Issue 4 | March 2013

IMCI Newsletter
Performance Report for January to December 2011

Contents
Messages and Editorial
Introduction
Data and Method
Limitation of the data
Results
Conclusion
Annexure

Management Information System (MIS)

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

P.02
P.03
P.04
P.05
P.05
P.16
P.16

Message

Editorial Note

Director General
Directorate General of Health Services
Mohakhali, Dhaka
Our country made a significant progress in child
mortality reduction and received the UN MDG Award
for its success in MDG4. IMCI program is playing the
vital role to sustain and improve universal child
immunization.
It is indeed a great pleasure for me to know that MIS
of DGHS is going to publish the 4th issue of IMCI
Newsletter. This newsletter is a very useful
publication as it enables us to get facility based
graphical data on childhood illness of the whole
country in a concised and understandable way.
I hope that this newsletter will give some
programmatic direction to policy-makers and program
managers and to understand the current situation to
undertake interventions for the future about the IMCI
services in Bangladesh. Finally, I would like to thank
everyone who worked hard directly and behind the
screen for publishing this newsletter successfully.

Professor Dr. Khondhaker Md. Shefyetullah

Message
Director, Primary Health Care
& Line Director, Maternal, Neonatal, Child
and Adolescent Health (MNC&AH)
Directorate General of Health Services
Mohakhali, Dhaka
I am happy to know that the Management Information
System (MIS) of the Directorate General of Health
Services (DGHS) is going to publish the 4th 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 congratulate the 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 would like to give thanks to
our development partners, specially UNICEF, UNFPA and
WHO for their financial and technical support for this
important task in the child health sector.
I expect that the IMCI Newsletter will be helpful for all
concerned and the Newsletter will be published regularly.

Dr. Syed Abu Jafar Md. Musa

02

Additional Director General

(Planning and Development)
& Line Director,
Management Information System (MIS)
Directorate General of Health Services
Mohakhali, Dhaka
Our country has made a remarkable progress in
improving the health of children. In fact, as per
recent estimate, we already achieved MDG4. The
recognition to Bangladesh's success in improving
child health came much earlier through the UN
MDG4 Award in 2010.
It is my great pleasure that the 4th issue of the
IMCI newsletter is going to be published from the
Department of MIS-Health of DGHS. The contents
of this newsletter will not only include the result of
the performance assessment of IMCI services in
facilities but will 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 those of the previous issues. An
attempt was made to analyze the data received
during the reporting period to understand the careseeking and morbidity pattern of the sick underfive children attending the IMCI-designated
facilities. I like to thank the entire team of IMCI
section for their sincere support and cooperation in
publishing this newsletter. I also wish to
congratulate the entire team of MIS-Health whose
relentless work and efforts have made this
possible. I also convey my thanks to all the
managers, doctors, paramedics, and other service
providers and staffs who helped in various ways
and thus enabled us to publish this newsletter.
I express my gratefulness to the Director General of
Health Services and Director, PHC, for their continuous
support and advice in accomplishing our tasks. I
extend my special thanks to UNICEF for their
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 attempt will
be successful if we can use the information for the
betterment of our children who deserve quality and
equitable health services.

Professor Dr. Abul Kalam Azad

A large number of childhood morbidity and

mortality (every year around 10 million children
die before they reach their fifth birthdays) in
the developing countries is caused by five
conditions: acute respiratory infections (mostly
pneumonia), diarrhoea, measles, malaria, or
malnutrition. The Integrated Management of
Childhood Illness (IMCI) strategy encompasses
a range of interventions to prevent and
manage this major childhood illness, both in
health facilities and in the home. . In spite of
various disease-specific 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).

Introduction
Mortality in children younger than 5 years
(under-5 mortality) remains high in Bangladesh
at 57 in 1000 live-births, despite declines over
the past decade. Pneumonia, diarrhoea,
malnutrition, and measles account for more
than half (52%) of these deaths. Integrated
Management of Childhood Illness (IMCI) is a
strategy developed and promoted by WHO
and UNICEF for reducing childhood morbidity
and mortality and promoting healthy growth
and development. In 1998, the Government of
Bangladesh adopted Integrated Management
of Childhood Illness (IMCI) strategy to reduce
these deaths and improve child health and
development. The IMCI strategy through
HPNSDP was designed to include coordinated
activities within two objectives: (1) to reduce
morbidity and mortality associated with the
major causes of diseases in under five children
through quality case management, and (2) too
promote healthy growth and development by
preventing diseases and promoting healthy
practices through counseling the mother and
caretakers.

After adaptation of WHO generic modules

Bangladesh had piloted the IMCI strategy in 3
Upazilas (Matlab, Chandpur, Dhamrai, Dhaka
and Kahaloo, Bogra) in the year 2002. After
completion of pilot activities in December
2002 a joint National-International Experts
Review of early implementation phase was
held in February 2003. Based on the
recommendations of the review, Bangladesh
has started expansion of IMCI. Facility IMCI has
expanded in 410 Upazilas up to December
2012. 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. We have
also started the process of developing and
introducing community-IMCI. A national
strategy paper on community IMCI has been
prepared to provide directions and guidelines
on the introduction, adaptation and
implementation of C-IMCI. C-IMCI has
expanded in 150 upazilas.

