Tyke Wellbeing: Outline.

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Kid Health in setting of Maternal Health. Worldwide Conventions and kid wellbeing ... Source: Bryce J et al for the Child Health Epidemiology Reference Group. ...
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Tyke Health: Overview Dr E Malek, Principal Specialist Department of Pediatrics, University of Pretoria, Witbank Hospital emalek@postino.up.ac.za

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Acknowledgments Dr Joy Lawn (Save the Children Fund) DR Lesley Bamford (National DOH) Dr Debbie Bradshaw (MRC NBD unit) Prof T Duke (CICH, University of Melbourne) Dr M Weber (WHO-CAH, Geneva) Dr N McKerrow (PMB Hospital) DR Macharia (UNICEF, Pretoria) Dr N Rollins (UKZN) DR C Sutton (MEDUNSA, Polokwane)

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Outline Global youngster wellbeing Child Health in South Africa

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Global Context (1) Child Health Inequity Causes of worldwide kid mortality Child inability and advancement Neonatal Health Adolescent Health Children in complex crises Effect of poor kid wellbeing on groups

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Global Context (2) Child Health in connection of Maternal Health International Conventions and kid wellbeing Evidence for compelling mediation in lessening kid mortality Pathways to & standards of worldwide tyke wellbeing

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10 million tyke passings – Why? For these 4 causes, ~ 53% of passings are malnourished youngsters AIDS is much greater extent in Southern Africa. Source: Bryce J et al for the Child Health Epidemiology Reference Group. The Lancet, March 2005. As utilized as a part of WHR 2005

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Three causes represent 86% of every single neonatal passing 4 million infant passings – Why? 60 to 90% of neonatal passings are in low birth weight babies, for the most part preterm Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. for 192 nations taking into account cause particular mortality information and multi cause displayed gauges. As utilized as a part of World Health Report 2005

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200 1990 181 175 180 2000 Least diminishment 160 3% 140 128 120 U5MR (passings per 1000 births) 100 Greatest decrease 80 32% 64 58 60 53 45 44 38 37 40 20 9 6 0 Sub-Saharan South Asia Middle East & East Asia and Latin America CEE/CIS and Industrialized Africa North Africa Pacific & Caribbean Baltics nations Under five death rates: Trends from 1990-2000 Slide: Ngashi Ngongo Source: UNICEF, 2001

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International Conventions Declaration of Alma Ata: "Wellbeing for All by the year 2000" UN Convention of the Rights of the Child (1990) UN Millenium Development Goals (MDGs)

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1 . Kill great neediness and appetite 2. Accomplish general essential instruction 3. Advance sex correspondence and strengthening of ladies 4. Diminish tyke mortality by 66% 5. Lessen MMR by seventy five percent 6. Battle HIV/AIDS, intestinal sickness and different infections 7. Guarantee natural manageability 8. Create worldwide organizations for advancement Millennium Development Goals (MDGs)

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Integrated Management of Chilldhood Illness (IMCI)

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IMCI office based use in Bangladesh (Lancet, 2004)

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WHO Initiatives to enhance nature of look after youngsters at doctor\'s facility level: best in class and prospects Martin Weber, Harry Campbell, Susanne Carai, Trevor Duke, Mike English, Giorgio Tamburlini 25 th International Congress of Pediatrics, Athens, 25-30 August 2007

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Standards of Hospital Care for Children: Hospital IMCI Evidence-Based Guidelines

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Child Health in South Africa Child Health Inequity Causes of Child Mortality Neonatal Health National intercessions for enhancing kid wellbeing Children\'s Act (Amendment Bill: 2007) Challenges

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UNICEF comments at opening of SA Child Health Priorities gathering (Dec 2007, Durban)

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Distribution of Resources

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Slide: Ngashi Ngongo

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South Africa advancement to MDG 4 Under 5 mortality is expanding, identified with HIV (73 000 a year) Neonatal mortality is most likely static and records for ~30% of under five passings (23,000 infant passings a year) Source: Lawn JE, Kerber K Opportunities for Africa " s Newborns. PMNCH, 2006

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Causes of U5M Source: MRC 2003

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Every Death Counts

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Challenges: Health Service in South Africa

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Child Mortality (1) The National Burden of Disease study evaluated simply over a large portion of a million passings of which 106 000 were of youngsters less than 5 years old years A further 7800 were kids matured 5-14 years. An expected 4564 passings are from protein-vitality lack of healthy sustenance (Kwashiorkor) all in all, youthful infants are a great deal more powerless than more seasoned The reason for death designs in the diverse age gatherings are altogether different.

