Demography, Child Health

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Bagian Ilmu Kesehatan Anak FK UNSRAT/

RSU. Prof. Dr. R.D. Kandou-Manado

INTRODUCTIONCHILD HEALTH SITUATION in

INDONESIA

and CONTRIBUTING FACTORS

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GROWTH

Increase of physical sizeHeight, weight, head circumference etc.

DEVELOPMENTIncrease of ability in human function

-physical (motoric),

-cognitive (intelligence)- affective (emotion-social),

.

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Mother, subtitute

mother, Parent, sibling, caregiver,toys, norm, rule, stimulation

Health Service, EducationNeighbor, peer

Gov. Policy, International

UNICEF, WHO

CHILD GROWTH & DEVELOP. QUALITYDeterminants : INTRINSIC (genetic- heredoconstitutional)+ EXSTRINSIC ( environment)

(Kobayashi, 1985;

Sularyo, 1989;Ismael, 1991,) ENVIRONMENT

ROLE:to met :

Bio +Psycho-social nee

BIO:nutrition,imunisation,medicine,cloth, etcl

PSYCHO

SOCIALLove, care,

Stimulationcognitive,emotion-sociall7/19/2013


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THE QUALITY OF FAMILIES

1. EDUCATION : illiteracy 16 millions Father: 49 % Primary + Secondary School

Mother : (Primary 31.7%, Secondary 11,7 %).

Illiteracy : adult female 12 %, male 10 % (Unicef, 1999).

Female illiteracy (1997) on village 19.12 %, urban 8.06%,

Male illiteracy on village 9.26 %, urban 2.87 %.

(females 2 - 3 X > males )

.

2.AGE ON FIRST MARRIED, FAMILY PLANNINGfirst married < 17 tahun : village 24.4 %, urban 16.1 %

Use contraceptive (1997/1998) 66.9 %

3. FEMALE STATUS IN FAMILY7/19/2013


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QUALITY OF FAMILIES

4. HYGIENE and SANITATION UNSAFE WATER : village 38 %, urban 13 %

Coliform contamination > 100 / 100 ml 63 %.

Contaminated Risk : very high 15.04 %, high 21.06 %

UNSAFE SANITATION : village 79 % urban 36 %

House without window 32 %

5. POVERTY :39.1 % keluarga miskin

6. UNEQUAL POPULATION DISTRIBUTION,

GEOGRAPHICAL HANDICAP, DISTANCE

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THE QUALITY OF MATERNAL

and CHILD HEALTH SERVICES

1. MATERNAL and INFANT HEALTH SERVICEunreach 22 % ( 1,1 m) pregnant women and infant

geographics, population distribution, sosio-economic,

social status of females, education (Depkes, 1997).

2. DELIVERYtraditional birth attendance 47.5 % (2,3 m deliveries)

by family 8.2 % (400.000 deliveries),

at home 71.9 % (SKRT 1995).

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3. POSYANDU (INTEGRATED SERVICE POST)244.032 Posyandu : 45 % elementary (110.563),

active posyandu 80 % ( 37.6 % - 85.6 %).

1996 ; each Posyandu have 4.6 kader,

1997 4.4 kader / Posyandu balita brought to Posyandu : 1.2 x / fam / year

(range 0.1 - 4.62)

4. BKB, PADU, PPA, TPA, TK ?limited area geographic handicap, unequal population distribution

SUPERVISION ?: unintensive, poormonitoring and

evaluation ?,project oriented ?

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5. PRIMARY HEALTH SERVICEPuskesmas : 12 % no doctor.

Puskesmas doctor 45 % - 80 % (some Province)

Nurse : unequal distribution (3 - 4/1000 people)

PTT Midwive : poor quality of skill ( crash program)Geographic handicap, socio-culture.

6 .REFERRAL HOSPITALPediatricians on Hospital type D : 0.24 / Hospital,

Obs-Gyn : 0.35 / H.blood bank, medicine, budget, facility

Distance, geographic, transportation

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MATERNAL HEALTH STATUS

1. NUTRITIONAL STATUS ON PREGNANT WOMEN

CHRONIC MALNOURISHED : 30 % (1,5 million) pregnancy

FE DEFF ANEMIA: 40.5 - 51 % (2 2,5 m) since firsttrimester

Fe tablet (minimum 90 tebletss) just 23.4 % pregnancy

12,2 % (600.000) never had Fe tablet

SHORT STATURE (small pelvic)

height < 140 cm : 5 % (250.000 women),

140 - 144 cm : 11 % (550.000 women ) .

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2. REPRODUCTIVE CHARACTERISTIC (age, spacing,number of delivery)too young (< 20 year) : 14 % (700.000 pregnancy),

too old (r > 35 tahun) : 12.7 % ( 600.000 pregnancy).

too short spacing (< 2 tahun) : 17 %,

too frequent (> 4 X ) : 35.1 %

3. MATERNAL HEALTH CARE

never: 22.1 % ( 1,1 m illion pregnancy).delayed (since 7 mo) : 18,2 % (900.000 pregnancy),

delyed (since 4 mo) : 33.1 %.

< 4 X during pregnancy : 26 %

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4. MATERNAL MORTALITY

373 / 100.000 pregnancy (18.000 maternal /year ) Every day : 50 maternal mortality

Every hour : 2 maternal mortality

THREE DIRECT CAUSES OF MATERNAL MORTALITY bleeding (36.1%),

toksemia gravidarum (25%),

Infection, delayed delivery, abortus (11.1%)

THREE TOO LATE:1. to identify dangerous signs,

2. to reach the hospital

3. to get adequate intervention

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MATERNAL MORTALITY

UNDIRECT CAUSES

1. Nutritional status (Chronic malnutrition, anemia)

2. Reproductive characteristic (age, spacing, no. of

delivery)

3. Maternal health care (delayed or never)4. Unable to pay for delivery

.

