Preventive obstetrics, pediatrics and geriatrics (2)

VYJAYANTHI KADAMBI S

PREVENTIVE OBSTETRICS, PEDIATRICS AND GERIATRICS

ANTENATAL CARE INTRODUCTION OBJECTIVES COMPONENTS

INTRODUCTION ANTENATAL CARE IS THE CARE OF THE

WOMAN DURING PREGNANCY HEALTHY MOTHER AND HEALTHY BABY NOTIFICATION OF PREGNANCY

COMPONENTS ANTENATAL VISITS PRENATAL ADVICE SPECIFIC HEALTH PROTECTION MENTAL PREPARATION FAMILY PLANNING PEDIATRIC COMPONENT

ANTENATAL VISITS

ANM- ESTIMATION OF NUMBER OF PREGNANCIES IN A SPECIFIED AREA AND PREGNANCY TRACKING

FIRST ANTENATAL VISIT - COMPONENTS HISTORY TAKING PHYSICAL EXAMINATION ABDOMINAL EXAMINATION ASSESMENT OF GESTATIONAL AGE LABORATORY INVESTIGATIONS

LABORATORY INVESTIGATIONS

RISK APPROACH ELDERLY PRIMI 3O YEARS OR OVER SHORT STATURED PRIMI LESS THAN 140 CMS MALPRESENTATION APH THREATENED ABORTION PRE ECLAMPSIA ECLAMPSIA ANEMIA TWINS HYDRAMNIOS

PREVIOUS STILL BIRTH IUD MANUAL REMOVAL OF PLACENTA ELDERLY GRAND MULTIPARA PROLONGED PREGNANCY H/O PREVIOUS LSCS OR INSTRUMENTAL

DELIVERY PREGNANCY + SYSTEMIC DISORDERS TREATMENT FOR INFERTILITY 3 OR MORE SPONTANEOUS CONSECUTIVE

ABORTIONS

TAAYI CARD

PRENATAL ADVICE DIET PERSONAL HYGIENE DRUGS RADIATION WARNING SIGNS CHILD CARE

PERSONAL HYGIENE PERSONAL CLEANLINESS REST AND SLEEP BOWELS EXERCISE SMOKING ALCOHOL DENTAL HYGIENE SEXUAL INTERCOURSE

WARNING SIGNS SWELLING OF FEET FITS HEADACHE BLURRING OF VISION BLEEDING OR DISCHARGE PV ANYTHING UNUSUAL

MOTHER CRAFT

SPECIFIC HEALTH PROTECTION ANEMIA – 100 mg ELEMENTAL IRO + 500

mcg FA FOR 100 DAYS OTHER NUTRITIONAL DEFICIENCIES- VIT A

AND D FREE SUPPLY TOXEMIAS OF PREGNANCY TETANUS – 1ST DOSE = 16-20 WEEKS 2ND DOSE= 20-24 WEEKS SYPHILIS – 10 DAILY INJECTIONS OF

PROCAINE PENICILLIN (600,000 UNITS) GERMAN MEASLES

Rh Status

HIV INFECTION HEP B INFECTION PRENATAL GENETIC SCREENING

MENTAL PREPARATION

FAMILY PLANNING

PEDIATRIC COMPONENT

INTRANATAL CARE INTRODUCTION AIMS DOMICILIARY CARE INSTITUTIONAL CARE ROOMING IN

INTRANATAL CARE FIVE CLEANS 1. CLEAN HANDS AND FINGERNAILS2. CLEAN SURFACE FOR DELIVERY3. CLEAN BLADE TO CUT THE CORD4. CLEAN TIE FOR THE CORD5. CLEAN BIRTH CANAL

