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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
INTRODUCTION
In Nigeria today , one out of every 5 Children die before their 5th birthday; and 70% of these death are due to one or a combination of six major diseases ( Malaria, ARI especially pneumonia, diarrhea, measles, malnutrition and increasingly HIV/AIDs and neonatal condition addressed by the Integrated Management of Childhood Illness ( IMCI ) strategy.
IMCI Strategy:
• An approach (integrated) to managing major killer diseases in children in a holistic manner (developed by WHO &UNICEF)
• It prepares first level health workers to use simple signs, symptoms and simple drug formulation, to identify, treat and refer sick children.
• It also promotes good health and management of common children illnesses at home and in the community.
Objective of IMCI
• To contribute to the reduction of morbidity and mortality associated with these disease conditions
• To promote healthy growth and development of under-five children.
IMCI is a key evidence based integrated strategy to deliver the high impact child survival intervention of the IMNCH strategy.
Components of IMCI
In order to achieve the stated objectives, IMCI has 3 components or intervention areas namely:
1. Improving health worker skills.
2. Improving the Health system to support IMCI
3. Improving key family and community practices ( KHHPs)
Status of IMCI Strategy in the State
Active monitoring of Child welfare Clinics at all the PHCs in the State showed that a lot work needs to be done on all components of IMCI strategies.
We are currently training Health workers from different PHCs in different LGAs/LCDAs twice yearly. The six days training of sixty (60) health workers from PHCs in PATH2 supported LGAs/LCDAs at Hello Lagos in Lagos State University Teaching Hospital (LASUTH) held between 26th to 31st January,2015
Trainings on IMCI carried out since 2011-2015
YEAR LGAs/LCDAs NUMBER OF PARTICIPANTS
5TH -10TH December 2011 Alimosho (LGA) Ayobo Ipaja, Mosan Okunola,Igando-ikotun LCDAs 9
15th -19th December 2011
Community IMCI Agbowa Ward 30
23rd -28th April 2012 Ikeja,kosofe 23
17th -20th July 2012 Oworo ward of Koshofe 30
13th-18th January 2013 Epe , Eredo, Ibeju lekki, 28

27th January-1st Feb 2014 Badagry, Badagry West, Olrunda,Otto Awori, 60
17th -22nd February 2014 Alimosho 37
26th -31st January,2015 Amuwo-Odofin, ikorodu,kosofe, Ifako-Ijaye, Agege, Alimosho. 60
24th & 25th February, 2015 LSDPC,Magodo 350
1st-10th April,2015 LCCIC,Olowopopo 125
15th June, 2105 LCCIC,Olowopopo 350
10th-15th August,2015 Ikeja 24
Training of 2 batches (24/batch) of CHEW from the LGAs on IMCI Aug 10-15, Sept 14-19 1 participant per LGA/State & PHCB 48
TOT CHEW on CIMCI October 5th – 8th Participants were selected from LGA & PHCB 25
Training of Private HWs on IMCI case management @Hello Lagos from October 19 -24, 2015 Participants were selected by AGPMPN 25

PROGRAMMES IN IMNCH UNIT
S/N Programme Period of Implementation
1 IMCI-Case Management Training January,August
2 National Immunization Plus Days March and April
3 Maternal Newborn and Child Health Week May and November
4 IMCI-Case Management Training August
5 CIMCI Training (TOT) October

• Implementation of 1st round of March 2015 NIPDs on the 14th to 17th March 2015- Total no of children vaccinated in March 2015 was 4,415,215 which was 96% of March 2014 OPV coverage with 4,615,708 as Target Population
• Implementation of 2nd round of April 2015 NIPDs on the 25th to 28th April 2015- Total no of children vaccinated in April 2015 was 4,789,537 which was 104% of the March 2014 coverage
• Implementation of 1st Round 2015 MNCH Week from 29th June – 3rd July, 2015.
S/N INTERVENTION COVERAGE
1 OPV3/PENTA3 12173 (12.2%) /12207(12.3%)
2 MEASLES/YF 8,879
3 VIT A 6-11months 268,560 (112%)
12 -59 months 1, 887, 9518 (99%)
6 – 59 months 2,156,518 (100%)
4 MUAC 1,984,858 (green), 302 (yellow), 6 (red)
5 DEWORMING 924,282 (48%)
6 FP 36,290
7 BIRTH REGISTRATION 7,655
8 KHHP 110,016
9 LLIN 7,310

