Neonatal, Infant, Child and Mothers Health

Family Health

از • حمایت در جهانیان دس��تاوردهایاستعدادهای تحق��ق و کودکان حقوق

ب�ا توان م�ی بیشت�ر را قد انس�ان بلندیآسمانخراشها کودکان ارتفاع تا .سنجید

ملتها پیشرفت یونیسف 2000گزارش

اهدافآن • انواع و خانواده تعریفخانواده • بهداشت به پرداختن اهمیتخانواده • بهداشت تعریفخانواده • بهداشت مختلف های برنامه و وظایف

خانواده اولين و اساسي ترين نهاد اجتماعيخانواده•جم+ع مشترك دو ي+ا چن+د نف+ر ك+ه ب+ه واس+طه س+ببي ي+ا ت•

نس+بي ب+ا ه+م رابط+ه زيس+ت شناخت+ي داشت+ه و زي+ر ي+ك .سقف زندگي مي كنند

.متشكل از والد يا والدين و فرزندان آنان مي باشد•س++المت افراد تح++ت تأثي++ر اص++ول، ارتباطات، تكام++ل •

شراي+ط اقتص+ادي و فرهنگ+ي آ+ن قرار م+ي ، اجتماع+يگيرد.

اعضاء خانواده، مجموع+++++ه اي از ژ+++++ن هاي مشترك •هس++تند و ب++ه عنوان واحدي فرهنگ++ي، منعك++س كننده

فرهنگ اجتماع بزرگتر مي باشند. همچني++ن خانواده واحدي اپيدميولوژي++ك و واحدي براي •

فراه+م كردن خدمات اجتماع+ي و مراقب+ت هاي جام+ع پزشكي است.

چگونگي تأثير خانواده بر افراد و يا بالعكس با توجه به •تغييرات ط++++بيعي تكام++++ل افراد در طول زندگ++++ي و آشناي+ي ب+ا عوام+ل خط+ر در خانواده بيشت+ر مشخ+ص م+ي

گردد.

خانواده اولي+ن محي+ط اجتماع+ي اس+ت ك+ه فرد در •.آن قرار مي گيرد و از آن تاثير، مي پذيرد

اي+ن تاثيرپذيري م+ي توان+د از طري+ق بيولوژيك+ي و •يا رفتاري باشد.

تاثي++ر بيولوژيك++ي خانواده فرد را ممك++ن اس++ت •مس+تعد ابتالء ب+ه بيماري نماي+د مانن+د افس+ردگي؛

كانسرها تاثي+ر رفتاري مانن+د پرخوري، عدم تحّرك، اعتياد •

و الكليسم از طريق الگوي والدين.

خانواده انواعتنوع ارتباطات افراد، منج++ر ب++ه تشكي++ل انواع خانواده گرديده •

.است

خانواده س+نتي ت+ك هس+ته اي معمول تري+ن ،هنوز در اكث+ر جوام+ع•نوع مي باشد.

واحدهاي خانواده در س++رتاسر دني++ا شك++ل هاي متفاوت++ي دارند. •دانشمندان علوم اجتماع+ي س+ه نوع خانواده را تعري+ف كرده ان+د

:

(Nuclear Family) � خانواده هسته اي 1••(Extended Family � خانواده گسترده )2•• � خانواده سه نسلي3•

خانواده انواع(Nuclear Family) � خانواده هسته اي 1•

خانواده هس+ته اي ي+ا اوّلي+ه در تمام جوام+ع انس+اني، مشترك اس+ت و شام+ل •زوجين و كودكان وابسته آنها مي شود.

(Extended Family � خانواده گسترده )2•يك+ي از راي+ج تري+ن نوع خانواده در خاور دور و خاور ميان+ه اس+ت و بيشت+ر در •

مناط+ق زراع+ي روس+تائي، مرس+وم اس+ت. ب+ه طوري ك+ه چن+د خانواده ب+ا رابط+ه خون+ي بي+ن مرده+ا باه+م زندگ+ي م+ي كنن+د، قدرت در دس+ت مرد س+الخورده فامي++ل اس++ت، رواب++ط فاميل++ي بر رواب++ط زناشوئ++ي، ارج++ح م++ي باش++د و

مسئوليت ها تقسيم شده است.

