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In addition, poor child health and nutrition negatively affects the country's development breast feeding and complementary feeding, safe water supply,





     The Allan and Nesta Ferguson Trust

Introduction to Child Health Course

    A distance learning course of the Directorate of Learning Systems (AMREF)

? 2007 African Medical Research Foundation (AMREF)

    This course is distributed under the Creative Commons Attribution-Share Alike 3.0 License. Any part of this unit including the illustrations, may be copied, reproduced or adapted to meet the needs of local health workers or for teaching purposes, provided proper citation is accorded AMREF. If this work is altered, transformed or built upon, the resulting work may be distributed only under a license identical to this one. AMREF would be grateful to learn how you are using this course, and welcomes constructive comments and suggestions. Please address any correspondence to:

Directorate of Learning Systems

    AMREF Headquarters

    P O Box 27691 00506, Nairobi, Kenya


Writer: Prof Nimrod Bwibo

    Cover Design: Bruce Kynes

    Technical Co-ordinator: Joan Mutero

    The African Medical Research Foundation (AMREF wishes to acknowledge the contribution of the Commonwealth of Learning (COL) and The Allan and Nesta Ferguson Trust whose financial assistance made the development of this course possible.


    Welcome to the Child Health Course. This is one of the continuing professional development courses offered by AMREF through distance learning. This course has been revised and contains the most current concepts such as the integrated management of childhood diseases (IMCI), care of the newborn and HIV/AIDS.

    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.


By the end of this course you should be able to:

    ? Describe how to diagnose correctly the common conditions and diseases

    affecting children;

    ? Describe how to manage common conditions and diseases affecting


    ? Explain how to measure and monitor growth and development in a child; ? Explain how to develop and give relevant health messages to individuals,

    families and communities; ? Discuss the principles of counseling;

    ? Describe how to effectively organise and carry out immunisation activities; ? Explain how to minimise the common accidents and injuries occurring in

    children in your catchment area; ? Describe rehabilitative activities that are needed for children with physical or

    mental challenges.



According to the United Nations Convention on the Rights of the Child (UNCRC)

    and the Kenya Childrens 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 they form the majority of our clients in the health facilities.


    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%.



The five most common diseases among this age group are:

- Pneumonia;

    - Malaria;

    - Diarrhoeal disease;

    - Measles;

    - 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 also 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.



    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


    ? 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


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.


    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.



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


    ? Simple diagnostic and treatment guidelines on common childhood

    diseases which you can internalize through self-guided learning.


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


    ? 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.


    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 studyguide and assignment. There is no accompanying reference textbook.

    This course emphasises 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


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