MOTHER

 

INTRODUCTION

 

          In any community, mothers and children constitute a priority group but they are also a vulnerable or special risk group so specific programmes should be targeted on their welfare.


MATERNAL AND CHILD HEALTH

Definition:

          According to WHO, MCH is defined as the promotive, preventive, curative and rehabilitative care for mother and children.

 

Objectives:

1.    Reduction of maternal, perinatal and infant and child mortality and morbidity rate.

2.    Promotion of reproductive health.

3.    Promotion of physical and psychological development of the child and adolescent within the family.

4.    Ultimate objective of MCH is life long health.

5.    Atleast 40% of newborn babies to have birth weight of 2500gm.

6.    Atleast 90% of children to have weight age corresponding reference value.

 

Targets of MCH Service

          Under the Health for all by 2000 movement the following target have been proposed to be achieved by the members of WHO India is also committed to achieve these goals.

1.     Infant mortality  rate reduces to 60.

2.     1-4 years mortality rate reduces to 10.

3.     Maternal mortality rate reduce than 2 per 1000 per birth.

 

MCH Services

          The important health problems affecting the mother and the child are mainly malnutrituion, infections and hazards associated with uncontrolled reproduction or fertility MCH services in India are now delivered as a package services against these problems to promote continuity of care and to reduce number of visits by mother, for herself and for the child.

          The MCH care package services include antenatal care, intranatal care, prenatal care, post natal care, nutrition advice, immunization, primary health care and rational family planning.

          MCH services should always be flexible and based on local needs and resources of the community it serves.  It is organized in integrated and risk approach and delivered as priority element of primary health care MCH services highlights the concept of mother and child as one unit because the child health is closely related to maternal health and a healthy mother only can bring a healthy child.

CHILD SURVIVAL AND SAFE MOTHERHOOD [CSSM]

PROGRAM

          This program was launched in 1992, combined all the maternal and child  health interventions.  It aimed to prevent maternal and under five morbidity and mortality.  The CSWSM programme incorporates a package of services for the children (Child survival component ) and the mother (Safe Motherhood component).

PACKAGE OF SERVICES

For children

·        Essential newborn care

·        Immunization

·        Appropriate management of diarrhea

·        Appropriate management of ARI (Acute respuatory infections).

·        Vitamin A prophylaxis.

 

FOR Mother

·        TT immunization

·        Prevention and treatment of anemia.

·        Antenatal care and early identification of maternal complications.

·        Deliveries by trained personnel.

·        Promotion of institutional deliveries.

·        Management of obstetric emergencies

·        Birth spacing

Organisation of CSSM services

·        This program is being implemented essentially through the existing network of subcenters, primary health centers and community health centes and district hospitals in each district, 4 to 6 first referral units [FRUS] are being created by upgrading CHCs or PHCs by 1997, the child survival component was expected to be extended to all the 466 districts, while the safe motherhood component was to be implemented in 219 districts.

          Thus the activities already initiated under the CSSM program will continue to strengthened and expanded under the RCH services.

 


REPRODUCTIVE AND CHILD HEALTH

Definition

          Reproductive and child health approach has been defined as “people have the ability reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successfully in terms of maternal and infant survival and well being and couples are able to have sexual relations free of fear of pregnancy and contracting disease”.

Elements of RCH services

          The basic elements of reproductive and child health are:-

·        Family planning

·        Maternal and child health

·        Safe abortion services

·        Effective control of STD and RTI

·        Prevention and management of infertility.

·        Prevention, detection cum treatment of reproductive tract malignancies.

 

RCH SERVICES

          The package of services provide under the RCH programme includes

1.     For mothers

a.     Essential care for all

b.    Early detection of complications

c.     Emergency care for those who need it

2.     For children

a.     Essential new born care

b.    Exclusive breast freeding and weaning

c.     Immunisation

d.    Appropriate management of diarrhaoe.

e.     Appropriate management of ARI

f.       Vitamin A prophylaxis

g.     Treatment of anemia

3.     For eligible couples

a.     Prevention of pregnancy through contraception services and safe abortion

4.     Prevention and management of Reproductive Tract Infection [RTI] and sexually transmitted infections [STI’s].

5.     Adolescent Health services including counseling of family life and reproductive health.

 


FOR MOTHER:

Essential care for all

·        Register by 12-16 weeks

·        Antenatal check up at least 3 times during pregnancy [20,32,36 weeks].

·        Tetanus toxoid immunization should be given to all pregnant women with two doses at one month interval.

·        Give iron and folic acid tablets daily for 100 days to all pregnant women.

·        Treat those with clinical signs of anaemia with 2 tablets of IFA.

·        Deworm with mebendazole in areas where hookworm infestation is common.

·        Safe and clean delivery services.

·        Prepare the women for exclusive breast feeding and timely weaning

·        Post natal care, including advice and services for limiting and spacing birth.

 

Early Detection of Complications

·         Clinical examination to detect anaemia

·        If there is bleeding before and excessive bleeding after delivery, she should be referred to the hospital.

·        All medical emergency cases should be referred to nearest hospital.

·        Fever above 3900C should be treated in hospital.

·        In case of prolonged or obstructed labour immediately take them to nearest hospital where facilities for caesarean section are available.

Emergency care for those who need it

·        Early identification of obstetric emergencies.

·        Provide initial management and refer to identified referral hospitals minimum time should be wasted as delay can be fatal.

·        Use fast available mode of transport in case of emergency.

 

Women in the reproductive

·        Counselling on

·        Importance on care of girl child

·        Small Family norms

·        Use and choice of contraceptives

·        Prevention of RTIs or STD’s

·        Information of availability of

·        MTP services

·        IUD and sterilization services

·        Provide family planning services

o       Condom distribution

o       Oral contraceptives

o       IUD

·        Recognition and referral of RTIs/STDs

·        Provision of clean and safe delivery practices at the community level.

·        Create awareness in the community on need for 5 clean and safe deliveries.

·        Deliveries by trained personnel.

·        Provision of disposable delivery kits[DOK] to all pregnant women.

·        Promotion of institutional deliveries.

·        Identification and referral of high risk cases at the community level trained dais.

Infants and children

·        Take birth weight of all new borns Resuscitation should be done in case asphyxiated babies.

·        Advice mother regarding exclusive breast feeding within one hour of delivery.


Immunization

          The universal immunization programme will continue to provide vaccines for polio, tetanus, DPT, measles and tuberculosis.

·        Prevention of deaths due to dirrhoea disease.

·        Advice mother

          To give increased volume of fluids as soon as diarrhea starts how to prepare OrS solution

·        Prevention of deaths due to pneumonia

·        Early initiation of cotrimoxazole to children with signs of pneumonia.

·        Referral of children with severe pneumonia.

 


CONCLUSION

 

          These programmes aimed at the health and development of women and children.         

          These programmes are not just a new package of services.  These programmes lays emphasis on quality of services and satisfaction of the consumers.


BIBLIOGRAPHY

 

1.      K.Park, “Preventive and Social medicine”. Banarsidas Bhanot publishers., 18th edition Pg 343-345.

2.      B.T Basavantappa, ‘Community health Nursing’ Jaypee Publishers, 2nd Edition, Pg No.359-361.

3.      O.P.Ghai “Essential pediatrics” 5th Edition, Pg.518-524.

 

 

 

 

 

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