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1. Pediatric Nursing
(Seminar - 2)
Mortality & Morbidity in Pediatrics
Tagreed Awad Khalid
KU – Nursing Collage - PHD (4) 2016

2. Objectives
At the end of this presentation, the objectives should be
achieved are:
1. Define morality
2. Define morbidity
3. Identify leading causes of death in children
4. Identify factors that influencing child health

3. Introduction
O Measuring health status is not always a simple process.
O For example, some women and children with chronic illnesses do
not see themselves as “ill” if their disease is under control.
O A traditional method of measuring health is to examine mortality
and morbidity data.
O This information is collected and analyzed to provide an objective
description of the nation’s health

4. Outlines:
- Definition of mortality
- Definition of morbidity
- Mortality rates
- Leading causes of death in pediatric.
- Factors that influencing health of the child.

5. Mortality
O Mortality is the incidence or number of people who have died
over a specific period.
O This statistic is presented as rates per 100,000 and is calculated
from a sample of death certificates.

6. Fetal Mortality
O The fetal mortality rate or fetal death rate refers to the
intrauterine death of a fetus who is 20 weeks of gestation or
more per 1,000 live births.
O Fetal mortality refers to spontaneous intrauterine death at any
time during pregnancy
O Fetal deaths later in pregnancy are sometimes referred to as
stillbirths

7. The U.S. fetal mortality rate is 6.2 per 1,000 live births
O Healthy People 2020’s goal is to reduce it to 5.6 fetal deaths.
O Fetal mortality may be attributable to maternal factors
- Malnutrition
- Maternal Disease
- Preterm cervical dilation
or fetal factors
- Chromosomal abnormalities
- Poor placental attachment

8. Neonatal and Infant Mortality
O The neonatal mortality rate is the number of infant deaths
occurring in the first 28 days of life per 1,000 live births.
O The death rate of infants less than 1 month old
O The United States now ranks 41st in the world in terms of
neonatal mortality
O The neonatal mortality rate is 4.5
O Healthy People 2020’s goal is to reduce it to 4.1

9. O Each year the deaths of 2 million babies are linked to
complications during birth or within the first month
O Perinatal mortality, defined as the number of stillbirths and
deaths in the first week of life per 1,000 live Births.
O The perinatal mortality is the sum of the fetal mortality and the
neonatal mortality.

10. O The infant mortality rate is the number of deaths
occurring in the first 12 months of life.
O It is documented as the number of deaths of infants
younger than 1 year of age per 1,000 live births.
O Neonatal mortality and post-neonatal mortality
(covering the remaining 11 months of the first year of
life) are reflected in the infant mortality rate.

11. O The infant mortality rate is used as an index of the general health
of a country, is one of the most significant measures of
children’s health.
O In 2010, the infant mortality rate in the United States was 6.14
for White infants and 11.61 for Black infants per 1,000 live
births.
O Healthy People 2020’s goal is to reduce it to 6.0.
O In 2011, the United States ranked 41st in infant mortality rates
among industrialized nations

12. O The main causes of early infant death in the United States include
problems occurring at birth or shortly thereafter, such as
- Prematurity
- Low birth weight
- Congenital and chromosomal anomalies.
- Sudden infant death syndrome
- Respiratory distress syndrome
- Unintentional injuries
- Bacterial sepsis.
- Necrotizing enterocolitis

13. O FIGURE 1.2 Infant and neonatal mortality from 1940 to 2007.

14. O Childhood Mortality
O The childhood mortality rate is the number of deaths per
100,000 population in children 1 to 14 years of age.
O The childhood mortality rate in the United States has
decreased by about 50% since 1980 .
O In 2007, the mortality rate for children between ages 1 and 4
years was 28.6 per 100,000 with the leading cause of death
being unintentional injuries followed by congenital
malformations .

15. O The mortality rate for children between 5 and 14
years of age was 15.3 per 100,000 with the leading
cause, again, unintentional injuries followed by
cancer.
O Other causes of childhood mortality include
- suicide.
- Homicide.
- Heart diseases.
- Influenza and pneumonia

16. O Unintentional injury :
- Motor vehicle accidents
- Fires
- Drowning
- Bicycle or pedestrian accidents
- Poisoning
- Falls
remains a leading cause of mortality and
morbidity in children.

17. O These deaths can often be prevented through
education about the value of using
- Car seats and seat belts,
- Dangers of driving under the influence of alcohol and
other substances
- Importance of pedestrian and bicycle safety
- Fire safety
- water safety
- Home safety.

