WHO EMRO - CHILD AND ADOLESCENT HEALTH

The Ministry of Public Health and Population, Yemen, has tested the use of primary health care (PHC) mobile teams, including IMCI care, in two districts, as a means of providing services to underserved populations. Initial results, reported at the Regional IMCI Coordinators’ Meeting held in Amman this month, are encouraging.

The Ministry of Public Health and Population, Yemen, has tested the use of primary health care (PHC) mobile teams, including IMCI care, in two districts, as a means of providing services to underserved populations. Initial results are encouraging. A number of factors hinder accessibility to health services in many parts of the country, especially in rural areas, where most of the population lives and under-five mortality is higher. Beside economic and social access, geographical access is hampered by a difficult terrain landscape, with mountains, desert and a widely disperse population over a vast area in the country. Utilization of health services is also low. Despite efforts made in the past three years, only about one in four primary health care (PHC) facilities has staff trained in IMCI. Based on the positive experience of outreach services for immunization, four rounds of outreach PHC services were carried out in August 2007 in two districts having a relatively high population and low number of health facilities. Two mobile teams composed of a physician and health worker trained in IMCI, a midwife, EPI and health education staff visited each of the two districts for 5 days. Fig. 1 and 2 show the number of children under-five who received care in the two districts during the visit of the mobile teams and the many conditions that were identified. A higher number of children were seen in these five-day visits of mobile teams than during a period of one month at health facilities (Fig.3). The challenge is to expand this service, sustain it and monitor its effects.

The Regional Director announces IMCI strategy as the primary child health care strategy for children under-five in the Region
18 September 2007

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The announcement by Dr Hussein A. Gezairy, the WHO Regional Director for the Regional Office for the Eastern Mediterranean, was made on 2 September 2007 at the opening of the Regional IMCI Coordinators’ Meeting held in Amman, Jordan: “Given its crucial role in promoting the health and development of children and its ability to respond to evolving needs, I am pleased to announce today that IMCI is adopted by the Regional Office as the primary child health care strategy, offering a wide range of interventions under its overall umbrella. I invite countries to see IMCI within this vision, and not as a vertical training programme, and to commit increased resources for it to achieve the child mortality-related Millennium Development Goal no. 4. I am also reiterating today our firm commitment to improve child health in the Region and to the implementation of the IMCI strategy, through continued close collaboration and provision of all necessary technical support to Member States.”

The announcement by Dr Hussein A. Gezairy, the WHO Regional Director for the Regional Office for the Eastern Mediterranean, was made on 2 September 2007 at the opening of the Regional IMCI Coordinators’ Meeting held in Amman, Jordan: “Given its crucial role in promoting the health and development of children and its ability to respond to evolving needs, I am pleased to announce today that IMCI is adopted by the Regional Office as the primary child health care strategy, offering a wide range of interventions under its overall umbrella. I invite countries to see IMCI within this vision, and not as a vertical training programme, and to commit increased resources for it to achieve the child mortality-related Millennium Development Goal no. 4. I am also reiterating today our firm commitment to improve child health in the Region and to the implementation of the IMCI strategy, through continued close collaboration and provision of all necessary technical support to Member States.” Dr Gezairy also emphasized the evolution of the IMCI strategy in the Region: “IMCI has evolved in our Region from the initial focus on survival to the more comprehensive one of health and development, in accordance with its original conceptual framework. This framework, in line with primary health care principles, emphasizes not only curative care but also preventive care and health promotion. This is, in fact, what IMCI is: primary child health care. IMCI is essential, integrated child care at primary health care level to address the main issues of children under five. It relies on scientifically sound methods, affordable technology and cost-effective interventions. It is flexible and dynamic in order to adapt and respond to different needs. It advocates for community leadership through its community component.

