CHILD & FAMILY CHILD & FAMILY HEALTHHEALTH

Infant MortalityInfant MortalityModule 2 of 2Module 2 of 2

Grace E. Foege Holmes, MDGrace E. Foege Holmes, MD

Learning Learning Objectives:Objectives:

Performance Performance Objectives:Objectives:

Dr. Grace Holmes and grandson, Dr. Grace Holmes and grandson, QuentinQuentin

DIRECT/MEDICALDIRECT/MEDICALImmediateImmediate (birth defects)(birth defects)

ChronicChronic (malnutrition)(malnutrition)

INDIRECTINDIRECTSocialSocial

EconomicEconomic

EnvironmentalEnvironmental

BIRTHWEIGHTBIRTHWEIGHTis the single most is the single most

important predictor important predictor for infant survival.for infant survival.

Mother with NewbornMother with NewbornChild SurvivalChild SurvivalWorld DevelopmentWorld Development

• Premature < 37 weeks’ Premature < 37 weeks’ gestationgestation

• Full term, but long and Full term, but long and skinny, or short-for-datesskinny, or short-for-dates

Low Birth Weight Low Birth Weight (< 2500 grams)(< 2500 grams)

PREMATURITYPREMATURITYGestation of less than 37 weeksGestation of less than 37 weeks

• calculation from last menstrual calculation from last menstrual period (CGA-Calculated period (CGA-Calculated Gestational Age)Gestational Age)

• estimation by physical and estimation by physical and neurological signs of the baby neurological signs of the baby (EGA-Estimated Gestational Age)(EGA-Estimated Gestational Age)

UNDERNUTRITIONUNDERNUTRITION

Adult female stunted

< 151 cms

Drawing:Drawing: The Crisis of Undernutrition. The Crisis of Undernutrition. Credit:Credit: Teaching Aids at Low Cost (TALC) Teaching Aids at Low Cost (TALC)

More undernutrition

• Poor nutrition in pregnancy

with anemia• Smoking• Frequent infection e.g. malaria• 10% + of birth weights under

2.5kg

More infections and deaths of small babies, and other effects which continue till fourth year

More backward children

Chart shows Chart shows poor growth poor growth of a girl in of a girl in first 3 yearsfirst 3 years

Contrast of well-fed and underfed pregnant women.Contrast of well-fed and underfed pregnant women.

Underfed Underfed mother’s mother’s

pregnancy pregnancy weight weight gain gain

= 6 kg= 6 kg

Underfed Underfed mother’s mother’s

pregnancy pregnancy weight weight gain gain

= 6 kg= 6 kg

Blood + tissue fluid + Blood + tissue fluid + uterus + breastuterus + breast

Blood + tissue fluid + Blood + tissue fluid + uterus + breastuterus + breast

Well-fed Well-fed mother’s mother’s

pregnancy pregnancy weight weight gaingain

= 14 kg= 14 kg

Well-fed Well-fed mother’s mother’s

pregnancy pregnancy weight weight gaingain

= 14 kg= 14 kg BabyBaby++

PlacentaPlacenta++

AmnioticAmnioticfluidfluid

BabyBaby++

PlacentaPlacenta++

AmnioticAmnioticfluidfluid

Maternal education Maternal education appears to have a appears to have a strong and strong and independent effect on independent effect on infant mortality.infant mortality.

ADULT LITERACY ADULT LITERACY RATERATE

• Percentage of persons aged 15 Percentage of persons aged 15 years and older who can read years and older who can read and write.and write.

• 60% of all illiterate people are 60% of all illiterate people are women.women.

Bar Graph: Bar Graph: Literacy in Women and Men Literacy in Women and Men

(TALC)(TALC)North AmericaNorth America

USSRUSSR

EuropeEurope

South East AsiaSouth East Asia

Latin AmericaLatin America

Arab StatesArab States

Middle South AsiaMiddle South Asia

AfricaAfrica

Adult malesAdult males

Adult femalesAdult females

0 20 40 60 80 1000 20 40 60 80 100

Percentage literatePercentage literate

Male and Female Shares of TasksMale and Female Shares of Tasks

30%

50%

70%

60%

80%

80%

90%

60%

50%

AGRICULTURAL WORKAGRICULTURAL WORKDivision of rural labor by task and sex, Africa Male share Female share

Source: Economic Commission for Africa, 1975

(Child Survival/World Development)

70%

50%

30%

40%

20%

20%

10%

40%

50%

PLOUGHING

PLANTING

HOEING/WEEDING

HARVESTING

TRANSPORTING

STORING

PROCESSING

MARKETING

HUSBANDRY

AGRICULTURE

HUSBANDRY

COOPERATIVES

85%

80%

90%

AGRICULTURAL TRAINING AGRICULTURAL TRAINING Male and female participation in agricultural training programs, Africa

Source: International Children’s Center, “Children in the Tropics”, Issue No 146, Paris, 1983

Educating Girls

““... train a woman and you ... train a woman and you build a nation.”build a nation.”

It’s It’s never never

too too early to early to

start start learning!learning!

What Slows What Slows Population Growth?Population Growth?

Source: Source: UNICEFUNICEF

Source: Source: UNICEFUNICEF

Source: Source: UNICEFUNICEF

Gift Gift Poster Poster From From ChinaChina

Bangladesh: World Fertility SurveyBangladesh: World Fertility Survey

All twenty-nine other countries studied showed similar trends (TALC)All twenty-nine other countries studied showed similar trends (TALC)

Spacing Between BirthsSpacing Between Births

Health status of Health status of mother directly mother directly

affects child survival.affects child survival.

IMPACT IMPACT OF OF

EDUCATIONEDUCATION

GEFHGEFH

Primary Primary education education for for women women is a critical is a critical factor in any factor in any country’s country’s development.development.

Education:Education:An An

Influential Influential InvestmentInvestment

Women: Women: the Key to Healthy Childrenthe Key to Healthy Children

Source: UNICEFSource: UNICEF

GEFHGEFH