Maternal and Child Health Problems and their Management

MS. RACHANA JOSHI
Assistant Professor,
Sumandeep Nursing College
OBSTETRIC AND GYNAECOLOGICAL
NURSING
Ms. Rachana Joshi, Assistant Professor,
Sumandeep Nursing College, SVDU
1

MAGNITUDE OF
MATERNAL AND
CHILD HEALTH
PROBLEMS
FACTORS
INFLUENCING
MATERNAL AND
CHILD HEALTHMs. Rachana Joshi, Assistant Professor,
2

JOURNEY OF CLASS…..
• Introduction
• Definition
• Objectives & Goals of MCH
• Maternal health problems
• Child health problems
• Issues of M & Child Health
• Conclusion
3

INTRODUCTION:
Maternal and child health.
HEALTH
MOTHER CHILD
SOCIETY
Healthy children need healthy mothersMs. Rachana Joshi, Assistant Professor,
4

Integral Care HEALTH
ACESSPHC
ACTION
S
OBJETO
SEPSIS
SHOCK
DEATH
Survival
SHC actinos
DISEASES
PREVENTION
AGENT
CAUSE
Maternal & child health. Hollistic approach.
MORTALITY
MORBIDITY
RISK FACTORS
5

Factors affecting Health
Diseases
• In 2002, nearly 11 million children died before reaching their
fifth birthday – 98% of these deaths were in developing
countries.
2006 World Health Organization
6

WHY IS A NEED?
7

WE HAVE TO FOCUS……
8

MAGNITUDE
• Largeness, Importance.
Magnitude is the total size of an
effect.
• Statistics that can be measured..!
9

MATERNAL AND CHILD
HEALTH (MCH)
 A package of comprehensive health care
services which are developed to meet promotive,
preventive, curative, rehabilitative
health care of mothers and children.
10

MATERNAL HEALTH
According to WHO-
• “Maternal health refers to the health of women
during pregnancy, childbirth and the
postpartum period. While motherhood is often
a positive and fulfilling experience, for too
many women it is associated with suffering,
ill-health and even death.”
11

REPRODUCTIVE HEALTH
“People have the ability to reproduce and regulate
their fertility, women are able to go through
pregnancy and child birth safely, the outcome of
pregnancies is successful in terms of maternal and
infant survival and well being and couples are
able to have sexual relations free of fear of
pregnancy and of contracting diseases.”
• According to the WHO, "Reproductive and sexual
ill-health accounts for 20% of the global burden
of ill-health for women, and 14% for men."
12

OBJECTIVES OF MCH :
 To reduce maternal, infant and childhood mortality and
morbidity.
 To reduce perinatal and neonatal mortality and morbidity.
 Promoting satisfying and safe sex life.
 Regulate fertility so as to have wanted and healthy children
when desired.
 Provide basic maternal and child Health Care to all mothers
and children.
 Promote and protect health of mothers.
 To promote reproductive health.
 To promote physical and psychological development of
children and adolescents with in the family.Ms. Rachana Joshi, Assistant Professor,
13

GOALS MCH
SERVICES:
 To ensure the birth of a healthy infant to every expectant
mother.
 To provide services to promote the healthy growth and
development of children up to the age of under- five- years.
 To identify health problems in mother and children at an early
stage and initiate proper treatment.
 To prevent malnutrition in mothers and children.
 To promote family planning services to improve the health of
mothers and children.
 To prevent communicable and non- communicable diseases in
mothers and children.
14

MATERNAL HEALTH
PROBLEMS
I. Nutritional Problems
II. Infection Problems
III. Disturbances and Menstruation
IV. Mature Gravidas
V. Adolescent Gravida
VI. Adolescent Parents Problems
VII. Unregulated Fertility
VIII. Abortions
IX. Complications of Deliveries
X. Infertility
XI. Uterine Prolapse
XII. Cancer of the CervixMs. Rachana Joshi, Assistant Professor,
15

NUTRITIONAL PROBLEMS
• a)Malnutrition
• b)Nutritional Anemia
16

17

18

19

20

21

22

II.INFECTION PROBLEMS
• a)Reproductive Tract Infections ( RTIs)/
Sexually Transmitted Infection (STI)
• b)Infection in general
• c)Puerperal Sepsis
23

24

25

26

27

III. Disturbances and Menstruation
Menstruation is perceived as a particular
problem for women.
• Amenorrhea-absence of menstrual flow
• dysmenorrhea-painful menstruation
• abnormal uterine bleeding
• hypermenorrhoea/ menorrhagia-excessive
bleeding (amount and duration)
• Metrorrhagia-bleeding between menstrual
periods. Ms. Rachana Joshi, Assistant Professor,
28

