|
  


 

m 57% of Total Population in India are
women in the reproductive age
group(15--45years) and children<15
group(15
years.
m Comprise the vulnerable section due
to risk connected with child bearing
in women and growth, development
and survival in infants and children
 þ 





 

 | 






|
 | 




|
|

|
   

m
m  


 

m
m 
m





   
 




  |


|

|
 |
þ 
 



 |
 
 




m 1/3rd girls married by the age of 15

m 2/3rd girls married by 18 years resulting in
TEENAGE / RISKY PREGNANCIES
m Every year roughly 30 million women
experience pregnancy and 27 million have
live birth.
m Annually 1lac pregnancy related maternal
deaths occur in country
m Millions suffer pregnancy related ill health
m Coverage of ANC remains around 50%
with variable quality
m Only 42.3% deliveries are attended by
TBA.
 | 

 !"#
m Nearly 65% deliveries occur at
home.
m Post--natal care is low at 17%.
Post
m Dubious distinction of having
unacceptable very high maternal
mortality at 407 per 100000 with
states like Assam, Bihar, U.P.,
experiencing >700 per 100000.
   |
 


m Anemia
m Hemorrhage

m Abortion

m Toxemia

m Puerperal sepsis

m Malpresentation

ALL ARE PREVENTABLE

For every maternal death 30 more suffer injuries,
infections & disability in pregnancy and childbirth.
4-6 million are illegal induced abortions whereas
11% are sex selective.
|  
| 
|m
m High Maternal Mortality
m Malnutrition in women and adolescent girls
m Early marriage
m Teenage pregnancy
m High fertility and high level of unmet
needs of contraceptives.
m RTI
m Unsafe Abortions
m Unsafe deliveries
|  
| 
|m
m Low level of coverage of ANC &
variable quality of ANC
m Low coverage of post natal care
m Illiteracy, poverty & lack of
information
m Adverse female sex ratio
m Poor referral services (Inadequate
first referral units)
 

m  
m
m
m 27 million babies born each year in
India
m 10% of them do not survive upto 5
years of age
m Neonatal, infant and child mortality
is high
   m m
 m 
|


m Prematurity
m Sepsis
m Asphyxia
m Acute respiratory infections
m Fever
m Negligible neonatal care in rural & urban
slums
All are preventable and curable.1/3rd
babies born are low birth weight i.e.
weighing less than 2500gms.
   | m 
m

m Poor environmental conditions

m Under nutrition
m Overcrowding
m Killer diseases like acute respiratory
infections, diarroheal diseases and
fever
|  
| 
m
m High level of neonatal, infant & under-
under-5
mortality due to
m Malnutrition
m Low Birth Weight
m Lack of essential neonatal care
m Wrong beliefs and faulty feeding
m Acute respiratory infections
m Diarroheal diseases
m Low level of coverage of measles
vaccination
m Gender disparity
|  
| 
m
m Adverse child sex ratio
m Low level of retention & enrolment in
schools for girls
m Unrecognized school health &
adolescent health services
m Street children face several
hardships in addition to behavioral
problems
MCH has been the pivotal function of
Primary Health Care provided through
Primary Health Centers & Subcentre.
Initially 3MCH sub centers were placed
under one PHC, subsequently 3 more were
added.
Under ICDS programme no. of subcentres
increased & due to universalisation of
Primary Health Care under National Health
Policy 1983.
Presently one subcentre available for 5000
population in rural & 3000 in tribal areas.
 At village level MCH services given
by
m Traditional Birth Attendants
m Health Guides
m ANMs
Referral services for mothers and
children are provided by PHC & CHC.
  
|
m  m
 
   
In rural areas MCH services are delivered
through organized infrastructure
m Through Primary Health Care delivery
system of Anganwadi Centres
m Birth Attendants
m Health guides at village level
m Accredited Social Health Activist (ASHA)
under NRHM
m Through S.C, PHC, CHCs and FRUs.
m By private practitioner
m By NGOs
 Urban areas lack well structured Health
System.
Multiple Health Agencies are available
m A.W.Cs
m Private Hospitals
m District Hospital
m Maternity Homes
Lack coordination.
Tribal areas constitute 8.2% of country's
population but have poor access to health
care
 |
!"
!
# !"$%!&
m Early registration
m At least 3 Antenatal checkups
m Universal coverage with TT vaccination &
treatment of anemia
m Advice on adequate food & rest
m Early detection and referral for maternal
complications
m Safe abortion and MTP services
m Delivery by trained personnel
m Institutional deliveries at FRUs / SDH for women
with bad obstetric history & risk factors
 |
!"
!
# !"$%!&
m Management of obstetric
emergencies
m Birth spacing & contraceptives
m Three post natal checkups
m Prevention & treatment of RTI &
STDs
m Early detection and treatment of
cervical cancers
m Management of infertility
  
   
O



 

m Resuscitation of new born with asphyxia

m Prevention of hypothermia( Kangaroo
Approach)
m Prevention of infections
m Promotion of Exclusive Breast feeding
m Referral of sick new born


