8. (MNCH) refers to an effective
and integrated continuum of
care that delivers basic
services to mothers and their
infants at critical points , and
to children in their first five
years of life, with the goal of
ensuring the health and
survival.
Maternal, Newborn and Child Health
12
9. These include:1.better prenatal care,
2.having a skilled health
assistant during birth,
Maternal, Newborn and Child Health
13
10. 3.access to emergency obstetrics
and newborn care,
4.postnatal visits,and antibiotics
to treat infections of mothers and
newborns.
Maternal, Newborn and Child Health
14
12. The lifetime risk of a women dying
from pregnancy-related causes
(maternal death) in the developing
world is 1 per 76, compared with 1
per 8,000 in the industrialized
world.
Maternal, Newborn and Child Health
16
13. Of all deaths worldwide among
pregnant women, infants, and
children under age 5, about 99
percent occur in developing
countries.
Maternal, Newborn and Child Health
17
14. •In UK, Europe and USA and
until the Second World War
organized antenatal care was
not available to all people.
Maternal, Newborn and Child Health
18
15. In sudan 90% of mothers
deliver at home and attended
to by midwives or sometimes
by general practioners.
Maternal, Newborn and Child Health
19
16. •The maternity care
services, are mainly at
the level of the local
community ever since
the start of midwifery
training in 1921.
Maternal, Newborn and Child Health
20
17. •The health system in this
country is based on the
primary
health
care
approach
since
its
inception more than 70
years ago.
Maternal, Newborn and Child Health
21
18. •Sudan is committed to
the Alma Ata
Declaration of
1978, and the adoption
of primary health care
policy.
Maternal, Newborn and Child Health
22
19. In september 2000,the primary
health care changed into
Millennium Development
Goals,which has 8 goals have
agreed to try to achieve by the
year 2015,MDG4 and MDG5(to
reduce child death and improve
maternal health).
Maternal, Newborn and Child Health
23
20. In spite of all efforts at all
levels of health care to
improve the health of the
mother and newborn ,still
mortility rate is high.
Maternal, Newborn and Child Health
24
22. Maternal mortality
• 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.
Maternal, Newborn and Child Health
26
23. • To reduce maternal deaths globally
we need to assure that effective
services are provided for improving
overall maternal health .
Maternal, Newborn and Child Health
27
24. • Causes of maternal mortality
• Women die as a result of complications
during and following pregnancy and
childbirth.
• Most of these complications develop
during pregnancy.
Maternal, Newborn and Child Health
28
25. • Other complications may exist before
pregnancy but are worsened during
pregnancy.
Maternal, Newborn and Child Health
29
28. • In developing countries, conditions
related to pregnancy and childbirth
constitute the second leading causes
(after HIV/AIDS) of death among
women of reproductive age.
Maternal, Newborn and Child Health
32
29. • The state of maternal health mirrors
the gap between the rich and the
poor.
• Only 1% of maternal deaths occur in
high-income countries.
Maternal, Newborn and Child Health
33
30. • Also, maternal mortality is higher in
rural areas and among poorer and less
educated communities.
• Of the 1000 women who die every
day, 570 live in sub-Saharan Africa, 300
in South Asia and five in high-income
countries.
Maternal, Newborn and Child Health
34
31. • Many of these deaths could be
prevented if information on family
planning and contraceptives were
available and put into practice.
Maternal, Newborn and Child Health
35
32. • One target of the Millennium
Development Goals (MDGs) is to
reduce the maternal mortality ratio
by three quarters between 1990 and
2015.
Maternal, Newborn and Child Health
36
33. • So far, progress has been slow. Since
1990 the global maternal mortality
ratio has declined by only 2.3%
annually instead of the 5.5% needed
to achieve MDG 5, aimed at
improving maternal health.
Maternal, Newborn and Child Health
37
34. • The main obstacle to progress
towards better health for mothers is
the lack of skilled care.
• This is aggravated by a global
shortage of qualified health workers.
Maternal, Newborn and Child Health
38
35. Integrated Management of Pregnancy and
Childbirth (IMPAC)
• IMPAC - Integrated Management of
Pregnancy and Childbirth is the package
of guidelines and tools which is central to
the Department's technical assistance
activities to support countries in strategic
and systematic ways to improve
maternal, perinatal and newborn health .
Maternal, Newborn and Child Health
39
36. • IMPAC offers a framework in which
national policies, programs and
action plans can be elaborated.
• It targets health systems, health
workers, as well as health
promotion.
Maternal, Newborn and Child Health
40
37. • Health systems
• On the health systems level, the
approach aims at improving not only the
access to, but also the quality of essential
and emergency care
• Health workers
• To improve the skills and competencies
of health care workers is the second
strategy of the IMPAC approach
Maternal, Newborn and Child Health
41
38. • Health Promotion
• To better respond to women and
newborn's health needs and to increase
the utilization of available health
services, programmes need to
implement interventions to improve
health in the home and to involve
women, families and community
actors, including other sectors, to identify
key problems and solutions to reaching
Maternal, Newborn and Child Health
42
40. Safe Motherhood
• Is one of the important components of
Reproductive Health.
• Means ensuring that all women receive
the care they need, to be safe and
healthy throughout pregnancy and
childbirth.
• The ability of a mother to have Safe &
Healthy pregnancy & Child Birth.
Maternal, Newborn and Child Health
44
41. •The Safe Motherhood Initiative is a
worldwide effort that aims to increase
attention to and reduce the devastating
numbers of women that suffer death or
serious illness every year.