IV. Mature Gravidas
• The pregnant woman over 35 years faces unique
problems. The primigravida in this age category has
generally decided to postpone child bearing until her
career is well established.
29

V. Adolescent Gravida
• The adolescent mother and her family create a
particularly difficult problem.
• The mean age of menarche is around 12 years. Forty
two percent of girls and 64 percent of young boys are
sexually active by age 18.
• Sex education and family planning help to adolescent
gravida.
• Parents and teachers need education also.
30

VI. Adolescent Parents Problems
• Teenagers fathers have many problems. They are
young, are capable of sexual reproduction, but not
considered adults, are cognitively and
psychologically immature possess few legal rights
and are out of life cycle synchrony with their peers.
• Adolescent parents are rarely able to support
themselves and their children
• They may need to guided through the decision
making process
31

VII. Unregulated Fertility
–Unregulated fertility has adverse effects on
both mother and children
–Decrease in birth spacing results in
inadequate care for the existing child and
risk of more complications during
pregnancy ( such as anemia, IUGR,
abortion)
–The risk increases greatly after the 4th
pregnancy
32

Interventions mainly include
• family planning services form an important
part of MCH programs
–Measures like Intrauterine contraceptive
device, oral contraceptive pills, long acting
injectable medroxy progesterone acetate,
female sterilisation and barrier methods
can be used.
33

34

35

36

37

38

39

40

41

42

43

HPV vaccine
•Cervarix vaccine,
manufactured by
GlaxoSmithKline
• The researchers published two
studies online on October 9
2013 in the journal The Lancet
Oncology, which noted that the
vaccine “offers excellent
protection” against two key
strains of HPV
• particularly when given to
young adolescent girls before
they become sexually active.Ms. Rachana Joshi, Assistant Professor,
44

45

46

47

CHILD HEALTH PROBLEMS
48

“Children's growth up to age
five is influenced by:
nutrition, environment and
health care,
rather than by
genetics or ethnicity.”
- WHO
49

I. Nutritional deficiency Problems
a) Malnutrition
b) Vitamin Deficiency
c) Iron Deficiency
d) Low Birth Weight
50

Malnutrition, a Global Trauma
Child with Spina Bifida and Hydrocephalus
(Folic acid deficiency during pregnancy)
High Prevalence of Prematurity
Child with Myelomeningocele (Folic
acid deficiency during pregnancy)
Protein, Calories, Vitamins
deficiencies
51

World Health Organization data 2001 (from Global Health Council http://www.globalhealth.org)
Leading Causes of Death in Children
Under 5 years of age
Perinatal (22%)
All other causes
(29%)
HIV / AIDS
(4%)Diarrhea
(12%)
Measles
(5%)
Malaria
(8%)
Pneumonia
(20%)
Malnutrition
underlying factor
(60%)
52

II.
a)Tuberculosis
b)Diphtheria
c)Pertussis (Whooping Cough)
d)Tetanus
e)Poliomyelitis
f)Measles
g) Acute Respiratory Infection (ARI)
h) Diarrheal Diseases
53

54

III. Problems of Neonates
• a)Hyper bilirubinemia
• b)Hypothermia
• c)Neo-natal tetanus
• d)Birth asphyxia
• e)Oral thrush
• f)sepsis
• g)The infected New Born
55

CONCLUSION
(of First Topic)
56

MDGs and maternal/child health :
• Millennium Development Goal 4 aims to reduce
child deaths by two-thirds between 1990 and 2015.
• Millennium Development Goal 5 has the target of
reducing maternal deaths by three-quarters over the
same period.
• Unfortunately, on present trends, most countries are
unlikely to achieve either of these goals.
• A recent review of MDG progress, show that the world
have only 32% of the way to achieving the child health
goal and less than 10% of the way to achieving the goal
for maternal health.
57

ISSUES OF MATERNAL AND
CHILD HEALTH
NEED FOR IMPROVEMENT OF MATERNAL
AND CHILD HEALTH:-
1. Mothers and children below the age of 15 years make up
majority of the population in almost all countries.
2. Mothers and children constitute a “special risk” or
vulnerable group – in terms of illnesses and deaths.
3. By improving the health of mothers and children we
improve the health of the family and community.
4. Ensuring child survival is a future investment for the
family and community.
58

National programmes related to
mother and child health
• MCH PROGRAMME
• ICDS PROGRAMME
• CHILD SURVIVAL AND SAFE MOTHERHOOD
PROGRAMME
• RCH PROGRAMME
• JANANI SURAKSHA YOJANA
• NRHM
59

