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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