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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 Web:www.dghs.gov.bd; Email: [email protected]

Management Information System (MIS)Directorate General of Health Services (DGHS)Mohakhali, Dhaka-1212 Web:www.dghs.gov.bd; Email: [email protected]

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)


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


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

Message

Editorial Note

Message

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

02

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

03

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 Patuakhali; Chittagong division: Brahmanbaria, Bandarban, Chandpur, Chittagong, Comilla, Cox's Bazar, Khagrachhari, Laxmipur, and Rangamati; Dhaka division: Dhaka, Gazipur, Gopalganj, Jamalpur, Kishoreganj, Madaripur, Mymensingh, Narsingdi, Netrokona, Shariatpur, Sherpur, and Tangail; Khulna division: Bagherhat, Jessore, Narail, Khulna, and Shatkhira; Rajshahi division: Bogra, Chapainawabganj, Naogaon, Natore, Joypurhat, Pabna, Rajshahi, and Sirajganj; Rangpur division: Dinajpur, Ghaibandha, Kurigram, Lalmonirhat, Nilphamari, Panchgarh, Rangpur, and Thakurgaon; and Sylhet division: Hobiganj, Maulvibazar, Sunamganj, and Sylhet. In 2010, data were collected from the 42 IMCI program districts because these 42 districts were fully functional during the reporting period. The rest of the districts were included at the mid or last part of the year 2010. All reports

covered 1,804,576 children "out-patient and emergency disease-encounters" (a child may have multiple illnesses). An attempt has been made to analyze data on these children to understand their morbidity pattern. In this newsletter, results of analysis of the data received from facilities have been presented.

Limitations of the DataThis newsletter is based on the monthly IMCI reports received by MIS-Health from the IMCI upazilas. The morbidity status of the children was analyzed; the cases were assessed as per the IMCI protocol. This newsletter captures data only on the children who attended the IMCI facilities. A number of children visit private doctors, some take help from traditional healers, or some even do not take any treatment. Those children were not included in the report.

ResultsA. Coverage of IMCI FacilitiesOut of 482 upazilas, 395 were covered as IMCI upazila up to June 2011. Among the covered upazilas, all of Rajshahi, Rangpur and Sylhet divisions were included. The lowest coverage (60.0%) were in Barisal division (Table 1).

Table 1. Distribution of IMCI upazilas in seven

divisions

Division Total

no. of

districts

Total no.

of

upazilas

Total no.

of covered

IMCI

districts

Total no. of

covered

IMCI

upazilas

% of total

upazila

coverage

Barisal 6 40 3 24 60.0

Chittagong 11 99 9 83 83.8

Dhaka 17 122 11 90 73.8

Khulna 10 59 5 36 61.0

Rajshahi 8 66 8 66 100.0

Rangpur 8 58 8 58 100.0

Sylhet 4 38 4 38 100.0

Total 64 482 48 395 82.0

04

B. IMCI diseases by age-groupsThe distribution of the IMCI diseases among the children aged below 5 years by age-groups, viz. 0-28 day(s), 29-59 day(s), 2-12 month(s) and 1-5 year(s) has been shown in Figure 1. The data were received from IMCI facilities in 42 districts in 2010. It is seen that children from 1 to 5 year(s) age-group constituted the largest IMCI service recipients (56%), followed by 2 to 12 months age-group (34%). Of the total under-five children, 3% were at the neonatal age. Age-group 29 to 59 days comprised 7% of the total children receiving services from the IMCI facilities.

Figure 1. Distribution of children with IMCI

diseases by age-group in Bangladesh 2010

(N=1,804, 576)

Figure 2. Percent distribution of male children

with IMCI diseases by age-group in Bangladesh

2010 (n=927,426)

Figure 3. Percent distribution of female

children with IMCI diseases by age-group in

Bangladesh 2010 (n=877,151)

Sl. no.

