Child helath in ethiopia
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Child Health In Ethiopia
Prof . Bogale Worku Medical Faculty,
DPCHOctober 2009
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Objectives of the session
Define Child health indicators of EthiopiaDescribe the major causes of morbidity
and mortality
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Illness burden
6-12 episodes of illness per year (<5 yrs)Fever 30%Diarrhoea 25%Cough 23 %Rapid breathing 13%
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Child health indicators
Define each of the following
NMR 39/1000 LB
IMR 77/1000 LB
<5 MR 123/1000 LB
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The Millennium Development Goal No 4.
Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed - missing from current programmes
050
100
150
Glo
bal
mo
rtal
ity
pe
r 10
00
bir
ths
1960 1980 2000 2020Year
Under-5 mortality rate
Late neonatal mortality
Early neonatal mortality
Target for
MDG-4
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Opportunities for Africa’s Newborns, 2006
Meeting MDG 4 in Africa?
New hope for reducing under five deaths!
Over the last year several large African countries have reported reductions of 25% or more in under five deaths
41
164
0
100
200
300
1960 1970 1980 1990 2000 2010
Year
Mor
talit
y pe
r 1,
000
births
. Neonatal Mortality Rate
Under 5 Mortality Rate
Infant Mortality Rate
MDG 4 target for 2015
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Opportunities for Africa’s Newborns, 2006.
National progress to MDG 4
32% of child deaths are newborns. MDG 4 cannot be met without addressing neonatal
deaths.
39
123
77 68
0
100
200
300
1960 1970 1980 1990 2000 2010
Year
NMRU5MRIMRMDG Target
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5
Other
29%
Diarrhoea
12%
Pneumonia
20%
Malaria
8%
Measles
5%HI V/ AI DS
4%
Perinatal
22%
Deaths associated w ith undernutrition
60%
Major causes of death among children under five, world, 2000
EI P/ W HO; Caulfi eld et al, f or t hcoming
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When are children dying
neonate (29%)
1-4 yrs (42%)
1-11 months(29%)
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Acute Respiratory Illness
Major cause of mortalityPneumonia is the major cause of death
about 20%/(28%)Number one cause of visit to health facility 6-8 episodes /year/child
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Key interventions
PneumoniaExclusive breast feedingAdequate complementary feedingHib vaccinationMeasles vaccinationPMTCTVitamin A supplementationAntibiotic treatment
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Diarrhea
A major cause of OPD visit and admissionAbout 6 episodes/child/yearA major cause of death Leads to dehydration and deathVicious cycle of Diarrhea and Malnutrition
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Diarrhea: Key interventions
Hygiene/sanitation/ safe waterExclusive breast feedingAdequate complimentary feedingVitamnin A supplementationORSZinc supplementAntibiotic
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Malaria
A major cause of death in tropical countries and a major cause of epidemics.
75% of the land in Ethiopia malariousLong lasting insecticide treated bed netsAnti-malarial drugs
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Measles
A major VPD causing deathResults in many complications
MalnutritionPneumoniaEncephalitisEtc…
High mortality ratesMay cause epidemics
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NutritionEthiopia is one of the countries in the sub Sahara
Africa with the highest rates of malnutrition. Breast-feeding is an important component of
Ethiopian tradition culture. About 90% of the mothers breast feed up to two years. Exclusive breast-feeding reported to be 62.3% up to 6
month.The median age of introduction of complementary
feeding was 7.1 m. Introduction of early feeding associated with an increased
risk of diarrhea due to poor sanitary condition and lower quality of supplements:
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Malnutrition
height for age 51.1%weight for age 47.2%wasted weight for height 10.5 %
to poor feeding practice, periodic drought, war and displacement have contributed to the
severe malnutrition status of Ethiopian children
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Deaths of Ethiopian infants due to sub-optimal breastfeeding practices
70,000 infants deaths annually70,000 infants deaths annually
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Malnutrition interventions
Breast feedingComplementary feedingNutrition advice and supplementationVitamin A supplementationMeasles vaccinationFamily planningManagement of severe acute malnutritionZinc
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Vaccination
BCG oral polio 0 at birthPenta1 polio1 6th weekPenta 2 polo2 10th weekPenta3 polio3 14th week Measles 9th month
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Childhood HIV/AIDS
Mother to child transmissionIn uteroDeliveryBreast feeding
OthersSexual (adolescents)Blood transfusionHarmful traditional practices
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HIV : interventions
VCTPMTCT ARTTreating opportunistic infections
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New born health
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I have the right to survive and grow healthy like any other new born
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Other7%
Infection26%
Tetanus7%
Diarrhoea3%
Preterm27%
Asphyxia23%
Congenital 7%
Infections36%
The estimated distribution of the direct causes of 4 million neonatal deaths for the year 2000 based on vital registration data for 45 countries and modelled estimates for 147 countries
Source: 7
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The world atlas with neonatal mortality burden
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Preterm, 25%
Asphyxia, 24%
Tetanus, 6%
Diarrhoea, 4%
Congenital, 6%
Other, 7%
Sepsis/ pneumonia,
28%
Infections
39%
Source: Opportunities for Africa’s Newborns, 2006. Based on vital registration for one country and updated modeling using the CHERG neonatal methods for 45 African countries using 2004 birth cohort, deaths and predictor variables.
WHY do African newborns die?
3 causes account for 88% of neonatal deaths
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Opportunities for Africa’s Newborns, 2006.
Causes of newborn deaths
Infections and tetanus account for
43% of neonatal deaths in Ethiopia
Tetanus, 7%
Infection, 36%
Asphyxia, 25%
Diarrhoea, 3%
Congenital, 4%
Pretern, 17%
Other, 7%
Low birthweight rate: 15%
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Opportunities for Africa’s Newborns, 2006
0
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4
6
8
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0 5 10 15 20 25 30
Day of life
Da
ily r
isk
of
de
ath
pe
r 1
00
0 s
urv
ivo
rs
.
When -? 1.16 million newborn deaths in Africa
Up to 50% of neonataldeaths are in the first 24 hours
75% of neonatal deaths are in the first week –
Birth and first week is key: when most babies die yet when coverage of care is lowest for mothers and babies
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Antenatal care
(ANC 28%)
Avoiding adolescent pregnancy and spacing births by at least 24 months
(CPR 15%)
Clean and safe childbirth
(SBA 6%)
Simple solutions to save newborn lives
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Examples of simple solutions to save newborn lives
Treating newborn infections with antibiotics
Breastfeeding promotion and support
Keeping babies warm, especially preterm babies – Kangaroo Mother Care
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Thank you