Final ppt ofNEW BORN AND CHILD CARE

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NEW BORN AND CHILD HEALTHCARE Presented By: Dr. Kalpit Sharma Dr. Amit Chhabra Dr. Aditi Mittal Anamika Prasad Apoorvya Kapoor Akanksha Sharma

Transcript of Final ppt ofNEW BORN AND CHILD CARE

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NEW BORN AND CHILD HEALTHCARE

Presented By:Dr. Kalpit SharmaDr. Amit ChhabraDr. Aditi MittalAnamika PrasadApoorvya KapoorAkanksha Sharma

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Overview Definition Areas of concern National Health Programmes• RCH• IMNCI• UIP• NSSK State Health Programmes Analysis of Health organizations at different levels Suggestions/Recommendations

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What do we mean by newborn and child health care

The professional and academic field that focuses on the determinants , mechanisms and systems that promote and maintain the health , safety , well-being and appropriate development of children in community and society in order to enhance the future health and welfare of subsequent generations.

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TERMS:

• Neonatal Period-Birth --> 28 days of life

• IMR- the number of infant deaths per 1000 live births

• Neonatal mortality rate-the number of neonatal deaths per 1000 live births.

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UP26.1%

MP13.0%

Bi11.8%

Rj7.2%

AP6.4%

Mh5.6%

Or4.7%

Guj4.5%

WB4.5%

Kn4.1%

TN3.8%

As2.9%

Hr1.8%

Pb1.3%

Kr0.5%

HP0.4%

Rest1.5%

Neonatal Mortality burden in major states

Estimation based on data from National Human Development Report 2001 & SRS 2000

UP:Uttar Pradesh;MP:Madhya Pradesh;Bi:Bihar;Rj:Rajasthan;Mh:Maharashtra;Or:Orissa;WB: West Bengal; Kn:Karnataka,TN:Tamil Nadu;As: Assam;Hr:Haryana;Pb:Punjab;Ke:Kerala;HP:Himachal Pradesh

State-wise burden of neonatal deaths

UP

Mh

APRj Bi

MPOr

Gj

WB

Kn

TNAs Hr Pb

Estimation based on data from National Human Development Report 20017 & SRS 2001

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About half of child deaths occur in the neonatal period (ICMR Study 2003)

When do neonates die die?

Day U5 Child deaths

1st day 20%

By 3rd day 25%

By 7th day 37%

By 28th day

50%3.1

10

12.6

2.8

2.8

5.5

6.2

10.2

7.3

39.3

74.1

0 10 20 30 40 50 60 70 80

Week 4

Week 3

Week 2

D7

D6

D5

D4

D3

D2

D1

Week 1

Percent (%)

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National goals & MDG context

1990 Current NRHM 2012

MDG2015

Infant Mortality Rate

80 55(2007)

<30 <27

Neonatal Mort rate

53 37(2005)

<20 <20

U5M Rate 107 74(2005) - <36

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Developments related to child health

• 1978 : EPI• 1984 : UIP• 1985 : Oral rehydration therapy 1• 1990 : UIP and ORT universalized , ARI as a

pilot in 26 districts• 1992 : CSSM• 1997 : RCH 1 • 2005 : NRHM and RCH 2

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NRHM

•Launched in April 2005.•To reduce maternal and infant mortality and •To provide universal access to public health services.

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Reproductive Child Health (RCH) Programme

•To improve the health status of women and children, especially the poor and under served, Government of India during 1997-98 launched the RCH Programme for implementation during the 9th plan period.•The second phase of RCH program i.e. RCH – II has been commenced from 1st April, 2005 the five year file 2010. The main objective of the program is to bring about a change in mainly three critical health indicators i.e. reducing total fertility rate, infant mortality rate and maternal mortality rate

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COMPONENTS OF RCH-II:

1. Population Stabilization2. Material Health3. Newborn Care4. Child Health5. Adolescent Health6. RTI/STI treatment and control7. Urban Health. 8. Tribal Health 9. Other Priority Areas: a. Targeted of services b. Strengthening service delivery c. Infrastructure and maintenance d. Supply of drugs and equipment e. Strengthening of health care providers.

