EPIDEMIOLOGICAL ASPECTS OF MATERNAL AND CHILD

HEALTH

Presented by

Mrs. Sinmayee DeviAsst professorL.J.M College of

nursingBhubaneswar

DEFINITIONEpidemiology “The study of the distribution and

determinants of health related status or events in specified population and the application of this study to the control and prevention of health problems.”

By- M. Last (1988)

This includes study of health services used by the population and to measure the impact . It is more concern about society then individual.

Definition:Maternal and Child Health “Maternal and child health refers to

the promotive, preventive, curative and rehabilitative health care for mothers and children.”

By- Park K. (2007)

AREAS OF MATERNAL AND CHILD HEALTH Maternal health, Child health, Family planning, School health, Handicapped children, Adolescence health Health aspects of care of children in

special settings such as day care.

Mother and child one unit ?• During antenatal period foetus is an

integral part of mother

• Health of the mother and child are interrelated

• Mother can transmit certain diseases to the child during pregnancy

• Breast feeding is a regulatory process during early child hood

• Mother initiated primary socialization to the child

Epidemiological Aspects of Maternal and Child Health

The study of the distribution and determinants of health related status or events in mothers and children and the application of this study to the control and prevention of health problems related to mother and child.

It follows systematic assessment of the health of the women in reproductive age and children in the community including timely collection of data , analysis , interpretation, dissemination and use of MCH related data.

The Problems in Women

• Early age of marriage—teenage pregnancies• Unsafe abortion• Unwanted fertility and infertility• High fertility rate and rising population• Unacceptably high mortality rate amongst

women in reproductive age group• Poor nutritional status—high level of anaemia• Reproductive tract infections, sexually

transmitted diseases and emerging problem of• HIV/AIDS• Unfavorable sex ratio—gender discrimination• Low level of literacy amongst females• Low status of women and heavy work load and

violence against women

Problems in Children & Adolescent Children• Low birth weights• Unacceptably high mortality rate during early

childhood period• Poor nutritional status—high level of anaemia• Acute respiratory tract infections• Diarrhoeal diseases• High level of school dropouts• Child labour and abuse• Social problems of adolescents—Drug Abuse and

Sexual problems• Disabled children—Physical, Mental and also

behavioural problems in street childrenAdolescent• Problem of adolescent girl –Teen age pregnancy,

depression, malnutrition

Epidemiological Tried Related to Mother and Child

Agent: ChildFoetal Life –Nutrition, change in hormonal level,

growth and developmentChildhood – Nutrition ,physical care , growth

and development, socialization & care during illness

Host: MotherNutrition, physical health, genetic

inheritance & social status

Environment:Physical, Biological and psychosocial.

MCH Problems Triad

Hea

lth c

are delivery

system

factors

Soc

ial

EconomicC

ultural

MA

LNU

TRIT

ION

INFE

CTIO

NUNREGULATED

FERTILITY

MATERNAL &

CHILD HEALTH

Maternal Mortality Rates (Per 1000 live births)

Place MMR

World4.0

Developed country1.3

India2.9

WHO review of maternal conditions most frequently reported(97-02)

Morbidity Number of studies (%)

Hypertensive disorders of pregnancy 885 (14.9)

Stillbirth 828 (13.9)

Preterm delivery 489 (8.2)

Induced abortion 400 (6.7)

Haemorrhage (antepartum, intrapartum, postpartum) 365 (6.2)

Anaemia 267 (4.5)

Placenta anomalies (pravia, abruptio, etc.) 245 (4.1)

Spontaneous abortion 235 (4.0)

Gestational diabetes 224 (3.8)

Ectopic pregnancy 146 (2.5)

Premature rupture of membranes 140 (2.4)

Perineal laceration 139 (2.3)

Uterine rupture 116 (2.0)

Obstructed labour 102 (1.7)

Depression (postpartum, during pregnancy) 96 (1.6)

Puerperal infection 86 (1.5)

Violence during pregnancy 77 (1.3)

Other conditions 1093 (18.4)

Overall 5933

Pie diagram:- Showing the percentage wise distribution of major causes of maternal mortality, World wide (2001)

