MCH Mother and Child Health CHP310: Community Health Program-l Mohamed M. B. Alnoor

gy Lin, Yutang

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

OBJECTIVES OF MCH SERVICES: 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. MCH gy

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

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

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. MCH gy Evidences:- Importance of reproductive health:

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

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

MCH (ICPD 1994) gy Reproductive Health Policy: Universal education Reduction of infant and child mortality Reduction of maternal mortality Access to reproductive and sexual health services including family planning

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

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

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

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

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

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

MCH gy C) Chronic Diseases Stillbirth Abortion Low birth weight High perinatal mortality D) Smoking II. During pregnancy: PERIODS OF MATERNAL CARE: 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. MCH gy II. During pregnancy: PERIODS OF MATERNAL CARE: First visit………Beyond 16 weeks Second visit….. Between 24 and 28 weeks Third visit……... Fourth visit…… Between 30 and 32 weeks Between 36 and 40 weeks (key family practices)

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

b) Care during labour MCH a) Antenatal Care (Risk assessment) - Infection ophthalmia neonatorum tetanus neonatorum - Bleeding - Trauma Mother Newborn - Asphyxia gy III. During labour : PERIODS OF MATERNAL CARE:

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

SAFE MOTHERHOOD FP ANC SDEOC E Q U I T Y F O R W O M E N PRIMARY HEALTH CARE BASIC MATERNITY CARE gy THE RIGHTS OF WOMEN ! MCH

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

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

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

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

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

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

Periods in and around infancy 28 th week of gestation Birth7 Days28 Days gy MCH I N F A N T FOETUS N E O N A T E PERINATAL PERIOD 1 Year

Mortality in and around infancy Infant Mortality Perinatal death Post-neonatal death Neonatal death Late neonatal death Early neo- natal death Still birth Birth7 Days28 Days 1 Year gy MCH 28 th week of gestation

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

CONCLUSION gy  Addressing mortality in and around infancy  Integrated Management of Childhood Illness (IMCI)  Child care starts ideally before conception  Antenatal care is the key to modification of outcome to the mother and the newborn  Prevention and management of bleeding and infection during and after labour