Magnitude of MCH problems

Magnitude of MCH problems

1. MAGNITUDE OF MATERNAL AND CHILD HEALTH PROBLEMS Mrs.Jagadeeswari.J M.Sc Nursing

2. INTRODUCTION Maternal and child health is recognized as one of the significant components of Family Welfare. Health of both mother and children is a matter of Public Health concern. It is also being observed that the deaths of mothers and children are the major contributors to mortality in any community in India. Maternal and Child Health care services are essential and specialized services because mothers and children have special health needs which are not catered to by general health care services.

3. DEFINITION OF MATERNAL AND CHILD HEALTH Maternal and Child Health (MCH) refers to a package of comprehensive health care services which are developed to meet promotive, preventive, curative, rehabilitative health care of mothers and children.

4. OBJECTIVES OF MATERNAL AND CHILD HEALTH To reduce maternal, infant and childhood mortality and morbidity. To reduce perinatal and neonatal mortality and morbidity. Promoting and satisfying safe sex life. Regulate fertility so as to have wanted and healthy children when desired. Provide basic maternal and child Health Care to all mothers and children. Promote and protect health of mothers. To promote reproductive health. To promote physical and psychological development of children and adolescents with in the family.

5. DEFINITION OF MATERNAL HEALTH /REPRODUCTIVE HEALTH Maternal Health is now referred as "Reproductive  Health”   (RH). According to WHO it is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity in all matters relating to the reproductive system and its functions and processes.

6. GOALS OF MATERNAL AND CHILD HEALTH SERVICES To ensure the birth of a healthy infant to every expectant mother. To provide services to promote the healthy growth and development of children up to the age of under- five- years. To identify health problems in mother and children at an early stage and initiate proper treatment. To prevent malnutrition in mothers and children. To promote family planning services to improve the health of mothers and children. To prevent communicable and non- communicable diseases in mothers and children. To educate the mothers on improvement of their own and their children’s health

7. MATERNAL HEALTH PROBLEMS The Maternal Health Problems are as follows:- I . Nutritional Problems a)Malnutrition  b)Nutritional Anaemia II. Infection Problems a)Reproductive Tract Infections ( RTIs)/ Sexually Transmitted Infection (STI)  b)Infection in general c)Puerperal Sepsis III. Disturbances and Menstruation IV. Mature Gravidas V. Adolescent Gravida VI. Adolescent Parents Problems VII. Unregulated Fertility VIII. Abortions IX. Complications of Deliveries X. Infertility XI. Uterine Prolapse XII. Cancer of cervix

8. NUTRITIONAL PROBLEMS A.MALNUTRITION Malnutrition is a very common problem among women who are discriminated and underprivileged. Pregnant and nursing mothers are especially prone to the effects of malnutrition. Malnutrition can cause poor resistance, abortion, anaemia, miscarriage or  premature delivery, low birth weight baby (<2.5kg), eclampsia, postpartum haemorrhage. These conditions can cause fatal effects on mothers, unborn and new born babies. Malnutrition in women needs to be prevented and treated  by  some of  the direct measures such as nutrition education, modification and improvement of dietary intake before, during and after pregnancy, supplementation of diet, distribution of iron and folic acids tablets,   subsidizing of food items and their fortification and enrichment.

9. B.NUTRITIONAL ANAEMIA Anaemia in pregnancy is defined as a haemoglobin concentration of less than 11g%.Anemia is a condition in which concentration of haemoglobin in the red blood cell is reduced. Haemoglobin is essential for life. It carries oxygen to all parts of the body for its development and day to day function. It also maintains the immune system which provides resistance to infection. Therefore, an anaemia person acquires infection easily. Brain also gets less oxygen if a person is anaemic.

10. MAGNITUDE OF THE PROBLEM More than half of the pregnant women during pregnancy suffer from anemia.13%are severely anaemic. Haemoglobin is less than 7 gm/ decilitre. 1/5 of all maternal deaths are attributed to anaemia during pregnancy. More than half of the adolescent girls are anaemic Anaemia during pregnancy leads to : 20% of maternal deaths 3 times greater risk of premature delivery and LBW babies 9 times greater risk of perinatal mortality Irrecoverable brain damage in infants born to severe anaemic mother.

