Maternal and Child Health

1. Maternal and Child Health • Breast feeding Week 2017 • Baby Friendly Hospital Initiative • MCH indicators • Indian newborn Action Plan

3. World Breastfeeding Week is coordinated by the World Alliance for Breast Feeding Action(WABA) • It is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding • The World Breastfeeding Week’s 25th year in 2017 is about working together for the common good

4. Objectives of WABA World Breastfeeding Week 2017 • INFORM: Understand the importance of working together across the 4 Thematic Areas • ANCHOR: Recognise your role and the difference you make within your area of work • ENGAGE: Reach out to others to establish areas of common interest • GALVANISE: Work together to achieve the SDGs by 2030

5. Four thematic areas • Nutrition, Food Security and Poverty Reduction • Survival, Health and Wellbeing • Environment and Climate Change • Women’s Productivity and Employment

6. 1.Nutrition, Food Security and Poverty Reduction • Nutrition: Breastfed infants are provided with optimal nutrition and protection against infections • Food security: Breast milk is a safe and secure source of food even in times of humanitarian crises • Poverty reduction: Breastfeeding is a low cost way of feeding babies without burdening household budgets

7. 2.Survival, Health and Wellbeing • Survival: Breastfeeding significantly improves the survival of infants, children and mothers • Health and wellbeing: Breastfeeding significantly improves the health, development and wellbeing of infants and children as well as mothers, both in the short- and long-term

8. 3.Environment and Climate Change • Environment: Breast milk is a natural, renewable food that is environmentally safe: produced and delivered without pollution, packaging or waste • Climate change: Formula production generates greenhouse gas (GHG) emissions which accelerate global warming

9. 4.Women’s Productivity and Employment • Women’s productivity: Employers benefit from having a more contented and productive workforce due to less employee absenteeism, increased loyalty and less staff turnover • Employment: Workplace policies can enable women to combine breastfeeding with paid work

10. National guidelines on Infants and Young Child feeding • Infant Milk Substitutes, Feeding Bottles, and Infant Food (Regulation of Production, Supply and Distribution) Act 1992 and Amendment Act 2003 (IMS Act) • Prohibits: promotion of artificial foods

11. Goals set :- • Intensify nutrition and health education to improve infant and child feeding and caring practices so as to a)Bring down the prevalence of under-weight children under three years from the current level of 47 percent to 40 percent (b)Reduce prevalence of severe under-nutrition in children in the 0-6 years age group by 50 percent

12. Enhance early institution of breast feeding (colostrum feeding) from the current level of 15.8 % to 50% • Enhance the exclusive breast-feeding rate for the first 6 months from the current rate 55.2 % (for 0-3 months ) to 80% • Enhance the complementary feeding rate at six months from current level of 33.5 % to 75 %

13. State of breastfeeding & Infant and Young Child feeding in India

14. Baby Friendly Hospitals Initiatives • “Baby-friendly hospital initiative”(BFHI) created and promoted by WHO and UNICEF, has proved highly successful in encouraging proper infant feeding practices starting at birth

15. Ten steps-BFHI • Written policy-communicate: staff • Train staff-implement policy • Inform pregnant women: benefits, management: breast-feeding • Help mothers initiate breast feeding • Show : how-breastfeed, maintain lactation

16. Continued 6. Give newborns no food/drink: unless medical 7. Rooming in 8. Encourage on demand 9. No artificial teats/ pacifiers 10. Foster establishment of support groups and refer mothers to them before discharge

17. Commonly used indicators • Maternal mortality ratio • Mortality in infancy and childhood • Perinatal mortality rate • Neonatal mortality rate • Post-neonatal mortality rate • Infant mortality rate • Under five mortality rate • Child survival rate

18. Maternal mortality ratio: Maternal death: Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration of pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes. Late maternal deaths: beyond 42 days but before 1 year after termination of pregnancy

19. Maternal mortality ratio: Maternal deaths per 100,000 live births during the same time period • Maternal mortality rate: Maternal deaths per 100,000 women of reproductive age during the same time period

21. Incidence: • 2 countries account for 1/3rd of the deaths: India, Nigeria • India: 212/ lac live birth rates • Karnataka: 178 • 56,000 deaths: India