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RCH II

• HBNC• NRC• Facility based care – SNCUs• Micronutrient Supplementation – Vitamin A

and Iron folic acid• IMNCI

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HBNC-Home based newborn and childhood care

• Care of Sick • New born at Home• Based on Gadchiroli Model.• Pilot in UP, Bihar, Orissa, Rajasthan and MP

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Iron and folic acid supplementationObjectives• Screening of children for anaemia wherever required and

appropriate treatment of those found anaemic• Reducing prevalence of anaemia by 25% and moderate and

severe anemia by 50% in children

StrategyInfants: Exclusive breast feeding for six months, and

introduction of green leafy vegetables in the seventh month

Preschool children : advocacy with regard to dietary diversification

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Vitamin A supplementation strategy

Objectives• Decrease prevalence of Vitamin A deficiency

form the current 0.7% to 0.3%Strategy• Infancy: to encourage colostrums feeding• 1,00,000 IU dose of Vitamin A is being given at

nine months• Childhood:• Vitamin A dose of 2,00,000I.U at 18,24,30 and

36 months of age

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Integrated Management of Neonatal and Childhood illness (IMNCI)

• The Indian version of IMCI funded by WHO-UNICEF.

• Component of newborn and child health strategy in RCH Phase II.

• IMNCI for children Management of Acute Respiratory Illnesses Management of Diarrhoea and Dehydration Management of malnutrition and growth

monitoring of under fives

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IMNCI country adaptation and implementation so far

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Training for IMNCI

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IMNCI status

India Rajasthan

Number of districts where IMNCI is implemented

156 33

Total number of people trained on IMNCI (30,nov,2009)

124636 16672

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Immunization

• Delivering effective and safe vaccines

• Aim is to reduce mortality and morbidity due to VDPs.

• India has one of the lowest routine immunization (RI) rates in the world.

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only 43.5% of children age 12-23

months

were fully vaccinated

5% had received

no vaccinations at all

Annual birth

cohort of 24

million surviving

infants

under 5 year

mortality rate of

74/1000

over 12.5 million under-immunized children each

year

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EPI •was launched in India in 1978 to control other VPDs. •diphtheria, pertussis, tetanus, poliomyelitis, typhoid and childhood tuberculosis

UPI• It gained momentum in 1985 • Measles vaccine was included in

the programme and typhoid vaccine was discontinued

CSSM• UIP was merged in child survival

and safe motherhood program (CSSM) in 1992-93

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• The Cold-chain system was strengthened • Training programmes were launched

extensively throughout the country. • Intensified polio eradication activities were

started in 1995-96

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• Since 1997 immunization activities are an important component of Reproductive and Child Health (RCH) program.

• From April 2005, immunization is an important component of RCH II under the National Rural Health Mission (NRHM).

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IMMUNIZATION PROGRAM IN RAJASTHAN• Deptt. Of Medical & Health services is organizing MCHN days

on Monday and Thursday.• On this day, the ANM, Aanganwadi workers, trained Midwife

are taking parts.• Microplans of all districts are prepared after training of

workers/ officers jointly to organize the MCHN days.• Alternate vaccine delivery system is implemented so that

vaccines reaches each Aanganwadi/sub centre as per microplan.

