maternal & child health-iii dr. aliya junaid community medicine dept. army medical college

Maternal & Child Maternal & Child Health-IIIHealth-III

Dr. Aliya JunaidDr. Aliya Junaid

Community Medicine Dept.Community Medicine Dept.

Army Medical CollegeArmy Medical College

ContentsContents Reproductive Health & its ComponentsReproductive Health & its Components Safe motherhood & its ComponentsSafe motherhood & its Components Maternal Mortality Rate, causes & Maternal Mortality Rate, causes &

preventionprevention Infant Mortality Rate, causes & Infant Mortality Rate, causes &

preventionprevention MCH CenterMCH Center Child Care- IMCIChild Care- IMCI STDs and its Control. STDs and its Control.

Hierarchy of Health System

Higher level carefacilities

First level care

facility

First level referralfacility

Tertiaryhospital

DistrictHeadquartes

Hospital

Tehsil/TalukaHeadquarters hospital

Rural Health CentersBasic Health Units

Need For MCHNeed For MCH MCHC is a strategy to unite interventions MCHC is a strategy to unite interventions

for women and children in order to for women and children in order to increase and improve their Health status. increase and improve their Health status.

Early evidence suggests that implementing Early evidence suggests that implementing maternal and child health interventions maternal and child health interventions simultaneously is cost-effective and simultaneously is cost-effective and convenient, and some estimate that this convenient, and some estimate that this model could prevent up to two-thirds of model could prevent up to two-thirds of maternal & child deaths maternal & child deaths

Objectives of MCHCObjectives of MCHC

Reduction of Morbidity & Mortality Reduction of Morbidity & Mortality rates for mother & childrenrates for mother & children

Promotion of Reproductive HealthPromotion of Reproductive Health

Promotion of the Physical & Promotion of the Physical & Psychological development of the Psychological development of the children within family. children within family.

MCH CenterMCH Center

Preconceptional Preconceptional guidanceguidance

Ante-natal, Intra-natal, Ante-natal, Intra-natal, Post-natal servicesPost-natal services

Family planning Family planning services.services.

Marriage counseling. Marriage counseling. Growth Monitoring Growth Monitoring

Special services for Special services for the children with the children with special needs.special needs.

Home sanitation.Home sanitation. Nutritional guidance.Nutritional guidance. Immunization Immunization

services.services. TBA training.TBA training.

It includes:It includes:

Preventive Interventions At Preventive Interventions At MCHCMCHC

Folic acid, Vitamin AFolic acid, Vitamin A Tetanus toxoid (neonatal) Tetanus toxoid (neonatal) Pre-eclampsia and eclampsia prevention Pre-eclampsia and eclampsia prevention

(calcium supplementation)(calcium supplementation) Detection and management of breech Detection and management of breech Clean delivery practices Clean delivery practices Breastfeeding AdviseBreastfeeding Advise Prevention and management of Prevention and management of

Hypothermia Hypothermia Insecticide-treated materials Insecticide-treated materials

Treatment interventions Treatment interventions at MCHCat MCHC

Detection and treatment of asymptomatic Detection and treatment of asymptomatic bacteriuria. bacteriuria.

Corticosteroids for preterm labor Corticosteroids for preterm labor Newborn resuscitation Newborn resuscitation Oral rehydration therapy Oral rehydration therapy Anti-malarials Anti-malarials Antibiotics for dysentery , Neonatal Antibiotics for dysentery , Neonatal

sepsis, pneumonia.sepsis, pneumonia. Vitamin AVitamin A

Requirements / Concerns For Requirements / Concerns For MCHCMCHC

SiteSite BuildingBuilding StaffStaff Budget Budget Work loadWork load MCH OrganizationMCH Organization

SiteSite

For an ideal MCH centre it should For an ideal MCH centre it should be located centrally in the areas be located centrally in the areas where population can easily drain where population can easily drain into.into.

