Issue 4 | March 2013 IMCI NewsletterIMCI Newsletter · IMCI NewsletterIMCI Newsletter Performance...

IMCI NewsletterIMCI NewsletterIMCI NewsletterIMCI NewsletterPerformance Report for January to December 2011Performance Report for January to December 2011

Issue 4 | March 2013

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



Contents

Messages and Editorial P.02

Introduction P.03

Data and Method P.04

Limitation of the data P.05

Results P.05

Conclusion P.16

Annexure P.16

Director General Directorate General of Health Services

Mohakhali, Dhaka

Our country made a significant progress in child

mortality reduction and received the UN MDG Award

for its success in MDG4. IMCI program is playing the

vital role to sustain and improve universal child

immunization.

It is indeed a great pleasure for me to know that MIS

of DGHS is going to publish the 4th issue of IMCI

Newsletter. This newsletter is a very useful

publication as it enables us to get facility based

graphical data on childhood illness of the whole

country in a concised and understandable way.

I hope that this newsletter will give some

programmatic direction to policy-makers and program

managers and to understand the current situation to

undertake interventions for the future about the IMCI

services in Bangladesh. Finally, I would like to thank

everyone who worked hard directly and behind the

screen for publishing this newsletter successfully.

Professor Dr. Khondhaker Md. Shefyetullah

Additional Director General(Planning and Development)

& Line Director,Management Information System (MIS)Directorate General of Health Services

Mohakhali, Dhaka

Our country has made a remarkable progress in

improving the health of children. In fact, as per

recent estimate, we already achieved MDG4. The

recognition to Bangladesh's success in improving

child health came much earlier through the UN

MDG4 Award in 2010.

It is my great pleasure that the 4th issue of the

IMCI newsletter is going to be published from the

Department of MIS-Health of DGHS. The contents

of this newsletter will not only include the result of

the performance assessment of IMCI services in

facilities but will 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 those of the previous issues. 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 like to thank the entire team of IMCI

section for their sincere support and cooperation in

publishing this newsletter. I also wish to

congratulate the entire team of MIS-Health whose

relentless work and efforts have made this

possible. I also convey my thanks to all the

managers, doctors, paramedics, and other service

providers and staffs who helped in various ways

and thus enabled us to publish this newsletter.

I express my gratefulness to the Director General of

Health Services and Director, PHC, for their continuous

support and advice in accomplishing our tasks. I

extend my special thanks to UNICEF for their

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 attempt will

be successful if we can use the information for the

betterment of our children who deserve quality and

equitable health services.

Professor Dr. Abul Kalam Azad

Director, Primary Health Care& Line Director, Maternal, Neonatal, Child

and Adolescent Health (MNC&AH)Directorate General of Health Services

Mohakhali, Dhaka

I am happy to know that the Management Information

System (MIS) of the Directorate General of Health

Services (DGHS) is going to publish the 4th 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 congratulate the 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 would like to give thanks to

our development partners, specially UNICEF, UNFPA and

WHO for their financial and technical support for this

important task in the child health sector.

I expect that the IMCI Newsletter will be helpful for all

concerned and the Newsletter will be published regularly.

Dr. Syed Abu Jafar Md. Musa

Message

Editorial NoteMessage

02

IntroductionMortality in children younger than 5 years (under-5 mortality) remains high in Bangladesh at 57 in 1000 live-births, despite declines over the past decade. Pneumonia, diarrhoea, malnutrition, and measles account for more than half (52%) of these deaths. Integrated Management of Childhood Illness (IMCI) is a strategy developed and promoted by WHO and UNICEF for reducing childhood morbidity and mortality and promoting healthy growth and development. In 1998, the Government of Bangladesh adopted Integrated Management of Childhood Illness (IMCI) strategy to reduce these deaths and improve child health and development. The IMCI strategy through HPNSDP was designed to include coordinated activities within two objectives: (1) to reduce morbidity and mortality associated with the major causes of diseases in under five children through quality case management, and (2) too promote healthy growth and development by preventing diseases and promoting healthy practices through counseling the mother and caretakers.

Newborn HealthReducing Neonatal mortality and ensure health of the newborn is one the main target of IMCI section. National Neonatal Strategy & Guidelines has developed and Standard Operation Protocol (SOP) has formulated. Implementation of Neonatal Action Plan has started. Twelve Special Care Newborn Unit (SCANU) in the District Hospitals and Medical Colleges are functioning. A total of 41 SCANU will be established by 2015.

