Intensified Diarrhoea Control Fortnight(IDCF)

Background

Childhood diarrhoea continues to be a major killer among under-five children, contributing to 10 percent of all under-five deaths i.e. around 1 lakhs deaths every year in the country. Diarrhoeal deaths are usually clustered in summer and monsoon months and the worst affected are children from poor socioeconomic situations. Lives of under-five children can be saved by preventing and treating dehydration, using ORS (Oral Rehydration Salts) and administration of Zinc tablets along with adequate nutritional intake by the child during diarrhoea.

The objective of IDCF is to ensure high coverage of ORS and Zinc use in under-five children with diarrhoea , inculcating appropriate behaviour in parents and care givers for diarrhoea prevention and management and to ensure management of childhood diarrhoea cases at community and facility level as per standard treatment protocol.

Brief Note

Intensified Diarrhoea Control Fortnight (IDCF) consists of a set of activities to be implemented in an intensified manner during the fortnight for prevention and control of deaths due to diarrhoea across all States & UTs.  IDCF   focusses  on delivery of simple proven interventions that have large impact towards control of childhood diarrhoeal morbidity and mortality. These activities mainly include intensification of advocacy & awareness generation activities for diarrhoea management, strengthening service provision for diarrhoea case management, establishment of ORS-Zinc corners, prepositioning of ORS by ASHA in households with under-five children and awareness generation activities for hygiene and sanitation. The overall objective of IDCF is to ensure high coverage of ORS and Zinc use rates in children with diarrhoea throughout the country with emphasis on the high priority areas and vulnerable communities, along with inculcating appropriate behaviour in care givers of under-five children for diarrhoea prevention & management.

The IDCF strategy is three folds, as below:

1) Improved availability and use of ORS and Zinc at households

2) Facility level strengthening to manage cases of dehydration

3) Enhanced advocacy and communication on prevention and control of diarrhoea through IEC campaign.

At Community level  there is distribution of ORS to households (pre-positioning) and counselling by ASHA , IPC activities by ANM on hygiene and sanitation along with management of diarrhoea, handwashing demonstration in schools, out-reach sessions, VHNSDs and AWCs and mobile health teams for urban areas and hard to reach terrains.

     At health facility level there is establishment of ORS and Zinc corners for treatment of diarrhoea, promotion of  standard case management of diarrhoeal cases

Bihar has adopted special strategy for conducting IDCF with the help of UNICEF to make the round successful even amidst COVID 19 pandemic . It includes the following key activities 

Home Based Care for Young Child (HBYC)

Background

This is a Joint initiative of Ministry of Health and Family Welfare and Ministry of Women and Child Development. Under National Health Mission, Home-Based Care for Young Child Programme (HBYC) is rolled out as an extension of the Home Based New Born Care programme (HBNC) which is currently implemented across the country. Under HBNC, home visits by ASHAs to the infants ends at 42nd day after birth and there exists a gap in the household contact of ASHAs with the child beyond this period except the ones for immunization.

Addressing this gap in health system contact is crucial. Therefore, additional home visits by ASHAs between 3rd and 15th months were proposed under HBYC to fill this gap.

Under Home Based Care of Young Child (HBYC) programme, the additional five home visits will be carried out by ASHA/AWW, from 2-3 month onward ASHAs/AWWs will provide quarterly home visits (3rd, 6th, 9th, 12th and 15th month). The quarterly home visits schedule for low birth weight babies, SNCU & NRC discharges will now be harmonized with the new HBYC schedule.

Goals of the Program

1. Promoting good CHILD NUTRITION by appropriate infant and young child feeding practices.

a. Early initiation of breast feeding within one hour of birth,

b. Exclusive breast feeding for the first 6 months of life,

c. Appropriate and adequate complementary feeding from 6 months of age with continuation of breastfeeding.

2. Ensuring age appropriate immunization.

3. Ensuring optimal early childhood development.

4. Ensuring reduction in child morbidity and mortality by appropriate health care seeking behaviour.

The purpose of the additional home visits by ASHAs/AWWs are promotion of evidence based interventions delivered in four key domains namely nutrition, health, child development and WASH (water, sanitation & hygiene).

