prof. laila kamel1. 2 premarital care & counseling (pmcc) prof. laila kamel professor of public...

Prof. Laila kamelProf. Laila kamel 11

22Prof. Laila kamelProf. Laila kamel

Premarital Care & Premarital Care & CounselingCounseling

(PMCC)(PMCC)

Prof. Laila KamelProf. Laila Kamel

Professor of Public Health & Professor of Public Health & Community MedicineCommunity Medicine

Cairo UniversityCairo University

Some referencesSome references

• MOHP (2007); “Practice Guidelines for Family Physicians; Vol. 3

• Premarital screening & Counseling http://www.easternbiotech.com/resource_Pre%20marital

%20Screening.php http://www.moh.gov.sa/en/HealthAwareness/

Beforemarriage/Pages/default.aspx https://www.haad.ae/haad/tabid/1042/Default.aspx http://www.mayoclinic.org/tests-procedures/premarital-

counseling/basics/definition/prc-20013242


OverviewOverview

Premarital care and counseling (PMCC) is a health promotion activity directed to each of the future couples to establish a healthy family raising a healthy future generation (Healthy marriage).

This is also an opportunity to meet with a physician who can address any other health concerns before marriage.


Health is a state of complete physical, mental, social and spiritual wellbeing not just the absence of disease or infirmity


Healthy MarriageHealthy Marriage

• Healthy marriage is defined as state of agreement and harmony between the marriage partners with regard to the healthy, psychological, sexual, social, and legislative aspects, aiming at making a sound family and begetting healthy, happy children.


Overview (Cont.)Overview (Cont.)

• PMCC would prevent reproductive health hazards, sexual dysfunction, marital distress, divorce & family breakdown and it will allow people to enjoy life.

• PMCC can help ensure that future couples have a strong, healthy relationship and a better chance for a stable and satisfying marriage.

• Premarital counseling can help identifying weaknesses that could become bigger problems during marriage.


Overview (Cont.)Overview (Cont.)

• In some countries premarital counseling is provided by licensed therapists known as marriage and family therapists. In Egypt Family Physicians is the key provider

• Religious leaders can play an important role


Background informationBackground information

On 12 June 2008, a presidential decree regarding the Child Law was issued. The decree included two main articles, increasing the minimum age of marriage for males and females to 18 years, and the establishment of premarital testing and counseling as a precondition to issue a marriage certificate


Background information (Cont.)Background information (Cont.)

• UNFPA was involved through supporting a steering committee on premarital examination.

• The role of the committee was to come up with a draft of the components to be included in the premarital testing and counseling.



• the committee recommended the following:

• Obligatory tests should include a complete blood picture, RH factor in the blood and urine analysis, whereas additional tests could be requested based on history taking, counseling and consent of the couple.



• Necessary vaccinations and supplementation should be taken by the couple, including Hepatitis B vaccine, Rubella vaccine and folic acid pills for the female.

• Premarital counseling, to include counseling on such topics as nutrition, harmful behavior and misconceptions regarding sexual and reproductive health, married life and responsibilities of the married couple, intimate relations and budgeting for the family.


By the end of this session we should By the end of this session we should have covered the following:have covered the following:

• Value of premarital care

• Premarital care package

• Premarital counseling

• Timing of PMCC

• Components of premarital counseling

• At-risk approach in PMCC

• Genetic counseling


Value of premarital careValue of premarital care

• Establish a healthy family

• Prevent several medical and psychological problems

• Prevention of genetic disorders and congenital anomalies

• Promotion of a healthy life style for each of the couples, early detection and management of any health problems.


Timing of PMCCTiming of PMCC

• Conceptually premarital care extends from birth, throughout the premarital period. It is also affected by the health of the grandparents in a spiral life cycle continuum. By caring for the health of the present children and adolescents we are actually starting to provide care for the future generation.

• In practice the specific service provided is the premarital examination which is now required by law.

•


Timing (cont.)Timing (cont.)

• School years: Mainly secondary school (May be late preparatory)

• Just before marriage

Premarital care should be an essential part of primary and preventive care rather than an isolated visit.


Who provides PMCCWho provides PMCC

• As premarital care extends from birth, throughout the premarital period, the Primary Health Care / family physician is the main provider

• Immediate pre-marriage mandatory examination to obtain the certificate required to register marriage is done in specified hospitals


Premarital care packagePremarital care package

• Examination: clinical and basic investigations, referral as needed.

• Vaccination and supplementation

• Health education and counseling

• Genetic counseling

The at-risk approach


Premarital examinationPremarital examination

Although the main concern in premarital examination is to diagnose and manage health problems related to marriage and reproduction, yet, it is a chance to provide full clinical assessment and to care for the individual in a total person approach.


Premarital examination (Cont.)Premarital examination (Cont.)

Medical examination includes

•Personal medical history / any specific concerns

•Family history / consanguinity

•Family pedigree

•General and systematic examination

•Laboratory investigations


Laboratory investigationsLaboratory investigations

• Routine investigations– complete blood picture, – Rh factor in the blood – urine analysis

• Additional tests could be requested based on history taking, counseling and consent of the couple. These may include VDRL, HIV, etc. Examination for thalassemia is now under consideration.


Vaccination and supplementationVaccination and supplementation

• Rubella

• HBV

• Folic acid for females (to prevent neural tubal defect)


Premarital counselingPremarital counseling

Health education and counseling are key components of PMCC

What is the difference between HE and counseling?


Health Education Health Education

HE messages include-Healthy life style-family life and reproductive health in general -Appropriate time for the first pregnancy and contraception -Importance of antenatal care visit early in pregnancy -Precautions to be taken in pregnancy e.g., to avoid taking any drugs or be exposed to other teratogens


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Healthy life styleHealthy life style

Lifestyle is a way of living based on identifiable patterns of behaviour which are determined by the interplay between an individual's personal characteristics, social interactions, and socioeconomic and environmental living conditions

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Healthy life styleHealthy life style

• Healthy surroundings and housing• Personal hygiene• Adequate diet and good nutrition• Physical exercise• Coping with stress• Avoid harmful practices as smoking, alcohol,

violence, etc.• Accident and injury prevention• Preventive practices: immunization, early

detection of disease, etc.

Adequate diet and good nutritionAdequate diet and good nutrition

- Premarital education is a good chance to improve the feeding habits for the future family

- Good nutrition education takes into consideration the socioeconomic level of the future couple

- Food exchange lists should be discussed


Premarital counselingPremarital counseling

• Counseling is geared to specific needs of individuals

• It is directed to specific health problems, either related to the health of the individual him/herself, or to the expected offspring.

• Genetic counseling is an important form of premarital counseling

Counseling should end with an informed decisionProf. Laila kamelProf. Laila kamel 2929

Genetic counselingGenetic counseling

A specific form of counseling to advise the parents about the probabilities of having a congenital or hereditary disease. It is done either in the premarital period, or during inter-conceptual care, usually after having such a problem with the previous child.

Genetic counseling include study of the pedigree (through family history for both partners), and chromosomal studies for cases that could be discovered through this technique.


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prof. laila kamel1. 2 premarital care & counseling (pmcc) prof. laila kamel professor of public...

Documents

laila kameloverview

laila kamelsome referencesmohp

healthy family

marriage partners

satisfying marriage

marriage certificateprof

counseling pmcc

family therapists