Maternal, Newborn and Child Health
45
42. • Making motherhood safe for the
world’s women calls for national
governments, funding agencies, and
non-governmental organizations (NGOs)
to make maternal health an urgent
health priority and to ensure that the
necessary political and financial support
is dedicated to this effort.
Maternal, Newborn and Child Health
46
43. •In order to reduce life-threatening risks
and reduce mortality, good-quality
maternal health services by trained
health workers must be available and
must be used.
•Therefore, safe motherhood strategies
must be comprehensive in nature; even
when quality health services are
available, other limiting factors can get in
the way of women using these
services, such as social, economic and
cultural factors
Maternal, Newborn and Child Health
47
44. Safe Motherhood includes antenatal
care, delivery care (including skilled
assistance for delivery with appropriate
referral for women with obstetric
complications) and postnatal
care, including care of the baby and
breastfeeding support. Sexually
transmitted disease (STD)/ HIV/ AIDS
prevention and management, family
planning services.
Maternal, Newborn and Child Health
48
45. BASIC MATERNITY CARE
postpartum care
Clean/Safe
Delivery
FAMILY PLANING
ANTINATAL CARE
SAFE MOTHERHOOD
PRIMARY HEALTH CARE
EQUITY FOR WOMEN
Maternal, Newborn and Child Health
Health policy
49
46. Prenatal care is a type of preventative care
with the goal of providing regular check-ups
that allow doctors or midwives to treat and
prevent potential health problems throughout
the course of the pregnancy while promoting
healthy lifestyles that benefit both mother and
child.
Maternal, Newborn and Child Health
50
47. • During check-ups, women will receive
medical information over maternal
physiological changes in
pregnancy, biological changes, and
prenatal nutrition including prenatal
vitamins. Recommendations on
management and healthy lifestyle
changes are also made during regular
check-ups
Maternal, Newborn and Child Health
51
49. Family planning allows individuals and
couples to anticipate and attain their
desired number of children and the spacing
and timing of their births. It is achieved
through use of contraceptive methods and
the treatment of involuntary infertility. A
woman’s ability to space and limit her
pregnancies has a direct impact on her
health and well-being as well as on the
outcome of each pregnancy
Maternal, Newborn and Child Health
53
50. Clean save delivary
•
•
•
•
•
•
•
Clean hand
Clean surface
Clean cord tie
Clean blade
Clean cord stumb
Clean towel
Clean water
Maternal, Newborn and Child Health
54
51. Postpartum Care Since up to 50 per cent of
maternal deaths occurs after delivery, a
midwife or a trained and supervised TBA
should visit all mothers as soon as possible
within the first 24-48 hours after birth.
The midwife or TBA should assess the
mother's general condition and recovery
after childbirth and identify any special
needs.
This attention is particularly important when
the woman is alone as head of the family..
Maternal, Newborn and Child Health
55
52. The postpartum visit provides an occasion for
assessing and discussing issues of
cleanliness, care of the
newborn, breastfeeding and appropriate
methods and timing of family planning .
Health providers should support early and
exclusive breastfeeding, and discuss proper
nutrition with the mother.
Iron folate tablets should be continued and
Vitamin A and iodised oil/ salt should be
provided when necessary.
Maternal, Newborn and Child Health
56
53. • During the postpartum visit, the health
and well being of the newborn should
also be assessed and its birth weight
measured.
• Newborns should be referred to the
under-five clinic to start
immunisations, growth monitoring and
other well-child services.
Maternal, Newborn and Child Health
57
54. • Community Health Workers (CHW) and
TBAs should be trained for appropriate
referral of postpartum
complications, such as
haemorrhage, sepsis, perineal
trauma, breastfeeding problems, and
newborn complications, such as
prematurity or failure to thrive, that
may require additional surveillance
Maternal, Newborn and Child Health
58
56. Reproductive Health
Learning Objectives
• Learn to define Reproductive health
• Understand the concept and importance of
RH
• Describe the components of RH package
Maternal, Newborn and Child Health
60
57. Reproductive Health
It is a state of complete physical, mental and
social well-being and not merely absence of
disease or infirmity, in all matters relating to
reproductive system and to its functions and
processes.
Reproductive health care is defined as the
constellation of methods, techniques and
services that contribute to reproductive health
and well-being through preventing and solving
reproductive health problems.
Maternal, Newborn and Child Health
61
58. Concept of Reproductive Health
It implies that
• couples have the ability to reproduce and regulate
their fertility
• women are able to go through pregnancy and
child birth safely
• outcome of the pregnancy is successful in terms of
maternal and infant survival and well-being and
• couples are able to have sexual relations free of
the fear of pregnancy and of contracting any
disease
Maternal, Newborn and Child Health
62
59. Every minute in the world
380 women become pregnant
190 of these did not plan or do not
wish the pregnancy
Maternal, Newborn and Child Health
63
60. Every minute in the world
110 women experience a pregnancyrelated complication
40 women have an unsafe abortion
1 woman dies from a pregnancy
related issue
Maternal, Newborn and Child Health
64
62. RH Package Offers-Following
Services
Comprehensive family planning for
and males;
·
Maternal health care including safe motherhood,
and pre and post abortion care for
complications;
·
Infant Health Care;
·
Management of reproductive health related
problems of adolescents;
Maternal, Newborn and Child Health
females
66
63. Reproductive Health Package
contd…
Management of other reproductive
health related problems of women;
Prevention and management of
RTIs/STIs and HIV/AIDS;
Management of infertility;
Detection of breast and cervical
cancers;
Management of reproductive health
related issues of men.
