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Child Health Programme 4 Chapter Child health Programme 4.1 INTRODUCTION 4.1.2 Causes of Child Mortality in India India is committed to reduce child deaths by two- The major causes of child mortality in India thirds between 1990 and 2015 as pledged in the (as per WHO, 2012) are - Neonatal causes Millennium Development Goals (MDG). This (53%), Pneumonia (15%), Diarrhoeal diseases implies a reduction of Under Five Mortality Rate (12%), Measles (3%) and others. Besides these, (U-5MR) from 125/1000 live births in 1990 to malnutrition is a contributory factor in 33% child 42/1000 live births by 2015. This commitment is deaths. also reflected under the National Health Mission Causes of Child Deaths in India (WHO, 2012) (NHM). 14 3 4.1.1 Situation of Child Mortality in India 12 At present, as per SRS 2013, the Under Five 53 Mortality Rate in India is 49/1000 live births, 15 Infant Mortality Rate (IMR) is 40/1000 live births and Neo-natal Mortality Rate is 28/1000 live births. This translates into an estimated 12.7 lakh Neonatal causes Pneumonia Diarrhoea Measles Others under-5 child deaths annually. The U-5MR has declined at a faster pace in the period 2008-2013, 4.1.3 Interventions under Child Health registering a compound annual decline of 6.6% Based on the identified causes of mortality, five per year, compared to 3.3% compound annual major strategic areas have been identified to decline observed over 1990-2007. However, the improve child health outcomes. These are : efforts need to be intensified to attain the MDG of 3. Interventions to 42/1000 live births by 2015. Four States together 1. Newborn 2. Nutrition related address pneumonia Health Interventions interventions contribute to 58% of all child deaths in the country, and diarrhoea namely- Uttar Pradesh (3.5 lakhs), Bihar (1.5 4. Interventions to lakhs), Madhya Pradesh (1.3 lakhs) and Rajasthan address birth 5. Immunization defects, disabilities, activities (1.0 lakh). About 45% of under-five deaths take delays and deficiencies place within the first 7 days of birth, about 57% of within first one month of birth and approximately Besides the above, maternal health and family 81% within one year of the birth. planning interventions are also linked inextricably 37 Annual Report 2015-16 to child health outcomes. Therefore, the 4.2.2 Strategic interventions under newborn RMNCH+A approach strategises continuum of health are as under: care across life stages as the over-arching umbrella ● Promotion of Institutional Deliveries and under which these child health interventions have Essential Newborn Care: Since antenatal been built in. and intra-partum events have a bearing on 4.2 NEWBORN HEALTH newborn health, institutional deliveries are being promoted with cash incentives in ● The Newborn Mortality Rate in India is the form of Janani Suraksha Yojana (JSY). 28/1000 live births (SRS 2013) which Newborn Care Corners (NBCCs) have been translates into approximately 7.3 lakhs operationalized at delivery points to provide deaths, annually. essential newborn care at the time of birth. ● Newborn deaths contribute to 57% of the In order to reduce out of pocket expenses, Under-5 deaths in the country. Janani Shishu Swasthya Karyakram (JSSK) entitlements have been provided to ensure ● After a period of stagnation (from 2003 to cashless treatment of pregnant woman and 2007), the decline in neo-natal mortality her child till one year of age in public health gained pace with a 17% decline been facilities. This also includes free referral recorded in the last 5 years from (2008 to transport. 2012). More importantly, 6% fall occurred Home Based Newborn Care (HBNC) in the each of the last two consecutive years ● has (highest so far). been initiated by ASHAs for promotion of essential newborn care including ● The major causes of newborn deaths in India breastfeeding practices, early identification are: Infections (31%), Prematurity (35%), and referral of neo-natal illnesses. Where Asphyxia (20%), Congenital (9%) and ASHAs are paid an incentive for visiting Diarrhoea (2%). each newborn and post-partum mother in the first six weeks of life as per the schedule. Major causes of Newborn Deaths in India More than 58 lakh newborn have been visited by ASHAs in 2014-15, whereas in first quarter (April-June, 2015) of 2015-16, around 18 lakh newborn visited by ASHAs. ● Facility Based Newborn Care (FBNC) is being scaled up for care of small or sick newborns. 602 Special Newborn Care Units (SNCUs) have been setup in district hospitals and medical colleges to provide round the clock services for sick newborns. More 4.2.1 India Newborn Action Plan (INAP) was than 7.5 lakh newborn babies were treated launched in 2014 to make concerted efforts towards at SNCUs in 2014-15. 