Maternal & Child Health

Syed Muhammad Baqui Billah

Associate Professor, CM
SBMC
 Learning Objectives
• Define MCH, ANC
• Mother and child –one unit explain
• Objectives of ANC
• ANC visit
• 1st ANC visit-what should be done
 Objectives
• Risk approach
• High risk mother
• Danger sign in pregnancy
• Intra-natal care-definition/objectives/aims
• Rooming-in
• Domiciliary care/domiciliary mid-wifery
service
 Objectives
• Post-natal care-definition
• Objectives of post-natal care
• Complication of post-natal care
• care of new born baby
• Coloststrum
• Breast feeding-advantage
• At risk infants
 Definition

• The term MCH ( maternal and child health)

refers to promotive, preventive, curative and
rehabilitative health care for mothers and
children
 Components
• Maternal health
• Child health
• School health
• Adolescent health
• Family planning
• Handicapped children
• Care of children in special setting, such as day
care centre's
 Objectives

• Reduction of maternal, perinatal, infant and

childhood mortality and morbidity

• Promotion of reproductive health

• Promotion of physical and psychological

development of the child and adolescent
within the family
 MCH problems in developing country

• Malnutrition

• Infection

• Uncontrolled reproduction
 Malnutrition

Mother Children

Maternal depletion LBW -infections

LBW Marasmus
Anaemia Kwashiorkor
Toxaemia of pregnancy (weaning time)
PPH
 Infections

Maternal Children

TORCH infections Diarrhoea

UTI causes: Respiratory infection
LBW Skin infection
IUGR
Embryopathy
Abortion
Puerperal sepsis
 Uncontrolled Reproduction

• Increase prevalence of LBW

• Severe anaemia

• Abortion

• APH( ante-partum haemorrhage)

 Maternity cycle
• Fertilization
• Ante-natal period
• Intranatal period
• Postnatal period
• Inter-conceptional period
 Some common terms
• Embryo : 14 days- 9 weeks
• Foetus: 9 weeks – birth
• Premature : from 28 weeks - 36 weeks of
gestation
• Full term: average 280 days of gestation
• Neonate: First 28 days
• Infant: Up to year 1
• Toddler: 1-3 years
• Child: 1-5 years/(Up to puberty)
Ante-natal period

Ante-natal care:
Care of the mother during pregnancy
 Mother and child-one unit
During ante-natal period:
Get O2 and nutrients
• Child health closely related to mother health
Certain diseases and condition: TORCH, drug intake
•

After birth:
Exclusive breast feeding
Mental and social development
Mother is also the first teacher of the child
 ANC ( Ante-natal care)

Objectives:

• Promote, protect and maintain the health of the mother

during pregnancy

• To detect high risk cases and give them special attention

• To foresee complications and prevent them

• To remove anxiety and dread associated with delivery

• To reduce maternal and infant mortality and morbidity

• To teach the mother about child care, nutrition,
personal hygiene and environmental sanitation

• To sensitize the mother to the need of family

planning

• To attend the under-5 accompanying the mother

 Ante-natal visit

• Ideal visit: 14
• Minimum visit: 4
 ANC visit

• Ideal visit: 14
1st month- 7 month: once a month
8th month: twice a month
Thereafter : once in a week

• Minimum visit: 4
1st visit: as soon as possible/16week
2nd visit: at 32 wks
3rd visit: at 36 wks
4th visit: at the time of EDD
 1st ANC visit
• Registration
• History-obs/medical/ Inj.TT
• Physical examination
• Laboratory examination
 Risk Approach

To identify the high risk mother

and arrange for them skilled care

Who are the high risk mother?

 Risk approach

Elderly primi
Short statured primi
2
Malpresentation
Ante-partum Haemorrhage
1
Toxaemia of pregnancy
Anaemia
Twin, hydroamnios
Prolong pregnancy (14 days after expected date of
delivery)
APH (ante-partum hemorrhage)
 Hydroamnios

100cm
 Risk factors
• Previous still birth,IUD,manual removal of
placenta

• H/o -C/S,or instrumental delivery

▪ Pregnancy associated with general diseases,

CVD,renal disease, tuberculosis,liver disease
 Danger signs during pregnancy

Blurred
vision

Edema Convulsion

APH
Severe headache
 Intra-natal care

Care of the mother during delivery

 Intra natal care
• The aims of good intra-natal care:
1. Thorough asepsis

2. Delivery with minimum injury to the infant and mother

3. Readiness to deal with complications such as prolonged

labour, ante-partum hemorrhage, convulsion,
malpresentations, cord prolapse etc.

