Introduction The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. Methods A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. Results Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). Conclusion This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).
Community-based management of severe wasting (CMSW) programs have solely focused on exit outcome indicators, often omitting data on nutrition emergency preparedness and scalability. This study aimed to document good practices and generate evidence on the effectiveness and scalability of CMSW programs to guide future nutrition interventions in South Sudan. A total of 69 CMSW program implementation documents and policies were authenticated and retained for analysis, complemented with the analyses of aggregated secondary data obtained over five (2016–2020 for CMSW program performance) to six (wasting prevention) years (2014–2019). Findings suggest a strong and harmonised coordination of CMSW program implementation, facilitated timely and with quality care through an integrated and harmonised multi-agency and multidisciplinary approach. There were challenges to the institutionalisation and ownership of CMSW programs: a weak health system, fragile health budget that relied on external assistance, and limited opportunities for competency-based learning and knowledge transfer. Between 2014 and 2019, the prevalence of wasting fluctuated according to the agricultural cycle and remained above the emergency threshold of 15% during the July to August lean season. However, during the same period, under-five and crude mortality rates (10,000/day) declined respectively from 1.17 (95% confidence interval (CI): 0.91, 1.43) and 1.00 (95% CI: 0.75, 1.25) to 0.57 (95% CI: 0.38, 0.76) and 0.55 (95% CI: 0.39, 0.70). Both indicators remained below the emergency thresholds, hence suggesting that the emergency response was under control. Over a five-year period (2016–2020), a total of 1,105,546 children (52% girls, 48% boys) were admitted to CMSW programs. The five-year pooled performance indicators (mean [standard deviations]) was 86.4 (18.9%) for recovery, 2.1 (7.8%) for deaths, 5.2 (10.3%) for defaulting, 1.7 (5.7%) for non-recovery, 4.6 (13.5%) for medical transfers, 2.2 (4.7%) for relapse, 3.3 (15.0) g/kg/day for weight gain velocity, and 6.7 (3.7) weeks for the length of stay in the program. In conclusion, all key performance indicators, except the weight gain velocity, met or exceeded the Humanitarian Charter and Minimum Standards in Humanitarian Response. Our findings demonstrate the possibility of implementing robust and resilient CMSAM programs in protracted conflict environments, informed by global guidelines and protocols. They also depict challenges to institutionalisation and ownership.
Background: As per statistics on infant mortality, the State of Maharashtra has done well in bringing down IMR from 33 to 21 per 1000 live births. However a lot needs to be achieved still. Various child health programs like home based new born care and others have improved child survival. But the analysis of cases will throw light on actionable points for policy change. Methods: Keeping in mind mortality statistics of the State, an analysis was done on causes of neonatal deaths and social determinants. A retrospective study was done on causes of death from birth to 28 days during 2015-2016 in the State of Maharashtra. 6 deaths per block were reviewed by a committee that included a pediatrician. Verbal autopsy was done and all factors like social, cultural, behavioral as well as factors that resulted in delay in deciding to take the baby to health facility, delay in transport and delay at health facility were studied in details. Results: Latur circle had the highest deaths i.e. 70%, Nashik and Gadchiroli had 62 and 63% respectively. Males were more than females (55.7%). ^0.6% of deaths occurred in babies weighing less than 2500 gms. Delay in deciding to take the baby to the health facility and getting treatment was important (41.4% cases). In 40.8% cases delay in receiving treatment at health facility was observed. Major causes were infections, prematurity and asphyxia. Conclusions: Various causes of neonatal deaths are studied. Delay in deciding to take the baby to the health facility was one of the major factors. Majority of deaths were due to infection prematurity and asphyxia.
Although South Sudan's vitamin A supplementation program has demonstrated success, vitamin A supplementation remains a critical public health need for young children. How can South Sudan best maintain high vitamin A supplementation coverage for the short to medium term while planning a more sustainable delivery approach for the longer term?
Introduction: Cysticercosis is a systemic manifestation caused by dissemination of larval form of Tacnia solium, also called as pork tape worm, is a major public health problem in developing countries. The aim of present study was undertaken to evaluate the histopathological spectrum of cysticercosis with their demographic pattern in our tertiary care hospital. Material and methods: A total of 3055 patients of different age, sex and religions with nodular swelling in different parts of their body were attending in different OPD. From all the patients, a total of 3055 specimens were received in our department for histopathological evaluation. Results: Out of 3055 specimen received for biopsy, 8 (0.26%) cases were diagnosed as cysticercosis. Out of which 50% cases (4 cases) were of less than 20 years of age group and 62.5% cases were female patients. The disease was found in both religions Hindus and Muslims (87.5% in Hindus) Conclusion: Even fine needle aspiration cytology (FNAC) has very limited value in diagnosis of cysticercercosis in most of the cases and could not be recommended due to poor diagnostic value and in cases of neurocysticercosis as well as ocular or orbital cysticercosis, FNAC could not be attempted due to risky procedure with very limited diagnostic value, although serological tests are done for the serious complications of cysticercosis,but the final diagnosis is Histopathological study which is justified and the ultimate diagnostic technique for correct diagnosis.
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