Maternal and child health care

PRESENTED BY

DR. KAILASH NAGAR

DEPARTMENT OF COMMUNITY

HEALTH

Maternal and children health.HEALTH

MOTHER CHILD

SOCIETY

Healthy children need healthy mothers

INTRODUCTION

Maternal and child health services are the foremost priorities of community health programmes.

According to Indian culture mother is the foundation of the family and children are the future of the country.

DEFINITION

According to WHOMaternal and child health services can be

defined as “promoting, preventing, therapeutic or rehabilitation facility or care for the mother and child.

OBJECTIVE OF MCH

• To reduce maternal and childhood mortality and morbidity.

• Promoting satisfying and safe sex life.

• Regulate fertility

• Child survival

• Promote and protect health of mothers.

• To promote reproductive health.

• Ensure birth of healthy child

• Promote healthy G & D

GOALS

• To ensure the birth of a healthy infant to every

expectant mother.

• To promote the healthy Growth and Development of

children.

• To identify health problems in mother and children.

• To prevent malnutrition in mothers

and children.

GOALS

• To promote family planning services.

• To prevent communicable and non-

communicable diseases in mothers and children.

• To educate the mothers on improvement of their

own and their children’s health.

SCENARIO/ FACTS OF INDIA

Every year more than 2 crore 70 lakh women become pregnant.

Only 48.3% deliveries are conducted by trained health personnel.

Only 36% mothers are getting postnatal care by skilled professionals.

33% women’s Body Mass Index below than normal.

CONTI…..

57.9% pregnant women b/w the age group 15-49 are suffering with anemia.

Only 57% women familiar with the AIDS.45.9% children below 3 years of age low weight

than normal.Out of total deliveries ,only 40% are institutional

deliveries.

MATERNAL HEALTH PROBLEMS 

 • I. Nutritional Problems • Malnutrition• Nutritional Anemia • II. Infection Problems• Reproductive Tract Infections ( RTIs)/ Sexually Transmitted

Infection (STI)• Infection in general• Puerperal Sepsis 

MATERNAL HEALTH PROBLEMS 

III. Disturbances and Menstruation• IV. Mature Gravida• V. Adolescent Gravida• VI. Adolescent Parents Problems• VII. Unregulated Fertility• VIII. Abortions• IX. Complications of Deliveries• X. Infertility• XI. Uterine Prolapse• XII. Cancer of the cervix

INDICATORS OF MCH

MMRIMRNeonatal mortality rateUnder five mortality rateChild survival rate• Coverage indicators• Knowledge, attitude & practice indicators

Recent trends in MCH care• Integration of care• Risk approach• Manpower changes• Primary health care• Reproductive and child health

TARGETS OF MCH

MMR - Below 2IMR -Below 60Death rate of 1-4 -Below 10 age group.Size of family -2-3 memberBirth weight of child -Minimum 2500 grmWeight of minimum -According to hgt/wgt 90% of total children

Organizational activities of MCH services

• Complete health check up and care of the child and mother from conception to birth

• Studying the health problems of mothers and child

• Providing health education to parents for taking care of children

• Training to professionals and assistant workers

Responsibilities of community health nurse in MCH services

Direct care

Managerial

functions

Educational

functions

Maternal and child health services

Prenatal/antenatal care services

Intranatal care services

Postnatal care services

Under five child health services

SOCIAL AND ENVIRONMENTAL FACTORS

• 1. Age of marriage• 2. Age of child bearing• 3. Child spacing• 4. Family size• 5. Level of education• 6. Economic status• 7. Customs and beliefs• 8. Role of women in society

Common causes of maternal deaths in India

Hemorrhage 37%

Sepsis 11%

Hypertensive disorder 5%

Obstructed labour 5%

Complications of abortion

8%

Other disorders 34%

Antenatal services

Antenatal servicesANTENATAL CARE: The care of the women during pregnancy.

AIM The primary aim of antenatal care is to

achieve at the end of a pregnancy a healthy mother and a healthy baby.

OBJECTIVES

To promote protect and maintain the health of the mother during pregnancy

To detect:” high risk” cases and special attention To foresee complications and prevent them To remove anxiety and dread associated with delivery To reduce maternal and infant mortality and morbidity To teach the mother elements of child care,

nutrition ,personal hygiene and environmental sanitation

To sensitize the mother to need for family planning

ANTENATAL SERVICES

A MINIMUM OF 3 VISITS COVERING THE ENTIRE PEROID OF PREGNANCY SHOLUD BE

1st visit at 20th weeks 2nd visit at 30th weeks 3rd visit at 36th weeksPREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY)a. THE FIRST VISIT: - Health history - Physical examination - Laboratory examinationb. ON SUBSQUENT VISITS: -Physical examination - Laboratory tests -Iron and folic acid supplementation

CONTI….

