Maternal, Newborn, and Child Health and Nutrition Strategy PDF

NOTRE DAME OF TACURONG COLLEGE COLLEGE OF NURSING Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines Telephone No.: (064) 200-3631 Fax No.: (064) 200-4131 Subject: Community Health Nursing 1 Course Credit: 2 units...

NOTRE DAME OF TACURONG COLLEGE COLLEGE OF NURSING Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines Telephone No.: (064) 200-3631 Fax No.: (064) 200-4131 Subject: Community Health Nursing 1 Course Credit: 2 units lecture;1unit RLE Placement: First Semester, BSN 2 Clinical Instructor: Shalom Faith Tingzon, RN,RM Maternal, Newborn, and Child health and Nutrition Strategy OBJECTIVES: at the end of the lesson, the students must have: 1. Explained the four key strategies of MNCHN, highlighting their significance in improving healthcare for women, newborns, and children. 2. Described the intermediate goals of MNCHN, focusing on ensuring wanted pregnancies, proper pregnancy management, facility-based deliveries, and postpartum care. 3. Identified and explain the components of the MNCHN core package of services, with a particular emphasis on the prepregnancy package. 4. Discussed the importance of promoting a healthy lifestyle, family planning, and preventive measures in MNCHN, including nutrition, exercise, and disease management. Maternal, Newborn, and Child health and Nutrition Strategy Four Key Strategies of MNCHN 1. Ensuring universal access to and utilization of MNCHN core package services and interventions directed not only to individual women of reproductive age and newborns at different stages of the life cycle. 2. Establishment of a service delivery network at all levels of care. 3. Organized use of instruments for health systems development 4. Rapid build-up of institutional capacities of DOH and PhilHealth. MNCHN aims to achieve the following intermediate results: 1. Every pregnancy is wanted, planned, and supported 2. Every pregnancy is adequately managed throughout its course. 3. Every delivery is facility-based and managed by skilled birth attendants or skilled health professionals. 4. Every mother-and-newborn pair secures proper postpartum and newborn care with smooth transition to women’s health care package for the mother and child survival package for the newborn. Three levels of care in the MNCHN service delivery network 1. Community level service providers or community health care team. TWO BASIC FUNCTIONS Navigations functions Basic Delivery functions 2. A BemONC-capable facility 6 signal obstetric function (Basic Emergency Obstetric and Newborn Care) 1. Parenteral administration of oxytocin in the third stage of labor 2. Parenteral administration of loading dose of anticonvulsant 3. Performance of assisted deliveries (imminent breech delivery) 4. Removal of retained products or conception 5. Manual removal of retained placenta 6. Emergency newborn interventions Newborn resuscitation Oxygen support 3. A CEmONC- capable Facility (Comprehensive Emergency Obstetrics and Newborn Care) Can perform the six-signal function as in BEmONC CS delivery services Blood blanking and transfusion services Other highly specialized obstetric interventions. Reproductive Health Reproductive health involves a person's overall well-being, which includes their physical, mental, and social health. The World Health Organization (WHO) defines it as the state of complete physical, mental, and social well-being regarding one's reproductive system and its functions. Reproductive Health Care Reproductive health care encompasses a range of methods, services, and techniques to maintain an individual's health throughout their reproductive life. It plays a crucial role in preventing and addressing issues related to reproductive health. The Magna Carta of Women (RA 9710) Enacted in 2009, the Magna Carta of Women is all about ensuring health services that respect cultural and gender diversity. It covers all stages of a woman's life and aims to reduce health problems faced by women. Republic Act 10354 (RPRH Law): Republic Act 10354, also known as the Responsible Parenthood and Reproductive Health Law, was signed into law in 2013. This law recognizes and guarantees the rights of individuals to sustainable development, health, education, and information. It emphasizes the right to make choices based on one's beliefs and values. The Reproductive Health Program of the Philippines The program takes a client-centered approach and recognizes that reproductive health is a concern for people of all ages. It focuses on providing services based on individual needs rather than following a one-size-fits-all approach. Local governments are encouraged to offer these services, and the personnel providing them should have the required competence. The reproductive health program of the Philippines adopts the life-span approach. It recognizes the fact that RH is a concern that affects different age brackets. 10 elements of reproductive health care 1. Family planning 2. Maternal and child health and nutrition 3. Prevention and control of reproductive tract infections, STIs and HIV/AIDS 4. Adolescents reproductive health 5. Prevention and management of abortions and its complications 6. Prevention and management of breast and reproductive tract cancers and other gynecological conditions. 