The document provides an overview of child health issues globally and in South Africa. It discusses the major causes of child mortality worldwide, which include neonatal deaths, malaria, diarrhea, and pneumonia. It also outlines key international conventions related to child health, such as the Millennium Development Goals, which aim to reduce child mortality rates by two-thirds by 2015. Additionally, it addresses challenges facing child health in South Africa, where under-five mortality is increasing due to HIV, and neonatal mortality accounts for about 30% of under-five deaths annually.
Matthew Holt analyzed several forecasts and scenarios related to health care spending and insurance coverage in the United States. His analysis showed that forecasts from 2010 underestimated the number of uninsured Americans and overestimated per capita health care spending. Reform after 2010 led to fewer uninsured Americans but health care spending as a share of GDP remained higher than predicted. Without reform, more Americans would be uninsured and health care costs would continue to rise rapidly.
A peek into "The Power of Data" with specific ref to Supply-chain where lots of data is generated by the minute & Teams are busy fire -fighting every moment !!
T.S. Eliot was a revolutionary literary critic in the 20th century. He recognized the greatness of metaphysical poets from the 17th century, which led to their revival. Eliot also renewed interest in Jacobean dramatists through his essays. His criticism of Dante aroused curiosity in the late middle ages. Eliot believed the role of criticism was to bring adjustment between old and new works, and to reorder poets and poems from time to time. As a critic, he had a strong historical sense and views on art, depersonalization, and poetry.
The document discusses using storytelling to teach simple verbs to students of English as a second language. It describes how storytelling incorporates listening, speaking, reading and writing skills. Through listening to stories, students learn new verbs which the teacher writes on the board. Students then look up the meanings and write them in their notebooks, improving their reading and writing. The teacher asks students questions about the story to encourage speaking practice. This self-learning approach builds confidence without explicitly teaching grammar rules. The teacher should make the story visually clear and highlight example sentences to reinforce learning.
Politics of difference in 'Waiting for Barbarians'bhavnabaraiya
This document appears to be notes for a paper on the topic of politics of difference in the novel Waiting for Barbarians. The notes discuss binary oppositions between white and African culture and religious differences. It also examines who or what constitutes a "barbarian" in the context of the novel, focusing on the character Colonel Joll and differences between dominant and minority groups.
Eklavya was a Nishada prince who revered Dronacharya as his guru despite being from a lower caste. He learned archery on his own by creating a clay image of Dronacharya and practicing excessively. However, when Eklavya's skills surpassed Dronacharya's star pupil Arjuna, Dronacharya demanded Eklavya's right thumb as guru dakshina. This highlights the marginalization of lower castes in ancient India and questions the type of role models society creates when differences in caste persist in practical life.
Matthew Holt analyzed several forecasts and scenarios related to health care spending and insurance coverage in the United States. His analysis showed that forecasts from 2010 underestimated the number of uninsured Americans and overestimated per capita health care spending. Reform after 2010 led to fewer uninsured Americans but health care spending as a share of GDP remained higher than predicted. Without reform, more Americans would be uninsured and health care costs would continue to rise rapidly.
A peek into "The Power of Data" with specific ref to Supply-chain where lots of data is generated by the minute & Teams are busy fire -fighting every moment !!
T.S. Eliot was a revolutionary literary critic in the 20th century. He recognized the greatness of metaphysical poets from the 17th century, which led to their revival. Eliot also renewed interest in Jacobean dramatists through his essays. His criticism of Dante aroused curiosity in the late middle ages. Eliot believed the role of criticism was to bring adjustment between old and new works, and to reorder poets and poems from time to time. As a critic, he had a strong historical sense and views on art, depersonalization, and poetry.
The document discusses using storytelling to teach simple verbs to students of English as a second language. It describes how storytelling incorporates listening, speaking, reading and writing skills. Through listening to stories, students learn new verbs which the teacher writes on the board. Students then look up the meanings and write them in their notebooks, improving their reading and writing. The teacher asks students questions about the story to encourage speaking practice. This self-learning approach builds confidence without explicitly teaching grammar rules. The teacher should make the story visually clear and highlight example sentences to reinforce learning.
