Introduction To The Course

=CHILD HEALTH COURSE=

INTRODUCTION TO THE COURSE
ACKNOWLEDGEMENTS

The revision of this course has been the product of collaboration between officers from the Ministry of Health, Division of Child Health and The University of Nairobi, Department of Paediatrics and Child Health. AMREF is indepted to Prof Nimrod Bwibo, Prof. Rachel Musoke, Dr Daniel Njai from the University of Nairobi and Dr Santau Migiro from the Division of Child Health who worked tirelessly on the revision of this course.

AMREF would also like to acknowledge the contribution of the Commonwealth of Learning, whose financial assistance made the development of this course possible.

INTRODUCTION

Welcome to the Child Health Course. This is one of the continuing professional development courses offered by AMREF through Distance Education. This course has been revised and contains the most current concepts such as integrated management of childhood diseases (IMCI).

The course is designed to expose you as a health worker to that part of medicine concerned with the health and wellbeing of children and aims at updating your knowledge, attitudes and skills to enable you provide quality health care to the children of this country.

WHO IS A CHILD?
According to the United Nations Convention on the Rights of the Child (UNCRC) and the Kenya Children’s Act of 2001, a child is any person aged below 18 years. The word child refers to all the various stages of growth and development that a person goes through before attaining adulthood. The stages are divided into two groups; those before birth and those after birth.



•	Stages before birth

Before birth we have the Embryo and Foetus. The Embryo is the product of conception up to 8 weeks of pregnancy while the Foetus is the product of conception up to birth. These two stages are not covered in this course but may be referred to as we discuss the wellbeing of children. •	Stages after birth

The stages of the child after birth are as follows:
 * The newborn also known as the neonate from birth to the first 28 days of life.
 * The infant which is from birth up to one year of life;
 * The young child (Preschool child) which is a child from the age of one year to five years of life.
 * The child is also referred to as the Under five child.
 * The school child is the child from 5 years to 15 years of age.
 * The final stage is the Adolescent who is a child aged from 9 to 18 years of age. This is the transitional stage to adulthood.

Kenya has a population of 38 million people of whom 40% are children below 15 years of age, 14.3% are children below 5 years of age, and 3.8% being children below one year of age.

As you can see from the figures on the population of children, children below 15 years of age account for 48% of the total population in this country. I am sure you can now see why there are so many children visiting our health facilities for treatment.

WHY CHILD HEALTH?
Health is an inherent right of the child as stipulated in the United Nations. Also, Child and maternal health indicators are commonly used to determine the country's economic development. This includes the infant and under-five mortality rate, maternal mortality ratio, immunization coverage and child malnutrition rate among others. In addition, poor child health and nutrition negatively affects the country's development through resources diverted to the treatment of the illnesses, the working hours lost by caregivers of the sick children and the loss of life of the children. The Long-term effects of children's poor health and nutrition include the dependence caused by mental and physical handicaps while some children fail to reach their genetically pre-determined capacity. Further, poor health in schools including helminthic infestation, malnutrition and micronutrient deficiency reduce the cognitive capacity of children, further reducing the value of the resources invested in education. Healthy children lead to a healthy future generation while children are crucial agents for transmission of health messages to the communities. Kenya was also ranked the 40th country with the highest under-five mortality rate out of 193 nations in the year 2002. In addition, Kenya is among the 16 countries in the world in which the current levels of under five mortalities were higher than the 1990 levels. In the second health sector strategic plan (2005-10), the government is committed to reversing the declining trends in the health status of all the Kenyan population of whom children account for 48%.

WHAT ARE THE COMMON CHILDHOOD DISEASES?
The five most common diseases among this age group are pneumonia, malaria, diarrhoeal disease, measles and malnutrition. These five conditions alone are responsible for about 70% of all the under-five children’s deaths. They are also responsible for high Infant Mortality Rate of 77/1000 live births and Under-five Mortality Rate of 115/100 live births in this country. Other childhood health problems include anaemia from various causes, intestinal helminths, childhood accidents. The new scourge of HIV/AIDs has had devastating effects on child health. You will learn more about how to diagnose, manage and prevent these conditions in the various units of this course.

