Lectures note on Reproductive heal3

1. College of Health and Medical sciences
Major Neonatal and Child health problems & services
Elias. A (BSc, MPH/RH)
For: Second year Health Officer students
1

2. learning objectives
At the end of this session student should be able
to:
• Understand the scope of the child health
problem
• Identify Why we focus on child health?
• Mention Major child health problems & the
wider context of causes
• Elucidate Strategies to deliver child health
services

3. Introduction
• A newborn infant, or neonate, is a child under 28 days
of age.
• A child is a human being below the age of 18 years
unless under the law applicable to the child majority is
attained earlier"(UNICEF)
• A child is a person 19 years or younger unless national
law defines a person to be an adult at an earlier
age(WHO).
• About 26 percent of the world's population were
under 15 years old…..40 % 0-14 Ethiopia.

4. Introduction
• Child health is a state of physical, mental, intellectual,
social and emotional well-being and not merely the
absence of disease or infirmity.
• Healthy children live in families, environments, and
communities that provide them with the opportunity to
reach their fullest developmental potential.
• Child health is foundational to adult health and well-
being.

5. Introduction ….
• The world has made substantial progress in reducing
child mortality in the past several decades.
• The total number of U5 deaths dropped to 5.6 million in
2016 from 12.6 million in 1990 – 15,000 every day
compared with 35,000 in 1990.
• Globally, the U5MR dropped to 41 deaths per 1,000 live
births in 2016 from 93 in 1990  56 per cent decline.

6. Cont’d…
• Regardless of the substantial progress in reducing child
mortality, child survival remains an urgent concern
• Of the 5.6 M child mortality, 2.6 million (46 per cent)
died in the first month of life.
• Even though the knowledge and technologies for life-
saving interventions (67%) are available children are
dying mostly from preventable causes and treatable
diseases

7. Cont’d…
• Inequities in child mortality across and within countries
remain large.
• Five countries accounted for half of all newborn deaths:
India, Pakistan, Nigeria, the Democratic Republic of the
Congo and Ethiopia.
• SSA remains the region with the highest U5MR in the
world. In 2016, the region had an average U5MR of 79
deaths per 1,000 live births
• 1 in 13 dying before his or her fifth birthday – 15 times
higher than the average ratio of 1 in 189 in high-income
countries

8.  Every year, more than 257,000 children under the age of
five die and 120,000 die in the neonatal period.
More than 60 percent of infant and 40 percent of under-
five deaths in Ethiopia are neonatal deaths.

9. Cont’d…
• Some common diseases do not have high case fatality
rate but do cause significant disability
– Vitamin A deficiency: leading cause of preventable
blindness world wide.
– Iodine deficiency anaemia: leading cause of mental
retardation with 43 million affected.
– Iron deficiency: affects >50% of the children
decreased IQ and poor school performance, anaemia
– Helminthic infections poor growth, anaemia and
decreasing learning

10. Why focus on child health?
• Children
– Represent the most vulnerable segment of the society
– Suffer disproportionately in terms of mortality risk
• Improvement in child health
– Good measures of societal progress
• Childhood illness
– Contribute substantially to the global burden of
disease
• Majority of childhood deaths
– Preventable or treatable with currently available
interventions

11. Recognizing risk factors affecting child
health and problems
• There is a limited list of factors that have the greatest
impact on the child health:
1. Low birth weight  20 times higher than NW
• 25 million LBW babies are born annually (95%)
• 13% weighed less than 2.5 kg at birth EDHS/
(22.5% Jimma, 17% Gondar)
• Improving the nutrition of women of child bearing
age translates into reduced risks of having LBW
babies.

12. Risk Cont’d…
2. Nutrition
 both the quantity and quality
 Malnutrition arise both from lack of availability of food
and from inequitable distribution of food within the
families.
 52 million children under 5 years of age are
wasted of whom 17 million are severely wasted
and 155 million are stunted, while 41 million are
overweight or obese.
 Around 45% of deaths are linked to under
nutrition.
 Early initiation, EBF and complementary feeding
 The quality of food and the amount of valuable
micronutrients it supplies and Supplementation

13. The prevalence of overweight
children remained low at 1%.

14. Risk Cont’d…
3. Environmental impact
• Significantly contribute to the incidence of child hood
mortality around the world
• Inadequate sanitation, poor housing conditions, lack of
proper personal hygiene, often aggravated by a scarcity
of water, increase the likelihood of developing diarrheal
diseases and pneumonia.
• Investing in clean water and sanitation is a critical
element in reducing the rate of childhood diarrhea

15. Risk Cont’d…
• Pneumonia is the single largest infectious cause of death
in children worldwide, killed 920 136 children under the
age of 5, accounting for 16% of all deaths.
• Pneumonia affects children and families everywhere, but
is most prevalent in South Asia and sub-Saharan Africa.
• In Ethiopia, it is estimated that 3,370,000 children
encounter pneumonia annually which contributes to 20
per cent of all causes of deaths killing over 40,000
under-five children every year.