BuildingBuilding A reception or a A reception or a

waiting-room.waiting-room. OPD Rooms for OPD Rooms for

medical officers.medical officers. A waiting roomA waiting room An immunization An immunization

room. room. Store roomStore room

Conference room.Conference room. DispensaryDispensary Family planning Family planning

room for advice to room for advice to mothersmothers

Antenatal care Antenatal care roomroom

Delivery room Delivery room Under – 5 clinicUnder – 5 clinic

StaffStaff

Doctor, preferably Doctor, preferably femalefemale

Health educationHealth education Antenatal, Antenatal,

intranatal, postnatal intranatal, postnatal care care

Growth monitoring Growth monitoring Immunization Immunization

servicesservices

Pharmacist Pharmacist LHV LHV Dai Dai Peon Peon SweeperSweeper GuardGuard etcetc

Staff is required for following services;Staff is required for following services;

BudgetingBudgeting

Pays for all staff, electricity bills, Pays for all staff, electricity bills, transports expenses, phone bills and transports expenses, phone bills and othersothers

Work loadWork load Work load basis of such a unit would be Work load basis of such a unit would be

as follow:as follow:

a.a. Population-----------5000Population-----------5000b.b. Yearly new births approx. -----------200Yearly new births approx. -----------200c.c. Pregnant women under care-----------Pregnant women under care-----------

225 approx225 approxe.e. Infants under care-----------200Infants under care-----------200f.f. Preschoolers------------------- (15% of the Preschoolers------------------- (15% of the

total total population= .15 x population= .15 x 5000 =750)5000 =750)

Integrated Integrated Management of Management of

Childhood Illness Childhood Illness ( IMCI) ( IMCI)

IMCI IMCI A A strategystrategy for reducing mortality and for reducing mortality and

morbidity associated with major causes of morbidity associated with major causes of childhood illnesschildhood illness

A A joint WHO/UNICEFjoint WHO/UNICEF initiative since 1992 initiative since 1992

Comes as a general Comes as a general GuidelinesGuidelines for for Curative & Preventive ManagementCurative & Preventive Management which have been adapted to each country at which have been adapted to each country at first level health facilitiesfirst level health facilities

IMCI - Aim & IMCI - Aim & ObjectivesObjectives

It aims to reduce death, illness and It aims to reduce death, illness and disability, and promote improved disability, and promote improved growth and development among growth and development among children under five years of age. children under five years of age.

Its objective is to reduces global Its objective is to reduces global morbidity and mortality associated morbidity and mortality associated with the major causes of illnesses in with the major causes of illnesses in children under 5 years of age.children under 5 years of age.

Why IMCI ?Why IMCI ?

Every day, millions of parents seek Every day, millions of parents seek health care for their sick children, health care for their sick children, taking them to hospitals, health taking them to hospitals, health centers, pharmacists, doctors and centers, pharmacists, doctors and traditional healers. traditional healers.

Surveys reveal that many sick children Surveys reveal that many sick children are are not properly assessed and not properly assessed and treatedtreated by these health care providers by these health care providers

Their parents are Their parents are poorly advisedpoorly advised. .

At first-level health At first-level health facilitiesfacilities in low- in low-income countries, diagnostic income countries, diagnostic supports such as radiology and supports such as radiology and laboratory services are minimal or laboratory services are minimal or non-existent, and drugs and non-existent, and drugs and equipment are often equipment are often inadequate.inadequate.

These factors make These factors make providing providing quality care to sick children a quality care to sick children a serious challenge. serious challenge.

WHO and UNICEF have addressed WHO and UNICEF have addressed this challenge by developing a this challenge by developing a strategy called the strategy called the Integrated Integrated Management of Childhood Illness Management of Childhood Illness (IMCI).(IMCI).

IMCI ComponentsIMCI Components

i.i. Improving case management skills Improving case management skills of health-care staff of health-care staff

ii.ii. Improving overall health systems Improving overall health systems

iii.iii. Improving family and community Improving family and community health practiceshealth practices

i. Improving case i. Improving case management skills of management skills of

health care staffhealth care staff

Teaches health care worker about Teaches health care worker about the integrated case management the integrated case management process.process.

Provision of locally adopted Provision of locally adopted guidelines on IMCIguidelines on IMCI

Activities to promote their use.Activities to promote their use.

ii. Improving overall health ii. Improving overall health systemssystems

Identify actions to prevent illness Identify actions to prevent illness through the;through the; Immunization of sick childrenImmunization of sick children Supplementation of micronutrientsSupplementation of micronutrients Promotion of breast feedingPromotion of breast feeding Counseling of mothers to solve Counseling of mothers to solve

feeding problems. feeding problems.

iii. Improving Family & iii. Improving Family & Community Health Community Health

PracticesPractices Children who can be treated at Children who can be treated at

home. Caregivers are taught how to home. Caregivers are taught how to provide treatment and when to seek provide treatment and when to seek care for their children .care for their children .