Newborn Health
Reducing Neonatal mortality and ensure
health of the newborn is one the main target of
IMCI section. National Neonatal Strategy &
Guidelines has developed and Standard
Operation Protocol (SOP) has formulated.
Implementation of Neonatal Action Plan has
started. Twelve Special Care Newborn Unit
(SCANU) in the District Hospitals and Medical
Colleges are functioning. A total of 41 SCANU
will be established by 2015.
IMCI has 3 (three) components
1. Improving case management skills of
health workers
2. Improving the health system
3. Improving family and community practices
03

Welfare for implementing the IMCI program.

Various other development partners and
NGOs also collaborate with the Government.

IMCI protocol has incorporated in under

graduate medical curriculum. All the
Government Medical Colleges and most of
the Private medical colleges are following the
protocol. Initiative has taken to incorporate
this protocol in Nursing Institute and Medical
Assistant Training Schools (MATS) curriculum.

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 web-based software (District
Health Information System [DHIS]) has been
developed by MIS, DGHS, with the help of GIZ
to collect IMCI service data from different
levels of designated IMCI facilities. All the
IMCI-designated 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,
Chuadanga, 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 2011, data were collected from the 50 IMCI
program districts because these 50 districts
were fully functional during the reporting
period. The rest of the districts were included
at the mid or last part of the year 2011. All
reports covered 2,560,909 children "out-

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-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 410
upazilas) from 50 districts. Community-based
IMCI is running in 150 upazilas. UNICEF and
WHO jointly provide technical and financial
assistance to the Ministry of Health and Family
04

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, 405 were covered as IMCI
upazila up to December 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
Total
Total
no. of
no. of
districts upazilas

Division

Barisal
Chittagong
Dhaka
Khulna
Rajshahi
Rangpur
Sylhet
Total

6
11
17
10
8
8
4
64

40
99
122
59
66
58
38
482

Total no. of Total no. of

% of
received
received
upazila
data from data from
data
IMCI
IMCI
coverage
districts
upazilas
60.0
3
24
84.8
9
84
73.8
12
90
76.3
6
45
100.0
8
66
100.0
8
58
100.0
4
38
84.0
50
405

Table 2. Distribution of IMCI patients and disease patterns in 2011 in Bangladesh

A.1

Male

29097

55440

367573

732261

1184371

% of
total
patients
50.7

A.2

Female

29156

54111

351478

718878

1153623

49.3

Total (A1+A2)

58253

109551

719051

1451139

2337994

100.0

B.1

Very severe disease

9609

15713

15394

15299

56015

2.4

B.2

Pneumonia

85488

118988

204476

8.7

B.3

No pneumonia-cough and cold

280830

506152

786982

33.7

B.4

Diarrhea

6109

18640

110946

212985

348680

14.9

B.5

Fever-malaria

2107

4787

6894

0.3

B.6

Fever-no malaria

156785

319747

476532

20.4

B.7

Measles

201

407

1059

1597

3264

0.1

B.8

Ear problem

2835

7916

31740

66399

108890

4.7

B.9

Malnutrition

4663

11199

32200

64751

112813

4.8

B.10

Others

20602

37292

112274

286195

456363

19.5

Total (B1-B10)

44019

91167

828823

1596900

2560909

109.5

Refer

4849

7358

14557

20408

47172

2.0

Sl.
no.

Diseases/Medical Condition

0-28
day(s)

29-59
days

2-12
1-5 year(s)
months

05

Total

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 50 districts in 2011. It is seen that
children from 1 to 5 year(s) age-group
constituted the largest IMCI service recipients
(62.1%), followed by 2 to 12 months agegroup (30.8%). Of the total under-five
children, 2.5% were at the neonatal age. Agegroup 29 to 59 days comprised 4.7% of the
total children receiving services from the IMCI
facilities.
Figure 1. Distribution of children with IMCI
diseases by age-group in Bangladesh 2011
(N=2,337,994)
0-28 day(s),
n=58253,
2.5%

1-5 years,
n=1451139,
62.1%

0-28 day(s),
n=29156,
2.5%

1-5 years,
n=718878,
62.3%

29-59 days,
n=109551,
4.7%

2-12 months,
n=719051,
30.8%

29-59 days,
n=54111,
4.7%

2-12 months,
n=351478,
30.5%

Figure 4. Percent distribution of children with

very severe diseases by age-group (n=56,015;
2.4% of total)
1-5 year(s),
n=15299,
27.3%

Figure 2. Percent distribution of male children

with IMCI diseases by age-group in Bangladesh
2011 (n=1,184,371)
0-28 day(s),
n=29097,
2.5%

Figure 3. Percent distribution of female

children with IMCI diseases by age-group in
Bangladesh 2011 (n=1,153,623)

