Maternal & Child Health-II Dr. Aliya Junaid Community Medicine Dept. Army Medical College
Contents • Reproductive Health & its Components • Safe motherhood & its Components • Maternal Mortality Rate, causes & prevention • Infant Mortality Rate, causes & prevention • MCH Center • Child Care- IMCI
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.
Safe Motherhood • The ability of a mother to have Safe & Healthy pregnancy & Child Birth.
SAFE MOTHERHOOD Antenatal care Clean/Safe Delivery Essential Obstetric Care Family Planning BASIC MATERNITY CARE PRIMARY HEALTH CARE EQUITY FOR WOMEN Health policy 1997
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.
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.
Prevention of Maternal Mortality • Pre - conception Guidance • Ante-natal Care • Natal Care • Post-natal care
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
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
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
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)
Infant Mortality • Death of the child under 1 year of age
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.)
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
Still Birth • Death of a fetus weighing 1000 g or equivalent to 28 weeks of gestation.
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
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.
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
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
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
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
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
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
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
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
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
Child Survival Index points towards the need for preventive services through: • Breast feeding • Adequate nutrition • Clean water • Immunization • Oral Rehydration Therapy • Birth spacing
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