National health National health programmesprogrammes

Dr. M.L. Siddaraju

National health National health programmesprogrammes

Perinatal period:Extends from the 28th week of

gestation (or more than 1000 grams) to the 7th day of life.

Neonatal period:Early: Birth to first 7 days.Late : 7 days to 28 days.

Perinatal mortality Perinatal mortality Rate(PMR)Rate(PMR)

Late fetal deaths(28 wks of gestation or more)

+ Early neonatal deaths in one year Total no of births in one year

Perinatal mortalityPerinatal mortality

Causes:a. Antenatal: 1. Maternal anemia, PIH, DM,

Malnutrition.2. Pelvic/Uterine anomalies.3. Antepartum haemorrhage, Blood

incompatibilities.

Perinatal mortalityPerinatal mortality

b. Intranatal: 1. Birth asphyxia. 2. Birth injuries. 3. Obstetric complications. c. Postnatal: 1. Prematurity.,LBW 2. RDS. 3. Infections.

Infant mortality rateInfant mortality rate

Most important direct indicator of health status of community and indirect indicator of socio – economic status of the country.

No. of deaths of children<1 yr of age in a yr*1000

Total No. of live births in same year.

Infant mortality rateInfant mortality rate

Causes: A. Neonatal (0-4 wks) 1. Low birth weight(IUGR)/Prematurity. 2. Birth injuries/Birth asphyxia. 3. Congenital anomalies. 4. Infections. 5. Hemorrhagic disease. 6. Placental/cord conditions.

Infant mortality rateInfant mortality rate

B. Postnatal (1-12 months). 1. ARI. 2.Diarrhoea. 3. Other communicable

infections(VPD’s) 4. Malnutrition. 5. Congenital anomalies. 6. Accidents.

Infant mortality rateInfant mortality rate

Developed countries : 6-8 /1000 live births(2000).

India: 60/1000 live births(2000).Karnataka: 58 /1000 live births.Lowest in Kerala: 16 /1000 live

births.Highest in orissa : 16 /1000 live

births.

National health National health programmesprogrammes

Nutritional Programmes.

Infection control programmes.

Immunization programmes.

Nutritional programmesNutritional programmes

1. Vitamin A prophylaxis programme. Average prevalence of deficiency 6.0%

among <6 years of age. “Immunization” against xerophthalmia. 2 lakh I.U. – Oral oil preparation 6

monthly – (1-6 years) 1 lakh I.U. - <1 year of age.

Nutritional programmesNutritional programmes

Iodine deficiency disorders(IDD) Programme(1962).

167 million are exposed to risk of IDD - not only the Himalayan belt!!! Various degree of intellectual impairment - not only goitre!!! Nation wide implementation: Iodized salt. Monitoring – surveillance – training done.

Nutritional programmesNutritional programmes National Nutritional Anemia Prophylaxis

Programme: At risk population: Pregnants, lactating mothers & children

upto 12 years. Mothers : 60 mg elemental iron(with 0.5 mg of

folate) Children : 20 mg elemental iron(with 0.1 mg of

folate).

Nutritional programmesNutritional programmes

Mid day meal programme:

Ministry of education.

Retain children in school + nutritional supplement.

Mid day meal programmeMid day meal programme

Principles: 1. Meal a supplement – not a substitute. 2. 1/3rd of total calorie requirement. ½ of total protein requirement. 3. Ease of preparation. 4. Locally available. Ingredients. 5. Low cost. 6. Menu should be changed frequently.

Infection control programmesInfection control programmes

National malaria eradication programme.

NMCP – 1953.NMEP – 1958.1970 – Resurgence.Modified plan of operations – 1977

National malaria National malaria eradicationeradication

Malaria action programme(MAP)1994 high Stratification medium risk areas Low

Malaria action Malaria action programme(MAP)programme(MAP)

Management of serious/complicated malaria.

Prevention of mortality.Control of outbreaks/epidemics.Reduction of P. Falciparum &

containment of drug resistant malaria.

National tuberculosis control National tuberculosis control programme(NTP)programme(NTP)

Operational since 1962.DTP – Backbone.DTC – Nucleus.RNTCP – 1992.- Achievement of 85% cure rate.- Detect at least 70% cases.- Involve NGO’s.

