Phila Mntwana: Child Health Priorities in KZN

Dr Victoria MubaiwaKZN – DOHIsibalo 12/13 September 2013

What do we know already:

50% of under five year old die in the community with little or no contact with the health system.

Many of the deaths are attributable to preventable and treatable conditions that can be managed thru IMCI

Breastfeeding can reduce diarrhoea by up to 27% between the ages of 0-5 months

Hand-washing alone is associated with 35% reduction in diarrhoea Joint statement by the WHO and UNCEF: community-level

treatment of pneumonia can be carried out by well-trained and supervised community health workers

Strengthen the linkages between the health systems and the community

INTRODUCTION:

POPULATION DISTRIBUTION

0-4 years5-19 years20-24 years, and 30-34 years

10% 36% 9% 6.7%

KZN has a young population KZN second most populous province with

population of 10 Million 5.3 million people were living in poverty and 54% of the population living in rural areas

Children of KZNBirths

◦ 220,100◦ 20.3% of all births in RSA

U5 U15◦ No 1,198,180 3,276,121◦ Children in RSA 22.1% 22.1%◦ Population of KZN 11.8% 32.3%◦ Live in eThekwini 27.4% 26.4%

◦ U15 25.2% of pop of eThekwini44.3% of pop of Uthukela

Living conditions

Household size 4.0 people/Hhold Formal housing 71.6% Electricity 77.9% Access to piped H2O 85.9% Income pc R 20 762.00

Child headed Hhold 0.9%

Child mortality - KZN vs RSA

Province IMR U5MR % in Hosp

% SAM % HIV

CFR

GE ARI SAM

Eastern Cape 24.4 36.3 46.1 24.3 40.6 10.0 8.1 20.5

Free State 72.4 92.4 47.9 56.7 50.7 13.0 9.7 24.9

Gauteng 50.1 63.2 48.5 32.3 51.2 7.2 6.0 19.5

KwaZulu-Natal 37.2 49.7 62.0 33.8 54.9 7.0 4.8 13.1

Limpopo 32.9 48.9 45.8 38.1 57.1 9.5 10.4 22.9

Mpumalanga 36.5 62.2 50.6 29.8 44.4 12.3 10.1 17.6

Northern Cape 48.1 63.7 49.1 35.5 41 6.3 4.5 21.9

North West 48.4 63.1 39.7 60.6 49 8.2 7.5 18.7

Western Cape 23.4 28.2 49.3 22.6 28.4 0.5 0.3 4.8

                 

South Africa 38.1 50.7 50.0 33.7 47.8 7.3 6.5 18.3

Progress in reducing NNMR & U5MR

Lancet 2005; 365, 1891 - 900

In KZN ...

1 in 20 children die before their 5th birthdayOf these…

◦ 38% die outside the health service◦ 55% die in association with HIV◦ 33% have underlying severe malnutrition

Age distribution of under 5 deaths

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Global Practices & Lessons Learnt

With training and supportive supervision,

CCGs - deliver package of less complex maternal & child health and nutrition interventions

E.g. Vitamin A supplementation, antibiotics for community-based management of pneumonia, ORS/ORT/SSS for the management of diarrhoea, plus administration of deworming.

Global Practices & Lessons Learnt

Even with presumably weak health systems, Malawi, Mozambique, Madagascar, Ethiopia and Eritrea reduced child mortality significantly between 1990 and 2006.

Attributed to effective community-based delivery

of health and nutrition interventions through CCG programmes, home visits, child health days & community mobilisation

Aim

To Reduce morbidity and mortality from preventable conditions: HIV, Pneumonia, diarrhoea and malnutrition

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Objectives

To provide comprehensive prevention and health promotion package for children at community level.

To provide the community leadership and warroom members with a simple diagnosis of the status of the children in the community, so that corrective measures may be taken when necessary.

To monitor the Nutritional and Health Status of all Children under 5 years at community level on a monthly basis.

To ensure early identification of children with malnutrition, diarrhoea, TB and other health conditions as early as possible and to refer for health care.

To identify children who require referral for government To improve access to preventative health services: Growth

Monitoring; Oral rehydration, Breastfeeding and Immunization.

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Phila Mntwana CentreA simple structure

where basic health promotion and therapeutic services can be accessed by communities where formal curative services are not immediately available or accessible.

Location

The location of the “PHILA MNTWANA CENTRE” will be dependent on the decision by the local leadership as part of the OSS operations in the ward. The location will include but not limited to the following structures:

War rooms Early Childhood Development Centers (ECDs) Elderly Luncheon Clubs Any other point in the ward depending on the

catchment population under 5 years and the accessibility based on geographical size of the ward

N.B. Each “PHILA MNTWANA CENTRE” should be linked to a local PHC facility or mobile team

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Child Mortality: Growth Monitoring:

Mid Upper Arm Circumference (MUAC) Tape– early detection of underweight children or weighing where applicable

Effective recognition of sick / malnourished children in the community (OSS).

SASSA/ DOH/ DSD Cooperation on Malnutrition – referral of children with malnutrition for social relief intervention

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Child Mortality: Oral Rehydration • To prevent dehydration from diarrhoea, sugar/salt water solution is best for rehydration

• CCG have been trained to educate all mothers and care givers

CCGs also have ORS for rehydration prior

to referral

Breastfeeding

New Infant and Young Child Feeding (IYCF) in the Context of HIV Policy launched October 2010 – Full implementation 1 July 2011

• BREAST IS STILL BEST• Support for appropriate

infant and child feeding and nutritional counselling

• One-home-one garden

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wellness

Immunization EPI Screening and /or referral and other Health Services for

children under 5 years.  Wellness Vitamin A supplementation to children 12 – 59 months

administered 6 monthly. HIV counseling and referral. TB screening and/or referral. DSD (social worker) referral for further assessments and

intervention

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Home affairs

Department of Educati

on

SASSA and DSD

Various stakeholders

Agriculture: one home,

one garden

Community leadership

Operation Sukuma Sakhe‘Mbo’

TOOLS AND MATERIALS

latex glovesMid Upper Arm

Circumstance (MUAC) tapes

ORSHand soapVit AData tools

TOOLS AND MATERIALS

Monitoring and data management

Set of data elements already in the DHIS

Neonatal death Maternal death Children receiving neonatal carePatients receiving palliative care Children monitored for Growth Condoms Distributed Referrals for Family Planning Referrals for Antenatal Care Referrals for Postnatal Care Referrals to health facility Child beneficiaries seen Adult beneficiaries seen Vitamin A

data tool

Future PlansScale up – full coverage of warroomsRapid scale of Ward-based Family Health

TeamsContinuing development of CCGsOpportunities for additional interventional

services: Up and down referral system (being piloted)Continuing Quality Improvement

NGIYABONGA