IMCI Newsletter

Performance Report for January to December 2010

Issue 3 March 2012

Management Information System (MIS) Directorate General of Health Services (DGHS) Mohakhali, Dhaka-1212 Web:www.dghs.gov.bd; Email: info@dghs.gov.bd

Contents
Messages & Editorial Introduction Data and Method Limitation of the Data Results Conclusion Annexure P.02 P.03 P.03 P.04 P.04 P.16 P.16

Message
Director General Directorate General of Health Services Mohakhali, Dhaka It is a great pleasure for me to know that MIS of DGHS is going to publish the IMCI Newsletter (Issue 3). This newsletter is a very useful publication as it enables us to get facility-based graphical data on childhood illness all over Bangladesh in concise and understandable way. Bangladesh has made a remarkable progress in child mortality reduction and received the UN MDG Award for its success in MDG4. IMCI program is playing the key role to sustain and improve universal child immunization. It is expected that this newsletter will give some programmatic direction to policy-makers and program managers to understand the current situation and undertake interventions for the future about the IMCI services in Bangladesh. I would like to thank everyone who worked hard for publishing this newsletter successfully.

Editorial Note
Additional Director General (Planning and Development) and Line Director, Management Information System (MIS) Directorate General of Health Services Mohakhali, Dhaka Bangladesh has made a remarkable progress in improving the health of children and recently received the MDG Award for its success in Millennium Development Goal 4. It is one of the few countries in the developing world that is on track to achieve Millennium Development Goal 4: reducing the under-five mortality rate by two-thirds within 2015. Bangladesh is among only six countries in the world that have reduced by half or more child mortality rate since 1990 (from 151/1000 in 1990 to 65 in 2007). The infant mortality rate has also significantly declined to reach 52 deaths per 1000 livebirths in 2007 from 117 deaths/1000 in 1990. Therefore, we must increase our efforts to attain the expected target. I am delighted that the third issue of the IMCI newsletter is going to be published from the office of Director, MIS-Health of DGHS. This newsletter will not be limited to publishing result on only the performance assessment of IMCI services in facilities but would also encompass other areas of child and neonatal health, including community IMCI. The team associated with this newsletter made very sincere efforts to improve the quality of the contents than in the previous issue. An attempt was made to analyze the data received during the reporting period to understand the care-seeking and morbidity pattern of the sick under-five children attending the IMCI-designated facilities. I want to thank the entire team of IMCI section for their support and cooperation in publishing this newsletter. I wish also to congratulate the entire team of MISHealth whose relentless work and efforts have made this success. I also like to convey my sincere thanks to all the managers, doctors, paramedics, and other service providers and staff who helped in various forms and thus enabled us to publish this newsletter. I also convey my gratefulness to Director General of Health Services and Director, PHC, for their continuous support and advice in accomplishing our tasks in MIS. I extend my special thanks to UNICEF for their all-out cooperation as well as technical and financial support in publishing this newsletter. I congratulate the editorial board for their success in reviewing the contents of this newsletter despite various constraints. The effort will be fruitful if we can use the information for the betterment of our children who deserve quality and equitable health services.

Professor Dr. Khondhaker Md. Shefyetullah

Message
Line Director, Maternal, Neonatal, Child and Adolescent Health (MNC&AH) and Director, Primary Health Care Directorate General of Health Services Mohakhali, Dhaka I am glad to see that the Management Information System (MIS) of the Directorate General of Health Services (DGHS) is going to publish the third issue of IMCI Newsletter. This publication has now become a necessary source of information containing statistics on child health aspects of the health sector. I would like to thank MIS-Health and IMCI program as well as the health managers and service providers at different levels for their reporting from the IMCI facilities for publication of the newsletter. I thank our development partners, specially UNICEF, ICDDR,B, and WHO for their financial and technical support for this important task in the child health sector. I expect continuing publication of the IMCI Newsletter.

Professor Dr. Abul Kalam Azad Dr. Syed Abu Jafar Md. Musa

02

Introduction One of the major challenges in achieving Millennium Development Goal 4 is the slow progress in preventing neonatal deaths, which now account for 57% of all under-five deaths and 70% of infant deaths. In Bangladesh, 14 babies under one month of age die every hour and 120,000 every year (UNICEF, 2010). Every year around 10 million children die in developing countries before they reach their fifth birthdays. Two-thirds of these deaths could be prevented by effective low-cost interventions. Seven in ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria, or malnutrition and often due to a combination of these illnesses. In spite of various diseasespecific control programs in operation, there has not been significant reduction in childhood morbidity and mortality. In response to this challenge, WHO/UNICEF proposed a comprehensive single efficient and effective approach to manage childhood illnesses, i.e. Integrated Management of Childhood Illness (IMCI). The Government of Bangladesh decided to adopt the IMCI strategy in 1998. Ten training centers for IMCI have been established where the Clinical Management Training (11-days CMT) is ongoing for all types of service providers (doctors, nurses, paramedics) from selected upazilas. In 2010, IMCI has been included in undergraduate medical curriculum, and the process of inclusion is going on in Nursing Institutes and Medical Assistant Training Schools (MATS). Up to June 2010, Facility-based IMCI has been implemented in 48 districts (343 upazilas) and at present (June 2011), it is being implemented in 395 upazilla health 03

complexes (UHC). Community-based IMCI is being implemented in 63 upazilas. In the Health, Population and Nutrition Sector Development Programme (HPNSDP) period 2011-2016, facility-based IMCI and community-based IMCI will be scaled up in 85 UHCs and 263 UHCs respectively. During the HPNSDP (2011-2016) implementing period, the main activities regarding IMCI program will be: strengthening the delivery of neonatal and child health services through facility-based IMCI; expanding facility-based IMCI for out-patient sick child services; achieving saturation to cover 482 upazilas, 59 District Hospitals (DH) and 19 Medical College Hospitals (MCH) in 64 districts with adequate quality IMCI services; strengthening referral care (including Emergency Triage Assessment and Treatment) for sick under-five children in all UHCs/DHs; ensuring growth promotion with counseling on appropriate feeding practices, including exclusive breastfeeding and combining monitoring and supervision of IMCI and EPI at the facility and community levels.

