Professional Documents
Culture Documents
SUBMITTED TO SUBMITTED BY
Mrs. Somibala Thokchom Mrs. Sneha Sehrawat
Tutor M.Sc Nursing
Rufaida College of Nursing Rufaida College of Nursing
INTRODUCTION
Moreover, children are the asset for the family, community and nation. They are their future.
Whereas mothers have an important role in their growth and development. Mother’s health
status during pregnancy and after delivery determines health status of child. Therefore health
care of mothers and children occupies an important place in our health care delivery system
and is integrated part of Primary Health Care.
The problems of maternal and child mortality are complex, involving women’s status,
education, employment opportunities and the availability to women of basic rights and
freedom. The maternal health status differs tremendously from place to place and in the
same place. It is assessed in terms of maternal health problems (maternal morbidity) and
maternal mortality. The factors which are responsible for maternal health problems i.e.
maternal morbidity and maternal mortality include poverty, ignorance, illiteracy,
malnutrition, age at marriage and pregnancy, the number and frequency of child bearing and
the number of unwanted pregnancies and abortions, lower status and worth of women in
society, lack of access to quality maternal health/ reproductive health services, gender
discrimination.
Results: A total of 18 relevant studies that fulfilled the study inclusion criteria were identified out of 471
studies found. These studies generated high quality policy relevance evidence relating to task shifting,
breastfeeding practices, maternal nutrition, childhood immunization, kangaroo mother care (KMC),
prevention of maternal to child transmission of HIV, etc. These indicated significant improvements in
maternal health outcomes in localities and health facilities where the studies were undertaken.
Conclusion: There is a dire need for more implementation research related to MNCH in low income settings
because the priority for improved MNCH outcome is not so much the development of new technologies but
solving implementation issues, such as how to scale up and evaluate interventions within complex health
system.
- Improving maternal and child health policymaking processes in Nigeria: an
assessment of policymakers' needs, barriers and facilitators of evidence-informed
policymaking.
Uneke CJ
Abstract
BACKGROUND:
In Nigeria, interest in the evidence-to-policy process is gaining momentum among
policymakers involved in maternal, newborn and child health (MNCH). However, numerous
gaps exist among policymakers on use of research evidence in policymaking. The objective
of this study was to assess the perception of MNCH policymakers regarding their needs and
the barriers and facilitators to use of research evidence in policymaking in Nigeria.
METHODS:
The study design was a cross-sectional assessment of perceptions undertaken during a
national MNCH stakeholders' engagement event convened in Abuja, Nigeria. A
questionnaire designed to assess participants' perceptions was administered in person. Group
consultations were also held, which centred on policymakers' evidence-to-policy needs to
enhance the use of evidence in policymaking.
RESULTS:
A total of 40 participants completed the questionnaire and participated in the group
consultations. According to the respondents, the main barriers to evidence use in MNCH
policymaking include inadequate capacity of organisations to conduct policy-relevant
research; inadequate budgetary allocation for policy-relevant research; policymakers'
indifference to research evidence; poor dissemination of research evidence to policymakers;
and lack of interaction fora between researchers and policymakers. The main facilitators of
use of research evidence for policymaking in MNCH, as perceived by the respondents,
include capacity building for policymakers on use of research evidence in policy
formulation; appropriate dissemination of research findings to relevant stakeholders;
involving policymakers in research design and execution; and allowing policymakers' needs
to drive research. The main ways identified to promote policymakers' use of evidence for
policymaking included improving policymakers' skills in information and communication
technology, data use, analysis, communication and advocacy.
CONCLUSION:
To improve the use of research evidence in policymaking in Nigeria, there is a need to
establish mechanisms that will facilitate the movement from evidence to policy and address
the needs identified by policymakers. It is also imperative to improve organisational
initiatives that facilitate use of research evidence for policymaking.
- Risk factors for anemia among pregnant women attending antenatal clinic at Jimma
University Hospital, southwest Ethiopia.
Belachew
Abstract
OBJECTIVE:
to determine anemia and its risk factors among pregnant women
METHODS:
A cross-sectional analytic study was carried out among pregnant women who came for
antenatal care follow up for the first time to Jimma University hospital, Jimma town,
southwestern Ethiopia from May-June 2005.
