Control of Acute respiratory infection in Nepal 77/78

Control of Acute respiratory infection in Nepal 77/78

1. Control of Acute Respiratory Infection (ARI) Prepared by: Saloni Tamrakar Monika Katuwal Durga Oli

2. Family Welfare Division: Child health and immunization is one of the four sections of Family Welfare Division This section has two programs: National Immunization Program and IMNCI program.

3. National Immunization Program Support the Ministry of Health and Population to prepare national policies, strategies, directories, quality standards, and protocols regarding vaccinations and child health. To prepare vaccine and vaccine supplies supply and distribution plan at national level. Necessary assistance in new vaccinations involving regular vaccinations program. Analyzing the vaccine and child health, and to provide technical assistance to national level policy.  National level work on child health according to national policy and strategy

4. Integrated Management of Neonatal and Childhood Illnesses (IMNCI) Focuses on the health and well-being of the child. aims to reduce preventable mortality, minimize illness and disability, and promote healthy growth and development of children under five years of age. also maintains its aim to address major childhood illnesses like Pneumonia, Diarrhea, Malaria, Measles and Malnutrition among under 5 year’s children

5. Major activities of IMNCI FB IMNCI Training for Medical Officer, nursing staffs and paramedics CBIMNCI training to health service providers Training on Routine Data Quality Assessment (RDQA) Procurement of various equipment, commodities, and medicines for IMNCI programs Development of Preterm Care Guideline Revision of CBIMNCI and FB-IMNCI training package

6. Goals, targets, objectives, strategies, interventions and activities Goal: Improve New-born child survival and ensure healthy growth and development. Targets: Target for reduction of NMR, U-5MR & Stillbirths

7. Objectives To reduce neonatal morbidity and mortality by promoting essential New- borncare services&managing major causes of illness To reduce childhood morbidity and mortality by managing major causes of illness among under 5 years of age children

8. Strategies Quality of care through system strengthening and referral services for specialized care Ensure universal access to health care services for New-born and under 5 years of age children Capacity building of healthservice providers and FCHVs Increase service utilization through demand generation activities Promote decentralized and evidence-based planning and programming

9. Major interventions New-born Specific Interventions Promotion of essential New-born care practices and postnatal care to mothers and New-born Identification and management of non-breathing babies at birth Case management of children aged between 2-59 months for 5 major childhood diseases (Pneumonia, Diarrhoea , Malnutrition, Measles and Malaria) Onsite coaching (guidelines development /revision, coach development, coaching &mentoring) Routine Data Quality Assessment Behavioural change communications for healthy pregnancy, safe delivery and promotion of personal hygiene and sanitation Improved knowledge related to Immunization and Nutrition and care of sick children Improved interpersonal communication skills of HSPs and FCHVs

10. Introduction Acute respiratory infection is a serious infection that prevents normal breathing function. It usually begins as a viral infection in the nose, trachea (windpipe), or lungs. Types Upper acute respiratory infection (UARI) Lower acute respiratory infection (LARI)

11. According to the World Health Organization (WHO), respiratory infections account for 6% of the total global disease burden. Around 6.6 million, under-five aged children years of age die each year worldwide Acute respiratory infection (ARI) is responsible for about 30–50 percent of visits to health facilities and for about 20–30 percent of admissions to hospitals in Nepal for children under 5 years old. Incidence of ARI in children among under-five years of age is 344 per 1000 in Nepal.

12. Viruses that causes ARI respiratory syncytial viruses (RSVs), parainfluenza viruses, influenza virus A and B, and human metapneumovirus ( hMPV )

13. Classification of ARI Severe pneumonia or Very severe disease Pneumonia No pneumonia (cough and cold)

14. Problems of ARI Congestive heart failure Respiratory arrest ,which occur when the lungs stop functioning Respiratory failure ,a rise in CO2 in your blood caused by your lungs not functioning correctly . Pneumonia, meningitis, sepsis, and bronchitis

15. Management of ARI Clinical Assessment Physical Examination Classifying ARI according to sign and symptoms for different ages Treatment accordingly Improved living conditions Better nutrition Better MCH care Immunization Health Promotional activities – Vulnerable areas

16. ARI control programme MoHP recognizes Acute Respiratory Infection (ARI) as one of the major public health problems in Nepal among children under 5 years of age. Acute Respiratory Infection (ARI) Control Program began in Nepal in 1987. 1995/96 CB-ARI Program piloting 1997/98 CB-ARI intervention was combined with CDD and named as CB-AC program Based on the recommendations from the pilot, it was decided to include a community component and FCHV to provide CDD, ARI, Nutrition and services to the community. The Community based ARI and CDD program was merged into IMCI in 1999 and was named the Community Based Integrated Management of Childhood Illness (CB‐IMCI).

17. Activities to control ARI Establishing/Strengthening SNCU/NICU Procurement of various equipment, commodities, and medicines for IMNCI programs (ORS, Zinc, Amoxicillin, Gentamycin, Chlorohexidine gel) at provincial level. Implementation of Free New-born Care Program at federal, provincial, district and local levelhospital . CBIMNCI training to health service providers Revision of CBIMNCI Coaching guideline and Equity and Access Guideline

18. Problems/ constraints Increasing proportion of severe pneumonia cases No separate post of CB‐IMCI Focal Person in district, like EPI Supervisor. IMCI Protocol not used properly at all levels. Lack of designated Human Resource in Hospital for SNCU/NICU/KMCU New Health workers without CBIMCI training No provision of CBIMNCI dedicated officer at province & municipalities Inadequate resources to sustain and provide quality IMCI. Inadequate and poor quality supply of IMCI/NCP equipment and drugs.

19. Thank you