N eonatal, Infant , C hild and Mothers Health Family Health

1. Neonatal, Infant, Child and Mothers HealthFamily Health

2. دستاوردهای جهانیان در حمایت از حقوق کودکان و تحقق استعدادهای انسان را بیشتر می توان با بلندی قد کودکان سنجید تا ارتفاع آسمانخراشها. گزارش پیشرفت ملتها2000 یونیسف

4. اهداف • تعریف خانواده و انواع آن • اهمیت پرداختن به بهداشت خانواده • تعریف بهداشت خانواده • وظایف و برنامه های مختلف بهداشت خانواده

5. خانواده • خانوادهاولين و اساسي ترين نهاد اجتماعي • تجمع مشترك دو يا چند نفر كه به واسطه سببي يا نسبي با هم رابطه زيست شناختي داشته و زير يك سقف زندگي مي كنند. • متشكل از والد يا والدين و فرزندان آنان مي باشد. • سلامت افراد تحت تأثير اصول، ارتباطات، تكامل اجتماعي، شرايط اقتصادي و فرهنگي آن قرار مي گيرد. • اعضاء خانواده، مجموعه اي از ژن هاي مشترك هستند و به عنوان واحدي فرهنگي، منعكس كننده فرهنگ اجتماع بزرگتر مي باشند. • همچنين خانواده واحدي اپيدميولوژيك و واحدي براي فراهم كردن خدمات اجتماعي و مراقبت هاي جامع پزشكي است. • چگونگي تأثير خانواده بر افراد و يا بالعكس با توجه به تغييرات طبيعي تكامل افراد در طول زندگي و آشنايي با عوامل خطر در خانواده بيشتر مشخص مي گردد.

6. خانواده اولين محيط اجتماعي است كه فرد در آن قرار مي گيرد و از آن تاثير، مي پذيرد. • اين تاثيرپذيري مي تواند از طريق بيولوژيكي و يا رفتاري باشد. • تاثير بيولوژيكي خانواده فرد را ممكن است مستعد ابتلاء به بيماري نمايد مانند افسردگي؛ كانسرها • تاثير رفتاري مانند پرخوري، عدم تحرّك، اعتياد و الكليسم از طريق الگوي والدين.

7. انواع خانواده • تنوع ارتباطات افراد، منجر به تشكيل انواع خانواده گرديده است. • هنوز در اكثر جوامع، خانواده سنتي تك هسته اي معمول ترين نوع مي باشد. • واحدهاي خانواده در سرتاسر دنيا شكل هاي متفاوتي دارند. دانشمندان علوم اجتماعي سه نوع خانواده را تعريف كرده اند : • 1 ـ خانواده هسته اي (Nuclear Family) • 2 ـ خانواده گسترده (Extended Family) • 3 ـ خانواده سه نسلي

8. انواع خانواده • 1 ـ خانواده هسته اي (Nuclear Family) • خانواده هسته اي يا اوّليه در تمام جوامع انساني، مشترك است و شامل زوجين و كودكان وابسته آنها مي شود. • 2 ـ خانواده گسترده (Extended Family) • يكي از رايج ترين نوع خانواده در خاور دور و خاور ميانه است و بيشتر در مناطق زراعي روستائي، مرسوم است. به طوري كه چند خانواده با رابطه خوني بين مردها باهم زندگي مي كنند، قدرت در دست مرد سالخورده فاميل است، روابط فاميلي بر روابط زناشوئي، ارجح مي باشد و مسئوليت ها تقسيم شده است. • 3 ـ خانواده سه نسلي • خانواده اي كه افراد جوان به دليل نبودن امكانات با نسل هاي قبلي خود به طور موقت زندگي مي كنند. • انواع مشروع و نامشروع ديگري از خانواده نيز وجود دارد كه در جدول 2 به آن ها اشاره شده است.

9. جدول 2 ـ انواع خانواده

10. چرخه خانواده • خانواده ها پايدار نيستند و همواره درحال تغييرند.

