1. Main causes of global burden of disease in young children
   1. Where in the world do most deaths occur
      1. Africa, India
   2. Child mortality is decreasing across the world
      1. but still a huge problem, especially in developing countries
   3. causes
      1. Neonatal
         1. Preterm
         2. Congenital
         3. Diarrhoea
         4. Asphyxia
         5. Infection
         6. Tetanus
      2. HIV/AIDS
         1. causing increases in child deaths in some countries although child mortality is decreasing overall globally
      3. Diarrhoea
         1. very cheap for treatment
            1. no excuse not to treat
      4. Pneumonia
         1. treatment cost for pneumonia is very cheap
      5. Measles
      6. Malaria
      7. Others
      8. Mal/Undernutrition
         1. lack of
            1. zinc
            2. vit A
            3. Iodine
            4. protein
      9. if untreated, these can occur in rounds, another vicious circle
   4. proportion of causes of death vary between different areas
   5. poverty
      1. 1.2 billion people live on less than $1 a day
      2. 2.4 billion people lack adequate sanitation
      3. 1 billion lack access to safe water
      4. 130 million children have no access to education
         1. strong links with higher mortality
            1. less contact with healthcare
      5. 350 million children work
      6. 10 million AIDS orphans in sub-Saharan Africa
      7. MAJOR DETERMINANT OF MORTALITY MALDISTRIBUTION
         1. huge disparity within countries
   6. Child mortality distributed unevenly within countries
      1. China:
         1. are they going to distribute wealth evenly?
   7. Gini Coefficient
      1. : measure of inequality of income distribution or inequality of wealth distribution
         1. not just about how much income a country is getting, how much it is distributed throughout country
   8. Price of inequity
      1. Social challenge
         1. promotes anger, grievance, injustice, despondency
      2. cannot have political stability where there is [social] inequity
   9. 50% newborn deaths occur in the first 24 hours after birth
      1. time when most babies die is when coverage of care is lowest
   10. immunisation
       1. very successful
       2. new vaccines
          1. pneumococcal conjugate
          2. Hib conjugate
          3. GAVI
2. Global WHO IMCI strategy
   1. 8 Goals
      1. 4. Reduce Child Mortality
         1. Most countries have signed up
   2. To achieve MDG 4
      1. Safe motherhood
      2. Breastfeeding and nutrtion
      3. Neonatal care
      4. Micronutrient supplementation
      5. Childhood vaccines
      6. IMCI & improving quality of hospital care
         1. paediatrics dept
            1. training
            2. guidelines
            3. appropriate technology
            4. essential medicines
            5. standards and assessment
            6. policy and evidence
      7. improve family and community practices
      8. insecticide treated bed nets
      9. HIV prevention
      10. community/home based interventions to improve nutrition
      11. feeding/breastfeed counselling
      12. 13 essential drugs
      13. improve individual, family and community response to sickness
          1. early care management
          2. appropriate care-seeking
          3. compliance with treatment
   3. FAIL
      1. 5.5 million lives could be saved by simple, cost effective interventions
      2. weak health systems
      3. lack of trained human resources
      4. inadequate care seeking and low utilization
      5. hard to reach those who need it most
      6. inappropriate delivery channels
      7. pressing national need to address lack of resources and availability of good care and education for those who want to provide good care
      8. scaling up coverage
         1. reaching poor and other marginalised groups (poor, geography, ethnicity)
         2. implementation gap
   4. Global responsibilities
      1. Subtopic 1
   5. Global priorities
      1. lots of money being invested to try and solve this
      2. but not much compared to how much has gone into war
   6. challenges within medical profession
      1. address human resource crisis
         1. education in developing countries
         2. improve quality of career for healthcare worker students
         3. increase sharing of info