HBYC program has been rolled out in 13 aspirational districts in Bihar . So far 12421 ASHAs have been  trained in total 30367 ASHAs and 911 ASHA Facilitators have been trained out of 1455 ASHA Facilitators in 44 batches. 

Integrated Action for Prevention of Pneumonia & Diarrhea (IAPPD)

Pneumonia and diarrhoea are the two major causes of under-five deaths. To address this, community health workers are trained on detection of pneumonia by counting respiration and on assessment of dehydration in case of a child suffering from diarrhea. 

Goals

• Capacity building of district level officials. 

• To ensure skills of the frontline workers on counselling, identification of danger signs and community management.

• To increase awareness on prevention of Pneumonia & diarrhoea and use of ORS and zinc for childhood diarrhoea. 

National Deworming Day(NDD)

National Deworming Day(NDD) programme is implemented by Department of Health, Government of Biharwith an objective of making  every child in the state worm-free. It is one of the largest public health programmewhich reaches to aged children 1-19 years in the state, through a network of schools and anganwadis.

Background

More than 836 million (83.6 crore) children are at-risk of parasitic worm infectionsalso known as Soil-Transmitted Helminths (STH), worldwide. According to the World Health Organization (WHO) 241 million (24.1 crore) children and adolescents between the ages of 1 and 14 years  are at-risk of parasitic worms in India.

There is evidence of the detrimental effectsof STH on children’s educational performance andschool attendance, including impacting nutrientuptake that leads to anemia, malnourishment,and impaired mental and physical development . Children with the highest intensity of STH infestation are often too sick or too tired to concentrate at school or attend school at all.School and anganwadi-based programme comprising deworming, improvement of water and sanitation, and health education can reduce the transmission of STH infections and prevent the development of associated morbidity. 

Periodic deworming of school-age children also provides an important contribution to the achievement of UN Sustainable Development Goals (SDGs), in particular, Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture, and Goal 3: Ensure healthy lives and promote well-being for all at all ages.

Brief Note

Bihar is a pioneer state in the country that started implementing the deworming programme from 2011.With the instituting of NDD Programme by the Government of India (GoI) in 2015, Bihar conducts bi-annual round of deworming every year i.e. first round in February and second round in August.The programmeaimsto deworm pre-school and school-age children and adolescents(enrolled and non-enrolled) between the ages of 1-19 years through the platform of schools and Anganwadi Centers in order to improve their overall health, nutritional status, access to education and quality of life.

The deworming drug, Albendazole (400 mg) is administered to target population on the NDD and mop-up day. Albendazole is effective, inexpensive and easy to administer drug recommend by the WHO. 

Albendazole is administered to target population by anganwadi workers and teachers in AWCs and schools, respectively. Teachers, Anganwadi workers and ASHAs  are trainedon the program components before each round of deworming. The awareness campaign messaging focusses on the importance and benefits of deworming, as well as prevention strategies related to improved behaviors and practices for hygiene and sanitation.  Platforms like mass media (newspaper, TV, radios), posters/hoardings/handouts, social media are used as tools for programme information dissemination. Bihar is working strategically to further increase programme outreach for maximum number of children and adolescents. Various awareness activities (media mix) are implemented to increase participation of private schools, technical institute (ITIs, children below 19 years of age enrolled in intermediate or degree colleges) and out-of-school children to maximize deworming benefits for all children aged 1 to 19 years.

Key stakeholders:

The department of Health is the nodal agency for implementation of National Deworming Day (NDD). The programme is \implemented in collaboration with the combined efforts of different state departments namely Social Welfare (ICDS), Education Dt, ,Panchayati, Bihar Rural Livelihoods Promotion Society (BRLPS) and thePulicHealth and Education Department(PHED).

Nutrition Rehabilitation Centre (NRC)

Background

Bihar is one of the high priority state with 8.8% children with severe wasting (weight for height ≤3 SD) which accounts to around 14 lakh children as per NFHS-5 Report.  As per epidemiological data bout 10% are likely to develop complications due to infection of various kind. There children need urgent support to get treated without which there is ahigh chance of mortality and morbidity. It is estimated that the death among children with SAM have about 11 times more than the child with normal nutrition status. Therefore, it is a critical intervention to evade child mortality and morbidity.  