IMCI has 3 (three) components1. Improving case management skills of health workers2. Improving the health system3. Improving family and community practices

A large number of childhood morbidity and mortality (every year around 10 million children die before they reach their fifth birthdays) in the developing countries is caused by five conditions: acute respiratory infections (mostly pneumonia), diarrhoea, measles, malaria, or malnutrition. The Integrated Management of Childhood Illness (IMCI) strategy encompasses a range of interventions to prevent and manage this major childhood illness, both in health facilities and in the home. . 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).

After adaptation of WHO generic modules Bangladesh had piloted the IMCI strategy in 3 Upazilas (Matlab, Chandpur, Dhamrai, Dhaka and Kahaloo, Bogra) in the year 2002. After completion of pilot activities in December 2002 a joint National-International Experts Review of early implementation phase was held in February 2003. Based on the recommendations of the review, Bangladesh has started expansion of IMCI. Facility IMCI has expanded in 410 Upazilas up to December 2012. 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. We have also started the process of developing and introducing community-IMCI. A national strategy paper on community IMCI has been prepared to provide directions and guidelines on the introduction, adaptation and implementation of C-IMCI. C-IMCI has expanded in 150 upazilas.

03

IMCI NewsletterIMCI NewsletterPerformance Report for January to December 2011


IMCI protocol has incorporated in under graduate medical curriculum. All the Government Medical Colleges and most of the Private medical colleges are following the protocol. Initiative has taken to incorporate this protocol in Nursing Institute and Medical Assistant Training Schools (MATS) curriculum.

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-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 410 upazilas) from 50 districts. Community-based IMCI is running in 150 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 web-based software (District Health Information System [DHIS]) has been developed by MIS, DGHS, with the help of GIZ 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, Chuadanga, 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 2011, data were collected from the 50 IMCI program districts because these 50 districts were fully functional during the reporting period. The rest of the districts were included at the mid or last part of the year 2011. All reports covered 2,560,909 children "out-

04



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, 405 were covered as IMCI upazila up to December 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

05

Division

Total

no. of

districts

Total

no. of

upazilas

Total no. of

received

data from

IMCI

districts

Total no. of

received

data from

IMCI

upazilas

% of

upazila

data

coverage

Barisal 6 40 3 24 60.0

Chittagong 11 99 9 84 84.8

Dhaka 17 122 12 90 73.8

Khulna 10 59 6 45 76.3

Rajshahi 8 66 8 66 100.0

Rangpur 8 58 8 58 100.0

Sylhet 4 38 4 38 100.0

Total 64 482 50 405 84.0

Table 2. Distribution of IMCI patients and disease patterns in 2011 in Bangladesh

Sl.

no. Diseases/Medical Condition

0-28

day(s)

29-59

days

2-12

months 1-5 year(s) Total

% of

total

patients

A.1 Male 29097 55440 367573 732261 1184371 50.7

A.2 Female 29156 54111 351478 718878 1153623 49.3

A Total (A1+A2) 58253 109551 719051 1451139 2337994 100.0

B.1 Very severe disease 9609 15713 15394 15299 56015 2.4

B.2 Pneumonia 0 0 85488 118988 204476 8.7

B.3 No pneumonia-cough and cold 0 0 280830 506152 786982 33.7

B.4 Diarrhea 6109 18640 110946 212985 348680 14.9

B.5 Fever-malaria 0 0 2107 4787 6894 0.3

B.6 Fever-no malaria 0 0 156785 319747 476532 20.4

B.7 Measles 201 407 1059 1597 3264 0.1

B.8 Ear problem 2835 7916 31740 66399 108890 4.7

B.9 Malnutrition 4663 11199 32200 64751 112813 4.8

B.10 Others 20602 37292 112274 286195 456363 19.5

B Total (B1-B10) 44019 91167 828823 1596900 2560909 109.5

C Refer 4849 7358 14557 20408 47172 2.0



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 50 districts in 2011. It is seen that children from 1 to 5 year(s) age-group constituted the largest IMCI service recipients (62.1%), followed by 2 to 12 months age-group (30.8%). Of the total under-five children, 2.5% were at the neonatal age. Age-group 29 to 59 days comprised 4.7% of the total children receiving services from the IMCI facilities.

