PHC Maternal and Child Health Services

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Maternal and Child Health

Services/Care� Because parents and children are generally healthy

and childbearing is usually a normal healthy event

the practice of maternal and child health nursingemphasizes health promotion and prevention of

disease(Novak & Broom,1999).

� Global and national vital statistics indicate that the

status of maternal infant health has improved but it

still of major concern

� Maternal child health is a component of PHC



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What is maternal and child health

services� It is a specialized area of nursing focus on the

health needs and identifiable response of

women, their partners, and families to real orpotential health problems associated with

childbearing and childrearing Novak &

Broom,1999).

� It also include concern for the developing fetus

from conception to birth and the child from

birth through adolescence



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objectives� At the completion of this unit the student is able

to:

� 1.Explain:i) The objectives and the policies of maternal and

child health services

ii) The extent and factors contributing to problems

in child health servicesiii) The organization structure in the planning,

implementation and evaluation of maternal andchild health services



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cont- objective� 2. Describe the operations and management of

MCH clinics in the provisions of ANC, PNC andchild health services.

� 3. Demonstrate skills in planning, targeting &evaluating MCH services

� 4. Identify and discuss factors that are significantin the prenatal environment that influence neonatal

health� 5.Describe the characteristic element of physical

and psychosocial growth and development in thefirst 5years of life



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cont

� 6. Identify & discuss major cause of death &

illness in the child from through to the first 5 yearsof age

� 7. Discuss the appropriate nursing assessmenttools for the child from birth to 5 years

� 8. Identify the role of the community health nurse

& discuss appropriate nursing intervention that promote & maintain the health of infants, toddlersand preschoolers



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MCH overall objective� The ultimate goal of maternal and child health

nursing is to help children and parents attain and

maintain optimal health� To achieve that goal, nurses must be aware of

historical and current trends as well as national

goals to improve the health of the mother and

child

� The overall objective of maternal child health is to

protect the health of the mother and the child



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Factors contributing to problem

in child health servicesEnvironmental Variables

Socio-economic and Cultural:

� Culture is made up of ideals, values, andassumptions about life that guide people¶s behavior ± transmitted from generation togeneration

� Believe that what happens in their culture isnatural and correct and what happens in other culture is unnatural and incorrect



cont� - child rearing beliefs and practices, food

preference and eating habits, concept of

health and illness and the use of lay healer

and folk medicines all vary across different

subgroups/Ethnicity

� - primary health care worker needs to beaware of this differences in order tosuccessfully bridge this cultural gap and tointegrate scientific medicine with traditional

care pattern 8



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contSocio-economic Status

� -Poverty is the most handicapping, disabling

condition in childhood that affects the healthservices of a child.

� Education level, age, employment andunemployment pattern and the use of prenatalservices

� -being poor and uneducated increases substantiallythe possibility of having a complication of pregnancy in general and a low birth weight in particular (Berk 2004)



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cont� Socio-economics status appears to influence

nutritional status ± a low family income is also

related to high incidence of poor diet� Lack of education in these families also

contributes to poorly balanced diet

� Child-rearing beliefs and practices- numerous

studies have shown that differences in education

level and socio-economic background affects the

attitude and child-rearing practices of parents



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contHealth Services(State)

Lack of resources- Government or state are not

servicing the community as expected because of unavailability of resources e.g. out of stock of syringes and needles, vaccines etcetera.

� -poor support for the cold chain system

� -transportation problem to take nurses to work sites

� Shortage of manpower-many nursing stations have been without a nurse for years &some zones have

been empty for a lengthy period of time



Organization Chart for MCH/FP12

DPH

Dr J

Koroivueta

National MCH/FP

Manager/Dr J

Samuela

DHS C,E,W,&N

SDHS

MCH Nurse

Zone Nurse

District Nurse



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Ante Natal Care� High maternal mortality in developing countries is

considered a major public health problem so much sothat it has become a UN Millennium Development Goal

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� It is estimated that 515,000 women die each year of pregnancy related causes (global overview) and the fifthMDG is to reduce maternal mortality by 75 percent

between 1990 to 2015 but the progress has been slow

� 80 percent of maternal deaths are the result of directcauses ( complications of pregnancy, labor and delivery)



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contProvision of Ante Natal clinic

� Essential for a community health nurse to set time

apart for caring her ante-natal mothers special dayfor ANC

� Provide special set up- privacy & comfort-

� Bookings should be corresponding with the

population(CBA) of the zone, area of coverage or district & the gestational status of themother/client