2-12 months,
n=15394,
27.5%

0-28 day(s),
n=9609,
17.2%

29-59 days,
n=15713,
28.1%

Figure 5. Percent distribution of children with

pneumonia by age-group (n=204,476; 8.7% of
total)

29-59 days,
n=55440,
4.7%
2-12 months,
n=85488,
41.8%

1 - 5 years,
n=732261,
61.8%

2-12 months,
n=367573,
31.0%

06

1-5 year(s),
n=118988,
58.2%

Figure 6. Percent distribution of children with

'no pneumonia-cough and cold' by age-group
(n=786,982; 33.7% of total)

Figure 9. Percent distribution of children with

'fever-no malaria' by age-group (n=476,532;
20.4% of total)
2-12 months,
n=156785 ,
32.9%

2-12 months,
n=280830,
35.7%

1-5 year(s),
n=319747 ,
67.1%

1-5 year(s),
n=506152,
64.3%

Figure 7. Percent distribution of children with

'diarrhea' by age-group (n=348,680; 14.9% of
total)
0-28 day(s),
n=6109,
1.8%

Figure 10. Percent distribution of children with

'measles' by age-group (n=3,264; 0.1% of
total)

29-59 days,
n=18640,
5.3%

1-5 year(s),
n=1597,
48.9%

1-5 year(s),
n=212985 ,
61.1%

2-12 months,
n=110946 ,
31.8%

Figure 8. Percent distribution of children with

'fever-malaria' by age-group (n=6,894; 0.3% of
total)

2-12 months,
n=1059,
32.4%

Figure 11. Percent distribution of children with

'ear problem' by age-group (n=108,890; 4.7%
of total)
0-28 day(s),
n=2835,
2.6%

2-12 months,
n=2107,
30.6%

1-5 year(s),
n=4787,
69.4%

1-5 year(s),
n=66399,
61.0%

07

0-28 day(s),
n=201 ,
6.2%
29-59 days,
n=407,
12.5%

29-59 days,
n=7916,
7.3%

2-12 months,
n=31740,
29.1%

Figure 12. Percent distribution of children with

'malnutrition' by age-group (n=112,813; 4.8%
of total)
0-28 day(s),
n=4663,
4.1%

1-5 year(s),
n=64751,
57.4%

29-59 days,
n=11199,
9.9%

2-12 months,
n=32200 ,
28.5%

Figure 13. Percent distribution of children with

'others illness' by age-group (n=456,363; 19.5%
of total)
0-28 day(s),
n=20602,
4.5%

1-5 year(s),
n=286195 ,
62.7%

29-59 days,
n=37292,
8.2%

2-12 months,
n=112274 ,
24.6%

Figure 14. Percent distribution of 'referred

children' by age-group (n=47,172; 2.0% of
total)
1-5 year(s),
n=20408,
43.3%

0-28 day(s),
n=4849,
10.3%
29-59 days,
n=7358,
15.6%

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 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.
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: 33.7%; pneumonia: 8.7%). Fever (malaria or
no malaria), and diarrhea were the morbidities
of 20.7% and 14.9% of the children respectively.
Similar pattern of morbidities was also
observed among children of all age-groups.
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=58,253; 2.5%
of total)
Very severe diseases
Pneumonia
No pneumonia
-cough and cold
Diarrhea

Fever-malaria

Fever-no malaria

Measles
Ear problem
Malnutri on

2-12 months,
n=14557,
30.9%

9,609
6,109

201
2,835
4,663

Others illness
Refered

08

20,602
4,849

Figure 16. Distribution of various diseases

among post-neonatal babies of 29-59 days
(n=109,551; 4.7% of total)

Very severe diseases

15,713

Very severe diseases

Figure 18. Distribution of various diseases

among children of 1-5 years (n=1,451,139;
62.1% of total)

Pneumonia
No pneumonia
-cough and cold
Diarrhea

Pneumonia
No pneumonia
-cough and cold
Diarrhea

Fever-malaria

Fever-malaria

Fever-no malaria

Fever-no malaria

Measles

18,640

407

Measles

7,916

Ear problem

11,199

Malnutri on

37,292

Others illness

7,358

Refered

Pneumonia
No pneumonia
-cough and cold
Diarrhea
Fever-malaria

85,488
1,10,946

4,787
3,19,747
1,597

Malnutri on

64,751
2,86,195

Others illness

20,408

Figure 19. Distribution of various diseases

among 0 day to 5 years old children
(N=2,337,994)
56,015
2,04,476

Pneumonia
No pneumonia
-cough and cold
Diarrhea
Fever-malaria

2,107

Fever-no malaria
Measles

2,80,830

7,86,982
3,48,680
6,894
4,76,532

Fever-no malaria

1,56,785

Measles

1,059

3,264

Ear problem

31,740

Ear problem

1,08,890

Malnutri on

32,200

Malnutri on

1,12,813

Refered

4,56,363

Others illness

1,12,274

Others illness

Refered

14,557

5,06,152

2,12,985

66,399

Very severe diseases

15,394

1,18,988

Ear problem

Refered

Figure 17. Distribution of various diseases

among infants of 2-12 months (n=719,051;
30.8% of total)
Very severe diseases

15,299

47,172

D. Percent distribution of IMCI patients by

division in 2011
In Barisal division, a total of 120,977 children
received service from IMCI facilities; of them
61, 819 were male and the rest were female.