Diseases/Medical Condition 0-28 days

29-59 days

2-12 months

1-5 years Total % of total

A.1 Male 26811 62031 315640 522944 927426 51.4

A.2 Female 25600 57357 301262 492932 877151 48.6

A Total (A1+A2) 52411 119389 616901 1015875 1804576 100.0

B.1 Very severe disease 20447 40464 16166 19195 95134 5.3

B.2 Pneumonia 0 0 79623 115087 194755 10.8

B.3 No pneumonia-cough and cold 0 0 173322 295698 470088 26.0

B.4 Diarrhea 10470 22959 79859 156399 269687 14.9

B.5 Fever-malaria 0 0 5425 11017 16442 0.9

B.6 Fever-no malaria 0 0 97841 188322 286188 15.9

B.7 Measles 155 326 2148 5664 8293 0.5

B.8 Ear problem 1967 6011 22912 44676 75566 4.2

B.9 Malnutrition 5044 13684 30685 57517 106930 5.9

B.10 Others 19619 39683 119432 252577 431311 23.9

B Total (B1-B10) 57702 123127 627413 1146152 1954394 108.3

C Refer 1673 2524 5468 10549 20214 1.1

Table 2. Distribution of IMCI patients and disease patterns in 2010 in Bangladesh

0-28 days,

n=26,811,

3%

29-59 days,

n=62,031,

7%

2-12 months,

n=315,640,

34%

1-5 years,

n=522,944,

56%

0-28 days,

n=25,600,

3%

29-59 days,

n=57,357,

7%

2-12 months,

n=301,262,

34%

1-5 years,

n=492,932,

56%

0-28 days,

n=52,411,

3%)

29-59 days,

n=119,389,

7%

2-12 months,

n=616,901,

34%

1-5 years

n=1,015,875

56%

05

Figure 4. Percent distribution of children with

very severe diseases by age-group (n=95,134;

5.3% of total)


pneumonia by age-group (n=194,755; 10.8% of

total)


'no pneumonia-cough and cold' by age-group

(n=470,088; 26.0% of total)


'diarrhea' by age-group (n=269,687; 14.9% of

total)


'fever-malaria' by age-group (n=16,442; 0.9% of

total)


'fever-no malaria' by age-group (n=286,188;

15.9% of total)

0-28 days,

n=20,447,

21%

29-59 days,

n=40,464,

42%

2-12 months,

n=16,166,

17%

1-5 years,

n=19,195,

20%

2-12 months,

n=79,623,

41%1-5 years,

n=115,087,

59%

2-12 months,

n=173,322,

37%

1-5 years,

n=295,698,

63%

0-28 days,

n=10,470,

4%29-59 days,

n=22,959,

8%

2-12 months,

n=79,859,

30%

1-5 years,

n=156,399,

58%

2-12 months,

n=5,425,

33%

1-5 years,

n=11,017,

67%

2-12 months,

n=97,841,

34%

1-5 years,

n=188,322,

66%

06


'measles' by age-group (n=8,293; 0.5% of total)


'ear problem' by age-group (n=75,566; 4.2% of

total)


'malnutrition' by age-group (n=106,930; 5.9%

of total)

Figure 4 to 14 show the distribution of the IMCI diseases among children aged 0 day to 5 years. It is seen that the number and percentage of patients increased with age in

case of each disease. Caution is needed to interpret this situation. This trend should be related to more attendance of the older children in the IMCI facilities than the younger ones.


'others illness' by age-group (n=431,311; 23.9%

of total)

Figure 14. Percent distribution of 'referred

children' by age-group (n=20,214; 1.1% of total)

Table 2 presents the distribution of the IMCI diseases within each age-group. Among the total children, the problem of respiratory tract was the leading cause of morbidity (cough and cold: 26%; pneumonia: 11%). Fever (malaria or no malaria), and diarrhea were the morbidities of 16% and 15% of the children respectively. Similar pattern of morbidities was also observed among children of all age-groups.

0-28 days,

n=155,

2%

29-59 days,

n=326,

4%

2-12 months,

n=2,148,

26%

1-5 years,

n=5,664,

68%

0-28 days,

n=1,967,

3%

29-59 days,

n=6,011,

8%

2-12 months,

n=22,912,

30%

1-5 years,

n=44,676,

59%

0-28 days,

n=5,044,

5% 29-59 days,

n=13,684,

13%

2-12 months,

n=30,685,

28%

1-5 years,

n=57,517,

54%

0-28 days,

n=19,619,

4%29-59 days,

n=39,683,

9%

2-12 months,

n=119,432,

28%

1-5 years,

n=252,577,

59%

0-28 days,

n=1,673,

8%

29-59 days,

n=2,524,

13%

2-12 months,

n=5,468,

27%

1-5 years,

n=10,549,

52%

07

C. Number distribution of cases with IMCI diseases by age-groupsFigure 15 to 19 show the burden of each of the age group (based on the number of children visiting IMCI facilities) shared by the IMCI facilities in various IMCI diseases.

