Health of Young Children

- Importance of Child health

o Approx. 5.9 million children under 5 die each year (as of 2015)
o Most under-5 deaths are preventable. Estimates suggest half of the deaths could be
avoided by simple solutions including clean water/sanitation, disease management and
proper nutrition
o Close link to poverty
o 16, 000 children die each day and there is still much to be done to reduce morbidity and
mortality in childhood
o Sub-Saharan Africa (SSA) and south Asia (SA) have highest rates of neonatal, infant, and
under-5 child mortality
o In the poorest countries there can be up to 20 years of reduced life expectancy as
compared to high-income countries
- Mortality and Burden of disease
o 99% of childhood deaths are in low and middle income countries. Half of these deaths
occur in India, Nigeria, DRC, Pakistan, and China
o 44% of under-5 deaths occur in neonates
o General trend is declining however there is a considerable variation in decline amongst
regions
o Under-5 children with uneducated mothers are 2x more likely to die as those with
secondary education or higher
o In India and China girls are more likely to die than males
o The most progress in reducing under-5 mortality is seen in neonatal period by
addressing issues during this fragile time – including tetanus
o Tetanus was leading cause of death during neonatal phase – due to use of unsterile
equipment used during birth – progress is being made in this area
o Very close link between health of mother and health of baby – 60 to 80% of deaths
occur in low birthweight babies
o Nutrition (including nutrition of mother) remains key factor in infant mortality

- Causes of death in under-5 children

o Leading causes are related to prematurity, Pneumonia, birth asphyxia, and diarrhea
o Stunting is most prevalent in South Asia followed by Sub-Saharan Africa
- Pneumonia
o Under-5 children in low and middle income countries average 3-6 acute respiratory
infections per year
o These tend to be more severe and cause higher rates of death than in high income
countries
o Pneumonia is leading infectious cause of death in under-5 children
- Diarrhea
o Second leading infectious cause of death in under-5 children
o Causes dehydration, wasting, and damage to intestines
o Children in low and middle income countries have 3-4 cases per year and children 6-11
months can have almost twice as many cases
- Malaria
o Causes over 600,000 deaths per year
o Leading cause of death in children in SSA
o High morbidity – in SSA some people have 5+ episodes/year
- HIV/AIDS
o In 2013 there were 200,000 newborns infected with virus. More than 90% of these were
in SSA
o Can be transmitted from mother to child during birth or breastfeeding
o Newborn has 15-45% chance of being infected by HIV-positive woman not receiving
antiretroviral therapy (ARVT)
o Causes approx. 2% of deaths in children under-5
o Children not treated with AVRT have 33% risk of dying in first year of life and 50% risk of
dying by second birthday. If ARVT started by 12 weeks decreases risk by up to 75%
- Measles
o Extremely contagious. Can include many complications including pneumonia, diarrhea,
encephalitis, blindness
o Causes approx. 2% of all deaths in under-5 children
o Rates have declined with improved vaccination programs
o Children who are deficient in vitamin A and/or zinc or who are HIV positive are more
vulnerable to complications from measles virus
- Soil-transmitted Helminths
o Roundworm, hookworm, whipworm
o 880 million children at risk of infection in 2012 – only 30% of children receive treatment
o Infection can lead to serious morbidity such as iron deficiency anemia
o Burden highest for children 6-7 years old
- Risk factors for under-5 deaths
o Social determinants and poverty
o Nutritional status of mother/baby
o Education of mother
o Access to skilled practitioners during birth and neonatal period
o Water quality and sanitation
o War and conflict
- Cost and Consequence
o High costs incurred caring for sick children
o Potential for long term disability
o Growth and cognitive impairments can lead to low attendance at school and low
performance
o Families have more children to compensate for potential death (causing increased risk
for birth related complications etc.)
- Addressing key challenges
o Progress has been made in reducing childhood deaths between 1-5yrs however
neonatal period has seen less progress
o SSA and SA both demonstrate insufficient progress
o There are many low-cost and highly effective interventions which are not being
implemented where they are most needed and that could prevent 2/3 of all child deaths
o There are several critical interventions including a holistic approach across the lifespan
 Mother and baby nutrition is key factor
 Prenatal care and micronutrient supplementation is important
 Preventative measures to reduce transmission of HIV between mother/infant
 Skilled birth attendants and emergency obstetric care are needed
 Kangaroo care is essential to well-being of infant
 Breastfeeding for first 6 months
 Hygienic introduction of foods
 Management of pneumonia and diarrhea
 Immunization
 Bed nets for malaria and regular drug administration for worms
o Refer to chart in text for more details
o Women are key for addressing challenges
 Community based approaches are effective
 All levels of action are required for increased progress to be made