09

Figure 20. Percent distribution of male children

with various illnesses by age-groups in Barisal
division in 2011 (51.1% of total)
0-28 day(s),
n=1355,
2.2%

1-5 year(s),
n=38166,
61.7%

29-59 days,
n=2928,
4.7%
2-12 months,
n=19370,
31.3%

of them 225, 615 were male, and 218, 211 were

female.
Figure 23. Percent distribution of male children
with various illnesses by age-groups in
Chittagong division in 2011 (50.8% of total)
0-28 day(s),
n=6934,
3.1%

2-12 months,
n=68024,
30.2%

1-5 year(s),
n=139418,
61.8%

Figure 21. Percent distribution of female

children with various illnesses by age-groups in
Barisal division in 2011 (48.9% of total)
0-28 day(s),
n=1269,
2.1%

1-5 year(s),
n=36386,
61.5%

29-59 days,
n=2959,
5.0%

29-59 days,
n=11239,
5.0%

Figure 24. Percent distribution of female

children with various illnesses by age-groups in
Chittagong division in 2011 (49.2% of total)
0-28 day(s),
n=6906,
3.2%

29-59 days,
n=10465,
4.8%

2-12 months,
n=18544,
31.3%
2-12 months,
n=65038,
29.8%

Figure 22. Percent distribution of total children

with various illnesses by age-groups in Barisal
division in 2011

0-28 day(s),
n=2624,
2.2%

29-59 days,
n=5887,
4.9%

1-5 year(s),
n=135802,
62.2%

Figure 25. Percent distribution of totalfemale

children with various illnesses by age-groups in
Chittagong division in 2011
0-28 day(s),
n=13840,
3.1%

1-5 year(s),
n=74552,
61.6%

2-12 months,
n=37914,
31.3%

In Chittagong division total of 443,826

children received service from IMCI facilities,
10

29-59 days,
n=21704,
4.9%

2-12 months,
n=133062,
30.0%
1-5 year(s),
n=275220,
62.0%

In Dhaka division, a total of 623,630 children

received service from IMCI facilities; of them
323,183 were male, and the rest were female
(300,447).

In Khulna division, a total of 147, 480 children

received service from IMCI facilities; of them
75, 324 were male, and the rest were female
(72,156).

Figure 26. Percent distribution of male children

with various illnesses by age-groups in Dhaka
division in 2011 (51.8% of total)

Figure 29. Percent distribution of male children

with various illnesses by age-groups in Khulna
division in 2011 (51.1% of total)

0-28 day(s),
n=5757,
1.8%

0-28 day(s),
n=960,
1.3%

29-59 days,
n=13262,
4.1%

29-59 days,
n=1781,
2.4%
2-12 months,
n=23503,
31.2%

2-12 months,
n=104736,
32.4%
1-5 year(s),
n=199428,
61.7%

Figure 27. Percent distribution of female

children with various illnesses by age-groups in
Dhaka division in 2011 (48.2% of total)
0-28 day(s),
n=4862,
1.6%

Figure 30. Percent distribution of female

children with various illnesses by age-groups in
Khulna division in 2011 (48.9% of total)
0-28 day(s),
n=829,
1.1%

29-59 days,
n=11519,
3.8%

2-12 months,
n=95291,
31.7%
1-5 year(s),
n=188775,
62.8%

Figure 28. Percent distribution of total children

with various illnesses by age-groups in Dhaka
division in 2011
0-28 day(s),
n=10619,
1.7%

1-5 year(s),
n=49080,
65.2%

1-5 year(s),
n=46847,
64.9%

2-12 months,
n=200027,
32.1%

1-5 year(s),
n=95927,
65.0%
1-5 year(s),
n=388203,
62.2%

11

2-12 months,
n=22870,
31.7%

Figure 31. Percent distribution of total children

with various illnesses by age-groups in Khulna
division in 2011
0-28 day(s),
n=1789,
1.2%

29-59 days,
n=24781,
4.0%

29-59 days,
n=1610,
2.2%

29-59 days,
n=3391,
2.3%

2-12 months,
n=46373,
31.4%

In Rajshahi division, a total of 525,849 children

received service from IMCI facilities; of them
262,176 were male, and the rest were female
(263,673).

In Rangpur division, a total of 216,906 children

received service from IMCI facilities; of them
109,143 were male, and the rest were female
(107,763).

