Heart Breaks
Recent years have seen a surge in births worldwide, as well as the highest number of child deaths. According to the World Health Organization (WHO), 1 in 27 children die before the age of five. Majority of the underlying causes of death in children stem from often ignored or under-projected issues including pre-natal birth defects; maternal and child mortality; child abuse and maltreatment; poverty, hunger and malnutrition; preventable ailments and terminal diseases, disability, and societal and cultural vices.
Pre-natal Birth Defects
Maternal and Child Mortality
Child Abuse and Maltreatment
Poverty, Hunger and Malnutrition
Societal and Cultural Vices
Preventable Ailments
PRE-NATAL BIRTH DEFECTS
Birth defects, also known as congenital abnormalities, congenital disorders or congenital malformations, are structural or functional anomalies that occur during intra-uterine life. The most common birth defects are heart defects, neural tube defects, Down syndrome, congenital heart defects, cleft lip or palate and club foot.
A minority of birth defects are caused by genetic abnormalities i.e. chromosomal abnormalities or single gene defects (e.g. cystic fibrosis). Others occur because of environmental factors like maternal infections (syphilis, rubella), exposure to radiation, maternal nutritional deficiencies (e.g., iodine, folate deficiency), illness (maternal diabetes) or certain drugs (alcohol, phenytoin). Consanguinity (where parents are related by blood) also increases the prevalence of rare genetic birth defects and nearly doubles the risk for neonatal and childhood death, intellectual disability and other anomalies.
According to the WHO, an estimated 240,000 new-borns die worldwide within 28 days of birth every year due to birth defects. Birth defects cause a further 170,000 deaths of children between the ages of 1 month and 5 years. Notably, it is estimated that about 94% of severe birth defects occur in low-and-middle-income countries. This higher estimation stems from a possible lack of access to sufficient nutritious foods by pregnant women, an increased exposure to agents or factors such as infection, or poorer access to health care and screening. Accordingly, although birth defects may be the result of one or more genetic causes, other identified causes such as infections, nutritional, and environmental factors make some birth defects highly preventable.
MATERNAL AND CHILD MORTALITY
Developing nations are a major contributor to the global burden of maternal and child deaths, thus requiring intensified efforts to rapidly reduce the high mortality indices. the region with the highest number of neonatal deaths is sub-Saharan Africa at a rate of 27 (25-32) deaths per 1000 live births. There are approximately 6,700 neonate deaths everyday globally and majority of them are in sub-Saharan Africa.
Seventy-five percent of neonatal deaths occur within the first week of life. For proper context, the new-born period, that is the time from birth till 28 days of extra uterine life, can be divided into early neonatal period (first 7 days) and late neonatal period (8th to 28th day). Nearly 1/3 of all under-5 deaths occur in the early neonatal period. Genetic factors such as birth defects, pre-term birth, distressful birth, and infections also contribute to early neonatal deaths. In the late neonatal period, pneumonia, diarrhoea, birth defects, malnutrition and malaria are common causes of severe disease and death. Other factors such as unhygienic umbilical cord treatment also lead to fatal but otherwise uncommon diseases such as neonatal tetanus.
As it pertains to the mothers, the main causes of maternal mortality are haemorrhage, infection, obstructed labour, eclampsia, malaria in pregnancy, anemia, et al. Majority of these conditions can be prevented, and/or their impact minimized to such an extent that they do not cause maternal death.
CHILD ABUSE AND MALTREATMENT
Children worldwide are vulnerable to various forms of abuse and neglect , which could be physical abuse , psychological abuse , and sexual abuse . A quarter of all adults’ report having been abused as children. Every year there is a low estimate of 41,000 homicide deaths in children under the age of 15 years with majority of these homicides due to abuses and maltreatment, which are incorrectly reported as accidents. Further, war infested countries and countries with low social security consistently record high incidence of sexual violence and exploitation and abuse by security forces, community members, aid workers and many others.
