Maternal & Child Health (MCH) Lecture 5 PDF

Primary Health Care Lecture 5 Maternal & Child Health (MCH) Elements of PHC … Reminder 1. 2. 3. 4. 5. 6. 7. 8. Health education. Environmental sanitation & safe water supply. Maternal & child health. Immunization. Proper nutrition. Control of local endemic diseases. Treatment of common diseases...

Primary Health Care Lecture 5 Maternal & Child Health (MCH) Elements of PHC … Reminder 1. 2. 3. 4. 5. 6. 7. 8. Health education. Environmental sanitation & safe water supply. Maternal & child health. Immunization. Proper nutrition. Control of local endemic diseases. Treatment of common diseases & injuries. Provision of essential drugs. Mothers & Children We mean by Mothers & Children: - Women of child bearing age (15 - 49 years). - Children under 15 years of age. Definition The preventive, curative, promotive, and rehabilitative health care for mothers & children. Why MCH is important? • Nearly 72% of population of the developing countries. • They are major consumers of health services. • They are special risk group: o During child bearing in case of women. o During growth in case of infants and children. • Much of morbidity & mortality in this group is preventable. Why They are Considered One Unit? 1. During antenatal period fetus is part of the mother. 2. Certain diseases and conditions of the mother during pregnancy are likely to have effects upon fetus. 3. Child health is closely related to mother health. 4. After birth child dependent upon mother. 5. Many services are given simultaneously to both mother and child like post partum care. 6. The mother is also the first teacher of child. Topics of MCH • Maternity Cycle. • Neonatal Care. • Phys. Changes in pregnancy. • Infant Growth & Development • High Risk Pregnancy. • Toddler Growth & Development. • Maternal Nutrition. • Pre-school Child G & D. • Antenatal Care. • School Child G & D. • Intranatal Care. • Adolescent G & D. • Postnatal care. • MCH Indicators. Objectives of MCH 1. Reduction of maternal, perinatal, infant and childhood mortality & morbidity. 2. Promotion of reproductive health. 3. Promotion of physical and psychological development of the child and adolescent within the family. Major Mother Problems 1. Malnutrition. 2. Infection. 3. Uncontrolled reproduction: increase probability of:      Increased prevalence of low birth weight. Anemia. Abortion. Antepartum hemorrhage. High maternal and perinatal mortality. Major Child Problems 1. Low birth weight. 2. Malnutrition. 3. Infections & parasitic Infestations. 4. Accidents & poisoning. 5. Behavioral problems. Assessment of MCH MCH status is assessed through: 1. Mortality (most common & most important), 2. Morbidity, 3. Growth & Development. Commonly Used Mortality Indicators I. Maternal Mortality Ratio (MMR). II. Mortality in infancy and childhood: 1. Perinatal mortality rate. 2. Infant mortality rate. A. Neonatal mortality rate. B. Post neonatal mortality rate. 3. 1-4 mortality rate. 4. Under 5 mortality rate. 5. Child survival index. Maternal Mortality Ratio (MMR) Death of a female while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes / number of live births.  Global: 211/100,000 Live Birth.  KSA: 17/100,000 Live Birth (year 2017). Main Causes of Maternal Mortality • Hemorrhage 38% • Sepsis 11% • Abortions 8% • Hypertension 5%. • Obstructed labor 5% Medical Causes Obstetric Causes Toxemia (HPT) Hemorrhage Infection Obstructive labor Unsafe abortion Non Obstetric Causes Anemia Associated diseases: cardiac, renal, diabetes. Infection Malignancy Accidents Social Risk Factors • Age at first child birth. • High Parity. • Too close pregnancies. • Family size • Malnutrition • Poverty. • Illiteracy. • Ignorance. • Delivery by untrained persons. • Poor communication & transport facility. • Social customs. • Poor environmental sanitation. Preventive Measures to Reduce MMR • • • • • • • • • • • Early registration of pregnancy Monthly check up. If not possible, at least 3 antenatal visits. Dietary supplements: iron & folic acid. Prevention of infection & hemorrhage during labor. Prevention of complications e.g. Eclampsia & ruptured uterus. Treatment of medical conditions Clean delivery practices. Promotion of institutional delivery. Training to local midwives. Promotion of family planning. Identification of every maternal death and its causes. Mortality around Infancy Beginning of Pregnancy Fetal Death Still birth Perinatal death Neonatal death Post neonatal death Infant death End of 28 