Mother and child health

1. Maternal & Child Health -1

2. Specific Learning Objectives
RCHA1.1 List the important mortality indicators related to RCH & MCH
RCHA 1.2 List at least five most common causes of morbidity and mortality
during pregnancy
RCHA 1.3 Describe the burden of maternal and child morbidity & mortality
RCHA 1.4 Describe the life cycle approach using an example
RCHA 3.1 List the components of preconception advise
RCHA 3.2 Describe the health needs of the married couples in the
preconception period
RCHA 3.3 Describe the rationale of various components of preconception
advice

3. 20/02/2024 Col A S Kushwaha
“Children are the future of society, and their mothers
are guardians of that future”

4. 20/02/2024 Col A S Kushwaha
• Pregnancy and childbirth are two very
important life change events for the mother,
newborn and the family.
• The health of women and children has always
been an important social goal of all societies.

5. 20/02/2024 Col A S Kushwaha
Mother and Child: A Single Entity
1. At childbirth, both mother and child are at risk for complications.
2. Health of the child and the mother are closely linked.
3. TORCH infections ---congenital defects.
4. Some specific health interventions jointly protect pregnant women and
their babies –e.g. Inj T.T., Iron & Folic acid
5. After birth, the newborn is solely dependent on mother for breastfeeding,
care and development.
6. The postpartum care of the mother is inseparable from newborn care,
immunization and family planning advice.

6. 20/02/2024 Col A S Kushwaha
Why so much attention to this issue?
• Number – 70%
• Most vulnerable section- death, disease, disability &
discrimination
• High morbidity and mortality
• Avoidable / preventable
• Effective interventions available

7. 20/02/2024 Col A S Kushwaha
Indicators
Mortality indicators-
• Maternal mortality ratio
• Infant mortality rate
• Peri-natal mortality rate
• Post Neonatal mortality rate
• Stillbirth rate
• Under Five mortality rate
• Child death rate
Fertility/ Demographic
indicators
• Total Fertility rate
• Crude Birth rate
• General Fertility rate
• Gross Reproduction rateNet
Reproduction rate
• Pregnancy rate
• Abortion rate
• Marriage rate

8. 20/02/2024 Col A S Kushwaha
Social/ Health care related services/ indicators
• Sex Ratio
• Couple protection rate
• Age at marriage
• Registration of marriage, Births, deaths
• Pre-pregnancy Nutritional status of mother( BMI,
Anemia, Weight)
• Antenatal care- registration, visits, IFA
supplementation, TT2 coverage
• Attended deliveries by TBAs
• Institutional deliveries
• Proportion of LBW babies
• Breast feeding related- initiation, exclusive breast
feeding, duration
• Immunization coverage of children- completeness
• Incidence of diarrhea , ARI in children
• Child survival rate
• Incidence of malnutrition in children- PEM,
stunting
• Enrolment in school- years of schooling, sex
differential in education
• School Health Services
• Adolescent health services
• Legislation for welfare of mothers and children

9. Maternity cycle
• Fertilization
• Antenatal period
• Intranatal period
• Postnatal period
• Interconceptional period
20/02/2024 Col A S Kushwaha
Stages of Growth-
• Ovum -0 to 14 days
• Embryo – 14 days to 9 wks
• Foetus – 9 wks to 9 months
• Premature infant – 28 to 37 wks
• Full term – 280 days/37- 40 wks

10. MCH
• Preventive + Promotive + Curative & rehab services for
mothers & children
• Sub areas/ elements – maternal health, child health, family
planning, school health, adolescence, handicapped & orphans
(HIV)
Objectives –
• Reduction of mortality/morbidity
• Promotion of reproductive health
• LIFE LONG HEALTH
20/02/2024 Col A S Kushwaha

11. Problems in MCH
Varies from developing to developed countries
– Triad of malnutrition, infection & Unregulated
fertility
– Lack of health infrastructure
– Gender based discrimination
– Poor socio-economic conditions
20/02/2024 Lt Col A S Kushwaha

12. Malnutrition
• Pregnant, nursing mothers & children are particularly
vulnerable
• Maternal – LBW, anemia, toxemia, PPH,
• Intrauterine – IUGR – Metabolic syndrome
• Childhood – growth failure, stunting, delayed milestones
• Prevention-
• Direct –supplementary nutrition , Fe FA tab, food fortification
• Indirect – control communicable disease (measles), family
planning, health education & primary health care services
20/02/2024 Col A S Kushwaha

