Global 4-1 undernutrition
undernutrition is a _______ factor?
"contributing" -underlying causes
number 1 "Cause" of under 5 death
"neonatal" causes -Neonatal>PNA>diarrhea
Of the 3 types of PEM= ______affects child more
"stunting" -India, SSA, SE Asian more than 40 stunted -Puts them more at a risk to chronic dzs
Primary reason children are dying- "fundamental cause"
"water"/sanitation
map- vitamin a
-central America and south America, -ssa, -asia
Underlying causes-
-intake, -access
UNICEF- PNA can be prevented....
-nutrition, exclusive breastfeeding for first 6mos, access to Hib and PNA vaccines, maintain clean physical environment
Insufficient nutrition
-quantity= how much -quality= how good- rice in Asia -poor nutrient uptake b/c of illness
Under 5-
0-5th birthday
Unprotected children - Major problem in 10 countries
= Ethiopia, Congo, India, Indonesia, Pakistan, Philippines, Uganda, south Africa, Iraq, and Nigeria
used to be the biggest killer, but now better at tx
Diarrheal dz-
diarrheal dz spread via?
Fecal-oral transmission - Water and sanitation
Solutions that are simple since building water infrastructure is hard
Oral rehydration salts =ORS/ORT
This is reason the death of children dropped from number 1 to 2
Oral rehydration salts =ORS/ORT -Zinc matters a lot - this means they are worse off if insufficient
S pneumoniae vaccine
PC: -covers multiple strains -S pneumoniae can have multiple strains
Nutrition role
PE and micronutrient - Breastfeeding- way for protection Environmental role - Housing, health facilities, ..
____ kills more children WW than any other single cause under 5
PNA
leading "single" cause of child death in L/MI countries
PNA/ALRI
type of oral rehydration salts (ORT) in the US?
Pedialyte-
who is at high risk of xeropthalmia from vitamin a deficiency?
Pregnant women
interventions When you have an acute situation - PEM
RUTF - Ready to use therapeutic foods - High density, high fat to save people from dying
Estimated deaths in under 5, most in?
SSA>south Asia
UNICEF- Guatemala - video
The United Nations Children's Emergency Fund is a United Nations program headquartered in New York City that provides long-term humanitarian and developmental assistance to children and mothers in developing countries.
Diarrheal dz is caused by?
a variety of pathogens (group of bugs) -Rotavirus(number 1), -ETEC (ecoli), -vibrio, -shigella, -salmonella, -campylobacter, -giardia, -clostridium = all bacteria
People in the US don't vaccinate their children for measles b/c of the fear of
autism
undernutrition is considered a ______ factor to child mortality
contributing
Perinatal-
first "week" of life
Infant-
first year of life
Iodine is key for?
mental health -Most common form of preventable mental health illness
iodine deficient= causes?
mental problems
necessary, but hard for people to get = most insufficient globally?
micronutrient deficiencies
number 1 cause of diarrheal dz
rotavirus
sign for "acute " undernutrition
wasting
stunting
you are too short for your age = height for age
GAVI-Public-private partnership
- Involves WHO, world bank and NGOs like Gates and people that make the vaccines and countries that cant afford them
Micronutrient deficiencies
- Vitamin A - Iron - Zinc - Iodine
Nutrition nerd- micronutrient video
- Vitamins and mineral that are needed for basic health - Hidden hunger- cant always see the effects it does to your body
Iodine causes?
-Goiter- in women -Impaired intellectual
Oral rehydration salts =ORS/ORT
-Sugar or salt with water - Children are really dying from dehydration- losing fluids -The gut cells need salt and sugar to maximize absorption (both)
tx for vitamin A deficiency
-Supplementation 2x/year because it stays in "liver" - Improvements in diet
PATH- agency in Seattle
-Work with vaccines and children = rotavirus vaccine drops - Rotavirus is leading cause of diarrheal dzs - Breastfeeding can reduce death by 50% - Water chemical tx, hygiene, sanitation - ORS and zinc
Vitamin a- causes?
-Xeropthalmia (night blindness) and blindness -Growth and immune system function
Globally ___ of child deaths are attributable to undernutrtion
1/3
Graph - Decrease in child deaths since?
1980 (recent) - Since we developed key interventions - Dip at the end- if we would have met the MDG we would have been lower
___ SD from median = undernourished
2
Protein energy malnutrition -
not enough energy, calories, etc -stunting, wasting, and underweight
GAVI alliance -Global alliance for vaccination and immunization: Mission?
provide vaccines to children in poor countries -"Closing three critical gaps in the provision of vaccines:
PNA- Sxs
- Rapid labored breathing, wheezing, cracking in lungs - Cough, fever, chills, loss of appetite
Main funder of GAVI alliance (vaccines)
Gates Foundation
Hib: vaccine
can be combined with DPT, polio, Hep. B
wasting
when a child is too skinny for their height =weight for height
ALRI (PNA)- Dx?
