National programs related to child health

National programs related to child health and welfare in India
Introduction

1. NATIONAL PROGRAMMES RELATED TO CHILD HEALTH PRESENTED BY-MISS.JYOTSNA KAMBLE nursing tutor Vijaysinh mohite patil , college of nursing , akluj

2. INTRODUCTION During the pre-independence era the situation of public health was precarious. After independence the Government of India reorganized health care delivery system to provide three tier health services through a network of National health programs. These programs were launched to combat health programs like communicable diseases, environmental sanitation , population explosion and poor nutrition.

3. National programs related to child health and welfare in India 1. Reproductive and child health. 2. New born and child health. 3.Integrated management and neonatal and childhood illness (IMNCI) 4.Diarrheal diseases . 5.ORS program 6.Acute respiratory infections 7. Breastfeeding 8.Baby friendly hospital initiative 9 . Universal Immunization Program 10.Adolscent health

4. Reproductive and child health

5. Reproductive and child health programs REPRODUCTIVE AND CHILD HEALTH PROGRAMME The process of integration of related programs initiated with the implementation of the CSSM program was taken a step further in 1994 when the International conference on population and development in Cairo recommended that the participant countries should implement unified programs for reproductive and child health (RCH). The RCH approves means a holistic and integrated approach of contraception issues, maternal health issues.

6. Definition : == It is defined as "people have the ability to reproduce and regulate their fertility, women are able to go through pregnancies and child delivery safety, the outcome of pregnancies is successful in terms of survival and well being and couples are able to have sexual relationships free of fear of pregnancies and of competing diseases . " The Reproduction and child health programs incorporates the components covered under the child survival and safe motherhood programme and includes additional component relating to STD and reproductive tract infections ( RTI).

7. - Main Highlights of RCH • The program integrates all interventions of fertility regulation, maternal and child health with reproductive health of both men women. • The services to be provided will be client centered, demand driven, and high quality and based on the needs of the community arrived at through decentralized participatory planning and the target free approach. • The Program envisages up gradation of the level of facilities for providing various interventions and quality of care. The First Referral Units (FRUs) being set-up at sub-district level will provide comprehensive emergency obstetric and newborn care. Similarly RCH facilities in PHCs will be substantially up graded.

8. • The Program will improve access of the community to various services, which are commonly required. It is proposed to provide facilities for MTP at the PHCs, counseling and IUD insertion at sub-centers in a phased manner. • The Program aims at improving the outreach of services particularly for the vulnerable groups of population - Special Programs will be taken up for urban slums, tribal population and adolescents. - Non-Governmental Organizations will be involved in a much longer way to improve out reach and make it people's program. = Involvement of skilled practitioners in indigenous system of medicine. Interventions in all Districts • Child survival interventions (as available under CSSM programme ) • Safe motherhood interventions (as under CSSM programme

9. New born and child health EFFECTIVE NEWBORN CARE INTERVENTION: 1.Antenatal Care Pregnancy -TT immunization ,iron and folic acid, counselling, identification of major risk of obstructed labor . 2. Intrapartum and immediate new born care : -Clean and safe delivery , prevention of hypothermia ,immediate and exclusive breastfeeding ,eye care, antibiotics for premature rupture of membranes ,neonatal resuscitation.

10. 3.Early neonatal period- ---Exclusive breastfeeding , maintainence of temperature, optimal cord care and hygiene, immunization ,recognition of danger signs and prompt care seeking ,care of LBW baby, management of sickness.

11. Important determinants of child mortality 1.DEMOGRAPHIC --Rural ,urban slum ,high birth order, spacing. 2.BIOLOGICAL --Congenital, infection, malnutrition. 3.SOCIO-ECONOMIC --Female gender , lower caste ,poverty 4.ENVIRONMENTAL --Poor housing , poor water supply. 5.CULTURAL --Discarding colostrum ,early and late weaning, faulty habits and misconceptions about food. 6.HEALTH SERVICES --Poor antenatal history, home delivery, poor vaccination coverage.

