Child Health DR AMIR NASIR

Topics

Definitions & some key facts

Major causes of child mortality.

Determinants of child health.

Interventions to improve child health.

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Why Child Health Children are most vulnerable segment of society

Higher risk of morbidity/mortality

Global share of morbidity and mortality

Majority conditions are preventable

Indicative of health of society

Definitions & Epidemiology

Stillbirth

Infant Mortality

Neonatal Death Post-neonatal Death

Early neonatal Death

Perinatal Death

Late neonatal death

28 weeks of gestation Birth 7 Days 28 Days 1 Year

MORTALITY IN AND AROUND INFANCY; TERMINOLOGY

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Indicators of child mortality Indicator Definition

Under 5 mortality Rate (U5MR) Deaths under 5 years/ 1000 live births

Infant Mortality Rate (IMR) Deaths under 1 year / 1000 live births

Neonatal Mortality Rate (NMR)

Deaths upto 28 days after birth / 1000 live births

How big is the problem Year Under 5 deaths

1990 12.7 million

2010 7.1 million

2012 6.6 million

2015 5.9 million

Neonatal deaths

2.7 million neonatal deaths every year

50% of all neonatal deaths occur in first 24 hours 75% of all neonatal deaths occur in first week

1 million neonatal deaths occur on the day of birth

More than half of under 5 deaths are preventable with simple interventions

Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in developed regions

45%55%

Proportion of neonatal & post-neonatal deaths

neonatal deathspost neonatal deaths

Inequity 99% of childhood deaths occur in low & middle income countries

42% in Asia

51% in Africa

93% combined in Asia & Africa

Causes of Child Mortality

5 leading Causes of under 5 mortality

Leading causes of death in children under 5 years are

1. Prematuriy…………………………………………(18%)2. Pneumonia ……………………………………….(16%)3. birth asphyxia ………………………………… (11%) 4. diarrhoea …………………………………………..(9%)5. Malaria ……………………………………………….(5%)

Important causes by age NEONATAL PERIOD

Prematurity Birth asphyxia

POST NEONATAL PERIOD

Pneumonia Diarrhea Malaria

Malnutrition Contributing to U 5 Mortality, 2008 (percent)

Determinants of Child Health

Determinants of Child Mortality 1. Biological

2. Socio-economic

3. Cultural

Biological Birth Weight: low birth weight (< 2.5 kg) & high birth weight (> 4 kg) Age of The Mother : <19 years) or >over 30 years High FertilityRepeated pregnanciesBirth Spacing: < 1 year = 2-4 times risk Mutiple Births: more risk due to low birth weight Family Size: 3 or more children, more frequent/prolonged illnessBirth Order: Mortality risk increased after the third birth.

Socio-economic Factors Low income countriesRural areas Low education Nutrition Breast & formula milk use Health care quality Environmental conditionsViolence (wife beating, infanticide)

Cultural Factors Religion Customs Early marriages Sex of child Quality of mothering

Traditions affecting cleanliness, eating, clothing, child care

Interventions & Results Future Targets

MDG 4: Reduce child mortality

Target 4 A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Indicator 4.1 Under-five mortality rate Indicator 4.2 Infant mortality rate Indicateur 4.3 Proportion of 1 year-old children immunized against measles

WHO strategies

To deliver these interventions, WHO promotes four main strategies:

1. Appropriate home care & timely treatment of complications for newborns

2. Integrated management of childhood illness (IMCI)

3. Expanded programme on immunization;

4. infant and young child feeding

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Simple, effective proven measures to reduce U5MR

Vaccines 

Antibiotics

micronutrient supplementation,

insecticide-treated bed nets,

improved family care

Hand washing with soap 

Breast feeding practices 

Oral rehydradion therapy

Empowering women,

removing financial and social barriers to accessing basic services,

developing innovations that make the supply of critical services

Integrated Management of Childhood illness (IMCI)

Integrated approach to child health

Focus on well being of whole child instead of one disease

Aims to reduce death, illness & promote growth in under 5

Preventive & curative services implemented by families, communities, health facilities

Has been introduced in 75 countries

IMCI Strategy

Strategy includes 3 main components Improved skills of health care staff Improved overall health systems Improving family & community health practices

Progress in Pakistan Year U5MR

1990 139

2000 112

2015 81

42% reduction

Reduction in neonatal Mortality Year Neonatal Deaths

1990 5.7 million

2015 2.7 million

MDG4, 1990-2015

62 /195 countries achieved MDG target 4 of 2/3rd reduction in U5MR

74 /195 countries have reduced U5MR by half

10 of the 12 low-income countries that achieved MDG4 are in Africa.

MDGs end (2015) …. SDGs Begin

Sustainable Development Goals SDGs ……….. 17 Goals ……… 169 targets

SDG 3 “Ensure healthy lives & promote wellbeing, for all, at all

ages”

Target 3.2 …… By 2030, end preventable deaths of newborns and children

under 5, to reduce neonatal mortality to 12 /1000 and U5MR to 25 /1000 .

Sustainable Development Goals

SDG target for U5MR is at least 25 / 1000 for all countries

Currently 79 countries have U5MR above 25 / 1000

47 countries are unlikely to achieve the target till 2030 if current trends continue

Global Initiatives to achieve SDGs1. "ending preventable maternal mortality" and "every

newborn action plan" to promote universal coverage of high quality maternal and newborn care;

2. the “Global Action Plan for the Prevention and treatment of Pneumonia and Diarrhoea“ (GAPPD)

3. a "comprehensive implementation plan on maternal, and infant and young child nutrition" to reduce under nutrition and obesity;

Global Initiatives to achieve SDGs4. the "Global Technical Strategy for Malaria" to reduce

global malaria case incidence and mortality by 2030

5. the "Global Vaccine Action Plan" to prevent childhood diseases through vaccination

6. the United Nations Decade of Action on Nutrition 2016–2025 to eradicate hunger and prevent all forms of malnutrition worldwide.

Global Action Plan for the Prevention & treatment of Pneumonia & Diarrhoea (WHO)Peumonia & diarrhea together cause 29% of under 5 deaths

Deaths of 2 million children annually

Targets (for 2025) Reduce pneumonia deaths to < 3 / 1000Reduce diarrhea deaths to < 1 / 1000

ENAP Targets Year Neonatal mortality rate

(NMR)Target Still birth rate (SBR)targt

2020 15 / 1000 14/ 1000

2025 12 / 1000 11/ 1000

2030 9/ 1000 9/1000

2035 7/1000 8/1000

Pakistan Perspective

MDG 4 progress in Pakistan

Deaths by age period (Pak)

U5MR inequities (Pak)

U5MR by region in Pakistan

Causes of U5MR in Pakistan

Nutritional status Pakistan

Thank You

References http://data.worldbank.org/indicator/SH.DYN.MORT

http://www.who.int/en/

http://www.childmortality.org/

https://data.unicef.org/topic/child-survival/under-five-mortality/