IMNCH
IMNCH
IMNCH
PRESENTERS
Ogunleye Olushola
Olaitan U04MD1012
Iyalla Ada Joy
U04MD1021
Abubakar Magaji
U04MD1023
Mohammed Dauda
U04MD1039
Pindar Wakawa Yakubu
U04MD1056
Onyeacho David
Obiorah U04MD1063
OUTLINE
Overview of Maternal, Newborn
and Child Health; Situation
Analysis
Why we need an Integrated
Maternal, Newborn and Child
Health Strategy
IMNCH Strategy
Strategic Approaches, Objectives
and Organisation of Maternal,
Newborn and Child Health
Services
IMNCH Continuum of Care
Partnership for Maternal,
Newborn and Child Health
OVERVIEW OF
MATERNAL,
NEWBORN & CHILD
HEALTH
OGUNLEYE OLUSHOLA OLAITAN
U04MD1012
INTRODUCTION
Each year, millions of
women, newborns, and
children die from
preventable causes.
While the interventions
that could save their
lives are widely known,
PRESENT STATUS OF
MATERNAL & CHILD
HEALTH: WORLDWIDE
A look at the statistics worldwide
shows that each year:
More than 60 million women deliver at
home without skilled care.
About 530,000 women die from
pregnancy related complications, with
some 68,000 of those deaths resulting
from unsafe abortion.
About 4 million babies die within the
first month of life (the newborn
period), and more than 3 million die as
stillbirths.
PRESENT STATUS OF
MATERNAL & CHILD
HEALTH: NIGERIA
NIGERIAS GLOBAL
RANKING
NIGERIAS RANKING IN
AFRICA
MILLENNIUM
DEVELOPMENT GOALS
(MDGs)
Problems with
Achievement of the
MDGs in Nigeria
SITUATION ANALYSIS:
MORBIDITY AND
MORTALITY PATTERNS
MATERNAL MORBIDITY
AND MORTALITY
The maternal mortality
ratio in Nigeria is
estimated to be
800/100,000 live
births. NE:
1,549/100,000 live
births; SW:
165/100,000 live births
compared to 48 per
1000 births as
indicated by NDHS
2003.
The highest neonatal
rates were also
observed in the NE
and NW zones of the
country. The lowest
rates were seen in the
SE zone.
CHILDREN UNDER FIVE
YEARS
KEY DETERMINANTS OF
MATERNAL, NEWBORN AND
CHILD MORTALITY
Inadequate coverage and low
quality of essential obstetric
care.
Access:
Socio-cultural factors:
WHY WE NEED AN
INTEGRATED
MATERNAL
NEWBORN AND
CHILD HEALTH
STRATEGY
obstetric or neonatal
emergencies.
In addition, the
socioeconomic and the
long term health
status of the mother
contributes
significantly to the
mortality and
morbidity of mothers
and their children.
Maternal and neonatal
mortality are often the
result of a badly
managed pregnancy
and home delivery
without a skilled birth
attendant.
The Integrated
Maternal, Newborn and
Child Health Strategy
involves the
reorganization and
reorientation of the
health system to
ensure the delivery of
a set of essential
interventions which
will provide a
continuum of care for
women, neonates and
children.
In conclusion,
integrating maternal
newborn and child
healthcare services
provides an
opportunity for the
health sector to
eliminate unhelpful
dichotomies that stifle
funding and lead to
confusion and
ultimately cost lives.
IMNCH STRATEGY
ABUBAKAR MAGAJI
U04MD1024
IMNC STRATEGY
Vision and Mission
Goals, Target And
Indicators
Analysis of Selection of
Intervention
Mission
To deliver integrated
high-impact and cost
effective maternal,
newborn and child
health interventions at
high population
coverage to achieve
the MDG 4 and 5
Goals
To reduce maternal,
neonatal and child
morbidity and
birth in 1990 to
77/1000 in 2015
Indicators
Maternal mortality
ratio
Proportion of birth
assisted by skilled
birth attendants
Contraceptive
prevalence rate
Under 5 mortality rate
Infant mortality rate
Multisectoral
collaboration
Contributions from
other sectors will help
in achieving health
development issues
6. Partnership
Emphasis on
developing new
partnerships and
strengthening existing
ones to ensure that
MN & CH interventions
Packages of
intervention for family
and community
A. Family preventive/
WASH services like
Contd
B. Family neonatal
care
Clean delivery and
cord care
Putting to breast
within 30mins of
delivery
Universal extra
community based
care of low birth
weight infants/ referral
for very low birth
weight
Infant and child feeding
Exclusive
breastfeeding for
children 0 6 months
Continued
breastfeeding for
children btw 6 23
months
Adequate
complementary
feeding from 6 months
Supplementary
feeding with
moderately
malnourished
children(<2SD)
Contd
D.
