In any community, mothers and children constitute a priority group. In sheer numbers, they comprise approximately 71.14 per cent of the population of the developing countries. In India, women of the child bearing age(15-44 years) constitute 52.4 per cent of total female population, and children under 15 years of age about 26.5 per cent of the total population. Together they constitute nearly 57.5 per cent of the total population. By virtue of their numbers, mothers and children are the major consumers of health services, of whatever form. Mothers and children not only constitute a large group, but they are also a "vulnerable" or special-risk group. The risk is connected with child-bearing in the case of women; and growth, development and survival in the case of infants and children. Whereas 50 per cent of all deaths in the developed world are occurring among people over 70, the same proportion of deaths are occurring among children during the first five years of life in the developing world. Global observations show that in developed regions maternal mortality ratio averages at 12 per 100,000 live births; in developing regions the figure is 232 for the same number of live births (1). From commonly accepted indices, it is evident that infant, child and maternal mortality rates are high in many developing countries. Further, much of the sickness and deaths among mothers and children is largely preventable. By improving the health of mothers and children, we contribute to the health of the general population. These considerations have led to the formulation of special health services for mothers and children all over the world. The problems affecting the health of mother and child are multifactorial. Despite current efforts, the health of mother and child still constitutes one of the most serious health problems affecting the community, particularly in the developing countries. The present strategy is to provide mother and child health services as an integrated package of "essential health care", also known as primary health care which is based on the principles of equity, intersectoral coordination and community participation. The primary health care approach combines all elements in the local community necessary to make a positive impact on the health status of the population, including the health of mothers and children. Mother and child - one unit Mother and child must be considered as one unit. It is because: (1) During the antenatal period, the foetus is part of the mother. The period of development of foetus in mother is about 280 days. During this period, the foetus obtains all the (2) Child health is closely related to maternal health. A healthy mother brings forth a healthy baby; there is less chance for a premature birth, stillbirth or abortion. (3) Certain diseases and conditions of the mother during pregnancy (e.g., syphilis, german measles, drug intake) are likely to have their effects upon the foetus. (4) After birth, the child is

2. INTRODUCTION
1. In any community, mothers and children constitute a priority group. In
sheer numbers, they comprise approximately 71.14 per cent of the
population of the developing countries. In India, women of the child
bearing age(15-44 years) constitute 52.4 per cent of total female
population, and children under 15 years of age about 26.5 per cent of the
total population. Together they constitute nearly 57.5 per cent of the
total population. By virtue of their numbers, mothers and children are the
major consumers of health services, of whatever form.
2. Mothers and children not only constitute a large group, but they are
also a "vulnerable" or special-risk group. The risk is connected with
child-bearing in the case of women; and growth, development and
survival in the case of infants and children. Whereas 50 per cent of
all deaths in the developed world are occurring among people over
70, the same proportion of deaths are occurring among children
during the first five years of life in the developing world.

3. MAGNITUDE OF MATERNAL & CHILD
HEALTH PROBLEMS: MATERNAL &
CHILD HEALTH PROBLEMS
LALRINCHHANI, Roll No.-11
1st Year, MSc. Nursing

4. MATERNAL AND CHILD HEALTH
1. 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, adolescence, and health
aspects of children in special settings such as day care .
2. The specific objectives of MCH are:
• Reduction of maternal, perinatal, infant and childhood
mortality and morbidity;
• Promotion of reproductive health; and o promotion of
the physical and psychological development of the child
and adolescent within the family. The ultimate objective
of MCH services is lifelong health.

5. MATERNAL HEALTH PROBLEMS
MCH problems cover a broad spectrum. At one extreme, the most
advanced countries are concerned with problems such as perinatal
problems, congenital malformations, genetic and certain behavioural
problems. At the other extreme, in developing countries, the primary
concern is reduction of maternal and child mortality and morbidity,
spacing of pregnancies, limitation of family size, prevention of
communicable diseases, improvement of nutrition and promoting
acceptance of health practices. Currently, the main health problems
affecting the health of the mother and the child in India, as in other
developing countries, revolve round the triad of malnutrition, infection
and the consequences of unregulated fertility. Associated with these
problems is the scarcity of health and other social services in vast areas
of the country together with poor socio-economic conditions.

6. MALNUTRITION
Malnutrition is like an iceberg; most people in the
developing countries live under the burden of
malnutrition.
Pregnant women, nursing mothers and children are
particularly vulnerable to the effects of malnutrition.
The adverse effects of maternal malnutrition have been
well documented-maternal depletion, low birth weight,
anaemia, toxemias of pregnancy, postpartum
hemorrhage, all leading to high mortality and morbidity.
The effects of malnutrition are also frequently more
serious during the formative years of life

7. MAGNITUDE OF MATERNAL MALNUTRITION
According to the WHO, an estimated 613 million women of
reproductive age worldwide suffer from anemia, a
condition caused by iron deficiency and one of the most
common forms of maternal malnutrition

8. INFECTION
1. Maternal infections may cause a variety of adverse effects such as
foetal growth retardation, low birth weight, embryopathy, abortion
and puerperal sepsis. In industrial societies, the risk of the mother
acquiring infections during pregnancy is relatively low, but in
underdeveloped areas, the mother is exposed to significantly higher
risks. Many women are infected with HIV, hepatitis B, cytomegalo
viruses, herpes simplex virus or toxoplasma during pregnancy.
2. Furthermore, about 2 to 10 per cent pregnant women suffer from
asymptomatic bacteriuria.
3. As far as the baby is concerned, infection may begin with labour
and delivery and increase as the child grows older.

9. MAGNITUDE OF MATERNAL INFECTION
1. According to the World Health Organization (WHO), an estimated
10% of pregnant women worldwide develop a bacterial infection
of the urinary tract during pregnancy. Maternal infections such as
urinary tract infections (UTIs) can lead to preterm labor and
delivery, low birth weight, and neonatal sepsis.

10. UNCONTROLLED REPRODUCTION
1. The health hazards for the mother and the child
resulting from unregulated fertility have been
well recognized - increased prevalence of low
birth weight babies, severe anaemia, abortion,
antepartum haemorrhage and a high maternal
and perinatal mortality, which have shown a
sharp rise after the 4th pregnancy. Statistics
have shown that in almost every country in the
world, a high birth rate is associated with a high
infant mortality rate and under-five death rate.

11. MAGNITUDE OF UNCONTROLLED
REPRODUCTION
● According to the World Health Organization (WHO), approximately 121
million pregnancies occur each year worldwide, and about 40% of these
pregnancies are unintended

12. Country Crude birth
rate per
1000
population (mid
2018)
IMR per 1000
live births
(mid 2018)
Under-five
mortality rate
per 1000 live
births (2018)
India
Pakistan
Bangladesh
Thailand
Sri Lanka
China
Switzerland
UK
USA
Singapore
Japan
18
29
18
10
16
12
10
12
12
9
7
30
57
25
8
6
7
4
4
6
2
2
37
69
30
9
7
9
4
4
7
3
2
Selected rates by country for crude birth rates, infant
mortality rates and under-five mortality rates (mid 2018)

13. PREVENTIVE
SERVICES FOR
THE MOTHER
ANTENATAL
CHECK-UP

14. History-taking
1. During the first visit, a detailed history of the woman needs to be taken to:
• Confirm the pregnancy (first visit only).
• Identify whether there were complications during any previous
pregnancy/confinement that may have a bearing on the present one;
• Identify any current medical surgical or obstetric conditions that may
complicate the present pregnancy;
• Record the date of first day of last menstrual period and calculate the
expected date of delivery by adding 9 months and seven days to the first
day of last menstrual period;
• Record symptoms indicating complications, eg.fever, persisting vomiting,
abnormal
• vaginal discharge or bleeding, palpitations, easy fatigability, breathlessness
at rest or on mild exertion, generalise swelling in the body, severe headache
and blurring of vision, burning in passing urine, decreased or absent foetal
movements etc.

15. History of any current systemic illness,
e.g.,hypertension, diabetes, heart disease,
tuberculosis, renal disease, epilepsy, asthma,
jaundice, malaria, reproductive tract infection,
STD, HIV/AIDS etc. Record family history of
hypertension, diabetes, tuberculosis, and
thalassaemia.Family history of twins or
congenital malformation; and
History of drug allergies and habit forming
drugs.

16. Physical examination
1. Pallor
2. Pulse
3. Respiratory rate
4. Oedema
5. Blood pressure
6. Weight
7. Breast Examination

17. Abdonimal examination
1. Examine the abdomen to monitor the progress of the pregnancy
and foetal growth. The abdominal examination
2. includes the following :
3. 1. Measurement of fundal height
4. 2. Foetal heart sounds
5. 3. Foetal movements
6. 4. Foetal Parts
7. 5. Multiple pregnancy
8. 6. Foetal lie and presentation
9. 7. Inspection of abdominal scar or any other relevant abdominal
findings.
10. 8. Foetal lie and presentation

18. Assessment of gestational age
Measurement of gestational age has
changed over the time. As the
dominant effect of gestational age on
survival and long-term impairment has
become apparent over the last 30 years,
perinatal epidemiology has shifted
from measuring birth weight alone to
focusing on gestational age.

