بسم هللا الرحمن الرحيم الحمد هلل رب العالمين والصالة والسالم على نبينا محمد خاتم األ نبياء وسيد المرسلين وعلى آله وصحبه أجمعين وبعد

Transcription

1 بسم هللا الرحمن الرحيم الحمد هلل رب العالمين والصالة والسالم على نبينا محمد خاتم األ نبياء وسيد المرسلين وعلى آله وصحبه أجمعين وبعد

2 Infant and Child Mortality/The five measures of infant and child mortality Neonatal mortality, the probability of dying in the first month of life Postneonatal mortality, the probability of dying after the first month of life but before the first birthday (the difference between infant and neonatal mortality rates) Infant mortality (1q0), the probability of dying before the first birthday

3 Child mortality (4q1), the probability of dying between the first and fifth birthday Under-five mortality (5q0), the probability of dying before the fifth birthday. All of these rates are calculated per 1,000 live births, except for child mortality which is calculated per 1,000 children surviving to age one.

4 Children health. Child's health includes physical, mental and social well-being too. Each year more than 10 million children under the age of five die. At least 6.6 million child deaths can be prevented each year if affordable health interventions are made available to the mothers and children who need them.

5 Underlying causes of Child illness and death. Poverty: More than 200 million children under five live in absolute poverty, on less than $1 per day. Under-nutrition and malnutrition: At least 200 million children under five are malnourished. High fertility and short birth intervals.

6 Under-five mortality rate (U5MR). Indicates the probability of dying between birth and exactly five years of age, expressed per 1,000 live births, if subject to current mortality rates. It has several advantages as a barometer of child well-being in general and child health in particular. It measures an outcome of the development process.

7 Under-five mortality rate (U5MR) Is known to be the result of a wide variety of inputs: nutritional status and the health knowledge of mothers; level of immunization and oral rehydration therapy; availability of maternal and child health services (including prenatal care);

8 Under-five mortality rate (U5MR) Income and food availability in the family; Availability of safe drinking water and basic sanitation; Safety of the child s environment, among other factors U5MR is less susceptible to the fallacy due that is a picture of the health status of the majority of children (and of society as a whole).

9 Post-2015 UN development agenda MDG 1: eradicate extreme poverty and hunger MDG 2: Achieve universal primary education MDG 3: promote gender equality and empower women MDG 4: reduce child mortality MDG 5: improve maternal health MDG 6: combat HIV/AIDS, malaria and other diseases MDG 7: ensure environmental sustainability MDG 8: develop a global partnership for development

10 MDGs and maternal/child health Millennium Development Goal 4 aims to reduce child deaths by two-thirds between 1990 and Millennium Development Goal 5 has the target of reducing maternal deaths by three-quarters over the same period.

11 MDGs and maternal/child health Unfortunately, on present trends, most countries are unlikely to achieve either of these goals. A recent review of MDG progress, show that the world have only 32% of the way to achieving the child health goal and less than 10% of the way to achieving the goal for maternal health.

12 Key facts (as of May 2012) 1-Every day approximately 800 women die from preventable causes related to pregnancy and childbirth. 2-99% of all maternal deaths occur in developing countries. 3- Young adolescents face a higher risk of complications and death as a result of pregnancy.

13 Skilled care before during and after childbirth can save the lives of women and newborn babies. Between 1990 and 2010 maternal mortality worldwide dropped by almost 50% Everyday 8000 newborn babies die from preventable causes. Nearly 99% of all neonatal deaths occur in low and middle income countries

14 70% of global deaths among newborn babies happen in just two WHO regions: Africa and South East Asia Essential maternal and newborn care and access to care for complications can save the lives of mothers and newborn babies.

15 Some conclusions. Maternal, neonatal and child mortality has been very persistent in a global context. Now 38 percent of all child deaths (4 million) occur in the first month of life. More than 10 million children under 5yr die each year. Most result from preventable and treatable causes. That s 30,000 children a day. Most of these children live in developing countries

16 Conclusions Improving newborn health and care is critical to attaining the MDG targets for child survival To do so would require concerted efforts to improve maternal care, outreach and provide innovative models of community support and education Emerging data from demonstration projects in health system settings indicate that this is doable and can be scaled up using affordable models of care Community engagement and ownership is a critical element in successful intervention models for maternal and newborn care

17 Few indicators for health status of children MCH coverage; Vaccination Coverage % of Fully Immunized Infant mortality rate Under five mortality rate ORT use rate

18 Well Baby Clinic Very imp. Preventive child health clinic. From 6 weeks of age to 5 years. Main goals: A-Health education B- Growth and development. C- Vaccination D- Nutritional and Psychological counseling.

19 WBC baby should be seen by a health care provider at the following ages: two months Four months Six months Nine months Fifteen months Eighteen months Two years Three years

20 Assessing the baby's capabilities

21 Monitoring Growth and Development. Growth : Head circ. Length and weight.(growth chart.) Infant Feeding. Skills and Behavior.

