C HILDREN A T R ISK: H EALTH N EEDS OF C HILDREN

1. CHILDREN AT RISK:HEALTH NEEDS OFCHILDREN Jody Collinge Global CHE Network

2. Objectives • Name some of the major causes of disease and death in infants and young children. • Use case studies to examine some causes of illness. • Describe when children need to go to a health care provider. • List ways that these illnesses can be prevented or cared for at home. • Describe how CHEs can be involved. • Learn how to use tools such as IMCI (Integrated Management of Childhood Illness) and teaching materials from the Health Education Program for Developing Countries.

3. Health Needs of Children • Nearly 10 million children under the age of 5 die every year. • That is more than 1000 children every hour. • Most are in low- and middle-income countries. • Most of these health problems could be prevented or treated. • CHEs (community health evangelists) can have a vital impact in protecting the health of children. Source: WHO, 2008, What are the key health dangers for children?

4. What are the major causes of deathin infants and children worldwide?

5. Africa—Causes of death of children under 5Do you notice any differences?

6. We are going to look at some case studies, and then decide how to respond. For these case studies, you are not pastors or doctors or nurses or CHE trainers. You are community health evangelists in a village. What can we do to improve the health of infants and children? Photos are from Wikimedia.

7. Roberto’s mother comes to see you. Her son is two years old. Roberto has a bad cough and is working hard to breathe. What do you notice about Roberto? What else would you check? Roberto Source of illustrations: Health Education Program for Developing Countries, 2009.

8. Roberto • You check to see how fast Roberto is breathing. He is breathing fast, about 60 times a minute. • Roberto looks anxious. • He is pulling on his ribs to breathe. • Your thermometer is broken, so you can’t check his temperature. • Now what should you do?

9. How do you check out a sick child?Follow the guidelines of Integrated Management of Childhood Illness.First: Source: World Health Organization/ UNICEF.2008. Integrated Management of Childhood Illness.

10. Next ask about the main symptoms. Source: WHO. 2008. IMCI. Technical notes: “Stridor” is noisy breathing as you breathe in or inhale. “Wheezing” is noisy breathing or a whistling sound as you breathe out or exhale. “Bronchodilators” are medicines that are inhaled or breathed in.

11. Roberto • How does this apply to Roberto? • He has no general dangers signs. • He is alert and able to drink. • He is breathing fast. So he probably has pneumonia. • He has chest indrawing. So he has severe pneumonia. • What would you do? • Take him to the hospital or health center right away. • CHEs do not give meds. So you would not give him a bronchodilator medicine. • Pray with Roberto and his mother.

12. Pneumonia • Pneumonia is the number one cause of death in children under 5 years of age. • Major risk factors for pneumonia include: • Malnutrition • Indoor air pollution • Prematurity and newborn problems • Pneumonia often needs to be treated with antibiotics. • What are some ways to prevent pneumonia?

13. What are some ways to prevent illness and deaths from pneumonia? • Learn to recognize pneumonia and severe pneumonia. • Know when to take a child to the hospital or health center. • Give balanced foods (3x3) to improve nutrition. • Continue breastfeeding until at least six months of age. That improves the baby’s nutrition and resistance to infection. • Avoid indoor cooking fires. • Do not smoke cigarettes. • Get all the routine immunizations. Those protect against many causes of pneumonia.

14. Amare has vomiting and diarrhea. The diarrhea just started yesterday. There is no blood in the stool. He is thirsty and drinks eagerly. His mother is giving him ORS at home. What else should you check for? Amare Source: Health Education Program for Developing Countries, 2009.

15. Amare What else should you check for? • Is he able to drink or does he vomit everything up? • Check his mouth. • Are his lips and mouth dry? • Look at his eyes. Do they look sunken? • (For a baby) Is his soft spot sunken? • Does a skin pinch go back slowly? • Is he listless or very irritable?

16. Amare • Amare is alert and able to drink. • There is no blood in his poop. • So he does not have dysentery. • His mouth is dry. • His eyes are not sunken. • A skin pinch goes back quickly. • So he only has mild dehydration. • He can be treated at home with ORS. • You will also want to give him zinc. • Encourage him to eat.

17. Again, you can follow the IMCI recommendations. But a chart like this could be too technical for some CHEs.

18. When should you take a child with diarrhea to the health care provider? • What do you notice? • Persistent diarrhea • Mucous in the stool (poop) • Severe vomiting • Blood in the stool • Lethargic • High fever • Eyes sunken • Refuses ORS Source: HEPFDC, 2009

19. Diarrhea • Diarrhea is a leading cause of death among young children in developing nations. • More than 4 million children a year (or 10,000 children per day) die from diarrhea. • But most of these deaths can be prevented. • How can we prevent illness and death from diarrhea?

