By Vidya Kulkarni
28 March 2006: Usha Sakat, an Aanganwadi Worker in Honala village in Osmanabad district of the state of Maharashtra, proudly recalls how she succeeded in improving the health of an underweight newborn baby girl in her village. The new born weighed less than 2 kg. Usha, therefore, advised the family members, especially the mother to keep the baby warm, not to bathe her but wipe her instead with a cloth dipped in warm water, and most importantly, to give exclusive breastfeeding. Usha routinely visited the family to monitor the baby, who gained one kg within a month.
The significance of early breast feeding is not yet understood, while the concept of exclusive breastfeeding is still alien to most.
According to Usha, ‘In rural areas families still adhere to some practices that are detrimental to the health of the new born. Some put kumkum (red powder that women use on their foreheads) on the naval cord, some feed honey and water to the baby, leading to bacterial infection. The significance of early breast feeding is not yet understood, while the concept of exclusive breastfeeding is still alien to most. Lack of awareness of proper practices and adherence to unhealthy local practices are major reasons behind child morbidity and mortality. As village based workers, our effort is to convince people against them and instead adapt to appropriate practices to make the baby survive and remain healthy.’
Usha Sakat underwent training in Integrated Management of Neonatal and Childhood Illnesses or IMNCI, where she learned how to take care of new born babies and guide the mothers to adopt appropriate health care practices. IMNCI is a child survival strategy that addresses malnutrition and infant mortality. Since neonatal deaths account for most of the infant deaths, IMNCI focuses and provides systematic guidelines for health service providers to reduce neonatal mortality. The Government of India together with UNICEF piloted the IMNCI package in Osmanabad district in 2003.
The introduction of IMNCI package starts with an intensive 8-day training of Aanganwadi workers and other health staff - Auxiliary Nurse and Midwifes and Multipurpose Health Workers at the sub center level and Medical officers and supervisors at the primary health center level. The training equips the health workers to identify and treat basic illnesses of children from 0 to 5 years age. The major emphasis of the training is on identifying and classifying health symptoms during the neonatal period. The step by step guidelines developed for check-up and the colour-coded classification manual help detect illnesses to provide timely and proper treatment.
The major challenge in ensuring survival of a child is to reach all newborns.
The major challenge in ensuring survival of a child is to reach all newborns. The existing health services are not locally based and health workers visit only on certain weekdays. IMNCI fills this gap by enhancing capacities of Aanganwadi workers, who are village based, and visit every house with a newborn baby within 24 hours of birth and thereafter every 3 days. Regular visits, weight monitoring, immunization and check-ups, provision of first aid and immediate treatment and timely referral all contribute to survival and healthy growth of the baby. The workers provide basic treatment as well as counselling, and together with the health staff make available an efficient health service management of childhood illnesses, making every child count.