Primary Health Care Maternal & Child Health

Primary Health Care
Maternal & Child Health

Primary Health Care
Preventive services Curative services
Outpatient clinic (referral)

General services Care of vulnerable groups Laboratory services
Dispensary
Health education Maternal &child health s.
Monitoring of environment First aid and emergency
School health services
Prev.&control of endemic
services
Geriatric health services
diseases
Health office Occupational health services
services
Maternal and Child Health
 Mothers and children are both vulnerable
groups of the community. Women in the
childbearing period (15-49 years) constitute
about 25% of the population. Children on the
other hand constitute about 40% to 45% of the
population in developing countries. This group
is characterized by relative high mortality and
morbidity rates.
Maternal Health
 According to 2000 WHO estimations it was
concluded that:
 From every 210 pregnant women who annually get
pregnant, 8 suffer from life threatening complications.
 More than half a million (529,000) women died during
pregnancy
 MMR globally was500/100,000 LB, ranging from2.4 in
Scandinavia and Switzerland to 1200 in Yemen
 50,000,000 women are left with chronic debilitating
diseases annually.
Maternal Mortality
 The other 1/3rd of
 Nearly 2/3rds of maternal maternal deaths
deaths worldwide results worldwide results from
from five causes: indirect causes or an
 Hemorrhage (24%) existing medical condition
 Obstructed labor (8%)
made worse by pregnancy
or delivery:
 Eclampsia (pregnancy
 Malaria
induced hypertension)
 Anemia
(12%)
 Hepatitis
 Sepsis (15%)
 Unsafe abortion (13%)  AIDS
 Tuberculosis
 Malnutrition
Some Factors that Contribute to
Maternal Mortality and Morbidity
 The 4 “too”s of pregnancy:
 Too young
 Too old
 Too many
 Too soon
 In other words: young or old age of pregnancy,
short intervals between pregnancies, and high
parity. Other factors include low socio-
economic status and inadequate maternal care.
MDGs
 In the 8 Millennium Development Goals, 3 of
them are directed to MCH:
 Improve maternal health
 Reduce infant and child mortality
 Combat HIV, malaria, TB and other conditions.
Objective of MCH
 To improve the health status of the largest

and most vulnerable sector of the
population by providing the best health
care available.
Maternal Health Care
MHC
MHC
Preconceptional Antenatal Intra-natal Postnatal

Care Care Care Care
Including
Premarital
Care
Preconceptional Care
 It is a care of female before conception.

 It is continued care from birth, through stages
of growth and development, and until the time
of conception and pregnancy, so as to prepare
the female for normal child bearing and
delivery in the future.
Components of Preconceptional
Care:
 Health promotion and prevention of health hazards
specially those of particular risk to pregnancy.
 Regular health appraisal for early case detection and
management, and prevention of sequelae or
complications.
 Health education of young girls e.g. determinants and
requirement of health, family health, family
planning…..
 Premarital care (for both partners).
Premarital Care
It includes:
 Premarital counseling
 Premarital immunization
 Premarital examination:
 History taking
 Genetic counseling
 Systemic medical examination
 Investigations
Antenatal (Prenatal) Care
 General objective:
“ The general objective of antenatal (prenatal)
care is to prepare the mother both physically
and psychologically to give birth to a healthy
newborn (favorable outcome of pregnancy)
and to be able to care for it.”
Components Antenatal (Prenatal)
Care
 Registration: During the booking visit, and record
keeping
 Medical examination and investigations; for both the
booking visit and continuing visits.
 Health education
 Immunization
 Supplementations
 Clinical services
 Social services (outreach services).
Intra-natal Care
“Normal delivery is defined as a process of delivery
of a single fetus and other products of conception
within 24 hours, through the normal birth canal and
without complications.”
 Objectives of intra-natal care: safety of mother and
fetus, by helping the pregnant to have a normal

delivery, and providing emergency services when
needed.
 Determination of place of birth, with a well-organized
back up system.
High Risk Deliveries
Mother Delivery Fetus
Toxemia of Prolonged labor Prematurity

pregnancy
Diabetes mellitus Breech LBW
presentation
Age < 20 yrs Cord prolapse Fetal distress
Age > 35 yrs Multiple Meconium

pregnancy stained liquor
Parity 5 + Premature rupture amnii
of membranes
Postnatal Care
 Care of mother after delivery.
 Its components are:
 Postpartum examination
 Medical care
 Follow up
 Health education
 Family planning services
 Psychological and social support
CHILD HEALTH
Why tackle child health?
 The global equity gap in health is largest among
children, and is concentrated in communicable diseases.

 Children under five years of age account for more than
50% of the global gap in mortality between the poorest

and richest quintiles of the world's population.
 Children under five bear 30% of the total burden of
disease in poor countries.

