Under fives clinic

April 12, 2023 Department Of Community Medicine SKIMS, Soura. Dr.Q.M.IQBAL

UNDER FIVES CLINICPRACTICAL DEMONSTRATION

FOR 4TH SEMESTER

Under Fives-A Special Group1. They constitute about 15 % of the total

population.2. They suffer high rates of mortality and

morbidity.3. The effects of malnutrition and other diseases

have a role in later life.4. The majority of the deaths are preventable

through available interventions.5. This is a period of growth and development.

6. Brain growth is completed during 1st five years.

7. Most causes of morbidity are preventable byimmunization.

8. Health of children under five years and family health are inter-related.

Under five clinic is a center, where preventive, promotive, curative, referral and educational services are provided in a package manner to under five children under one roof.

The services are made available through trained nurses, so that not only the services become economical but also becomes available to larger proportion of children population in the community.

The overall goal of the Under-Fives Clinic is to provide comprehensive health care to young children in a separate specialized facility.

The under five clinic is represented by traditional logo of a triangle with four internal triangles and an outer enveloping triangle as shown in the Fig.

Functions:

(a) Care in Illness : This is the felt need of the mother and child for which any child is brought to the clinic. The usual illnesses encountered in children under five are fever, diarrhoea, ARI, infections of the skin and helminthiasis. The facility should provide for essential laboratory investigations and X-ray facilities. The Clinic should be backed by an effective referral mechanism.

(b) Growth Monitoring : This is one of the most important functions of the clinic. The child is weighed periodically – every month during the first year, every 2 monthly from 1 to 3 years of age and every 3 monthly in 4th and 5th years.Besides weighing, measuring height, mid arm circumference can also be carried out depending upon the availability of trained manpower and equipments. The growth is plotted on the growth chart and any faltering in the growth is detected and suitable action initiated. The milestones are also recorded and any delay in achieving milestone is evaluated.

(c) Preventive Care :This involves primarily the immunization services during the 1st five years of life, vitamin A supplementation and administration of Iron supplementation and antihelminthic treatment to prevent anemia. The preventive care also provides for regular health check up and use of ORS during Diarrhoea to prevent dehydration from developing.

(d) Family Planning : Family planning is central to any program directed towards women and children. The mothers are more receptive to family planning during early Puerperium and lactation. Mother is counselled on the various options available, their merits and de-merits so that she can make a choice.

(e) Health Education : The opportunity should be made use to educate the mother on issues of child care, breast feeding, nutrition, growth monitoring, immunization and hygiene of safe water and food preparation.

IMMUNIZATION

Why immunization?• Immunization is one of the safest and most

effective methods of preventing childhood diseases.

• Under the Universal Immunization Programme (UIP), significant achievements have been made in preventing and controlling the Vaccine Preventable Diseases (VPDs).

• Immunization has to be sustained as a high priority to further reduce the incidence of all VPDs, control measles, eliminate tetanus and eradicate poliomyelitis.

• Full immunization (i.e. received one dose of BCG, three doses of DPT, Hep-B and OPV each and one dose of Measles before one year of age) gives a child the best chance for a healthy life. Preventing disease before it occurs saves money, energy, and lives.

• Immunization is a key strategy to child survival. By protecting infants from VPDs, immunization significantly lowers morbidity and mortality rates in children. The security provided to families can lead to lower birth rates.

• Immunization is an indicator of a strong primary health care system.

Reasons for Low immunization coverage

• Failure to provide immunization.

• Dropouts.

• Unreached populations.

• Resistant populations.

• Missed Opportunities.

The following are the targeted vaccine preventable diseases along with their

symptoms, mode of spread and methods of prevention.

• Tuberculosis• Polio• Diphtheria• Pertussis• Tetanus• Hepatitis B• Measles

Tuberculosis• Tuberculosis (TB) is caused by a bacteria

(Mycobacterium tuberculae).• It is a highly contagious disease that affects

the lungs but can also affect the intestines, bones and joints, lymph glands, meninges, and other tissues of the body.

PolioPolio is a viral infection that affects the nervous system and can cause severe illness, paralysis, and even death.Due to intensive immunization campaigns, there has been a very significant decline of polio cases in the country since 1999.

DiphtheriaDiphtheria is caused by bacteria (Coryne bacterium diphtherae). Diphtheria is an infectious disease that commonly infects the tonsils and pharynx, forming a membrane that can lead to obstructed breathing and death.

Pertussis (Whooping Cough)

Pertussis, commonly known as whooping cough, is caused by bacteria (Bordetella pertussis). Pertussis is a highly contagious bacterial disease, involving the respiratory tract. It is characterized by repeated cough that may lead to aspiration and possible death, in a few cases.

TetanusTetanus is caused by bacteria (Clostridium tetani). People of all ages can become infected with tetanus.

MeaslesMeasles is a highly infectious illness caused by a virus that can be found in the nose, mouth or throat of an infected person. Infection is characterized by fever, cough and spreading rash that may lead to death due to secondary infections like diarrhea and pneumonia.

Hepatitis BHepatitis B is a highly infectious viral disease (40-100 times more infectious than HIV) and is the leading cause of jaundice, fulminant liver disease, cirrhosis and liver cancer.

Administration summary: BCG vaccine

Administration summary: DTP vaccine

Administration summary: OPV

Administration summary: measles vaccine

Adverse Events FollowingImmunization (AEFIs)

• What is an Adverse Event Following Immunization?An Adverse Event Following Immunization (AEFI) is a medical incident that takes place after an immunization, causes concern, and is believed to be caused by immunization.

Cold Chain

The Cold Chain is a system of storing and transporting vaccines at recommended temperatures from the point of manufacture to the point of use.

The key elements of the cold chain are:Personnel: to manage vaccine storage and

distributionEquipment: to store and transport vaccine and to

monitor temperatureProcedures: to ensure that vaccines are stored and

transported at appropriate temperatures

• Keeping vaccines at the right temperature is not an easy task, but the consequences of not doing so can be disastrous. Once vaccine potency is lost, it cannot be regained.

• The damaged vaccines must be destroyed, leading to inadequate vaccine stocks and wastage of expensive vaccines.

• Moreover, children and women who receive a vaccine that is not potent are not protected.

• The physical appearance of the vaccine may remain unchanged even after it is damaged. However, the loss of potency due to either exposure to heat or cold is permanent and can not be regained.

HEAT DAMAGE• All vaccines are damaged by temperatures more

than +80C, whether they are exposed to a lot of heat in a short time (e.g., as a result of keeping vaccine in a closed vehicle in the sun) or a small amount of heat over a long period (e.g., as a result of the frequent opening of lid of ILR).

• Reconstituted BCG, measles and JE vaccines are the most sensitive to heat and light. Since these live vaccines do not contain preservatives, there is risk of contamination with staphylococcus aureus leading to Toxic Shock Syndrome and, therefore, they should not be used after 4 hours of reconstitution.

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