Data and Method The childhood diseases covered by IMCI program in Bangladesh have been classified into 10 broad categories, viz. (i) very severe disease, (ii) pneumonia, (iii) no pneumoniacough and cold, (iv) diarrhea, (v) fever-malaria, (vi) fever-no malaria, (vii) measles, (viii) ear problem, (ix) malnutrition, and (x) others. IMCI is provided through facility-based treatment as well as through home-care. The latter is called Community IMCI Program. Currently, facility-based IMCI is being delivered, (in 395 upazilas) from 49 districts. Community-based IMCI is running in 63 upazilas. UNICEF and WHO jointly provide technical and financial

assistance to the Ministry of Health and Family Welfare for implementing the IMCI program. Various other development partners and NGOs also collaborate with the Government. The Management Information System (MIS) of the Directorate General of Health Services (DGHS) tries to capture the data from IMCI services provided in different IMCI facilities. Recently, a desktop and web-based software (IMCI Facility MIS System) has been developed by MIS, DGHS, with the help of ICDDR,B to collect IMCI service data from different levels of designated IMCI facilities. All the IMCIdesignated facilities are to send IMCI performance report to the MIS of DGHS every month for compilation, analysis, monitoring, and tracking of the progress of the program and dissemination. Community IMCI program has been implemented by NGOs and monitored by DGHS. The IMCI program districts are listed below: Barisal division: Barisal, Bhola, and Patuakhali; Chittagong division: Brahmanbaria, Bandarban, Chandpur, Chittagong, Comilla, Cox's Bazar, Khagrachhari, Laxmipur, and Rangamati; Dhaka division: Dhaka, Gazipur, Gopalganj, Jamalpur, Kishoreganj, Madaripur, Mymensingh, Narsingdi, Netrokona, Shariatpur, Sherpur, and Tangail; Khulna division: Bagherhat, Jessore, Narail, Khulna, and Shatkhira; Rajshahi division: Bogra, Chapainawabganj, Naogaon, Natore, Joypurhat, Pabna, Rajshahi, and Sirajganj; Rangpur division: Dinajpur, Ghaibandha, Kurigram, Lalmonirhat, Nilphamari, Panchgarh, Rangpur, and Thakurgaon; and Sylhet division: Hobiganj, Maulvibazar, Sunamganj, and Sylhet. In 2010, data were collected from the 42 IMCI program districts because these 42 districts were fully functional during the reporting period. The rest of the districts were included at the mid or last part of the year 2010. All reports 04

covered 1,804,576 children "out-patient and emergency disease-encounters" (a child may have multiple illnesses). An attempt has been made to analyze data on these children to understand their morbidity pattern. In this newsletter, results of analysis of the data received from facilities have been presented. Limitations of the Data This newsletter is based on the monthly IMCI reports received by MIS-Health from the IMCI upazilas. The morbidity status of the children was analyzed; the cases were assessed as per the IMCI protocol. This newsletter captures data only on the children who attended the IMCI facilities. A number of children visit private doctors, some take help from traditional healers, or some even do not take any treatment. Those children were not included in the report. Results A. Coverage of IMCI Facilities Out of 482 upazilas, 395 were covered as IMCI upazila up to June 2011. Among the covered upazilas, all of Rajshahi, Rangpur and Sylhet divisions were included. The lowest coverage (60.0%) were in Barisal division (Table 1). Table 1. Distribution of IMCI upazilas in seven divisions
Division Total Total no. Total no. no. of of of covered districts upazilas IMCI districts Barisal 6 40 3 Chittagong 11 99 9 Dhaka 17 122 11 Khulna 10 59 5 Rajshahi 8 66 8 Rangpur 8 58 8 Sylhet 4 38 4 Total 64 482 48 Total no. of covered IMCI upazilas 24 83 90 36 66 58 38 395 % of total upazila coverage 60.0 83.8 73.8 61.0 100.0 100.0 100.0 82.0

Table 2. Distribution of IMCI patients and disease patterns in 2010 in Bangladesh

Sl. no. A.1 A.2 A B.1 B.2 B.3 B.4 B.5 B.6 B.7 B.8 B.9 B.10 B C Diseases/Medical Condition Male Female Total (A1+A2) Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total (B1-B10) Refer 0-28 days 26811 25600 52411 20447 0 0 10470 0 0 155 1967 5044 19619 57702 1673 29-59 days 62031 57357 119389 40464 0 0 22959 0 0 326 6011 13684 39683 123127 2524 2-12 months 315640 301262 616901 16166 79623 173322 79859 5425 97841 2148 22912 30685 119432 627413 5468 1-5 years 522944 492932 1015875 19195 115087 295698 156399 11017 188322 5664 44676 57517 252577 1146152 10549 Total 927426 877151 1804576 95134 194755 470088 269687 16442 286188 8293 75566 106930 431311 1954394 20214 % of total 51.4 48.6 100.0 5.3 10.8 26.0 14.9 0.9 15.9 0.5 4.2 5.9 23.9 108.3 1.1