60

ISSUES OF MATERNAL AND CHILD HEALTH
SOCIOCULTURAL INFLUENCE ON WOMEN’S HEALTH
• FAMILY STRUCTURE AND MULTIPLE ROLES
• POVERTY
• LONGEVITY
• POLICY AND RESEARCH ISSUES
• MALNUTRITION AND ANEMIA
CRITICAL ISSUES FACING WOMEN’S HEALTH-
• VIOLENCE AGAINST WOMEN
• RAPE
• SUBSTANCE ABUSE
• SEXUALLY TRANSMITTED DISEASES
• MENTAL AND EMOTIONAL DISORDERS
• SUICIDE: Ms. Rachana Joshi, Assistant Professor,
61

Cont…
SOCIOECONOMIC INFLUENCE ON CHILD’S HEALTH:-
• POVERTY
• HOMELESSNESS:
• MIGRANT FARMWORKER FAMILIES
• CHILD LABOR
• GENDER BIAS
• CHILD ABUSE AND NEGLECT (CAN)
CULTURAL INFLUENCES ON CHILD HEALTH:-
• CULTURAL RELATIVISM
• FOOD CUSTOMS
RELIGIOUS INFLUENCES ON CHILD’S HEALTHMs. Rachana Joshi, Assistant Professor,
62

ISSUES IN MATERNAL
HEALTH:-
SOCIOCULTURAL INFLUENCE ON
WOMEN’S HEALTH –
Respecting sociocultural values is important in
maternal and child health because child bearing and
child rearing are both surrounded by many cultural
traditions.
Nurses can provide multicultural care by
understanding cultural concepts and sociocultural
influences on families.
63

1. FAMILY STRUCTURE AND
MULTIPLE ROLES:
In the 21st century role of women has changed a
lot .
Family structure has also been changed from joint
families to nuclear families in which the family is
headed by the women.
A higher percentage of women have entered the
workforce and they now shoulder all part of the
families economic burden. But still they are
responsible for majority of household and family
care tasks.
64

2. POVERTY:-
• Poverty is associated with poor physical and
mental health. Sexually transmitted
diseases(STDs) including Acquired Immune
Deficiency Syndrome(AIDS), complications of
pregnancy, child birth, substance abuse and
addiction are all common among
low income women.
65

3.POLICY AND RESEARCH
ISSUES:-
• In the 21st century women were not included
in the clinical research trials as women might
be pregnant and the treatment being tested
might harm the fetus.
• The United States Public Health Services
recommended increased emphasis be placed
on women’s health research.
66

4. MALNUTRITION AND
ANEMIA:-
• Malnutrition and anaemia are common among
women. Both malnutrition and anaemia have
increased among women since 1998-99.
67

CRITICAL ISSUES FACING
WOMEN’S HEALTH
• 1. VIOLENCE AGAINST WOMEN:-
Violence against women occurs within all
ethnic and socioeconomic groups.
• Physical consequences of sexual abuse include
damage to reproductive organs, STDs, low self
esteem, social isolation,
68

2. RAPE:-
• Rape is a forced sexual intercourse. It is
estimated that 133,000 women are victims of
rape or attempted rape each year.
• Only 44% of rapes are committed by people
who are strangers to the victims.
• 55% of the women who are raped know their
rapist.
69

3. SUBSTANCE ABUSE:-
The term “ substance use”, “ abuse”, and “ addiction” can be
applied to alcohol, legal and illegal drugs and nicotine.
Women may use substance for recreational purposes or in a
compulsive manner. Recreational use refers to occasional
modest use of a substance for pleasure. Compulsive use is the
frequent use of a drug in spite of the fact that there may be
adverse medical or social consequences.
Substance use and abuse can lead to high level of stress,
depression, post traumatic stress syndrome and other mental
disorders.
70

4. SEXUALLY TRANSMITTED
DISEASES:-
• Sexually transmitted diseases affect women
throughout their life span.
• Consequences of STDs in women include
pelvic inflammatory diseases, miscarriages,
infertility and even death.
• STD will remain major cause of morbidity and
mortality among women until reliable, safe
and effective female controlled methods of
protection are developed.
71

5. MENTAL AND EMOTIONAL
DISORDERS:-
Depression occurs more than twice as often
among women than men.
Risk factors for depression in women include
young age, low income, low educational level,
unemployment, lack of social support etc.
72

6. SUICIDE:-
• Suicide is a leading cause of death among
females aged 5-44.
• Among 15 to 24 year old women, suicide is the
third leading cause of death.
• Depression is the major risk factor for suicide;
therefore, all depressed clients should be
assessed for suicide risk.
73

SOCIOECONOMIC INFLUENCE
ON CHILD’S HEALTH:-
1.POVERTY:- Poor families usually suffer
from poor nutrition, without medical
insurance, inadequate health maintenance and
limited access to medical treatment.
One of the most significant health
problems related to poverty is
high infant mortality rate.
74

