Integrated Management Of Neonatal And Childhood Illness Research Articles

Feasibility and acceptability of the paediatric pulse oximeter in integrated management of neonatal and childhood illnesses (IMNCI) services by public health facilities: A qualitative study in rural Western India.

Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management.

Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County, Kenya

Purpose: Kangaroo Mother Care (KMC) entails infants and mothers having constant skin-to-skin contact. KMC is done in the hospital after delivery to preterm infants or after early discharge. Mothers or caregivers are sensitized on proper positioning, breastfeeding, hygiene, and preventive measures to protect infants from infections. Proper follow-up is critical to ensure effective results are achieved. The use of KMC was endorsed by the World Health Organization (WHO) as routine care for preterm infants with a birth weight of ≤2000 grams, especially the clinically stable infants. This recommendation was based on the available moderate-quality evidence that it works by providing warmth (thermal care) and increasing breastfeeding opportunities irrespective of setting, birth weight, or gestational age. Also, KMC has been strongly acclaimed and used as a natural thermoregulator, infection prevention, and nutrition for preterm infants, which are critical for physiological functions that are strongly affected by physical immaturity. Although this technique offers quality care to these babies, its implementation is low. There is a need to determine the suitable methods to improve its implementation in Kenya's healthcare facilities. This study aimed to determine factors influencing the implementation of KMC in Makueni County health facilities.
 Methodology: The study was conducted in maternity units of six sub-county hospitals (Makueni county referral hospital, Makindu sub-county hospital, Kibwezi sub-county hospital, Mbooni sub-county hospital, Kilungu sub-county hospital, and Sultan-Hamud sub-county hospital) in Makueni County. Cross-sectional study design with mixed methods was used. Semi-structured questionnaires and KMC checklist were filled by the researcher and research assistants. The convenience sampling technique was carried out, and 90 healthcare providers and 6 Key Informants were interviewed. Data was analyzed using version 23 of a statistical package for social sciences using descriptive and inferential statistics.
 Findings: The study results reveal that young health care providers portrayed better KMC implementation compared to the old (r=-.210, p=0.047). In relation to gender, female health care providers had better KMC implementation compared to the male (r= -.290, p=0.006).Knowledge (r=.282, p=0.007) and health workers' perception of KMC (r=.245, p=0.02) had a positive and significant relationship with implementing KMC. Perception (β=1.149, p=0.05) and funds (β=0.958, p=0.05) had a positive and significant effect on implementing KMC. R squared indicated that jointly, age, gender, perception, and budget accounted for 29.4% of the overall variation in the KMC implementation. Results demonstrated a high level of KMC (33.3%) implementation among the health facilities. The study concluded that funds and collaboration had a positive and significant effect on implementing KMC.
 Unique Contribution to Theory, Practice and Policy: The study recommends that the hospital management should ensure there is provision of adequate resources to support KMC implementation. In particular, the hospital management should focus on strengthening physical and human resources. There is also a need to link all relevant programs, such as essential newborn care and Integrated Management of Neonatal and Childhood Illnesses (IMNCI), to support KMC implementation.

Assess the Knowledge on Clinical Guidelines regarding Integrated Management of Neonatal and Childhood Illness (IMNCI) among Health Care Workers Serving in Selected Health Care Centers of Maharashtra

Assess the Knowledge on Clinical Guidelines regarding Integrated Management of Neonatal and Childhood Illness (IMNCI) among Health Care Workers Serving in Selected Health Care Centers of Maharashtra

Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision.

Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.

Evaluation of Quality of Nursing Care Services Provided to Children under Five Years Based on Integrated Management of Child Health at Primary Health Care Centers in Baquba City

