The document discusses antenatal, intranatal, postnatal care and care of children. It covers components of antenatal care including antenatal visits, prenatal advice, health protection, mental preparation and pediatric components. Intranatal care includes domiciliary and institutional care as well as rooming in. Postnatal care focuses on care of the mother and newborn. Care of children sections discusses antenatal pediatrics, neonatal care including immediate newborn care, examinations and care of at-risk infants.

1. VYJAYANTHI KADAMBI S
PREVENTIVE OBSTETRICS,
PEDIATRICS AND GERIATRICS

2. ANTENATAL CARE
INTRODUCTION
OBJECTIVES
COMPONENTS

3. INTRODUCTION
ANTENATAL CARE IS THE CARE OF THE
WOMAN DURING PREGNANCY
HEALTHY MOTHER AND HEALTHY BABY
NOTIFICATION OF PREGNANCY

5. COMPONENTS
ANTENATAL VISITS
PRENATAL ADVICE
SPECIFIC HEALTH PROTECTION
MENTAL PREPARATION
FAMILY PLANNING
PEDIATRIC COMPONENT

6. ANTENATAL VISITS

9. ANM- ESTIMATION OF NUMBER OF PREGNANCIES
IN A SPECIFIED AREA AND PREGNANCY TRACKING

12. FIRST ANTENATAL VISIT -
COMPONENTS
HISTORY TAKING
PHYSICAL EXAMINATION
ABDOMINAL EXAMINATION
ASSESMENT OF GESTATIONAL AGE
LABORATORY INVESTIGATIONS

13. LABORATORY INVESTIGATIONS

16. RISK APPROACH
 ELDERLY PRIMI 3O YEARS OR OVER
 SHORT STATURED PRIMI LESS THAN 140 CMS
 MALPRESENTATION
 APH
 THREATENED ABORTION
 PRE ECLAMPSIA
 ECLAMPSIA
 ANEMIA
 TWINS
 HYDRAMNIOS

17.  PREVIOUS STILL BIRTH
 IUD
 MANUAL REMOVAL OF PLACENTA
 ELDERLY GRAND MULTIPARA
 PROLONGED PREGNANCY
 H/O PREVIOUS LSCS OR INSTRUMENTAL
DELIVERY
 PREGNANCY + SYSTEMIC DISORDERS
 TREATMENT FOR INFERTILITY
 3 OR MORE SPONTANEOUS CONSECUTIVE
ABORTIONS

19. TAAYI CARD

20. PRENATAL ADVICE
DIET
PERSONAL HYGIENE
DRUGS
RADIATION
WARNING SIGNS
CHILD CARE

21. PERSONAL HYGIENE
PERSONAL CLEANLINESS
REST AND SLEEP
BOWELS
EXERCISE
SMOKING
ALCOHOL
DENTAL HYGIENE
SEXUAL INTERCOURSE

22. WARNING SIGNS
SWELLING OF FEET
FITS
HEADACHE
BLURRING OF VISION
BLEEDING OR DISCHARGE PV
ANYTHING UNUSUAL

23. MOTHER CRAFT

24. SPECIFIC HEALTH
PROTECTION
ANEMIA – 100 mg ELEMENTAL IRO + 500 mcg
FA FOR 100 DAYS
OTHER NUTRITIONAL DEFICIENCIES- VIT A
AND D FREE SUPPLY
TOXEMIAS OF PREGNANCY
TETANUS – 1ST DOSE = 16-20 WEEKS
2ND DOSE= 20-24 WEEKS
SYPHILIS – 10 DAILY INJECTIONS OF
PROCAINE PENICILLIN (600,000 UNITS)
GERMAN MEASLES

25. Rh Status

26. HIV INFECTION
HEP B INFECTION
PRENATAL GENETIC SCREENING

27. MENTAL PREPARATION

28. FAMILY PLANNING

29. PEDIATRIC COMPONENT

30. INTRANATAL CARE
INTRODUCTION
AIMS
DOMICILIARY CARE
INSTITUTIONAL CARE
ROOMING IN

31. INTRANATAL CARE
FIVE CLEANS
1. CLEAN HANDS AND FINGERNAILS
2. CLEAN SURFACE FOR DELIVERY
3. CLEAN BLADE TO CUT THE CORD
4. CLEAN TIE FOR THE CORD
5. CLEAN BIRTH CANAL

32. AIMS OF GOOD INTRANATAL
CARE

33. DOMICILIARY CARE

34. ADVANTAGES
MOTHER DELIVERS IN FAMILIAL
SURROUNDINGS OF HER HOME AND THUS
REMOVES FEAR
LOWER CHANCES OF CROSS INFECTION AT
HOME THAN IN HOSPITAL
MOTHER IS ABLE TO KEEP AN EYE UPON
HER CHILDREN AND DOMESTIC AFFAIRS AND
HENCE EASES HER MENTAL TENSION

35. DISADVANTAGES
LESS MEDICAL AND NURSING SUPERVISION
THAN IN THE HOSPITAL
SHE MAY RESUME HER DOMESTIC DUTIES
TOO SOON
DIET MAYBE NEGLECTED