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Top twenty particular reasons for death in kids under 5 years, South Africa 2000 (NBD)

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Leading reasons for death among newborn children under 1 year of age, South Africa 2000

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Leading reasons for death among babies under 1 year of age, South Africa 2000

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Child Mortality (2) The NBD study appraises that by the year 2000, the Infant Mortality Rate had ascended to 60 for each 1000 live births and the Under-5 death rate had ascended to 95 for every 1000. This disintegration in tyke wellbeing happened in spite of the presentation of free social insurance and nourishment programs and was inferable from pediatric AIDS, proportionate with the high predominance of HIV saw among pregnant ladies.

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Leading reasons for death among kids matured 1-4 years, South Africa 2000

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Leading reasons for death among youngsters matured 1-4 years, South Africa 2000

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Child Mortality (3) As kids get more seasoned, outside reasons for death (eg. street activity wounds and suffocating) ascent in significance. This is especially discernible among young men who bite the dust in more noteworthy numbers than young ladies. This example turns out to be especially set apart among the 10 - 14 year age bunch, where street auto collisions is the main source of death. Manslaughter and suicide highlight in the top causes among the 10-14 year age bunch, murder is the second driving reason for death.

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HIV test ~ 54% tried 26% +ve 20% uncovered Only 8% tried - ve HIV clinical stage ~ 58% arranged of which half were Stages III & IV Child passings in RSA - Why? Kid PIP in Mpumalanga: ChPIP Data: Witbank Hospital had 2244 kid confirmations & 101 youngster passings in 2006; general case casualty rate 4.5; 31% of all passings inside 1 st 24 hours of affirmation ChPIP Sites: 2004: Witbank 2006: Witbank & Barberton 2007: above in addition to 8 new locales 88% HIV if avoid neonatal Most passings 1 month to 5 yrs * Source: WHO World wellbeing Statistics 2006 www.who.int

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Causes of death of kids in healing centers (n = 1695)

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Child Mortality: HIV/AIDS 1998 SADHS U5MR 61/1000 (1994-8) 2003 SAHDS U5MR 58/1000 (1999-2003)? Without PMTCT 33% of infants destined to HIV+ moms will be contaminated: of these, 60% anticipated that would pass on before 5 years old 40% U5 healing center passings because of AIDS Child mortality in SA too high for center pay nation, and expanding, in spite of youngsters\' rights

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Child mortality: HIV/AIDS Vertical transmission rate 20.8% (KZN) <50% pregnant ladies being tried 2/3 all HIV+ newborn children requiring ART by 10 months of age – without access to ARV 1/3 of HIV+ kids kick the bucket in 1 st year of life One in 6 qualifying kids get ARV

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Policy Brief: Child Mortality The Medical Research Council distributed the Initial Burden of Disease Estimates for South Africa, 2000 in March 2003. A noteworthy finding of the study was the fourfold weight of illness experienced in South Africa coming about because of the blend of the pre-transitional causes identified with underdevelopment, the rising unending maladies, the damage weight and HIV/AIDS.

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Policy Implications (1) The mortality information demonstrates that a large portion of the kid passings happening in South Africa are preventable. We have recognized three wide ranges that will require varying methodologies for intercession:

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Policy Implications (2) 1. The counteractive action of mother-to-kid transmission of HIV, even at its present viability, is the absolute best mediation to lessen mortality among under-5-year olds, overshadowing every other intercession for different reasons for death consolidated.

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Policy Implications (3) 2. Albeit commanded by the ascent of HIV/AIDS, the great irresistible illnesses, for example, loose bowels, respiratory contaminations and lack of healthy sustenance are still essential reasons for mortality. Environment and advancement activities, for example, access to adequate amounts of safe water, sanitation, diminishments in presentation to indoor smoke, enhanced individual and local cleanliness and in addition far reaching essential human services will go far to keeping these ailments. Destitution diminishment activities are additionally essential in such manner.

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Policy Implications (4) 3. Street car crashes and brutality, which incorporates crime and suicide is another gathering of high mortality conditions that will require committed mediations.

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PMTCT (1) Most vital mediation to lessen HIV contamination in youngsters Almost all ANC administrations give PMTCT, however numerous obstructions to testing and viable treatment. Cotrimoxazole prophylaxis from 6 weeks of age diminishes HIV related kid mortality by as much as 43%

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PMTCT (2) Recommendation: Mandatory testing all youngsters at 6 week inoculation visit & twofold testing of pregnant ladies Currently 300 000 HIV contaminated kids – 50-60% anticipated that would right now need ARV\'s SA is one of just 9 nations worldwide where kid mortality is expanding

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PMTCT (3) Routine supplier started testing for every one of the 6 week old babies is as of now avoided from the NSP on HIV/AIDS Memorandum of concern: Maternal & Child survival (2007) TAC Media Statement

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