Introduction
This topic covers the medico-social issues of child care and the Child Health programme of the National Health Insurance Fund (NHIF): risk factors for child mortality, newborn vaccination and home visits, newborn screening, social problems of childhood, family effects and prevention.
Child mortality and age-related problems
- Main causes of death: pneumonia, diarrhoea, malaria.
- Malnutrition is an underlying contributing factor in 45% of deaths.
Problems by age:
- Early school, 7-9 years: obesity, dental caries, allergens.
- School age, 10-14 years: accelerated growth, social problems.
- Adolescent, 14-18 years: social behaviours and lifestyle (alcohol, drugs, smoking).
Child health care and the NHIF Child Health programme
- The NHIF has developed a programme for children from age 0 to 18 called "Child health".
- It is implemented by the child's GP or paediatrician.
- It targets all children irrespective of the health insurance status of their parents. Children are not divided into insured and uninsured, because by law all children are health insured on behalf of the state budget.
- It defines all preventive activities (examinations, tests, immunisations) required to monitor the growth and development of the child.
- It is aimed at healthy children, children with increased medico-social risk, and children with chronic diseases.
Newborn care and vaccination
- In the hospital all necessary medical care is given: examinations, tests, treatments.
- After the first 12 hours: vaccination against hepatitis B.
- 24 hours after birth: vaccination against tuberculosis.
- Children born outside hospital: mandatory vaccination against tetanus.
- If the doctor decides: vaccination against poliomyelitis (0 intake).
Home visits by the GP
- First visit: from 24 hours after discharge, up to 7 days after discharge. Second visit: after the 30th day.
- Aim of the first visit: the GP must be sure that the home conditions are suitable for the baby and that parents and relatives are well informed on how to provide the necessary care.
- If the GP feels the home conditions or the parents' knowledge are inadequate or pose a high risk for the baby, the GP may give helpful advice on adjusting the home settings and conditions or improving their knowledge.
- If the GP decides the risk is still very high, the GP is obliged to contact and report to the child protection services.
- The GP may also decide to hospitalise the newborn and mother on social indications (medical, social and mixed) because the risk at home is too high.
- Any errors in the first year may impact negatively on the baby's health later in life.