37. DANGER SIGNALS

38. INSTITUTIONAL CARE

39. ROOMING IN
KEEPING THE BABY’S CRIB BY THE SIDE OF
THE MOTHER’S BED
OPPURTUNITY FOR THE MOTHER TO KNOW
HER BABY
BETTER CHANCE FOR BREAST FEEDING
ALSO ALLAYS THE FEAR IN THE MOTHER’S
MIND THAT THE BABY IS MISPLACED IN THE
CENTRAL NURSERY
BUILDS UP HER SELF CONFIDENCE

40. POSTNATAL CARE
INTRODUCTION
CARE OF THE MOTHER
COMPLICATIONS
RESTORATION OF THE MOTHER TO
OPTIMUM HEALTH
BREAST FEEDING
FAMILY PLANNING
BASIC HEALTH EDUCATION

41. INTRODUCTION
CARE OF THE MOTHER AND THE NEWBORN
AFTER DELIVERY IS KNOWN AS POSTNATAL
OR POSTPARTAL CARE
OBSTETRICIAN + PEDIATRICIAN
COMBINATION IS CALLED PERINATOLOGY

42. CARE OF THE MOTHER

43. COMPLICATIONS
PUERPERAL SEPSIS
THROMBOPHLEBITIS
SECONDARY HEMORRHAGE
UTI, MASTITIS

44. RESTORATION OF MOTHER TO
OPTIMUM HEALTH
PHYSICAL
PSYCHOLOGICAL
SOCIAL

45. PHYSICAL COMPONENT
1. POSTNATAL EXAMINATIONS
2. ANEMIA
3. NUTRITION
4. POSTNATAL EXERCISES

47. BREAST FEEDING

48. FAMILY PLANNING
POSTPARTUM STERILIZATION IS GENERALLY
RECOMMENDED ON THE 2ND DAY AFTER
DELIVERY
IUCD
NON HORMONAL CONTRACEPTION

49. BASIC HEALTH EDUCATION
PERSONAL AND ENVIRONMENTAL HYGIENE
FEEDING FOR MOTHER AND INFANT
PREGNANCY SPACING
IMPORTANCE OF HEALTH CHECK UP
BIRTH REGISTRATION

50. CARE OF CHILDREN

51. 0-14 YEARS
40% OF TOTAL POPULATION
SOCIALIZATION PROCESS
VULNERABLE TO DISEASE, DEATH AND
DISABILITY

53. ANTENATAL PEDIATRICS
AMNIOCENTESIS
USG
FETOSOCPY
CHORION BIOPSY
SPACING- 2 TO 3 YEARS
PREVENTION OF CONGENITAL
ABNORMALITIES AND INBORN ERRORS OF
METABOLISM

54. INFANCY
2.92 % OF TOTAL POPULATION
ABOUT 40% IMR OCCURS IN FIRST MONTH
OF LIFE
IMR = 58/1000 IN INDIA

55. NEONATAL CARE
EARLY NEONATAL CARE
1. IMMEDIATE CARE
2. NEONATAL EXAMINATIONS
3. THE INFECTED NEWBORN
4. MEASURING THE BABY
5. NEONATAL SCREENING
6. AT RISK INFANTS
LATE NEONATAL CARE

56. OPTIMUM NEWBORN CARE

58. OBJECTIVES OF EARLY NEONATAL
CARE
 ESTABLISHMENT AND MAINTENANCE OF
CRDIORESPIRATORY FUNCTIONS
 MAINTENANCE OF BODY TEMPERATURE
 AVOIDANCE OF INFECTION
 ESTABLISHMENT OF SATISFACTORY FEEDING
REGIMEN
 EARLY DETECTION AND TREATMENT OF
CONGENITAL AND ACQUIRED DISORDERS,
ESPECIALLY INFECTIONS.

59. IMMEDIATE CARE
CLEARING THE AIRWAY
APGAR SCORE
CARE OF THE CORD
CARE OF THE YES
CARE OF THE SKIN
MAINTENANCE OF BODY TEMPERATURE
BREAST FEEDING

60. CLEARING THE AIRWAY

61. APGAR SCORE

63. 9 TO 10- NORMAL
0-3 – SEVERELY DEPRESSED
4-6 – MODERATELY DEPRESSED
SCORE BELOW 5 REQUIRES PROMPT ACTION

64. CARE OF THE CORD

65. KEEP CORD DRY AS POSSIBLE
ASEPTIC PREPARATION ON THE CORD
STUMP AND SKIN AROUND THE BASE
DRIES AND SEPARATES BY ASEPTIC
NECROSIS IN 5-8 DAYS

66. CARE OF THE EYE

67. CARE OF THE SKIN

68. MAINTENANCE OF THE BODY
TEMPERATURE

69. BREAST FEEDING

70. NEONATAL EXAMINATIONS
FIRST EXAMINATION- SOON AFTER BIRTH IN
THE LABOUR ROOM
SECOND EXAMINATION- WITHIN 24 HOURS
BY PEDIATRICIAN

71. THE INFECTED NEWBORN
NEONATAL TETANUS
CONGENITAL SYPHILIS
NEWBORN WITH HBV +VE MOTHER
NEWBORN WITH HIV +VE MOTHER

72. MEASURING THE BABY
BIRTH WEIGHT(within first hour of life)
LENGTH(within 3 days)
HEAD CIRCUMFERENCE- maximum
circumference of the head at the occipito frontal
diameter