Figure 1. Distribution of children with IMCI

diseases by age-group in Bangladesh 2011

(N=2,337,994)

Figure 2. Percent distribution of male children

with IMCI diseases by age-group in Bangladesh

2011 (n=1,184,371)

Figure 3. Percent distribution of female

children with IMCI diseases by age-group in

Bangladesh 2011 (n=1,153,623)

Figure 4. Percent distribution of children with

very severe diseases by age-group (n=56,015;

2.4% of total)


pneumonia by age-group (n=204,476; 8.7% of

total)

06

0-28 day(s),

n=58253,

2.5%29-59 days,

n=109551,

4.7%

2-12 months,

n=719051,

30.8%1-5 years,

n=1451139,

62.1%

0-28 day(s),

n=29097,

2.5%

29-59 days,

n=55440,

4.7%

2-12 months,

n=367573,

31.0%1 - 5 years,

n=732261,

61.8%

0-28 day(s),

n=29156,

2.5%

29-59 days,

n=54111,

4.7%

2-12 months,

n=351478,

30.5%1-5 years,

n=718878,

62.3%

0-28 day(s),

n=9609,

17.2%

29-59 days,

n=15713,

28.1%2-12 months,

n=15394,

27.5%

1-5 year(s),

n=15299,

27.3%

2-12 months,

n=85488,

41.8%

1-5 year(s),

n=118988,

58.2%




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

(n=786,982; 33.7% of total)


'diarrhea' by age-group (n=348,680; 14.9% of

total)


'fever-malaria' by age-group (n=6,894; 0.3% of

total)


'fever-no malaria' by age-group (n=476,532;

20.4% of total)


'measles' by age-group (n=3,264; 0.1% of

total)


'ear problem' by age-group (n=108,890; 4.7%

of total)

07

2-12 months,

n=280830,

35.7%

1-5 year(s),

n=506152,

64.3%

0-28 day(s),

n=6109,

1.8%

29-59 days,

n=18640,

5.3%

2-12 months,

n=110946 ,

31.8%

1-5 year(s),

n=212985 ,

61.1%

2-12 months,

n=2107,

30.6%

1-5 year(s),

n=4787,

69.4%

2-12 months,

n=156785 ,

32.9%

1-5 year(s),

n=319747 ,

67.1%

0-28 day(s),

n=201 ,

6.2%29-59 days,

n=407,

12.5%

2-12 months,

n=1059,

32.4%

1-5 year(s),

n=1597,

48.9%

0-28 day(s),

n=2835,

2.6%29-59 days,

n=7916,

7.3%

2-12 months,

n=31740,

29.1%1-5 year(s),

n=66399,

61.0%




'malnutrition' by age-group (n=112,813; 4.8%

of total)


'others illness' by age-group (n=456,363; 19.5%

of total)

Figure 14. Percent distribution of 'referred

children' by age-group (n=47,172; 2.0% 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.

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: 33.7%; pneumonia: 8.7%). Fever (malaria or no malaria), and diarrhea were the morbidities of 20.7% and 14.9% of the children respectively. Similar pattern of morbidities was also observed among children of all age-groups.

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=58,253; 2.5%

of total)

08

0-28 day(s),

n=4663,

4.1%

29-59 days,

n=11199,

9.9%

2-12 months,

n=32200 ,

28.5%

1-5 year(s),

n=64751,

57.4%

0-28 day(s),

n=20602,

4.5%

29-59 days,

n=37292,

8.2%

2-12 months,

n=112274 ,

24.6%

1-5 year(s),

n=286195 ,

62.7%

0-28 day(s),

n=4849,

10.3%

29-59 days,

n=7358,

15.6%

2-12 months,

n=14557,

30.9%

1-5 year(s),

n=20408,

43.3%

4,849

20,602

4,663

2,835

201

-

-

6,109

-

-

9,609

Refered

Others illness

Malnutri on

Ear problem

Measles

Fever-no malaria

Fever-malaria

Diarrhea

No pneumonia-cough and cold

Pneumonia

Very severe diseases




among post-neonatal babies of 29-59 days

(n=109,551; 4.7% of total)


among infants of 2-12 months (n=719,051;

30.8% of total)


among children of 1-5 years (n=1,451,139;

62.1% of total)


among 0 day to 5 years old children

(N=2,337,994)

D. Percent distribution of IMCI patients by division in 2011In Barisal division, a total of 120,977 children received service from IMCI facilities; of them 61, 819 were male and the rest were female.