B. IMCI diseases by age-groups The distribution of the IMCI diseases among the children aged below 5 years by agegroups, viz. 0-28 day(s), 29-59 day(s), 2-12 month(s) and 1-5 year(s) has been shown in Figure 1. The data were received from IMCI facilities in 42 districts in 2010. It is seen that children from 1 to 5 year(s) age-group constituted the largest IMCI service recipients (56%), followed by 2 to 12 months age-group (34%). Of the total under-five children, 3% were at the neonatal age. Age-group 29 to 59 days comprised 7% of the total children receiving services from the IMCI facilities. Figure 1. Distribution of children with IMCI diseases by age-group in Bangladesh 2010 (N=1,804, 576)
0-28 days, n=52,411, 3%) 29-59 days, n=119,389, 7%

Figure 2. Percent distribution of male children with IMCI diseases by age-group in Bangladesh 2010 (n=927,426)
0-28 days, n=26,811, 3% 29-59 days, n=62,031, 7%

1-5 years, n=522,944, 56%

2-12 months, n=315,640, 34%

Figure 3. Percent distribution of female children with IMCI diseases by age-group in Bangladesh 2010 (n=877,151)
0-28 days, n=25,600, 3% 29-59 days, n=57,357, 7%

1-5 years n=1,015,875 56%

2-12 months, n=616,901, 34%

1-5 years, n=492,932, 56%

2-12 months, n=301,262, 34%

05

Figure 4. Percent distribution of children with very severe diseases by age-group (n=95,134; 5.3% of total)
1-5 years, n=19,195, 20% 0-28 days, n=20,447, 21%

Figure 7. Percent distribution of children with 'diarrhea' by age-group (n=269,687; 14.9% of total)
0-28 days, n=10,470, 4%

29-59 days, n=22,959, 8%

2-12 months, n=16,166, 17%

29-59 days, n=40,464, 42%

1-5 years, n=156,399, 58%

2-12 months, n=79,859, 30%

Figure 5. Percent distribution of children with pneumonia by age-group (n=194,755; 10.8% of total)

Figure 8. Percent distribution of children with 'fever-malaria' by age-group (n=16,442; 0.9% of total)

2-12 months, n=5,425, 33% 2-12 months, n=79,623, 41% 1-5 years, n=11,017, 67%

1-5 years, n=115,087, 59%

Figure 6. Percent distribution of children with 'no pneumonia-cough and cold' by age-group (n=470,088; 26.0% of total)

Figure 9. Percent distribution of children with 'fever-no malaria' by age-group (n=286,188; 15.9% of total)

2-12 months, n=97,841, 34% 2-12 months, n=173,322, 37% 1-5 years, n=295,698, 63% 1-5 years, n=188,322, 66%

06

Figure 10. Percent distribution of children with 'measles' by age-group (n=8,293; 0.5% of total)
0-28 days, n=155, 2% 29-59 days, n=326, 4%

case of each disease. Caution is needed to interpret this situation. This trend should be related to more attendance of the older children in the IMCI facilities than the younger ones. Figure 13. Percent distribution of children with 'others illness' by age-group (n=431,311; 23.9% of total)
0-28 days, n=19,619, 4% 29-59 days, n=39,683, 9%

2-12 months, n=2,148, 26%

1-5 years, n=5,664, 68%

Figure 11. Percent distribution of children with 'ear problem' by age-group (n=75,566; 4.2% of total)
0-28 days, n=1,967, 3%

1-5 years, n=252,577, 59%

2-12 months, n=119,432, 28%

29-59 days, n=6,011, 8%

Figure 14. Percent distribution of 'referred children' by age-group (n=20,214; 1.1% of total)
2-12 months, n=22,912, 30% 0-28 days, n=1,673, 8% 29-59 days, n=2,524, 13%

1-5 years, n=44,676, 59%

Figure 12. Percent distribution of children with 'malnutrition' by age-group (n=106,930; 5.9% of total)
0-28 days, n=5,044, 5%

1-5 years, n=10,549, 52% 2-12 months, n=5,468, 27%

29-59 days, n=13,684, 13%

1-5 years, n=57,517, 54% 2-12 months, n=30,685, 28%

Figure 4 to 14 show the distribution of the IMCI diseases among children aged 0 day to 5 years. It is seen that the number and percentage of patients increased with age in 07

Table 2 presents the distribution of the IMCI diseases within each age-group. Among the total children, the problem of respiratory tract was the leading cause of morbidity (cough and cold: 26%; pneumonia: 11%). Fever (malaria or no malaria), and diarrhea were the morbidities of 16% and 15% of the children respectively. Similar pattern of morbidities was also observed among children of all agegroups.