Community
management of illness
Oral rehydration
therapy
Zinc for diarrhoea
management
Vit A treatment of
measles
Anti malaria treatment
2. Population oriented
key interventions
A Preventive
healthcare for
adolescent and adult
Family planning
B - Preventive
healthcare during
delivery
Antenatal care
Tetanus immunization
Deworming in pregnancy
Detection and treatment of
asymptomatic bacteriuria
Contd
C
HIV/AIDS
prevention and care
Voluntary confidential testing
and counselling (VCCT) and
treatment with Nevirapine
Infant feeding counselling
Condom use
Contd
D. Preventive
healthcare for infants
Measles vaccine
BCG vaccine
TT vaccine
OPV vaccine DPT vaccine
HBV vaccine
Vit A- supplementation
ITN for <5 through NPI
3. Intervention at
health facility level
Detection and
management of
preeclampsia (MgS04)
Management of
neonattal infection at
PHC level.
Intervention cont
B. Management of
illnesses at primary
clinical level.
Antibiotics for
pneumonia
Antibiotics for
diarrhoea and enteric
fever
Vit A. treatment for
measles
Zinc for diarrhoea mgt
Oral rehydration
therapy for diarrhoea
management.
Artemisinin based
combination therapy
for children.
Artemisini based
combination therapy
for pregnant women
Combination therapy
for mother and infants
for PMTCT
HIV treatment of
mothers and children
with ARDs
Intervention cont
C.
Clinical first
Referral illness mgt.
Comprehensive
emergency obs and
neonatal care
Other emergency
acute care
Mgt of complicated
AIDS.
STRATEGIC APPROACHES,
OBJECTIVES AND
ORGANISATION OF
MATERIAL, NEWBORN
AND CHILD HEALTH
SERVICES
Mohammed Dauda
U04MD1039
STRATEGIC APPROACHES,
OBJECTIVES AND
ORGANISATION OF
MATERIAL, NEWBORN AND
CHILD HEALTH SERVICES
A- STRATEGIC APPROACHES
1.ADVOCACY
2. STRENGETHING OF THE HEALTH SYSTEM
3.EMPOWERING FAMILIES AND COMMUNITIES
4.ORGANISING OPERATIONAL PARTNERSHIPS
5.MOBILIZATION OF RESOURCES
B-STRATEGIC OBJECTIVES
I
PRIORITY ACTIONS
PRIORITY ACTIONS
Institute and support community education on
MNCH issues.
V. ESTABLISH A FINANCING
MECHANISM THAT ENSURES
ADEQUATE FUNDING,
AFFORDABILITY, EQUITY, AND
VI .STRENGTHEN
SUPERVISION, MONITORING
AND EVALUATION SYSTEM TO
REPORT ON PROGRESS
TOWARDS ACHIEVING MCH
MDGS
PRIORITY ACTIONS
PRIORITY ACTIONS
Conduct advocacy at all levels to promote
partnership for IMNCH.
Establish the national partnership for MNCH.
C .ORGANISATION OF
MATERNAL, NEWBORN AND
CHILD HEALTH SERVICES
-At local government level
A. Role of household and community
.Ensure the health of the mother, newborn and
child.
. Address the element of self care.
B. Role of PHC
. Focused ANC, PMTCT, early diseases detentions
and treatment.
.Early detention and timely referral of
complications in pregnancy.
. Normal delivery .
.Postnatal care for mother and newborn.
. Early initiation of exclusive breastfeeding,
continued breastfeeding with timely complimentary
feeding.
.Full immunization and growth monitoring
At state levels
Role of secondary health care facility
. Offers comprehensive emergency Obs and
newborn care.
. Surgical procedures, including CS.
. Safe blood transfusion.
. Assisted vaginal delivery.
At National Level
.FMOH and its agencies are to step up their
stewardship role to improve service coverage
and quality
. National PHC fund will play a role in making
increased revenue available for IMNCH
implementation.