Figure 15. Distribution of various diseases

among neonates of 0-28 days (n=52,411; 2.9%

of total)


among post-neonatal babies of 29-59 days

(n=119,389; 6.6% of total)


among infants of 2-12 months (n=616,901;

34.2% of total)


among children of 1-5 years (n=1015,875;

56.3% of total)

20,447

0

0

10,470

0

0

155

1,967

5,044

19,619

1,673

Very severe disease

Pneumonia

No pneumonia-cough and cold

Diarrhea

Fever-malaria

Fever-no malaria

Measles

Ear problem

Malnutrition

Others

Refer

40,464

0

0

22,959

0

0

326

6,011

13,684

39,683

2,524

Very severe disease

Pneumonia


Diarrhea

Fever-malaria

Fever-no malaria

Measles

Ear problem

Malnutrition

Others

Refer

16,166

79,623

173,322

79,859

5,425

97,841

2,148

22,912

30,685

119,432

5,468

Very severe disease

Pneumonia


Diarrhea

Fever-malaria

Fever-no malaria

Measles

Ear problem

Malnutrition

Others

Refer

19,195

115,087

295,698

156,399

11,017

188,322

5,664

44,676

57,517

252,577

10,549

Very severe disease

Pneumonia


Diarrhea

Fever-malaria

Fever-no malaria

Measles

Ear problem

Malnutrition

Others

Refer

08


among 0 day to 5 years old children (N=1804,

576)

D. Percent distribution of IMCI patients by division in 2010In Barisal division, a total of 122,046 children received service from IMCI facilities; of them 59,441 were male and the rest were female.


with various illnesses by age-group in Barisal

division in 2010 (48.7% of total)


children with various illnesses by age-group in

Barisal division in 2010 (51.3% of total)

Figure 22. Percent distribution of total children

with various illnesses by age-group in Barisal

division in 2010

In Chittagong division, a total of 255,028 children received service from IMCI facilities, of them 129,988 were male, and the rest were female (125,040).


with various illnesses by age-group in

Chittagong division in 2010 (51.0% of total)

95,134

194,755

470,088

269,687

16,442

286,188

8,293

75,566

106,930

431,311

20,214

Very severe disease

Pneumonia


Diarrhea

Fever-malaria

Fever-no malaria

Measles

Ear problem

Malnutrition

Others

Refer

0-28 days,

n=1,716,

3%

29-59 days,

n=3,649,

6%

2-12 months,

n=19,094,

32%

1-5 years,

n=34,982,

59%

0-28 days,

n=1,953,

3%

29-59 days,

n=3,787,

6%

2-12 months,

n=20,718,

33%

1-5 years,

n=36,147,

58%

0-28 days,

n=3,669,

3%

29-59 days,

n=7,436,

6%

2-12 months,

n=39,812,

33%

1-5 years,

n=71,129,

58%

0-28 days,

n=2,716,

2%

29-59 days,

n=6,836,

5%

2-12 months,

n=52,887,

41%

1-5 years,

n=67,548,

52%

09


children with various illnesses by age-group in

Chittagong division in 2010 (49.0% of total)

Figure 25. Percent distribution of total children

with various illnesses by age-group in

Chittagong division in 2010

In Dhaka division, a total of 524,730 children received service from IMCI facilities; of them 269,263 were male, and the rest were female (255,467).


with various illnesses by age-group in Dhaka

division in 2010 (51.3% of total)

Figure 27. Percent distribution of female children with various illnesses by age-group in Dhaka division in 2010 (48.7% of total)

Figure 28. Percent distribution of total children with various illnesses by age-group in Dhaka division in 2010

In Khulna division, a total of 70,947 children received service from IMCI facilities; of them 35,403 were male, and the rest were female (35,544).

Figure 29. Percent distribution of male children with various illnesses by age-group in Khulna division in 2010 (49.9% of total)

0-28 days,

n=3,071,

2%

29-59 days,

n=4,755,

4%

2-12 months,

n=50,695,

41%

1-5 years,

n=66,519,

53%

0-28 days,

n=5,787,

2%

29-59 days,

n=11,591,

4%

2-12 months,

n=103,583,

41%

1-5 years,

n=134,067,

53%

0-28 days,

n=4,275,

2%

29-59 days,

n=11,739,

4%

2-12 months,

n=87,259,

32%

1-5 years,

n=165,990,

62%

0-28 days,

n=4,020,

2%

29-59 days,

n=10,601,

4%

2-12 months,

n=82,384,

32%

1-5 years,

n=158,462,

62%

0-28 days,

n=8,295,

2%

29-59 days,

n=22,340,

4%

2-12 months,

n=169,643,

32%

1-5 years,

n=324,452,

62%

0-28 days,

n=428,

1%

29-59 days,

n=1,256,

4%

2-12 months,

n=9,729,

27%

1-5 years,

n=23,990,

68%

10

Figure 30. Percent distribution of female children with various illnesses by age-group in Khulna division in 2010 (50.1% of total)

Figure 31. Percent distribution of total children with various illnesses by age-group in Khulna division in 2010

In Rajshahi division, a total of 321,002 children received service from IMCI facilities; of them 169,763 were male, and the rest were female (151,238).

