National health programmes

Dr. M.L. Siddaraju

National health programmes

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 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 mortality
Causes: a. Antenatal: 1. Maternal anemia, PIH, DM, Malnutrition. 2. Pelvic/Uterine anomalies. 3. Antepartum haemorrhage, Blood incompatibilities.

Perinatal mortality

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

Infant mortality rate

Most important direct indicator of health status of community and indirect indicator of socio economic status of the country.
Total No. of live births in same year.

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

Infant 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 rate

B. Postnatal (1-12 months). 1. ARI. 2.Diarrhoea. 3. Other communicable infections(VPDs) 4. Malnutrition. 5. Congenital anomalies. 6. Accidents.

Infant 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 programmes

Nutritional Programmes.
Infection control programmes. Immunization programmes.

Nutritional 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 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 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 programmes

Mid day meal programme:

Ministry of education.

Retain children in school + nutritional supplement.

Mid day meal programme

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

Infection control programmes

National malaria eradication programme. NMCP 1953. NMEP 1958. 1970 Resurgence. Modified plan of operations 1977

National malaria eradication

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

Malaria action 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 programme(NTP)

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

National tuberculosis control programme(NTP)

RNTCP:

Short course chemotherapy free. Intensive phase DOTS.

Diarrhoeal diseases control programme

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) control programme

Integrated in CSSM Standard case management of pneumonia <5 years. Train PHC staff. Promote timely referral. Improve maternal knowledge - cough/cold/danger signs EBF Weaning Immunization.

National AIDS control programme

1992 National AIDS control organization(NACO) Surveillance centers. Identification of high risk group & screening. Guidelines for management & follow up.

National AIDS control 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 Programmes

Extended programme on immunization(EPI) -January 1978. -6 VPDs. Now, UIP- Universal immunization programme. November 1985.

National immunization schedule

A) For infants: At birth: BCG & OPV-0 6 wks BCG( if not given) DPT-1,OPV-1 10 wks - DPT-2,OPV-2 14 wks - DPT-3,OPV-3 9 mo Measles.

National 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.

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 blocks Anganwadi worker Focal point.

ICDS

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.

CSSM

CSSM

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.

CSSM

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

Reproductive & child health(RCH)

1997

Family welfare RCH CSSM

RCH

Conceptual frame work:

Family welfare/Plan

CSSM

Client centered approach

RTIs &STDs

RCH

Primary goal: Encourage small families by helping families meet their own health & family planning needs.

Priority services: Full range of MCH.

RCH
Performance measure: Quality of care Client satisfaction.

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

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

Accountability: To the client, community, health & family welfare staff.

CSSM v/s RCH

CSSM
Aug 1992 All MCH under one umbrella 1997 -Client driven -Decentralized -Target free. -Aimed at client satisfaction

RCH

CSSM v/s RCH

CSSM
Package

RCH
Package

Child survival component: CSSM + Family Essential newborn care,Vit A planning + RTIs & Immunization,Diarrhoea/ARI. STDs Safe motherhood: Immunization,Anemia,ANC, Institutional delivery,Spacing

CSSM v/s RCH

CSSM
Target population Pregnants & children upto 5 years

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