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contClinical set-up

� Provide privacy

� Comfortable examination couch/pillows/ linen

� Stethoscope/fetoscope/ doppler � Urine testing equipment- urine cup, urine dipstick

� Centimeter tape measure

� Scale/height measure

� Non sterile gloves

� Pap smear supplies

� Speculum� Gestational calendar

� Folders/necessary documents



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contProvision of Post Natal Clinic

� Also important for the community health nurse to

set aside a time for PNC as it an essential part of maternal care

� 6weeks after delivery(postnatal) the mother iscalled back to the clinic to undergo series of

examination to confirm return to normalcy of thereproductive system after confinement of pregnancy and delivery

� Another important concept of PNC is to assist the

the mother to choose freely, family planningwhether it is a contrace tive or natural famil



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contWhy family planning at PNC?

� Most suitable time for the nurse to see the mother

and to interview them individually and offer assistance regarding their choice of family planning

� This clinic should be running concurrently with

the MCH clinic or at least MCH in the am and post natal clinic in the pm

� Most mothers will give priority to family planningwhen they have a small infant to care for so they

will seek protection



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contClinical set up

� A room with complete privacy, comfortable

examination couch� Equipment for examining the vagina and pap

smear taking

� Assortment of contraceptives

� Equipment for taking vital signs/blood pressure &weight



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Significant factors in the prenatal

environment that influenceneonatal health� Prenatal environment is the mother¶s body-

virtually everything that impinges on her wellbeing from her diet to her moods, may alter her unborn child¶s environment and affect its growth(Papalia, Olds & Feldman, 2004) Many factorscan affect the developing embryo and fetus andone of them is an unsafe environment

� Teratogens refers to any environment agent thatcauses damage to the developing embryo or fetusduring the prenatal period. Greek word tera meansmalformation or monstrosity(Novak&Boom 2004)



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Environmental factors� Prescription and nonprescription drugs

� Illegal drugs( marijuana,(opiates,cocaine)

� Tobacco/nicotine smoking

� Alcohol

� Caffeine� Sexually Transmitted Infection



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cont� Environmental pollution

� Radiation

� Infectious disease



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Maternal factorsFactors influencing the health of pregnant women

and infants may be related to their obstetric history

genetic, socio economic status, or life stylechoices

� Regular moderate exercise e.g. walking,swimming, hiking aerobics is related to increase birth weight(Hatch et al.,1993 cited byBerk.,2004).



� Nutrition-a developing fetus depends

completely on its mother for nutrition,

which comes from the mother¶s blood ± children born to malnourished mothers are

more likely to be malformed

� children grow more rapidly during prenatal period than any other phase of

development-totally depend on the mother

for nutrients so a healthy diet ensures the23



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cont� Prenatal malnutrition can cause serious damage to

the central nervous system (Berk 2004)- the

poorer the mother¶s diet the greater the loss in the brain¶s weight especially if malnutrition occur in

the last trimester

� Poor nutrition suppresses development of the

immune system prenatal malnourished babiesfrequently catch respiratory illness(Chandra 1991)



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cont� Vitamins & minerals enrichment is also crucial

e.g. folic acid supplementation around the time of

conception greatly reduces abnormalities of theneural tube such as anencephaly and spina bifida

� Adequate folate intake during the last 10 weeks of pregnancy reduces by half the risk of prematuredelivery and low birth weight

� When the poor nutrition persist through the prenatal period infants usually require more thandietary improvement



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contEmotional stress

� When women experience severe emotional stress

& fear during pregnancy their babies are at risk for a variety of difficulties ± producing adrenalin inresponse to fear restricts blood flow to the uterinearea and may deprive the fetus from oxygen

� Intense anxiety is associated with higher rate of miscarriage, prematurity, low birth weight,newborn irritability, respiratory illness, anddigestive disturbances(Santrock, 1998).

� It is also related to certain physical defects such ancleft alate and hare li Santrock, 1998 .



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Physical growth &development� One important set of parameters required for

pediatric health assessment is physical growth

� The parameters of weight, length or height &head circumference(depend on age) are essential

in physical growth measurements e.g. by plotting

a child¶s growth (weight) on a chart, you are able

to determine normal or abnormal growth curvesaccording to the child¶s age



cont� Child¶s growth and development are orderly

and sequential

� Growth and development are related to

environment

� The pace of growth and development is

specific for each child

� Growth and development occur in a

cephalocaudal direction28



cont� Growth & development occur in a

proximodistal direction ± controlled

movements closest to the centre of the bodyoccur before controlled movement that are

distant to the body axis

� Growth & development becomeincreasingly differentiated-general

responses progress to skilled, specific,

responses 29



cont� Growth & development become

increasingly integrated- behavior and

function progress from simple to complexas the child gains new skill

� Growth & development are continuous and

are influenced by many factors- heredityand environment work together genetic

factors provide the potential & set in the

motion that is stimulated 30



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cont� Infants average birth weight is 3.5kg

� Length: 48-53cm

� Head circumference : 33- 35cm� Infants should double the birth weight at 6mths

and triple birth weight at 1yr of age

� Infants height increases about 1inch(2.5cm) per

month for the first 6/12 and slows to ½inch(1.3cm) per month until 12 months

� Toddler(12-24 months) growth, begins to slow.