Maternal, Newborn and Child Health
67
64. FAMILY PLANNING
The adult lifetime risk of maternal
death (the probability that a 15-year-old
female will die eventually from a
maternal cause:
1. 1 in 31 in sub-Saharan Africa,
2. 1 in 11 in Afghanistan,
3.1 in 4300 in developed regions.
4. In Belgium, the risk is 1: 10 900.
IN WHO 2010.
Maternal, Newborn and Child Health
68
65. • Quality family planning services bring a
wide range of benefits to women, their
families and society.
Maternal, Newborn and Child Health
69
66. Benefit of family planning
A. Preventing pregnancy-related health
risks in women
B. Reducing infant mortality
C. Helping to prevent HIV/AIDS
D. Reducing the need for unsafe abortion
E. Empowering people
F. Reducing adolescent pregnancies
G. Slowing population growth
Maternal, Newborn and Child Health
70
67. • Fertility control is achieved through the
usage of contraceptive methods. This
has been practiced by men and women
for so many years.
• Countries and communities differ very
much in their knowledge, attitude and
practice towards fertility control issue.
Maternal, Newborn and Child Health
71
68. The Ideal Contraceptive:
• There is no one method that will suit
everyone and individuals may use
different methods of contraception at
different stage of their lives.
Maternal, Newborn and Child Health
72
69. • The ideal contraceptive is characterized
by:
• Highly effective.
• No side effects.
Maternal, Newborn and Child Health
73
70. • Independent sexual intercourse.
• Rapidly reversible (fertility comes back
quickly).
• Cheap.
• Widespread availability.
• Acceptable to all cultures and religions.
• Does not require administration by
healthcare workers.
• Easily distributed.
Maternal, Newborn and Child Health
74
71. • A-Hormonal Contraception
1-Combined Oral Contraceptive Pill (COC
or the Pill).
2-Progestogen-only Contraception
Maternal, Newborn and Child Health
75
72. • B-intrauterine Contraception
• C-Barrier Methods of Contraception
• D-Natural Family Planning Methods
Maternal, Newborn and Child Health
76
76. • Key facts
• 7.6 million children under the age of five
die every year,.
• Over two-thirds of these early child
deaths are due to conditions are
• pneumonia, diarrhoea, malaria and
health problems during the first month
of life.
• Over one third of all child deaths due to
malnutrition.
Maternal, Newborn and Child Health
80
77. • Over 70% of all child deaths occur in
Africa and South-East Asia. Within
countries, child mortality is higher in
rural areas, and among poorer and less
educated families.
Maternal, Newborn and Child Health
81
78. • Neonates
• More than three million babies die
every year in their first month of life ,a
similar number are stillborn and 75%
occur in the first week.
• the mother can increase her child's
chance of survival and good health by
attending antenatal care
consultations, being immunized against
tetanus, and avoiding smoking and use
of alcohol.
Maternal, Newborn and Child Health
82
79. • After birth, essential care of a newborn
should include:
1. ensuring that the baby is breathing;
2. starting the newborn on exclusive
breastfeeding right way;
3. keeping the baby warm,washing hands
before touching the baby.
4. Sick babies must be taken immediately
to a trained health care provider.
Maternal, Newborn and Child Health
83
80. Causes of Neonatal Deaths, Sudan, Source: World Health
Statistics, 2006
Neonatal Tetanus
Sepsis
Asphyxia
Diarrhoel Diseases
Congenital anomalies
Preterm Birth
Others
Maternal, Newborn and Child Health
84
81. • Children under five
• Over two thirds of child deaths are due
diseases that are preventable and treatable
through simple affordable interventions
such as immunization and attenuated
nutrition . Strengthening health systems to
provide such interventions to all children
will save many young lives.
Maternal, Newborn and Child Health
85
84. • 1-WHO recommends
• exclusive breastfeeding for the first six
months(180 days) of life. At six
months, other foods should
complement breastfeeding for up to
two years or more.
• breastfeeding should begin within an
hour of birth
bottles should be avoided.
Maternal, Newborn and Child Health
88
85. • 2- diarrhoea and pneumonia
are two primary causes of child
mortality . Breast milk is readily
available and affordable, which helps to
ensure that infants get adequate
sustenance.
Maternal, Newborn and Child Health
89
86. • 3-Health benefits for infants
• Breast milk is the ideal food for
newborns and infants. It gives infants all
the nutrients they need for healthy
development. It is safe and contains
antibodies that help protect infants
from common childhood illnesses .
Maternal, Newborn and Child Health
90
87. • 4-Benefits for mothers
• Breastfeeding also benefits mothers. It
reduces risks of breast and ovarian
cancer later in life, helps women return
to their pre-pregnancy weight
faster, and lowers rates of obesity.
Maternal, Newborn and Child Health
91
88. • 5-Long-term benefits for children
• the immediate benefits for
children, breastfeeding contributes to a
lifetime of good health. have lower
blood pressure and lower cholesterol, as
well as lower rates of
overweight, obesity and type-2 diabetes
Maternal, Newborn and Child Health
92
89. • 6-Why not infant formula?
• Infant formula does not contain the
antibodies found in breast milk.
Malnutrition can result from overdiluting formula to "stretch" supplies.
Maternal, Newborn and Child Health
93
91. • Injuries of children
• Nearly 90% of injuries to children are
the result of unintentional or
"accidental" incidents.