AIMS OF GOOD INTRANATAL CARE

DOMICILIARY CARE

ADVANTAGES MOTHER DELIVERS IN FAMILIAL

SURROUNDINGS OF HER HOME AND THUS REMOVES FEAR

LOWER CHANCES OF CROSS INFECTION AT HOME THAN IN HOSPITAL

MOTHER IS ABLE TO KEEP AN EYE UPON HER CHILDREN AND DOMESTIC AFFAIRS AND HENCE EASES HER MENTAL TENSION

DISADVANTAGES LESS MEDICAL AND NURSING SUPERVISION

THAN IN THE HOSPITAL SHE MAY RESUME HER DOMESTIC DUTIES

TOO SOON DIET MAYBE NEGLECTED

DANGER SIGNALS

INSTITUTIONAL CARE

ROOMING IN KEEPING THE BABY’S CRIB BY THE SIDE OF

THE MOTHER’S BED OPPURTUNITY FOR THE MOTHER TO KNOW

HER BABY BETTER CHANCE FOR BREAST FEEDING ALSO ALLAYS THE FEAR IN THE MOTHER’S

MIND THAT THE BABY IS MISPLACED IN THE CENTRAL NURSERY

BUILDS UP HER SELF CONFIDENCE

POSTNATAL CARE INTRODUCTION CARE OF THE MOTHER COMPLICATIONS RESTORATION OF THE MOTHER TO

OPTIMUM HEALTH BREAST FEEDING FAMILY PLANNING BASIC HEALTH EDUCATION

INTRODUCTION CARE OF THE MOTHER AND THE NEWBORN

AFTER DELIVERY IS KNOWN AS POSTNATAL OR POSTPARTAL CARE

OBSTETRICIAN + PEDIATRICIAN COMBINATION IS CALLED PERINATOLOGY

CARE OF THE MOTHER

COMPLICATIONS PUERPERAL SEPSIS THROMBOPHLEBITIS SECONDARY HEMORRHAGE UTI, MASTITIS

RESTORATION OF MOTHER TO OPTIMUM HEALTH PHYSICAL PSYCHOLOGICAL SOCIAL

PHYSICAL COMPONENT1. POSTNATAL EXAMINATIONS2. ANEMIA3. NUTRITION4. POSTNATAL EXERCISES

BREAST FEEDING

FAMILY PLANNING POSTPARTUM STERILIZATION IS GENERALLY

RECOMMENDED ON THE 2ND DAY AFTER DELIVERY

IUCD NON HORMONAL CONTRACEPTION

BASIC HEALTH EDUCATION PERSONAL AND ENVIRONMENTAL HYGIENE FEEDING FOR MOTHER AND INFANT PREGNANCY SPACING IMPORTANCE OF HEALTH CHECK UP BIRTH REGISTRATION

CARE OF CHILDREN

0-14 YEARS 40% OF TOTAL POPULATION SOCIALIZATION PROCESS VULNERABLE TO DISEASE, DEATH AND

DISABILITY

ANTENATAL PEDIATRICS AMNIOCENTESIS USG FETOSOCPY CHORION BIOPSY SPACING- 2 TO 3 YEARS PREVENTION OF CONGENITAL

ABNORMALITIES AND INBORN ERRORS OF METABOLISM

INFANCY 2.92 % OF TOTAL POPULATION ABOUT 40% IMR OCCURS IN FIRST MONTH

OF LIFE IMR = 58/1000 IN INDIA

NEONATAL CARE EARLY NEONATAL CARE1. IMMEDIATE CARE2. NEONATAL EXAMINATIONS3. THE INFECTED NEWBORN4. MEASURING THE BABY5. NEONATAL SCREENING6. AT RISK INFANTS LATE NEONATAL CARE

OPTIMUM NEWBORN CARE

OBJECTIVES OF EARLY NEONATAL CARE ESTABLISHMENT AND MAINTENANCE OF

CRDIORESPIRATORY FUNCTIONS MAINTENANCE OF BODY TEMPERATURE AVOIDANCE OF INFECTION ESTABLISHMENT OF SATISFACTORY FEEDING

REGIMEN EARLY DETECTION AND TREATMENT OF

CONGENITAL AND ACQUIRED DISORDERS, ESPECIALLY INFECTIONS.

IMMEDIATE CARE CLEARING THE AIRWAY APGAR SCORE CARE OF THE CORD CARE OF THE YES CARE OF THE SKIN MAINTENANCE OF BODY TEMPERATURE BREAST FEEDING

CLEARING THE AIRWAY

APGAR SCORE

9 TO 10- NORMAL 0-3 – SEVERELY DEPRESSED 4-6 – MODERATELY DEPRESSED SCORE BELOW 5 REQUIRES PROMPT ACTION

CARE OF THE CORD

KEEP CORD DRY AS POSSIBLE ASEPTIC PREPARATION ON THE CORD

STUMP AND SKIN AROUND THE BASE DRIES AND SEPARATES BY ASEPTIC

NECROSIS IN 5-8 DAYS

CARE OF THE EYE

CARE OF THE SKIN

MAINTENANCE OF THE BODY TEMPERATURE

BREAST FEEDING

NEONATAL EXAMINATIONS

FIRST EXAMINATION- SOON AFTER BIRTH IN THE LABOUR ROOM

SECOND EXAMINATION- WITHIN 24 HOURS BY PEDIATRICIAN

THE INFECTED NEWBORN NEONATAL TETANUS CONGENITAL SYPHILIS NEWBORN WITH HBV +VE MOTHER NEWBORN WITH HIV +VE MOTHER

MEASURING THE BABY

BIRTH WEIGHT(within first hour of life) LENGTH(within 3 days) HEAD CIRCUMFERENCE- maximum

circumference of the head at the occipito frontal diameter

NEONATAL SCREENING DETECT INFANTS WITH TREATABLE GENETIC,

DEVELOPMENTAL, AND SECONDARILY, TO PROVIDE PARENTS WITH GENETIC COUNSELLING

10 – 15 ML CORD BLOOD STORED

COMMON DISORDERS SCREENED: 1. PHENYLKETONURIA2. NEONATAL HYPOTHYROIDISM3. COOMBS’ TEST4. SICKLE CELL OR OTHER HEMOGLOBINOPATHIES5. CDH