BASIC CAUSES

Education (< Secondary school)

Women status in society or family

Poverty

Geographic handicap, distance, transportation

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CHILD MORTALITY

BIRTH RATE : 4.8 million / year (9 babies /minute)PERINATAL MORTALITY (umur < 1 bulan)1 baby < 1 mo / 10 minutes

INFANT MORTALITY (age < 1 year)40/ 1000 life birth / year (Unicef, 2000)186.500 babies die / year, 511 babies / day,

22 babies / hour , 1 baby / 3 minutes

UNDERFIVE MORTALITY (56-59 / 1000 lifebirth)(Depkes 1998, Unicef 2000), 261.000 under5 / year,

715 under5/ year , 30 under5/hour1 under5/ 2 mnt

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Perinatal Mortality (> 1 mo)Direct cause :

Fetal/perinatal problems :

respiratory & circulatory distress (45.5%),Low birth weight / premature (32.8 %)

Infection (6.9%)

Hypothermia (5,9 %)

Tetanus (3.4%)

Metabolic (1.7%)

Maternal problems :

Nutritional status, reproduction (age, spacing, birth), prenatalcare, diseases

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on infant and underfivesSevere acute respiratory tract infection (pneumonia)

diarrhoeamalnutrition

other infection

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INFANT & CHILD HEALTH STATUS

1. LOW BIRTH WEIGHT (< 2.5 kg) : 450.000/year

2. PERINATAL CARE (< 1 mo) unadequate

Umbilical care : traditional 17,7% (800.000 perinatal).

Never seen by health staff before 1 mo of age (30 % )

Pra lacteal feeding :

banana 17 % air tajin 9.3%, sugar or honey 3.1 %,

others 9.5%.Geographical handicap, poverty, culture

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INFANT and CHILD HEALTH STATUS

2. NUTRITIONAL STATUS

SEVERE MALNUTRITION (Unicef 2000) 8 % under5

(1,8 milllions underfive)

SEVERE + MODERATE MALN.: 34 % (7 million under5)

MILD MALNUTRITION : 26 % (5.2 million underfive).

1996 : mild malnutrition 20.96 %,

increase 5 % (1 millions underfive).

VITAMINE A DEFFSevere Malnutrition

Fe ANEMIA : underfive 40.5 % (9,4 million underfive) . Primary School age : 45 70 % anemia

IODIUM DEFF. 30 million s lower intelligence

family consumed Iodine Salt 62 %

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3. IMMUNIZATION10 % (450.000) not fully basic immunization .

4. DENTAL: Decay, missing, filled : school-age 74.41 %,

mean 2.5 teeth / child Dental health service for primary school 60.16 %.

malnutrition

5. MORBIDITY & MORTALITY

Acute respiratory tract infection (pneumonia), Diarrhoea, Malnutrition

Geographic handicap, poverty

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INFANT d CHILD HEALTH STATUS


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6. DELAY DEVELOPMENT LOWER

INTELLIGENCEEarly detection at Puskesmas

Jabar 1987-1992 : delay development : 2 13,2 %

Jateng 1988 1992 : delay dev. :2.6 4.4 %

7. EDUCATION Drop out Primary School : 900.000 child/year

Primary & Second. School Age not enroll : 6 million

Secondary School age not enrollbut : 3.6 juta

Enrollment on Secondary School : 71, 87 % Lower intelligence ?: IQ borderline ?, Mentally

retarded ?

Parent appreciation, poverty, geographics

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8. OTHER SOCIAL PROBLEMS

Child workers : 2.5 millions Street Childreen : 150.000 child

l Sexual exploitation : 40.000

70.000 child

Child abuse : ??

Crime : 4000 child

Child neglect: ?

Drug abuse : 120.000

1 million ? Orphanage ?

Disabled ?

in refugee camp ?

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STRATEGI FOR OPTIMIZING

QUALITY OFCHILD GROWTH and DEVELOPMENT

Directto the infant and child

Indirect : improving quality of family,especially mother, father and adolescence

girl

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Improving quality of mother, father

and adolescens girl

1. Improving nutritional status of motherand adolescencegirl: chronic malnutrition, Fe deffiency Anemia Iodium

defficiency

2. Improving educational statusmother, father and

adolescen girl : reading for health information and itsapplication

3. Improving knowledge and skill mother, father and

adolescen girl on :a. FAMILY PLANNING : pregnant >21 year < 35 year,

spacing for 2 3 years, number of child < 3 ,

b. MATERNAL HEALTH : prevention for anemia,

malnutrition, infection

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c. PREGNANCY CARE : prevention for anemia,

malnutrition, imunization, early identification of bleeding,

toxemia, infection

d. SAFE DELIVERY : especiallyfor high risk mother

(chronic malnourish, anemia, too young or too old, too short,

too short spacing, too frequent, delayed care)

e. INFANT and CHILD CARE : perinatal care,

umbilical, MM, immunization, infant feeding, prevention for

infection, accident, early identification for ARTI, diarrhoea,

malnutrtion

f. EARLY STIMULATION for COGNITIVE and

EMOTION-SOCIAL : playing, BKB, PADU / Early Child

Education

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g. HYGIENE & SANITATION : washing hand

before handle baby, safe water, disposal, safe cooking,feeding, home ventilatioan

4. Improving knowlegde mother, father and adolescence

girls onfCHILD RIGHT, especially : child protection for

child abuse, neglect, exploitation, drug abuse

5. Improving knowledge and skill forfamily income

generating by optimizing resource in family at home

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Demography, Child Health

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