09

Refered

Others illness

Malnutri on

Ear problem

Measles

Fever-no malaria

Fever-malaria

Diarrhea


Pneumonia


7,358

37,292 11,199

7,916

407

-

-

18,640

-

-

15,713

Refered

Others illness

Malnutri on

Ear problem

Measles

Fever-no malaria

Fever-malaria

Diarrhea


Pneumonia


14,557

1,12,274

32,200

31,740

1,059

1,56,785

2,107

1,10,946

2,80,830 85,488

15,394

Refered

Others illness

Malnutri on

Ear problem

Measles

Fever-no malaria

Fever-malaria

Diarrhea


Pneumonia


20,408

2,86,195

64,751

66,399

1,597

3,19,747

4,787

2,12,985

5,06,152 1,18,988

15,299

Refered

Others illness

Malnutri on

Ear problem

Measles

Fever-no malaria

Fever-malaria

Diarrhea


Pneumonia


47,172

4,56,363

1,12,813

1,08,890

3,264

4,76,532

6,894

3,48,680

7,86,982

2,04,476

56,015




with various illnesses by age-groups in Barisal

division in 2011 (51.1% of total)


children with various illnesses by age-groups in

Barisal division in 2011 (48.9% of total)

Figure 22. Percent distribution of total children

with various illnesses by age-groups in Barisal

division in 2011

In Chittagong division total of 443,826 children received service from IMCI facilities,

of them 225, 615 were male, and 218, 211 were female.


with various illnesses by age-groups in

Chittagong division in 2011 (50.8% of total)



Chittagong division in 2011 (49.2% of total)

Figure 25. Percent distribution of totalfemale


Chittagong division in 2011

10

0-28 day(s),

n=1355,

2.2%29-59 days,

n=2928,

4.7%

2-12 months,

n=19370,

31.3%1-5 year(s),

n=38166,

61.7%

0-28 day(s),

n=1269,

2.1%

29-59 days,

n=2959,

5.0%

2-12 months,

n=18544,

31.3%

1-5 year(s),

n=36386,

61.5%

0-28 day(s),

n=2624,

2.2%

29-59 days,

n=5887,

4.9%

2-12 months,

n=37914,

31.3%

1-5 year(s),

n=74552,

61.6%

0-28 day(s),

n=6934,

3.1%

29-59 days,

n=11239,

5.0%

2-12 months,

n=68024,

30.2%

1-5 year(s),

n=139418,

61.8%

0-28 day(s),

n=6906,

3.2%

29-59 days,

n=10465,

4.8%

2-12 months,

n=65038,

29.8%1-5 year(s),

n=135802,

62.2%

0-28 day(s),

n=13840,

3.1%

29-59 days,

n=21704,

4.9%

2-12 months,

n=133062,

30.0%

1-5 year(s),

n=275220,

62.0%



In Dhaka division, a total of 623,630 children received service from IMCI facilities; of them 323,183 were male, and the rest were female (300,447).


with various illnesses by age-groups in Dhaka




Dhaka division in 2011 (48.2% of total)


with various illnesses by age-groups in Dhaka

division in 2011

In Khulna division, a total of 147, 480 children received service from IMCI facilities; of them 75, 324 were male, and the rest were female (72,156).


with various illnesses by age-groups in Khulna




Khulna division in 2011 (48.9% of total)


with various illnesses by age-groups in Khulna

division in 2011

11

0-28 day(s),

n=5757,

1.8%

29-59 days,

n=13262,

4.1%

2-12 months,

n=104736,

32.4%1-5 year(s),

n=199428,

61.7%

0-28 day(s),

n=4862,

1.6%

29-59 days,

n=11519,

3.8%

2-12 months,

n=95291,

31.7%

1-5 year(s),

n=188775,

62.8%

0-28 day(s),

n=960,

1.3%29-59 days,

n=1781,

2.4%

2-12 months,

n=23503,

31.2%

1-5 year(s),

n=49080,

65.2%

0-28 day(s),

n=829,

1.1%

29-59 days,

n=1610,

2.2%

2-12 months,

n=22870,

31.7%1-5 year(s),

n=46847,

64.9%

0-28 day(s),

n=1789,

1.2%

29-59 days,

n=3391,

2.3%

2-12 months,

n=46373,

31.4%1-5 year(s),

n=95927,

65.0%



0-28 day(s),

n=10619,

1.7%

29-59 days,

n=24781,

4.0%

2-12 months,

n=200027,

32.1%

1-5 year(s),

n=388203,

62.2%

In Rajshahi division, a total of 525,849 children received service from IMCI facilities; of them 262,176 were male, and the rest were female (263,673).


with various illnesses by age-groups in Rajshahi




Rajshahi division in 2011 (50.1% of total)


with various illnesses by age-groups in Rajshahi

division in 2011

In Rangpur division, a total of 216,906 children received service from IMCI facilities; of them 109,143 were male, and the rest were female (107,763).