Regional IMCI Coordinators’ Meeting, Amman, Jordan, 2-6 September 2007
18 September 2007

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This meeting, inaugurated by Dr Hussein A. Gezairy, the WHO Regional Director for the Eastern Mediterranean, and Dr Ali Asaad, acting Minister of Health of Jordan, had the main purpose to review progress of 10 years of implementation of the Integrated Management of Child Health (IMCI) strategy since it was introduced in the Region in 1996 and set the way forward, also in relation to achieving the Millennium Development Goal no. 4 on reduction of child mortality. A total of 76 participants attended the meeting, including representatives from ministries of health and universities of 16 countries in the Region, partners (Aga Khan Health Services/Pakistan, Medicus Mundi/Andalucia, UNICEF and United Nations Relief and Works Agency/Jordan) and WHO. Through review of country experiences, especially during the many interactive group work sessions, approaches were discussed to scaling up IMCI towards universal coverage and sustaining achievements while keeping the quality of implementation. A session was devoted to the issue of reporting on outcome indicators periodically to monitor progress. Meeting deliberations are summarized in a set of conclusions and recommendations.

Pocket book of hospital care for children - Guidelines for the management of common illnesses with limited resources
[ISBN 92 4 154670 0]

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The French version of the following WHO publication is available:

The French full version of this reference manual can be downloaded from the following website as a pdf file (~ 4 MB):
http://www.who.int/child_adolescent_health/documents/9241546700/en/index.html

Regional IMCI Coordinators Meeting, Amman, Jordan, 2-6 September 2007
28 August 2007

17 countries, which have introduced IMCI, have been invited to participate in this Meeting to review over 10 years of IMCI implementation in the Region and discuss approaches to scale up coverage of cost-effective interventions. More information will be posted after the Meeting.

Report on the “Regional workshop for university staff to promote good breastfeeding practices as part of the IMCI community component” available on-line
29 August 2007

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The report on the “Regional workshop for university staff to promote good breastfeeding practices as part of the IMCI community component”, held in Rabat, Morocco, 8 – 9 July 2007, is now available on-line. Preliminary information on the workshop was posted on this website soon after the workshop. The report, after explaining the rationale for re-emphasizing breastfeeding in the Region, describes facilitating and hindering factors related to teaching of breastfeeding and breastfeeding practices at teaching institutions and the role of university staff in breastfeeding promotion, as reviewed by the participants during active discussions in the workshop. Conclusions and recommendations to Member States and WHO are then presented in the report. Information on training materials on counselling on infant and young child feeding developed by the Regional Office and IMCI pre-service education are also available on this website.

First national IMCI pre-service education workshop for medical and nursing schools
Ras Sedr, Egypt
16 - 19 July 2007

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Egypt, a country which pioneered and led efforts to introduce IMCI (Integrated Management of Child Health) into pre-service education since 1998, took another major step with this national workshop to expand the initiative not only to other medical schools but also to nursing schools. The 44 participants in the workshop included representatives from Paediatrics, Family Medicine and Community Medicine Departments of 15 medical schools—eight of which already exposed to IMCI—, seven nursing schools, the Supreme Council of Higher Education, the Ministry of Health and Population (MOHP) and the WHO Regional Office. The main objectives of the workshop were to review the IMCI pre-service education experience in Egypt to date, also in light of the recommendations made by the pre-service training working group during the Second IMCI Programme Review in January 2007, establish a national IMCI pre-service education training committee to coordinate all efforts, strengthen coordination with MOHP and develop plans for expansion and to sustain the initiative. Click on the hyperlinks to read more information about the workshop, the list of schools oriented to IMCI in Egypt and the region and IMCI pre-service education.