• To monitor MCHN days effectively - a core group is framed at Distt. Level, Panchyat samiti level, PHC level etc. - special monitoring drive is being organized with the help of Deptt.of Women and child Welfare

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RECOMMENDED IMMUNIZATION SCHEDULE FOLLOWED IN INDIA

SINo Age Disease Vaccination Remarks

1 AT BIRTH HEPATITIS B HEP B VACCINE -I

2 AT BIRTH POLIO ORAL PV 0 DOSE

3 BIRTH TO 6 WK TUBERCULOSIS BCG

4 4 -6 WEEKS HEPATITIS B HEP B VACCINE -II

5 6 WEEKS

DIPHTHERIAPERTUSISTETANUS

POLIO

DPT-IOPV -I

6 10 WK

DIPHTHERIAPERTUSISTETANUS

POLIOHEPATITIS B

DPT-IIOPV-II

HEP B VACCINE III*

*DELHI GOVT RECOMMENDA

TION

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7 14 WEEKS

DIPHTHERIAPERTUSISTETANUS

POLIO

DPT-IIIOPV- III

HEP B VACCINE IV*

*DELHI GOVT RECOMMENDATION

8 24 WEEKS HEPATITIS B HEP B VACCINE III* *IAP RECOMMENDATION

9 9 -12MTHS POLIOMEASLES

OPV-IVMEASLES

10 15-18 MTHSMUMPS

MEASELESRUBELLA

MMR*

11 18 MTHS

DIPHTHERIAPERTUSISTETANUS

POLIO

DPT –BOOSTER IOPV –V

*RECOMMENDED BY DELHI GOVT &

IAP ONLY

12 24 MTHS TYPHOID TYPHOID* *IAP RECOMMENDATION

13 4-5 YR

DIPHTHERIAPERTUSISTETANUS

POLIO

DPT BOOSTER – IIOPV -VI

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Navjat shishu suraksha karyakram (NSSK)

Launched on 15th september,2009Focuses on:• Prevention of hypothermia• Prevention of infection• Early initiation of breast feeding• Basic newborn resuscitation

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Objectives of NSSK

• One trained person at institutional facility, where deliveries take place

• NSSK will train healthcare providers at the district hospitals, CHCs and PHCs

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RAJASTHAN GOVT.

Concerned Deptt: “Deptt. Of Women & Child Development”

Draft XIth Five-Year Plan document prepared by the Govt. of Rajasthan Basic theme and focus: women and children.

The main thrust ofthe XI plan• To ensure survival, protection and development of Children• IMR• MMR • Malnutrition among children in the 0-3 years age group• Sex ratio• Countering Anemia (among women in the 15-49 years age group)• Minimizing drop out rate in elementary education.

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• Reduction in IMR to at least 32/1000 by2012 end

• At least 90 % of children to receive complete Immunization

• Quality essential new born care Appr. care & treatment of infants and children suffering from common

illness

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STATE CHILD POLICY 2008Child policy so as to enable systematic implementation and effective monitoring of programmes

and policies aimed at children up to the age of 18 years.

• Ensuring food and nutrition security at all levels specially keeping in mind the specific needs of children and adolescent girls.

• Providing quality education for all children of all categories up to secondary level.• Securing for all children legal and social protection from all kinds of abuse, exploitation

and neglect with a special focus on girls.

• Provide essential healthcare to all children from birth to adulthood, as a right, to reduce mortality and morbidity due to preventable causes.

• Strengthen maternal healthcare with special focus on child delivery and feeding practices.

• Take care of children affected by HIV and AIDS.• Ensuring facilities of sanitation and safe drinking water.• Ensure effective teamwork of public and private partners and ensure child

participation in matters relating to and decisions affecting their lives.

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CHILD HEALTH: APPROACH

• Strengthening the convergence between the Deptt. ofMedical & Health and Deptt. Of Women & Child Development.

• “Monitoring and Evaluation Cell” in the DOHFW for MCH services(in association with DOWCD)

• Management Information System (MIS) about children• Combining the role of “Sahyogini”(additional worker at

Anganwari ) with ASHA • “Yashoda”:Facility based new-born aides• Training of people in IMNCI (16,672) (30,nov,2009)

• Well baby clinics at Distt. Hospitals (eg.Dausa DH Thurs3-5Pm)

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• ORS Therapy promotion• Acute Respiratory Infections (ARI) awareness.• Promoting institutional deliveries for minimizing

MaternalMortality (MMR) • A system for Maternal Mortality auditing being

developed.• Strengthen and re-energize school health

programme• Community based monitoring.

