INDEX

PAGE NO

CONTENT

01. INTRODUCTION

02. OBJECTIVES

03. DEFINITIONS

04. CONTENT ON

 Epidemiological aspects of maternal and child health

 Aims of epidemiology
 Purposes
 Importance of epidemiology related to MCH
 Major elements related to MCH
 Areas of Maternal and child health
 Epidemiological tried related to mother and child
 MCH problem triad
 Maternal mortality and morbidity related statistics
 Child related statistics (per 1000 live birth)
 Epidemiological approach
 Epidemiological methods

 Magnitude of Maternal and child health problems

 Introduction
 Objectives of MCH
 Goals of MCH
 Maternal and Child health problems
 Magnitude of problem
 Factors influencing maternal and child health
 Issues of maternal and child health
 Policies
 Process
 Human resource
 Logistic finance
 Limited management to maternal and child
health services
05. SUMMARY

06. CONCLUSION

07. BIBLIOGRAPHY
 MANISHA COLLEGE OF NURSING
SHEELA NAGAR, VISAKHAPATNAM

MASTER PLAN
Subject: Obstetrics and Gynaecological Nursing
Unit number: I

Topics:
 Epidemiological aspects of maternal and child health
 Magnitude of maternal and child health
 Issues of maternal and child health

Submitted to: Submitted By:

Prof: Mrs. Jyothi MSC(N) Mrs. Ratnakumari G
Associate professor MSC Nursing I year
Dept. of Obstetrics and Department of obstetrics and
Gynaecological Nursing Gynaecological Nursing
Manisha college of nursing Manisha college of nursing

Submitted on :25/07/2022
INTRODUCTION
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. Maternal and Child Health care services are essential
and specialized services because mothers and children have special health needs which are
not catered to by general health care services

OBJECTIVES:
General objectives
 At the end of the class students will gain in-depth knowledge about epidemiology
aspects of maternal and child health, Magnitude of maternal and child health
Issues of maternal and child health and will be able to apply in the clinical setting
during their professional practice.
Specific objectives
 Introduce the epidemiology aspects of maternal and child health
 Define epidemiology and maternal child health
 Enlist the area of maternal and child health
 Describe epidemiological aspects of both mother and child
 Explain Epidemiological Tried Related to Mother and Child
 Specify the mortality and morbidity rate of maternal child health
 Enumerate the importance of epidemiology in the world and also Ind
DEFINITION:
1. MATERNAL AND CHILD HEALTH 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.

2. DEFINITION OF MATERNAL HEALTH /REPRODUCTIVE HEALTH Maternal Health is now

referred as "Reproductive Health” (RH). According to WHO it is defined as a state of
complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity in all matters relating to the reproductive system and its
functions and processes.
-WHO
3. DEFINITION Epidemiology
“The study of the distribution and determinants of health related status or events in
specified population and the application of this study to the control and prevention
of health problems.”
- M. Last (1988)
This includes study of health services used by the population and to measure the
impact . It is more concern about society then individual.

4 .  Definition: Maternal and Child Health:

“Maternal and child health refers to the promotive, preventive, curative and
rehabilitative health care for mothers and children.”
- Park K. (2007)

Aim & Purposes of epidemiology

Prevention and control of diseases among women and children Purpose (a)Identify  trends
and emerging threats to the health of women on reproductive age and child  local impacts
on the prevention strategies (b)Targeting effective implementation (c)Appropriate
coordination with other agencies

Importance of epidemiology related to MCH (A) World

 Mother and child constitute around two third of the total population
 Most of the maternal and child hood mortality are due to preventable causes
 They are pillars of any of the developing or developed nation
 Though various strategies are made since many decades the progress seems to be very
slow
 They are vulnerable /special risk groups

Importance of epidemiology for MCH (INDIA)

 Mother and child constitute 70% of total population of which women between 15 -44
yrs of age is 19% and 40% are children
 Slow progress in the national MCH related programmes
 Newly emerging problems
 Un utilized funds
 Poor distribution system of skilled services and transport s
 Unmet needs of contraceptions
 Major Elements of PHC Related to MCH
 MCH including family planning
 immunization against major infectious diseases and education of the community about
health and nutrition These have direct bearing on the outcome of the Maternal and
Child Health related goals and objectives.
 Challenges in Collecting and Monitoring Data Data Related Information Systems Data
Capability Community Readiness
 Data access
 Data availability
 Quality of data
 Timeliness of data
 Problems with data collection
 Creating and maintaining information systems
 Availability of user-friendly hardware/software and manuals
 Recruitment and retention of skilled staff
 Lack of analytic capability
 Lack of data management skills
 Lack of interpretation skills
 Need for additional staff
 Training
 Community awareness
 Community interest
 Political will
 Communication
 Collaboration
 Agency’s readiness to change
AREAS OF MATERNAL AND CHILD HEALTH

 Maternal health
 Child health
 Family planning
 School health
 Handicapped children
 Adolescence health
 Health aspects of care of children in special settings such as day care.
 Mother and child one unit
 During antenatal period foetus is an integral part of mother
 Health of the mother and child are interrelated
 Mother can transmit certain diseases to the child during pregnancy
 Breast feeding is a regulatory process during early child hood
 Mother initiated primary socialization to the child
 Epidemiological Aspects of Maternal and Child Health
 The study of the distribution and determinants of health-related status or events in
mothers and children and the application of this study to the control and prevention
of health problems related to mother and child. It follows systematic assessment of
the health of the women in reproductive age and children in the community
including timely collection of data, analysis, interpretation, dissemination and use of
MCH related data.