Report on Third Intercountry Workshop on the Child Health Policy Initiative (CHPI) available on-line
23 July 2007

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The report on the Third Intercountry Workshop on the Child Health Policy Initiative (CHPI), held in Tunis, Tunisia, from 10 to 13 December 2006, is now available on-line. Information on the workshop was posted on this website on 4 February 2007. The report, after an overview of the regional Child Health Policy Initiative (CHPI), describes the experience gained in each of the three phases of CHPI, namely the situation analysis, the development of the policy document and its official adoption. As the situation analysis is described in detail in the reports on the previous two workshops on CHPI, in the Regional Office document “Development of National Child Health Policy—Phase I: The Situation Analysis” and in country documents, this report provides more information on the development of the policy document, describing the process, the prioritization of the policy issues, the concept of “effective policy”—a policy with a higher potential to be implemented and produce the desired outcome—and the document structure. As Tunisia has been the first country in the Region to finalize and launch a national child health policy, its experience throughout the process is highlighted as are key lessons learned on CHPI. The report also provides brief updates on Regional Office work in child health, namely the development of the regional training materials on “Counselling on infant and young child feeding” and the IMCI pre-service training evaluation guide.

Regional workshop for university staff to promote good breastfeeding practices as part of the IMCI community component
Rabat, Morocco
8 - 9 July 2007

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This workshop, inaugurated by Dr Hussein A. Gezairy, the WHO Regional Director for the Eastern Mediterranean, and H.E. Dr Mohamed Cheikh Biadillah, Minister of Health of Morocco, brought together teaching staff of 21 universities and national child health programme managers from 10 countries in the Region, UNICEF staff from the hosting country and four staff from the WHO Regional Office for the Eastern Mediterranean and country level, to discuss university staff's contributing role to breastfeeding promotion. The workshop followed another workshop on breastfeeding promotion held in June for religious leaders and other EMRO-led initiatives on IMCI pre-service training. Despite the fact that breastfeeding is one of the most cost-effective interventions to reduce neonatal and child deaths, breastfeeding indicators in the Region remain low. These EMRO initiatives aim to involve influential actors to improve infant and young child feeding practices and, thus, child health. The development of a regional training package on counselling on infant and young child feeding and the child health policy initiative (covering also breastfeeding) are just examples of other recent regional initiatives to support breastfeeding promotion. After a stimulating technical presentation on breastfeeding, workshop participants reviewed the placement of breastfeeding in their school teaching curriculum and facilitating factors and barriers to breastfeeding promotion in their settings, and developed plans of action.

New growth charts developed for IMCI guidelines based on new growth standards
3 July 2007

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New weight-for-age growth charts have been developed for the IMCI guidelines and are now available based on the new growth standards for infant and young children which were released by WHO in 2006. Those international, prescriptive standards, showing how a child should grow, have more recently been introduced in regional and country activities. Endorsed among others by the International Pediatric Association and the UN Standing Committee on Nutrition, they provide an effective tool for detecting both undernutrition and overweight / obesity, thus addressing the double burden of malnutrition. The updated IMCI growth charts include one set for boys and one for girls, if a country opts for sex-specific charts, and one combined for boys and girls developed for ease of use as in the previous generic IMCI growth chart. Click on the hyperlinks to view further information on the WHO child growth standards, the WHO Multicentre Growth Reference Study which has provided the data to generate the new growth charts, and the standards.

Regional workshop for religious leaders to promote good breastfeeding practices as part of the IMCI community component, Damascus, Syrian Arab Republic, 2 - 3 June 2007
27 June 2007

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Religious leaders and national child health programme managers of ministries of health convened to discuss their contributing role to breastfeeding promotion in the region. The workshop, organized by the Regional Office, was co-sponsored by the Islamic Educational, Scientific and Culture Organization (ISESCO). It is part of a series of initiatives carried out by the Regional Office to promote optimal child feeding practices, especially breastfeeding, which are seen as a core element of child healthy growth and development. Religious leaders are important partners: they enjoy trust and respect in the community and are among key influential actors on policies and actions on breastfeeding practices. The workshop brought together 78 people, including 27 participants from 14 countries in the region, a seven-member technical committee, 23 observers from the hosting country, 14 representatives of UN and other international and national organizations, and 7 WHO regional and country staff. The workshop scenario was set with a presentation on "Breastfeeding: between religion and science". Next, after briefly reviewing the advantages of breastfeeding, its impact on child health and sub-optimal performance of breastfeeding indicators in the region, active discussions followed on practices and beliefs on breastfeeding, key simple messages to be promoted and actions which could be undertaken by religious leaders to encourage and support breastfeeding ("breastfeeding in Islam"). Click on the hyperlinks to see information on the workshop and the pamphlet.

