demography, child health
TRANSCRIPT
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Bagian Ilmu Kesehatan Anak FK UNSRAT/
RSU. Prof. Dr. R.D. Kandou-Manado
INTRODUCTIONCHILD HEALTH SITUATION in
INDONESIA
and CONTRIBUTING FACTORS
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GROWTH
Increase of physical sizeHeight, weight, head circumference etc.
DEVELOPMENTIncrease of ability in human function
-physical (motoric),
-cognitive (intelligence)- affective (emotion-social),
.
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Mother, subtitute
mother, Parent, sibling, caregiver,toys, norm, rule, stimulation
Health Service, EducationNeighbor, peer
Gov. Policy, International
UNICEF, WHO
CHILD GROWTH & DEVELOP. QUALITYDeterminants : INTRINSIC (genetic- heredoconstitutional)+ EXSTRINSIC ( environment)
(Kobayashi, 1985;
Sularyo, 1989;Ismael, 1991,) ENVIRONMENT
ROLE:to met :
Bio +Psycho-social nee
BIO:nutrition,imunisation,medicine,cloth, etcl
PSYCHO
SOCIALLove, care,
Stimulationcognitive,emotion-sociall7/19/2013
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THE QUALITY OF FAMILIES
1. EDUCATION : illiteracy 16 millions Father: 49 % Primary + Secondary School
Mother : (Primary 31.7%, Secondary 11,7 %).
Illiteracy : adult female 12 %, male 10 % (Unicef, 1999).
Female illiteracy (1997) on village 19.12 %, urban 8.06%,
Male illiteracy on village 9.26 %, urban 2.87 %.
(females 2 - 3 X > males )
.
2.AGE ON FIRST MARRIED, FAMILY PLANNINGfirst married < 17 tahun : village 24.4 %, urban 16.1 %
Use contraceptive (1997/1998) 66.9 %
3. FEMALE STATUS IN FAMILY7/19/2013
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QUALITY OF FAMILIES
4. HYGIENE and SANITATION UNSAFE WATER : village 38 %, urban 13 %
Coliform contamination > 100 / 100 ml 63 %.
Contaminated Risk : very high 15.04 %, high 21.06 %
UNSAFE SANITATION : village 79 % urban 36 %
House without window 32 %
5. POVERTY :39.1 % keluarga miskin
6. UNEQUAL POPULATION DISTRIBUTION,
GEOGRAPHICAL HANDICAP, DISTANCE
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THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES
1. MATERNAL and INFANT HEALTH SERVICEunreach 22 % ( 1,1 m) pregnant women and infant
geographics, population distribution, sosio-economic,
social status of females, education (Depkes, 1997).
2. DELIVERYtraditional birth attendance 47.5 % (2,3 m deliveries)
by family 8.2 % (400.000 deliveries),
at home 71.9 % (SKRT 1995).
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THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES
3. POSYANDU (INTEGRATED SERVICE POST)244.032 Posyandu : 45 % elementary (110.563),
active posyandu 80 % ( 37.6 % - 85.6 %).
1996 ; each Posyandu have 4.6 kader,
1997 4.4 kader / Posyandu balita brought to Posyandu : 1.2 x / fam / year
(range 0.1 - 4.62)
4. BKB, PADU, PPA, TPA, TK ?limited area geographic handicap, unequal population distribution
SUPERVISION ?: unintensive, poormonitoring and
evaluation ?,project oriented ?
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THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES
5. PRIMARY HEALTH SERVICEPuskesmas : 12 % no doctor.
Puskesmas doctor 45 % - 80 % (some Province)
Nurse : unequal distribution (3 - 4/1000 people)
PTT Midwive : poor quality of skill ( crash program)Geographic handicap, socio-culture.
