Important progress has been made in
reducing infant and child mortality
globally.
Improvements in the survival of children
have the main component of the overall
increase in average life expectancy in the
world over the past century, first in
developed countries and over the past 50
years in the developing countries.
However, improvements have been much
slower in sub – Saharan African and in
some Asian countries where.
more than 1 in every 10 children born
alive died before their first birthday.
Poverty, malnutrition, a decline in
breastfeeding and inadequacy or lack of
sanitation and of health facilities are
factors associated with high infant and
child mortality
Unwanted births, child neglect and abuse
are factors contributing to the rise in child
mortality.
Young children whose mothers die are at
very high risk of dying themselves at a
young age.
Child survival is also closely linked to the
timing, spacing and number of births and
to the reproductive health of mothers.
Early, late, numerous, and closely spaced
pregnancies are major contributors to high
infant and child mortality and morbidity
rates, especially where health care
facilities are scarce.
First births and births of very high risk
carry higher than average mortality risks.
First births may occur before a woman has
reached full physical and reproductive
maturity, leading to increased perinatal
risks
The five main killer diseases of children
ARI, diarrhea, measles, malaria and
malnutrition contribute more than 70% of
the deaths in children fewer than five
years of age.
Globallymalnutrition underlies 50% of all
childhood deaths.
African children bear much greater than
their share of the burden of infectious
diseases.
The percent of total deaths due to ARI,
diarrhea, malaria and measles for sub-
Saharan African children is about 37%,
41%, 98%, and 63% respectively.
in general, in developing countries 39 out
of 1000 live births die before reaching one
month of age and one in every six babies
is born under weight.
DIARRHOEAL DISEASES
Diarrhoea is commonly defined as three or
more loose or watery stools.
If an episode of diarrhoea lasts for less
than 14 days it is known as acute
diarrhoea
if it lasts 14 days or more, it is known as
persistent diarrhoea.
Diarrhoea in children causes dehydration
and contributes to malnutrition. The death
of a child with acute diarrhoea is usually
due to dehydration.
Also data from surveys conducted in 40
Asian and African countries by national CDD
programs suggest a decline in mortality
over the past decade. This is speculated to
be due to
Improved case management
General improvement in standard of living
Improved nutrition
Increase in immunization coverage and the
combination of all these factors.
Factors underlying increased risk of
diarrhoeal morbidity and mortality are:
Low socio-economic status
Poor personal and domestic hygiene
Low family income
Living in a crowded room and earthen floor
Lower maternal education
Lack of breastfeeding
Malnutrition - increases severity and
duration,
Low birth weight
Measles
Immunodeficiency or immunosuppression – This
may be temporary, after certain viral infections
(e.g. measles) or it may be prolonged as in AIDS.
When immunosuppression is severe, diarrhoea
can be caused by unusual pathogens and may
also be prolonged.
Age – Most diarrhoeal episodes occur during the
first 2 years of life. This pattern reflects the
combined effects of declining levels of
maternally acquired antibodies, the lack of
active immunity in the infant, the introduction of
food that may be contaminated with faecal
bacteria and direct contact with human or
animal faeces when the infant starts to crawl.
Seasonality –
Dysentery
This is diarrhoea with visible blood in the
faeces. Important effects dysentery includes
anorexia, rapid weight loss, and damage to
the intestinal mucosa by the invasive
bacteria.
A number of other complications may occur.
The main cause of acute dysentery is
Shigella; other causes are Campylobacter
jejuni and infrequently enteroinvasive [Link]
or Salmonella. Entamoeba histolytica can
cause serious dysentery in young adults but
is rarely a cause of dysentery in young
Classification of Dehydration
The Integrated Management of Childhood
Illnesses classified dehydration into three
classes and proposed options for
management of the sick child.