ROLE OF THE MINISTRY OF HEALTH IN PROMOTING CHILD HEALTH
The development of any nation is influenced by the health and well being of her children.

It is in this context that the Ministry of Health established in the year 2001, the Division of Child Health with specific mandate to implement activities that would lead to the improvement of Child Health and Nutrition. The responsibilities of this division are:


 * To ensure growth, survival and development of children aged below five years;
 * Health promotion in all children – pre-school and school age including adolescents (up to 18 years) both in school and out of school;
 * To promote good nutrition for children, expectant and nursing mothers, the sick and the general population including elimination of micronutrient deficiency.

In the current National Health Sector Strategic Plan (NHSSP 2005-10), child health promotion and IMCI is one of the 5 minimum Kenya Essential package for Health (KEPH). The concept of Integrated Management of Childhood Infections (IMCI) is discussed right at beginning of this course so that you can apply it in subsequent units.

Kenya is also a signatory to the internationally defined Millennium Development Goals (MDG) and has expressed its commitment to reach these targets in the remaining ten years. Out of the eight MDGs, three of them are related to child health. These are:


 * Goal 4: reducing child mortality by setting a target of reducing the Under-five Mortality Rate (U5MR) by two-thirds between 1990 and 2015 and increasing proportion of one year old children immunized against measles.
 * Goal 5: Improving maternal health which indirectly improves the health of the newborn child.
 * Goal 6: Combating HIV/AIDS, Malaria and other diseases such as tuberculosis. This aims at reversing the spread of HIV/AIDs; reducing prevalence of HIV among pregnant mothers thus reducing Maternal to Child Transmission (MTCT), reducing the prevalence of tuberculosis and reducing the prevalence and death rates associated with malaria.

The Ministry of Health has translated international targets set by the MDG into national targets, and will further translate them into regional and district level targets in order to inform and guide local priority setting and resource allocation.

CHILDREN’S RIGHTS
According to the United Nations Convention on the Rights of the Child, EVERY child and young person under 18 has rights and responsibilities appropriate to their age and development. This convention which has been ratified by almost all countries in the world sets out protective measures for member state to take in order to protect the children. These are popularly known as the rights of the child. As children are totally dependent on their parents and guardians for their care throughout childhood, this care is enshrined in the rights which the child is entitled to and must enjoy. These Rights of the Child are summarized as follows:


 * The right to live
 * The right to acquire a name and nationality
 * The right to enjoy parental care
 * The right to proper food and medical care
 * The right to education
 * The right to be protected from all kinds of harm
 * The right to moral upbringing
 * The right to a culture

Although the child may not be in a position to claim or demand them, nonetheless he or she must be provided with these rights.

Having looked at the definition of a child and why our government places great importance in child health, let us now look at why you should take this course and how it is organised.

WHY TAKE THIS COURSE?
This course is designed to equip you with the knowledge, skills and attitudes necessary to enable you provide effective and efficient promotive, preventive and curative child health services. It is intended to provide you with the following:


 * Well prepared self-guided  materials on child health;
 * A quick reference for use at your place of work so that you can effectively and promptly diagnose, treat and refer children with common childhood diseases;
 * Simple diagnostic and treatment guidelines on common childhood diseases which you can internalize through self-guided learning.

WHY THE HEALTH WORKER?
As a health worker, you are a part of the big team which supports our country’s health system. You undertake important and indispensable activities through your service to the community. Some of these activities are to diagnose, manage, and prevent childhood diseases  We hope that this course will prepare you efficiently and accurately to undertake the following tasks:
 * Diagnose correctly the common conditions and diseases affecting a child;
 * Provide the appropriate case management of common conditions and diseases affecting children using the IMCI approach;
 * Initiate and carry out growth promotion and monitoring activities;
 * Give relevant health education and counselling to  individuals, families and communities;
 * Organise and carry out effective immunisation activities;
 * Educate caretakers on how to minimize common accidents and injuries occurring in children in your catchment area;
 * Facilitate and carry out rehabilitative activities for children with physical and mental disabilities;

As you can see from these tasks, you are an important partner in ensuring that our children remain healthy citizens. One way of ensuring that you perform these tasks properly is by taking a course such as this one. The materials in this course is meant to compliment and not substitute the knowledge and experience you continue to gather from ongoing continuing education activities organised at your workplace.

