1. IN THE NAME OF ALLAH, THE MOST BENEFICENT, THE MOST MERCIFUL

2. MATERNAL AND CHILD HEALTH(MCH) It is branch of public health which is planned for the health supervision of the mothers and children, not only physical but also emotional health. It is branch of public health which is planned for the health supervision of the mothers and children, not only physical but also emotional health. It refers to the promotive, preventive, curative and rehabilitative health care services for mothers and children. It refers to the promotive, preventive, curative and rehabilitative health care services for mothers and children.

3. WHO Statistics.  Mothers & Children: 70% Total population  Women of 15—45 Y 1 9%  Children under 15Y 40%  MMR in Developed Countries: 30 / 100,000  MMR in Developing Countries: 480 / 100,000  IMR in Developed Countries 15 / 1000  IMR in Developing Countries 80 / 1000  PMR in Developed Countries 13 / 1000 total births  PMR in developing Countries 130 / 1000 total births.

4. OBJECTIVES OF MCH 1. To improve the health of mother and child. 2. To reduce maternal morbidity & mortality. 3. To reduce infant morbidity & mortality. 4. To reduce the birth rate. 5. To reduce the death rate. 6. To ensure birth registration. 7. To study and obtain information regarding women education, family income, women education, family income, environment and physiological status. environment and physiological status.

5. COMPONENTS I. Maternal Health II - Child Health. III -Family planning III -Family planning IV -Training of TBAS V. Day care centre for working mothers. VI. Health education.

6. MCH BROBLEMS ( IN MOTHERS)  Malnutrition.  Infection.  Uncontrolled reproduction.

7. MALNUTRITION  Maternal Malnutrition: Anaemia. Toxemia of pregnancy. Anaemia. Toxemia of pregnancy. Post partum Haemorrhage. Low birth weight. Post partum Haemorrhage. Low birth weight. Direct Interventions Direct Interventions Supplementary feeding programs Supplementary feeding programs. Distribution of Iron and folic acid tablets, Fortification & enrichment of food, Fortification & enrichment of food, Nutrition education Nutrition education Indirect Interventions. Indirect Interventions. Control of communicable diseases, improvement of environment sanitation, provision of clean drinking water. Control of communicable diseases, improvement of environment sanitation, provision of clean drinking water. food hygiene education & primary health care. food hygiene education & primary health care.

8. INFECTION: Maternal infections may cause…. Maternal infections may cause…. foetal growth retardation, low birth weight embryopothy, abortion and puerperal sepsis. foetal growth retardation, low birth weight embryopothy, abortion and puerperal sepsis. - Cytomegalovirus - Herpes simplex virus - Toxoplasmosis Children may be ill debilitating diarrhoeal, respiratory and skin infections. Children may be ill debilitating diarrhoeal, respiratory and skin infections.

9. UNCONTROLLED REPRODUCTION: A high birth rate is associated with a high infant mortality rate and under-five death rate. Country Crude Birth Rate per 1000 population (1999) IMR per 1000 live births (2000) Under-five mortality rate per 1000 live births (2000) India256996 Pakistan3585110 Bangladesh285482 Thailand162529 Sri Lanka 181719 China163240 Switzerland1134 UK1266 USA1478 Singapore1444 Japan1044

10. MATERNAL MORTALITY RATE: Maternal mortality rate is defined as ratio of death of mother due to child bearing and puerperal causes in a year to live births expressed per 1000. Total no. of death of women (during child bearing age due to pregnancy, child birth and puerperal causes at a place during one year) Total no of live births recorded at same place during same year M.M.R = x 1000

11. CAUSES OF INCREASE IN MMR. Main Causes: 1. Haemorrhage abortion, ectopic pregnancy, placenta praevia, placental abruption, ruptured uterus, partum hemorrhage, retained placenta and membranes. 2. Puerperal sepsis. 3. Hypertensive diseases 4. Anaemia in pregnancy 5. Malnutrition 6. Anaesthesia accidents 7. Pulmonary embolism & amniotic fluid embolism

12. CONTRIBUTORY CAUSES: 8. Pre-existing diseases 9. Biological factors: Age, Parity, Social class 10. Social factors: Birth interval, literacy, family size, delivery by untrained.