75. NEONATAL SCREENING
 DETECT INFANTS WITH TREATABLE GENETIC,
DEVELOPMENTAL, AND SECONDARILY, TO PROVIDE
PARENTS WITH GENETIC COUNSELLING
 10 – 15 ML CORD BLOOD STORED
 COMMON DISORDERS SCREENED:
1. PHENYLKETONURIA
2. NEONATAL HYPOTHYROIDISM
3. COOMBS’ TEST
4. SICKLE CELL OR OTHER HEMOGLOBINOPATHIES
5. CDH

76. “AT-RISK” INFANTS
 BIRTH WEIGHT LESS THAN 2.5 KG
 TWINS
 BIRTH ORDER 5 OR MORE
 ARTIFICIAL FEEDING
 WEIGHT BELOW 70% OF THE EXPECTED WEIGHT
 FAILURE TO GAIN WEIGHT DURING 3
SUCCESSIVE MONTHS
 CHILDREN WITH PEM OR DIARRHEA
 WORKING MOTHER/ ONE PARENT

77. LATE NEONATAL CARE

78. LOW BIRTH WEIGHT
THE BIRTH WEIGHT OF AN INFANT IS THE
SINGLE MOST IMPORTANT DETERMINANT OF
ITS CHANCES OF SURVIVAL, HEALTHY
GROWTH AND DEVELOPMENT

79. 2 GROUPS
SHORT GESTATION
IUGR

80. BIRTH WEIGHT LESS THAN 2.5 KGS AT FIRST
HOUR OF LIFE
A LBW INFANT IS ANY INFANT WITH A BIRTH
WEIGHT OF LESS THAN 2.5 KGS
REGARDLESS OF GESTATIONAL AGE.

81. PRETERM BABIES
1. EXTREMELY PRETERM (<28 WEEKS)
2. VERY PRETERM (28 TO 32 WEEKS)
3. MODERATE TO LATE PRETERM(32 TO 37
WEEKS)

82. PRETERM BIRTH-TWO BROAD SUB TYPES
1. SPONTANEOUS PRETERM BIRTH
2. PROVIDER INITIATED PRETERM BIRTH

84. SMALL-FOR-DATE BABIES
THESE MAY BE BORN AT TERM OR PRETERM
THEY WEIGH LESS THAN THE 10TH
PERCENTILE FOR THE GESTATIONAL AGE

85. MATERNAL FACTORS
 MALNUTRITION
 SEVERE ANEMIA
 HEAVY PHYSICAL WORK
 HYPER TENSION
 MALARIA
 TOXAEMIA
 SMOKING
 LOW ECONOMIC STATUS
 SHORT MATERNAL STATURE
 HIGH PARITY
 CLOSE BIRTH SPACING
 LOW EDUCATION STATUS

86. FOETAL FACTORS
1. FOETAL
ABNORMALITIES
2. INTRAUTERINE
INFECTIONS
3. CHROMOSOMAL
ABNORMALITY
4. MULTIPLE
GESTATION
PLACENTAL
FACTORS
1. INSUFFICIENCY
2. ABNORMALITY

87. PREVENTION
DIRECT INTERVENTION MEASURES
1. INCREASING FOOD INTAKE
2. CONTROLLING INFECTIONS
3. EARLY DETECTION AND TREATMENT OF MEDICAL
DISORDERS
INDIRECT INTERVENTION
TREATMENT
a) <2KGS - FIRST CLASS MODERN NOENATAL CARE
b) 2-2.5KGS – ICU FOR ADAY ORTWO
KANGAROO MOTHER CARE

88. KANGAROO MOTHER CARE
COLOMBIA 1979 Dr HECTOR MARTINEZ AND
EDZAR REY
FOR LBW BABIES

89. COMPONENTS
1. SKIN TO SKIN POSITIONING OF THE BABY
ON THE MOTHER’S CHEST
2. ADEQUATE NUTRITION THROUGH BREAST
FEEDING
3. AMBULATORY CARE AS A RESULT OF
EARLIER DISCHARGE FROM HOSPITAL
4. SUPPORT FOR THE MOTHER AND HER
FAMILY IN CARING FOR THE BABY

90. INTENSIVE CARE
INCUBATORY CARE
FEEDING
PREVENTION OF INFECTION

92. BREAST FEEDING
450-600 ML OF MILK PER DAY
1.1 GM PROTIEN PER 100 ML
70 KCAL PER 100 ML

93. ADVANTAGES
BABY
 IT IS SAFE , CLEAN , HYGENIC , CHEAP AND
AVAILABLE TO THE INFANT AT THE CORRECT
TEMPERATURE
 NUTRITIONAL REQUIREMENTS SATISFIED
 ANTI-MICROBIAL FACTORS
 EASILY DIGESTED AND UTILISED
 PROMOTES BONDING
 DEVELOPMENT OF JAW AND TEETH-SUCKING
 PROTECTS FROM OBESITY
 PREVENTS MALNUTRITION AND REDUCES IMR
 SPACING
 INCREASE IQ AND BETTER VISUAL ACTIVITY