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ICDS(INTEGRATED CHILD DEVELOPMENT SCHEME)

•Aanganwadi Centers Exclusive breast-feeding promotion upto 6months. Promoting Infant and Young Child Feeding(IYCF) practices by encouraging colostrums feeding Complementary feeding promotion of infants aged 6-9 month. Provision of Nutritional supplements for < 6 years of age children

•Micro-Nutrient deficiency (Vitamin A, iron, folic acid, iodine, zinc) supplementation and fortification.•Strengthening the “Kishore Shakti Yojana” for adolescent girls.•State level Nutrition Mission under DWCD to coordinating with NRHM-ICDS.•Nutrition management and surveillance system.•Monthly Maternal Child Health and Nutrition Day (MCHN) organized.•Partnership with community and “PRIs”.•Malnutrition Treatment Centres (MTCs) in district hospitals/ at all levels.

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CHILDREN WITH SPECIAL NEEDS• Strengthening services and care of such children (in all concerned deptts inclu. Medical & Health and Education)

• Special schools at district level with residential facilities.• Close monitoring of interventions (under the Sarva Shiksha Abhiyan).• Training of social workers, health workers and families for early

detection of disability.• Provide for counseling of children and their families.• Including requirements of such children in all existing schemes for

children and frame appropriate schemes for their growth and development.

• Dissemination of information programs and schemes related to such children

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CHILDREN AFFECTED/INFECTED BY HIV/AIDS

• state-wide assessment of children infected and affected

• Strengthening Prevention of Parent to Child Transmission (PPTCT) services at the district level.

• Anti Retroviral Treatment (ART) and OI(Opportunistic Infection)treatment services at district hospitals

• Capacity Building in Health Care workers.

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District Hospital

Norms for newborn and child care: Specialist care:• Paediatrician• Neonatologist• Paediatric surgeon Treatment of acute childhood infections Fully equipped laboratory and diagnostic services Fully equipped blood bank Pharmacy

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Paediatric wards Neonatal ICU Nursery Emergency care of newborn and children Immunization sessions Postnatal care Fully equipped operation theatre Incubator/ Warmer Phototherapy Unit Functional ambulance

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Ground reality:

Specialist are present but not in adequate number Infrastructure is adequate Manpower is inadequate No post for neonatologist and paediatric surgeon Laboratories were fully equipped and there were full dignostic

facilities including X-ray , USG , etc No. of beds in paediatric ward were inadequate as per the

patient inflow( 8 beds) Well baby clinic: On every thursday• Free consultation by the paediatrician• Free gifts and toys given to children

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No Neonatal ICU No incubator/warmer No phototherapy unit No nursery No instruments for emergency care of the newborn Operation theatre is also not fully equipped No facilities for neonatal and child surgeries Provisions for BPL patients were adequate Senior paediatrician post was vacant since 13th May 2010

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Community Health Center

Norms for newborn and child care : Specialist care-• Paediatrician Emergency care of sick children Post natal clinics Immunization sessions National health programs

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Essential laboratories and diagnostic services Referral services Internal monitoring External monitoring Standard operating procedures Standard treatment protocols RMRS

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Ground reality: Specialist are present Manpower is adequate X-ray and hematology lab services are available No nursery Incubator/warmer is not operational due to lack of expertise Suction machine is not working Hepatitis B vaccination is not been given No aseptic conditions Due to lack of anaesthetist OT is not operational No provision for admissions of newborn and children No pediatric sphygmomanometer is available No phototherapy unit is available

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Primary Health Center

Norms for newborn and child care: Treatment of children with• Anaemia• Diarrhoea• Dehydration Postnatal care Newborn care Immunization programmes Management of low birth weight babies Fixed immunization day

