1. Family Planning Food Supplementation Female Education Low Birth Weight

2. Specific Objectives Specific Objectives At the end of the lecture you will be able to 1.Define family planning (FP), its objectives and parameters. 2.Draw a line diagram shows the association of FP parameters and maternal,perinatal, neonatal and infant mortality and morbidity. 3.Realize the importance, way of administration and target groups for food supplementation. 4.Define food fortification. 5.Enumerate most common micro-nutrients used. 6.State way of administration with stress of Vit A (target group outcome, prevention of Vit A deficiency.

3. 7. Realize the importance of female education in enhancing overall family health. 8.Define low birth weight (LBW), small – for- date and preterm newborns. 9. Enumerate common causes of LBW. 10. State importance and incidence of LBW (worldwide and Iraq). 11.Suggest a plan for prevention of LBW.

4. Family Planning Practice that help couples to attain certain objectives: To avoid unwanted pregnancy. To regulate intervals between pregnancies (spacing). To control time at which birth occurs in relation to age of parents particularly mothers (timing). To determine the ideal number of children within the family (family size).

5. Dependant Variable Mortality Morbidity family planning parameters (independent) Risk to mothers & infants is greatest at the following situations <<18 years of age (too young) >>35 years of age (too old) AAfter the 4 th birth (too many ) LLess than 2 years apart (too close)

6. Food Supplementation Three Three specific forms of food supplements that have proved to be high cost- effective: 1.Food supplements directed to target groups  Pregnant women at risk of delivering LBW Extra food supplements(3 rd trimester) (500 cal+10g PTN /day) Extra gain in WT of 1.5 kg 300g in BW

7. 2.Food fortifications A process where by micro-nutrients are added to food to maintain or improve the quality of diet of a community. In order to deal with specific nutritional deficiencies & is typically used with conjunction with staple foods.

8. Iodine added to salt Vit A capsules or drops every 6mnths Iron changing dietary habits Iron supplements to pregnant +lactating food fortification (salt, sugar).

9. Vitamin A Impact of Vit on child survival Impact of Vit on child survival Improving vit A status in children results in global mortality reduction of 23%. Vit A helps to prevent 1.3-2.5 million deaths annually in children less than 5 years of age.

11. Vitamin A Vit A is used in treatment and prevention Indications Indications Current Xerophthalmia Measles Severe malnutrition

12. Bitot spots

13. Keratomalacia

14. Vit A: prevention National immunization days  Combining the administration of vitamin A supplements with immunization is an important part of this effort together with measles immunization and National immunization days to eradicate polio.

15. soon 200 000 IU  Providing high – dose supplementation to new mothers soon after delivery has provided further benefits to young infants through enriched breast milk (200 000 IU) during immunization contact. (only once)

16.  Periodic oral supplementation Children age 9-12 months, 100.000 IU every 4-6 month. > 12 months, 200.000 IU every 4-6 months.

17.  Optimal interval between doses is (4 – 6 months).  A dose should not be given soon after a previous dose of vitamin A supplement.  Interval can be reduced in order to treat clinical vitamin A deficiency and in measles cases.

18.  Food fortification : Vit A fortified sugar  Food diversification Yellow fruits Carrots Green leafy vegetable Liver and oil

19. Female Education Act as a powerful independent force in reducing number of infants & children deaths. How? 1.Schooling enhances women’s ability to provide adequate care. 2.Education enhances women status & power within the family. 3.Educated mothers can use health services & facilities properly.

20. Considering l ll low birth weight (LBW) There are two main groups Those born p pp prematurely Those with f ff fetal growth retardation In Iraq…….which is more common?????

21. Definition…. Birth weight (BW) less than 2.5 kg ( up to and including 2499 gm) Measurements being taken preferably with the f ff first hour of life.

22. 3 groups Apart from BW, babies can be classified into 3 groups ☺ Preterm ☺ Preterm born before 37 wks of gestation ☺ Term ☺ Term… 37-42 completed wks of gestation ☺ Post term… 42 ☺ Post term… 42 completed wks and over

23. Preterm C CC Causes..multifactorial…. multiple births, acute infection, hard physical work, hypertensive disorders of pregnancy. PPPPrevention … good antenatal care, discouragement of adolescent pregnancy, and treatment of hypertension.

24. Small for date … The weight is l ll less than the 10th percentile for the gestational age..it is the result of intrauterine growth retardation.

25. Small for date  Maternal causes…. malnutrition, severe anemia, heavy physical work during pregnancy, hypertension, toxemia, smoking, malaria, short maternal stature, high parity, short spacing, too young mothers ….etc

26. Percentage of low BW babies (incidence) = No. of live birth babies with weight less than 2.5 kg Total no. of live births x100

27.  Incidence……17%  Incidence……world wide is 17%  95%  95% in developing countries. 10%  The target reduction in the incidence is to less than 10%

28. Importance o f low BW Low BW is the m mm most serious challenge in MCH in both developed and developing countries. Its public health significance may be ascribed to..

29. Importance o f low BW  High incidence.  Its association with mental retardation.  High risk of perinatal and infant mortality.  Human wastage and suffering.  Very high cost of special care.  Its association with socio-economic under development.

30. Prevention Direct intervention measures high risk approach Identification of at risk pregnant women and steps should be taken to reduce the risk……use the high risk approach Some of the direct intervention are as follows:

31. Prevention Prevention  Proper feeding of pregnant women.  Treatment of anemia by iron folic acid supplementation.  Supplementary feeding.  Fortification and enrichment of food…..etc.  Controlling infection..e.g. UTIs, malaria, rubella, toxoplasmosis, syphilis.  Early detection and treatment of hypertension, toxemia, and diabetes.

32. Prevention Indirect intervention  Family planning.  Avoidance of smoking.  Measures aimed to improve health and nutrition of young girls.  Improvement of socio-economic and environmental conditions conditions.  Distribution of health services especially in the under-served areas.  Government support through maternity leaves with full wages and child benefits.

33. Treatment  Incubatory care.  Feeding.  Prevention of infection.

34. Leading Causes of Death  Atelactasis  Malformation  Pulmonary hemorrhage  Intracranial hemorrhage secondary to birth trauma or anoxia  Pneumonia and other infections

35. Conclusion  Family planning, female education and food fortification play an important role in the child health care strategy.  Low birth weight is an important problem. Its public health significance is ascribed to its high icidence and significant association with high infant and childhood mortality and morbidity, which is reflected on the community development as a whole.