Reproductive Health Care Quiz

Introduction to Family Health

• The presentation is an introduction to family health, presented by Firehiwot Haile (MPH RH).
• The learning objectives include defining family and family health, listing and discussing family health components, discussing characteristics of a healthy family, and discussing determinants of family health.

Definition of Family

• A family is a group of two or more people related by birth, marriage, or adoption, living together in a household.
• It is the smallest social unit in society, focused on its members' replacement and unique to the community's context.
• Different family types exist: nuclear (married couple and children), extended (nuclear plus relatives), and joint (two or more married couples).

Definition of Family Health

• Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1958).
• Family health is the positive interaction among family members, enabling them to achieve optimum physical, mental, and social well-being.
• It is a component of community health and a unit of healthcare.

Major Components of Family Health

• Reproductive health: Safe motherhood (family planning, antenatal care, obstetric care, post-natal care, abortion care, and control of STI/HIV/AIDS), nutritional deficiencies, low birth weight (LBW), reproductive tract infections (RTIs), and infertility. Adolescent health (suicide, depression, and STIs) is also encompassed.
• Child health: Childbearing, rearing, child health services (nutrition, immunization, and growth monitoring), child mortality, and social health problems (child abuse, street children, child labor, juvenile delinquency, and battered baby syndrome).
• Gender issues: Girls trafficking, gender mainstreaming, female genital mutilation (FGM), and female feticide (sex-selective abortion).
• Aging: Problems of aging and active aging.
• Mental health: The state of mental health, its causes and prevention, along with national mental health policy

Characteristics of a Healthy Family

• Commitment: Interdependent parts of a family must work together, support each other and coordinate in order for survival.
• Togetherness: Family members should spend time together participating in activities to foster strong family bonds.
• Appreciation: Mutual admiration and appreciation among family members are essential for a healthy family unit.
• Good communication: Strong communication creates a sense of belonging and strengthens relationships
• Spiritual well-being: Shared faith amongst family members promotes support, patience, forgiveness, and acceptance

Determinants of Family Health

• Socioeconomic factors: Availability of resources to meet daily needs, social norms, attitudes, discrimination, exposure to crime and violence.
• Physical environment: Exposure to toxins, contaminants (air, water, food, and soil) and other hazards are significant determinants of poor health outcomes.
• Health Services: Access to, and quality of, health services significantly impacts health status.
• Genetics: Hereditary diseases (e.g., anemia, hemophilia, and cystic fibrosis) contribute to issues with health status.
• Lifestyle/individual behaviors: Dietary and physical activity practices, hygiene, alcohol consumption, cigarette smoking, and other drug use have an impact on health outcomes.
• Culture: Factors like marginalization, stigmatization, loss or devaluation of language and culture and lack of access to appropriate health care and services are key determinants.

Introduction to Reproductive Health (RH)

• Definition of RH: A "state of complete physical, mental, and social wellbeing" in all matters related to reproductive systems, functions, and processes (ICPD, 1994).
• Components of RH: Sexual health, reproductive freedom (access to information, methods, and services), and safe motherhood (safe/healthy pregnancies, childbirth and healthy Children.)

Sexual Health

• A positive and respectful approach to sexuality and sexual relationships that are free of coercion, discrimination, and violence.
• Sexuality includes aspects like sex, gender identities and roles, sexual orientation and sexual intimacy.
• It acknowledges that sensuality and awareness of one's own body, and others' bodies are crucial aspects of sexuality.

Concept of RH

• Implies a responsible, satisfying, and safe sexual life, as well as successful maternal and infant survival, freedom to control reproduction, and minimization of gynecological diseases throughout life.
• Right to information and access to safe, effective, affordable, and acceptable family planning services, access to appropriate health care services that facilitate safe pregnancies/childbirth, and lead to healthy infant outcomes.
• Equality between men and women and empowering women in reproductive health is fundamental.

Components of RH care

• Quality family planning counseling, information, education, and services (IEC).
• Prenatal, safe delivery, and postnatal care, including breastfeeding.
• Prevention and treatment of infertility and complications of unsafe abortions.
• Safe abortion services (where legal).
• Treatment of reproductive tract infections, other conditions of the reproductive system, counseling on human sexuality, responsible parenthood, and reproductive health, and discouragement of harmful practices.

Youth-Friendly Health Services (YFHS)

• Defined by WHO as services that are accessible, safe, effective, acceptable, and appropriate for adolescents to address their needs, in the right place and at the right price.
• The ideal approach addresses the demands and standards for delivery of quality service in the context of youth health needs.
• This should include characteristics and programming for better youth-based health services,

Maternal Health and Safe Motherhood

• Maternal Health concerns the health of women during pregnancy, childbirth, and the postpartum period.
• It encompasses areas like family planning, preconception care, prenatal care, and postnatal care.
• Women's specific needs, like the prevention and treatment of unwanted pregnancy, and managing complications during and after childbirth, are crucial to ensure a positive and fulfilling experience.

