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