94. MOTHER
LOWER RISK OF PPH AND ANEMIA
BOOST IMMUNE SYSTEM
DELAYS NEXT PREGNANCY
REDUCES INSULIN OF DIABETIC MOTHERS
PROTECT FROM OVARIAN AND BREAST
CANCER AND OSTEOPOROSIS

95. FEED BY THE CLOCK
1-4 HRS INTERVAL
NO OTHER FOOD IS REQUIRED UNTIL 6
MONTHS AFTER BIRTH

96. BREAST MILK SUBSTITUTES
DRIED WHOLE MILK POWDER
FRESH MILK FROM A COW OR OTHER
ANIMALS
OTHER COMMERCIAL FORMULAE

97. WEANING

98. BABY FRIENDLY HOSPITALS
INITIATIVES
WHO , UNICEF
ENCOURAGE PROPER INFANT FEEDING
PRACTICES

99.  HAVE A WRITTEN BREAST FEEDING POLICY THAT IS
ROUTINELY COMMUNICATED TO ALL HEALTH CARE
STAFF.
 TRAIN ALL HEALTH CARE STAFF IN SKILLS NECESSARY
TO IMPLEMENT THIS POLICY
 INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS
AND MANAGEMENT OF BF
 HELP MOTHERS INITIATE BF WITHIN HALF HOUR OF
BIRTH
 SHOW MOTHER, HOW TO BF AND MAINTAIN
LACTATION, EVEN IF SEPARATED FROM THEIR INFANTS

100.  GIVE NEWBORNS NO FOOD OR DRINK OTHER
THAN BREAST MILK, NOT EVEN SIPS OF WATER
UNLESS MEDICALLY INDICATED
 PRACTICE ROOMING-IN
 ENCOURAGE BF ON DEMAND
 GIVE NO ARTIFICIAL TEATS OR PACIFIERS
 FOSTER THE ESTABLISHMENT OF BF SUPPORT
GROUPS AND REFER MOTHERS TO THEM ON
DISCHARGE FROM HOSPITAL OR CLINIC.

101. IN INDIA

102. DETERMINANTS OF GROWTH AND DEVELOPMENT
1. GENETIC INHERITANCE
2. NUTRITION
3. AGE
4. SEX
5. PHYSICAL SURROUNDINGS
6. PSYCHOLOGICAL FACTORS
7. INFECTIONS
8. ECONOMIC FACTORS
9. OTHER FACTORS

103. SURVEILLANCE OF GROWTH AND
DEVELOPMENT
 PHYSICAL GROWTH
1. WEIGHT FOR AGE
2. HEIGHT FOR AGE
3. WEIGHT FOR HEIGHT
4. HEAD AND CHEST CIRCUMFERENCE
 BEHAVIOURAL DEVELOPMENT
1. MOTOR DEVELOPMENT
2. PERSONAL SOCIAL DEVELOPMENT
3. ADAPTIVE DEVELOPMENT
4. LANGUAGE DEVELOPMENT

105. GROWTH CHART
 ROAD TO HEALTH CHART
 DESIGNED BY DAVID MORLEY AND LATER MODIFIED
BY WHO
 IT IS A VISIBAL DISPLAY OF THE CHILD’S PHYSICAL
GROWTH AND DEVELOPMENT.
 MEANT FOR LONGITUDINAL FOLLOW-UP (GROWTH
MONITORING)
 COMPARE WITH REFERENCE CURVES

106. WEIGHT IS THE MOST SENSITIVE MEASURE
OF GROWTH
CHILD CAN LOSE WEIGHT BUT NOT HEIGHT
INEXPENSIVE WAY OF MONITORING WEIGHT
GAIN AND CHILD’S HEALTH

107. WHO CHILD GROWTH
STANDARDS- 2006
MULTICENTRE GROWTH REFERENCE STUDY
– CONDUCTED
9440 HEALTHY BREAST FED INFANTS AND
CHILDREN (0 TO 60 MONTHS)
WIDELY DIVERSE ETHNIC BACKGROUND AND
CULTURAL SETTINGS

109. GROWTH CHART USED IN INDIA
 ADOPTED IN FEB 2009
 WITHIN NRHM AND ICDS
 “MOTHER AND CHILD PROTECTION CARD”
 IT IS THE DIRECTION OF THE GROWTH THAT IS MORE
IMPORTANT THAN THE POSITION OF DOTS ON THE
LINE
 FLATTENING OR FALLING OF THE CHILD’S WEIGHT
CURVE SIGNALS GROWTH FAILURE
 OBJECTIVE IS TO KEEP THE CHILD IN THE NORMAL
ZONE

113. USES OF GROWTH CHART
1. FOR GROWTH MONITORING
2. DIAGNOSTIC TOOL: IDENTIFY HIGH RISK CHILDREN
3. PLANNING AND POLICY MAKING
4. EDUCATIONAL TOOL
5. TOOL FOR ACTION
6. EVALUATION
7. TOOL FOR TEACHING
“PASSPORT TO CHILD HEALTH CARE”

