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Integrated Management of Childhood Illness: The
major medical causes of deaths of children in the Region include acute
respiratory infection, diarrhoea, vaccine
preventable diseases notably measles and tetanus. Malaria and HIV/AIDS are
problems in selected pockets.
Malnutrition contributes to over half of the deaths. WHO promotes the
Integrated Management of Childhood Illness (IMCI) strategy to address the
major causes of child mortality. The focus of the
strategy is improving health system capacity at first level health facilities
for management of sick children, effecting health system improvements and
influencing family and community behaviour. The
Regional office provides technical support to member states for introducing,
scaling-up and evaluation of the IMCI strategy.
It is relevant to note that
evidence suggests that only a small proportion of sick children are taken to
appropriate health care providers. Some studies suggest that less than 20%
sick children seek medical care. And even among these a majority seeks care
from the private sector. Thus, there is room for initiatives to influence
health-seeking behaviour as well as involvement of
the private sector in providing quality care in addition to rapidly scaling
up provision of quality child health care through public sector facilities.
Newborn Health: Health of the newborn has received
relatively less attention in the Region. Over 40% of child mortality is
accounted for by deaths in the neonatal period. The Region accounts for about
1.4 million neonatal deaths every year. The direct medical causes of newborn
mortality (asphyxia, sepsis, prematurity,
congenital malformations) are well-defined. High prevalence of low-birth
weight approaching 33% in some countries contributes to the high neonatal
mortality. Evidence based cost-effective interventions are available to
address most of the direct causes of newborn mortality. The Regional office
has developed a strategy for improving health outcomes in the newborn period
in consultation with states and partners. Technical support is provided to
member states to incorporate initiatives for newborn health in the maternal
and child health programme.
Factors that impact neonatal
outcomes include the health status of and care received by the mother before
and during pregnancy, during child birth and postnatal care of the mother and
neonate. More than 60% of births in the Region take place at home. Skilled
attendance at delivery (including access to referral care) and family and community/family
practices regarding care of the newborn particularly related to
breastfeeding, provision of warmth, prevention of infection, recognition of
sickness and care seeking from an appropriate provider are interventions that
can contribute to a positive outcome. Availability of skilled attendance in
countries with the maximal number of births ranges between 13-42%. The Child
Health and Development unit works closely with the Reproductive Health and
Research unit to support member-states in their efforts to ensure skilled
care at all births.
Malnutrition: Malnutrition in children of South-East
Asia is a major issue of public health concern. Malnutrition not
only prevents the child from achieving full physical and mental potential but
also affects mortality rates. The
pernicious link between malnutrition and infections is well documented. A
high proportion of children in this Region (25-33%) start their lives with
the disadvantage of low-birth weight. While reduction in prevalence of
low-birth weight is a long-term goal as it has inter-generational and social
dimensions, special care of low-birth weight babies has the potential of
reducing the high burden of morbidity and mortality in this vulnerable group.
Over three-fourths (79%) of the worlds malnourished children live in the
South-East Asia Region. Inappropriate
breastfeeding and complementary feeding practices and the burden of
infectious diseases contribute to this. Exclusive breastfeeding rates up to 4
months of age range between 4-47%. Complementary feeding rates are also low.
In most populous countries of the Region these range between 20-30%. Along
with the Nutrition for Health and Development guidance and support is
provided to member-states to operationalise the
global strategy for infant and young child feeding.
Health System Responsiveness: Most Member Countries of the
Region have a reasonable public health infrastructure in place. The challenge
is to make it responsive to community needs. This would involve improving
skills and competency of health care providers, exploring alternate
mechanisms for delivery of interventions, logistics and supplies, and
establishing a system of constant monitoring and supervision. The unit works
with member-states and partners to explore avenues for improving quality of
child health services provided through the health system.
Operational
Research:
Effective clinical interventions for child health care are known. However,
socio-behavioural factors influencing health care
practices and health care seeking need further investigation. There are
important knowledge gaps about essential requirements for effective
community-based care, scaling-up of interventions, and facilitation of an
essential health system response including management. Support is provided for evaluating
programme implementation, identify lessons learned, and conduct additional
research to improve effectiveness of intervention delivery.
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