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: /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. Essential newborn care:
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 CSSM RCH Aug 1992 1997 All MCH under one umbrella
-Client driven
-Decentralized
-Target free.
-Aimed at client satisfaction

38. CSSM v/s RCH CSSM RCH Package Child survival component:
Essential newborn care,Vit A
Immunization,Diarrhoea/ARI.
Safe motherhood:
Immunization,Anemia,ANC,
Institutional delivery,Spacing
CSSM + Family planning + RTIs & STDs

39. CSSM v/s RCH CSSM RCH Target population
Pregnants & children upto 5 years
Children, adolescents, eligible couples, expecting mothers.
Both men & women.

40. Thank you