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7/27/2019 Maternal Child Health (MCH)
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MCH
Dr. K. N. Patel
Former Additional Director
Health & Family Welfare
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Human
Development
Index
Economy
Health
Education
Economy
Human
Development
Index
Health
Human
Development
Index
Education
Health
Human
Development
Index
Educa
tion
Health
Human
Development
Index
Educa
tion
Health
Human
Development
Index
Economy
HDI
Life Expectancy
IMR
MMR
TFR
Child maternal Health
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MDGs1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Ensure gender equality and promotewomens empowerment
4. Reduce child mortality5. Improve maternal health
6. Reduce HIV/AIDS infection, TB,malaria and other diseases
7. Ensure environmental sustainability
8. Develop global partnership for development
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HEALTH
Indicator: Life Expectancy at Birth. Greatly
influenced by deaths at smaller age.
Infant Mortality Rate. Deaths in first 12
months of life in one year per 1000 livebirths. Gujarat:41 India:44 (SRS-2011)
Mortality in first month Neonatal Mortality
60% of IMR
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Mother and child - one unit
During pregnancy, foetus is part of mother, Gets nutrition
and oxygen from mothers blood (280 days)
After birth, for 6 months infant is completely dependant onmother for food
Certain diseases, factors of pregnant mother
(HIV, syphilis, German measles, drug intake, malnutrition)adversely affects health and survival of child
Mental & social development of child is dependant onmother. Mother is the first teacher of child
Interventions in mother affect directly to child e.g. Inj. TT tomother prevents NNT, IFA->better birth outcome
Good maternal nutrition->better brain development in child
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-
1000
Perinatal period
Still Birth
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Infant Mortality
Definition:41(Guj)/44 (India)2011
Causes: Neonatal deaths
BITWA +(Birth Infections Trauma LBWAsphyxia)Hypothermia; Congenital anomalies
Maternal anaemia, toxaemia, diseases
Social factors:
Teenage mothers or elderly primi-para
High fertility : Frequent & too many births Quality of birth assistance (health care)
Poverty, women literacy, maternal nutrition
Post-neonatal deaths: DD, ARI-pneumonia, accidents
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Reducing infant mortality
1. Care at Birth
2. GOBIFFF
3. Weaning / Annaprasan /complementary feeding
4. Vitamin A doses: 5 doses / 3 years
5. IMNCI
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Immediate Care of New born
Cleaning the airways
Care of the cord, stump 2.5 inches
Care of the eyes Care of the skin
Maintenance of body temperature,
warmth, kangaroo care to LBW Immediate Breast feeding
Polio Zero dose & BCG; HEP-B Zero
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Identification of at-risk infants
Birth weight less than 2.5 kg
Twins
Birth order 5 and above
Artificial feeding
Weight below 70% of expected as per age
Failure to gain weight in 3 successive months
PEM and diarrhoea
Working mother/one parent
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Indias share of the global challenge
20
15
39
21
15
28
32
0
10
20
30
40
50
Child
Populatio
n
MaternalDeaths
Under-weig
ht
Under-5ChildrenDeat
hs
P
eoplewith
HIV/AID
S
Lessthan
1$perd
ay
HHs
withoutSanitatio
n
%
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Development Paradox in Gujarat:Impressive economic growth
with Poor Social Development Indicators
Key
Indicators
Gujarat Best performing
state in India
NPP
2010
MDG
2015
IMR 41 10, 13
(Goa, Kerala)
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0
20
40
60
80
100
120
140
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2010
2011
2013
2015
Rural Total Urban
Infant Mortality trends in Gujarat
44 T51 R
30 U
Source: SRS
Wide difference in Rural and Urban areas
66 % in first 7 days
MDG Goal 27MDG Goal 27MDG Goal 27MDG Goal 27 T
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Synergy in causes of death
Malnutrition and infectiousdiseases lead to death
Mildly underweight children
- two-fold higher risk ofdeath than children who arebetter nourished
Moderately or severelyundernourished children -5-8 fold increase in risk ofdeath.