MCH Problem triad:

The Problems in Women

 Early age of marriage—teenage pregnancies

 Unsafe abortion
 Unwanted fertility and infertility
 High fertility rate and rising population
 Unacceptably high mortality rate amongst women in reproductive age group
 Poor nutritional status—high level of anaemia
 Reproductive tract infections, sexually transmitted diseases and emerging problem
like HIV/AIDS
 Unfavourable sex ratio—gender discrimination
 Low level of literacy amongst females
 Low status of women and heavy work load and violence against women

Problems in Children & Adolescent Children

 Low birth weights

 Unacceptably high mortality rate during early childhood period
 Poor nutritional status—high level of anaemia
 Acute respiratory tract infections
 Diarrhoeal diseases
  High level of school dropouts
 Child labour and abuse
 Social problems of adolescents—Drug Abuse and Sexual problems
 Disabled children—Physical, Mental and also behavioural problems in street
children Adolescent
 Problem of adolescent girl –Teen age pregnancy, depression, malnutrition

Epidemiological Tried Related to Mother and Child

 Agent: Child Foetal Life –Nutrition, change in hormonal level, growth and
development Childhood – Nutrition, physical care, growth and development,
socialization & care during illness
 Host: Mother Nutrition, physical health, genetic inheritance & social status
 Environment: Physical, Biological and psychosocial.

MCH Problems Triad Health care delivery system factors Social Economic Cultural. Maternal
Mortality Rates (Per 1000 live births) Place MMR World 4.0 Developed country 1.3 India 2.9.
WHO review of maternal conditions most frequently reported Morbidity Number of studies
(%) Hypertensive disorders of pregnancy 885 Stillbirth 828 Preterm delivery 489 Induced
abortion 400 Haemorrhage (antepartum, intrapartum, postpartum) 365 Anaemia 267
Placenta anomalies (pravia, abruptio, etc.) 245 Spontaneous abortion 235 Gestational
diabetes 224 Ectopic pregnancy 146 Premature rupture of membranes 140 Perineal
laceration 139 Uterine rupture 116 Obstructed labour 102 Depression (postpartum, during
pregnancy) 96 Puerperal infection 86 Violence during pregnancy 77 Other conditions 1093
Overall 5933

Causes of maternal mortality in Asia (1997- 02) Morbidity Percentage Haemorrhage 30.8
Anaemia 12.8 Other indirect causes of deaths 12.5 Sepsis/infection 11.6 Obstructed labour
9.4 Hypertensive disorders 9.1 Unclassified deaths 6.1 Abortion 5.7 Other direct causes of
deaths 1.6 Embolism 0.4 Ectopic pregnancy 0.1 HIV/AIDS 0.0

Child related statistics(Per 1000 live births) Problems Developed country India World IMR
6.86 56 56.29 Underfives mortality 87 74 Early Neonatal mortality 33 Post neonatal
mortality 24 Total neonatal mortality 39 Birth rate 24 Malnutrition 470 Acute respiratory
infection 150-300 Others (Sexual harassment, adolescent. Still after various studies Exact
statistics not available

 Achievements related to Family planning programme in India (2007-08) Family

planning methods Achievement (in %) Sterilization 71 IUD 69 Oral pills 72 Couple
protection rate 47.8
 Achievements of National Immunization Programme (2004) Vaccine Achievement (in
%) Measles 56 DPT 64 Polio 70 BCG 73 TT 80
 National Health Indicators, Achievements & Strategies Indicators Achievement (2004)
Strategies (2015) MMR 2.9/1000 0.75/1000 IMR 56/1000 35/1000 Delivery by skill
birth attendant 43% 90% Access to reproductive health 100% Gender equity Poverty
Reduction Population growth Reduction Antenatal Coverage 60% 100% Couple
protection rate 47% 100% Total fertility rate 3.2% <2%
Epidemiological Approach Epidemiology deals with interaction of agent host and environment which
if operating in combination determine the – WHAT ? WHEN ? WHERE ? WHO ? WHY ?
And also plans ;HOW TO PREVENT AND CONTROL THE PROBLEMS

Epidemiological methods Observational Experimental Correlational Prevalence Case-control Cohort

Randomized controlled trials Field trials Community trials

MAGNITUDE OF MATERNAL AND CHILD HEALTH PROBLEMS

Maternal and child health. mortality morbidity risk factors. Factors affecting Health Diseases
In 2002, nearly 11 million children died before reaching their fifth birthday – 98% of these
deaths were in developing countries. 2006 World Health Organization.
MATERNAL AND CHILD HEALTH (MCH): A package of comprehensive health care services
which are developed to meet promotive, preventive, curative, rehabilitative health care of
mothers and children.
MATERNAL HEALTH According to WHO, “Maternal health refers to the health of women
during pregnancy, childbirth and the postpartum period. While motherhood is often a
positive and fulfilling experience, for too many women it is associated with suffering, ill-
health and even death.”
REPRODUCTIVE HEALTH “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.”
According to the WHO, "Reproductive and sexual ill-health accounts for 20% of the global
burden of ill-health for women”
OBJECTIVES OF MCH:
 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 both mother and child.

GOALS OF MATERNAL AND CHILD HEALTH SERVICES:

 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.

