CHILD & FAMILY HEALTH Infant Mortality Module 2 of 2 Grace E. Foege Holmes, MD

Learning Objectives:

Performance Objectives:

Dr. Grace Holmes and grandson, Quentin

DIRECT/MEDICAL Immediate (birth defects) Chronic (malnutrition) INDIRECT Social EconomicEnvironmental

BIRTHWEIGHT is the single most important predictor for infant survival.

Mother with Newborn Child Survival  World Development

Premature < 37 weeks’ gestationPremature < 37 weeks’ gestation Full term, but long and skinny, or short-for-datesFull term, but long and skinny, or short-for-dates Low Birth Weight (< 2500 grams)

PREMATURITY Gestation of less than 37 weeks calculation from last menstrual period (CGA-Calculated Gestational Age)calculation from last menstrual period (CGA-Calculated Gestational Age) estimation by physical and neurological signs of the baby (EGA-Estimated Gestational Age)estimation by physical and neurological signs of the baby (EGA-Estimated Gestational Age)

UNDERNUTRITION

Adult female stunted < 151 cms Drawing: The Crisis of Undernutrition. Credit: Teaching Aids at Low Cost (TALC) More undernutrition Poor nutrition in pregnancy with anemia Smoking Frequent infection e.g. malaria 10% + of birth weights under 2.5kg More infections and deaths of small babies, and other effects which continue till fourth year More backward children Chart shows poor growth of a girl in first 3 years

Contrast of well-fed and underfed pregnant women. Underfed mother’s pregnancy weight gain = 6 kg Blood + tissue fluid + uterus + breast Well-fed mother’s pregnancy weight gain = 14 kg Baby + Placenta + Amniotic fluid

Maternal education appears to have a strong and independent effect on infant mortality.

ADULT LITERACY RATE Percentage of persons aged 15 years and older who can read and write.Percentage of persons aged 15 years and older who can read and write. 60% of all illiterate people are women.60% of all illiterate people are women.

Bar Graph: Literacy in Women and Men (TALC) North America USSR Europe South East Asia Latin America Arab States Middle South Asia Africa Adult males Adult females Percentage literate

Male and Female Shares of Tasks 30% 50% 70% 60% 80% 90% 60% 50% AGRICULTURAL WORK AGRICULTURAL WORK Division of rural labor by task and sex, Africa Male share Female share Source: Economic Commission for Africa, 1975 (Child Survival/World Development) 70% 50% 30% 40% 20% 10% 40% 50% PLOUGHING PLANTING HOEING/WEEDING HARVESTING TRANSPORTING STORING PROCESSING MARKETING HUSBANDRY AGRICULTURE HUSBANDRY COOPERATIVES 85% 80% 90% AGRICULTURAL TRAINING AGRICULTURAL TRAINING Male and female participation in agricultural training programs, Africa Source: International Children’s Center, “Children in the Tropics”, Issue No 146, Paris, 1983

Educating Girls “... train a woman and you build a nation.”

It’s never too early to start learning!

What Slows Population Growth?

Source: UNICEF

Gift Poster From China

Bangladesh: World Fertility Survey All twenty-nine other countries studied showed similar trends (TALC) Spacing Between Births

Health status of mother directly affects child survival.

IMPACT OF EDUCATION

GEFH

Primary education for women is a critical factor in any country’s development.

Education: An Influential Investment

Women: the Key to Healthy Children Source: UNICEF

GEFH