Child Health
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Transcript Child Health
Child Heath- status and
Initiatives in Gujarat
Dr Siddharth Nirupam
Presentation outline
Current Status of Child Heath
Mortality trends
Causes of Child Death
Child Nutrition
Priority intervention (within continuum of care)
Programme Thrust- Reaching the Unreached
Where are the unreached- mapping and HP areas
Why they are not reached- barrier identification and
action
Trend of Infant Mortality Rate
(IMR) in Gujarat
60
54
53
52
50
@ 3 per year i.e.
6.8 & 7.3 %
48
50
IMR per 1000 Live Births
44
41
40
30
38
@ 1 per
year i.e.
1.9%
@ 2 per
year i.e. 2.8
&4%
35
29
@ 4 per year
i.e. 8.3 %
24
20
10
0
NRHM Chiranj 108 Nirogi BalSakha
Bal
eevi
2005
2006
2007
2008
2009
2010
Source: SRS Infant Mortality Estimates
2011
2012
2013
2015
2017
Causes of under- Five Death
Child Nutrition Status - Gujarat
Source:- NFHS- 3 (2005-06)
Too Thin for Age
44.6
%
55.4
%
Normal %
[Green]
28.3
%
Moderate Under
Weight % [Yellow]
16.3
%
Severe Under
Weight % (Red)
Underweight (%)
Too Thin for Height
18.7
%
12.9
%
Moderate Acute
Malnutrition
(MAM) %
5.8%
Severe Acute
Malnutrition
(SAM) %
Wasting (%)
Priority Interventions for Child Health
Improving new born care – Home and facility
2. Diarrhea and Pneumonia - Prevention &
Management
3. Routine Immunization with equity focus
4. Child Nutrition- IYCF; Malnutrition management
1.
Gujarat’s Child Health Programme within
Continuum of Care
Time Period
VHND – Mamta Abhiyan, e Mamta
JSSK, FRU
3 levels of care- Family care, outreach, Facility
Adolescent
N
U T R I T I O N
Pregnancy
KPSY-1
IMNCI Plus
JSY
M I S S I O N
Delivery
Newborn
NSSK
FBNC
KPSY-2
RSBY
MA
Infant
Follow up of LBW & SCNU
Discharged
KPSY-3
Bal Sakha Ext. BalSak (Trbl Bloks)
Chiranjeevi Yojana
EMRI-108
Khilkhilat
Evaluated Achievements of key Interventions across life stages- Gujarat
Adolescen
ce
Pre-preg
Pregnan
cy
Delivery
Postnatal
Neonatal
Infancy
(%-National Average)
Data source: CES 2009;DLHS 3
Newborn Care Continuum
Home based
NB Care
• By 34,000 ASHA at home
Emergency
Medical
Transport
• Linkages with 108,
• Free drop back for Mother & Baby (JSSK)
• Strengthening of inter-facility Transport
Facility Based
Newborn Care
• Co-ordination with other departments
• Newborn Care Corners NBCC-562 units;
Newborn Stabilization Unit NBSU -153 in
FRUs/CHCs
• Sick Newborn Care Units SNCU : 34 units in DH,
MC, NGO
• Availability of skilled HR- Bal sakhaYojana
Role of Private Sector - (Diarrhoea)
Curative care & Private Sector
CES -2009
ORS Use Rate
56.9
60
50
40
30
36.7
24.4
20
10
0
DLHS-2
DLHS-3
CES-2009
Children Treated with ORS
Undernutrition in Gujarat
coverage of 10 proven interventions for its reduction
100
The Goal 100%
%
1. Initiation of BF < 1 hr ***
75
2. Exclusive BF upt 6 mo
3. Introduction of CF at 6-9 mo
4. Three expected IYCF practices
50
5. Stools safely disposed
6. Vitamin A supplementation (0-35 mo)
7. Adolescent girls (15-19 yr) non-anemic*
25
8. Households with iodized salt (>15 ppm)*
9. Diarrhea: Children fed <= usual (0-2 years)*
10. SAM: Children with acces to care**
0
Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India
***Coverage Evaluation Survey, UNICEF,2009
BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition
Reaching the Unreached for Child
Health
Where are The
unreached?
IInfant Mortality trends- Rural Vs Urban
Death rates higher in rural but
Urban poor death rates > urban average
IMR in ST > State average
48
41
27
Goal 27
Latest SRS reference -2009 by RGI
Immunization Status by Wealth Quintile, Gujarat
Coverage Evaluation Survey, 2009
Disparity in Infant Feeding by District
1. BF: Timely Initiation
3. CF: Timely Introduction
2. Exclusive BF: 0-6 mo
IYCF: Composite Index (1+2+3)
DLHS-3
Gujarat High Priority Districts (8)
HPD and Tribal districts
HPD but not Tribal districts
Reaching the Unreached for Child
Health
Why are they
unreached?
Six Coverage determinants- Tanahashi Model
Effective Coverage -quality
Adequate Coverage -continuity
Utilization -first contact
Geographical Access
Availability of Human Resources
Availability of drugs/supplies
18
Immunization Coverage- where is the gap
Fully
Immunized
(69%)
Effective
coveragequality
Adequate coverageContinuous
(Measlescontinuity
coverage (79%)
Utilisation
– 1rst contact
with services
Initial
Utilization
(BCG coverage
( >95%- DLHRS 11)
Accessibility
– physical
accessdiwas
to services
Functional
Access
to Mamta
(near 100%)
Accessibilityof– to
human resources
Availability
vaccinator
(near 100%)
Availability –ofcritical
inputs
health (near
system
Vaccines
and to
Supplies
100%)
ImmunizationTarget
ProgramPopulation
aim 100% coverage
From Tanahashi T. Bulletin of the World Health Organization, 1978, 56 (2)
http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf
Some Common Bottlenecks in Child
Health Programming in India
Limited availability of Human Resources
Low availability and access to Child Health in some areas
e.g. Urban
Low Demand generation in some areas
Low skill building- e.g. Facility Newborn care
Transport/ communication gaps in difficult areas
Inadequate supervision
Data Quality
Suggested Issues for Child Health
Programming
Unreached Areas
Rural- Drilling down to at least taluka level for local barrier
analysis and local solutions
Urban Poor- Mapping, infrastructure, service delivery, MIS
Child Malnutrition- Experiences from other countries IYCF communication; SAM management; Micronutrients
Gram Sanjivini Samiti - Increasing community participation
Emergency Transport- number and type for difficult areas
Strengthen Supportive supervision for skills and quality
Private sector- Evolving relationship
Thanks