MATERNAL HEALTH PROBLEMS

 Nutritional Problems
o Malnutrition
o Nutritional Anaemia
 Infection Problems
 Disturbances and Menstruation
 Mature Gravidas
 Adolescent Gravida
 Adolescent Parents Problems
 Unregulated Fertility
 Abortions
 Complications of Deliveries
 Infertility
 Uterine Prolapse
 Carcinoma

 NUTRITIONAL PROBLEMS
 A. MALNUTRITION Malnutrition is a very common problem among women who are
discriminated and underprivileged. Pregnant and nursing mothers are especially prone to the
effects of malnutrition. Malnutrition can cause poor resistance, abortion, anaemia, miscarriage
or premature delivery, low birth weight baby (<2.5kg), eclampsia, postpartum haemorrhage.
These conditions can cause fatal effects on mothers, unborn and new born babies.
Malnutrition in women needs to be prevented and treated by some of the direct measures such
as nutrition education, modification and improvement of dietary intake before, during and
after pregnancy, supplementation of diet, distribution of iron and folic acids tablets,
subsidizing of food items and their fortification and enrichment.
  B.NUTRITIONAL ANAEMIA Anaemia in pregnancy is defined as a haemoglobin
concentration of less than 11g%.Anemia is a condition in which concentration of
haemoglobin in the red blood cell is reduced. Haemoglobin is essential for life. It carries
oxygen to all parts of the body for its development and day to day function. It also maintains
the immune system which provides resistance to infection. Therefore, an anaemia person
acquires infection easily. Brain also gets less oxygen if a person is anaemic.
 MAGNITUDE OF THE PROBLEM More than half of the pregnant women during
pregnancy suffer from anemia.13%are severely anaemic. Haemoglobin is less than 7 gm/
decilitre. 1/5 of all maternal deaths are attributed to anaemia during pregnancy. More than
half of the adolescent girls are anaemic Anaemia during pregnancy leads to : 20% of maternal
deaths 3 times greater risk of premature delivery and LBW babies 9 times greater risk of
perinatal mortality Irrecoverable brain damage in infants born to severe anaemic mother.
 PREVENTION OF NUTRITIONAL ANAEMIA Promoting consumption of iron rich food 
Promoting growth of iron rich at home will increase the availability of iron in food, like
spinach, lemon, amala , etc. Promoting consumption of iron and folic acid supplements.