2.HOMELESSNESS:
Homeless children experience all health
problems. They do not have regular source of
health care. Their care is fragmented and crisis
oriented.
Children who are homeless often experience
trauma related injuries like developmental
delays, anemia, asthma etc.
Homeless adolescent youth are at risk of
violence, substance, pregnancy and STDs.
75

3.MIGRANT FARMWORKER
FAMILIES
Migrants generally suffer from both acute and
chronic illness. They live in an environment of
poverty, unstable and overcrowded housing, poor
sanitation, unreliable transportation and social
isolation.
Children of migrant farm workers are at risk of
respiration and ear infection, intestinal parasites
and skin infection etc.
When medical care is provided to migrant families
follow up care is usually impossible because of
their transient life style.
76

4.CHILD LABOR:-
Child labor may be defined as employment of children in
gainful occupations.
 A large number of growing children of poor socio
economic group are employed in various occupations as
child labor. These children are working both in
unorganized sectors and in organized sectors.
In unorganized sectors, the child labors are found as
domestic servants, as helpers in shops, dhabas and
restaurants, as vendors, as rag pickers etc.
In organized sectors only small proportion of working
children are found. Child labors are mostly seen in semi
organized sectors i.e. carpet weaving, sari embroidery,
bidi making, balloon factory, automobile workshops and
garbage's.
77

5.GENDER BIAS:-
Gender bias or discrimination against females is
more prominent in India and in developing
countries.
The cultural pattern of “Son-complex” of Indian
family leads to discrimination against female
child and creates gender gap between male and
female children. Discrimination against girl
child starts before birth as female feticide and
afterwards found as female infanticide and
inappropriate rearing of girl child.Ms. Rachana Joshi, Assistant Professor,
78

Female Infanticide And Female
Feticide
• Female Feticide is the act of aborting a baby
because it is of a female gender. Sex selective
abortion is a big problem in India.
79

• Female Infanticide is the act of killing a female
girl either new-born or within the first few years
of life. It could be actively, murdering through
suffocation, poisoning etc.
• Such acts can also be passive, where no interest
is taken with regards to feeding or towards her
general health in affect total neglect.
80

6.CHILD ABUSE AND
NEGLECT (CAN):-
1.Child abuse includes physical violence, mental and emotional
maltreatment with negligence, deprivation and lack of
opportunity
2. The children are abused at home, school, day care centers and
working places by the care takers and other adults.
3.The factors responsible for child abuse are poverty,
overcrowding in the family, mental illness, alcohol or drug
abuse, crisis situations and violence.
4.The consequences of child abuse are physical injury,
malnutrition, lack of hygiene care, growth failure, behavioral
problems etc.
81

CULTURAL INFLUENCES ON CHILD
HEALTH:-
• 1.CULTURAL RELATIVISM:-
Culture relativism is the concept that any
behavior be judged in context of the
culture in which it occurs.
• for example Chinese culture see diarrhea
as a cleansing of the body that is essential
for health maintenance and
illness prevention.
82

2.FOOD CUSTOMS:-
• Food customs are an integral part of various
culture groups.
• In many cultures specific food practices are
followed during pregnancy in belief that
certain foods damage the developing fetus.
• Children in strange environment such as
hospitals feels more comfortable when they are
served familiar foods.
83

RELIGIOUS INFLUENCES ON
CHILD’S HEALTH
• Religion affects the way people interpret and
respond to illness
• Among many groups illness, injury or death is
believed to be sent by God as a punishment for
sin.
• Some believe that health workers will be
unable to help a person whom God is
punishing and may express a attitude toward
treatment stating it is “ the will of God.”
84

CONCLUSION:-
• Improving the well-being of mothers, infants,
and children is an important public health goal.
Their well-being determines the health of the
next generation and can help predict future
public health challenges for families,
communities, and the health care system
85

Now, try to answer this question
 You have been appointed as the leader of a
Health maintenance officer, How would you
motivate the team to reduce IMR, MMR in
their community setting…
86

What has to be done:
Improve social conditions of the poorest.
Eliminate health care inequality
Preventive Medicine Improvement
Improve Mental Health Services for Children and adults.
Incorporate public mental health approaches including
systematic screening and trauma/grief-focused interventions
within a comprehensive disaster recovery program.
Programs of reduction of illiteracy
Sustainable use of natural resources
Increase Employment and salaries
National infrastructure development
87

Assignment:
• Write an assay on: How can be maternal and
child health improved???
In your own words around 250 words.
Date of Submission:
-2-2014()
@ 10 am
88

Let us join our hands to reduce
MMR & IMR in
India => World
Thank You
Any questions please?
89

Have a blessed day !
90

Maternal and Child Health Problems and their Management

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