Infectiou
disease
Underweight
(Malnutrition)
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Child malnutrition
Gujarat : 45%malnourished
80% Children (6m-3yrs)
Anemic in Gujarat
Source; NFHS III (2005-06)
Iodized salt
Intake 56%
In Gujarat
Only 24% get adequateCalories & Proteins
Vitamin A
Supplement
Coverage 17%
53
45
50
40
45
50
55
1992-93 1998-99 2005-06
FI Children
38
37
37.6
25
22.9
29.8
32.5
39.9
44.6
25.6
42.4
60
39.6
24.9
26.1
36.5
56.5
40.7
47.1
48.855.9
36.4
19.7
22.1
39.619.9
32.5
25.2
38.7
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1013
24 28
4448
55
61 61 62
Goa Kerala TN
Mah
arashtra Gu
jarat
Bihar
Rajas
than UP Orissa
MP
IMR in Gujarat v/s other States
SRS 2011
India-47
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Child mortality trends in Gujarat
42 40 33
69 6350
10685
61
0
50
100
150
200
250
NFHS 1
1992
NFHS 2,
1998
NFHS 3
2005
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Preventive interventions
Source :
Lancet Series on Child Survival,India analysis - 2004 0 2 4 6 8 10 12 14 16 18
Measles Vaccine
Antibiotics for PRM
Tentanus Toxid
Newborn temperature management
Antenatal Steroids
Vitamin A
Zinc
Clean water, sanitation & hygiene
HiB Vaccine
Clean Delivery
Complementary Feeding
Breastfeeding
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Prevention of Anemia
Reduce anemia and build iron stores
through iron supplementation/ iron fortified
foods and nutrition
School going adolescents Out of school adolescents (KSY/Mamta
Taruni)
ANC
Communication to improve dietary intake
of iron and Vitamin-C rich foods.
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Vitamin A Deficiency and Child health
23% reduction in child mortality rate
50% reduction in child mortality rate due to acute
measles
35-50% reduction in child mortality rate due todiarrhoea
Improving vitamin A status of children(6 months-5 yrs.)
Results in to
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Vitamin A
1. Improve coverage of 1st dose Vit A along with Measlesafter completion of 9 months
2. Improve Bi-annual round coverage reaching the un-
reached
3. Improve therapeutic dose coverage of Vit A in Measles
out break response
4. Mega dose Vit A post natal period
Minimize the gap between rich and poor
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Health Intervention-3:
Mamta Divas
Immunization+ : children/pregnant women
Weighing of children (0-3 yrs) & plotting on Mamta card
IFA to Pregnant, lactating & out of school adolescent girls
1.5 Kg iodised salt to pregnant & lactating women/month ANC (BP, HB, Urine examination, Folic Acid /Calcium
tablets, Physical examination etc)
PNC (Calcium tablets, Vit A etc)
Assessment of sick children using IMNCI protocol Nutrition counseling/ Counseling for Institutional Delivery
Community growth monitoring
Others
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Identify bottlenecks & address them
Adapted from Tanahashi T. Bulletin of the World Health Organization, 1978, 56 (2)http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf
Availability - critical health system inputs
Adequate coverage - continuity
Utilization first contact of multi contactservices
Accessibility physical access of services
Effective Coverage -quality
Target Population
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Inclusive planning for the excluded
Plan & Monitor quality Health and Nutritionservices to excluded groups
Hard to reach areas
Agaria Costal areas
Hilly terrain
Deserts
Staying in Vadis and small hamlets Urban slums/ street children
Migratory population
Socio-economically excluded communities
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Maternal Health
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In India, One woman dies every 4 minutes dueto complications of pregnancy or child birth 136,000 maternal deaths in India
26% of the global burden
Highest for any country
Perhaps very little decline in recent