Figure 32. Percent distribution of male children

with various illnesses by age-groups in Rajshahi
division in 2011 (49.9% of total)

Figure 35. Percent distribution of male children

with various illnesses by age-groups in Rangpur
division in 2011 (50.3% of total)

0-28 day(s),
n=7367,
2.8%

0-28 day(s),
n=2056,
1.9%

29-59 days,
n=13651,
5.2%

2-12 months,
n=79527,
30.3%
1-5 year(s),
n=161631,
61.6%

Figure 33. Percent distribution of female

children with various illnesses by age-groups in
Rajshahi division in 2011 (50.1% of total)
0-28 day(s),
n=8147,
3.1%

1-5 year(s),
n=69336,
63.5%

1-5 year(s),
n=68252,
63.3%

1-5 year(s),
n=163136,
61.9%

2-12 months,
n=78572,
29.8%

Figure 34. Percent distribution of total children

with various illnesses by age-groups in Rajshahi
division in 2011
0-28 day(s),
n=15514,
3.0%

1-5 year(s),
n=324767,
61.8%

1-5 year(s),
n=137588,
63.4%

2-12 months,
n=158099,
30.1%

12

29-59 days,
n=5026,
4.7%

2-12 months,
n=32146,
29.8%

Figure 37. Percent distribution of total children

with various illnesses by age-groups in Rangpur
division in 2011
0-28 day(s),
n=4395,
2.0%

29-59 days,
n=27469,
5.2%

2-12 months,
n=33090,
30.3%

Figure 36. Percent distribution of female

children with various illnesses by age-groups in
Rangpur division in 2011 (49.7% of total)
0-28 day(s),
n=2339,
2.2%

29-59 days,
n=13818,
5.2%

29-59 days,
n=4661,
4.3%

29-59 days,
n=9687,
4.5%

2-12 months,
n=65236,
30.1%

In Sylhet division, a total of 259,326 children

received service from IMCI facilities; of them
127,111 were male, and the rest were female
(132,215).
Figure 38. Percent distribution of male children
with various illnesses by age-groups in Sylhet
division in 2011 (49.0% of total)
0-28 day(s),
n=4668,
3.7%

Figure 39. Percent distribution of female

children with various illnesses by age-groups in
Sylhet division in 2011 (51.0% of total)
0-28 day(s),
n=4804,
3.6%

29-59 days,
n=7918,
6.2%
1-5 year(s),
n=79680,
60.3%

1-5 year(s),
n=75202,
59.2%

2-12 months,
n=39323,
30.9%

29-59 days,
n=8714,
6.6%

2-12 months,
n=39017,
29.5%

Figure 40. Percent distribution of total children

with various illnesses by age-groups in Sylhet
division in 2011
0-28 day(s),
n=9472,
3.7%

1-5 year(s),
n=154882,
59.7%

29-59 days,
n=16632,
6.4%

2-12 months,
n=78340,
30.2%

E. Percent distribution of IMCI cases with various illnesses by division in 2011

Figure 41. Percent distribution of children with various illnesses by age-group in Barisal division in 2011

13

Figure 42. Percent distribution of children with various illnesses by age-group in Chittagong division in 2011

Figure 43. Percent distribution of children with various illnesses by age-group in Dhaka division in 2011

Figure 44. Percent distribution of children with various illnesses by age-group in Khulna division in 2011

14

Figure 45. Percent distribution of children with various illnesses by age-group in Rajshahi division in 2011

Figure 46. Percent distribution of children with various illnesses by age-group in Rangpur division in 2011

Figure 47. Percent distribution of children with various illnesses by age-group in Sylhet division in 2011

15

Figure 48. Percent distribution of children with various illnesses by age-group in Bangladesh, 2011

Conclusion
The newsletter represents the general picture of the childhood illnesses and diseases of under-five
children in Bangladesh. The newsletter will give some programmatic direction to the policy-makers,
managers, and development partners for further providing IMCI services to the children of Bangladesh.
Annexure
Table 3. Distribution of IMCI patients and diseases patterns by division in Bangladesh, 2011
Diseases
Male
Female

Barisal
61819
59158

Chittagong

Dhaka

225615 323183
218211 300447

Khulna Rajshahi Rangpur

Sylhet

Bangladesh

75324 262176 109143

72156 263673 107763

127111
132215

1184371
1153623

Total patients

120977

443826 623630 147480 525849 216906

259326

2337994

Very severe disease

Pneumonia
No pneumonia-cough and cold
Diarrhea
Fever-malaria
Fever-no malaria
Measles
Ear problem
Malnutrition
Others
Total cases
Refer

2529
7680
38094
17341
365
28333
93
5523
6067
27377
133402
1582

11036
41715
140935
68223
2770
82953
919
18088
21795
92482
480916
14450

7823
24596
69242
50053
479
38857
466
16588
14844
49165
272113
2437

56015
204476
786982
348680
6894
476532
3264
108890
112813
456363
2560909
47172

16

16413
3367
8401
6446
60728
7320 41986 20451
220599 54490 190087 73535
90549 19567 65895 37052
1132
307
1064
777
144092 39179 91322 51796
980
110
496
200
28700
4323 24587 11081
26268
4001 28063 11775
112920 30108 110240 34071
702381 162772 562141 247184
11176
2598 12253
2676

