In India, an estimated 26 millions of children are born every year. As per census 2011, the share of Children (0-6 years) accounts 13% of the total population in the country. An estimated 15.5 lakhs children die every year before completing 5 years of age. However, 79% of under-five child mortality takes place within one year of the birth which accounts nearly 11.6 lakhs infant deaths whereas 56% of under-five deaths take place within first one month of life accounts 8.7 lakhs neo-natal deaths every year in the country.

As a part of UN Millennium Development Goals; India is committed to reduce child mortality by 2/3rd of 1990 by year 2015. India had Infant Mortality Rate of 80 per 1000 live births in 1990 and MDG is 28. IMR has declined by 12 points in the decade 1990-2000. Thus, showing about 15% decline in IMR during the decade 1990-2000 and during 2000-1005. However, IMR decline has accelerated by 4% annually during the NHM period and thus 24% decline from 2005 to 2011. At present, IMR stands at 44 per 1000 live births. On the other hand, rural-urban differential of IMR was observed to be very wide before the NHM period. This gap has narrowed down during the period of 2005 to 2011 from 24 to 19 due to intensive programs aimed at rural populations.

Under five-mortality rate is 55 per thousand live births (SRS 2011), showing a 19 point decline since 2005-06 (NFHS III). A 14 point decline was observed in just three years between 2008 and 2011. Neonatal Mortality Rate is 31 per thousand live births (SRS 2011), showing a slow decline of 6 point since 2005.Child Health strategies under RCH II/NHM are designed to achieve the goals and objectives for child survival committed in NHM, the XIth Plan and Millennium Summit (MDGs). The Reproductive and Child Health programme (RCH) II under the National Rural Health Mission (NHM) comprehensively integrates interventions that promote child health and addresses factors contributing to Infant and Under-Five Mortality.

Child Health Goal under RCH II/NHM

Child Health Indicator

Current status

RCH II/NHM 2010/2012

MDG 2015

IMR (Infant Mortality Rate)

44(SRS 2011)

<30

28

Neonatal Mortality rate

31 (SRS 2011)

<20

--

Under 5Mortality Rate

55( SRS 2011)

 

<38

Source: Sample Registration System (SRS) 2011

Causes of Child Mortality in India

As per WHO 2012 estimates, the causes of Child Mortality in the age group 0-5 years in India are (a) Neonatal causes (52%), (b) Pneumonia (15%), (c) Diarrhoeal disease (11%), (d) Measles (3%), (e) Injuries (4%) and (f) others (15%). However, The major causes of neonatal deaths are Infections (16%) such as Pneumonia, Septicemia and Umbilical Cord infection; Prematurity (18%) i.e birth of newborn before 37 weeks of gestation and Asphyxia (10%) i.e. inability to breathe immediately after birth and leads to lack of oxygen.

Thrust area under Child Health programme

Thrust Area 1 : Neonatal Health

  • Essential new born care (at every ‘delivery’ point at time of birth)
  • Facility based sick newborn care (at FRUs & District Hospitals)
  • Home Based Newborn Care

Thrust Area 2 : Nutrition

  • Promotion of optimal Infant and Young Child Feeding Practices
  • Micronutrient supplementation (Vitamin A, Iron Folic Acid)
  • Management of children with severe acute malnutrition

Thrust Area 3: Management of Common Child hood illnesses

  • Management of Childhood Diarrhoeal Diseases & Acute Respiratory Infections

Thrust Area 4: Immunisation

  • Intensification of Routine Immunisation
  • Eliminating Measles and Japanese Encephalitis related deaths
  • Polio Eradication

The strategies for child health intervention focus on improving skills of the health care workers, strengthening the health care infrastructure and involvement of the community through behaviour change communication.

 

Schemes

 

Facility Based Newborn and Child Care :

Neonatal mortality is one of the major contributors (2/3) to the Infant Mortality. To address the issues of higher neonatal and early neonatal mortality, facility based newborn care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust area under NHM.

Special Newborn Care Units (SNCU)

  • States have been asked to set up at least one SNCU in each district. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services.

Newborn Stabilization units (NBSUs)

  • NBSUs are established at community health centres /FRUs. These are 4 bedded units with trained doctors and nurses for stabilization of sick newborns.

New Born Care Corners (NBCCs)

  • These are 1 bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.

A comprehensive “Facility Based Newborn Care Operational Guide- 2011, a guideline for planning and Implementation” have been published and disseminated in 2011 by Child Health Division, MoHFW, GOI to act as reference tool for the states to take necessary steps in implementation of same.

Janani Shishu Suraksha Karyakram (JSSK)

Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011and has provision for both pregnant women and sick new born till 30 days after birth are (1) Free and zero expense treatment, (2) Free drugs and consumables, (3) Free diagnostics & Diet, (4) Free provision of blood, (5) Free transport from home to health institutions, (6) Free transport between facilities in case of referral, (7) Drop back from institutions to home, (8) Exemption from all kinds of user charges.

The initiative would further promote institutional delivery, eliminate out of pocket expenses which act as a barrier to seeking institutional care for mothers and sick new borns and facilitate prompt referral through free transport.