12. بهداشت خانواده • براي دستيابي به بهداشت خانواده بايد مراحل مختلف تكامل، عوامل خطرآفرين در خانواده و عوامل موثر بر سلامت خانواده را شناخت. شماي كلي بهداشت خانواده در شكل 1 نشان داده شده است.

14. مراحل مختلف زندگي • با وجود تفاوت هاي وسيع در فرآيند تكاملي افراد، وجوه مشترك مشخصي در اكثر موارد در مراحل زندگي وجود دارد و لذا اين مراحل به 6 دوره طبقه بندي مي شود : شيرخوارگي و كودكي، بلوغ و نوجواني، جواني، ميانسالي، از كارافتادگي و پيري.

15. Women & children make 70% of developing countries population • The 10.6 million annual child deaths are not distributed evenly over the 0-4 year age period • More than 70% of all child deaths occur in the first year of life • And of these … nearly 40% occur in the first month of life (the neonatal period)

16. More than 42%of total mortality occurs in under 5 children. • Family planning decrease MMR at least 25% • When IMR decreases, desire for child bearing decreases

17. Only 2 WHO regions account for more than 70% of all under-five deaths: 42% in the African region 29% in South-east Asia region • Only 6 countries account for 50% of all child deaths (2002 data): India (Sear) Nigeria (Afr) China (Wpr) Pakistan (Emr) Ethiopia (Afr) DR Congo (Afr)

18. What are under-fives dying of?(excluding neonatal causes of death) • Pneumonia • Diarrhoea • Malaria • Measles • HIV/AIDS } ~ 50% Malnutrition contributes to more than half of all under-five deaths

20. What are neonates dying of? • Preterm births • Severe infection • Asphyxia • Congenital anomalies • Tetanus } ~ 75%

21. Progress has been variable • Neonatal mortality has fallen at a lower rate than post-neonatal or early child mortality • Relatively greater progress has been made in some regions and countries e.g. neonatal mortality is now 58% lower in high income countries than in 1983, compared to 14% reduction in low/ middle income countries • Large variations in mortality rates exist even within the same country

22. About half of child deaths occur in the neonatal period When do neonates die?

23. Child mortality and causes of death • Infant mortalityIn 2015, 4.5 million (75% of all under-five deaths) occurred within the first year of life • Neonatal mortalityIn 2015, approximately 45% of under-five deaths occured during their first month of life • The proportion of child deaths which occur in the neonatal period has increased in all WHO regions over the last 25 years. • Causes of child mortalityPrematurity was the largest single cause of death in children under five in 2015

25. Under-five mortality • 5.9 million children under age five died in 2015, 16 000 every day • Trends • Global under-five mortality rate dropped 53% since 1990 • Leading causes of death in under-5 children are • preterm birth complications, • pneumonia, • birth asphyxia, • diarrhoea and malaria. • About 45% of all child deaths are linked to malnutrition.

28. What are mothers dying of? • Pregnancy related bleeding • Pregnancy related infections • Pregnancy related hypertention

29. In a developing country, pregnancy related maternal mortality is 38 times more than a developing one. • Every minute in the world, a young woman dies from pregnancy related causes.(585000 annually) • Unplanned and wrongly-spaced pregnancies • compensation of mother,s reservoirs, • the opportunity to take care of child • The ultimate result is child mortality

30. Crowded family: • higher chidren,s malnutrition, cost of family food • Lower protein & energy and food per capita • Increase in birth order: decrease in IQ and mental capacity • Doubling time of population • Developing: 20-40 years • Developed: 583 years • In Iran as other developing countries marriage rate is very high • 1375 census: more than 45 year old never married • Men 1.7 % • Women 1.6 %

31. Annual estimated unsafe abortion worldwide: 20 million leads to 76000 young women death mostly in developing countries. Family planning prevents most of these deaths. • Without assessment of pregnancy and essential care leading to maternal and child mortality or irreversible complications. • lactation: lower rate of pregnancy, child health

32. In Iran, despite family planning activities • 24% of pregnancies are unwanted. • Only 50% of OCP users, use it correctly.

33. Maternal MortalityDefinition • A maternal death is defined as "the death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."

