The document outlines the action plan for child death audits in India. It describes a multi-level process involving: 1) community-level notification and investigation of child deaths by ASHAs and ANMs; 2) facility-level review of deaths by medical officers; and 3) review of reports at block, district, and state levels to identify gaps and corrective actions. Key responsibilities are assigned to nodal officers at each level to ensure timely reporting and data-driven decision making. Training and monitoring processes support high-quality implementation of the child death review.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
Despite population growth, the number of deaths in children under five worldwide declined from 12.7 million in 1990 to 6.3 million in 2013, which translates into about 17,000 fewer children dying each day.
Since 2000, measles vaccines have averted over 14 million deaths.
Despite determined global progress in reducing child deaths, an increasing proportion of child deaths are in sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
As the rate of under-five deaths overall declines, the proportion that occurs during the first month after birth is increasing.
Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.
Children of educated mothers—even mothers with only primary schooling—are more likely to survive than children of mothers with no education.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
Rashtriya bal swasthya karyakram (RBSK) is a health programme launched for screening of over 27 crore children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities by the ministry of health and family welfare under national rural health mission (NRHM) in india
Despite population growth, the number of deaths in children under five worldwide declined from 12.7 million in 1990 to 6.3 million in 2013, which translates into about 17,000 fewer children dying each day.
Since 2000, measles vaccines have averted over 14 million deaths.
Despite determined global progress in reducing child deaths, an increasing proportion of child deaths are in sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
As the rate of under-five deaths overall declines, the proportion that occurs during the first month after birth is increasing.
Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.
Children of educated mothers—even mothers with only primary schooling—are more likely to survive than children of mothers with no education.
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
The Maternal Death Surveillance and Response (MDSR) is a system of identification, notification, and review of maternal deaths followed by actions to prevent future deaths.
Child Death Review (CDR) is a strategy to understand the geographical variation in causes of child deaths and thereby initiating specific child health interventions.
Abstract. The Ministry of Health and Social Services in Namibia under the division of epidemiology uses a manual
paper-based approach to capture disease surveillance data through 5 levels of reporting which include the community level, the health facility level, the district level, and the national level. As a result, this method of communicating
and exchanging disease surveillance information is cost and time consuming, which delay disease surveillance information from reaching the head office on time.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. ACTION PLAN OF CHILD DEATH AUDIT
One of the prime objectives of NRHM is to reduce the Infant Mortality Rate
(IMR). Various attempts are being made to reduce Infant Mortality by improving
quality of child health care delivery through strengthening of Facility Based Newborn
Care Units, introduction of Home Based Newborn Care Programme and stepping up
monitoring.
However, it has been felt that prompt reporting and review of child deaths (0-
59 months) can provide insight into:
Identify the bottlenecks in delivery of maternal and child health services by
investigating and recording the sequence of events leading to child deaths
and drawing inferences from the data generated locally.
Analysis would guide the programme managers at all levels to recognise the
key gap areas for service delivery and institute corrective measures.
Data on causes of neonatal and child deaths are also useful for health
planners, administrators, and medical professionals to evaluate trends in
causes of mortality over time and thus assess the impact of the on-going
health programmes and to make a decision on allocation of resources for
different strategies to prevent and manage neonatal and childhood illnesses.
Key Steps in Child Death Review
All deaths among children in the age group 0-59 months will be reviewed and
reported irrespective of the place it takes place: at home, in health facility or in
transit.
The review processes will remain the same for all children; however the
details to be investigated will vary in neonates (0-28 days) and children (29
days-59 months).
Child Death Review will be undertaken at two levels:
Community level
Facility level
COMMUNITY BASED CHILD DEATH REVIEW
Step 1: Notification of child death
1. Done by ASHA/ AWW/ ANM/ Link worker/Panchayat member. They will visit the
family of the deceased child and fill the Notification Card in duplicate, one copy
of the notification card will be submitted for record to be maintained in the Sub
centre and the other handed over to the family to be shown to persons of health
department if anyone asks. The Block Medical Officer should be informed of the
death within 24 hours through SMS (where such facility is available). If the SMS
facilities are not yet established in the state or district, informant will post the
message in a standard format printed on an inland letter.
