Interventions 0-2 years
In India, nearly 26 million infants are born each year.1.2 million die before completion of the first 4 weeks of life and 1.7 million die before reaching the first birthday. Two-thirds of deaths occur in the first week of life and two-thirds of these within the first 2 days of life22.
India accounts for 2.1 million of the 9.7 million annual under-five child deaths globally, thereby contributing to about 21 per cent of the global burden of child deaths.
Research shows that over half of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures.
In order to ensure better newborn and infant health we have identified few key evidence- based interventions which could have a long term impact in the communities we are working with.
The 10K Club adopts a preventive and promotive health approach - a dollar used for prevention can save 60 dollars needed for treatment and management. The interventions adopted are based on the rationale that decline in child mortality rates is not necessarily dependent on the use of sophisticated and expensive technologies but rather on a holistic approach that combines the use of strategies that are cheap and can be made universally available and accessible to all. These interventions involve active involvement of family members and the community in the health care process.
1. Adequate antenatal Care for women
The care that a woman receives during pregnancy plays a major role in ensuring healthy outcomes for women and children. Women reporting at least four antenatal care visits are on average 3.3 times more likely than other women to give birth a with a skilled provider33
Under the 10K Club
- Women groups are formed in the community who meet regularly with pregnant women and inform them about benefits of iron folic acid consumption, Tetanus toxoid immunization and institutional delivery.
- Women's groups increase awareness of danger signs amongst pregnant women and assist in developing "birth preparedness" or "birth plans", which will prepare for emergencies and assist women and their families in ensuring that they have what they need for the birth.
2. Essential newborn care (community based extra care of babies with low birth weight and early and exclusive breastfeeding)
Kangaroo Mother Care
is the low cost, human technique for caring low birth weight babies by direct skin to contact with the mother
Kangaroo Mother Care shows early and good weight gain in low birth weight babies
. It is simple, low cost technique and well acceptable by mother and family and can be continued at home. Breastfeeding is the perfect way to provide the best food for a baby’s first six months of life worldwide. Immediate breastfeeding can decrease the risk of maternal hemorrhage and newborn hypoglycemia (low blood sugar). Besides this exclusive breastfeeding has a wide variety of proven health benefits for newborns, including improved cognitive development, reduced risk of infections, and better chances of survival. Optimal breastfeeding practices have the single greatest potential impact on child survival, with the potential to prevent 1.4 million under-5 deaths in the developing world (Lancet 2008
Under the 10K Club:
- Womens groups and community workers reinforce postnatal care and postnatal visits for women recently delivered.
- Women’s groups educate pregnant and lactating women on the benefits of skin to skin care (Kangaroo mother care) and breastfeeding.
- Outreach workers and women’s group promote exclusive and early breastfeeding and weaning foods during local celebrations like breastfeeding week, nutrition week in the community.
3. Complementary Infant feeding
Childhood under-nutrition remains a major health problem in resource-poor settings. Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under-nutrition. There is evidence that complementary feeding practices are generally poor in most developing countries, meaning that many children continue to be vulnerable to largely irreversible outcomes such as stunting and poor cognitive development, as well as to significantly increased risks of diseases like diarrhea and pneumonia.
Under the 10K Club:
- Efforts will be made to expand ICDS coverage in the marginalized slums by creating awareness about health and nutrition.
- Low cost nutritional recipes are taught in the community for undernourished children through community kitchens and working towards community based interventions to address all grades of under-nutrition.
4. Early identification, prevention and management of newborn and childhood illness
Illnesses such as diarrheal dehydration, acute respiratory infections, measles, malaria, and malnutrition can either be treated or prevented.4 Despite this, more than 25,000 under-five children die from these illnesses each day. Factors that contribute to illness are poor living conditions like lack of safe water supply, poor hygiene, overcrowding. The inability of parents to recognize danger signs and delay in seeking appropriate treatment contribute also to the high death rate. The problem is aggravated by the poor quality of care provided at the health facilities5
Under the 10K Club:
- Community based groups increase community awareness on Oral Re-hydration Solutions (ORS) as the most inexpensive, easily available, and effective treatment for diarrhoea.
- CBOs educate the community to recognize the symptoms of diarrhoea and Actue Respiratory Infection (ARI) for proper and timely treatment.
- Operational Interventions include promoting behaviour change of the community to follow appropriate child survival practices and building linkages with health facility.
- Seasonal migrants are contacted and given pictorial cards with optimal feeding / child care practices as well as hygiene behaviour, which they could refer to irrespective of their place of residence.
5. Complete Immunization
Immunization is one of the most cost effective public health interventions available. Yet, a large proportion of vulnerable infants and children in India are not receiving this simple intervention. States with poorer immunization rates are generally the same states with higher infant mortality. India also has the largest number of infants who reach their first birthday not fully immunized6
Under the 10K Club:
- Women's groups educate the community on common misconceptions including fever, swelling and sterility associated with vaccinations which need to be dispelled.
- Community health groups provide support in ensuring better logistics and coordination for increasing Public Health immunization coverage through outreach camps.
- Involvement of religious heads and community leaders in communicating the importance of timely and complete immunization is sought to increase demand and utilization.
6. Enhancing health seeking behavior
Majority of the mothers seek treatment for their newborns from private health providers. It is therefore essential that these professionals are regularly trained to update their technical knowledge to manage common childhood ailments and refer in case of complications.
Under the 10K Club:
- Periodic staff sensitization and motivation workshops are organized to ensure sympathetic treatment and good quality of care to the community.
- Linkages are established between existing public health staff, private doctors and pediatricians with specialists who could help in providing technical guidance and advice as required. This can be especially helpful in diagnosis and treatment of complications
- www.whoindia.org/en/Section6/Section415.htm last accessed on 10th January 2010
- Baseline surveys of Multi-centric Home based Intervention project of the Indian Council of Medical Research [ICMR]
- www.savethechildren.org last accessed on 10th January 2010
- Neonatal survival series 4 -Neonatal survival: a call for action Jose Martines, Vinod K Paul, Zulfiqar A Bhutta, Marjorie Koblinsky, Agnes Soucat, Neff Walker, Rajiv Bahl, Helga Fogstad, Anthony Costello, for the Lancet Neonatal Survival Steering Team*
- J. Nepal Paediatr. Soc. Vol 29, No. 1Kangaroo Mother Care for Low Birth Weight Babies: A prospective Observational Study ,Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal.