Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
At the end of this session, you will be able to
1. Describe the delivery of family planning services at various levels of health care delivery
2. Define unmet need of contraception and enumerate it’s reasons
3. List the various evaluations done on family planning services
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
At the end of this session, you will be able to
1. Describe the delivery of family planning services at various levels of health care delivery
2. Define unmet need of contraception and enumerate it’s reasons
3. List the various evaluations done on family planning services
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
This slide contains information regarding Maternal and Child Health Program. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
RMNCH + A MCH Program Dr Girish .B Associate Professor, Department of Community Medicine, Chamarajanagar Institute of Medical Sciences (CIMS), Chamarajanagar
The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It captures the likelihood of both becoming pregnant and dying during pregnancy (including deaths up to six weeks after delivery).
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
Prevention of Mother to Child Transmission of HIV 2017Helen Madamba
This is a lecture delivered during the Integrated Orientation on HIV/AIDS and TBHIV Collaboration by the Department of Health Region 7 at Bohol Tropics Resort, Tagbilaran City, Bohol
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
This slide contains information regarding Maternal and Child Health Program. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
RMNCH + A MCH Program Dr Girish .B Associate Professor, Department of Community Medicine, Chamarajanagar Institute of Medical Sciences (CIMS), Chamarajanagar
The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It captures the likelihood of both becoming pregnant and dying during pregnancy (including deaths up to six weeks after delivery).
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
Prevention of Mother to Child Transmission of HIV 2017Helen Madamba
This is a lecture delivered during the Integrated Orientation on HIV/AIDS and TBHIV Collaboration by the Department of Health Region 7 at Bohol Tropics Resort, Tagbilaran City, Bohol
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
Health index in contrast of maternal healthNehaNupur8
Health index
Characteristics of maternal indicators
Commonly used maternal health indicators
Maternal mortality rate
Fertility rate
Perinatal mortality rate
Neonatal mortality rate
Postneonatal mortality rate
Infant mortality rate
Health index also called health indicators depending on the measure, a health indicators may be defined for a specific population, place, or geographic area.
Indicators are defined as “variable which help to measure changes
Obesity in pregnancy is now rampant and bringing about concern because of the associated morbidity and mortality both to the mother and child. All hands must be on deck to prevent and manage this condition and associated sequel.
This presentation is the analysis of current newborn care in India. It focuses on the Hospital birth scenario and Factors contributing to newborn death. It further highlights , how the Midwives can make a difference.
At the end of this session, the students shall be able to, Define Cause
Define Association
Define Correlation
Types of association
Additional criteria for judging causality
Differentiate between association and causation
Clinico-social case format for diarrhoea, demographic details, chief complaint, history of presenting illness, treatment history, past history, brief antenatal history, birth historym postnatal history, developmental history, nutrition history, immunisation history, personal history, family history, socio-economic / psycho-social history, environmental history, KAP about the disease, general examination, systemic examination, local examiantion, investigations, summary and case management.
Definition of mental health
Describe the problem statement
List the characteristics of a mentally healthy person
List the warning Signals of Poor Mental Health
Classify mental illness
Enumerate the causes of mental ill-health
Discuss the consequences of poor mental health
Explain about the Mental Health Services
Epidemiology of Alcoholism and Drug Dependence
Describe the Symptoms of drug addiction
Prevention, treatment, and rehabilitation for drug dependence
When is World Mental Health Day
At the end of this session, you will be able to
1. Define Occupational Health
2. What is the occupational environment?
3. Classify and describe the various occupational hazards causing diseases in workplace.
4. Define Occupational Diseases
5. Classify occupational diseases
6. Describe the etiology, signs/symptoms, diagnosis, treatment and prevention of various common occupational diseases
At the end of this session, the student shall be able to
What is gerontology and it’s branches?
Describe the growing burden of geriatric age group.
Classify and Enumerate the Health problems of the aged.
What are the lifestyle factors which helps the aged?
Describe the health status of the aged in India.
Describe the Schemes & Policy for Older Person in India
Explain the Implication of the ageing population in India
How are these diseases prevented in the elderly?
This presentation has the following.
1. Definitions - accidents and injuries
2. The burden of accidents and injuries
3. Epidemiology of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snakebite.
4. Prevention and control of RTA, industrial accidents, railway accidents, violence, domestic violence, drowning, burns, domestic accidents, poisoning and snake bite.
At the end of the session, the students shall be able to
Describe the HIV AIDS introduction, epidemiology of HIV AIDS, diagnosis of HIV AIDS, treatment of HIV AIDS and prevention control of HIV AIDS.
At the end of the session, the students shall be able to
Explain the concept of Preventive Medicine in Obstetrics, Paediatrics and Geriatrics
Enumerate and discuss the MCH Problems
Feeding of infants and baby friends hospital initiativeJayaramachandran S
At the end of this session, you will be able to
List the advantages of breastfeeding
Describe artificial feeding of Infants
Enumerate the differences b/n human and cow’s milk
Explain the concept of weaning
Enumerate the 10 steps of Baby-Friendly Hospital Initiative
At the end of the session, the students shall be able to
What are the various measurements in assessing the growth and maturity of the baby
Describe the purpose of neonatal screening
Identify at-risk infant
Define low birth weight. Enumerate the causes of LBW and discuss the prevention and treatment of LBW babies.
At the end of the session, you shall be able to
Define educational psychology
List atleast 5 aims of education psychology
Describe the history of educational psychology
Apply the psychological theories to the life of a Student
Enumerate the types of learners
Screening for diseases from community medicine. It explains the definition of screening, lead time, uses of screening, differences between screening and diagnostic test, criteria for a disease to be screened and criteria for a screening test, cut-off points, etc
Measurements of morbidity and mortality
At the end of the session, the students shall be able to
List the basic measurements in epidemiology
Select an appropriate tools of measurement
Measure morbidity & mortality
Perform standardization of rates
It describes the types of research, differences between quantitative and qualitative research and gives an introduction to Participatory Rural Appraisal tools
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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1. Preventive Medicine in
Obstetrics, Paediatrics and
Geriatrics
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine
2. At the end of this session, you will be able to
• Enumerate the MCH indicators and describe it
• List the SDGs related to MCH indicators
3. MCH Indicators
• Maternal and child health status is assessed through mortality,
morbidity and growth & development.
Commonly used mortality indicators
1. Maternal mortality ratio
Mortality in infancy and
childhood
1. Perinatal mortality rate
2. Neonatal mortality rate
3. Post neonatal mortality rate
4. Infant mortality rate
5. 1-4 mortality rate
6. Under 5 mortality rate
7. Child survival rate
4. Maternal mortality ratio
• Maternal Death: “Death of a female while pregnant or with in 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.
• In developed countries MMR has declined significantly
5. Causes of Maternal deaths
Direct obstetric causes
• Pregnancy
• Labour
• Postnatal period
• Incorrect treatment
Indirect obstetric causes
• Resulting from previous existing
disease
• Or disease that developed
during pregnancy
6. Maternal Mortality Ratio (contd.)
• Maternal Mortality Ratio:
• =
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Maternal mortality rate, direct and indirect obstetric death
rates are fine measures of the quality of maternal services
7. Approaches for measuring maternal mortality
• Civil registration system: Birth, death registration
• Household survey
• Sisterhood methods: Interviewing a representative sample about the
survival of all their adult sisters
• Reproductive age mortality studies (RAMOS): Identify & Investigate
the cause of deaths in women (reproductive age)
8. Approaches for measuring maternal mortality
• Verbal autopsy: done in case where medical certification of cause of
death is not available
• Census
9. Incidence
• Global: 400/100, 00 LB
• India: 122 /100,000 LB
• Anaemia is the leading
cause of death and also
the aggravating factor
in sepsis, haemorrhage
and toxemia
25%
20%
13%
15%
12%
8%
8%
MMR : Global causes
Severe bleeding
Indirect causes
Unsafe abortion
Infection
Eclampsia
Obstructed labour
Other direct causes
10.
11. Medical causes of maternal deaths
Obstetric Causes
• Toxaemia
• Haemorrhage
• Infection
• Eclampsia
• obstructed labour
• Unsafe abortion
Non Obstetric Causes
• Anaemia
• Associated diseases
• Cardiac, renal, metabolic
• Malignancy
• Accidents
12. Social causes of maternal deaths
• Age of mother at child birth
• Parity
• Too close pregnancy
• Family size
• Malnutrition
• Poverty
• Illiteracy
• Ignorance
• Delivery by untrained dais
• Poor communication & transport
• Social customs
• Poor environmental sanitation
13. Preventive & social measures to reduce MMR
• Early registration of pregnancy
• At least 4 antenatal check-ups
• Dietary supplements: Iron & FA
• Prevention of infection & haemorrhage during labour
• Prevention of complications e.g., eclampsia, ruptured & malformation
of uterus
• Treatment of medical conditions
14. Preventive & social measures to reduce MMR
• Tetanus prophylaxis
• Clean delivery practices
• Training of birth attendants
• Promotional of institutional deliveries
• Promotion of family planning
• Identification of every maternal deaths and search for its cause
16. Initiatives to improve Maternal Health
• Establishment of Comprehensive Emergency Obstetric and Newborn
Care (CEmONC) Centers within 30 minutes reach
• Establishment of Basic Emergency Obstetric and Newborn Care
(BEmONC) PHCs at the rate of one per block
17. Initiatives to improve Maternal Health
• Audit of every maternal death for identifying the circumstances
leading to the death and prevention of similar deaths in future
• Dr. Muthu Lakshmi Reddy Maternity Benefit Scheme – mother is paid
amount Rs 18,000 to cover expenses of child birth.
• Establishment of 24x7 delivery centers in all PHCs
• Establishment of urban PHCs
18. Initiatives to improve Maternal Health
• Establishment of birth waiting homes in the foot hills, Birth
companion scheme
• Establishment of Blood Storage centers in PHCs
• EMRI 108 ambulance services
• Hospital on Wheels in 385 Blocks for RCH outreach services
19. Initiatives to improve Maternal Health
• Establishment of 42 MCH level-II centers (CEmONC PHC)
• Functional PHC Operation Theatres
• Pregnancy and Infant Cohort Monitoring System (PICME) at the
Health Sub centre level.
• Injection iron sucrose for anaemic mothers given in PHCs and Govt.
Hospitals
20. Initiatives to improve Maternal Health
• Emergency Referral Services (Toll
free no 108) introduced in all the
districts.
• 606 Ambulances on road.
• 7 Newborn transport
ambulances are also in service
21. Initiatives to improve Maternal Health
• Establishment of 24x7 delivery
centers in all PHCs with well
trained nurses
• Establishment of urban PHCs
22. Hospital on Wheels in 385 Blocks for RCH outreach services
Initiatives to improve Maternal Health
23. Initiatives to improve Maternal Health
Diet for Antenatal mothers visiting the Ante
Natal clinics, and postnatal mothers are
provided in all PHCs.
Establishment of
Blood Storage
centers in PHCs
24. Mortality in Infancy & childhood
Still birth
Perinatal death
Early
neonatal Late
neonatal
Post neonatal deathNeonatal death
Infant death
1 year28 weeks Birth 7 days 28 days
25. Foetal death
• Death prior to complete expulsion or extraction from its mother of a
product of conception, irrespective of duration of pregnancy.
• Signs: foetus doesn’t breathe, heartbeat or pulsation of umbilical
cord & voluntary movements is absent
• Still birth rate: death of foetus weighing 1000gm (which is equal to 28
wks. of gestation) or more, occurring during one year in 1000 total
births (live + dead)
26. Foetal death – Prevention
• Diagnosis and Rx of infection
• High BP
• Rh incompatibility
• Diabetes
• Premature rupture of membranes
27. 1. Perinatal mortality rate
• Includes both late foetal deaths (still births) & early neonatal deaths
(7days) in one year/ live births.
• Minimum birth wt = 1000 g ≈ 28wks of Gestation
• or if age & wt isn’t available, body length crown to heal of at least 35
cm.
• India – 23/1000 births in 2016
•
• PMR =
"#$% &'%$#" (%#$)* (,-./* '& 0%*$ '1 2'1%)
4 %#1"5 6%'6#$#" (%#$)* 7*$ .%%/ 86 '6% 51
"89% :81$)*4"#$% &'%$#" (%#$)* 86 *#2% 51
× 1000
28. Perinatal mortality rate (contd.)
• PMR gives a good indication of the extent of pregnancy wastage as
well as the quality and quantity of health care available to the mother
and the new born
• It reflects the results of maternity care more clearly than the neonatal
death rate
29. Perinatal mortality rate (contd.)
Social / biological factors:
• Maternal age > 35 or < 16
• High parity ( with short spacing)
• Heavy smoking
• Malnutrition – severe anaemia
• Infections
30. Perinatal mortality rate (contd.)
Main Causes
• Intrauterine and birth asphyxia
• Low birth weight
• Birth trauma
• Intrauterine and neonatal infection
Antenatal causes
• Maternal diseases
• Anatomical defects
• Endocrine imbalance
• Blood incompatibilities
• Malnutrition
• Toxaemia of pregnancy
• Ante partum haemorrhage
• Congenital defects
• Advanced maternal age
32. 2. Neonatal mortality rate
• Number of deaths of children < 28 days of age in a year/ total number
of LB in same year
Causes of NMR
• LBW
• Birth asphyxia
• Atelectasis
• Birth injuries
• Congenital malformation
• Infections (tetanus, diarrhoea)
• NMR is more in boys as they are
biologically more fragile than
girls
• NMR in India = 18 / 1000 LB in
2016
33. 3. Post neonatal mortality rate
• Number of deaths of children between 28 days to 1 year of age in a
year / total number of LB in same year
• Exogenous factors are responsible
• Girls die more frequently than boys because of neglect of female child
in terms of nutrition and health care
• India – 23 / 1000 LB
34. 4. Infant mortality rate
• Number of deaths of children <
1 year / total number of live
births.
• Indicates:
• Health status of community
• Level of living
• Effectiveness of MCH services
• It 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 programme
35. Infant mortality Rate (contd.)
• IMR in developed countries = 5 / 1000 LB
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
Any further reduction will depend upon preventing congenital anomalies
36. Infant mortality Rate (contd.)
• IMR in India – 38 / 1000 LB in 2016
State wise variations
• Kerala – 10 / 1000 LB
• Tamilnadu – 17/1000 LB
• Orissa, MP, Assam, Bihar, UP, Haryana and Raj have IMR above national
level
• Mortality patterns:
• Age – 67.6 % deaths in first month of life, of these 52 % die in first week
• Sex – females die more than males
37. Medical causes of Infant mortality
Neonatal mortality
• LBW and prematurity
• Birth injury & difficult labour
• Sepsis
• Congenital anomalies
• Haemolytic diseases of new born
• Communicable diseases
• Conditions of placenta and cord
• Diarrhoea, ARI, tetanus
Post neonatal mortality
• Diarrhoea
• ARI
• Malnutrition
• Cong anomalies
• Accidents
38. Factors affecting Infant Mortality
Cultural and social factors
• Breast feeding
• Early marriage
• Sex of child
• Quality of mothering
• Maternal education
• Quality of health care
• Broken families
• Brutal habits & customs
• Bad sanitation
• Economic factors
Biological Factors
• Birth weight
• Age of mother
• Birth order
• Birth spacing
• Multiple births
• Family size
• High fertility
39. Preventive and social measures
Multi approach
• Prenatal nutrition
• Prevention of infection – EPI
• Breast feeding
• Growth monitoring
• Family planning
• Sanitation
• PHC – detecting mothers with
high risk factors
• Socioeconomic development
• Education
40. 5. 1-4 years mortality rate
• Number of deaths of children aged 1-4 years / Total number of
children aged 1-4 years at the middle of year X 1000
• More refined indicator of situation of country than IMR.
• Reflects environmental hazards
• In developing countries – 30
• In developed countries – < 1
• 2nd year of life accounts 50% of all deaths in 1-4 yrs. Of life
41. Causes of 1-4 years mortality
Developing countries
• Diarrhoea
• ARI
• Malnutrition
• Infectious diseases
• Accidents
Developed countries
• Accidents
• Cong anomalies
• Malignancies
• Influenza
• Pneumonia
42. 6. Under 5 mortality rate (birth-5yrs)
• UNICEF defines and considers it as “Annual number of deaths of
children under 5 years expressed as a rate / 1000 LB”
• Best single indicator of social development and well being as it
reflects the income, nutrition, health care and basic education
• World – 39 / 1000 LB (2017)
• India – 39 / 1000 LB (2017)
43.
44. 7. Child Survival Index
• The basic measure of infant and child survival is the Under-5 mortality
• Child survival rate/ 1000 LB is calculated as
CSI = 1000 – Under 5 mortality rate / 10
• CSI of India = 96.06%
45. Initiatives to improve Infant Health
• Nutrition interventions through ICDS
• High level of immunization coverage
• Establishment of Newborn Intensive Care Units
• Sick Newborn Care units
• Inclusion of Paediatric emergencies under Hon’ble
• Chief Minister’s Comprehensive Health Insurance
46. Initiatives to improve Child Health
• To control anaemia among the children in the age group of 1-3 yrs, 1
ml ( 20 mg) of IFA syrup is given for 100 days.
• IFA tablet is given to the children in the age group of 3- 5 years
• All 2 - 5 years children are given one dose of albendazole once in 6
months.
• Vitamin A administration is organized on Campaign basis (during
March and September) for all children in the age group of 6 – 60
months .
51. Written assignment to be submitted
1. List the MCH mortality indicators.
2. Enumerate the causes of MCH mortality
indicators and discuss the measures in brief
to improve MCH indicators.
52. The test of any civilization is the
measure of consideration and care
which it gives to its weaker members
Any Questions?