Activity 1: Child Health

PI: Dr. Shams-El-Arifeen

For Bangladesh to be able to reach MDG on reducing child mortality by 2015, the IHP project has funded three major activities to improve child health.

Evaluation the Efficacy of Integrated Management of Childhood Illness (IMCI)

The first component evaluates the efficacy of Integrated Management of Childhood Illness (IMCI), a high priority programme of the Government of Bangladesh. We have supported the IMCI section of DG Health Services in the national expansion of IMCI and IMCI launching activities in various Upazillas, participated in IMCI supervisory and reporting format development which will be incorporated in the IMCI Section’s MIS system. We have contributed to the development of the community-IMCI counseling module and village doctors training module, revised English and Bangla versions of the11-day IMCI Clinical Management Training modules. We have given logistic support and distributed drugs to government’s 1st-level health facilities in the IMCI area in Matlab. Our home-based counseling and mothers group meetings is delivered by the Community Nutrition Promoters of the National Nutrition Programme. We have assisted the IMCI section in conducting different IMCI surveys and assessments and with evidence. ICDDR,B through its research and programmes on facility-based and community-based IMCI has contributed to the national adaptation and expansion of the IMCI programme in Bangladesh.

Neonatal Health Research Projects in Sylhet and Mirzapur, Tangail

The second component involved an effectiveness evaluation, i.e., the Neonatal Health Research Projects in Sylhet and Mirzapur, Tangail. Under these projects we trained doctors, paramedics and nurses of Upazilla health complexes, Union health and family welfare centres and other NGO clinics on essential newborn care. We provided Upazilla and Union level health facilities with essential equipment and supplies to manage normal deliveries and sick newborns. Efforts are underway to scale up Projahnmo lessons in Bangladesh, particularly through the National newborn health strategy, which is currently being drafted by the government agencies.

Maternal and Infant Nutrition Intervention Study at Matlab (MINIMat)

The third component was the Maternal and Infant Nutrition Intervention Study at Matlab (MINIMat) study, also in Matlab. We enrolled pregnant women, and randomly allocated them to receive one of three microntrient supplements (30 mg of iron, 60 mg of iron or multiple micronutrients) and to either early or usual start of food supplements. They were followed through birth of their baby (measured birth weight), 2 year of the child and the next pregnancy. We found that none of the interventions effected birth weight. Infant mortality was lower among live births of women who received multiple micronutrient supplements. These findings suggest the importance of reviewing current policy and programmes. There are 16 manuscripts under preparation from this phase of the MINIMat study. From April 2007, we have initiated the 5-year follow-up of the MINIMat children. This involves assessment of growth, metabolic, micronutrient and development markers as of 30th June 2007. We have successfully enrolled 671 children to-date.

Collaborating Institutions:

• Primary Health Care Directorate General of Health Services
• IMCI Section of Directorate General of Health Services
• Mother, Child and Reproductive Health Unit (MCRH), Directorate General of Family Planning
• Dhaka Shihu Hospital
• Kumudini Women Medical College Hospital, Mirzapur

Results:

Bangladesh is expected to be one of the five countries stated to achieve the targets of MDG 4 (reducing child mortality by two-third) and the results of the neonatal study in Sylhet and Mirzapore are key to that achievement.

a. IMCI
As of December 2006 facility based IMCI activities have been expanded to 174 Upazilla.

• MCE findings were used extensively in national planning and implementation of IMCI.
• Training materials and tools developed and tested through research were adopted by national program.
• Established monitoring criteria and mechanisms that strengthened national program.

b. Projahnmo I,& III

• Projahnmo-I (Sylhet): Reducing neonatal mortality
• Thirty three percent (33%) reduction in neonatal mortality rate (NMR) has been observed in the last 6 months of the intervention period in home care arm of this study.
• Projahnmo-III (Sylhet): Intervention has started for the study Impact of umbilical cord cleansing with chlorhexidine on neonatal mortality and omphalitis in rural Sylhet District of Bangladesh.

c. Projahnmo II (Mirzapur)

• Data cleaning and analysis of data form, and end of project (EOP) survey are being carried out.