13. Infection
• Maternal infections- abortions, foetal growth retardation, LBW,
congenital anomalies,
• Foetal infection – in utero, labour, after birth
• 1/3 rd of 1st year of life may be cumulative duration of illness
• Diarrhea, ARI, exanthematous fevers, malaria, TB
• Infection may predispose, precipitate malnutrition
• Malnutrition Infection
• Prevention – EPI, 6 VPDs, ORT, Nutrition
20/02/2024 Col A S Kushwaha

14. Unregulated Fertility
• too early, too many and too close
• Universal marriage
• Early marriage
• Male child preference
• Lack of education
• Women empowerment – poor
• Lack of health services ( Unmet needs)
20/02/2024 Col A S Kushwaha

15. PRENATAL CARE
Why ?
Three types of health problems exist in pregnancy.
1. The complications of pregnancy itself,
2. Second, diseases that happen to affect a pregnant
woman and which may or may not be aggravated
by pregnancy, and
3. Third, the negative effects of unhealthy lifestyles

22. Health of Women
• Low sex ratio of 933 female per thousand male.
• Early marriage in women and universality of marriage are
important social issues.
• The median age at first marriage among women is 17.2 years.
• Among young women age 15-19, 16 percent have already begun
childbearing.
• Less than half of women received antenatal care
• Three out of every five births in India take place at home;.
• Every seven minutes an Indian woman dies from complications
related to pregnancy and childbirth.

23. Causes of Maternal Deaths

26. Preconception care
• Refers to physical and mental preparation of
both parents for pregnancy and childbearing
in order to improve the pregnancy outcome.

27. Pre-conception Care
Indications for Preconception Care
1. Advanced maternal (>35 years) or paternal (>55 years) age
2. history of neural tube defects in family or previous pregnancy
3. Congenital heart disease, hemophilia, thalassemia, sickle cell
disease, Tay-sach’s disease, cystic fibrosis, Huntington
chorea, muscular dystrophy, Down’s syndrome.
4. Maternal metabolic disorders
5. Recurrent pregnancy loss (>3)
6. Use of alcohol, recreational drugs or medications
7. Environmental or occupational exposures

29. History
• Medical History –thyroid, DM, HTN
• Reproductive History – abortion, *Two or more pregnancies
ending in first trimester, One or more fetal deaths, *One or more preterm
deliveries, One or more small-for-gestational-age infants, One or more
infants with a birth defect?
• Nutrition –dietary habits
• Family History – congenital disorders/anomalies, Hemophilia,
Thalassemia Tay-Sachs trait or disease, Sickle cell disease or trait,
Phenylketonuria, Cystic fibrosis, Birth defects, Mental retardation?
• Social History –smoking /alcohol
• Laboratory tests

32. LIFE CYCLE APPROACH- Diabetes

33. (C. Savona-Ventura et al : Int. J Risk Safety Med , 2007, 19:229-236

36. Health Needs of married couples
• Fertility /Infertility
• Family planning
• Parenting
• Breastfeeding
• Early child care
• Nutrition
• Sexual and
reproductive health
• Drugs
• Lifestyle & pregnancy
• Child health
• Vaccination

37. 20/02/2024 Col A S Kushwaha
Opportunities in MCH
• Lifecycle approach
Adolescence - pregnancy Birth Postpartum
Linking across the times of care giving
Neonatal/Postnatal
Infancy
Adolescence Childhood

38. 20/02/2024 Col A S Kushwaha
Maternal, Newborn and child care continuum
Pregnancy Birth Neonatal period
Service
delivery
continuum
Facility based
Outreach services
Family &Community
Me OC
Resuscitation
Mgt of Preterm labour
PROM
APH
Mgt of Neonatal illnesses,
sepsis, VLBW babies, KMC
ANC Visits
TT, Fe/FA
Malaria
UTI
Early detection of
complications
Referral, Postnatal care
Breastfeeding
Nutritional support
Birth preparedness
Promote Institutional
delivery
Counseling on care of
mother & child
Clean delivery,
cord care,
warm chain
EBF
Family planning
Hygiene,
LBW care
Case mgt of ARI
Diarrhea
Vaccination
Vaccination
Postnatal care
Postnatal care