According to the Afghan Health and Demographic Survey of 2016, 5.5 percent of children under five years and 4.5 percent of infants die each year of preventable illnesses in Afghanistan. Though the death rate, compared to previous years, has reduced remarkably, it is still much higher as compared to other countries.
To reduce the infant and child mortality rate, many consistent efforts at the primary healthcare level are needed. Building the capacity of healthcare practitioners in handling of newborns, infants and children under five years at health facilities is identified as one such need. Conducting a training on Integrate Management of Newborn and Child Illnesses (IMNCI) is seen as one approach to meeting this need.
The IMNCI is a systematic approach to children’s health which focuses completely on the child, as a whole. This means not only focusing on curative care and diseases but also on the prevention of the disease for which the child is seeking medical attention. This approach was developed as a joint effort of the UNICEF and WHO in 1992 and approach was first implemented in Africa and then later adopted by other countries. Being trained on IMNCI is now a requirement of the Ministry of Public Health (MoPH) Afghanistan, thus all its health partners are required to implement it in their health facilities. This vital approach to child health care facilitates health workers in improve patient assessments, diagnosis, case management and referrals. Based on its dire need in rural Afghanistan and in accordance to the MoPH requirement, the Partnership for Strengthening Mother, Neonatal Care for Health (PSMNCH) project prioritized to conduct IMNCI trainings in all its six health facilities.
The first IMNCI, seven-day training under the project was conducted for one nurse each from all the six health facilities in December 2017. Since the training required practical clinical exercises, it was held at the Nangarhar regional hospital and facilitated by the national IMNCI trainers (MoPH regional trainers). The training aimed at reducing mortality rates of newborn, infants and children under five years, by simply enhancing nursing skills through:
- Improving case management skills of health-care staff
- Improving health care services delivery
- Implementing MoPH standards of IMNCI
- Improving family and community health practices
The IMNCI is a standard package which is inclusive of a series of books, charts, and forms, which were all introduced and practised on during training. The training was divided into two sections; theoretical and clinical practices. In the theory sessions, the IMNCI books were read and discussed. Forms, charts and booklets were filled and exercised. While in the clinical practice, participants were taken to the Out Patient Department (OPD) and In Patient Department (IPD) for monitoring and delivering case assessments, diagnosis and management of related cases discussed in the theoretical sessions. Participating health practitioners were also taken to the pediatric ward of Nangarhar hospital where they discussed signs and symptoms, diagnostic steps and management of different cases included cold, pneumonia, diarrhea, severe diseases, baby warming and resuscitation of unwell babies.
Participants were enrolled in practicing various methods including:
- Protecting newborn from hypothermia
- Resuscitation of abnormal newborn
- Usage of ambu bag
- Hand-washing practices
- Breastfeeding and examination of newborn babies
- Assessment and diagnosis of child aged under 2 months and under 5 years
- Assessment of danger signs and severe cases
The training delivered sessions on:
- Universal precaution of newborn where it was discussed how a new born should be safely handled during the first time of their birth in relation to their cleaning, warming and positioning.
- Routine care of newborns with focus on vaccination, breastfeeding, hygiene and clothing.
- Alternative feeding methods
- Case assessment, diagnosis, management and referral of child aged under 2 months children and 5 years
Nurses’ newly acquired knowledge from the training has enabled them to properly assess, diagnose and manage illnesses of newborn and children under five years visiting the health facilities in rural Nangarhar.
shared Hanif, a nurse at Nawda Mora Clinic.
The IMNCI is vital for improving child health. The training has helped increase our knowledge on assessment and management of multiple diseases in children aged between under two months and five years,
 Integrate Management of Newborn and Child Illnesses (IMNCI)