“AT-RISK” INFANTS BIRTH WEIGHT LESS THAN 2.5 KG TWINS BIRTH ORDER 5 OR MORE ARTIFICIAL FEEDING WEIGHT BELOW 70% OF THE EXPECTED

WEIGHT FAILURE TO GAIN WEIGHT DURING 3

SUCCESSIVE MONTHS CHILDREN WITH PEM OR DIARRHEA WORKING MOTHER/ ONE PARENT

LATE NEONATAL CARE

LOW BIRTH WEIGHT THE BIRTH WEIGHT OF AN INFANT IS THE

SINGLE MOST IMPORTANT DETERMINANT OF ITS CHANCES OF SURVIVAL, HEALTHY GROWTH AND DEVELOPMENT

2 GROUPS

SHORT GESTATION IUGR

BIRTH WEIGHT LESS THAN 2.5 KGS AT FIRST HOUR OF LIFE

A LBW INFANT IS ANY INFANT WITH A BIRTH WEIGHT OF LESS THAN 2.5 KGS REGARDLESS OF GESTATIONAL AGE.

PRETERM BABIES 1. EXTREMELY PRETERM (<28 WEEKS)2. VERY PRETERM (28 TO 32 WEEKS)3. MODERATE TO LATE PRETERM(32 TO 37

WEEKS)

PRETERM BIRTH-TWO BROAD SUB TYPES1. SPONTANEOUS PRETERM BIRTH2. PROVIDER INITIATED PRETERM BIRTH

SMALL-FOR-DATE BABIES THESE MAY BE BORN AT TERM OR PRETERM THEY WEIGH LESS THAN THE 10TH

PERCENTILE FOR THE GESTATIONAL AGE

MATERNAL FACTORS MALNUTRITION SEVERE ANEMIA HEAVY PHYSICAL WORK HYPER TENSION MALARIA TOXAEMIA SMOKING LOW ECONOMIC STATUS SHORT MATERNAL STATURE HIGH PARITY CLOSE BIRTH SPACING LOW EDUCATION STATUS

FOETAL FACTORS1. FOETAL

ABNORMALITIES2. INTRAUTERINE

INFECTIONS3. CHROMOSOMAL

ABNORMALITY4. MULTIPLE

GESTATION

PLACENTAL FACTORS

1. INSUFFICIENCY2. ABNORMALITY

PREVENTION DIRECT INTERVENTION MEASURES1. INCREASING FOOD INTAKE2. CONTROLLING INFECTIONS3. EARLY DETECTION AND TREATMENT OF

MEDICAL DISORDERS INDIRECT INTERVENTION TREATMENTa) <2KGS - FIRST CLASS MODERN NOENATAL

CAREb) 2-2.5KGS – ICU FOR ADAY ORTWO KANGAROO MOTHER CARE

KANGAROO MOTHER CARE COLOMBIA 1979 Dr HECTOR MARTINEZ AND

EDZAR REY FOR LBW BABIES

COMPONENTS1. SKIN TO SKIN POSITIONING OF THE BABY

ON THE MOTHER’S CHEST2. ADEQUATE NUTRITION THROUGH BREAST

FEEDING3. AMBULATORY CARE AS A RESULT OF

EARLIER DISCHARGE FROM HOSPITAL4. SUPPORT FOR THE MOTHER AND HER

FAMILY IN CARING FOR THE BABY

INTENSIVE CARE INCUBATORY CARE FEEDING PREVENTION OF INFECTION

BREAST FEEDING 450-600 ML OF MILK PER DAY 1.1 GM PROTIEN PER 100 ML 70 KCAL PER 100 ML

ADVANTAGESBABY IT IS SAFE , CLEAN , HYGENIC , CHEAP AND

AVAILABLE TO THE INFANT AT THE CORRECT TEMPERATURE

NUTRITIONAL REQUIREMENTS SATISFIED ANTI-MICROBIAL FACTORS EASILY DIGESTED AND UTILISED PROMOTES BONDING DEVELOPMENT OF JAW AND TEETH-SUCKING PROTECTS FROM OBESITY PREVENTS MALNUTRITION AND REDUCES IMR SPACING INCREASE IQ AND BETTER VISUAL ACTIVITY

MOTHER LOWER RISK OF PPH AND ANEMIA BOOST IMMUNE SYSTEM DELAYS NEXT PREGNANCY REDUCES INSULIN OF DIABETIC MOTHERS PROTECT FROM OVARIAN AND BREAST

CANCER AND OSTEOPOROSIS

FEED BY THE CLOCK 1-4 HRS INTERVAL NO OTHER FOOD IS REQUIRED UNTIL 6

MONTHS AFTER BIRTH

BREAST MILK SUBSTITUTES DRIED WHOLE MILK POWDER FRESH MILK FROM A COW OR OTHER

ANIMALS OTHER COMMERCIAL FORMULAE

WEANING

BABY FRIENDLY HOSPITALS INITIATIVES WHO , UNICEF ENCOURAGE PROPER INFANT FEEDING

PRACTICES

HAVE A WRITTEN BREAST FEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTH CARE STAFF.

