This document provides an overview of community pediatrics and key facts about the pediatric population in the Philippines. It discusses the definition of pediatrics, age groups of pediatric patients, leading causes of infant and child mortality, and important early childhood health intervention programs in the Philippines. It also outlines the primary health care approach, components of community pediatrics, and guidelines for community pediatric services.
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Overview & Community Pediatrics: Definition
This document provides an overview of community pediatrics and key facts about the pediatric population in the Philippines. It discusses the definition of pediatrics, age groups of pediatric patients, leading causes of infant and child mortality, and important early childhood health intervention programs in the Philippines. It also outlines the primary health care approach, components of community pediatrics, and guidelines for community pediatric services.
Download as DOCX, PDF, TXT or read online on Scribd
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Overview & Community Pediatrics
Overview I. Lectures: - Introduction and Community Pediatrics - Growth & Development - Genetics - Nutrition - Fluids & Electrolytes - Normal Newborn - Preventive Pediatrics II. Ward Work (Preceptorial) - History Taking - Physical Examination
Definition: Branch of Medicine which - Deals with treatment of the child, his devt. and care - Deals with diseases of children and their treatment Whole of medicine applied to a distinct individual below 20 years of age
FACTS REGARDING PEDIATRIC POPULATION Morbidity and mortality is higher since children are vulnerable A number of diseases, deficiencies or handicaps in children may be carried on to adulthood Sickness in children can cause much apprehension and worry among parents consult more readily for the young ones than for adults Unique population: - Biologic and physiologic characteristics - Disease peculiarities and health problems - Requires specific nutrients in adequate amounts since the child is continuously growing and developing; greater requirements - Responds to environmental factors, to drugs and medical procedures in a different manner
*Appendicitis- periumbilical/diffuse pain in children *Medications are based on body weight per age
AGE GROUPS - Perinatal Period from the 20 th wk of gestation to the first 6 days after birth - Neonatal Period first 28 days after birth - Under Five: Early Infancy <1 mo-1 yr Later Infancy (Toddlers) 2 (Terrible twos) to 3 yrs Pre-school 4 to 5 yrs - School Age from 6 yrs (formal schooling) - Adolescence 10 -19 yrs
* Modern Philippine Pediatrics started with the birth of the Philippine Pediatric Society in 1947 * Total Philippine population: (1980) 48.1M; (1990) 60.7M; (1995) 68.6; (1999) 74.7M * 49% of the total population in the Philippines are children/ predominantly young populationthus, a substantial burden of dependency is placed on those who work * 49% live in urban areas * Population increased by 12.6 over the past 10 years * Population growth rate increased by 2.32% (annual) one of the highest rates in SE Asia * New population policy (Phils.) 3 children per family; aims to improve health by reducing infant, maternal, and early child mortality and also the incidence of teenage pregnancy and early marriage
INFANT MORTALITY Ten (10) Leading Causes, Philippines, 1995 (Source: National Statistics Office) Causes Percentage 1. Pneumonias 37% 2. Respiratory Conditions of Fetus & Newborn 24% 3. Congenital Anomalies 9% 4. Birth Injury and Difficult Labor 5% 5. Diarrheal Diseases 7% 6. Septicemia 6% 7. Meningitis 8. Avitaminosis and Other Nutritional Def. 5% 9. Other Diseases of the Respiratory System
10. Measles
INFANT MORTALITY RATE
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Year Infant mortality rate Rank Percent Change Date of Information 2003 24.98 106 2003 est. 2004 23.51 105 -5.88 % 2004 est. 2005 23.51 105 0.00 % 2005 est. 2006 22.81 105 -2.98 % 2006 est. 2007 22.12 103 -3.02 % 2007 est. 2008 21.2 104 -4.16 % 2008 est. 2009 20.56 103 -3.02 % 2009 est. Infant mortality rate: total: 20.56 deaths/1,000 live births male: 23.17 deaths/1,000 live births female: 17.83 deaths/1,000 live births (2009 est.)
