1. UNDER FIVES CLINIC
PRACTICAL DEMONSTRATION
FOR 4TH SEMESTER
Department Of Community Medicine
17 October 2012 1
SKIMS, Soura. Dr.Q.M.IQBAL
2. Under Fives-A Special Group
1. They constitute about 15 % of the total
population.
2. They suffer high rates of mortality and
morbidity.
3. The effects of malnutrition and other diseases
have a role in later life.
4. The majority of the deaths are preventable
through available interventions.
5. This is a period of growth and development.
Department Of Community Medicine
17 October 2012 2
SKIMS, Soura. Dr.Q.M.IQBAL
3. 6. Brain growth is completed during 1st five
years.
7. Most causes of morbidity are preventable by
immunization.
8. Health of children under five years and family
health are inter-related.
Department Of Community Medicine
17 October 2012 3
SKIMS, Soura. Dr.Q.M.IQBAL
5. Under five clinic is a center, where
preventive, promotive, curative, referral and
educational services are provided in a
package manner to under five children under
one roof.
The services are made available through
trained nurses, so that not only the services
become economical but also becomes
available to larger proportion of children
population in the community.
Department Of Community Medicine
17 October 2012 5
SKIMS, Soura. Dr.Q.M.IQBAL
6. GOAL
The overall goal of the Under-Fives Clinic is to
provide comprehensive health care to young
children in a separate specialized facility.
Department Of Community Medicine
17 October 2012 6
SKIMS, Soura. Dr.Q.M.IQBAL
7. The under five clinic is represented by
traditional logo of a triangle with four internal
triangles and an outer enveloping triangle as
shown in the Fig.
Department Of Community Medicine
17 October 2012 7
SKIMS, Soura. Dr.Q.M.IQBAL
8. Functions:
(a) Care in Illness :
This is the felt need of the mother and child for
which any child is brought to the clinic. The
usual illnesses encountered in children under
five are fever, diarrhoea, ARI, infections of the
skin and helminthiasis. The facility should
provide for essential laboratory investigations
and X-ray facilities. The Clinic should be backed
by an effective referral mechanism.
Department Of Community Medicine
17 October 2012 8
SKIMS, Soura. Dr.Q.M.IQBAL
9. (b) Growth Monitoring :
This is one of the most important functions of the clinic.
The child is weighed periodically – every month during the
first year, every 2 monthly from 1 to 3 years of age and
every 3 monthly in 4th and 5th years.
Besides weighing, measuring height, mid arm
circumference can also be carried out depending upon the
availability of trained manpower and equipments.
The growth is plotted on the growth chart and any
faltering in the growth is detected and suitable action
initiated. The milestones are also recorded and any delay
in October 2012
17 achieving milestone is evaluated.
Department Of Community Medicine
SKIMS, Soura. Dr.Q.M.IQBAL
9
10. (c) Preventive Care :
This involves primarily the immunization
services during the 1st five years of
life, vitamin A supplementation and
administration of Iron supplementation and
antihelminthic treatment to prevent anemia.
The preventive care also provides for regular
health check up and use of ORS during
Diarrhoea to prevent dehydration from
developing.
17 October 2012
Department Of Community Medicine
10
SKIMS, Soura. Dr.Q.M.IQBAL
11. (d) Family Planning :
Family planning is central to any program
directed towards women and children. The
mothers are more receptive to family planning
during early Puerperium and lactation.
Mother is counselled on the various options
available, their merits and de-merits so that
she can make a choice.
Department Of Community Medicine
17 October 2012 11
SKIMS, Soura. Dr.Q.M.IQBAL
12. (e) Health Education :
The opportunity should be made use to
educate the mother on issues of child
care, breast feeding, nutrition, growth
monitoring, immunization and hygiene of safe
water and food preparation.
Department Of Community Medicine
17 October 2012 12
SKIMS, Soura. Dr.Q.M.IQBAL
16. Why immunization?
• Immunization is one of the safest and most
effective methods of preventing childhood
diseases.
• Under the Universal Immunization Programme
(UIP), significant achievements have been
made in preventing and controlling the
Vaccine Preventable Diseases (VPDs).
• Immunization has to be sustained as a high
priority to further reduce the incidence of all
VPDs, control measles, eliminate tetanus and
eradicate poliomyelitis.
Department Of Community Medicine
17 October 2012 16
SKIMS, Soura. Dr.Q.M.IQBAL
17. • Full immunization (i.e. received one dose of
BCG, three doses of DPT, Hep-B and OPV each
and one dose of Measles before one year of
age) gives a child the best chance for a healthy
life. Preventing disease before it occurs saves
money, energy, and lives.
• Immunization is a key strategy to child survival.
By protecting infants from VPDs, immunization
significantly lowers morbidity and mortality
rates in children. The security provided to
families can lead to lower birth rates.
• Immunization is an indicator of a strong
primary health care system.
Department Of Community Medicine
17 October 2012 17
SKIMS, Soura. Dr.Q.M.IQBAL
18. Reasons for Low immunization coverage
• Failure to provide immunization.
• Dropouts.
• Unreached populations.
• Resistant populations.
• Missed Opportunities.