Severe Dehydration: A child who has two
of the following signs
◦ Lethargic or unconsciousness
◦ Sunken eyes
◦ Not able to drink or drinking poorly
◦ Skin pinch goes back very slowly (more 2
seconds)
Some Dehydration: Two of the following
signs
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back slowly
No dehydration
Not enough signs to classify as some or
severe dehydration
Prevention of Diarrhoea
Measures that interrupt the transmission of
pathogens
Giving only breast milk for the first 4 –6 months
of life
Avoiding the use of infant feeding bottles
Improving practices related to the preparation
and storage of weaning food ( to minimize
microbial contamination and growth)
Using clean water for drinking
Washing hands (after defecation or disposing of
faeces, and before preparing food or eating)
Safely disposing of faeces, including those of
infants
Effective control of Diarrhoea includes
1. Effective case management in all public and
private health facilities i.e. replacing poor
diarrhoea management with effective case
management including education on home
therapy as described by WHO
2. Increase access to effective case
management in all public and private health
facilities by training staff and expanding
distribution of ORS
3. Promotion of services: Increase use of
facilities offering effective case Management
4. Increasing access: Increasing access to ORS
by adding new providers (CHWs, pharmacists,
shopkeepers); social marketing
5. Home therapy: Extensive education about
home therapy through channels such as mass
media and social organizations as well as
interpersonal communication with health staff.
Identifying food that should be given to a
child with diarrhoea a
The following points should kept in mind when
preparing food and feeding a child with
diarrhoea.
Feed frequently every 3 - 4 hrs (6x a day)
Small frequent feedings are best because they
are easily digested and preferred by the child
Fermenting, mashing and grinding make it
easier to digest
.Freshly prepared food minimize the chance of
contamination
Feeding Recommendations for children
During illness, children may not to eat
much. However, they should be the types of
food recommended for their age, as often
as recommended, even though they may
not take much at each feeding.
After illness, good feeding helps make up
for weight loss and helps prevent
malnutrition. When the child is well, good
feeding helps prevent future illnesses.
Sick child visits are a good opportunity to
counsel the mother on how to feed the child
during illness and when the child is well.
Up to 4 4 – 6 months 6 – 12 months 12 months – 2 2 years and
months Breastfeed as often as Breastfeed as often as years older
Breast feed the child wants, day the child wants. Breastfeed as often Give family
as often as and night, at least 8 Give adequate as the child wants. foods at least 3
the child times in 24 hours. servings of: Shiro Give adequate meals each day.
wants, day Add complementary fitfit, merek fitfit, servings of: Also, twice daily,
and night, at foods: mashed porridge made of porridge made of give nutritious
least 8 times potatoes softened with cereal and legumes, cereal and legume foods between
in 24 hours milk, cereal+ legume mashed potatoes and mixes. meals such as:
Do not give mixes with milk. carrot, mashed Shiro, kik, merek egg, milk, fruits,
other foods Give these foods with gommen, egg and fitfit, mashed kitta, dabo.
or fluids cup and spoon 1 or 2 fruits. potatoes and carrot,
Expose the times per day in Add extra butter or gommen, undiluted
child to addition to oil to child’s food. milk and egg and
sunshine 20 breastfeeding. - 3 times per day if fruits.
– 30 Expose the child to breastfed Add extra butter or
minutes sunshine for at least - 5 times per day if oil to child’s food.
daily 20 – 30 minutes daily. not breastfed. Give these foods
Expose child to three times per day.
sunshine.
ACUTE RESPIRATORY INFECTIONS
Respiratory tract infections can occur in any part
of the respiratory tract such as the nose, throat,
larynx, trachea, bronchi or lungs.
Acute respiratory infections (ARI) can be
divided as Upper Respiratory Tract Infections
(URTI) which includes Nasophryngits, Otitis
media, Pharyngotonsilitis, and Epiglottitis and
Lower Respiratory Tract Infections which include
Laryngitis, Tracheobronchitis, Bronchitis,
Bronchiolitis and Pneumonia.
ARI are one of the most frequent illnesses
globally and a leading cause of death in the
developing world.
