maternal child health (mch)

7/27/2019 Maternal Child Health (MCH)

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MCH

Dr. K. N. Patel

Former Additional Director

Health & Family Welfare


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Human

Development

Index

Economy

Health

Education

Economy

Human

Development

Index

Health

Human

Development

Index

Education

Health

Human

Development

Index

Educa

tion

Health

Human

Development

Index

Educa

tion

Health

Human

Development

Index

Economy

HDI

Life Expectancy

IMR

MMR

TFR

Child maternal Health


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MDGs1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Ensure gender equality and promotewomens empowerment

4. Reduce child mortality5. Improve maternal health

6. Reduce HIV/AIDS infection, TB,malaria and other diseases

7. Ensure environmental sustainability

8. Develop global partnership for development


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HEALTH

Indicator: Life Expectancy at Birth. Greatly

influenced by deaths at smaller age.

Infant Mortality Rate. Deaths in first 12

months of life in one year per 1000 livebirths. Gujarat:41 India:44 (SRS-2011)

Mortality in first month Neonatal Mortality

60% of IMR


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Mother and child - one unit

During pregnancy, foetus is part of mother, Gets nutrition

and oxygen from mothers blood (280 days)

After birth, for 6 months infant is completely dependant onmother for food

Certain diseases, factors of pregnant mother

(HIV, syphilis, German measles, drug intake, malnutrition)adversely affects health and survival of child

Mental & social development of child is dependant onmother. Mother is the first teacher of child

Interventions in mother affect directly to child e.g. Inj. TT tomother prevents NNT, IFA->better birth outcome

Good maternal nutrition->better brain development in child


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-

1000

Perinatal period

Still Birth


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Infant Mortality

Definition:41(Guj)/44 (India)2011

Causes: Neonatal deaths

BITWA +(Birth Infections Trauma LBWAsphyxia)Hypothermia; Congenital anomalies

Maternal anaemia, toxaemia, diseases

Social factors:

Teenage mothers or elderly primi-para

High fertility : Frequent & too many births Quality of birth assistance (health care)

Poverty, women literacy, maternal nutrition

Post-neonatal deaths: DD, ARI-pneumonia, accidents


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Reducing infant mortality

1. Care at Birth

2. GOBIFFF

3. Weaning / Annaprasan /complementary feeding

4. Vitamin A doses: 5 doses / 3 years

5. IMNCI


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Immediate Care of New born

Cleaning the airways

Care of the cord, stump 2.5 inches

Care of the eyes Care of the skin

Maintenance of body temperature,

warmth, kangaroo care to LBW Immediate Breast feeding

Polio Zero dose & BCG; HEP-B Zero


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Identification of at-risk infants

Birth weight less than 2.5 kg

Twins

Birth order 5 and above

Artificial feeding

Weight below 70% of expected as per age

Failure to gain weight in 3 successive months

PEM and diarrhoea

Working mother/one parent


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Indias share of the global challenge

20

15

39

21

15

28

32

0

10

20

30

40

50

Child

Populatio

n

MaternalDeaths

Under-weig

ht

Under-5ChildrenDeat

hs

P

eoplewith

HIV/AID

S

Lessthan

1$perd

ay

HHs

withoutSanitatio

n

%


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Development Paradox in Gujarat:Impressive economic growth

with Poor Social Development Indicators

Key

Indicators

Gujarat Best performing

state in India

NPP

2010

MDG

2015

IMR 41 10, 13

(Goa, Kerala)


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0

20

40

60

80

100

120

140

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2010

2011

2013

2015

Rural Total Urban

Infant Mortality trends in Gujarat

44 T51 R

30 U

Source: SRS

Wide difference in Rural and Urban areas

66 % in first 7 days

MDG Goal 27MDG Goal 27MDG Goal 27MDG Goal 27 T


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Synergy in causes of death

Malnutrition and infectiousdiseases lead to death

Mildly underweight children

- two-fold higher risk ofdeath than children who arebetter nourished

Moderately or severelyundernourished children -5-8 fold increase in risk ofdeath.