decades
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Maternal deaths: Causes
Maternity related: Hemorrhage29%, Puerperalsepsis16%, Obstructed labor10% position offetus, Eclampsia8%, Complicated abortion8%
Not related to maternity: Anaemia19% Associated conditions: heart disease, TB,Diabetes, Malaria, other diseases
Social:Home deliveries ; Lack of skilled care atbirth, Lack of appropriate Health ServicesLow female literacy, lack of awareness, poornutritional status, early marital age, low status ofwomen, poverty
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Prevention of maternal mortality
(1) Emergency Obstetric Care: TimelyIdentification of complications-availability of
transport-timely availability of emergency care
service
a) Skilled birth attendant at delivery
b) Early identification of complications
c) Referral transport system
d) Emergency obstetric care (EmOC)-FRUs
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Prevention of maternal mortality
(2) Essential Obstetric Care:A. Antenatal Care:
Early Registration (name, age, parity, LMP, history etc)
Physical Examination (Height, wt, BP, Oedema feet, anaemia,
position of foetus etc)
Lab. Examination: Blood, Urine
Counseling (Inst del., Diet, rest, preparations, 5 cleans EBF, FP)
provide TT and IFA, DDK
B. Natal Care
Institutional delivery
Skilled assistance
Good Referal Transport System
Five Cleans
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Prevention of maternal mortality
(2) Essential Obstetric Care:C. Post - natal care
5 visits (1st, 3rd, 7th and 42nd day)
Ask if bleeding, foul smeling discharge, breast
feeding
See temperature, uterine involution
Advise
diet (Extra 700 calories, 25 Gm protein)
Family planning
EBF
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Prevention of maternal mortality
(3) Social Interventions:
A. Raise maternal age at marriage: Now 18 yrs
B. Avoid unwanted pregnancies: FPC. Improve Nutrition: ICDS
D. Quality Health Services: Dai training, FRUs
E. Woman empowerment: Kishori Shakti Scheme
F. Safe abortion care: The MTP Act 1971
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Skilled birth attendants (SBAs) Doctors, nurses, ANMs, LHVs, if trained in
and proficient in midwifery, are SBAs
Trained TBA is not an SBA
Most of SBAs in India are located in
institutions
Hence, policy to promote institutional deliveries
Dai Training: Local, confidence, about: 5 cleans, high
risk mothers, normal del, identification ofcomplications, referral, care of new born, should
mobilise families for birth registration, immunisation, FP
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Emergency obstetric care (EmOC)
BASIC
Use of antibiotics,
oxytocics,anticonvulsants
Assisted deliveries
Manual removal ofretained products
COMPREHENSIVE
Basic plus: (FRU)
Cesarean section
Blood transfusion
Specialist
MMR i G j t
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MMR in Gujarat
Trend in Deliveries
64.7
53.5
43.4
36.8
46.3
54.6
NFHS-3NFHS-2NFHS-1
Institution Health Person
Maternal Mortality Ratio, India (2004-2006)
95
111
130141
154 160
186 192
213
254
303312
335
388
440
480
0
100
200
300
400
500
600
Keral
aT.N
.
Maha
rashtr
a
W.Be
ngal
A.P.
Gujar
at
Harya
naPu
njab
Karna
taka
India
Oriss
a
Bihar/
Jrkd
M.P.
/Chtg
d
Rajas
than
U.P./
Utrch
l
Assa
m
SRS 2006
MMR Trend in Gujarat
160
100
202172
389
0
100
200
300
400
500
1989 1999-01 2001-03 2004-06 2015
MaternalDealth
Goal
Hemorrhage
PIH
Sepsis
Anemia
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47
@160
MMR52%of
estimated 80%of
reported
Maternal Deaths Reported and Verbal Autopsy
Carried out (2008-09)
1333
690
551
0
200
400
600
800
1000
1200
1400
Estimated Reported VA carried out
M
A
T
E
R
N
A
L
D
E
A
T
H
S
>70 delays are in making decision toseek formal health care
Abortion related deaths are not
reported (0.5%)
Hemorrhage, PIH and sepsis are
leading causes of death
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