11. PREVENTION OF NUTRITIONAL ANAEMIA Promoting consumption of iron rich food Promoting growth of iron rich at home will increase the availability of iron in food, like spinach, lemon, amala , etc. Promoting consumption of iron and folic acid supplements.

12. INFECTION PROBLEMS A.REPRODUCTIVE TRACT INFECTIONS/STD RTIs include a variety of bacterial, viral and protozoal infections of the lower and upper reproductive tract of both sexes. RTIs pose a threat to women’s lives and well being throughout the world. Vaginal discharge is amongst the first 25% reasons to consult a doctor. 40 % gynaecological  OPD attendance is because of RTIs and 16 % of gynaecological admissions and due to pelvic inflammatory disease (PID)

13. CAUSE OF RTI/STD Infections caused by overgrowth of organism normally found in the vaginal tract are known as endogenous infection. These infections are associated with inadequate personal, sexual and menstrual hygienic practices. Sexually Transmitted Diseases (STDs) are a specific  group  of  communicable diseases that are transmitted through sexual contact. Infections which are due to inadequate medical procedures such as unsafe abortion, unsafe delivery or unhygienic IUD insertion are known as iatrogenic infections

14. SIGNS AND SYMPTOMS OF RTI IN WOMEN : Increased discharge from the vagina that looks and smells different from ( change in amount, colour and smell) Pain or burning while urinating. Painful or painless sores, blisters or warts on or near the genitals. Pain on one or both sides of lower abdomen. Irregular menstrual periods. Pain or bleeding during intercourse. Rash on the entire body or just on the palms and soles. Swelling on one or both sides of the groins. In Men: Symptoms usually appear within 2-3 days or a couple of weeks or even months after having sex with an infected partner are: Pus or discharge from the penis. Burning or pain while urinating. Painful or painless sores, blisters or warts on or near the penis. Pain in one or both the testicles

15. PREVENTION OF RTI/STD Identify the women with RTIs/STI Refer the women to medical officer of PHC promptly for examination and treatment. Identify sexual partners and ensure their treatment. Advice correct use of condom during every sexual act. Provide counselling/health education to individuals, family and community.

16. INFECTION IN GENERAL The women during pregnancy, especially in underdeveloped areas and developing countries are at risk of contact infection. Many women get infected with herpes simplex virus,  cytomegalovirus , protozoon which causes toxoplasmosis Coli causing nephritis or  cystitis.Infection  during pregnancy can cause various harmful effects e.g. retardation of foetal growth, abortion, low birth weight baby and puerperal sepsis. It is very important that women during pregnancy need to alert and careful regarding prevention and control of infection.

17. PUEPERAL SEPSIS It is mainly due to infection during labour and after delivery because of lack of personal hygiene, insanitary conditions, septic procedures, etc. This may lead to inflammation of ovaries, fallopian tubes, endometrium, cervix and vagina. Many time leucorrhoea may persist for years. Some times secondary sterility may follow after acute or chronic salpingitis. Chronic infections of cervix may predispose to cancer of the cervix. It requires proper preparations for confinement by the mother, conduct of deliveries by trained and skilful dais, midwives etc. And availability of equipment's and supplies etc.

18. DISTURBANCE AND MENSTRUTION Amenorrhoea, , dysmenorrhoea, hypermenorrhoea/  menorrhagia and , metrorrhagia. Menstruation is perceived as a particular problem for women. HEALTH TEACHING REGARDING MENSTRUATION : Knowledge of the physiological process. Factors that may alter the menstrual cycle, stress, fatigue, exercise, acute or chronic illness, changes in climate, or working hours and pregnancy. Personal hygiene Mild Exercise Diet Sex during menstruation

19. MATURE GRAVIDAS The pregnant woman over 35 years faces unique problems. The primigravida in this age category has generally decided to postpone child bearing until her career is well established They feel unable to take care of themselves and often have little experience in relying on others during times of need. The educational level of the client must be  considered  when recommending literature.

