“COMMUNITY SPECIALIZED SERVICES”

Positive Energy
Utsahan, Niscayad, dhairyat,
Tat- tat Karma- pravartanat,…
Sanga-tyagat, sato vrtteh.
Sadbhir bhaktih, Prasidhyati…

Divya Gyan Hradiya Prakasita..

 Introduction
The scope of community health is very extensive
and community health services have different
aspects. Providing community health services to
every class or group of the community is the
chief aim of community health nursing.
Maternal and child health care
School health services
Industrial Nursing
Geriatric Nursing
Rehabilitation Nursing
 Maternal and child health care

PRESENTED BY

By. Kailash Nagar

Assistant Professor
Dept. Of Community
Health
 HEALTH
Maternal and children health.

MOTHER CHILD

SOCIETY

Healthy children need healthy mothers

 INTRODUCTION

 Maternal and child health services are the

foremost priorities of community health
programmes.

 According to Indian culture mother is the

foundation of the family and children are the
future of the country.
 DEFINITION

According to WHO
Maternal and child health services can be
defined as “promoting, preventing,
therapeutic or rehabilitation facility or care
for the mother and child.
 OBJECTIVE OF MCH

• To reduce maternal and childhood mortality and morbidity.

• Promoting satisfying and safe sex life.

• Regulate fertility

• Child survival

• Promote and protect health of mothers.

• To promote reproductive health.

• Ensure birth of healthy child

• Promote healthy G & D

 GOALS

• To ensure the birth of a healthy infant to every

expectant mother.
• To promote the healthy Growth and Development of
children.
• To identify health problems in mother and children.
• To prevent malnutrition in mothers

and children.
 GOALS

• To promote family planning services.

• To prevent communicable and non-

communicable diseases in mothers and children.
• To educate the mothers on improvement of their
own and their children’s health.
 SCENARIO/ FACTS OF INDIA

 Every year more than 2 crore 70 lakh women

become pregnant.
 Only 48.3% deliveries are conducted by trained
health personnel.
 Only 36% mothers are getting postnatal care by
skilled professionals.
 33% women’s Body Mass Index below than
normal.
 CONTI…..

 57.9% pregnant women b/w the age group 15-49

are suffering with anemia.
 Only 57% women familiar with the AIDS.
 45.9% children below 3 years of age low weight
than normal.
 Out of total deliveries ,only 40% are institutional
deliveries.
 MATERNAL HEALTH PROBLEMS
 

 
• I. Nutritional Problems 
• Malnutrition
• Nutritional Anemia
 
• II. Infection Problems
• Reproductive Tract Infections ( RTIs)/ Sexually Transmitted
Infection (STI)
• Infection in general
• Puerperal Sepsis
 
 MATERNAL HEALTH PROBLEMS
 

III. Disturbances and Menstruation

• IV. Mature Gravida
• 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 cervix
 INDICATORS OF MCH

MMR
IMR
Neonatal mortality rate
Under five mortality rate
Child survival rate
• Coverage indicators
• Knowledge, attitude & practice indicators
 Recent trends in MCH care
• Integration of care
• Risk approach
• Manpower changes
• Primary health care
• Reproductive and child health
 TARGETS OF MCH

 MMR - Below 2
 IMR -Below 60
 Death rate of 1-4 -Below 10
age group.
 Size of family -2-3 member
 Birth weight of child -Minimum 2500 grm
 Weight of minimum -According to hgt/wgt
90% of total children
 Organizational activities of MCH services

• Complete health check up and care of the child

and mother from conception to birth
• Studying the health problems of mothers and
child
• Providing health education to parents for taking
care of children
• Training to professionals and assistant workers
 Responsibilities of community health nurse in MCH services

Managerial Educational
Direct care
functions functions
 Maternal and child health services

Prenatal/antenatal care services

Intranatal care services

Postnatal care services

Under five child health services

 SOCIAL AND ENVIRONMENTAL FACTORS

• 1. Age of marriage
• 2. Age of child bearing
• 3. Child spacing
• 4. Family size
• 5. Level of education
• 6. Economic status
• 7. Customs and beliefs
• 8. Role of women in society
Common causes of maternal deaths in India

Other
disorders 34% Hemorrhage
37%

Sepsis 11%

Complications
of abortion Obstructed Hypertensive
8% labour 5% disorder 5%
Antenatal services
 Antenatal services
ANTENATAL CARE:
The care of the women during pregnancy.

AIM
The primary aim of antenatal care is to
achieve at the end of a pregnancy a healthy
mother and a healthy baby.
 OBJECTIVES

 To promote protect and maintain the health of the

mother during pregnancy
 To detect:” high risk” cases and 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 elements of child care,
nutrition ,personal hygiene and environmental
sanitation
 To sensitize the mother to need for family planning
 ANTENATAL SERVICES

A MINIMUM OF 3 VISITS COVERING THE ENTIRE PEROID OF

PREGNANCY SHOLUD BE
1st visit at 20th weeks
2nd visit at 30th weeks
3rd visit at 36th weeks
PREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY)
a. THE FIRST VISIT:
- Health history
- Physical examination
- Laboratory examination
b. ON SUBSQUENT VISITS:
-Physical examination
- Laboratory tests
-Iron and folic acid supplementation
 CONTI….