12. Newborn health Home visits by providers anganwadi workers or link volunteers with the help of workers would be ensured for neonates on days 1,2,7,14 and 28 in RCH II. At these contacts, the Anganwadi would provide home based care to both the baby and mother. Newborn health action in states like UP or Rajasthan with predominantly home deliveries may be in the community settings, while the major thrust of newborn health strategies ,in states like Tamil Nadu, where institutional delivery rates have raised up, will be further strengthening facilities for newborn care.

13. The above stratified approach based on different newborn health status and health care system scenarios may be applied in different states in consultation with experts and program managers in RCH II.

14. INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI)

15. INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI) IMNCI is the Indian adaptation of the WHO-UNICEF generic IMCI (Integrated Management of Childhood Illness) and having different features as specified . Process of IMNCI- - When a child fall sick and report to the health facilities or observed by the health worker he/she has to follow set pattern of line of action .

16. STRATEGY: --The mission in RCH II is to translate knowledge into action and use it in the child survival revolution in the country . The following principles will govern the planning and implementation of newborn and child health strategies. Evidenced based interventions Approach integrated with RCH programs Implementation and monitoring. Rational mix of community and facility based interventions. Participation of the private sector

17. IMNCI-PLUS -- The package of Integrated Management of Neonatal and Childhood Illnesses also consists of immunization, care at birth and BCC. IMNCI adapted and under early implementation in India takes the generic 1MCI approach much further - by including 0-6 days of age group, by having a health worker module, and by incorporating the home-based approach for newborn care But there is a need to add the inpatient care component for facilities to ensure effective care of sick neonates and children who require hospitalization.

18. This will be done by adapting WHO and local guidelines and tools. Even in this comprehensive form, IMNCI package would still not cover the vital care of the neonates at birth in home and facility settings . Further, the IMNCI approach includes counseling for immunization, but the implementation of immunization in India is largely a periodic outreach activity and that cannot be adequately captured by the IMNCI contacts alone. Therefore, a/comprehensive immunization plan will be an additional pillar of the newborn and child health strategy. Health system inputs and community level activities are germane to the effectiveness of not only IMNCI, but also that of care at birth, as well as successful immunization strategies.

19. objectives The objectives of IMNCI plus strategy in RCH are; Implement by 2010 , a comprehensive newborn and child health package at the level of all subcentres , PHC and refferal units and child health package at the household level in 250 districts. Health strategy in RCH II. It has three complementary elements. 1.Care at birth 2. IMNCI 3.Immunization

20. This approach empowers with the skills of the health worker when he/she see a sick child. The worker should follow the steps as suggested in the chart provided by IMNCI. Home based newborn care based on the Gadchiroli model ,where appreciable decline in infant mortality rates has been documented on basis of work.

21. National anti-diarrheal diseases(ADD) control programme The program was launched in1981 to reduce the mortality in children below 5 years of age due to Acute diarrheal diseases through introduction of Oral rehydration treatment (ORT). Diarrhoea is a major cause of death of many infants and also among children under the age of five years. It is estimated that more than 6 lakhs children die because of diarrhoea every year in India.

22. Diarrheal diseases In India acute diarrheal disease is one of the major consequences of not only water pollution but also of proper management of sewage in both cities and rural areas The median diarrheal incidence rate ranges from 1.0 to 4.7episodes per child per year. In slum areas of major cities an incidence as high as 10.5 episodes per child per year was also reported. About 3 million deaths globally associated with diarrhea.

23. India alone account for one third of these deaths . Around 65% of deaths are due to dehydration, 20-35% due to persistent diarrhea and remaining 15% due to dysentery . Beside this, there is problem of reemergence of new strains of Cholera, Escherichia and Shigella that need to be tackled properly otherwise nation may face the severe epidemics.