19. Laboratory investigations
The following laboratory
investigations are carried out at the
facilities indicated below:
a. At the sub-centre:
Pregnancy detection test.
Haemoglobin examination.
Urine test for presence of albumin
and sugar.
Rapid malaria test.

20. CHILD HEALTH PROBLEMS

21. I. Low birth weight
● The birth weight of an infant is the single most important determinant of
its chances of survival, healthy growth and development.
● There are two main groups of low-birth-weight babies -
● (a) those born prematurely (short gestation); and (b) those with foetal
growth retardation. In countries where the population of low-birth-weight
infants is less, short gestation period is the major cause. In countries where
the proportion is high (e.g., India), most 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 and including 2499 g), the measurement
being taken preferably within the first hour of life, before significant
postnatal weight loss has occurred

22. MAGNITUDE OF LOW BIRTH WEIGHT
● According to the World Health Organization (WHO), the global
incidence of LBW is estimated to be around 15%. However, the
incidence varies widely by region, with the highest rates occurring in
South Asia and sub-Saharan Africa. In some countries, such as India
and Bangladesh, the incidence of LBW can be as high as 30% or
more.
● In developed countries, the incidence of LBW is lower, but still
significant. In the United States, for example, the overall incidence
of LBW is around 8%, but there are significant disparities among
different racial and ethnic groups. African American and Native
American babies have higher rates of LBW than White or Asian
babies.

23. I. MALNUTRITION
● Malnutrition is the most widespread condition affecting
the health of children. Scarcity of suitable foods, lack of
purchasing power of the family as well as traditional
beliefs and taboos about what the baby should eat, often
lead to an insufficient balanced diet, resulting in
malnutrition
● Malnutrition makes the child more susceptible to
infection, recovery is slower, and mortality is higher.
● Undernourished children do not grow to their full
potential of physical and mental abilities.

24. Malnutrition in infancy and childhood leads to
stunted growth. It also manifests by clinical
signs of micronutrient and vitamin deficiencies.
Prevention and appropriate treatment of
diarrhea, measles and other infections in infancy
and early childhood are important to reduce
malnutrition rates as infection and malnutrition
often make vicious cycle. Exclusive
breastfeeding in first 6 months of life is very
important.

25. Specific nutritional deficiencies
Protein-energy
malnutrition
Iodine
deficiency
Micronutrient
malnutrition
Vitamin A
deficiency and
nutritional
blindness

26. MAGNITUDE OF MALNUTRITION
1. According to the World Health Organization (WHO), an
estimated 149 million children under the age of five
were stunted, 50 million were wasted, and 40 million
were overweight or obese globally in 2020.
2. The prevalence of malnutrition varies by region and
country. South Asia and sub-Saharan Africa are the
regions with the highest burden of malnutrition,
accounting for approximately 75% of all stunted
children worldwide. In these regions, poverty, food
insecurity, poor sanitation, and limited access to health
care contribute to the high rates of malnutrition

27. INFECTIOUS AND PARASITIC DISEASES
1. Young children fall an easy prey to infectious
diseases.
2. The leading childhood diseases are: diarrhea,
respiratory infections, measles, pertussis, polio,
neonatal tetanus, tuberculosis, and diphtheria. It
is known that a child may get affected several
times in a year; the incidence increases with the
aggravation of a state of malnutrition

28. INFECTIOUS AND PARASITIC DISEASES
1. Young children fall an easy prey to infectious
diseases.
2. The leading childhood diseases are: diarrhea,
respiratory infections, measles, pertussis, polio,
neonatal tetanus, tuberculosis, and diphtheria. It
is known that a child may get affected several
times in a year; the incidence increases with the
aggravation of a state of malnutrition

29. MAGNITUDE
1. Of about 4 million deaths a year from acute respiratory
infections in the developing world, a quarter are linked
to malnutrition, and a further quarter associated with
complications of measles, pertussis, malaria and
HIV/AIDS. During 2017, about 8 per cent of under-five
mortality worldwide was due to diarrhoeal diseases,
about 12 per cent due to ARI, about 2 per cent deaths
were due to measles and about 5 per cent due to malaria.
In India, during the year 2018, 11,720 cases of
diphtheria, 20,815 cases of measles, 18,006 cases of
pertussis, and 181 cases of neonatal tetanus were

30. Accidents and poisoning
1. In the developed world, accidents and poisoning
have become a relatively more important child
health problem.
2. There is every reason to believe that accidents
among children are frequent in the developing
countries also, especially burns and trauma as a
result of home accidents and, to an increasing
degree, traffic accidents. Children and young
adolescents are particularly vulnerable to
domestic accidents - including falls, burns,
poisoning and drowning.