with various illnesses by age-groups in Rangpur




Rangpur division in 2011 (49.7% of total)


with various illnesses by age-groups in Rangpur

division in 2011

12

0-28 day(s),

n=7367,

2.8%

29-59 days,

n=13651,

5.2%

2-12 months,

n=79527,

30.3%1-5 year(s),

n=161631,

61.6%

0-28 day(s),

n=8147,

3.1%

29-59 days,

n=13818,

5.2%

2-12 months,

n=78572,

29.8%1-5 year(s),

n=163136,

61.9%

0-28 day(s),

n=15514,

3.0%

29-59 days,

n=27469,

5.2%

2-12 months,

n=158099,

30.1%

1-5 year(s),

n=324767,

61.8%

0-28 day(s),

n=2056,

1.9%29-59 days,

n=4661,

4.3%

2-12 months,

n=33090,

30.3%1-5 year(s),

n=69336,

63.5%

0-28 day(s),

n=2339,

2.2%

29-59 days,

n=5026,

4.7%

2-12 months,

n=32146,

29.8%

1-5 year(s),

n=68252,

63.3%

0-28 day(s),

n=4395,

2.0%

29-59 days,

n=9687,

4.5%

2-12 months,

n=65236,

30.1%

1-5 year(s),

n=137588,

63.4%



In Sylhet division, a total of 259,326 children received service from IMCI facilities; of them 127,111 were male, and the rest were female (132,215).


with various illnesses by age-groups in Sylhet




Sylhet division in 2011 (51.0% of total)


with various illnesses by age-groups in Sylhet

division in 2011

E. Percent distribution of IMCI cases with various illnesses by division in 2011Figure 41. Percent distribution of children with various illnesses by age-group in Barisal division in 2011

13

0-28 day(s),

n=4668,

3.7%

29-59 days,

n=7918,

6.2%

2-12 months,

n=39323,

30.9%

1-5 year(s),

n=75202,

59.2%

0-28 day(s),

n=4804,

3.6%29-59 days,

n=8714,

6.6%

2-12 months,

n=39017,

29.5%1-5 year(s),

n=79680,

60.3%

0-28 day(s),

n=9472,

3.7%29-59 days,

n=16632,

6.4%

2-12 months,

n=78340,

30.2%

1-5 year(s),

n=154882,

59.7%



Figure 44. Percent distribution of children with various illnesses by age-group in Khulna division in 2011

Figure 43. Percent distribution of children with various illnesses by age-group in Dhaka division in 2011

Figure 42. Percent distribution of children with various illnesses by age-group in Chittagong division in 2011

14



Figure 46. Percent distribution of children with various illnesses by age-group in Rangpur division in 2011

Figure 47. Percent distribution of children with various illnesses by age-group in Sylhet division in 2011

Figure 45. Percent distribution of children with various illnesses by age-group in Rajshahi division in 2011

15



Table 3. Distribution of IMCI patients and diseases patterns by division in Bangladesh, 2011

Figure 48. Percent distribution of children with various illnesses by age-group in Bangladesh, 2011

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

16

Annexure



Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh

Male 61819 225615 323183 75324 262176 109143 127111 1184371

Female 59158 218211 300447 72156 263673 107763 132215 1153623

Total patients 120977 443826 623630 147480 525849 216906 259326 2337994

Very severe disease 2529 11036 16413 3367 8401 6446 7823 56015

Pneumonia 7680 41715 60728 7320 41986 20451 24596 204476

No pneumonia-cough and cold 38094 140935 220599 54490 190087 73535 69242 786982

Diarrhea 17341 68223 90549 19567 65895 37052 50053 348680

Fever-malaria 365 2770 1132 307 1064 777 479 6894

Fever-no malaria 28333 82953 144092 39179 91322 51796 38857 476532

Measles 93 919 980 110 496 200 466 3264

Ear problem 5523 18088 28700 4323 24587 11081 16588 108890

Malnutrition 6067 21795 26268 4001 28063 11775 14844 112813

Others 27377 92482 112920 30108 110240 34071 49165 456363

Total cases 133402 480916 702381 162772 562141 247184 272113 2560909

Refer 1582 14450 11176 2598 12253 2676 2437 47172

Table 5. Distribution of IMCI patients and disease patterns in Barisal division in 2011

17

Editorial Board

Table 6. Distribution of IMCI patients and disease patterns in Chittagong division in 2011

Table 4. Percent distribution of IMCI patients and disease patterns by division in Bangladesh, 2011

Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh

Male 5.2 19.0 27.3 6.4 22.1 9.2 10.7 100.0

Female 5.1 18.9 26.0 6.3 22.9 9.3 11.5 100.0

Total patients 5.2 19.0 26.7 6.3 22.5 9.3 11.1 100.0

Very severe disease 4.5 19.7 29.3 6.0 15.0 11.5 14.0 100.0

Pneumonia 3.8 20.4 29.7 3.6 20.5 10.0 12.0 100.0

No pneumonia-cough and cold 4.8 17.9 28.0 6.9 24.2 9.3 8.8 100.0

Diarrhea 5.0 19.6 26.0 5.6 18.9 10.6 14.4 100.0

Fever-malaria 5.3 40.2 16.4 4.5 15.4 11.3 6.9 100.0

Fever-no malaria 5.9 17.4 30.2 8.2 19.2 10.9 8.2 100.0

Measles 2.8 28.2 30.0 3.4 15.2 6.1 14.3 100.0

Ear problem 5.1 16.6 26.4 4.0 22.6 10.2 15.2 100.0

Malnutrition 5.4 19.3 23.3 3.5 24.9 10.4 13.2 100.0

Others 6.0 20.3 24.7 6.6 24.2 7.5 10.8 100.0

Total cases 5.2 18.8 27.4 6.4 21.9 9.7 10.6 100.0

Refer 3.4 30.6 23.7 5.5 26.0 5.7 5.2 100.0

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

Male 1355 2.2 2928 4.7 19370 31.3 38166 61.7 61819 51.1

Female 1269 2.1 2959 5.0 18544 31.3 36386 61.5 59158 48.9

Total patients 2624 2.2 5887 4.9 37914 31.3 74552 61.6 120977 100.0

Very severe disease 375 14.8 705 27.9 866 34.2 583 23.1 2529 2.1

Pneumonia 0 0.0 0 0.0 3182 41.4 4498 58.6 7680 6.3

No pneumonia-cough and cold 0 0.0 0 0.0 13549 35.6 24545 64.4 38094 31.5

Diarrhea 373 2.2 993 5.7 5301 30.6 10674 61.6 17341 14.3

Fever-malaria 0 0.0 0 0.0 122 33.4 243 66.6 365 0.3

Fever-no malaria 0 0.0 0 0.0 9298 32.8 19035 67.2 28333 23.4

Measles 7 7.5 4 4.3 31 33.3 51 54.8 93 0.1

Ear problem 203 3.7 602 10.9 1642 29.7 3076 55.7 5523 4.6

Malnutrition 364 6.0 888 14.6 1903 31.4 2912 48.0 6067 5.0

Others 1384 5.1 2735 10.0 6678 24.4 16580 60.6 27377 22.6

Total cases 2706 39.2 5927 73.4 42572 31.9 82197 61.6 133402 110.3

Refer 58 3.7 170 10.7 564 35.7 790 49.9 1582 1.3

Patient/Diseases0-28 days 29-59 days 2-12 months 1-5 years Total

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

Male 6934 3.1 11239 5.0 68024 30.2 139418 61.8 225615 50.8

Female 6906 3.2 10465 4.8 65038 29.8 135802 62.2 218211 49.2

Total patients

13840

3.1

21704

4.9

133062

30.0

275220

62.0

443826

100.0


Pneumonia 0 0.0 0 0.0 16556 39.7 25159 60.3 41715 9.4


Diarrhea 1287 1.9 3331 4.9 21004 30.8 42601 62.4 68223 15.4

Fever-malaria 0 0.0 0 0.0 795 28.7 1975 71.3 2770 0.6

Fever-no malaria 0 0.0 0 0.0 27447 33.1 55506 66.9 82953 18.7

Measles 27 2.9 77 8.4 295 32.1 520 56.6 919 0.2

Ear problem 527 2.9 1256 6.9 5128 28.4 11177 61.8 18088 4.1

Malnutrition 842 3.9 1684 7.7 6719 30.8 12550 57.6 21795 4.9

Others 6288 6.8 7823 8.5 20454 22.1 57917 62.6 92482 20.8

Total cases 10694 2.2 17168 3.6 151492 31.5 301562 62.7 480916 108.4

Refer 1825 12.6 2271 15.7 3962 27.4 6392 44.2 14450 3.3


Table 7. Distribution of IMCI patients and disease patterns in Dhaka division in 2011

Table 8. Distribution of IMCI patients and disease patterns inKhulna division in 2011

Table 9. Distribution of IMCI patients and disease patterns in Rajshahi division in 2011

