Transcript Phila Mntwana: Child Health Priorities in KZN

Phila Mntwana: Child Health
Priorities in KZN
Dr Victoria Mubaiwa
KZN – DOH
Isibalo 12/13 September 2013
INTRODUCTION:
What do we know already:

50% of under five year old die in the community with little or no contact with the
health system.

Many of the deaths are attributable to preventable and treatable conditions that
can be managed thru IMCI

Breastfeeding can reduce diarrhoea by up to 27% between the ages of 0-5 months
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Hand-washing alone is associated with 35% reduction in diarrhoea

Joint statement by the WHO and UNCEF: community-level treatment of
pneumonia can be carried out by well-trained and supervised community health
workers

Strengthen the linkages between the health systems and the community
POPULATION DISTRIBUTION
0-4 years
 5-19 years
 20-24 years, and
 30-34 years

10%
 36%
 9%
 6.7%

 KZN has a young population
 KZN second most populous province with population
of 10 Million
 5.3 million people were living in poverty and
 54% of the population living in rural areas
Children of KZN

Births
◦ 220,100
◦ 20.3% of all births in RSA

◦
◦
◦
◦
No
Children in RSA
Population of KZN
Live in eThekwini
◦ U15
U5
U15
1,198,180
22.1%
11.8%
27.4%
3,276,121
22.1%
32.3%
26.4%
25.2% of pop of eThekwini
44.3% of pop of Uthukela
Living conditions

Household size
Formal housing
Electricity
Access to piped H2O 85.9%
Income pc

Child headed Hhold




0.9%
4.0 people/Hhold
71.6%
77.9%
R 20 762.00
Child mortality - KZN vs RSA
Province
IMR
U5MR
% in
Hosp
%
SAM
% HIV
CFR
GE
ARI
SAM
Eastern Cape
24.4
36.3
46.1
24.3
40.6
10.0
8.1
20.5
Free State
72.4
92.4
47.9
56.7
50.7
13.0
9.7
24.9
Gauteng
50.1
63.2
48.5
32.3
51.2
7.2
6.0
19.5
KwaZulu-Natal
37.2
49.7
62.0
33.8
54.9
7.0
4.8
13.1
Limpopo
32.9
48.9
45.8
38.1
57.1
9.5
10.4
22.9
Mpumalanga
36.5
62.2
50.6
29.8
44.4
12.3
10.1
17.6
Northern Cape
48.1
63.7
49.1
35.5
41
6.3
4.5
21.9
North West
48.4
63.1
39.7
60.6
49
8.2
7.5
18.7
Western Cape
23.4
28.2
49.3
22.6
28.4
0.5
0.3
4.8
South Africa
38.1
50.7
50.0
33.7
47.8
7.3
6.5
18.3
Progress in reducing NNMR & U5MR
Lancet 2005; 365, 1891 - 900
In KZN ...
1 in 20 children die before their 5th birthday
 Of these…
◦ 38% die outside the health service
◦ 55% die in association with HIV
◦ 33% have underlying severe malnutrition

Age distribution of under 5 deaths
10
Global Practices & Lessons Learnt

With training and supportive supervision,

CCGs - deliver package of less complex maternal & child
health and nutrition interventions

E.g. Vitamin A supplementation, antibiotics for communitybased management of pneumonia, ORS/ORT/SSS for the
management of diarrhoea, plus administration of deworming.
Global Practices & Lessons Learnt

Even with presumably weak health systems, Malawi,
Mozambique, Madagascar, Ethiopia and Eritrea reduced child
mortality significantly between 1990 and 2006.

Attributed to effective community-based delivery of health
and nutrition interventions through CCG programmes, home
visits, child health days & community mobilisation
Aim

To Reduce morbidity and mortality from
preventable conditions: HIV, Pneumonia,
diarrhoea and malnutrition
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Objectives





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To provide comprehensive prevention and health promotion
package for children at community level.
To provide the community leadership and warroom members with
a simple diagnosis of the status of the children in the community,
so that corrective measures may be taken when necessary.
To monitor the Nutritional and Health Status of all Children under
5 years at community level on a monthly basis.
To ensure early identification of children with malnutrition,
diarrhoea, TB and other health conditions as early as possible and
to refer for health care.
To identify children who require referral for government
To improve access to preventative health services: Growth
Monitoring; Oral rehydration, Breastfeeding and Immunization.
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
Phila Mntwana Centre
A simple structure
where basic health
promotion and
therapeutic services can
be accessed by
communities where
formal curative services
are not immediately
available or accessible.
Location




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The location of the “PHILA MNTWANA CENTRE” will be
dependent on the decision by the local leadership as part of the
OSS operations in the ward. The location will include but not
limited to the following structures:
War rooms
Early Childhood Development Centers (ECDs)
Elderly Luncheon Clubs
Any other point in the ward depending on the catchment
population under 5 years and the accessibility based on
geographical size of the ward
N.B. Each “PHILA MNTWANA CENTRE” should be linked
to a local PHC facility or mobile team
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Child Mortality: Growth Monitoring:



Mid
Upper Arm
Circumference (MUAC) Tape–
early detection of underweight
children or weighing where
applicable
Effective recognition of sick /
malnourished children in the
community (OSS).
SASSA/ DOH/ DSD
Cooperation on Malnutrition –
referral of children with
malnutrition for social relief
intervention
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Child Mortality: Oral Rehydration
• To
prevent dehydration from diarrhoea,
sugar/salt water solution is best for
rehydration
• CCG have been trained to educate all
mothers and care givers
CCGs also have ORS
for rehydration prior
to referral
Breastfeeding

New Infant and Young Child
Feeding (IYCF) in the Context
of HIV Policy launched October
2010 – Full implementation 1
July 2011
•
BREAST IS STILL BEST
•
Support for appropriate infant and
child feeding and nutritional
counselling
•
One-home-one garden
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wellness




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
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Immunization
EPI Screening and /or referral and other Health Services for children
under 5 years.
Wellness
Vitamin A supplementation to children 12 – 59 months administered 6
monthly.
HIV counseling and referral.
TB screening and/or referral.
DSD (social worker) referral for further assessments and intervention
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Operation Sukuma Sakhe
‘Mbo’
Home
affairs
Department
of Education
Various
stakeholders
SASSA and
DSD
Economic
development
Human
settlement
Agriculture:
one home,
one garden
Community
leadership
TOOLS AND MATERIALS
TOOLS AND MATERIALS
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latex gloves
Mid Upper Arm
Circumstance
(MUAC) tapes
ORS
Hand soap
Vit A
Data tools
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Monitoring and data
management
Set of data elements already
in the DHIS
Neonatal death
Maternal death
Children receiving neonatal care
Patients receiving palliative care
Children monitored for Growth
Condoms Distributed
Referrals for Family Planning
Referrals for Antenatal Care
Referrals for Postnatal Care
Referrals to health facility
Child beneficiaries seen
Adult beneficiaries seen
Vitamin A
data tool
Future Plans


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Scale up – full coverage of warrooms
Rapid scale of Ward-based Family Health Teams
Continuing development of CCGs
Opportunities for additional interventional services:
Up and down referral system (being piloted)
Continuing Quality Improvement
NGIYABONGA