Similarly, child globally continue to encounter maltreatment, which cause them suffering, impairs brain development; and as adults, these maltreated children are more violent, depressed, are more likely to abuse substances, have a much worse health outcome, participate in high-risk sexual behaviours as well as propagating their own forms of abuse.
Notably, a number of characteristics of relationships within families, friends and peers, communities and societies may increase the risk of child maltreatment, such as: a lack of awareness of child development or having unrealistic expectations of a child; financial difficulties, high levels of unemployment or poverty; physical, developmental or mental health problems of a family member; family breakdown or violence between family members; gender and social inequality; and social and cultural norms that promote or glorify violence towards others, support the use of disproportionate corporal punishment, promote rigid gender roles, or diminish the status of the child in parent–child relationships.
In all, children are the victims and are never to be blamed for abuse or maltreatment.
POVERTY, HUNGER AND MALNUTRITION
A very high percentage of children in developing countries (orphaned or with a parent(s) alive), live in poverty or extreme poverty. This makes it difficult for them to access or afford everyday essentials such as food, water, shelter or healthcare. This is made worse by the fact that most of these countries do not have the social support or have a plan to alleviate distressed families from poverty. Often, these children that are born with nothing to their names grow up with such a limited mentality that they too have children that end up with nothing to their names, and the poverty cycle continues.
In Africa alone, children living in extreme poverty are just over 50% of the children population. This low socio-economic standing leaves a lot of families unprotected when health challenges arise. In 2012, it was estimated that 3.5 million children in Africa are two parent orphans while another 28.6 million are single parent orphans, with the number expected to have increased in the last couple of years.
Attendant to poverty is malnutrition, which can be undernutrition, over-nutrition, or vitamin or mineral deficiency. Undernutrition is the most common type of malnutrition in developing countries. It is associated with more than 40% of child deaths as it has certain implications such as impaired growth of the child, weakened immunity and poor healing and repair. Not many children have access to good and nutritionally balanced food. Further, most infants under 6-month of age are not exclusively breastfed. In fact, according to the WHO, 800,000 children’s lives could be saved every year among under-5s, if all children under the age of 23 months were exclusively breastfed. What this means is that good nutrition falls under the inexpensive part of medicine known as preventive medicine.
SOCIETAL AND CULTURAL VICES
Children worldwide are vulnerable to various forms of abuse due to child labour, child trafficking, female genital mutilation, child marriage which sees girls as young as 10 married off, and violence involving children and against children.
Under-aged Marriages
Every year, about 15 million girls are married before the age of 15 years, and 60% of births by girls between the ages of 13 and 19 occur within forced or unplanned marriages. Some of the causes of this menace include restrictive laws and government policies that make it hard to access information on sexual health; financial constraints of adolescents to acquire contraceptives; and in some situations, underage girls may be unable to refuse unwanted sex or resist coerced sex which is often unprotected; and rape. This does not just happen in war torn countries but in relatively peaceful countries where said girls may be afraid of speaking out against the perpetrators of these acts.
Child Trafficking
27% of trafficking victims are children. Labour and sex trafficking are the most common form of trafficking faced by children and involves the use of fraud, coercion, or force. Nearly 4 million children are trafficked for forced labour, generating $150 billion in illegal profits per year. Children being trafficked are disconnected from their families, schools and friends and forced to work, with a majority of them forced to carry out hazardous tasks. 66% of child labour trafficking victims are girls, while 99% of sexual exploitation trafficking victims are women and girls, with most of the victims from poor neighbourhoods and have little to no education, thereby further worsening the outcome of their lives. It is estimated that there are 5.4 victims of modern slavery for every 1000 people worldwide and 7.6 victims for every 1000 people in Africa, making Africa the highest region in terms of modern slavery in the world.
