GLOBAL HEALTH INITIATIVES ON CHILD HEALTH Tubi Fiyinfoluwa

1. GLOBAL HEALTH INITIATIVESON CHILD HEALTH Tubi Fiyinfoluwa

2. Outline INTRODUCTION BURDEN OBJECTIVES HEALTH INDICATORS OF CHILD SURVIVAL STRATEGY PROGRAMMES CONCLUSION

3. Introduction The first five years of life are the most crucial to the physical and intellectual development of children and can determine their potentials to thrive for a lifetime. The past few decades have witnessed major improvement in the health of children throughout the world ,through programmes spearheaded by UNICEF and WHO , giving birth to the GLOBAL HEALTH INITIATIVES.

4. Burden The under 5-constitutes 20% of total population of Nigeria(28 million out of 140 million) Nigeria contributes significantly to the under5 mortality rate in the world 1 million of Nigeria U5 die annually before age 5. U5MR = 194/1000 live birth

5. Burden cnt�d IMR = 101/1000 live birth NMR = 47/1000 live birth The majority of causes of the morbidity and mortality are preventable The major causes includes; Malaria, ARI, diarrhoea ,measles ,HIV/AIDS, malnutrition , anaemia For neonates ? low birth weight, asphyxia, sepsis, NNJ, NNT. In order to be most effective , the service must reach all children , with particular attention , to the most vulnerable.

6. Risk factors for U5 mortality Inadequate child spacing Poverty Unhygienic environment Poor mother�s education Lack of potable water supply

7. Objectives Decrease infant and childhood mortality and morbidity through prevention and early identification of diseases Promote physical, emotional, psychological and social growth of children to ensure that they achieve optimal growth and development in order to have a healthy and economically productive population Treat diseases and disorders with particular emphasis on early diagnoses

8. objectives cnt�d Protect children from major hazards through specific measures and improvement in the level of care provided by the mothers and family. The interventions to help achieve the objectives must be: Effective Cheap Low technology Widely applicable

9. Health indicators of child survival strategies Infant mortality rate U5mortality rate Immunization coverage Incidence of low birth weight Total fertility rate.

10. PROGRAMMES GOBIFFF/GOBIFFFETH BFHI-Baby friendly hospital initiative IMCI-integrated mgt of childhood illness WCFHS-Women and children friendly health services IMNCHS-Integrated maternal, newborn and child health strategy ACSD-Accelerated child survival and development programme

11. GOBIFFF/GOBIFFFETH These strategies includes: Growth monitoring Oral rehydration therapy Breastfeeding Immunisation Family planning Female education Food supplementation Environmental health Treatment of common ailment Health education

12. GOBIFFFETH The main objective of 1978 Alma ata declaration was to achieve health for all by 2000 hence in 1983, UNICEF approved the GOBIFFF childhood survival strategies. Further research suggested that additional would further promote child survival. Hence, ETH was added to make it GOBIFFFETH

13. Growth Monitoring It is important that a child be seen at clinic regularly in the 1st 5yrs of life. Detect inadequate growth before the obvious clinical signs - Weight - Height - MUAC ?tape rule, shakir�s strip Health personnel are being trained to chart the various measurements on the growth chart

14. ORT It is the most successful breakthrough in the 90�s A sugar and salt solution in the mgt of diarrhoea Prevent dehydration which is the leading cause of death in diarrhoea dx Home made remedies; 1 level teaspoon of salt and 10 level teaspoons(5 cubes) of sugar Rice water, garri water

15. Breast Feeding To be exclusive for babies in their 1st 6months and prolonged for at least 2yrs It cuts across the pillars of childhood survival Strategy Beneficial to the baby, mother, family and society

16. Immunization It is the most cost-effective health intervention in the world It�s the admin of potent vaccines against child killer disease (TB, diphtheria, pertusis , tetanus, measles, polio, HBV, yellow fever) Are for children btw 0 � 11months and T.T for women 15 � 49yrs

17. Immunization Schedule

18. Family Planning Main objectives are; Prevention of unwanted pregnancy Securing desired pregnancies Spacing of pregnancy Limiting the size of the family Couples should have children by choice and not by chance. This will help in reducing material morbidity and mortality by preventing unwanted and high risk pregnancy.

