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Dr. Soha Rashed

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Title: Dr. Soha Rashed


1
Preschool Health Services Indicators of quality
of Under-five Health Services
  • Presented by
  • Dr. Soha Rashed
  • Professor of Community Medicine
  • Faculty of Medicine - Alexandria University
  • 2011-2012

2
Preschool Health Services
  • Preschool children are those aged one to less
    than six years.
  • In most countries, there is a relative neglect of
    children of preschool age, where the schedule of
    work in MCH centers provides only one day per
    week for preschool children.

1-lt6 Y
3
 Characteristics of preschool period
  • High morbidity of infectious and parasitic
    diseases
  • High prevalence of malnutrition
  • High incidence of injuries
  • High mortality  
  • Growth and development

4
1. High morbidity of infectious and parasitic
diseases 
  • Infectious Diseases
  • Respiratory e.g., ARI, Chicken Pox, Whooping
    Cough, German Measles, etc.
  • GIT e.g., Diarrheal Diseases, Enterica ,
    Hepatitis A.
  • Skin Diseases e.g., Impetigo, Scabies and
    Fungal Diseases.
  • Parasitic infections e.g., Oxyuris and Ascaris.

5
2. High prevalence of malnutrition
  • Malnutrition is prevalent among preschool
    children due to
  •  
  • Hyperactivity and lack of interest in food.
  • Faulty feeding habits.
  • High prevalence of infectious and parasitic
    diseases .

6
The most common malnutrition diseases among
preschool children are
  • Protein energy malnutrition (mild, moderate and
    severe)
  • Micronutrient deficiencies iron deficiency
    anemia, vitamin A deficiency and iodine
    deficiency.
  • Rickets.

7
  • Malnutrition in early life affects the physical
    growth, and is considered a risk factor for
    mortality from infectious diseases.
  • Severe prolonged malnutrition in the first two
    years of life is associated with retarded brain
    growth and mental development, which persists to
    adult life.

8
3. High incidence of injuries
  • Preschool children are more prone to injuries as
    they are curious, energetic and eager to explore
    the environment.
  • Most injuries occur where children spend the most
    active portion of their day (home, nursery or
    playgrounds).
  • Falling downstairs causing head injuries or
    fractures.
  • Household liquids Ingestion (kerosene, potash ,
    insecticides).
  • Ingestion of drugs.
  • Burns or scalds.
  • Electric shock.
  • Almost all injuries are preventable. Efforts to
    reduce preschool injury rate should focus on the
    promotion of safety at homes, kinder gardens and
    play grounds as regards conditions and practices.
  •  

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4. High mortality
  • Child Death Rate
  • Under-five Mortality Rate

12
5. Growth and development
  • Growth
  • By the end of the second year, the birth weight
    gets quadrupled. After the second year, the
    increase is steady at an annual rate of about
    2.25 - 2.75 kg in weight and 7.5 cm in height
    until the adolescent spurt occurs.
  • Development
  •  Motor skills are usually more coordinated in the
    second year relative to the first year. The
    behavioral development of the child must be
    assured through emotional and moral stability,
    that is, a home where he will find bonds of
    affection and discipline.

13
Care of preschool children
  • This is the responsibility of MCH centers (urban
    areas), and Rural Health Centers/Units (rural
    areas).
  • Care of preschool children includes
  • Preventive activities
  • Care in illness
  • Treatment of dental problems
  • Nutritional education
  • Health education

14
I. Preventive activities
  • Why important?
  • Events in early life (nutritional status and
    infections) can affect health as the child is
    growing up to an adult.
  • Many health problems can be prevented through
    early intervention, e.g. rheumatic heart disease
    (caused by repeated acute follicular
    tonsillitis), mental retardation (caused by
    congenital hypothyroidism).
  • Certain diseases may have their roots in early
    life. e.g., Rickets, Dental caries, Deafness,
    Obesity.
  • Some chronic adult orthopedic ailments are
    probably connected with development anomalies in
    young children (e.g. congenital dislocation of
    the hip).
  • Thus, preventive activities are necessary to
    detect any health deviation, and provide early
    intervention.

15
Periodic checkup
  • During the 2nd year of life, at least four visits
    should be paid to MCH centers or RHU/RHC
  • During the third to sixth years of age, two
    visits should be paid every year.

16
Aims of these routine evaluations (periodic
check up) are
  •  1. Assessment of the growth and development of
    the child using growth charts and developmental
    tables.
  •  

17
Growth charts
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  • 2. Screening for detection of
  • Visual defects.
  • Hearing defects. Children with perceptual
    disorders particularly deafness should be
    screened as early as possible at least by the end
    of the second year.
  • Speech defects.
  • Orthopedic defects.
  • Dental appraisal should always be part of the
    preschool program as milk teeth are important for
    the growth of permanent teeth, and for the
    general growth of the jaws.
  • Laboratory investigations, the nature of which
    depends on the community problems (e.g. blood,
    urine and stool).
  •  
  • 3. Communicable disease prevention in Egypt,
    preschool children receive booster doses of
    Polio, DPT and MMR vaccines at the age of 18-24
    months. (Refer to EPI)

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  •  II. Care in illness
  • Treatment of minor diseases, and referral of
    cases needing specialized care.
  • III. Treatment of dental problems
  •  
  • IV. Nutritional education
  • It aims at initiating healthy food habits for
    mothers and children. It requires adequate time,
    facilities, finance and personnel with practical
    dietary knowledge. Demonstration kitchens should
    be present in MCH centers to instruct mothers on
    how to prepare diet for young children.
  • V. Health education
  • Health education areas should cover growth and
    development, children needs, communicable disease
    prevention, diet during infection, injury
    prevention, family planning, etc.