7. Education and counseling on sexuality and sexual health 8. Men’s reproductive health and involvement 9. Prevention and management of violence against women and children 10. Prevention and treatment of infertility and sexual dysfunction THE PHILIPPINE FAMILY PLANNING PROGRAM (PFFP) The Family Planning program started in the 1970s as a family planning service delivery component to achieve fertility reductions. FP is means to prevent high- risk pregnancies brought about by the following conditions. 1. Being too young(less than 18 years old) or too old ( over 35 years old) 2. Having had too many (4 or more) pregnancies 3. Having closely spaced (too close) pregnancies (less than 36 months) 4. Being too ill or unhealthy/ too sick or having an existing disease or disorder like iron deficiency anemia. Four Pillars of PFFP The guiding principles of the FP program also called the four pillars of the (PFFP) are as follows. 1. Responsible parenthood 2. Respect for life 3. Birth spacing 4. Informed choice Four Pillars of Family Planning Program Responsible Parenthood - Nurture with love and care Birth Spacing - 3-5 years. Respect for life - Protection against abortion Informed choice - Freedom to choose what method they want to use Client counseling and assessment 1. Counseling must be based on client’s needs; the following are essential content of the nurse- client interaction regarding the chosen method 1. Effectiveness 2. Advantages and disadvantages 3. Possible side effects, complications and signs that require an immediate visit to the health facility. 4. How to use the chosen method 5. Prevention of STIs 6. When to return to the health facility Benefits of Family Planning Benefits to mothers 1. Enables her to regain her health after delivery 2. Gives enough time and opportunity to love and provide attention to her husband and children 3. Gives more time for her family and own personal advancement 4. When suffering from an illness, gives enough time for treatment and recovery Benefits for children 1. Lightens the burden and responsible in supporting his family 2. Enables him to give his children their basic needs 3. Gives him time for his family and own personal advancement Family Planning Methods  Antenatal Care Services OBJECTIVES: at the end of the lesson, the students must have: 1. Identify the Antenatal care services 2. Identify and explained the program include health and nutrition services provided at different stages. 3. Explain the Republic act 11148 4. Defined Bantay Buntis and explained prenatal visit. II. Course Content Antenatal care services (first 270 days) Republic act 11148, known as “kalusugan at nutrition ng Mag-Nanay act”, focuses on scaling up the national and local nutrition programs through a strengthened integrated strategy for maternal, neonatal childbirth health and nutrition in the first one thousand (1,000) days of life. 1.Pregnancy Tracking and Enrollment to Antenatal Care (ANC) ✔ Antenatal care (ANC) is defined as the care provided by skilled health professionals to prevent women and adolescent girls to ensures the best health conditions for both mother and the baby during pregnancy. (World health Organization, 2016). ✔ This visit is important because it helps reduce maternal and perinatal and mortality both directly, through detection and treatment of pregnancy-related complication, and indirectly. Through the identification pf women and girls at increased risk of developing complication during labor and delivery. ✔ In 2016, the WHO recommended eight ANCE visits instead of the four ANC visits to achieve a positive pregnancy experience instead of the four ANC visits proposed in the WHO Focuses Antenatal Care Model in 2002. ✔ The Philippines has yet to adopt this guideline, but in 2018, the Safe Motherhood Program began drafting implementation guidelines for ANC to strengthen Administrative Order (AO) 2016. ✔ The National Policy on the Provision of Quality Antenatal Care in Birthing Centers and Health Facilities Providing Maternal Care Services. ✔ The tracking of pregnancies in the community by barangay health workers (BHWs) is one of the factors that influence women to seek ANC consultation. ✔ Bantay Buntis, a practice at the regional level by organized communities with indigenous people, ensure pregnant women avail of professional assistance throughout pregnancy, delivery and postpartum.  ANTE-NATAL VISIT ✔ The first antenatal visit should be done as soon as possible once pregnancy is suspected. ✔ The second and third visits, should be done during 2nd and 3rd trimester respectively. ✔ After 8 months of pregnancy, mother should have their prenatal visits every two weeks until the baby is delivered. The prenatal visits is composed of several activities, including: a. Health History - It is primarily done to determine obstetric profile the Gravida, Parity, Term, Preterm, Abortion, and Living (GPTPAL), Expected Date of Confinement (EDC), and Age of Gestation (AOG). - Potential risk factors such as: ✔ Age < 18 years old or > 35 years old ✔ Height less than 145 cm (4’9”) ✔ Multiparous women (having fourth or more baby) ✔ One or more of the following: a previous cesarian, 3 consecutive miscarriages or stillborn baby, and/or postpartum hemorrhage. ✔ One or more of the following medical conditions: tuberculosis, heart disease, diabetes, bronchial asthma, or goiter. b. Prenatal Assessment. - The physical examination includes GTPAL, EDC, AOG, weight and height, fundic height measurement, Leopold's Maneuver, fetal heartbeat, and movement. - Laboratory examinations are conducted like complete blood count with platelet, blood typing and Rh factor determination, urinalysis (Benedict's sugar and acetic acid tests-albumin), screening test for sexually transmitted infection, blood sugar screening (FBS, OGTT, HbA1c), pregnancy