Maternal Morbidity and Mortality

• Maternal Morbidity: Any deviation from physiological or psychological well-being during pregnancy, childbirth, and the postpartum period (up to 42 days or 1 year).
• Maternal Mortality: The death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management.
• Pregnancy-related death: Death of a woman while pregnant or within 42 days of termination, regardless of the cause.
• Important causes of mortality include direct causes like obstetric complications, and indirect causes like existing diseases (e.g., malaria) or complications (e.g., blood infections).
• Late maternal death: A maternal death resulting from obstetric complications, more than 42 days, but less than a year after pregnancy termination.

Global Situation in Maternal Mortality (MM)

• Global MMR: In 2020, 223 deaths per 100,000 live births.
• Ethiopia's MMR: In 2022, 267 deaths per 100,000 live births.
• Trends show a decrease in maternal mortality, highlighting the need for continued efforts in maternal health programs.

Causes of Maternal Mortality

• Direct causes: Obstetric complications, pregnancy, labor and the puerperium, interventions, omissions, incorrect treatment & effects of chains of events. Indirect causes: Existing diseases (e.g., malaria, anemia HIV/AIDS) or complications aggravated during pregnancy

The Road to Maternal Mortality (The Three Delays Model)

• Maternal death results from three key delays: • The first delay: Delay in deciding to seek care for an obstetric complication due to socio-economic factors (e.g., women’s status, literacy, income, employment, workload), culture, values, and beliefs • The second delay: Delay in physically reaching the care facility due to inaccessibility (e.g., difficulty in finding or paying for transportation, lack of available transportation, road conditions etc) • The third delay: Delay in obtaining care once present at the facility due to poor skills of health providers, shortages of supplies, and basic equipment, lack of blood supplies and or operating theaters, or non-availability of health personnel.

Maternal Health Services (Safe Motherhood)

• Comprehensive care before, during, and after pregnancy and childbirth.
• Key strategies to achieve safe motherhood include reducing the number of high-risk and unwanted pregnancies, reducing obstetric complications, and reducing the case-fatality rate in women with complications.
• Components: Preconception care; Antenatal care; Delivery services; Postpartum care; Post-abortion care; Family planning; RH education for Adolescents; Community education on safe motherhood

Antenatal Care

• Aims: To improve maternal and perinatal outcomes through prevention, early detection, and management of complications.
• Best practice: All pregnant women benefit from a minimum of 8 antenatal visits, each lasting at least 20 minutes, covering prevention, early detection, and management of potential complications like anemia, vaginal bleeding, preeclampsia, infection, abnormal fetal growth/position, HIV, syphilis, malaria, and malnutrition, to name a few.

Focused Antenatal Care (FANC)

• A focused approach to ANC characterized by individualized care, client-centered care, fewer but more comprehensive visits, identifying disease, and care provided by skilled providers.
• Goals: Early detection and treatment of problems/complications; Prevention of complications/diseases; Birth preparedness and complication readiness; Health promotion.

WHO's 2016 ANC Model

• The model recommends a minimum of eight contacts: 5 in 3rd trimester, 1 in 1st trimester and 2 in 2nd trimester.
• These contacts are scheduled over specific gestational weeks.

Intra-partum Care

• Aims: Safe and clean delivery.
• Recognition, early detection, and management of complications like hemorrhage, eclampsia, and prolonged/obstructed labor.
• Strategies: All women and birth attendants should be aware of clean delivery practices (clean hands and surfaces.) Health providers should be adequately trained in and practice clean and safe delivery techniques to avoid unnecessary vaginal examinations and episiotomies. Care should promptly refer cases of prolonged or obstructed labor to a higher level of care. All institutional deliveries should be monitored using an adapted partograph.

Institutional Delivery

• To ensure skilled care during childbirth, all deliveries ideally take place in health facilities.
• This allows for prompt treatment of potential complications.

Skilled Attendance at Birth

• Definition: A process of providing adequate care to women during labor, delivery, and the postpartum period.
• This attendance depends on skilled health providers and an enabling environment.

Minimum set of Skills for the Skilled Attendant

• A detailed history, relevant questions, addressing cultural sensitivity and interpersonal skills.
• General examination identifying deviations from normal, and screening for prevalent or endemic conditions.
• Recording of vital signs (temperature, pulse, respiration, blood pressure).
• Calculating the estimated date of delivery.

