Imci Issue 3 March 2012

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  • IMCI NewsletterIMCI NewsletterPerformance Report for January to December 2010

    Issue 3March 2012

    Management Information System (MIS)Directorate General of Health Services (DGHS)Mohakhali, Dhaka-1212; Email:

    Management Information System (MIS)Directorate General of Health Services (DGHS)Mohakhali, Dhaka-1212; Email:

  • Director General

    Directorate General of Health Services

    Mohakhali, Dhaka

    It is a great pleasure for me to know that MIS of DGHS is

    going to publish the IMCI Newsletter (Issue 3). This

    newsletter is a very useful publication as it enables us to get

    facility-based graphical data on childhood illness all over

    Bangladesh in concise and understandable way. Bangladesh

    has made a remarkable progress in child mortality reduction

    and received the UN MDG Award for its success in MDG4.

    IMCI program is playing the key role to sustain and improve

    universal child immunization.

    It is expected that this newsletter will give some

    programmatic direction to policy-makers and program

    managers to understand the current situation and undertake

    interventions for the future about the IMCI services in

    Bangladesh. I would like to thank everyone who worked hard

    for publishing this newsletter successfully.

    Professor Dr. Khondhaker Md. Shefyetullah

    Additional Director General (Planning and Development)

    and Line Director, Management Information System (MIS)

    Directorate General of Health Services

    Mohakhali, Dhaka

    Bangladesh has made a remarkable progress in improving the health of

    children and recently received the MDG Award for its success in Millennium

    Development Goal 4. It is one of the few countries in the developing world

    that is on track to achieve Millennium Development Goal 4: reducing the

    under-five mortality rate by two-thirds within 2015. Bangladesh is among only

    six countries in the world that have reduced by half or more child mortality rate

    since 1990 (from 151/1000 in 1990 to 65 in 2007). The infant mortality rate

    has also significantly declined to reach 52 deaths per 1000 livebirths in 2007

    from 117 deaths/1000 in 1990. Therefore, we must increase our efforts to

    attain the expected target.

    I am delighted that the third issue of the IMCI newsletter is going to be

    published from the office of Director, MIS-Health of DGHS. This newsletter will

    not be limited to publishing result on only the performance assessment of IMCI

    services in facilities but would also encompass other areas of child and

    neonatal health, including community IMCI. The team associated with this

    newsletter made very sincere efforts to improve the quality of the contents

    than in the previous issue. An attempt was made to analyze the data received

    during the reporting period to understand the care-seeking and morbidity

    pattern of the sick under-five children attending the IMCI-designated facilities. I

    want to thank the entire team of IMCI section for their support and cooperation

    in publishing this newsletter. I wish also to congratulate the entire team of MIS-

    Health whose relentless work and efforts have made this success. I also like

    to convey my sincere thanks to all the managers, doctors, paramedics, and

    other service providers and staff who helped in various forms and thus

    enabled us to publish this newsletter.

    I also convey my gratefulness to Director General of Health Services and

    Director, PHC, for their continuous support and advice in accomplishing our

    tasks in MIS. I extend my special thanks to UNICEF for their all-out

    cooperation as well as technical and financial support in publishing this

    newsletter. I congratulate the editorial board for their success in reviewing the

    contents of this newsletter despite various constraints. The effort will be fruitful

    if we can use the information for the betterment of our children who deserve

    quality and equitable health services.

    Professor Dr. Abul Kalam Azad

    Line Director, Maternal, Neonatal, Child

    and Adolescent Health (MNC&AH)

    and Director, Primary Health Care

    Directorate General of Health Services

    Mohakhali, Dhaka

    I am glad to see that the Management Information System

    (MIS) of the Directorate General of Health Services (DGHS)

    is going to publish the third issue of IMCI Newsletter. This

    publication has now become a necessary source of

    information containing statistics on child health aspects of

    the health sector.

    I would like to thank MIS-Health and IMCI program as well

    as the health managers and service providers at different

    levels for their reporting from the IMCI facilities for

    publication of the newsletter. I thank our development

    partners, specially UNICEF, ICDDR,B, and WHO for their

    financial and technical support for this important task in the

    child health sector.