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BCG and Measles vaccine should be given regularly Nutrition services School health programmes Collection and reporting of vital statistics Education about health National child health programmes Promotion of safe water supply and basic sanitation Referral services Internal monitoring External monitoring

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Ground reality: Medical officer was present There is fixed immunization day and immunization schedule is

followed as per government guidelines Physicians visit the schools once in a year Suction machine was not working No equipments in the operation theatre No AYUSH facility No technical expertise and facilities for the management of

low birth weight babies No facilities for HIV testing No facility for proper disposal of hospital waste No ambulance services

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Sub Center

Norms for newborn and child care: Postnatal care:• Sterlization• Immunization Adolescents health School health education programmes Immunization services should be as per government schedule ORS for prevention of diarrhoea and dehydration

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Treatment of minor illness like:• Fever• Cough• Cold• Worm Facility for taking peripheral blood smear Field visit and home care National child health programmes Proper maintenance of records and register Transport facility

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Ground reality: Medicines and vaccines were available and used appropriately MPWs and ANM visit the school twice a month and swasthya

parikshan program once a year Doctor visits the sub centre twice a month Immunization services as per government guidelines ORS is given for the prevention of diarrhoea and dehydration Treatment of minor illness is given Field visit and home care is conducted Health education to adolescents is given by health worker

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SUGGESTIONS/RECOMMENDATIONS At Government level:• It should focus on the operational modalities in their action

plans.• It should fund for addressing inter-state and intradistrict disparities in terms of health infrastructure and indicators.• It should increase contribution to Public Health Budget,

increased devolution to Panchayati Raj Institutions and performance benchmarks for release of funds.

• It should fund interventions like ASHA,Programme Management Unit (PMU), and upgradation of SC/PHC/CHC .

• It should provide adequate manpower in terms of doctors, paramedics and other administrative staff.

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• It should provide adequate and the required equipments to the District hospital , CHC,PHC and sub centre.

• It should provide adequate salaries and perks to the doctors and can even provide some extra money if the doctor is working more than the required time frame.

• It should develop Health MIS upto CHC level.• It should prepare annual district reports on people’s health.• State and national reports on people’s health to be tabled in

assemblies , parliament.• There should be specific protocols on the reporting of sub

centres , PHC, CHC, and Disrict hospital. • There should be specific protocol to monitor citizens charter.

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• It should conduct mid course reviews and take appropriate corrective actions

• It should mainstream AYUSH in public health system.• It should change its approach from centralization to

decentralization at the district level.• It should define time bound goals and report publicly on their

progress.• Promotion of public private partnerships.• Regulation of private sector to ensure availability of quality

services to citizens at reasonable cost.• Specific protocols should be made to ensure quality.• It should appoint MBAs for the improved programme

management.

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At Panchayati Raj Institutions level:• A program should be created which can guide and manage all

public health institutions in the districts , sub centres , CHCs and PHCs.

• Regular auditing should be done at the CHC , PHC level• A village health plan should be prepared.• All health related database should be provided to the

panchayats.• Funds should be provided at the sub centre and PHC level.• Specific protocols for the training of health workers should be

developed.• Health awareness programmes should be organized regularly.

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At NGO level:• External evaluation and social audit should be conducted.• Provision of funds.• Provision of training and technical support to ASHA and

various other organizations.• It should conduct school health programmes and various

other health awareness programmes.• It should help CHC and PHC in conducting programmes which

can educate people about basic hygine.• It should educate people about institutional deliveries.

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At Institutional level:• The medical officer incharge/ Medical Suprintendent should

set some protocols for the internal monitoring which incudes: Social audit Medical audit Technical audit Economic audit Disaster preparedness audit• The incharge should set protocols for Standard Operating

Procedures.• The incharge should monitor citizens charter• The incharge should set specific protocols for procuring

equipments.

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SOME DOs and DONTs

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Thank you