Facility Based Integrated Management of Neonatal and Childhood Illness
(F- IMNCI)

F-IMNCI is the integration of the Facility based Care package with the IMNCI package, to empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as at the facility. Facility based IMNCI focuses on providing appropriate skills for inpatient management of major causes of Neonatal and Childhood mortality such as asphyxia, sepsis, low birth weight and pneumonia, diarrhea, malaria, meningitis, severe malnutrition in children. This training is being imparted to Medical officers, Staff nurses and ANMs at CHC/FRUs and 24x7 PHCs where deliveries are taking place. The training is for 11 days.

Integrated Management of Neonatal & Childhood Illnesses (IMNCI)

which includes Pre-service and In-service training of providers, improving health systems (e.g. facility up-gradation, availability of logistics, referral systems), Community and Family level care.

Home Based New Born Care (HBNC):

A new scheme has been launched to incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration, amounting to a total of Rs. 250 for five visits. This would be paid at one time after 45 days of delivery, subject to the following :

  • recording of weight of the newborn in MCP card
  • ensuring BCG , 1st dose of OPV and DPT vaccination
  • both the mother and the newborn are safe till 42 days of the delivery, and
  • registration of birth has been done

A comprehensive “Home Based Newborn Care Operational Guideline- 2011” has been developed, published and disseminated in 2011 by Child Health Division, MoHFW, GOI to provide framework and guidance to enable a coherent home based new born care strategy and act a reference tool for the states to plan necessary interventions.

Navjat Shishu Suraksha Karyakram(NSSK)

NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have a trained health personal in Basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.

Infant and Young Child Feeding:

Infant and Young Child Feeding is the single most preventive intervention for child survival. It advocates the following:-

  • Early initiation (within one hour of birth) and exclusive breast feeding till 6 months.
  • Timely complementary feeding after 6 months with continued breast feeding till the age of 2 yrs.

 

 

Comparison of indicators of child feeding practices :

Indicators

CES (2009)

DLHS-3 (2007-08)

NFHS-3 (2005-06)

Children under three years breastfed within an hour of birth

33.5%

40.2%

24.5%

Children 0-5 months exclusively breastfed

56.8%

46.4%

46.3%

Children age 6-35 months breastfed for at least 6 months

--

24.9%

--

Nutritional Rehabilitation Centres (NRC)

(treat severe acute malnutrition amongst children)

Severe Acute Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhoea and pneumonia. Deaths amongst SAM children are preventable, provided timely and appropriate actions are taken.

  • Nutritional Rehabilitation Centres (NRCs) are being set up in the health facilities for inpatient management of severely malnourished children, with counselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow up.

An “Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition-2011” has been published and disseminated in 2011 by Child Health Division, MoHFW,

Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases :

Promotion of zinc and ORS supplies is ensured.

Childhood Diarrhoea

In order to control Diarrrhoeal diseases Government of India has adopted the WHO guidelines on Diarrhoea management.

  • India introduced the low osmolarity Oral Rehydration Solution (ORS), as recommended by WHO for the management of diarrhea.
  • Zinc has been approved as an adjunct to ORS for the management of diarrhea. Addition of Zinc would result in reduction of the number and severity of episodes and the duration of diarrhoea.
  • New guidelines on management of diarrhoea have been modified based on the latest available scientific evidence.

Acute Respiratory Infections

  • Acute Respiratory Infections forms 19 % of all under five mortalities in India (WHO 2007 report) and along with Diarrhoea are two major killers of under five children.
  • India leads the world in the number of pneumonia cases with nearly 44, 00, 000 cases yearly. Early diagnosis and appropriate case management by rational use of antibiotics remains one of the most effective interventions to prevent deaths due to pneumonia. The ARI guidelines are being revised with the inclusion of the latest available global evidence.

Supplementation with micronutrients :

Supplementation with micronutrients through supplies of Vitamin A & iron supplements.

Vitamin – A

  • The policy has been revised with the objective of decreasing the prevalence of Vitamin A deficiency to levels below 0.5%, the strategy being implemented is:
    • 1,00,000 IU dose of Vitamin A is being given at nine months
    • Vitamin A dose of 2,00,000 IU (after 9 months) at six monthly intervals up to five years of age
    • All cases of severe malnutrition to be given one additional dose of Vitamin A.

Coverage with Vitamin A

CES (2009)

DLHS-3 (2007-08)

NFHS-3 (2005-06)

Children 9 months and above who have received at least one dose of Vitamin A

65.4 %

55.0%

24.8%

Iron and Folic Acid supplementation

  • To manage the widespread prevalence of anaemia in the country, the policy has been revised.
  • Infants from the age of 6 months onwards up to the age of five years shall receive iron supplements in liquid formulation in doses of 20mg elemental iron and 100mcg folic acid per day per child for 100 days in a year.
  • Children 6-10 years of age shall receive iron in the dosage of 30 mg elemental iron and 250mcg folic acid for 100 days in a year.
  • Children above this age group would receive iron supplements in the adult dose