Maternal and child health care

learning Objectives
At the end of this lecture student will be able to

• Define Maternal and Child Health

• Discuss General objectives of (MCH)
• Explain the Principles of Maternal and Child Health Service
Program
• Mention MCH center function
• Role of Community Health Nurse in Maternal and Child
Health
 Introduction:
ü The health of mothers and children is at the center of global
concerns. Mothers and children make up more than half of the
population (62%). They are the most voulneable members of
society because they face special risks such as pregnancy,
childbirth, infectious diseases, and the challenges of growth and
survival among children.
ü Both therefore require special attention in health promotion and
prevention of death, disease and congenital defects.
ü Maternal and child health services in Egypt are provided in
primary health care centers and are considered one of the
components of primary health care.
 Concept of Maternal and Child Health (MCH):

 Maternal health: refers to the health of women during

pregnancy, childbirth, and the postpartum period. It
encompasses the health care dimensions of family
planning, preconception, prenatal, and postnatal care in
order to reduce maternal morbidity and mortality.

child health refer to Promote, preventive, curative and

rehabilitative of the child during different stage of age .
 General objectives of (MCH):
1-Reduction of morbidity and mortality in this vulnerable

group ( mothers and children. )

 2-maintains good health for mothers such as (normal deliverary and child

care )

 3-Promotion of physical and emotional development of children through

conducting activities for children from 0-6 years of age

 4. Prevention and control disease and hazards.

 5. Prevention of disability and rehabilitation.

 6. Family planning services.

Objectives of maternal health care:
 1- Reduce maternal deaths.
2- Reduce maternal illness and complication due to
pregnancy.
3- Increase the proportion of pregnant women who
receive early and adequate prenatal care.
4- Reduce the breast cancer death rate.
6- Reduce the overall number of cases of osteoporosis.
7- Reduce iron deficiency among pregnant women
MCH center function
1. premarital care and counseling
2. maternity care
3. infant and preschool child care , and
vaccinations
4. family planning
5. health education
1. Consultation and participation –Consultation
with, and participation by, families is
integral to the services. to meet, the needs of
young children and their families.
2. Access and availability –
access the information, services and resources
that are appropriate for, and useful to,
mothers and their children
3. Primacy of prevention‫ – ةياقولأ ةيقبسأ‬Prevention of harm
or damage is preferable to repairing it later. Early
detection of risk factors , and appropriate intervention.
Primacy of prevention means Addressing the whole
range of behaviors that affect health is the key to a
healthier society.
4. Capacity building ‫–تاودقةيبء اةب‬is “a process that
improves the ability of a person, group, organization, or
system to meet objectives or to perform better.”
It suggests that no single approach is sufficient. effective health
promotion, service provision, and service utilization, require
continuous development of people, systems, structures, and
functions.
5. Equity ‫ – ةلادع‬All children should be able to grow up actively
learning, healthy, sociable and safe – irrespective of their family
circumstances and background.

6. Family-centered – The identification and management of child

and family needs requires a family-centered approach that focuses
on strengths..

7. Partnership – Quality services are achieved through integrated

service delivery and partnerships with other early childhood and
specialist services, and with families.
 maternal care
The target population for this care is all females during
childbearing period (15 to 49 years of age).

Components of maternal care include:

a) Preconceptional care (Premarital care)
b) Antenatal care
c) Intranatal care
d) Postnatal care
e) Interconceptional care
 a) Preconceptional care ( premarital care)
1. Premarital examination: history taking(personal,
medical family history.....
 Aim: prevention 2. physical examination
a n d e a r l y 3. laboratory Investigation: Blood groups, Rhesus
detection of factor (Rh)(, AIDS, Hepatitis B
health hazards or  X-Ray ches t to screen suspected tuberculous
diseases that may case for sputum examination, urine for
affect the normal albuminuria and glycosuria plus stool
child bearing in examination.
the future.  premarital education: about nutrition,
family planning, child rearing
through :
 Premarital counseling to avoid genetic genetic
(down syndrom) \hereditary diseases (DM)
b) Prenatal care (Antenatal care)

Aim: To achieve at the .1- schedule of Antenatal visits

end of the pregnancy a
healthy mother and a 2 . I m m u n i z a t i o n by te t a n u s
healthy baby. toxoid during pregnancy
This could be achieved
through four activities: 3 . He a l t h e d u c a t i o n d u r i n g
pregnancy

4. Early diagnosis and proper

management of at risk pregnancy
o schedule for

o 1st trimester 1 visit /month 1

o 2nd trimester 1 visit / month 3

o 7th and 8th month 2 visit each month 4

o 9th month 1 visit each week 4

 In the first contact: The following activities
should be done:
A.

B. Personal, family, obstetric and past histories.

Careful history taking is very important to identify pregnant
women with risk factors who need special care.