• Around 830 000 children die from such
injuries every year, nearly 2300 each
day. More than 1000 of these children
could be saved if proven injury
prevention measures were applied
worldwide.
Maternal, Newborn and Child Health
95
92. • Causes of Injuries
1. Road traffic crashes
2. drowning
3. burns
4. falls
5. poisoning
are leading to causes child death from
injuries.
Maternal, Newborn and Child Health
96
93. Causes
Around
Road traffic crashes
cause of death among children ages 10 to 19
Drowning
Around the world 480 children die from drowning
every day
Burns
Globally, 260 children die from burns every day.
Falls
130 children die from falls every day.
Poisoning
125 children die from poisoning daily.
Poverty
They are more likely to live in hazardous conditions residing in homes with open fires, unprotected
Maternal,
97
windows,Newborn androofs and stairs,
unsafe Child Health
94. • Prevention
public awareness about injury
prevention and providing better childoriented emergency care.
Maternal, Newborn and Child Health
98
96. The most common causes of
neonatal deaths are preterm
birth complications, newborn
infections and birth asphyxia.
They account for over 80% of all
global neonatal deaths.
Maternal, Newborn and Child Health
100
98. Care of the preterm and/or lowbirth-weight newborn
Preterm birth is the most common direct
cause of newborn mortality. Preterm birth
and being small for gestational age
(SGA), which are the reasons for lowbirth-weight (LBW), are also important
indirect causes of neonatal deaths.
Maternal, Newborn and Child Health
102
99. **LBW contributes to 60% to 80% of all
neonatal deaths.
**The global prevalence of LBW is
15.5%, which amounts to about 20 million
LBW infants born each year, 96.5% of them in
developing country
Maternal, Newborn and Child Health
103
100. Countries can reduce their neonatal and
infant mortality rates by improving the
care for the mother during pregnancy
and childbirth and of LBW infants.
Maternal, Newborn and Child Health
104
101. . Experience from developed and low- and
middle-income countries has clearly
shown that appropriate care of LBW
infants, including :
1- feeding,
2- temperature maintenance,
3- hygienic cord and skin care,
4- and early detection,
5-treatment of infections,
6- complications including : respiratory
distress syndrome can substantially
reduce mortality
Maternal, Newborn and Child Health
105
102. Interventions to improve care during
pregnancy, childbirth and the
postnatatal period as well as feeding are
likely to improve the immediate and
longer-term health and well-being of
the individual infant and have a
significant impact on neonatal and
infant mortality at a population level.
Maternal, Newborn and Child Health
106
103. Kangaroo mother care" is a method of
care of preterm infants weighing less
than 2 kg. It includes:
1- exclusive frequent of breastfeeding
2- skin-to-skin contact and support for the
mother-infant diet, and has been shown
to reduce mortality in hospital-based
studies in low- and middle-income
countries.
Maternal, Newborn and Child Health
107
105. Management of newborn illness and
complications
A newborn baby who is born preterm or
has a potentially life-threatening
problem is in an emergency situation
requiring immediate diagnosis and
management. Delay in identification of
the problem or in providing the correct
management may be fatal.
Maternal, Newborn and Child Health
109
106. Preterm and/or low birth weight infants
need special care, including additional
attention to breastfeeding and breastmilk feeding and to keeping them warm
at home and in health facilities..
Maternal, Newborn and Child Health
110
107. Those with preterm birth
complications, including :
respiratory problems, need
appropriate treatment in hospitals
Maternal, Newborn and Child Health
111
108. Appropriate care during labour and
childbirth combined with neonatal
resuscitation, when needed, can
substantially reduce mortality due to
birth asphyxia. Newborns with severe
asphyxia need post-resuscitation care in
hospitals.
Maternal, Newborn and Child Health
112
109. Early identification of newborn infections
with prompt and appropriate antibiotic
treatment will substantially reduce
mortality due to newborn sepsis and
pneumonia.
Maternal, Newborn and Child Health
113
110. Newborns with serious infections need
intramuscular or intravenous antibiotics
and supportive care in hospitals. Where
hospital referral is not
possible, intramuscular antibiotics
delivered by skilled health-care
providers will save lives.
Maternal, Newborn and Child Health
114
111. Other common newborn problems are
jaundice, eye infections and
diarrhoea, which may be managed at
health facilities or hospitals depending
on their severity.
Maternal, Newborn and Child Health
115
112. The Integrated Management of Childhood
Illness (IMCI) training materials and
Essential Newborn Care Course aim to
improve skills of health-care staff for
managing newborn illness at first level
health facilities.
Maternal, Newborn and Child Health
116
113. Care of the HIV-exposed or infected
newborn
A woman infected with HIV, however, can
transmit the virus to her child during
pregnancy, labour or delivery, or through
breastfeeding. The dilemma has been to
balance the risk of infants acquiring HIV
infection through breastfeeding with the
increased risk of death from causes other
than HIV, in particular malnutrition and
serious illnesses such as diarrhoea and
pneumonia, due to not breastfeeding
Maternal, Newborn and Child Health
117
114. *An estimated 430 000 children were newly
infected with HIV in 2008, over 90% of them
through mother-to-child transmission
(MTCT).
* Prevention of mother-to-child transmission
(PMTCT) of HIV has been at the forefront of
global HIV prevention efforts since
1998, following the success of the shortcourse zidovudine and single-dose nevirapine
clinical trials in reducing transmission.
.