20. What is happening here? Source: HEPFDC, 2009

21. What can we do to prevent diarrhea and dehydration? • Good hygiene • Handwashing (When?) • Use a VIP latrine or a bathroom • Safe drinking water • SODIS (SOlar DISinfection of water) • Boiling water • Filtration of water (biosand filters) • Safe food preparation

22. Newborns What are some health risks of newborns?

23. Health Needs of Newborns • Nearly 40% of the deaths of children under 5 years of age are among newborns. • Most of these deaths are in the first week of life. • Most mothers in developing countries do not receive skilled care for the birth. • Many newborn deaths can be prevented.

24. What can we do? • What are steps that we can take to improve the health of newborns? • Make sure there is skilled care during the pregnancy, delivery, and during the first days and weeks after birth. • Much of this care can be given at home. • CHEPs provide care and teaching during the pregnancy. • The World Health Organization is now recommending home visits shortly after birth. • What could CHEs teach and encourage during these newborn home visits?

25. Newborn Home Visits • Promote and encourage exclusive breastfeeding (nothing but breast milk) until at least 6 months of age. • Keep the newborn warm by skin-to-skin contact between the mother and baby. • Give good cord care. Keep the cord clean. • Check out the baby and mother. Are there any signs of serious disease? • Help the parents register the baby. • Encourage them to get regular health care and vaccines for the baby. • Pray with the parents and encourage them.

26. Tabita • Last night,Tabita had a high fever and shaking chills. • She also had a headache and muscle pains. • It is the rainy season. • You do not have access to a lab. • What questions would you ask? • What is going on?

27. Tabita • You talk to Tabita’s mother. • Yes, there is a lot of malaria in their area. • Yes, there are a lot of mosquitoes. • They use an insect net, but it has a lot of holes. • Tabita has had malaria several times.

28. Tabita • Tabita is alert and talks freely. • Last night, she had a high fever and shaking chills. • In the morning, she had drenching sweats. • She seems warm. (Your thermometer is still broken.) • But otherwise she seems okay. • Should you just send her home? • She can rest and take Tylenol.

29. Yes, she has a fever. It started yesterday. She doesn’t have a stiff neck. (Why is this important?) She has no rash or sign of measles. She lives in an area where there is malaria. What do you think? Now what should you do? You decide to check the IMCI recommendations.

30. Tabita • She probably has malaria. • But it is not an emergency. • She should be treated for malaria. • She lives in an area where the malaria is probably resistant to chloroquine. • The nurses and doctors at the health center will know what medicines to use in your area.

31. Malaria • Every 30 seconds, a child in Africa dies from malaria. • Malaria is a leading cause of death for young children in Africa. • Malaria is spread by mosquitoes. • Malaria can often be prevented. • What are some ways to prevent malaria?

32. Preventing Malaria • Mosquitoes breed in standing water (water that is not flowing). • Get rid of old tires, cans, and trash that may contain water. • Cover any containers or jugs of water. • Avoid contact with mosquitoes. • Use insecticide-treated bed nets. • This protects the child and also kills mosquitoes. • Long-lasting insecticidal nets are best, since they do not need to be retreated. Source: Health Education Program for Developing Countries, 2009.

33. Conclusions • Children, and especially newborns, are at high risk for many health problems. • But many of these health problems can be prevented by simple measures in the home. • Community health evangelists can work with the families to encourage good care of children.

34. Resources • Health Education Program for Developing Countries • New lessons on the health of infants and children • Preventing Injuries (a series for children) • IMCI (Integrated Management of Childhood Illness) • Care of Infants • Development of Infants and Small Children • Major Health Issues • Children’s CHE Lessons

35. References Health Education Program for Developing Countries. 2009. Available from: http://hepfdc.info/ Wikimedia. 2010. Available from: http://commons.wikimedia.org/wiki/Main_Page World Health Organization. 2007. 10 Facts on Child Health. Available from: http://www.who.int/features/factfiles/child_health2/en/index.html World Health Organization. 2008. What are the key health dangers for children? Available from: http://www.who.int/features/qa/13/en/index.html World Health Organization. 2010. Measuring child mortality. Available from: http://www.who.int/child_adolescent_health/data/child/en/index.html World Health Organization. 2010. Newborns: Preventing mortality. Available from: http://www.who.int/mediacentre/factsheets/fs333/en/index.html World Health Organization/ UNICEF.2008. Integrated Management of Childhood Illness. Available from: http://whqlibdoc.who.int/publications/2008/9789241597289_eng.pdf