By Catherine Allen,2014-05-20 12:26
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Complementary feeding to childre5 years and pregnant women through comprehensive health programs and nutrition in institutional and community preschool

     Value Number Source Key Socioeconomic When mothers survive and thrive, their children also Indicators survive, and the societies in which they live prosper. % literate women (at least 8 yrs 25% ENDESA The promotion of healthy mothers and children school) (Encuesta

    Nac. de involves the synergistic effect of combined well-salud) known and effective interventions, including policies 2001 that raise women’s and children’s social and Universal access to education: ENDESA economic status; involvement from families and Boys: 74.5% 2001

    Girls: 79.8% communities; education for all; universal access to basic health and care, improvement of health status; School drop out rateo of Grade 6: ENDESA improvement of nutritional status; access to family Boys: 22.7% 2001 planning services; ensuring skilled attendance Girls: 18.6% during childbirth for normal care and the % of population living below 45% World

    US$1/day Bank management of complications; and adequate 1990-neonatal and child health care. 2002 % of GDP spent on health 8% 4,539.2 National All countries have committed to the UN Millennium million count Development Goals (MDGs). The MDGs for Health expenditures per capita National $53 maternal and child health call for a reduction in the count mortality rate among children under five by two

    thirds by 2015, and a reduction in the maternal % of women in work force 40% ENDESA

    2001 mortality ratio by three quarters by 2015.

    % of women-headed households 30.9 ENDESA 2001.

     Key Maternal and Child Health Indicators

    Maternal mortality ratio (per 83.4 MINSA -Maternal MortalityRatesin Maternal MortalityRatesin NICARAGUA 1989 -2003NICARAGUA 1989 -2003100,000 live births) AIMA

    160140120Absolute # of women who die 119 MINSA/10080each year due to maternal AIMA 60mortality 2003 40200% of women 15-49 in union using 69% ENDESA1989199219931994199519961997199819992000200120022003contraception 2001 Fuente: S V M M

     % of women who receive prenatal 86% ENDESASource: Maternal Mortality Surveillance System care during pregnancy 2001


     Advances in policies during the Value Number Source Key Health Indicators last ten years % of women who have access to 66% ENDESA Nicaragua currently has a National Health Policy professional care during 2001 updated for 2004-2015; its priority is maternal and childbirth (skilled attendance at child health, which is revealed in the 7 general birth) guidelines of the policy: Total fertility rate 3.2 ENDESA 2001 ? Code of Childhood and Adolescence ? Law on Breast-feeding Under five mortality rate (per 40 ENDESA 1,000 lb.) 2001 ? General Health Law ? National Population Policy ? Law of Social Security (Delivery Care and Infant (up to 1 year old) 21.0 ENDESA Care Pre-Post Natal mortality rate 2001 ? Regulation of nontraditional professions that Early neonatal (<7 days) 90.46 SINEVI participate in delivery care (art. 207 Law of mortality rate (per 1,000 lb.) 2002 Organization, operation and procedures) ? Regulatory Law of the Relations Mother, Neonatal (up to 28 days) 17.0 ENDESA Father, and Children. mortality rate (per 1,000 lb.) 2001 Interagency Committee for Safe Number of tetanus cases reported 0 MINSA- Motherhood/Neonatal for infants (<28 days) PAI 2004

    ? An Interagency Technical Committee for

    Proportion of population 79% MINSA- Maternal Health was formed by the agencies: immunized against diphtheria, PAI 2004 UNFPA-PAHO/WHO and UNICEF, and pertussis, tetanus extends (reword?) to USAID and GTZ ? This committee meets every 2 months and ENDESA-% of women who use a has regular E -mail communication 2001 modern contraceptive ? An interagency success was the signing of method: the Interagency Strategic Consensus for the Urban: 70.7% Reduction of Maternal Morbidity and Mortality Rural: 60.0%

    Maternal-to-child transmission Prevalence: Nat’l rate (MTCT) 0.02 % program Key Sectors Involved STI/HIV/In Nicaragua the National Campaign for Maternal AIDS and Perinatal Mortality was formed by presidential 2003

    Percent of adult population PAHO/ decree with the following institutions: INSS,

    (Ages 15-49) with HIV/AIDs 0.2 PRB MIFAMILIA, Ministry of Education, Culture, and 2001 Sports (MECD) and the Ministry of Health. It is Women as percent of adult 27 PAHO/ coordinated by the Ministry of Health and the population with HIV/AIDS PRB following technical advisers: UNFPA, 2001

    Percent of youth ages 15-24 with PAHO/ PAHO/WHO, and UNICEF. CONAPINA (network HIV/AIDS PRB of organizations that work in health of the child) Female: .01 2001 also participates. Male: .02

    ? Available financial resources

    Currently both the Maternal Health and

    Childhood programs are developed through

    funding by donors (government of Sweden) and

    cooperating agencies.


