MATERNAL, CHILD AND ADOLESCENT HEALTH SERVICES Flashcards
“IMPLEMENTING HEALTH REFORMS FOR THE RAPID REDUCTION OF MATERNAL AND NEONATAL MORTALITY”
AO 2008-0029
- Every pregnancy is wanted, planned and supported;
- Every pregnancy is adequately managed throughout its course;
AO 2008-0029
- Every delivery is facility-based and managed by skilled birth attendants; and
- Every mother-and-newborn pair secures proper postpartum and postnatal care with smooth transitions to the women’s health care package for the mother and child survival package for the newborn
AO 2008-0029
guides the development, implementation and monitoring evaluation of various government programs aimed at improving the health of women, mothers, and children, with the goal of rapidly reducing maternal and neonatal mortality in the country
MATERNAL NEWBORN CHILD HEALTH AND NUTRITION (MNCHN) STRATEGY
- Low utilization of Family Planning Packages of PhilHealth
- Decrease in the number of PhilHealth Accredited Maternal and Child Program (MCP) Facilities
CHALLENGES
- Antenatal and postpartum care services lag
- Measles and polio outbreaks and increase in measles-related mortality
CHALLENGES
primarily focuses on the health and welfare of women throughout their pregnancy.
National Safe Motherhood Program/ SAFE MOTHERHOOD PROGRAM
also includes the adolescent pregnant and meeting the unmet needs for family planning contraceptives of women into its priority agenda until 2030.
National Safe Motherhood Program/ SAFE MOTHERHOOD PROGRAM
- Collaborating with Local Government Units in establishing sustainable, cost-effective approach of delivering health services that ensure access of disadvantaged women to acceptable and high quality maternal and newborn health services and enable them to safely give birth in health facilities near their homes
National Safe Motherhood Program/ SAFE MOTHERHOOD PROGRAM OBJECTIVE
- Establishing core knowledge base and support systems that facilitate the delivery of quality maternal and newborn health services in the country
National Safe Motherhood Program/ SAFE MOTHERHOOD PROGRAM OBJECTIVE
Component A
Local Delivery of the Maternal-Newborn Service Package
Component B
National Capacity to Sustain Maternal-Newborn
Services
PROGRAM COMPONENTS
- BemONC and CEmONC
- Improved Family Planning
- Integration of cervical cancer, syphilis, hepatitis B and HIV screening among others into antenatal care protocols
STRATEGIC CHANGES
Responsible Parenthood and Reproductive Health Act of 2012
RA 10354
The “Kalusugan at Nutrisyon ng Mag-Nanay Act”
RA 11148
The “ 105-Day Expanded Maternity Leave Law”
RA 11210
Implementing Health Reforms to rapidly Reduce Maternal and Neonatal Mortality
AO 2008-0029:
Guidelines Governing the Payment of Training Fees relative to the Attendance of Health Workers to Basic Obstetric and Newborn Care Skills Training Course at Duly Designated Training Centers
DO 2009-0084
Guidelines in the Administration of Life Saving Drugs During Maternal Care Emergencies by Nurse and Midwives in Birthing Centers
AO 2015-0020
Guidelines on the Provision of Quality Antenatal Care in All Birthing Centers and Health Facilities Providing Maternity Care Services
AO 2016-0035
National Policy on the Prevention of Illegal and Unsafe Abortion and Management of Post-Abortion Complications
AO 2018-0003
Expanded Breastfeeding Promotion Act of 2009
RA 0028
Philippine HIV and AIDS Policy Act of 2018
RA 11166
- Known appropriate clinical case management services
- Known cost-effective public health measures
(RMNCAHN) CORE PACKAGE OF SERVICE
1) Communication
2) Transportation
3) MNCHN Service Delivery Network Team
MNCHN SERVICE DELIVERY NETWORK
i) Community level service providers or Community Health Team (CHT)
ii) BEmONC-capable facilities
iii) CEmONC-capable facilities
3) MNCHN Service Delivery Network Team
based on the right to access appropriate health care services which enables women to go safely through pregnancy and childbirth and provides couples with the best chance of having healthy infant
Reproductive health, WHO, 2008
RA 9710
“MAGNA CARTA OF WOMEN “ (2009)
“The State shall, at all times, provide for a comprehensive, culture sensitive, and gender responsive health services and programs covering all stages of a woman’s life cycle and which addresses the major causes of woman’s morbidity and mortality”
RA 9710 “MAGNA CARTA OF WOMEN “ (2009)
“RESPONSIBLE PARENTHOOD”
RA 10354
the will and ability of parents to respond to the needs and aspirations of the family and children. It is a shared responsibility of the husband and the wife to determine and achieve the desired number, spacing, and timing of their children according to their own family life aspirations, taking into account psychological preparedness, health status, socio-cultural, and economic concerns
Responsible Parenthood
- The right to life
- The right to liberty and security of the person
- The right to equality, and to be free from all forms of discrimination
- The right to privacy
- The right to freedom of though
- The right to information and education
- The right to choose whether or not to marry and to find and plan a family
13 SEXUAL REPRODUCTIVE HEALTH RIGHTS
- The right to decide whether or when to have children
- The right to health care and health protection
- The right to the benefits of scientific progress
- The right to freedom of assembly and political participation
- The right to be free from torture and ill treatment
- The right to development
13 SEXUAL REPRODUCTIVE HEALTH RIGHTS
having the desired number of children and when you want to have them by using safe and effective modern methods
Family Planning (FP)
Proper birth spacing is having children 3 to 5 years apart, which is best for the health of the mother, her child, and the family.
