Mother and Child Healthcare
Mother and child healthcare is the highest priority in poverty health care. On the one hand it is the most cost effective. On the other hand it has the largest teaching component and is the most effective in promoting health, nutrition, hygiene and family planning awareness
Aims of Mother and Child Healthcare:
1. To give teaching on mother and child healthcare to mothers, families and neighborhood groups.
2. To provide preventive interventions at appropriate stages of pregnancy, delivery and childhood.
3. To detect danger signs and so prevent problems of pregnancy, delivery, post-partum and early childhood.
4. To provide primary treatment for common conditions and hospital referral when necessary.
The actions are all low-cost and readily performed by primary health workers but require ongoing training organisation and supervision, with consultatory back-up and a referral system (particularly for pre-eclampsia/eclampisia, complicated deliveries severe malnutrition and serious infections.)
Unfortunately with only one doctor the KHCP is unable to provide adequate medical supervision and consultatory support and without properly motivated obstetric support facilities in a very wide area complicated deliveries can be disastrous. (Recently a woman in obstructed labour ran into disaster from over delayed caesarian section at the regional medical college hospital. Injuries and complication resulted in constant drainage of urine and faeces from the vagina and paralysis of both legs.)
The Mother-child village health care programme now has its own separate small office. Village surveys have been done and family cards prepared for homes in nearby villages.
The programme is still needing to work out the difficulties of coordinating time-consuming individualized care with programme efficiency and necessary freedom of initiative with restrictions of administration and partnership in the overall project. Strong leadership is needed, particularly for problem solving and proper organization of village worker supervision.
Mother-Child Statistics for 2014
Number of Villages: 19 (population about 17,680)
Staff: 18, Village Workers 12, Supervisors 6
Under 4yr old Child Care: 1,245 children (13% more than 2013) at years’ end.
The weight survey at the end of the year showed nutrition problems in 3% (failure to gain weight over three consecutive months, a drop of 0.8kg not yet regained or below 3rd centile on weight chart). This very low figure shows the quality of care and teaching given. Unfortunately malnourished needing admission do not readily come.
Immunizations: Staff continue to support the government’s EPI programme.
Antenatal Care: 500 mothers were given ANC (29% more than 2013).
Delivery Care: 8% of ANC mothers had staff assisted deliveries, 30 deliveries (41% less than 2013), 28 in their homes and 2 at the health centre.
Family Planning: Staff continue to motivate for the government programme and 16 couples received oral contraceptives from the VHP.
The total cost of the VHP for 12 months was BDT 19,62,000 (USD25,500) (NZD32,700) (EURO 20,200) about BDT 950 (USD12) (NZD16) (EURO 10) per mother or child cared for. This is very cost effective and of enormous benefit to the community. It should be extended.
The TB Program
This programme implemented by KHCP staff under the Damien Foundation is part of the government’s national TB programme and a sub-centre of the Madhupur TB clinic. Bangladesh has the world’s sixth largest TB problem. Prevalence is estimated to be 404 per 100,000 population. The national DOTS (Direct Observation Treatment, Short Term) programme is now able to concentrate on MDR (multiple drug resistance), child, sputum negative and extra-pulmonary TB. Disease prevention is by poverty alleviation, health education, treatment of infected cases and BCG (for prevention of life-threatening childhood cases).
Treatment is six months (eight months for retreatment patients) which must be followed correctly (under observation) to prevent MDR which in Bangladesh is currently 1.4% in new cases and 29% in previously treated cases (World Health Organisation, 2016). The National TB programme has a culture and sensitivity screening system for suspect MDR patients followed up by referral for specialised management.
31 sputum positive patients started treatment between July 2014 and June 2015. Eight were subsequently transferred to other centres. Of the remaining 23 patients, 1 defaulted and 2 died i.e. 90% cure rate. The two patients who died also had other illnesses (their causes of death being heart failure and stroke). The default patient took proper treatment to begin with, but within one month he felt healthy, and moved far away to another district. Despite dedicated attempts by staff, he declined to return for further treatment.
The diabetes program is probably providing treatment and supervision for almost all poor Type One patients within 20 miles of its subcentres (ie from about 5% of the 11 million population in the four districts of Tangail, Jamalpur, Mymensingh and Sherpur). Tablet patients are less motivated for Kailakuri because the market price of medications is considerably less than the cost of travel to the subcentres. We are probably getting about 10% of poor Type Two’s within 15 miles but almost all within five miles. (Upgrade and expansion of other KHCP activities is a higher priority than increasing the coverage of Type Two diabetics.)
The Kailakuri Health Care Project is especially vital for diabetes patients, as diabetes is a life-long condition. Without subsidised treatment from Kailakuri and free or subsidised insulin from BIRDEM Diabetes Hospital, these poor families would have really struggled to manage their conditions, leading to complications like foot ulcers, cataracts, kidney problems, wasting and often death.
In a country where 30% of the people are poor and with rapidly increasing diabetes, KHCP has the only significant primary health care diabetes programme for the poor. It is essential for the masses of the people and the future of the country that its methods be studied, refined and copied. Its methods are very simple. All the work is done by paramedics under medical supervision, while linking with the BIRDEM (Diabetes) Hospital which provides concession rate insulin, without which the KHCP programme would be unable to continue. Results are as good as any with the poor in Bangladesh and costs much lower.
Patients under the age of 21 are linked into the BIRDEM-Novo Nordisk “Changing Diabetes in Children” programme which provides free insulin. The 106 children involved follow the same KHCP methods as all the other KHCP diabetes patients monitoring their diabetes by Benedict urine test (78% of all KHCP patients faithfully test their urine five times daily) and adjusting their insulin doses accordingly, taught and supervised by paramedics and trainers the same as all other Kailakuri patients. The diabetes programme is run by a staff of 22 of whom 8 are paramedics, 5 health educators and 9 back-up staff.