Community sheet # 8 -

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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http://www.4shared.com/document/Ygh60vFv/community_8.html
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بسم الله الرحمن الرحيم




Prematurely and low birth (differentiate ) high mortality and morbidity

1_respiratory distress syndrome :
The most important and the most serious in both pre mature baby and small weight birth baby due to retardation in maturity especially lung maturity and surfactant formation that responsible about the relaxation and contraction of the lungs (surfactant formation start after 38 week) so difficulties in inspiration and inhalation happen ,so that respiratory distress syndrome consider one of the high risk and important cause of acute or emergency death at birth in infant or at neonatal period

Q :what are the difference between premature and tern baby?

Pre mature :upper than 28 weeks and before 36weeks
Tern baby (small weight birth baby (weight <2.5 kg)

*baby born before 28 weeks consider abortion ,so baby birth in 30,31weeks in developed countries can survive due to good nursing ,technique skill stuff and incubation ……etc ,but (here) in Jordan any baby under 32 ,33 weeks is in high risk to die


2_ birth trauma :the baby is fragile human being so in some deliveries we need to use type of instruments to facilite baby delivery like suction method so accordingly the baby will be in high risk to have trauma or even if the baby drop he will have hemorrhage in (brain cells?)
Again and again premature baby is in higher risk than tern baby.

3-hemorrage

4- feeding problem

5- infection : in Jordan infection not cause number one in infant mortality but its prematurity

6- failure to thrive :future baby development will be retard ,for example the weight of new born baby is 2.5-3.5 kg (average ~3kg)and on one year baby weight will be 3 time of birth infant about 9-10 kg.
God be praised ,premature baby get one year and his weight between 7-8kg and this retardation not only in weight or length but also in general growth and skills (he will take more time than normal baby ,but after 5 year he will grow normally without difficulties  
All the risk present in both (pre mature and tern baby ) but more in pre mature one bcz tern babies although has (skill retardition?) but they take their full period (40 weeks)to growth but pre mature baby not take full period ,so retardation due to many pregnant complications will happen 


Figure 8.1 (trends in infant and child mortality by 5 years)


-The figure represent (demo graphic health survey study to 2007 )
-this study done every 5 years
- we have 3 column to three categories( infant <1year ,child 1-4years,children under 5 years) ,each column represent the study that done every 5 years ,in our example 2007 /2002/1997)
-in Jordan all numbers refer to family health survey 2007 bcz the next study will be in after 5 years in 2012 and until the report and the confirmation will be ready it will be 2013

Q: why this study is important ,and consider as major reference to us?
1- bcz this study continuous ,not reported from WHO but done every 5 years by doing (statistical analysis , مسح صحي )
2- demo graphical survey can correlate to previous studies
for example :when we say infant mortality in Jordan in 2007 was 19 and in 2002 was 21 and in 1997 was 23 ,it really good indicator to check the improvement .this give the study real value
3-this study compare the result that get with at least 10 years before .
{{{don’t memorize the numbers but notice that it has been decreasing by 2 }}}

_from figure infant mortality about 1/16
- child mortality about 1/6 of infant mortality bcz the first year baby is in high risk to die (75%of infant mortality occur at first month and 75% of death occur in first month occur in first week
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figure 8.3


infant mortality depend on many factors

1) mother age : if mother less than 20 years or more than 30,39,40,49 years ,infant mortality will be high .

2) birth order :prime birth is in very high risk ,and between 4-6 birth infant mortality will increase .the SAFEST PARITY is from 2-4 birth .


3) birth intervals :the period between one birth and other must be minimal 2 years

{{{don’t memorize the numbers ,but you should know what are the variables}}}



Figure 10.1


One of the important indicator of child and infant health is vaccination coverage

-(4) type of vaccine:

*DPT vaccine (triple vaccine )….. diphtheria &tetanus &pertussis
*BCG vaccine …….for TB /tuberculosis
*POLIO vaccine ….$LL a6fal
* MEASLE …… 79ba
-In Jordan this vaccine still given in certain age despite in developed countries it is given at the age of 1.5 years bcz no one have measle by this age .