2,228 Newborn attainment of the goals of “Single Digit Neo-natal Stabilization Units (NBSUs) at the level of Mortality Rate” and “Single Digit Stillbirth Rate”, FRUs and 16,968 Newborn Care Corners by 2030. (NBCCs) at delivery points have been 38 Annual Report 2015-16 operationalized in the continuum of care. years and 2.9% are severely anaemic. SNCU Online Reporting System (ORS) has 4.3.1 The strategic nutrition related been established in 16 States and more than interventions are as under: 400 facilities are reporting online. ● Promotion of Infant and Young Child ● Newer interventions to reduce newborn Feeding practices (IYCF): Exclusive mortality have also been implemented, breastfeeding for first six months, including Vitamin K injection at birth, complementary feeding beginning at six Antenatal corticosteroids in preterm months and appropriate Infant and Young labour, Kangaroo Mother Care (KMC) and Child Feeding practices (IYCF) are being empowering ANMs to provide injection promoted in convergence with the Ministry Gentamycin to young infants for possible of Woman and Child Development. serious bacterial infection. ● Establishment of Nutritional Rehabilitation 4.3 NUTRITION RELATED INTER- Centres (NRCs): 891 NRCs have been VENTIONS set up at facility level to provide medical ● Malnutrition is considered to be the and nutritional care to Severe Acute underlying cause of 33% of child deaths. Malnourished (SAM) children under 5 years of age who have medical complications. In ● 29.4% of under-5 children are underweight, addition, the mothers are also imparted skills 38.7% are stunted and 15.1% are acutely on child care and feeding practices so that malnourished (wasted). More importantly, the child continues to receive adequate care 4.6% of children are suffering from severe at home. acute malnutrition, as per the last available national survey. ● National Iron Plus Initiative (NIPI) - Child health components: To address ● Most recent survey in 100 worst districts anaemia, NIPI has been launched, which (according to child development index) includes provision of supervised bi-weekly showed 20.3% decrease in prevalence of Iron Folic Acid (IFA) supplementation by underweight during the seven year period ASHA for children aged 6 to 59 months and (2004-2011) with an annual rate of reduction Weekly Iron Folic Acid Supplementation of 2.9%. The prevalence of severe acute (WIFS) for children 5 to 10 years (known as malnutrition has also reduced to 3.4% in WIFS-junior). Thirteen States have initiated these 100 worst districts. bi-weekly IFA supplementation for children ● Only 44.6% newborns initiated on breastfeed 6 to 59 months and ten States have initiated within one hour of birth while, 64.9% WIFS junior for children 5 to 10 years. children breastfeed exclusively till 6 months ● National Deworming Day (NDD): of age. National Deworming Day, February, 2015: A fixed day strategy was implemented in ● Complimentary feeding started for only 277 districts out of 303 districts across 50.5% children on time (more than 6 months 11 States/UTs, excluding the Lymphatic of age). Filariasis endemic districts. Against a target ● 69.5% of children in age group 6 months-5 of 10.31 crore children between ages of 39 Annual Report 2015-16 1–19 years (with some of States not covering reportedly suffered from an episode of Acute the total range of age groups), a total of Respiratory Illness (ARI) in preceding two 8.98 crore children received deworming weeks and only 76.9% sought treatment for tablet (Albendazole) during the National this. Deworming Day. National coverage ● Integrated Action Plan for Pneumonia and achievement for deworming intervention Diarrhoea (IAPPD) has been formulated was 85 percent. The percent coverage ranged for four states with highest child mortality from a maximum of 95 percent in Dadra (Uttar Pradesh, Madhya Pradesh, Bihar Nagar Haveli & Maharashtra to lowest in and Rajasthan) to address the two biggest Assam (58 %). Except the States of Assam killers of children, namely - Pneumonia and & Tripura, rest all States/UTs reported a Diarrhoea. coverage of more than 80 percent. NDD was implemented across 4.70 lakh schools and 4.4.1 The strategic interventions targeting 3.67 lakh Anganwadi centers. pneumonia and diarrhoea are as below: It is decided to conduct National Deworming Day ● Promotion of Integrated Management in February, 2016 and guidelines for NDD are of Neo-natal and Childhood Illnesses being updated. (IMNCI) for early diagnosis and case management of common ailments of children STH prevalence survey has already been initiated with special emphasis on pneumonia, by NCDC in collaboration with other technical diarrhoea and malnutrition is being promoted agencies. for care of children at community as well as facility level. ● Bi-annual Vitamin-A Supplementation is being provided to all children aged 9 to ● Promotion of early detection and prompt 59 months of age. Bi-annual Vitamin-A referral of children with common ailments supplementation rounds are conducted in 15 like pneumonia and diarrhoea by ASHA: States. ASHAs are being trained in Modules 6 & 7 to aid in identifying common childhood ● Village Health and Nutrition Days illnesses like diarrhoea, pneumonia and (VHNDs) are also being organized for provide first level of care and refer baby to imparting nutritional counselling to mothers an appropriate health facility.
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