6 .REFERRAL HOSPITALPediatricians on Hospital type D : 0.24 / Hospital,
Obs-Gyn : 0.35 / H.blood bank, medicine, budget, facility
Distance, geographic, transportation
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MATERNAL HEALTH STATUS
1. NUTRITIONAL STATUS ON PREGNANT WOMEN
CHRONIC MALNOURISHED : 30 % (1,5 million) pregnancy
FE DEFF ANEMIA: 40.5 - 51 % (2 2,5 m) since firsttrimester
Fe tablet (minimum 90 tebletss) just 23.4 % pregnancy
12,2 % (600.000) never had Fe tablet
SHORT STATURE (small pelvic)
height < 140 cm : 5 % (250.000 women),
140 - 144 cm : 11 % (550.000 women ) .
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MATERNAL HEALTH STATUS
2. REPRODUCTIVE CHARACTERISTIC (age, spacing,number of delivery)too young (< 20 year) : 14 % (700.000 pregnancy),
too old (r > 35 tahun) : 12.7 % ( 600.000 pregnancy).
too short spacing (< 2 tahun) : 17 %,
too frequent (> 4 X ) : 35.1 %
3. MATERNAL HEALTH CARE
never: 22.1 % ( 1,1 m illion pregnancy).delayed (since 7 mo) : 18,2 % (900.000 pregnancy),
delyed (since 4 mo) : 33.1 %.
< 4 X during pregnancy : 26 %
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MATERNAL HEALTH STATUS
4. MATERNAL MORTALITY
373 / 100.000 pregnancy (18.000 maternal /year ) Every day : 50 maternal mortality
Every hour : 2 maternal mortality
THREE DIRECT CAUSES OF MATERNAL MORTALITY bleeding (36.1%),
toksemia gravidarum (25%),
Infection, delayed delivery, abortus (11.1%)
THREE TOO LATE:1. to identify dangerous signs,
2. to reach the hospital
3. to get adequate intervention
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MATERNAL HEALTH STATUS
MATERNAL MORTALITY
UNDIRECT CAUSES
1. Nutritional status (Chronic malnutrition, anemia)
2. Reproductive characteristic (age, spacing, no. of
delivery)
3. Maternal health care (delayed or never)4. Unable to pay for delivery
.
BASIC CAUSES
Education (< Secondary school)
Women status in society or family
Poverty
Geographic handicap, distance, transportation
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CHILD MORTALITY
BIRTH RATE : 4.8 million / year (9 babies /minute)PERINATAL MORTALITY (umur < 1 bulan)1 baby < 1 mo / 10 minutes
INFANT MORTALITY (age < 1 year)40/ 1000 life birth / year (Unicef, 2000)186.500 babies die / year, 511 babies / day,
22 babies / hour , 1 baby / 3 minutes
UNDERFIVE MORTALITY (56-59 / 1000 lifebirth)(Depkes 1998, Unicef 2000), 261.000 under5 / year,
715 under5/ year , 30 under5/hour1 under5/ 2 mnt
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Perinatal Mortality (> 1 mo)Direct cause :
Fetal/perinatal problems :
respiratory & circulatory distress (45.5%),Low birth weight / premature (32.8 %)
Infection (6.9%)
Hypothermia (5,9 %)
Tetanus (3.4%)
Metabolic (1.7%)
Maternal problems :
Nutritional status, reproduction (age, spacing, birth), prenatalcare, diseases
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on infant and underfivesSevere acute respiratory tract infection (pneumonia)
diarrhoeamalnutrition
other infection
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INFANT & CHILD HEALTH STATUS
1. LOW BIRTH WEIGHT (< 2.5 kg) : 450.000/year
2. PERINATAL CARE (< 1 mo) unadequate
Umbilical care : traditional 17,7% (800.000 perinatal).