Objective(s): The study aims to evaluating the quality of nursing care provided to children under five years to compare between quality related to type of health sectors; to determine the quality of nursing care and to compare between such care in Baquba Health Care Sector I and II.
 Methodology: A descriptive study is carried out for the period from December 15th 2019 to May 1st 2020. A purposive "non- probability" sample, of (60) staff nurse and (60) children is selected. An adopted questionnaire has been selected for the study which consists of three parts. The first part is nurses’ socio-demographic characteristic; the second part is child’s socio-demographic characteristics; and the third part is the nursing care for neonates and children under 5 years. The content validity and the internal consistency reliability for the study instrument are determined through a pilot study. Data are collected through the use of structured interview. Data are analyzed using frequency, percent, mean of scores, mean, standard deviation, total scores and ranges and inferential statistical measures of t-test and one - way analysis of variance.
 Results: Results showed the study that the assessment module and the communication module is inadequate for the most, while, the role of staff nurses in treatment module is adequate in Baquba Health Sector I. But, in Baquba Health Care Sector II the assessment module is inadequate, and the role of staff nurses in treatment module is adequate and equally adequate and inadequate for the communication module.
 Recommendations: The study recommends that staff nurses need to be seriously involved in designed, planned and implemented training sessions on Integrated Management of Neonatal and Childhood Illness (IMNCI) program with emphasis on the assessment and communication modules. Monitoring and evaluation of the IMNCI program have to be done for the benefits of children in Baquba Health Care Sectors Keywords: Evaluation, Quality of Nursing Care, and Integrated Management of Child Health

Validation of WHO-IMNCI Algorithm for Jaundice in 0-2 Months Aged Infants at Tertiary Level Hospital

Introduction: For the effective management of these major childhood illnesses, WHO and UNICEF have developed the “Integrated Management of Neonatal and Childhood Illness” (IMNCI) Strategy. Aims: The aim of study is to evaluate the utility of the WHO/ UNICEF algorithm for Integrated Management of Neonatal and Childhood Illness (IMNCI) for jaundice up to two months of age. Methods: This is Prospective observational comparative study. Total of 300 subjects were taken from Emergency and Outpatient Department of Pediatrics. The treatment steps were identified as according to the ‘Assess and Classify’ module of IMNCI algorithm. All relevant investigations were performed, using appropriate methods. Blood sugar was done in all recruited children and serum bilirubin levels were done in all infants presented with jaundice. Based on this detailed clinical evaluation and relevant investigations, final diagnosis were made and therapies were given. These diagnosis and treatments were considered as the ‘Gold Standard’ for comparison. Results: There were 300 young infants, of whom 162(54%) were male and 138(46%) were female infants. Total of 146 infants were admitted, 24 from OPD and 122 from Emergency. 154 infants were sent home after initial management in hospital. Severe jaundice was present in 24 infants according to IMNCI and 12 infants according to Gold Standard in 0-2 months of age. The predictive utility of algorithm for the diagnosis of severe jaundice with a sensitivity of 100%, specificity of 75%, positive predictive value of 50% and negative predictive value of 100% in 0-2 months of age group. Conclusion: Algorithm performed well in identifying severe jaundice with the sensitivity of 100% and specificity of 95%.

Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

BackgroundMisguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.MethodsSecondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription.ResultsThe prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription.ConclusionPrescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

Breastfeeding Week Celebrations at ESI Hospitals

In August 2014, the Department of Community Medicine celebrated breastfeeding week in our hospital(ESIC hospital, Joka) and field practice area (ESI hospital budge budge) which is our Urban health training centre in southern part of Kolkata. The theme for this year is “Breastfeeding: A Winning Goal for Life!” The theme for this year's World Breastfeeding Week asserts the importance of increasing and sustaining the Protection, Promotion and Support of Breastfeeding for achieving the Millenium Development Goals (MDGs) and improving child survival and nutrition in the Post 2015 development agenda of sustainable development goals.1To begin with, we referred to National Family Health Survey-3 data and tried to find out the status of breastfeeding practices in our areas. We found that percentage of children who received breastfeeding in one hour was just 23.7%.2 . District level health survey shows that percentage of children who received breastfeeding in one hour is 38.5% only while that the Mothers who received any antenatal check-up is 96.1% 3 This signifies poor implementation of breastfeeding policies in health care facilities and also signifies the missed opportunity to health educate the mother and her relatives about importance of exclusive breastfeeding. In the settings, where the ANC check up is high, the staff of healthcare facilities should ensure education of the mothers regarding exclusive breastfeeding, positioning, and attachment of infant to the breast while providing the ANC care and same should be continued after delivery. To achieve this, staff of the health care facility should be educated and trained in the importance of exclusive breastfeeding, positioning, and attachment of breast. Hence, as a part of breastfeeding week celebrations, we decided to conduct one-day workshop for the staff nurse working in maternity and paediatric wards and OPD of the ESIC hospital Joka and ESI hospital budge budge. We used this time to explain how important is exclusive breastfeeding and how does it influences neonatal mortality by decreasing it six times if exclusive breastfeeding is given.4 We showed how the mother can position the child and attach the child to the breast. We used an Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, which is recommended under National Rural Health Mission (NRHM). We could offer these skills-based training to 44 staff nurse of two hospital and 4 ward ayaa from ESI budge budge hospital. We used photographs, Power Point presentations and videos. We also emphasized the importance of breastfeeding week and its theme. We also emphasize on stopping or discontinuation of use of infant milk substitute, feeding bottles and infant foods which is also stated by government of India, in 1992 (IMS act) as provided by Ministry of Health and Family Welfare (MoHFW), India. Faculty of Community Medicine department, of which one is trained in IMNCI strategy, conducted the sessions.

