ch4GCH - Chapter 4: Chapter Maternal and Child Health...

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Unformatted text preview: Chapter 4: Chapter Maternal and Child Health Maternal & Child Health (MCH) Maternal Key area of international health Child health focuses on under-5s Maternal health focuses on reproductive Maternal health, including contraception, pregnancy (prenatal care), and delivery (prenatal Child Mortality Child More than 10 million children died in 2005 Most were under-5s Under-5 child mortality, 2004 Under-5 Missing 0 – 9.9 10 – 49.9 50 – 99.9 100 – 200 > 200 Under-5 child mortality by region, 2001 Under-5 Causes of death: birth to age 5 Causes Cause # deaths / year % of child deaths Neonatal (first 28 Neonatal days) days) ARIs (pneumonia) 3.9 million 37% 2.0 million 19% Diarrhea 1.8 million 17% Malaria 850,000 8% Measles 395,000 4% HIV/AIDS 320,000 3% Injuries 305,000 3% 1.0 million 10% All other causes Neonatal mortality Neonatal Deaths from birth to 28 days Includes: – Preterm birth: born before full term – Birth asphyxia: not enough oxygen – Birth trauma: any trauma during birth process – Neonatal tetanus: cord cut w/out sterile tool – Other infections – Other conditions Causes of mortality in children 29 days through 5 years old through Other 15% Injur i es 5% ARIs 30% HIV/AID S 5% Measles 6% Malar i a 13% D i ar r hea 26% Top 5 causes of death in children (ages 29 days through 5 years) (ages 1. ARIs (acute respiratory infections) like 1. pneumonia pneumonia 2. Diarrhea 2. Diarrhea 3. Malaria 4. Measles 5. HIV/AIDS 5. 5. Injuries 5. (basically a tie for HIV/AIDS & injuries) Pneumonia Pneumonia Respiratory system function: exchange of Respiratory gases gases – Oxygen in – Carbon dioxide out Heart and lungs work together to get Heart oxygen to cells oxygen Function of the Heart, Lungs, and Blood Right side of heart – sends blood to lungs path of blood LUNGS: Put oxygen into blood and take CO2 from blood HEART Left side of heart – sends blood to body path of blood Cells of the BODY: Release CO2 into blood and take oxygen from blood Pneumonia Pneumonia Pneumonia: llungs fill with fluid ungs fluid alveoli fill with fluid and gas exchange cannot occur hypoxia (too little hypoxia too oxygen in the blood) oxygen Symptoms: short rapid breathing; may turn Symptoms: blue if severe blue Pneumonia Pneumonia Many causes and may Cause: many Many types of infection (usually bacterial) types Treatment: antibiotics soon after start of Treatment: symptoms (will not work for viruses) symptoms Prevention: vaccines like Hib vaccines (Haemophilus influenza type b) Hib vaccines alone could prevent 500,000 deaths each year deaths % of under-5s with suspected pneumonia taken to a health-care provider taken Diarrhea Diarrhea Increase in volume of stool or frequency of Increase defecation defecation Causes dehydration and loss of Causes electrolytes (sodium, potassium, & bicarbonate) bicarbonate) Symptoms: Symptoms: – llow blood pressure (fluid loss decreases ow blood volume) blood – fast weak pulse – See WTIND Diarrhea Diarrhea Prevention: unsafe water, inadequate Prevention: amounts of water for hygiene, and lack of sanitation facilities contributes to about 88% of diarrhea deaths 88% Treatment: ORT (oral rehydration therapy) Treatment: ORT = sugar + salt + clean water sugar % of children with diarrhea who receive ORT and continued feeding receive Malaria Malaria Parasitic infection spread by mosquitoes Causes fever and in children may cause Causes coma (cerebral [brain] malaria) and death coma Relapse and re-infection is common – In endemic areas a child may have >6 bouts In per year per Increased risk of birth complications when Increased the mother has malaria the Malaria Malaria Prevention: avoid mosquito bites Sleep under an ITN (insecticide-treated Sleep bednet) bednet) Treatment: anti-parasitic drugs like Treatment: chloroquine chloroquine Measles Measles Highly contagious virus Airborne Severe complications in undernourished Severe children: diarrhea, ear infections ( children: deafness), pneumonia, encephalitis (brain swelling brain damage and blindness) Prevention: vaccination Treatment: none Undernutrition Undernutrition More than 50% of child deaths are related More to undernutrition. to Ways to avoid undernutrition Ways Exclusively breastfeed for 6 months Exclusively (provides clean liquid and antibodies) then add complementary foods add Social eating practices that allow children Social to get enough calories to Vitamin & mineral supplements Child Health Initiatives Child PHC (primary health care): under-5 clinics PHC (primary EPI (expanded program on immunizations) (expanded GOBI: growth monitoring, ORT, breastfeeding, growth immunizations immunizations GOBI/FFF: added family planning, food added production, and female education production, IMCI (integrated management of childhood