C. Number distribution of cases with IMCI diseases by age-groups Figure 15 to 19 show the burden of each of the age group (based on the number of children visiting IMCI facilities) shared by the IMCI facilities in various IMCI diseases. Figure 15. Distribution of various diseases among neonates of 0-28 days (n=52,411; 2.9% of total)
Very severe disease Pneumonia No pneumoniacough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Refer 1,673 0 0 155 1,967 5,044 19,619 0 0 10,470 20,447

Figure 17. Distribution of various diseases among infants of 2-12 months (n=616,901; 34.2% of total)
Very severe disease Pneumonia No pneumoniacough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Refer 5,468 2,148 22,912 30,685 119,432 5,425 97,841 79,859 16,166 79,623 173,322

Figure 18. Distribution of various diseases among children of 1-5 years (n=1015,875; 56.3% of total)
Very severe disease Pneumonia No pneumoniacough and cold 19,195 115,087 295,698 156,399 11,017 188,322 5,664 44,676 57,517 252,577 10,549

Figure 16. Distribution of various diseases among post-neonatal babies of 29-59 days (n=119,389; 6.6% of total)
Very severe disease Pneumonia No pneumoniacough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Refer 2,524 0 0 326 6,011 13,684 39,683 0 0 22,959 40,464

Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Refer

08

Figure 19. Distribution of various diseases among 0 day to 5 years old children (N=1804, 576)
Very severe disease Pneumonia No pneumoniacough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Refer 20,214 8,293 75,566 106,930 431,311 16,442 286,188 95,134 194,755 470,088 269,687

Figure 21. Percent distribution of female children with various illnesses by age-group in Barisal division in 2010 (51.3% of total)
0-28 days, n=1,953, 3% 29-59 days, n=3,787, 6%

1-5 years, n=36,147, 58%

2-12 months, n=20,718, 33%

Figure 22. Percent distribution of total children with various illnesses by age-group in Barisal division in 2010
0-28 days, n=3,669, 3% 29-59 days, n=7,436, 6%

D. Percent distribution of IMCI patients by division in 2010 In Barisal division, a total of 122,046 children received service from IMCI facilities; of them 59,441 were male and the rest were female. Figure 20. Percent distribution of male children with various illnesses by age-group in Barisal division in 2010 (48.7% of total)
0-28 days, n=1,716, 3% 29-59 days, n=3,649, 6%

1-5 years, n=71,129, 58%

2-12 months, n=39,812, 33%

In Chittagong division, a total of 255,028 children received service from IMCI facilities, of them 129,988 were male, and the rest were female (125,040). Figure 23. Percent distribution of male children with various illnesses by age-group in Chittagong division in 2010 (51.0% of total)
0-28 days, n=2,716, 2% 29-59 days, n=6,836, 5%

1-5 years, n=34,982, 59%

2-12 months, n=19,094, 32%

1-5 years, n=67,548, 52%

2-12 months, n=52,887, 41%

09

Figure 24. Percent distribution of female children with various illnesses by age-group in Chittagong division in 2010 (49.0% of total)
0-28 days, n=3,071, 2% 29-59 days, n=4,755, 4%

Figure 27. Percent distribution of female children with various illnesses by age-group in Dhaka division in 2010 (48.7% of total)
0-28 days, n=4,020, 2% 29-59 days, n=10,601, 4%

1-5 years, n=66,519, 53%

2-12 months, n=50,695, 41%

2-12 months, n=82,384, 32% 1-5 years, n=158,462, 62%

Figure 25. Percent distribution of total children with various illnesses by age-group in Chittagong division in 2010
0-28 days, n=5,787, 2% 29-59 days, n=11,591, 4%

Figure 28. Percent distribution of total children with various illnesses by age-group in Dhaka division in 2010
0-28 days, n=8,295, 2% 29-59 days, n=22,340, 4%

1-5 years, n=134,067, 53%

2-12 months, n=103,583, 41%

2-12 months, n=169,643, 32% 1-5 years, n=324,452, 62%

In Dhaka division, a total of 524,730 children received service from IMCI facilities; of them 269,263 were male, and the rest were female (255,467). Figure 26. Percent distribution of male children with various illnesses by age-group in Dhaka division in 2010 (51.3% of total)
0-28 days, n=4,275, 2% 29-59 days, n=11,739, 4%

In Khulna division, a total of 70,947 children received service from IMCI facilities; of them 35,403 were male, and the rest were female (35,544). Figure 29. Percent distribution of male children with various illnesses by age-group in Khulna division in 2010 (49.9% of total)
0-28 days, n=428, 1% 29-59 days, n=1,256, 4%

2-12 months, n=87,259, 32% 1-5 years, n=165,990, 62% 1-5 years, n=23,990, 68%

2-12 months, n=9,729, 27%

10

Figure 30. Percent distribution of female children with various illnesses by age-group in Khulna division in 2010 (50.1% of total)
0-28 days, n=457, 1% 29-59 days, n=1,314, 4%

Figure 33. Percent distribution of female children with various illnesses by age-group in Rajshahi division in 2010 (47.1% of total)
0-28 days, n=5,867, 4% 29-59 days, n=17,968, 12%

2-12 months, n=10,013, 28%

1-5 years, n=81,877, 54% 2-12 months, n=45,526, 30%

1-5 years, n=23,761, 67%

Figure 31. Percent distribution of total children with various illnesses by age-group in Khulna division in 2010
0-28 days, n=885, 1% 29-59 days, n=2,569, 4%

Figure 34. Percent distribution of total children with various illnesses by age-group in Rajshahi division in 2010
0-28 days, n=13,329, 4% 29-59 days, n=36,728, 11%

2-12 months, n=19,742, 28%

1-5 years, n=175,953, 55%

1-5 years, n=47,750, 67%

2-12 months, n=94,992, 30%

In Rajshahi division, a total of 321,002 children received service from IMCI facilities; of them 169,763 were male, and the rest were female (151,238). Figure 32. Percent distribution of male children with various illnesses by age-group in Rajshahi division in 2010 (52.9% of total)
0-28 days, n=7,462, 4% 29-59 days, n=18,760, 11%

