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
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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