Infectiou

disease

Underweight

(Malnutrition)


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Child malnutrition

Gujarat : 45%malnourished

80% Children (6m-3yrs)

Anemic in Gujarat

Source; NFHS III (2005-06)

Iodized salt

Intake 56%

In Gujarat

Only 24% get adequateCalories & Proteins

Vitamin A

Supplement

Coverage 17%

53

45

50

40

45

50

55

1992-93 1998-99 2005-06

FI Children

38

37

37.6

25

22.9

29.8

32.5

39.9

44.6

25.6

42.4

60

39.6

24.9

26.1

36.5

56.5

40.7

47.1

48.855.9

36.4

19.7

22.1

39.619.9

32.5

25.2

38.7


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1013

24 28

4448

55

61 61 62

Goa Kerala TN

Mah

arashtra Gu

jarat

Bihar

Rajas

than UP Orissa

MP

IMR in Gujarat v/s other States

SRS 2011

India-47


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Child mortality trends in Gujarat

42 40 33

69 6350

10685

61

0

50

100

150

200

250

NFHS 1

1992

NFHS 2,

1998

NFHS 3

2005


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Preventive interventions

Source :

Lancet Series on Child Survival,India analysis - 2004 0 2 4 6 8 10 12 14 16 18

Measles Vaccine

Antibiotics for PRM

Tentanus Toxid

Newborn temperature management

Antenatal Steroids

Vitamin A

Zinc

Clean water, sanitation & hygiene

HiB Vaccine

Clean Delivery

Complementary Feeding

Breastfeeding


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Prevention of Anemia

Reduce anemia and build iron stores

through iron supplementation/ iron fortified

foods and nutrition

School going adolescents Out of school adolescents (KSY/Mamta

Taruni)

ANC

Communication to improve dietary intake

of iron and Vitamin-C rich foods.


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Vitamin A Deficiency and Child health

23% reduction in child mortality rate

50% reduction in child mortality rate due to acute

measles

35-50% reduction in child mortality rate due todiarrhoea

Improving vitamin A status of children(6 months-5 yrs.)

Results in to


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Vitamin A

1. Improve coverage of 1st dose Vit A along with Measlesafter completion of 9 months

2. Improve Bi-annual round coverage reaching the un-

reached

3. Improve therapeutic dose coverage of Vit A in Measles

out break response

4. Mega dose Vit A post natal period

Minimize the gap between rich and poor


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Health Intervention-3:

Mamta Divas

Immunization+ : children/pregnant women

Weighing of children (0-3 yrs) & plotting on Mamta card

IFA to Pregnant, lactating & out of school adolescent girls

1.5 Kg iodised salt to pregnant & lactating women/month ANC (BP, HB, Urine examination, Folic Acid /Calcium

tablets, Physical examination etc)

PNC (Calcium tablets, Vit A etc)

Assessment of sick children using IMNCI protocol Nutrition counseling/ Counseling for Institutional Delivery

Community growth monitoring

Others


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Identify bottlenecks & address them

Adapted from Tanahashi T. Bulletin of the World Health Organization, 1978, 56 (2)http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf

Availability - critical health system inputs

Adequate coverage - continuity

Utilization first contact of multi contactservices

Accessibility physical access of services

Effective Coverage -quality

Target Population


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Inclusive planning for the excluded

Plan & Monitor quality Health and Nutritionservices to excluded groups

Hard to reach areas

Agaria Costal areas

Hilly terrain

Deserts

Staying in Vadis and small hamlets Urban slums/ street children

Migratory population

Socio-economically excluded communities


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Maternal Health


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In India, One woman dies every 4 minutes dueto complications of pregnancy or child birth 136,000 maternal deaths in India

26% of the global burden

Highest for any country

Perhaps very little decline in recent

decades


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Maternal deaths: Causes

Maternity related: Hemorrhage29%, Puerperalsepsis16%, Obstructed labor10% position offetus, Eclampsia8%, Complicated abortion8%