18. Is the number of children who die by the age of five, per
thousand live births:
 In 2007, the world average was 68 (6.8%).
 In 2006, the average in developing countries was 79
(decreased from 103 in 1990), whereas the average in
industrialized countries was 6 (decreased from 10 in 1990).
 One in six children in Sub-Saharan Africa die before their fifth
birthday

19.  According to UNICEF, most child deaths (and 70% in
developing countries) result from one of the following five
causes or a combination of:
1.Acute respiratory infection.
2.Diarrhea
3.Measles
4.Malaria
5.Malnutrition.
Causes of Child Mortality

20. 1. Congenital anomalies
2. Un specific low birth weight
3. SIDS: sudden infant death syndrome
4. Newborn affected by maternal complication of pregnancy
5. Newborns affected by complications of the placenta, cord or
membrane while pregnancy.
6. RDS: respiratory distress syndrome.
7. Accidents
8. Bacterial sepsis of newborns.
9. Diseases of circulatory system.
10. Intrauterine hypoxia and birth asphyxia.
Leading causes of infant death…USA

21. O Mortality in Sudan
- Neonatal mortality rate 91.78% (Wikipedia 2007)
- 15-30 death in 1000birth live (UNCIEF – 2014)
- 2015 –Aldaiat Maternity Hospital :
• Total number of birth 35149 baby.
• Number of mortality 916 baby

22. Morbidity
O Morbidity is the measure of the prevalence of a
specific illness in a population at a particular time.
O It is presented in rates per 1,000 population.

23. Childhood Morbidity
O In general, 55% of children in the United States enjoyed
excellent health and 27% had very good health as
reported in a summary of health statistics for children in
2009
O Issues that endanger children’s health today may include
- Obesity
- Environmental toxins
- Allergies
- Drug abuse
- Child abuse and neglect
- Mental health problems

24. Factors that may increase morbidity include
- Homelessness
- Poverty
- low birth weight
- Chronic health disorders
- Foreign-born adoption
- Barriers to health care

25. O The most important aspect of morbidity is the
degree of disability it produces, which is identified
in children as the number of days missed from
school or confined to bed.

26. O Common health problems in children include
- Respiratory disorders such as asthma
- Gastrointestinal disturbances, which lead to malnutrition and
dehydration
- Injuries .
• Diseases of the respiratory system were the major cause of
hospitalization for children ages 1 to 9.
• Mental health disorders are the leading cause for children 10
to 14 years of age.

27. O Health problems that increased morbidity and disability in recent
decades can include:
- Asthma
- Diabetes
- Attention-deficit- hyperactivity disorder
- Obesity

28. Child Morbidity in Sudan
O In household survey 2010 26.8% of children age 5 to
59months had diarrhea
O 18.7 have pneumonia.
O 12.6% suffering from malnutrition diseases.
O Neonatal morbidity in Omdorman Maternity Hospital
2015:
• Total number of birth 35149 baby.
• Number of morbidity 3649 baby
• Number of discharge 2832 baby

29. Major Causes of Death in Childhood
O Under 1 Year
1. Congenital malformations and chromosomal abnormalities
2. Disorders related to short gestation age and low birth weight
3. Sudden infant death syndrome
4. Newborn affected by maternal complications of pregnancy
5. Unintentional injuries (accidents)

30. O 1–4 Years
1. Unintentional injuries (accidents)
2. Congenital malformations and chromosomal abnormalities
3. Malignant neoplasms
4. Assault or homicide
5. Diseases of the heart

31. O 5–14 Years
1. Unintentional injuries (accidents)
2. Malignant neoplasms
3. Assault or homicide
4. Intentional self-harm (suicide)
5. Congenital malformations and chromosomal abnormalities

32. O 15–24 Years
1. Unintentional injuries (accidents)
2. Assault or homicide
3. Intentional self-harm (suicide)
4. Malignant neoplasms
5. Diseases of the heart

33. O Factors influencing the child Health:
1. Family
O The family is considered the basic social unit.
O family is a group of two or more persons related by birth,
marriage, or adoption and living together.
O The family greatly influences the development and health of its
members.
O children learn health care activities, health beliefs, and health
values from their family.

34. O The family’s structure, the roles assumed by family members,
and social changes that affect the family’s life can influence the
child’s health status.
O Families are unique; each one has different views and requires
distinct methods for support.