FAMILY PLANNING
- Modern Family Planning (MFP) Methods
- Modern Contraceptive Prevalance Rate (mCPR) Target: 65% formarried women of WRA
FAMILY PLANNING
I. Responsible Parenthood
II. Child Spacing
III. Respect for Life
IV. Informed Consent
FOUR PILLARS OF FAMILY PLANNING
Provision of free FP Commodities that are medically safe, legal, non-abortifacient, effective and culturally acceptable to all in need of the FP service
PROGRAM COMPONENT A
Demand Generation through Community-based Management Information System
PROGRAM COMPONENT B
Family Planning in Hospitals and other Health Facilities
PROGRAM COMPONENT C
Financial Security in FP
PROGRAM COMPONENT D
- Levonorgestrel intrauterine system (LNG IUD)
- Copper T intrauterine device (IUD)
Intrauterine Contraception
- Implant
- Injection or “shot”
- Combined Oral Contraceptives (COC)
- Progestin only pill (mini pill)
- Combined contraceptive patch
- Combined (Hormonal) contraceptive ring
Hormonal Methods
- Diaphragm or cervical cap
- Sponge
- Male condom
- Female condom
- Spermicides
Barrier Methods
For regular menstrual cycle: about nine or more fertile days each month
Fertility Awareness-Based Methods
- 3 Conditions
1. Amenorrhea
2. Fully or nearly fully breastfeeding
3. Less than 6 months after delivering a baby
Lactational Amenorrhea Methods (LAM)
- Copper IUD
- Emergency Contraceptive Pill- taken up to 5 days after unprotected sex
Emergency Contraception
- Female Sterilization- Tubal ligation or “tying tubes”
- Male Sterilization- Vasectomy
PERMANENT METHODS OF BIRTH CONTROL
- Withdrawal (Coitus Interruptus)
- Calendar or Rhythm Method
TRADITIONAL METHODS OF BIRTH CONTROL
Monitoring of menstrual pattern over 6 mos. Subtract 18 from the shortest cycle length (estimated 1st fertile day) and subtracts 11 from longest cycle length (estimated last fertile day)
Calendar or Rhythm Method
- Micronutrient supplementation
- Iron and Folate (60mg elemental iron with 400mcg folic acid tablet daily for 3-6 mos.
- Iodized oil capsule with 200mg iodine 1 capsule for 1 year (women ages 15-45)
- Promotion of the use of iodized salt
- Nutrition counselling
- Promotion of healthy lifestyle
MATERNAL-NEWBORN HEALTH PREPREGNANCY SERVICES
________elemental iron with ________ folic acid tablet daily for
60mg; 400mcg FOR 3-6 mos.
