Chapter Ten

Child Health

The Importance of Child Health

• 8.8 million children under the age of 5 die each year

• Many of these deaths are preventable• Children are a particularly vulnerable population• Closely linked with poverty• Insufficient progress has been made in certain

parts of the world in reducing childhood morbidity and mortality

Key Terms

• Perinatal : first week of life• Neonatal : referring to the first month of life• Infant : referring to the first year of life • Under-5 : referring to children 0-4 years old

Table 10.2: Selected Terms Relating to Causes of Child Illness and Death

The Burden of Childhood Illness

Children Under 5 Years• 99% of childhood deaths are in low- and middle-

income countries • Half of these deaths occur in India, Nigeria,

Democratic Republic of the Congo, Pakistan, and China

• 41% of under-5 child deaths occur among neonates• Rates and causes vary across and within countries• General trend is decline, but rates of decline also vary

considerably by region

Figure 10.1: Neonatal Mortality Rate, by WHO Region, 2004

Figure 10.2: Infant and Under-5 Mortality

Figure 10.4: Causes of Neonatal Deaths, by Percentage, 2008

Figure 10.5: Causes of Postneonatal Deaths in Children under 5, by Percentage, 2008

Table 10.3: Leading Causes of Under-5 Child Death for Selected WHO Regions, by Percentage, 2008

Figure 10.6: Declines in Under-5 Child Mortality, by Region, 1990-2008

Additional Comments on Selected Causes of Morbidity and Mortality

Acute Respiratory Infections• Leading cause of death in low- and middle-income

countries• More severe and cause higher rates of death in low-

and middle-income countries than in high-income countries

• Upper respiratory tract infections include the common cold and ear infections, lower respiratory infections include bronchiolitis and pneumonia

Additional Comments on Selected Causes of Morbidity and Mortality

Diarrhea• Caused by bacteria, viruses, protozoa, and

helminths• Causes dehydration, loss of nutrition or

wasting, and damage to the intestines• Infants 6-11 months are particularly vulnerable

because they have been introduced to unsafe water and foods

Additional Comments on Selected Causes of Morbidity and Mortality

Malaria• 750,000 children die from malaria each year• A child in sub-Saharan Africa is likely to have

a case every 40 days • Associated with premature birth and

intrauterine growth retardation, which reduce chances of survival

Additional Comments on Selected Causes of Morbidity and Mortality

HIV/AIDS• Can be transmitted from mother to child

during birth or breastfeeding• Number of HIV-infected children has grown,

particularly in sub-Saharan Africa

Additional Comments on Selected Causes of Morbidity and Mortality

Measles• Acute respiratory infection with complications

including pneumonia, diarrhea, encephalitis, and blindness

• Children who are vitamin A deficient or infected with HIV are more at risk of death

• Extremely contagious if a population is not vaccinated

Additional Comments on Neonatal Mortality

• 41% of children under 5 who die annually, actually die in the first month

• Little progress in reducing neonatal death rate• Every day that a child lives increases the

likelihood that he or she will stay alive• To reduce childhood death rates, the world

needs to focus more precisely on when the deaths occur

Risk Factors for Neonatal, Infant and Child Deaths

• Nutrition status• Household income and education of mother• Access to trained healthcare provider to attend

birth and provide counseling • Water quality and sanitation

The Cost and Consequences of Child Morbidity and Mortality

• High costs of caring for a sick child• Potential long-term disability • Poor school attendance and performance

Addressing Key Challenges in Child Health

• Progress has been largely between 1 and 5 years; very little has been made in reducing the death rate of neonates

• Insufficient progress in sub-Saharan Africa and South Asia

• Low-cost, highly effective interventions are not being implemented where they are needed most

Addressing Key Challenges in Child Health

Critical Child Health Interventions• Ensuring nutrition and health of the mother and

mother-to-be• Essential newborn care, extra care for small

babies, and emergency care for newborns• Preventing and managing diarrhea with hygiene,

proper nutrition, measles vaccinations, and ORT• Basic vaccinations

Addressing Key Challenges in Child Health

Community-Based Approaches to Improving Child Health

• Women’s groups to raise awareness of maternal, fetal, and neonatal issues

• Community-based promotion of hygiene, umbilical cord care, and keeping the baby warm

Addressing Key Challenges in Child Health

Integrated Management of Childhood Illness

• Integrated healthcare approach for children because of many interrelated factors

• Healthcare workers trained at all levels, particularly home and community-based