IMCI illnesses): iintegrate parents + communities + illnesses) ntegrate health professionals AND integrate case management management Examples of Family Practices under IMCI under Exclusive breastfeeding for 6 months Exclusive for Full course of immunizations Full immunizations Wash hands after defecation and before eating Wash or preparing food or Have children sleep under ITNs Have ITNs Give ORT for diarrhea Give for Prevent injuries Prevent child abuse Prevent abuse Ensure that pregnant women receive antenatal Ensure care care Recognize when children need to see a doctor Recognize doctor Include men in provision of childcare Include of IMCI Case Management IMCI ASSESS Check for DANGER SIGNS (cough or breathing difficulty, diarrhea, fever, vomiting, convulsions, etc.) ASK about main symptoms and EXAMINE the child Check NUTRITION Status (weight, height, anemia, etc.) Check status of child health ROUTINE (immunizations) CLASSIFY by signs and severity IDENTIFY TREATMENT, including referrals and home care and follow-up advice Protecting Children Protecting Child abuse Child labor (not just “economic activity”) – Sex worked, armed conflict, trafficing Protecting the “girl-child” against Protecting infanticide (killing infants), early marriage, lack of education, sexual abuse lack UNICEF – U.N. agency for children Sex & Gender Sex Sex: biological classification defined by anatomy and genetics (XX or XY) anatomy Gender: expression of ‘maleness’ or expression ‘femaleness’ that is shaped by culture as well as biology as Gender roles: cultural variations of how males Gender and females should behave and – What should women do? (cook, clean, care for What children, wear skirts) children, – What should women NOT do? (work in industry, be What religious leaders, drive cars, be in public spaces without a male relative, own property, vote) without Females and Violence Females Women may have little power over their bodies Women power because gender roles tend to give men authority and women tend to be physically smaller & weaker than men weaker Increased risk of interpersonal violence (spousal Increased abuse) and sexual abuse abuse) Multi-country study: Multi-country – 23% to 49% of women have been physically abused 23% by an intimate partner by – Many woman think it is okay for a man to beat his Many wife wife – Many women think it is not possible for a woman to Many avoid sex with her husband avoid Females and Violence Females Violence against females throughout the Violence life cycle: life – Pre-birth: sex-selective abortions – infanticide – Girlhood: FGM (female genital mutilation), Girlhood: early marriage, child prostitution early – Adolescence and adulthood: date rape, Adolescence sexual harassment, spousal abuse, forced pregnancy, trafficking, dowry abuse pregnancy, Women are not men! Women Women are not small men – different Women genes, hormones / body chemistry, brain function, response to medication function, Example: heart disease Women are not men! Women Women have more… Reproductive cancers Reproductive STIs STIs Burns Burns Mental illness Mental Sensory disorders Sensory Dementias Dementias Arthritis Arthritis Autoimmune disease Autoimmune Undernutrition Undernutrition Men have more… Lung cancer Lung Tropical infections Tropical Injuries Injuries Suicide Suicide Alcohol & drug use disorders Alcohol Liver disease Liver Lung disease Lung Pregnancy & Childbirth Pregnancy More than 500,000 women die each year due More to complications of pregnancy and childbirth to About 40% of women deliver without skilled About assistance (nurse or midwife) assistance Most common cause of maternal death: severe Most bleeding (postpartum hemorrhage) bleeding Also: – Infections – Eclampsia: high blood pressure convulsions, high organ failure organ – Obstructed labor: obstetric fistula (hole between obstetric vagina and bladder or rectum); > 50,000 new cases of fistula per year fistula Causes of maternal mortality Causes Maternal mortality Maternal Africa – On average 830 deaths / 100,000 births On 830 – Lifetime risk of maternal death: 1 in 16 Rich countries – 24 deaths / 100,000 births – Lifetime risk of maternal death: 1 in 2800 Women in Africa are 175x more likely to Women die than women in North America / Europe die Maternal Health Indicators, 2000 Maternal Country Afghan. Kenya Senegal Peru Philip. Canada Births Births attended by TBA by 14% 42% 58% 59% 60% 98% Maternal Maternal mortality / 100,000 live births live 1900 1000 690 410 200 5 Neonatal Neonatal mortality / 1000 live births births 60 29 31 16 15 4 Family Planning Family Contraception: iintentional prevention of ntentional pregnancy pregnancy Methods: Methods: – Abstinence (100% effective at preventing Abstinence pregnancy) pregnancy) – Barriers like condoms and diaphragms Barriers – Medications (hormones) that prevent ovulation Medications ovulation (release of an egg from an ovary) (release – Sterilization surgery Family Planning Methods Family Vasectomies and tubal ligation: >99% effective at Vasectomies preventing pregnancy during one year of use in sexually active American women sexually Hormone implants (Norplant) and injections (DepoProvera): 99% effective IUDs (intrauterine devices) that inhibit fertilization IUDs and implantation: 99% effective and Oral contraceptives like “the pill” (called the “family Oral planning pill” in other parts of the world): 98-99% effective IF USED CORRECTLY effective Family Planning Methods Family Male condom: 89% effective; prevent STIs Diaphragm with spermicide: 80-94% effective Sponge: 72-86% effective Periodic abstinence (avoiding intercourse during Periodic woman’s most fertile days): 80% effective woman’s Female condom: 79% effective Spermicides: 50-80% effective No contraceptive method used: 15% “effective” No (85% of women will become pregnant during one year) year) Abortion Abortion Abortion: the termination or loss of a the pregnancy pregnancy – Spontaneous abortion = miscarriage – Induced abortion = chemical or surgical termination of a pregnancy termination Not a form of contraception Reproductive History Reproductive Gravidity: # of pregnancies ever of ever Fertility: # of births (includes stillbirths) Parity: # live births Goal of family planning: minimize Goal unwanted gravidity but try to get parity to equal gravidity to Fertility rates (births per woman), 2004. Fertility Missing 0 – 1.99 2 – 2.99 3 – 5.00 > 5.00 Female Literacy and Fertility Female 8 7 6 5 4 Total Fertility 3 2 1 0 0 20 40 60 F e m a l e Ad u l t L i te ra cy Ra te 80 100 Population Growth Population What happens to a growing island What population? population? Loss of natural resources scarcity, Loss pollution, congestion crime & war Thomas Malthus (1798): predicted famine, Thomas epidemics, war (Malthusian catastrophes) epidemics, World Population Growth World 7 6 5 4 3 2 1 World Popluation (in billions) 0 1000 1250 1500 Ye a r J-shaped curve 1750 2000 Population Growth Population Carrying capacity: maximum human maximum population Earth can support population Ecological footprint: per capita area of per land needed to meet consumption land At present food production is increasing At faster than population BUT distribution is not equal not – Fertility rates often highest where food Fertility production is lowest production Demography Demography Demography: study of size and study composition of human populations composition Vital statistics: birth & death registries Birth rate: births / 1000 people Death rate: deaths / 1000 people Fertility rate: average # children a women average gives birth to during her lifetime gives Fertility Rate in Selected Countries Fertility 9 8 Fertility rate = 2 is a replacement population. 7 > 2: population grows; < 2: population shrinks over time 6 5 4 3 Total Fertility Rate 2 1 0 Niger D. R. Congo Nigeria Pakist an India Brazil Unit ed St at es China Sout h Korea Poland Age Structure Age Aging index: # people age 65+ / 100 people children age <15 children Dependency ratio: # dependent children + dependent older adults / 1 working age adult (age 20older 64) Elderly support ratio: # people age 65+ / people 100 people age 20-64 100 What is the relationship between fertility What rates and dependency ratios? rates Dependency Ratio per 100, 2004 Dependency 120 High fertility rate = high dependency ratios (lots of children) 100 80 60 40 20 Dependency Ratio (per 100) 0 Niger D.R. Nigeria Pak is tan India Congo Braz il Unit ed Stat es China South Korea Poland Population pyramid for less developed countries Population Males Females Population pyramid for more developed countries Population Males Females What happens as this population ages? (Hint: what happens to social security funds?) Demographic Transition birth rate death rate total population Stage 1: High fertility rate and high death rate; stable population size Stage 2: High fertility rate but death rates begin to decrease; population begins to Stage 3: Both fertility and death rates decrease; population continues to increase Stage 4: Low fertility rate and low death rate; population size stabilizes Population Control Population Reduce fertility by increasing access to Reduce contraception contraception Increase female education Create policies that encourage small families – China: “late, long, few” (1970s) one-child policy China: (1980s to present) (1980s 1.7 children / couple on average Problems: sex-selection; “one-two-four” family Problems: structure structure UNFPA (United Nations Population Fund) ...
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This note was uploaded on 09/23/2011 for the course GCH 100 taught by Professor Corso during the Fall '11 term at George Mason.

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