Figure 32. Percent distribution of male children with various illnesses by age-group in Rajshahi division in 2010 (52.9% of total)

Figure 33. Percent distribution of female children with various illnesses by age-group in Rajshahi division in 2010 (47.1% of total)

Figure 34. Percent distribution of total children with various illnesses by age-group in Rajshahi division in 2010

In Rangpur division, a total of 228,478 children received service from IMCI facilities; of them 117,225 were male, and the rest were female (111,253).

Figure 35. Percent distribution of male children with various illnesses by age-group in Rangpur division in 2010 (51.3% of total)

0-28 days,

n=457,

1%

29-59 days,

n=1,314,

4%

2-12 months,

n=10,013,

28%

1-5 years,

n=23,761,

67%

0-28 days,

n=885,

1%

29-59 days,

n=2,569,

4%

2-12 months,

n=19,742,

28%

1-5 years,

n=47,750,

67%

0-28 days,

n=7,462,

4%

29-59 days,

n=18,760,

11%

2-12 months,

n=49,465,

29%

1-5 years,

n=94,077,

56%

0-28 days,

n=5,867,

4%

29-59 days,

n=17,968,

12%

2-12 months,

n=45,526,

30%

1-5 years,

n=81,877,

54%

0-28 days,

n=13,329,

4%

29-59 days,

n=36,728,

11%

2-12 months,

n=94,992,

30%

1-5 years,

n=175,953,

55%

0-28 days,

n=1,713,

1%

29-59 days,

n=5,546,

5%

2-12 months,

n=51,972,

44%,

1-5 years,

n=57,995,

50%

11

Figure 36. Percent distribution of female children with various illnesses by age-group in Rangpur division in 2010 (48.7% of total)

Figure 37. Percent distribution of total children with various illnesses by age-group in Rangpur division in 2010

In Sylhet division, a total of 282,346 children received service from IMCI facilities; of them 146,343 were male, and the rest were female (136,004).

Figure 38. Percent distribution of male children with various illnesses by age-group in Sylhet division in 2010 (51.8% of total)

Figure 39. Percent distribution of female children with various illnesses by age-group in Sylhet division in 2010 (48.2% of total)

Figure 40. Percent distribution of total children with various illnesses by age-group in Sylhet division in 2010

0-28 days,

n=1,931,

2%

29-59 days,

n=4,120,

4%

2-12 months,

n=48,572,

43%

1-5 years,

n=56,630,

51%

0-28 days,

n=3,644

2%

29-59 days,

n=9,665,

4%,

2-12 months,

n=100,544,

44%

1-5 years,

n=114,625,

50%

0-28 days,

n=8,501,

6%

29-59 days,

n=14,246,

10%

2-12 months,

n=45,233,

31%

1-5 years,

n=78,363,

53%

0-28 days,

n=8,302,

6%

29-59 days,

n=14,813,

11%

2-12 months,

n=43,353,

32%

1-5 years,

n=69,536,

51%

0-28 days,

n=16,803,

6%

29-59 days,

n=29,059,

10%

2-12 months,

n=88,586,

31%

1-5 years,

n=147,899,

53%

12

E. Percent distribution of IMCI cases with various illnesses by division in 2010Figure 41. Percent distribution of children with various illnesses by age-group in Barisal division in 2010

Figure 42. Percent distribution of children with various illnesses by age-group in Chittagong division in 2010

12.7 0.00.0

7.6

0.0 0.0 0.0 1.0 1.6

4.9

1.5

26.1

0.0 0.0

11.4

0.0 0.0 0.1

13.0 14.811.5

5.7

31.6

46.940.9

24.3

13.7

34.7

23.9

32.228.7 27.2

22.629.6

53.159.1 56.7

86.3

65.3

76.0

53.8 54.9 56.4

70.1

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0-28 days 29-59 days 2-12 months 1-5 years


