1. CHILD & FAMILY HEALTH Infant Mortality Module 2 of 2 Grace E
CHILD & FAMILY HEALTH Infant Mortality Module 2 of Grace E. Foege Holmes, MD
OVERVIEW:
Infant Mortality–Module 2
The health status and education of the mother directly affect her child’s survival.
Grace E. Foege Holmes, MD Professor of Pediatrics and Preventive Medicine The University of Kansas School of Medicine Kansas City, Kansas (USA)

2. Learning Objectives: The student should be able to:
Recognize the role that low birth weight plays in infant mortality;
Recognize the importance of the mother’s health, dating to her own fetal development and postnatal growth, as these affect the health of her future offspring.
Appreciate the pivotal role of mother in the health of her child and family
Understand the positive effects of education of women as it relates to their care of their children and family.

3. Performance Objectives:
Understand the crucial role of a mother in any society and her impact on the IMR.
Understand the importance for the health of future generations of education of both girls and boys.
Correlate for a given country the literacy rate for girls, the birth rate of the country, the IMR, and the general nutritional status of the population.

4. Dr. Grace Holmes and grandson, Quentin
Grace E. Foege Holmes, MD The author loves to be and has been surrounded by children: as a child herself surrounded by five siblings, as a mother by six children, and as a grandmother by twelve grandchildren.
Likewise, professionally, she loves to be surrounded by children who need her helpespecially those with problems of growth and development. In addition to a long career at the University of Kansas School of Medicine, she practiced medicine in Malaysia ( ) and at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania ( ).

5. DIRECT/MEDICAL Immediate (birth defects) Chronic (malnutrition)
INDIRECT Social
Economic
Environmental
In Infant Mortality Rate (IMR) #1, we noted the various causes of infant death, namely DIRECT (both immediate and chronic medical problems), and INDIRECT (social, economic, and environmental causes.
In addition to those factors affecting infant mortality, it should be obvious that our first step should be to start with a healthy baby. The fetus and baby do not have any control of this. Let’s see how we can help move him/her along to a healthy state.

6. BIRTHWEIGHT is the single most important predictor for infant survival.
A major contribution we can make is to prevent the occurrence of low birth weight babies.
So, how do we do that?
Birthweight tells us something about the baby’s possible future. It also tells us something about the mother, (the baby’s past). It is an index of the mother’s health and nutritional status before and during pregnancy.

7. Mother with Newborn Child SurvivalWorld Development
Thus, a critical intervening variable in the life (both prenatal and postnatal) of a child is the MOTHER.

8. Low Birth Weight (< 2500 grams)
Premature < 37 weeks’ gestation
Full term, but long and skinny, or short-for-dates
Low Birth Weight (< 2500 grams)
Low birth weight infant is more likely to lead to infant death.
In developed countries, 2/3 of low birthweight (LBW) babies are premature.
In developing countries, only 1/5 of LBW are premature, while 4/5 are full term but short or thin.

9. PREMATURITY Gestation of less than 37 weeks
calculation from last menstrual period (CGA-Calculated Gestational Age)
estimation by physical and neurological signs of the baby (EGA-Estimated Gestational Age)
Prematurity is not decided by birthweight, but rather by length of gestation, or pregnancy.

10. UNDERNUTRITION
Undernutrition of a young girl may be a chronic problem, affecting her own health, her pregnancies, and her babies. It can become a vicious cycle.

11. More backward children
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
Chart shows poor growth of a girl in first 3 years.
Adult female with stunted height <151 cms
Poor nutrition in pregnancy with anemia
Smoking
Frequent infection (e.g. malaria)
10% + of birth weights under 2500 grams
More infections and deaths of small babies, and other effects which continue till fourth year
More undernutrition
More backward children
A Vicious Cycle

12. 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
Health of a mother is important to the well-being of the child, before, during, and after pregnancy.
The health status of the mother directly affects her child’s survival.
We tend to blame poverty for this situation, but ignorance can an even more deadly foe of infants than is poverty.

13. Maternal education appears to have a strong and independent effect on infant mortality.
We tend to blame poverty for this situation, but ignorance can be an even more deadly foe of infants that is poverty.
Let’s take a look then at maternal education and literacy of women in the world.

14. ADULT LITERACY RATE
Percentage of persons aged 15 years and older who can read and write.
60% of all illiterate people are women.
In our world, four out of ten women are illiterate: and in some African and Arab countries eight out of ten.
A U.N. report on the world’s women :
Illiteracy among women 1970 = 543 million
1985 = 597 million
In developing countries, 90% of boys have 6-11 years of school in contrast to only 64% of girls.
In all parts of the world, women work as much as men.
In Asia and Africa, women work an additional 13 hours per week.
U.N. Report 1992

15. 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

16. Male and Female Shares of Tasks
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%
PLOUGHING
PLANTING
HOEING/WEEDING
HARVESTING
TRANSPORTING
STORING
PROCESSING
MARKETING
HUSBANDRY
AGRICULTURE
COOPERATIVES
85%
80%
90%
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
30%
50%
70%
60%
80%
90%

17. “... train a woman and you build a nation.”
Educating Girls
“... train a woman and you build a nation.”
The education of girls is closely associated with a falling infant mortality and birth rate and improved nutrition.
“Train a man and you train an individual: train a woman and you build a nation.” (Bishop Nzimbe, Machakos, Kenya, May 1985)

18. It’s never too early to start learning!

19. What Slows Population Growth?

20. Source: UNICEF
Decades of experience have shown that it is a combination of changes –rather than any one change–which brings about a rapid fall in birth rates. Family size falls fastest when:
Countries move towards equality between men and women–so that women themselves can decide whether and when to become pregnant.

21. Source: UNICEF
Educational levels rise–especially for girls–so that son-preference fades and women have more awareness and choice.
Child death rates fall–so that parents can have confidence that their children will survive.

22. Source: UNICEF
Economic security improves–so that children are no longer essential for support in illness or old age.
High-quality family planning information and services are available to all.

23. Gift Poster From China

24. Bangladesh: World Fertility Survey
All twenty-nine other countries studied showed similar trends (TALC)
Spacing Between Births
Family planning information can affect spacing between births which, in turn, affects infant (and toddler, and child) mortality.

25. Health status of mother directly affects child survival.
Mother’s awareness of resources, ability to appreciate basic health causes and consequences, and to do something about them are vitally important for infants.

26. IMPACT OF EDUCATION

27. GEFH
Increases mother’s skills, knowledge, and ability to deal with new ideas.

28. Mother has better information about nutrition and hygiene.
Mother is better able to grasp the gravity of illnesses and understand the capability of modern medicine.

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

30. Education: An Influential Investment
Craft reports on data from 82 developing countries that indicate that for every extra year a woman stays at school, she reduces her children’s risk of early death by 7-9%.
High literacy in a country promotes not only health and social benefits. Interestingly, World Bank experts look upon education for Africa’s women as being “the most influential investment” with high financial returns!

31. Women: the Key to Healthy Children
Source: UNICEF
Healthy women are critical to the survival and welfare of infants. UNICEF helps women protect their own health and that of their children, improve nutrition, and learn new skills through training and practical assistance.
They can learn to recognize basic health problems and to treat their children in the home--quickly, safely, and economically, thus providing a safer environment for their families and a better future for their children. Projects have ranged from encouraging breast-feeding, instead of formula milk, to safe motherhood programs and improving girls’ access to primary education.

32. GEFH
Mother can be selective in applying traditional ways in caring for children.