MATERNAL HEALTH PROGRAM

protected from
neonate
⮚ Overall goal: to improve survival, health and
tetanus
well-being of mothers and unborn through
package of services for the pre pregnancy,
•Gives 3 years
pre-natal, natal and post-natal stages
protection for the
⮚ According to Philippine Health Statistics, mother
maternal deaths are due to:
o Hypertension TT3 At least 6 80% •Infants born to
o Postpartum hemorrhage weeks later the mother will be
o Pregnancy with abortive outcomes protected from
neonatal
tetanus
Essential Health Services

A. Antenatal Registration •Gives 5 years

B. Tetanus Toxoid Immunization protection for the
mother
C. Micronutrient Supplementation
D. Treatment of Diseases and Other
Condition
E. Clean and Safe Delivery
TT4 At least 1 year 99% •infants born to
F. Support to Breastfeeding
later the mother will be
G. Family Planning Counseling protected from
neonatal tetanus
Antenatal Registration
•gives 10 years
protection for the
Prenatal Visits Period of Pregnancy mother

1st visit As early in pregnancy as TT5 At least 1 year 99% •all infants born to
possible before four months later that mother will
or during the first trimester be protected

•gives lifetime
2nd visit During the 2nd trimester protection for the
mother

3rd visit During the 3rd trimester

Every 2 weeks After 8th month of
pregnancy till delivery
Note: if the woman received DPT in infancy 3 or 3
doses of DPT during infancy, this should be
considered as TT1 and TT2. The succeeding doses
will e TT3 and so forth

Tetanus Toxoid Immunization Micronutrients Supplements

Vitamins Dose Schedule of Remarks

Vaccin Minimum Precent Duration of Giving
e age/interval protecte Protection
Vitamin A 10,000 IU Twice a Do not give
d
week Vitamin
starting supplementation
TT1 As early as on the 4th before the 4th
possible month of month
during pregnancy of pregnancy. It
pregnancy might
cause
TT2 At least 4 80% •Infants born to congenital
weeks later the mother will be problems in the
 baby bimanual
uterine
Iron 60mg/400 daily compression if
ug tablet
ergometrine
treatment
Treatment of Diseases and other Conditions
done and
Condition/ What to do Do not give postpartum
Diseases bleeding still
persists
⮚ Give
Difficulty of 'Clear airway ergometrine
breathing/ 'Place in her best 0.2 mg IM and
obstruction of position another dose
airway 'Refer woman to after 15
hospital with
minutes
EmOC capabilities

Intestinal •Give •Do not give

Unconscious •Keep on her •Do not give Oral
parasite mebendazole mebendazole in
back arms at the Rehydration
infection 500mg tablet the first
side Solution to a
single dose
•Tilt head woman who is
anytime from 4-9
backwards (unless unconscious
months of
trauma is or has convulsion
pregnancy if none
suspected) •Do not give IVF if
was given in the
•Lift chin to open you are
past 6 months
airway not trained to do
•Clear secretions so
from throat Malaria •Give sulfadoxine-
•Give IVF to pyrimetamine to
prevent or correct women from
shock malaria endemic
•Monitor blood areas who are in
pressure, pulse, 1st or 2nd
shortness of breath pregnancy, 500
every 15 mg-25 mg tab, 3
minutes tabs at the
beginning of 2nd
•Monitor fluid and 3rd trimester
given. If difficulty not less than 1-
of breathing and month interval
puffiness develops,
stop infusion Clean and Safe Delivery