35. 2. Genetics
O Genetics, the study of heredity and its variations, is a field that
has applications to all stages of life and all types of diseases.
O The child’s biologic traits, including gender, race, some
behavioral traits, and the presence of certain diseases or
illnesses, are directly linked to genetic inheritance.
O Heredity is the process of transmitting genetic characteristics
from parent to offspring..

36. 3.Society
O Society has a major impact on the health of children, and families.
O Major components of a society that influence children and their
health include
- Social roles
- Socioeconomic status
- The media
- The expanding global nature of society.
Each of these areas may influence a person’s self-concept, the
communities where they live, their choice of lifestyle, and their health.

37. 4. Community
O Community encompasses a broad range of concepts, from the nation
where a person lives, to a particular neighborhood or group.
O The surrounding community affects many aspects of a child’s health
and general welfare.
O The quality of life within the community has a great influence on a
child’s ability to develop and become a functional member of society.
Community influences include the school, which is a community in itself,
and peer groups.

38. 5. Culture
O Culture (the view of the world and implementation of a set of
traditions that are used by a specific social group in order to
pass these traditions along to the next generation)
O Culture is a complex phenomenon involving the integration of
many components such as beliefs, values, language, time,
personal space, and view of the world, all of which shape a
child’s actions and behavior.

39. O Individuals learn cultural behaviors from their family and
community through a process called enculturation, which
involves acquiring knowledge and internalizing values.
O Culture is learned first in the family, then in school, and
then in the community and other social organizations.
O Culture influences every aspect of development and is
reflected in childbearing and child-rearing beliefs and
practices designed to promote healthy adaptation

40. 6. Health Status and Lifestyle
O The general health status of a person and specific lifestyle can
influence a child’s health.
O Health status may be a factor soon after birth.
For children, the lifestyle of the parents basically is the lifestyle of
the child, so parents need to set a good example in terms of
nutrition and physical activity

41. O Lifestyle Choices that affect a person’s health include
- Patterns of eating
- Amount and type of exercise
- Use of tobacco, drugs, or alcohol
- Methods of coping with stress. Most health problems
that arise today are due to a person’s lifestyle.

42. 7.Environmental Exposure:
O Some environmental exposures can affect health.
O In utero, the child can be affected by poor maternal
nutrition, maternal infections, or maternal use of
alcohol, tobacco, and drugs.
O These agents, known as teratogens, may be linked to
birth defects in children.

43. O Exposure to air pollution, tobacco, and water or food
contaminants can impair a child’s health status.
O Safety hazards in the home or community can contribute to falls,
burns, drowning, or other accidents.
O Exposure to secondhand smoke and other pollutants, such as
from radiation or chemicals, is a health hazard for children.
Because children are smaller and still developing, environmental
exposures can cause them additional health problems

44. 8. Nutrition
O It provides the body with the calories and nutrients to sustain life and
promote growth, as well as the essentials required to maintain health
and prevent illness
O Some factors contributing to poor nutrition include:
- Inadequate food intake
- Nutritionally unsound social and cultural food practices
- Nutritionally inadequate foods
- lack of nutrition education in homes and schools
- Presence of illness that interferes with ingestion, digestion, and
absorption of food

45. O Inadequate nutrition is associated with
- lowered cognitive ability
- Poor or altered emotional and mental health
- Increased susceptibility to childhood illnesses
- Stunted physical growth
Fast food or junk food that is a key factor in the epidemic of
childhood obesity and increases in the prevalence of childhood
type 2 diabetes

46. 9. Access to Health Care:
Factors can limit access to health care services:
- Noninsured children.
- Inaccessible health care setting
- Low income
- Unavailability of health care services.

47. O BARRIERS TO HEALTH CARE
O Women and children are major consumers of health care services,
in many cases arranging not only their own care but also that of
family members.
Access to care can be affected by lower incomes and greater
responsibilities (work and family).

48. Barriers to health care include
- Lack of finances
- Sociocultural barriers, including lack of transportation, no
babysitters, and language
- Health care delivery system barriers, including
inconvenient clinic hours and poor attitudes by health care
workers.
- These barriers often discourage clients from seeking
healthcare

49. References
O Suzan S- R, Terri-K, Suzan C (Maternity and Pediatric Nursing ),
2nd eddition,2013.
O Adele Pillitteri (Maternal and Child Health Nursing- care of child
bearing and child bearing family) 5th eddition,2010
O Terri –K (essential for pediatric Nursing) 1st edition 2008

50. Thank you