114. PRE SCHOOL CHILD
9.7% OF TOTAL POPULATION
2.3% OF ALL DEATHS

115. CHILD HEALTH PROBLEMS
LOW BIRTH WEIGHT
MALNUTRITION
INFECTIONS AND PARASITOSIS
ACCIDENTS AND POISONING
BEHAVIOURAL PROBLEMS
OTHER FACTORS:
1. MATERNAL HEALTH
2. FAMILY HEALTH
3. SOCIOECONOMIC CIRCUMSTANCES
4. ENVIRONMENT
5. SOCIAL SUPPORT AND HEALTH CARE

117. MCH
MOTHER AND CHILD HEALTH

118. INTRODUCTION
 IT IS A METHOD OF DELIVERING HEALTH CARE
TO SPECIAL GROUP IN THE POPULATION WHICH
IS ESPECIALLY VULNERABLE TO DISEASE,
DISABILTY OR DEATH
 CHILDREN UNDER 5 YEARS
 WOMEN BETWEEN 15 TO 44 YEARS
 32.4%OF TOTAL POPULATION OF INDIA

119. OBJECTIVES
1. REDUCTION OF MORBIDITY AND MORTALITY
RATES OF MOTHERS AND CHILDREN
2. PROMOTION OF REPRODUCTIVE HEALTH
3. PROMOTION OF THE PHYSICAL AND
PSYCHOLOGICSL DEVELOPMENT OF THE
CHILD WITHIN THE FAMILY

120. SUB AREAS
a) MATERNAL HEALTH
b) FAMILY PLANNING
c) CHILD HEALTH
d) SCHOOL HEALTH
e) HANDICAPPED CHILDREN
f) CARE OF THE CHILDREN IN SPECIAL SETTINGS
SUCH AS DAY CARE CENTRES

121. RECENT TRENDS IN MCH CARE
1. INTEGRATION OF CARE
2. RISK APPROACH
3. MANPOWER CHANGES
4. PRIMARY HEALTH CARE

122. INDICATORS OF MCH CARE
1. MATERNAL MORTALITY RATIO
2. PERINATAL MORTALITY RATE
3. NEONATAL MORTALITY RATE
4. POST NEONATAL MORTALITY RATE
5. INFANT MORTALITY RATE
6. 1-4 YEAR MORTALITY RATE
7. UNDER-5 MORTALITY RATE
8. CHILD SURVIVAL RATE

123. MATERNAL MORTALITY RATIO
MATERNAL DEATH IS DEFINED AS THE
DEATH OF A WOMAN WHILE PREGNANT OR
WITHIN 42 DAYS OF TERMINATION OF
PREGNANCY, IRRESPECTIVE OF DURATION
AND SITE OF PREGNANCY, FROM ANY
CAUSE RELATED TO OR AGGRAVATED BY
PREGNANCY OR ITS MANAGEMENT BUT NOT
FROM ACCIDENTAL OR INCIDENTAL CAUSES.

124. MMR

125. LATE MATERNAL DEATH
THE DEATH OF A WOMAN FROM DIRECT OR
INDIRECT CAUSES, >42 DAYS BUT <1 YEAR
AFTER TERMINATION OF PREGNANCY

128. MATERNAL DEATHS
Direct obstetric deaths
Indirect obstetric deaths
The maternal mortality rate, the direct obstetric rate
and the indirect obstetric rate are fine measures of
the quality of maternal services

130. Approaches for measuring Maternal
Mortality
Civil registration systems
Household survey
Sisterhood methods
Reproductive age mortality studies (RAMOS)
Verbal autopsy
Census

132. MMR IN INDIA = 178 PER 100,000 LIVE BIRTHS
KERALA, MAHARASHTRA AND TN = 100 PER
LAC LIVE BIRTHS
ASSAM = HIGHEST – 328/100,000 LIVE BIRTHS
SRS (CENTRAL REGISTRATION SYSTEM)
INTRODUCED “RHIME” THAT IS
REPRESENTATIVE, RE SAMPLED, ROUTINE
HOUSEHOLD INTERVIEW OF MORTALITY
WITH MEDICAL EVALUATION

133. MAJOR CAUSES ACOORDING TO SRS
SURVEY:
HEMORRHAGE 38%
HYPERTENSION 5%
SEPSIS 11%
OBS LABOR 5 %
ABORTION 8%
ANEMIA 19%

135. NATIONAL MATERNAL HEALTH CARE
INDICATORS
ANTENATAL CARE
INSTITUTIONAL DELIVERY
IFA TABLET CONSUMPTION
POSTNATAL CHECK UP WITHIN 2 DAYS

137. PREVENTIVE AND SOCIAL MEASURES
1. EARLY REGISTRATION OF PREGNANCY
2. AT LEAST 4 ANTENATAL CHECK UPS
3. DIETARY SUPPLEMENTATION, INCLUDING CORRECTION OF
ANEMIA
4. PREVENTION OF INFECTION AND HEMORRHAGE DURING
PUERPERIUM
5. PREVENTION OF COMPLICATIONS
6. TREATMENT OF MEDICAL CONDITIONS
7. ANTI-MALARIA AND TETANUS PROPHYLAXIS
8. CLEAN DELIVERY PRACTICE
9. TRAINED LOCAL DAIS AND FHW
10. INSTITUTIONAL DELIVERIES
11. PROMOTION OF FAMILY PLANNING
12. IDENTIFICATION OF EVERY MATERNAL DEATH AND ITS CAUSE
13. SAFE ABORTION SERVICES

