TABLE 16.17.
Basic Risks and Continuum of Care for Prevention of Child Morbidity and Mortality
| Stage | Risks | Prevention/Treatment |
|---|---|---|
| Pre-pregnancy | Education, marriage before age 19; poor nutrition, female genital mutilation, HIV, STIs | CHW assessment, counseling, iron and folic acid supplements, teach and monitor hygiene, promote breastfeeding, screen and treat hypertension, renal disease, HIV, STIs |
| Pregnancy and lactation | Lack of prenatal care, abuse, smoking, alcohol, drugs, lack of adequate diet; anemia; low birth weight, neural tube defect, fetal alcohol syndrome | CHW care; good nutrition, multi-micronutrient supplements including vitamin A, iron, and folic acid; risk assessment, referral if high risk, antenatal care from earliest stage, HIV treatment, counseling |
| Delivery | Preterm birth, lack of trained midwifery care, poor hygiene, anemia, hemorrhage, eclampsia, infection, hypertension, prolonged and obstructed labor; maternal death; vesicovaginal fistula | Trained attendants, hygienic, safe delivery, referral to medical center/hospital for high-risk patients; telemedicine (cell phone or landline); transportation; family support |
| Neonatal | Half of neonatal deaths occur in first 24 hours and three-quarters in first week of life; non-breastfeeding, lack of trained care providers, asphyxia, respiratory infection, diarrheal diseases, tetanus, HDN | Appropriate care by trained attendant; Apgar score; initiate and sustain exclusive breastfeeding; HIV care; vitamin K and hepatitis B injections and eye care with antibiotic after birth; oxygen and antibiotic if respiratory distress; ORS for diarrhea; register births and birth weight and complications |
| Infancy | Inadequate milk formula and feedings, contaminated water and food; worms; malnutrition; lack of stimulus of developmental tasks; infectious diseases – diarrhea, respiratory, malaria; non-breastfeeding with risk of childhood obesity, type 1 and type 2 diabetes, sudden infant death syndrome | Exclusive breastfeeding for minimum 6 months; add complementary feeding gradually; for adequate nutrition use multi-micronutrient powders for home fortification; immunization with DPT, polio, MMR, Hib, pneumococcal pneumonia, rotavirus; height and weight monitoring and recording on WHO growth charts; ORS and respiratory care as needed; vitamin supplementation; insecticide in home and impregnated bed nets, vector control |
| 1–5 years | Malnutrition – stunting, inadequate feeding, lack of iron and vitamin A supplements, and infectious diseases – pneumonia, diarrhea, malaria; childhood obesity | Monitoring and recording on growth chart; counseling, developmental assessment and support; ensure complete immunization; impregnated bed nets, multivitamins for children at risk; for adequate nutrition use multi-micronutrient powders for home fortification including iron supplements; add zinc with ORT for diarrhea; refer children with malnutrition, failure to thrive |
Note: HIV = human immunodeficiency virus; STI = sexually transmitted infection; HDN = hemorrhagic disease of the newborn; CHW = community health worker; ORT = oral rehydration therapy; DPT = diphtheria–pertussis–tetanus; MMR = measles–mumps–rubella; Hib = Haemophilus influenzae type b; WHO = World Health Organization.
Sources: See Chapters 4 and 6Chapter 4Chapter 6. World Health Organization. The integrated global action plan for the prevention and control of pneumonia and diarrhea. WHO/UNICEF; 2013. Available at: http://apps.who.int/iris/bitstream/10665/79200/1/9789241505239_eng.pdf [Accessed 11 June 2013]. World Health Organization. Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. Geneva: WHO; 2013. Available at: http://apps.who.int/iris/bitstream/10665/84409/1/9789241505550_eng.pdf [Accessed 12 June 2013]. World Health Organization. Essential interventions, comorbidities and guidelines for reproductive, maternal, newborn and child health: a global review of the key interventions related to reproductive, maternal, newborn and child health. Available at: http://www.who.int/pmnch/topics/part_publications/201112_essential_interventions/en/index1.html [Accessed 12 June 2013].