� خانواده سه نسلي3•خانواده اي ك+ه افراد جوان ب+ه دلي+ل نبودن امكانات ب+ا نس+ل هاي قبل+ي خود ب+ه •

طور موقت زندگي مي كنند. 2انواع مشروع و نامشروع ديگري از خانواده ني++ز وجود دارد ك++ه در جدول •

به آن ها اشاره شده است.

خانواده 2جدول انواع +

خانواده چرخه

خانواده ه+++++ا پايدار نيس+++++تند و همواره درحال • .تغييرند

خانواده بهداشت

مراح+ل • باي+د خانواده بهداش+ت ب+ه دس+تيابي برايو خانواده در خطرآفري+ن عوام+ل تكام+ل، مختل+ف . شناخت را خانواده س+++المت بر موث+++ر عوام+++ل

شك+ل در خانواده بهداش+ت كل+ي نشان 1شماي . است شده داده

زندگي مختلف مراحلب++ا وجود تفاوت هاي وس++يع در فرآين++د تكامل++ي •

افراد، وجوه مشترك مشخص++ي در اكث++ر موارد در مراح+ل زندگ+ي وجود دارد و لذا اي+ن مراح+ل

دوره طبق+ه بندي م+ي شود : شيرخوارگ+ي 6ب+ه و كودك+ي، بلوغ و نوجوان+ي، جوان+ي، ميانس+الي،

از كارافتادگي و پيري.

• Women & children make 70% of developing countries population

• The 10.6 million annual child deaths are not distributed evenly over the 0-4 year age period

• More than 70% of all child deaths occur in the first year of life

• And of these … nearly 40% occur in the first month of life (the neonatal period)

• More than 42% of total mortality occurs in under 5 children.

• Family planning decrease MMR at least 25%• When IMR decreases, desire for child bearing

decreases

• Only 2 WHO regions account for more than 70% of all under-five deaths:

42% in the African region 29% in South-east Asia region

• Only 6 countries account for 50% of all child deaths (2002 data):

India (Sear)Nigeria (Afr)China (Wpr)Pakistan (Emr)Ethiopia (Afr)DR Congo (Afr)

What are under-fives dying of?(excluding neonatal causes of death)

• Pneumonia• Diarrhoea• Malaria• Measles• HIV/AIDS

} ~ 50%

Malnutrition contributes to more than half of all under-five deaths

What are neonates dying of?

• Preterm births• Severe infection• Asphyxia• Congenital anomalies• Tetanus

} ~ 75%

What are mothers dying of?

• Pregnancy related bleeding• Pregnancy related infections• Pregnancy related hypertention

Progress has been variable

• Neonatal mortality has fallen at a lower rate than post-neonatal or early child mortality

• Relatively greater progress has been made in some regions and countries

e.g. neonatal mortality is now 58% lower in high income countries than in 1983, compared to 14% reduction in low/ middle income countries

• Large variations in mortality rates exist even within the same country

About half of child deaths occur in the neonatal period

Day % U5 deaths

1st day 20By 3rd day 25By 7th day 37

By 28th day 503.1

10

12.6

2.8

2.8

5.5

6.2

10.2

7.3

39.3

74.1

0 10 20 30 40 50 60 70 80

Week 4

Week 3

Week 2

D7

D6

D5

D4

D3

D2

D1

Week 1

Percent (%)

When do neonates die?

• In a developing country, pregnancy related maternal mortality is 38 times more than a developing one.

• Every minute in the world, a young woman dies from pregnancy related causes.(585000 annually)

• Unplanned and wrongly-spaced pregnancies – compensation of mother,s reservoirs,– the opportunity to take care of child

• The ultimate result is child mortality

• Crowded family: – higher chidren,s malnutrition, cost of family food– Lower protein & energy and food per capita

• Increase in birth order: decrease in IQ and mental capacity

• Doubling time of population – Developing: 20-40 years– Developed: 583 years

• In Iran as other developing countries marriage rate is very high– 1375 census: more than 45 year old never married

• Men 1.7 %• Women 1.6 %

• Annual estimated unsafe abortion worldwide: 20 million leads to 76000 young women death mostly in developing countries. Family planning prevents most of these deaths.

