Med 306 Famcom (Maternal, Newborn, Child Health and Nutrition) PDF

MODULE 3.02 MNCHN (MATERNAL, NEWBORN, CHILD HEALTH and NUTRIOTION) 1st Semester | S.Y. 2022-2023 | Date: November 16, 2022 LECTURER: Dr. NELSON HORA MODULE OUTLINE Maternal mortality and infant...

MODULE 3.02 MNCHN (MATERNAL, NEWBORN, CHILD HEALTH and NUTRIOTION) 1st Semester | S.Y. 2022-2023 | Date: November 16, 2022 LECTURER: Dr. NELSON HORA MODULE OUTLINE Maternal mortality and infant mortality are the § MNCHN (MATERNAL, NEWBORN, CHILD HEALTH and reflection of the efficiency of a healthcare NUTRIOTION) system of a country. At this modern time and § FACTORS CONTRIBUTING TO MATERNAL AND with sophisticated technology there should be NEONATAL DEATHS no death due to pregnancy and delivery. § MNCHN CORE PACKAGE OF SERVICES § DOH MATERNAL CARE PACKAGE PHILIPPINES SITUATION § POSTPARTUM PERIOD § ESSENTIAL ANTENATAL CARE FOR PREGNANT 14 million Filipino women in the reproductive WOMEN age group (15-49y/o) § TREATMENT OF MATERNAL INFECTIONS - MALARIA o 9 million are married or have partners § TREATMENT OF MATERNAL INFECTIONS - SYPHILIS o 6 million are considered to be at risk if they § ESSENTIAL CARE FOR NEWBORNS become pregnant because MNCHN (MATERNAL, NEWBORN, CHILD HEALTH § They are either too young (less than 20 y/o) and NUTRIOTION) § Too old (more than 35 y/o) DOH Administrative Order (A.O.) 2008-0029 § Have more than four pregnancies o Implementing Health Reforms for Rapid § Have too close or unspaced Reduction of Maternal and Neonatal pregnancies (less than 15 months) Mortality” § Too sick, mostly anemic or o Provides the strategy for rapidly reducing underweight maternal and neonatal deaths through the Average fertility rate – 3.7 (*number of children prevision of a package of maternal, per woman) newborn child health and nutrition 2.3 million women are expected to get pregnant (MNCHN) services. every year. o Minimum health services that we should o Two million of those who become pregnant provide to our mothers and newborn. will deliver. The strategy aims to achieve the ff. Lifetime risk of dying from maternal causes to intermediate results: Filipino women of reproductive age = 1:120 1. Every pregnancy is wanted, planned and 14% of death among women of reproductive supported. Pregnancy should be a happy age is due to maternal causes moment MMR- slow decline 2. Every pregnancy is adequately managed o 209/100,000 LB (1990) throughout its course from conception up to o 162/100,000 LB (2006) the birth of the child. Conception meaning Decline in UFMR and IMR bot not in NMR it should have been planned o UFMR 3. Every delivery is facility-based and § 61/1000 lb IN 1990 managed by skilled birth attendant/skilled § 32/1000 lb IN 200 health professionals. o IMR 4. Every mother and newborn pair secures § 42 % 1990 proper post-partum and newborn care with § 26% 2006 smooth transitions to the women’s health § A reflection of mother’s health when care package for the mother and child she was pregnan survival package for the newborn. o NMR *UFMR- Under five mortality rate; IMR-Infant mortality § 17/1000 LB in 2006 rate; NMR- Neonatal mortality rate; MMR- maternal § In 2000-2003, newborn death mortality rate accounted for 37% of all UFMR. Most EPIDEMIOLOGY neonatal death occur within the first 2 wks. after birth, half of which occur in Pregnancy related death worldwide: the first 2 days of life. 500,000/yr. o 99% from developing countries FACTORS CONTRIBUTING TO MATERNAL AND § MMR(WHO) 400/100,000 pop NEONATAL DEATHS o Compounded by 1. Mistimed, unplanned, unwanted and § High fertility unsupported pregnancy § Poor nutritional status 2. Not securing adequate care during the course of § Lack of basic health services pregnancy Infant mortality – 7.1 million/yr. 3. Delivering without being attended to by skilled o 50% die in the first 28 days after birth – the health professionals and lack of access to neonatal period emergency obstetric and newborn services § 75% die in the 1st week after birth 4. Not securing proper postpartum and newborn Majority of these maternal and newborn deaths care for the mother and her newborn, are preventable with currently available respectively. technologies TRANSCRIBERS: CAISO | KELLY | LIM-ANG and Neuro group // proofread by Pediaaa Page 1 of 7  MODULE 3.02 MNCHN (MATERNAL, NEWBORN, CHILD HEALTH and NUTRIOTION) 1st Semester | S.Y. 2022-2023 | Date: November 16, 2022 LECTURER: Dr. NELSON HORA MNCHN CORE PACKAGE OF SERVICES o Know estimate schedule of delivery 1. Pre- pregnancy DANGER SIGNS OF PREGNANCY 2. Pregnancy o Vaginal bleeding 3. Delivery o Severe abdominal pain 4. Post-partum o Looks very ill/ fever 5. Newborn care o Severe headache with visual disturbance 6. Child care (eclampsia/pre-eclampsia) o Severe breathing difficulty MATERNAL CARE o Severe vomiting Focuses on the child-bearing function of the o Unconscious/convulsion woman. PREGNANT WOMEN ARE RISK IF: Goal: o Too young, old o Promotion of safe motherhood and women’s o Too many health, and to