TRAIN ALL HEALTH CARE STAFF IN SKILLS NECESSARY TO IMPLEMENT THIS POLICY

INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS AND MANAGEMENT OF BF

HELP MOTHERS INITIATE BF WITHIN HALF HOUR OF BIRTH

SHOW MOTHER, HOW TO BF AND MAINTAIN LACTATION, EVEN IF SEPARATED FROM THEIR INFANTS

GIVE NEWBORNS NO FOOD OR DRINK OTHER THAN BREAST MILK, NOT EVEN SIPS OF WATER UNLESS MEDICALLY INDICATED

PRACTICE ROOMING-IN

ENCOURAGE BF ON DEMAND

GIVE NO ARTIFICIAL TEATS OR PACIFIERS

FOSTER THE ESTABLISHMENT OF BF SUPPORT GROUPS AND REFER MOTHERS TO THEM ON DISCHARGE FROM HOSPITAL OR CLINIC.

IN INDIA

DETERMINANTS OF GROWTH AND DEVELOPMENT1. GENETIC INHERITANCE2. NUTRITION3. AGE4. SEX5. PHYSICAL SURROUNDINGS6. PSYCHOLOGICAL FACTORS7. INFECTIONS 8. ECONOMIC FACTORS9. OTHER FACTORS

SURVEILLANCE OF GROWTH AND DEVELOPMENT PHYSICAL GROWTH1. WEIGHT FOR AGE2. HEIGHT FOR AGE3. WEIGHT FOR HEIGHT4. HEAD AND CHEST CIRCUMFERENCE

BEHAVIOURAL DEVELOPMENT1. MOTOR DEVELOPMENT2. PERSONAL SOCIAL DEVELOPMENT3. ADAPTIVE DEVELOPMENT4. LANGUAGE DEVELOPMENT

GROWTH CHART ROAD TO HEALTH CHART

DESIGNED BY DAVID MORLEY AND LATER MODIFIED BY WHO

IT IS A VISIBAL DISPLAY OF THE CHILD’S PHYSICAL GROWTH AND DEVELOPMENT.

MEANT FOR LONGITUDINAL FOLLOW-UP (GROWTH MONITORING)

COMPARE WITH REFERENCE CURVES

WEIGHT IS THE MOST SENSITIVE MEASURE OF GROWTH

CHILD CAN LOSE WEIGHT BUT NOT HEIGHT

INEXPENSIVE WAY OF MONITORING WEIGHT GAIN AND CHILD’S HEALTH

WHO CHILD GROWTH STANDARDS- 2006 MULTICENTRE GROWTH REFERENCE STUDY

– CONDUCTED

9440 HEALTHY BREAST FED INFANTS AND CHILDREN (0 TO 60 MONTHS)

WIDELY DIVERSE ETHNIC BACKGROUND AND CULTURAL SETTINGS

GROWTH CHART USED IN INDIA ADOPTED IN FEB 2009 WITHIN NRHM AND ICDS “MOTHER AND CHILD PROTECTION CARD”

IT IS THE DIRECTION OF THE GROWTH THAT IS MORE IMPORTANT THAN THE POSITION OF DOTS ON THE LINE

FLATTENING OR FALLING OF THE CHILD’S WEIGHT CURVE SIGNALS GROWTH FAILURE

OBJECTIVE IS TO KEEP THE CHILD IN THE NORMAL ZONE

USES OF GROWTH CHART1. FOR GROWTH MONITORING 2. DIAGNOSTIC TOOL: IDENTIFY HIGH RISK CHILDREN3. PLANNING AND POLICY MAKING4. EDUCATIONAL TOOL5. TOOL FOR ACTION6. EVALUATION7. TOOL FOR TEACHING

“PASSPORT TO CHILD HEALTH CARE”

PRE SCHOOL CHILD 9.7% OF TOTAL POPULATION 2.3% OF ALL DEATHS

CHILD HEALTH PROBLEMS LOW BIRTH WEIGHT MALNUTRITION INFECTIONS AND PARASITOSIS ACCIDENTS AND POISONING BEHAVIOURAL PROBLEMS OTHER FACTORS:1. MATERNAL HEALTH2. FAMILY HEALTH3. SOCIOECONOMIC CIRCUMSTANCES4. ENVIRONMENT5. SOCIAL SUPPORT AND HEALTH CARE