•Monitor urine 1. Do a quick assessment upon admission for

output
emergency signs
o Unconscious/convulsion
Postpartum •Massage uterus •do not give
o Vaginal bleeding
bleeding and expel clots ergometrine if
woman has o Severe headache with visual
•If bleeding eclampsia, disturbance
persists: preeclampsia or
o Severe breathing difficulty
hypertension
⮚ Place o Fever
cupped palm o Severe vomiting
on the uterine 2. Make the woman comfortable
fundus and
3. Assess the woman in labor. Take the history
feel for state
of contraction of the following:
⮚ Massage o Last menstrual period (LMP)
fundus in a o Number of pregnancies
circular
o Start of labor pains
motion
⮚ Apply
o Age/height
 o Danger signs of pregnancy
more frequent
4. Determine the stage of labor. Contraction
but no progress
is observed pushing down and vulva is in cervical
bulging, with leaking amniotic fluid, and dilation, with or
vaginal bleeding. A vaginal examination without
membranes
can be performed to determine the
ruptured
degree of contraction ⮚ It is false labor if
5. Decide if the woman can safely deliver after 8hours
6. Give supportive care throughout labor there is no
increase in
These are: contractions,
membrane is
● Encourage to take a bath at the onset of not ruptured
labor and no
progress in
● Encourage to drink but not to eat as this
cervical
may interfere surgery in case needed dilation
● Encourage to empty bladder bowels to
facilitate delivery of the baby. Remind to
First stage: in •Check every 30 •Do not allow
empty bladder every 2 hours active labor, minutes for woman to push
● Encourage to do breathing technique to cervix is dilated 4 emergency signs unless delivery is
cm or more imminent.; it will
help energy in pushing baby out the
•Check every four just exhaust the
vagina. Panting can be done by hours for fever, woman
breathing with open mouth with 2 short pulse, BP and
cervical dilation •do not give
breaths followed by long breath. This
medications to
prevent pushing at the end of the first •Record time of speed up labor.
stage ruptured of It may endanger
membranes and and cause
7. Monitor and manage labor
color of amniotic trauma to the
fluid mother and the
Stages of Labor What to do Not to do
baby
•Record findings in
Fist stage: not •Check every hour •Do not do partograph/patient
yet in active for emergency vaginal record
labor, cervix is signs, frequency examination
dilated 0-3cm and duration of more frequently
and contraction, fetal than every 4
contractions are heart rate, etc. hours
•Check every 5 •Do not apply
weak, less than
minutes for fundal pressure
2-10 minutes •Check every four
perineum thinning to help deliver
hours for fever,
and building visible the baby
pulse, BP and
descend of the
cervical fluid
head during
contraction,
•Assess progress of
emergency signs,
labor
fetal heart rate and
mood behavior
⮚ Refer woman
immediately to
•Continue
hospital facility
recording in the
with partograph
comprehensive
emergency
obstetrical Third stage: •Deliver the •Do not squeeze
care between birth of placenta or massage the
capabilities of the baby and abdomen to
the delivery of •Check the deliver the
after 8 hours,
the placenta completeness of placenta
contraction as
placenta and
stronger and
 membranes

8. Monitor closely within one hour after

delivery and give supportive care
9. Continue care after one-hour postpartum
keep watch closely for at least 2 hours
10. Educate and counsel on Family Planning
and provide FP method if available and
decision was made by the woman
11. Inform, teach and counsel the woman on
important MCH message:
o Birth registration
o Importance of Breastfeeding
o Newborn Screening for babies
INFANT AND YOUNG FEEDING PROGRAM
delivered in RHU or at home within
48 hours or up to 2 weeks after birth The Children Health Programs (Newborns, Infants
o Schedule when to return for and Children)
consultation for postpartum visits
⮚ Are vulnerable age group for common
1st visit 1st week postpartum childhood diseases
preferably 3-5 days
⮚ Risk for infection are high when:
2nd
visit 6 weeks postpartum ✔ Not screened for metabolic
disorders,
✔ Not exclusively breastfed
Support to Breastfeeding ✔ Unvaccinated
✔ Not properly managed when sick,
⮚ Most mother do not know the importance
and
of breastfeeding a support care groups
✔ Not given with vitamin
like nurses have a critical role to motivate
supplementation
them to practice breastfeeding
CHILD HEALTH PROGRAMS TO ADDRESS PROBLEMS
Family Planning Counseling
CREATED AND AVAILABLE IN A HEALTH FACILITIES:
⮚ Proper counseling of couples on the
⮚ Infant and young child feeding
importance of FP will help them inform on
⮚ Newborn screening
the right choice of FP methods, proper
⮚ EPI
spacing of birth and addressing the right
⮚ Management of childhood illnesses
number of children. Birth spacing of three
⮚ Micronutrients supplementation
to five years interval will help completely
⮚ Dental health
recover the health of a mother from
⮚ Early child development
previous pregnancy and children. The risks
⮚ Child health injuries
of complications increase after the
second birth. MAIN GOAL: is to reduce morbidity or mortality
rates for children 0-9 years with the strategies
necessary for program implementation