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cont� The birth weight usually quadruples by 2.5

years of age with an average weight gain of

(1.8 - 2.7kg) in a year.� The toddler usually grows(7.6cm) per year

� Preschoolers (2-6yrs) each gain an average

of (2

.3

kg) per year � Height increases between(6.4 - 7.6cm) per year (Estes 2002).



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development� Development refers to patterned and predictable

increases in the physical, cognitive, socio-

emotional and moral capacities of individuals thatenable them to successfully adept to their environment(Estes 2002)

� Growth refers to an increase in body size andfunction to the point of optimum maturity.

� Assessing the growth and development status of achild is an integral part of patient (child)assessment. It must be noted, however it shouldnot be imposed to a particular child, each child

have their unique development



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Developmental tasks of infants

� Infancy is a period of dramatic, and rapid physical,

motor, cognitive, emotional and social growth,

which makes it one of the most critical period of growth and development

� During the first year of life, infant change from

totally helpless, dependent new born to unique

individual who actively interact with their environment and form meaningful relationships

with significant others(Estes 2004).



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Week

2

objectives

At the completion of this unit the student is able to:

� 1. i)Assess and monitor growth and development

of a child

ii) Detect abnormalities early and refer/write referral

letters

iii) Effectively educate mothers on child care

iv)Document intervention/services rendered



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Cont objective� Demonstrate skills in planning, targeting and

evaluating MCH services

� Identify and discuss the major causes of death andillness in the child from birth through to the first5yrs of life

� Identify the role of the community health nurse

and discuss appropriate nursing interventions that promote and maintain the health of infants.



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contThe objective of child health services is classified

into 4:

� Monitoring of growth and development� Immunization administration

� Nutrition- feeding and nutritional advises/breast

feeding

� Health Education and management of minor

ailments and childhood illnesses(IMCI)



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contConducting a child health clinic focuses on these 4

main objective

� Monitoring Growth & Development ± theinfant/child is weighed, carefully examined andassessed for:

any deviation or delay from the normal growth

and development according to ageSuccessful weight gain/weight loss at every visit

Presence or absence of normal reflexes accordingto age.



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cont� Counseling and advise to the mother of the

management of identified problems.

� Referral of delayed milestone cases to proper management for further intervention- write areferral letter e.g. CRA

� Prioritizing problems to assist in the quick

recovery- will include assessment of the family,socio-background, home and the environment.

� Subsequent follow up of mother and child toensure progress is maintained



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contImmunization

� To ensure the protection of the child from the 9

target diseases� Assess the child¶s age, check the immunization

record and compare with the immunizationschedule for any vaccine that is due for

administration� Inform the mother of the injection to be

administered, give all the information about thevaccine and advise the mother/caregiver on how tocare for the child after the administration of vaccines.



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cont� Feeding & Nutritional Advices

� Weight measure is very important in the

monitoring of the growth of the baby,- wt ismeasured at every visit, chartered and plotted

� Poor wt gain, wt loss,and steady wt in the firstmonth indicates poor attachment and positioning

of the infant in breastfeeding. May also indicateother underlying problems

� Assist the mother in the correct positioning of thechild and proper attachment.



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cont� Guiding the mother/caregiver in nutritional

advises according to age

� Emphasizing on the importance of thecontinuity of breastfeeding while weaningof breast

� Give the child local fresh fruits and foodsfrom the three food groups

� Specific care and follow ups for underweight baby



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planning & targeting MCH

services

� To design programs and services for maternal-

infant population ,nurses need to have a soundunderstanding of the population they serve

� The maternal-child population makes up a major potion of a CHN¶s caseload

� Vital statistics and other data regarding maternal-infant populations serves nurses as they determine both the appropriateness and the effectiveness of programs and services



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cont� Delivering services vary based on the population

and its specific needs

� The geographic distribution of clients( CHNshould know her catchments area at the back of

her hand

� The hard to reach villages or settlement

� The heavily populated area

� Low socioeconomic( squatters/ slums)