Table 4. Percent distribution of IMCI patients and disease patterns by division in Bangladesh, 2011
Diseases
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

Barisal Chittagong Dhaka

5.2
5.1
5.2
4.5
3.8
4.8
5.0
5.3
5.9
2.8
5.1
5.4
6.0
5.2
3.4

19.0
18.9
19.0
19.7
20.4
17.9
19.6
40.2
17.4
28.2
16.6
19.3
20.3
18.8
30.6

27.3
26.0
26.7
29.3
29.7
28.0
26.0
16.4
30.2
30.0
26.4
23.3
24.7
27.4
23.7

Khulna Rajshahi Rangpur

6.4
6.3
6.3
6.0
3.6
6.9
5.6
4.5
8.2
3.4
4.0
3.5
6.6
6.4
5.5

22.1
22.9
22.5
15.0
20.5
24.2
18.9
15.4
19.2
15.2
22.6
24.9
24.2
21.9
26.0

Sylhet

9.2
9.3
9.3
11.5
10.0
9.3
10.6
11.3
10.9
6.1
10.2
10.4
7.5
9.7
5.7

Bangladesh

10.7
11.5
11.1
14.0
12.0
8.8
14.4
6.9
8.2
14.3
15.2
13.2
10.8
10.6
5.2

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 2011
Patient/Diseases
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

0-28 days
No.
%
1355
2.2
1269
2.1
2624
2.2
375 14.8
0
0.0
0
0.0
373
2.2
0
0.0
0
0.0
7
7.5
203
3.7
364
6.0
1384
5.1
2706 39.2
58
3.7

29-59 days
No.
%
2928 4.7
2959 5.0
5887 4.9
705 27.9
0 0.0
0 0.0
993 5.7
0 0.0
0 0.0
4 4.3
602 10.9
888 14.6
2735 10.0
5927 73.4
170 10.7

2-12 months
No.
%
19370 31.3
18544 31.3
37914 31.3
866 34.2
3182 41.4
13549 35.6
5301 30.6
122 33.4
9298 32.8
31 33.3
1642 29.7
1903 31.4
6678 24.4
42572 31.9
564 35.7

1-5 years
No.
%
38166 61.7
36386 61.5
74552 61.6
583 23.1
4498 58.6
24545 64.4
10674 61.6
243 66.6
19035 67.2
51 54.8
3076 55.7
2912 48.0
16580 60.6
82197 61.6
790 49.9

Total
No.
%
61819
51.1
59158
48.9
120977 100.0
2529
2.1
7680
6.3
38094
31.5
17341
14.3
365
0.3
28333
23.4
93
0.1
5523
4.6
6067
5.0
27377
22.6
133402 110.3
1582
1.3

Table 6. Distribution of IMCI patients and disease patterns in Chittagong division in 2011
Patient/Diseases
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

0-28 days
No.
6934
6906
13840
1723
0
0
1287
0
0
27
527
842
6288
10694
1825

%
3.1
3.2
3.1
15.6
0.0
0.0
1.9
0.0
0.0
2.9
2.9
3.9
6.8
2.2
12.6

29-59 days

2-12 months

No.
11239
10465
21704

No.
68024
65038
133062

%
5.0
4.8

4.9
2997 27.2
0
0.0
0
0.0
3331
4.9
0
0.0
0
0.0
77
8.4
1256
6.9
1684
7.7
7823
8.5
17168
3.6
2271 15.7

17

3324
16556
49770
21004
795
27447
295
5128
6719
20454
151492
3962

%
30.2
29.8
30.0
30.1
39.7
35.3
30.8
28.7
33.1
32.1
28.4
30.8
22.1
31.5
27.4

1-5 years
No.
139418
135802
275220
2992
25159
91165
42601
1975
55506
520
11177
12550
57917
301562
6392

%
61.8
62.2
62.0
27.1
60.3
64.7
62.4
71.3
66.9
56.6
61.8
57.6
62.6
62.7
44.2

Total
No.
225615
218211
443826
11036
41715
140935
68223
2770
82953
919
18088
21795
92482
480916
14450

%
50.8
49.2
100.0
2.5
9.4
31.8
15.4
0.6
18.7
0.2
4.1
4.9
20.8
108.4
3.3

Table 7. Distribution of IMCI patients and disease patterns in Dhaka division in 2011
Patient/Diseases
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

0-28 days
No.
5757
4862
10619
2888
0
0
1209
0
0
56
551
954
3843
9501
1173

%
1.8
1.6
1.7
17.6
0.0
0.0
1.3
0.0
0.0
5.7
1.9
3.6
3.4
1.4
10.5

29-59 days
No.
13262
11519
24781
4177
0
0
3726
0
0
139
1916
3054
8861
21873
1898

2-12 months

%
No.
4.1 104736
3.8
95291
4.0 200027
25.4
4497
0.0
25802
0.0
80137
4.1
29817
0.0
304
0.0
47403
14.2
334
6.7
8626
11.6
7537
7.8
28497
3.1 232954
17.0
3642

