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incidence of suicide in the 15-to-24-year-old age group (more girls than boys attempt suicide, but boys are more successful). Although school-age children and adolescents may not voice feelings of depression or anger during a health care visit, such underlying feelings may actually be a primary concern. Nurses who are alert to cues of depression or anger can be helpful in detecting these emotions and lowering the risk of suicide. The high incidence of homicide (1.5% in school-age children and 20% in adolescents) and an increase in the number of adolescents infected with human immunodeficiency virus (HIV) are also growing concerns. Childhood Morbidity Rate Health problems commonly occurring in large proportions of children today include respiratory disorders (including asthma and tuberculosis), gastrointestinal disturbances, and consequences of injuries. As more immunizations become available, fewer children in the United States are affected by common childhood communicable diseases. For instance, the incidence of poliomyelitis (once a major killer of children) is now extremely low (almost zero), because almost all children in the United States are immunized against it (NCHS, 2005). Measles flared in incidence in the early 1990s but now is scheduled as a disease to be completely eradicated by 2010. It is important that this happen, because measles encephalitis can be as destructive and lethal as poliomyelitis. Continued education about the benefits of immunization against rubella (German measles) is also needed, because if a woman contracts this form of measles during pregnancy, her infant may be born with severe congenital anomalies. Although the decline in the overall incidence of preventable childhood diseases is encouraging, as many as 50% of children younger than 4 years of age in some communities are still not fully immunized (NCHS, 2005). There is a potential for childhood infectious diseases to increase again if immunization is not maintained as a high national priority. The advent of HIV disease has changed care considerations in all areas of nursing, but it has particular implications for maternal and child health nursing. Childbearing women and sexually active teenagers are at risk for becoming infected with HIV through sexual contact or exposure to blood and blood products; in addition, infected women may transmit the virus to a fetus during pregnancy through placental exchange. To help prevent the spread of HIV, adolescents and young adults must be educated about safer sexual practices. Standard precautions must be strictly followed in maternal and child health nursing, as in other areas of nursing practice, to safeguard health care providers and other clients. Other infectious diseases that are increasing in incidence include syphilis, genital herpes, hepatitis A and B, and tuberculosis. The rise in cases of syphilis and genital herpes probably stems from an increase in nonmonogamous sexual relationships and lack of safer sex practices. The increase in hepatitis B is due largely to drug abuse and the use of infected injection equipment. One reason for the increase in hepatitis A is shared diaper-changing facilities in day care centers. Tuberculosis, once considered close to eradication, has experienced a resurgence, occurring today at approximately the same rate as measles in young adults. One form occurs as an opportunistic disease in HIV-positive persons and is particularly resistant to the usual therapy (Burgos et al., 2003). Trends in Health Care Environment The settings for maternal and child health care are changing to better meet the needs of increasingly well-informed and vocal consumers. Cost Containment Cost containment refers to systems of health care delivery that focus on reducing the cost of health care by closely 16 UNIT 1 Maternal and Child Health Nursing Practice BOX 1.7 Major Causes of Death in Childhood Under 1 Year Congenital malformations, chromosomal abnormalities Disorders related to short gestation age and low birthweight Sudden infant death syndrome Newborn affected by maternal complications of pregnancy Newborn affected by complications of placenta, cord, or membranes Unintentional injuries Respiratory distress of newborn Bacterial sepsis of newborn Diseases of the circulatory system Intrauterine hypoxia and birth asphyxia 1–4 Years Unintentional injuries Congenital malformations, chromosomal abnormalities Homicide Malignant neoplasms Diseases of the heart Influenza and pneumonia Septicemia Chronic lower respiratory tract diseases Disorders originating in the perinatal period Benign neoplasms 5–14 Years Unintentional injuries Malignant neoplasms Congenital malformations, chromosomal abnormalities Homicide Suicide Diseases of the heart Chronic lower respiratory tract diseases Septicemia Cerebrovascular accident Influenza and pneumonia 15–24 Years Unintentional injuries Homicide Suicide Malignant neoplasm Diseases of the heart Congenital malformations, chromosomal abnormalities Chronic lower respiratory tract diseases Human immunodeficiency virus (HIV) disease Diabetes mellitus Cerebrovascular diseases National Center for Health Statistics. (2005). Trends in the health of Americans. Hyattsville, MD: NCHS. monitoring the cost of personnel, use and brands of supplies, length of hospital stays,
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