Child Health

Essential New-born Care:

   Providing essential care at birth to all new-borns including provision of warmth, prevention of infection, early initiation of breastfeeding and resuscitation of new born if required. In order to achieve this, the following schemes and programmes are being carried out as per GOI guidelines: -

   To promote safe delivery in the hands of skilled birth attendant, State is aiming at achieving 100% institutional delivery. The following schemes and programmes are implemented as per the GOI guidelines: -

 Janani Shishu Suraksha Karyakram (JSSK):

   The following are the Free Entitlements for Sick new-borns till 30 days after birth. This has now been expanded to cover sick infants:

·         Free treatment

·         Free drugs and consumables

·         Free diagnostics

·         Free provision of blood

·         Exemption from user charges

·         Free Transport from Home to Health Institutions

·         Free Transport between facilities in case of referral

·         Free drop Back from Institutions to home

These free entitlements are met as per approval by the GOI as follows:

·         Free drugs and consumables @ Rs. 300 for each normal delivery

·         Free diagnostics @ Rs.200 for each delivery

·         Free transport from home to institution, between facilities in case of a referral and drop back home @ 800

 Training of Health Care Providers:

 ·         Integrated Management of Neonatal and Childhood Illness (IMNCI): The IMNCI guidelines target children less than 5 years old – the age group that bears the highest burden of deaths from common childhood diseases. The objective of the strategy is to reduce death and the frequency and severity of illness and disability, and to contribute to improve growth development. 

  ·         Facility based Integrated Management of Neonatal and Childhood Illness (F-IMNCI): F-IMNCI is the integration of the Facility based care package with the IMNCI package, to empower the health personnel with the skills to manage new born and childhood illness at the community level as well as the facility.

 ·         Navjaat Shishu Shuraksha Karyakram (NSSK): The main objective of NSSK is to train health personnel in Basic Newborn care and Resuscitation to reduce neonatal deaths.

 ·         Facility Based New-born Care (FBNC): The goal of newborn care training is to improve the skills of health workers so that they can save newborn lives. FBNC training will help in skill building of the medical officers and staff nurses posted in these units to provide quality care.

 

Home based New-born Care

           This programme has been started since 2013. 987 ASHAs who have been trained for 1^st round in Module 6 & 7 are being detailed to carry out visits to all new-borns in their areas as per guidelines. An incentive of Rs. 250 will be given after the completion of their visits.

 Facility based new born care (FBNC)

         FBNC, one of the key components under NHM is being established in the state to ensure a better new born health/survival. Even though the delivery load across the state is not much compared to other states, Mizoram is putting its best efforts of establishing FBNC.

New-born care units in various levels of facilities have been established as follows: -

Special Newborn Care Unit (SNCU)

          It is a neonatal unit in the vicinity of the labour room that provides care to all sick newborns (except to those requiring assisted ventilation or major surgery)

          The aim is provision and delivery of services for both essential newborn care and the care of sick newborns in the existing health facilities.

Currently, there are 5 functional SNCUs in Mizoram (Champhai DH, Lunglei DH, Lawngtlai DH, Siaha DH and Civil Hospital, Aizawl)

 Newborn Stabilisation Unit (NBSU)

         It is a facility within or in close proximity of the maternity ward where most sick and low birth weight newborns can be taken care of.

Currently, there are 3 functional NBSU (i.e Mamit DH, Serchhip DH and Kolasib DH) and upcoming in 3 new Districts (i.e Saitual, Khawzawl and Hnahthial DH)

 Newborn Care Corner (NBCC)

        NBCC is a space within the delivery room to ensure essential newborn care such as normal breathing, warmth, initiation of breastfeeding and infection prevention.

        This area is mandatory for all health facilities where deliveries take place.

Currently, there are 124 functional NBCCs in our state.

 

Intensified Diarrhoea Control Fortnight (IDCF)

            The ultimate goal of IDCF is to reach zero child deaths due to diarrhoea. The Objectives of IDCF is to ensure high coverage of ORS and Zinc use rates in children with diarrhoea throughout the country.

           These activities mainly includes – awareness generation activities for diarrhoea management, strengthening service provision for diarrhoea case management, establishment of ORS-Zinc corners, prepositioning of ORS by ASHA in households with under five children and awareness generation activities on hygiene and sanitation.

National Deworming Day (NDD)

             The objective is to deworm all preschool and school age children between the age of 1-19 years (enrolled in schools, registered in anganwadi’s , unregistered and out of schools) through the platform of schools and anganwadi’s in order to improve their overall health, nutritional status, access to education and quality of life. NDD has been observed biannually in the month of February and August.