19. Female Education Mother�s level of education and access to information greatly influences her decision to take advantage of available health programmes for her child�s survival The influence of maternal education is retained even in the presence of poverty and poor environment i.e. education is not equivalent to literacy

20. Food Supplementation Applies to both mothers and infants Involves provision of food supplements to at-risk pregnant women to prevent delivery of LBW babies Supplementing children�s diet with specific micro-nutrients such as Iron, Iodine and Vit A

21. BFHI In Aug 1990, at Flourence, Italy a declaration was made called Innocenti declaration which gave 10 steps to successful breast feeding. Followed by this, WHO and UNICEF launched BFHI in 1991 2 strategies were planned Transforming hosp & Maternity facilities to baby friendly hosp Ending the practice of distributing free & low cost breast milk substitutes By 1992, 52 hosp were declared to be baby friendly , including WGH, Ilesa

22. Breast Feeding Policies Have a written breast feeding policy that is routinely communicated to all health care staff Train all health care staff in skills necessary to implement the policy Inform all pregnant women about the benefit and mgt of breast feeding Help mothers initiate breast feeding within � hour of birth Show mothers how to breast feed and how to maintain lactation even if they should be separated from their infants

23. Policies cnt�d Give newborn infant no food/drink other than breast milk unless medically indicated Practise rooming-in and allow mothers and infants to remain together 24hrs a day Encourage breast feeding on demand Give no artificial teat or pacifiers to breast feeding infant Foster the establishment of breast feeding support groups and refer mothers to them on discharge from the hosp

24. IMCI It is an integrated approach to the mgt of a sick child focussing on the wellbeing of the whole child It was introduced by WHO & UNICEF Meant for community Health workers and not trained doctors Its aim was to reduce morbidity and mortality thereby enhancing the devpt of a child Started in Nigeria in 1997 with 6 LGA and now in expansion phase to about 200 LGA It is still largely donor funded, poor budgetary allocations and little political commitment

25. Components of IMCI Strategies Improving case mgt skills of H/care staff i.e. adapting local guidelines Improving overall health system Improving family and community health practices

26. Guidelines Assessing the child based on the hx Classifying the child - does the child requires referral or appropriate treatment Giving mothers instructions about what to do at home Identifying specific treatment needed by the child

27. Benefits Addresses major health problems e.g. malaria, measles, malnutrition, diarrhoea Lead to accurate diagnosis in outpatient settings Promote prevention of dx as well as cure Ensures appropriate and combined treatment of major illnesses Speeds referral of severely ill children

28. WCFHS It is a Nigerian strategy for child�s survival Launched on 13th oct 2004 by Late Chief Mrs Stella Obasanjo It entails services that are � easily reached, affordable, respect client�s right, ensures satisfaction of clients and providers and have highest possible standards It is said to be broad based as it integrate care for pre-preg women, preg women and children It takes care of MDG 4 & 5 Cuts across the major mortalities � MMR, NMR, IMR, U5MR Saves cost

29. Activities of WCFHS Breast feeding Hospital initiatives Nutrition Family planning Poverty alleviation Immunisation Reproductive health services Girl child education Girl child right against female genital mutilation

30. IMNCHS Made to reduce maternal, new born and child morbidity and mortality Objectives Improves access to good quality health services Ensures adequate provision of drugs, vaccines and other equipments Establish a financing mechanism that ensures adequate of the strategy Strengthening monitoring and evaluating systems to report on progress toward achieving the strategy (MDG) Establish and sustain partnership to support implementation of the strategy

31. Activities of IMNCHS Focused antenatal care for early detection and treatment of problems that may arise during pregnancy Infants and young children feeding which involves deworming of children >1yr twice a year and giving iron, zinc and vit A supplements Immunization for children and women of reproductive age group

32. ACSD Started in 2002 Its objective was to demonstrate within a very short period how the integrated implementation of low cost, high impact and evidenced based intervention could have a dramatic effect on child survival in 11 W/African and central African countries It is for neonate, U5 and school age children Goal is to ensure survival and healthy growth of Nigerian child

33. Targets To reduce NNMR, IMR by � of the 1990 rate by the year 2015 To reduce U5MR by 2/3rd of the 1990 rate by the year 2015 To reduce incidence of malaria, vaccine preventable dxs, ARI and diarrhoea dxs in U5.

34. Problems/Limitations of Various Initiatives/programmes Political instability Inadequate budgetary allocations Lack of up to date and reliable data Low status of women Low level of interventions coverage Poor skill and motivations among health workers

35. Way Forward Continued advocacy Continued surveillance Capacity building among health workers Women empowerment Improved data collection and management

36. Conclusion The challenges that we face regarding the health of Nigerian child cannot be overemphasized. We have all it takes ; the resources and knowledge, to address our nation�s most critical child survival problems. What is needed is urgent actions and greater national responsibilities placed on children�s issues. The call is � Children are leaders of tomorrow, hence lets come together to raise a healthy child�.

37. references Short Textbook of public health Medicine for the tropics by Lucas O. Tokunbo ,& Gilles M Herbert.4TH ed. Lecture note(part 4) http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1796626&tool=pmcentrez for contraception http://en.wikipedia.org/wiki/Birth_control for Birth control

38. Thank You