31. Behavioural problems.
Behavioural disturbances are notable child health
problem, the importance of which is increasingly
recognized in most countries. Children abandoned by
their families present severe social and health
problems. Over 60,000 children are abandoned each
year in India.

34. Causes of maternal deaths worldwide

35. CHILD
HEALTH
PROGRAMMES
Warmest congratulations on the
birth of your sweet baby girl!

36. National Deworming Day:
National Deworming Day (NDD)
August is being conducted bi-
annually in the months of
February and August since 2015,
to combat the worm infestations in
children and adolescents (1-19
years) by giving albendazole
tablets in a single fixed day
approach.

37. Intensified Diarrhoea Control Fortnight
(IDCF):
To increase awareness about use of ORS
and Zinc in diarrhoea- an Intensified
Diarrhoea Control Fortnight (IDCF) is
being observed during pre-monsoon/
monsoon season, with the aim of ‘zero child
deaths due to childhood diarrhoea’ since
2014(28th May-8th June).

39. Mother Newborn Care Units
SNCU complex are enumerated as under:
• Waiting Area
 Entry area – space for Gowning, hand washing, Shoe rack
 Follow UP area with AV facilities and adequate space for daily
counselling, during discharge and imparting FPC training.
 Reception area for receiving the cases and assess under triage area.
 Newborn care area
 NO newborn deserving admission in SNCU will be shifted to the MNCU

40. Janani Shishu Suraksha Karyakram (JSSK)
Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011
and has provision for both pregnant women and sick new born till 1 year aft
birth are (1) Free and zero expense treatment, (2) Free drugs and
consumables, (3) Free diagnostics & Diet, (4) Free provision of blood, (5) Fre
transport from home to health institutions, (6) Free transport between faciliti
in case of referral, (7) Drop back from institutions to home, (8) Exemption
from all kinds of user charges.
The initiative would further promote institutional delivery, eliminate out of
pocket expenses which act as a barrier to seeking institutional care for mothe
and sick new borns and facilitate prompt referral through free transport.

41. Facility Based Integrated Management of Neonatal and
Childhood Illness (F- IMNCI)
F-IMNCI is the integration of the Facility based Care
package with the IMNCI package, to empower the Health
personnel with the skills to manage new born and childhood
illness at the community level as well as at the facility.
Facility based IMNCI focuses on providing appropriate
skills for inpatient management of major causes of Neonatal
and Childhood mortality such as asphyxia, sepsis, low birth
weight and pneumonia, diarrhea, malaria, meningitis,
severe malnutrition in children. This training is being
imparted to Medical officers, Staff nurses and ANMs at
CHC/FRUs and 24x7 PHCs where deliveries are taking
place. The training is for 11 days.

42. Home Based New Born Care (HBNC)
Home Based New Born Care (HBNC) programme was launched in
2011 for accelerated reduction of Neonatal mortality and
morbidity rates especially in rural, remote areas where access to
care is largely unavailable or located faraway. The guidelines were
revised in 2014. Under this programme, ASHA to make visits to all
newborns according to specified schedule up to first 42 days of life.
This includes six visits in case of institutional deliveries on 3rd, 7th,
14th, 21st, 28th& 42nd days after birth and one additional visit
within 24 hours of delivery in case of home deliveries. Additional
visits for babies who are pre-term, low birth weight or ill and
SNCU discharged babies will be conducted. ASHAs are being paid
incentive of Rs. 250/- per newborn after completion of scheduled
home visits.

43. 1. Pappachan B, Choonara I. Inequalities in child health in
India. BMJ Paediatrics Open 2017;1: e000054. doi:10.1136/
bmjpo-2017-000054
India is a lower-middle-income country with one of the fastest
growing economies in the world. Despite improvements in its
economy, it has a high child mortality rate, with significant
differences in child mortality both between and within different
states. Poverty, malnutrition and poor sanitation are major
problems for many Indians and are a major contributor to child
mortality. More than 40% children are malnourished or stunted.
Healthcare provision is poor, and many families, especially in
rural areas, have major difficulties in accessing healthcare.
Kerala has the lowest child mortality rates in India. This has
been achieved by reducing poverty, malnutrition and
inequalities. The provision of universal education alongside
universal access to healthcare has demonstrated that child
mortality rates could be reduced. India could significantly
reduce its child mortality by following the example of Kerala.

44. CONCLUSION
The magnitude of maternal and health problems is very big and an important public
health issues because we have the opportunity to end preventable deaths among all
women, infants and children and to greatly improve their health and well-being.Far
too many women, infants and children worldwide still have little or no access to
essential, quality health services and education, clean air and water, and adequate
sanitation and nutrition.Investments in prevention, health care and education last a
lifetime.
Together as a nation we are improving the health and well-being of women and
children.

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46. THANK YOU