By Dr Khalid Badreldin Khalid

Maternal and child health (MCH) programs

• Focus on health issues concerning women, children and families, such
as access to recommended a) prenatal and well-child care, infant and
maternal mortality prevention, b) maternal and child mental health, c)

newborn screening, d) child immunizations, f) child nutrition and

services for e) children with special health care needs.

• States invest in healthy children and families to strengthen

communities and avoid unnecessary health care costs.
Understanding Maternal, Infant, and Child Health
Many factors can affect pregnancy and childbirth, including:

i. Preconception/health status

ii. Age

iii. Access to appropriate preconception, prenatal, and interconception health care

iv. Poverty

Infant and child health are similarly influenced by sociodemographic and

behavioural factors, such as education, family income, and breastfeeding, but are
also linked to parents and caregivers' physical and mental health.
Global Objectives:

• MCH-1: Reduce the rate of fetal and infant deaths

• MCH-2: Reduce the 1-year mortality rate for infants with Down syndrome

• MCH-2: Reduce the rate of child deaths

• MCH-3: Reduce the rate of adolescent and young adult deaths

• MCH-4: Reduce cesarean births among low-risk (full-term, singleton, and vertex
presentation) women
Global Objectives:
• MCH-5: Reduce the rate of maternal mortality

• MCH-6: Reduce maternal illness and complications due to pregnancy

• MCH-7: Reduce low birth weight (LBW) and very low birth weight (VLBW)

They are, in fact, 33

objectives.
National MCH indicators
• Maternal mortality rate.

• Infant mortality rate.

- They reflect the overall state of maternal health and the quality and
accessibility of PHC available to pregnant women and infants.

• Infant mortality includes:

- Neonatal mortality: first 28 days

- Postneonatal mortality: between 28 days and one year after birth

• Neonatal mortality.

- The leading causes of neonatal death include birth defects, disorders related to
short gestation and low birth weight, LBW, and pregnancy complications.

- Most newborn deaths are preventable through affordable interventions. To

address the high burden of newborn deaths, care must be available during
pregnancy, labour and postpartum.

• Post neonatal mortality:

- Post neonatal death reflects events experienced in infancy, including sudden

infant death syndrome “SIDS”, birth defects, injuries, and homicide.
• Fetal death:
- Fetal death often is associated with maternal complications of pregnancy,
like problems with amniotic fluid levels and blood disorders.

- Also when birth defects, such as anencephalous, renal agenesis, and

hydrocephalus, are present.

- Targeting prenatal risk screening and intervention to high-risk groups is

critical to reducing fetal death.
• Under five mortality:
- It has several advantages as a measure of child well-being in general
and child health in particular. It measures an ‘outcome’ of the
development process.
• It reflects a wide range of health issues like:
- Nutritional status and the health knowledge of mothers.
- Immunization and oral rehydration therapy.
- Availability of maternal and child health services (including prenatal
care);
- Income and food availability in the family;
- Availability of safe drinking water and basic sanitation;
• safety of the child’s environment.
Preconception care

Is the care for women of the reproductive age before pregnancy.

Goals of preconception care can include:

• Providing education and health promotion. (healthy lifestyle, nutrition,

vitamins like folic acid,)

• Screening and interventions for women of reproductive age to reduce

risk factors that might affect future pregnancies.
• High quality prenatal or antenatal care (ANC) is an essential component
of the reproductive, maternal, newborn and child health continuum of
care.

Medicine describes the delivery of health care over a period of time. This covers all
phases of illness in patients with a disease, from diagnosis to the end of life.

Continuum of care refers to the continuity of care throughout pregnancy, birth,

and after delivery: antenatal care, skilled birth attendance, and postnatal care.
Antenatal care
• Is the care of the woman during pregnancy.
• Women who begin prenatal care early in their pregnancies have
better birth outcomes than women who receive little or no care
during their pregnancies.
Antenatal care services
• Included in the antenatal care visits:
• History and clinical examination.
• Laboratory investigations (urine, blood), sonography.
• Supplementations (iron, folic acid) and medications as needed.
• Nutritional advice.
• Immunization (tetanus).
Motivate adherence to treatments
• The purpose of antenatal care is to prevent or identify and treat conditions
that may threaten the health of the fetus /newborn and the mother and help a
woman approach pregnancy and birth as positive experiences.

• Good antenatal care includes regular screening that can detect and prevent
early complications such as hypertension and pregnancy diabetes, which
can dramatically affect the fetus. Early detection means regular monitoring
and treatment.
 Policy considerations

Antenatal care is one of the most important services in health

care.

Every pregnant woman should have full access to it.

Person-Centred Maternity Care

• According to the Institute of Medicine (IOM), Person-Centred

Maternity Care (PCMC) is defined as providing maternity care that is
respectful and responsive to individual women's preferences, needs
and values; ensuring that their values guide all clinical decisions
before, during and after childbirth.
Antenatal care visit schedule

As soon as the period is missed or within the;

a. First three months of missing the period.

b. Second ANC Checkup. In the 4th – 6th month of pregnancy.

c. Third ANC Checkup. In the 7th – 8th month of pregnancy.

d. Fourth ANC Checkup. In the 9th month of pregnancy.