Politics of difference in 'Waiting for Barbarians'bhavnabaraiya
This document appears to be notes for a paper on the topic of politics of difference in the novel Waiting for Barbarians. The notes discuss binary oppositions between white and African culture and religious differences. It also examines who or what constitutes a "barbarian" in the context of the novel, focusing on the character Colonel Joll and differences between dominant and minority groups.
Eklavya was a Nishada prince who revered Dronacharya as his guru despite being from a lower caste. He learned archery on his own by creating a clay image of Dronacharya and practicing excessively. However, when Eklavya's skills surpassed Dronacharya's star pupil Arjuna, Dronacharya demanded Eklavya's right thumb as guru dakshina. This highlights the marginalization of lower castes in ancient India and questions the type of role models society creates when differences in caste persist in practical life.
Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eas...Global Bridges
Presentation by Feras Hawari, M.D., a pulmonologist and the Global Bridges regional director for the Eastern Mediterranean region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
This document discusses improving healthcare access and quality for children in low-resource countries. It notes that the main causes of child mortality have not changed significantly in decades. Hospital care is often of low quality, with many pediatric deaths due to avoidable issues. A WHO assessment tool is used to evaluate hospital quality, identifying critical areas in need of improvement. Focusing on standards, measurements, driving quality improvement and child-friendly services can help reduce unnecessary child deaths due to low quality care.
A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.
Germany faces challenges from an aging population and increasing rates of non-communicable diseases. Strategies to address this include expanding long-term care options, training more geriatric specialists, promoting lifelong learning and deferred retirement, strengthening prevention of infectious diseases, and shifting to individualized and multi-cause approaches in medicine. However, implementing personalized healthcare poses cost challenges that require country-specific solutions.
This document summarizes data on the economics of obesity and obesity interventions in the United States. It presents 8 exhibits that show: 1) The rise of obesity rates in the US from 1961-2008; 2) Projected obesity rates under optimistic and pessimistic scenarios; 3) International comparisons of overweight rates over time; 4) Increased healthcare spending associated with obesity by payer and service; 5) Estimated cost per quality-adjusted life year saved of different obesity interventions; and 6) The interaction between medicine and economics as it relates to cost and clinical effectiveness. The document analyzes obesity trends, economic costs, and cost-effectiveness of various policy options to address obesity at individual and societal levels.
1. Demography is the study of population statistics like size, density, and age distribution. It uses metrics like birth and death rates to understand factors influencing population growth or decline.
2. Key factors that affect human population growth are birth rates, death rates, economic development, access to family planning and women's education. The demographic transition model describes the shift from high birth/death rates to low rates as countries develop.
3. Population pyramids provide information on a population's age structure and future growth trends based on the proportion of people of reproductive age. Achieving population stabilization requires increasing access to healthcare, family planning and women's education.
Progress, Challenges and Opportunities for Vaccines to Reduce Under-5 Childho...Sara Berlanda
In this slideset, Professor Shabir Madhi, WAidid board member, analyses the trends in global and sub-Saharan Africa under-5 childhood mortality, to then demonstrate the contribution of new childhood vaccines in reducing under-5/neonatal morbidity and mortality by vaccination.
To learn more, visit www.waidid.org!
The document discusses cardiometabolic risk and its contributing factors such as metabolic syndrome, hypertension, diabetes, age, gender, smoking, and genetic factors. It shows increases in obesity rates in the US from 1960-2000 and estimates that the worldwide prevalence of diabetes will nearly double from 2000 to 2030. It also outlines the concept of positive energy balance, interactions between organs and the central nervous system in regulating food intake, and how total energy expenditure is affected by physical activity and exercise.
Hiv Drug Distribution in developing countries.hitjl
This presentation is a school work and represents student ideas and analysis ( safe harbor).
Perrine Dieusaert, Malam Aboubakar and I, presented it in January 2009.
Gardasil - Do we need Cervical Cancer Vaccine in India?Gaurav Gupta
The document provides an overview of HPV disease and the case for HPV vaccination. It discusses the high global and Indian disease burden of cervical cancer caused by HPV, with India accounting for over 27% of new cervical cancer cases and deaths worldwide despite having a small fraction of the global population. Clinical trial data demonstrates over 90% efficacy of the quadrivalent HPV vaccine in preventing cervical, vulvar, vaginal, and anal cancers and genital warts caused by HPV types 6, 11, 16, and 18. Long-term follow up studies show sustained immune memory response and protection for over 7 years. Worldwide and Indian guidelines recommend HPV vaccination for girls aged 9-14 years.
