Post on 16-Jan-2016
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CHILD & FAMILY CHILD & FAMILY HEALTHHEALTH
Infant MortalityInfant MortalityModule 2 of 2Module 2 of 2
Grace E. Foege Holmes, MDGrace E. Foege Holmes, MD
Learning Learning Objectives:Objectives:
Performance Performance Objectives:Objectives:
Dr. Grace Holmes and grandson, Dr. Grace Holmes and grandson, QuentinQuentin
DIRECT/MEDICALDIRECT/MEDICALImmediateImmediate (birth defects)(birth defects)
ChronicChronic (malnutrition)(malnutrition)
INDIRECTINDIRECTSocialSocial
EconomicEconomic
EnvironmentalEnvironmental
BIRTHWEIGHTBIRTHWEIGHTis the single most is the single most
important predictor important predictor for infant survival.for infant survival.
Mother with NewbornMother with NewbornChild SurvivalChild SurvivalWorld DevelopmentWorld Development
• Premature < 37 weeks’ Premature < 37 weeks’ gestationgestation
• Full term, but long and Full term, but long and skinny, or short-for-datesskinny, or short-for-dates
Low Birth Weight Low Birth Weight (< 2500 grams)(< 2500 grams)
PREMATURITYPREMATURITYGestation of less than 37 weeksGestation of less than 37 weeks
• calculation from last menstrual calculation from last menstrual period (CGA-Calculated period (CGA-Calculated Gestational Age)Gestational Age)
• estimation by physical and estimation by physical and neurological signs of the baby neurological signs of the baby (EGA-Estimated Gestational Age)(EGA-Estimated Gestational Age)
UNDERNUTRITIONUNDERNUTRITION
Adult female stunted
< 151 cms
Drawing:Drawing: The Crisis of Undernutrition. The Crisis of Undernutrition. Credit:Credit: Teaching Aids at Low Cost (TALC) Teaching Aids at Low Cost (TALC)
More undernutrition
• Poor nutrition in pregnancy
with anemia• Smoking• Frequent infection e.g. malaria• 10% + of birth weights under
2.5kg
More infections and deaths of small babies, and other effects which continue till fourth year
More backward children
Chart shows Chart shows poor growth poor growth of a girl in of a girl in first 3 yearsfirst 3 years
Contrast of well-fed and underfed pregnant women.Contrast of well-fed and underfed pregnant women.
Underfed Underfed mother’s mother’s
pregnancy pregnancy weight weight gain gain
= 6 kg= 6 kg
Underfed Underfed mother’s mother’s
pregnancy pregnancy weight weight gain gain
= 6 kg= 6 kg
Blood + tissue fluid + Blood + tissue fluid + uterus + breastuterus + breast
Blood + tissue fluid + Blood + tissue fluid + uterus + breastuterus + breast
Well-fed Well-fed mother’s mother’s
pregnancy pregnancy weight weight gaingain
= 14 kg= 14 kg
Well-fed Well-fed mother’s mother’s
pregnancy pregnancy weight weight gaingain
= 14 kg= 14 kg BabyBaby++
PlacentaPlacenta++
AmnioticAmnioticfluidfluid
BabyBaby++
PlacentaPlacenta++
AmnioticAmnioticfluidfluid
Maternal education Maternal education appears to have a appears to have a strong and strong and independent effect on independent effect on infant mortality.infant mortality.
ADULT LITERACY ADULT LITERACY RATERATE
• Percentage of persons aged 15 Percentage of persons aged 15 years and older who can read years and older who can read and write.and write.
• 60% of all illiterate people are 60% of all illiterate people are women.women.
Bar Graph: Bar Graph: Literacy in Women and Men Literacy in Women and Men
(TALC)(TALC)North AmericaNorth America
USSRUSSR
EuropeEurope
South East AsiaSouth East Asia
Latin AmericaLatin America
Arab StatesArab States
Middle South AsiaMiddle South Asia
AfricaAfrica
Adult malesAdult males
Adult femalesAdult females
0 20 40 60 80 1000 20 40 60 80 100
Percentage literatePercentage literate
Male and Female Shares of TasksMale and Female Shares of Tasks
30%
50%
70%
60%
80%
80%
90%
60%
50%
AGRICULTURAL WORKAGRICULTURAL WORKDivision of rural labor by task and sex, Africa Male share Female share
Source: Economic Commission for Africa, 1975
(Child Survival/World Development)
70%
50%
30%
40%
20%
20%
10%
40%
50%
PLOUGHING
PLANTING
HOEING/WEEDING
HARVESTING
TRANSPORTING
STORING
PROCESSING
MARKETING
HUSBANDRY
AGRICULTURE
HUSBANDRY
COOPERATIVES
85%
80%
90%
AGRICULTURAL TRAINING AGRICULTURAL TRAINING Male and female participation in agricultural training programs, Africa
Source: International Children’s Center, “Children in the Tropics”, Issue No 146, Paris, 1983
Educating Girls
““... train a woman and you ... train a woman and you build a nation.”build a nation.”
It’s It’s never never
too too early to early to
start start learning!learning!
What Slows What Slows Population Growth?Population Growth?
Source: Source: UNICEFUNICEF
Source: Source: UNICEFUNICEF
Source: Source: UNICEFUNICEF
Gift Gift Poster Poster From From ChinaChina
Bangladesh: World Fertility SurveyBangladesh: World Fertility Survey
All twenty-nine other countries studied showed similar trends (TALC)All twenty-nine other countries studied showed similar trends (TALC)
Spacing Between BirthsSpacing Between Births
Health status of Health status of mother directly mother directly
affects child survival.affects child survival.
IMPACT IMPACT OF OF
EDUCATIONEDUCATION
GEFHGEFH
Primary Primary education education for for women women is a critical is a critical factor in any factor in any country’s country’s development.development.
Education:Education:An An
Influential Influential InvestmentInvestment
Women: Women: the Key to Healthy Childrenthe Key to Healthy Children
Source: UNICEFSource: UNICEF
GEFHGEFH