National health programmes

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National health programmes

• Dr. M.L. Siddaraju

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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.

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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

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Perinatal mortality

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

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Perinatal mortality

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

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Infant 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 childrenlt1 yr of age in a
  yr1000
• Total No. of live births in same year.

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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.

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Infant mortality rate

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

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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.

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National health programmes

• Nutritional Programmes.
• Infection control programmes.
• Immunization programmes.

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Nutritional programmes

• 1. Vitamin A prophylaxis programme.
• Average prevalence of deficiency 6.0 among lt6
  years of age.
• Immunization against xerophthalmia.
• 2 lakh I.U. Oral oil preparation 6 monthly
  (1-6 years)
• 1 lakh I.U. - lt1 year of age.

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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.

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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).

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Nutritional programmes

• Mid day meal programme
• Ministry of education.
• Retain children in school
• nutritional supplement.

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Mid 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.

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Infection control programmes

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

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National malaria eradication

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

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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.

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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.

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National tuberculosis control programme(NTP)

• RNTCP
• Short course chemotherapy free.
• Intensive phase DOTS.

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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.

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Acute respiratory disease(ARI) control programme

• Integrated in CSSM
• Standard case management of pneumonia lt5 years.
• Train PHC staff.
• Promote timely referral.
• Improve maternal knowledge
• - cough/cold/danger signs
• EBF Weaning Immunization.

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National AIDS control programme

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

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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.

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Immunization Programmes

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

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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.

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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
• lt5 yrs of age
• Replace wild strain of virus.

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ICDS

• 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.

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CSSM

• 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.

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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.

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CSSM

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

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Reproductive child health(RCH)

• 1997
• Family welfare
• RCH
• CSSM

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RCH

• Conceptual frame work

Family welfare/Plan
Client centered approach
CSSM
RTIs STDs
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RCH

• Primary goal
• Encourage small families by helping families meet
  their own health family planning needs.
• Priority services
• Full range of MCH.

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RCH

• Performance measure
• Quality of care
• Client satisfaction.
• Management approach
• Decentralized.
• Driven by client needs.
• Gender sensitive.

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RCH

• Attitude to client
• Listen.
• Assess needs.
• Inform, advise.
• Accountability
• To the client, community, health family welfare
  staff.

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CSSM v/s RCH
CSSM RCH
Aug 1992 1997
All MCH under one umbrella -Client driven -Decentralized -Target free. -Aimed at client satisfaction
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CSSM v/s RCH
CSSM RCH
Package Package
Child survival component Essential newborn care,Vit A Immunization,Diarrhoea/ARI. Safe motherhood Immunization,Anemia,ANC, Institutional delivery,Spacing CSSM Family planning RTIs STDs
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CSSM v/s RCH
CSSM RCH
Target population Target population
Pregnants children upto 5 years Children, adolescents, eligible couples, expecting mothers. Both men women.
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Thank you