MOTHER AND CHILD HEALTH

CARE PROGRAM

Submitted to – Dr. Jyoti Hiremath SUBMITTED BY PRIYA

Lecturer GARG[43]
Dept of swasthvrita
 MCH

• The term "maternal and child health" refers to the promotive , preventive,
curative and rehabilitative health care for mothers and children. It includes the
sub-areas of maternal health, child health, family planning, school health,
handicapped children and health aspects of care of children in special settings
such as day care.

• Objectives of MCH programme:-

• Reduction of maternal, perinatal, infant and childhood mortality and morbidity.
• 2. Promotion of reproductive health.
• 3. Promotion of the physical and psychological development of the child and
adolescent within the family.
 COMPONENTS OF MCH SERVICES

• 1. Maternal health.
• 2. Child health.
• 3. Family planning.
• 4. School health.
• 5. Handicapped children.
• 6. Care of children in special settings such as day care.

Maternal health:-
It includes antenatal,
intranatal and postnatal care.
 ANTENATAL CARE

• The primary aim of antenatal care is to achieve a healthy mother and a healthy
baby at the end of a pregnancy. Ideally this care should begin soon after
conception and continue throughout pregnancy.

• Objectives of antenatal care –

• 1. To promote, protect and maintain the health of the mother during
pregnancy.
• 2. To detect "high-risk" cases and give them special attention.
• 3. To foresee complications and prevent them.
• 4. To remove anxiety associated with delivery.
• 5. To reduce maternal and infant mortality and morbidity.
• 6. To teach the mother elements of child care, nutrition, personal hygiene, and
environmental sanitation.
• ANTENATAL VISIT:-
• FIRST VISIT:-WITHIN 12 WEEKS
• 2ND VISIT:-BETWEEN 14 TO 26 WEEK
• 3RD VISIT:-28 TO 34 WEEK
• 4TH VISIT:-B/W 36 WEEKS AND TERM
 INTERVENTIONS AN D
COUNSELLING
1. Iron and folic acid supplementation and medication as needed.
2. 2. Immunization against tetanus.
3. 3. Group or individual instruction on nutrition, family planning, self-care,
delivery and parenthood.
4. 4. Home visiting by a female health worker/trained dai.
5. 5.Inform the woman about Janani Suraksha Yojana and other incentives
offered by the government
 HOME V ISITS AND ADVICE S

• Home visiting is the backbone of all MCH services. Even if the expectant
mother is attending the antenatal clinic regularly, it is suggested that she must
be paid at least one home visit by the Health Worker Female or Public Health
Nurse.
• More visits are required if the delivery is planned at home.
• Prenatal advice
• 1. A balanced and adequate diet should be taken during pregnancy and lactation
to meet the increased needs of the mother, and to prevent "nutritional stress".
• 2. Personal hygiene.
• 3. 8 hours sleep, and at least 2 hours rest after mid-day meals should be
advised.
• 4. Constipation should be avoided by regular intake of green leafy vegetables,
fruits and extra fluids.
• 5. Light household work is advised.
 INTRA NATAL CARE

• The aims of good intranatal care are:

• 1. Maintain the asepsis during intranatal care by using sterilized
instruments, cord clamp, gloves etc.
• 2. Delivery with minimum injury to the infant and mother.
• 3. Readiness to deal with complications such as prolonged
labour , antepartum haemorrhage , convulsions, prolapse of the
cord, etc.
• 4. Care of the baby at delivery resuscitation, care of the cord,
care of the eyes, etc
 DOMICIL IARY CARE
• In the case of mothers with normal obstetric history, the d delivery may be conducted by the Health
Worker Female or trained dai. This is known as "domiciliary midwifery service.“

• Advantages :-
• 1. The mother delivers in the familiar surroundings of her home and this may tend to remove the fear
associated with delivery in a hospital.
• 2. The chances for cross infection are generally lower at home than in the hospital.
• 3. The mother is able to keep an eye upon her children and domestic affairs which may release her
mental tension .

• Disadvantages of domiciliary midwifery:

• 1. The mother may have less medical and nursing supervision than in the hospital.
2. The mother may have less rest.
3. Resume her domestic duties too soon.
4. Her diet may be neglected.
In India, domiciliary care is a major component of intranatal health care because of more than 75% of
population live in rural areas, most deliveries will have to take place in the home. If there is any "danger
signal," the Female Health Worker or dai are advised to refer the mother to the nearest Primary Health
Centre or Hospital
 POSTNATAL CARE
• Care of the mother and the newborn after delivery is known as postnatal or
postpartal care.