21.7

0.00.0

1.9

0.00.0

7.0

1.4

6.3

5.4

5.5

43.6

0.0 0.0

5.9

0.0 0.0

4.9 6.29.6 9.6 11.2

15.3

39.034.9

28.832.1 32.4

20.624.8 23.6 22.5

26.4

19.4

61.065.1 63.4

67.9 67.6 67.5 67.6

60.562.5

56.9

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13

Figure 44. Percent distribution of children with various illnesses by age-group in Khulna division in 2010

Figure 43. Percent distribution of children with various illnesses by age-group in Dhaka division in 2010

10.3 0.00.0

1.3

0.0

0.0

4.71.7 2.0

3.2

12.4

20.7

0.0 0.03.9

0.0 0.0

9.27.0

10.2 8.2

17.1

31.6

41.037.0

31.4 30.4 32.429.7 31.0 32.9

26.7

32.237.3

59.063.0 63.3

69.6 67.6

56.460.4

54.9

61.9

38.3

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16.5 0.0 0.0

0.6

0.0 0.0 0.0 1.04.7

1.8

4.0

66.1

0.0 0.0 2.6 0.0 0.0 0.04.7 5.2 2.9 4.58.1

40.032.6

29.0

14.7

28.2 27.3 24.6 26.4 23.529.9

9.3

60.067.4 67.9

85.371.8 72.7 69.8

63.6

71.8

61.6

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14

Figure 46. Percent distribution of children with various illnesses by age-group in Rangpur division in 2010

Figure 45. Percent distribution of children with various illnesses by age-group in Rajshahi division in 2010

23.8

0.00.0

3.10.0 0.0 0.0 3.2 2.3

3.7

0.8

64.7

0.0 0.0

8.3

0.0 0.03.0

7.8 7.1 6.94.4

12.0

39.3 41.5

30.925.7

33.8 31.6 33.229.7 29.0

20.4

13.9

60.456.8 57.6

74.3

66.1 65.3

55.860.9 60.4

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29.3

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7.20.0 0.0 0.0 1.8 3.7

4.4

11.6

52.3

0.0 0.0

16.1

0.0 0.03.5

6.2

19.8

12.014.8

8.6

42.6

33.2

26.7

39.4 38.5

14.4

27.5 27.4 29.0 27.5

9.8

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60.6 61.5

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64.6

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15

Figure 47. Percent distribution of children with various illnesses by age-group in Sylhet division in 2010

ConclusionThe newsletter represents the general picture of the childhood illnesses and diseases of under-five children in Bangladesh. The newsletter will give some programatic direction to the policy-makers, managers, and development partners foe further providing IMCI services to the children of Bangladesh.

26.0

0.00.0

6.40.0 0.0

5.8 5.5

13.9

6.2

19.8

46.2

0.0 0.0

10.7

0.0 0.0

6.510.8

15.1

9.5

22.9

12.1

41.238.6

31.8

38.340.3

22.6

33.4

25.4

31.1

25.1

15.7

58.861.4

51.1

61.759.7

65.1

50.245.7

53.1

32.2

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16

Table 3. Distribution of IMCI patients and disease patterns by division in Bangladesh, 2010

Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh (Total)

Male 59441 129988 269263 35403 169763 117225 146343 927426

Female 62605 125040 255467 35544 151238 111253 136004 877151

Total patients 122046 255028 524730 70947 321002 228478 282346 1804576

Very severe disease 2437 14554 24359 2322 26987 7928 16547 95134

Pneumonia 4942 38118 60233 3823 35079 19534 33026 194755

No pneumonia-cough and cold 35097 62085 158845 19511 85730 61231 47589 470088

Diarrhea 16588 46019 67829 10060 46878 39171 43142 269687

Fever-malaria 168 1802 2411 367 3443 3789 4462 16442

Fever-no malaria 24483 36320 110064 14327 49715 29779 21500 286188

Measles 1596 286 992 22 954 2923 1520 8293

Ear problem 4615 8998 21163 1681 13993 8927 16189 75566

Malnutrition 10416 8676 28179 2528 22522 17241 17368 106930

Others 30796 58782 107658 16694 68412 46337 102632 431311

Total cases 131138 275640 581733 71335 353713 236860 303975 1954394

Refer 2137 3506 6652 645 2338 3426 1510 20214

Annexure

Table 5. Distribution of IMCI patients and disease patterns in Barisal division in 2010