Drug Dependency
Particularly worrisome is the escalating use of alcohol and mind-altering drugs amongst adolescents. This habit is closely linked with juvenile delinquency, school failure, HIV/AIDS transmission, violent crimes and a generally unsafe environment. Various types of drug use are prevalent, but cannabis remains the most widely used illicit substance in the developing regions. The highest prevalence and increase in use is being reported in the Americas and West and Central Africa with rates between 5.2% and 13.5%. Amphetamine-type stimulants (ATS) such as “ecstasy” and methamphetamine now rank as the second most widely abused drug type. Other substances that were used by children and youth surveyed in Sierra Leone, included benzodiazepines such as diazepam, chlorpromazine and different inhalants, while 3.7% were injecting drugs. Injecting drugs carries a high risk of infection with bloodborne viruses such as HIV, hepatitis B and hepatitis C, and the sharing of contaminated needles and syringes is an important mode of transmission for those viruses.
Education Exclusion
Of all regions, India and sub-Saharan Africa have the highest rates of education exclusion. Over one-fifth of children between the ages of about 6 and 11 are out of school, followed by one-third of adolescents between the ages of about 12 and 16. According to UIS data, almost 60% of children between the ages of about 15 and 17 are not in school. Without urgent action and intervention, the situation will most likely get worse.
PREVENTABLE AILMENTS
Pneumonia
Pneumonia is the most common cause of acute lower respiratory tract infections (ALRI) and the single most common cause of ALRI- related mortality. There are about 151.8 million reported new cases of pneumonia every year, of which about 13.1 million are severe enough to require hospital admission. According to the WHO, pneumonia is the commonest cause of death in children under the age of 5, and accounts for 16% of under 5 deaths.
In developing countries, the rate of under-5 deaths due to pneumonia is 3-10 times higher than it is in developed countries. Reasons for the increased incidence of pneumonia in developing regions include the presence of more severe forms of the pathogens, malnutrition leading to a weakened immune system, overcrowding in homes, biomass combustion, as well as the absence of or the under-equipping of relevant health facilities. Pneumonia, as a communicable infection of the lower respiratory tract, can be caused by bacteria, viruses and fungi. As with all communicable diseases it can be prevented by immunization, adequate feeding and environmental management.
Diarrhoea
Diarrhoea is the second leading cause of death in children under the age of 5. Globally 1.7 billion cases of childhood diarrhoeal disease are diagnosed every year with many losing their lives. Diarrhoea can lead to dehydration, malnutrition, heart failure and shock. It is characterised by the passage of stool of watery consistency, the passage of loose stool at a frequency of more than 3 times in a day, or the passage of explosive and voluminous stool once. This group of diseases in children include acute diarrhoea, persistent diarrhoea, chronic diarrhoea and dysentery.
Diarrhoea can be due to infection by ingestion of food or water containing causative microorganisms or it can be due to ingestion of osmotically active substances that draw fluid into the intestinal tract, the former is more common. This means that a large number of deaths due to diarrhoeal diseases can be prevented by providing safe drinking water and adequate sanitation and hygiene.
Malaria
Malaria kills an estimated 3,000 African children per day. That is one child in every 30 seconds. This makes it the most important disease caused by parasites in the tropics. In order for the infection to occur, there must be a susceptible human host and an environment that breeds the anopheles’ mosquitoes that harbour the parasite. Malaria is endemic in most sub-Saharan African countries due to the nature of the climate and it is transmitted in 97 countries. Of the 198 million cases or so that are reported each year, 80% are in Africa while 90% of deaths due to malaria are in Africa. About 70% of deaths from malaria are children under the age of 5.
Kidney Injury:
Acute and chronic kidney (AKI) injury refers to deterioration in renal function caused by injury to the kidneys. This is a global problem with severe morbidity and mortality especially in children. Kidney injury in developing countries is usually due to community acquired causes such as acute diarrhoea, infections and toxins. In Nigeria alone AKI accounts for 1-2% of all paediatric admissions in major hospitals and for 20% of children in paediatric ICU. The main causes of kidney injury in developing countries include dehydration secondary to diarrhoea, severe malaria, sepsis, haemoglobinuria and mini epidemics of diethylene glycol poisoning. Kidney injury can lead to many complications including heart failure, high blood pressure, seizures, anaemia, bleeding disorders, et al.