NATIONAL PROGRAMME ON IMMUNIZATION (NPI) ACTIVITIES`
Vaccine Preventable Diseases accounts for 20% of morbidity and mortality in children under 5s. Children by the age of 1 should have completed their immunization schedule according to the NPI schedule.

The Ministry of Health adopted the following key strategies:
ï‚• Development and dissemination of IEC materials.
ï‚• Institutional development including the provision of cold chain equipments and procurement of generators for the maintenance of the vaccines at the State cold store and the 20 LGA’s.
ï‚• Capacity building through refresher training of Local Government Immunization Officers (LIO’s) and other HW’s on cold chain vaccine maintenance, micro planning, new policy issues and vaccination procedures.
ï‚• Monthly cluster meetings with the LIO’s.
ï‚• Compilation of monthly Routine Immunization (RI) data to know the percentage coverage.
ï‚• Re-vitalization of the outreaches to strengthen RI through the Reach Every Ward (REW) Approach.Tuesday of every week has been set aside for routine immunization against vaccine preventable diseases in all primary health care facilities in the State.

Routine Immunization Coverage 2009 – 2015:
S/N Antigen 2009 2010 2011 2012 2013 2014 2015
1 BCG 85 92 79 111 112 107 101
2 DPT3 66 80 57 16 0 0 0
3 PENTA 3 0 0 0 39 85 80 79
4 OPV3 65 71 69 81 87 80 79
5 IPV 0 0 0 0 0 0 208
6 MEASLES 63 76 73 81 87 78 77

The drop in coverage in all antigens in 2014 was due to the strike embarked upon by Health workers that handicapped normal flow of clientelle in all PHCs. However, 2015 is appears better since by the end of September, 2015 there are remarkable improvement in coverages.
The main activities of the NPI unit includes but not limited to:
Collection of bundled Vaccines on quarterly basis from NPHCDA
1. Storage of vaccines
2. Distribution of Vaccines to the LGAs using two types of method : Pull & Push method
3. Cold Chain Maintenance
4. Conducting Monthly Cluster meeting of LIOs.
5. Conducting Immunization Plus Days Activities
6. Ensuring Availability of Vaccines at the State, LGA& Health Facilities
7. Use of Dashboard, to Monitor Vaccines at all levels to prevent Vaccine stock out
8. Compilation & Reporting of RI Monthly Report
9. Meeting of the State Task Force to oversee Polio Eradication & RI activities.
10. Collaboration with other units & on line Ministries to Sensitize & Enhance Immunization.
11. Partnering with WHO, UNICEF, CHAI, JICA, PATH2, Rotary International & Save the Children for review& planning on RI.
12. Monthly RI working Group (RIWG) meeting
13. Quarterly (IRP) inventory Replacement Plan.
14. Monitoring & Supervising the LGAs
15. Strengthen Accountability & Enhance efforts that will positively impact on reducing Maternal & Child Mortality Rate.
16. Outbreak Response Immunization.
17. Advocacy
18. Monthly Submission on Temperature Review
19. Conducting Training on (VMT) Vaccine Management. CDA to State cold store for onward distribution to LGAs as required. Lagos State in partnership with Clinton Health access initiative initiated strengthening of Vaccine supply chain in a push system in few LGAs.
BRIEF ON THE PUBLIC PATNERSHIP INITIATIVE FOR NEONATAL SERVICES IN LAGOS STATE.
GAPS OBSERVED IN THE STATE BEFORE COMMENCEMENT OF THE INITIATIVE.
1] Poor access to acute care for neonates in Lagos state second tier hospital.
2] Poor intra- team communication between acute care providers in the secondary and tertiary center.
3] Need for capacity building of the health care professionals involved with Neonatal Health.
4 ] Poor effective transportation of new babies during inter- hospital transfer. The use of private transport by care givers to transport sick babies.