140. STILL BIRTH RATE

142. PERINATAL MORTALITY RATE
1. BABIES CHOSEN FOR INCLUSION IN PERINATAL
STATISTICS SHOULD BE THOSE ABOVE A MINIMUM
BW I,E 1000 GM AT BIRTH
2. IF BW IS NA, A GA OF ATLEAST 28 WKS SHOULD BE
USED
3. IF 1 AND 2 ARE NA, BODY LENGTH OF ATLEAST
35CM SHOULD BE USED

145. WHY PERINATAL MORTALITY RATE?
 WITH DECLINE OF IMR, PMR HAS ASSUMED GREATER
SIGNIFICANCE AS A YARDSTICK OF OBSTETRIC AND PEDIATRIC
CARE BEFORE AND AROUND THE TIME OF BIRTH
 2 TYPES OF DEATH RATES ARE COMBINED THAT IS STILLBIRTHS
AND EARLY NEONATAL DEATH
 A PROPORTION OF DEATHS OCCURING AFTER BIRTH ARE
INCORRECTLY REGISTERED AS STILLBIRTHS,THEREBY
INFLATING STILLBIRTH RATE AND LOWERING NEONATAL DEATH
RATE
 THE VALUE OF PMR IS THAT IT GIVES A GOOD INDICATION OF
THE EXTENT OF PREGNANCY WASTAGE AS WELL AS THE
QUALITY AND QUANTITY OFNHEALTH CARE AVAILABLE TO THE
MOTHER AND THE NEWBORN

146. CAUSES OF PERINATAL MORTALITY

149. NEONATAL MORTALITY RATE

150.  NEONATAL MORTALITY IS A MEASURE OF
INTENSITY WITH WHICH ENDOGENOUS FACTORS
AFFECT INFANT LIFE
 DIRECTLY RELATED TO BW AND GA
 IN INDIA = 29/1000 LIVE BIRTHS

152. POST NEONATAL MORTALITY RATE

153.  WHEREAS NMR IS DOMINATED BY ENDOGENOUS
FACTORS, POST-NEONATAL MORTALITY IS DOMINATED BY
EXOGENOUS FACOTORS.
 DIARRHEA AND ARI ARE MAIN CAUSES
 IN DEVELOPED COUNTRIES, CONGENITAL ANOMALIES IS
THE MAIN CAUSE
 MALNUTRITION IS AN ADDITIONAL FACTOR
 IN INDIA= 13/1000 LIVE BIRTHS

154. INFANT MORTALITY RATE
 IMR IS UNIVERSALLY REGARDED NOT ONLY AS THE MOST
IMPORTANT INDICATOR OF HEALTH STATUS OF A
COMMUNITY BUT ALSO THE LEVEL OF LIVING OF PEOPLE
IN GENERAL, AND EFFECTIVENESS OF MCH SERVICES IN
PARTICULAR

155. LARGEST SINGLE AGE CATEGORY OF
MORTALITY
DEATHS AT THIS AGE ARE DUE TO PECULIAR
SET OF DISEASES AND CONDITIONS TO
WHICH ADULTS ARE LESS PRONE
AFFECTED RATHER QUICKLY AND DIRECTLY
BY SPECIFIC HEALTH PROGRAMMES

156. IMR IN INDIA = 41/1000 LIVE BIRTHS

158. FACTORS AFFECTING INFANT MORTALITY
BIOLOGICAL FACTORS
ECONOMIC FACTORS
SOCIAL FACTORS

159. BIOLOGIC FACTORS
1. BIRTH WEIGHT
2. AGE OF THE MOTHER
3. BIRTH ORDER
4. BIRTH SPACING
5. MULTIPLE BIRTHS
6. FAMILY SIZE
7. HIGH FERTILITY

160. CULTURAL AND SOCIAL FACTORS
1. BREAST FEEDING
2. RELIGION AND CASTE
3. EARLY MARRIAGES
4. SEX OF THE CHILD
5. QUALITY OF MONITORING
6. MATERNAL EDUCATION
7. QUALITY OF HEALTH CARE
8. BROKEN FAMILIES
9. ILLEGITIMACY
10. BRUTAL HABITS AND CUSTOMS
11. THE INDIGENOUS DAIS
12. BAD ENVIRONMENTAL SANITATION

161. PREVENTIVE AND SOCIAL MEASURES
1. PRENATAL NUTRITION
2. PREVENTION OF INFECTION
3. BREAT FEEDING
4. GROWTH MONITORING
5. FAMILY PLANNING
6. SANITATION
7. PROVISION OF PRIMARY HEALTH CARE
8. SOCIOECONOMIC DEVELOPMENT
9. EDUCATION

162. 1-4 YEAR MORTALITY RATE

164. UNDER 5 MORTALITY RATE
INDIA= 53/1000 LIVE BIRTHS

167. NATIONAL TECHINICAL COMMITTEE ON CHILD
HEALTH, 2000

168. CHILD SURVIVAL INDEX
INDIA= 94.7

169. INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS

170. 3 COMPONENTS

171. INTEGRATED MANAGEMENT OF
:
DIARRHOEA
ARI
MALARIA
MEASLES
MALNUTRITION
1 WEEK TO 5 YEAR OLD CHILDREN
ACTION- ORIENTED APPROACH