Tackling severe acute malnutrition: RUTFs as an innovative approach
20 June 2007

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Use of highly fortified, ready-to-use therapeutic foods (RUTFs) is an innovative approach for community-based management of severe acute malnutrition, for children over the age of six months with a good appetite and no medical complications, even in settings where hygiene conditions are sub-optimal. See the announcement and the Joint WHO/WFP/United Nations Standing Committee on Nutrition/UNICEF Statement.

Production of zinc tablets and zinc oral solutions - Guidelines for programme managers and pharmaceutical manufacturers

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Guidelines on the production of zinc tablets and oral solutions are now available on-line, to assist policy makers and programme managers in the selection and procurement of quality zinc products for use in the prevention and treatment of diarrhoeal diseases in children below five years old. In fact, zinc supplementation has recently been recommended as an adjunct to oral rehydration salts in the management of diarrhoeal diseases in children under-5 and zinc has been included in the 14^th Edition of the WHO Model List of Essential Medicines. There is a need to have a product which contains the recommended dose of zinc (only zinc) and formulations which mask the strong metallic after-taste. Zinc sulphate tablets and zinc oral solutions should be manufactured according to the principles of Good Manufacturing Practices (GMP) and comply with the specifications described in the relevant pharmacopeial monographs.
The guidelines focus on zinc sulphate as this is the most widely used zinc salt, other forms including zinc gluconate or zinc acetate, all water-soluble zinc salts. The guidelines describe the specifications for tablets and oral solutions, the evaluation of their acceptability, product formulation and production, registration, quality assurance and inclusion in the National Essential Medicine List, which guides the selection of medicines for procurement and standard treatment guidelines.

Dr H. Gezairy visits IMCI-implementing sites in Sudan, February 2007

Two years after carrying out a similar visit to Alexandria, Egypt, in February 2005, Dr Gezairy, the Regional Director for the Eastern Mediterranean Region, visited sites implementing the Integrated Management of Child Health (IMCI) strategy in Khartoum, Sudan, from 24 to 26 February 2007. Sites included Khartoum University and urban and rural health facilities. Dr Gezairy also met with H.E. the President of the Republic of Sudan, H.E. the Federal Minister of Health, the Chancellor of Khartoum University and other senior health officials. This visit emphasizes the priority accorded to child health by the Regional Office and support to the IMCI strategy, which is recognized as the primary child health care strategy to improve child health in the Region.

After meeting with the Chancellor of the University of Khartoum and the Dean of the Faculty of Medicine, Dr Gezairy visited the Paediatric Department, where he observed an ongoing IMCI teaching session with students and discussed with both senior teaching staff and students about their attitudes towards the new teaching approach. Both the teaching methodology and the holistic syndromic approach brought by IMCI were highly appreciated, as was the emphasis on a more public health and community-oriented teaching. Dr Gezairy stressed the added value of IMCI, an "integrated" primary health care approach which had anticipated the current emphasis on "integrated primary health care". The Regional Director underlined the importance of highlighting prevention in medical teaching programmes in addition to clinical care—this requiring proper orientation of teaching staff—, accrediting medical schools—based on evaluation and their community-oriented approach— and expanding the IMCI pre-service training initiative from the existing 7 medical schools to the remaining 16 in Sudan. Finally, Dr Gezairy recalled the historical background of collaboration between WHO and the University of Khartoum, observing that IMCI had opened new doors to such collaboration.

Accompanied by H.E. the Minister of Health, Dr Gezairy visited a rural health facility in Khartoum and observed medical students of Africa International University undergoing their practical training as part of the community medicine teaching programme, offering a model on the links between the training, health system and community components of IMCI. Also in this case, students valued the IMCI approach, as it covered all aspects of care, from prevention to curative care. The Regional Director also joined the students during their home visits. Families were appreciative of these activities, as they put students in the real context of their future work, going beyond clinic work.

