted [Evidence based ] interventions at sub- national
level