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