Utilization of Integrated Management of Neonatal and Childhood Illness (IMNCI) Guidelines and Associated Factors among Nurse at Public Health Institutions in West Arsi Zone, South East Ethiopia

Background: World health organization (WHO) and United Nations for Children‘s fund (UNICEF) in the early 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy designed to reduce child mortality and morbidity in developing countries. This study is aimed at assessing factors associated with utilization of IMNCI protocol by nurses West Arsi Zone, Oromia Region, Ethiopia. Methods: An institutional based cross-sectional study was conducted on a total of 185 nurses who were included from health facilities selected using simple random sampling technique. Data was coded, entered and cleaned using Epi-data 3.1 and exported to SPSS version 22 for analysis. Univariate and bivariate analysis was performed. Multivariate analysis was also done to control for possible confounding variables. Results: Data were obtained from 185 nurses, of which 131 (70.8%) were males. More than half 103 (55.7%) of the respondents was aged between 25-29 years. The mean (± SD) age was 26.65 ± (1.7) with the range of 20-43 years and 107 (57.8%) were diploma nurses. The overall IMNCI protocol utilization was 58.7%. In multivariate analysis, the odd of IMNCI utilizations among nurses who had attended IMNCI training were 2.76 times higher compared to nurses who had not attended IMNCI training [AOR=2.76, 95% CI:1.388, 5.51]. Nurses who had practice of always referring chart booklet during every case management process were three times more likely to utilize IMNCI protocols [AOR=2.95, 95% CI: 1.48, 5.89] compared to their counterparts. Conclusions: The proportion of IMNCI utilizations in the selected districts was low and less than the WHO recommendations. Training and frequent referring of chart booklet were found to significantly associate with the utilization of the IMNCI protocols. Therefore the emphasis should be given to the provision of IMNCI training to the nurse by the stakeholders and motivating the nurses to always refer chart booklet, in order to enhance proper utilization of the protocols.

Treatment by untrained providers among sick infants in rural Odisha, India.

This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants. In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice. A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form - designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers. A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics - cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.

Impact of training on practical skills of Iraqi health providers towards integrated management of neonate and child health - a multicentre cross- sectional study

Background: This study aims to assess the mandatory practical skills of caregivers towards the implementation of the Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy in primary health care (PHC) centers of Salah al-Din governorate in Iraq.&#x0D; Methods: A cross-sectional comparative study was conducted from January to May 2014. An equal sample of 42 trained and 42 non-trained caregivers who are working in 20 PHC centers in Tikrit city and other districts of Salah al-Din governorate of Iraq were included. The study tool was a semi-structured questionnaire with 20 questions covering different required practical skills that caregivers should have. The total score was 100 and in a range of 4- 6 points for each question. An independent sample t-test was used to compare the means of numerical variables.&#x0D; Results: The mean age of total respondents were (33.18 ± 5.82Years), and the vast majority (63, 75.0%) were females. More than two-third (58, 69.0%) were paramedical compared to 26 (31.0%), who were doctors. Trained caregivers had statistically significant better practice (73.48 ± 13.46) compared to non- trained caregivers (63.95 ± 17.44). Trained doctors had statistically significant better practice (88.15 ± 2.70) compared to trained paramedical staff (66.90 ± 10.84). Trained caregivers from Tikrit city had statistically significantly better practice (80.26 ± 7.38) compared to trained caregivers from districts (67.89± 14.85). The highest proportion (97.5%) of trained caregivers felt the child for fever or body hotness appropriately, and the lowest proportion (59.5%) of them recorded age, height, and weight correctly.&#x0D; Conclusion: This study showed that training has a positive influence on the implementation of IMNCI interventions. IMNCI-trained caregivers were more likely to correctly classify illnesses than non-trained caregivers.

