Key Family Practices

• TOM NYAIRO:h31/2407/2012
• SHABURE HUSSEIN:h31/34679/2013
 OBJECTIVES:-
• IMCI – First, Second and Third Components
• List the 16 Key Family Practices and include the
FOUR recommended by MOH Kenya
• Describe evidence for each in Child Survival
and Development
• Role of the Mother, Father, CHW and CHEW.
• Role of Levels 2 and 3
• Role of Partners – Community, NGOs and FBOs.
 INTERGRATED MANAGEMENT OF
CHILDHOOD ILLNESS
• Integrated Management of Childhood Illness (IMCI) was
developed by WHO & Unicef in 1995.
• IMCI is an integrated approach to child health that focuses on the
well-being of the whole child.
• The guidelines outlined in the IMCI offer simple and effective
methods to prevent and manage the leading causes of morbidity
and mortality in young children.
• IMCI aims to reduce death, illness and disability and to promote
improved growth and development among children under five
years of age.
• IMCI includes both preventive and curative elements that are
implemented by families and communities as well as by health
facilities.
 IMCI COMPONENTS
.
IMCI includes three main components:

• Improving case management skills of health-care staff

• Improving overall health systems
• Improving family and community health practices; . These include practices
to prevent malnutrition, child abuse and neglect within households. In
addition, this component aims to improve recognition of severe disease in
young children as well as practicing appropriate home-based care for certain
illnesses and improving adherence to recommended treatment prescribed
at health facilities.

Reference;
http://www.who.int/maternal_child_adolescent/topics/child/imci/en/
 16 Key Family Practices

• For Promotion of Physical Growth and Mental Development

• Breastfeed infants exclusively for six months (taking into account
WHO/UNICEF/UNAIDS policy and recommendations on HIV and
infant feeding).
• Starting at about six months of age, feed children freshly prepared,
energy and nutrient-rich complementary foods, while continuing to
breastfeed for up to two years or longer.
• Provide children with adequate amounts of micronutrients (vitamin
A and iron, in particular), either in their diet or through supplements.
• Promote children's mental and social development by being
responsive to the child's needs for care, and stimulating the
child through talking, playing, and other appropriate physical
and affective interactions
 16 Key Family Practices(2)
• For Disease Prevention
• Take children for a full course of immunisations (BCG), diphtheria,
pertussis and tetanus, oral polio vaccine and measles) before their
first birthday.
• Dispose of faeces (including children's faeces) safely, and
wash hands with soap after defecation, and before
preparing meals and feeding children.
• In malaria-endemic areas, ensure that children sleep under
recommended insecticide-treated mosquito nets.
• Adopt and sustain appropriate behavior regarding HIV/AIDS
prevention and care for the sick and orphans.
 16 Key Family Practices(3)
• For Appropriate Home Care
• Continue to feed and offer more fluids including breast
milk to children when they are sick.
• Give sick children appropriate home treatment for
infections.
• Prevent and provide appropriate treatment for child injuries.
• Take action to prevent child abuse, recognize it has
occurred and take appropriate action.
• that men actively participate in providing childcare, and that
they are involved in reproductive health initiatives.
 16 Key Family Practices(4)
• For Seeking Care
• Recognise when sick children need treatment outside the home and
take them for health care to the appropriate providers.
• Follow health workers’ recommendations regarding treatment, follow-
up and referral.
• Ensure that every pregnant woman receives the recommended four
antenatal visits, recommended doses of tetanus toxoid vaccination, and
is supported by family and community in seeking appropriate care,
especially at the time of delivery and during the
postpartum/breastfeeding period.

Reference:
https://www.unicef.org/nutrition/23964_familypractices.html
 Key Family Practices Recommended by MOH
Kenya
• Birth registration and issuance of birth certificate by six months of
age
• Growth monitoring done monthly up to five years
• Provision of safe drinking water to all children
• Ensure every child is protected from household air pollution
 EVIDENCE OF KEY PRACTICES IN CHILD SURVIVAL AND DEVELOPMENT
Immunization