Strategies Thrusts for 2005-2010

1. Develop local capacity to deliver the

whole range of essential health packages
for children. Pursue sentrong sigla initiative
 and identify priority areas for health ultimate growth and development
systems development of the child
2. Implement programs and projects that ⮚ (during pre-pregnancy and
favor disadvantage populations. (children pregnancy) affects the weight of
with disabilities, in areas of armed conflict, the baby at birth
street children, indigenous, and the like) ⮚ Low birth weight of the baby at
3. Reaching every Barangay (REB) strategy birth increase risk of infection,
for immunization to reach every child death, and long-term ill health
4. Intensify health education and information
Infant and Young Child Feeding (IYCF)
campaigns at the ground level to increase
the proportion of mothers practicing ⮚ Issued by WHO and UNICEF (2002)
behaviors that promote children health ⮚ To reverse disturbing trend in infant and
(breastfeeding immunization, knowledge young child feeding practices
on the danger signs of common childhood
Strategy IYFC:
diseases and control of child labor and
other child abuse practices. Breastfeeding
5. Enhance medical, nursing, midwifery
⮚ Promotion of breast milk
education with cost-effective life saving
⮚ Idea food for the healthy growth and
strategies such IMCI and the Basic
development if infants
Emergency Obstetric Care
▪ Exclusive BF for the first 6 months of life:
6. Pursue the implementation of laws and
❖ Achieve optimal growth,
policies for the protection of newborns,
development and health
infants and children:
newborns
⮚ Early Childhood development act
▪ Infants should receive nutritionally
of 2000
adequate safe complementary food
⮚ Newborn Screening Act of 2004
while breastfeeding continuous for up
⮚ EO 286 for the Bright Child Program
to two years of age and beyond
⮚ EO 51 – Milk Code
⮚ BF is a learned behavior
⮚ Rooming-In
⮚ All mothers need accurate information
⮚ Breastfeeding Act
skilled support and counselling within their
⮚ INFANT AND YOUNG CHILD FEEDING
families, communities and health care
Good nutrition in early months and years of system’s to successfully breastfeed
affects:
Overall Objectives:
⮚ Health and survival of infants and children
⮚ Is to improve the survival of infants and
⮚ Intellectual and social development
young children by improving their
⮚ Life-long impact on school performance
nutritional status, growth and
⮚ Overall productivity
development through optimal feeding
▪ Exclusively Breastfed children: (during
the first halt of life) The National Plan of Action for 2005-2010 for IYCF
⮚ Prevents infant and childhood morbidity
Goal:
and mortality
▪ Timely, adequate, safe and proper ⮚ Reduce Children Mortality Rate by 2/3 by
complementary feeding 2015
⮚ Prevent childhood malnutrition
Objective:
▪ Mothers health and nutrition is also
important: ⮚ To improve health and nutrition status of
⮚ Intrauterine life effectively infants and young children
establishes the potential for
Outcome:
 ⮚ To improve exclusive and extended