The CASE MANAGEMENT The CASE MANAGEMENT PROCESS is used to assess PROCESS is used to assess

and classify two age groups:and classify two age groups:

Age Group = 1 week up to 2 months

Age Group = 2 months up to 5 years

THE CASE THE CASE MANAGEMENT PROCESSMANAGEMENT PROCESS

The charts describes the following steps;The charts describes the following steps; 1. Assess the child or young infant1. Assess the child or young infant 2. Classify the illness2. Classify the illness 3. Identify the treatment3. Identify the treatment 4. Treat the child 4. Treat the child 5. Counsel the mother5. Counsel the mother 6. Give follow up care 6. Give follow up care

SELECTING THE APPROPRIATE CASE

MANAGEMENT CHARTS

For all sick children age 1 week up to For all sick children age 1 week up to 5 years who are brought to the 5 years who are brought to the

clinic, clinic,

what do you do ? what do you do ?

ASK THE CHILDS AGE

SELECTING THE APPROPRIATE CASE MANAGEMENT CHARTS

FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic

ASK THE CHILD’S AGE

IF the child is from 1 week up to 2 months

IF the child is from 2 months up to 5 years

USE THE APROPRIATE CHART: USE THE APROPRIATE CHART:

THE SICK CHILDTHE SICK CHILD Age 2 Months to 5 Age 2 Months to 5

Yrs Yrs ASSESS AND ASSESS AND

CLASSIFYCLASSIFY

When the child is When the child is brought to the clinicbrought to the clinic

Use Good Communication Use Good Communication Skills:Skills:

Listen carefully to what the Listen carefully to what the mother tells youmother tells you

Use words the mother Use words the mother understandsunderstands

Give mother time to answer Give mother time to answer questionsquestions

Ask additional questions Ask additional questions when mother not sure of when mother not sure of answeranswer

Record important informationRecord important information

GENERAL DANGER GENERAL DANGER SIGNSSIGNS

ASK:ASK:Is the child able to Is the child able to

drink or breastfeed?drink or breastfeed?Does the child vomit Does the child vomit

everything?everything?Has the child had Has the child had

convulsions?convulsions?

LOOK:LOOK:See if the child is See if the child is

lethargic or unconsciouslethargic or unconscious

Ask the mother or caretaker about the 4 main symptoms:cough or difficult breathingdiarrhoeafever, andear problem

SUMMARY OF ASSESS SUMMARY OF ASSESS AND CLASSIFYAND CLASSIFY

When a main symptom is present:

Assess the child further for signs related to the main symptom, and

Classify the illness according to the signs which are present or absent

THE CASE THE CASE MANAGEMENT PROCESSMANAGEMENT PROCESS

The charts describes the following steps;The charts describes the following steps; 1. Assess the child or young infant1. Assess the child or young infant 2. Classify the illness2. Classify the illness 3. Identify the treatment3. Identify the treatment 4. Treat the child 4. Treat the child 5. Counsel the mother5. Counsel the mother 6. Give follow up care 6. Give follow up care

THE CLASSIFICATION THE CLASSIFICATION TABLETABLE

have 3 ROWS (pink, yellow & have 3 ROWS (pink, yellow & green) on the assess and green) on the assess and

classify section.classify section.

COLOR of the row helps to COLOR of the row helps to IDENTIFY RAPIDLY whether the child IDENTIFY RAPIDLY whether the child has SERIOUS DISEASE requiring has SERIOUS DISEASE requiring

URGENT ATTENTION or not.URGENT ATTENTION or not.

Each row is colored either –Each row is colored either – PINKPINK - - means the child has a severe means the child has a severe

classification and needs urgent attention classification and needs urgent attention and referral or admission for inpatient careand referral or admission for inpatient care

YELLOWYELLOW- - means the child needs a specific means the child needs a specific medical treatment such as an appropriate medical treatment such as an appropriate antibiotic, an oral anti-malarial or other antibiotic, an oral anti-malarial or other treatment; also teaches the mother how to treatment; also teaches the mother how to give oral drugs or to treat local infections give oral drugs or to treat local infections at home. The health worker teaches the at home. The health worker teaches the mother how to care for her child at home mother how to care for her child at home and when she should return.and when she should return.