Maternal, Newborn and Child Health
118
115. *These trials offered the promise of a
relatively simple, low-cost intervention
that could substantially reduce the risk
of HIV transmission from mother to
baby.
*Research and programme experience
over the past ten years has
demonstrated newer and more effective
ways to prevent new pediatric HIV
infections, particularly
in high-burden, low-resource settings
Maternal, Newborn and Child Health
119
116. In recent years which shows that
giving antiretroviral drugs (ARVs) to
either the HIV-infected mother or
HIV-exposed infant can significantly
reduce risk of the transmitting HIV
through breastfeeding
Maternal, Newborn and Child Health
120
119. Key facts
Between 1990 and 2010, under-five
mortality dropped by 35% worldwide.
every day, nearly 21 000 children underfive die mostly from preventable causes.
Maternal, Newborn and Child Health
123
120. 99% of all under-five deaths occur in
developing countries.
Three-quarters of all child deaths are
mainly due to preventable causes:
• neonatal conditions,
• pneumonia,
• diarrhoea,
• Malaria
• measles. .
Maternal, Newborn and Child Health
124
121. Distribution of mortality rates
• Three-quarters of all under-five deaths
are concentrated in just two regions of
the world: 46% in the African region and
28% in South-east Asia.
• . More than half of all these deaths
were clustered in only 5 countries:
China, Ethiopia, India, Nigeria, and
Pakistan.
Maternal, Newborn and Child Health
125
123. Causes of mortality
• Almost half of under-five deaths are due
to infectious diseases. Pneumonia is the
largest single cause of death in children
less than five years of age, and is
responsible for nearly 1.4 million
deaths.
Maternal, Newborn and Child Health
127
124. • every year Malnutrition contributes to
more than one-third of all under-five.
Patterns of the distribution of causes of
death vary widely between deaths
region.
Maternal, Newborn and Child Health
128
125. • The lowest proportion of neonatal
deaths occurred in the African Region. In
the Americas, Europe and South-East
Asia, a high proportion of under-five
child deaths occurred during the
neonatal period.
Maternal, Newborn and Child Health
129
126. Newborn health epidemiology
• Key facts
• Maternal, perinatal and newborn health
and mortality are closely linked and the
risk of dying from neonatal conditions
can be lessened by improved access to
skilled care at birth.
Maternal, Newborn and Child Health
130
127. • interventions provided during
pregnancy and birth for the mothers
and immediate post partum/postnatal
period (within 48 hours).
• Every day, about 8000 newborn babies
die from preventable causes.
Maternal, Newborn and Child Health
131
128. Neonatal mortality
• Deaths that occur among babies less
than 28 days of life (neonatal period)
account for about 40% of all under-five
deaths. The risk of dying during the
neonatal period is highest closest to
birth and decreases over the
subsequent days and weeks: up to 50%
of neonatal deaths.
Maternal, Newborn and Child Health
132
129. • occur within the first 24 hours of life and
about 75% during the first week of life.
In 2010, an estimated 3.1 million babies
died during their first month of life.
Maternal, Newborn and Child Health
133
130. Distribution
–70% of all neonatal deaths were
concentrated in just two regions of
the world: the African Region and
South-east Asia. More than half (53%)
of all these deaths were clustered in
only five countries:
India, Nigeria, Pakistan,china
,ethiobia.
Maternal, Newborn and Child Health
134
131. Causes of neonatal mortality
• Among the 3.1 million deaths that
occurred among babies 0-28 days of
life, about one third were due to
infections (including
pneumonia, sepsis, neonatal tetanus
and diarrhea).
• Preterm birth complications caused
another one million deaths among
newborn babies. Birth asphyxia was the
third major cause of death in this early
Maternal, Newborn and Child Health
135
134. • Children need food of appropriate
quantity and quality for optimal
growth and development.
If their nutritional intake is
inadequate they will fail to gain
weight or lose it and will
subsequently fail to grow in height.
Maternal, Newborn and Child Health
138
135. 1-Element of major food(nutrient big)
fat-carbohydrate- protein.
2-Nutrients minutes
(micronutrients)vitamin-minerals.
3-Water and fiber.
Maternal, Newborn and Child Health
139
136. Division of the new food pyramid
Maternal, Newborn and Child Health
140
137. Poor nutrition may begin with the
child from the womb of the mother
,extend this effect during the first
years of the life.
Maternal, Newborn and Child Health
141
138. The vitamin A of the most important
micro nutrients needed by children of
mucous membrane and membrane eye
and skin and helps growth.
Maternal, Newborn and Child Health
142
139. Deficiency
• the signs of Vit A deficiency are
predominantly occular include:
1. night blindness
2. conjuctival xerosis
3. bitots spots
4. corneal xerosis
5. keratomalacia
extraoccular manifestation include follicular
hyper keratosis , anorexia and growth
retardation.
Maternal, Newborn and Child Health
143
140. Factors Affecting
Nutritional Status
1-Mother’s attributes
2-State of nutrition during
pregnancy
4-Feeding pattern(Exclusive breast feeding
for 6month)
5-Weaning & supplementation
6-Illness
Maternal, Newborn and Child Health
144
141. Breast feeding
(Exclusive breast feeding for 6month)
nutritionally adequate and safe
complementary feeding starting
from the age of 6 months with
continued breast feeding up
to2years of age or beyond
Maternal, Newborn and Child Health
145
142. Exclusive breast feeding for 6month)
nutritionally adequate and safe
complementary feeding starting from
the age of 6 months with continued
breast feeding up to2years of age or
beyond
Maternal, Newborn and Child Health
146
143. • Colostrum is the special milk that is
secreted in the first 2-3 days after delivery.
