MCH Mother and Child Health CHP200: Community Health Program-l Mohamed M. B. Alnoor

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SPECIFIC OBJECTIVES By the end of this presentation the gy By the end of this presentation the student should be able to: Appreciate the General Goals and Specific Objectives of MCH Appreciate the importance of reproductive health Be familiar with the Reproductive Health Policy gy Identify the different periods of maternal care, and recognize the important events in those periods: I. Before pregnancy II. During pregnancy III. During labour IV. Post-Natal Care V. Post lactation Understand the common causes of Maternal Mortality Understand the objectives and phases of child care Understand the mortality in and around infancy

MCH OBJECTIVES OF MCH SERVICES: gy 1.Reduction in maternal, perinatal, infant and childhood Mortality & Morbidity. 2.Promotion of reproductive health. 3.Promotion of physical and psychological development of child and adolescent within the family. gy 'Reproductive health' is defined as:“a state of complete physical, mental and social well-being and...not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of birth control which are not against RELIGION, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.  

MCH Importance of reproductive health: Evidences:- gy Evidences:- Females( 15 – 49): 19% Each year > 200 million women become pregnant. > 50 million women experience acute pregnancy related complications. gy

MCH Importance of reproductive health: Evidences:- gy Evidences:- > 50 million women experience acute pregnancy related complications: - Predictable - Manageable gy Prevention Diagnosis Treatment 15 million women develop long-term disabilities. 585,000 die annually. (UNICEF)

MCH Importance of reproductive health: Evidences:- gy Evidences:- Poor women health and nutritional status. Inappropriate management of labor is responsible for about 75% of 7.5 million annual perinatal deaths. Reproductive Health: - most neglected health problems. - interventions are available. - policies are inappropriate. gy

MCH Importance of reproductive health: gy Evidences:- Health of mothers greatly influences the healthy development and well-being of their children. gy Childhood Diseases depend on Genetics Environment (Very closely linked with mothers)

KAP of mother is beneficial MCH Importance of reproductive health: gy Evidences:- Healthy mother gy Healthy daughter KAP: Knowledge, Attitude and Practice. KAP of mother is beneficial to their own health and the health of their children.

MCH Reproductive Health Policy: (ICPD 1994) gy (ICPD 1994) Linking reproductive health policies to: girls’ education status of women overall poverty reduction. Preventing unwanted pregnancies. gy ICPD: International Conference on Population and Development

pregnancy complications. MCH Reproductive Health Policy: gy (ICPD 1994) Facilitating: safe pregnancy by preventing & managing pregnancy complications. safe delivery gy safe motherhood ICPD: International Conference on Population and Development Promoting positive health practices e.g. early treatment of STDs delayed marriages birth spacing .

MCH PERIODS OF MATERNAL CARE: I. Before pregnancy: gy I. Before pregnancy: (> 15 yrs.) for physical and psychological preparation to bear responsibility. A) Nutrition: The nutritional status strongly influences gy Foetal growth Birth weight (newborn) Nutrition during infancy

MCH PERIODS OF MATERNAL CARE: Maternal Abs passive immunization gy I. Before pregnancy: B) Infections: Maternal Abs passive immunization gy Maternal immunization against rubella protects the outcome of pregnancy. Tuberculosis severely affects nutritional status of mothers

MCH PERIODS OF MATERNAL CARE: (Antenatal Care) II. During pregnancy: gy Aims:- gy Promote, protect and maintain health. Detect high risk. Relieve fear and anxiety. Health Education: ( elements of child care, nutrition, hygiene …… etc)

MCH PERIODS OF MATERNAL CARE: A) Nutrition: gy II. During pregnancy: A) Nutrition: - Well nourished preg. good birth wt. - Anaemia during pregnancy gy - Common - Affects newborn infant - Preventable

MCH PERIODS OF MATERNAL CARE: B) Infection: II. During pregnancy: gy II. During pregnancy: B) Infection: - Rubella Congenital deformities Abortion gy - Syphilis IUFD Stillbirth - Malaria IUFD Low birth wt - UTI Amnionitis IUFD Placentitis Low birth wt