MCH

MOTHER AND CHILD HEALTH

INTRODUCTION IT IS A METHOD OF DELIVERING HEALTH CARE

TO SPECIAL GROUP IN THE POPULATION WHICH IS ESPECIALLY VULNERABLE TO DISEASE, DISABILTY OR DEATH

CHILDREN UNDER 5 YEARS WOMEN BETWEEN 15 TO 44 YEARS

32.4%OF TOTAL POPULATION OF INDIA

OBJECTIVES1. REDUCTION OF MORBIDITY AND MORTALITY

RATES OF MOTHERS AND CHILDREN

2. PROMOTION OF REPRODUCTIVE HEALTH

3. PROMOTION OF THE PHYSICAL AND PSYCHOLOGICSL DEVELOPMENT OF THE CHILD WITHIN THE FAMILY

SUB AREASa) MATERNAL HEALTHb) FAMILY PLANNINGc) CHILD HEALTHd) SCHOOL HEALTHe) HANDICAPPED CHILDRENf) CARE OF THE CHILDREN IN SPECIAL SETTINGS

SUCH AS DAY CARE CENTRES

RECENT TRENDS IN MCH CARE

1. INTEGRATION OF CARE2. RISK APPROACH3. MANPOWER CHANGES4. PRIMARY HEALTH CARE

INDICATORS OF MCH CARE1. MATERNAL MORTALITY RATIO2. PERINATAL MORTALITY RATE3. NEONATAL MORTALITY RATE4. POST NEONATAL MORTALITY RATE5. INFANT MORTALITY RATE6. 1-4 YEAR MORTALITY RATE7. UNDER-5 MORTALITY RATE8. CHILD SURVIVAL RATE

MATERNAL MORTALITY RATIO MATERNAL DEATH IS DEFINED AS THE

DEATH OF A WOMAN WHILE PREGNANT OR WITHIN 42 DAYS OF TERMINATION OF PREGNANCY, IRRESPECTIVE OF DURATION AND SITE OF PREGNANCY, FROM ANY CAUSE RELATED TO OR AGGRAVATED BY PREGNANCY OR ITS MANAGEMENT BUT NOT FROM ACCIDENTAL OR INCIDENTAL CAUSES.

MMR

LATE MATERNAL DEATH

THE DEATH OF A WOMAN FROM DIRECT OR INDIRECT CAUSES, >42 DAYS BUT <1 YEAR AFTER TERMINATION OF PREGNANCY

MATERNAL DEATHS

Direct obstetric deaths Indirect obstetric deaths

The maternal mortality rate, the direct obstetric rate and the indirect obstetric rate are fine measures of the quality of maternal services

Approaches for measuring Maternal Mortality Civil registration systems Household survey Sisterhood methods Reproductive age mortality studies (RAMOS) Verbal autopsy Census

MMR IN INDIA = 178 PER 100,000 LIVE BIRTHS

KERALA, MAHARASHTRA AND TN = 100 PER LAC LIVE BIRTHS

ASSAM = HIGHEST – 328/100,000 LIVE BIRTHS

SRS (CENTRAL REGISTRATION SYSTEM) INTRODUCED “RHIME” THAT IS REPRESENTATIVE, RE SAMPLED, ROUTINE HOUSEHOLD INTERVIEW OF MORTALITY WITH MEDICAL EVALUATION

MAJOR CAUSES ACOORDING TO SRS SURVEY:

HEMORRHAGE 38% HYPERTENSION 5% SEPSIS 11% OBS LABOR 5 % ABORTION 8% ANEMIA 19%

NATIONAL MATERNAL HEALTH CARE INDICATORS

ANTENATAL CARE INSTITUTIONAL DELIVERY IFA TABLET CONSUMPTION POSTNATAL CHECK UP WITHIN 2 DAYS

PREVENTIVE AND SOCIAL MEASURES1. EARLY REGISTRATION OF PREGNANCY2. AT LEAST 4 ANTENATAL CHECK UPS3. DIETARY SUPPLEMENTATION, INCLUDING CORRECTION OF

ANEMIA4. PREVENTION OF INFECTION AND HEMORRHAGE DURING

PUERPERIUM5. PREVENTION OF COMPLICATIONS6. TREATMENT OF MEDICAL CONDITIONS7. ANTI-MALARIA AND TETANUS PROPHYLAXIS8. CLEAN DELIVERY PRACTICE9. TRAINED LOCAL DAIS AND FHW10. INSTITUTIONAL DELIVERIES11. PROMOTION OF FAMILY PLANNING12. IDENTIFICATION OF EVERY MATERNAL DEATH AND ITS CAUSE13. SAFE ABORTION SERVICES