Accelerating innovation globally prof. dr. Mark Harris Intel - L'Internet du ...TelecomValley
This document discusses several pressing global challenges including climate change, energy supply and demand, water scarcity, food production, an aging society, and security issues related to increasing digital connectivity. It notes the urgency of addressing climate change through policy changes to halt rising greenhouse gas emissions in the next 10 years. To meet these challenges, the document argues that innovation must accelerate from an incremental, sustaining model to a revolutionary model. It also discusses opportunities for entrepreneurship and the need to close innovation gaps between the US and Europe.
The Democratic Republic of Congo experienced a civil war from 1997-2003 and still suffers humanitarian effects. A mortality survey from 2006-2007 found that over 99% of deaths were from preventable and treatable infectious diseases and malnutrition rather than violence. Diseases like fever/malaria, diarrhea, measles and respiratory infections caused over 60% of deaths. Fever/malaria alone caused 34% of deaths. Children under 5, who make up only 19% of the population, accounted for nearly 50% of deaths. The crisis in DR Congo remains underreported.
Empowerment for women and girls and the millennium development goalsArletty Pinel
This document discusses empowerment for women and girls and the Millennium Development Goals. It provides statistics on population and development in Asia, as well as facts about HIV/AIDS, gender-based violence, and maternal and child mortality in the region. The document outlines strategies to reduce maternal mortality through universal access to family planning, skilled birth attendance, and emergency obstetric care. It discusses how maternal mortality is an indicator of exclusion and disempowerment. The document also describes global initiatives and campaigns aimed at improving maternal and child health to achieve the MDGs, such as the Partnership for Maternal, Newborn and Child Health and the Deliver Now for Women and Children advocacy drive.
European Hematology Association Annual Congress 2011: Patient Advocacy Session on "Adherence:Are You Sure your Patients Are taking Their Medicines?", presented by Giora Sharf, Co-founder, CML Advocates Network
11% Federation
4%
The document summarizes global progress in reducing preventable child deaths. It notes that the global under-five mortality rate has fallen 41% from 1990 to 2011. However, sub-Saharan Africa and South Asia still account for the majority of under-five deaths. Half of global under-five deaths in 2010 occurred in just 5 countries: India, Nigeria, Democratic Republic of Congo, Pakistan, and China. While progress has been made in reducing deaths from preventable causes like pneumonia, diarrhea and malaria, more work is still needed to address disparities and strengthen community-based healthcare.
Data presentation on global trends in immunisation, health and development. The presentation included a summary of the issues Gavi was created to address and how the results of its work are manifested in different countries.
Goat value chains in Shinelle district, Somali zone, Ethiopia: Results of a r...ILRI
Presented by Hasen Abdurahman at the Multi-stakeholder Workshop for Targeting Action Research on Lowland Sheep and Goat Value Chains in Ethiopia, Debre Zeit, 1-2 April 2013
Research priorities to ensure better equity for childrenUnicefMaroc
Présentation de Gordon Alexander, Directeur de la recherche, l’UNICEF, à la Conférence Internationale d'Experts sur la mesure et les approches politiques pour améliorer l'équité pour les nouvelles générations dans la région MENA à Rabat, Maroc du 22 au 23 mai 2012.
The document discusses strategies used by IITA to address virus threats to food crops in sub-Saharan Africa. It focuses on cassava, describing efforts to characterize cassava mosaic viruses, understand their diversity and epidemiology. This includes tracking the spread of the recombinant EACMV-UG virus across countries. Research is also presented on developing diagnostic tools and investigating host resistance and alternative virus hosts. The approach involves interdisciplinary collaboration between virology, plant breeding, biotechnology and other fields.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eas...Global Bridges
Presentation by Feras Hawari, M.D., a pulmonologist and the Global Bridges regional director for the Eastern Mediterranean region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
This document discusses improving healthcare access and quality for children in low-resource countries. It notes that the main causes of child mortality have not changed significantly in decades. Hospital care is often of low quality, with many pediatric deaths due to avoidable issues. A WHO assessment tool is used to evaluate hospital quality, identifying critical areas in need of improvement. Focusing on standards, measurements, driving quality improvement and child-friendly services can help reduce unnecessary child deaths due to low quality care.
A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.