Implementing Community-based Health Planning and Services in impoverished urban communities: health workers\u2019 perspective

BackgroundThree-quarters of sub-Saharan Africa’s urban population currently live under slum conditions making them susceptible to ill health and diseases. Ghana characterizes the situation in many developing countries where the urban poor have become a group much afflicted by complex health problems associated with their living conditions, and the intra-city inequity between them and the more privileged urban dwellers with respect to health care accessibility. Adopting Ghana’s rural Community-Based Health Planning and Service (CHPS) programme in urban areas is challenging due to the differences in social networks and health challenges thus making modifications necessary. The Community Health Officers (CHOs) and their supervisors are the frontline providers of health in the community and there is a need to analyze and document the health sector response to urban CHPS.MethodsThe study was solely qualitative and 19 in-depth interviews were conducted with all the CHOs and key health sector individuals in supervisory/coordinating positions working in urban CHPS zones to elicit relevant issues concerning urban CHPS implementation. Thematic content data analysis was done using the NVivo 7 software.ResultsFindings from this appraisal suggest that the implementation of this urban concept of the CHPS programme has been well undertaken by the health personnel involved in the process despite the challenges that they face in executing their duties. Several issues came to light including the lack of first aid drugs, as well as the need for the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) programme and more indepth training for CHOs. In addition, the need to provide incentives for the volunteers and Community Health Committee members to sustain their motivation and the CHOs’ apprehensions with regards to furthering their education and progression in their careers were key concerns raised.ConclusionThe establishment of the CHPS concept in the urban environment albeit challenging has been fraught with several opportunities to introduce innovations which tailor the rural milestones to meet urban needs. Modifications such as adjusting timing of home visits and renting accommodation in the communities for the CHOs have been beneficial to the programme.

A survey on Integrated Management of Neonatal and Childhood Illness implementation by nurses in four districts of West Arsi zone of Ethiopia.

BackgroundIn Ethiopia, one in 17 children dies before 1 year of age and one in 11 children dies before 5 years. Research that examines the factors influencing the implementation of the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy in Ethiopia is limited. This study aimed to identify the factors compelling the execution of IMNCI by nurses in four districts of West Arsi zone of Ethiopia.MethodsA mixed-method cross-sectional study was conducted from February to March 2016 in West Arsi zone of Oromia regional state, Ethiopia. A total of 185 Integrated Management of Childhood Illness (IMCI)-trained registered nurses working at Under-Five Clinic were purposively chosen for the study among 291 registered nurses based at health centers and hospitals in the Arsi zone. The study was complemented by a qualitative method.ResultsMore than half (57.8%) of the nurses interviewed had been trained (51.35% of them attended in-service training). The most common issues encountered in the implementation of IMCI were: lack of trained staff (56.2%), lack of essential drugs and supplies (37.3%), and irregular supportive supervision (89.2%). The qualitative data supplemented the factors that influence IMNCI implementation, including drug unavailability, lack of human resources, and lack of effective supportive supervision and follow-up visits. Therefore, interventions aiming at training nurses, with emphasis on performing supportive consistent supervision and supporting the system of health care by enhancing admittance to indispensable drugs and supplies, are recommended to help IMCI implementation.

A Study to assess the Effectiveness of Structured Teaching programme on Knowledge of Nursing Students Regarding Integrated Management of Neonatal and Childhood Illness (IMNCI) in selected colleges of Amritsar, Punjab

A Study to assess the Effectiveness of Structured Teaching programme on Knowledge of Nursing Students Regarding Integrated Management of Neonatal and Childhood Illness (IMNCI) in selected colleges of Amritsar, Punjab

Experience of anganwadi workers running VCNC under ‘Misssion Balam Sukham’ in a tribal area of Gujarat, India

Background: State Government has started a programme “Mission Balam Sukham” to combat the malnutrition with 3 tier approach including Village Child Nutrition Center (VCNC), Child Malnutrition Treatment Center (CMTC) and Nutrition Rehabilitation Center (NRC). Present study was conducted with the objectives to compare the availability of articles present at anganwadies and VCNCs and to know the experience of anganwadi workers running VCNC. Methods: Ten VCNCs from Naswadi block were selected by systemic random sampling and compared with 10 anganwadies as control group from nearby block Sankheda to check the availability of necessary articles. Ten anganwadi workers who ran the VCNCs for 1 month were interviewed about their experience of running VCNC. Results: There were not major differences in availability of articles like weight machine, MUAC tap, IMNCI (Integrated management of neonatal and childhood illnesses) chart, utensils for cooking, soap and water supply, common medicines and food articles between control anganwadies and VCNCs. Some of the articles like referral slips and thermometer were lacking at control anganwadies as well as VCNCs. Anganwadi workers (AWW) did not get enough medicines and functioning weighing scales and proper training before starting the VCNCs. Conclusions: VCNC needs to supply proper medicine stocks, functional weighing scale and other necessary articles to make the programme successful. AWWs also need the proper training to identify and treat the malnutrition at anganwadi centres.