172. ELEMENTS:
ASSESS
• ASSESS A CHILD BY CHECKING FIRST FOR DANGER
SIGNS, ASKING QUESTIONS ABOUT COMMON
CONDITIONS, NUTRITION, IMMUNIZATION STATUS AND
OTHER HEALTH PROBLEMS
CLASSIFY
• CHILD’S ILLNESS USING A COLOU CODED TRIAGE
SYSTEM

173. IDENTIFY
• IDENTIFY SPECIFIC TREATMENTS FOR THE CHILD. IF
REQUIRES REFERRAL, GIVE ESSENTIAL TREATMENT BEFORE
TRANSFER
• IF NEEDS IMMUNIZATION, IMMUNIZE
TREAT
• PRACTICAL INSTRUCTIONS ON HOW TO GIVE ORAL
DRUGS, FEED, OR FLIDS
• ASK TO RETURN FOR FOLLOW UP AND HOW TO
RECOGNIZE DANGER SIGNS TO RETURN IMMEDIATELY
TO THE FACILITY

174. COUNSEL
• BREAST FEEDING PRACTICES
• COUNSEL ABOUT MOTHER’S HEALTH
FOLLOW-UP CARE
• REASSESS THE CHILD FOR NEW PROBLEMS

176. SCHOOL HEALTH SERVICE
SCHOOL HEALTH IS AN IMPORTANT BRANCH
OF COMMUNITY HEALTH
PERSONAL HEALTH SERVICE
ECONOMICAL AND POWERFUL MEANS OF
RAISING COMMUNITY HEALTH

177. HEALTH PROBLEMS OF THE SCHOOL
CHILD
1. MALNUTRITION
2. INFECTIUOS DISEASES
3. DISEASES OF SKIN, EYE AND EAR
4. INTESTINAL PARASITES
5. DENTAL CARIES

178. OBJECTIVES

179. ASPECTS OF SCHOOL HEALTH SERVICE

180. HEALTH APPRAISAL
STUDENTS+TEACHERS+OTHERS
a) PERIODIC MEDICAL EXAMINATION- EVERY 4
YRS
b) SCHOOL PERSONNEL
c) DAILY MORNING INSPECTION

181. MENTALLY HANDICAPPED CHILDREN

182. CAUSES
MISCALLANEOUS
GENETIC
ANTENAT
AL
FACTOR
S
PERINAT
AL
FACTOR
S
POSTNAT
AL
FACTOR
S

185. PRIMARY PREVENTION OF HANDICAP

186. JUVENILE DELINQUENCY
 “ A CHILD WHO HAS COMMITTED AN OFFENCE”
 BOY <16 YEARS
 GIRL <18 YEARS
 JUVENILE CRIME
 IT EMBRACES ALL DEVIATIONS FROM NORMAL
YOUTHFUL BEHAVIOUR
 INCLUDES INCORRIGIBLE,UNGOVERNABLE,
HABITUALLY DISOBEDIENT AND THOSE WHO DESERT
THEIR HOMES AND MIX WITH IMMORAL PEOPLE,
THOSE WITH BEHAVIOURAL PROBLEMS AND
ANTISOCIAL PRACTICES

187. CAUSES
GENETIC
• HEREDITARY
DEFECTS
• FEEBLE MIND
• XYY
SYNDROME
• GLANDULAR
IMBALANCE
SOCIAL
• PARENTAL
NEGLECT
• BROKEN
HOMES
• STEP
MOTHERS
• DEATH OF
PARENTS
OTHERS
• CHEAP
RECREATION
• URBANIZATION
• SEX THRILLERS
• TV
• NO
RECREATION

188. PREVENTIVE MEASURES
IMPROVEMENT OF FAMILY LIFE
SCHOOLING
SOCIAL WELFARE SERVICES

189. STREET CHILDREN

191. 24 HOURS SHELTER
FOOD
CLOTHING
NON FORMAL EDUCATION
GUIDANCE
RECREATION
COUNSELLING
SCHOOLING ETC PROVIDED

192. THE CHILD LABOUR ACT, 1986

193. CHILD GUIDANCE CLINIC

194. TEAM WORK….
PSYCHIATRIST------ CENTRAL FIGURE
CHILD PSYCHOLOGIST
EDUCATIONAL PSYCHOLOGIST
PSYCHIATRIC SOCIAL WORKERS
PUBLEC HEALTH NURSES
PAEDIATRICIAN
SPEECH THERAPIST
OCCUPATIONAL THERAPIST
NEUROLOGIST

195. SERVICES
PAEDIATRICIAN -> PHYSICAL HEALTH OF THE
CHILD
PSYCHOTHERAPY
1. PLAY THERAPY
2. COUNSELLING
3. SUGGESTIONS
4. CHANGE IN PHYSICAL ENVIRONMENT
5. EASING OF PARENTAL TENSIONS
6. RECONSTRUCTION OF PARENTAL ATTITUDES

196. CHILD PLACEMENT
ORPHANAGES
FOSTER
HOMES
ADOPTIONBORSTALS
REMAND
HOMES

197. 1975
INTEGRATED CHILD
DEVELOPMENT SERVICES

200. OBJECTIVES

201. SERVICES
1. SUPPLEMENTARY NUTRITION
2. NUTRITION AND HEALTH EDUCATION FOR
WOMEN
3. IMMUNIZATION
4. HEALTH CHECK-UP
5. MEDICAL REFERRAL SERVICES
6. NON FORMAL EDUCATION OF CHILDREN UPTO 6
YEARS, AND PREGNANT AND NURSING MOTHERS.

