Unit-5

Maternal and child health

Objective
At the end you will be able to:
 Describe the status of women and children
 Identify the socio-economic factors that affect the health
of women and children
 Discuss the historical development of MCH services in
relation to the advancement of modern medicine
 Explain the role of PHC in improving MCH services
 List reasons for giving priority to MCH services.
 List the major targets and components of MCH services
Introduction

Status of women and Children in Developing Countries

 women and children are the most vulnerable and the least
serviced In developing country .
 disease and death take the highest in developing country .
 Prenatal mortality 10 X more than developed country.
 IMR is 6-20 X more than that of Europe and north America
 MMR is 1000 per 100,000 live birth in developing country
when compared to 5-30 per 100,000 live birth in
industrialize country
Factors that result in premature aging and
disease and early death..

– maternal depletion related to pregnancy at

an early age
– continuous cycles of pregnancy
– inadequate diet leading to anemia or
malnutrition
– heavy work-load .
– Socioeconomic problems
Historical Development of MCH Services

 The term maternal and child health refers to:

– promotive, preventive, curative and rehabilitative health
care for mothers and children.
It includes :
– maternal health,
– child health,
– family planning,
– school health and
– adolescent health.
MCH….
The specific objectives of MCH are:
 Reduction of maternal, prenatal, infant and child mortality;

 Promotion of reproductive health and

 Promotion of the physical and psychological development of

the child and adolescent within the family.
Important events for dev’t of MCH
Worldwide,
• in 1948 WHO was established and its priorities were
proclaimed to be malaria, TB, MCH and veneral disease.
• 1976 - UN started advocacy about women equity social &
economic development.
• In 1978 - WHO – UNICEF international conference on
PHC at Alama-Ata, a comprehensive strategy to achieve
“Health for All” by the year 2000, was identified, MCH care
was seen as one of the essential components of PHC.
• 1976-1980 – WHO advocacy for women policy development
• 1980 – 85 – WHO created mechanisms in members countries
for health promotion, planning & coordination action
Events …..
• 1985 – 1990 effort is made to transfer concepts of women
health & development in to practical activities and the program
focus on.
– Promotion of women health
– Women as a beneficiaries of health care
– Women as a health care providers
– Women education for health socioeconomic development.
• The 1987 - Nairobi conference was the 1 st real universal
mobilization in favors of safe mother hood initiative (SM1), since
then maternal health issues become crucial agenda in many
international .
Events in Ethiopia
 In 1962 – Ethio – Swedish pediatric Hospital was established
which provided services to children at Black lion hospital
 In 1962 – March 1 st MCH/FP conference held at Gondar
public health college and MCH clinic started. ( 1 Day/ week)
 1963 – 1 st National health policy adopted
 1966 – Family Guidance Association Ethiopia (FGAE) established
 1979 – MCH Co-ordination office was established under MOH.
 1983 – FH department was established under MOH
 Main Reasons for prioritizing MCH service:
 Children are the future of the nation or community. b/c a
community survival value rests with its children.
 Women and children are majority of the population.
 The health of mothers and infants is inter-related. Mainly women
suffer during pregnancy, and deliveries.
 Mothers and children are particularly vulnerable to diseases
which are preventable by appropriate environmental sanitation,
improved nutrition and appropriate antenatal care
 The incidence of lives damaged by physical, mental and social
burdens can be reduced. MCH services can reduce the incidence
of mental and physical disability and provide special services for
disabled children .
Major Targets of MCH Services
– Women of reproductive age group (15-49 yr)
– Pregnant women
– Children < 15yr
– Children <5yr
– Children <1yr
Major component of MCH services

 ƒProvision of quality ANC, delivery care, PNC, and FP services

 ƒPrevention of STIs/HIV/AIDS
 Immunization
 Growth monitoring
 Well baby clinic
 Sick baby clinic
 Nutrition Rehabilitation Clinic (NRC)
 Nutrition counseling and health education
 School health education
 Adolescent health service
Child Health

 Children make up 50% of the population and needing more

medical care.
 Their diseases are preventable, and special clinic which have
name inter-changeably as:
– Under five clinics
– Well – baby clinics
– Children welfare clinics…
The usual services provided for children at these clinics are:
- Vaccinations
- Nutrition evaluation and advice
- Treatment of minor illness
- Referral for more difficult problem
MCH clinic …