• Without assessment of pregnancy and essential care leading to maternal and child mortality or irreversible complications.

• lactation: lower rate of pregnancy, child health

• In Iran, despite family planning activities – 24% of pregnancies are unwanted.– Only 50% of OCP users, use it correctly.

Maternal MortalityDefinition

• 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 Mortality• In 2008, an estimated 358 000 women died from

pregnancy - or childbirth-related complications. • More than 60% of maternal deaths occurred in

the postpartum period. • The risk of death is highest close to birth and

then decreases over the subsequent days and weeks.

• About 45% of postpartum maternal deaths occur within 1 day of delivery, more than 65% within 1 week, and more than 80% within 2 weeks.

Distribution• More than three-quarters of maternal deaths were

concentrated in just two regions of the world: 53% in the African Region and 25% in South-East Asia.

• The vast majority of maternal deaths occurred in developing countries.

• The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor.

• There are large disparities between countries: the average maternal mortality ratio in developing countries is 290 per 100 000 live births versus 14 per 100 000 live births in developed countries.

Trend• Between 1990 and 2008, maternal deaths worldwide

have dropped by 34%. • However, the global maternal mortality ratio declined by

only 2.3% per year in this same period. • This is far from the annual decline of 5.5% required to

achieve MDG5. • In sub-Saharan Africa, a number of countries have

halved their levels of maternal mortality since 1990. • In other regions, including Asia and North Africa, even

greater progress has been made

Causes of Maternal death

• The major complications that account for 80% of all maternal deaths are: – severe bleeding, – infections, – high blood pressure during pregnancy (pre-eclampsia

and eclampsia), – obstructed labour, – and unsafe abortion.

• Of these, haemorrhage and hypertensive disorders account together for the largest proportion of maternal deaths in developing countries.

Definition• Family health

– Major theme of it is promotion of the quality of life considering family as a unit.

Duties & Programmes of family health office of ministry of health

• Mothers• Children• Family planning• Nutrition improvement• Women and Elderly• School health( office of adolescents

health and school health)

Mothers• Health care before, during & after delivery• Health education• Healthy neonate during first 10 days of life• Safe motherhood

– Safe delivery– Maternal mortality– LBW– Premature delivery– MAMAROOSTA

Children• IMCI( Integrated Management of Childhood

Illnesses)– - مانا اطفال های ناخوشی یافته ادغام مراقبتهایسالم – كودك

• Health care of under 6 y/o children– Height, weight, growth monitoring, nutrition

education, vaccination, solid foods, control & treatment of infectious diseases

• Neonatal care• Breast feeding

Family planning

• Increasing quality & quantity of modern contraception

• But now?

Nutrition improvement• Prevention of malnutrition, IDA, IDD

– IDA: 30% under 5 & female adolescents, 20-50% pregnant women

– 1.4% of worldwide mortality( 0.8 million) is related to IDA– Objective: prevention of IDA in 15-49 y/o female and under 5

children.• Education of healthy nutrition in community

– 1374: 16% of under 5 moderate & severe malnutrition.– 1377: 13.7% rural & 9.6% of urban children moderate &

severe malnutrition.• Controlling parasitic and infectious

diseases( preparing the situation for malnutrition)

women

• Prevalent cancers: Breast, Cervix– screening: BSE, CBE, Mamography, Pap

smear

Elderly

• WHO: in 2050 1 in 5 of world population will be elderly.

• Iran– 1375: 4.1%– 1378: 5%– 1385: 5.2%– 1390: 5.7%– 1400 estimation: 10 million more than 60

y/o

Drugs

• IMCI, family planning, complementary drugs for children

Key messages

• Maternal and newborn care and support is essential to achieve a substantial reduction in neonatal mortality

• Improving child survival requires coordinated action between maternal and child health, and other programme areas (e.g. EPI, NUT, RBM, HIV)

• IMCI is an effective delivery strategy for multiple child survival interventions

• For substantive impact, strong community component must accompany the health system strengthening