? Community resources ? Development of community work in child health, Community work is implemented by funds surveillance of the growth (of what?), and in the arranged at local levels through specific projects promotion of key practices among various sectors of the and financed by agencies and local NGOs. communities (teachers, mayors, Red Cross, Catholic Church). ? Key partnerships, collaborating agencies: Progress in Key Interventions ? Civil society (describe more?), NICASALUD, UNICEF, UNFPA, USAID, Quality Integrated Management of Childhood Illness Asssurance Project (QAP), SARED, CARE, (IMCI) Catholic/CARITAS Church of Nicaragua, Describe IMCI briefly here? Nicaraguan Red Cross ? 152 municipalities of the country are developing IMCI strategy. Highlights of Successful Policies ? Currently a Neonatal section is being incorporated into and Programs the IMCI manual ? 61% of first level of care health facilities have 60% or Immunization more health workers trained in IMCI ? National Program for Immunization has broad ? Guía Básica para el Nivel de Referencia Hospitalaria: tradition (what does that mean?) in country o Adapted from a 2001 guide to the most ? Enough vaccination coverage during 80?s and common infectious childhood diseases and 90?s to permit: malnutrition o Eradication of polio in 1981; o Developed by PAHO/WHO and UNICEF o Measles elimination starting in 1994, o Authorized by the Ministry of Health and is and; being implemented in 11 hospitals in the o Effective control of the rest of the country vaccine-preventable diseases (such as?) o Represents a standard for health workers; ? Measles elimination attributed to 10 to 15% indicators were devised based on it reduction in infant mortality (reference) o Monitoring of these indicators has made it ? Trend in coverage and vaccination of last years possible to monitor the quality of health care at downward (numbers needed); poses a risk in hospitals (?) maintaining achievements already reached. Skilled Attendance at Birth (SAB) Nutrition ? Skilled Attendance at Birth being promoted by Ministry of ? National Program for prevention and control of Health and Nursing School (name?) micro nutrients: ? Hospitals are contributing to improving SAB by offering ? Impact: virtual elimination of Vitamin A clinical internships directed to general practitioners of the and iodine deficiency, and reduction of municipalities; internships emphasize proper nutritional anemia in children < 5 years of management of emergencies and/ or obstetric age and in woman of childbearing age complications. ? Integrated Surveillance System of the interventions in nutrition (SIVIN)Annual report Essential Obstetric Care (EOC) on the nutritional situation (of what? In country?) Qualitative advances in EOC (malnutrition, anemia, vitamin A; coverage and ? Ministry of Health prepared a diagnostic document in efficiency of food fortification.) 2000 on the availability of EOC with the support of UNFPA; Maternal Health ? Ten Integrated Healthy Systems (SILAIS) of the country, ? A model of the Integrated Systems of Essential and one supported by PAHO for the area of the South Obstetric Care (EOC) is being used?, which Atlantic (RAAS), received the document; integrates the actions of the community with ? Results of the evaluation supported programming and activities directed to improve the quality of care helped to plan the purchase of EOC equipment for of health services in maternal and child care SILAIS (?) ; and guaranteeing the provision of EOC.


    ? Training workshops aimed at the local ? SILAIS, which have trained health workers and implementation of the EOC have been held at the have selected the communities in order to national level; complete the phase of implementation this year. ? EOC policy document prepared in which experts ? from cooperating agencies and MINSA Contraception Post Obstetric Event

     participated in defining EOC; document includes ? Ministry of Health guarantees a contraceptive

     monitoring and evaluation of EOC in health units. method to all women who go to the health units,