22 Infant Morbidity Morbidity is a measure of disease, illness or injury within a population. Like infant mortality, conditions resulting from prematurity and low birth weight are strongly associated with infant morbidity. 1,2 Infant morbidity can be measured by the presence of diagnosed conditions, such as respiratory distress and hyperbilirubinemia (or jaundice), as well as by service utilization indicators, including admission to a neonatal intensive care unit (NICU) and length of hospital stay. 3

23 Prematurely and low birth (differentiate) Higher Morbidity and Mortality rates 1- Respiratory distress syndrome 2- Birth Trauma 3- Hemorrhages. 4-Feeding problems 5-Infections 6-Failure to thrive

24 lecture notes second med students- 12/5/2018 Vaccination 24

25 CHILDHOOD DISEASES 12/5/2018 lecture notes second med students- Vaccination 25

26 (Percentage of children under five with illness in the 2 weeks before the survey)

27 Trends in prevalence of anemia, 2002, 2009 and 2012

28 Acute respiratory infection Acute respiratory infections cause four and a half million deaths among children every year, the overwhelming majority occurring in developing countries. Pneumonia unassociated with measles causes 70% of these deaths; post-measles pneumonia, 15%;pertussis, 10%;and bronchiolitis and croup syndromes, 5%. Both bacterial and viral pathogens are responsible for these deaths.

29 Bacterial causes The most important bacterial agents are:- A- streptococcus pneumonia B- haemophilus influenza C- staphylococcus aureus.

30 Viral causes A- respiratory syncytial virus, 15%-20% B- Parainfluenza viruses, 7%-10% C- influenza A and B viruses and adenovirus, 2%-4% Mixed viral and bacterial infections occur frequently

31 Risk factors Risk factors that increase the incidence and severity of lower respiratory infection in developing countries include: A- large family size B- lateness in the birth order, C- crowding D- low birth weight E- malnutrition F-vitamin A deficiency G-young age -

32 H- lack of breast feeding I- Pollution Effective interventions for prevention and medical case management are urgently needed to save the lives of many children predisposed to severe disease.

33 Diarrhea Diarrheal diseases are one of the leading causes of childhood morbidity and mortality in developing countries. An estimated 1,000 million episodes occur each year in children under 5 years of age. Diarrhea causes an estimated 5 million deaths in children under 5 years of age per year.

34 About 80% of these deaths occur in children in the first 2 years of life. Approximately one third of deaths among children under five are caused by diarrhea

35 Most diarrheal illnesses are acute, usually lasting no more than 3-5 days and are secondary to infectious causes ( bacterial, viral, and parasitic). Infectious agents that cause diarrheal disease are usually spread by the fecal-oral route, specifically by a ingestion of contaminated food or water or contact with contaminated hands

36 Causes The following are the commonest etiologic agents of diarrhea for all ages in decreasing order of prevalence obtained from pooled data world wide. Rotavirus, Enterotoxigenic Escherichia coli (ETEC) bacteria, Shigella, Campylobacter, Vibrio Cholera, and non- Typhoidal Salmonella,

37 Noninfectious causes of diarrhea include drugs, surgical conditions, systemic infections and food intolerance.

38 بسم هللا الرحمن الرحيم الحمد هلل رب العالمين والصالة والسالم على نبينا محمد خاتم األ نبياء وسيد المرسلين وعلى آله وصحبه أجمعين وبعد

39 Proportional Mortality among<5 yrs. WHO Report 2002/World Wide

40 Children < 5 years mortality (2008). Globally, 80 percent of all child deaths to children under five are due to only a handful of causes: pneumonia (19 %), diarrhea (18 %), malaria (8 %), neonatal pneumonia or sepsis (10 %), pre-term delivery (10 %), asphyxia at birth (8 %), measles (4 %), HIV/AIDS (3 %).

41 Causes of Infant and Child Mortality in Jordan The 3 leading causes of infant death were 1-Conditions originating in the perinatal period. 2-Congenital malformations. 3- Diseases of the respiratory system.

42 The leading cause of death in the neonatal period was conditions originating in the perinatal period, while in the post-neonatal period, it was congenital malformations. Prematurity was the leading contributory cause of infant death.

43 CONCLUSION: This study showed that causes of infant mortality in Jordan tend to be similar to those prevailing in developed countries. Khoury SA, Mas'ad DF. Department of Family and Community Medicine, University of Jordan, Amman, Jordan. Saudi Med J Apr;23(4):432-5.

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45 Prevention and control of Communicable Diseases lecture notes second med students- Vaccination Communicable diseases are diseases that can be transmitted from a person to another through different means ( direct contact, droplet infection, sexual contact, or mother fetus infection.) 45 12/5/2018

46 Steps followed to accomplish control of communicable diseases: 1- Reporting lecture notes second med students- Vaccination 2- Observing of the coming foreigners and tourist who are going to stay in the country for more than one month and testing them for certain disease e.g AIDS, Malaria etc.. 3-Sending teams in cases of outbreaks and epidemics. 4-Coordination with other ministries (Ministry of agriculture and Brucellosis) 5-Vaccination 46 12/5/2018