It is produced small amount about 40-50ml
on the first day colostrum is rich in white
cell and antibodies especially IGA and it
contain large percentage of protein
,mineral, fat soluble vitamin (A-K-E)
colostrum provide important immune
protection to an infant.
Maternal, Newborn and Child Health
147
144. Weaning
• Gradual change from an all-milk diet to a
diet composed of a variety of foods(6 mos)
• Early abrupt weaning
– Marsamus
– Infections
– kwashiorkor
• Late weaning
– PEM
Maternal, Newborn and Child Health
148
147. Supplementary Feeding
Start at 6 months of age with small
amount of food and increase quantity as
the child gets older, while maintaining
frequent breast feeding .
Should be :.
1-rich in energy ,protein and micronutrient
2-not spicy or salty
3-easy for the child to eat and liked
4-locally available and affordable .
Maternal, Newborn and Child Health
151
148. Indications of Good Nutrition
1-Body weight gain.
2-Behavioral development
3-Bowel movements
4-Sleeping habit
5-Developed motor coordination
6-Well-formed muscles
Maternal, Newborn and Child Health
152
151. ORS program
• First started in 1986-1987
• Implemented through MCH programs
• ORS packet are supplied by central
government
Maternal, Newborn and Child Health
155
152. principle
• Glucose when given orally enhances
intestinal absorption of water and salt
• Thus it can correct electrolyte and water
deficit
Maternal, Newborn and Child Health
156
153. AIM
To correct the water and
electrolyte deficit
To prevent dehydration
Reduce mortality
Maternal, Newborn and Child Health
157
154. • Oral rehydration therapy, (also called
ORT, oral rehydration salts or
solutions (ORS), or oral electrolyte), is
a simple, cheap, and effective
treatment for diarrhea-related
dehydration.
Maternal, Newborn and Child Health
158
155. • Oral rehydration therapy is
widely considered to be the
best method for combating
the dehydration caused by
diarrhea and/or vomiting.
Maternal, Newborn and Child Health
159
156. It consists of :.
sodium chloride 3.5g
Potassium chloride 1.5g
Trisodium citrate 2.9g
Glucose anhydrous 20.0g
Maternal, Newborn and Child Health
160
157. IN WHAT CONDITION IT CAN BE
GIVEN
• 1- ALL AGE GROUP
• 2- ALL AETIOLOGIES
• 3- ALL COUNTRIES
Maternal, Newborn and Child Health
161
160. <2yers:- give 1-2 teaspoon every 2-3
minutes
Older children :- offer frequent sips out of
cup
Adult:- drink as much as they can
Give the estimated with in 4 hrs
Maternal, Newborn and Child Health
164
161. If the child vomits
• Wait for 10 minutes
• Give a teaspoonful every 2-3
minute
Maternal, Newborn and Child Health
165
163. How to prepare it ?
Maternal, Newborn and Child Health
167
164. If ORS packet are not available
• Table salt (5gm) +sugar (20 gm) in 1L
of drinking water
• Administrate till the diarrhea stops
• Earlier the treatment is instituted
better is for the patient
Maternal, Newborn and Child Health
168
165. Achievement and benefits
Low cost treatment
Treatment of the patient in their own
homes
Ingredients are inexpensive 0f readily
available
Mortality rate in the cholera has been
reduced to 0.11% from 49.3%
Maternal, Newborn and Child Health
169
168. • Immunization, is the process by which
an individual's immune system becomes
fortified against an agent.
• Vaccines against microorganisms that
cause diseases can prepare the body's
immune system, thus helping to fight or
prevent an infection.
Maternal, Newborn and Child Health
172
169. • The Expanded Programme of
Immunization (EPI) was established in
1974 through a World Health
organization resolution to build on the
success of the global smallpox
eradication programme, and to ensure
that all children in all countries
benefited from life-saving vaccines.
Maternal, Newborn and Child Health
173
170. • Immunization against vaccinepreventable diseases is essential to
reaching MDG4 on reducing underfive mortality by two thirds
• United Nations General Assembly
Special Session goals by 2015:
(i) Ensure full immunization of
children under one year of age.
(ii) Vitamin A Deficiency Elimination.
Maternal, Newborn and Child Health
174
171. • World Health organization (WHO) and goals
by 2015: (i) Polio Eradication, (ii) Measles
Mortality Reduction, (iii) Maternal and
Neonatal Tetanus Elimination (MNTE).
• For example, in 2010 an estimated 109
million children under the age of one were
vaccinated with three doses of diphtheriatetanus-pertussis (DTP3) vaccine.
Maternal, Newborn and Child Health
175
172. • Therefore, every death case or
disability of preventable disease is
unacceptable.
• The EPI started in 1976 in Sudan
and sience then smallpox has been
eradicated.
Maternal, Newborn and Child Health
176
173. EPI schedule in Sudan
AGE
VACCINE
At birth
BCG + polio (zero dose )
6 week
DPT + hepatitis b + H influenza
+polio+ ROTA
DPT + hepatitis b + H influenza
+polio+ ROTA
10 week
14 week
DPT + hepatitis b + H influenza
+polio
9 MONTH
MEASELS
Maternal, Newborn and Child Health
177
174. • BCG is a vaccine against tuberculosis . At
best the vaccine is effective in
preventing tuberculosis for duration of
15 years.