2. Block Medical Officer (BMO) will maintain line-listing of all deaths in his/her area.
The line list will be transmitted to the District Nodal Officer (MOH) at the end of
2. each month. BMO will also inform concerned ANM to further investigate the
death, using a structured format.
3. Incentives: Where ASHA is the primary informant, she may be given Rs. 50/- per
child death reported.
Step 2: Investigation of death
1. First Brief Investigation:
a) Will be conducted for all child deaths by the ANM of the area, by interviewing
parents/ close caregiver of the deceased, who were present at the time of death.
First Brief Investigation Form in Annexure 2 should be filled. ANM may be
paid incentive of Rs. 100/- per child death investigation carried out by her. FBI
should be done and report submitted to Block Medical Officer within one month
after notification of the death. These should be kept on record at the office of the
Block Medical Officer. Reports should be compiled monthly and sent to District
Nodal Officer (MOH).
b) District Nodal Officer (MOH) is the person designated by the State as the
overall ‘in charge’ for the planning and implementation of the Child Death Review
process in the district.
c) Detailed investigation is undertaken by performing a Verbal Autopsy (an
investigation of train of events, circumstances, symptoms and signs of illness
leading to death through an interview of the relatives or associates of the
deceased) and Social autopsy (identifying social, behavioural, and health
systems contributors to neonatal and child deaths). It should be completed within
1-2 months of the death.
d) The investigating team should comprise of at least 2 persons: one from
medical(PHC Medical Officer, Public Health Nurse, LHV, Staff Nurse or Nursing
Tutor) and other from non-medical background (Block Supervisor, LHV, ASHA
Facilitator, NGO facilitator or any other person).
e) A minimum sum of Rs. 250/- will be given to each member of the team for each
death investigated. In addition Rs.100/- may be provided to cover the cost of
travel to the household and back.
f) Maintenance of records: One copy of the Verbal Autopsy Format of all child
deaths investigated in the block will be kept on record at the office of the Block
Medical Officer. The original format will be sent to District Nodal Officer within
one week of receiving the report.
Step 3: Data transmission and analysis
1. BMO will compile reports and send to District Nodal officer every month.
2. District Nodal Officer will forward the compiled report from all the health facility
of the district to the State Nodal Officer each month in Format Two
3. The deaths reported from district /states through the Child Death Review must
also be reported in the HMIS, starting right from the Subcentre level.
4. The State Nodal Officer will compile reports from all districts for onward
transmission to the national programme managers every two months.
3. Step 4: Feedback for improved planning and institution of corrective
measures
Same as facility based child death review
FACILITY-BASED CHILD DEATH REVIEW
Step 1: Notification of child deaths
For all deaths occurring in the hospital, Medical Officer/Specialist on duty at
the time of death should fill in the Notification Card and send it to the office of the
Facility Nodal Officer (FNO) within 24 hours of death. The office of the FNO (MS/
Principal/ SMO incharge) should inform the child death to the District Nodal Officer
(MOH) within 48 hours of the occurrence of death.
Step 2: Investigation
The Facility Based Child Death Review (FBCDR) Form should be filled for
each child death by the Duty Medical Officer with details of the medical cause of
death and add any other information that s/he has regarding the social factors and
delays associated with the death. Medical cause of death is to be ascertained based
on SRS coding for causes of death and recorded in the Death Certificate. The
completed form should be submitted to the Facility Nodal Officer within one week of
the occurrence of death in duplicate. One copy of the form will be sent to the MOH
within one month of death and the second copy retained in the hospital for records.
All children treated, and died, in departments other than the Paediatrics department,
must also be reported and investigated.
Step 3: Data Flow & Analysis
The office of the FNO will prepare a line list of all child deaths (0-59 months)
that have taken place at the hospital and get data entered using pre-coded Facility
Based Child Death Review format during the month and information will also be
electronically transmitted to the District Nodal Officer for information and compilation
in the Format Three. These reports will also be compiled and analysed at the district
level and key findings and recommendations included in the report to be presented
to District Child Death Review Committee, from now onwards FBMDR committee will
also functional as FBCDR committee with additional members from Pediatrics.