25
Indicators of quality of Under-five Health
Services
  1. Infant Mortality Rate
  2. Neonatal Mortality Rate
  3. Post neonatal Mortality Rate
  4. Child Death Rate
  5. Under-five Mortality Rate

26
1. Infant Mortality Rate IMR
  • It is an age-specific mortality rate.
  • Infant mortality rate is computed using the
    following formula

IMR
27
  • In Egypt, Infant mortality rate is 19/1000 LB
    according to WHO (2010).
  • In Malaysia IMR was 6.4/1000 LB in 2008.
  • Infant deaths are related directly to poverty,
    diseases, bad sanitary conditions, overcrowding
    and ignorance.
  • Infant mortality rate is a good index for
    community development in general, and of infant
    welfare services in particular, as it is a
    measure of the effect of the different
    environmental factors surrounding the infant
    during the first year of life.

28
The main causes of infant mortality (ordered by
frequency) are
  • ARI (acute respiratory infections bronchitis and
    bronchopneumonia).
  • Gastroenteritis and dehydration.
  • Low birth weight and congenital anomalies.

29
Means of reducing infant mortality
  • Since the etiology of infant mortality is
    multifactorial, no single intervention can reduce
    infant mortality.
  • The measures needed for the reduction of infant
    mortality are classified into general measures
    and specific measures.

30
I. General measures
  • Improvement of socioeconomic standards and
    environmental sanitation. Since mortality of
    infants is mainly related to environmental and
    socioeconomic conditions, improvement of
    nutritional standards, provision of safe water
    and basic sanitation, improvement of housing,
    agriculture and industry are all measures that
    reduce infant mortality.
  • This is why infant mortality is universally
    recognized not only as the most important
    indicator of health status of children, but also
    as an indicator of community development.

31
  • Education of females This can result in
  • delay in the age of marriage
  • prevention of early pregnancy
  • increases womens awareness regarding personal
    hygiene, better utilization of health services
    and family planning services, better care of
    their children, etc.
  • Studies show that high illiteracy rates are found
    among women with high infant mortaliy rate.

32
II- Specific measures
  • Maternal care
  • Antenatal, natal and postnatal care.
  • Family planning.
  • Adequate maternal nutrition.
  • Infant care
  • Prevention of infections especially through
    immunization against the EPI targeted diseases.
  • Early detection and proper management of ARI and
    gastroenteritis.
  • Breast-feeding and safe weaning practices.
  • Growth monitoring.
  • Special care to LBW (low birth weight) babies.

33
2. Neonatal Mortality Rate NMR
NMR
  • Neonatal mortality rate can be divided into
  • Early neonatal mortality deaths in the first
    week of life.
  • Late neonatal mortality deaths from 7 to 28 days
    of life.

34
The main causes of neonatal mortality are
  1. Low birth weight and prematurity.
  2. Congenital anomalies.
  3. Asphyxia neonatorum.
  4. Birth injuries e.g. head injuries.
  5. Neonatal infections e.g., tetanus neonatorum,
    neonatal septicemia, neonatal meningitis,
    neonatal pneumonia and neonatal diarrhea.

35
Services aiming at reducing neonatal mortality
include
  1. Antenatal, natal and postnatal services.
  2. Special care of LBW babies.
  3. Improving quality of obstetric care to prevent
    birth injuries and asphyxia.
  4. Family planning.

36
3. Post neonatal Mortality Rate PNMR
PNMR
  • The main causes of post neonatal mortality are
  • ARI.
  • Gastroenteritis and dehydration.
  • Congenital anomalies and prematurity.
  • Services aiming at reducing post neonatal
    mortality include
  • (Same as what have been discussed in infant
    mortality rate)
  • I. General measures Improvement of socioeconomic
    standards and environmental sanitation and
    education of females.
  • II. Specific measures Maternal care and Infant
    care.

37
4. Child Death Rate
  • The child death rate is the number of deaths of
    children aged 1 4 years per 1000 children in
    the same age group in a given year and locality.
    It thus excludes infant mortality.
  • The child death rate is computed by the following
    formula

In Malaysia, Child Death Rate was 0.4 per 1000
population aged 1-4 years in 2008.
38
The main causes of death in children aged 1-4
years old are
  1. ARI
  2. Gastroenteritis and dehydration.
  3. Other infections coupled with malnutrition.
  4. Injuries.

39
  • The child death rate is a more refined indicator
    of the social situation in a country than is the
    infant mortality rate.
  • It reflects the adverse environmental health
    hazards (e.g. malnutrition, poor hygiene,
    infections and injuries) including economic,
    educational and cultural characteristics of the
    family.
  • In the age group 1-4 years, the second year is
    the period when the young child is at highest
    risk.

40
5. Under-five Mortality Rate
  • UNICEF defines this as the annual number of
    deaths of children age under-five years,
    expressed as a rate per 1000 live births.
  • More specifically, it measures the probability of
    dying between birth and exactly 5 years of age.
  • It is considered as the best single indicator of
    social development and well being as it reflects
    income, nutrition, health care and basic
    education, etc.
  •  
  • Under-five mortality rate is computed by the
    formula
  •  
  •  
  • In Egypt, it is 21.8/1000 LB (2008).
  • In Malaysia, it is 6/1000 LB (2011)

41
The main causes of under- five mortality rate
are
  1. ARI
  2. neonatal and perinatal causes
  3. Gastroenteritis and dehydration
  4. Injuries

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