4. Care of the baby at delivery-resuscitation, care of the

cord, care of the eyes, etc
 Danger sign during delivery

• Sluggish pain/no pain after rupture of membranes

• Good pains for an hour after rupture of membranes
but no progress
• Cord prolapse
• Excessive bleeding during labour
• Retained placenta
• PPH
• Collapse during labour
Domiciliary care

History of normal delivery

Satisfactory home condition

Delivery may be conducted in home by

trained dai
 Domiciliary care

Domiciliary mid-wifery services:

• Mother with normal obstetric history

• Provided the home conditions are satisfactory
• Mother may advised to conduct delivery at home by
health worker or trained dai

This is known as domiciliary mid-wifery services

 Advantage of Domiciliary Services

• Mother delivered in the familiar surroundings of her

home and this may tend to remove the fear
associated with delivery in hospital

• Less chance of cross infections

• The mother is able to keep an eye on her children

and domestic affair
 Disadvantage of Domiciliary Services

• The mother may have less nursing and medical

supervision than hospital

• The mother may have less rest

• She may resume her domestic duties too soon

• Her diet may be neglected

Rooming -In

Baby's crib by the side of

mother’s bed

•To know her baby

•Interest in breast feeding

•Allays the fear of the

mother about her child
nursing
 KMC
KMC is one of the most promising way to save preterm and LBW
babies in high and low income setting alike

Skin to skin
contact on
mother chest
Adequate
nutrition:
breast feeding
 Advantage of KMC
KMC :
• Prevent infection
• Promote breast feeding
• Regulate baby's temperature
• Regulate breathing and brain activity
• Encourage mother and baby bonding

KMC is more effective than incubator care, cutting newborn

death by 51%
 Scenario in Bangladesh

• KMC: first introduce in Bangladesh hospital in

Dinajpur in the late 1990

• Matlab hospital of ICDDR,B in 2007

• Dhaka Shishu hospital in 2013

 Post-natal

Care of the mother and the newborn after delivery

 Objectives

• To prevent complications of the postnatal period

• Rapid restoration of mother to optimum health

• Check adequacy of breast feeding

• Provide family planning services

• Provide basic health education

Complications
Thrombophlebitis
Puerperal
sepsis

Secondary
hemorrhage
UTI
Mastitis
 Neonatal care

• Cleaning the airway

• Apgar score
• Care of the cord
• Care of the eyes
• Care of the skin
• Maintenance of body temperature
• Breast feeding
Cleaning airway
Care of cord
 APGAR score
• 1min------------5mins
 Care of eyes
To prevent ophthalmia neonatorum
Maintenance of Temperature
Care of the skin
Sign 0 1 2
Appearance Blue/pale Body pink but Completely pink
extremities blue

Pulse/HR Absent Slow Over 100

Grimace / No response Poor response cry

Reflex

Activity/ Flaccid Poor muscle Active

muscle tone tone movement

Respiration Absent Good crying

Slow

Total score-10 0-3 4-6 7-10

Severe mild depression No
depression depression
 Measuring the baby
• Birth-weight

• Length

• Head circumference
 Feeding of infants

• Colostrum –The first milk, high concentration

of protein and other nutrient
rich in anti-infective factors

Prevent from diarrheal disease & RTI

• Regular milk: comes on 3rd---6th day after birth

• Energy value: 70kcal/100ml
 Advantage of breast milk
• Cheap, clean, hygienic and correct temperature

• Fully meet the nutritional requirement of the

infant in the first 6 months of life

• Contains anti-microbial factors- GIT & RTI

• Easily digested and utilized by both normal and

pre-term baby
 Advantage of breast milk (cont.)
• Helps in jaw development

• Prevent tendency to obesity

• Promotes bondage

• Helps in jaw development

• Prolonging period of infertility-family spacing

 Advantage for mother

• Risk of PPH (post-partum hemorrhage) & anaemia

reduced
• Boosts mother immunity
• Delays next pregnancy
• Reduces the insulin of diabetic mothers
• Protect mother from ovarian and breast cancers and
osteoporosis
 At-risk infants
• LBW
• Twins
• Birth order 5 or more
• Artificial feeding
• Weight below 70% of the expected weight
• PEM
• Diarrhoea
 LBW