20. ADOLESCENT GRAVIDAS The adolescent mother and her family create a particularly difficult problem. The need can be so extensive that care will be fragmented and ineffective unless and interdisciplinary team approach coordinates the school, social and health care services. The mean age of menarche is around12 years.42% of girls and 64 % of young boys are sexually active by age of 18.A family’s reaction to teen age pregnancy varies considerably. In certain ethnic and cultural groups, teenage parenting is common. Sex education and family planning helps the adolescent gravida

21. ADOLESCENT PARENTS PROBLEMS Adolescent parents are rarely able to support themselves and their children. Optimally, the family should be involved early. Detailed arrangements must be worked out, and allowing enough time before delivery makes the crisis less overwhelming. Building on supplementing family resources and only substituting for families when absolutely necessary is believed to be the most effective way to help adolescents and their infants. Today, a pregnant woman has three choices, to abort, to have the child place it for foster care or adoption, or to have the child and raise it. Adolescents parents have the same choices, but may need to guided through the decision making process.

22. UNREGULATED FERTILITY Unregulated fertility has been recognized to cause many maternal health hazards. These include abortions, miscarriage, premature  deliveries, low   birth  weight  babies,APH etc  All these health hazards are responsible for high maternal and perinatal mortality. It is being  recognized  to regulate fertility by integrated and comprehensive approach in family  welfare  services which include effective measures related to reproductive health, child health and family planning

23. ABORTIONS 20% of maternal mortality is directly related to abortion related causes. The number of abortions is on the increase because of unwanted pregnancies. Medical Termination of Pregnancy (MTP) has been legalized under the MTP Act of 1971, under certain conditions. By and large abortions are still done by quacks and unauthorized persons in the rural areas. This is mainly due to lack of access to safe abortion clinics, non- availability of such clinics, poor financial resources to reach to  clinics  in urban areas, lack of information about the availability of safe abortions clinics, lack of privacy and impersonal atmosphere in the Government run clinics and reluctance of unmarried or widowed.

24. COMPLICATIONS OF DELIVERIES In India most of the deliveries take place at home under unhygienic environment and mostly by untrained dais lacking obstetric skill. Often various health hazards results in such as perineal tears, cervical damage, prolapse and displacement of uterus, fetal distress, postpartum haemorrhage etc. Thus it is very important to have properly trained, skilful and qualified health workers, adequate facilities and well linked referral units where skilful and efficient emergency care can be given to save mother and baby.

25. INFERTILITY Infertility is both medical and social problem Even if the fault/defect is in the male partner, usually it is the woman who is labelled and is socially not treated properly by the family and the society. Therefore this problem is to be considered medically as well as socially. There is need to have empathetic attitude towards childlessness of woman by society.

26. UTERINE PROLAPSE Uterine prolapse is the major problem in women of hilly region. Women working at construction sites, climbing heights, or digging and ground or climbing 2-3 storey with heavy weights are predisposed to prolapse uterus. Certain child birth practices such as  fundal pressure during labour, pulling the baby etc. Lead to prolapse of the uterus, especially when the mother is weak and malnourished. Uterine prolapse may cause lot of inconvenience to mother and predispose her to infection. Hence the need for trained and skilful dais and midwives, improvement of working conditions and education of women.

27. CANCER OF CERVIX Cancer of the cervix is very common among Indian women. There are various factors which contribute to the prevalence of cancer of cervix. These are early marriage and early pregnancy, multiple child birth, poor hygiene by  the male partner, multiple partners, and repeated infections. Most of these factors are pertaining to sociocultural aspects of a community and families are imply involving attitudinal change in these practices to prevent the occurrence of cancer of the cervix.