weeks of pregnancy Birth End of 7 days End of 28 days End of 1 year Fetal Death Fetal death: Death prior to complete expulsion or extraction from its mother of a product of conception, irrespective of duration of pregnancy. Still birth rate: death of fetus weighing 1000 gm (which is equal to 28 weeks of gestation) or more, occurring during one year / 1000 total births (live + dead). Causes: - Infection. - High Blood Pressure. - Diabetes - RH incompatibility. - Premature rupture of membranes. Perinatal Mortality Rate Includes late fetal deaths (28 weeks gestation or more) and early neonatal deaths (7 days) in one year / live births. Babies minimum weight should be 1000 gm or body length crown to heal of at least 35 cm. Risk factors: • Maternal age > 35 or <16 • High parity (with short intervals between pregnancies) • Heavy smoking. • Malnutrition • Severe anemia • Infections Causes of Perinatal Mortality Antenatal causes: • Pelvic diseases: e. g.; tumors. • Anatomical defects: e. g.; uterine anomalies. • Endocrine imbalance • Blood incompatibilities • Malnutrition • Toxemia of pregnancy • Ante partum hemorrhage • Congenital defects. Intra-natal causes: • Birth injuries. • Asphyxia. • Obstetric complications. Postnatal causes: • Prematurity. • Respiratory distress syndrome. • Infection • Congenital anomalies. Infant Mortality Rate (IMR): A. Neonatal mortality rate. B. Post neonatal mortality rate. Neonatal Mortality Rate (NMR) Number of deaths of children < 28 days of age in a year × 1000 Total number of live births in same year • NMR is more in boys as they are biologically more fragile than girls. • NMR in Saudi Arabia: 3.7 /1000 live births (year 2019). Main Causes of Neonatal Mortality • Low birth weight & prematurity. • Birth asphyxia. • Atelectasis. • Birth injuries. • Congenital malformation. • Infections (neonatal tetanus, diarrhea). Post neonatal Mortality Rate Number of deaths of children between 28 days to 1 year of age in a year × 1000 Total number of live births in same year • Exogenous factors are more responsible. • Girls die more frequently than boys because of neglect of female children in terms of nutrition and health care. Main Causes of Post Neonatal Mortality • Birth injury & difficult labor • Congenital anomalies. • Acute Respiratory Infections (ARI). • Diarrhea • Malnutrition. • Accidents. Infant Mortality Rate (IMR) Number of deaths of children < 1 year × 1000 Total number of live births in the same year IMR indicates: • Health status of community. • Level of living. • Effectiveness of MCH services. IMR is given a separate treatment because: • It is largest single age category of mortality. • Deaths are due to peculiar set of disease and conditions. • It is affected quickly by special health program. Reasons of Low IMR in Developed Countries • Improved quality of life. • Improved perinatal care. • Better control of communicable diseases. • Advances in chemotherapy. • Better nutrition, emphasis on breast feeding. • Family planning. Factors Affecting IMR Biological Factors: • Birth weight. • Age of mother. • Birth order. • Birth spacing. • Multiple births. • Family size. Cultural & Social Factors: • Breast feeding • Early marriage • Sex of child • Economic factors (poverty) • Maternal education • Quality of health care • Broken families • Illegitimacy • Brutal habits and customs. • Bad sanitation. Preventive Measures • • • • • • • • • Prenatal nutrition. Prevention of infection - Immunization. Breast feeding. Growth monitoring. Family planning. Sanitation. PHC- high risk approach. Socioeconomic development. Education. 1 - 4 Years Mortality Rate Number of deaths of children aged 1 - 4 years in a year × 1000 Total number of children aged 1 - 4years in the middle of year • It is more refined indicator of social situation of country than IMR. • It reflects environmental health hazards. Causes in Developing countries: Diarrhea, Acute Resp. Inf., Malnutrition, Infectious diseases, accidents. Causes in Developed countries: Accidents, Congenital anomalies, Malignancies, Influenza, Pneumonia. Under Five Mortality Rate UNICEF considers it as the best single indicator of social development and well being as it reflects income, nutrition, health care and basic education. • In developed countries: 7 /1000 Live Births. • In developing countries: 90 /1000 Live Births. • In Saudi Arabia: 6.6/ l000 live births (2019). Child Survival Index (CSI) CSI = (1000 – Under 5 mortality rate) /10 CSI of Saudi Arabia = (1000 – 6.6) / 10 = 99.34 %