Step 4: Feedback for improved planning and instituting corrective measures
The reports from First Brief Investigation reports and the Detailed
Investigation should be reviewed at the block and district level and definite actions to
address the delays and causes of death should be identified. The analysis of causes
of death will facilitate fine-tuning of programmes locally in the district. An Annual
Child Death report should be prepared and disseminated to all stakeholders. It
should also be used for the purpose of formulating Annual State and District
programme Implementation plans.
4. DISTRICT CHILD DEATH REVIEW COMMITTEE
The Maternal and CDR Committee should be assigned the responsibility of
reviewing Child Death Reports, plus additional members are suggested:
1. District Magistrate/District Collector ( Chairperson)
2. Chief Medical Officer (Member Secretary)
3. District Nodal Officer (for Child Death Review )
4. Paediatrician/ MD Paediatrics degree holder from the district, one or two in
number
5. District Project Officer for ICDS
6. Representative/s from recognised professional bodies (Indian Academy of
Paediatrics, National Neonatology Forum, IAPSM)
7. Expert from medical college/development agency (if present/located in the
district)
8. Any other official or person deemed important for providing a specific
technical input (at the discretion of the Chairperson)
The Child Death Review meeting should be conducted simultaneously with the
Maternal Death Review, every month, with the purpose of reviewing the causes and
trend of child deaths in the district.
State Level Taskforce: A single State Level Taskforce will be constituted for
review of both maternal and child deaths. The meeting of the taskforce is to be
convened every 6 months.
Members
1. Principal Secretary Health & Family Welfare
2. Mission Director
3. Commissioner Health
4. Director General of Health Services
5. Deputy Director/ Director Child Health under NRHM
6. State Nodal Officer, Child Death Review
7. Paediatricians and Public Health Experts from State Govt. and Private
Medical Colleges ( Maximum 3)
8. Obstetric Specialists from State Govt. and Private Medical Colleges (
Maximum 1)
9. State ICDS Officer
10.Deputy Director/ Director Nursing
11.Deputy Director/ Director MSD (materials/ supplies and disposables)
12.Any other expert, official , person deemed important for discussion on a
particular issue (at the discretion of the Chairperson)
The implementation of the Child Death Review requires that a nodal person is
identified at Block, District and State to support and monitor the processes, ensure
quality of data collected and compiled and transmit data to the next level. One key
person /Nodal officer should be designated at each level.
5. Block Nodal Officer
The Block Medical Officer or the Block Programme Manager can be
designated as the Block Nodal Officer (BNO) for the Child Death Review by the
official order issued by the District CMO. The BNO will be responsible for the CDR
process at the block, and will also act as a supervisor for the teams for carrying out
the verbal autopsy.
Roles and Responsibilities
1. Maintain line-list all child deaths in the block
2. Select cases for detailed investigation; delegate teams for conduct of Verbal
Autopsy; ensure the timely reception of all formats (facility and community
based death review) every month.
3. Assign the medical cause/s of death with local assistance.
4. Ensure quality of data and timely reporting to the district
5. Transmit data to district in the agreed time frame and formats/s.
6. Participate in the meetings of the District Child Death Review Committee and
present the block report ( when asked to do so) ; follow up of the
recommendations specific to the block
Facility Nodal Officer (FNO) /Medical Superintendent of the hospital
1. Inform the District Nodal Officer and State Nodal Officer on the occurrence of
child death in the hospital within one week of occurrence of death.