28. CHILD HEALTH PROBLEMS

29. CHILD HEALTH PROBLEMS Nutritional deficiency Problems Malnutrition Vitamin Deficiency Iron Deficiency Low Birth Weight Infectious Diseases a)Tuberculosis b)Diphtheria c)Pertussis (Whooping Cough) d)Tetanus e)Poliomyelitis f)Measles Problems of Neonates a)Hyper bilirubinaemia  b)Hypothermia c)Neo-natal tetanus d)Birth asphyxia

30. NUTRITIONAL DEFICENCY PROBLEMS MALNUTRITION The primary cause of malnutrition is inadequate and faulty diet. Apart from poverty and other socio economic factors, environmental factors also play an important role in aggravating the dietary deficiency diseases. These  precipitating factors are the widespread chronic infections among the poor living  under  conditions of poor environmental sanitation and personal hygiene

31. REASONS OF MALNUTRITION IN INDIA Food availability Poverty Population problem Socio factors-diet ,caste ,alcohol.

32. PROTEIN ENERGY MALNUTRITION Protein Energy Malnutrition is defined as a range of pathological conditions arising from coincident lack of varying proportions of protein and calorie, occurring most frequently in infants and young children and often associated with infection. -WHO 1973 CLINICAL FORMS OF PEM : KWASHIORKOR MARASMUS

33. CONTD…. KWASHIORKOR: Kwashiorkor  is the condition of deficiency of protein with an adequate supply  of  calories. MARASMUS: Marasmus results from general malnutrition of both calories and protein. It is common occurrence in underdeveloped countries.

34. CAUSES OF PEM a)Nutritional Factors Poor caring practices include  Not feeding the sick children.  Not providing the adequate complementary feeding.  Not supporting mothers to breast- feed adequately.  Non – breastfed. Late weaning. Inadequate supplementation. Failure to feed during illness. Failure to increase to caloric intake immediately after the illness. b)Non – Nutritional Factor Due to poverty, mother is not able to provide sufficient food to the child resulting in under nutrition.  Non- immunization Improper growth monitoring. Poor weight gain during adolescence Poor environmental and personal hygiene Illiteracy Large family

35. SIGNS OF SYMPTOMS OF PEM

36. VITAMIN DEFICIENCY VITAMIN A DEFICIENCY Vitamin A deficiency is a major nutritional problem affecting young children leading to blindness. In India about 5 – 7 % children suffer annually from eye damage caused by vitamin  A   Deficiency . CLINICAL FORMS OF SEVERE VITAMIN A DEFICIENCY : Xeropthalmia Night blindness Bitot spots Conjunctival xerosis Corneal xerosis Keratomalacia Corneal scars

37. MANAGEMENT OF PEM Adequate nutritious diet either by breastfeeding or a proper weaning diet. 5 grams of protein/ kg body weight/day should be given for the existing weight. Rehydration with an oral rehydration solution that also replaces electrolytes. Treatment of infections. Medications such as antibiotics and antidiarrheal. Health education Diet rich in fat and calories is given Vitamin A should be given Folic acid should be given

38. MANAGEMENT OF VITAMIN A DEFICIENCY Immediately on diagnosis, water soluble  1,00,000  IU of vitamin  A intramuscularly can be given for corneal xerosis, ulcer,  keratomal-acia , xerophthalmia, severe infection and malnutrition. Immediately on diagnosis for less severe forms like night blindness, conjunctival xerosis, Bitot’s spot, oil solutions as palmitate 2, 00,000 IU can be given orally. On second day oil solution of 2, 00, 000 IU orally should be given prior to the discharge from the hospital.

39. PREVENTIVE MEASURES Nutrition and health education should be given to the mothers. Pregnant and lactating mothers should be encouraged to consume dark green leafy vegetables and yellow or orange fruits so that there is sufficient storage in vitamin A in the liver of new born. Mothers should be motivated to feed their children as vitamin A present in the milk is adequate for 3 to 6 months of infant’s life. The weaning diet should be consist of dark green leafy vegetables, yellow or orange fruits, whole milk, butter, fish and egg. Monitor vitamin A periodically.

40. VITAMIN D DEFICIENCY Deficiency of vitamin D causes rickets in young children in the age group of 6 months to 2 years. It reduces calcifications of bones which affects growth of bones and cause deformity of bones such as curved legs, pigeon chest, rickety rosary, deformed pelvis. There is delayed teething, standing and walking. It is no more a serious problem because of improvement in child health care services, socio-cultural practices, plenty of available sunshine.   Food rich in vitamin D such as butter, cheese, egg yolk, liver, fortified food such as milk, Vanaspati oil etc. Fish liver oil is very good source of vitamin D .