D. Immunization against tetanusE. Instruction on nutrition, family planning ,self care,

delivery and parenthoodF. Home visiting by a female health workerG. Referral servicesRisk approachMaintenance of records:Home visits: is back bone of MCH services. Home

visit by the health worker female or public health nurse

Intranatal services

INTRANATAL SERVICES

Child birth is a normal physiological process ,but complications may arise, septicemia may arise result from unskilled and septic manipulations, and tetanus neonatarum from the use of unsterile instruments. The emphasis on the cleanliness. It entails-

- Clean hands and fingernails - Clean surface for delivery - Clean cutting and care of cord

OBJECTIVE

• To provide thorough asepsis• To prevent injury to baby and mother• To prevent complications• To provide care to the baby

INTRANATAL CARE

1.DOMICILLARY CARE: Mother with normal obstetric history may be

advised to have their confinement in their homes, provided the home conditions are satisfactory. In such cases the delivery may be conducted by the” health worker female or trained dai” this is known as “ domiciliary midwifery service”.

CONTI….

ADVANTAGES OF DOMICILLARY SERVICE:• Mother delivers in the familiar surroundings of her home.• Less chance of cross infection.• Mother is able to keep an eye upon her children and domestic

affairs.DISADVANTAGES:-Mother may have less medical and nursing supervision-Mather may have less rest-Mother resume her duties too soon-Diet may be neglected

CONTI…

2.INSTITUTIONAL CARE: At about 1% of deliveries tend to be

abnormal, requiring the services of a doctor institutional care is recommended for all ‘ high risk’ cases and where home conditions are unsuitable.

CONTI….

. ROOMING IN: Keeping the baby ‘s crib the side of the mother ‘s bed is called “rooming-in”.

It also allays the fear in the mother mind that the baby is not misplaced in the central nursery.

Post natal services

PHOTO

Post natal services

Care of the mother( and the new born ) after delivery is known as post-natal care.

OBJECTIVES

• To prevent complications of the postnatal period.• To provide care for the rapid restoration of the

mother to optimum health.• To check adequacy of breast feeding.• To provide family planning services.• To provide basic health education to mother\

family.• To provide care to mother and baby

POSTNATAL SERVICES

• Postnatal examination

• Hb examination during postnatal visit

• Teaching postnatal exercises

• Family planning services

• Health education

Child health services

PHOTO

OBJECTIVES

• Decreasing child death and infant mortality rate

• Complete protection of child• Nutritious diet to children• Overall growth of children• Preserve and promote health of under

five children• Increasing health level of children

SERVICES

• Immunization• Breast feeding• Growth and development• Personal hygiene• Detection of health problems &

treatment

Causes of under-five deaths in India

Child Clinics

Under five clinics

Child guidance clinics

Under five clinics

Aims and activities

• Preventive care

• Growth monitoring

• Care in illness

Child Guidance Clinic

• For children suffering from abnormal behaviour or psychological problem

• Psychiatrists, community health nurse and other auxiliary workers serve in these clinics.

• Bed wetting/ enuresis• Refusing to go to school

CONTI….

• Hating a family member• Complain of being ignored/ neglected• Cruel behavior towards other children

and animals• Stealing the objects• Intense reaction to normal situation

NEONATAL CARE

• EARLY NEONATAL CARE:The first week of the life is most crucial period in infancy . OBJECTIVES:1. Establish & maintenance of cardio- respiratory functions2. Maintenance of body temperature3. Avoidance of infection4. Establish of satisfactory feeding regimen 5. Early detection and treatment of congenital and

acquired disorders.

CONTI…

IMMEDIATE CARE:1.Clearing the airway: to help to estabilish breathing, the

airways should be cleared mucus and other secretions2.Apgar score: it is taken 1 minute & again at 5 minutes

after birth.

CONTI…

Sign Score 0 Score 1 Score 2

Heart Rate Absent Slow (below 100) Over 100

Respiratory Effort Absent Slow irregular Good crying

Muscle Tone Flaccid Some flexion of extremities

Active movements

Reflex Response No response Grimace Cry

Color Blue, pale Blue, pink extremities blue

Completely pink

Total score=10 Severe depression 0-3 Mild depression 4-7 No depression 7-10

MANAGEMENT

3.CARE OF THE CORD: The cord should be cut & tied when it has stopped pulsating. Care must be taken to prevent tetanus of newborn by unsterilized instruments and cord ties

4.CARE OF THE EYES: Before the eyes are open, the lid margins of the newborn should be cleaned with sterile wet swabs, one for each eye from inner to outer side.

5. CARE OF THE SKIN: The first bath is given with soap and warm water to remove vernix, mechonium and blood clots. Some prefer to apply warm oil before the bath

CONTI….

6.MAINTAINANCE OF BODY TEMPERATURE: The normal body temperature of a newborn is between 36.5

deg c to 37.5 deg c it is important that immediately after birth the child is quickly dried with a clean cloth and wrapped in warm cloth and given to the mother for skin-to skin contact and breast feeding.

7.BRAEST FEEDING • NEONATAL EXAMINATIONS• MEASURING THR BABY : Ht, Wt, HEAD

CIRCUMFERENCE• IDENTIFICATION OF “ AT RISK” INFANTS• LATE NEONATAL CARE

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CONTI….Programmes and schemes are support to the MCH

NRHM NUHM RCH Janani suraksha yojana (JSY) Vandematarm Scheme Skilled birth attendants (SBA) Home based newborn care (HBNC) Integrated management of neonatal and childhood

illness (IMNCI).

Slogans• “Today’s children are tomorrow’s

helmsmen”

• “Safe life of a child is the investment of future’

FINISHED