new initiatives in child health dr sangeeta saxena ... health conclave/new initiatives in...
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NEW INITIATIVES IN CHILD HEALTH
Dr Sangeeta SaxenaAssistant Commissioner(Child Health)Ministry of Healtrh and family Welfare
Government of india
2. CURRENT STATUS VIS-À-VIS RCH II/
NRHM GOALS RCH II Goal
IndicatorAll India Trends(Source of Data)
Targets for No. of states having achieved
10th Plan (2007)
RCH II /NRHM (2012)
10th Plan targets
RCH II /NRHM targets
MMR(per lakh live births)
398(SRS 1997-98)
254(SRS 2004-06)
<200 <100 8 1
IMR(per 1000 live births)
71(SRS 1997)
53(SRS 2008)
<45 <30 13 5
TFR 3.3(SRS 1997)
2.7 (SRS 2007)
2.3 2.1 10 9
Note: 1.Data covers first year of RCH II for MMR, and first half of RCH II for IMR and TFR.2.Union territories (except Delhi) have been excluded in the findings
21% of all under five deaths occur in India
Under-5 Mortality Worldwide
Rest of the world
7 million
Rest <5 deaths
0.6 million
Infant Deaths
1.6 millionIndia
2.2 million
Source: World Health Statistics, 2007
Under-5 deaths in India
Latest data shows that worldwide U-5 deaths have declined to 8.8 million, with India accounting for nearly 1.85 million.
72 7169
66 65
59 5856 55 54
52 5148 48 47 47
4339
37 37 36 35 34 34
2321
13 13 12
0
10
20
30
40
50
60
70
80
Mad
hya
Pra
desh
Oris
sa
Utta
r P
rade
sh
Ass
am
Raj
asth
an
Chh
attis
garh
Bih
ar
Meg
hala
ya
Har
yana
And
hra
Pra
desh
Guj
arat
J &
K
Jhar
khan
d
Utta
rakh
and
Him
acha
l Pra
desh
Kar
nata
ka
Pun
jab
Trip
ura
Aru
nach
al P
rade
sh
Wes
t Ben
gal
Del
hi
Tam
il N
adu
Mah
aras
htra
Sik
kim
Miz
oram
Nag
alan
d
Goa
Ker
ala
Man
ipur
INFANT MORTALITY RATE
13 states have met 10th Plan target
5 states have met RCH II/ NRHM target
RCH II Goal: '10
10th Plan Goal : '07
Source: RGI-SRS 2007
INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD
DEATHSCAUSES INTERVENTIONS
Severe infections (36% deaths) IMNCI / F-IMNCI, Basic new born care, Early initiation of breast feeding
Preterm birth (25% deaths) NSSK
Birth asphyxia (23% deaths) NSSK
Neonatal tetanus (4% deaths) TT (mother)
INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD
DEATHSCAUSES INTERVENTIONS
Acute respiratory infections (19% deaths)
Antibiotics, IMNCI
Diarrhoeal diseases (17% deaths) ORS, Zinc
Measles (4%) Immunization
Undernutrition Community and facility based management
Children’s Nutritional StatusChildren under age 5 years who are underweight (%)
2022 23
25 25 25 26 26
3033 33
36 37 37 38 38 39 40 40 40 41 42 4345
4749
56 5760
20
0
10
20
30
40
50
60
70
SK
MZ
MN
KE PJ
GA
NA
JK DL
TN AP
AR
AS
HP
MH
KA
UT
WB
HR
TR RJ
OR
UP IN GJ
CH
MG
BH JH MP
Source: NFHS-3
CHILD HEALTH: STRATEGIES• Integrated management of neonatal and childhood illnesses (IMNCI) and F
IMNCI– Pre-service and In-service training of providers – Improving health systems (e.g. facility upgradation, availability of logistics, referral
systems)– Community and Family level care
• Home Based Newborn and Child Care/ HBNCC
• Facility Based Newborn Care : SNCUs;Stabilization units;newborn corners
• Infant and Young Child Feeding– including Improving Early and Exclusive Breastfeeding and Complementary Feeding
• Nutritional Rehabilitation Centres
• Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases
• Supplementation with micronutrients: Vitamin A & iron folic acid
• School Health Program
Facility - Integrated Management of Neonatal & Childhood Illnesses (IMNCI)
• An integrated approach for sick infant & under-fives - Includes:– community and family level care
– improving health systems e.g. facility up gradation, availability of logistics, referral systems.