Postpartum Care

• Comprehensive medical care provided to women after childbirth.
• Focuses on the physical and psychological well-being of the mother and the newborn baby.
• The postpartum period typically lasts 6-8 weeks.
• Primary focus: preventing major complications (haemorrhage, infection, hypertension, sepsis), and supporting breastfeeding.

Post-abortion care

• Emergency treatment for complications of incomplete/potentially life-threatening abortions.
• Comprehensive care including family planning counseling and links between post-abortion emergency services and reproductive health care.
• Essential components include emergency treatment (diagnosis and management of complications), partner counseling/management; family planning counseling and services, and links between post-abortion care and reproductive health system.

Gender and Reproductive Health

• Sex: Biological differences (e.g., genitals, chromosomes, hormones). Gender: Economic, social, and cultural attributes associated with being male or female in a particular social setting at a particular point in time.
• Gender equality: Equal treatment, policies, and access to resources and services.
• Gender equity: Fairness in distributing benefits and responsibilities between men and women.

Family Planning

• Decision-making process by couples (or individuals) to determine the number and spacing of their children.
• Objectives: Limit family size, space children, reduce maternal/child morbidity/mortality related to unwanted/high-risk pregnancies, and help infertile couples conceive.
• Advantages: Reduced maternal/child morbidity/mortality, improved family well-being (better food, clothing, housing and living standards), reduced fertility rates promoting economic development, conservation of natural resources, and decreased dependence of youth.

Family Planning Methods

• Refers to methods or ways to prevent unwanted pregnancy.

Hormonal Contraceptive Methods

• Oral contraceptives (pills): Contain estrogen and progestin, taken daily; immediate effect.
• Injectable contraceptives: Systemic progestin preparations administered by injection, every 2-3 months, effective immediately, reduced need for daily medication, and long-term.
• Implants: Matchstick-sized progestin-filled rods inserted under the skin of the upper arm, provide up to 5 years of protection, highly effective, immediately effective and user friendly.
• Contraceptive patches: Release daily doses of hormones via the Skin, used for 3 weeks followed by one week without a patch.

Contraceptive Patches

• Releases daily doses of hormones (estrogen and progestin) into the bloodstream through the skin.
• Used for 3 weeks, followed by a withdrawal bleed week

Injectable Contraceptives

• Systemic progestin preparations by injection, given every 2-3 months.

Intrauterine Contraceptives Devices (IUDs)

• Small flexible plastic devices inserted into the uterus, with or without copper, preventing pregnancy for years.
• Types: Copper-releasing (e.g., Copper T 380A, Nova-T) and progestin-releasing (e.g., Progestasert, LevoNova).

Surgical Sterilization

• Tubal Ligation: Sealing of fallopian tubes to prevent egg passage.
• Vasectomy: Sealing of vas deferens to prevent sperm transport.

Emergency Contraception

• Methods used to prevent pregnancy following unprotected sexual intercourse.
• Types: Emergency contraceptive pills (ECPs), and Copper releasing IUDs.

Menstrual Cycle and Safe Period

• Ovulation typically occurs 10-16 days before the next menstrual cycle.
• Calculating the safe period involves determining the fertile and infertile days in the menstrual cycle.

Child Health

• Biologically: Child is in developmental stage of childhood, between infancy and adulthood. Health: state of physical, mental, intellectual, social and emotional well-being. Healthy Children grow in families, environments and communities with opportunities to reach their full potential.
• Causes of Child Mortality in Ethiopia; Neonatal causes, pneumonia, diarrhea, malaria, measles, Malnutrition, HIV/AIDS

Child Health Services

• Newborn care, Immunization, Growth monitoring, early detection and treatment of health problems.

Growth and Development

• Process from conception to maturity, orderly sequence in each person.
• Growth: Gradual increase in body size, increase in cell numbers and size.
• Development: Maturation of organs and systems, acquisition of physical, intellectual, and interpersonal skills, ability to adapt to stress, creative expression.

Growth Assessment Parameters

• Weight for age—Growth faltering
• Height for age—Stunting
• Weight for height—Wasting
• Head circumference (average 35cms)
• Mid-upper arm circumference (1-5 years; normal >12 cm)

Vaccine Management System

• Cold chain: Ensuring potency, quality and safety of vaccines by maintaining correct temperature during transport and storage.
• Importance of Cold chain systems: Ensuring potency; Quality of Vaccines; Safety of Vaccines (from Manufacturer to Children/Women)

Vaccination Storage

• National level: Storing Vaccines up to 6 months, using appropriate storage temperatures to preserve Vaccine Potency
• Regional level: Storing Vaccines up to 3 months, and sending Vaccines via appropriate Insulated Containers
• District Level: Storing Vaccines up to 1 month, and sending vaccines via insulated containers
• Health Facility: Storing Vaccines up to 1 month, maintaining storage conditions to preserve Vaccine Potency.

