INTRODUCTION:

With a child population of over 400 million, India has the largest number of children between the ages of 0-18 years globally.¹As per Census 2011, children (0-5 years) account for 13% of the total population in the Country.² In India, an estimated 24.7 million of children are born every year.³ It is well known that millions of children under five years of age in our country still do not receive appropriate care and support to become physically healthy, mentally alert and emotionally secure. India’s annual birth cohort is 26 million, this would translate to around 17 lakh birth defects, which account for almost 10% of the total newborn deaths and 4% of under-five mortality in our country.⁴

Various nutritional deficiencies affecting the preschool children range from 4 to 70%. Nearly 47% of all children are malnourished, 43% underweight and 20% wasted, including 8 million severely acute malnourished children.⁵ We have made progress in reducing child mortality and in improving child’s health with the help of nurses. We can see the current evidence from Sample Registration System, 2018 Report; The Under Five Mortality Rate in India is 36/1000 live births. Infant Mortality Rate is 32/1000 live births.⁶ Further reduction in child mortality is still desired, along with a need to improve the survival outcome. This necessitated drawing up an effective program dedicated to nurse’s involvement in early identification of defects and deficiencies followed by their appropriate management.

All child health programs have nurses to implement all the existing child health services at all levels, be that preventive, promotive, curative or rehabilitative. Nurses are to play a major role in improving the child health status of the country and in achieving National Health Goals. Many health programs are mainly involving nursing personnel i.e. nurses and community health workers to provide services to the children e.g. Nurses, ANMs and health supervisors.⁷ Research has demonstrated that nurses are effective at supporting individuals to make behavior change, administering disease management programs and enabling self-care as well as self-management.⁸

Existing situation about child health:

The new national health policy 2017 aims to reduce mortality rate of children under 5 years of age to 23 (per 1000) by 2025 and maternal mortality rate (MMR) from current levels to 100 by 2020. Reduce infant mortality rate to 28 by 2019. Reduce neo-natal mortality to 16 and still birth rate to 'single digit' by 2025.⁹

Table 2: Current Child mortality indicator in India⁶:

Mortality indicators	Rate	Year
Still birth rate	04/1000 total birth	2018
Perinatal mortality rate	22/1000 total birth
Neonatal mortality rate	23/1000 live birth
Post neonatal mortality rate	09/1000 live birth
Infant mortality rate	32/1000 live birth
Under five mortality rates	36/1000 live birth

Role of nursing personnel in Child Health Services:

The Government of India has launched various programmes for children.

1.Universal Immunization Program:

It was launched in 1978 with objective to increase the immunization coverage. Under this program mission Indradhanush was launched in 2014 against seven diseases diphtheria, measles, polio, tetanus, pertussis, tuberculosis, hepatitis B.¹⁰

Role of nurses in universal immunization program:

• Reviewing immunization schedule for updates

• Calculating, indenting storing and handling required vaccines

• Administering vaccines using right routes, dosages, sites and technique

• Documenting, recording vaccine administered and manufacturer of vaccine; patient reaction/adverse events

• Educating parents regarding importance of immunization.

• Informing parents about the date of next visit for immunization.¹¹

2. Child Survival and Safe Motherhood Program:

It was launched in 1992. The main aim of this programme was to reduce infant mortality.¹²

3. Reproductive and Child Health (RCH):

· The first phase of RCH program was launched in 1997.RCH phase1 program incorporated the 4 components are family planning, CSSM, client approach to health care, prevention/ management of STD/ RTI/AID. RCH –PHASE II began from 1st April 2005.The focus was to reduce maternal and child mortality and morbidity with emphasis on rural health care.¹³

Role of nurse in reproductive and child health program:

The community health nurse ensures provision of the following care:

· Early registration and provision of ante natal care.

· Monitoring the growth of the foetus and its wellbeing.

· Promoting and implementing good perinatal care.

· Promoting institutional deliveries.

· Promoting delivery by trained personnel.¹¹

4. Integrated management of neonatal and childhood illness:

It was launched in 2002. Components of this program are improvement of the case management skills of health providers, improvement in the overall health system, improvement in family and community health care practices and collaboration/coordination with other Departments.¹⁴

Role of nurses in IMNCI:

Recognition of illness and risk. Management of diarrhoea, ARI malaria, measles, acute ear infection, malnutrition and anaemia. Timely and appropriate referral, if needed. Prevention and management of Iron and Vitamin A deficiency. Counselling of danger signs with immediate reporting, feeding for all children below 2 years. Counselling on feeding for malnourished children.¹¹

5. Facility based new born and child care (FBNC):

Neonatal mortality is one of the major contributors (2/3) to the Infant Mortality. Facility based newborn and child care consists of Special New born Care Units (SNCU), New-born Stabilization units (NBSUs) and New Born Care Corners (NBCCs).¹⁵

Role of nurse in Facility Based New born and Child care:

Ensuring functionality of FBNC by review and monitoring of SNCUs, NBSUs and NBCC. Ensuring functionality of FBPC by review and monitoring functionality in all centres, reviewing services at paediatric ward. Monitoring, validation and corrective actions on Child Death Reviews.¹¹

6. National health mission:

Government of India Launched NRHM on 5th April 2005 for a period of 7 years (2005-2012), extended up to 2017. It was launched to improve rural healthcare delivery system. National health mission has two sub parts: National Rural Health Mission and National Urban Health Mission. Main goal of this mission is to reduction in IMR and MMR and universal access to public health services.