24. Causes of diarrhea: Most of the time the causative agents are bacteria and viruses which are self limiting and do not required antibiotics . Major pathogens involved in diarrheas are given below: Pathogen Organism Virus Rotavirus Bacterial Escherichia coli Shigella Campylobacter jejuni Vibrio cholerae Salmonella Protozoans Cryptosporidium No pathogen found

25. Risk factors Poverty Illiteracy of mother Baby exposed to early weaning Use of bottle feed Polluted water Low level of sanitization Hardly a small fraction of cases are reported while the vast majority remains unrecorded

26. Plan of action Promotion of ORT to deal with cases of dehydration Orientation of all health personnel at the district and primary health centre level. At PHC level:- --arrange for the training of PHC staff, procure ORS and distribute it. --extension of the villages through training of mothers. --interpersonal communication and inter sectoral coordination with the field workers in the block and ICDS centres.

27. Health education regarding feeding practices during and after diarrhoea. Educating mothers regarding necessary skills to diagnose a case of diarrhoea Household management Involvement of private practioners and voluntary organizations Monitoring and evaluation

28. Role of Nurse in ADDP • Orientation of health personnel about the importance of program • Organize training program for all the field functionaries • Develop training module and distribute to all the field staff • Ensure the supply of oral rehydration therapy • Detection of cases • Asses the level of dehydration • Find out the source of infection • Encourage ORS to mild cases

29. • Refer the moderate and severe cases • Notification to the health authority • Chlorination of water sources • Health education • Report submission • Searching of cases Follow-up.

30. ACUTE RESPIRATORY INFECTIONS (ARI) Acute Respiratory Infection (ARI) is one of the most common causes of deaths in under 5 years of age group contributing around 13% of inpatient deaths in pediatric wards. ARI, mainly lower respiratory tract infections ("pneumonia") are a major cause of death in children, accounting for about 30% of under-five deaths. NFHS If data shows that 19% children under the age of 3 years experienced cough with fast breathing became a (indicating lower respiratory tract infection) during He two weeks preceding the survey. NFHS -3 showed that 64.2% of children who had ARI/Fever were taken to health facility. Timely treatment based on well, researched algorithms can save most.children with Axis The pilot project was initiated as a pilot project in I99d and since 1992, the ARI control program part of the CSSM (now RCH) program. Treatment of acute respiratory infection is very simple and can be instituted at home itself or at subcenter level.

31. Risk factors for Acute Lower Respiratory tract infections I n under fives ( Broor 2001) are lack of breast feeding, upper respiratory infection (URI) in mother or siblings, cooking fuel other than LPG, inappropriate immunization for age and history of lower respiratory tract infection in the family. Acute Respiratory Tract Infection (A RI) is an acute infection of any part of the respiratory tract and related structures including paranasal sinuses, middle ear and the pleural cavity, it includes all infections of less than 30 days duration except those of the middle ear where the duration of an acute episode is less than 14 days.

32. Acute Respiratory tract Infection is often classified into Acute Upper respiratory tract infection (AURI) including common cold, pharyngitis and otitis media or Acute Lower (ALRI) Respiratory Tract Infection including epiglottitis, laryngitis, bronchitis, bronchiolitis and pneumonia. It is diagnosed on the basis of sign and symptoms. The simplified way of diagnosis and appropriate management, which can be given in field conditions Challenges in managing sick neonates and children There is no single intervention that would prevent all neonatal and infant morbidity. While preventive and promotive approaches is continued with added vigor and intensity, the management of sick neonates and children at household, community and facility levels have received more emphasis in RCH II.

33. Advice the mother to give correct dosage. Adequate feeding including breast feeding in younger children. Mother should be educated to recognize the danger signs when she brings the child for treatment. Mother should be advised to keep young infants warm and away from draught. Exclusive breast feeding up to six months of age. DPT and measles vaccination age. at the appropriate Hand washing before feeding and touchin the baby. g • For no pneumonia, do not require antibiotic can be treated at home. • For pneumonia and severe pneumonei referral should be done.