On the third and last day, the Regional Director visited an urban health facility in Khartoum and observed "IMCI community health promoters" promoting community-based interventions, as another example of the links between health facilities and the community. Dr Gezairy commented that the IMCI strategy three components (improving health provider skills, health systems and community child health care practices) were a good model also for other public health programmes and initiatives.

Key recommendations offered as a result of the visit were the need to increase IMCI coverage in the country and accelerate its implementation and allocate financial resources also from the government budget to sustain its progress.

A press conference was held before the end of the visit.

Click here to read more about IMCI implementation in Sudan. The IMCI guidelines adapted to Sudan are available here.

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List of schools which have introduced IMCI into their teaching programmes updated
15 February 2007

The number of medical and, more recently, allied health professional schools which have introduced IMCI into their teaching programmes in the Region keeps increasing. The list has been updated based on information made available during the Second Consultation on IMCI Pre-service Training, held in Cairo, Egypt, from 27 to 31 August 2006. It is recognized that the list may be incomplete, as it includes only the information which has been provided to us. Schools which have taken steps to introduce IMCI into their teaching programmes are encouraged to provide us with updated information, briefly describing the year of introduction and process followed. For more information on IMCI pre-service training, please refer to the section dedicated to it on our website.

First national training course on counselling on infant and young child feeding held in Sudan, 22-28 December 2006
11 February 2007

The seven-day training course was held at the Omdurman military hospital in Khartoum, which has a high rate of deliveries allowing good exposure for practice, using the training package in Arabic which had been developed by the regional office. The aim of the course was to create a pool of facilitators to build national capacity, in addition to health providers working at health facilities. A total of 25 participants attended the course, including physicians and nutritionists. Seventeen hours (30%) of the 56-hour course were spent on clinical sessions to practise the counselling skills. Participant performance was followed up by a monitoring tool to measure progress and provide feedback accordingly.

Third Intercountry Workshop on the Child Health Policy Initiative (CHPI) held in Tunis, Tunisia, 10-13 December 2006
4 February 2007

This workshop was the third of a series of workshops on the CHPI organized by EMRO to guide the process on national child health policy development, share experiences between interested countries and support their work in this area. A total of 43 participants attended the workshop, including 31 national representatives of 10 countries in the Region (Egypt, Iraq, Islamic Republic of Iran, Jordan, Morocco, Oman, Sudan, Syrian Arab Republic, Tunisia and Yemen), staff from four UNICEF country offices, the WHO Regional Office for the Eastern Mediterranean, WHO Regional Office for Africa and WHO country offices in the EMR. Click on the following hyperlinks: to read about the Tunisian national child health policy document and its launching, read more information on this workshop, learn about the CHPI, and view information and reports on the previous intercountry workshops on the CHPI: first workshop (Damascus, 2004) and second workshop (Cairo, 2005).

Report on the 2nd Consultation on IMCI Pre-service Training available on-line
1 February 2007

The report on the Second Consultation on IMCI Pre-service Training is now available on line. The Consultation was held in Cairo, Egypt, from 27 to 31 August 2006. Initial information on the consultation was posted on this website on 6 September 2006. To view the report and information on the Consultation, click here. The report provides an overview of IMCI pre-service training in the Eastern Mediterranean Region, describing the progress of introducing IMCI elements into teaching programmes of medical and allied health professional schools in countries in the region, highlighting the strategy developed and recommended by the regional office (EMRO) for this purpose and providing information also on the experience in this area in the African region. The report also briefly describes issues on the sustainability of this approach discussed in the consultation and provides an update on developmental work which is being carried out by the regional office, including the development of an e-learning material and an IMCI pre-service training evaluation guide. Finally, examples of main findings of the evaluations conducted using the draft tool in two countries are summarized.