 Almost all (99%) of the 10.9 million children under five
who died in 2000 were from developing countries. Of

these children, 36% died in Asia, 33% in Africa.
Perinatal mortality accounted for more than 20% of deaths in children
under five years of age, in 2000 and includes birth asphyxia, trauma,
and low birth weight.
Infant and child priorities (UNICEF)
1. Reduction of infant and under 5 mortality
rate
2. Reduction of moderate and severe
malnutrition
3. Universal access to safe drinking water
4. Access to all couples to information and
services to prevent pregnancies that are too
early, too closely spaced, too late or too
many.
cont.
6. Reduction of low birth weight babies
7. Elimination of iodine deficiency
8. Elimination of vitamin A deficiency
9. Encouragement of women to breast feed their
children exclusively
10. Growth promotion and monitoring
11. Eradication of poliomyelitis
12. Elimination of neonatal tetanus
13. Reduction of measles death
cont.
14. Maintenance of a high level of immunization
coverage.
15. Reduction of deathes due to diarrheal diseases
16. Reduction of deaths due to ARIs
17. Increased acquisition of knowledge, skills and
values required for better living by all families.
What can be done to
improve child health?
Child Health Service (Program)
The MCH center provides child care that starts
before birth and continues through out childhood.
Functions of MCH centers for child care:

 Maternal care (prenatal and natal)
 Neonatal care
 Adequate nutrition of infants and children
 Health appraisal (assessment)
 Prevention and control of communicable diseases including

immunization.
 Clinical (curative services)
 Social services.
The Integrated Management of
Childhood Illness (IMCI)
 IMCI is a broad strategy to improve child health outcomes
developed by WHO and UNICEF. IMCI encompasses
interventions at home, in the community and in the health
system. The aims are to reduce childhood deaths, illnesses,
and disability and to improve children's growth and
development, with a particular focus on the poorest and most
disadvantaged children. IMCI has three main components:
 Improve family and community practices related to child
health and nutrition;

 Improve the health system for effective management of
childhood illness;
 Improve health workers' skills.
Improve family and community practices
related to child health and nutrition;
 Counseling on child feeding including

 exclusive breast feeding
 Adequate amount of micronutrient or supplementation
 Complete full course of immunization for children

 Promote safe disposal of waste and hand washing before
preparing meals and feeding children
 Provide adequate care to sick children
 Promote mental and social development by responding to
children's needs for care,
 Provide adequate prenatal care to every pregnant woman
Improve the health system for effective
management of childhood illness;
 Ensure drugs and supplies for treating major

childhood illnesses are available in health
facilities
 Improve quality of care provided at health
facilities and organization of work
 Improve referral pathways
 Identify and develop methods for sustainable
financing and equity of access
Improve health workers' skills.
 Develop and adapt case management

guidelines and standards for major childhood
illnesses in the country
 Train health providers at first level health
facilities and referral level in standard case
management
 Improve and maintain health workers'
performance through follow-up after training
and periodic supervision
 A combination of integrated curative and
preventive interventions is required to address
the immediate and underlying determinants of
child health. Maternal determinants and risk
factors associated with pregnancy and
childbirth are especially important.
 Simple, cost-effective interventions delivered
at the community level can save most newborn
and children lives in developing countries.
To summarize
Optimum child health is achieved through:
 Adequate maternal care
 Periodic follow up of the “healthy child”
 Breast feeding and proper child nutrition
 Immunization
 Early detection and proper management
 A sanitary and safe environment
 Health education of parents.

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Primary Health Care Maternal & Child Health

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Primary Health Care Maternal & Child Health

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Primary Health Care

Maternal & Child Health

Preventive services Curative services

Outpatient clinic (referral)

 Unsafe abortion (13%)  AIDS

 To improve the health status of the largest

Preconceptional Antenatal Intra-natal Postnatal

 It is a care of female before conception.

 Systemic medical examination

fetus, by helping the pregnant to have a normal

Toxemia of Prolonged labor Prematurity

Age > 35 yrs Multiple Meconium

children, and is concentrated in communicable diseases.

50% of the global gap in mortality between the poorest

disease in poor countries.

who died in 2000 were from developing countries. Of

Functions of MCH centers for child care:

 Adequate nutrition of infants and children

 Health appraisal (assessment)

 Prevention and control of communicable diseases including

health and nutrition;

 Counseling on child feeding including

 Adequate amount of micronutrient or supplementation

 Complete full course of immunization for children

 Ensure drugs and supplies for treating major

 Develop and adapt case management

 Periodic follow up of the “healthy child”

 Breast feeding and proper child nutrition

 Early detection and proper management

 A sanitary and safe environment

 Health education of parents.

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