Not related to maternity: Anaemia19% Associated conditions: heart disease, TB,Diabetes, Malaria, other diseases

Social:Home deliveries ; Lack of skilled care atbirth, Lack of appropriate Health ServicesLow female literacy, lack of awareness, poornutritional status, early marital age, low status ofwomen, poverty


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Prevention of maternal mortality

(1) Emergency Obstetric Care: TimelyIdentification of complications-availability of

transport-timely availability of emergency care

service

a) Skilled birth attendant at delivery

b) Early identification of complications

c) Referral transport system

d) Emergency obstetric care (EmOC)-FRUs


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(2) Essential Obstetric Care:A. Antenatal Care:

Early Registration (name, age, parity, LMP, history etc)

Physical Examination (Height, wt, BP, Oedema feet, anaemia,

position of foetus etc)

Lab. Examination: Blood, Urine

Counseling (Inst del., Diet, rest, preparations, 5 cleans EBF, FP)

provide TT and IFA, DDK

B. Natal Care

Institutional delivery

Skilled assistance

Good Referal Transport System

Five Cleans


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(2) Essential Obstetric Care:C. Post - natal care

5 visits (1st, 3rd, 7th and 42nd day)

Ask if bleeding, foul smeling discharge, breast

feeding

See temperature, uterine involution

Advise

diet (Extra 700 calories, 25 Gm protein)

Family planning

EBF


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(3) Social Interventions:

A. Raise maternal age at marriage: Now 18 yrs

B. Avoid unwanted pregnancies: FPC. Improve Nutrition: ICDS

D. Quality Health Services: Dai training, FRUs

E. Woman empowerment: Kishori Shakti Scheme

F. Safe abortion care: The MTP Act 1971


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Skilled birth attendants (SBAs) Doctors, nurses, ANMs, LHVs, if trained in

and proficient in midwifery, are SBAs

Trained TBA is not an SBA

Most of SBAs in India are located in

institutions

Hence, policy to promote institutional deliveries

Dai Training: Local, confidence, about: 5 cleans, high

risk mothers, normal del, identification ofcomplications, referral, care of new born, should

mobilise families for birth registration, immunisation, FP


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Emergency obstetric care (EmOC)

BASIC

Use of antibiotics,

oxytocics,anticonvulsants

Assisted deliveries

Manual removal ofretained products

COMPREHENSIVE

Basic plus: (FRU)

Cesarean section

Blood transfusion

Specialist

MMR i G j t


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MMR in Gujarat

Trend in Deliveries

64.7

53.5

43.4

36.8

46.3

54.6

NFHS-3NFHS-2NFHS-1

Institution Health Person

Maternal Mortality Ratio, India (2004-2006)

95

111

130141

154 160

186 192

213

254

303312

335

388

440

480

0

100

200

300

400

500

600

Keral

aT.N

.

Maha

rashtr

a

W.Be

ngal

A.P.

Gujar

at

Harya

naPu

njab

Karna

taka

India

Oriss

a

Bihar/

Jrkd

M.P.

/Chtg

d

Rajas

than

U.P./

Utrch

l

Assa

m

SRS 2006

MMR Trend in Gujarat

160

100

202172

389

0

100

200

300

400

500

1989 1999-01 2001-03 2004-06 2015

MaternalDealth

Goal

Hemorrhage

PIH

Sepsis

Anemia


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@160

MMR52%of

estimated 80%of

reported

Maternal Deaths Reported and Verbal Autopsy

Carried out (2008-09)

1333

690

551

0

200

400

600

800

1000

1200

1400

Estimated Reported VA carried out

M

A

T

E

R

N

A

L

D

E

A

T

H

S

>70 delays are in making decision toseek formal health care

Abortion related deaths are not

reported (0.5%)

Hemorrhage, PIH and sepsis are

leading causes of death


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maternal child health (mch)

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