No. % No. % No. % No. % No. %

Male 1716 2.9 3649 6.1 19094 32.1 34982 58.9 59441 48.7

Female 1953 3.1 3787 6.0 20718 33.1 36147 57.7 62605 51.3

Total patients 3669 3.0 7436 6.1 39812 32.6 71129 58.3 122046 100.0

Very severe disease 309 12.7 637 26.1 770 31.6 721 29.6 2437 2.0

Pneumonia 0 0.0 0 0.0 2318 46.9 2624 53.1 4942 4.0

No pneumonia-cough and cold 0 0.0 0 0.0 14340 40.9 20757 59.1 35097 28.8

Diarrhea 1257 7.6 1895 11.4 4033 24.3 9403 56.7 16588 13.6

Fever-malaria 0 0.0 0 0.0 23 13.7 145 86.3 168 0.1

Fever-no malaria 0 0.0 0 0.0 8503 34.7 15980 65.3 24483 20.1

Measles 0 0.0 1 0.1 382 23.9 1213 76.0 1596 1.3

Ear problem 46 1.0 598 13.0 1486 32.2 2485 53.8 4615 3.8

Malnutrition 168 1.6 1538 14.8 2992 28.7 5718 54.9 10416 8.5

Others 1510 4.9 3532 11.5 8377 27.2 17377 56.4 30796 25.2

Total cases 3290 2.5 8201 6.3 43224 33.0 76423 58.3 131138 107.4

Refer 33 1.5 122 5.7 484 22.6 1498 70.1 2137 1.8

0-28 days 29-59 days 2-12 months 1-5 years TotalPatient/Diseases

17

Table 6. Distribution of IMCI patients and disease patterns in Chittagong division in 2010

No. % No. % No. % No. % No. %

Male 2716 2.1 6836 5.3 52887 40.7 67548 52.0 129988 51.0

Female 3071 2.5 4755 3.8 50695 40.5 66519 53.2 125040 49.0

Total patients 5787 2.3 11591 4.5 103583 40.6 134067 52.6 255028 100.0


Pneumonia 0 0.0 0 0.0 14881 39.0 23237 61.0 38118 14.9


Diarrhea 878 1.9 2724 5.9 13238 28.8 29179 63.4 46019 18.0

Fever-malaria 0 0.0 0 0.0 579 32.1 1223 67.9 1802 0.7

Fever-no malaria 0 0.0 0 0.0 11757 32.4 24563 67.6 36320 14.2

Measles 20 7.0 14 4.9 59 20.6 193 67.5 286 0.1

Ear problem 126 1.4 554 6.2 2232 24.8 6086 67.6 8998 3.5

Malnutrition 550 6.3 832 9.6 2048 23.6 5246 60.5 8676 3.4

Others 3164 5.4 5637 9.6 13227 22.5 36754 62.5 58782 23.0

Total cases 7892 2.9 16110 5.8 81937 29.7 169701 61.6 275640 108.1

Refer 192 5.5 393 11.2 926 26.4 1995 56.9 3506 1.4


Table 4. Percent distribution of IMCI patients and disease patterns by division in Bangladesh, 2010

Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh (Total)

Male 6.4 14.0 29.0 3.8 18.3 12.6 15.8 100.0

Female 7.1 14.3 29.1 4.1 17.2 12.7 15.5 100.0

Total patients 6.8 14.1 29.1 3.9 17.8 12.7 15.6 100.0

Very severe disease 2.6 15.3 25.6 2.4 28.4 8.3 17.4 100.0

Pneumonia 2.5 19.6 30.9 2.0 18.0 10.0 17.0 100.0

No pneumonia-cough and cold 7.5 13.2 33.8 4.2 18.2 13.0 10.1 100.0

Diarrhea 6.2 17.1 25.2 3.7 17.4 14.5 16.0 100.0

Fever-malaria 1.0 11.0 14.7 2.2 20.9 23.0 27.1 100.0

Fever-no malaria 8.6 12.7 38.5 5.0 17.4 10.4 7.5 100.0

Measles 19.2 3.4 12.0 0.3 11.5 35.2 18.3 100.0

Ear problem 6.1 11.9 28.0 2.2 18.5 11.8 21.4 100.0

Malnutrition 9.7 8.1 26.4 2.4 21.1 16.1 16.2 100.0

Others 7.1 13.6 25.0 3.9 15.9 10.7 23.8 100.0

Total cases 6.7 14.1 29.8 3.6 18.1 12.1 15.6 100.0

Refer 10.6 17.3 32.9 3.2 11.6 16.9 7.5 100.0

Table 7. Distribution of IMCI patients and disease patterns in Dhaka division in 2010