41. IRON DEFICIENCY The iron deficiency causes nutritional anaemia  in  children. About  50 % of children have anaemia. It is due to malnutrition. It usually leads to various others problems such as general weakness affecting work performance, reduced immunity and resistance to infections resulting in increased  morbidity  and  mortality . It affects physical and  psychological  behaviour of  the   children . Anaemia is aggravated by worm  infestation and malarial parasites.

42. ROLE OF NURSE IN IRON DEFICIENCY Encourage mothers and family members to monitor growth and development of their children and to bring them to health centres for regular check up and record weight, height etc. Ensure 100% coverage of administration of vitamin A mega doses to children. Help and guide health workers and mothers detect early cases of malnutrition and other nutritional deficiencies such as vitamin A, iron and vitamin D and refer them to health centres as the need to be. Guide and supervise health workers to participate in nutrition programmes like Integrated Child Development  Scheme, Nutritional  Anaemia  prophylaxis  programme, midday meal programme.

43. LOW BIRTH WEIGHT Low birthweight is a major public health problem in many developing countries. About 30  %of  babies born in India are low birth weight as compared to  4%in  some developed countries. In countries when the proportion of low birth weight is high the majority are suffering from fetal growth retardation. The causes of LBW are malnutrition ,anaemia ,infection ,high parity ,smoking ,etc.

44. CLASSIFICATION OF LBW Preterm babies : Babies born before 37weeks or less than 259 days. Small for date : Infants birth weight below 10 th percentile for the gestational age MANAGEMENT OF LBW NEWBORN Provide warmth Exclusive breast feeding Prevent infections Teach mother to recognize danger signs PREVENTION OF LBW BABIES Increasing food intake Controlling infection Early detection of conditions or problems and treatment of disorders

45. INFECTIOUS PROBLEMS TUBERCULOSIS It is a communicable disease suffered by all ages. It is a problem in community. It is an infectious disease caused by mycobacterium tuberculosis. The  major  source of infection is infected sputum of persons having tuberculosis who are either not being treated or not being fully treated. Tuberculosis affects all age group. The incidence of infections increases sharply from infancy to adolescence. 1% of children in the age group under five are infected with tubercle bacilli as evidenced by tuberculin test. MAGNITUDE OF PROBLEM : 15 million cases of infectious tuberculosis at present 2-3 million cases are added every year  1-2 million people die every year.

46. PREVENTION AND CONTROL OF TUBERCULOSIS Specific protection by BCG. Improving general health and resistance of children Early identification and treatment Regular treatment and follow up Educate parents family members and community Health supervisor must supervise and guide health workers.

47. DIPHTHERIA Diphtheria is very serious disease because if it is not treated immediately it leads to high mortality. It is caused by Corynebacterium diphtheria. Diphtheria is transmitted by direct droplet and direct airborne. The incidences of diphtheria are highest in the age group of 1-3 years. incubation period of disease is 3-4 days.

48. MAGNITUDE OF THE PROBLEM Diphtheria is a worldwide problem in most developed countries owing to routine children vaccination.  In India, it is an endemic disease.  Fatality rate on an average is about 10 % which has changed little in the past 50 years in untreated cases and about 5 % in treated cases.

49. PREVENTION AND CONTROL OF DIPHTHERIA Diphtheria is preventable by specific protection by immunization of all children with diphtheria toxoid. The children should be immunized as early as possible so as to protect them before they lose their natural immunity. The immunization of diphtheria is done by combined or mixed vaccines which include diphtheria, pertussis and tetanus vaccine (DPT).

50. PERTUSIS(WHOOPING COUGH) Whooping cough is an acute infectious disease causing  complications  and high mortality in many parts of the world. It is caused by Bordetella Pertussis. The source of infection is infected human being The period of incubation usually ranges from 7 – 14 days, but in any case not more than 21 days.  Prevalence is more in children living in overcrowded homes and slums. The disease affects trachea, bronchi and bronchioles.