In Rangpur division, a total of 228,478 children received service from IMCI facilities; of them 117,225 were male, and the rest were female (111,253). Figure 35. Percent distribution of male children with various illnesses by age-group in Rangpur division in 2010 (51.3% of total)
0-28 days, n=1,713, 1% 29-59 days, n=5,546, 5%

1-5 years, n=94,077, 56%

1-5 years, n=57,995, 50% 2-12 months, n=49,465, 29% 2-12 months, n=51,972, 44%,

11

Figure 36. Percent distribution of female children with various illnesses by age-group in Rangpur division in 2010 (48.7% of total)
0-28 days, n=1,931, 2% 29-59 days, n=4,120, 4%

Figure 39. Percent distribution of female children with various illnesses by age-group in Sylhet division in 2010 (48.2% of total)
0-28 days, n=8,302, 6% 29-59 days, n=14,813, 11%

1-5 years, n=56,630, 51%

1-5 years, n=69,536, 51% 2-12 months, n=48,572, 43% 2-12 months, n=43,353, 32%

Figure 37. Percent distribution of total children with various illnesses by age-group in Rangpur division in 2010
29-59 days, n=9,665, 4%,

Figure 40. Percent distribution of total children with various illnesses by age-group in Sylhet division in 2010
0-28 days, n=16,803, 6% 29-59 days, n=29,059, 10%

0-28 days, n=3,644 2%

1-5 years, n=114,625, 50%

1-5 years, n=147,899, 53% 2-12 months, n=100,544, 44% 2-12 months, n=88,586, 31%

In Sylhet division, a total of 282,346 children received service from IMCI facilities; of them 146,343 were male, and the rest were female (136,004). Figure 38. Percent distribution of male children with various illnesses by age-group in Sylhet division in 2010 (51.8% of total)
0-28 days, n=8,501, 6% 29-59 days, n=14,246, 10%

1-5 years, n=78,363, 53% 2-12 months, n=45,233, 31%

12

E. Percent distribution of IMCI cases with various illnesses by division in 2010 Figure 41. Percent distribution of children with various illnesses by age-group in Barisal division in 2010
86.3 76.0 65.3 59.1 53.1 46.9 40.9 31.6 26.1 29.6 0.0 12.7
Very severe disease Pneumonia

70.1 53.8 54.9 56.4

56.7

34.7 24.3 11.4 0.0 0.0 0.0 7.6

Fever-malaria Fever-no malaria No pneumonia-cough and cold Diarrhea

32.2 23.9 13.0

28.7 14.8 1.0

Malnutrition

27.2 11.5

22.6 5.7 1.5

13.7 0.0 0.0 0.0 0.0

Measles

0.1

0.0
Ear problem

1.6
Others

0-28 days

29-59 days

2-12 months

1-5 years

Figure 42. Percent distribution of children with various illnesses by age-group in Chittagong division in 2010
65.1 61.0 67.9 63.4 67.6 67.5 67.6 60.5 62.5 56.9

43.6 39.0 34.9 28.8 19.4 15.3 21.7 0.0 0.0 0.0 0.0 32.1 32.4 24.8 20.6 5.9 0.0 0.0 0.0 0.0 1.4 6.2 23.6 9.6 6.3 5.4 26.4 22.5 9.6 11.2 5.5

4.9 7.0

Very severe disease

Fever-malaria

Diarrhea

Fever-no malaria

Measles

No pneumonia-cough and cold

Malnutrition

Pneumonia

Ear problem

Others

0-28 days

29-59 days

2-12 months

1-5 years

13

Refer

1.9

Refer

4.9

Figure 43. Percent distribution of children with various illnesses by age-group in Dhaka division in 2010
69.6 59.0 63.0 63.3 56.4 67.6 60.4 54.9 61.9

37.3 31.6 20.7

41.0

37.0 31.4 30.4 32.4 29.7 31.0

32.9 26.7

38.3 32.2 17.1

9.2 10.3
Very severe disease

0.0
Pneumonia

0.0

0.0 0.0
No pneumonia-cough and cold

3.9 1.3

7.0 4.7 1.7

10.2 2.0
Malnutrition

8.2

12.4

0.0
Fever-malaria

0.0

0.0 0.0
Fever-no malaria Measles

Diarrhea

Ear problem

Others

0-28 days

29-59 days

2-12 months

1-5 years

Figure 44. Percent distribution of children with various illnesses by age-group in Khulna division in 2010
85.3 66.1 60.0 40.0 32.6 9.3 8.1 16.5
Very severe disease

67.4

67.9

71.8

72.7

69.8 63.6

71.8 61.6

29.0 14.7

28.2

27.3

24.6 4.7 0.0

Ear problem

26.4 5.2 4.7

Malnutrition

29.9 23.5 2.9

Others

0.0
Pneumonia

0.0

0.0 0.0
No pneumonia-cough and cold

2.6
Diarrhea

0.0
Fever-malaria

0.0

0.0 0.0
Fever-no malaria

0.0
Measles

1.0

4.5 4.0
Refer

0.6

1.8

0-28 days

29-59 days

2-12 months

1-5 years

14

Refer

3.2

Figure 45. Percent distribution of children with various illnesses by age-group in Rajshahi division in 2010
82.2 66.8 57.4 52.3 42.6 33.2 26.7 29.3 8.6 9.8 0.0
Very severe disease Pneumonia

