MCH Services By Dr Khawla al- hiasat

1. MCH ServicesBy Dr Khawla al-hiasat

2. “Children are the future of society, and their mothers are guardians of that future”

3. objectives • At the end of the Session the participant will be able to: • To know the importance of services provided to Mothers and Children at MCH centers • To be familiar with best practices to provide these services

4. Main strategy of PHC is to ensure providing optimum and universal primary health care free of cost to vulnerable groups e.g. mothers and children aged birth to school age with an emphasis on prevention, promotion, early detection and intervention

5. Methodology of Application • Equity in coverage: These services should be available affordable and accessible to all the target population in their communities. • Detection. • High risk management. • Follow up.

6. OBJECTIVES OF MCH SERVICES: 1.Reduction in maternal, perinatal, infant and childhood Mortality & Morbidity. 2.Promotion of reproductive health. 3.Promotion of physical and psychological development of child and adolescent within the family.

7. Definition (WHO) Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Elements of maternal health • Antenatal care. • Postnatal care. • Family planning.

8. Antenatal care • ANC : is the health care given to the pregnant women from the first month till the delivery time, to insure safe pregnancy and safe outcome. • The outcome is referred to safe delivery and healthy newborn • The objective of antenatal care is to assure that every wanted pregnancy culminates in the delivery of a healthy baby without impairing the health of the mother.

9. Activities 1. History : Personal, family, medical and surgical history, besides menstrual ,obstetrical history.Specific questions for those with medical problems or known complications. during revisits: Brief history to uncover any new problems. Ask about pain, contractions, vaginal discharge, fetal movements… 2. General physical examination and risk assessment according to Coopland form

10. Activities 3.Follow up visit during each visit • Weight and Blood pressure are measured. • Fundal Level of the uterus is defined after the 12th week of pregnancyfetal presentation from 30 weeks • fetal auscultation from 20 weeks • Urinalysis by dipstick for the presence of albumin and sugar • Ultrasound is done once each trimester • inspection of legs for oedema

11. Activities 4. Health education : Assessment of the educational needs of the woman related to her history and the physiological changes occurring in her body. Topics: Nutrition, Personal hygiene, Care of nipples, Awareness about signs and symptoms associated with high risk pregnancy, physiology of pregnancy. 5. Provision of supplements including ferrous tablets and folic acid tablets

12. Activities 6. Laboratory tests : Complete blood examination including hemoglobin level , blood group and Rh factor , fasting blood sugar and GTT 7. Immunization : Tetanus toxoid should be given for all pregnant women according immunization status of the woman and EPI schedule, it is usually given at 20 weeks of pregnancy .

14. Complications arising in pregnancy • Hypertensive disorders. Anemia. Urinary tract infection. Ante-partum hemorrhage. Vaginal bleeding. Pre-term labour. Pre-term rupture of membranes. Abnormal lie/presentation. Polyhydramnios. Multiple pregnancy. Intrauterine growth restriction. • High risk pregnant women are advised for more frequent antenatal visits and they have to deliver in a hospital

15. Visit Schedule The first visit or initial visit should be made as early is pregnancy as possible. Return Visits: Then every 4 weeks until 28 weeks. Then every 2 weeks until 36 weeks. Then weekly until delivery. For high risk patients, individualized and more visits are required. The WHO recommends 4 ANC visits for normal pregnancy: • In 1st trimester (ideally before 12 weeks but no later than 16 weeks) • At 24 – 28 weeks • At 32 weeks • At 36 weeks

16. Postnatal care The puerperium is the period following child-birth during which the uterus and other organs return to the pre- pregnant state. It begins after the placenta is expelled and last for 6 weeks. This component is the weakest component in the maternal health care , where the percentage of women who receive this service is relatively low.

17. Postnatal care • General Examination • Check for signs of hemorrhage or infection • Counsel for family planning and breast Feeding. The most frequent reported health problems in the postpartum period are : - Infections ( genital infections ) . - Bladder problems . - Frequent pelvic and headache pain . - Hemorrhoid and anemia . - Constipation . - Depression , anxiety . - Breast problems .

18. Maternal health logs • Antenatal care daily log • Postnatal care daily log All services provided are registered in these logs for each mother with her folder number so that it easy to monitor provision of services on supervisory visit. • Expected date of delivery log so that midwife can track women after delivery if they didn’t show up for postnatal care.