INFECTION PROBLEMS
A.REPRODUCTIVE TRACT INFECTIONS/STD 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. Vaginal discharge is amongst
the first 25% reasons to consult a doctor. 40% gynaecological OPD attendance is because of
RTIs and 16 % of gynaecological admissions and due to pelvic inflammatory disease (PID)
  CAUSE OF RTI/STD Infections caused by overgrowth of organism normally found in the
vaginal tract are known as endogenous infection. These infections are associated with
inadequate personal, sexual and menstrual hygienic practices. Sexually Transmitted Diseases
(STDs) are a specific group of communicable diseases that are transmitted through sexual
contact. Infections which are due to inadequate medical procedures such as unsafe abortion,
unsafe delivery or unhygienic IUD insertion are known as iatrogenic infections
  SIGNS AND SYMPTOMS OF RTI IN WOMEN: Increased discharge from the vagina that
looks and smells different from ( change in amount, colour and smell) Pain or burning while
urinating. Painful or painless sores, blisters or warts on or near the genitals. Pain on one or
both sides of lower abdomen. Irregular menstrual periods. Pain or bleeding during
intercourse. Rash on the entire body or just on the palms and soles. Swelling on one or both
sides of the groins.
 In Men: Symptoms usually appear within 2-3 days or a couple of weeks or even months
after having sex with an infected partner are: Pus or discharge from the penis. Burning or pain
while urinating. Painful or painless sores, blisters or warts on or near the penis. Pain in one
or both the testicles
 PREVENTION OF RTI/STD Identify the women with RTIs/STI Refer the women to
medical officer of PHC promptly for examination and treatment. Identify sexual partners and
ensure their treatment. Advice correct use of condom during every sexual act. Provide
counselling/health education to individuals, family and community.
 INFECTION IN GENERAL The women during pregnancy, especially in underdeveloped
areas and developing countries are at risk of contact infection. Many women get infected with
herpes simplex virus, cytomegalovirus, protozoon which causes toxoplasmosis Coli causing
nephritis or cystitis.Infection during pregnancy can cause various harmful effects e.g.
retardation of foetal growth, abortion, low birth weight baby and puerperal sepsis. It is very
important that women during pregnancy need to alert and careful regarding prevention and
control of infection.
 PUEPERAL SEPSIS It is mainly due to infection during labour 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 time
leucorrhoea may persist for years. Some times secondary sterility may follow after acute or
chronic salpingitis. Chronic infections of cervix may predispose to cancer of the cervix. It
requires proper preparations for confinement by the mother, conduct of deliveries by trained
and skilful dais, midwives etc. And availability of equipment's and supplies etc.
 DISTURBANCE AND MENSTRUTION Amenorrhoea, , dysmenorrhoea, hypermenorrhoea
menorrhagia and , metrorrhagia. Menstruation is perceived as a particular problem for
women.
 HEALTH TEACHING REGARDING MENSTRUATION: Knowledge of the physiological
process. Factors that may alter the menstrual cycle, stress, fatigue, exercise, acute or chronic
illness, changes in climate, or working hours and pregnancy. Personal hygiene  Mild
Exercise Diet Sex during menstruation
 MATURE GRAVIDAS The pregnant woman over 35 years faces unique problems. The
primigravida in this age category has generally decided to postpone child bearing until her
career is well established .They feel unable to take care of themselves and often have little
 experience in relying on others during times of need. The educational level of the client must
be considered when recommending literature.
 ADOLESCENT GRAVIDAS The adolescent mother and her family create a particularly
difficult problem. The need can be so extensive that care will be fragmented and ineffective
unless and interdisciplinary team approach coordinates the school, social and health care
services. The mean age of menarche is around12 years.42% of girls and 64 % of young boys
are sexually active by age of 18.A family’s reaction to teen age pregnancy varies
considerably. In certain ethnic and cultural groups, teenage parenting is common. Sex
education and family planning helps the adolescent gravida
 ADOLESCENT PARENTS PROBLEMS Adolescent parents are rarely able to support
themselves and their children. Optimally, the family should be involved early. Detailed
arrangements must be worked out, and allowing enough time before delivery makes the crisis
less overwhelming. Building on supplementing family resources and only substituting for
families when absolutely necessary is believed to be the most effective way to help
adolescents and their infants. Today, a pregnant woman has three choices, to abort, to have
the child place it for foster care or adoption, or to have the child and raise it. Adolescents
parents have the same choices, but may need to guided through the decision making process.
  UNREGULATED FERTILITY Unregulated fertility has been recognized to cause many
maternal health hazards. These include abortions, miscarriage, premature deliveries, low birth
weight babies,APH etc All these health hazards are responsible for high maternal and
perinatal mortality. It is being recognized to regulate fertility by integrated and
comprehensive approach in family welfare services which include effective measures related
to reproductive health, child health and family planning
 ABORTIONS 20% 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, non-
availability of such clinics, poor financial resources to reach to clinics in urban areas, lack of
information about the availability of safe abortions clinics, lack of privacy and impersonal
atmosphere in the Government run clinics and reluctance of unmarried or widowed.
  COMPLICATIONS OF DELIVERIES  In India most of the deliveries take place at home
under unhygienic environment and mostly by untrained dais lacking obstetric skill. Often
various health hazards results in such as perineal tears, cervical damage, prolapse and
displacement of uterus, fetal distress, postpartum haemorrhage etc. Thus it is very important
to have properly trained, skilful and qualified health workers, adequate facilities and well
linked referral units where skilful and efficient emergency care can be given to save mother
and baby.
 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 labelled and is socially not treated properly by
the family and the society. Therefore this problem is to be considered medically as well as
socially. There is need to have empathetic attitude towards childlessness of woman by
society.
 UTERINE PROLAPSE Uterine prolapse is the major problem in women of hilly region.
Women working at construction sites, climbing heights, or digging and ground or climbing 2-
3 storey with heavy weights are predisposed to prolapse uterus. Certain child birth practices
such as fundal pressure during labour, pulling the baby etc. Lead to prolapse of the uterus,
especially when the mother is weak and malnourished. Uterine prolapse may cause lot of
inconvenience to mother and predispose her to infection. Hence the need for trained and