34. BREASTFEEDINGPOLICY Ten Steps to Successful Breastfeeding Every facility providing maternity services and care for newborn infants should : 1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff. 2. Train all healthcare staff in skills necessary to implement this policy . 3. Inform all pregnant women about the benefits and management of breastfeeding . 4. Help mothers initiate breastfeeding within half-hour of birth . 5. Show mothers how to do breastfeeding, and how to maintain lactation even if they should be separate from their infants.

35. 6. Give newborn infants no food or drink other than breast milk, unless medically indicated . 7. Practice rooming-in—allow mothers and infants to remain together for 24 hours a day . 8. Encourage breastfeeding on demand . 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants . 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

36. Disadvantages of Artificial Feeding • Contamination: Artificial needs are often contaminated with bacteria, especially if the mother uses a feeding bottle which she does not clean and boil properly. • Animal milk does not contain living white cells and antibodies to protect the baby against infections. Artificially fed babies fall ill more often with diarrhea and respiratory infections. • Animal milk may not contain enough vitamins for a baby. The iron from animal milk is not absorbed as completely as the iron from human milk. An artificially fed baby may develop anemia . Animal milk contains too much salt, which may result in fits. Animal milk also contains excessive calcium and phosphates, which may cause tetany , i.e. twitching. Animal milk contains more saturated fatty acids and does not contain enough for the essential fatty acids, which are vital for proper growth and development. Animal milk contains too much casein, which is difficult for a baby's immature kidneys to excrete. Animal milk is more difficult to digest, as it does not contain the enzyme lipase, which helps digest the fat. Babies fed on animal milk may develop allergies. Animal milk is expensive and the family might not be able to afford it. Any supplement started before the baby is r months of age increases the risk of infection even death.

37. Animal milk contains more saturated fatty acids and does not contain enough for the essential fatty acids, which are vital for proper growth and development . Animal milk contains too much casein, which is difficult for a baby's immature kidneys to excrete . Animal milk is more difficult to digest, as it does not contain the enzyme lipase, which helps digest the fat. Babies fed on animal milk may develop allergies. Animal milk is expensive and the family might not be able to afford it . Any supplement started before the baby is of 6 months of age increases the risk of infection even death.

38. IMMUNIZATION PROGRAM

39. UNIVERSAL IMMUNIZATION PROGRAMME The UIP was started in a phased manner on November 19th, 1985, the birth anniversary of Indira Gandhi . This program was inaugurated and is being implemented in the entire country. This program has put a heavy responsibility on health workers of rendering quality immunization services to all pregnant women and infants, in a manner, that produces significant reduction in vaccine preventable diseases and ultimately have an impact on child survival in the country. This tremendous task can be achieved by meticulous planning, implementation and close, effective supervision. Under this program, it is expected that all infants are protected against tuberculosis, diphtheria, whooping cough, tetanus, poliomyelitis, and measles for pregnant Women against 2 doses of tetanus. Vaccination is available in all government primary health centers and government hospitals.

40. • Full immunity is not acquired only by one dose . • It is essential that all pregnant women and all children meticulously get all the prescribed doses of vaccination, so that they will be fully protected against VPD.

41. Responsibilities of Health Professionals • Do not refuse immunization even if only one child is brought . • For each child and for each vaccination, separate freshly sterilized needle and syringe should be used . • It is important that 100 percent coverage is essential, and drop out cases are detected and vaccinated. • Ensure that every child receives all doses of vaccination. • Health card should be maintained for every family and filling up the entry at the time of vaccination and can easily remind the family and the Health worker . • Register all pregnant women and infants and update the list during regular visits to the villages .