GREENGREEN- - not given a specific medical not given a specific medical treatment such as antibiotics or other treatment such as antibiotics or other treatments. The health worker teaches the treatments. The health worker teaches the mother how to care for her child at home.mother how to care for her child at home.

•Any general danger sign or•Chest indrawing or•Stridor in calm child.

SEVEREPNEUMONIA

OR VERYSEVERE DISEASE

•Give first dose of an appropriate antibiotic.•Refer URGENTLY to hospital.

•Fast breathingPNEUMONIA

•Give an appropriate oral antibiotic for 5 days.•Soothe the throat and relieve the cough with a safe remedy.•Advise mother when to return immediately.•Follow-up in 2 days.

No signs of pneumoniaor very severe disease.

NO PNEUMONIA:COUCH OR COLD

•If coughing more than 30 days, refer for assessment.•Soothe the throat and relieve the cough with a safe remedy.•Advise mother when to return immediately.•Follow-up in 5 days if not improving.

CLASSIFICATION TABLE FOR COUGH OR DIFFICULT BREATHING

SIGNS CLASSIFY AS IDENTIFY TREATMENT(Urgent pre-referral treatments are in bold print.)

Always start at the top of the Always start at the top of the classification table. If the child has classification table. If the child has signs from more than 1 row always signs from more than 1 row always select the more serious select the more serious classificationclassification. .

Integrated Integrated Case management processCase management process

Summary of the Integrated Summary of the Integrated case Management Processcase Management Process

For all sick For all sick children age 1 children age 1 week up to 5 week up to 5 years who are years who are brought to a first-brought to a first-level health level health facilityfacility

Summary of the Summary of the Integrated case Integrated case

Management ProcessManagement Process

ASSESS the Child:ASSESS the Child: Check for danger signs Check for danger signs

(or possible bacterial (or possible bacterial infection). infection).

Ask about main symptoms. Ask about main symptoms. If a main symptom is If a main symptom is

reported, assess further. reported, assess further. Check nutrition and Check nutrition and immunization status.immunization status.

Check for other problems Check for other problems

Summary of the Integrated Summary of the Integrated Case Management ProcessCase Management Process

Classify the child’s illness:Classify the child’s illness: Use a color-coded Use a color-coded triage system to classify triage system to classify the child’s main the child’s main symptoms and his or symptoms and his or her nutrition or feeding her nutrition or feeding status.status.

Summary of the Summary of the Integrated Case Integrated Case


IF URGENTIF URGENT

REFERRALREFERRAL

is needed and is needed and possiblepossible


Management ProcessManagement ProcessIDENTIFY URGENT IDENTIFY URGENT

PRE-REFERRAL PRE-REFERRAL TREATMENT(S)TREATMENT(S)

Needed prior to Needed prior to referral of the child referral of the child

according to according to classificationclassification


Management ProcessManagement ProcessTREAT THE TREAT THE CHILD:CHILD:

Give urgent pre-Give urgent pre-referral referral treatment(s) treatment(s) needed.needed.


Management ProcessManagement ProcessREFER THE CHILD:REFER THE CHILD:Explain to the child’s Explain to the child’s

caretaker the need for caretaker the need for referral. referral.

Calm the caretaker’s Calm the caretaker’s fears and help resolve fears and help resolve any problems. Write a any problems. Write a referral note. referral note.

Give instructions and Give instructions and supplies needed to supplies needed to care for the child on care for the child on the way to the hospitalthe way to the hospital



IF NO URGENT IF NO URGENT REFERRAL REFERRAL

is needed oris needed or

PossiblePossible


Management ProcessManagement ProcessIDENTIFY IDENTIFY

TREATMENT TREATMENT

needed for the needed for the child’s child’s

classifications: classifications: identify specific identify specific

medical medical treatments and/or treatments and/or

adviceadvice


Management ProcessManagement ProcessTREAT THE CHILD:TREAT THE CHILD:Give the first dose of Give the first dose of

oral drugs in the clinic oral drugs in the clinic and/or advice the and/or advice the child’s caretaker.child’s caretaker.

