1. Chapter Ten
Child Health

2. 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

3. 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

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

5. 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

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

7. Figure 10.2: Infant and Under-5 Mortality

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

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

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

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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