19. Family planning It is an essential component of any broad – based development strategy that seeks to improve the quality of life for both individuals and communities. Research has repeatedly shown the physical dangers to mother and children of having too many pregnancies too early and too close together

20. Rights of client Every F.P. client has the right to: 1- information:- to learn about the benefits and availability of FP 2- choice:- to choose freely whether to practice FP. and which method to use. 3- confidentiality:- to be assured that any personal information about them will remain confidential. 4- privacy:- to have a private environment during counseling or the provision of services. 5-dignity:- to be treated with courtesy , consideration and attentiveness.

21. Rights of client 6- safety:- to be able to practice safe and effective FP 7- continuity:- to receive contraceptive services and supplies for as long as they need them. 8- comfort:- to feel comfortable when receiving services. 9- access:- to obtain services regardless of sex, color, religion or location. 10- opinion:- to freely express their views on the services offered.

22. FP Methods 1- Intrauterine device (IUD) 2- Hormonal: • oral contraceptive pills : • combined cocp • progesterone only pop • injectable: . depoprovera • s.c. implants: norplant, implanon 3- Condom : female condom 4- Tubal ligation

23. FP logs and reports • Logistic monthly report for FP methods dispensed and received, the balance inventory is done monthly by the midwife before writing the report in order to calculate her need from FP methods from HD and to avoid stock out. • FP daily log where all the information about FP services provided to clients and the methods dispensed are registered

24. Maternal Health record • Each client registered for any service at MCH should have a file where all health information about her is documented ,and it has three sections : antenatal, postnatal and FP care , and covers 2 periods . • Each client should have an appointment card where her next visit date should be written, besides risk factors and her pregnancy follow up information are documented.

25. Well baby ClinicComponents • General Examination • Growth and development Monitoring • Immunization • Counseling & Health Education. • Nutrition • Injury Prevention • Health screening

26. HEALTH SCREENING IN CHILDREN • Neonatal screening – Congenital Hypothyroidism,pheynylketonurea &G6PD deficiency • Hemoglobin: 9-12 months; yearly till 5 years. • Vision screening. • Hearing Screening.

27. The Pediatric Physical Assessment Objectives To promote & optimize the growthand development of each childHow ? • Detailed history. • Careful physical examination. • Early detection of problems • Implementation of solutions

28. Stages of Growth and Development Infancy Neonate Birth to 1 month Infancy 1 month to 1 year Early Childhood Toddler 1-3 years Preschool 3-6 year

29. Why developmental assessment? • Early detection of deviation in child’s pattern of development • Simple and time efficient mechanism to ensure adequate surveillance of developmental progress • Domains assessed: cognitive, motor, language, social / behavioral and adaptive

30. Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the MCH approach to providing primary care for children and an appropriate responsibility of all pediatric health care professionals. • This process of recognizing children who might be at risk for developmental delays should be incorporated at every well-child preventive care visit. 

31. Why Monitor Growth ? • Growth is the most sensitive indicator of health normal growth only occurs if a child is healthy • Growth assessment is an essential part of the examination or investigation of any child. • Allows objective detection of growth disorders at population level at earliest opportunity • Early identification and treatment improves outcome. Identify under or over nutrition

32. What does a growth chart measure Length/Height for age: whether an infant is an appropriate length /height for their age Weight for age: whether an infant is an appropriate weight for their age Weight for length: whether the weight and length of an infant are in proportion Head circumference for age: informatiom about brain development

33. Frequency of visits seven visits in first year (including visits at time of vaccination) Two visits each year from 2-5 years Wt., Ht, and HC. For each visit Every infant has a health record kept in the MCH containing the following information : • Name of parents • Date of birth

34. Place of delivery • Attendance at labor • Type of delivery (ND, forceps, C.S,…) • Health condition at birth (weight, length, and any congenital anomalies) • Social data of the family • Immunizations • Risk factors which affects child’s health • Measurements of wt., length, H.C and growth curves • Developmental Monitoring according age

35. Child’s health log books • Child’s health care services daily log book: All services provided are registered in these logs for each child with her/his folder number so that it is easy to monitor provision of services on supervisory visit. • Immunization log book: Information about immunization status for each child is documented in order to follow up those late for their scheduled dose according EPI program

36. MCH services monthly report • Each MCH center should report monthly the work load for all MCH services ( ANC, Postnatal, FP and Child’s Health services up to 5 years of age) . • MCH report will be sent to the health directorate where the head of MCH division or MCH supervisor verify data to be sent to WCH directorate both electronically and hard copy to be further verified and to be published on MOH website.

37. THANK YOU