Germany faces challenges from an aging population and increasing rates of non-communicable diseases. Strategies to address this include expanding long-term care options, training more geriatric specialists, promoting lifelong learning and deferred retirement, strengthening prevention of infectious diseases, and shifting to individualized and multi-cause approaches in medicine. However, implementing personalized healthcare poses cost challenges that require country-specific solutions.
This document summarizes data on the economics of obesity and obesity interventions in the United States. It presents 8 exhibits that show: 1) The rise of obesity rates in the US from 1961-2008; 2) Projected obesity rates under optimistic and pessimistic scenarios; 3) International comparisons of overweight rates over time; 4) Increased healthcare spending associated with obesity by payer and service; 5) Estimated cost per quality-adjusted life year saved of different obesity interventions; and 6) The interaction between medicine and economics as it relates to cost and clinical effectiveness. The document analyzes obesity trends, economic costs, and cost-effectiveness of various policy options to address obesity at individual and societal levels.
1. Demography is the study of population statistics like size, density, and age distribution. It uses metrics like birth and death rates to understand factors influencing population growth or decline.
2. Key factors that affect human population growth are birth rates, death rates, economic development, access to family planning and women's education. The demographic transition model describes the shift from high birth/death rates to low rates as countries develop.
3. Population pyramids provide information on a population's age structure and future growth trends based on the proportion of people of reproductive age. Achieving population stabilization requires increasing access to healthcare, family planning and women's education.
Progress, Challenges and Opportunities for Vaccines to Reduce Under-5 Childho...Sara Berlanda
In this slideset, Professor Shabir Madhi, WAidid board member, analyses the trends in global and sub-Saharan Africa under-5 childhood mortality, to then demonstrate the contribution of new childhood vaccines in reducing under-5/neonatal morbidity and mortality by vaccination.
To learn more, visit www.waidid.org!
The document discusses cardiometabolic risk and its contributing factors such as metabolic syndrome, hypertension, diabetes, age, gender, smoking, and genetic factors. It shows increases in obesity rates in the US from 1960-2000 and estimates that the worldwide prevalence of diabetes will nearly double from 2000 to 2030. It also outlines the concept of positive energy balance, interactions between organs and the central nervous system in regulating food intake, and how total energy expenditure is affected by physical activity and exercise.
Hiv Drug Distribution in developing countries.hitjl
This presentation is a school work and represents student ideas and analysis ( safe harbor).
Perrine Dieusaert, Malam Aboubakar and I, presented it in January 2009.
Gardasil - Do we need Cervical Cancer Vaccine in India?Gaurav Gupta
The document provides an overview of HPV disease and the case for HPV vaccination. It discusses the high global and Indian disease burden of cervical cancer caused by HPV, with India accounting for over 27% of new cervical cancer cases and deaths worldwide despite having a small fraction of the global population. Clinical trial data demonstrates over 90% efficacy of the quadrivalent HPV vaccine in preventing cervical, vulvar, vaginal, and anal cancers and genital warts caused by HPV types 6, 11, 16, and 18. Long-term follow up studies show sustained immune memory response and protection for over 7 years. Worldwide and Indian guidelines recommend HPV vaccination for girls aged 9-14 years.
Accelerating innovation globally prof. dr. Mark Harris Intel - L'Internet du ...TelecomValley
This document discusses several pressing global challenges including climate change, energy supply and demand, water scarcity, food production, an aging society, and security issues related to increasing digital connectivity. It notes the urgency of addressing climate change through policy changes to halt rising greenhouse gas emissions in the next 10 years. To meet these challenges, the document argues that innovation must accelerate from an incremental, sustaining model to a revolutionary model. It also discusses opportunities for entrepreneurship and the need to close innovation gaps between the US and Europe.
The Democratic Republic of Congo experienced a civil war from 1997-2003 and still suffers humanitarian effects. A mortality survey from 2006-2007 found that over 99% of deaths were from preventable and treatable infectious diseases and malnutrition rather than violence. Diseases like fever/malaria, diarrhea, measles and respiratory infections caused over 60% of deaths. Fever/malaria alone caused 34% of deaths. Children under 5, who make up only 19% of the population, accounted for nearly 50% of deaths. The crisis in DR Congo remains underreported.