STILL BIRTH RATE

PERINATAL MORTALITY RATE1. BABIES CHOSEN FOR INCLUSION IN

PERINATAL STATISTICS SHOULD BE THOSE ABOVE A MINIMUM BW I,E 1000 GM AT BIRTH

2. IF BW IS NA, A GA OF ATLEAST 28 WKS SHOULD BE USED

3. IF 1 AND 2 ARE NA, BODY LENGTH OF ATLEAST 35CM SHOULD BE USED

WHY PERINATAL MORTALITY RATE? WITH DECLINE OF IMR, PMR HAS ASSUMED GREATER

SIGNIFICANCE AS A YARDSTICK OF OBSTETRIC AND PEDIATRIC CARE BEFORE AND AROUND THE TIME OF BIRTH

2 TYPES OF DEATH RATES ARE COMBINED THAT IS STILLBIRTHS AND EARLY NEONATAL DEATH

A PROPORTION OF DEATHS OCCURING AFTER BIRTH ARE INCORRECTLY REGISTERED AS STILLBIRTHS,THEREBY INFLATING STILLBIRTH RATE AND LOWERING NEONATAL DEATH RATE

THE VALUE OF PMR IS THAT IT GIVES A GOOD INDICATION OF THE EXTENT OF PREGNANCY WASTAGE AS WELL AS THE QUALITY AND QUANTITY OFNHEALTH CARE AVAILABLE TO THE MOTHER AND THE NEWBORN

CAUSES OF PERINATAL MORTALITY

NEONATAL MORTALITY RATE

NEONATAL MORTALITY IS A MEASURE OF INTENSITY WITH WHICH ENDOGENOUS FACTORS AFFECT INFANT LIFE

DIRECTLY RELATED TO BW AND GA

IN INDIA = 29/1000 LIVE BIRTHS

POST NEONATAL MORTALITY RATE

WHEREAS NMR IS DOMINATED BY ENDOGENOUS FACTORS, POST-NEONATAL MORTALITY IS DOMINATED BY EXOGENOUS FACOTORS.

DIARRHEA AND ARI ARE MAIN CAUSES

IN DEVELOPED COUNTRIES, CONGENITAL ANOMALIES IS THE MAIN CAUSE

MALNUTRITION IS AN ADDITIONAL FACTOR

IN INDIA= 13/1000 LIVE BIRTHS

INFANT MORTALITY RATE

IMR IS UNIVERSALLY REGARDED NOT ONLY AS THE MOST IMPORTANT INDICATOR OF HEALTH STATUS OF A COMMUNITY BUT ALSO THE LEVEL OF LIVING OF PEOPLE IN GENERAL, AND EFFECTIVENESS OF MCH SERVICES IN PARTICULAR

LARGEST SINGLE AGE CATEGORY OF MORTALITY

DEATHS AT THIS AGE ARE DUE TO PECULIAR SET OF DISEASES AND CONDITIONS TO WHICH ADULTS ARE LESS PRONE

AFFECTED RATHER QUICKLY AND DIRECTLY BY SPECIFIC HEALTH PROGRAMMES

IMR IN INDIA = 41/1000 LIVE BIRTHS

FACTORS AFFECTING INFANT MORTALITY

BIOLOGICAL FACTORS ECONOMIC FACTORS SOCIAL FACTORS

BIOLOGIC FACTORS

1. BIRTH WEIGHT2. AGE OF THE MOTHER3. BIRTH ORDER4. BIRTH SPACING5. MULTIPLE BIRTHS6. FAMILY SIZE7. HIGH FERTILITY

CULTURAL AND SOCIAL FACTORS

1. BREAST FEEDING2. RELIGION AND CASTE3. EARLY MARRIAGES4. SEX OF THE CHILD5. QUALITY OF MONITORING6. MATERNAL EDUCATION7. QUALITY OF HEALTH CARE8. BROKEN FAMILIES9. ILLEGITIMACY10. BRUTAL HABITS AND CUSTOMS11. THE INDIGENOUS DAIS12. BAD ENVIRONMENTAL SANITATION

PREVENTIVE AND SOCIAL MEASURES1. PRENATAL NUTRITION2. PREVENTION OF INFECTION3. BREAT FEEDING4. GROWTH MONITORING5. FAMILY PLANNING6. SANITATION7. PROVISION OF PRIMARY HEALTH CARE8. SOCIOECONOMIC DEVELOPMENT9. EDUCATION