IMNCH CONTINUUM OF
CARE
PINDAR WAKAWA
YAKUBU
U04MD1056
Definition
This is the core
principle which
underpins the IMNCH
strategy to save
mothers,neonates and
children whose lives
and health care needs
are intrinsically related
It has two
dimensions:
It connects essential
MNCH interventions
throughout
adolescence,pregnanc
y,child
birth,postnatal,newbor
n periods & into
childhood
It is also a seamless
linkage btw the
family,community &
Intrapartum care
Priority interventions
include:
Skilled birth
attendance
Supportive care &
pain relief
Monitoring the
progress of labour with
a partograph
rd
Active mgt of 3 stage
of labour neonatal
resuscitation
Detection of
complications &
treatment
Infection prevention
Advice on danger
signs
Identification & mgt of
low birth weight babies
Newborn care
Neonatal
interventions that
need to be scaled up
will include:
the neonate
warm,hygienic cord
e.t.c
Timely & appropriate
care-seeking for
infections &
monitoring of low
birth-weightinfants
Water sanitation and
hygiene
Targeted at mothers &
primary care-givers
Low-cost water
treatment methods
Construction of
laterines(VIP) & safe
disposal of excreta
Promotion of Hand
washing;bf
preparing/eating
food,after
defaecation,after
cleaning up a faecessoiled infant
Prevention of malaria
Use of insecticide
treated nets(ITNs)
Intermittent preventive
treatment of
malaria(IPT)
Modalities include;
Free or subsidized ITN
distribution on a
regular basis
Integrating ITN &IPT
into the National
programme on
immunization, ANC,
IMCH.
Infant and young child
feeding(IYCF)
Exclusive breastfeeding in the first six
months of life
Adequate
micronutrient intake
Integration of IYCF
with other child health
services;
Baby friendly
initiatives
Growth monitoring &
promotion
Institutionalizing
routine immunization
Provision of tetanus
toxoid to pregnant
women in ANC
Childhood
immunization at
community &PHC
facilities
ANC,nutrition
programmes,reproduct
ive health services
Modalities;
VCT
Antiretroviral
prophylaxis treatment
Counseling on infant
feeding options
Family planning
Mgt of common
childhood illnesses &
care of HIV-exposed
children
Integrated mgt of
childhood
illnesses(IMCI)
addresses common
childhood illnesses in
an holistic manner.
Modalities;
Oral rehydration
therapy
Zinc supplementation
in the mgt of diarrhoea
& pneumonia
Effective & antibiotic
treatment of
pneumonia,dysentry &
neonatal infections
prompt & effective
treatment of malaria
Cotrimoxazole to HIV
exposed & HIV-positive
children
Repositioning family
planning
Family planning could
reduce maternal
mortality by 20%
2yrs birth interval
increases infants
survival 2x
It is one of the
fundamental pillars of
safe motherhood
Repositioning FP
entails;
Provision of
equipments
Building consensus
among
stakeholders(religious
leaders & men),
Addressing the family
planning needs of
vulnerable
populations-young
people, displaced
persons, refugees in
war/conflicts
Sustained financing
Rolling out the IMNCH
strategy
IMNCH strategy is not
another vertical
programme, but a
strategy to integrate
an existing range of
interventions to;
Improve the use of
resources
Expand health care
coverage
Onyeacho David
Obiorah
U04md1063
The partnership
To mobilize
&maximize the use of
resources.
To promote synergies
& avoid duplication of
interventions.
Stakeholders
Governments
International
Agencies:
USAID,UNAIDS,UNFPA,
UNICEF,
Existing interventions
are effective
The existing packages
of interventions for
reduction of newborn,
child mortality &
improving maternal
health are proven to
be practicable and
cost-effective only if
they can be expanded
and religiously
implemented:
Contd
Ensuring access to
voluntary family
planning could reduce
maternal deaths by
20-35%; & child
mortality by 20%.
Skilled attendance
during delivery would
reduce maternal
deaths by about 75%.
Exclusive
breastfeeding up to 6
Dept. of hospital
services.
Dept of food & drugs
National AIDS & STI
control programme
National malaria
control programme.
Family health division
NAFDAC
NPHCDA
NACA
NPC
Nat. planning comm.
Medical institutions
Line ministries:
education
women affairs
infom. &
comm.
transport. Etc.
National partners
contd
Private Sector:
Banks
Industries
NGOs: CHAN, FOMWAN
International Devpt.
Partners:
WHO
UNICEF
DFID/PATHS
USAID
UNFPA
WORLD BANK
CONCLUSION
only a focused and
coordinated effort
by all
stakeholders can
bring
change to the
health of
our mothers,
newborns
and children in
their
remotest areas
REFERENCES
Federal Ministry of Health, Nigeria. The
Maternal Newborn Roadmap, 2005.
Federal Bureau of Statistics: Nigerian
Demographic Health Survey, 1999.
Nigerian Demographic and Health Survey,
2003 (National Population Commission and
ORC Macro, Calverton, MD, 2004).