breastfeeding and complementary
feeding
Specific Objectives:
o 70% of newborns are initiated to
breastfeeding within one hour after birth
o 60% of infants are exclusively breastfed up
to 6 months
o 90% of infants are started on
complementary feeding by 6 months of
age
o Media duration of breastfeeding is 18
months
Key Messages on Infants and Young Child
Feeding:
⮚ Initiate breastfeeding within 1 hour after
birth
⮚ Exclusive for the first 6 months of life
(means giving a baby only breast milk,
and no other liquids or solids, not even
water)
⮚ Complemented at 6 months with
appropriate food, excluding milk
supplements
⮚ Extend breastfeeding up to 2 years and
beyond
BENEFITS OF BREASTFEEDING:
A. To Infants
⮚ Provides a nutritional complete
food for the young infants
⮚ Strengthens the infant’s immune
system preventing many infections
⮚ Safely rehydrates and provides
essentials suffering from diarrheal
diseases
⮚ Reduces the infant’s exposure to
infection
⮚ Increase IQ points
B. To Mother
⮚ Reduces womans risk of excessive
blood loss after birth
⮚ Provides natural methods of
delaying pregnancies
⮚ Reduces the risk of ovarian and
breast cancers and osteoporosis
C. To Household and the Community
⮚ Conserve funds that otherwise
would be spent on breastmilk
substitute, supplies and fuel to
prepare them
⮚ Saves medical cost to families and
government by preventing illnesses
and by providing immediate
postpartum and contraception
NATIONAL IYCF STRATEGY:
A. Health Facilities
⮚ Mother-baby friendly hospitals
⮚ Health workers: advocates,
protectors, promotes of IYCF
⮚ Enforces of laws not violators
B. Family/Community
⮚ Supportive family
⮚ Milk code “vigilantes”
⮚ Lay/peer counselors
⮚ IYCF “bayanihan” spirit
⮚ Mother-baby friendly public places
C. Working Places
⮚ Maternity leave
⮚ Lactation/breastfeeding rooms
⮚ Breastfeeding breaks
D. Industry
⮚ Comply with the “code”
⮚ Apply codex Alimentarius
standards
E. Schools
⮚ Introducing the “breastfeeding
culture”
COMPLEMENTARY FEEDING
After 6 months of age, all babies require other
foods to complement breast milk.
But BF should still continue for up to 2 years and
beyond
a. Timely
⮚ They are introduced when the
need for energy and nutrients
exceeds what can be provided
through exclusive and frequent
breastfeeding
b. Adequate
⮚ They provide sufficient energy,
CHON, and micronutrients to meet
a growing child’s nutritional needs
 c. Safe
⮚ They are hygienically stored and
prepared and fed with clean
hands using clean hands using
clean utensils and not bottles and
treats
d. Properly Fed
⮚ They are given consistent with a
child’s signals of hunger and that
meal frequency and feeding
methods are suitable for the child’s
age
DRINKS (sodas) are not suitable for young
children
c) TEAS AND COFFEE reduce the IRON that is
absorbed from foods. Should not be given at
the same time as food ir within 2 hours before
or after food.
d) Sometimes a child is thirsty during a meal. A
small drink will satisfy the thirst and they may
then eat more of their meal
e) Drinks should not replace

