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Child Health (MCH) refers to a package of comprehensive health care services which are developed to meet promotive, preventive, curative, rehabilitative health care of mothers and children. It includes the sub areas of maternal health, childhealth, family planning, school health and health aspects of the adolescents, handicapped children and care for children in special settings. DEFINITION AND CONCEPTS OF MATERNAL HEALTH/REPRODUCTIVE HEALTH Maternal Health is now referred as . Reproductive Health is defined as People have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and infant survival and well being and couples are able to have sexual relations free of fear of pregnancy and of contracting diseases. OBJECTIVES OF MATERNAL AND CHILD HEALTH: To reduce maternal, infant and childhood mortality and morbidity To reduce perinatal and neonatal mortality and morbidity. Promoting satisfying and safe sex life. Regulate fertility so as to have wanted and healthy children when desired. Provide basic maternal and child Health Care to all mothers and children. Promote and protect health of mothers. To promote reproductive health. To promote physical and psychological development of children and adolescents with in the family. GOALS OF MATERNAL AND CHILD HEALTH SERVICES: The main goal of maternal and child health services is the birth of a healthy infant into the family and prevention of diseases in mothers and children. The goals which are included are as follows: To ensure the birth of a healthy infant to every expectant mother. To provide services to promote the healthy growth and development of children upto the age of under- five- years. To identify health problems in mother and children at an early stage and initiate proper treatment. To prevent malnutrition in mothers and children. To promote family planning services to improve the health of mothers and children. To prevent communicable and non- communicable diseases in mothers andchildren. To educate the mothers on improvement of their own and their children s health . A .MATERNAL HEALTH PROBLEMS The Maternal Health Problems are as follows: -I. Nutritional Problems: a)Malnutrition b)Nutritional Anemia II. Infection Problems: (a)Reproductive Tract Infections/STI s (b ) Infection in general (c)Puerperal Sepsis III. Disturbances and Menstruation IV. Mature Gravidas V. Adolescent Gravida VI. Adolescent Parents Problems VII. Unregulated Fertility VIII. Abortions IX. Complications of Deliveries X. Infertility

XI. Uterine Prolapse XII.Cancer of the cervix I.Nutritional Problems a)Malnutrition Malnutrition is a very common problem among women who are discriminated and under privileged. Pregnant and nursing mothers are especially prone to the effects of malnutrition. Malnutrition can cause poor resistance, abortion, anemia, miscarriage or premature delivery, low birth weight baby (<2.5kg), eclampsia, postpartum hemorrhagic. These conditions can cause fatal effects on mothers, . b)Nutritional Anemia Anemia in pregnancy is defined as a hemoglobin concentration of less than 11g. It is also a serious public health problem in India. Although it is wide spread in the country, it especially affects woman in reproductive age, young children and adolescent girls. Magnitude of the Problem More than half of the pregnant women during pregnancy suffer from anemia.13%are severely anemic. Hemoglobin is less than 7 gm/ deciliter. 1/5 of all maternal deaths are attributed to anemia during pregnancy. More than half of the adolescent girls are anemic. Anaemia during pregnancy leads to 20% of all maternal deaths. 3 times greater risk of premature delivery and LBW babies 9 times higher risk of perinatal mortality. H i g h er r i s k of i r r ec o ver a bl e br ai n dam a g e i n i nf a n t s bo r n t o s e ver el y a na em i c mothers. . II.Infection Problems (a)Reproductive Tract Infections (RTIs): RTIs include a variety of bacterial, viral and protozoal infections of the lower and upper reproductive tract of both sexes. RTIs pose a threat to women s lives and well being throughout the world. A high incidence of infertility, tubal pregnancy, and poor reproductive outcome is an indirect reflection of high prevalence of RTIs/ STIs in India (b)Infection in general: The women during pregnancy, especially in underdeveloped areas and developing countries are at risk ofcontractinginfection.M an y w om e n g e t i n fec t ed w i t h h er pe s si m pl e x v i r u s , c y t om e g a l ov i r u s , p r o t oz oo n wh i c h c a u se s t o x op l a sm o s i s , E Co l i c au s i ng n ep hr i t i s or c y s t i t i s. I n fe c t i o n d ur i ng pregnancy can cause various harmful effects e.g. retardation of fetal growth, abortion,low birth weight baby and puerperal sepsis. ( c )Puerperal Sepsis: It is mainly due to infection during labor and after delivery because of lack of personal hygiene, insanitary conditions, septic procedures, etc. This may lead to inflammation of ovaries, fallopian tubes, endometrium, cervix and vagina. Many a time leucorrhoea may persist for years. III. Disturbances and Menstruation Amenorrhoea, absence of menstrual flow, dysmenorrhoea, painful menstruation, abnormal uterine bleeding, hypermenorrhoea/ menorrhagia, bleeding between menstrual periods.. IV. Mature Gravidas The pregnant woman over 35 years faces unique problems. .V. Adolescent Gravida The adolescent mother and her family create a particularly difficult problem. The needs can be so extensive that care will be fragmented and ineffective unless and interdisciplinary team approach coordinates the school, social and health care services. VI. Adolescent Parents Problems VIII. Abortions