22. Approaches to measure maternal mortality • Civil registration system: • Household survey: • Sisterhood methods: Interview a representative sample of respondents about the survival of their adult sisters (marriage number, number being pregnant, number alive and number died) • Reproductive age mortality studies (RAMOS): Identifying and investigating the causes of all deaths of women of reproductive age in a defined population using multiple sources of data • Verbal autopsy: Assign cause of death by interview with family proxy Social autopsy: 3 point delays

23. Causes: Haemorrhage accounts for quarter of the deaths Puerperal infections : 15% of maternal mortality Co morbidities: 10-12 %

24. Causes:

25. Preventive and social measures • Early registration • Antenatal check-ups • Dietary supplementation • Prevent infection, haemorrhage • Prevent complications • Treat medical conditions • Clean delivery practices • Train local dais, female health workers • Institutional deliveries • Identify every maternal deaths • Safe abortion services

26. Review: • World Breast feeding Week • Ten steps of BFHI • Maternal mortality ratio • Maternal mortality rate • Causes and Prevention • Social schemes and National Programmes

27. Mortality in infancy and childhood • Perinatal mortality rate • Neonatal mortality rate • Post-neonatal mortality rate • Infant mortality rate • 1-4 year mortality rate

28. Foetal death • Death prior to complete expulsion or extraction from its mother of product of conception • Death after 28th or 20th week • Stillbirth rate: WHO criteria: Foetus born dead, weighing >500 g, gestation: 22 weeks. International comparisons: Foetal deaths weighing over 1000 grams at birth, equivalent to 28 weeks of gestation

29. Why perinatal mortality rate? • Stillbirths, deaths under first week: factors similar • Proportion of deaths: occur after birth: incorrectly registered as stillbirths: inflates stillbirth rate Significance: • Yardstick of obstetric and paediatric care before and immediate after birth • Reflects the extent of pregnancy wastage and quality of health care available

30. Perinatal mortality rate: • Late foetal deaths (stillbirths) and early neonatal deaths (postnatal deaths) • 28th week – 7th day after birth • (Late foetal + postnatal deaths/ Live births in year)X1000

32. Social and biological factors • Low SES • Maternal age • High parity • Heavy smoking • Maternal height: short stature • Poor past obstetric history • Malnutrition, severe anaemia • Multiple pregnancy

34. Neonatal mortality rate • Number of deaths occurring between birth and 28 completed days after birth • Causes: Measure of involvement of endogenous factors affecting infant survival • Low birth weight • Asphyxia • Birth injuries • Congenital malformations

35. Causes of neonatal deaths

36. Incidence • 2.9 million newborns die every year <4 weeks • Half of them die in 24 hours • Newborn deaths : 40% of all deaths • India: 25/1000 live births • Kerala :5, Madhya Pradesh: 34

37. Post neonatal mortality rate • 28 days- 1year • Exogenous: environmental, social factors, diarrhoea, respiratory infections • Increases with birth order • Girls > boys: neglect

39. Infant mortality rate • Children less than one year of age • Single largest age category of mortality • Effectiveness of MCH care • Can be reduced by targeted health programmes

40. International • 5/1000: developed, 69/1000 developing • Reflect socio-economic development: country • Decline: improved ANC, quality of life, better control –diseases, family planning, nutrition

41. India • 47/1000 live births • 129:1970, 114: 1980 • MP: 62, Kerala: 13

43. Medical causes • Neonatal: • low birth weight • Birth injury • Sepsis • Congenital anomalies • Haemolytic disease of newborn • Diarrhoeal diseases • ARI • Tetanus

44. Post-neonatal: • Diarrhoeal • ARI • Malnutrition • Congenital anomalies • Accidents

45. Factors affecting • Biological: • Birth weight • Age of mother • Birth order • Birth spacing • Multiple births • Family size

46. Economic causes: • Cultural and social: • Breast feeding • Religion, caste • Early marriage • Sex of child • Quality of mothering

47. Maternal education • Quality: health care • Broken families • Illegitimacy • Bad habits, customs • Indigenous dais • Bad environment

48. Preventive and social measures • Multifactorial- multipronged approach • Prenatal nutrition: • Prevent infection • Breast feeding • Growth monitoring • Family planning • Sanitation

49. Primary health care • Socio-economic development • Education