Major initiatives of National Health mission relevant to child health:

· Web enabled Mother and Child Tracking system:

Name based tracking of pregnant women and children up to the age of 3 years.

· Mother and Child Health wings:

100/50/30 bedded maternal and child health wings have been sanctioned in public health facilities.

· Kilkari:

It is an Interactive Voice Response based mobile services that delivers time sensitive audio messages about pregnancy and child health.^16,17

7. Navjat Shishu Suraksha Karyakaram:

• It was launched in 2009.NSSK is a program aimed to train health personnel in basic newborn care and resuscitation, has been launched to address issues at birth. The objective is to have a trained health personnel in Basic newborn care and resuscitation at every delivery point.¹⁸

8. Janani Shishu Suraksha Karyakaram:

Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011and has provision for both pregnant women and sick new born till 30 days after birth are¹⁹:

(1) Free and zero expense treatment.

Role of nurse in JSSK:

· Ensuring operationalization of all delivery points in the health centers.

· Reviewing and hand holding (Institutional deliveries and status of delivery points- Equipment, Consumables including drugs and investigations (Including sonography services), Free transport services, dietary services through in house kitchen. Field visit of at least one sub center per week. Ensuring Operationalization of Blood Transfusion Services. Ensuring quality intrapartum and immediate postpartum. Ensure availability of free drugs, diagnostics and referral transport to infants up to 1 year.¹¹

9. Reproductive, maternal, newborn, child and adolescent health:

• RMNCH+A approach has been launched in 2013 The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.²⁰

10. Rashtriya bal swasthya karyakram:

It was launched in 2013. The Ministry of Health and Family Welfare, Government of India, under the National Health Mission launched RBSK which includes child Health Screening and Early Intervention Services basically refer to early detection and management of a set of 30 health conditions prevalent in children less than 18 years of age. These conditions are broadly Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities - 4D’s.²¹

Role of nurse in Rashtriya Bal Swasthya Karyakram:

Ensure that all the new born with birth defects are referred to DEIC by checking birth defect register during visit of delivery points. Work with mobile Health Team for visit to school and anaganwadi for early identification and referral of children. Ensure screening of planned facilities / number of infants and children, as well as treatment of all 4D positive children, including cleft lip / palate surgeries.¹⁷

11. India newborn action plan:

The India Newborn Action Plan (INAP) was launched in September 2014 with the aim of ending preventable newborn deaths and stillbirths by 2030.⁹

Role of nurse in India newborn action plan:

Preconception and antenatal care. Care during labour and child birth. Immediate new born care, Care of healthy new born, Care of small and sick new born.

12. The Baby Friendly Hospital Initiative:

The Baby Friendly Hospital Initiative (BFHI) was started in India in 1993. Under this, the hospital with maternity services, have to follow the ten steps to successful breastfeeding. These hospitals are assessed and certified as baby friendly (BF) if they adopt the “Ten Steps” and follow these practices.²²

Existing problems:

a. Poor utilization of reproductive and child health services.²³ (Biswas R 2002)

b. Inadequate infrastructure and logistic supply.²⁴ (Sahoo J 2016)

c. Lack of supervision of different National Health Programmes for children.²⁵ (Sinha LN 2014)

d. Insufficient staff training.²⁶ (Venkatchalam J 2011)

e. Low numbers of qualified health workers.²⁷ (Rao KD 2016)

f. Lack of awareness among people.²⁸ (Rao N 2012)

Challenges of nurses during COVID-19:

1. Close monitoring of child health and well-being with prompt contact of primary health care providers if changes are noticed.

2. Continuing to provide care in-person or using telehealth to maintain well visits and immunization schedules while receiving anticipatory guidance and necessary screenings.

3. Designing hospital experiences to support social distancing in a developmentally appropriate way.

4. Increasing access to hand sanitation.

5. Ensuring PPE is available for all staff.²⁹

6. Advocating for mental health awareness and connection to resources, referring families to credible sources of health information and reminding families to present for well care.

7. Nurses need to continue to be active learners, adaptive and flexible while serving as trusted sources of information for families with children while considering the immediate and long-term impacts and implications of COVID-19.³⁰

Strategies to improve the situation / minimize or solve problems:

· Innovative communication strategies for community level health workers.

· Strengthening of grass root level facilities based on the need assessment, effective monitoring and supervision.

· Continuous drills, exercise and supervision of health workers.³¹

· Periodical refresher training should be conducted for all level of community health workers.

· Refresher training for nurses may boost up the decline in the knowledge and skills.

· Create awareness among people regarding National Health Programmes for children.³²

· Increase community participation through intensive and extensive health education campaign should be done.³³

· Enable transportation facilities for beneficiaries.

· Provision of free diagnostic services.

· Collaborative international efforts are needed to create an inpatient checklist to improve quality and reduce facility-based child mortality.

· Strengthening Pre – service medical and nursing education.

· Adequate interventions at the community level, capacity building for healthcare providers, and measures to address underlying structural and systemic barriers are needed to improve the uptake of institutional maternal and child healthcare.³⁴

CONCLUSION:

Child health care is a human right. Every child deserves a dignified comprehensive care during the course of her childhood and even thereafter. India has made considerable improvements in decreasing the child mortality rates in previous years. Government of India is committed to achieve the National Health policy Goals and SDG’s. Nurses have a major role to play in improving the child health status of the country and in achieving National Health Goals.

REFERENCES:

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Received on 22.12.2020 Modified on 12.06.2021

Asian J. Nursing Education and Research. 2022; 12(1):57-61.

DOI: 10.52711/2349-2996.2022.00011