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Maternal & Child Health-II

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  1. Maternal & Child Health-II Dr. Aliya Junaid Community Medicine Dept. Army Medical College

  2. Contents • Reproductive Health & its Components • Safe motherhood & its Components • Maternal Mortality Rate, causes & prevention • Infant Mortality Rate, causes & prevention • MCH Center • Child Care- IMCI

  3. Reproductive Health

  4. Reproductive Health • Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of reproductive disease or infirmity.

  5. Safe Motherhood

  6. Safe Motherhood • The ability of a mother to have Safe & Healthy pregnancy & Child Birth.

  7. Safe Motherhood Components

  8. SAFE MOTHERHOOD Antenatal care Clean/Safe Delivery Essential Obstetric Care Family Planning BASIC MATERNITY CARE PRIMARY HEALTH CARE EQUITY FOR WOMEN Health policy 1997

  9. Maternal Mortality

  10. Maternal Mortality It is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause related or aggravated by the pregnancy or its management and NOT due to any accidental or incidental cause.

  11. Causes of Maternal Mortality

  12. Causes of Maternal Mortality • Hemorrhage • Septicemia • Toxemia( Eclampsia) of pregnancy • Abortions • Abnormalities of bony pelvis • Ectopic Pregnancy • Disproportion or mal-position of fetus • Improper management • Poor technique in natal & postnatal periods.

  13. Prevention of Maternal Mortality

  14. Prevention of Maternal Mortality • Pre - conception Guidance • Ante-natal Care • Natal Care • Post-natal care

  15. Routine antenatal care

  16. Routine antenatal care • History • Physical Examination i.e. Height, weight blood pressure pulse, abdominal etc • Investigation i.e. complete Blood Picture, Urine R/E, Blood group and Rh Factor, Random Blood Sugar, Ultrasound • Prescribe Medications i.e. iron , folic acid, calcium • Counseling i.e. nutrition, avoiding drugs, radiation, rest, • Immunization • Reschedule Next visit

  17. Schedule of Tetanus Toxoid (WHO) for Child bearing Age (15-44 yrs) • TT1: During child bearing age • TT2: Four weeks after TT1 • TT3: Six months after TT2 • TT4: One year after TT3 • TT5: One year after TT4 or during next pregnancy

  18. Schedule of Tetanus Toxoid for Pregnant Women • TT1 – 7 months • TT2 – 1 month after TT1 • TT3 - 6 Months after TT2 • TT4 - 1 Year after TT3 • TT5 – 1 Year after TT4

  19. INFANT MORTALITY

  20. Childhood division into age-periods: • Infancy ( up to 1 year of age) • Neonatal period (first 28 days of life) • Post neonatal period (28th day- to 1 yr) • Pre-school age (1-4 years) • School age (5-14 years)

  21. Infant Mortality

  22. Infant Mortality • Death of the child under 1 year of age

  23. Infant Mortality Rate

  24. Infant Mortality Rate • It is 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 thousand live births.)

  25. Infant Mortality Rate Number of deaths of children less than 1 year of age in a year Number of live births in the same year IMR= X 1000

  26. Mortality In & Around Infancy

  27. Still Birth

  28. Still Birth • Death of a fetus weighing 1000 g or equivalent to 28 weeks of gestation.

  29. Still Birth Rate Fetal deaths weighing over 1000 g at Birth during the year SBR = x 1000 Total live + Stillbirths over 1000 g at Birth during the year

  30. Peri-natal Mortality Rate

  31. Peri-natal Mortality Rate • Includes both late fetal deaths (Still birth) and early neonatal deaths. • Is defined as lasting from 28th week of gestation to the seventh day after birth.

  32. Peri- Natal Mortality Rate Late fetal deaths (28 wks gestation & more) + early neonatal deaths (first week) in one year PNMR = X 1000 Late fetal deaths + Live Births In The Same Year

  33. Neonatal Mortality Rate

  34. Neonatal Mortality Rate • These are deaths occurring during the neonatal period, commencing at birth and ending 28 completed days after birth. • Early neonatal death • Late neonatal death

  35. Neonatal Mortality Rate Number of deaths of children under 28 days of age in a year NMR = x 1000 Total live births in the same year

  36. Early Neonatal Mortality Rate

  37. Early Neonatal Mortality Rate Number of deaths of children <1 wk of age in a year ENMR = x 1000 Total live births in the same year

  38. Late Neonatal Mortality Rate

  39. Late Neonatal Mortality Rate Number of deaths of children after 7th day till 28th day of age in a year LNMR = x 1000 Total live births in the same year

  40. Post- Neonatal Mortality Rate

  41. Post Neonatal Mortality Rate Total number of deaths of children between 28 days and one year of age in a given year PNMR = x 1000 Total live births in the same year

  42. 1 - 4 year Mortality Rate (Child Death Rate)

  43. 1 - 4 year Mortality Rate (Child Death Rate) No of deaths of children aged 1-4 years during a year Child DR= X 1000 Total no. of children aged 1-4 years at the middle of the year • Mid-year estimated population means population counted on the 1st of July

  44. Under 5 Mortality Rate/ Child Mortality Rate

  45. Under 5 Mortality Rate/ Child Mortality Rate Number of deaths of < 5 years of age in a given year U5MR = x 1000 Total number of live births in the same year

  46. Child Survival Index 1000 – under 5 mortality rate CSR= 10 A child survival rate per 1000 births can be simply calculated by subtracting the Under -5 mortality rate from 1000. Dividing this figure by ten shows the percentage of those who survive to the age of 5 years. = U5MR of Pakistan in 2003 = 107/1000 live births = 1000 – 107/10 = 89.3 % Ref: Unicef

  47. Child Survival Index points towards the need for preventive services through: • Breast feeding • Adequate nutrition • Clean water • Immunization • Oral Rehydration Therapy • Birth spacing

  48. Predisposing Factors of Infant Mortality

  49. Predisposing Factors of Infant Mortality • Biological Factors • Birth weight, Age of the mother, Birth order, Birth spacing, Multiple births, Family size, High Fertility. • Economic Factors • Low socioeconomic factors, quality & availability of health care • Cultural & Social Factors • Breast feeding, Early marriage, maternal education etc