Empowerment for women and girls and the millennium development goalsArletty Pinel
This document discusses empowerment for women and girls and the Millennium Development Goals. It provides statistics on population and development in Asia, as well as facts about HIV/AIDS, gender-based violence, and maternal and child mortality in the region. The document outlines strategies to reduce maternal mortality through universal access to family planning, skilled birth attendance, and emergency obstetric care. It discusses how maternal mortality is an indicator of exclusion and disempowerment. The document also describes global initiatives and campaigns aimed at improving maternal and child health to achieve the MDGs, such as the Partnership for Maternal, Newborn and Child Health and the Deliver Now for Women and Children advocacy drive.
European Hematology Association Annual Congress 2011: Patient Advocacy Session on "Adherence:Are You Sure your Patients Are taking Their Medicines?", presented by Giora Sharf, Co-founder, CML Advocates Network
11% Federation
4%
The document summarizes global progress in reducing preventable child deaths. It notes that the global under-five mortality rate has fallen 41% from 1990 to 2011. However, sub-Saharan Africa and South Asia still account for the majority of under-five deaths. Half of global under-five deaths in 2010 occurred in just 5 countries: India, Nigeria, Democratic Republic of Congo, Pakistan, and China. While progress has been made in reducing deaths from preventable causes like pneumonia, diarrhea and malaria, more work is still needed to address disparities and strengthen community-based healthcare.
Data presentation on global trends in immunisation, health and development. The presentation included a summary of the issues Gavi was created to address and how the results of its work are manifested in different countries.
Goat value chains in Shinelle district, Somali zone, Ethiopia: Results of a r...ILRI
Presented by Hasen Abdurahman at the Multi-stakeholder Workshop for Targeting Action Research on Lowland Sheep and Goat Value Chains in Ethiopia, Debre Zeit, 1-2 April 2013
Research priorities to ensure better equity for childrenUnicefMaroc
Présentation de Gordon Alexander, Directeur de la recherche, l’UNICEF, à la Conférence Internationale d'Experts sur la mesure et les approches politiques pour améliorer l'équité pour les nouvelles générations dans la région MENA à Rabat, Maroc du 22 au 23 mai 2012.
The document discusses strategies used by IITA to address virus threats to food crops in sub-Saharan Africa. It focuses on cassava, describing efforts to characterize cassava mosaic viruses, understand their diversity and epidemiology. This includes tracking the spread of the recombinant EACMV-UG virus across countries. Research is also presented on developing diagnostic tools and investigating host resistance and alternative virus hosts. The approach involves interdisciplinary collaboration between virology, plant breeding, biotechnology and other fields.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Child Health: Overview
Dr E Malek, Principal Specialist
Department of Paediatrics, University
of Pretoria, Witbank Hospital
emalek@postino.up.ac.za
2. Acknowledgements
• Dr Joy Lawn (Save the Children Fund)
• DR Lesley Bamford (National DOH)
• Dr Debbie Bradshaw (MRC NBD unit)
• Prof T Duke (CICH, University of Melbourne)
• Dr M Weber (WHO-CAH, Geneva)
• Dr N McKerrow (PMB Hospital)
• DR Macharia (UNICEF, Pretoria)
• Dr N Rollins (UKZN)
• DR C Sutton (MEDUNSA, Polokwane)
4. Global Context (1)
• Child Health Inequity
• Causes of global child mortality
• Child disability and development
• Neonatal Health
• Adolescent Health
• Children in complex emergencies
• Effect of poor child health on communities
5. Global Context (2)
• Child Health in context of Maternal Health
• International Conventions and child health
• Evidence for effective intervention in
reducing child mortality
• Pathways to & principles of global child
health
6.
7.
8. 10 million child deaths
– Why?
HIV/AIDS
Measles Injuries
3%
4% 3%
For these 4 Malaria
causes, ~ 8% Neonatal
53% of deaths
deaths are 36%
malnourish
ed children Diarrhoea
17%
AIDS is much bigger
proportion in Southern Pneumonia Other
Africa. 19% 10%
Source: Bryce J et al for the Child Health Epidemiology Reference Group. The Lancet, March 2005. As used in WHR 2005
9. 4 million newborn deaths –
Why?