Teach the caretaker Teach the caretaker how to give oral drugs how to give oral drugs and how to treat local and how to treat local infections at home.infections at home.

If needed, give If needed, give immunizations.immunizations.


Management ProcessManagement ProcessCOUNSEL THE MOTHER:COUNSEL THE MOTHER:Assess the child’s feeding, Assess the child’s feeding,

including breastfeeding including breastfeeding practices, and solve feeding practices, and solve feeding problems, if present. problems, if present.

Advise about feeding and Advise about feeding and fluids during illness and about fluids during illness and about when to return to a health when to return to a health facility.facility.

Counsel the mother about her Counsel the mother about her own health.own health.


Management ProcessManagement ProcessFOLLOW-UP FOLLOW-UP CARE:CARE:

Give follow-up care Give follow-up care when the child when the child returns to the clinic returns to the clinic and, if necessary, and, if necessary, re-asses the child re-asses the child for new problems.for new problems.

If the mother complain is regarding If the mother complain is regarding

Cough or difficult breathing Cough or difficult breathing

Cough or Difficult Cough or Difficult Breathing?Breathing?

IF YES, ASK:IF YES, ASK:For how long?For how long?

LOOK, LISTEN, FEEL:LOOK, LISTEN, FEEL:

Count the breaths in one minute.Count the breaths in one minute. 2-12 mos = fast breathing >/= 50/min2-12 mos = fast breathing >/= 50/min 12 mos-5yrs = fast breathing >/= 12 mos-5yrs = fast breathing >/= 40/min40/min

Look for chest indrawingLook for chest indrawingLook and listen for stridorLook and listen for stridor

Classify COUGH or DIFFICULT Classify COUGH or DIFFICULT BREATHINGBREATHING

•Any general danger sign or•Chest indrawing or•Stridor in calm child.

SEVEREPNEUMONIA

OR VERYSEVERE DISEASE

•Give first dose of an appropriate antibiotic.•Refer URGENTLY to hospital.

•Fast breathingPNEUMONIA

•Give an appropriate oral antibiotic for 5 days.•Soothe the throat and relieve the cough with a safe remedy.•Advise mother when to return immediately.•Follow-up in 2 days.

No signs of pneumoniaor very severe disease.

NO PNEUMONIA:COUCH OR COLD

•If coughing more than 30 days, refer for assessment.•Soothe the throat and relieve the cough with a safe remedy.•Advise mother when to return immediately.•Follow-up in 5 days if not improving.

CLASSIFICATION TABLE FOR COUGH OR DIFFICULT BREATHING

SIGNS CLASSIFY AS IDENTIFY TREATMENT(Urgent pre-referral treatments are in bold print.)

The Sick Young The Sick Young Infant Age 1 Week Infant Age 1 Week

upto 2 Months:upto 2 Months:Assess & ClassifyAssess & Classify

Ask the mother or caretaker about the Ask the mother or caretaker about the youngyoung

If this is an INITIAL VISIT for the problem, follow the steps below.

(If this is a follow-up visit for the problem, give follow-up care according to PART VII)

Check for POSSIBLE BACTERIAL INFECTION and classify the illness.

Ask the mother or caretaker aboutDIARRHOEA:

If diarrhoea is present:•assess the infant further for signs related to diarrhoea, and •classify the illness according to the signs which are present or absent.

Check for FEEDING PROBLEM OR LOW WEIGHT and classify the

Check the infant’s immunization status and decide if the infant needs any immunization today.

Assess any other problems.

Then: Identify Treatment, Treat the Infant and Counsel the Mother

SUMMARY OF ASSESS AND CLASSIFY

GIVE FOLLOW-GIVE FOLLOW-UP CAREUP CARE

Follow-up care for the Follow-up care for the sick young infantsick young infant

When to return immediatelyWhen to return immediately Signs of any of the following:Signs of any of the following:

Breastfeeding or drinking Breastfeeding or drinking poorlypoorly

Becomes sickerBecomes sicker Develops a feverDevelops a fever Fast breathing Fast breathing Difficult breathing Difficult breathing Blood in the stool Blood in the stool

Follow-up care for the Follow-up care for the sick young infantsick young infant

Follow-up in 2 daysFollow-up in 2 days – on – on antibiotics for local bacterial antibiotics for local bacterial infection or dysenteryinfection or dysentery

Follow-up in 2 daysFollow-up in 2 days - with a - with a feeding problem or oral thrushfeeding problem or oral thrush

Follow-up in 14 daysFollow-up in 14 days – with low – with low weight for ageweight for age

Breast feedingBreast feeding

Breast FeedingBreast Feeding

Mothers milk is the ideal food for the infant Mothers milk is the ideal food for the infant no other supplementation is required for the no other supplementation is required for the baby until 4-6 months.baby until 4-6 months.