Twenty percent of maternal mortality is directly related to abortion related causes. The number of abortions is on the increase because of unwanted pregnancies. Medical Termination of Pregnancy (MTP) has been legalized under the MTP Act of 1971, under certain conditions. By and large abortions are still done by quacks and unauthorized persons in the rural areas. This is mainly due to lack of access to safe abortion clinics, nonavailability of such clinics, IX. Complications of Deliveries In India most of the deliveries take place at home under unhygienical environment andmostly by untrained dais lacking obstetric skill. X. Infertility Infertility is both medical and social problem Even if the fault/defect is in the male partner, usually it is the woman who is labeled as Banjh or Barren and is sociallynot treated properly by the family and the society. Therefore XI. Uterine Prolapse Uterine prolapse is the major problem in women of hilly region. Women working atconstruction sites, climbing heights, or digging and ground or climbing 2-3 storey with heavy weights are predisposed to prolapse uterus.. XII. Cancer of the Cervix Cancer of the cervix is very common among Indian women. There are various factorswhich contribute to the prevalence of cancer of cervix. These are early marriage andearly pregnancy, multiple child birth, poor hygiene by the male partner, multiple partners, and repeated infections B. CHILD HEALTH PROBLEMS I. Nutritional deficiency Problems a) Malnutrition b) Vitamin Deficiency c) Iron Deficiency

II.Infectious Diseases
a)Tuberculosis b)Diphtheria c)Pertussis (Whooping Cough d)Tetanus e)Poliomyelitis f)Measles g)Acute Respiratory Infection (ARI) h)Diarrhoeal Diseases III.Problems of Neonates a)Hyper bilirubinemia b)Hypothermia c)Neo-natal tetanus d)Birth asphyxia e)Oral thrush f)sepsis g)The infected New Born I. Nutritional deficiency Problems a ) Malnutrition The primary cause of malnutrition is inadequate and faulty diet. Apart from poverty andother socio economic factors, environmental factors also play an important role Protein Energy Malnutrition Protein Energy Malnutrition is defined as a range of pathological conditions arising from coincident lack of varying proportions of protein and calorie, occurring most frequently in infants and young children and often associated with infection. b)Non Nutritional Factors Due to poverty, mother is not able to provide sufficient food to the child resulting inunder nutrition. Non- immunization Improper growth monitoring. Poor weight gain during adolescence Poor environmental and personal hygiene Illiteracy Large family b)Vitamin Deficiency Vitamin A deficiency

Vitamin A deficiency is a major nutritional problem affecting young children leading to blindness.In India about 5 7 percent children suffer annually from eye damage caused byvitamin A Deficiency, Conjunctival Xerosis: The conjunctiva becomes dry, appears muddy andwrinkled due to failure to shed the epithelial cells and consequent keratinisation.The pigmentation gives the conjunctiva a peculiar smoky appearance. Thissymptom in children under 5 years is more likely to be due to dietary deficiency Night blindness: This is the first sign of Xerophthalmia. The child is not ableto see in darkness in a dark room or when it gets dark in the late evening. This isdue to lack of retinal pigments. Bitot s spots: They are accumulations of fomy cheesymaterial on the conjunctiva on either side of the cornea, often in association withother signs of Xerophthalmia, such as blindness. In children under 5 years of agethey are usually due to vitamin A deficiency. Vitamin D Deficiency Deficiency of vitamin D causes rickets in young children in the age group of 6 monthsto 2 years. It reduces calcifications of bones which affects growth of bones and causedeformity of bones such as curved legs, pigeon chest, rickety rosary, deformed pelvis.There is delayed teething, standing and walking. It is no more a serious problem because of improvement in child health care services, socio-cultural practices, c)Iron Deficiency The iron deficiency causes nutritional anaemia in children. About 50 percent of children have anaemia. It is due to malnutrition. It usually leads to various others problems such as general weakness affecting work performance, reduced immunity .d)Low Birth Weight It is major nutritional public health problem in many developing countries. Low birthweight is a major public health problem in many developing countries. About 30 percent of babies born in India are low birth weight as compared to 4 percent in some developed countries. II. Infectious Diseases a)Tuberculosis It is a communicable disease suffered by all ages. It is a problem in community. It is aninfectious disease caused by mycobacterium tuberculosis. The major source of infection is infected sputum of persons having tuberculosis who are either not beingtreated or not being fully treated . Magnitude of the problem 15 million cases of infectious tuberculosis at present 2-3 million cases are added every year 1-2 million people die every year. (b)Diphtheria Diphtheria is very serious disease because if it is not treated immediately it leads to high mortality. It is caused by corynebacterium diphtheriae.The source of infection aremild and missed cases and convalescent and healthy carriers. The persons remainineffective usually for two weeks to four weeks if no treatment is given. The rare cases become chronic carriers. They may remain ineffective for 6 months or mor Magnitude of the problem Fatality rate on an average is about 10 percent which has changed little in the past 50 years in untreated cases and about 5 percent in treated case c)Pertussis (Whooping Cough) Whooping cough is an acute infectious disease causing complications and highmortality in many parts of the world. It is caused by Bordetella Pertussis. Magnitude of the problem Whooping cough occurs in all countries There has been a marked and continuous drop in details from whooping cough. Pertussis is still a clinically serious illness, with high mortality and complication rates. d)Tetanus Tetanus is an acute and highly fatal disease. It is caused by clostridium tetani which is aspore forming bacteria. The spores are highly resistant and can survive for years in the soil and dust Magnitude of the problem