• Increases in immunization coverage in the past

decades have contributed substantially to
decrease under-five mortality.
• Yet, more efforts are needed to further
improve immunization coverage.
• Routine immunization could have averted 1.5
million deaths due to vaccine-preventable
diseases in 2008.
 2. Exclusive Breastfeeding For 6 Months
• Exclusive breastfeeding (i.e. 90% of children under 6
months of age), 13% of under-five deaths could have
been prevented in the 42 countries which
contributed to 90% of worldwide under-five deaths,
i.e. over 1.3 million deaths saved a year
• Breastfeeding can reduce diarrhoeal mortality by
24–27% among infants aged 0–5 months
(Lancet 2003; 362:65-71)
Feachem & Koblinsky (1984)
Exclusive Breastfeeding For 6 Months (2)
• Decreasing the proportion of infants who are not
breastfed by 40% can potentially avert 3% of all
pneumonia deaths (range 0.5–7% due to
differences in regional breastfeeding prevalence.
• Breastfed children typically grow more quickly
than non-breastfed children in the first 2–3
months of life, and less rapidly from 3–12 months.
Victora et al. (1999)
(WHO, 2002; Eckhardt et al., 2001; Dewey, 1998; Adair et al., 1993).
 3.Complementary feeding
• Interventions to improve complementary feeding
practices in infants 6-12 months of age have resulted in
improved energy intake and growth, corresponding to a
decrease in the prevalence of malnutrition by 20% and in
malnutrition-associated deaths from 6 months of age by
an estimated 2%13%.
• A reduction in diarrhoea-associated mortality of similar
magnitude and a reduction in ARI (acute respiratory
infections)-associated mortality have also been suggested
Family and community practices that promote child survival, growth and development: a review of the evidence.
 Complementary feeding continued

• With universal coverage (99%) of this intervention, 6% of

under-five deaths could have been prevented in the 42
countries where 90% of worldwide under-five deaths
occurred, while observational studies suggested that
“improving feeding practices could save 800 000 lives per
year” globally
• Promoting continued breastfeeding and complementary
feeding from age 6 months has been confirmed more
recently as one of the key evidence-based interventions
to reduce child mortality.
(Lancet 2003; 362:65-71)
(The Review).
 4. Micronutrients
• Vitamin A. In Vitamin-A-deficiency areas, vitamin A supplementation
has been shown to reduce child mortality by over 20% in children 6
months to 5 years old Iron.
• Iron supplementation in children with reduced iron stores has been
shown to restore iron stores and improve haemoglobin levels,
attention and appetite.
• Public health interventions in this area include among others
intermittent iron supplementation, dietary diversification and food
fortification.
• Intermittent iron supplementation has been recommended in pre-
school and school-age children in areas where the prevalence of
anaemia in these age groups is 20% or higher as an intervention to
improve iron status and reduce the risk of anaemia.
Family and community practices that promote child survival, growth and development: a review of the evidence
 Micronutrients continued
• Zinc; supplementation given during an episode of acute
diarrhoea (10 mg/day for children less than 6 months old and
20 mg/day for children 6 to 59 months) reduces the severity
and duration of the episode. When given for 10-14 days, it
lowers the incidence of diarrhoea in the following 2-3 months
• Zinc administration as a treatment measure can prevent 4%
(about 400 000) of under-five deaths in the 42 countries which
totally contributed to 90% of global under-five deaths

WHO/UNICEF joint statement on clinical management of acute diarrhoea

Lancet 2003; 362:65-71
 5. Hygiene
• It has been estimated that 88% of the diarrhoeal disease burden is
attributable to unsafe water supply, sanitation and hygiene, and mostly falls
on children in developing countries.
• Faecal disposal. Improved sanitation has been associated with a median
reduction in all-cause child mortality by 55%, diarrhoea mortality by 65%,
and diarrhoea morbidity by 26%
• Handwashing. Handwashing have resulted in significant reductions in
diarrhoea incidence, by a median of 33%. The impact has been higher for
interventions focusing only on handwashing and no other practice.

Family and community practices that promote child survival, growth and development: a review of the
evidence
Family and community practices that promote child survival, growth and development: a review of the
evidence
 5.Malaria - use of bednets
• Protect children in malaria-endemic areas, by ensuring
that they sleep under insecticide-treated bednets.

• Use of insecticide-treated bednets has been associated

with a reduction in child mortality (by 17%) and malaria
morbidity (by 48% in stable malaria areas).