     Funding for the provision of EOC: following information and counseling subsequent ? Support from various cooperating agencies of delivery care, complications from abortion or

    caesarean section. ? Collaborative project with QAP/PAHO for

     improvement of maternal and neonatal care being Nutrition carried out in Chinandega, Matagalpa, RAAS, Esteli and Grenada ? Fortification of salt, sugar, and wheat flour (with iodine, vitamin A and iron respectively); coverage ? Project being carried out for training of Obstetric 90% and efficiency (describe more) 80% in homes nurses, and will possibly be funded by the Swedish Cooperating Agency for International ? Supplementation with vitamin A and iron to boys Development (Asdi). and girls from 6 to 59 months; supplementation to pregnant women with iron and folic acid Immunization(Coverage in Vitamin A 80%; in iron 50%)

     ? Breast-feeding promotion: 31% of women practice ? Plan of Elimination of Rubella and Congenital

     exclusive breast-feeding until 6 months and 40% Rubella Syndrome initiated in 2005

     up to 4 months old. ? MR (measles/ rubella) vaccine administered to

    ? Community program of health and nutrition the population (6 to 40 year olds, both sexes);

    (PROCOSAN) and community IMCI: monitoring of Plan (which one?) will help consolidate eradication

    the growth in boys and girls less than two years of measles. olds, counseling in nutrition and breast-feeding; surveillance and prevention of morbidity (how?) Promotion of contraceptive methods and distribution of iron salts The Family Planning program is promoting and implementing several strategies and methods of ? Integrated System of Interventions in Nutrition family planning in order to increase family planning (SIVIN): systematic information on nutritional coverage and method use situation (in country?) and of micronutrients, as Below we describe new methods that the Ministry of well as coverage and efficiency of programs for

     Health has incorporated in its program in addition to food fortification and breast-feeding promotion.

     those which it traditionally offer such as oral ? Complementary feeding to children < 5 years and contraceptives, injectable hormones and condoms, pregnant women through comprehensive health among others. programs and nutrition in institutional and

     community preschool children, and in children’s

    lunchrooms. The Method of Fixed Days(MFD) ? It is a simple method to learn and use, based on Strengthening the epidemiological the mechanism of natural methods: no sexual maternal mortality surveillance system relations on the days a woman is most fertile ? The Ministry of Health is promoting the ? This method can solve difficulties of access to reactivation of the Surveillance System of family planning, or for women and their partners Maternal Mortality with the participation of whose cultural, religious, or health beliefs do not women’s care, epidemiology and vital statistics allow them to accept modern contraceptive programs at the national level methods.

    Domestic Violence The Strategy of “Community Delivery of

    ? Surveillance and analysis occurring for incidental, Contraceptives Methods” (ECMAC)

    accidental, and direct obstetrical maternal deaths ? Publication of document (name?) that contains

    caused by violence, unwanted pregnancy and “Aptitudes for the Delivery of Contraceptive

    suicide in adolescents; Methods in Remote Communities

     ? ECMAC is in development phase in the SILAIS of

    Matagalpa and Jinotega, and in a phase of initial

    implementation in the rest of the country’s 4

? Of total maternal deaths, 11% are due to

    homicide and 69% to suicide; Of these deaths, 69% were adolescents (Ministry of Health, 2004). Community interventions linked to other interventions of reduction in

    maternal mortality

    Delivery Plan Strategy:

    ? Ministry of Health and Federation Network

    NicaSalud developing strategy to provide comprehensive care to pregnant woman from


    ? Strategy promotes actions based on safe motherhood pillars;

    ? Goal to improve response capacity of the family

    and community for care of pregnant women

    during their delivery, puerperium and for the newborn, and in case of an obstetric

    complication for woman or newborn; ? Actions of the Plan of Delivery are directed to

    improve coverage in: prenatal care, care of the puerperium, use of contraceptives and to

    facilitate the access to the essential obstetric

    care given in the health unit, through the timely

    reference, in light of the presence or not of risk

    factors or danger signs;

    ? Currently implemented in five SILAIS (Jinotega,

    Matagalpa, León, Chinandega and Madriz) with

    goal to extend it to other regions of the country.

Updating of the Perinatal Information System


    In Nicaragua, the Bertha Calderon Hospital, which is a center associated with CLAP (Centro Latinamericano de Perinatologia), is a hospital of national reference which specializes in Gynecology/Obstetrics and Neonatology. The SIP is being implemented in 7 hospitals (which ones?); each hospital has had different

    progress but in general all have accomplished the


    ? Utilization of SIP software version 1.34. This software allows countries to assess perinatal health status and quality of care, identify trends,

    address issues of data standardization, and

    identify under-served and at-risk groups; ? Generation of basic indicator reports; ? Analysis for decision-making component to be strengthened.


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