13. MEASURES TO REDUCE M.M.R: 1. Improve maternal nutrition 2. Early detection of high risk cases 3. Quick handling with emergencies 4. Aseptic measures 5. Birth spacing. 6. Training of the TBAs / Dais 7. Effective MCH services. 8. Control of three delays

14. ANTE NATAL CARE Care of mother during pregnancy. Care of mother during pregnancy.Objectives. 1 To promote, protect and maintain the health of the 1 To promote, protect and maintain the health of the mother during pregnancy. mother during pregnancy. 2 To detect high risk cases and give them special 2 To detect high risk cases and give them special attention. attention. 3 To foresee complications and prevent them. 3 To foresee complications and prevent them. 4 To sensitize mother for need of family planning. 4 To sensitize mother for need of family planning. 5 To remove the anxiety & fear of delivery. 5 To remove the anxiety & fear of delivery. 6 To teach the mother on, child health care, nutrition, personal hygiene and environmental sanitation. 6 To teach the mother on, child health care, nutrition, personal hygiene and environmental sanitation. 7 To reduce the MMR & IMR. 7 To reduce the MMR & IMR.

15. ANTENATAL CARE Antenatal Visits. Antenatal Visits.  1 st visit as soon as possible  After every 4 weeks till 28 weeks.  After every 2 weeks till 36 weeks.  Once a week till delivery.

16. 1 Antenatal visits Antenatal Visits Antenatal Visits  At least 3 visits are required:  1 st visit 20 weeks or at confirm of pregnancy.  2 nd visit 32 weeks to find out position.  3 rd visit 38 week, where to deliver the baby.

17. Antenatal Preventive Services Health care Card or Antenatal card. Health care Card or Antenatal card. General Physical Examination. General Physical Examination. 1 Urine for albumin and sugar 1 Urine for albumin and sugar 2 Blood pressure and weight recording 2 Blood pressure and weight recording 3 Pelvic examination. 3 Pelvic examination. 4 weight recording. 4 weight recording. 5 Blood exam. for Hb, blood grouping 5 Blood exam. for Hb, blood grouping 6 Health education on nutrition, PH, 6 Health education on nutrition, PH, 7. TT vaccination. 7. TT vaccination.

18. 2 ANTENATAL ADVICE 1 Diet. 1 Diet. 2 Personal hygiene. 2 Personal hygiene. personal Cleanliness, Rest, Bowels, Exercise, Sleep personal Cleanliness, Rest, Bowels, Exercise, Sleep Smoking, Alcohol, Dental care, Sexual Restriction. Smoking, Alcohol, Dental care, Sexual Restriction. 3 Drugs: 3 Drugs: i. Tetracycline. ii. Streptomycin. i. Tetracycline. ii. Streptomycin. iii. Corticosteroids. iv. LHD iii. Corticosteroids. iv. LHD v. Iodine containing preparations v. Iodine containing preparations vi. Anaesthetic agents vi. Anaesthetic agents

19. 4 Radiation: X-Ray is absolutely contraindicated 5 warning signs: Swelling of feet, Fits, Headache, Blurring vision, Swelling of feet, Fits, Headache, Blurring vision, PV Bleeding and unusual symptom. PV Bleeding and unusual symptom. 6 Child Care.

20. 3 Special health protection. Anaemia. Nutritional Deficiencies. Toxaemia of Anaemia. Nutritional Deficiencies. Toxaemia of pregnancy. German measles. Tetanus. Syphilis. pregnancy. German measles. Tetanus. Syphilis. Rh. Status,HIV. Rh. Status,HIV. Care for any health problem 4. Mental preparation. 5. Family planning.

21. HIGH RISK APPROACH  Too young, too old( 35)  Short stature primigravida. (<5 feet)  Pre-maturity (<37 weeks)  Post maturity (>41 weeks)  Grand multipara  Twin pregnancy, hydromnios.  Anaemia  Mal presentation  Toxaemia of pregnancy i.e.Pre-eclamptic toxaemia  Past bad obstetric history.  Pregnancy with associated diseases (DM, epilepsy, heart diseases, renal diseases etc)

22. INTRANATAL CARE Care during delivery. unskilled and septic manipulation--- Septicaemia Unsterlized instruments ----- Tetanus neonatorum. Aims of good intra-natal care are; 1. Through Aseptic measures. 1. Through Aseptic measures. Clean delivery surface. Clean delivery surface. Clean hands, fingers & nails. Clean hands, fingers & nails. Clean cutting and care of cord. Clean cutting and care of cord. Keeping Birth Canal Clean Keeping Birth Canal Clean 2. Delivery with minimum injury to infant and mother. 2. Delivery with minimum injury to infant and mother. 3. Readiness to deal with complications. 3. Readiness to deal with complications. 4. Care of baby at time of delivery. 4. Care of baby at time of delivery.