18

Editorial Board

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

Male 5757 1.8 13262 4.1 104736 32.4 199428 61.7 323183 51.8

Female 4862 1.6 11519 3.8 95291 31.7 188775 62.8 300447 48.2

Total patients 10619 1.7 24781 4.0 200027 32.1 388203 62.2 623630 100.0


Pneumonia 0 0.0 0 0.0 25802 42.5 34926 57.5 60728 9.7


Diarrhea 1209 1.3 3726 4.1 29817 32.9 55797 61.6 90549 14.5

Fever-malaria 0 0.0 0 0.0 304 26.9 828 73.1 1132 0.2

Fever-no malaria 0 0.0 0 0.0 47403 32.9 96689 67.1 144092 23.1

Measles 56 5.7 139 14.2 334 34.1 451 46.0 980 0.2

Ear problem 551 1.9 1916 6.7 8626 30.1 17607 61.3 28700 4.6

Malnutrition 954 3.6 3054 11.6 7537 28.7 14723 56.0 26268 4.2

Others 3843 3.4 8861 7.8 28497 25.2 71719 63.5 112920 18.1

Total cases 9501 1.4 21873 3.1 232954 33.2 438053 62.4 702381 112.6

Refer 1173 10.5 1898 17.0 3642 32.6 4463 39.9 11176 1.8


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

Male 960 1.3 1781 2.4 23503 31.2 49080 65.2 75324 51.1

Female 829 1.1 1610 2.2 22870 31.7 46847 64.9 72156 48.9

Total patients 1789 1.2 3391 2.3 46373 31.4 95927 65.0 147480 100.0


Pneumonia 0 0.0 0 0.0 3054 41.7 4266 58.3 7320 5.0


Diarrhea 191 1.0 602 3.1 6283 32.1 12491 63.8 19567 13.3

Fever-malaria 0 0.0 0 0.0 61 19.9 246 80.1 307 0.2

Fever-no malaria 0 0.0 0 0.0 13474 34.4 25705 65.6 39179 26.6

Measles 7 6.4 20 18.2 34 30.9 49 44.5 110 0.1

Ear problem 76 1.8 238 5.5 1163 26.9 2846 65.8 4323 2.9

Malnutrition 191 4.8 422 10.5 1084 27.1 2304 57.6 4001 2.7

Others 757 2.5 1235 4.1 6967 23.1 21149 70.2 30108 20.4

Total cases 1612 1.0 3168 1.9 53695 33.0 104297 64.1 162772 110.4

Refer 295 11.4 428 16.5 707 27.2 1168 45.0 2598 1.8


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

Male 7367 2.8 13651 5.2 79527 30.3 161631 61.6 262176 49.9

Female 8147 3.1 13818 5.2 78572 29.8 163136 61.9 263673 50.1

Total patients 15514 3.0 27469 5.2 158099 30.1 324767 61.8 525849 100.0


Pneumonia 0 0.0 0 0.0 17579 41.9 24407 58.1 41986 8.0


Diarrhea 1081 1.6 3804 5.8 21461 32.6 39549 60.0 65895 12.5

Fever-malaria 0 0.0 0 0.0 384 36.1 680 63.9 1064 0.2

Fever-no malaria 0 0.0 0 0.0 29596 32.4 61726 67.6 91322 17.4

Measles 16 3.2 49 9.9 169 34.1 262 52.8 496 0.1

Ear problem 732 3.0 1760 7.2 6691 27.2 15404 62.7 24587 4.7

Malnutrition 947 3.4 2322 8.3 7635 27.2 17159 61.1 28063 5.3

Others 5476 5.0 11155 10.1 28796 26.1 64813 58.8 110240 21.0

Total cases 9313 1.7 21153 3.8 180489 32.1 351186 62.5 562141 106.9

Refer 809 6.6 1565 12.8 4127 33.7 5752 46.9 12253 2.3


Table 10. Distribution of IMCI patients and disease patterns in Rangpur division in 2011

Table 11. Distribution of IMCI patients and disease patterns in Sylhet division in 2011