RESULTS:
A total of 168 pregnant women who came for their first antenatal care visit to Jimma
University hospital were enrolled in the study. A structured and interviewer administered
questionnaire was used to collect data on the socio-demographic variables, dietary habit and
other gynecologic and obstetric history. Dietary data were collected using food frequency
questionnaire prepared for assessing nutritional factors for anemia. Sahli hemoglobinometer
and a microscope were used for assessing hemoglobin level and stool for hookworm
infection, respectively. Data were cleaned, edited and entered in to a computer and analyzed
using SPSS for windows, version 11.0. Statistical tests were performed at the level of
significance of 5%. The prevalence of anemia was 64/168 (38.2%) and the mean hemoglobin
level was 11.3 mg/dl. Anemic cases were 4 times likely to have history of excess menstrual
bleeding prior to the index pregnancy 2 times likely to have hook worm infection and 3
times likely not to have shoe wearing habit, 3 times likely to have birth intervals less than 24
moths between the previous pregnancy and index pregnancy (p < 0.05).
CONCLUSION:
This finding suggests the need for strengthening of interventions related to child spacing and
raising awareness about family planning methods. All ANC attendants should be screened
for anemia and hookworm infection at first visit and those anemic mothers and infected with
hookworm should be treated appropriately. Health education should be given to pregnant
mothers on family planning, and the need to gynecologic evaluation before pregnancy and
the importance of wearing shoes to decrease hook worm infection and subsequent anemia.
The prevalence and causes of anemia during pregnancy in Maharaj Nakorn Chiang
Mai Hospital: Sukrat
Abstract
OBJECTIVE:
To determine the prevalence and causes of anemia during pregnancy in Maharaj Nakorn
Chiang Mai Hospital.
MATERIAL AND METHOD:
The pregnant women were screened with hemoglobin, hematocrit, osmotic fragility test,
hemoglobin E test and serology for hepatitis B, syphilis and HIV at first antenatal visit. In
anemic cases, serum ferritin, serum iron/total iron binding capacity, or therapeutic trial with
iron supplementation were performed to assess the iron status. The cases of abnormal
thalassemia screening were followed by hemoglobin A2 level, PCR for alpha-1 (SEA type)
and hemoglobin electrophoresis. Additional tests were stool exam, stool occult blood and red
blood cell indices. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first
and third trimester or less than 10.5 g/dl in the second trimester of pregnancy. The data was
presented as mean, standard deviation and percentage.
RESULTS:
Six hundred and forty eight pregnant women were recruited. The prevalence of anemia was
20.1 percent (128 cases). Classified in each trimester the prevalence was 17.3%, 23.8% and
50.0% in the first, second and third trimester, respectively. Thalassemia carriers and diseases
were detected in 56 from 102 anemic pregnant women (54.9%). Iron status was assessed in
58 cases and iron deficiency anemia was found in 25 cases (43.1%). Other causes of anemia
were parasitic infection (8.7%) and anemia of chronic disease (2.7%). In 37 anemic pregnant
women (33.0%), the causes of anemia were not found.
CONCLUSION:
The prevalence of anemia in pregnant women who first attended at the antenatal clinic was
20.1%. The main causes of anemia were thalassemia carriers/diseases and iron deficiency
anemia.
Maternal and 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, child health, family
planning, school health and health aspects of the adolescents, handicapped children and care
for children in special settings.
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
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 up to 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 and children.
To educate the mothers on improvement of their own and their children’s health.
FACTORS INFLUENCING MATERNAL AND CHILD HEALTH
Maternal Age
As maternal age advances, so does the rate of aneuploidy. The result is increased rates of
pregnancy loss and birth of infants with chromosomal anomalies. Most women and men are
aware that advanced maternal age (older than 35 years) may affect a pregnancy adversely.
This awareness is the direct outcome of the adoption of practice standards that obligate
obstetricicians, gynecologists, and women’s health nurses to appropriately disseminate this
information and the considerable media exposure about this issue through public service
campaigns, news programs, and storylines in popular entertainment.
Conversely, the general public health care providers are less aware that advanced paternal
age (older than 45 years at conception) unfavourably affects fetal growth and development.
People of advanced reproductive age require information about the possible outcomes for a
child conceived with their genetic gametes. The nurse should offer education and counseling
using incidence tables for chromosomes anomalies associated with advanced maternal age
and review characteristics of disorders that may occur through paternal transmission of
spontaneous new mutation as a result of advanced paternal age.
