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INTRODUCTION TO CHILD HEALTH

Introduction

Throughout the world, poor women and children are the most vulnerable and the least served. In the less developed areas of the world, disease and death take the highest toll among mothers and children who make up over two-thirds of the population. Perinatal mortality may be as much as ten times higher than that of infants born in industrialized countries; the infant mortality rate may be six to twenty times greater than that the industrialized regions of Europe and North America; the death rate among pre-school children is also up to ten times high. Furthermore, in underdeveloped countries, half of the total mortality may occur in children under 5 years of age compared to only 5% in countries such as the United Kingdom and Sweden. In technically advanced countries, the child survival rate is over 97% while in less developed countries over 50% of total deaths are of children under the age of 5, and the average lifespan is about 35 years. In scientifically advanced countries, only 5% of the total mortality occurs among the under 5; and the average lifespan is over 70 years. Before the advent of scientific medicine, it was taken for granted that a large proportion of children born alive would die in childhood, and the parents felt it necessary to have many children in the hope that some would survive, that few of them paid much attention to childhood diseases

Safe motherhood in relation to child

health

High Neonatal Mortality Rates are preventable Proven,

simple, low-cost solutions exist; up to 70% of neonatal deaths could be prevented through intervention for the mother. Impact of mother-baby package interventions on neonatal death (WHO mother-baby package 1994).

Antenatal Care: ƒ In the first visit

  • History taking
  • Physical examination
  • Laboratory examination (Blood for RH, anaemia, urine for albumine..)
  • Treatment of minor ailment
  • In the second and subsequent visit
  • Measuring BP, fundal height, weight
  • Maternal immunization with tetanus toxoid
  • Nutritional support including iron/ folate supplementation
  • Birth planning
  • Counseling on breastfeeding
  • Presumptive malaria treatment where appropriate
  • Syphilis screening and treatment where appropriate
  • Voluntary counselling and testing for HIV, where appropriate
  • Recognition of danger signs; treatment & referral as needed.

Detecting high risk pregnancy:

  • • Age <18 and > 35 years
  • Primigravida
  • Previous Cesarean section (C/S)
  • Instrumental deliveries (vacuum, forceps)
  • Destructive deliveries
  • Previous prenatal death
  • Previous stillbirth
  • Previous antepartum haemorrhage (APH)
  • Previous postpartum haemorrhage (PPH)
  • Grand multiparty
  • Preeclampsia, eclampsia
  • Cardiac disease
  • Renal disease
  • Diabetes mellitus
  • Multiple pregnancy

Labor and Delivery Care:

Trained health worker during labour and delivery should attend Mother and baby. Delivery should be conducted under hygienic condition. Clean hand, delivery surface, clean cord-cutting and tying, clean environment, and clean perineum. Skilled attendant at delivery. Recognition of danger signs (mother and baby); treatment and referral as needed.

Age and disease patterns:

  1. Essential Newborn Care: ƒ Immediate assessment

ƒ Care of the new-born baby should be guided by the following principles

ƒ Dry the new-born as soon as possible

ƒ Wrap the new-born in a dry towel to prevent heat loss from the body

ƒ Place the new-born next to the mother to get the breast and warmth (rooming in).

ƒ Cut the cord when it becomes thin and white. Apply

tetracycline eye ointment 1% to both eyes to prevent eye infection. Delay washing of the new-born for 12-24 hours to avoid unnecessary chilling. Nothing should be applied to the cord except gentian violet.

Age and disease and patterns:

To define the task better, it is important to look in more details at the types of diseases that are prominent in childhood. The following list summarizes the most important diseases that will be encountered at different ages.

  • Birth to 1 month-neonatal period
  • Obstetric complications and birth injuries
  • Asphyxia (failure to breathe at birth)
  • Low birth weight babies (prematurity)
  • Infection leading to septicemia
  • Tetanus (from infected cord)
  • Death of mother – the newborn baby is likely to die of starvation, (or gastroenteritis, if bottle-fed) unless another woman can be found to breastfeed him.
  1. First year of life- infancy
  • Respiratory diseases- pneumonia, whooping cough, etc.
  • Diarrheal diseases ( Especially likely if the baby is bottle fed
  • Malaria, measles marsmus, due to either lack of an adequate diet or a chronic disease
  • Vit A deficiency
  • Vit D deficiency