ensure healthy newborn. o Too soon o Too sick PRIMARY CAUSES OF MATERNAL MORTALITY PRENATAL CARE Direct causes: o THEN: Risk Scoring and Prediction o Severe bleeding o NOW: Recognize that every pregnancy is at o Infection risk o Consequences of unsafe abortions o Promotion and support to breastfeeding and o Hypertensive disorders such as pre- management of breast complications eclampsia and eclampsia o H.E, Counselling and Family Planning o Obstructed labor Services Indirect causes: o STD/HIV prevention and management o Anemia o Dental care o Malaria PARADIGM SHIFT: o Poverty o Every pregnancy faces risks o Race, ethnic or tribal affiliation REMEMBER: Once a woman is pregnant most o Lack of education serious complications cannot be predicted or § WHO. 1999. “Reduction of maternal prevented, but they can be treated. mortality. A joint Home deliveries are highly discouraged WHO/UNFPA/INOICEF/World Bank 2. NUTRITION INCLUDING VITAMIN A, IRON, statement.” FOLATE SUPPLEMENTATION MAJOR DISABILITIES FROM PREGNANCY & 50.3% anemic pregnant women CHILDBIRTH COMPLICATIONS 46% anemic lactating mother SEVERE Anemia, Infertility, Hormonal 3. TETANUS TOXOID BLEEDING damage INFECTION PID, chronic pelvic pain, Vaccine Minimum Duration of reproductive organ damage, Interval Protection infertility T1 At first NIL-no protection OBSTRUCTED Incontinence, fistula, genital contact with OR PROLONGED prolapse, uterine rupture, woman 15- LABOR nerve damage 49 years or PREGNANCY- Precursor to chronic at first AP INDUCED hypertension, kidney failure, visit HYPERTENSION nervous system problems TT2 At least 4 Infants born to UNSAFE PID, chronic pelvic pain, weeks after the mother will be ABORTION reproductive organ damage, TT1 protected from reproductive tract infection, neonatal tetanus infertility 3 years of Lori Ashford 2002. Hidden Suffering: Disabilities from protection for the pregnancy and childbirth in Less Dev Countries. ORB mother TT3 At least 4 Infants born to DOH MATERNAL CARE PACKAGE months after the mother will be 1. ANTENATAL REGISTRATION TT2 protected from AP VISITS: minimum is at least 3 visits neonatal tetanus 1st trimester – 1 visit 5 years of 2nd trimester – 1 visit protection for the 3rd trimester - 2 visits mother Why prenatal check-up? TT4 At least 1 Infants born to o Prepare and cope with the pregnancy year after the mother will be o Early detection and treatment of illness TT3 TRANSCRIBERS: CAISO | KELLY | LIM-ANG and Neuro group // proofread by Pediaaa Page 2 of 7  MODULE 3.02 MNCHN (MATERNAL, NEWBORN, CHILD HEALTH and NUTRIOTION) 1st Semester | S.Y. 2022-2023 | Date: November 16, 2022 LECTURER: Dr. NELSON HORA protected from B. DELAY IN IDENTIFYING AND REACHING neonatal tetanus THE APPROPRIATE HEALTH FACILITY 10 years of Distance: woman’s home to facility protection for the Lack of roads/poor condition of roads mother Not aware of existing services/no referral TT5 At least 1 Infants born to system year after the mother will be Lack of communication with referral facility TT4 protected from Lack of moral, financial/logistics, support from neonatal tetanus neighbors/Punong barangay, Barangay officials Lifetime and others protection for the C. DELAY IN RECEIVING APPROPRIATE AND mother ADEQUATE CARE AT THE HEALTH FACILITY 4. TREATMENT OF EXISTING DISEASES Lack of health care worker Non-professional attitude of health workers Eg. Anemia, Diabetes and heart diseases Shortage of supplies/medicines/blood 5. RECOGNITION, EARLY DETECTION, MGMT Poor skills of health care workers OF COMPLICATIONS BEFORE, DURING, Health is not a priority of the LGU/Officials DELIVER=Y AND POST PARTUM Lack of budget from the LGU PRENATALS: 6. CLEAN AND SAFE DELIVERY o Urinalysis SKILLED BIRTH ATTENDANTS o Hemoglobin/Blood typing o Emergencies are best handled by skilled o VDRL for STD/Hep. B Screening, HIV hands such as doctors, nurses, and Screening midwives o DEWORMING: 2nd Trimester-safe to be given because deworming drugs are POSTPARTUM PERIOD luminal. Time Things to do WHAT IS A BIRTH PLAN? - discussed during 24 hrs after delivery Postpartum (Pp) are prenatal period visited/assessed o Document prepared during the prenatal -can be discharged if care which states the woman’s condition uncomplicated delivery during pregnancy 1 week after delivery 2nd visit to facility o Her preference for place of delivery Within a month after Pp are given vit a o Choice of birth attendant delivery 200,000iu o Her available resources for her childbirth supplementation and newborn baby such as Phil health At least 3 months Pp are given feso4 o Preparations needed should an emergency To be able to regain situation arise during pregnancy, strength and to be able to childbirth and postpartum continue breastfeeding o Also includes: Family planning Pp are counseled to start § Transportation to be used within 6 weeks their family planning § Baby’s and Mother’s clothing and other needs NEWBORN CARE § Possible blood donors Epidemiology: § Who will accompany the pregnant a. Neonatal mortality: death