42. • All such families should be informed of the place, date, and time of immunization session . The pregnant women and the children should also be reminded of the subsequent doses of vaccine . During the field visit, the influential people in the village, and other functionaries like Panchayat Leaders, Teacher Dais, Village Health Guides, ICDS workers, should be con- tacted and their help should be sought to mobilize the beneficiaries to reach the place of immunization session on day, the scheduled Complications followed immunizatio4if should be notified to the medical

43. • A fixed day of the week has been pres,4, for vaccination (Wednesday has beef selected) so that people do not forget. NI • It is necessary to carry the vaccine vaccine carrier or day carrier in which"filtib • frozen ice packs have been already kept. 1Y Vials of DPT, DT and TT should not be kept in direct contact with the ice packs a PI get frozen and become useless, s they • Keep the vaccine vials in a poly insideba which has no labels on it.fag inside the vaccine carrier. Never accept • Diluents for BCG and measles vaccine an dropper of polio vaccine should also bci , carried in the vaccine carrier. • Life expired vaccines should never be accepted and used. • Do not collect extra vials, if it is not used it would lose potency and become useless . • All opened vials should be destroyed after the session is over. • Measles vaccine once reconstituted should be used with in 4 hours. • During pulso polio immunization campaign Vaccine Vial Monitor (VVM) of OPV should be used to test the potency of vaccines. change of color to be noted

44. Precautions to be Taken During Immunization Session • On the basis of the beneficiaries prepare the vaccine indent (11 percent of the population) • Sterilize sufficient needles and syringes in pressure cooker sterilizer (Double Rack • The venue should be easily identifiable and • One syringe/needle should be used for one approachable. child/pregnant, woman.

45. For full protection, to follow the immunization schedule. partially used vial should be discarded after the session and in no case should be used on the next day or in future. I• n every village or .ward, the place, day and time of immunization should be displayed. • It is important that the parents know the benefits of immunization. The UIP is being systematically expanded to cover all the districts by 1990 to achieve universal coverage with in the year and maintain the same in the subsequent year. It aims to cover 100 percent mothers and 80 percent of infants. Thus over a five years period, more than 90 million pregnant women and 83 million infants are to be immunized. The program has been taken up as one of the Five Technology Mission to give a sense of urgency and commitment to achieve the policy goals within the stipulated period.

46. Role of Nurse in Universal Immunization Programme • Draw a list of under five children • Calculate 10 percent of the population • Place indent for adequate vaccines including wastage • Prepare ice packs • Draw a plan of action • Plan strategies for implementation • Conduct vaccination program • Maintenance of cold chain • Supervision and monitoring • Evaluation of achievement • Mop-up work for drop-outs • Report submission • Follow-up

47. Adolscent health Adolscent refers more broadly to the phase of human development encompassing the transition from childhood to adulthood. In terms of age it is a period of life that is extended from 10-19 years this includes pubertal development also This period is crucial since these are the formative years in the life of an individual when major physical, psychological and behavioural changes takes place.

48. Health problems 1. irregular menstrual cycles: --irregular bleeding is sometimes seen after menarche. Health workers should reassure the girl and explain the parents and the girl to take nutritious diet. 2.under nourished : --undernourished adolscents may suffer from impaired growth , anemia ,iodine deficiency etc 3.Risk behaviour: --a large number of school adolscents in urban areas get exposed to sexual intercourse and many times they do not use safety measures.similarly many adolscents keep experimenting with drugs.

49. 3.sexually transmitted diseases: --high prevalence of sexual intercourse in adolscents in associated with high risk of sexually trransmitted disease and HIV/AIDS because many do not use condom.majority of adolscents (70% of male and 80% of female) had heard of STD’s (2006) 4.teenage pregnancy --teenage pregnancy are high number and associated with illegal abortion and infection leading to death

50. 5.anemia in adolscents : -- anemia is a major nutritional deficiency disorder in india and other developing countries .large population of anemia ranges from 38-72% depending upon age and sex.

51. Program goal To achieve optimum health and development of the adolescent segment of the population in a phased manner. OBJECTIVE: To introduce a comprehensive adolescent health initiative in selected districts in collaboration with partner departments and other stake holders The adolescent health initiative consists of two components --adolescent friendly health services --adolescent health counselling services

52. Adolescent health clinics will provide following services Clinical services General examination Nutrition advice Detection and treatment of anaemia Easy and confidential access to medical termination of pregnancy Antenatal care and advice regarding child birth HIV detection and counselling Treatment of psychosomatic problems.

53. School health program