National tuberculosis control National tuberculosis control programme(NTP)programme(NTP)

RNTCP:

Short course chemotherapy –free.

Intensive phase – DOTS.

Diarrhoeal diseases control Diarrhoeal diseases control programmeprogramme

ORS Packets to VHG. DTU – in medical college hospitals. - in district hospitals. Integrated into CSSM. Educate mothers - Home available fluids. - Continue feeding during diarrhoea. - Recognize early signs of dehydration. Promote exclusive breastfeeding. Proper weaning Immunization & vitamin A prophylaxis.

Acute respiratory disease(ARI) Acute respiratory disease(ARI) control programmecontrol programme

Integrated in CSSM Standard case management of

pneumonia <5 years. Train PHC staff. Promote timely referral. Improve maternal knowledge - cough/cold/danger signsEBF – Weaning – Immunization.

National AIDS control programmeNational AIDS control programme

1992National AIDS control

organization(NACO)Surveillance centers.Identification of high risk group &

screening.Guidelines for management &

follow up.

National AIDS control National AIDS control organization(NACO)organization(NACO)

Formulating guidelines for blood banks, donors, dialysis units.

IEC activities.Research.Reduction of personal & social

impact of the disease.Control of STD.

Immunization ProgrammesImmunization Programmes

Extended programme on immunization(EPI)

-January 1978.-6 VPDs.Now, UIP- Universal immunization

programme. – November 1985.

National immunization scheduleNational immunization schedule

A) For infants:At birth: BCG & OPV-06 wks – BCG( if not given) DPT-1,OPV-110 wks - DPT-2,OPV-214 wks - DPT-3,OPV-39 mo – Measles.

National immunization scheduleNational immunization schedule

16-24 mo – DPT,OPV 5-6 years – DT 10 years, 16 years – TT Pregnant women – TT – 2 doses at 1 mo

interval. Pulse polio Immunization:

1995 <5 yrs of age Replace wild strain of virus.

ICDSICDS Integrated child developmental services. –

1975 1. Supplementary nutrition. 2. Immunization. 3. Health checkup. 4. Referral. 5. Nutritional & Health education for women. 6. Non formal education upto 6 years.Community developmental blocksAnganwadi worker – Focal point.

CSSMCSSM Child survival and safe motherhood.-

1992 ‘Package’ of services. For children – 1. Essential newborn care 2. Immunization 3. Appropriate management of

Diarrhoea. 4. Appropriate management of ARI. 5. Vit A prophylaxis.

CSSMCSSM

For mothers 1. Immunization. 2. Prevention and treatment of anemia. 3. ANC 4. Delivery by TBA. 5. Promotion of institutional deliveries. 6. Obstetric emergencies- Management. 7. Birth spacing.

CSSMCSSM

Essential newborn care:Resuscitation.Prevention of hypothermia.Prevention of infections.EBF.Referral of sick newborn.

Reproductive & child health(RCH)Reproductive & child health(RCH)

1997

Family welfare RCHCSSM

RCHRCH

Conceptual frame work:

Client centered approach

Family welfare/Plan

CSSM RTIs &STDs

RCHRCH

Primary goal:Encourage small families by

helping families meet their own health & family planning needs.

Priority services:Full range of MCH.

RCHRCH

Performance measure: Quality of care Client satisfaction.

Management approach: Decentralized. Driven by client needs. Gender sensitive.

RCHRCH

Attitude to client: Listen. Assess needs. Inform, advise.

Accountability: To the client, community, health &

family welfare staff.

CSSM v/s RCHCSSM v/s RCH

CSSM RCH

Aug 1992 1997

All MCH under one umbrella

-Client driven-Decentralized-Target free.-Aimed at client satisfaction

CSSM v/s RCHCSSM v/s RCH

CSSM RCH

Package Package

Child survival component:Essential newborn care,Vit AImmunization,Diarrhoea/ARI.Safe motherhood:Immunization,Anemia,ANC,Institutional delivery,Spacing

CSSM + Family planning + RTIs & STDs

CSSM v/s RCHCSSM v/s RCH

CSSM RCH

Target population Target population

Pregnants & children upto 5 years

Children, adolescents, eligible couples, expecting mothers.Both men & women.