HOW IS THE COURSE ORGANISED?
This course is arranged in 22 booklets each of which deals with a specific disease or group of conditions related to Child Health as shown in the course outline below. Each booklet has a study guide and assignment. There is no accompanying reference textbook.

The course emphases an integrated approach to the management of childhood diseases. It discusses the case management of various conditions that afflict children as well as the role of child nutrition; breast feeding and complementary feeding, safe water supply, sanitation and hygiene, and counselling of caretakers, especially in cases of children with HIV/AIDS. Also children with mental health problems and children with disabilities are discussed and given emphasis since you have an important role to play in supporting parents through counselling and rehabilitation activities

HOW TO GO THROUGH THE COURSE
•	Duration of the course;

One advantage of a distance education course such as this one is that it allows you to work at your own time and pace. Therefore, If you work consistently and complete at least two Units every week, it will take you a minimum of 10 months to complete this course.

•	Getting started and working on your course.

Once we accept your application for this course, we shall send you the course introduction, a pretest and the first three units of this course. You should start by doing the Pretest. Try to answer all the questions in the pretest. It is designed to evaluate our material/teaching rather than to test you. When you complete the pretest, go through the course introduction first and then proceed to go through the Units, starting with Unit 1. As you go through each unit, read it thoroughly and do all the in-text activities. In-text activities are designed to help you check your understanding as you go along. When you feel confident that you have learnt the work of the unit, complete the assignment and send it back to us for marking. Do not forget to post the pretest. They will be marked and returned to you together with the next lessons. This will continue until you complete the last unit and do the Post-test.

•	How to make the most of this course.

It is important to remember that you cannot learn all about child health from one course. Although we learn a lot of things from books and courses, we learn even more from our patients -- from listening carefully to their story and from observing their appearance and behavior. While a book can describe general symptoms and signs of a disease, a patient can tell you in great detail about what they feel; and your observations of the patient will show you the clinical signs. That is how patients teach us about illness.

After you complete each unit in this course, try to apply what you have learned in the lesson to your day-to-day clinical work. Listen carefully to the patients who come to you, and see if they describe symptoms you have read about. Use the knowledge you have gained from this course to ask patients about other symptoms they may have forgotten to mention.

Share your new knowledge with your co-workers by discussing cases you have come across, presenting your findings, explaining the significance of those findings, and asking for their opinions. In that way, the patient will benefit from other insights, and your co-workers will also refresh their knowledge in the process.

Remember, the real objective of this course is to help you give better care to your patients. So use what you learn in this course to improve your clinical work.

SYMBOLS USED IN THE COURSE





This symbol indicates the LEARNING OBJECTIVES for that unit.

LIMITATION OF THE COURSE
Although the writers of this course have done their best to give you the most current information on child health, remember that health is a dynamic field with new changes taking place all the time. You will therefore need to be on the look out for new information from time to time to supplement the one given in this course. Also, in order to gain the necessary skills in IMCI case management, you will need to arrange with an IMCI trained focal person to demonstrate these skills. The Division of Child Health has so far trained IMCI focal persons in 55 districts and still continues to train more. Find out if there is a trained focal person in your hospital or district team who can demonstrate the necessary skills to you.

If you find any part of this course a little advanced write to your tutor at AMREF for assistance. Our contact is:

AMREF Directorate of Learning Systems Distance Education Courses P O Box 27691 – 00506 Nairobi, Kenya Email: decourses@amrefhq.org

Welcome to the course!