203. SUPPLEMENTARY NUTRITION

204.  MORE THAN ONE MEAL TO THE CHILDREN WHO COME TO
AWCs, WHICH INCLUDE PROVIDING A MORNING SNACK IN
THE FORM OF MILK/BANANA/EGG/SEASONAL
FRUIT/MICRONUTRIENT FORTIFIED FOOD F/B A HOT
COOKED MEAL
 IF <3 YRS, PREGNANT OR LACTATING : TAKE HOME
RATION
 BPL IS NOT A CRITERIA FOR ICDS SERVICES
 ALL ARE ELIGIBLE
 THE SCHEME IS UNIVERSAL
SUPPLEMENTARY NUTRITION IS GIVEN 300 DAYS IN A YEAR

205. HEALTH CHECK UP

206. CONTD..
ANTENATAL
POSTNATAL
CHILDREN <6 YEARS
IFA + PROTEIN FOR MOTHERS

207. SCHEMES FOR ADOLESCENT GIRLS
KISHORI SHAKTI YOJANA (11-18 YRS)
UNDER ICDS
NUTRITION PROGRAMME FOR ADOLESCENT
GIRLS ( UNDER ICDS)

208. 2 MORE UNDER ICDS
RAJIV GANDHI SCHEME FOR
EMPOWERMENT OF ADOLESCENT GIRLS –
SABLA
INDIRA GANDHI MATRUTVA SAHYOG
YOJANA

209. HOW ICDS IS ORGANISED?
COMMUNITY DEVELOPMENT BLOCK in rural
areas
TRIBAL DEVELOPMENT BLOCK in tribal areas
RURAL/URBAN PROJECT has 100,000
population
TRIBAL PROJECT has 35,000 population
100 Villages in rural project
50 villages in tribal project

210. FUNCTIONARIES OF ICDS
ANGANWADI WORKER- AWW
CHILD DEVELOPMENT PROJECT OFFICER-
CDPO in charge of 4 mukhyasevika and 100
AWW
MUKHYA SEVIKA in charge of 20-25
ANGANWADIS and mentor of AWW

211. AWW- ROLE
 MULTIPURPOSE AGENT
 SELECTED FROM THE COMMUNITY
 DIRECT LINK TO CHILDREN AND MOTHER
 ASSISTS CDPO IN SURVEY PF COMMUNITY AND
BENEFICIARIES
 NON FORMAL EDUCATION SESSIONS
 HEALTH AND NUTRITION EDUCATION TO MOTHERS
 ASSISTS PHC STAFF IN PROVIDING HEALTH SERVICES
 MAINTAINS RECORDS AND IMMUNIZATION
 FEEDING AND PRESCHOOL ATTENDANCE
 LIASES WITH BLOCK ADMINISTRATOR
 COMMUNITY BASED ACTIVITIES

212. 10 TO 19 YEARS : ADOLESCENTS
15 TO 24 YEARS : YOUTH
10 TO 24 YEARS : YOUNG PEOPLE

213. PREVENTIVE GERIATRICS

214. HEALTH PROBLEMS OF THE
AGED
PROBLEMS DUE TO AGEING PROCESS
PROBLEMS ASSOCIATED WITH LONG TERM
ILLNESS
PSYCHOLOGICAL PROBLEMS

215. PROBLEMS DUE TO AGEING
PROCESS
SENILE CATARACT
GLAUCOMA
NERVE DEAFNESS
OSTEOPOROSIS
EMPHYSEMA
FAILURE OF SPECIAL SENSES
CHANGES IN MENTAL OUTLOOK………..

216. PROBLEMS ASSOCIATED WITH LONG
TERM ILLNESSES
DEGENERATIVE DISEASES OF HEART AND
BLOOD VESSELS
CANCER
ACCIDENTS
DIABETES
DISEASES OF LOCOMOTOR SYSTEM
RESPIRATORY ILLNESSES
GENITOURINARY ILLNESSES

217. PSYCHOLOGICAL PROBLEMS
MENTAL CHANGES
SEXUAL ADJUSTMENT
EMOTIONAL DISORDERS

218. HEALTH STATUS OF THE AGED IN
INDIA
NATIONAL POLICY ON OLDER PERSONS 1999
1. FINANCIAL SECURITY
2. SHELTER
3. WELFARE
4. PROTECTION
5. HEALTH CARE
6. OLD AGE PENSION
7. SELF HELP GROUPS
8. OLDAGE HOMES, DAY CARE CENTRES

219. BHAVISHYA AROGYA MEDICLAIM
RURAL GROUP LIFE INSURANCE SCHEMES
HelpAge India
1. Largest voluntary organization
2. Free cataract operations
3. Mobile medicare units
4. Income generation and micro credit
5. Old age homes and day care centres
6. Adopt-a-gran
7. Disaster mitigation

220. THANK YOU