Department Of Community Medicine
17 October 2012 18
SKIMS, Soura. Dr.Q.M.IQBAL
19. The following are the targeted vaccine
preventable diseases along with their
symptoms, mode of spread and methods of
prevention.
• Tuberculosis
• Polio
• Diphtheria
• Pertussis
• Tetanus
• Hepatitis B
• Measles
Department Of Community Medicine
17 October 2012 19
SKIMS, Soura. Dr.Q.M.IQBAL
20. Tuberculosis
• Tuberculosis (TB) is caused by a bacteria
(Mycobacterium tuberculae).
• It is a highly contagious disease that affects
the lungs but can also affect the
intestines, bones and joints, lymph
glands, meninges, and other tissues of the
body.
Department Of Community Medicine
17 October 2012 20
SKIMS, Soura. Dr.Q.M.IQBAL
21. Polio
Polio is a viral infection that affects the
nervous system and can cause severe
illness, paralysis, and even death.
Due to intensive immunization
campaigns, there has been a very significant
decline of polio cases in the country since
1999.
Department Of Community Medicine
17 October 2012 21
SKIMS, Soura. Dr.Q.M.IQBAL
22. Diphtheria
Diphtheria is caused by bacteria (Coryne
bacterium diphtherae). Diphtheria is an
infectious disease that commonly infects the
tonsils and pharynx, forming a membrane
that can lead to obstructed breathing and
death.
Department Of Community Medicine
17 October 2012 22
SKIMS, Soura. Dr.Q.M.IQBAL
23. Pertussis (Whooping Cough)
Pertussis, commonly known as whooping
cough, is caused by bacteria (Bordetella
pertussis). Pertussis is a highly contagious
bacterial disease, involving the respiratory
tract. It is characterized by repeated cough
that may lead to aspiration and possible
death, in a few cases.
Department Of Community Medicine
17 October 2012 23
SKIMS, Soura. Dr.Q.M.IQBAL
24. Tetanus
Tetanus is caused by bacteria (Clostridium
tetani). People of all ages can become
infected with tetanus.
Department Of Community Medicine
17 October 2012 24
SKIMS, Soura. Dr.Q.M.IQBAL
25. Measles
Measles is a highly infectious illness caused by
a virus that can be found in the nose, mouth or
throat of an infected person. Infection is
characterized by fever, cough and spreading
rash that may lead to death due to secondary
infections like diarrhea and pneumonia.
Department Of Community Medicine
17 October 2012 25
SKIMS, Soura. Dr.Q.M.IQBAL
26. Hepatitis B
Hepatitis B is a highly infectious viral disease
(40-100 times more infectious than HIV) and
is the leading cause of jaundice, fulminant liver
disease, cirrhosis and liver cancer.
Department Of Community Medicine
17 October 2012 26
SKIMS, Soura. Dr.Q.M.IQBAL
34. Adverse Events Following
Immunization (AEFIs)
• What is an Adverse Event Following
Immunization?
An Adverse Event Following Immunization (AEFI)
is a medical incident that takes place after an
immunization, causes concern, and is believed to
be caused by immunization.
Department Of Community Medicine
17 October 2012 34
SKIMS, Soura. Dr.Q.M.IQBAL
40. Cold Chain
Department Of Community Medicine
17 October 2012 40
SKIMS, Soura. Dr.Q.M.IQBAL
41. The Cold Chain is a system of storing and
transporting vaccines at recommended
temperatures from the point of manufacture to
the point of use.
The key elements of the cold chain are:
Personnel: to manage vaccine storage and
distribution
Equipment: to store and transport vaccine and to
monitor temperature
Procedures: to ensure that vaccines are stored and
transported at appropriate temperatures
Department Of Community Medicine
17 October 2012 41
SKIMS, Soura. Dr.Q.M.IQBAL
42. • Keeping vaccines at the right temperature is
not an easy task, but the consequences of not
doing so can be disastrous. Once vaccine
potency is lost, it cannot be regained.
• The damaged vaccines must be
destroyed, leading to inadequate vaccine
stocks and wastage of expensive vaccines.
• Moreover, children and women who receive a
vaccine that is not potent are not protected.
Department Of Community Medicine
17 October 2012 42
SKIMS, Soura. Dr.Q.M.IQBAL
45. • The physical appearance of the vaccine may
remain unchanged even after it is damaged.
However, the loss of potency due to either
exposure to heat or cold is permanent and can
not be regained.
Department Of Community Medicine
17 October 2012 45
SKIMS, Soura. Dr.Q.M.IQBAL
46. HEAT DAMAGE
• All vaccines are damaged by temperatures more
than +80C, whether they are exposed to a lot of
heat in a short time (e.g., as a result of keeping
vaccine in a closed vehicle in the sun) or a small
amount of heat over a long period (e.g., as a result
of the frequent opening of lid of ILR).
• Reconstituted BCG, measles and JE vaccines are
the most sensitive to heat and light. Since these
live vaccines do not contain preservatives, there is
risk of contamination with staphylococcus aureus
leading to Toxic Shock Syndrome
and, therefore, they should not be used after 4
hours of reconstitution.
Department Of Community Medicine
17 October 2012 46
SKIMS, Soura. Dr.Q.M.IQBAL