No. % No. % No. % No. % No. %

Male 4275 1.6 11739 4.4 87259 32.4 165990 61.6 269263 51.3

Female 4020 1.6 10601 4.1 82384 32.2 158462 62.0 255467 48.7

Total patients 8295 1.6 22340 4.3 169643 32.3 324452 61.8 524730 100.0


Pneumonia 0 0.0 0 0.0 24669 41.0 35564 59.0 60233 11.5


Diarrhea 913 1.3 2676 3.9 21326 31.4 42914 63.3 67829 12.9

Fever-malaria 0 0.0 0 0.0 733 30.4 1678 69.6 2411 0.5

Fever-no malaria 0 0.0 0 0.0 35649 32.4 74415 67.6 110064 21.0

Measles 47 4.7 91 9.2 295 29.7 559 56.4 992 0.2

Ear problem 353 1.7 1473 7.0 6558 31.0 12779 60.4 21163 4.0

Malnutrition 552 2.0 2879 10.2 9277 32.9 15471 54.9 28179 5.4

Others 3496 3.2 8880 8.2 28693 26.7 66589 61.9 107658 20.5

Total cases 7870 1.4 21047 3.6 193613 33.3 359203 61.7 581733 110.9

Refer 823 12.4 1136 17.1 2145 32.2 2548 38.3 6652 1.3


Table 8. Distribution of IMCI patients and disease patterns inKhulna division in 2010

No. % No. % No. % No. % No. %

Male 428 1.2 1256 3.5 9729 27.5 23990 67.8 35403 49.9

Female 457 1.3 1314 3.7 10013 28.2 23761 66.8 35544 50.1

Total patients 885 1.2 2569 3.6 19742 27.8 47750 67.3 70947 100.0


Pneumonia 0 0.0 0 0.0 1529 40.0 2294 60.0 3823 5.4


Diarrhea 59 0.6 260 2.6 2913 29.0 6828 67.9 10060 14.2

Fever-malaria 0 0.0 0 0.0 54 14.7 313 85.3 367 0.5

Fever-no malaria 0 0.0 0 0.0 4045 28.2 10282 71.8 14327 20.2

Measles 0 0.0 0 0.0 6 27.3 16 72.7 22 0.0

Ear problem 16 1.0 79 4.7 413 24.6 1173 69.8 1681 2.4

Malnutrition 120 4.7 132 5.2 668 26.4 1608 63.6 2528 3.6

Others 298 1.8 485 2.9 3925 23.5 11986 71.8 16694 23.5

Total cases 875 1.2 2492 3.5 20094 28.2 47874 67.1 71335 100.5

Refer 26 4.0 29 4.5 193 29.9 397 61.6 645 0.9


Table 9. Distribution of IMCI patients and disease patterns in Rajshahi division in 2010

No. % No. % No. % No. % No. %

Male 7462 4.4 18760 11.1 49465 29.1 94077 55.4 169763 52.9

Female 5867 3.9 17968 11.9 45526 30.1 81877 54.1 151238 47.1

Total patients 13329 4.2 36728 11.4 94992 29.6 175953 54.8 321002 100.0


Pneumonia 0 0.0 0 0.0 14929 42.6 20150 57.4 35079 10.9


Diarrhea 3369 7.2 7531 16.1 12528 26.7 23450 50.0 46878 14.6

Fever-malaria 0 0.0 0 0.0 1355 39.4 2088 60.6 3443 1.1

Fever-no malaria 0 0.0 0 0.0 19148 38.5 30567 61.5 49715 15.5

Measles 0 0.0 33 3.5 137 14.4 784 82.2 954 0.3

Ear problem 245 1.8 864 6.2 3846 27.5 9038 64.6 13993 4.4

Malnutrition 835 3.7 4463 19.8 6178 27.4 11046 49.0 22522 7.0

Others 3036 4.4 8190 12.0 19851 29.0 37335 54.6 68412 21.3

Total cases 15393 4.4 35203 10.0 108740 30.7 194377 55.0 353713 110.2

Refer 271 11.6 346 14.8 642 27.5 1079 46.2 2338 0.7

Total0-28 days 29-59 days 2-12 months 1-5 yearsPatient/Diseases

18

Table 10. Distribution of IMCI patients and disease patterns in Rangpur division in 2010

