Maternal and child health care

:Definition of MCH -
The term maternal and child health refers to promotive, preventive,
curative and rehabilitative health care for mothers and children

:Objective of MCH -

Health promotion of mothers during pregnancy, labor especially high -1

.risk group

Health promotion of children form 0-6 years of age-2

Prevention and control disease and hazards-3

.Reducing mortality and morbidity for mothers and children -4

. prevention of disability and rehabilitation -5

.Family planning services -6

Reason for maternal and child health care must be considered -

?as one unit- why
.A healthy mother will bring a healthy baby -1

Up to age of five years the child is dependent on his mother -2

Separation of a child from his mother even during hospitalization has -3

been reported to be harmful

:Component of MCH centers -

a) premarital care

b) Antenatal care

c) Natal care

d)Postnatal care

e) Inter-conceptional care

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A- premarital care

Aim of premarital care : prevention and early detection of health

hazards or diseases that may affect the normal child bearing in the
.future

Components of the premarital package -

Immunization by MMR and Tetanus toxoid-1

Premarital examination -2

Family history stressing on diabetes and schizophrenia , diseases of -3

genetic and congenital significance

General examination -4

Genetic counseling to avoid genetic hereditary diseases -5

Investigation: blood groups, rhesus factor(Rh) ,hepatitis, AIDS , chest -6

x- ray to screen suspected tuberculous case for sputum examination

B- Antenatal care

Aim: to achieve at the end of the pregnancy a healthy mother and a

healthy baby

This could be achieved through four activities

Antenatal visits -1

Immunization by tetanus during pregnancy -2

Health education during pregnancy -3

Early diagnosis and proper management at risk pregnancy -4

Antenatal visits: schedule of antenatal visits should be once a month -1

in the first 28 weeks, every two weeks till 36 weeks and every week
thereafter , if everything is normal.However the following minimum
visits should be implemented

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Initial visit

first to confirm diagnosis of pregnancy -

history: personal , family, obstetric and past histories .careful history -

taking is very important to identify pregnant woman with risk factors
.who need special care

Examination includes

weight and height -

teeth inspection -

general examination( including blood pressure measurement and -

examination of leg for edema)

auscultation of heart and lung -

examination of breast and nipples -

examination of abdomen and assessment of the size of the uterus -

inspection of vagina and cervix-

examination of pelvis -

Immunization by tetanus toxoid during pregnancy (WHO schedule) -

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Dose Timing Protection
1st At the 1stantenatal Zero
visit provided being
after 12 weeks
nd 2 At least 4 weeks after %80
1st dose
3rd At least 6 months %95
after or during next
pregnancy
4th At least one year after %99
or during next
pregnancy
5th At least one year after Long life
or during next
pregnant

Health education during pregnancy-3

Management of risk pregnancy -4

Definition : presence of some risk factors during the current pregnancy

or in previous pregnancies .Identifying those high risk group and
referring them to obstetric consultation will save a lot of effort and cost
and will reduce undesirable outcomes

c)Natal care ( child birth)

:Aims

To conduct delivery under aseptic condition with minimum injury to -1

the infant and to the mother

The three cleans 3Cs: clean hands , clean surface for delivery and clean
.cutting and dressing of the umbilical cord

They do not only prevent neonatal tetanus but also reduce the incidence
of maternal sepsis during the postpartum period as well as mortality and
morbidity rates

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To be ready to manage emergencies -2

Care of baby at birth -3

Home delivery-

Home delivery is only allowed under the following condition

.Normal pregnancy-

If the home condition is satisfactory-

Under medical supervision-

Institutional delivery-

.At health centers: for only normal pregnancy and low risk group -

.Well-equipped delivery room and trained team should be available

At hospital : all pregnancies including high risk pregnancy. Obstetrician -

operating room and blood bank facilities should be available

D-Post natal care

:Aim

prevent complications of postnatal period -1

Restore health of the mother to the optimum -2

Ensure success of breast feeding -3

Provide family planning services-4

Postnatal visits

Schedule: twice a day during the first three days, once day till umbilical -
cord of the new-borne falls off and one at the end of the puerperium

The following activities should be done during the postnatal visits -

proper history taking -

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examination: pulse , temperature ,respiratory rate ,breast examination -
vaginal discharge ( color and smell for signs of sepsis)

health education during puerperium -

E- interconceptional care : it is care of the mother in between

pregnancies for preparation of the mother for the next pregnancy

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 Family planning
Definition: family planning is defined as voluntary regulation of child
birth for the aim of bringing healthy baby at proper time , in proper
numbers and at proper spacing

The proper time of childbearing for women is 20-34 years old-

And the proper spacing between children is 2-3 years

:Impact of family planning on health

Impacts on women health: it reduces maternal mortality, morbidity -1

and improves maternal health

Impact on fetal health: timing of births in relation to the age of the -2

mother can prevent a number of congenital anomalies that are
associated with advancing maternal age