%
32.4
31.7
32.1
27.4
42.5
36.3
32.9
26.9
32.9
34.1
30.1
28.7
25.2
33.2
32.6

1-5 years
No.
199428
188775
388203
4851
34926
140462
55797
828
96689
451
17607
14723
71719
438053
4463

%
61.7
62.8
62.2
29.6
57.5
63.7
61.6
73.1
67.1
46.0
61.3
56.0
63.5
62.4
39.9

Total
No.
323183
300447
623630
16413
60728
220599
90549
1132
144092
980
28700
26268
112920
702381
11176

%
51.8
48.2
100.0
2.6
9.7
35.4
14.5
0.2
23.1
0.2
4.6
4.2
18.1
112.6
1.8

Table 8. Distribution of IMCI patients and disease patterns inKhulna division in 2011
Patient/Diseases
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

0-28 days
No.
960
829
1789
390
0
0
191
0
0
7
76
191
757
1612
295

%
1.3
1.1
1.2
11.6
0.0
0.0
1.0
0.0
0.0
6.4
1.8
4.8
2.5
1.0
11.4

29-59 days
No.
1781
1610
3391
651
0
0
602
0
0
20
238
422
1235
3168
428

%
2.4
2.2
2.3
19.3
0.0
0.0
3.1
0.0
0.0
18.2
5.5
10.5
4.1
1.9
16.5

2-12 months
No.
23503
22870
46373
1021
3054
20554
6283
61
13474
34
1163
1084
6967
53695
707

%
31.2
31.7
31.4
30.3
41.7
37.7
32.1
19.9
34.4
30.9
26.9
27.1
23.1
33.0
27.2

1-5 years
No.
49080
46847
95927
1305
4266
33936
12491
246
25705
49
2846
2304
21149
104297
1168

%
65.2
64.9
65.0
38.8
58.3
62.3
63.8
80.1
65.6
44.5
65.8
57.6
70.2
64.1
45.0

Total
No.
75324
72156
147480
3367
7320
54490
19567
307
39179
110
4323
4001
30108
162772
2598

%
51.1
48.9
100.0
2.3
5.0
36.9
13.3
0.2
26.6
0.1
2.9
2.7
20.4
110.4
1.8

Table 9. Distribution of IMCI patients and disease patterns in Rajshahi division in 2011
Patient/Diseases
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

0-28 days
No.
7367
8147
15514
1061
0
0
1081
0
0
16
732
947
5476
9313
809

%
2.8
3.1
3.0
12.6
0.0
0.0
1.6
0.0
0.0
3.2
3.0
3.4
5.0
1.7
6.6

29-59 days

2-12 months

No.
%
No.
13651 5.2
79527
13818 5.2
78572
27469 5.2 158099
2063 24.6
2693
0 0.0
17579
0 0.0
65485
3804 5.8
21461
0 0.0
384
0 0.0
29596
49 9.9
169
1760 7.2
6691
2322 8.3
7635
11155 10.1
28796
21153 3.8 180489
1565 12.8
4127

18

%
30.3
29.8
30.1
32.1
41.9
34.5
32.6
36.1
32.4
34.1
27.2
27.2
26.1
32.1
33.7

1-5 years
No.
161631
163136
324767
2584
24407
124602
39549
680
61726
262
15404
17159
64813
351186
5752

%
61.6
61.9
61.8
30.8
58.1
65.5
60.0
63.9
67.6
52.8
62.7
61.1
58.8
62.5
46.9

Total
No.
262176
263673
525849
8401
41986
190087
65895
1064
91322
496
24587
28063
110240
562141
12253

%
49.9
50.1
100.0
1.6
8.0
36.1
12.5
0.2
17.4
0.1
4.7
5.3
21.0
106.9
2.3

Table 10. Distribution of IMCI patients and disease patterns in Rangpur division in 2011
Patient/Diseases
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

0-28 days
No.
2056
2339
4395
1353
0
0
382
0
0
25
224
455
1029
3468
257

%
1.9
2.2
2.0
21.0
0.0
0.0
1.0
0.0
0.0
12.5
2.0
3.9
3.0
1.4
9.6

29-59 days
No.
%
4661 4.3
5026 4.7
9687 4.5
2460 38.2
0 0.0
0 0.0
1890 5.1
0 0.0
0 0.0
25 12.5
793 7.2
935 7.9
2054 6.0
8157 3.3
457 17.1

2-12 months
No.
33090
32146
65236
1259
8570
24900
11806
258
15839
67
3182
3238
8810
77929
853

%
30.3
29.8
30.1
19.5
41.9
33.9
31.9
33.2
30.6
33.5
28.7
27.5
25.9
31.5
31.9

1-5 years
No.
69336
68252
137588
1374
11881
48635
22974
519
35957
83
6882
7147
22178
157630
1109