Family and community practices that promote child survival, growth and development – A review of the
evidence
 6.Psychosocial development
• Promote mental and social development by responding to a child’s needs for care
and through talking, playing and providing a stimulating environment
• Psychosocial interventions can improve child psychological development; they
should start very early in life. Likewise, successful nutrition interventions can
improve not only physical growth but also child development if implemented
earliest in life.

• When implemented together, psychosocial and nutrition interventions have a

greater effect than when implemented individually.

• The benefits apply also to the disadvantaged children who live in a poor
environment and are at higher risk of malnutrition, illness and poor development.

• The main source of physical and emotional care for young children is the family.
Counselling parents is an effective approach to help them acquire the necessary
skills to feed their children adequately, stimulate their development and be
responsive to their emotional and psychological needs.
 7 STIMULATION
• Key practice. Promote mental and social development by responding
to a child’s needs for care, and through talking, playing and providing
a stimulating environment.
• There is an extensive scientific basis for the benefits of home and
center based stimulation on early childhood development. Adults
born in poverty who participated in a quality active-learning
preschool programme at ages three and four, have higher social
responsibility, education performance, earnings and property wealth
and greater commitment to marriage (Schweinhart, Barnes &
Weikart, 1993).
• Children who participate in early childcare programmes show
stronger performance on IQ tests and are less likely to repeat grades
or be placed in remedial classes (WHO, 1999).
 8 Home care for illness
• Continue to feed and offer more fluids, including breastmilk, to children when they are sick.

• Continuing feeding —including breastfeeding—and offering more fluids to a child when

he/she is sick aims at preventing malnutrition and dehydration.

• It is reasonable to stimulate child feeding actively also during the recovery period
(convalescence), when catch-up growth may occur.

• This approach has been the cornerstone of the home management of acute diarrhoeal
episodes in under-fives, later recommended as standard home care for child illness.

• The anorexia pattern in child illness is peculiar in that it is more pronounced for non-human
milk and solid fluids than for breastmilk: breastmilk therefore remains a key food item also
during illness.
 9.Home treatment for infections
Three approaches will be summarized in terms of survival benefit:

• oral rehydration therapy for acute diarrhoea; ORT can save 15% of
under-five deaths occurring in the 42 countries where 90% of
worldwide under-five deaths occurred.

• community case management of malaria; Community case

management of malaria with antimalarials in children under five years
of age is a promising strategy to prevent progress to severe malaria and
death in areas with limited access to health facility-based child care
services.

• management of pneumonia in community settings ;mortality from

pneumonia has been shown to reduce by 24%.
Lancet 2003; 362:65-71
 10.Home treatment for infections(2)
• Community-based interventions in which adequately trained
and supervised community health workers have provided case
management have had a significant impact on both overall and
pneumonia specific under-five mortality, with a reduction
estimated at 20% and 24%, respectively
• A meta-analysis of seven community-based trials of case
management of pneumonia showed a 26% reduction of child
mortality and a 37% reduction in mortality from pneumonia.

Family and community practices that promote child survival, growth and development – A review of the
evidence
WHO report on “Evidence base for the community management of pneumonia”(2002)
 11.Care-seeking
• Most severe infections can be effectively treated if the correct
treatment is given In severe illness, death can occur rapidly
after the onset of symptoms and care-seeking and treatment
must be timely
• Reducing treatment delays thus has the potential to decrease
morality and morbidity
• poor care-seeking implicated in 6–70% of deaths

Pandey et al., 1991; Reyes et al., 1997; Roesin et al., 1990).

Akpede, 1995; Talan & Zibulewsky, 1997; Roesin et al., 1990; Reyes et al., 1997
Sodemann et al., 1997; Reyes et al., 1998; Aguilar et al., 1998; Terra de Souza et al., 2000; Bojalil, 2002
 12.Compliance with advice
• Follow the health worker’s advice about
treatment, follow-up and referral.
Compliance encompasses the following three
areas;
1. Compliance with advice on treatment