Maternal, Newborn and Child Health
178
175. • Polio vaccine are used
through the world to
compact poliomyelitis . It can
be administrated orally or can
be injected . The two vaccines
have eliminate polio from
most countries in worldwide
and reduce the world
incidence from an estimated
350000 cases in 1988 to 1.652
case in 2007.
Maternal, Newborn and Child Health
179
176. • Rota vaccine protects
children from
rotavirus which lead
to sever diarrhea
among infants and
young children . Each
year an estimate
453.000 child die from
diarrheal disease
caused by rotavirus.
Maternal, Newborn and Child Health
180
177. • Measles still remains a
leading cause of death
among young children
Although there is no
cure, a highly
effective, safe vaccine is
available , nowdays thier
is another booster dose
at 18 month of age .
Maternal, Newborn and Child Health
181
178. • Maternal and neonatal tetanus deaths can be
easily prevented by hygienic delivery and
cord care practices, and/or by immunizing
mothers with tetanus vaccine.
Maternal, Newborn and Child Health
182
179. • Child has painful muscle contraction from
tetanus
Maternal, Newborn and Child Health
183
180. • Heptities B vaccine helps to protect
against heptities B , which is a very
serious and fatel condition ,their is
amonth interval between the first
and second dose and after 6
monthes the thired dose.
Maternal, Newborn and Child Health
184
181. • This woman is suffering from liver cancer
caused by hepatitis B
Maternal, Newborn and Child Health
185
182. Progress of immunization in sudan
•
•
•
•
•
From 1980-2010
Diphtheria 587 ------------------ one case
Polio 4151 -----------------------zero case
Measles 50168 ---------------- 680 case
Pertussis 28631 -------------- 209 case
Maternal, Newborn and Child Health
186
183. • Despite the massive international efforts to
eliminate and eradicate vaccine preventable.
diseases they still known to be found due to
:• 1.financial condition.
• 2.difficulty in reaching all parts of sudan.
• 3.poor education about the diseases and
their complication.
Maternal, Newborn and Child Health
187
185. Adolescence health
Adolescence represents a stage
of life characterized by
significant
biological, psychosocial, and
cognitive development; a stage
of transference from childhood
to adulthood.
1
Maternal, Newborn and Child Health
189
186. introduction
• This category population aged 10 – 19
years- was thought to be the least one
having health problems; this is because
most of their problems are ignored even
by themselves.
• Globally, 1.4 millions deaths occur each
year among adolescents due to road
traffic accidents, complications during
pregnancy and child
2
birth, suicide, violence, and HIV/ AIDS.
Maternal, Newborn and Child Health
190
187. •Towards the end of the last decade, the
issue of adolescents’ health starts to
attract the attention of the health
programmers both in the developed and
developing countries.
•. Sudan’s national health policy doesn’t
mention adolescents’ health specifically .
3
Maternal, Newborn and Child Health
191
188. .
•To keep space with the other
countries,
the
government
established the adolescent health
unit to constitute with the child
health the IMCI and Adolescent
Health Programme .
4
Maternal, Newborn and Child Health
192
189. •The program has in place :_
•a national level plan of action,
• a budget for activities, and a
national taskforce.
• Besides, different institutions,
NGOs have interest in adolescent
health but are working in a
fragmented and scattered manner.
5
Maternal, Newborn and Child Health
193
190. On adolescent health concern with:~
1The state of adolescent health
2HIV and young people
3Early pregnancy and childbirth
6
Maternal, Newborn and Child Health
194
192. Adolescent health epidemiology
Mortality
In last years. 2.6 million young people
died (10-24 years) and most of these
deaths were preventable. Ninetyseven percent of these deaths (2.56
million) occur in low and middle income.
8
Maternal, Newborn and Child Health
196
193. mortality occurs in:
•Almost two thirds of the 2.6 million deaths
among young people were in sub-Saharan
Africa and southeast Asia, (1.67 million).
•Pronounced rises in mortality rates were
recorded from early adolescence (10–14
years) to young adulthood (20–24
years), but reasons varied by region and
sex.
11
Maternal, Newborn and Child Health
197
194. Cause of adolescent mortality_
6%
15%
12%
female death due to maternal condition
death due to HIV and TB
death due to traffic accident
death due to violence
death due to suicide
11%
14%
12
Maternal, Newborn and Child Health
198
195. .
Disability adjusted life years
Its measure of over all disease burden
expressed as the number of year lost due
to ill health ,disability or early death
13
Maternal, Newborn and Child Health
199
196. .
Disability adjusted life years (DALY)
•The total number of incident DALYs in those
aged 10–24 years was about 236 million,
representing 15.5% of total DALYs for all age
groups.
• Africa had the highest rate of DALYs for
this age group, which was 2.5 times greater
than in high-income countries.
14
Maternal, Newborn and Child Health
200
197. .
.