60.6 50.0 39.4

61.5

64.6 54.6 49.0 46.2 29.0 12.0 6.2 0.0

Measles Ear problem

38.5 27.5 14.4 27.4 19.8 27.5 14.8 11.6

16.1 0.0 0.0 7.2

Fever-malaria Diarrhea No pneumonia-cough and cold

0.0

0.0

0.0

0.0 0.0
Fever-no malaria

3.5

1.8
Malnutrition

3.7
Others Refer 1-5 years
74.3 20.4 4.4 0.8

4.4

0-28 days

29-59 days

2-12 months

Figure 46. Percent distribution of children with various illnesses by age-group in Rangpur division in 2010
74.3 64.7 66.1 60.4 56.8 41.5 30.9 25.7 23.8 12.0 13.9 0.0 0.0 0.0 0.0 8.3 3.1 0.0 0.0 0.0 0.0 3.0 0.0 7.8 3.2 7.1 2.3 6.9 33.8 31.6 33.2 29.7 29.0 57.6 65.3 55.8 60.9 60.4

39.3

Very severe disease

Fever-malaria

Diarrhea

Fever-no malaria

Measles

No pneumonia-cough and cold

Malnutrition

Pneumonia

Ear problem

Others

0-28 days

29-59 days

2-12 months

1-5 years

15

Refer

3.7

Figure 47. Percent distribution of children with various illnesses by age-group in Sylhet division in 2010
58.8 46.2 41.2 38.6 31.8 22.6 12.1 26.0 15.7 0.0
Very severe disease Pneumonia

61.4 51.1

61.7

65.1 59.7 50.2 45.7 53.1

38.3

40.3 33.4 25.4 10.8 6.5 15.1 13.9 5.5 6.2

Measles Malnutrition Ear problem Others Refer
1-5 years

31.1

32.2 25.1 22.9 19.8

10.7 0.0 0.0 0.0 6.4

Fever-malaria Diarrhea No pneumonia-cough and cold Fever-no malaria

9.5

0.0

0.0

0.0 0.0

5.8

0-28 days

29-59 days

2-12 months

Conclusion The newsletter represents the general picture of the childhood illnesses and diseases of underfive children in Bangladesh. The newsletter will give some programatic direction to the policymakers, managers, and development partners foe further providing IMCI services to the children of Bangladesh. Annexure Table 3. Distribution of IMCI patients and disease patterns by division in Bangladesh, 2010
Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh (Total)

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

59441 62605 122046 2437 4942 35097 16588 168 24483 1596 4615 10416 30796 131138 2137

129988 125040 255028 14554 38118 62085 46019 1802 36320 286 8998 8676 58782 275640 3506

269263 255467 524730 24359 60233 158845 67829 2411 110064 992 21163 28179 107658 581733 6652

35403 35544 70947 2322 3823 19511 10060 367 14327 22 1681 2528 16694 71335 645

169763 151238 321002 26987 35079 85730 46878 3443 49715 954 13993 22522 68412 353713 2338

117225 111253 228478 7928 19534 61231 39171 3789 29779 2923 8927 17241 46337 236860 3426

146343 136004 282346 16547 33026 47589 43142 4462 21500 1520 16189 17368 102632 303975 1510

927426 877151 1804576 95134 194755 470088 269687 16442 286188 8293 75566 106930 431311 1954394 20214

16

Table 4. Percent distribution of IMCI patients and disease patterns by division in Bangladesh, 2010
Diseases Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh (Total)

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

6.4 7.1 6.8 2.6 2.5 7.5 6.2 1.0 8.6 19.2 6.1 9.7 7.1 6.7 10.6
0-28 days No. %

14.0 14.3 14.1 15.3 19.6 13.2 17.1 11.0 12.7 3.4 11.9 8.1 13.6 14.1 17.3
29-59 days No.

29.0 29.1 29.1 25.6 30.9 33.8 25.2 14.7 38.5 12.0 28.0 26.4 25.0 29.8 32.9

3.8 4.1 3.9 2.4 2.0 4.2 3.7 2.2 5.0 0.3 2.2 2.4 3.9 3.6 3.2
2-12 months No. %

18.3 17.2 17.8 28.4 18.0 18.2 17.4 20.9 17.4 11.5 18.5 21.1 15.9 18.1 11.6

12.6 12.7 12.7 8.3 10.0 13.0 14.5 23.0 10.4 35.2 11.8 16.1 10.7 12.1 16.9
1-5 years

15.8 15.5 15.6 17.4 17.0 10.1 16.0 27.1 7.5 18.3 21.4 16.2 23.8 15.6 7.5
Total

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 5. Distribution of IMCI patients and disease patterns in Barisal division in 2010
Patient/Diseases % No. % No. %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

1716 1953 3669 309 0 0 1257 0 0 0 46 168 1510 3290 33

2.9 3.1 3.0 12.7 0.0 0.0 7.6 0.0 0.0 0.0 1.0 1.6 4.9 2.5 1.5

3649 3787 7436 637 0 0 1895 0 0 1 598 1538 3532 8201 122

6.1 6.0 6.1 26.1 0.0 0.0 11.4 0.0 0.0 0.1 13.0 14.8 11.5 6.3 5.7

19094 20718 39812 770 2318 14340 4033 23 8503 382 1486 2992 8377 43224 484

32.1 33.1 32.6 31.6 46.9 40.9 24.3 13.7 34.7 23.9 32.2 28.7 27.2 33.0 22.6

34982 36147 71129 721 2624 20757 9403 145 15980 1213 2485 5718 17377 76423 1498
1-5 years No. %

58.9 57.7 58.3 29.6 53.1 59.1 56.7 86.3 65.3 76.0 53.8 54.9 56.4 58.3 70.1

59441 62605 122046 2437 4942 35097 16588 168 24483 1596 4615 10416 30796 131138 2137
Total No.