• The objectives of postnatal care are:

• 1. To prevent complications of the postnatal period.
• 2. To provide care for the rapid restoration of the mother to optimum health.
• 3. To check adequacy of breast-feeding.
• 4. To provide family planning services. Complications due to post
natal period:-
1.Puerperal sepsis
2.Secondary haemorrhage
3.UTIs etc.
• Care of children • Neonatal care
• 1. Infancy (upto 1 year of age). • Immediate care
a. Neonatal period (first 28 days of life). • 1. clearing the airways.
• b. Post neonatal period (28th day to 1 • 2.apgar score.
year).
• 3.care of the cord
• 2. Pre-school age (1-4 years).
• 4.care of the eyes and skin
• 3. School age (5-14 years).
• 5maintence of body temperature.
 IMMEDIATE C ARE

Clearing The Airway APGAR Score

To help establish breathing, the airways Apgar score is taken at 1 minute and again at 5
should be cleared of mucus and other minutes after birth.
secretions. It requires immediate and careful observation
Positioning the baby with his head low may of the heart rate, respiration, muscle tone,
reflex response and colour of the infant.
help in the drainage of secretions.
Each sign is given a score of 0, 1 or 2 . It
This process can be assisted by gentle provides an immediate estimate of the physical
suction to remove mucus and amniotic fluid. condition of the baby. A perfect score should be
Resuscitation becomes necessary if natural 9 or 10;
breathing fails to establish within a minute, as 0-3 indicates that the baby is severely
in the case of babies who have already been depressed and 4-6 moderately depressed.
subject to hypoxia during labour.
If the heart has stopped beating for 5
minutes, the baby is probably dead.
 Care Of The Cord Care Of The Eyes
cord should be cut and tied when it has stopped pulsating. Before the eyes are open, the lid margins of the newborn
The baby derives about 10 ml of extra blood, if the cord is should be cleaned with sterile wet swabs, one for each eye
cut after pulsation ceases. from inner to outer side.
This is particularly important in India, where anaemia is Instil a drop of freshly prepared silver nitrate solution (1
frequent . Care must be taken to prevent tetanus of the per cent) to prevent gonococcal conjunctivitis, alternatively,
newborn by using properly sterilized instruments and cord a single application of tetracycline 1 per cent ointment
ties. It is essential to apply an antiseptic preparation on the can be given. Any discharge from the eye of an infant is
cord stump and the skin around the base. pathological and calls for immediate treatment.

Care Of The Skin Maintenance Of Body Temperature

When a baby is a few hours old, the first bath is given with The normal body temperature of a newborn is between 36.5 to
soap and warm water to remove vernix, meconium and 37.5°C. A newborn baby is projected out of warm womb of the
blood clots. mother into an environment which may be 10 to 20°C cooler
especially in winter months in India.
Some prefer to apply warm oil before the bath. The first As much as 75 per cent of the heat loss can occur from the head.
bathing is done by the nursing staff. It is important that immediately after birth the child is quickly dried
If culturally acceptable, the first bathing may be delayed for with a clean cloth and wrapped in warm cloth and given to the
12-24 hours after birth to avoid cooling the body mother for skin-to-skin contact and breast-feeding.
temperature (28). Pre-term and low birth weight babies lose heat more easily
through their thin skin as they have less sub-cutaneous fat for
insulation.
 LOW B IRTH W EIGHT
There are two main groups of low birth weight babies - those born prematurely (short gestation) and those with
foetal growth retardation. In countries where the proportion is high (e.g. India), the majority of cases can be
attributed to foetal growth retardation.
By international agreement low birth weight has been defined as a birth weight of less than 2.5 kg (upto
andincluding 2499 g), the measurement being taken preferably within the first hour of life, before significant
postnatal weight loss has occurred
Apart from birth weight, babies can also be classified into 3 groups according to gestational age, using the word
"preterm", "term" and "post term", as follows (32):
a. Preterm: Babies born before the end of 37 weeks gestation (less than 259 days).
b. b.Term: Babies born from 37 completed weeks to less than 42 completed weeks (259 to 293 days) of
gestation.
c. c. Post term: Babies born at 42 completed weeks or any time thereafter (294 days and over) of gestation .
Importance
its association with mental retardation and a high risk of perinatal and infant mortality and
morbidity (half of all perinatal and one-third of all infant deaths are due to LBW);
LBW is the single most important factor determining the survival chances of the child. Many of them die
during their first year.
The infant mortality rate is about 20 times greater for all LBW babies than for other babies. The lower
the birth weight, the lower is the survival chance. Many of them become victims of protein-energy
malnutrition and infection. LBW is thus an important guide to the level of care needed by individual
babies,
• Neonatal examinations • Identification of "at-risk" infants
• 1. The first examination is made soon after birth • The basic criteria for identifying "at-
to detect injuries during the birth process, to risk" infants are –
detect malformations and to assess maturity.
• 1. Birth weight less than 2.5 kg.
• The abnormalities found on examination
• 2. Twins.
should be immediately attended –
• 3. Birth order 5 and more.
• 1. Cyanosis of the lips and skin.
• 4. Artificial feeding.
• 2. Any difficulty in breathing.
• 5. Weight below 70% of the expected
• 3. Imperforated anus.
weight (i.e., II and III degrees of
• 4. Persistent vomiting. malnutrition).
• 5. Signs of cerebral irritation such as • 6. Failure to gain weight during three
convulsions, neck rigidity, bulging of anterior successive months.
fontanel..
• 7. Children with PEM, diarrhoea.
• 6. Temperature instability.
• 2. The second examination should be made
preferably by a pediatrician within 24 hours
after birth. It is a detailed systematic
examination from head to foot, conducted in
good light.
 PRE SCHOOL AGE CHILD HEALTH
PROBLEMS