Table 12. Distribution of IMCI patients and disease patterns in Bangladesh, 2011

19

Editorial Board

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

Male 2056 1.9 4661 4.3 33090 30.3 69336 63.5 109143 50.3

Female 2339 2.2 5026 4.7 32146 29.8 68252 63.3 107763 49.7

Total patients 4395 2.0 9687 4.5 65236 30.1 137588 63.4 216906 100.0


Pneumonia 0 0.0 0 0.0 8570 41.9 11881 58.1 20451 9.4


Diarrhea 382 1.0 1890 5.1 11806 31.9 22974 62.0 37052 17.1

Fever-malaria 0 0.0 0 0.0 258 33.2 519 66.8 777 0.4

Fever-no malaria 0 0.0 0 0.0 15839 30.6 35957 69.4 51796 23.9

Measles 25 12.5 25 12.5 67 33.5 83 41.5 200 0.1

Ear problem 224 2.0 793 7.2 3182 28.7 6882 62.1 11081 5.1

Malnutrition 455 3.9 935 7.9 3238 27.5 7147 60.7 11775 5.4

Others 1029 3.0 2054 6.0 8810 25.9 22178 65.1 34071 15.7

Total cases 3468 1.4 8157 3.3 77929 31.5 157630 63.8 247184 114.0

Refer 257 9.6 457 17.1 853 31.9 1109 41.4 2676 1.2


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

Male 4668 3.7 7918 6.2 39323 30.9 75202 59.2 127111 49.0

Female 4804 3.6 8714 6.6 39017 29.5 79680 60.3 132215 51.0

Total patients 9472 3.7 16632 6.4 78340 30.2 154882 59.7 259326 100.0


Pneumonia 0 0.0 0 0.0 10745 43.7 13851 56.3 24596 9.5


Diarrhea 1586 3.2 4294 8.6 15274 30.5 28899 57.7 50053 19.3

Fever-malaria 0 0.0 0 0.0 183 38.2 296 61.8 479 0.2

Fever-no malaria 0 0.0 0 0.0 13728 35.3 25129 64.7 38857 15.0

Measles 63 13.5 93 20.0 129 27.7 181 38.8 466 0.2

Ear problem 522 3.1 1351 8.1 5308 32.0 9407 56.7 16588 6.4

Malnutrition 910 6.1 1894 12.8 4084 27.5 7956 53.6 14844 5.7

Others 1825 3.7 3429 7.0 12072 24.6 31839 64.8 49165 19.0

Total cases 6725 2.5 13721 5.0 89692 33.0 161975 59.5 272113 104.9

Refer 432 17.7 569 23.3 702 28.8 734 30.1 2437 0.9


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

Male 29097 2.5 55440 4.7 367573 31.0 732261 61.8 1184371 50.7

Female 29156 2.5 54111 4.7 351478 30.5 718878 62.3 1153623 49.3

Total patients 58253 2.5 109551 4.7 719051 30.8 1451139 62.1 2337994 100.0


Pneumonia 0 0.0 0 0.0 85488 41.8 118988 58.2 204476 8.7


Diarrhea 6109 1.8 18640 5.3 110946 31.8 212985 61.1 348680 14.9

Fever-malaria 0 0.0 0 0.0 2107 30.6 4787 69.4 6894 0.3

Fever-no malaria 0 0.0 0 0.0 156785 32.9 319747 67.1 476532 20.4

Measles 201 6.2 407 12.5 1059 32.4 1597 48.9 3264 0.1

Ear problem 2835 2.6 7916 7.3 31740 29.1 66399 61.0 108890 4.7

Malnutrition 4663 4.1 11199 9.9 32200 28.5 64751 57.4 112813 4.8

Others 20602 4.5 37292 8.2 112274 24.6 286195 62.7 456363 19.5

Total cases 44019 1.7 91167 3.6 828823 32.4 1596900 62.4 2560909 109.5

Refer 4849 10.3 7358 15.6 14557 30.9 20408 43.3 47172 2.0


Advisors

1. Professor Dr. Khondhaker Md. Shefyetullah

Director General of Health Services (DGHS)

2. Dr. Syed Abu Jafar Md. Musa

Director, Primary Health Care

& Line Director, MNC&AH , DGHS

Chief Editor

Professor Dr. Abul Kalam Azad

Additional Director General (Planning and

Development) & Line Director, MIS-Health, DGHS

Associate Editor

Md. Ashraful Islam Babul

Deputy Chief, MIS-Health, DGHS

Assistant Editor and Designer

Nayeem Al Mifthah

Consultant (HIS & GIS), MIS-Health, DGHS

Data Analysis and Composer

Md. Jalal Uddin

Office Assistant, MIS-Health, DGHS

Members

1. Dr. Chand Sultana

Chief (HIU), MIS-Health, DGHS

2. Dr. Md. Gowsal Azam

Deputy Chief (Medical), MIS-Health, DGHS

3. Dr. Ashish Kumar Saha

Program Manager, Medical Biotechnology &

Assistant Director, MIS-Health, DGHS

4. Dr. Md. Altaf Hossain

Program Manager (IMCI), DGHS

5. Mr. Sukhendu Shekhor Roy

System Analyst, MIS-Health, DGHS

6. Dr. Shah Ali Akbar Ashrafi

Deputy Program Manager, eHealth, MIS, DGHS

7. Mr. Burhan Uddin Ahmad

Programmer, MIS-Health, DGHS

8. Dr. Sultan Shamiul Bashar

OSD, MIS-Health, DGHS

9. Dr. Ziaul Matin

Health Specialist, UNICEF, Bangladesh

Editorial BoardEditorial 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

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

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