Maternal and Child Health II

Child Health Post- 2015

Why do children die? First and foremost, about 50% of children’s deaths are related to complications that occur in newborn period. And these are preterm birth complications. Complication during the intra-partum period. We also call them as birth asphyxia, as a composite cause of death. That infections of newborn babies such as sepsis, meningitis and pneumonia and malformations, birth defects. In post-neonatal period the predominant causes are three: pneumonia, diarrhea and malaria. And they account for about a third of global child mortality burden. It’s also important to know that nutrition plays a very important part in determining the child survival. Under-nutritional state, whether in the form of wasting, stunting or low birth weight has a bearing on at least half of under-five child mortality. And we need to correct under-nutrition in a significant way to make an overall progress towards better child survival. We have well established evidence based affordable effective interventions to save lives of children. Neonatal life can be saved with good care of the mother in ante-natal period. Skilled care at birth. Skilled care in labor and at and soon after birth will save many child lives. Resuscitation of the baby who doesn’t breathe at birth. Kangaroo mother care for a small baby who needs warmth and access to breastfeeding. Antibiotics. Supportive care. Beyond the newborn period, immunization. We talked about measles, but we also have haemophilus influenzae and pneumococcal vaccine and rotavirus vaccine which avoid pneumonia and diarrhea. And if diarrhea does occur, effective treatment is possible through the use of oral rehydration solution and the zinc. And for pneumonia, if it does indeed occur, antibiotic therapy will save most children. In the recent times we have been able to package these interventions into programs. So integrated management of childhood illness combines these interventions into a package which is delivered by the health workers after training and insuring that there is a supply chain of treatments out there in the field where the babies and children are. Home based newborn care. Facility based care of sick newborns and children. These packages of services will save most lives. It must also be stated that safe water, sanitation and hygiene are also crucial in improving the health outcomes of children, particularly in preventing illnesses. And nutrition is fundamental to child survival. Exclusive breastfeeding in the first six months of life. Timely and appropriate introduction of complimentary food. Addressing moderate under-nutrition and addressing severe, acute malnutrition aggressively are the building blocks of a good nutrition program in a nation. If we have interventions they must reach children, women and households. If they do not reach, these interventions cannot save children. So when we examine the coverage of various interventions we find that there are gaps. For instance, breastfeeding which does so much good to children is, covered to only about 40% of the global population. Exclusive breastfeeding rates in the first six months of life at just about 40% globally. This should be 90%-plus. Oral rehydration solution should be accessible to every child with diarrhea,100% coverage. But what we have is 30%. And antibiotics for pneumonia which should be accessible to any child with pneumonia, is at the present rate is only 50% coverage. The gap amounts to deaths. And this gap has to be bridged therefore. The interventions must be taken to scale and every child should receive the intervention that he or she deserves. It’s not just about access to interventions alone. Interventions to be delivered through an efficient, and a quality mechanism. So quality of services is also extremely important. For instance if you just close the quality gap and newborn care, we can save additional two million newborn lives. So it’s not only about reaching, but reaching effectively, reaching with quality, that will lead to optimum survival of children. Access to intervention is also linked to mechanisms that connected the babies, that target children, target mothers, target infants to the intervention. In Rwanda performance based payment to community workers led to a better connect of this nature, that children accessed care and services. In Bangladesh engagement with NGOs and commercial partners led to disconnectivity of increasing access by the, the children, by the families to the live-saving interventions. And in India, conditional cash transfers to families and to health workers led to a phenomenal increase in facility births from 40% to 80% in a span of five to seven years. There are drivers of change that lead increased uptick of interventions on scale that we should learn from, adapt them, and implement them if appropriate contextually. What is the agenda of child health beyond 2015? First and foremost we still have to end all preventable child deaths. There are still too many child deaths happening, particularly among newborn babies as we stated. For this, the global community has now set 2035 as the horizon, by which time we all as a global community end all preventable child deaths. And this translates to bringing down under-five mortality rate to 20 per 1000 or less by this timeline. Just to remind you, the current rate is 46 per 1000 live births. So our endeavor is to reduce it by more than half beyond 2015 and up to 2035, a span of about two decades. Likewise, global newborn mortality rate is now targeted to be brought down to single digit by 2035. Current rate being 20 per 1000 live births. So this is the new set of goals and targets that the global community has set for itself and that’s the direction that 2015 onwards we will take as a global community. There are other priorities beyond survival for children. Over-nutrition is looming large. Too many children are becoming obese because of changes in lifestyle. In some ways the ill effects of so-called development. Diabetes, childhood cancer, childhood kidney diseases, birth defects that requires surgical corrections. And very importantly, psycho-social issues, autism, abuse and disabilities are increasingly important to be tackled even in the lesser resource settings and nations. There is also an area of insuring intact survival that is the expectation of the society of today. There’s another important area which is calling for attention, now and beyond 2015. And this is the domain of developmental origins of health and disease. We now know very well that the physiology prevailing in fetal life, distresses and the well-being as fetus has a profound implication in regard to growth, development, health, ill health, abnormal physiology in adolescence and adulthood. The nine months within the womb of the mother have profound programming that determines how the life goals of individual is as an adult. We now know very clearly that if the fetus is constrained, restricted in growth and in terms of well-being in utero, that this baby is predisposed to obesity, hypertension, heart disease, diabetes and so on. So we have an interesting situation here that we have a baby who was deprived in utero. If he survives, comes out as a small baby. And then if he does well and moves into adulthood, he has a second jeopardy and that is the risk of diseases such as the heart disease, hypertension, dyslipidemia, stroke and so on. Can this be modified? Can this be changed? Can this be averted? That babies not only are healthy in utero, not only they are healthy as fetuses, but also as children, also as adult. This is a Holy Grail in child health and adult health in…and in the context of non-communicable disease today. And post-2015, as it is now, this will be a major area of attention for all of us by way of research, by way of intervention design and by way of scaling up these interventions to, to avert this catastrophic pathway that you…that we now know operates in a very significant way in our lives. Health we believe is a driver of development. And that’s at the heart of the global and the national agendas beyond 2015. But healthy children of today are healthy adults of tomorrow. So if adults will drive development, then they have to be healthy. And healthy adults, the beginning is made by being healthy children. So beyond 2015, we have one part of the agenda of ending preventable deaths. And in this context we have summarized the, the…the trend and the situation by making a statement that child mortality has been halved since 1990. Further progress is linked to acceleration in newborn survival in particular and we offered reasons for it. Universal coverage of interventions with quality is the key to end preventable child mortality that stands today. Birth defects will need attention. Their prevention and correction should be a priority. As we move beyond survival, in post-MDG IV scenario we have to ensure that babies not only survive, but they’re intact in terms of their potential for growth and in terms of their neuro-development abilities. Childhood disability, autism, neuro-developmental problems will be an important priority in this period. Under-nutrition will continue to plague us for quite some time, but we now have an epidemic of over-nutrition in children looming large. And we need to apply our attention to both these areas of nutrition. Chronic pediatric diseases such as cancer and systemic iseases will require attention. And a huge effort will be required to find ways of insuring that fetal origins of adult disease could be averted or could be modified. So that children who survive the fetal life and early neonatal life eventually do…do not pick up non-communicable diseases such as heart disease, hypertension and diabetes. And this would be a very major challenge that we will have to put our heads together to energize the science and epidemiology and operations research to, to tackle this emerging area of a huge problem which will be a very important focus post-2015.


OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Maternal and Child Health II. Global Heritages. Recuperado em 19 de Abril de 2026 de https://doi.org/10.58079/p2oq


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