Impact on child health: it reduces child mortality and morbidity -3

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 Child health care
Components of child health care

prenatal child care -1

care of the newborn -2

infant health care and care of pre-school age group -3

prenatal child care: achieved through preconcepstional care if genetic -1

counseling is included ,antenatal care

care of the new born -2

aseptic cutting of the cord and dressing the stump -

clearance of the respiratory passage and ensure regular breathing -

cleanliness of the eyes and disinfectant eye drops -

examination to detect any abnormalities -

birth weight and length assessment -

care of the skin( bathing) -

the first few days are very important to establish successful breast- -
feeding

BCG, polio and Hepatitis B vaccination could be done at birth -

special care for the premature-

:Infant health care and care of pre-school age group-

a) promotive health services

promotion of food supply and proper nutrition -

monitoring growth and development for using growth chart, this is -

very important for early diagnosis and prompt treatment of growth and
developmental disorders

health education for the mothers -

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b) preventive health services

expanded program of immunization -

control measures of communicable diseases -

c) curative health services

diagnosis and management of common health problem -

referral to higher levels of those who are in need for consultation or -

admissions to the hospital

:recognition and proper management of high risk children including -

congenital anomalies.

mental abnormalities .

malnutrition.

chronic diseases( bronchial asthma) .

child born with birth weight <2500g .

bottle fed child .

death of parents .

Role of the community health MCH.

The functions are explained under 4 headings as follows

:direct care provides -1

a) antenatal care ( care women during pregnancy)

b) intranatal care ( care women at time of delivery)

c) post natal care(care women after delivery)

d) child care by immunization , promotion of breast feeding , growth

monitoring , weaning , oral rehydration

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administrative role -2

health communication and educational role -3

role in research and evaluation -4

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 Cardiovascular diseases, community
:Importance
:These diseases have enormous burden on -1

personal activity &productivity .

utilization of health services .

economy of the country.

CVDs are of public health significance since many of them are -2

preventable through avoiding exposure to their risk factors

)proper ante-natal care healthful life –style (

Rheumatic fever &RHD represent a good proportion of the major -3

health problem in developing countries. The factors that favour their
:endemicity include

poor housing, overcrowding , malnutrition , unhealthy behavior , .

unsanitary environment ( especially house&school),poverty and illiteracy

IHD is called black plague of the recent centuries due to following -4

:reasons

Regarding morbidity .

incidence &prevalence-

affect younger age -

unsatisfactory treatment( long –term expensive treatment & -

permanent disability)

Regarding mortality.

kills adult at peak of their productive years -

the leading cause of death in developing countries -

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a prominent public health problem in developing countries ( case -
fatality rate)

Classification of CVD

A) congenital anomalies of the heart &blood vessels

:B)acquired

Rheumatic heart disease .

Non-Rheumatic .

Congenital CVD -

Types-

a- malposition of the heart

b- communication between the systemic & pulmonary circulation mat

:be

Intracardiac: atrial-septal defect ,ventricular septal defect -

Extracardiac : patent ductus arteriosus ,aortic pulmonary septal defect -

c- valvular malformation: aortic stenosis , pulmonary stenosis

d- abnormalities of blood vessels:e.g. coarctation of the aorta

e- combination of defects : e.g. fallout tetralogy

:A etiology

Genetic : single gene disorder or chromosomal aberration -1

Environmental factors -2

physical : radiation (x-ray) , air pollution (co) smoking -

chemical: drugs ( teratogenicity) , pesticides , metabolic -

disorders( D.M)

biological: viral( e.g. rubella) bacterial ( e.g. syphilis) protozoa (e.g. -

toxoplasma)

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:Prevention

premarital genetic counseling to screen heart diseases -1

avoiding exposure to x- ray radiation during pregnancy -2

management of the problem of air pollution if possible -3

avoiding smoking of females in the childbearing period( active or -4

passive)

prohibiting drug-abuse during pregnancy-5

avoiding use of domestic aerosol insecticide during pregnancy -6

better management &control of D.M. during pregnancy-7

.prevention of biological hazards during pregnancy-8

:Control measures

early detection &diagnosis of cases through: Neonatal examination ,at -

, school entry

better management of the screened cases: Whether medical or surgical -

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 Ischemic heart diseases

Definition: it is the cardiac disability acute or chronic , arising from

reduction of blood supply to the myocardium in association with
.disease process of the coronary arterial system

Factors causes IHD-

:Modifiable risk factors -1

Age: the risk increase with age increasing ( marked after the age 40y.) -

Sex (Gender) : the sex ratio differs by the age of female before -
menopause: male\female ratio=5:1 after menopause :male \female
narrows gradually till become equal

family history of IHD -

Genetic susceptibility ( heredity) : in the past detected by studying -

blood groups ( increase in A&B and decrease in O) recently genetic
techniques detect DNA markers

Race and social standard-

potentially modifiable: hypertension, smoking, diet, dyslipidemia, -2

obesity, D.M.physical inactivity , emotion stress& minor risk factors e.g.
.alcohol & coffee

: Prevention

primary prevention: management of the potential risk factors is -1

valuable e.g. diet control(just adequate fats, calories &salt)

avoid smoking-

encourage regular exercise (increase functional capacity of heart) -

Secondary prevention: measures for patients after an attack of the -2

:disease

drug control of hypertension, D.M. heart disease (B-blockers) .

medical supervision &checkup .

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Tertiary prevention( cardiac Rehabilitation): this is achieved through a -3
program of exercise and patient education to

improving functional capacity of the patient -

decrease activity related symptoms -

enabling the patient to return to satisfying role -

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