# 
þ
m Semisolid feeding
m Feeding during illness
m Supplementary feeding
m Exclusive Breast feeding for atleast 6
months
  
    

m Control of vit.A deficiency
m Control of ARI-
ARI-Pneumonia control
m Integrated management of newborn &
childhood illness
m Immunization
m School Health services
m Adolescent Health
m Referral services
m Management of physical problems like
disability & behavioral problems
     m 
|
' ||
Launched on Sadbhavna Divas on
20th Aug.1992 by President of India.
Directed on achieving 9 of 17 goals
of NHP 1983
Interventions to reduce child
mortality & morbidity include:
Immunization, ORT, treatment of
pneumonia, vit.A prophylaxis
 |
Interventions for the mothers include
m T.T. immunization

m Prevention & treatment of anaemia

m Training of TBAs

m Provision of DDKs for clean delivery

m Referral for maternal complications,

obstetric emergencies, birth spacing
 

   
 

| þ 
A) REDUCTION OF MORTALITY RATE/1000
Current level 2000 level
m IMR(1992) 79 <60
m PMR(1992) 48.4 35
m Child 0-
0-4
mortality rate
(1990) 26.3 10
m MMR(1992) 4 2
 !$$
!$$
%&'
m Under weight babies
Current level 2000 level
30 10
 





 þ
m Immunization
Current level 2000 level
Infant 85.8 85
Preg. women 79.4 100
Delivery by
Trained personnel
1990 44.1 100
ANC 79 100



 


 %

Due to vitamin-
vitamin-A deficiency
Incidence of Blindness%0.3(2000level)
Current levels not available.
!()*+!*|
m Essential new born care
m Maternal Care especially clean
delivery by observing 5 cleans viz
clean surface, clean hands, clean
blade, clean tie & clean cord stump
without any application
m Provision of Drug Kits to sub-
sub-centers
under CSSM Programme annually.
 ),--
),
m IFA Large 1500 tab.(100mg)
m IFA Small 1300 tab.(20mg)
m Vit. A 5Bottle(20mg)1ml=1lacI.U

m Cotrimoxazole 1000 tab. Pediatric

m ORS packets 150 packs
 ),-- %
),
m Methyl ergometrine 1000 tab(.125)
m Chlorphenaramine 400 tab
m Paracetamol 500 tab
m Antispasmodic 250tab
m Inj. Methylergometrine 5 amp (.2mg)
m Mebendazole 300 tab (100mg)
m Chloramphenicol 1% 500 eye applicaps
m Cetrimide powder 5 packets (125mg)
m Povidone oint. 5 tubes of 25 gm each
m Cotton Bandage 120 rolls 4cm4mtr
m Cotton Absorbent 500gm (1 roll)


þ



 |





Integrated Child Development Service
Centers (ICDS) is another approach to
PHC.
ICDS was launched in 1975.
Till date 5068 projects have been
sanctioned.
OBJECTIVE: Improvement of nutrition,
immunization, health status of pregnant,
lactating women & less than 6year age
group.

 %.


 !"#
m To lay foundation for proper psychological,
physical & social development of children.
m To decrease incidence of mortality,
morbidity, malnutrition & school drop
outs.
m To achieve effective coordination & policy
implementation among various
departments to promote child
development.

 %.


 !"#
m Enhance capability of mother to look after
normal health, nutritional needs through
Nutrition & Health Education.
m Look after school drop-
drop-out girls
(adolescent girls) ÿ
 
ÿ 


2000 of 5068 centers are concerned with
this scheme to meet their needs for self
development, Nutrition & Health
Education.
 , þ 




m Supplementary Nutrition: Vit. A, Iron &
Folic Acid.
m Immunization.
m Growth monitoring.
m Health check ups.
m Referral services.
m Treatment of minor ailments.
m Nutrition & Health Education of children 3-
3-
6year.
 , þ 




m Convergence of supportive services
like water supply, sanitation.
m Adolescent girls (school drop-
drop-outs) to
be provided with basic knowledge on
Health & Nutrition.
m Health & Nutrition Education to
women in reproductive age group
15--45 years
15

+!+//*0
Anganwadi Worker (AWW) is the
heart of ICDS System. Each covers
1000 population in rural areas, 700
in tribal areas.
5 AWW are attached to one sub-
sub-
center.
  
Anganwadi workers function as
primary health care functionaries.
m They treat minor ailments like
fever, diarrhea, cough/cold, worm
infestation, cuts & wounds.
m Referral for sick & malnourished
children & mothers.
m Immunization of target population.

 !"#
m Supplementary feeding for 300 days
a year, in addition to home diet.
Children with Grade II malnutrition
given 300 Kcals & 10 grams protein
per day.
Pregnant & lactating mothers, Grade
IV malnourished children given 600
Kcals & 20 grams protein per day.

 !"#
m Incentives to pregnant women to get
themselves enrolled at the earliest.
m Iron folic acid tablets to mothers, children
& adolescent girls.
m Nutrition & Health Education to enhance
capability of mothers about their own
nutrition & that of their children, infant
feeding practices, environmental
sanitation & food hygiene.