 National New born Week (NNW)

                 National New born Week is celebrated every year in the country from   15^th – 21^st November since 2000.

              The aim of celebrating this week is to raise awareness about the importance of the new born care for child survival and development, to renew focus and commitment for Facility based and Community based newborn care.

 Mother’s Absolute Affection (MAA): World Breastfeeding week (1^st – 7^th August)

             MAA is an intensified programme for promotion of breastfeeding to bring undiluted focus on promotion of breastfeeding practices.

Goals & Objectives

            The Goal of MAA Programme is to revitalize efforts towards promotion, protection and support of breastfeeding practices through health systems to achieve higher breastfeeding rates.

 Kangaroo Mother Care (KMC): KMC is a simple method of care for low birth weight infants that include early and prolonged skin-to-skin contact with the mother (or a substitute caregiver) and exclusive and frequent breastfeeding. This natural form of human care stabilizes body temperature, promotes breast feeding, prevents infection and other morbidities. This also leads to early discharge, better neurodevelopment and encourages bonding between mother and infant.

                KMC is initiated in the hospital and continued at home until the infant needs it and for optimum care a regular follow-up should be ensured.

 Kangaroo mother care has following components:

i)                   Skin to skin contact

ii)                 Exclusive breast feeding 

KMC satisfies all five senses of the infant. The infant feels the mother’s warmth through skin-to-skin contact (touch), listens to her voice and heartbeat (hearing), sucks breast milk (taste) has eye contact with her (vision) and smells her odour (olfaction).

        Though all LBW infants should be provided KMC but considering the huge burden at facilities, priority must be given to infants with birth weight less than 2000 grams.

Minimum duration of a KMC session should be one hour because frequent handling may be stressful for the infant. The duration of each KMC session should be gradually increased for as long as the mother can comfortably provide KMC.

 Social Awareness and Action to Neutralise Pneumonia Successfully (SAANS)

            The goal of SAANS is to intensify action for reducing mortality due to childhood in India to less than 3 per thousand live births by 2025.

 The main Objective of SAANS Campaign are-

            To create awareness in community on interventions for Protection and Prevention of Childhood Pneumonia

           To increase caregiver awareness to enable them to identify pneumonia early

Dispel myths & notions and trigger behaviour change to take pneumonia seriously and seek care early.

            Currently , SAANS is implemented in all the Districts.

 Nutrition Rehabilitation Centre (NRC): The main objectives of NRC are as follows:

·         Improve access to basic preventive & curative services.

·         Encourage sustainable behaviour change

·         Support caring practices

·         Stimulate social mobilization by the community to demand better services and accountability.

The functions of NRC:

·         Physical, mental & social development of the children with Severe Anaemic Malnutrition (SAM).

·         To encourage the child to eat as much as possible energy dense foods.

·         To re-initiate and/or encourage breastfeeding as necessary.

·         Psychosocial care and development by creating several stimulating activities.

Integrated NRC is approved under NHM Plan for FY 2023-24 for 2 Districts i.e Aizawl & Lawngtlai Districts. 

MusQan: 

        MusQan aims to ensure provision of quality child friendly services in public health facilities to reduce preventable newborn and child morbidity and mortality.

The main objectives of MusQan are as follows:

·         To reduce preventable mortality and morbidity among children below 12 years of age.

·         To enhance Quality of Care (QoC) as per National Quality Assurance Standards (NQAS).

·         To promote adherence to evidence-based practices and standard treatment guidelines & protocols.

·         To provide child- friendly services to newborn and children in humane and supportive environment.

·         To enhance satisfaction of mother and family, seeking healthcare for their child.

At present there are 5 facilities planned for MusQan facilities (i.e Civil Hospital Aizawl, Champhai DH, Lawngtlai DH, Lunglei DH and Siaha DH).  

 

Child Death review

         Child Death Review (CDR) is an important strategy to reduce IMR/under 5 mortalities by analysing the causes of infant/child death in a population and identify the gaps in health service delivery and social factors that contribute to child deaths so that specific child health interventions can be initiated.

          District CDR Committee has been formed in all the 9 districts and these committees have been reviewing the cases.

         The new CDR Guideline has been recently circulated to all district CMOs for a wider dissemination in their respective districts. There are incentives for ASHA@ Rs. 50, ANM @ Rs. 100, audit team @ Rs. 300 and two family members of the deceased child who would be present at the time of review @ Rs. 100.