skilful dais and midwives, improvement of working conditions and education of women.
 CANCER OF CERVIX Cancer of the cervix is very common among Indian women. There
are various factors which contribute to the prevalence of cancer of cervix. These are early
marriage and early pregnancy, multiple child birth, poor hygiene by the male partner, multiple
partners, and repeated infections. Most of these factors are pertaining to sociocultural aspects
 of a community and families are imply involving attitudinal change in these practices to
prevent the occurrence of cancer of the cervix.
 28. CHILD HEALTH PROBLEMS
 29. CHILD HEALTH PROBLEMS  Nutritional deficiency Problems a) Malnutrition b)
Vitamin Deficiency c) Iron Deficiency d) Low Birth Weight  Infectious Diseases
a)Tuberculosis b)Diphtheria c)Pertussis (Whooping Cough) d)Tetanus e)Poliomyelitis
f)Measles  Problems of Neonates a)Hyper bilirubinaemia b)Hypothermia c)Neo-natal
tetanus d)Birth asphyxia
 30. NUTRITIONAL DEFICENCY PROBLEMS MALNUTRITION  The primary cause of
malnutrition is inadequate and faulty diet. Apart from poverty and other socio economic
factors, environmental factors also play an important role in aggravating the dietary
deficiency diseases. These precipitating factors are the widespread chronic infections among
the poor living under conditions of poor environmental sanitation and personal hygiene
 31. REASONS OF MALNUTRITION IN INDIA Food availability Poverty Population
problem Socio factors-diet ,caste ,alcohol.
 32. 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. -WHO 1973 CLINICAL FORMS OF PEM:  KWASHIORKOR 
MARASMUS
 33. CONTD….  KWASHIORKOR: Kwashiorkor is the condition of deficiency of protein
with an adequate supply of calories.  MARASMUS: Marasmus results from general
malnutrition of both calories and protein. It is common occurrence in underdeveloped
countries.
 34. CAUSES OF PEM  a)Nutritional Factors  Poor caring practices include  Not feeding
the sick children.  Not providing the adequate complementary feeding.  Not supporting
mothers to breast- feed adequately.  Non – breastfed.  Late weaning.  Inadequate
supplementation.  Failure to feed during illness.  Failure to increase to caloric intake
immediately after the illness.  b)Non – Nutritional Factor  Due to poverty, mother is not
able to provide sufficient food to the child resulting in under nutrition.  Non- immunization
 Improper growth monitoring.  Poor weight gain during adolescence  Poor environmental
and personal hygiene  Illiteracy  Large family
 35. SIGNS OF SYMPTOMS OF PEM
 36. VITAMIN DEFICIENCY VITAMIN A DEFICIENCY  Vitamin A deficiency is a major
nutritional problem affecting young children leading to blindness. In India about 5 – 7 %
children suffer annually from eye damage caused by vitamin A Deficiency. CLINICAL
FORMS OF SEVERE VITAMIN A DEFICIENCY:  Xeropthalmia  Night blindness 
Bitot spots  Conjunctival xerosis  Corneal xerosis  Keratomalacia  Corneal scars
 37. MANAGEMENT OF PEM  Adequate nutritious diet either by breastfeeding or a proper
weaning diet.  5 grams of protein/ kg body weight/day should be given for the existing
weight.  Rehydration with an oral rehydration solution that also replaces electrolytes. 
Treatment of infections. Medications such as antibiotics and antidiarrheal.  Health education
 Diet rich in fat and calories is given  Vitamin A should be given  Folic acid should be
given
 38. MANAGEMENT OF VITAMIN A DEFICIENCY  Immediately on diagnosis, water
soluble 1,00,000 IU of vitamin A intramuscularly can be given for corneal xerosis, ulcer,
keratomal -acia, xerophthalmia, severe infection and malnutrition.  Immediately on
diagnosis for less severe forms like night blindness, conjunctival xerosis, Bitot’s spot, oil
solutions as palmitate 2, 00,000 IU can be given orally.  On second day oil solution of 2, 00,
000 IU orally should be given prior to the discharge from the hospital.
 39. PREVENTIVE MEASURES  Nutrition and health education should be given to the
mothers.  Pregnant and lactating mothers should be encouraged to consume dark green leafy
 vegetables and yellow or orange fruits so that there is sufficient storage in vitamin A in the
liver of new born.  Mothers should be motivated to feed their children as vitamin A present
in the milk is adequate for 3 to 6 months of infant’s life.  The weaning diet should be consist
of dark green leafy vegetables, yellow or orange fruits, whole milk, butter, fish and egg. 
Monitor vitamin A periodically.
 40. VITAMIN D DEFICIENCY Deficiency of vitamin D causes rickets in young children in
the age group of 6 months to 2 years. It reduces calcifications of bones which affects growth
of bones and cause deformity 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, plenty
of available sunshine. Food rich in vitamin D such as butter, cheese, egg yolk, liver, fortified
food such as milk, Vanaspati oil etc. Fish liver oil is very good source of vitamin D .
 41. IRON DEFICIENCY The iron deficiency causes nutritional anaemia in children. About
50% 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 and
resistance to infections resulting in increased morbidity and mortality. It affects physical and
psychological behaviour of the children. Anaemia is aggravated by worm infestation and
malarial parasites.
 42. ROLE OF NURSE IN IRON DEFICIENCY  Encourage mothers and family members to
monitor growth and development of their children and to bring them to health centres for
regular check up and record weight, height etc.  Ensure 100% coverage of administration of
vitamin A mega doses to children.  Help and guide health workers and mothers detect early
cases of malnutrition and other nutritional deficiencies such as vitamin A, iron and vitamin D
and refer them to health centres as the need to be.  Guide and supervise health workers to
participate in nutrition programmes like Integrated Child Development Scheme, Nutritional
Anaemia prophylaxis programme, midday meal programme.
 43. LOW BIRTH WEIGHT  Low birthweight is a major public health problem in many
developing countries. About 30 %of babies born in India are low birth weight as compared to
4%in some developed countries. In countries when the proportion of low birth weight is high
the majority are suffering from fetal growth retardation.  The causes of LBW are
malnutrition ,anaemia ,infection ,high parity ,smoking ,etc.
 44. CLASSIFICATION OF LBW  Preterm babies: Babies born before 37weeks or less than
259 days.  Small for date: Infants birth weight below 10th percentile for the gestational age
MANAGEMENT OF LBW NEWBORN  Provide warmth  Exclusive breast feeding 
Prevent infections  Teach mother to recognize danger signs PREVENTION OF LBW
BABIES  Increasing food intake  Controlling infection  Early detection of conditions or
problems and treatment of disorders
 45. INFECTIOUS PROBLEMS TUBERCULOSIS  It is a communicable disease suffered
by all ages. It is a problem in community. It is an infectious disease caused by mycobacterium
tubercul osis. The major source of infection is infected sputum of persons having tuberculosis
who are either not being treated or not being fully treated. Tuberculosis affects all age group.
The incidence of infections increases sharply from infancy to adolescence. 1% of children in
the age group under five are infected with tubercle bacilli as evidenced by tuberculin test.

