Child Health: An Overview

Introduction to Child Health

• Health is defined as complete physical, mental, and social well-being, not just the absence of disease.
• A child is defined as a human being below the age of 18 years.

Phases of Childhood

• Neonatal period: The first 4 weeks after delivery (28 days of life).
• Early Infancy: The first year of life.
• Late Infancy: The second year of life.
• Early Childhood: Ages of 2-6 years.
• Late Childhood: Ages 6-12 years.
• Early Adolescence: Ages 12-15.
• Late Adolescence: Ages 15-18.

Child Health Program

• Part of the Maternal and Child Health program (MCH).
• Children constitute about 40% of the population.
• Children under 5 years make up 15% of the population.
• Children are the most vulnerable group, exposed to various health risks.
• There are high infant and maternal mortality rates.
• Objectives include health promotion for mothers and children and also the prevention and control of health hazards that affect them.
• Child health services are provided via maternal and child health centers in cities.
• Also provided via family health units in rural areas.
• Services include preventive, curative, and social health services.

Preventive Health Services

• Care of the newborn.
• Consistent infant care.
• Breastfeeding instructions.
• Vaccination.

Curative Health Services

• Sick children are attended to and examined at the center.
• Severe cases should be referred to the hospital.
• A high-risk child includes those with congenital anomalies, mental abnormalities and malnutrition.

Child Health Problems

• Nutritional deficiency diseases, infections, prematurity, and infant mortality can be major problems.

Social Health Services

• Social life is important in children's development of personality.
• Common social health problems includes unhealthy family dynamics, exposure to abuse/neglect, and bullying.

Immunity and Vaccination

• Immunity is the ability to recognize, destroy, and eliminate foreign antigenic material.
• Herd immunity is the level of immunity in a population that determines disease behavior.
• Herd immunity often results from unapparent subclinical infections.
• Herd immunity also comes from deliberate artificial active immunization.
• Passive immunization of poliomyelitis (through water contamination by sewage).
• During outbreaks, the risk of paralytic polio & fatality is higher in developed countries because of better sanitation and subclinical infection absence.

Types of Immunity

• Innate immunity is inborn and based on characteristics of each species.
• Acquired immunity is gained throughout life and is divided into natural and artificial types.

Natural Acquired Immunity

• Acquired through exposure to the disease organism, either through infection or vaccination.
• Subclinical infection: Repeated exposure gives immunity against endemic diseases like polio & diphtheria.
• Manifest disease: Attacks of infectious diseases followed by variable degrees of immunity.
  • Absolute: Lifelong immunity, only known in yellow fever.
  • Solid: High, long-lasting immunity after measles, smallpox, mumps, & diphtheria.
  • Moderate immunity after enteric fever, common cold, & influenza.
• Passive natural acquired immunity is passed from mother to child.
  • Transplacental: Antibodies obtained by the fetus from the mother protect against infectious diseases.
  • Milk: Colostrum is rich in antibodies.

Artificial Induced Immunity

• Passive immunization (seroprophylaxis) involves inoculation of immune serum with ready-made antibodies that protect for a few weeks.
  • Human normal immunoglobulin is prepared from pooled plasma of donors exposed to diseases such as hepatitis or rubella.
  • Human specific immunoglobulin is prepared from donors immunized against specific diseases like mumps and tetanus.
  • Animal antisera: Antitoxin sera (e.g., diphtheria, tetanus) and antiviral sera (e.g., rabies).

Active Immunization (Vaccination)

• Vaccination started with Edward Jenner's smallpox vaccine in the 1790s.
• Currently available vaccines prevent up to 3 million deaths, and 750,000 children avoid serious disabilities each year.

Vaccine Composition

• Adjuvants promote an earlier & stronger response (e.g., aluminum salts).
• Preservatives prevent contamination (e.g., thiomersal).
• Additives stabilize vaccines from adverse conditions.

Stages of Vaccine Trials

• Vaccine development includes phases I,II, and III.
• The process can take over 10 years, depending on the disease and safety.
• Phase I studies:Focus on safety involving small groups of healthy adults.
• Phase II studies: Subjects in target age group tested for safety and dose response.
• Phase III studies: comparative efficacy trials of vaccines.
• Vaccines that show safety in Phase 1 and 2 are tested with randomized comparative trials to assess efficacy.
• Vaccination efficacy can be measured through the following equation: VE = (ARU - ARV) / ARU x 100, where VE = vaccine efficacy.

Types of Traditional Vaccines

• Inactivated vaccines are produced by killing the microorganism, vaccines require booster doses.
• Live, attenuated vaccines are grown under conditions that cause it to lose its virulence.
• Subunit vaccines (Toxoids): Toxins produced are detoxicated by formalin.

New Vaccine Technologies

• Conjugate Vaccines: outer coating of polysaccharides.
  • Conjugation attaches the polysaccharide antigen to a protein carrier.
• Subunit Vaccines: Made by taking part of a microbe.
• Recombinant DNA vaccines: DNA is injected into cells where they "read" the DNA as foreign.

Vaccination Process

• Vaccine is processed and transporetd through cold chain.
• It is a system that keep vaccines safe throughout their long journey.
• Vaccine stability is affected by temperature: Sensitive to heat and frost.

Sensitivity to Light

• Sensitive to strong light, sunlight, ultraviolet & fluorescent (neon)
• Vaccines should be stored in their original packaging to shield from light.
• Cold chain equipment includes refrigerators, cold boxes, and ice packs.
• The cold chain must be maintained to ensure the integrity and effectiveness of vaccines.

Rules for Keeping Vaccines in the Refrigerator

• Arrange vaccines neatly with air spaces in between.
• New vaccines should be stored towards the back.
• Temperature should be checked everyday.(0-8 °C)
• Vaccines not put in the door or in freezer.
• Store vaccines according to guidelines and to seperate containers for different classes.
• Vaccines should be stored and handled properly during immunization sessions.

Key Steps During an Immunization Session

• Insulated pot & ice are needed to keep both the vaccine & diluents cold.
• The vaccine should be held in a cool place away from the sun.
• Certain vaccines are very easily damaged by sunlight and these are stored in brown colored vials.

Vaccine storage

• Use vaccine fridge
• Safeguard electicity supple
• NO more than 50% full
• Put vaccines clearly labelled in plastic baskets
• Group vaccines by type depending on who they are for
• Defrost/calibrate fridge regularly

Failure Indication of the Vaccine

• Check the expiration date
• Check for any color change for polio
• DPT vaccine spoiled by freezing -> On shaking -> turbidity will form if left 30 min.

Immunization schedule in Egypt

• Lists Vaccines and the recommended route of distribution.
• Includes zero doses and 18 month doses.

Unavailable but Recommended vaccines in Egypt

• Rotavirus vaccine
• Prevenar (pneumococcal saccharide conjugate vaccine)
• Chickenpox (varicella) vaccine
• Hepatitis A vaccine
• Meningitis vaccine
• Typhoid Fever vaccine