Ante-Natal Care (ANC) profile
• Haemoglobin levels.
tests help assess the general
health of the mother, along with • Syphilis (VDRL)
testing for diabetes, genetically
• HIV Test.
transferred diseases, and
• Blood glucose level.
infectious diseases like HIV.
ANC profile tests also help the • Urine analysis.
doctor monitor the growth of
• TB screening.
the fetus and provide treatment
• ABO/Rh Blood group.
if required.
Another screening test

• Ultrasound is used during pregnancy to check the baby's development

and the presence of multiple pregnancies and help pick up any

abnormalities. The ultrasound scan isn't 100 per cent accurate, but the

advantages of the test are that it's non-invasive, painless and safe for

both mother and unborn baby.

Iron and folate
1 tablet, iron= 60 mg, folic acid = 400µg

All women Women with anaemia

1 tablet 2 tablets
In pregnancy Throughout the pregnancy 3 months
Postpartum and post- 3 months 3 months
abortion
Advice to ensure adherence to treatment
Give aspirin and calcium (if in an area of low dietary calcium intake)
• To all pregnant women at high risk of developing pre-eclampsia. Once-daily in
pregnancy to delivery

• Check the woman's supply of calcium and aspirin tablets at each visit and dispense
three month supply

Aspirin
• 1 tablet = 75 mg (or nearest dose). Give 75 mg to every pregnant woman at risk of
developing pre-eclampsia from 12 weeks until delivery.
Advice to ensure adherence to treatment

Calcium

• 1 tablet = 1500 mg of elementary calcium. Give 1500 mg to every

pregnant woman at risk of developing pre-eclampsia living in an area

with low dietary calcium intake from 20 weeks until delivery.

Perception Target Messages
Explore local perceptions about Explain to mother and her - Iron is essential for her health
iron treatment (examples of family during pregnancy and after
incorrect perceptions: making delivery
more blood will make bleeding - The danger of anaemia and the
worse, iron will cause too large a need for supplementation.
baby).

Explore the mother's concerns Explain to mother and her Has she used the tablets before?
about the medication family - Were there problems?
- Any other concerns?

Advise on how to take the Explain to mother and her With meals or, if once daily, at
tablets family night
- Iron tablets may help the
patient feel less tired. Do not
stop treatment if this occurs
- Do not worry about black
stools. This is normal.
Perception Target Messages
Give advice on how Explain to mother, her - If constipated, drink more water
to manage side- family, MWs, other - Take tablets after food or at night to avoid
effects community–based health nausea
workers - Explain that these side effects are not serious
- Advise her to return if she has problems
taking the iron tablets.
- Discuss, how to help in promoting the use of
iron and folate tablets.
- Counsel on eating iron-rich foods
If aspirin and Explain to mother and her - Both medicines are essential for good
calcium prescribed family maternal health and health of the baby, since
they prevent pre-eclampsia, which is a
serious complication.
- If taking calcium and iron, advise on taking
them several hours apart, for example,
calcium in the morning and iron in the
evening.
- Counsel on eating calcium rich foods, such as
milk, yoghurt, cheese, dark leaf vegetables,
soybean.
Intra-natal care

• Care is given during childbirth.

• Aims of services needed during delivery:

• Ensure asepsis.

• Delivery with minimum injury to baby and mother.

• Dealing with delivery complications.

• Care of the baby at delivery.

Postnatal care
• Care given after childbirth for the mother and the baby.
• Postnatal care services are related to issues like:
• Recovery from childbirth (to prevent haemorrhage, infections and
puerperal sepsis).
• Concerns about newborn care.
• Adequacy of breastfeeding
• Family planning services.
• Basic health education (feeding, hygiene, health check-ups, birth
registration).
• Postnatal care
Time just after delivery is especially critical for newborns and mothers,
especially during the first 24 hours.

Two-thirds of all maternal deaths occur in this postnatal period.

• Child care
Child care begins before the mother conceives, as her health affects her
child’s health.

The first year of life, infancy, is a vulnerable age with the most crucial
period in the first month, i.e. neonatal period.
Neonatal care
• Early neonatal care: This period carries a high risk of death. Early
neonatal care aims to help the newborn adapt to the new environment. It
is comprehensive care performed by a team where nursing plays a
significant role.

• Immediate neonatal care:

- Clearing the airway: from mucus and secretions, positioning the baby,
suction may be needed.
- APGAR score: Taken at 1 min then at 5 min after birth. Observation
for: heart rate, respiration, muscle tone, reflex responses and colour of the
newborn.
• Neonatal care immediate care
Care of the cord: Umbilical cord should be cut and tied after it stops
pulsating.

Care of the eyes: cleaning, checking for infection.

Care of the skin: the first bath is better given by the nursing staff to
remove vernix, meconium and blood clots.

We maintain body temperature: wrapping the baby and skin to skin

contact.
Thank for your attention

Mother and child health are closely related and considered one unit.

Most of the causes of illnesses and deaths related to mothers and

children are preventable.

Indicators for mother and child health reflect the quality of services and
the health system.

Improving mother and child health will enhance the population’s health.