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cont� The nursing staff available to deliver the services

� The main form of transportation for the area of

coverage(zone)� The socio- economical structure of the community



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evaluation of MCH programs� Evaluation is a critical aspect of maternal-infant

health program planning as it is with any planning

� 4 questions in particular should be addressedi) Did the program meet the identified needs of this

particular population

ii) Did the program meet its goal and objectives

iii)Was the program cost effective/iv) What is the program¶s long term impact on the

health of this population



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cont� Auditing of client¶s record-whether objective have

been met

� Checking the daily total book � Auditing the child health register book

� Feed back from clients through periodicquestionnaires and personal interviews or

telephone surveys� Health status of pregnant women, mothers and

children



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major causes of death & illness

from birth ± 5yrs� The UN Millennium Development Goal 4 is -

reducing childhood mortality

� Healthy children are a vital resource to ensure thefuture well being of a nation, and their future lie inthe hands of those people responsible for their wellbeing, including the community health nurse.

� Accidents and injuries are a leading cause of death

(Allender & Spreadly200

5)� Preventable communicable diseases increasemortality among the very young infant



Accidents & Injury

� Toddlers and preschools are vulnerable tomany types of accidents and unintentional

injuries e.g. MVA� Injury from burns can happen to children of

all ages-sources of burns electrical, cigarettelighters, matches and scalds from hot water

� Young children are at risk of drowningwherever water occurs in depth exceedingfew inches such as in toilet bowels, bath

tubs, buckets filled with rain water 49



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cont

� Currently the infant mortality rate, often considered to be afairly sensitive indicator of the general health status of a

population

� Major cause of death among the birth ± 4yr old populationare :

NEONATES

� Asphyxia/hypoxia

� Infection

� Congenital abnormality� trauma

� Malignant neo-plasms



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cont

� Unintentional injuries

� MVA

� falls

� drowning



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cont

Poisoning-sources are:

� Household plants, prescription medication,

unintentional medication overdoses, householdcleaning products and other chemical storedwithin the child¶s reach

� Communicable Diseases e.g. respiratory illness,

infectious and parasitic disease and digestiveconditions are the most common

� The incidence of measles and rubella, pertussis,and other vaccine preventable diseases havedropped considerably because of immunization



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cont

� Chronic Diseases e.g. asthma most common, foodallergies,muscular dystrophy

Nurses Roles in promoting the health of infants� Nurses working with maternal-infant population

require special qualities and education

� Solid understanding of the nursing process

� Effective communication skills� Effective organizational and leadership skills

� A sincere nonjudgmental approach to clients

� Willingness to work with other community res.



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cont

Educator

� Because nursing is such an integral part of any

maternal-infant program, nurses working in thesearea must possess good communication andteaching skills

� Nurse should select teaching methodologies thatare appropriate to the client group

� Teaching aids should be appropriate for eachaudience- should be congruent with the language,race and culture of the population being served soclient can understand and identify with them



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cont

� Teaching and motivating women to promote

their own health and the health of their

babies are major challenges and there is nosingle correct way to approach the task

� Community Health Nurses need to be

innovative and creative in their approach toteaching



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cont roles

Advocator

� The maternal-infant population has complex

needs- the nurse cannot meet all the needs of thisclient, they must act as advocates in referringclients to other community resources.

� The nurse must have working knowledge of available community resources for maternal-childhealth including family planning services,community childbirth education classes, resourcesavailable through the state department of socialservices.



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cont

Facilitator

� The CHN can influence legislation and policies

that affect the services provided at the local level.� the role of the nurse may include giving testimony

on behalf of the maternal-infant population

� The role of the facilitator may also include writing

grants/proposal to obtain funding for new project

or to maintain existing programs



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Reference List

� Allender, J.N. & Spradley, B. W. (200) . Community Health Nursing : Promoting and Protecting the Public Health, Philadelphia: LippincottWilliams & Wilkins.

� Bennett. R. & Brown, L. K.(1999) .Myles Textbook for Midwives (13th ed.). London : Churchill Livingstone.

� Estes, M. E. Z. Health Assessment: Physical Examination(2nd ed). New York : Thomson Learning Inc.

� Mott. S. R.,& James. S. R.(1998). Child Health Nursing California : Addison Wesley Publishing Company.

� Novak, J. C. , & Broom, B. L. (1999). M aternal and Child Health Nursing (9th ed.). St Louis: Mosby.

� Papalia, D. E., Olds, S. W., & Feldman, R. D. (2004) . Human Development (9th ed.). New York : McGraw HillCompanies, Inc.

PHC Maternal and Child Health Services

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