1-4 YEAR MORTALITY RATE

UNDER 5 MORTALITY RATE INDIA= 53/1000 LIVE BIRTHS

NATIONAL TECHINICAL COMMITTEE ON CHILD HEALTH, 2000

CHILD SURVIVAL INDEX INDIA= 94.7

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

3 COMPONENTS

INTEGRATED MANAGEMENT OF : DIARRHOEA ARI MALARIA MEASLES MALNUTRITION

1 WEEK TO 5 YEAR OLD CHILDREN ACTION- ORIENTED APPROACH

ELEMENTS:ASSESS• ASSESS A CHILD BY CHECKING FIRST FOR DANGER

SIGNS, ASKING QUESTIONS ABOUT COMMON CONDITIONS, NUTRITION, IMMUNIZATION STATUS AND OTHER HEALTH PROBLEMS

CLASSIFY• CHILD’S ILLNESS USING A COLOU CODED TRIAGE

SYSTEM

IDENTIFY• IDENTIFY SPECIFIC TREATMENTS FOR THE CHILD. IF

REQUIRES REFERRAL, GIVE ESSENTIAL TREATMENT BEFORE TRANSFER

• IF NEEDS IMMUNIZATION, IMMUNIZE

TREAT• PRACTICAL INSTRUCTIONS ON HOW TO GIVE

ORAL DRUGS, FEED, OR FLIDS• ASK TO RETURN FOR FOLLOW UP AND HOW TO

RECOGNIZE DANGER SIGNS TO RETURN IMMEDIATELY TO THE FACILITY

COUNSEL• BREAST FEEDING PRACTICES• COUNSEL ABOUT MOTHER’S HEALTH

FOLLOW-UP CARE• REASSESS THE CHILD FOR NEW PROBLEMS

SCHOOL HEALTH SERVICE SCHOOL HEALTH IS AN IMPORTANT BRANCH

OF COMMUNITY HEALTH

PERSONAL HEALTH SERVICE

ECONOMICAL AND POWERFUL MEANS OF RAISING COMMUNITY HEALTH

HEALTH PROBLEMS OF THE SCHOOL CHILD1. MALNUTRITION

2. INFECTIUOS DISEASES

3. DISEASES OF SKIN, EYE AND EAR

4. INTESTINAL PARASITES

5. DENTAL CARIES

OBJECTIVES

ASPECTS OF SCHOOL HEALTH SERVICE

HEALTH APPRAISAL STUDENTS+TEACHERS+OTHERSa) PERIODIC MEDICAL EXAMINATION- EVERY

4 YRSb) SCHOOL PERSONNELc) DAILY MORNING INSPECTION

MENTALLY HANDICAPPED CHILDREN

CAUSESMISCALLANEOUS

GENETICANTENAT

AL FACTORS

PERINATAL

FACTORS

POSTNATAL

FACTORS

PRIMARY PREVENTION OF HANDICAP

JUVENILE DELINQUENCY “ A CHILD WHO HAS COMMITTED AN OFFENCE”

BOY <16 YEARS GIRL <18 YEARS

JUVENILE CRIME

IT EMBRACES ALL DEVIATIONS FROM NORMAL YOUTHFUL BEHAVIOUR

INCLUDES INCORRIGIBLE,UNGOVERNABLE, HABITUALLY DISOBEDIENT AND THOSE WHO DESERT THEIR HOMES AND MIX WITH IMMORAL PEOPLE, THOSE WITH BEHAVIOURAL PROBLEMS AND ANTISOCIAL PRACTICES

CAUSESGENETIC• HEREDITARY

DEFECTS• FEEBLE MIND• XYY

SYNDROME• GLANDULAR

IMBALANCE

SOCIAL• PARENTAL

NEGLECT• BROKEN

HOMES• STEP MOTHERS• DEATH OF

PARENTS

OTHERS• CHEAP

RECREATION• URBANIZATION• SEX THRILLERS• TV• NO

RECREATION

PREVENTIVE MEASURES

IMPROVEMENT OF FAMILY LIFE SCHOOLING SOCIAL WELFARE SERVICES

STREET CHILDREN

24 HOURS SHELTER FOOD CLOTHING NON FORMAL EDUCATION GUIDANCE RECREATION COUNSELLING SCHOOLING ETC PROVIDED

THE CHILD LABOUR ACT, 1986

CHILD GUIDANCE CLINIC

TEAM WORK…. PSYCHIATRIST------ CENTRAL FIGURE CHILD PSYCHOLOGIST EDUCATIONAL PSYCHOLOGIST PSYCHIATRIC SOCIAL WORKERS PUBLEC HEALTH NURSES PAEDIATRICIAN SPEECH THERAPIST OCCUPATIONAL THERAPIST NEUROLOGIST

SERVICES

PAEDIATRICIAN -> PHYSICAL HEALTH OF THE CHILD

PSYCHOTHERAPY1. PLAY THERAPY2. COUNSELLING3. SUGGESTIONS4. CHANGE IN PHYSICAL ENVIRONMENT5. EASING OF PARENTAL TENSIONS6. RECONSTRUCTION OF PARENTAL ATTITUDES