60 to 90% of
neonatal deaths
are in low birth
weight babies,
mostly preterm
Three causes
account for 86%
of all neonatal
deaths
Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. for 192 countries based on cause specific mortality
data and multi cause modelled estimates. As used in World Health Report 2005
10. Under five mortality rates: Trends from 1990-
2000
200
181 1990
180 175
Least 2000
reduction
160 3%
U5MR (deaths per 1000 births)
140
128
120
100
100
Greatest
80 reduction
80 32%
64
58
60 53
44 45
37 38
40
20
9 6
0
Sub-Saharan South Asia Middle East & East Asia and Latin America CEE/CIS and Industrialized
Africa North Africa Pacific & Caribbean Baltics countries
Source: UNICEF, 2001 Slide: Ngashi Ngongo
11.
12.
13.
14.
15.
16. International Conventions
• Declaration of Alma Ata: “Health for All by
the year 2000”
• UN Convention of the Rights of the Child
(1990)
• UN Millenium Development Goals (MDGs)
17. Millennium Development Goals
(MDGs)
1. Eradicate extreme 5. Reduce MMR by three
poverty and hunger quarters
2. Achieve universal 6. Combat HIV/AIDS,
primary education malaria
and other diseases
3. Promote gender
7. Ensure environmental
equality sustainability
and empowerment of
women 8. Develop global
partnerships
4. Reduce child mortality for development
by two thirds
18.
19.
20.
21. Integrated Management of
Chilldhood Illness (IMCI)
Assess and classify
Department of Child and Adolescent Health
and Development
23. WHO Initiatives to improve
quality of care for children at
hospital level:
state of the art and prospects
Martin Weber, Harry Campbell, Susanne Carai,
Trevor Duke, Mike English, Giorgio Tamburlini
25th International Congress of Paediatrics,
Athens, 25-30 August 2007
27. Child Health in South Africa
• Child Health Inequity
• Causes of Child Mortality
• Neonatal Health
• National interventions for improving child
health
• Children’s Act (Amendment Bill: 2007)
• Challenges
28. UNICEF remarks at opening of SA
Child Health Priorities conference
(Dec 2007, Durban)
34. South Africa progress
150
to MDG 4
N e o na t a l M o r t a lit y
R ate
U nd e r 5 M o r t a li t y R a t e
.
Mortality per 1,000 births
Inf a nt M o r t a l ity R a t e
10 0
M D G 4 Targ et
67
50 54
21
20
0
198 0 19 8 5 19 9 0 19 9 5 2000 2005 2 0 10 2 0 15
Under 5 mortality is increasing, related to HIV (73 000 a year)
Neonatal mortality is probably static and accounts for ~30% of
under five deaths (23,000 newborn deaths a year)
Source: Lawn JE, Kerber K Opportunities for Africa’s Newborns. PMNCH, 2006
42. Child Mortality (1)
• The National Burden of Disease study estimated
just over half a million deaths of which
• 106 000 were of children under the age of 5
years
• A further 7800 were children aged 5-14 years.
• An estimated 4564 deaths are from protein-
energy malnutrition (Kwashiorkor)
• In general, young babies are much more
vulnerable than older
• The cause of death patterns in the different age
groups are very different.
43. Top twenty specific causes of death in children
under 5 years, South Africa 2000 (NBD)
90
80
70
60
50 East
40 West
30 North
20
10
0
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
44. Leading causes of death among infants
under 1 year of age, South Africa 2000
45. Leading causes of death among infants
under 1 year of age, South Africa 2000
46. Child Mortality (2)
• The NBD study estimates that by the year 2000,
– the Infant Mortality Rate had risen to 60 per 1000 live
births and
– the Under-5 mortality rate had risen to 95 per 1000.
• This deterioration in child health occurred
despite the introduction of free health care and
nutrition programmes and was attributable to
paediatric AIDS, commensurate with the high
prevalence of HIV observed among pregnant
women.
47. Leading causes of death among children
aged 1-4 years, South Africa 2000
48. Leading causes of death among children
aged 1-4 years, South Africa 2000
49. Child Mortality (3)
• As children get older, external causes of death
(eg. road traffic injuries and drowning) rise in
importance.
• This is particularly noticeable among boys who
die in greater numbers than girls. This pattern
becomes particularly marked among the 10 -14
year age group, where road traffic accidents is
the leading cause of death.
• Homicide and suicide feature in the top causes
among the 10-14 year age group, homicide is
the second leading cause of death.