Never seen by health staff before 1 mo of age (30 % )
Pra lacteal feeding :
banana 17 % air tajin 9.3%, sugar or honey 3.1 %,
others 9.5%.Geographical handicap, poverty, culture
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INFANT and CHILD HEALTH STATUS
2. NUTRITIONAL STATUS
SEVERE MALNUTRITION (Unicef 2000) 8 % under5
(1,8 milllions underfive)
SEVERE + MODERATE MALN.: 34 % (7 million under5)
MILD MALNUTRITION : 26 % (5.2 million underfive).
1996 : mild malnutrition 20.96 %,
increase 5 % (1 millions underfive).
VITAMINE A DEFFSevere Malnutrition
Fe ANEMIA : underfive 40.5 % (9,4 million underfive) . Primary School age : 45 70 % anemia
IODIUM DEFF. 30 million s lower intelligence
family consumed Iodine Salt 62 %
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INFANT and CHILD HEALTH STATUS
3. IMMUNIZATION10 % (450.000) not fully basic immunization .
4. DENTAL: Decay, missing, filled : school-age 74.41 %,
mean 2.5 teeth / child Dental health service for primary school 60.16 %.
malnutrition
5. MORBIDITY & MORTALITY
Acute respiratory tract infection (pneumonia), Diarrhoea, Malnutrition
Geographic handicap, poverty
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INFANT d CHILD HEALTH STATUS
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INFANT and CHILD HEALTH STATUS
6. DELAY DEVELOPMENT LOWER
INTELLIGENCEEarly detection at Puskesmas
Jabar 1987-1992 : delay development : 2 13,2 %
Jateng 1988 1992 : delay dev. :2.6 4.4 %
7. EDUCATION Drop out Primary School : 900.000 child/year
Primary & Second. School Age not enroll : 6 million
Secondary School age not enrollbut : 3.6 juta
Enrollment on Secondary School : 71, 87 % Lower intelligence ?: IQ borderline ?, Mentally
retarded ?
Parent appreciation, poverty, geographics
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INFANT and CHILD HEALTH STATUS
8. OTHER SOCIAL PROBLEMS
Child workers : 2.5 millions Street Childreen : 150.000 child
l Sexual exploitation : 40.000
70.000 child
Child abuse : ??
Crime : 4000 child
Child neglect: ?
Drug abuse : 120.000
1 million ? Orphanage ?
Disabled ?
in refugee camp ?
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STRATEGI FOR OPTIMIZING
QUALITY OFCHILD GROWTH and DEVELOPMENT
Directto the infant and child
Indirect : improving quality of family,especially mother, father and adolescence
girl
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Improving quality of mother, father
and adolescens girl
1. Improving nutritional status of motherand adolescencegirl: chronic malnutrition, Fe deffiency Anemia Iodium
defficiency
2. Improving educational statusmother, father and
adolescen girl : reading for health information and itsapplication
3. Improving knowledge and skill mother, father and
adolescen girl on :a. FAMILY PLANNING : pregnant >21 year < 35 year,
spacing for 2 3 years, number of child < 3 ,
b. MATERNAL HEALTH : prevention for anemia,
malnutrition, infection
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c. PREGNANCY CARE : prevention for anemia,
malnutrition, imunization, early identification of bleeding,
toxemia, infection
d. SAFE DELIVERY : especiallyfor high risk mother
(chronic malnourish, anemia, too young or too old, too short,
too short spacing, too frequent, delayed care)
e. INFANT and CHILD CARE : perinatal care,
umbilical, MM, immunization, infant feeding, prevention for
infection, accident, early identification for ARTI, diarrhoea,
malnutrtion
f. EARLY STIMULATION for COGNITIVE and
EMOTION-SOCIAL : playing, BKB, PADU / Early Child
Education
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g. HYGIENE & SANITATION : washing hand
before handle baby, safe water, disposal, safe cooking,feeding, home ventilatioan
4. Improving knowlegde mother, father and adolescence
girls onfCHILD RIGHT, especially : child protection for
child abuse, neglect, exploitation, drug abuse
5. Improving knowledge and skill forfamily income
generating by optimizing resource in family at home
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