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Child health Problems & services

March, 2012

Addis Ababa University

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Learning objectives

At the end of this lecture the students will be able to: Identify the major health problems of

children

Familiar with the basic health services of children

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Contents Child health problems

Major problems Contributing factors

Child health services Healthy baby clinic Sick baby clinic Day care centre services School health care Care for the handicaps Preventing HTPs

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Child health Problems

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Problems…. Each year more than 10 million children in

low-and middle-income countries die before they reach their 5th birthday.

70% of these deaths are due to just five preventable and treatable conditions:

Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition

Often to a combination of these conditions.

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Problems….

Sources: For cause-specific mortality: EIP/WHO. For deaths associated with malnutrition: Caulfield LE, Black RE. Malnutrition and the global burden of disease: underweight and cause-specific mortality. Paper in preparation.

Diarrhoea12%

Other29%

Pneumonia20%

Malaria8%

Measles5%HIV/AIDS

4%

Perinatal22%

Deathsassociated withundernutrition

60%

Major causes of deathamong children under five, world, 2000

Causes of deaths among children less than 5 years old in all developing countries, 2000

(Source: WHO, IMCI Model Handbook)

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Problems…. The global burden of disease indicates that

these conditions will continue to be major contributors to child deaths unless significantly greater efforts are made to control them.

In Ethiopia, an estimated 472,000 U5 children

die each year

Placing Ethiopia 6th in the world in terms of absolute number of U5 deaths.

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Problems…. The proportions of attributable causes

of U5 deaths in Ethiopia have been estimated as:

Pneumonia 28% Neonatal complications 25% Malaria 20% Diarrhoea 20% Measles 4% AIDS 1% and Others 2%.

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Problems…. There are other problems associated with

high infant and child morbidity and mortality.

These include: Other vaccine preventable diseases Injuries and accidents Eye and skin infections Harmful traditional practices

FGM Uvulectomy Milk-teeth extraction Etc

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Contributing factors: Poverty Malnutrition Decline in breastfeeding Inadequacy or lack of sanitation Inadequate access to health facilities In some countries, civil unrest &wars Unwanted births, child neglect and

abuse

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Child health services

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Services… The health of the young child is intimately

bound up with that of the mother.

Planned child health services therefore encompass activities before pregnancy, during pregnancy, during labour & delivery up to school & adolescent.

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Services… Important progress has been made in

reducing infant and child mortality globally.

Improvements in the survival of children have the main component of the overall increase in average life expectancy in the world over the past century

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Services…

Health services for young children

should deal with

Promotive

Preventive &

Curative services

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Services… Health service components for children

1. Well-baby clinic Screening Growth monitoring Immunization Health education

2. Sick baby clinic3. Day care centre services4. School health care5. Care for the handicaps6. Preventing/reducing HTPs

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Screening Screening is making a rapid assessment of

the health needs of the child with the purpose of identifying problems for appropriate management.

Making rapid assessment of all children using health facilities for different reasons missed opportunities will be minimized.

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Screening…

The screening process involves: Examination of the child’s general health

status Observation and assessment of child’s

immunization status Observations for childhood problems like

child neglect and abuse. Observation for acute problems which need

urgent treatment or referral

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Growth Monitoring (GM) GM is the process of sequential

measurement for the assessment of physical growth and development

For the purpose of promoting child health,

human development and quality of life.

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Objectives of GM1. To promote growth monitoring as an instrument of

individual health and to instigate effective action in response to growth faltering.

2. To teach mothers, families & health workers how diet & illness affect child growth

3. To provide regular contact with primary health services

4. To determine age specific characteristics of growth

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Immunization Immunization is the process of protecting a

person from a specific disease.

It is the process of administering a weakened or killed micro-organisms or its product to stimulate the host’s immunologic response to that antigen.

Immunization decreases susceptibility by producing antibodies or sensitized cells to fight the agent and its product.

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Immunization…

Types of Immunization Active:

Natural active Acquired active

Passive: Natural passive Acquired passive

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EPI EPI was launched in 1974 by the WHO.

It was started in Ethiopia in 1980

With the intention of increasing the immunisation coverage by 10% annually and reaches 100% coverage in 1990.

However, in 1986, only 10% of the countries eligible children were fully vaccinated.

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EPI… After launching of Social Mobilization of intensification

of EPI to attain Universal Child Immunization (UCI), the coverage increased to 59% by 1990.

Subsequently as a result of the escalating civil war

and public unrest, the EPI coverage for DPT3 dropped from 59% to 21% in 1991, and 13% in 1992

With the revival of EPI in 1993, DPT3 coverage reached 28% and reached 43% in 1995.

In 2007, 72%

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Diseases under EPI in Ethiopia

Tuberculosis, Polio, Diphteria, Pertussis, Tetanus, and Measles. Currently HepB and Hib are included in the

Pentavalent preparation. Yellow fever is also currently being included

in the EPI program.

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Objectives of EPI 1. To reduce mortality and morbidity in

children from EPI target diseases through the immunization of all children less than 1 year of age.

2. To promote national self-reliance in developing immunization services within the comprehensive health services.

3. To promote regional self-reliance in vaccine production and quality control.

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Recommended EPI schedules

Vaccine Diseases Age Route BCG Tuberculosis At birth ID DPT + HepB + Hib (pentavalent)

Diphteria, Pertussis, Tetanus, HBV & Homophilus Influenzea type b

6, 10, 14 weeks

IM

OPV Polio At birth, 6, 10, 14 weeks

PO

Measles & Yellow fever

Measles & Yellow fever 9 months Sc

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Strategies to EPI delivery1. Routine EPI:

Static: in health facility Out reach services Mobile health facility

2. Supplementary campaigns: Polio campaign Measles campaign, Vit’ A supplementation

3. RED and SOS To increase the coverage in certain priority

areas which are very far to be covered by routine programmes

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Problems to EPI

Geographical barriers (inaccessibility)

Dropouts and

Missed opportunity

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IMCI The young child suffers from diseases and

death as compared to other segments of the population because of reasons related to immunity and

inadequacy of care given to them.

Child health care programmes therefore should cater for the diagnosis, treatment and follow-up sick children from common childhood diseases.

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IMCI--- To prevent the common health problems of the new

born, Improve ANC Health education Better nutrition Safe delivery Family planning and Breast feeding are very important

After the diseases once occurred appropriate diagnosis and treatment are very important.

For this purpose WHO developed the approach called Integrated Management of Childhood Illnesses (IMCI).

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IMCI… IMCI is an innovative approach which was

started in 1995 by WHO and UNICEF with the aim of introducing a comprehensive and timely management of the 5 most common causes of ill health and death among the under-fives.

These illnesses are: Pneumonia, Diarrhoea, Malaria, measles, malnutrition.

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Why IMCI? Most sick children present with signs and symptoms related

to more than one conditions.

The overlap means that a single diagnosis may neither be possible nor appropriate.

Treatment of childhood illness may also be complicated by

the need to combine therapy for several conditions.

The need to go beyond single diseases and address the overall health of a child.

Nutrition, immunization, and several other important influences on child health, including maternal health will be addressed .

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Components of IMCI…

Improvement of health worker skills.

Improvement of health systems

Improvement of family and community practices

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IMCI case management

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