- X-ray or lab tests - Resource-poor settings: clinical sxs
ALRI- Transmission via
- air - Respiratory droplets, aerosol, normal flora into lungs(bugs live in you=carrier)
Neonatal
- first "month" of life
Vaccines for HIB and Pneumococcus
-"Conjugate" vaccines- simple vaccines with proteins - Very effective
Child survival
-70% decline in last 50 years -7% million under 5 die each year -Closely linked with poverty -99% deaths in L/MI countries
under 5 death Focus:
-ARI, -diarrheal dz -vaccine preventable, -neonatal mortality
diarrheal dz prevention
-Access to water supply and water sanitation -Rotavirus immunization -Exclusive breastfeeding the first 6 mos = Passive antibodies from the mother
Additional important vaccine-preventable diseases
-Diphtheria -Mumps -Rubella -Hepatitis B -Polio -Yellow Fever
access to water supply and sanitation against diarrheal dz=
-Disinfection and storage -Piped water
undernutrition= Deficiencies in ?
-Energy -Protein -Micronutrients
Cost effective short term interventions for micronutrient deficiency?
-Exclusive breastfeeding- for 6 mos of life in poor settings -Vitamin supplementation - take a capsule -Iodization salt -Fortification - food product spiked with nutrients they need to get- ex ^ salt - GMOs foods = fortification - golden rice
challenges for Hib and PC vaccines
-Expense - Because they are relatively new -Delivery - Remote areas -Targeting vaccine to areas with most dz
Key period to avoid nutrition gaps which can cause irreversible problems (mental, physical, etc.)
-First 1000 days of child's life -conception to 2nd birthday
3 goals for GAVI alliance
-Gap between children for whom immunization is given and those with "no access" to basic vaccine -Between the "time" intro of a new vaccine in rich countries and for the same vaccine to reach L/M -Gap between need for "new vaccines" in developing countries and the "lack of research and funds" (better vaccines)
Zinc deficiency causes?
-Growth retardation, -impaired immune function, -skin disorders, -hypothyroidism
Greater severity and mortality in L/MI countries due to?
-Malnutrition -Housing quality -Indoor smoke -HIV -less access to vaccines
problem with child deaths?
-Many of these deaths are preventable -Simple, low-cost interventions
diarrheal dz facts
-Mild to life threatening -Multiple episodes per year in children -Main thing is fecal-oral transmission and the relationship with water sources
diarrheal dz- tx?
-ORT-Oral rehydration therapy -Zinc supplementation -Axs (rarely)
ARI- acute respiratory infections
-PNA/ALRI (acute "lower" resp.= in lungs and bronchi) - 3-6 cases ARI/year per child
#1 Vaccine preventable dzs graph
-PNA= 32% - Rotavirus-vaccine prevents 30%
Long term solutions- micronutrient deficiencies
-Policies- agricultural and trade -Improvements in women's status and access to education -Access and consumption of affordable food that meets nutrition needs
Consequences of undernutrition
-Poor health -Low energy levels -Mental/cognitive impairment -Poverty - Vicious cycles
3 steps to deal with child who has PNA
-Recognize child is sick -Seek appropriate care -Treat appropriately with axs
diarrheal dz mortality graph
-Rota>shigella>typhoid - Cholera not as big- in terms of child death
Hunger map- world food program
-SSA, -S Asia, -S America
Half of all child deaths are in just __ countries
5 -India -China -Nigeria -DRC -Pakistan
who is more at risk of anemia from iron deficiency?
50%- pregnant women 40%- preschool children
all cause mortality from vitamin A deficiency?
6.5 of all deaths of children "under 5" in low and middle are due to vit. A deficiency
Measuring malnutrition -
Assessed as standardized deviation from a reference population in z-scores
Map and vaccine coverage
Blue area- all kids have access- Australia, US, Europe -SSA, and Asia - don't get it
immune system dysfunction from vitamin a= increase
Chances of fighting infections
"major" cause ALRI
H influenza (HIB)
diarrhea, PNA- causes?
Immune system problems-
HANS- movie and child deaths
Linked to family planning- the more we can provide access to planning= less child deaths
"leading" cause of ALRI
Streptococcal(S) Pneumoniae (pneumococcus)
Country where people don't get measles vaccines=
US - We are on the list b/c anti-vaccination movement- link between development of "autism"
how long has DPT3 been in play?
Using since the 80s - Trends in DPT coverage has increased for all countries (20-30 years)
DPT3
Vaccine that protects from diphtheria, pertussis, and tetanus
500 million have _______- from iron deficiency = less productivity
anemia
Iron deficiency causes?
anemic -30% of worlds population is anemic
PEM= indicators of protein undernutrition
anthropometric indicators
Underweight
child weighs too little for their age
Child mortality -Number 2 cause ?
diarrheal dz
1/3 vitamin a def- causes problems with?
immune system
Child mortality- highest percent of?
neonatal causes
Zinc-deficiency affects
organ systems - skin, neuro, reproductive, etc
when you have "chronic" undernutrition - long period of undernutrition, leads to?
stunting
1/2 of under 5 deaths from ________ as an underlying cause
undernutrition