-in Jordan national casual vaccination this vaccine given at 9 month bcz when baby finish 6month of active maternal immunity he expose to measles so we give 2 doses (first does at 9 month and post dose (12 month)

-the coverage of all vaccine except BCG are about 94%(huge coverage )



Indicators to describe a children well being (1-4 years) including nutrional ,environmental &social community


1-number of low birth babies ( more low birth baby ;more mortality )

Although we said that infant mortality is high but prematurity followed by failure to growth and this mean not if premature baby finish one year no risk ,we still have risk but less ,SO pre mature and tern baby are in higher risk mortality and morbidity

2-infant mortality rate :we calculate the number of infant who die below the age of one year in relation to 1000 (most sensitive indicator in infant and child health)

3- children death rate (age group 1-14 years) calculate per 100,000 bcz children death less than infant so we calculate not from1000 but out of 100,000



4-teens death (age group 16-19year),the most common cause of teens death in Jordan is car accident {dr . mention difficulties pregnant teens face like obstructive delivery… etc }


5 –percentage of teenagers school drop out maternal education is very important factor ( teen at the same time will be in school and will be mother and this reflex on the general health and social aspect.

6- percentage of teens not ascending to school nor work so the mortality and morbidity will be higher in child ,although in Jordan it not accepted for child to work due to the Jordanian laws and the social and economic part ,so we are interested to continuo studying at least high school then work but in less developing country ---high working teens .

7-percentage of child whose parent don’t have full year employment


8-percentage of child in poverty (very important factor for maternal and infant and child health )

9-number of families with children headed by single parent (one father without mother OR one mother without father .so we will have social ,economic problems .

10-number of children with health insurance and social security .its one of the most important factors that reflex the general health at the child so the poor communities consider as risky environment on children increasing the mortality rate .




School health services that should be provided at no cost to student

Q:what are the important of school health ?

Promote the health of child in between the school age (6-18 year )

Q :what the school cover ?

General screening for children school except who is patient and need follow up

_health coverage done by public (government )and private school in 4 grade
1GRADE,4GRADE,7GRADE.11GRADE



1-health physical
2-immunization
3-health education , counseling is very weak and consider weakest services in Jordan bcz its done by tutor or social guidance who know no thing about health

- so the counseling should not be only social
-usually all school health related to one counseling which is social counseling and it not consider enough to cover all health state >

4-care for acute illness and injury; emergency and first aid should be part of the school health

5-care for common adolescents (12-18) physical problems (as smoking ,drugs addiction, infection transmitted disease who start sexual contact early although this limited in JORDAN due to religious and social and traditional aspects of community but it still present in small percentage ,unwanted pregnancy that occur by wrong and also it present in very small % IN JORDAN ….etc)

- AND ACTUALLY ALL THES NOT INCLUDED IN SCHOOL HEALTH 

6-follow-up as requested by physician
7-adminstration of prescription for routine medication for chronic disease like (diabetes , epilepsy ,bronchi asthma ,cardiac problem as stenosis and valvular problem ,eczema ,hemorrhage problem ,congenital problem )

8-nutrition counseling

Family planning services
- the object of family planning services is protecting both maternal and infant health
family planning services consider as part of the preventive services provided by PHC which enable the couples ton choose the perfect time of having baby ;providing certain quality in the life and saving the normal population count from multiplying
-protection of children health from congenital disorder 25%
For example here in Jordan , thalacymia is wide spread disease


Counseling

Is very important in family planning
(the lady cant decide what to use to prevent pregnancy but she should ask her doctor about what is suitable for her bcz not what lady choose is good as counseling (ex.: some lady is suitable to use loop ,other pills ,some to use no thing …etc )


When the lady come and ask for contraception ,she need :
1-great
2-reassure
3- explain the different methods
4- answer some Q
E.X: if the lady use LOOP for 5years ,she should know when to refer to the clinic if bleeding or infection happen or when to stop talking the pills
5- treatment

In Counseling theres personal consideration and effectiveness and safety and :

A)detail history
B) information about all method and to give the lady more than one choice


Q:what are the tradioinal or natural method to use ?

-First we said traditional not modern
-Second we said natural or physical method and no introduction to any medication or mechanical problem in body 

1-breast feeding :not effective in all ladies bcz it should be proper feeding for baby and some working lady cant give this gratifying feeding ,also when the lady have menses there’s chance to get another baby ,bcz during lactation the prolactin level will be high and prevent other pregnancy but since lady has menses prolactin level will drop down
** lactation amenorrhea :no menses during lactation and its about <= 6 months

2-another natural method or traditional one is take period or to count and it need regular period so lady will has regular menses after 1-2 years of marriage
3-withdrawl
4- the body temperature ,but we don’t use this method in family planning (for spacing between births),instead we use it to check ovulation as measure of fertility
5- hormonal contraceptive ,which is the most used method in developing countries but not in Jordan .


THE MOST USED METHOD IN JORDAN IS (IVD)


GOOD LUCK
Done by :aseel albadayna
Lecture number 8
6/3/2011