OBJECTIVES OF THE PARTNERSHIP
1. To increase the institutional capacity of acute care neonatal service in Lagos.
2. To create a model of Public Sector Partnering with Private Sector Provider in providing short term Neonatal care to babies who require urgent care and may die if not given.
3. To create a model of joint Public Private Partnership in providing Neona tal Acute Care Management Training for Doctors, Nurses and Ambulance Paramedics
4. Understanding of the epidemiology of neonatal illnesses in Lagos State. Improving communication between acute care facilities in maternal / neonatal/ ambulance service providers in the public sector in Lagos State.
5. Developing a risk management of strategy/ patient safety Solution in acute neonatal care.
TOTAL ANALYSIS UNDER THE PERIOD OF REVIEW (2011 TO 2014)
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
Hypoxic Ischemic Encephalophathy 150 98 52
SEPSIS 209 152 57
PRETERM 288 162 124
Neonatal Jaundice 210 176 34
OTHERS 75 45 30
TOTAL 932 633 297

TOTAL ADMISSION 932
SAVED BABIES 633
DEATH 297
PERCENTAGE SAVED 68%
PERCENTAGE DEAD 32%
YEAR 2011
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
HIE 1 1
SEPSIS 4 1 3
PRETERM 3 2 1
NNJ 4 3 1
OTHERS
TOTAL 12 7 5

YEAR 2012
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
HIE 54 38 16
SEPSIS 64 51 13
PRETERM 111 81 30
NNJ 76 65 11
OTHERS 40 27 13
TOTAL 345 262 83

YEAR 2013
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
HIE 56 35 21
SEPSIS 97 61 36
PRETERM 99 48 51
NNJ 74 60 14
OTHERS 18 7 11
TOTAL 344 211 133

YEAR 2014 (JAN – DEC)
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
HIE 39 24 15
SEPSIS 44 39 5
PRETERM 75 31 42
NNJ 56 48 8
OTHERS 17 11 6
TOTAL 231 153 76

YEAR 2015 (JAN-JUNE) NO MEMO WAS RAISED FOR JULY, AUGUST & SEPTEMBER AS A RESULT OF LACK OF FUND
DIAGNOSIS TOTAL ADMISSION SAVED DEATH
HIE 10 5 5
SEPSIS 5 2 3
PRETERM 8 4 4
JAUNDICE – – –
OTHERS 1 – 1
TOTAL 24 11 13

STATUS REPORT ON THE SUPPLY AND INSTALLATION OF NEONATAL EQUIPMENT
S/N CONTRACTOR SUPPLY INSTALLATION
1 Messrs Mogbonju Nig Ltd 100% 100%
2 Messrs JNCI Ltd 100% 100%
3 Messrs PPC Ltd 100% 100%
4 Messrs First Foundation 100% 100%

LIST OF HOSPITALS SUPPLIED WITH NEONATAL EQUIPMENT
1. LASUTH
2. Massey/LIMH
3. Ifako – Ijaiye GH
4. Ikorodu GH
5. Isolo GH
6. Ajeromi GH
7. Randle GH
8. Gbaja GH
9. Somolu GH
10. Mushin GH
11. Badagry GH
12. Alimosho GH
13. Orile – Agege GH
14. Ibele – Lekki GH
15. Epe GH
16. Apapa GH
17. Harvey RD H
18. Ijede H/C
19. Onikan H/C

PROJECT CONSTRAINTS
1. Financial constraints due to an over stretched budget in the Ministry. No budgetary allocation to the program
2. Poor stabilization of babies at the referring hospital
3. Obstetricians/ Gynecologists were not included on the stakeholders list at the inception of the program. The role of birthing professionals in the eventual survival of the neonate was not given adequate consideration in the program package.

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