51. MAGNITUDE OF THE PROBLEM Whooping cough : occurs endemically and epidemically in tropical countries. Since the reporting of whooping cough is inadequate, reliable information about the incidence of this diseases lacking in most countries. About 10 percent of all whooping cough cases and about half of the death occur in children under one year . PREVENTION AND CONTROL OF WHOOPING COUGH The occurrences of pertussis can be prevented by immunization of children which is done in combinations with diphtheria and tetanus. The child either having or suspected having whooping cough should be isolated as far as possible The usual treatment is administration of antibiotic to control secondary infections Clothes, fomites should be disinfected and discarded properly to prevent spread of infections

52. TETANUS Tetanus is an acute and highly fatal disease. It is caused by clostridium tetani which is as pore forming bacteria Infections enter the body through injury which gets contaminated.   Infections can take place by many other ways for example during delivery and after delivery, while cutting the cord and thereafter by improper care of the cord, extraction of teeth, injections, tattooing, gangrenous foot, otitis media etc. The usual average incubation period ranges from 6-10 days. The mortality rate is very high (40-80%). It is highest in neonatal tetanus (80-90%).

53. MAGNITUDE OF THE PROBLEM It is one of the leading causes of infant mortality 5 to 10 percent of neonatal deaths in Calcutta were due to tetanus PREVENTION AND CONTROL OF TETANUS T.T immunization is done soon after road injury especially if T.T immunizations are not done with in 5 years. In addition, all wounds and injuries should be thoroughly cleaned and covered with sterilized dressing aseptically. Tetanus can be prevented by active immunization by tetanus toxoid of all antenatal mothers and children according to national immunization schedule.

54. POLIOMYELITIS Poliomyelitis is a crippling disease as it causes lameness. It is caused by virus. The virus is found only in human beings. The source of infections is human faeces and or  pharyngeal secretions of an infected person. The disease occurs in children under five years of age, but mostly between 6 months and 3 years. The incubation period ranges from 3 to 35 days but usually the clinical signs appear 7to 14 days after the infections

55. PREVENTION AND CONTROL OF POLIOMYELITIS Poliomyelitis is prevented and eradicated by immunization of all infants by 6months of age. There are two types of vaccines which are used. These are inactivated polio vaccine (IPV) and Oral Polio Vaccine (OPV). Three doses of OPV at an interval of one month each are recommended by WHO. The immunization must be completed by six months; one booster dose is to begiven at 12-18 months later. The health worker must educate parents and family members about the importance of polio immunization and motivate them for the same.

56. MEASLES Measles is a worldwide endemic disease. It occurs more in the winter months. children in the age group of 6 months to 3 years are the most susceptible.  Incubation period 10 days but it ranges from 8 to 16 days. The common complications which can occur during measles include Broncho-pneumonia, diarrhoea ,otitis media, encephalitis etc. depending upon the nutritional status and general body resistance of the child.

57. PREVENTION AND CONTROL MEASLES The occurrence of measles can be prevented completely by  achieving  an immunization level of 95 percent and by continuing immunization of children of successive generation. As per National Immunization Programme, immunization must be done at the age of 9 months by giving a single dose of 0.5ml of live attenuated  vaccine subcutaneously. Health education of people at large to educate about prevention and control of measles

58. PROBLEMS OF NEONATES HYPERBILIRUBINEMIA This condition refers to excessive presence of bilirubin in the blood. It is indicated as pallor of the skin and eyes. It is either due to physiological jaundice, RH or ABO incompatibility. Physiological jaundice usually  disappears  with in days with phototherapy. Jaundice due to RH incompatibility occurs due to 24 hours and requires blood transfusion.

59. HYPOTHERMIA The new born baby may go into hypothermia within one hour of birth, with the temperature (axillary) falling below 36.5 degree c (97.7 degree F). This happens if  proper precautions are not taken to prevent chilling of the baby. The woman in the family and birth attendant should be made aware about drying the baby after birth, providing skin to skin contact with the mother and initiating breast feeding within an hour of birth. Hypothermia is harmful to the new born, increasing the risk of the morbidity and mortality.