ü Examination includes:- Weight and Height- General

examination (including blood pressure- examination of
leg for edemato detect DVT, preeclampsia,
C. Investigations:

ü - Urine examination

ü - Blood sample for hemoglobin level, blood group, Rh

 2. Immunization by tetanus toxoid during pregnancy (WHO
schedule)
dose timing protection duration
1st At the 1st antenatal visit (provided being after 12 zero -
weeks of gestation)

2nd At least 4 weeks after (and more than 2 weeks 80% 3 years
before term)

3rd At least 6 months after or during the next 95% 5 years

pregnancy

4th At least one year after or during the next 99% 10 year
pregnancy

5th At least one year after or during the next 99% life long
pregnancy
Continue Antenatal care:
1. Immunization: tetanus toxoid during pregnancy.

2. Health Education.:

during pregnancy health education acording women case)

ex. avoid heavy weights in 2nd trimester

airlines after 32 weeks can lead to premature labor

warning sings

3- Early diagnosis and proper management of at risk pregnancy.

at risk pregnancy: Presence of some risk factors during the current pregnancy or
in previous pregnancies. ex. teenage-old-DM-

ü Identifying those high risk group and referring them to obstetric consultation

ü will save a lot of effort and cost and will reduce undesirable outcomes.
c) Intranatal care :

Aims:

1.To conduct delivery under aseptic condition with minimum

injury to the infant and to the mother.

2. To be ready to manage emergencies. ex. emergency supplies

3. Care of baby at birth.( Thermal care, early initiation of

breastfeeding

This could be done through either:

1.Home delivery for Normal pregnancy.

2.Institutional delivery
d) Post-natal Care
Aims:
1. Prevent complications of postnatal period.
2. Restore health of the mother to the optimum.
3. Ensure success of breast feeding.
4. Provide family planning services.
 Post-natal visits Schedule
A minimum of four postnatal
care contacts is recommended.

First visit within 24 hours of birth.

(could be a home visit)

Second visit 48 and 72 hours after birth.

Third visit 7-14 days after birth

 fourth visit 6 weeks after birth

through:
Post-natal visits activites:
o history taking

o Examination: Pulse, temperature, respiratory rate,

breast examination, uterine involution, inspection of
lochia for any signs of sepsis

o health education
e) Interconceptional care
Ø It is care of the mother in between pregnancies for
preparation of the mother for the next pregnancy.

Ø Family Planning
 Impact of family planning on Health:
Family planning influences maternal and child health, through the
proper timing and spacing of births.

It reduces maternal morbidity , mortality,and improves maternal

health

prevention of congenital anomalies (e.g Down‟s syndrome) that

are associated with advancing maternal age.

a) It reduces child morbidity and mortality .

b) improving the Child growth, development .
 maternal mortality:

 causes of maternal mortaltiy:

1. hemorrhage
2. abortion
3. rubture of uterus
4. cesarean section
Child health care
Child's health includes physical, mental and social
well-being ,
Each year more than 10 million children under the age
of five die.
• At least 6.6 million child deaths can be prevented
each year if affordable health interventions are made
available to the mothers and children who need them
Objectives of Child Health Care:

1. To prevent the major causes of morbidity and

mortality.

2. To promote physical and psychological development

of the children.

3. care of acute and chronic diseases including early

diagnosis and proper management
Causes of Child morbidity and mortality
o• Poverty: More than 200 million children under five
live in absolute poverty
o• Under-nutrition and malnutrition: At least 200
million children under five are malnourished
oshort birth intervals
 indicator of population health
Critical indicator of population health reflecting the overall state
of maternal and child health as well as quality and accessibility
of PHC available to pregnant women and infants

Infant Mortality Rate (IMR): Infant mortality is

the death of an infant before his or her first birthday.
 Under-five mortality rate (U5MR)

• Indicates the probability of dying between birth and

exactly five years of age.
couses of Under-five children mortality
a) pneumonia (19 %),
b) • diarrhea (18 %),
c) • malaria (8 %),
d) • neonatal pneumonia
(10 %),
e) • measles (4 %),
Role of community health nurse for the
child program:
1. Ensure that infant got all vaccines according to
national immunization program

2. Ensure normal growth and development

according to different stage and at all levels
physically, psychology and emotionally
 :
Ø provision of information and health education
regard, Immunization, importance, care of child after
getting vaccine, importance of follow up the
immunization schedule.
Ø Nutrition: teach mother about breast feeding,
artificial feeding and related
hygienic practices, mixed feeding, child food and when to
start food, malnutrition sign and symptoms.
Ø provide council to mother related to different health
issues child feeding method, nutrition council,
Ø Referral: refer child to nutritionist if developed any
malnutrition problems,
Role of Community Health Nurse in
maternal health :
1. Teaching and counseling:

to teach mother regarding maintaining health during pregnancy, prevention of

any complication, by providing information regarding nutrition, life style, sex,
medication use , exercise , sleep and rest.

 2. Referral:

community health nurse detect as early as possible any associated risk factors
that may end with pregnancy complication and refer women to appropriate health
care facility according to case and diagnosis
3-Researcher:
 Applying the latest research finding and find any
related problem or issues that need for research.

4-Advocate:act on behalf of the client

Questions

Thanks