48.7 51.3 100.0 2.0 4.0 28.8 13.6 0.1 20.1 1.3 3.8 8.5 25.2 107.4 1.8

Table 6. Distribution of IMCI patients and disease patterns in Chittagong division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

2716 3071 5787 3154 0 0 878 0 0 20 126 550 3164 7892 192

2.1 2.5 2.3 21.7 0.0 0.0 1.9 0.0 0.0 7.0 1.4 6.3 5.4 2.9 5.5

6836 4755 11591 6349 0 0 2724 0 0 14 554 832 5637 16110 393

5.3 3.8 4.5 43.6 0.0 0.0 5.9 0.0 0.0 4.9 6.2 9.6 9.6 5.8 11.2

52887 50695 103583 2231 14881 21685 13238 579 11757 59 2232 2048 13227 81937 926

40.7 40.5 40.6 15.3 39.0 34.9 28.8 32.1 32.4 20.6 24.8 23.6 22.5 29.7 26.4

67548 66519 134067 2820 23237 40400 29179 1223 24563 193 6086 5246 36754 169701 1995

52.0 53.2 52.6 19.4 61.0 65.1 63.4 67.9 67.6 67.5 67.6 60.5 62.5 61.6 56.9

129988 125040 255028 14554 38118 62085 46019 1802 36320 286 8998 8676 58782 275640 3506

51.0 49.0 100.0 5.7 14.9 24.3 18.0 0.7 14.2 0.1 3.5 3.4 23.0 108.1 1.4

17

Table 7. Distribution of IMCI patients and disease patterns in Dhaka division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % 1-5 years No. % No. Total %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

4275 4020 8295 2509 0 0 913 0 0 47 353 552 3496 7870 823

1.6 1.6 1.6 10.3 0.0 0.0 1.3 0.0 0.0 4.7 1.7 2.0 3.2 1.4 12.4

11739 10601 22340 5048 0 0 2676 0 0 91 1473 2879 8880 21047 1136

4.4 4.1 4.3 20.7 0.0 0.0 3.9 0.0 0.0 9.2 7.0 10.2 8.2 3.6 17.1

87259 82384 169643 7704 24669 58709 21326 733 35649 295 6558 9277 28693 193613 2145

32.4 32.2 32.3 31.6 41.0 37.0 31.4 30.4 32.4 29.7 31.0 32.9 26.7 33.3 32.2

165990 158462 324452 9098 35564 100136 42914 1678 74415 559 12779 15471 66589 359203 2548

61.6 62.0 61.8 37.3 59.0 63.0 63.3 69.6 67.6 56.4 60.4 54.9 61.9 61.7 38.3

269263 255467 524730 24359 60233 158845 67829 2411 110064 992 21163 28179 107658 581733 6652

51.3 48.7 100.0 4.6 11.5 30.3 12.9 0.5 21.0 0.2 4.0 5.4 20.5 110.9 1.3

Table 8. Distribution of IMCI patients and disease patterns inKhulna division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % 1-5 years No. % No. Total %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

428 457 885 382 0 0 59 0 0 0 16 120 298 875 26

1.2 1.3 1.2 16.5 0.0 0.0 0.6 0.0 0.0 0.0 1.0 4.7 1.8 1.2 4.0

1256 1314 2569 1536 0 0 260 0 0 0 79 132 485 2492 29

3.5 3.7 3.6 66.1 0.0 0.0 2.6 0.0 0.0 0.0 4.7 5.2 2.9 3.5 4.5

9729 10013 19742 189 1529 6352 2913 54 4045 6 413 668 3925 20094 193

27.5 28.2 27.8 8.1 40.0 32.6 29.0 14.7 28.2 27.3 24.6 26.4 23.5 28.2 29.9

23990 23761 47750 215 2294 13159 6828 313 10282 16 1173 1608 11986 47874 397

67.8 66.8 67.3 9.3 60.0 67.4 67.9 85.3 71.8 72.7 69.8 63.6 71.8 67.1 61.6

35403 35544 70947 2322 3823 19511 10060 367 14327 22 1681 2528 16694 71335 645

49.9 50.1 100.0 3.3 5.4 27.5 14.2 0.5 20.2 0.0 2.4 3.6 23.5 100.5 0.9

Table 9. Distribution of IMCI patients and disease patterns in Rajshahi division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % 1-5 years No. % No. Total %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

7462 5867 13329 7908 0 0 3369 0 0 0 245 835 3036 15393 271

4.4 3.9 4.2 29.3 0.0 0.0 7.2 0.0 0.0 0.0 1.8 3.7 4.4 4.4 11.6

18760 17968 36728 14122 0 0 7531 0 0 33 864 4463 8190 35203 346

11.1 11.9 11.4 52.3 0.0 0.0 16.1 0.0 0.0 3.5 6.2 19.8 12.0 10.0 14.8

49465 45526 94992 2317 14929 28451 12528 1355 19148 137 3846 6178 19851 108740 642