D. Immunization against tetanus

E. Instruction on nutrition, family planning ,self care,
delivery and parenthood
F. Home visiting by a female health worker
G. Referral services
Risk approach
Maintenance of records:
Home visits: is back bone of MCH services. Home
visit by the health worker female or public health
nurse
Intranatal services
 INTRANATAL SERVICES

Child birth is a normal physiological process ,but

complications may arise, septicemia may arise
result from unskilled and septic manipulations,
and tetanus neonatarum from the use of unsterile
instruments. The emphasis on the cleanliness. It
entails-
- Clean hands and fingernails
- Clean surface for delivery
- Clean cutting and care of cord
 OBJECTIVE

• To provide thorough asepsis

• To prevent injury to baby and mother
• To prevent complications
• To provide care to the baby
 INTRANATAL CARE
1.DOMICILLARY CARE:
Mother with normal obstetric history may be
advised to have their confinement in their
homes, provided the home conditions are
satisfactory. In such cases the delivery may be
conducted by the” health worker female or
trained dai” this is known as “ domiciliary
midwifery service”.
 CONTI….
ADVANTAGES OF DOMICILLARY SERVICE:
• Mother delivers in the familiar surroundings of her home.
• Less chance of cross infection.
• Mother is able to keep an eye upon her children and domestic
affairs.
DISADVANTAGES:
-Mother may have less medical and nursing supervision
-Mather may have less rest
-Mother resume her duties too soon
-Diet may be neglected
 CONTI…
2.INSTITUTIONAL CARE:
At about 1% of deliveries tend to be
abnormal, requiring the services of a doctor
institutional care is recommended for all ‘ high
risk’ cases and where home conditions are
unsuitable.
 CONTI….

. ROOMING IN: Keeping the baby ‘s crib the

side of the mother ‘s bed is called “rooming-
in”.
It also allays the fear in the mother mind that
the baby is not misplaced in the central nursery.
 Post natal services

PHOTO
 Post natal services

Care of the mother( and the new born ) after

delivery is known as post-natal care.
 OBJECTIVES

• To prevent complications of the postnatal period.

• To provide care for the rapid restoration of the
mother to optimum health.
• To check adequacy of breast feeding.
• To provide family planning services.
• To provide basic health education to mother\
family.
• To provide care to mother and baby
 POSTNATAL SERVICES

• Postnatal examination

• Hb examination during postnatal visit

• Teaching postnatal exercises

• Family planning services

• Health education
 Child health services

PHOTO
 OBJECTIVES

• Decreasing child death and infant mortality rate

• Complete protection of child
• Nutritious diet to children
• Overall growth of children
• Preserve and promote health of under five
children
• Increasing health level of children
 SERVICES

• Immunization
• Breast feeding
• Growth and development
• Personal hygiene
• Detection of health problems & treatment
Causes of under-five deaths in India
 Child Clinics

 Under five clinics

 Child guidance clinics

 Under five clinics

Aims and activities

• Preventive care

• Growth monitoring

• Care in illness
 Child Guidance Clinic

• For children suffering from abnormal behaviour

or psychological problem

• Psychiatrists, community health nurse and other

auxiliary workers serve in these clinics.
• Bed wetting/ enuresis
• Refusing to go to school
 CONTI….
• Hating a family member
• Complain of being ignored/ neglected
• Cruel behavior towards other children and
animals
• Stealing the objects
• Intense reaction to normal situation
 NEONATAL CARE

• EARLY NEONATAL CARE:

The first week of the life is most crucial period in infancy .
OBJECTIVES:
1. Establish & maintenance of cardio- respiratory functions
2. Maintenance of body temperature
3. Avoidance of infection
4. Establish of satisfactory feeding regimen
5. Early detection and treatment of congenital and
acquired disorders.
 CONTI…

IMMEDIATE CARE:
1.Clearing the airway: to help to estabilish breathing, the
airways should be cleared mucus and other secretions
2.Apgar score: it is taken 1 minute & again at 5 minutes
after birth.
 CONTI…

Sign Score 0 Score 1 Score 2

Heart Rate Absent Slow (below 100) Over 100

Respiratory Effort Absent Slow irregular Good crying

Muscle Tone Flaccid Some flexion of Active movements

extremities

Reflex Response No response Grimace Cry

Color Blue, pale Blue, pink Completely pink

extremities blue

Total score=10 Severe depression 0-3 Mild depression 4-7 No depression

7-10
 MANAGEMENT

3.CARE OF THE CORD: The cord should be cut &

tied when it has stopped pulsating. Care must be taken
to prevent tetanus of newborn by unsterilized
instruments and cord ties
4.CARE OF THE EYES: Before the eyes are open, the
lid margins of the newborn should be cleaned with
sterile wet swabs, one for each eye from inner to outer
side.
5. CARE OF THE SKIN: The first bath is given with
soap and warm water to remove vernix, mechonium and
blood clots. Some prefer to apply warm oil before the
bath
 CONTI….

6.MAINTAINANCE OF BODY TEMPERATURE:

The normal body temperature of a newborn is between 36.5
deg c to 37.5 deg c it is important that immediately after birth
the child is quickly dried with a clean cloth and wrapped in
warm cloth and given to the mother for skin-to skin contact and
breast feeding.
7.BRAEST FEEDING
• NEONATAL EXAMINATIONS
• MEASURING THR BABY : Ht, Wt, HEAD
CIRCUMFERENCE
• IDENTIFICATION OF “ AT RISK” INFANTS
• LATE NEONATAL CARE
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Programmes andCONTI….
schemes are support
to the MCH
 NRHM
 NUHM
 RCH
 Janani suraksha yojana (JSY)
 Vandematarm Scheme
 Skilled birth attendants (SBA)
 Home based newborn care (HBNC)
 Integrated management of neonatal and childhood
illness (IMNCI).
 Slogans
• “Today’s children are tomorrow’s
helmsmen”

• “Safe life of a child is the investment of

future’
FINISHED