•Worldwide, there is three main causes of DALY for 10–
24- old which is:_
Years
1 neuropsychiatric disorders (45%)
2unintentional injuries (12%)
3infectious and parasitic disease(10%)
15
Maternal, Newborn and Child Health
201
198. •But here in Sudan the infectious
and parasitic disease is more
common cause of DALY between
10-24years
16
Maternal, Newborn and Child Health
202
199. Risk factors
The main risk factors for DALYs in
the world is:_
•alcohol (7% of DALYs)
•unsafe sex (4%)
•iron deficiency (3%)
•lack of contraception (2%)
•illicit drug use (2%)
17
Maternal, Newborn and Child Health
203
200. •But the major risk factor in
Sudan is:_ iron deficiency, un
safe water and hygiene
18
Maternal, Newborn and Child Health
204
201. •. However, there are still substantial data
gaps and uncertain particularly for causes
of death and levels of adolescent and adult
mortality in Africa and parts of Asia
19
Maternal, Newborn and Child Health
205
204. School health program:
Definition of school health:
all the activities and services provided in
schools to enhance the health of the pupil
and the staff in the educational field
physically, psychologically and socially
through programs and activities
concerned with health through the
health system
Maternal, Newborn and Child Health
208
205. justification for the establishment of
health promoting school
•The children represent in most countries
at least a quarter of the population.
• Easy access to the school environment.
•Teachers have influential educational
role among students and schools.
• Ability of transmission of health
awareness from school to the family and
society.
Maternal, Newborn and Child Health
209
206. •The school is the starting point for
effective health promotion through:
1-prevention .
2-early detection
3-intervention whenever possible
Maternal, Newborn and Child Health
210
207. Objectives:
•1 Raise awareness of health education
within the school community
• 2Provision of curative services and
health care in schools.
•3Improve health of school environment.
•4Building the capacity of
workers in the field of school
health.
Maternal, Newborn and Child Health
211
208. •5Contribute in building a healthy
balanced diet.
•6Motivation and capacity in confronting
and combating epidemics and endemic
diseases.
•7Promote the mental health of students
and workers in the education field.
•8Activation of physical activity in schools
for the health of the body
Maternal, Newborn and Child Health
212
209. Health school can be achieved by:
1 Fresh water safe for drinking and use.
2Safe means of sanitation
3Protection from infectious
diseases.
4protection from violence
5Protection from smoking and
drugs.
Maternal, Newborn and Child Health
213
210. Specific component of school health include:
1school health services
a initial medical examination on the new
students
b periodic check-ups (for fourth grade
and seventh and second secondary)
c activities of the health survey and
to identify priority health problems
d First aid procedures
Maternal, Newborn and Child Health
214
211. e emergency care
f early detection of health problems
g vaccination programs against infectious
diseases
h care of pupils with special needs
i Oral health care and dentistry
j eye-care and vision consideration
k care of ear, nose and throat
Maternal, Newborn and Child Health
215
212. 2 /. school health education
A / messages at the morning program
B / Exhibitions
C / wall newspapers
D / Health lectures, video presentations
E / the curriculum
Maternal, Newborn and Child Health
216
213. 3 / Environmental Health School
Is the environment of the school
community to protect against
direct injury or disease and
promote health and provide
preventive measures and
positions against the known risk
factors that can lead to diseases
or health problems or disability in
the future.
Maternal, Newborn and Child Health
217
214. • These include:
1- Furniture and study aids
2- A sufficient number of toilets
3- School canteens
4- Classes of health (the space 'lighting
and ventilation)
5- Sporting field
6- Shady areas and places of worship
7- Sewage
Maternal, Newborn and Child Health
218
215. 4 / Mental Health based on primary health
care for detecting the
emotional, psychological mental and
educational problems.
5/ school feeding : Aimed at the
administration's plan to cover some of the
schools with a healthy school meal
,distribution of preventive doses of vitamin
A .Ensure the safety of the food vendors
outside schools and to provide safe and
clean canteen services.
Maternal, Newborn and Child Health
219
216. 6/ physical
health including holidays , rest
between classes. Physical activities and
this is done in coordination with the
Department of Student Activity
7 / community involvement : Associations
and councils of parents and teachers.
Community participation in planning for
school health programs
Maternal, Newborn and Child Health
220
217. 8/ promoting the health of school staff
by :
Health insurance for workers in
schools. Vaccination against diseases
(meningitis). Services, safe motherhood
and reproductive health. Tobacco
Control (School of smoke-free)
Maternal, Newborn and Child Health
221
218. *Basic constraints of the program:
1-Poor coordination
2-Training
3- Movements of the trainers
4- The school environment
5- Coverage of private schools
6- Inactivation of some components of
school health
7-Lack of fund
Maternal, Newborn and Child Health
222
Notas del editor
بعد هذا الشريحه في فيديو و بعد الفيديو مدثر خليفه
FP; to ensure that individuals & couples have the information And services to plan timing, number & spacing of pregnancies.ANC: to prevent complications where possible and ensure that complications of pregnancy are detected early & treated appropriately.C/S d: to ensure that all birth attendants have the knowledge, skills & equipment to perform a clean & safe delivery and provide postpartum care to mother & baby.E o c: to ensure that essential care for high risk pregnancies & complications is made available to all women who need it.
بعدك عبد الباسط اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
يا عبد الباسط بعدك عماد ادم وفي صوره بعد كده اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
بعدك يا عماد في اروى عبد الوهاب اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
بعد كده في صوره خليها شويه و بعدين اشكري الناس و اقلبي على تقديم مياده اسحاق
بعدك يا مياده في شهلاء عابدين اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
يا شهلاء بعد كده في الصوره بتاعت الشكر خليها شويه و بعدين قدمي ريم عبد المحسن و اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
اخر شريحه ..... قدمي فردوس با بكر .........اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
يا ريم بعد كده في شكر خليه شوي و قدمي يوسف عبد الرحمن ....اقلب على الشريحه بتاعت الي بعدك قبل ما نتزل
يديك العافيه يا يوسف بعد كده في فيديو اقلب الشريحه و انزل