50. Child deaths in RSA - Why?
Child PIP (%) (1532 deaths) WHO* (%)
Child PIP in
1 month to 5 years Mpumalanga:
Zero to 5 years
HIV/AIDS -
Most deaths 1 month to 5 yrs 57 88% HIV if
ChPIP Data:
exclude
Pneumonia 22 HIV test Witbank Hospital
1 neonatal
~ 54% tested had 2244 child
Septicaemia/meningitis 21 26% +ve -
admissions & 101
20% exposed child deaths in
Diarrhoea 20 Only 8% tested -ve
1
2006; overall case
TB 5 fatality rate 4.5;
-
HIV clinical stage 31% of all deaths
PCP 11 ~ 58% staged -
within 1st 24
of which half were hours of
Other 19 Stages III & IV
1
admission
Malaria - ChPIP Sites:
0
2004: Witbank
Measles - 0
2006: Witbank &
Injuries Included under “other” 5
(16% of all admissions but causes Barberton
Neonatal
tabulated for 1 month to 5 years)
35
* Source: WHO World health Statistics 2006 www.who.int 2007: above plus 8
51. Causes of death of children in hospitals
(n = 1695)
35
30 33
25
20
% 20
15
15 16
10 12 13
12
5 10 7
3
0
2004 2005
ARI DD Sepsis AIDS TB PCP
52. Child Mortality: HIV/AIDS
• 1998 SADHS U5MR 61/1000 (1994-8)
• 2003 SAHDS U5MR 58/1000 (1999-2003)?
• Without PMTCT one third of babies born to HIV+
mothers will be infected: of these, 60% expected
to die before 5 years of age
• 40% U5 hospital deaths due to AIDS
• Child mortality in SA too high for middle-income
country, and increasing, despite children’s rights
53. Child mortality: HIV/AIDS
• Vertical transmission rate 20.8% (KZN)
• <50% pregnant women being tested
• 2/3 all HIV+ infants needing ART by 10
months of age – without access to ARV
1/3 of HIV+ children die in 1st year of life
• One in 6 qualifying children get ARV
54. Policy Brief: Child Mortality
• The Medical Research Council published the
Initial Burden of Disease Estimates for South
Africa, 2000 in March 2003.
• A major finding of the study was the quadruple
burden of disease experienced in South Africa
resulting from the combination of the pre-
transitional causes related to underdevelopment,
the emerging chronic diseases, the injury burden
and HIV/AIDS.
55. Policy Implications (1)
• The mortality data indicates that many of
the child deaths occurring in South Africa
are preventable.
• We have identified three broad areas that
will require differing approaches for
intervention:
56. Policy Implications (2)
1. The prevention of mother-to-child
transmission of HIV, even at its current
efficacy, is the single most effective
intervention to reduce mortality among
under-5-year olds, eclipsing all other
interventions for other causes of death
combined.
57.
58. Policy Implications (3)
2. Although dominated by the rise of HIV/AIDS, the classic
infectious diseases such as diarrhoea, respiratory
infections and malnutrition are still important causes of
mortality.
Environment and development initiatives such as access
to sufficient quantities of safe water, sanitation,
reductions in exposure to indoor smoke, improved
personal and domestic hygiene as well as
comprehensive primary health care will go a long way to
preventing these diseases.
Poverty reduction initiatives are also important in this
regard.
59. Policy Implications (4)
3. Road traffic accidents and violence, which
includes homicide and suicide is another
group of high mortality conditions that will
require dedicated interventions.
60. PMTCT (1)
• Most important intervention to reduce HIV
infection in children
• Almost all ANC services provide PMTCT,
but many barriers to testing and effective
treatment.
