IB WCS 16
MAJOR CHILD HEALTH PROBLEMS
Prof. YL Lau
Paediatrics
Thu 05-09-02
Mortality
Morbidity
Fewer children sick these days - indicates a more mature society. Therefore, need to change focus from disease to health
LEADING CAUSES OF DEATH IN 1996
Under 1 yr.
- Congenital anomalies: congenital doesn't necessary indicate genetic (eg. Rubella: infection during pregnancy) - therefore congenital indicates "at birth"
- Immaturity
- Birth asphyxia
- Perinatal cause
1-4 yr.
- Injury and poisoning
- Pneumonia
- Congenital anomalies
- Cancer
5-14 yr.
- Injury and poisoning
- Cancer
- Diseases of nervous system
- Pneumonia
4-5% of mothers smoke during pregnancy (8x increase from 5-6 yr. ago)
INJURIES IN CHILDREN IN HK
Biggest single cause of death in age 1-14
Unintentional injuries kill about 50 children < 15 yo / yr. (> 1/5 of total death toll (21%): don't use the word 'accidental' because this is fatalistic (indicates that nothing can be done about it)
Annual mortality rates: 4.8/100,000 for boys; 3.0/100,000 for girls
30% of paediatric attendance in A&E department were injury related, of which 30% required hospital admission
30% of admitted cases could suffer long term effects
POTENTIAL YEARS OF LIFE LOST BEFORE 65 (PYLL-5)
Measure of burden of premature mortality
In 1995, PYLL-65 due to
- Injuries: 30,645
- Stroke: 6,394
- Heart disease: 10,000
- Cancer: 48,669
AT RISK GROUPS
Male children and toddlers under 5 are most prone to unintentional injuries
The gender ratio (M:F) lies between 3:2 and 2:1 for most kinds of injuries
SETTING OF UNINTENTIONAL INJURIES IN HK
About half of childhood injuries occur at home, followed by stress and school injuries
Unattended children left alone at home at major risk (113 died between 1989-1994)
57% of childhood injuries seen at A&E were preventable
CATEGORIES OF UNINTENTIONAL FATAL INJURIES
MVA 30%
Drowning and submersion 20%
Accidental falls 20%
Fires and flames
Accidental poisoning
ROAD TRAFFIC ACCIDENT (RTA)
- Foremost cause of death from unintentional injuries (30%) in HK children, 10-15 lives/ year
- For every child who dies, 35 or more sustain serious injuries
- On average, 6-7 children reported injured on the roads every day
- Both incidence and severity of road injuries increase with age and higher among boys; peak during school dispersal hours
PREVENTION OF RTA
- Safety fences and pedestrian railings, humps on roads nearby schools
- Pick-up traffic near schools discouraged
- Bicycle helmets
- Use of safety seats, child restraints in motor vehicles because standard safety belts are inappropriate for young children
- Safe driving
- Drink driving, for every 20 mg/dl increase in blood alcohol concentration, the likelihood of a fatal crash is doubled
No safety limit with drinking and driving because any alcohol amount will lengthen reaction time
DROWNING AND SUBMERSION
- The 2nd largest cause of deaths, responsible for 1/5 of deaths from unintentional injuries
- Boys, aged 5-9, most at risk
- Swimming lessons, adequate supervision with trained staff
ACCIDENTAL FALLS
- 3rd most common cause of deaths, responsible for 20% from unintentional injuries
- 60 deaths result from falling out of a building
- Toddlers under 5 yo at greatest risk
- Never leave children unattended at home
FIRES AND FLAMES
- Not a major cause of mortality
- 50% of burn deaths in children involve those age 0-4
- Temperature regulation of tap water
- Wax boiling in mid-autumn festival
- Mishandled lighted smoking materials
ACCIDENTAL POISONING
- Mostly at home
- Household produces and therapeutics drugs are commonly involved
- Childproof packaging of medicines
- Safe storage
- Poison centres
OTT medication sale is on the increase in HK
APPROACHES IN INJURY CONTROL
Behavioural
Engineering
Legislative: eg. Seatbelts; most effective way of changing behaviour (eg. Fines, jail)
MORBIDITY IN PRIMARY SCHOOL CHILDREN IN 1995/6
VA defect 20.4%
Passed vision screening test with glasses 16.0%
Obesity 11.8%
Asthma 9.2%
Psychosocial problems 4.9%
OBESITY
- Weight above 120% median weight for height of the same sex
- Lower HDL (cholesterol)
- Impaired glucose tolerance (DM)
- Increasing prevalence
- 1993: 7.6% in boys; 7.8% in girls
- 1996: 10.4% in boys; 8.9% in girls
BREASTFEEDING IN HK
Lowest ever rate of 5% in 1978
Rose to 19% in 1992 when the Baby Friendly Hospital Initiative HK Association was formed
Achieved 47% for post-natal ward discharge breastfeeding rate in 1998; of those breastfeeding mothers, 53% continued to breastfeed at 4 weeks and 32% at 8 weeks
OBSTACLES TO BREASTFEEDING
- Working mothers
- Aggressive advertisement of infant formula
- All hospitals in HK receive "free" or low-cost infant formula from milk companies
- Propagated by medical profession: a lot of events, education etc are sponsored by milk companies
- Violation of International Code of Marketing of Breast-Milk Substitutes
PROMOTION OF BREAST FEEDING
- Baby-friendly hospitals
- Monitor the International Code
- Maternity and even paternity leave
- Provisions for breastfeeding in public places
- Health education curriculum in schools
ASTHMA
Asthma in children in HK
- Asthma: wheezing 'hehe' in the chest
- Allergic rhinitis: sneezing, running nose nasal blockage
- Atopic eczema: itchy skin rash
- 3,618 6-7 yo
- 9.2% experienced wheeze in past 12 months
- 16.8% wheeze-ever prevalence
- International comparison (12 month prevalence of wheezing)
- HK 10%
- Similar to: Singapore, Taiwan, Seoul, Japan
- Less than NZ & Australia (> 20%)
- International comparison (12 month prevalence of allergic rhinitis)
- HK 10%
- Similar to Australia
¯ chance: having 2-3 siblings
chance: RTI in last 12m; parents wheeze; parents eczema
Summary: from 1995-2001
- No
in asthma or eczema prevalence
Noticeable in prevalence of current rhinitis
¯ sibship size, frequent RTI and parental history of wheeze and atopic disorders were found to be associated with 12 month prevalence of rhinitis
rhinitis symptoms varied significantly with environmental pollutants, including NO2, RSP and O3 (respiratory suspended particulates; ozone)
SMOKING
A case-control study in HK showed smoking in mothers resulting in babies born smaller y 200g, shorten by 1cm, and head circumference smaller by 0.3cm
Passive smoking resulting in increased respiratory symptoms
"One in Two" message
Prevalence of children ever smoking in 1991 in HK
|
Age (y) |
Boys (%) |
Girls (%) |
|
8 |
7 |
3 |
|
9 |
9 |
5 |
|
10 |
14 |
6 |
|
11 |
21 |
9 |
|
12 |
28 |
13 |
|
13 |
51 |
20 |
|
Subtotal |
15% |
7% |
SMOKING PREVALENCE IN WOMEN AND CHILDREN
- Continuous drop in overall prevalence
- Rising trend in women, except those aged 60 and above
- Rate of smoking among females rose from 2.7% in 1993 to 3.1% in 1996 to 5% in 2000
- Every-smoking rate of Form One students was 21% rising to 37% in Form Three students in 1995