29.1 30.1 29.6 8.6 42.6 33.2 26.7 39.4 38.5 14.4 27.5 27.4 29.0 30.7 27.5

94077 81877 175953 2640 20150 57279 23450 2088 30567 784 9038 11046 37335 194377 1079

55.4 54.1 54.8 9.8 57.4 66.8 50.0 60.6 61.5 82.2 64.6 49.0 54.6 55.0 46.2

169763 151238 321002 26987 35079 85730 46878 3443 49715 954 13993 22522 68412 353713 2338

52.9 47.1 100.0 8.4 10.9 26.7 14.6 1.1 15.5 0.3 4.4 7.0 21.3 110.2 0.7

18

Table 10. Distribution of IMCI patients and disease patterns in Rangpur division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % 1-5 years No. % No. Total %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

1713 1931 3644 1885 0 0 1212 0 0 0 287 402 1732 5518 29

1.5 1.7 1.6 23.8 0.0 0.0 3.1 0.0 0.0 0.0 3.2 2.3 3.7 2.3 0.8

5546 4120 9665 5128 0 0 3269 0 0 88 694 1223 3182 13584 152

4.7 3.7 4.2 64.7 0.0 0.0 8.3 0.0 0.0 3.0 7.8 7.1 6.9 5.7 4.4

51972 48572 100544 953 7685 25408 12117 973 10064 925 2963 5118 13431 79637 699

44.3 43.7 44.0 12.0 39.3 41.5 30.9 25.7 33.8 31.6 33.2 29.7 29.0 33.6 20.4

57995 56630 114625 1100 11804 34755 22573 2816 19690 1910 4983 10498 27992 138121 2546

49.5 50.9 50.2 13.9 60.4 56.8 57.6 74.3 66.1 65.3 55.8 60.9 60.4 58.3 74.3

117225 111253 228478 7928 19534 61231 39171 3789 29779 2923 8927 17241 46337 236860 3426

51.3 48.7 100.0 3.5 8.5 26.8 17.1 1.7 13.0 1.3 3.9 7.5 20.3 103.7 1.5

Table 11. Distribution of IMCI patients and disease patterns in Sylhet division in 2010
Patient/Diseases 0-28 days No. % 29-59 days No. % 2-12 months No. % 1-5 years No. % No. Total %

Male Female Total patients Very severe disease Pneumonia No pneumonia-cough and cold Diarrhea Fever-malaria Fever-no malaria Measles Ear problem Malnutrition Others Total cases Refer

8501 8302 16803 4300 0 0 2782 0 0 88 894 2417 6383 16864 299

5.8 6.1 6.0 26.0 0.0 0.0 6.4 0.0 0.0 5.8 5.5 13.9 6.2 5.5 19.8

14246 14813 29059 7644 0 0 4604 0 0 99 1749 2617 9777 26490 346

9.7 10.9 10.3 46.2 0.0 0.0 10.7 0.0 0.0 6.5 10.8 15.1 9.5 8.7 22.9

45233 43353 88586 2002 13612 18377 13704 1708 8675 344 5414 4404 31928 100168 379

30.9 31.9 31.4 12.1 41.2 38.6 31.8 38.3 40.3 22.6 33.4 25.4 31.1 33.0 25.1

78363 69536 147899 2601 19414 29212 22052 2754 12825 989 8132 7930 54544 160453 486

53.5 51.1 52.4 15.7 58.8 61.4 51.1 61.7 59.7 65.1 50.2 45.7 53.1 52.8 32.2

146343 136004 282346 16547 33026 47589 43142 4462 21500 1520 16189 17368 102632 303975 1510

51.8 48.2 100.0 5.9 11.7 16.9 15.3 1.6 7.6 0.5 5.7 6.2 36.3 107.7 0.5

19

Editorial Board
Advisors
1. Professor Dr. Khondhaker Md. Shefyetullah Director General of Health Services (DGHS) 2. Dr. Syed Abu Jafar Md. Musa Line Director, MNC&AH and Director, Primary Health Care , DGHS

Members
1. Dr. Chand Sultana Chief (HIU), MIS-Health, DGHS 2. Dr. Md. Altaf Hossain Program Manager IMCI, DGHS 3. Dr. Ashish Kumar Saha Assistant Director, MIS-Health and Program Manager, Meical Biotechnology, DGHS 4. Mr. Sukhendu Shekhor Roy System Analyst, MIS-Health, DGHS 5. Dr. Shah Ali Akbar Ashrafi DPM, HIS & eHealth, DGHS 6. Dr. Sultan Shamiul Bashar OSD, MIS-Health, DGHS 7. Dr. Ziaul Matin Health Officer, UNICEF, Bangladesh

Chief Editor
Additional Director General (Planning and Development) and Line Director, MIS-Health, DGHS

Associate Editor
Deputy Chief, MIS-Health, DGHS

Assistant Editor and Designer

1. GIS Consultant, MIS-Health, DGHS 2. Statistician, MIS-Health, DGHS

Data Analysis and Composer

Md. Jalal Uddin Office Assistant, MIS-Health, DGHS

Review of Manuscript
1.

.............................................................................................................................................................................

Correspondence should be addressd to:

From,
.................................................................................................... .................................................................................................... ....................................................................................................

To, Director Management Information System (MIS) Directorate General of Health Services (DGHS) Mohakhali, Dhaka -1212, Bangladesh Phone:88-02-8816459; Fax: 88-02-8813875 E-mail: info@dghs.gov.bd Web: www.dghs.gov.bd