Maternal and child health care services and reproductive child health

1. Maternal and child health care
PRESENTED BY
DR. KAILASH NAGAR
DEPARTMENT OF
COMMUNITY
HEALTH

2. Maternal and children health.
HEALTH
MOTHER CHILD
SOCIETY
Healthy children need healthy mothers

3. 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.

4. DEFINITION
According to WHO
Maternal and child health services can be
defined as “promoting, preventing,
therapeutic or rehabilitation facility or care
for the mother and child.

5. 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

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

11. 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

12. INDICATORS OF MCH
MMR
IMR
Neonatal mortality rate
Under five mortality rate
Child survival rate
• Coverage indicators
• Knowledge, attitude & practice indicators

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

14. TARGETS OF MCH
MMR - Below 2
IMR -Below 60
Death rate of 1-4 -Below 10
age group.
Size of family -2-3 member
Birth weight of child -Minimum 2500 grm
Weight of minimum -According to hgt/wgt
90% of total children

15. 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

16. Responsibilities of community health
nurse in MCH services
Direct care
Managerial
functions
Educational
functions

17. Maternal and child health services
Prenatal/antenatal care services
Intranatal care services
Postnatal care services
Under five child health services

18. SOCIALAND 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

19. Common causes of maternal deaths in
India
Hemorrhage
37%
Sepsis11%
Hypertensive
disorder5%
Obstructed
labour5%
Complications
of abortion
8%
Other
disorders34%

20. Antenatal services

21. Antenatal services
ANTENATAL 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.

22. 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

23. 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 weeks
PREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY)
a. THE FIRST VISIT:
- Health history
- Physical examination
- Laboratory examination
b. ON SUBSQUENT VISITS:
-Physical examination
- Laboratory tests
-Iron and folic acid supplementation

24. CONTI….
D. Immunization against tetanus
E. Instruction on nutrition, family planning ,self care,
delivery and parenthood
F. Home visiting by a female health worker
G. Referral services
Risk approach
Maintenance of records:
Home visits: is back bone of MCH services. Home
visit by the health worker female or public health
nurse

25. Intranatal services

26. 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

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

28. 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”.

29. 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

30. 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.

31. 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.

32. Post natal services
PHOTO

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

34. 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
motherfamily.
• To provide care to mother and baby

35. POSTNATAL SERVICES
• Postnatal examination
• Hb examination during postnatal visit
• Teaching postnatal exercises
• Family planning services
• Health education

36. Child health services
PHOTO

37. 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

38. SERVICES
• Immunization
• Breast feeding
• Growth and development
• Personal hygiene
• Detection of health problems & treatment

39. Causes of under-five deaths in India

40. Child Clinics
Under five clinics
Child guidance clinics

41. Under five clinics
Aims and activities
• Preventive care
• Growth monitoring
• Care in illness

42. 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

43. 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

44. NEONATAL CARE
• EARLY NEONATAL CARE:
The first week of the life is most crucial period in
infancy .
OBJECTIVES:
1. Establish & maintenance of cardio- respiratory
functions
2. Maintenance of body temperature
3. Avoidance of infection
4. Establish of satisfactory feeding regimen
5. Early detection and treatment of congenital and
acquired disorders.

45. CONTI…
IMMEDIATE CARE:
1.Clearing the airway: to help to estabilish breathing, the
airways should be cleared mucus and other secretions
2.Apgar score: it is taken 1 minute & again at 5 minutes
after birth.

46. 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

47. 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

48. 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

49. MANAGEMENT

50. MANAGEMENT

51. MANAGEMENT

52. MANAGEMENT

53. MANAGEMENT

54. MANAGEMENT

55. MANAGEMENT

56. MANAGEMENT

57. MANAGEMENT

58. MANAGEMENT

59. 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).

60. Slogans
• “Today’s children are tomorrow’s
helmsmen”
• “Safe life of a child is the investment of
future’

62. FINISHED