• When a clinic promotes the health of both mother & children

together, we call it MCH clinic.
• An integrated MCH clinic should include
– Vaccination for children
– ANC
– FP service
– Nutrition advice
– Health education about–sanitation of house environment
etc…..
Common Indicators of MCH Services
1. Perinatal mortality rate:
2. Neonatal mortality rate
3. post-natal mortality rate
4. Infant mortality rate
5. Child mortality rate
6. Maternal mortality rate (MMR)
7. Contraceptive Prevalence Rate (CPR)
8. ANC percentage
9. Percentage of institutional deliveries
10. Percentage of LBW
11. Total fertility rate (TFR)
12. Percentage of EPI coverage
Indicators…..
1. Prenatal mortality rate: the total number of still-births plus
the number of deaths under one week old, per 1000 birth or the
sum of late fetal and early neonatal deaths.
– The causes of PMR are trauma and stress of labor, toxemia
APH, maternal disease, congenital anomalies, infection and
induced abortions.
2. Neonatal mortality rate: The number of deaths under 28
days of age per 1000 live births.
– It reflects the quality of care available to women during
pregnancy and childbirth and to the newborn during the first
months of life.
– Immaturity is main cause . 80% of infants who die within 48
hours of birth weight less than 2500g.
Indicators ….

3. Post natal mortality rate :

– This is number of deaths over 28 days but less than 1 year
age Per 1000 live births ‘
4. Infant mortality rate
– It is umber of deaths of infant under 1 year age pre 1000
live births.
– It is the sum of post natal & neonatal deaths. The primary
cause is immaturity and the second leading cause is
gastroenteritis, which can be prevented by putting the
newborn immediately with the mother and advocating
breast-feeding
5.
Indicators…
5. Child mortality rate
– It is the no of death b/n 1-4 years of age pre 1000 children.
– This reflects main environmental factors affecting the child
health, such as nutrition, sanitation, communicable
diseases and accidents around the home. It is a sensitive
indicator of socioeconomic development in a community
and may be 25 times higher in developing countries
compared to developed countries.
Indicators ….
5. The total Fertility Rate:
– is the average number of children that would be born to a
woman throughout her life time or her child bearing age (15-
49 years),
– According to world population data at 2003, was
• world = 2.8 Children per woman
• Sub – Sahara Africa = 5.6 Children per woman
• Eastern Africa = 5.6 Children per woman
• Ethiopia = 5.9 Children per woman
• Ethiopia 1994 = 6.5 Children per woman
• Ethiopia 1984 = 7.2 Children per woman
• Ethiopia 2014= 5.23 children born / woman
Indicators …
6. Maternal mortality rate (MMR)
– the death of women during pregnancy, child birth or up to
42 days after delivery or abortion, regard less of
the site of pregnancy and from any cause related to
pregnancy or aggravated by pregnancy or its management
but not from accidental cause (WHO, 1997)
– Every minute of every day a woman dies
– Every minute 8 babies die because of poorly managed
pregnancy and delivery .
–According to WHO, reported 585,000 maternal deaths
occurred each year.
–In Ethiopia there are estimated 871/100,000 LB maternal
death (2005 report )
The major cause of MM includes
 Direct cause: are these disease or complications occur only
during pregnancy and child birth
– ƒHemorrhage – 25%
– Sepsis – 15%ƒ
– Unsafe abortion – 13%ƒ
– Hypertensive disorder – 12%
– Obstructed labor – 8%
 Indirect cause – are these which are pre-existing disease but
aggravated by pregnancy.
– Anemia, Heart disease, Essential HTN , DM, Kidney disease
• Coincidental causes – are not related to pregnancy
e.g. Death from traffic acciden.
Some selected indicator in Ethiopia 2014
estimate.
• Infant mortality rate=55.77 deaths/1000 live birth

• Maternal mortality rate=676 deaths/100,000 live births (2011

EDHS )

• Total fertility rate= 5.23 children /woman

• Contraceptive prevalence rate = 28.3% 2014 estimate.

• HIV/AIDS adult Prevalence Rate=1.3%

• Life expectancy =60.75 years

• Literacy total population = 39 %

 Individual Assignment
Describe the target and achievement of the
following indicators using EDHS, 2016
• MMR
• CMR
• IMR
• NMR
USING THE OUTLINES BELOW TRY TO
WRITE THE
TRENDS OF KEY HEALTH
INDICATOR IN ETHIOPIA
Introduction
Maternal Health
Child Health
Nutrition
Hygiene and Sanitation
Thank you !