The first milk which is called colostrum is The first milk which is called colostrum is ideal for the child during the early days, it is ideal for the child during the early days, it is rich in proteins it also contains protective rich in proteins it also contains protective factors against infections.factors against infections.Advantages:Advantages: Safe, clean, hygienic, cheap and at the right Safe, clean, hygienic, cheap and at the right

temp.temp. Fully meets the nutritional requirement (infant)Fully meets the nutritional requirement (infant) Promotes bonding between mother and childPromotes bonding between mother and child Contains macrophages, lymphocytes, secretory Contains macrophages, lymphocytes, secretory

IgA. IgA.

WeaningWeaning

It is the gradual process of starting liquid and semi It is the gradual process of starting liquid and semi liquid diet in addition to breast milk at the age of 4-6 liquid diet in addition to breast milk at the age of 4-6 months.months.

Weaning foods:Weaning foods:.Mashed banana.Mashed banana.Dahlia.Dahlia.Khichery.Khichery.Halwa.Halwa.Fruit juices.Fruit juices

Advantages of Breast Advantages of Breast feedingfeeding

Advantages to babyAdvantages to baby Advantages to MotherAdvantages to Mother

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Advantages to babyAdvantages to baby

Natural source and devoid of feeding difficulties.Natural source and devoid of feeding difficulties. Easily available Easily available Proper temperatureProper temperature Adequate caloric valueAdequate caloric value Fresh and free of contamination, free from ill Fresh and free of contamination, free from ill

effects of lower-socio-economic group and effects of lower-socio-economic group and unsanitary conditionsunsanitary conditions

Decreased chances of cow’s milk intolerance.Decreased chances of cow’s milk intolerance. Decreased atopic disorders due to IgA which Decreased atopic disorders due to IgA which

prevents absorption of dietary antigen in the gut prevents absorption of dietary antigen in the gut of baby.of baby.

Colostrum is rich in proteins, salts and leukocytes.Colostrum is rich in proteins, salts and leukocytes. If mother is adequately nourished there is a If mother is adequately nourished there is a

sufficient reserve of all nutrients.sufficient reserve of all nutrients.

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Advantages to motherAdvantages to mother

Family planning and birth spacingFamily planning and birth spacing Prevents mastitisPrevents mastitis Decreased chances of breast cancerDecreased chances of breast cancer Involution of uterusInvolution of uterus Good way to lose weightGood way to lose weight Psychological advantage, sense of Psychological advantage, sense of

accomplishment.accomplishment.

Baby Friendly Hospital Baby Friendly Hospital Initiative (BFHI)Initiative (BFHI)

Launched in 1991.Launched in 1991. Effort by UNICEF & WHO.Effort by UNICEF & WHO. It ensure that all maternities become It ensure that all maternities become

centers of breastfeeding support.centers of breastfeeding support. The initiative is a global effort for The initiative is a global effort for

improving the role of maternity improving the role of maternity services to enable mothers to services to enable mothers to breastfeed babies for the best start in breastfeed babies for the best start in life.life.

Baby Friendly Hospital Baby Friendly Hospital Initiative (BFHI)Initiative (BFHI)

It aims at improving the care of It aims at improving the care of pregnant women, mothers and pregnant women, mothers and newborns at health facilities that newborns at health facilities that provide maternity services for provide maternity services for protecting, promoting and protecting, promoting and supporting breastfeeding.supporting breastfeeding.

Breast feeding could prevent about 1 Breast feeding could prevent about 1 million children deaths a year. million children deaths a year.

BFHI- Steps for BFHI- Steps for Successful Breast Feeding in Successful Breast Feeding in

Hospitals Hospitals 1. Maintain a 1. Maintain a written breastfeeding policy written breastfeeding policy that is that is

routinely communicated to all health care staff.routinely communicated to all health care staff.