• Birth weight less than 2.5 kg in first hour of life

• Pre-term baby
• Small for date
Causes of LBW:
• Malnutrition Placental cause
• Placental insufficiency
• Severe anaemia • Placental abnormality
• Multiple births
• Hypertension
• Acute infection
• Hard working mother
Foetal cause:

• Multiple pregnancy
• Foetal abnormalities
• Intrauterine infection
• Chromosomal abnormality
 Baby friendly hospital initiatives
Since 1993 WHO effort-
• Improve nutritional status of infant and young
child- by promoting breast feeding
 Growth and Development
• Growth :
The term growth refers to increase in the
physical size of the body

• Development:
the term development implies to increase
skills and functions
 Determinants of growth and
development
• Genetic inheritance
• Nutrition
• Age
• Sex
• Physical surroundings
• Psychological factors: love, care and child parent
relation
• Infection and parasitosis
• Economic factors
 Physical growth
• Weight for age
• Height for age
• Weight for height
• Head and chest circumference
 Behavioral development
• Motor development
• Personal –social development
• Adaptive development
• Language development
 Growth chart
• Also known as road to health chart

• Designed by David Morley and later modified

by WHO

• It is a visible display of child's physical growth

and development
Growth chart

50 percentile

3 percentile
 Use of growth chart
• Growth monitoring
• Diagnostic tool: high risk children
• Planning, policy making and action
• Educational tool: mother
• Tools for action: health worker (intervention)
• Evaluation
• Teaching: Importance of breast feeding
 Indicators of MCH care
• MMR
• Mortality in infancy and childhood
✓ Perinatal mortality rate
✓ Neonatal MR
✓ Post-neonatal M R
✓ Infant MR
✓ 1-4 year MR
✓ Under 5 mortality rate
✓ Child survival rate
 Maternal mortality
The death of a woman
while pregnant or within 42 days of termination
of pregnancy
Irrespective of duration or site of pregnancy
From any cause related to or aggravated by the
pregnancy or its management
Not from any accidental or incidental cause
 MM Ratio

total no. of female death due to

complication of pregnancy/child birth/within 42
days of delivery, in an area in a given year
MMR = x 1000
total No. of live birth in the same area and
year
MMR: 163/100,000 LB (2022)
 MM Rate
• The number of maternal deaths in a given
period per 100000 women of reproductive age
at the same time period

total no. of female death due to complication of

pregnancy/child birth/within 42 days of delivery,
in an area in a given year
MMR = x 1000
total no. of women of reproductive age at
the same area and year
 Causes of MM
• Post partum hemorrhage
• Infections
• Prolong /obstructed labour
• Eclampsia
• Complication of abortion
 IMR
• The number of infant deaths for every 1000
live births
– Gives key information about maternal and infant
health
– Important marker of the overall health of a society
– 22/1000 LB (2022)
 Cause of infant mortality
Neonatal M. Post-neonatal M.
• LBW • Diarrhoeal disease
• Birth injury • ARI
• Sepsis • Other communicable
• Congenital anomalies disease
• Haemolytic disease • Malnutrition
• Condition of placenta • Congenital anomalies
• Diarrhoeal disease • accidents
• ARI
• tetanus
 IMCI

Integrated management of childhood illness

It is a strategy to the management of childhood
illness by integrated approach
• The core of the IMCI strategy is integrated
case management of the most common
childhood illness-
❑Diarhoea
❑ARI
❑Malaria
❑Measles
❑Malnutrition
A single diagnosis may not be possible/ appropriate

Many sick children are not properly assess and treated

and parents are poorly advised

In response to this challenge WHO and UNICEF

develop a strategy known as IMCI
• A clinical guidelines, designed for the
management of sick children aged 1 week to 5
years

• The IMCI case management process include:

❑Assess
❑Classify
❑Identify
❑Treatment
❑Parents counseling
Diarrhea
Malnutrition
 Ear Problem
Signs Diagnose Treatment
Pneumonia (ARI)
THE END