Tachypnea and Other Danger Signs vs Pulse Oximetry for Prediction of Hypoxia in Severe Pneumonia/Very Severe Disease.

To compare the performance of respiratory rate and other clinical signs against pulse oximetry for predicting hypoxia in children with Severe pneumonia/Very severe disease as per Integrated Management of Neonatal and Childhood Illness (IMNCI) classification. Cross-sectional study. Pediatric emergency department of a tertiary-care hospital in Delhi, India. 112 hospitalized children (2 mo - 5 y) with Severe pneumonia/Very severe disease as per IMNCI classification. Respiratory rate was recorded at enrolment, along with other clinical signs and symptoms. Oxygen saturation (SpO2) was measured by a pulse oximeter. Clinical predictors of hypoxia (SpO2 <90%) and their combinations (index test) were evaluated for their sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of hypoxia, against pulse oximetry (reference test). Hypoxia was present in 57 (50.9%) children. Presence of tachypnea, head nodding, irritability, inability to drink/breastfeed, vomiting, and altered sensorium was significantly associated with hypoxia (P<0.05). Multiple logistic regression revealed that age-specific tachypnea (RR≥70/min for 2-12 mo, and RR ≥60/min for ≥12 mo), head nodding, and inability to drink/breastfeed were independent predictors for hypoxia with sensitivity of 70.2%, 50.9% and 75.4%, respectively; and specificity of 88.9%, 96.4%, and 90.9%, respectively. When all three predictors were used in conjunction, the sensitivity increased to 91.2% and specificity was 81.8%. No single clinical sign can perform as well as pulse oximetry for predicting hypoxia in children with severe pneumonia. In settings where pulse oximetry is not available, combination of signs, age-specific tachypnea, head nodding, and inability to drink/breastfeeding has acceptable sensitivity and specificity.

PRAKTIK BIDAN DALAM PENGGUNAAN ALGORITMA MANAJEMEN TERPADU BAYI MUDA PADA KUNJUNGAN NEONATAL

Neonatal mortality in Indonesia declined slowly and tended to stagnant in number of 20/1000 live births. Proportion of neonatal mortality in Cilacap Regency at 2015 reached 69% of infant mortality. A quality neonatal care might decrease 34-62% mortality, but not all midwives used integrated management of neonatal and childhood illness (IMNCI) algorithm. This study aimed to figure out factors associated with midwives’ practice on using IMNCI algorithm in neonatal care. This study used cross sectional approach with purposive sampling until 60 respondents were collected. Data were analyzed with chi-square test. There were association between knowledge (p=0.000), attitude (p=0.023), availability of facilities (p=0.023), support from leader (p=0.017), length of work (p=0.011), and supervision (p=0.039) with midwives’ practice on using IMNCI algorithm. There were not assocation on age (p=0.124), employment status (p=0.124), extra work load (p=0.290), and reward (p=0.053). Factors associated with midwives’ practice on using IMNCI algorithm in neonatal care were knowledge, attitude, availability of facilities, support from leader, length of work, and supervision.

Study of health-care seeking behavior of parents for child health problems in an urban slum area of Solapur

Background: Integrated management of neonatal and childhood illness (IMNCI) considers health-seeking behavior an important determinant in childhood morbidity and envisions an improvement in the behavior. The World Health Organization (WHO) recognizes health-care seeking as one of the three central components of the IMNCI. A thorough understanding of health-care seeking behavior is of utmost importance in planning and formulating interventions for decreasing childhood morbidities in India. Objectives: To study the health-care seeking behavior of parents toward child health problems, to study the association between parent’s behavior and socioeconomic factors, and also to determine the decision-making person regarding health-care seeking. Materials and Methods: This was a community-based, descriptive, cross-sectional study, conducted in the urban slum area under Urban Health Training Centre in Solapur city. A sample size of 100 was taken, and data were collected using a questionnaire. Analysis of the data was done using percentage and Chi-square test. Results: Nearly 56% of parents sought health care from private clinic while only 15% went to an urban health-care center. Only 5% of parents directly went to the pharmacy without consulting a doctor, and 21% treated the children at home. The decision-making authority was mother followed by joint decision by the father and the mother. Conclusion: Majority of the parents sought health care in a private set up. The time taken to seek care was 1-2 days. There was an association of age and education of father as well as mother to health-care seeking behavior. The decision-making authority was mother.