2. 2. Train all health care staff Train all health care staff in skills necessary to in skills necessary to

implement this policy.implement this policy.

3. 3. Inform all pregnant women Inform all pregnant women about the benefits about the benefits

and management of breastfeeding.and management of breastfeeding.

4. 4. Help mothers Help mothers initiate breastfeeding within one initiate breastfeeding within one

hour of birth.hour of birth.

5. 5. Show mothers Show mothers how to breastfeed and how to how to breastfeed and how to maintain lactation, even if they are separated from maintain lactation, even if they are separated from

their infants.their infants.

BFHI- Steps for BFHI- Steps for Successful Breast Feeding in Successful Breast Feeding in

Hospitals Hospitals

6. Give infants 6. Give infants no food or drink other than no food or drink other than

breast milk,breast milk, unless medically indicated. unless medically indicated.

7. Practice 7. Practice “rooming in”-- “rooming in”-- allow mothers and allow mothers and

infants to remain together 24 hours a day.infants to remain together 24 hours a day.

8. 8. EncourageEncourage unrestricted breastfeeding. unrestricted breastfeeding.

9. Give 9. Give no pacifiers no pacifiers or artificial nipples to or artificial nipples to

breastfeeding infants.breastfeeding infants.

10. Foster the 10. Foster the establishment of breastfeeding establishment of breastfeeding

support groupssupport groups and refer mothers to them on and refer mothers to them on

discharge from the hospital or clinic.discharge from the hospital or clinic.

Sexually Transmitted Sexually Transmitted Diseases Diseases

Sexually Transmitted Sexually Transmitted DiseasesDiseases

These are a group of communicable These are a group of communicable diseases that are transmitted diseases that are transmitted predominantly by sexual contact.predominantly by sexual contact.

Caused by a wide range of bacterial, Caused by a wide range of bacterial, viral, protozoal and fungal agents viral, protozoal and fungal agents and ectoparasites. and ectoparasites.

Control of STDsControl of STDs

A.A. Initial PlanningInitial Planning

B.B. Intervention StrategiesIntervention Strategies

C.C. Support ComponentSupport Component

D.D. Monitoring and evaluationMonitoring and evaluation

Control of STDs- Initial Control of STDs- Initial Planning Planning

Problem definitionProblem definition Prevalence, health effects, geographical Prevalence, health effects, geographical

distribution etc distribution etc Establishing prioritiesEstablishing priorities

Priority groups maybe categorized on Priority groups maybe categorized on basis of age, sex, place, occupation etcbasis of age, sex, place, occupation etc

Setting ObjectivesSetting Objectives Achievable & measurable. Achievable & measurable.

Considering strategies Considering strategies Most appropriate for the setting.Most appropriate for the setting.

Control of STDsControl of STDs

A.A. Initial PlanningInitial Planning

B.B. Intervention StrategiesIntervention Strategies

C.C. Support ComponentSupport Component

D.D. Monitoring and evaluationMonitoring and evaluation

Control of STDs-Interventional Control of STDs-Interventional StrategiesStrategies Case DetectionCase Detection

Screening, Contact Tracing, Cluster Testing.Screening, Contact Tracing, Cluster Testing. Case Holding & TreatmentCase Holding & Treatment

Complete & adequate TreatmentComplete & adequate Treatment Epidemiological TreatmentEpidemiological Treatment

Contact TreatmentContact Treatment Personal ProphylaxisPersonal Prophylaxis

Contraceptives, Proper hygiene of exposed Contraceptives, Proper hygiene of exposed parts, HBV vaccine. parts, HBV vaccine.

Health EducationHealth Education

Control of STDs-Support Control of STDs-Support ComponentsComponents

STD ClinicSTD Clinic Laboratory ServicesLaboratory Services Primary Health CarePrimary Health Care Information SystemInformation System LegislationLegislation Social Welfare Measures/Social Social Welfare Measures/Social

TherapyTherapy

Control of STDs-Monitoring & Control of STDs-Monitoring & EvaluationEvaluation

Monitoring & Evaluation of disease Monitoring & Evaluation of disease trends will provide a more direct trends will provide a more direct measure of program effectiveness. measure of program effectiveness.

maternal & child health-iii dr. aliya junaid community medicine dept. army medical college

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