Sexuality Factor
Both the client and her partner may express concerns about sexuality and intercourse during
pregnancy. Although there is no reason why the healthy woman need abstain from
intercourse or orgasm during pregnancy, some sources suggest that women should avoid
coitus and orgasm in the last 4 weeks of pregnancy. Regardless of suggestions studies have
found that the frequency of coitus decreases as pregnancy progresses.
Intercourse or orgasm is contraindicated in cases of known placenta previa, or ruptured
membranes.
Nipple stimulation, vaginal penetration, or orgasm may cause uterine contractions secondary
to the release of prostaglanins and oxytocin. Therefore women who are predisposed to
preterm labour or threatened abortion may choose to avoid intercourse.
Development of sexuality is an important part of each person’s psychosocial identity,
integrated sense of self, reproductive capacity and ability to fulfill role functions in society.
Nutrition
During pregnancy changes must occur to ensure that gestation progresses and both mother
and fetus remain healthy. These changes involve synthesis of new tissues and hormonal
variations to regulate essential processes. Nutrition has critical role in pregnancy outcomes
maternal nutritional status at conception and throughout gestation greatly influences not only
the mother’s health but also that of the fetus. Although solid nutrition cannot guarantee a
healthy pregnancy, it can certainly minimize problems.
Adequate folate status, which helps prevent neural tube defects, and control of blood glucose
level, which improves the abilities to conceive and to give birth to a healthy newborn.
Women require proper nutrition and normal endocrine function for normal fetal
development. Women specially require additional vitamins and minerals to support fetal
growth and development. Especially important is additional folic acid to reduce the risk for
neural tube defects.
Environmental Factor
Environmental factor also influence on maternal and child health. So we have to know about
the environment in which the woman and partner reside and work.
Men exposed to toxic substances such as heat, radiation, viruses, bacteria, alcohol, and
prescription and recreational drugs are more likely to have decreased morphologically and
genetically normal sperm in a single ejaculate. This results in reproductive failure
preconception and post fertilization.
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
Virtually all culture emphasizes the importance of maintaining a psychological and agreeable
environment for a pregnant woman. An absence of stress is important in ensuring a
successful outcome for the mother and baby. Harmony with other people must be fostered,
and visits from extended family members may be required to demonstrate pleasant and no
controversial relationships. If discord exists in a relationship, it is usually dealt with in
culturally prescribed ways.
Certain environmental factors such as emotional stress, anxiety, fears, frustrations, broken
homes, poverty and many others can lead to mental illness. The psychosocial environment at
home or school is an essential factor for health. Children exposed to happy and healthy
homes make them physically and mentally healthy. Other factors affecting the health status
of children include community and social support measures etc.
Pregnancy is the gestational process. Comprising the growth and development with a woman
of a new individual from conception through the embryonic and fetal periods to birthing
environment. However, an increasing amount of social science and midwifery research has
explored the issue of social support for child bearing women and the role that the maternity
services might play in offering or facilitating rather than undetermining such support to
women.
Support must be individualized and tailored to the woman’s changing needs during labour.
Emotional support includes physical presence and words of affirmation reassurance,
encouragement and praise. Comfort measures are any hands on activity aim at decreasing the
physical discomfort (pain, hunger and thirst) of labour. Information and advice ensure that
the woman is aware of what is happening and of techniques that may help her to cope.
Lifestyle Factors
The health of an individual has direct relationship to the lifestyle. It is nothing but just a way
of living. A person who has healthy practices of day to day living will remain healthy. Those
people who follow the healthy life styles are much healthier than those who follow injurious
life styles. The way of life of people in a community and their individual life style also has a
significant impact on health.
Health is related deeply to life- style which includes ways of living, personal hygiene, habits
and behaviour. A healthy lifestyle helps to promote health and poor lifestyle has ill effects on
health. Lifestyles are the most critical modifiable factor influencing the health today. Life
style refers to a person’s general way of living, including living conditions and individual
patterns of behaviour that are influenced by sociocultural factors and personal characteristics.
Life styles choices may have positive or negative effects on health. Practices that have
potentially negative effects on health are often referred to as risk factors.
E.g. over eating
Getting insufficient exercise
Being over viewing are closely related to the incidence of heart disease, diabetes and
hypertension. Excessive use of tobacco is clearly implicated in lung cancer, emphysema and
cardiovascular diseases. These lifestyle risk factors have gained increased attention because
it is known that many of the leading causes of death. This also represents a huge impact on
the economics of the health care system. Therefore it is important to understand the impact
of lifestyle behaviours on health status. Nurses can educate their clients and the public on
wellness- promoting lifestyle behaviours.