Cold Chain Equipment

• Cold boxes: Transporting vaccines
• Vaccine carriers: Carrying vaccines (16-20) vials.
• Ice packs: Maintaining the cold temperature during storage and transportation.

Tools for monitoring the cold chain

• Cold Chain Refrigerators graph
• Cold chain Monitor Card
• Thermometers: Checking temperatures.
• StopWatch and Freeze Tag cards: Checking storage/ transportation temperatures, for immediate action based on findings.

Vaccine preventable disease surveillance

• Monitoring vaccine effectiveness through randomised field trials; retrospective cohort studies, case control and incidence density measures

HIV/AIDS and Reproductive Health

• Introduction: HIV and AIDS are significant health and development challenges, causing millions of deaths. Current global trends show about 1.5 million new infections.
• Transmission: Sexual contact, direct contact with infected blood or secretions and Mother -to-child transmission;
• Prevention: Primary prevention (ABC/Condoms, Screening); Secondary prevention (ART); and Tertiary Prevention (Psycho-social Support)
• Proposed Treatment target: Aims to provide testing, treatment and Viral suppression by implementing 90-90-90 Treatment Approach
• STI and Syndromic Approach: Identifying and treating common symptoms and potential pathogens in STI's, enabling more inclusive and efficient STI management. Identifying and treating the main pathogens in a community/region will aid in the overall reduction of STI's in the region.

Sexually Transmitted Infections (STIs)

• Introduction: STI is commonly caused by organisms transmitted via sexual contact, poses a significant burden of disease and economic consequences globally.
• Etiology: Caused by more than 30 different pathogens (bacteria, viruses, protozoa), often occurring as mixed infections and are characterised by a variety of symptoms.
• Epidemiological synergy with HIV: Inflammatory STIs and genital ulcers increase HIV acquisition; STIs may increase resistance to HIV treatments. HIV affects susceptibility to STI pathogens leading to difficulties in treatment and spread of infections.
• Approaches to STI management: Etiologic, Clinical, and Syndromic approaches.

Population Dynamics

• Defining a Population as a group of individuals of the same species living and interbreeding in a given geographic area. Population dynamics refer to variations among populations due to births, deaths, and migration.

Measures of Fertility and Reproduction

• Fecundity: Physiological capacity to conceive.
• Infecundity (sterility): Lack of capacity to conceive (primary, secondary).
• Fecundability: Probability of conception during a menstrual cycle.
• Fertility or natality: Manifestation of fecundity.
• Infertility: Inability to bear a live birth.
• Natural fertility: Fertility without deliberate parity control.
• Reproductivity: Extent to which a group replaces itself through natural processes.
• Gravidity: Number of pregnancies.
• Parity: Number of live births from a given woman.
• Birth interval: Time between successive live births.
• Pregnancy interval: Time between successive pregnancies.

Measures of Mortality

• Mortality: Deaths in a population over a given period.
• Crude Death Rate (CDR): Number of deaths per 1,000 population in a given year (a measure of health status of population) .
• Age-specific Mortality Rate (ASMR): Deaths in specified age groups per 1,000 population in the same age group (used for comparing mortality at different ages).
• Infant Mortality Rate (IMR): Number of deaths of infants under one year of age per 1,000 live births.
• Under-five Mortality Rate (<5MR): Number of deaths of children under five years of age per 1,000 children under five years of age (also a measure of health status of population).
• Neonatal Mortality Rate (NNMR): Deaths of infants under one month of age per 1,000 live births (measure of prenatal and obstetric care).
• Post-neonatal Mortality Rate (PNNMR): Deaths of infants between one month and one year of age per 1,000 live births.
• Maternal Mortality Ratio (MMR): Number of maternal deaths related to pregnancy, childbirth, and post-natal complications per 100,000 live births.
• Lifetime risk of maternal death: Calculated by multiplying the maternal mortality rate by the length of woman’s reproductive age.

Questions (page 309)

• Using given data (population, women of reproductive age, number of births, and maternal deaths), calculate the maternal mortality ratio, maternal mortality rate, and lifetime risk of maternal death for country X in a given year.

Measurement of Migration

• Migration: Movement of people from one geographic area to another, crossing pre-defined boundaries.
• Types: Internal (within a country) and international (across borders).
• Measures: Net internal migration (in-migrants - out-migrants); Net international migration (immigrants - emigrants); Gross internal migration; Overall net migration; Immigration rate; and emigration rate