No. % No. % No. % No. % No. %

Male 1713 1.5 5546 4.7 51972 44.3 57995 49.5 117225 51.3

Female 1931 1.7 4120 3.7 48572 43.7 56630 50.9 111253 48.7

Total patients 3644 1.6 9665 4.2 100544 44.0 114625 50.2 228478 100.0


Pneumonia 0 0.0 0 0.0 7685 39.3 11804 60.4 19534 8.5


Diarrhea 1212 3.1 3269 8.3 12117 30.9 22573 57.6 39171 17.1

Fever-malaria 0 0.0 0 0.0 973 25.7 2816 74.3 3789 1.7

Fever-no malaria 0 0.0 0 0.0 10064 33.8 19690 66.1 29779 13.0

Measles 0 0.0 88 3.0 925 31.6 1910 65.3 2923 1.3

Ear problem 287 3.2 694 7.8 2963 33.2 4983 55.8 8927 3.9

Malnutrition 402 2.3 1223 7.1 5118 29.7 10498 60.9 17241 7.5

Others 1732 3.7 3182 6.9 13431 29.0 27992 60.4 46337 20.3

Total cases 5518 2.3 13584 5.7 79637 33.6 138121 58.3 236860 103.7

Refer 29 0.8 152 4.4 699 20.4 2546 74.3 3426 1.5


Table 11. Distribution of IMCI patients and disease patterns in Sylhet division in 2010

No. % No. % No. % No. % No. %

Male 8501 5.8 14246 9.7 45233 30.9 78363 53.5 146343 51.8

Female 8302 6.1 14813 10.9 43353 31.9 69536 51.1 136004 48.2

Total patients 16803 6.0 29059 10.3 88586 31.4 147899 52.4 282346 100.0


Pneumonia 0 0.0 0 0.0 13612 41.2 19414 58.8 33026 11.7


Diarrhea 2782 6.4 4604 10.7 13704 31.8 22052 51.1 43142 15.3

Fever-malaria 0 0.0 0 0.0 1708 38.3 2754 61.7 4462 1.6

Fever-no malaria 0 0.0 0 0.0 8675 40.3 12825 59.7 21500 7.6

Measles 88 5.8 99 6.5 344 22.6 989 65.1 1520 0.5

Ear problem 894 5.5 1749 10.8 5414 33.4 8132 50.2 16189 5.7

Malnutrition 2417 13.9 2617 15.1 4404 25.4 7930 45.7 17368 6.2

Others 6383 6.2 9777 9.5 31928 31.1 54544 53.1 102632 36.3

Total cases 16864 5.5 26490 8.7 100168 33.0 160453 52.8 303975 107.7

Refer 299 19.8 346 22.9 379 25.1 486 32.2 1510 0.5

1-5 years TotalPatient/Diseases

0-28 days 29-59 days 2-12 months

19

Advisors

1. Professor Dr. Khondhaker Md. Shefyetullah

Director General of Health Services (DGHS)

2. Dr. Syed Abu Jafar Md. Musa

Line Director, MNC&AH

and Director, Primary Health Care , DGHS

Chief Editor

Additional Director General (Planning and

Development) and Line Director, MIS-Health, DGHS

Associate Editor

Deputy Chief, MIS-Health, DGHS

Assistant Editor and Designer

1.

GIS Consultant, MIS-Health, DGHS

2.

Statistician, MIS-Health, DGHS

Review of Manuscript

1.

Members

1. Dr. Chand Sultana

Chief (HIU), MIS-Health, DGHS

2. Dr. Md. Altaf Hossain

Program Manager IMCI, DGHS

3. Dr. Ashish Kumar Saha

Assistant Director, MIS-Health and Program

Manager, Meical Biotechnology, DGHS

4. Mr. Sukhendu Shekhor Roy

System Analyst, MIS-Health, DGHS

5. Dr. Shah Ali Akbar Ashrafi

DPM, HIS & eHealth, DGHS

6. Dr. Sultan Shamiul Bashar

OSD, MIS-Health, DGHS

7. Dr. Ziaul Matin

Health Officer, UNICEF, Bangladesh

Data Analysis and Composer

Md. Jalal Uddin

Office Assistant, MIS-Health, DGHS

Editorial Board

Correspondence should be addressd to:

From, ....................................................................................................

....................................................................................................

....................................................................................................

To,DirectorManagement Information System (MIS)Directorate General of Health Services (DGHS) Mohakhali, Dhaka -1212, BangladeshPhone:88-02-8816459; Fax: 88-02-8813875 E-mail: [email protected]: www.dghs.gov.bd

.............................................................................................................................................................................