47 How Some Childhood Infectious Diseases Are Spread lecture notes second med students- Vaccination Direct Contact with infected person's skin or body fluid Respiratory Transmission (passing from the lungs, throat, or nose of one person to another person through the air) Fecal-Oral Transmission (touching feces or objects contaminated with feces then touching your mouth) 47 12/5/2018

48 Direct Contact with infected Person's skin or body fluid Chickenpox* Cold Sores Conjunctivitis Head Lice Impetigo Ringworm Scabies 12/5/2018 lecture notes second med students- Vaccination 48

49 Respiratory Transmission Chickenpox Common Cold Diphtheria Fifth Disease Bacterial meningitis Hand-Foot-Mouth Disease Impetigo Influenza Measles Mumps Pertussis Pneumonia Rubella* 12/5/2018 lecture notes second med students- Vaccination 49

50 Fecal-Oral Transmission Campylobacter E. Coli Enterovirus Giardia Hand- Foot- Mouth Disease Hepatitis A Infectious Diarrhea Pinworms Polio Salmonella Shigella 12/5/2018 lecture notes second med students- Vaccination 50

51 Vaccination lecture notes second med students- Vaccination Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions available (UNICEF 2002; World Bank 1993). By reducing mortality and morbidity, vaccination can contribute substantially to achieving the Millennium Development Goal of reducing the mortality rate among children under five by two-thirds between 1990 and /5/2018

52 Vaccination lecture notes second med students- Vaccination Protecting Your Newborn From Disease How do vaccines work? Are vaccines safe? Keeping an immunization record 52 12/5/2018

53 Immunity lecture notes second med students- Vaccination It is the defense mechanism of the body against the invasion of pathological microorganisms. General immunity General defensive mechanisms available from birth. eg skin, mucosal barriers, tears, blood substances that inhibit motility or multiplication of organisms...etc 53 12/5/2018

54 Immunity ( contd) lecture notes second med students- Vaccination Specific Immunity This type develops against specific microorganisms. It can be acquired in 2 ways: Active immunity: acquired by coming in contact with the pathogen either by contracting the disease itself or by vaccination /5/2018

55 lecture notes second med students- Vaccination Passive immunity Acquired by receiving antibodies from an actively immunized person or animal. It is quickly acquired Short lived in comparison to actively acquired immunity. Can be acquired in two ways: 55 12/5/2018

56 Passive Immunity lecture notes second med students- Vaccination Natural : Antibodies passing from mother to newborn via placenta start falling during the first weeks and disappear within the first 6 months. Artificial: acquired by injection of specific or standard ( non-specific gamma globulins).e.g. Specific immunoglobulins are available for hepatitis B, tetanus, mumps..etc /5/2018

57 Importance of vaccination lecture notes second med students- Vaccination Diseases that are common, can kill or cause disability, Can be prevented. The main diseases are: TB, Pertusis, Diphteria, Poliomyelitis, Tetnus. Measles 57 12/5/2018

58 Vaccination TWO TYPES OF VACCINES: LIVE/ ATTENUATED KILLED/ INACTIVATED 12/5/2018 lecture notes second med students- Vaccination 58

59 Types of vaccines Live attenuated viruses (measles, mumps, rubella, varicella, oral polio) Inactivated viruses (injectable polio (Sabin), hepatitis B, influenza) Inactivated bacteria (pertussis, diphtheria, tetanus, H. influenzae type b, pneumococcus)

60 Live/attenuated Vaccines lecture notes second med students- Vaccination Highly effective They induce slight infection long lasting protection even with a small dose. BCG, measles, MMR, and polio ( trivalent oral polio vaccine TOPV) are live vaccines /5/2018

61 Inactivated Vaccines lecture notes second med students- Vaccination Produce a lower immune response to a single dose in comparison to live vaccines Multiple doses are usually required to give long term protection Pertussis, polio ( injectable, inactivated polio vaccines IPV), typhoid, tetanus, are inactivated vaccines The vaccines for diphteria and tetnus are prepared from the bacterial exotoxin rather than the bacteria organism itself. These are referred to as toxoid vaccines /5/2018

62 How serious is the situation?

63 Rationale for Immunization lecture notes second med students- Vaccination Every year, out of 100 children in the world: 3 die from measels 2 from pertusis 1 from tetanus For every 200 children who are infected with polio virus, one will be crippled for life /5/2018

64 Expanded Program on Immunization lecture notes second med students- Vaccination WHO set Target: 90% of all children below one year be fully immunized by the year Immunization is an essential part of PHC It is a program that was started worldwide by WHO / UNICEF, called ( EPI) /5/2018

65 Immunization E P I ( E X P A N D E D P R O G R A M O N I M M U N I Z A T I O N ) W A S L A U N C H E D I N J O R D A N I N J O R D A N A C H I E V E D U N I V E R S A L C H I L D I M M U N I Z A T I O N I N /5/2018 lecture notes second med students- Vaccination 65

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67 months with specific vaccination (JPFHS, 2007, Section 10.2, Table 10.2, pg.117) (JPFHS, 2012, Section 10.2, Table 10.3, pg.127)

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69 Thank you!!! 12/5/

70 تم بحمد هللا