2. Notify all deaths in the facility to the District Nodal Officer and maintain line list
of facility based child deaths
3. Review the FBCDR format and approve it for onward transmission;
4. Prepare Facility Based Child Death Review Report every quarter;
5. Participate in the meetings of the District Child Death Review Committee;
follow up on specific recommendation pertaining to specific health facility or
those under his/her jurisdiction
District Nodal Officer (DNO) / District MOH Officer is the District Nodal Officer
1. Maintain line list of facility based deaths and community based deaths in the
district; facilitate the data entry and analysis of the CBCDR and FBCDR at the
district level
2. Prepare the District Child Death Review Report for presentation in the
meeting of the District Child Death Review Committee Meetings
3. Timely transmission of information from all blocks and the district to state
level; overall responsibility for quality of CDR undertaken in the district
4. Organize the quarterly District Child Death Review Committee Meetings under
directions of the Chief Medical Officer, maintain minutes of meetings ; follow
up action to be taken ; prepare Action Taken Report
5. Participate in the meetings of the State Level Taskforce; follow up of any
recommendation/s specific to the district
6. Share the district and state child death review reports with the key
stakeholders and the communities to create awareness and initiate action at
village level
6. Trainings
Trainings will be imparted to various personnel involved in the process. These
include:
1. ASHA/Primary Informant
2. ANM
3. Block Nodal Officer
4. Investigation Teams for Verbal Autopsy
5. District Nodal Officer
6. State Nodal Officer
7. Block , District and State Data Managers (and /or Data Entry Operators)
Selected institution/s /agency/ies will conduct trainings at the state level for
the following personnel:
• Orientation of the Primary Informants
• Training of ANMs for conducting first brief investigation, reporting and record
keeping
• Training of Data Managers (Block, District and State) on compilation of
information in standard formats, maintaining data base and transmission of
information to the next level. ( Three days training at District / State level)
• Training of Block and District Nodal Officers on review of brief and detailed
investigation formats, assigning medical causes of death and identifying
socio-cultural and systemic factors, reporting, checking the quality of data,
preparing reports (for districts/state), use of data and reports for feedback and
corrective measures. (Three days training at District/State level)
• Training of investigation teams/investigators: Orientation on the Verbal
Autopsy formats, processes and guidelines (Three days training at District
level).
• Training of Medical Officers on assigning causes of death based on SRS: At
least two medical officers should be trained in each district for assigning the
"Most Probable Causes of Death" using the SRS coding for the based on
Verbal Autopsy.
• Training of Facility Nodal Officers and Specialists (Paediatric and others
dealing with children): Orientation on the FBCDR formats, processes and
guidelines, data analysis and interpretation, use of data to improve services at
the facility (Two days training at District/State level)
These trainings will be imparted by the organisation with expertise in the field.
Trainings will be skill based and each trainee will be required to achieve a
satisfactory level of proficiency.
In order to plan the roll out of CDR, each state should work out the district
wise training load of various personnel. At least two –three teams per block should
be available to conduct investigation for 10 deaths each month. The training load of
the investigators will however vary from state to state. Some states having low child
mortality will need fewer teams and the planning process should take this into
account.
Trainings should be budgeted under IDR/CDR under the NRHM/CH
component.
7. Monitoring
The BMO will ensure timely reporting and investigation through regular
feedback to the ANMs and investigating team. S/he will be responsible for scrutiny of
the filled up formats and provide handholding support to the block investigation team
to improve quality of investigation. The BMO as a supervisor of the block team will
also participate in the field level investigation himself/herself, as the time permits.
The District Nodal Officer and the Chief Medical Officer (as Secretary of the
District Child Review Committee) will monitor the process and provide feedback to
the blocks regarding the quality of data as well as the analysis. S/he will also give
feedback on the quality of investigation through scrutiny of filled up formats to FNO.
The DNO and CMO and will also inform and follow up with the blocks/ health
facilities on implementation of specific response plan/s.
The State Nodal Officer will monitor the information received from various
districts and accordingly provide feedback to districts regarding the completeness of
reporting, timeliness and quality of investigation, regularity of review meetings and
development of response plans.
In addition to the designated nodal officers, agencies located at block/district
/state level can also be assigned the task of monitoring the Child Death Review.
Medical Colleges (Departments of Paediatrics and Community Medicine) can also be
brought in for this purpose. The objective is to provide support through experts for
streamlining of the process, enhancing the quality of reports generated from the data
and implementing the key recommendations made by the District Committee and the
State Level Taskforce.
Process indicators
1. Child deaths reported / estimated number of child deaths (District-wise)
2. Detailed Child Death Investigation (Verbal Autopsy) Formats submitted / child
deaths selected for detailed investigation (Data to be computed district wise)
3. Proportion of child deaths investigated (denominator: All child deaths taking
place in public health facilities) (Data to be computed district wise)
4. No. of districts conducting meetings of the District Child Death Review
Committee as per plan
5. No. of State Level taskforce Meetings held / numbers planned