• Nutrition Rehabilitation Center (NRC) is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Besides treatment, there is provision of diet in the NRC for the SAM child and his/her mother along with loss of wages for family during stay at the facility. Mothers are also trained on preparation of nutritious food and maintenance of hygiene during child feeding. Moreover, for sensory stimulation of children, there is provision of indoor & outdoor games and audio-visual aids in the facility.

• Detection of SAM children is generally done by Anganwadi workers at Anganwadi Centres. In addition to this, they are also being detected at VHND sessions by Rashtriya Bal Swasthya Karyakram (RBSK) team. 

• Once discharged from the NRC, the child continues to be in the Nutrition Rehabilitation program at community level till she/he attains the defined discharge criteria from the program. 

• In addition to curative care, special focus is given on timely, adequate and appropriate feeding for children; and on improving the skills of mothers and caregivers on complete age appropriate caring and feeding practices. In addition, efforts are made to build the capacity of others/caregivers through counselling and support to identify the nutrition and health problems in their child.

Objective of NRC:

• To provide clinical management and reduce mortality among children with severe acute malnutrition, particularly among those with medical complications.

• To promote physical and psychosocial growth of children with severe acute malnutrition (SAM).

• To build the capacity of mothers and other care givers in appropriate feeding and caring practices for infants and young children 

• To identify the social factors that contributed to the child slipping into severe acute malnutrition.

Brief Note

Since the year 2011-12 the NRCs were established at the state following Govt of India Guideline. Currently, there are 41 Number of NRCs are functioning in the state, out of which 38 are of 20 beded capacity located either at District Hospital or SDH,PHC Or CHC. Remaining 3 NRCs are located at Medical College Hospital premises of PMCH, NMCH & DMCH. There is also provision of 13 more 10 beded NRCs at different Medical Colleges and districts with high case load. The state has established a Centre of Excellence at PMCH, Patna to demonstrate the best practices, monitor and build capacity of all NRCs at state. 

The NRC is equipped with trained manpower such as Pediatrician, Nutritional Counselor, Nursing staff, Community Based Care Extender and support staff. The 

4. Guideline: (GoI Guideline on NRC Attached)

a. Front side flip book

b. NRC Guideline- MOHFW

c. NRC toolkit Back Side hindi

Admission Criteria:

SAM: WFH < -3SD/ and /or severe visible wasting and / or bilateral pedal oedema and /or MUAC < 15 mm WITH Medical complications (any one) -

• Poor appetite

• Visible severe wasting

• Oedema of both feet

• Severe palmar pallor

• Any sick young infant (<2 months old)

• Lethargy, drowsiness, unconsciousness

• Continually irritable and restless

• Any respiratory distress

• Signs suggesting severe dehydration in a child with diarrhoea

Screening and Referral:

Frontline community workers (AWW, ASHA, ANM) can identify children with SAM by using simple mid upper arm circumference (MUAC) tape. They should also be able to recognise nutritional oedema of the feet, which is another sign of this condition. Regular growth monitoring at the Anganwadi centre or during Village Health and Nutrition Day is an opportunity for active case finding.a

Once identified, these children with SAM need further assessment to determine if they require referral to health facility and facility based care or whether they can be managed at community level with visits as outpatients to a health centre or facility. 

Besides active case finding in the community (through regular growth monitoring at AWC or during VHND) all possible contact opportunities with children should be exploited including home visits, immunisation outreach sessions, visit to sub centres and all levels of health facilities. Assessing the nutrition status of all sick children presenting to health facility should be emphasized and wherever possible, included in physical examination guidelines/formats.

The Medical officer at Paediatic OPD can assess the nutrition status and medical complication to refer the child to NRC.

Once identified, the FLW to support the family for referral transport using 108 Ambulance service. 

Facility for child and caretaker/mother at NRC:

There is provision for theuraptic food and treatment for the child at the centre. The mother /caretaker also provided with food and financial assistance for loss of wage. Along with feed, the child id provided with sensory stimulation with indoor and outdoor game 

Events / News of the scheme :

“POSHAN MAHA” 1-30 September 2021