34. Maternal Mortality • In 2008, an estimated 358 000 women died from pregnancy - or childbirth-related complications. • More than 60% of maternal deaths occurred in the postpartum period. • The risk of death is highest close to birth and then decreases over the subsequent days and weeks. • About 45% of postpartum maternal deaths occur within 1 day of delivery, more than 65% within 1 week, and more than 80% within 2 weeks.

35. Maternal Mortality2015 • Key facts • Every day, approximately nearly 830 women die from preventable causes related to pregnancy and childbirth. • 99% of all maternal deaths occur in developing countries. • Maternal mortality is higher in women living in rural areas and among poorer communities. • Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. • Skilled care before, during and after childbirth can save the lives of women and newborn babies. • Between 1990 and 2015, maternal mortality worldwide dropped by about 44%. • Between 2016 and 2030, as part of the Sustainable Development Agenda, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births.

36. 2015 • Maternal mortality is unacceptably high. • About 830 women die from pregnancy- or childbirth-related complications around the world every day. • By the end of 2015, roughly 303 000 women will have died during and following pregnancy and childbirth. • Almost all of these deaths occurred in low-resource settings, and most could have been prevented.

37. Distribution • More than three-quarters of maternal deaths were concentrated in just two regions of the world: 53% in the African Region and 25% in South-East Asia. • The vast majority of maternal deaths occurred in developing countries. • The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. • There are large disparities between countries: the average maternal mortality ratio in developing countries is 290 per 100 000 live births versus 14 per 100 000 live births in developed countries.

39. Trend • Between 1990 and 2008, maternal deaths worldwide have dropped by 34%. • However, the global maternal mortality ratio declined by only 2.3% per year in this same period. • This is far from the annual decline of 5.5% required to achieve MDG5. • In sub-Saharan Africa, a number of countries have halved their levels of maternal mortality since 1990. • In other regions, including Asia and North Africa, even greater progress has been made

40. Causes of Maternal death

41. The major complications that account for 80% of all maternal deaths are: • severe bleeding, • infections, • high blood pressure during pregnancy (pre-eclampsia and eclampsia), • obstructed labour, • and unsafe abortion. • Of these, haemorrhage and hypertensive disorders account together for the largest proportion of maternal deaths in developing countries.

42. 2015 • The major complications that account for nearly 75% of all maternal deaths are: • severe bleeding (mostly bleeding after childbirth) • infections (usually after childbirth) • high blood pressure during pregnancy (pre-eclampsia and eclampsia) • complications from delivery • unsafe abortion.

44. Definition • Family health • Major theme of it is promotion of the quality of life considering family as a unit.

45. Duties & Programmes of family health office of ministry of health • Mothers • Children • Family planning • Nutrition improvement • Women and Elderly • School health( office of adolescents health and school health)

46. Mothers • Health care before, during & after delivery • Health education • Healthy neonate during first 10 days of life • Safe motherhood • Safe delivery • Maternal mortality • LBW • Premature delivery • MAMAROOSTA

47. Children • IMCI( Integrated Management of Childhood Illnesses) • مراقبتهای ادغام یافته ناخوشی های اطفال- مانا • كودك سالم • Health care of under 6 y/o children • Height, weight, growth monitoring, nutrition education, vaccination, solid foods, control & treatment of infectious diseases • Neonatal care • Breast feeding

48. Family planning • Increasing quality & quantity of modern contraception • But now?

49. Nutrition improvement • Prevention of malnutrition, IDA, IDD, Vitamin D3 • IDA: 30% under 5 & female adolescents, 20-50% pregnant women • 1.4% of worldwide mortality( 0.8 million) is related to IDA • Objective: prevention of IDA in 15-49 y/o female and under 5 children. • Education of healthy nutrition in community • 1374: 16% of under 5 moderate & severe malnutrition. • 1377: 13.7% rural & 9.6% of urban children moderate & severe malnutrition. • Controlling parasitic and infectious diseases( preparing the situation for malnutrition)

50. women • Prevalent cancers: Breast, Cervix • screening: CBE, Mamography, Pap smear