Child health

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why child health

  • children and young people are still large proportion in whole population
  • large disease burden in children
    • 60% of malaria deaths, 10% of TB cases
  • children are very vulnerable not only to infectious diseases but also injuries of all causes
  • neonate and other children groups are still neglected and lacking epidemiological data
  • children are not little adults
  • preterm birth, neonatal and childhood health affect long-term health and wealth in later adulthood
  • children are future

children death

  • 5.9 mil. < 5 y/o died in 2015
    • 16,000 children death everyday
    • most in sub-Sahara and SE Asia
  • pneumonia, malaria, diarrhea, poverty...
  • the top death cause < 5 y/o is pneumonia
  • 47% of <5 y/o deaths are neonates

pneumonia

framework for pneumonia control

  • WHO
    • protect
      • exclusive breastfeeding for 6 months
      • adequate nutrition
      • prevent LBW
        • smoking cessation, maternal health control, prevent of young marriages
      • reduce indoor air pollution
      • handwashing
    • prevent
      • vaccine - pertussis, pneumococcal and Hib
      • prevention of child HIV
      • cotrimoxazole prevention for HIV children
      • zinc supplementation for diarrheal children
    • treat
      • appropriate medical treatment

IMCI Integrated Management of Childhood Illness

Integrated Management of Childhood Illness (IMCI)

injury, accident, disability in LMICs

epidemiology of injuries

  • 5 mil. deaths (in all ages) due to injuries per year
    • 9% of global mortality
    • more than three major IDs with 3 mil. deaths
    • injuries are neglected more than infectious diseases
  • proportions of injuries-caused deaths in 2012
    • road traffic 24%
    • falls 14%
    • suicide 16%
  • children deaths in HICs
    • <1 y/o suffocation is the major
    • 1-4 y/o traffic accident, drowning, fall
    • 5-9 y/o traffic accident, drowning, burn

suffocation

  • overlay by other person
  • entrapment (wedging)
  • strangulation of neck
  • choking
  • confinement like in fridge or laundry machine

burn

  • 100,000 deaths <20 y/o per year
  • girls are more suffered from burn than boys
    • possibly because girls tend to help cooking

drowning

  • leading cause of children death in WPRO and South East Asian countries

poisoning

  • seasoning, alcohol, fuel in kitchen
  • medicine, drug

bite

  • wild or strayed animal bites
  • poisonous insect bites

road traffic accident

  • deaths due to road traffic are increasing in LMICs contrary to HICs because of accelerated motorization without improvement of road conditions, traffic safety education and traffic legal system
  • Haddon Matrix

violence

  • child abuse
  • human trafficking
  • illegal organ trade
  • sexual exploitation
  • child labor
    • 158 mil. children 5-14 y/o
    • hazardous work; mines, chemical work,
  • child soldier
  • witch hunt

disability

  • sharp decline of children deaths directly linked to increase of children in disabilities
  • "impairment, disability, handicap" transformed into social model
    • disability is activity prevented by society
    • handicap is participation prevented by society
  • vicious cycle of disability and poverty

neonatal health

  • year to year decline rate of neonatal deaths is lesser than that of overall child death
    • another neglected health problem in LMICs

prescribing antimicrobials for children and pregnant women

  • first line empiric antimicrobials for neonatal sepsis:
    • ampicillin and gentamycin
    • cefotaxim and gentamycin
    • ceftriaxone is not recommended because of risk of bilirubiuria
    • but in fact AMPC/GM or CTX/GM doesn't cover well neonatal sepsis pathogens now.... meropenem might be the best
  • dose varies not depending on weight but also on age, especially in neonates and preterm babies because of differences of absorption, distribution, metabolism and excretion