Among children under five alone, about
four million deaths (33% of the deaths)
annually are ascribed to ARI most of which
are due to pneumonia.
That mortality due to pneumonia is 10 - 15
times higher in developing countries
suggests that there is ample room for
improvement in addressing this important
public health problem
Viruses are the predominant etiological
agents in ARI, especially Upper Respiratory
Tract Infections (URTI).
The majority of these are benign and self-
limiting.
The most common non-bacterial agents of
lower respiratory tract infections (LRTI) are
respiratory syncitial virus (RSV),
adenoviruses, Para influenza and influenza
A and B viruses.
Some agents are more frequently
associated with some clinical syndromes
than others e.g. RSV and bronchiolitis.
In some cases, however, viral infections
are the causes of severe disease or
complicated by bacterial super infection
that can end in death (e.g. complications
of influenza, measles and some adeno and
rhinoviruses).
VACCINE PREVENTABLE DISEASES
Each year more than a third of a million
children die from immunizable diseases
and diarrhoea.
The six childhood diseases preventable
by immunization (neonatal tetanus,
measles, poliomyelitis, tuberculosis,
pertussis and diphtheria) are responsible
for a considerable proportion of the high
morbidity, mortality and disability of
Ethiopian children.
POLIOMYELITIS
Poliomyelitis is a viral disease conveyed
through faecal oral transmission.
In unhygienic environments with
unvaccinated populations, transmission is
widespread, the faecal oral route is
predominant, and virtually everyone will
have been infected prior to age 5.
The incubation period is from 7 - 14 days,
but may range from 3 - 35 days.
On entry through the oral route, the virus
multiplies in the oropharynx and the
lymphoid tissue of the intestinal tract from
where it enters the blood stream causing
viremia. The prodormal phase corresponds
with this early viremia. If the infecting
strain of the virus is highly invasive or if
the host resistance is inadequate, the
virus is then able to invade the CNS.
Neurological manifestations of the result
of haematogenous spread by the virus of
the anterior horn cells of the spinal cord.
NEONATAL TETANUS
Tetanus is a completely preventable disease
caused by contamination of wounds with
anaerobic bacillus, Clostridium tetani.
The organism is ubiquitous in soil and dust
and has the ability to form highly resistant
spores.
It exists harmlessly in the gut of many
animals, including man.
If the pathogen is introduced into necrosis
tissues, it multiplies and produces a
powerful neurotoxin.
Neonatal tetanus occurs mainly as a result
of umbilical cord contamination with
tetanus spores at birth.
The disease manifests itself commonly
between the third and the twenty eighth
day after birth when an apparently healthy
baby stops nursing, becomes
progressively more rigid, has convulsions
and dies within a few days.
In the developing world, some 85% of the
newborns contracting neonatal tetanus
will die.
Prevention and Control
Neonatal tetanus is a preventable disease
which can be eliminated by two
complementary strategies: vaccinating
women with tetanus toxoid; and ensuring
a clean and safe environment for the
umbilical cord during and after delivery
Immunize all women of child bearing age
Immunization against tetanus is achieved by
vaccinating different target groups with vaccines
such as DPT, DT, TT and Td (tetanus - diphtheria
with a reduced component of diphtheria antigen) all
of which contain tetanus toxoid. TT and Td are
suitable for adults, whereas DPT is given to children
less than 5 years old and preferably during infancy.
The DT vaccine is used for young children unable to
receive DPT, and is mainly administered in schools.
MEASLES
Reports by WHO indicate that of the
estimated 70 million cases of measles
annually 2 million die. There is a huge cost
in terms of the number of healthy years
lost, and the loss of productivity.
The disease usually presents with what
appears to be URI with conjunctivitis and
nasal discharge, followed by a rash.
GI problems are amongst the most
frequent. Painful mouth often prevents
children from eating properly.
Diarrhoea is a frequent complication with
serious consequences. In a study in
Bangladesh, the CFR for measles was
11.9% if the child has diarrhoea, as
compared to 4% in those without
diarrhoea.