16. Risk Cont’d…
• Diarrheal diseases: Diarrheal disease is the second
leading cause of death in children under five years old. It
is both preventable and treatable.
• Each year diarrhea kills around 525 000 children under
five globally.
• Diarrhea is a leading cause of malnutrition in children
under five years old.
• Acute childhood diarrhea is the leading cause of death
in children under five in Ethiopia.
• Magnitude of diarrhea among children younger than 5
years old in different regions of the country ranges from
18 to 31%

17. Risk Cont’d…
4. Poverty and inequality
– Poverty is associated with mortality
– Geographic, economic and cultural accessibility to
services by mothers

18. Risk Cont’d…
• Vaccines are available for some of the most deadly
childhood diseases
– Measles, polio, diphtheria, tetanus, and pertussis,
pneumonia due to Haemophilius influenzae type B
and Streptococcus pneumonia and diarrhoea due to
rotavirus.
– Vaccines can protect children from illness and death.
– 19.5 million unvaccinated children /

19. Risk Cont’d…
• Measles is one of the leading causes of death among
young children even though a safe and cost-effective
vaccine is available.
• In 2016, there were 89 780 measles deaths globally.
• 134,200 estimated deaths from measles in 2015 (15
deaths every hour)
• An estimated 19.5 million infants worldwide are still
missing out on basic vaccines.
• 69 percent, EDHS 2016

20. Risk Cont’d…
• HIV/AIDS in children
– There was a 70% decline in the number of new HIV
infections among children between 2000 and 2015.
– About 150 000 children became infected with HIV in 2015,
down from 490 000 in 2000. About 110000 died AIDS
related illness.
– The risk of a mother living with HIV passing the virus to
her child can be reduced to 5% or less if she has access to
effective antiretroviral therapy during pregnancy, delivery
and breastfeeding.
– Children aged 0 to 14 living with HIV-62 000

21. Risk Cont’d…
• Preterm birth, intrapartum-related complications(birth
asphyxia or lack of breathing at birth), and infections
cause most neonatal deaths.
• From the end of the neonatal period and through the
first 5 years of life, the main causes of death are
pneumonia(15%), diarrhea (9%)and malaria (7%).
• Malnutrition is the underlying contributing factor, making
children more vulnerable to severe diseases.

23. Risk Cont’d…
• Prior to birth,
– a mother can increase her child's chance of survival
and good health by attending antenatal care
consultations,
– being immunized against tetanus,
– avoiding smoking and use of alcohol.

24. Risk Cont’d…
• At the time of birth, a baby's chance of survival
increases significantly with delivery in a health facility in
the presence of a skilled birth attendant.
• After birth, essential care of a newborn should include:
– ensuring that the baby is breathing;
– starting the newborn on exclusive breastfeeding right
away;
– keeping the baby warm; and
– washing hands before touching the baby.
• Sick babies must be taken immediately to a trained
health care provider.

25. Strategic directions
• Delivery platforms
• Integrated delivery of services
• Quality of services
• Promoting equity
• Innovations

28. Global initiatives and action plans to achieve
2015-30 targets
1. Moving beyond 2015, the global community has set
goals and targets for tackling the unfinished child
survival agenda to achieve under 5 mortality of 25 or less
per 1000 live births by 2030
2. Ending Preventable Maternal Mortality”
3. Every Newborn Action Plan” to promote universal
coverage of high quality maternal and newborn care
4. Global Action Plan for the Prevention and Treatment of
pneumonia and diarrhea
5. Comprehensive Implementation Plan on Maternal, and
Infant and Young Child Nutrition” to reduce under
nutrition and obesity

29. Cont’d…
1. Global Technical Strategy for Malaria to reduce global
malaria case incidence and mortality by 2030
2. Global Vaccine Action Plan to prevent childhood
diseases through vaccination by 2030

30. Ethiopia
• National Strategy for Newborn and Child
Survival in Ethiopia 2015/16-2019/20
• Reduce
– U5M 64/1,000 (2013 level) to at least 29 /1,000,
– IMR from 44/1000 to 20/1000 and
– NMR from 28 to 11/1,000 by 2020.

31. Guiding principles
• equity and accessibility;
• community engagement,
• empowerment and ownership;
• efficient use of resources;
• Innovation and use of evidence based
interventions,
• provision of quality MNCH services,
• strong monitoring and dissemination of best
practices.

32. Cont’d…
• A package of 34 high impact and cost effective
newborn and child survival interventions are
prioritized with coverage targets for 2019/20.