 MAGNITUDE OF PROBLEM: 15 million cases of infectious tuberculosis at present  2-3

million cases are added every year 1-2 million people die every year.

  PREVENTION AND CONTROL OF TUBERCULOSIS Specific protection by BCG.

Improving general health and resistance of children  Early identification and treatment
Regular treatment and follow up Educate parents family members and community Health
supervisor must supervise and guide health workers.
 DIPHTHERIA  Diphtheria is very serious disease because if it is not treated immediately it
leads to high mortality. It is caused by Corynebacterium diphtheria. Diphtheria is transmitted
 by direct droplet and direct airborne. The incidences of diphtheria are highest in the age group
of 1-3 years. incubation period of disease is 3-4 days.
  MAGNITUDE OF THE PROBLEM Diphtheria is a worldwide problem in most developed
countries owing to routine children vaccination. In India, it is an endemic disease. Fatality
rate on an average is about 10 % which has changed little in the past 50 years in untreated
cases and about 5 % in treated cases.
  PREVENTION AND CONTROL OF DIPHTHERIA  Diphtheria is preventable by specific
protection by immunization of all children with diphtheria toxoid. The children should be
immunized as early as possible so as to protect them before they lose their natural immunity.
The immunization of diphtheria is done by combined or mixed vaccines which include
diphtheria, pertussis and tetanus vaccine (DPT).
 PERTUSIS(WHOOPING COUGH) Whooping cough is an acute infectious disease causing
complications and high mortality in many parts of the world. It is caused by Bordetella
Pertussis. The source of infection is infected human being The period of incubation usually
ranges from 7 – 14 days, but in any case not more than 21 days. Prevalence is more in
children living in overcrowded homes and slums. The disease affects trachea, bronchi and
bronchioles.
 MAGNITUDE OF THE PROBLEM Whooping cough: occurs endemically and epidemically
in tropical countries. Since the reporting of whooping cough is inadequate, reliable
information about the incidence of this diseases lacking in most countries. About 10 percent
of all whooping cough cases and about half of the death occur in children under one year.
PREVENTION AND CONTROL OF WHOOPING COUGH The occurrences of pertussis
can be prevented by immunization of children which is done in combinations with diphtheria
and tetanus. The child either having or suspected having whooping cough should be isolated
as far as possible  The usual treatment is administration of antibiotic to control secondary
infection Clothes, fomites should be disinfected and discarded properly to prevent spread of
infections
  TETANUS Tetanus is an acute and highly fatal disease. It is caused by clostridium tetani
which is as pore forming bacteria Infections enter the body through injury which gets
contaminated. Infections can take place by many other ways for example during delivery and
after delivery, while cutting the cord and thereafter by improper care of the cord, extraction of
teeth, injections, tattooing, gangrenous foot, otitis media etc. The usual average incubation
period ranges from 6-10 days. The mortality rate is very high (40-80%). It is highest in
neonatal tetanus (80-90%).
 MAGNITUDE OF THE PROBLEM It is one of the leading causes of infant mortality  5 to
10 percent of neonatal deaths in Calcutta were due to tetanus PREVENTION AND
CONTROL OF TETANUS T.T immunization is done soon after road injury especially if T.T
immunizations are not done with in 5 years. In addition, all wounds and injuries should be
thoroughly cleaned and covered with sterilized dressing aseptically.  Tetanus can be
prevented by active immunization by tetanus toxoid of all antenatal mothers and children
according to national immunization schedule.
 POLIOMYELITIS Poliomyelitis is a crippling disease as it causes lameness. It is caused by
virus. The virus is found only in human beings. The source of infections is human faeces and
or pharyngeal secretions of an infected person. The disease occurs in children under five
years of age, but mostly between 6 months and 3 years. The incubation period ranges from 3
to 35 days but usually the clinical signs appear 7to 14 days after the infections
 PREVENTION AND CONTROL OF POLIOMYELITIS Poliomyelitis is prevented and
eradicated by immunization of all infants by 6months of age. Ther e are two types of vaccines
which are used. These are inactivated polio vaccine (IPV) and Oral Polio Vaccine (OPV).
Three doses of OPV at an interval of one month each are recommended by WHO. The
immunization must be completed by six months; one booster dose is to begiven at 12-18
months later. The health worker must educate parents and family members about the
importance of polio immunization and motivate them for the same.
 MEASLES Measles is a worldwide endemic disease. It occurs more in the winter months.
children in the age group of 6 months to 3 years are the most susceptible. Incubation period
10 days but it ranges from 8 to 16 days. The common complications which can occur during
measles include Broncho-pneumonia, diarrhoea ,otitis media, encephalitis etc. depending
upon the nutritional status and general body resistance of the child.
 PREVENTION AND CONTROL MEASLES The occurrence of measles can be prevented
completely by achieving an immunization level of 95 percent and by continuing
immunization of children of successive generation. As per National Immunization
Programme, immunization must be done at the age of 9 months by giving a single dose of
0.5ml of live attenuated vaccine subcutaneously. Health education of people at large to
educate about prevention and control of measles
 PROBLEMS OF NEONATES HYPERBILIRUBINEMIA This condition refers to excessive
presence of bilirubin in the blood. It is indicated as pallor of the skin and eyes. It is either due
to physiological jaundice, RH or ABO incompatibility. Physiological jaundice usually
disappears with in days with phototherapy. Jaundice due to RH incompatibility occurs due to
24 hours and requires blood transfusion.
 HYPOTHERMIA The new born baby may go into hypothermia within one hour of birth, with
the temperature (axillary) falling below 36.5 degree c (97.7 degree F). This happens if proper
precautions are not taken to prevent chilling of the baby. The woman in the family and birth
attendant should be made aware about drying the baby after birth, providing skin to skin
contact with the mother and initiating breast feeding within an hour of birth. Hypothermia is
harmful to the new born, increasing the risk of the morbidity and mortality.
  NEONATAL TETANUS  Neo- Natal tetanus is the common problem. It is usually due to
sepsis caused by uncleaned delivery and cord care. Considering the preventable nature of
NNT, WHO has resolved to eliminate NNT by aiming to reduce the incidence to less than 1
case per 1000 live births. The same goal is accepted by the Indian Government. The following
actions are implemented… 100 percent coverage of pregnant women with two doses of
Tetanus Toxoid (T.T.) 100 percent clean deliveries.  Surveillance of neonatal deaths and
investigations of tetanus.
 BIRTH ASPHYXIA Birth asphyxia is characterized by absent or depressed breathing at birth.
Difficulty in initial breathing is due to variety of reasons such as prolonged or obstructed
labour, prematurity, infection etc. often it can be anticipated. The following actions should be
taken to reduce neonatal deaths due to birth asphyxia. To keep ready the necessary
equipment's for management of birth asphyxia. Clearing of air passage immediately as the
child is born. Ventilating with mask or bag and mask. Cardiac massage when brady- cardia
persists. Mouth to mouth breathing when necessary. Training of health workers in the
assessment and management of birth asphyxia.
 FACTORS INFLUENCING MATERNAL AND CHILD HEALTH Maternal health
Sexuality factor Nutrition Environmental factor  Psychological factor Ethnic and socio
cultural aspects factor Lifestyle factors
MATERNAL FACTOR 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 .Information and
the considerable media exposure about this issue through public service campaigns
  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. Nipple stimulation,
vaginal penetration, or orgasm may cause uterine contractions secondary to the release of
prostaglandins and oxytocin. Therefore women who are predisposed to preterm labour or
threatened abortion
 NUTRITION During pregnancy changes must occur to ensure that gestation progresses and
both mother and fetus remain healthy. 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. 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.
 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 diseases decrease fecundity and increase fetal
wastage.
 PSYCHOLOGICAL FACTOR 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.
  ETHINIC AND SOCIO CULTURAL FACTOR Culture and family must be viewed
simultaneously for, regardless of the family type, it remains the basic unit of society and
influences human development over the life span. Religious beliefs and practices are part of
cultural and familial heritage and influence health care behaviours. Within the neighbourhood
and community
LIFE STYLE FACTORS
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.
 HEALTHY LIFE STYLE CHOICES OF MCH
 Regular exercise
 Weight control  Avoidance of saturated fats
 Alcohol and Tobacco avoidance Seat beat use
 Immunisation updates Regular dental check up
 Regular health maintenance.