60. NEONATAL TETANUS Neo- Natal tetanus is the common problem. It is usually due to sepsis caused by uncleaned delivery and cord care. Considering the preventable nature of NNT, WHO has resolved to eliminate NNT by aiming to reduce the incidence to less than 1 case per 1000 live births. The same goal is accepted by the Indian Government. The following actions are implemented… 100 percent coverage of pregnant women with two doses of Tetanus Toxoid (T.T.) 100 percent clean deliveries. Surveillance of neonatal deaths and investigations of tetanus.

61. BIRTH ASPHYXIA Birth asphyxia is characterized by absent or depressed breathing at birth. Difficulty in initial breathing is due to variety of reasons such as prolonged or obstructed labour, prematurity, infection etc. often it can be anticipated. The following actions should be taken to reduce neonatal deaths due to birth asphyxia. To keep ready the necessary equipment's for management of birth asphyxia. Clearing of air passage immediately as the child is born. Ventilating with mask or bag and mask. Cardiac massage when brady- cardia persists. Mouth to mouth breathing when necessary. Training of health workers in the assessment and management of  birth asphyxia.

62. FACTORS INFLUENCING MATERNAL AND CHILD HEALTH Maternal health Sexuality factor Nutrition Environmental factor Psychological factor Ethnic and socio cultural aspects factor Lifestyle factors

63. MATERNAL FACTOR As maternal age advances, so does the rate of aneuploidy. The result is increased rates of pregnancy loss and birth of infants with chromosomal anomalies. Most women and men are aware that advanced maternal age (older than 35 years) may affect a pregnancy adversely. This awareness is the direct outcome of the adoption .Information and the considerable media exposure about this issue through public service campaigns

64. SEXUALITY FACTOR Both the client and her partner may express concerns about sexuality and intercourse during pregnancy. Although there is no reason why the healthy woman need abstain from intercourse or orgasm during pregnancy, some sources suggest that women should avoid coitus and orgasm in the last 4 weeks of pregnancy. Nipple stimulation, vaginal penetration, or orgasm may cause uterine contractions secondary to the release of prostaglandins and oxytocin. Therefore women who are predisposed to preterm labour or threatened abortion 

65. NUTRITION During pregnancy changes must occur to ensure that gestation progresses and both mother and fetus remain healthy.  Nutrition has critical role in pregnancy outcomes maternal nutritional status at conception and throughout gestation greatly influences not only the mother’s health but also that of the fetus. Adequate folate status, which helps prevent neural tube defects, and control of blood glucose level, which improves the abilities to conceive and to give birth to a healthy newborn.

66. ENVIRONMENTAL FACTOR Environmental factor also influence on maternal and child health. So we have to know about the environment in which the woman and partner reside and work .Men exposed to toxic substances such as heat, radiation, viruses, bacteria, alcohol, and prescription and recreational drugs are more likely to have decreased morphologically and genetically normal sperm in a single ejaculate. This results in reproductive failure preconception and post fertilization. Women exposed to similar toxic agents experience diminished ovarian reserver, poor endometrial lining development, and abnormal fetal development. Likewise, chronic and acute diseases decrease fecundity and increase fetal wastage.

67. PSYCHOLOGICAL FACTOR Environmental factors such as emotional stress, anxiety, fears, frustrations, broken homes, poverty and many others can lead to mental illness. The psychosocial environment at home or school is an essential factor for health. Children exposed to happy and healthy homes make them physically and mentally healthy.

68. ETHINIC AND SOCIO CULTURAL FACTOR Culture and family must be viewed simultaneously for, regardless of the family type, it remains the basic unit of society and influences human development over the life span. Religious beliefs and practices are part of cultural and familial heritage  and  influence health care behaviours. Within the neighbourhood and community

69. LIFE STYLE FACTORS Health is related deeply to life- style which includes ways of living, personal hygiene, habits and behaviour. A healthy lifestyle helps to promote health and poor lifestyle has ill effects on health. HEALTHY LIFE STYLE CHOICES OF MCH Regular exercise Weight control Avoidance of saturated fats Alcohol and Tobacco avoidance Seat beat use Immunisation updates Regular dental check up Regular health maintenance.

70. CONCLUSION Maternal and child health is recognized as one of the significant components of Family Welfare. Health of both mother and children is a matter of Public Health concern