2.Second to the fifth year of life

  • Malnutrition (Marasmus or kwashiorkor) sometimes both together
  • Pneumonia often caused by measles or whooping cough
  • Diarrhea diseases
  • Measles • Malaria
  • Anemia, sometimes accused of hookworm
  • Tuberculosis
  • Accidents
  • Streptococcal tonsillitis

After 5 years

  • Infectious diseases( HHookwormround worm)
  • Malnutrition
  • Malaria
  • Skin diseases
  • Respiratory diseases and other age specific diseases ( E.g: rheumatic fever, Streptococcal pharyngitis and post streptococcal acute glumelonephritis are not common

before five years of age)It is obvious from this list that most of these child hood diseases are preventable. This why such a great emphasis must be put on preventive programs including nutrition education, immunization and environmental sanitation

Health Priorities for children

Child health Indicators:

  1. Perinatal mortality rate:- the total number of still-births

plus the number of deaths under one week old, per 1000 birth or the sum of late fetal and early neonatal deaths. The causes of Perinatal mortality are generally attributed to trauma and stress of labour, toxemia ante partum hemorrhage, maternal disease (particularly malaria and malnutrition), congenital anomalies, infection and induced abortions. Rates and causes of perinatal mortality are less well documented in developing areas.

Neonatal mortality rate: – The number of deaths under 28 days of age per 1000 live births. The neonatal death reflects not only the quality of care available to women during pregnancy and childbirth but also the quality of care available

to the newborn during the first months of life. Immaturity of the infant is the chief cause of these early deaths. Approximately 80 % of infants who die within 48 hours of birth weight less than 2500 g.

Post-natal mortality rate: – The number of deaths over 28 days but under one year of age per 1000 live births.

  1. Infant mortality rate: – The number of infant under one year of age dies per 1000 live births. It is the sum of neonatal and postnatal deaths. The primary cause is immaturity and the second leading cause is gastroenteritis, which can be prevented by putting the newborn immediately with the mother and advocating breastfeeding.
  2. Child mortality rate: – The number of deaths between 1 and 4 years in a year per 1000 children. This rate reflects the main environmental factors affecting the child health, such as nutrition, sanitation, communicable diseases and accidents around the home. It is a sensitive indicator of socioeconomic development in a community and maybe 25 times higher in developing countries compared to developed countries.

Care of the Under-Fives

In most countries of the world, there is a relative neglect of the

children of pre-school age. They are a vulnerable or special risk group in any population. The reasons why they need special health care are:

  • Large numbers: constitute 15 – 20% of the population in developing countries.
  • High mortality: Apart from infant mortality which is more than 100/1000 live birth in developing countries, the mortality in age groups 1-4 years is not less than 40/1000 as compared to 0.5 in developed countries. The major causes of death in this group are due to malnutrition and infection, both preventable.
  • Morbidity: The major diseases which affect this preschool age group are: diphtheria, whooping cough tetanus, diarrhoea, dysentery, malnutrition, accidents all are preventable etc…

A) Major childhood problems:

  • Pneumonia
  • Diarrhea
  • Malaria
  • Tuberculosis
  • HIV ( mother to child transmission)
  • Perinatal infection
  • Malnutrition

2. B) Major child health programs/activities:

  • CDD see the section on IMCI case management of Diarrhea
  • ARI see the section on IMCI case management of ARI
  • Malaria control see the section on IMCI case management of fever
  • HIV control activities (mother to child transmission prevention) see the section on HIV prevention.

3. C) Antenatal and deliver care:

Every child begins as a fetus, and the months before delivery are some of the most important in his life. Pregnant mothers should be checked regularly and advised on their nutrition and any other difficulties they have. Every mother should receive tetanus immunization to protect her new baby. Finally, skilled help during labour and delivery will provide the final step for a good start in life.

4. D) EPI (Immunization):

Tuberculosis, diphtheria, whooping cough, tetanus, polio and measles can all be prevented by Immunization. These are some of the main causes of sickness and death among children. These methods of primary prevention are available and effective and should be given to every child.

5. E) Under Five Clinic:

  • The aims and objectives of the under-fives clinic are to provide curative, preventive and promotive health services within the resources available in the country such as:
  • Well baby care
  • Care in illness
  • Adequate nutrition
  • Immunization

6. F) Traditional Practice:

Everyone is greatly influenced by the traditional customs of his family, tribe, and country. Some of these traditional practices are good for health, such as breastfeeding or the acceptance of modern medicine, should be supported. Those traditional practices and beliefs, which are bad (cutting of uvula, female genital mutilation etc ) need to be gradually changed. This is another important area in which health workers can have a strong influence in improving health.

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