By the maternal and child health care facilities achieved maximum effort and utilised
available health care facilities in the area of health problem of pregnant women are
prevented by proper health care check-ups to avoid increased morbidity and mortality rate.
By the help of healthcare team, all the women those who are needed at most care at the
time of their pregnancy and baby birth. All the areas the women should get awareness
regarding maternal and child health care.
ISSUES OF MATERNAL AND CHILD HEALTH
India is the second most populous country and the highest contributor of maternal deaths
globally. The maternal mortality ratio of India has been reduced from 400 in 1999 to 178 in
2012, a drop of more than 50% as per the Sample Registration System (SRS) of India report.
Despite this decrease, India will not be able to achieve the fifth Millennium Development
Goal (MDG 5) by 2015, and the magnitude of decrease in maternal mortality has remained
same for the past decade. India has implemented national level programs to improve
maternal health starting with Child Survival Safe Motherhood (CSSM) in the 1990s, to the
recent National Rural Health Mission (NRHM) implemented in 2005 which has led to some
improvement in maternal healthcare utilization despite as documented in demographic
surveys. The coverage of antenatal care has improved, with about 75% of all mothers
receiving some antenatal care in 2007-08 compared to 65% in 1998-99. Similarly,
institutional deliveries rose to 50% in 2008 from 34% in 1999.

Issues:
 Policy
 Human resources
 Logistic finance
 Limited management to maternal and child health services
Policy
The health system of India has been chronically underfunded for greater than the previous
40 years. The Government spends only about 1% of gross domestic product (GDP) on health
services, including expenditure by the Central and State Governments. This is one of the
lowest in the world. The CSSM and RCH programmes contributed an additional fund of
US$600 million and about US$300 million of which was for maternal health, spread over a
period of 12 years. However, during these 12 years, there were about 300 million new births
in India, giving an average of only an additional US$1 per birth, which is insufficient to
change maternal care provided to pregnant women. Given the enormous size of India, it
cannot hope to improve maternal health based only on donors’ support. Recently under
NRHM, the government increased the spending from US$735 million in 2005-06 to
US$2,829 million in 2012-13.
National AIDS Control Organization (NACO), the government body set up to reduce
incidence of HIV in India, reformed blood banking policies in the early 1990s. These policies
made the blood safer but scarcer, and even the decision to allow blood storage units where
blood banks could not be established has not made blood accessible in rural areas.
As postpartum haemorrhage is one of the most common causes of maternal death, and
anaemia is endemic among Indian mothers, blood transfusion is an essential life-saving
There are many more examples such as lack of clear policies regarding posting of doctors
trained in specialities and anaesthesia, and Under NRHM, institutional deliveries were
promoted as a measure to reduce maternal mortality. The international evidence suggests
that provision of skilled birth attendance for 100% births with access to reduce maternal
mortality in low resource settings.
The Indian government promoted institutional deliveries by incentivising them, but without
strengthening the capacity of public health facilities to provide skilled birth attendance or
manage emergency obstetric cases. Review of demographic surveys shows that despite
significant increase in the institutional deliveries, maternal mortality has not been reduced
significantly in India.
This observation is also reflected globally, and shows that erroneous interpretation of
evidence can mislead policymakers. Thus, without a robust and standardized policymaking
process, India will not be able make significant progress in making maternity safer.
Also, the policymaking and program implementation needs to be scientific and policymakers
should learn from past mistakes. JSY incentives for institutional deliveries provide a
flashback of incentives for family planning in 1970s. The emphasis on increasing service
utilization without improving the ability of system to provide quality care can lead to
disappointment and poor perception of quality among clients. Unfortunately, there is no
long-term policy for improving maternal health in India. Unlike its neighbours, India has not
invested time and efforts to prepare a long-term policy to reduce maternal mortality that
also has documentation of strategies to achieve the target. Past experience has shown that
attempting too many interventions with limited managerial capacity does not lead to
success – this is especially true within a weak health system.
Infrastructure of the Indian health system. Appearance of labour rooms in Primary Health
Centres in India.
A labour room in a rural health facility. It lacks the basic supply of mackintosh and clean
linen. Surgical drums are lying on the floor. Water seepage in the walls can be seen, which
affect the quality of care provided and increase the probability of infection.
A clean labour room in a rural health facility. It is well-ventilated and well-organized. Tiled
walls are easy to clean and disinfect for adequate infection control leading to higher quality
of care. Surgical theatres for operative maternity care in India. Operating theatre for
maternity care from a rural health facility illustrates the substandard equipment, potential
open air access through sealed windows, and trash including used gloves littered on the
floor. The nature of the room makes it difficult to thoroughly clean. Infrastructure issues
such as peeling paint from the walls worsen infection control issues leading to maternal
morbidity and mortality. An up-to-date operating theatre for obstetrical care having modern
appliances, and no immediate access to the outside environment. This room can easily be
sanitized between patients.

