EKC Child Health

Umoyo Wa Ana Athu – Our Children’s Health

For several decades, societies in high-income countries (HICs) have witnessed a shift from infectious diseases, undernutrition, and neonatal disorders towards NCDs as the main drivers of morbidity and mortality in their child population. This development led even to the term ‘new morbidities’ (in addition to NCDs) in the area of paediatrics and child health.

In low-and-middle income countries (LMICs), ministries of health, policy makers, international agencies like WHO and UNICEF, healthcare providers and communities themselves have focused much longer on those three broad categories, namely infectious diseases, undernutrition, and neonatal disorders, as the main causes of morbidity and mortality, concentrating heavily on children under the age of five. Only during the recent decade, adolescents have received more attention. Children between 6 and 12 years of age have not attracted much attention yet, which led to the term ‘missing middle of childhood’.

Epidemiological data from global health research now clearly indicate that in LMICs children and adolescents are more and more affected by NCDs the more they survive with congenital and acquired chronic disorders/disabilities and the older they grow (IHME; Countdown to 2030).

How It's Done

The guideline development first started with reviewing existing national and international paediatric NCD guidelines (desk review). During the phase, we considered the varying levels of healthcare facilities and available resources, considering the perspectives and experiences of over 30 senior paediatricians who author the guidelines and work in district and central hospitals across Malawi. In order to make the guideline comprehensive, each chapter encompasses not only clinical components but also integrates public health aspects, covering health promotion and prevention. The final product undergoes internal and external reviews conducted by the project´s core members who are paediatricians, as well as external reviewers and relevant stakeholders such as the MoH, Directorate of Quality Management etc.

A user-friendly app (name to be provided) is to be created to serve as a practical tool for delivering guideline content and facilitating interactive training and collaboration among healthcare workers. The app is designed to be used offline and includes knowledge-check questions in each chapter. We will keep records of the number of downloads and uninstalls to track the app´s utilization. Additionally, feedback will be collected from healthcare workers to evaluate the overall acceptance and usability of the app.

Under the guidance of PACHA, the guidelines will be implemented initially through group training sessions utilizing the paper-based guidelines and the newly developed app.

IEC materials will be developed and deployed to inform patients, including children and their caregivers, about the importance of prevention, early screening and detection of NCDs, and the associated risks, as well as preventive measures. These materials aim to raise awareness and prevent negative consequences stemming from chronic conditions.

The M&E process aims to track the progress of the entire project and assess its success using the method of an interrupted time series analysis. Data collection and evaluation will take place in all four central hospitals (Blantyre, Lilongwe, Zomba, Mzuzu) as well as the following district hospitals: Phalombe, Mwanza, Mchinji, Nsanje, Nkhatabay and Dowa, along with six designated health centres. The primary data sources include the Health Management Information System, patient´s mastercards on paediatric NCDs, exit interviews with caretakers, and surveys of healthcare workers.

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