%
63.5
63.3
63.4
21.3
58.1
66.1
62.0
66.8
69.4
41.5
62.1
60.7
65.1
63.8
41.4

Total
No.
109143
107763
216906
6446
20451
73535
37052
777
51796
200
11081
11775
34071
247184
2676

%
50.3
49.7
100.0
3.0
9.4
33.9
17.1
0.4
23.9
0.1
5.1
5.4
15.7
114.0
1.2

Table 11. Distribution of IMCI patients and disease patterns in Sylhet division in 2011
Patient/Diseases
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

0-28 days

29-59 days

No.
4668
4804
9472
1819
0
0
1586
0
0
63
522
910
1825
6725
432

No.
7918
8714
16632
2660
0
0
4294
0
0
93
1351
1894
3429
13721
569

%
3.7
3.6
3.7
23.3
0.0
0.0
3.2
0.0
0.0
13.5
3.1
6.1
3.7
2.5
17.7

%
6.2
6.6
6.4
34.0
0.0
0.0
8.6
0.0
0.0
20.0
8.1
12.8
7.0
5.0
23.3

2-12 months
No.
39323
39017
78340
1734
10745
26435
15274
183
13728
129
5308
4084
12072
89692
702

%
30.9
29.5
30.2
22.2
43.7
38.2
30.5
38.2
35.3
27.7
32.0
27.5
24.6
33.0
28.8

1-5 years
No.
75202
79680
154882
1610
13851
42807
28899
296
25129
181
9407
7956
31839
161975
734

%
59.2
60.3
59.7
20.6
56.3
61.8
57.7
61.8
64.7
38.8
56.7
53.6
64.8
59.5
30.1

Total
No.
127111
132215
259326
7823
24596
69242
50053
479
38857
466
16588
14844
49165
272113
2437

%
49.0
51.0
100.0
3.0
9.5
26.7
19.3
0.2
15.0
0.2
6.4
5.7
19.0
104.9
0.9

Table 12. Distribution of IMCI patients and disease patterns in Bangladesh, 2011
Patient/Diseases
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

0-28 days
29-59 days
2-12 months
1-5 years
Total
No.
%
No.
%
No.
%
No.
%
No.
%
29097
2.5
55440 4.7 367573 31.0 732261 61.8 1184371
50.7
29156
2.5
54111 4.7 351478 30.5 718878 62.3 1153623
49.3
58253
2.5 109551 4.7 719051 30.8 1451139 62.1 2337994 100.0
9609 17.2
15713 28.1 15394 27.5
15299 27.3
56015
2.4
0
0.0
0 0.0 85488 41.8 118988 58.2
204476
8.7
0
0.0
0 0.0 280830 35.7 506152 64.3
786982
33.7
6109
1.8
18640 5.3 110946 31.8 212985 61.1
348680
14.9
0
0.0
0 0.0
2107 30.6
4787 69.4
6894
0.3
0
0.0
0 0.0 156785 32.9 319747 67.1
476532
20.4
201
6.2
407 12.5
1059 32.4
1597 48.9
3264
0.1
2835
2.6
7916 7.3 31740 29.1
66399 61.0
108890
4.7
4663
4.1
11199 9.9 32200 28.5
64751 57.4
112813
4.8
20602
4.5
37292 8.2 112274 24.6 286195 62.7
456363
19.5
44019
1.7
91167 3.6 828823 32.4 1596900 62.4 2560909 109.5
4849 10.3
7358 15.6 14557 30.9
20408 43.3
2.0
47172

19

Editorial Board
Advisors

Members

1. Professor Dr. Khondhaker Md. Shefyetullah

Director General of Health Services (DGHS)

1. Dr. Chand Sultana

Chief (HIU), MIS-Health, DGHS

2. Dr. Syed Abu Jafar Md. Musa

Director, Primary Health Care
& Line Director, MNC&AH , DGHS

2. Dr. Md. Gowsal Azam

Deputy Chief (Medical), MIS-Health, DGHS

Chief Editor
Professor Dr. Abul Kalam Azad
Additional Director General (Planning and
Development) & Line Director, MIS-Health, DGHS

Associate Editor
Md. Ashraful Islam Babul
Deputy Chief, MIS-Health, DGHS

Assistant Editor and Designer

Nayeem Al Mifthah
Consultant (HIS & GIS), MIS-Health, DGHS

Data Analysis and Composer

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

3. Dr. Ashish Kumar Saha

Program Manager, Medical Biotechnology &
Assistant Director, MIS-Health, DGHS
4. Dr. Md. Altaf Hossain
Program Manager (IMCI), DGHS
5. Mr. Sukhendu Shekhor Roy
System Analyst, MIS-Health, DGHS
6. Dr. Shah Ali Akbar Ashrafi
Deputy Program Manager, eHealth, MIS, DGHS
7. Mr. Burhan Uddin Ahmad
Programmer, MIS-Health, DGHS
8. Dr. Sultan Shamiul Bashar
OSD, MIS-Health, DGHS
9. Dr. Ziaul Matin
Health Specialist, UNICEF, Bangladesh

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

Correspondence should be addressd to:

From,
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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
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