It is one of the leading causes of infant mortalityGeographical variation in incidence has been related toclimate, organic content of soil, amount of agricultural activity and prevalence of local customs tending to promote infection. The incidence of the disease in Calcutta during1971 was 24/ 100,000 population (e)Poliomyelitis Poliomyelitis is a crippling disease as it causes lameness. It is caused by virus. Thevirus is found only in human beings. The source of infections is human faeces and or pharyngeal secretions of an infected person (f.)Measles Measles is a worldwide endemic disease. It occurs more in the winter months fromDecember to April in the form of endemic in 2-3 years time. It is an acute and veryinfectious disease. g)Acute Respiratory Infection (ARI) Acute respiratory infection causes inflammation of respiratory tract from nose to deepdown in the lungs. Most of the time infection is mild characterized by cough and cold b ut 1 0 2 5 pe r c e n t of c hi l dr e n i n th e de ve l op i n g c o un tr i e s h av e pn eu m o ni a w hi c hf r e q ue n tl y c a u se s d e at h. D ea t h r a te s a r e hi g h er i n y o un g i n f a nt s a n d m al n ou r i s he dchildren. On an average a child gets 5-8 episodes of ARIs per annum.In India ARIs isone of the leading causes of death. h)Diarrhoeal Disease D i ar r h oe a i s a n ac u te o r c hr o ni c i n te s ti n al di s tu r ba n c e c h ar a c t er i z e d by i nc r e a se d frequency , or volume of lower movement. It has been defined as passing of more thanthree loose motions in a day or 24 hours. It has been further classified an acute diarrheai.e. Magnitude of Problem According to certain small studies conducted in India it is assumed as 100 millionchildren (14.1 percent of the total population) suffer from 300 million episodes of diarrhea per year. Ten percent or 30 million develop

dehydration and one percent or 3million may face death..

III. Problems of Neonates (a)Hyper bilirubinemia b)Hypothermia c)Neo-natal tetanus d)Birth asphyxia e)Oral thrush f)Sepsis g)The infected New Born 2. FACTORS INFLUENCING MATERNAL AND CHILDHEALTH Maternal Age Sexuality Factor Nipple stimulation, vaginal penetration, or orgasm may cause uterine contractions.secondary to the release of prostaglanins and oxytocin. Nutrition Environmental Factor Women exposed to similar toxic agents experience diminished ovarian reserver, poor endometrial lining development, and abnormal fetal development. Likewise, chronic and acute diseses decrease fecundity and increase fetal wastage. Psychological Factor An absence of stress is important in ensuring a successful outcome for the mother and baby. Harmony with other peoplemust be fostered, and visits from extended family members may be required todemonstrate pleasant and n o controversial relationships Ethnic and Socio Cultural Factor Home remedies and folk care practices for prevention of illness, maintenance of health, and curative purposes remain primary sources for most families, regardless of ethnic and cultural background Lifestyle Factors

BT Basavanthapa, Community Health Nursing ,2nd Edition, Chapter-11,Maternal and Child Health, Published by Jaypee Brothers Medical publishers, 2008,Page No.-355-560 Potter Perry, Fundamental Of Nursing 6th Edition, Chapter 9, caring for Families, Page No.: 99 Krishna Kumari Gulani, Community Health Nursing (Principles andPractices) ,1stEdition ,Chapter-11, Maternal and Child Health, Published byKumar Publishing House, 2005, Page No.: 339 366