Care of newborn in the community and at home.

India has contributed immensely toward generating evidence on two key domains of newborn care: Home Based Newborn Care (HBNC) and community mobilization. In a model developed in Gadchiroli (Maharashtra) in the 1990s, a package of Interventions delivered by community health workers during home visits led to a marked decline in neonatal deaths. On the basis of this experience, the national HBNC program centered around Accredited Social Health Activists (ASHAs) was introduced in 2011, and is now the main community-level program in newborn health. Earlier in 2004, the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program was rolled out with inclusion of home visits by Anganwadi Worker as an integral component. IMNCI has been implemented in 505 districts in 27 states and 4 union territories. A mix of Anganwadi Workers, ASHAs, auxiliary nursing midwives (ANMs) was trained. The rapid roll out of IMNCI program resulted in improving quality of newborn care at the ground field. However, since 2012 the Ministry of Health and Family Welfare decided to limit the IMNCI program to ANMs only and leaving the Anganwadi component to the stewardship of the Integrated Child Development Services. ASHAs, the frontline workers for HBNC, receive four rounds of training using two modules. There are a total of over 900 000 ASHAs per link workers in the country, out of which, only 14% have completed the fourth round of training. The pace of uptake of the HBNC program has been slow. Of the annual rural birth cohort of over 17 million, about 4 million newborns have been visited by ASHA during the financial year 2013–2014 and out of this 120 000 neonates have been identified as sick and referred to health facilities for higher level of neonatal care. Supportive supervision remains a challenge, the role of ANMs in supervision needs more clarity and there are issues surrounding quality of training and the supply of HBNC kits. The program has low visibility in many states. Now is the time to tap the missed opportunity of miniscule coverage of HBNC; that at least half of the country's birth cohort should be covered by this program by 2016, coupled with rapid scale up of the community-based treatment of neonates with pneumonia or sepsis, where referral is not possible.

Breastfeeding pattern and the risk of neonatal illnesses among urban poor in Lucknow, Northern India: A prospective follow-up study

BackgroundExclusive breastfeeding has been shown to be protective against infants’ illnesses. Evidence is sparse about the association of different breastfeeding patterns on neonatal illnesses. MethodsThe study was conducted at two urban public hospitals at Lucknow. Neonates who did not have any morbidity or congenital malformation and were residents of Lucknow were enrolled within 48h of birth and followed up once at 6 weeks of age, at the outpatients clinic or home to assess neonatal illnesses and established (voluntary) breastfeeding pattern (exclusive, predominant, partial, never breastfed). Association of established breastfeeding patterns with neonatal illnesses was studied using multivariate logistic regression, adjusting for potential confounders. ResultsA total of 1020 neonates were enrolled. Follow-up information on occurrence of neonatal illnesses (if any) as well as established breastfeeding pattern was available for 937 (91.8%) enrolled neonates. Among these, 46% (431/937) presented with any illness, with 20.2% (189/937) reported with at least one danger sign of severe illnesses as mentioned in Integrated Management of Neonatal and Childhood Illnesses (IMNCI).Partially breastfed neonates were significantly more likely to develop any illness (Adj. OR=6.6; 95% CI: 4.0–10.8, p<0.001) as well as IMNCI illnesses (Adj. OR=5.8; 95% CI: 2.9–11.8, p<0.001) as compared to exclusively breastfed neonates. Similarly, predominantly breastfed neonates were also significantly more likely to develop any illness (Adj. OR=3.4; 95% CI: 2.0–5.8, p<0.001) as well as IMNCI illnesses (Adj. OR=2.9; 95% CI: 1.3–6.4, p<0.01) as compared to exclusively breastfed neonates. The strength and consistency of these associations remained similar on refitting the model with term, singleton, and normal birth weight neonates. ConclusionsExclusive breastfeeding during the neonatal period was significantly protective against the occurrence of any illness as well as illnesses mentioned in the IMNCI program, as compared to predominant or partial breastfeeding.