CHILD PLACEMENT

ORPHANAGES FOSTER HOMES

ADOPTIONBORSTALS

REMAND HOMES

1975

INTEGRATED CHILD DEVELOPMENT SERVICES

OBJECTIVES

SERVICES1. SUPPLEMENTARY NUTRITION

2. NUTRITION AND HEALTH EDUCATION FOR WOMEN

3. IMMUNIZATION

4. HEALTH CHECK-UP

5. MEDICAL REFERRAL SERVICES

6. NON FORMAL EDUCATION OF CHILDREN UPTO 6 YEARS, AND PREGNANT AND NURSING MOTHERS.

SUPPLEMENTARY NUTRITION

MORE THAN ONE MEAL TO THE CHILDREN WHO COME TO AWCs, WHICH INCLUDE PROVIDING A MORNING SNACK IN THE FORM OF MILK/BANANA/EGG/SEASONAL FRUIT/MICRONUTRIENT FORTIFIED FOOD F/B A HOT COOKED MEAL

IF <3 YRS, PREGNANT OR LACTATING : TAKE HOME RATION

BPL IS NOT A CRITERIA FOR ICDS SERVICES

ALL ARE ELIGIBLE

THE SCHEME IS UNIVERSALSUPPLEMENTARY NUTRITION IS GIVEN 300 DAYS IN A YEAR

HEALTH CHECK UP

CONTD.. ANTENATAL POSTNATAL CHILDREN <6 YEARS

IFA + PROTEIN FOR MOTHERS

SCHEMES FOR ADOLESCENT GIRLS

KISHORI SHAKTI YOJANA (11-18 YRS) UNDER ICDS

NUTRITION PROGRAMME FOR ADOLESCENT GIRLS ( UNDER ICDS)

2 MORE UNDER ICDS RAJIV GANDHI SCHEME FOR EMPOWERMENT

OF ADOLESCENT GIRLS – SABLA

INDIRA GANDHI MATRUTVA SAHYOG YOJANA

HOW ICDS IS ORGANISED? COMMUNITY DEVELOPMENT BLOCK in rural

areas

TRIBAL DEVELOPMENT BLOCK in tribal areas

RURAL/URBAN PROJECT has 100,000 population

TRIBAL PROJECT has 35,000 population 100 Villages in rural project 50 villages in tribal project

FUNCTIONARIES OF ICDS ANGANWADI WORKER- AWW

CHILD DEVELOPMENT PROJECT OFFICER-CDPO in charge of 4 mukhyasevika and 100 AWW

MUKHYA SEVIKA in charge of 20-25 ANGANWADIS and mentor of AWW

AWW- ROLE MULTIPURPOSE AGENT SELECTED FROM THE COMMUNITY DIRECT LINK TO CHILDREN AND MOTHER ASSISTS CDPO IN SURVEY PF COMMUNITY AND

BENEFICIARIES NON FORMAL EDUCATION SESSIONS HEALTH AND NUTRITION EDUCATION TO MOTHERS ASSISTS PHC STAFF IN PROVIDING HEALTH SERVICES MAINTAINS RECORDS AND IMMUNIZATION FEEDING AND PRESCHOOL ATTENDANCE LIASES WITH BLOCK ADMINISTRATOR COMMUNITY BASED ACTIVITIES

10 TO 19 YEARS : ADOLESCENTS

15 TO 24 YEARS : YOUTH

10 TO 24 YEARS : YOUNG PEOPLE

PREVENTIVE GERIATRICS

HEALTH PROBLEMS OF THE AGED

PROBLEMS DUE TO AGEING PROCESS

PROBLEMS ASSOCIATED WITH LONG TERM ILLNESS

PSYCHOLOGICAL PROBLEMS

PROBLEMS DUE TO AGEING PROCESS

SENILE CATARACT GLAUCOMA NERVE DEAFNESS OSTEOPOROSIS EMPHYSEMA FAILURE OF SPECIAL SENSES CHANGES IN MENTAL OUTLOOK………..

PROBLEMS ASSOCIATED WITH LONG TERM ILLNESSES

DEGENERATIVE DISEASES OF HEART AND BLOOD VESSELS

CANCER ACCIDENTS DIABETES DISEASES OF LOCOMOTOR SYSTEM RESPIRATORY ILLNESSES GENITOURINARY ILLNESSES

PSYCHOLOGICAL PROBLEMS

MENTAL CHANGES SEXUAL ADJUSTMENT EMOTIONAL DISORDERS

HEALTH STATUS OF THE AGED IN INDIA NATIONAL POLICY ON OLDER PERSONS

19991. FINANCIAL SECURITY2. SHELTER3. WELFARE4. PROTECTION5. HEALTH CARE6. OLD AGE PENSION7. SELF HELP GROUPS8. OLDAGE HOMES, DAY CARE CENTRES

BHAVISHYA AROGYA MEDICLAIM RURAL GROUP LIFE INSURANCE SCHEMES

HelpAge India1. Largest voluntary organization2. Free cataract operations3. Mobile medicare units4. Income generation and micro credit5. Old age homes and day care centres6. Adopt-a-gran7. Disaster mitigation

THANK YOU