2. Compliance with advice on follow-up

3. Compliance with advice on referral

 Compliance with advice(2)
• Not adhering to treatment regimens and referral
instructions may lead to incomplete treatment,
• Therapy failure, drug resistance and the later misuse of
leftover medicines, which can cause unnecessary
mortality and morbidity.
• For example, a study in Nigeria found that 84% of children
diagnosed with malaria who did not get better when
prescribed chloroquine were ‘non-adherers’
Madhi,Taha & Al Rifai, 1983; Minchola de Perez, 1984; Abdulaziz Al-Sekait, 1989; El Tom & Sharif, 1997; Homedes
& Ugalde, 2001
Okonkwo et al., 2001
 13. Antenatal care
• Ensure that every pregnant woman has adequate antenatal
care. This includes her having at least four antenatal visits with
an appropriate health-care provider, and receiving the
recommended doses of the tetanus toxoid vaccination
• The mother also needs support from her family and
community in seeking care at the time of delivery and during
the postpartum and lactation period.
• To underline the effects of maternal health on child health,
“Family and community practices that promote child survival,
growth and development – A review of the evidence” reports
also the findings of a study in Yemen where a high proportion
of infants—almost two thirds—died within a year of their
mothers’ death.
 Role of Mother
• Physical
• To provide nutrition by EBF and complementary feeding
• Provide a safe and secure home
• Ensure the child receives all immunizations on time
• To attend ANC in aim of protecting their child
• Uphold a child’s right to live
• Protect the child from discrimination on the basis of color,
sex or disability
• Provide safe and clean drinking water
• Ensure the child has access to school
 Role of Mother
• Social & mental needs
• Love the child regardless of their sex or
disability
• Provide stimulation through social play with
the child
• Being a role model to the child
• Provide emotional support
• Instill good manners and responsibility
 Role of Father
• Physical
• Provide physically for his family, food, a good
home, clothing ,security and medical care
• Protect the child from discrimination on the
grounds of gender, color or disability
• Protect the child from forced labor
• Ensure the child has access to a good education
 Role of Father
• Social &mental needs
• Provide stimulation through providing social
play
• Being a good role model to the children
• Instilling good manners and a sense of
responsibility
Role of the community health worker(CHW)

• Identify emergency and priority symptoms and start

prompt treatment or identify cases for urgent referral.
• Teach the caretaker to give oral drugs at home
• Teach the caretaker to treat local infections at home
• Counsel the mother about breastfeeding problems,
about feeding and fluids and about when to return and
about her own health
• Follow-up care for the sick child
• Home visits
 Role of CHWs continued
• Providing culturally appropriate health education, information
and outreach in community-based settings, such as homes,
clinics, schools, shelters, local businesses, and community
centers
• Culturally mediating between individuals, communities and
health and human services, including actively building
individual and community capacity
• Assuring that people access the coverage and services they
need
• Providing direct services, such as informal counseling, social
support, care coordination and health screenings
• Advocating for individual and community needs
 Role of CHEWs(community health extension
workers)
• Community-based education and competency-based training
• Updates on recognition and classification of disease and taking appropriate
action (treating and referral)
• C-IMCI, handling essential drugs and supplies
• Supervision of community health workers
 Role of Level 2 & Level 3
• They serve the community directly by providing
primary and secondary prevention services such
as maternal and child health, family planning,
immunization, prevention of locally endemic
diseases, treatment of common diseases or
injuries, provision of essential facilities, health
education, provision of food and nutrition
• They also provide referral for severe or
complicated cases of illness
 Role of partners
• Slide caters for NGOs and FBOs (Faith based organizations)
• Provide health status information (systems)
• Plan, implement, monitor, evaluate and provide feedback on
activities
• Mobilize and manage resources
• Support, provide and protect water sources at village level
• Manage community-based information system
• Provide technical support, supportive supervision and coaching
• Train village leaders on level one services
• Establish and maintain working links, including monitoring) of NGOs
and CBOs
• Train and conduct social mobilization on rights for health to all
communities
 Role of Partners
• Community-
Ensure a clean and safe environment
Providing support
Water and sanitation
NGOs-
Providing resources eg medication, funds, skilled health
workers etc
Community health promotion and education
Promoting provision of a healthy environment eg by
organizing clean up exercises
Infrastructure development eg roads and schools.
 References
• http://www.unicef.org
• https://kenya.savethechildren.net
• IMCI Handbook by WHO
• Family and community practices that promote child survival, growth
and development: A REVIEW OF THE EVIDENCE by WHO

• Taking the Kenya Essential Package for Health to the community at

level one by the ministry of health
• http://www.emro.who.int/child-health/community-family/key-family
-practices-on-child-health-care/All-Pages.html
• http://www.who.int/maternal_child_adolescent/topics/child/imci/e
n/