• 1. low birth weight

• 2.Malnutrition
• 3.Infections and parasitosis
• 4.Accidents and poisioning
• 5.behavioual problems
 OTHER FACTORS AFFECTING HEALTH
OF CHILDREN

• . Child health is adversely affected if the mother is malnourished, if she is under 18 years or over 35, if her
last child was born less than 2 years ago, if she has already more than 4 births.
• 2. In pre-school years, the child health depends upon the family's physical and social environment.
• 3. Other factors are the family size, the family relationships, and family stability.
• 4. Socio-economic status of the family is a very important factor in child health.
• A detailed analysis of socio-economic factors shows the part played by the parents' education, profession and
income, their housing, the urban or rural, industrialized or non- industrialized nature of the population.
Poverty, illiteracy (especially mothers' illiteracy)
• 5. Environmental factors play a very great role as determinants of infant and childhood morbidity and
mortality. Diarrhoea, pneumonia and other bacterial, viral and parasitic infections are extremely common in
children exposed to insanitary and hostile environment.
 PREVENTIVE MEASURES

• 1. Primary prevention:
• (a) Genetic counselling (optimum age for producing normal babies is between 20 and 30 years.)
• (b) People "at-risk" of transmitting inherited diseases such as chromosomal or sex-linked diseases should
be identified.) Immunization against communicable diseases such as rubella should also be considered.
• (d) Proper nutrition of the expectant mother is important to reduce the incidence of prematurity which
is associated with mental handicaps.

• 2. Secondary prevention:
• (a) Early diagnosis of handicap should be done through MCH and School Health Services and such other
agencies...
• (b) Specialized treatment facilities such as physiotherapy, occupational therapy, speech therapy and
prosthetics (provision of artificial limbs, hearing aids and other equipment).
• (c) Vocational guidance (handicapped child is trained for an independent living
INDICATORS OF MCH
 MATERNAL MORTALITY RATIO

Maternal mortality ratio measures women dying from "puerperal causes" and is
defined as:

Total no. of female deaths due to complications of pregnancy,

childbirth or within 42 days of delivery from "puerperal causes
in an area during a given year
x 1000 (or 100,000)
Total no. of live births in the same area and year
 STILLBIRTH RATE

The most widespread use of the term is, "death of a foetus weighing 1000 g (this is equivalent to 28
weeks of gestation) or more" occurring during one year in every 1000 total births (live births plus
stillbirths). Stillbirth rate is given by the formula:

Foetal deaths weighing over 1000 g at birth during the year

Stillbirth Rate = x 1000
Total live + stillbirths weighing over 1000 g at birth
during the year
 PERINATAL MORTALITY RATE

The WHO's definition, more appropriate in nations with less well established vital records, is:

Late foetal deaths (28 weeks + of + postnatal deaths (first

week) in a year gestation)
Perinatal mortality rate= x 1000
Live births in a year
 NEONATAL MORTALITY RATE

The neonatal mortality rate is tabulated as:

Number of deaths of children under 28 days of age in a year

= x 1000
Total live births in the same year
 POST-NEONATAL MORTALITY RATE

The post-neonatal mortality rate is tabulated as:

Number of deaths of children between 28 days and one year

of age in a given year
= x 1000
Total live births in the same year
 INFANT MORTALITY RATE

Infant mortality rate (IMR) is defined as "the ratio of infant deaths registered in a given year to the total
number of live births registered in the same year; usually expressed as a rate per 1000 live births" (86). It
is given by the formula:

Number of deaths of children less than 1 year of age in a year

IMR = x 1000
Number of live births in the same year