• Community IMNCI– Home visits for all newborns to teach the mother ways to prevent illnesses
through exclusive breastfeeding and essential newborn care.
– At these visits, mothers are also taught to recognize illnesses early and seek timely care.
PLUS• Asphyxia management
• Inpatient management of sick newborns and children
IMNCI (IN-SERVICE) IMPLEMENTATION STATUS
75
140
258
219
160
1400025500
46000
90401
202015
0
50
100
150
200
250
300
Sep-06 Jul-07 Dec-07 Dec-08 Mar-09
0
50000
100000
150000
200000
250000
No. of District
Personnel Trained
Source: NRHM MIS reports
F–IMNCI• To enhance the skills missing at facilities to manage newborn and
childhood illness.• Overcome the acute shortage of paediatricians in the country. No. of posts of paediatricians in rural health facilities:
– Required = 4276– Sanctioned = 1620– In position = 866
• The introduction of F-IMNCI will help bridge this acute shortage of specialists.
• There is also a need to simultaneously increase the number of sanctioned posts.
IMNCI Progress• IMNCI Implementation
– In 258 districts
– Over 2 lakh personnel trained
• Pre-service IMNCI– Introduced in to the curriculum of 79 Medical colleges
– Nearly 4000 students trained
First course of FIMNCI started on 10th November 2009
Navjaat Shishu Suraksha Karyakram
•A new programme on Basic Newborn Care and Resuscitation, launched nationally by GoI to address important interventions of care at birth:
Prevention of Hypothermia
Prevention of Infection
Early initiation of Breast feeding and
Basic Newborn Resuscitation.
•OBJECTIVE: To have one trained person at institutional facility, where deliveries take place.
•To be completed by June 2010
Community
PHC
CHC
District Hospital
Newborn corner
(1 bed)
At DeliverySick newborn
Stabilization units
(4 beds)
Special newborn care unit
(12-20 beds)
NSSK NSSK IMPLEMENTATIONIMPLEMENTATION
Sick Newborn Care Units (SNCUs)
Approximately 174 Special New Born Care Units (SNCU), 1592 Stabilization units and 4793 New Born Care Corner have been established at district hospital, CHC/FRU and 24-hour PHCs respectively.
5145 43 40
20 23
0
10
20
30
40
50
60
Stunted Underweight Wasted
NFHS-2 NFHS-3
Undernutrition in Children under Age 3
Percent
Nutrition• Nutrition is the primary responsibility of MoWCD
• MoHFW responsible for management of severe acute malnutrition, supplementation of micronutrients (Vitamin A & IFA to children, IFA to pregnant and lactating women).
• MoHFW also promotes breastfeeding and complementary feeding.
Nutrition Rehabilitation
Centre12 bedded units at DH, malnutrition managed by high calorie hot cooked locally
available foods and nutrition counselling
524 such units in place across states
7479
4 5
0
10
20
30
40
50
60
70
80
90
Any anaemia Severe anaemia
NFHS-2 NFHS-3
Anaemia among Children Age 6-35 Months
Percent
Vitamin A & IFA supplementation
• Vitamin A supplementation from 9 months to 5 years of age, every six months
• IFA supplementation with Iron Folic Acid, for 100 days in a year to children found clinically anaemic (syrup for children 6 months- 5 years, tablets thereafter)
• IFA supplementation for 100 days to all pregnant and lactating women.
School Health Programme
• School Health Programme (SHP) is currently being implemented in 33 States and UTs.
• Health check-up, treatment of minor ailments, health education, micronutrient supplementation, immunization, services are being offered in close conjunction with the Ministry of HRD
• State plans for SHP increased from Rs. 56.58 crores in 2007-08, to Rs. 65.04 crores in 2008-09, and 112.10 crores in 2009-10.