HIGHER NEONATAL MORBIDITY AND MORTALITY IN THE FIRST WEEK Infrequent and inadequate prenatal consultation reasons: geographic, economic, ignorance Majority are home deliveries (home [e.g. by hilot] 70%; hospitals or lying-in clinics 30%) Traditional birth attendants (TBAs) continue to play important role in neonatal care (for at least 1 month) *Adequate visits = not less than 3 visits *Weight gain=25lbs *Make baby cry at birth= do not spank instead, vigorous rubbing of the back or sole of feet
UNDER-FIVE (Provision of Low-cost Comprehensive Child Care) Concerns: I. Treatment of common childhood illnesses: - ARI - Diarrheas - Malnutrition - Micronutrient deficiency *preventable, lamentable *IMCI-program to treat childhood infections to bring down MR of under 5 age group (CARI, CDD)
II. Primary prevention through: - Growth surveillance (ht, wt, HC) - Proper nutrition - Immunization: 1BCG 3HepB 3DPT 3OPV 1MMR - Promotion of Breastfeeding, Oral Rehydration Therapy, Family Planning - Environmental sanitation - Counseling mothers on health matters, safety, and protection of the childs psychosocial environment and how to set priorities for health
III. Identification of at-risk children and prompt management of recognized problems or diseases and its possible complications
IV. Promotion of parent-child relations
TEN LEADING CAUSES OF CHILD MORTALITY (1990) 1. Pneumonia 6. Heart disease 2. Measles 7. Malignant neoplasms 3. Diarrhea 8. Diphtheria 4. Accidents 9. Tuberculosis 5. Bronchitis 10. Malaria
* #s 1 6 = primary causes * #s 7 - 10 + influenza (after TB in del Mundo) = secondary causes * survival sensitive indicator of child survival and individual progress * child mortality rate (1990) 5.3 per 1000 children
SIGNIFICANT EARLY CHILD HEALTH INTERVENTION PROGRAMS IN THE PHILIPPINES AND THEIR TRENDS (1997)
Expanded Program Immunization (EPI) 87.35% (1998) Includes TB, DPT, polio, measles, neonatal tetanus, Hep B, yellow fever Launched by the DOH on July 12, 1976 (BCG for school entrants) 80% goal by the Universal Children Immunization (UCI) for 1990 attained earlier on 1989 National Immunization Days 3 rd Wednesday of April and May 1993, March 1994 and 1995 April 1993 95% coverage
ORS (oral rehydration salts) for diarrheas early 70s (Bangladesh and India) Diarrhea one of the top 3 leading causes of morbidity and mortality among infants; one of the leading causes of mortality and morbidity among the under-fives *Gatorade/sports drink- should not be given to someone with diarrhea since will cause osmotic diarrhea (sugar pulls water out, aggravating the diarrhea) *ORS- salts/electrolytes NA at 75mmol lessens the duration of illness Zinc-added
Breastfeeding promotion and Mother-Baby Friendly Hospitals Initiative (MBFHI) 1992 Natl Demographic Survey showed that breastfeeding is not common August 10 Mother and Baby Friendly Hospital Week; Proclamation #14 (Phils.) rooming in; to promote mother-baby bonding Milk Code
Control of Acute Respiratory Infection (CARI)
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Pneumonia major killer of infants and children in the Phils. 1989: 28% infant deaths and 60% of all deaths between 1- 4 yrs
Micronutrient Awareness and Programs (1996-1997) Micronutrients substances essential to the body yet needed only in minute amounts; adequate intake is important during period of rapid growth Important for physical and cognitive development; important in the production of enzymes, hormones, and other materials that help to regulate growth, development, activity and the immune system National Micronutrient Operative Plan (1996-1998) Iodine, Iron, Vit. A, Zinc, and Folate
THE PRIMARY HEALTH CARE APPROACH Declared as key to the goal of health care for all by 2000 Essential health care made accessible to individuals and people in the community by means acceptable to them towards their full participation at a cost that the community can afford, in a spirit of self-reliance and self-determination
COMPONENTS OF PRIMARY HEALTH CARE Health education Promotion of good and proper nutrition Maternal and child care
COMMUNITY PEDIATRICS The family physician, practitioner or pediatrician should: Be community-oriented and community-involved Deliver comprehensive or best possible health care to the children in the community
ROLE OF THE PEDIATRICIAN IN THE COMMUNITY The Pediatrician should be: An educator A consultant identify problem A coordinator A health planner A counselor A group worker
GUIDELINES FOR COMMUNITY SERVICES 1. Understand the community fully in terms of its - Nature - Characteristics - Capacities - Priority needs of the children 2. Be aware of the existing patterns of health care delivery and possible alternative solutions 3. Obtain baseline data; encourage participation and involvement of the local people in priority programs for children, from the very early stages of planning to organization and implementation 4. Assist in training activities so that ultimately local people in the community may be health educated and trained. This is particularly important in most developing countries where there is a paucity of health manpower resources 5. Include health activities as an integral part of community development programs; enhance services that are not dependent exclusively on outside aid so that innate capacities of the community are developed
CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES (CEDC) Neglected / abandoned Those in situations of armed conflict Street children Children in hazardous occupations Disabled
IMCI (Integrated Management of Childhood Illnesses, WHO Department of Child & Adolescent Health, June 1999) Broad strategy that focuses on the child as a whole Aims to reduce child mortality and morbidity through integrated case management of: - Acute respiratory infection (ARI) - Diarrhea - Measles - Malaria - Malnutrition Stresses prevention and the vital role of the environment and child health Emphasizes prevention of disease through: - Immunization - Improved nutrition - Exclusive breast feeding Implementation of IMCI involves three phases -Introduction -Early implementation -Expansion Success in reducing mortality in children requires more than just adequate health systems and trained health staff and personnel communities and families must be actively involved and committed.
Millennium Development Goals by 2015 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development