test, ultrasound, cervical cancer screening test using acetic acid wash and Papanicolaou smear. - Danger sign during pregnancy include: ✔ Headache ✔ Blurring of vision ✔ Dangerous fever (Temperature > 38 degree Celsius) ✔ Severe difficulty of breathing ✔ Abdominal pain ✔ Burning on Urination ✔ Vaginal Bleeding c. Birth Preparation and Emergency Plans. - This component focuses on promoting birth planning and facility-based delivery. Moreover, the Mother Baby Booklet and Birth Plan should be used to indicate the mother’s plan of care during labor and delivery, including her preferences of birth attendant and available resources for childbirth and newborn care. The basic contents of the birth plan: ✔ Place of delivery and method of transportation ✔ Person or personnel to assist her during delivery. ✔ Expectations during labor and delivery ✔ Materials to prepare and estimated cost of delivery ✔ Possible blood donors and where the mother will be referred in case of emergency 2. Diphtheria Tetanus Toxoid Immunization ✔ Diphtheria Tetanus (DT) Toxoid Immunization involves the intramuscular administration of 0.50mL diphtheria tetanus toxoid at the deltoid muscle. ✔ Two doses of the toxoid provide protection to the baby against neonatal tetanus through natural passive immunity, while a single dose offers protection only to the mother by artificial active immunity. ✔ A mother who received the complete five (5) doses of diphtheria tetanus is called a fully immunized mother. ✔ As per Administration Order No. 15, the schedule for the diphtheria tetanus toxoid immunization. 3. Consumption of Iodized Salt 4. Micronutrient and Macronutrient Supplement ✔ Micro- and Macronutrient supplementation primarily focus on addressing nutrient deficiencies namely: iron deficiency anemia, vitamin A deficiency, iodine deficiency disorder, and macronutrient deficiencies. a. Iron deficiency Anemia - A risk factor for neural tube defect such as spina bifida and anencephaly. Iron deficiency anemia both supplemental iron and folic acid alongside vitamin C-rich food for better absorption. However, mothers should be informed of the potential side effect which includes teeth and stool discoloration. Aside from supplementation, natural sources of iron and folate should be ingested such as red meat, liver, and green leafy vegetables. b. Vitamin A Deficiency. -This deficiency is mitigated through the ingestion of supplemental Vitamin A at the start of the second trimester until postpartum period. Vitamin A supplementation is not given during the first trimester since it is a teratogen and may lead to fetal deformities or even fetal demise. c. Deficiency Disorder. - This deficiency may lead to congenital hypothyroidism and cronyism not prevented. Hence, children should receive supplementation at least once a year. d. Macronutrient Supplementation. - Calcium supplementation is recommended for the prevention of preeclampsia in pregnant women particularly among those at risk of developing hypertension. Preferably, it should be taken at mealtime from 20 weeks gestation until the end of pregnancy. - Women are regarded as at risk of developing gestational hypertension and preeclampsia if they have one or more of the following risk factors: ✔ obesity previous preeclampsia ✔ diabetes ✔ chronic hypertension ✔ renal disease ✔ autoimmune disease ✔ nulliparity ✔ advanced maternal age ✔ adolescent pregnancy, and ✔ conditions to hyperlactation and large placentas as in as of twin pregnancy. Early Identification and Management of Nutritionally At-Risk Pregnant Client The nutritional status of the Philippines is monitored and targeted by the Nutrition Program which is legally embedded in Presidential Decree. 491, which declared July as the Nutrition Month and created the Nutrition Council, and the LOI 441 or the Integration of Nutrition Education in the school curriculum. The program is composed of nutritional assessment methods evaluating the anthropometric measurements, biochemical or laboratory parameters, chemical indicators, dietary history, and health history of the patient. Different anthropometric measurements are evaluated among patients: ✔ weight-for-age ✔ height-for-age ✔ body mass index ✔ mid-upper arm circumference, and ✔ skin-fold thickness. 5. Counselling on maternal nutrition breastfeeding and rooming-in, appropriate infant and young child feeding practices. 6. Assessment of risk for parasitism and provision of anti-helminthic medicines 7. Provision of oral health services including oral health assessment 8. Counseling on proper handwashing environmental sanitation and personal hygiene’ 9. Counselling on nutrition, smoking cessation, and adoption of healthy lifestyle practices 10. Philippine Health Insurance Corporation (PhilHealth) enrollment and linkages to facility and community-based health and nutrition workers and volunteers 11. Social welfare support to improve access to health and nutrition services, such as, but not limited, to dietary supplementation, healthy food products and commodities for nutritionally at-risk pregnant women belonging to the poorest of the poor families including those with disabilities 12. Maternity protection during pregnancy 13. Counselling and support to parents and caregivers on parent/caregiver-infant/child interaction for responsive care and early stimulation for early childhood. 14. Provision of counselling and psychological support to parents and caregivers III. References Nies, M., & McEwen, M. (2020 C.E.). Community health and Public Health Nursing (2nd ed.). Elsevier.