Meaningful work
Creative outlet
Interpersonal Relationship
Recreational activities
Opportunity for spiritual and intellectual growth
The school children must be taught good health habits and include health topic in
curriculum.
Health education is a basic element of all health activity.
Regular exercise
Weight control
Avoidance of saturated fats
Alcohol and tobacco avoidance
Seat belt use
Immunization updates
Regular dental check up
Regular health maintenance
Regular exercise
Regular routine exercise is very important in human life. Regular exercise makes the body
healthy. Regular exercise helps in maintaining the muscle tone, preventing from diseases.
During the antenatal period the pregnant mother can do light exercise daily.
Weight control
There is need to control the weight to maintain healthy life style .In obese people the excess
weight leads to happen different diseases like cardiac disease, hypertension, diabetes etc.
These saturated fats are not good for health. These fats will lead to accumulation in our body
which affects the healthy life. The mother and the children should be avoided of taking
saturated food.
Example of saturated food like burger, oil junk foods, noodles, deep fried food etc
Excessive use of alcohol and tobacco is clearly implicated in lung cancer, emphysema,
cardiovascular disease, pulmonary diseases, gastrointestinal disease, cirrhosis of liver,
hepatitis, reproductive disorders (infertility). Tobacco smoke contains different chemical
substances of which it produces cancer. Tobacco is the second major cause of death in the
world. Smoking produces peptic ulcer by increasing acid secretion. The role of the nurse in
avoidance of alcohol and tobacco through education, giving information and cessation efforts
etc.
Immunization is very necessary to protect from the six major killer diseases like
tuberculosis, tetanus, diphtheria, whooping cough, measles and poliomyelitis in the children.
After having immunization the update should be done appropriately. The detail of
immunization should be updated for not to miss any dose which may help to maintain
healthy life style.
Regular dental check up should be done to know the condition of the teeth and to prevent
from dental carries. Regular dental check up should be done every interval of 6 months.
Regular health check up which includes monitoring of Blood Pressure, blood sugar, closterol
level and follow up for the pre- existing problems.
Gender
In some society there may be the discrimination between the male and female baby. If the
mother having a male baby the family will provide more care and attention towards the
mother and baby. And if the mother having a female babies the family members will provide
her less care and attention towards the mother and baby. So gender also influences the
maternal and child health.
CONCLUSION
Maternal and child health is recognized as one of the significant components of Family
Welfare. Health of both mother and children is a matter of Public Health concern. It is also
being observed that the deaths of mothers and children are the major contributors to
mortality in any community in India.
The maternal health status differs tremendously from place to place and in the same place. It
is assessed in terms of maternal health problems (maternal morbidity) and maternal
mortality. The factors which are responsible for maternal health problems i.e. maternal
morbidity and maternal mortality include poverty, ignorance, illiteracy, malnutrition, age at
marriage and pregnancy, the number and frequency of child bearing and the number of
unwanted pregnancies and abortions, lower status and worth of women in society, lack of
access to quality maternal health/ reproductive health services, gender discrimination.
The different factors which influence the maternal and child health are age, gender, sexuality,
sociocultural factor, environment, nutrition etc.
“Assessment and Utilization of Maternal and Child Health and Family Welfare Services
among Rural Women.”
This study was conducted in selected primary health centers and its health sub centres areas
of Pondicherry health unit district. Out of 250 mothers selected, 208 mothers were delivered
and given birth to a baby and 42 mothers who were pregnant. A structured interview
schedule was used for data collection and analysis was done, the collected data were
analyzed and found out the main out come, Association of demographic variables, awareness
of MCH and family welfare services and the extent of utilization of services during perinatal
period. The conceptual frame work adopted for the study was based on systems model that
influences the factors that intervene in the utilization of maternal and child health services.
The infant mortality was found to be 33.5/1000 live births which was low, when compared to
National average (62/1000 live births) and it was statistically significant (P< 0.000). The
most causes of infant mortality identified were prematurity, asphyxia, and low birth weight.
The mother had poor knowledge in purpose of immunization, Vaccine Preventable diseases,
high risk factors, antenatal diet, family welfare methods and warning signs of pregnancy.
Though the government has given top priority in implementation of MCH Programmes, the
women were not aware of many health programmes related to mother and child health and
had poor knowledge in existing programmes.
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