Low Birth Weight Babies

⮚ Means birth weight of less than 2500

grams
⮚ Who are born before term
⮚ Who are premature
⮚ Babies who are small for their
gestational age
⮚ RISK FOR INFECTION

Babies Born at Term

⮚ Suckle effectively
⮚ Often very hungry and need to be
breastfed more often than larger babies

Babies Born Pre-term

⮚ May have difficulty suckling effectively at

first
⮚ They can be fed on breast milk by tube or
cup
⮚ Breastfeeding is easier for these babies
than bottle feeding

Fluids Needs of the Young Child

⮚ Exclusive breastfeeding children

receives all the liquid they need in the
breast milk.
⮚ Extra fluid is needed if the child has a
fever or diarrhea
a) Water is good for thirst. Too much fruit juice
can cause diarrhea and may reduce the
child’s appetite for foods
b) Drinks that contain a lot of sugar may actually
make the child thirstier as their body has to
deal with the extra sugar. Look for fruit juiced
that has lesser added sugar contents. FIZZY
 ⮚ Calmette and Guerin – names of the
persons who develop the vaccine

vaccine given to children for protection against

tuberculosis

How to stored?

✔ Vaccine and diluents should be stored

EXPANDED PROGRAMS FOR IMMUNIXATION at a temperature between 2 to 8
degree Celsius
⮚ Was launched in July 1976 by the DOH in
✔ It is not damaged by freezing
cooperation with the WHO and the UNICEF
✔ It is damaged by heat
⮚ Presidential decree no. 996 – compulsory
basic immunization for infants and children When o sot given?
below 8 years of age
✔ Given at birth or as soon as possible
OBJECTIVES ✔ Should not be given to children who
have signs and symptoms of AIDS
o To reduce the morbidity and mortality
among infants and children caused by The number and size of doses
six childhood immunolabel disease
✔ One dose of 0.05 ml
PRINCIPLES
Where and how it is given
o The program is based on
✔ Injected in the top layer of the skin of
epidemiological situation
the upper left arm, right deltoid.
o The whole community rather than just
✔ Intradermal
the individual os to be protected
o Immunization is basic health service Side Effect:
and such it is integrated into the health
1. Normal reaction
services being provided by the RHU
o Small lumps appears at the
Elements of EPI injection site but disappears within
30 minutes
o Target setting
o After 2 weeks a red sore develops
o Cold chain logistic management
10mm in diameter
o Information, education and
o Sore remains for another 2 weeks
communication
and the heals
o Assessment and evaluation of the
o Small scar 5 mm across remains;
program’s overall performance
this is the sign that the child has
o Surveillance, studies and research
been effectively immunized
Expanded Program for Immunization 2. Not normal

o BCG Swelling of glands or formation of

o DPT abscess occurs because:
o OPV
a. Unsterile needle or syringe
o HEPATITIS B
was used
o MEASLES
b. Too much vaccine was
BCG injected
c. Vaccine was injected
⮚ Bacillus, Calmette and Guerin
under the skin instead of
⮚ Bacillus – describes the shape of a
in its top layer
bacterium
ORAL POLIO VACCINE (OPV) Side Effect

⮚ Gives protection against the three 1. Fever – the evening after receiving DPT. It
types of virus that causes polio should disappear within a day
⮚ Liquid form
Fever that begins more than 24 hours after DPT
How it is stored? injection is unlikely to be a reaction to the
vaccine
✔ Should be stored at a temperature
between 0 to +8 degree Celsius 2. Soreness – pain, redness or swelling at the
injection site
When it is given
3. Abscess occurs because:
✔ 6 weeks of age a. Unsterile needle or syringe was
✔ 10 weeks of age used
✔ 14 weeks of age b. Too much vaccine was injected
With an interval of 4 weeks or 1 months
HEPATITIS B VACCINE
The number and size of doses
⮚ It is a cloudy liquid that comes in a vial or
✔ 3 doses each of 2gtts a prefilled syringe

Where and how it is given How it is stored?

✔ Oral route ✔ Should be at a temperature between

0 to +8 degree Celsius
Side effect
✔ It is damaged by freezing and heat
✔ No side effects
When it is given
DIPHTERIA-PERTUSSIS-TETANUS (DPT)
✔ 6 weeks of age, the same time as DPT1
Vaccine is made from and POV1

o Diphtheria toxoid ✔ 10 weeks of age, the same time as

o Pertussis vaccine DPT2 and POV2
o Tetanus toxoid
✔ 14 weeks of age, the same time as
How is it stored DPT3 and POV3

✔ Should be at a temperature between With an interval of 4 weeks or 1 months

0 to +8 degree Celsius
The number and size of doses
✔ It is damaged by freezing
✔ Pertussis vaccine is damaged by heat ✔ 3 doses given, each of 0.5 ml

When it is given Where and how it is given

✔ 6 weeks of age ✔ Injected into the muscle in the outer

✔ 10 weeks of age part of thigh
✔ 14 weeks of age
✔ Intramuscular
With an interval of 4 weeks or 1 months
✔ When DPT vaccine is given at the
The number and size of doses
same time as hepatitis B, do not inject
✔ 3 doses given, each of 0.5 ml both in the same thigh

Where and how it is given Side Effect

✔ Injected into the muscle in the outer ✔ Fever may develop one or two days
part of thigh after an injection
MEASLES

When, where, how and number of doses it is

give?

✔ 9 months, one dose, subcutaneous, 0.5

ml

VACCINE MINIMUM NUMBER OF MINIMUM

AGE, FIRST DOSE INTERVAL
DOSE, ROUTE,
DOSAGE

BGC Birth or any 1

time after
birth,

0,05 ml,
intradermal

DPT 6 weeks 3 4 weeks

0.5 ml

Intramuscular

OPVV 6 weeks 3 4 weeks

2-3 gtts,

Oral

HEPATITIS B 6 weeks 3 4 weeks

0.5 ml

Intramuscular

MEASLES 9 months 1

0.5 ml

subcutaneous