MCH PERIODS OF MATERNAL CARE: II. During pregnancy: gy II. During pregnancy: C) Chronic Diseases gy Stillbirth Abortion Low birth weight High perinatal mortality D) Smoking

MCH PERIODS OF MATERNAL CARE: gy II. During pregnancy: E) Heavy work and stress in late pregnancy leads to low birth wt F) Psychological stress Good ANTENATAL care can provide for all of this and more. gy

MCH PERIODS OF MATERNAL CARE: (Intra-natal Care) III. During labour : gy AIMS: Asepsis Minimum injury to mother and newborn. gy Preparedness to deal with complications. (prolonged labor – ante partum hemorrhage – convulsions ) Care of baby at delivery.

MCH PERIODS OF MATERNAL CARE: b) Care during labour gy III. During labour : a) Antenatal Care(Risk assessment) b) Care during labour - Infection ophthalmia neonatorum gy tetanus neonatorum - Bleeding Perinatal asphyxia or neonatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It results most commonly from a drop in maternal blood pressure or some other substantial interference with blood flow to the infant's brain during delivery. - Trauma Mother Newborn - Asphyxia

MCH PERIODS OF MATERNAL CARE: IV. Post-Natal Care Aims: gy Aims: Restoration of health. Check adequacy of breast feeding. Provide basic health education. (Evaluate effect of antenatal Care)?! gy V. Post lactation: spacing?

MCH THE RIGHTS OF WOMEN ! PRIMARY HEALTH CARE gy SAFE MOTHERHOOD FP ANC SD EOC gy BASIC MATERNITY CARE FP: Family planning, ANC: Antenatal care, SD : Safe delivery, EOC: Emergency obstetrics care PRIMARY HEALTH CARE E Q U I T Y F O R W O M E N

MCH Maternal Mortality Malnutrition Anaemia Pregnancy Infection gy Malnutrition Anaemia Infection Pregnancy gy Bleeding Infection Labour Bleeding Infection Postpartum Lack of awareness Lack of health services Lack of utilization of health services

MCH Child Welfare Infancy and Early Childhood: Rapid growth gy Infancy and Early Childhood: Rapid growth - Period of Development Learning gy Infection - Vulnerability Malnutrition Environmental hazards - Infants: 4% of population: 25% of deaths - “1- 4” years: 13% of pop: 20% of deaths

MCH Child Welfare Child Care Program Objectives of child care: gy Child Care Program Objectives of child care: Safe entry to life Reduction in perinatal and neonatal deaths Reaching a healthy adulthood Promotion, protection and maintenance of health (Overcome genetic factor)? gy

MCH Child Welfare Child Care Program gy Child Care Program 1. Prenatal Care( Ideally before conception ) Parental guidance and discussion involving: Genetics Family history Feeding plans (Br. F) Home preparation for baby care Answering questions gy

MCH Child Welfare Child Care Program gy Child Care Program 1. Prenatal Care( Ideally before conception ) Parental guidance and discussion involving: Obstetric gy - Work of mothers - Nutrition - Smoking - Drugs

MCH Child Welfare Child Care Program 2. Infant Care - Early evaluation gy Child Care Program 2. Infant Care - Early evaluation - Encourage breast feeding - Face parents’ concern - Developmental problems - Anxiety - Sleep - Overfeeding - Active immunization - Monitoring of growth and development gy

Mortality in and around infancy MCH Mortality in and around infancy gy I N F A N T gy N E O N A T E FOETUS PERINATAL PERIOD 28th week of gestation Birth 7 Days 28 Days 1 Year

Mortality in and around infancy MCH Mortality in and around infancy gy Infant Mortality Post-neonatal death Neonatal death Early neo-natal death Late neonatal death gy Perinatal death Still birth 28th week of gestation Birth 7 Days 28 Days 1 Year

MCH Child Welfare Child Care Program 3. Second year of life gy Child Care Program 3. Second year of life - Rapid development - Increased parental concern 4. Pre-school years (< 5 years) - Accident prevention 5. School years gy 6. Adolescent Care - Rapid physical growth - Marked emotional changes - Personality development

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