23. Domiciliary Care Normal obstetric history may be provided to have their confinement in their own homes, provided the home condition are satisfactory. Normal obstetric history may be provided to have their confinement in their own homes, provided the home condition are satisfactory.Advantages: 1. Fear of hospitalization. 2. less Chance of cross infection. 3. Remain keep touch with her family & domestic affairs. 4. Less stress. Disadvantages: 1. less medical & nursing supervision. 2. Less rest. 3. Resumes her duties too soon. 4. Diet may be neglected.

24. Danger Signals immediate transferring to nearest hospital. 1 Sluggish pain or no pain after the membrane ruptures. 2 good pain but no progress. 2 good pain but no progress. 3 Prolapsed of the cord or hand. 3 Prolapsed of the cord or hand. 4 Meconium stained liquor or a slow irregular or excessive fast foetal heart. 4 Meconium stained liquor or a slow irregular or excessive fast foetal heart. 5 Excessive Show, or bleeding during labour. 5 Excessive Show, or bleeding during labour. 6 collapse during labour. 6 collapse during labour. 8 Retained placenta. 8 Retained placenta. 9 Temperature more than 38 c. 9 Temperature more than 38 c. 10 PPH or collapse. 10 PPH or collapse.

25. POSTNATAL CARE Care of mother after delivery of foetus. Care of mother after delivery of foetus. 1 TO prevent the complications, 1 TO prevent the complications, 2 Restoration of mother to optimum health. 2 Restoration of mother to optimum health. 3 To check the adequacy of breast feeding. 3 To check the adequacy of breast feeding. 4 To provide FP services. 4 To provide FP services. 5 To provide HE to mother / family. 5 To provide HE to mother / family. Complication of post partal period: Puerperal Sepsis. Puerperal Sepsis. Thrombophlebitis. Thrombophlebitis. Secondary Haemorrhage. Secondary Haemorrhage. UTI\ & Mastitis. UTI\ & Mastitis.

26. Restoration of mother to optimum Health. PHYSICAL: PHYSICAL: 1 Postnatal Examination. 1 Postnatal Examination. VISITS ; VISITS ; Day 0-3 days. twice a day. Day 0-3 days. twice a day. Then daily for 7 days. Then daily for 7 days. Last visit end of 6 weeks. Last visit end of 6 weeks. 2 Anaemia; 2 Anaemia; 3 Nutrition; 3 Nutrition; 4 Postnatal exercise; 4 Postnatal exercise; Psychological Issue Psychological Issue Social Acceptance Social Acceptance

27. Postnatal care.  Breast feeding.  Family planning.  Health Education. Hygiene. Hygiene. Feeding for mother & infant Feeding for mother & infant importance of health check up. importance of health check up. pregnancy spacing. pregnancy spacing. Birth registration. Birth registration.

28. POSTNATAL COMPLICATIONS a.) Puerperal sepsis. b.) Thrombo-phelbitis. c.) Secondary haemorrhage. d.) Mastitis. e.) Urinary tract infections.

29. MATERNAL DEATH DEFINITION (WHO): The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggregated by pregnancy but excluded the accidental cause. The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggregated by pregnancy but excluded the accidental cause.

30. MATERNAL MORTALITY RATE DEFINITION: MMR measures the risk of woman dying from pregnancy or puerperal causes in an area of community, in a given year. MMR measures the risk of woman dying from pregnancy or puerperal causes in an area of community, in a given year. # maternal death in the area during given a year MMR = ---------------------------------------------------------------- x 1000 # live birth in the same area, in the given same years

31. MCH PROBLEMS 1 Malnutrition: LBW, Anaemia, Toxaemias of pregnancy& PPH LBW, Anaemia, Toxaemias of pregnancy& PPH Prevention: Prevention: Direct Intervention Direct Intervention SFP, Iron and Folic acid Tab, Nutrition Edu. SFP, Iron and Folic acid Tab, Nutrition Edu. Indirect Intervention; Indirect Intervention; Immunization, Environmental Sanitation, Immunization, Environmental Sanitation, Clean drinking water, FP Clean drinking water, FP 2 Infection 3 uncontrolled Reproduction