Child Health

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Introduction

In India, an estimated 26 millions of children are born every year. As per Census 2011, the share of children (0-6 years) accounts 13% of the total population in the Country. The child health programme under the National Health Mission (NHM) comprehensively integrates interventions that improve child survival and addresses factors contributing to infant and under-five mortality. It is now well recognized that child survival cannot be addressed in isolation as it is intricately linked to the health of the mother, which is further determined by her health and development as an adolescent. Therefore, the concept of Continuum of Care, that emphasizes on care during critical life stages in order to improve child survival, is being followed under the national programme. Another dimension of this approach is to ensure that critical services are made available at home, through community outreach and through health facilities at various levels (primary, first referral units, tertiary health care facilities). The newborn and child health are now the two key pillars of the Reproductive, maternal, newborn, child and adolescent health (RMNCH+A) strategic approach, 2013.

India has shown progress in Sample registration System indicators:

NMR (SRS)					IMR (SRS)					U5MR (SRS)
2016	2017	2018	2019	2020	2016	2017	2018	2019	2020	2016	2017	2018	2019	2020
24	23	23	22	20	34	33	32	30	28	39	37	36	35	32

NMR-Neonatal Mortality Rate; IMR-Infant Mortality Rate; U5MR-Under 5 Mortality Rate; SRS-Sample registration system.

Child Health goals under National Health Policy 2017/SDG

The Child Health programme under the Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy of the National Health Mission (NHM) comprehensively integrates interventions that improve child health and nutrition status and addresses factors contributing to neonatal, infant, under-five mortality and malnutrition. The National Population Policy (NPP) 2000, the National Health Policy 2002, Twelfth Five Year Plan (2007-12), National Health Mission (NRHM - 2005 – 2017), Sustainable Development Goals (2016-2030) and New National Health Policy, 2017 have laid down the goals for child health.

Child Health Indicator	Current status	NHP Target
IMR (Infant Mortality Rate)	28	28 by 2019
Neonatal Mortality rate	22	16 by 2025
Under 5 Mortality Rate	35	23 by 2025

*Sample Registration System

Child Health Goals under SDG:

Goal 3.2: By 2030, end preventable deaths of newborn and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.

Causes of Child Mortality in India

The major causes of child mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth weight (29.8%), Pneumonia (17.1%), Diarrheal diseases (8.6%), Other non-communicable diseases (8.3%), Birth asphyxia & birth trauma (8.2%), Injuries (4.6%), Congenital anomalies (4.4%), Ill-defined or cause unknown (4.4%), Acute bacterial sepsis and severe infections (3.6%), Fever of unknown origin (2.5%), and all other remaining causes (8.4%)

Causes of Infant Mortality

The major causes of infant mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth weight (35.9%), Pneumonia (16.9%), Birth asphyxia & birth trauma (9.9%), Other non-communicable diseases (7.9%), Diarrhoeal diseases (6.7%), Ill defined or cause unknown (4.6%), Congenital anomalies (4.6%), Acute bacterial sepsis and severe infections (4.2%), Injuries (2.1%), Fever of unknown origin (1.7%), and all other remaining causes (5.4%).

Causes of Neo-natal Mortality

The major causes of neonatal deaths as per Sample Registration System Report (2015-17) are Prematurity & low birth weight (46.1%), Birth asphyxia & birth trauma (13.5%), Neonatal Pneumonia (11.3%), Other noncommunicable diseases (8.4%), Sepsis (5.7%), Ill defined or cause unknown (5.3%), Congenital anomalies (4.3%), Diarrhoeal diseases (2.3%), Injuries (1.2%), Fever of unknown origin (1.4%) and all other remaining causes (0.6%).

Thrust area under Child Health programme

Thrust Area 1 : Neonatal and Child Health

Essential new born care (at every ‘delivery’ point at time of birth)
Facility based sick newborn care (at FRUs & District Hospitals)
Home Based Newborn Care and Home Based Care for Young Child (HBYC) Programme

Thrust Area 2 : Nutrition

Promotion of optimal Infant and Young Child Feeding Practices under Mother’s Absolute Affection (MAA) Programme
Micronutrient supplementation (Vitamin A, Iron Folic Acid)
Management of children with severe acute malnutrition
National Deworming Day

Thrust Area 3: Management of Common Child hood illnesses

Management of Childhood Diarrhoeal Diseases & Acute Respiratory Infections

Thrust Area 4: Immunisation

Intensification of Routine Immunisation
Eliminating Measles and Japanese Encephalitis related deaths
Polio Eradication

The strategies for child health intervention focus on improving skills of the health care workers, strengthening the health care infrastructure and involvement of the community through behaviour change communication.

Child Health indicators: (SRS 2012 to 2020)