Processes

Lack of clear processes and protocols is an important barrier to improve maternal health in
India. Even where protocols are available, they are not being followed in the field. The
monitoring system does not evaluate quality of care and is not geared to foster good
practices.
There is no penalty for not following protocols in the public sector or private sector. There is
no technical supervision of quality of care and outcomes. There is a void of relevant data for
monitoring, planning and documentation. Although the private sector is a major service
provider of maternal health care services in India, there is hardly any service data available
from the private sector. Similarly, even for the public sector, functionality and service
statistics of facilities is limited and intermittent, which makes it difficult to understand the
trend of utilization and functionality.
Under NRHM, the modified management information system is more focused on preventive
care than on curative care, and the data on morbidity or mortality is not collected and
analysed systematically. There is a large-scale inflation of service statistics by field
functionaries as the monitoring is based purely on numbers. Systematic comprehensive
evaluations of programs including innovations are not performed, and program managers
have a limited ability to the use of data for planning at regional level. There are
inconsistencies in recording formats and lack of integration of electronic maternal child
tracking system with routine HMIS. There are duplication of efforts and inefficient
implementation of newer electronic monitoring systems. The HMIS system lacks the ability
to integrate, synthesize and analyse the data to ensure a timely response. The focus is on
requirement of top level officers, and not on the need of lower level healthcare providers,
to improve patient management. Here, also, the lack of penalty or reward leads to no
incentive to improve the quality of data. Despite the progress in technology, data entry
takes place manually at multiple levels leading to duplication of work and wastage of skilled
human resources. The majority of health programs have their own MIS, leading to collection
of as many as 3,000 data points for a health worker in order to fulfil the divergent
requirements of local, state and national government.
Human Resources
India has significant shortage of skilled human resources for healthcare, similar to any other
developing country. As per Rural Health Statistics report of 2012, there is a 65% shortfall of
obstetricians in the public health sector. This limits access to maternity care in rural areas.
Training of medical doctors for providing maternity care including either not implemented
or poorly implemented in many states in spite of national health policies. Practical training
for all the levels, from ANMs to medical doctors, is too short and not geared towards skill
building, and refresher trainings have the same issues. The majority of training programs
have not been evaluated for either content, methodology or effectiveness. As pointed out
earlier in the chapter, there is a lack of management training and short-term duration
trainings are not sufficient to improve the management capacity of maternal health system.

At both the national level and state level there is lack of clear HR policies for posting,
transfer and promotions. The career path of a public health care provider is not clear
irrespective of the level. This leads to job dissatisfaction and demotivation among the
providers. Absenteeism is rampant in the public health sector - a majority of staff do not
stay at the headquarters and thus are not available for emergency obstetric care.
contractual staff has been a strategy to improve service delivery since RCH I, but there is no
consensus or clarity on the role of these staff. Contractual staff includes a staff nurse and
AYUSH doctor to staff a PHC, as well as a district level program manager to manage
maternal health in the district, and a state maternal health consultant. As there is no clarity
as to their roles, the decision-making power of these staff members vary in different states,
and their day-to-day activities also vary. Lack of parity regarding work allocation and
remuneration between contractual and regular staff has led to high turnover and
demotivation among contractual staff. Human resources issues are important for the public
sector as the majority of new medical graduates prefer to work in the private sector.
Despite substantial numbers of new doctors graduating every year, there is a huge shortfall
in the availability of skilled providers in the public health sector.

Logistics and Finance

Compounding the problem of the low level of government funding, the financial systems of
public health sector are highly bureaucratic, slow-reacting, and procedure-oriented,
resulting in non-availability of funds at peripheral locations where needed. This occurs even
when money is centrally available – with the result that unused funds are unavailable after
the financial year is concluded. The financial and accounting regulations require much
procedural and paper work for using money which has been specifically budgeted, with the
result that non-budgeted essential activities cannot be performed. Under the NRHM, the
Government is trying to streamline this process. Many states in India are in a severe
financial crisis due to reluctance to collect taxes and profligacy of expenditure in the
Government - as a consequence, there are diminished funds available for maternal health.
Before NRHM, there was no flexibility of spending at the grass root level which affected the
availability of locally required equipment, drugs, and frequently the maintaining/repairing of
available equipment. Despite improvement in the financial system within the NRHM,
financials other than NRHM such as state treasuries still follow the same bureaucratic
processes. This leads to a delay in the supply of equipment, shortages of drugs and
disposables at all levels, and lack of equipment maintenance. Following the example of
Tamil Nadu, many states have developed similar mechanisms for logistics management such
as TNMSC to improve logistics management. Unfortunately, the majority of the Indian states
still have wasteful and inefficient logistics and financial management systems which have
not been substantially reformed.
Limited Management Capacity of Maternal Health Services

At the national level, there are two major divisions within the Ministry of Health and Family
Welfare - the Department of Family Welfare (DFW) and the Department of Health (DH).
MCH, reproductive health, rural health, primary healthcare, and family planning come under
the DFW; medical colleges, national institutes, and disease-control programmes come under
the DH. The Maternal Health Division within the DFW is responsible for all technical and
administrative aspects of maternal health activities throughout India. These findings are
based on interviews done with the officers from maternal health divisions.

SUMMARY

As we learned about introduction of MCH and epidemiological aspects of maternal and child
health, as well problems of both mother and child and causes and mortality morbidity ratio
by statistical phenomenon, issues of MCH can use our day today care practice to provide
productive work output.

CONCLUSION
Mother and child are one unit and most vulnerable to the morbidity and mortality. Hence it
is essential to protect them through appropriate action at each level. MCH epidemiology
programme emphasizes the analytical skills to address the health problems of the mothers
and children through surveillance, assessment, planning, implementation, monitoring and
evaluation. Nurse as team member of the health can contribute her skill for the promotion
of health of mother and children.

BIBLIOGRAPHY:
1. J B Sharma, “A text book of Midwifery And Gynaecological Nursing 1 st Eddition 2018
avichal publication company. Pge no :03, 06, & 08-11
2. DC Dutta, “Atext book of obstretrics including Perinatology and contraception, 6 th
Eddition 2004, New central Book Agency (P) LTD Page no: 599-608
3. https://www.slideshare .net
4. www.google .com