• Cotrimoxazole prophylaxis from 6 weeks
of age reduces HIV related child mortality
by as much as 43%
61. PMTCT (2)
• Recommendation: Mandatory testing all
children at 6 week immunisation visit &
double testing of pregnant women
• Currently 300 000 HIV infected children –
50-60% expected to currently need ARV’s
• SA is one of only 9 countries world-wide
where child mortality is increasing
62. PMTCT (3)
• Routine provider-initiated testing for all 6
week old infants is currently excluded from
the NSP on HIV/AIDS
• Memorandum of concern: Maternal &
Child survival (2007)
• TAC Media Statement: Call for finalisation
of Revised PMTCT Guidelines (Jan 2008)
63. Key Child Survival Strategies
1. Infant and Young Child Feeding (including
EBF)
2. Immunisation
3. Treatment of common childhood illnesses
4. Care of children with HIV-infection
5. Provision of Vitamin A
6. PMTCT
65. Key MCH interventions
MATERNAL CARE NEONATAL CARE CHILD CARE
Basic neonatal 1. Infant and
1. Focused ANC care Young Child
2. PMTCT-Plus 1. Resuscitation Feeding
3. Skilled 2. LBW care 2. HIV care
attendant 3. Early EBF 3. IMCI (clinic)
deliveries 4. KMC 4. Hospital care
4. EMOC 5. PMTCT-Plus 5. EPI
5. Family 6. Infection 6. Vitamin A
planning management 7. HIV testing,
cotrim, ARV
66. South Africa:
Coverage along the
MNCH continuum of care
100%
The days
75% of highest risk
have the lowest
50% coverage of care
25%
no data 7%
94% 84% 93%
0%
Ant enat al care Skilled Post nat al care Excl. BF I m m unisat ion
( at least one at t endant ( DPT3)
visit ) during
childbirt h
Source: Lawn JE, Kerber K Opportunities for Africa’s Newborns. PMNCH, 2006
67.
68.
69. Infant and Young Child Feeding
• Exclusive breastfeeding (BFHI)
• Provision of good quality complementary
feeds
• Appropriate care of children with
malnutrition
70. Only 12% of infants EBF by 6 months
100
90
Not BF
80
70
60
50 Solid mushy food
40
30
Other liquids
20
Plain water only
10
EBF at 6 months
0
0-4 4-6 7-9 10-12
Source: Demographic Health Survey 2003 Slide: Ngashi Ngongo
71. Immunisation
• Good coverage
• Major reduction in number of children with measles
• South Africa declared polio free
• Need to ensure high coverage is maintained, and to
use every opportunity to immunise children
• Community outreach programmes RED STRATEGY
• Management issues e.g. cold chain, monitoring
coverage
• Not linked to HIV screening (6 week visit!)
72. Existing norms and standards
• Primary Health Care package
• District Hospital package
• Regional hospital package
• Service Transformation Plan
• Modernization of Tertiary Services
73. Existing norms and standards
• IMCI
• Clinic supervisors manual
• EDL
• WHO pocketbook
74. Staffing norms
• No official staffing norms for the country
• Various systems have been used
75. Service transformation plan
• PHC clinics: 1 for 10 000 people
• CHC: 1 for 60 000 people
• District hospital: 1 for 300 000 people
• Regional (Level II) hospital:1 for 1.2 million
• Tertiary (Level III) hospital:1 for 3-
3.5million people
78. Care of children
with HIV-infection
• Prevention is key
• Early diagnosis and
preventive care
• Staging and referral for
ART when appropriate
• Psychosocial support
79. IMCI: Bringing it all together
Nutrition Appropriate
(Vitamin A) infant
feeding
IMCI PMTCT Maternal
EPI Plus
Health
Care of HIV
infected children
HOUSEHOLD AND COMMUNITY IMCI
80.
81.
82.
83. Active Site
Future Site
TINTSWALO
TEMBA
MIDDELBURG ROB FERREIRA
WITBANK CAROLINA
BARBERTON
EVANDER ERMELO
STANDERTON
PIET RETIEF
90. “There can be no
keener revelation
of a society’s soul
than the way it
treats its children”
Nelson Mandela,
1988
Editor's Notes
UNICEF has very recently reviewed the progress made on achieving the World Summit for Children goals. The results of this review have been included in an update to the UN Secretary General’s 2001 report The present slide is taken from this update and shows progress in the reduction of the under-five mortality rate (U5MR) during the 1990s. The region with the smallest reduction is where U5MR is highest, in sub-Saharan Africa, and the largest reduction is where U5MR is lowest, in the industrialized countries.
..comparing 2004 and 2005, the differences noted are mainly due to changes in ChIP’s classification of causes of death rather than reflecting any significant change in the profile. AIDS is no longer used but rather each child’s HIV experience is recorded as mentioned earlier. PCP, both suspected and confirmed, is new to the classification and one can see that by adding ARI and PCP in 2005 one gets a similar total to that for ARIs in 2004. TB refers to all TB (pulm, mening and miliary).