    I expect continuing publication of the IMCI Newsletter.

    Dr. Syed Abu Jafar Md. Musa


    Editorial Note


    ContentsMessages & Editorial P.02

    Introduction P.03

    Data and Method P.03

    Limitation of the Data P.04

    Results P.04

    Conclusion P.16

    Annexure P.16


  • IntroductionOne of the major challenges in achieving Millennium Development Goal 4 is the slow progress in preventing neonatal deaths, which now account for 57% of all under-five deaths and 70% of infant deaths. In Bangladesh, 14 babies under one month of age die every hour and 120,000 every year (UNICEF, 2010).

    Every year around 10 million children die in developing countries before they reach their fifth birthdays. Two-thirds of these deaths could be prevented by effective low-cost interventions. Seven in ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria, or malnutrition and often due to a combination of these illnesses. In spite of various disease-specific control programs in operation, there has not been significant reduction in childhood morbidity and mortality. In response to this challenge, WHO/UNICEF proposed a comprehensive single efficient and effective approach to manage childhood illnesses, i.e. Integrated Management of Childhood Illness (IMCI).

    The Government of Bangladesh decided to adopt the IMCI strategy in 1998. Ten training centers for IMCI have been established where the Clinical Management Training (11-days CMT) is ongoing for all types of service providers (doctors, nurses, paramedics) from selected upazilas. In 2010, IMCI has been included in undergraduate medical curriculum, and the process of inclusion is going on in Nursing Institutes and Medical Assistant Training Schools (MATS).

    Up to June 2010, Facility-based IMCI has been implemented in 48 districts (343 upazilas) and at present (June 2011), it is being implemented in 395 upazilla health

    complexes (UHC). Community-based IMCI is being implemented in 63 upazilas. In the Health, Population and Nutrition Sector Development Programme (HPNSDP) period 2011-2016, facility-based IMCI and community-based IMCI will be scaled up in 85 UHCs and 263 UHCs respectively.

    During the HPNSDP (2011-2016) implementing period, the main activities regarding IMCI program will be: strengthening the delivery of neonatal and child health services through facility-based IMCI; expanding facility-based IMCI for out-patient sick child services; achieving saturation to cover 482 upazilas, 59 District Hospitals (DH) and 19 Medical College Hospitals (MCH) in 64 districts with adequate quality IMCI services; strengthening referral care (including Emergency Triage Assessment and Treatment) for sick under-five children in all UHCs/DHs; ensuring growth promotion with counseling on appropriate feeding practices, including exclusive breastfeeding and combining monitoring and supervision of IMCI and EPI at the facility and community levels.

    Data and MethodThe childhood diseases covered by IMCI program in Bangladesh have been classified into 10 broad categories, viz. (i) very severe disease, (ii) pneumonia, (iii) no pneumonia-cough and cold, (iv) diarrhea, (v) fever-malaria, (vi) fever-no malaria, (vii) measles, (viii) ear problem, (ix) malnutrition, and (x) others. IMCI is provided through facility-based treatment as well as through home-care. The latter is called Community IMCI Program. Currently, facility-based IMCI is being delivered, (in 395 upazilas) from 49 districts. Community-based IMCI is running in 63 upazilas. UNICEF and WHO jointly provide technical and financial


  • assistance to the Ministry of Health and Family Welfare for implementing the IMCI program. Various other development partners and NGOs also collaborate with the Government.

    The Management Information System (MIS) of the Directorate General of Health Services (DGHS) tries to capture the data from IMCI services provided in different IMCI facilities. Recently, a desktop and web-based software (IMCI Facility MIS System) has been developed by MIS, DGHS, with the help of ICDDR,B to collect IMCI service data from different levels of designated IMCI facilities. All the IMCI-designated facilities are to send IMCI performance report to the MIS of DGHS every month for compilation, analysis, monitoring, and tracking of the progress of the program and dissemination. Community IMCI program has been implemented by NGOs and monitored by DGHS. The IMCI program districts are listed below: Barisal division: Barisal, Bhola, and Patuakhal