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National health programmes

National health programmes. Dr. M.L. Siddaraju. National health programmes. Perinatal period: Extends from the 28 th week of gestation (or more than 1000 grams) to the 7 th day of life. Neonatal period: Early: Birth to first 7 days. Late : 7 days to 28 days. Perinatal mortality Rate(PMR).

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National health programmes

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  1. National health programmes Dr. M.L. Siddaraju

  2. 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.

  3. 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

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

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

  6. 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 children<1 yr of age in a yr*1000 Total No. of live births in same year.

  7. 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.

  8. Infant mortality rate • B. Postnatal (1-12 months). • 1. ARI. • 2.Diarrhoea. • 3. Other communicable infections(VPD’s) • 4. Malnutrition. • 5. Congenital anomalies. • 6. Accidents.

  9. 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.

  10. National health programmes • Nutritional Programmes. • Infection control programmes. • Immunization programmes.

  11. 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.

  12. 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.

  13. 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).

  14. Nutritional programmes • Mid day meal programme: • Ministry of education. • Retain children in school + • nutritional supplement.

  15. 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.

  16. Infection control programmes • National malaria eradication programme. • NMCP – 1953. • NMEP – 1958. • 1970 – Resurgence. • Modified plan of operations – 1977

  17. National malaria eradication • Malaria action programme(MAP) • 1994 • high • Stratification medium risk areas • Low

  18. 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.

  19. 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 NGO’s.

  20. National tuberculosis control programme(NTP) • RNTCP: • Short course chemotherapy –free. • Intensive phase – DOTS.

  21. 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.

  22. 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.

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

  24. 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.

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

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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.

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

  32. Reproductive & child health(RCH) • 1997 Family welfare RCH CSSM

  33. RCH • Conceptual frame work: Family welfare/Plan Client centered approach CSSM RTIs &STDs

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

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

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

  37. CSSM v/s RCH

  38. CSSM v/s RCH

  39. CSSM v/s RCH

  40. Thank you

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