Causes of maternal mortality in Asia (1997-02)

Morbidity Percentage

Haemorrhage 30.8

Anaemia 12.8

Other indirect causes of deaths 12.5

Sepsis/infection 11.6

Obstructed labour 9.4

Hypertensive disorders 9.1

Unclassified deaths 6.1

Abortion 5.7

Other direct causes of deaths 1.6

 Embolism  0.4

Ectopic pregnancy 0.1

HIV/AIDS 0.0

Pie diagram:- Showing the percentage wise distribution of causes of maternal mortality in India(2002)

Child related statistics(Per 1000 live births)

ProblemsDevelope

d country

India World

IMR 6.86 56 56.29

Underfives mortality 87 74

Early Neonatal mortality 33

Post neonatal mortality 24

Total neonatal mortality 39

Birth rate 24

Malnutrition 470

Acute respiratory infection 150-300

Others (Sexual harassment, adolescent pregnancy, abuse) Exact statistics not available

Pie diagram:- Showing the percentage wise distribution of important causes of Perinatal mortality in India (2004)

Achievements related to Family planning programme in India (2007-08)

Family planning methods

Achievement (in %)

Sterilization71

IUD69

Oral pills72

Couple protection rate 47.8

Achievements of National Immunization Programme (2004)

VaccineAchievement

(in %)

Measles 56

DPT 64

Polio 70

BCG 73

TT 80

National Health Indicators, Achievements & Strategies

Indicators Achievement (2004)

Strategies (2015)

MMR 2.9/1000 0.75/1000

IMR 56/1000 35/1000

Delivery by skill birth attendant

43%90%

Access to reproductive health

100%

Gender equity

Poverty Reduction

Population growth Reduction

Antenatal Coverage 60% 100%

Couple protection rate 47% 100%

Total fertility rate 3.2% <2%

AimPrevention and control of diseases

among women and children Purpose(a)Identify

trends and emerging threats to the health of women on reproductive age and child

local impacts on the prevention strategies

(b)Targeting effective implementation(c)Appropriate coordination with other

agencies

Aim & Purposes of epidemiology

Importance of epidemiology related to MCH(A) World Mother and child constitute around two

third of the total population Most of the maternal and child hood

mortality are due to preventable causes They are pillars of any of the developing

or developed nation Though various strategies are made

since many decades the progress seems to be very slow

They are vulnerable /special risk groups

Importance of epidemiology for MCHIndia Mother and child constitute 70% of total

population of which women between 15 -44 yrs of age is 19% and 40% are children

Slow progress in the national MCH related programmes

Newly emerging problems Un utilized funds Poor distribution system of skilled

services and transport s Unmet needs of contraceptions

Major Elements of PHC Related to MCH

MCH including family planning; immunization against major infectious

diseases; and education of the community about

health and nutrition

These have direct bearing on the outcome of the Maternal and Child Health related goals and objectives.

Challenges in Collecting and Monitoring Data

Data Related

Information Systems

Data Capability

Community

Readiness Data access

Data availability

Quality of data

Timeliness of data

Problems with data collection

Creating and maintaining information systems Availability of user-friendly hardware/software and manuals

Recruitment and retention of skilled staff Lack of analytic capability

Lack of data management skills

Lack of interpretation skills

Need for additional staff

Training

Community awareness Community interest

Political will

Communication

Collaboration

Agency’s readiness to change

Epidemiological Approach

Epidemiology deals with interaction of agent host and environment which if operating in combination determine the –

WHAT ?WHEN ?

WHERE ? WHO ?

WHY ? HOW TO PREVENT AND CONTROL THE

PROBLEM?

Epidemiological methods

ExperimentalObservational

Correlational

Prevalence

Case-control

Cohort

Randomized controlled trials

Field trials

Community trials

CONCLUSIONMother and child are one unit and most

vulnerable to the morbidity and mortality. Hence it is essential to protect them through appropriate action at each level. MCH epidemiology programme emphasizes the analytical skills to address the health problems of the mothers and children through surveillance, assessment, planning, implementation ,monitoring and evaluation. Nurse as team member of the health can contribute her skill for the promotion of health of mother and children

THANK YOU