Iodized oil capsule with ________ iodine_______capsule for _____women ages______
200mg; 1; 1 year; 15-45
- Advise on family planning and provision of family planning services
- Prevention and management of lifestylerelated diseases
- Counselling prevention and management of infection (STIs, HIV/AIDS)
- Adolescent health services
- Deworming women of reproductive age
- Provision of oral health services
MATERNAL-NEWBORN HEALTH PREPREGNANCY SERVICES
PRE-PREGNANT SERVICES:
Antenatal Care Services (ANC)
First 270 days
” Kalusugan at Nutrisyon ng MagNanay Act”:
RA 11148; First 1000 days of life
1ST PRENATAL VISIT
ASAP
2ND PRENATAL VISIT
2ND TRIMESTER
3RD PRENATAL VISIT
3RD TRIMESTER
AFTER 8TH MONTH - DELIVERY
EVERY 2 WEEKS
- HEALTH HISTORY
- PRENATAL ASSESSMENT
- BIRTH PREPARATION AND EMERGENCY PLANS
ACTIVITIES: OF PRE-NATAL VISIT
- Pregnancy Tracking and Enrollment to Antenatal Care (ANC)
- Diphtheria Tetanus Toxoid Immunization (AO 15)
- CONSUMPTION OF IODIZED SALT
- MICRONUTRIENT AND MACRONUTRIENT SUPPLEMENTATION
- EARLY IDENTIFICATION AND MANAGEMENT OF NUTRITIONALLY AT RISK PREGNANT CLIENT (PD 491)
PRE-PREGNANT SERVICES
- IRON DEFICIENCY ANEMIA
- VITAMIN A DEFICIENCY
- IODINE DEFICIENCY DISORDER
- MACRONUTRIENT SUPPLEMENTATION (CALCIUM)
MICRONUTRIENT AND MACRONUTRIENT SUPPLEMENTATION ACTIVITIES
DOSE/DURATION FOR IRON AND FOLIC SUPPLEMENT FOR PREGNANT WOMEN
1 TAB/DAY = 6 MONTHS
2 TABS/DAY IF PRENATAL CONSULT STARTED ON 2ND/3RD TRIMESTER
DOSE/DURATION FOR IRON AND FOLIC SUPPLEMENT FOR LACTATING WOMEN
1 TAB/DAY = 3 MONTHS / 90 DAYS
VITAMIN A SUPPLEMENT FOR PREGNANT WOMEN
10,000 IU
VITAMIN A SUPPLEMENT FOR LACTATING WOMEN
200,000 IU
DOSE/DURATION FOR VIT A SUPPLEMENT FOR LACTATING WOMEN
1 CAP ONCE AFTER DELIVERY/ WITHIN 4 WEEKS
DOSE/DURATION FOR VIT A SUPPLEMENT FOR PREGNANT WOMEN
1 CAP 2X/WEEK = 4 MONTHS
IODINE SUPPLEMENT FOR CHILDREN OF SCHOOL AGE, WOMEN 15-25 YRS/OLD, AND ADULT MALES
200 MG OF IODIZED OIL CAPSULE = 1 CAP/YR
ELEMENTAL CALCIUM SUPPLEMENT FOR PREGNANT WOMEN
1-2 G = 3 DIVIDED DOSES
ELEMENTAL CALCIUM SUPPLEMENT FOR PREGNANT WOMEN
1-2 G = 3 DIVIDED DOSES
Used to evaluate the degree of undernutrition
WEIGHT
1ST DEGREE UNDERNUTRITION (MILD)
76-90%
2ND DEGREE UNDERNUTRITION (MODERATE)
61-75%
3RD DEGREE UNDERNUTRITION (SEVERE)
<60%
NORMAL WEIGHT
91-110%
OBESITY
> 110
An indicator of child growth used to assess stunting depending on the px sex
HEIGHT-FOR-AGE (HFA) / BMI
LOW HFA(<+2SD)
STUNTING
An indicator of child growth used to assess wasting depending on the px sex
WEIGHT-FOR-HEIGHT (WFH)
LOW WFH(<+2SD)
WASTING
LOW WFH(>+2SD)
OVERWEIGHT
Used as a rapid screening for malnutrition for children who are 1-4 y/o
MID-UPPER ARM CIRCUMFERENCE (MUAC)
> 115MM MUAC
NORMAL
<115MM MUAC
ACUTE UNDERNUTRITION
Estimates the percentage of body fat at specific locations of the body (femoral, abdominal, triceps)
SKINFOLD THICKNESS
- Counselling on maternal nutrition, breastfeeding and rooming-in, appropriate infant and young feeding practices
- Assessment of risk for parasitism and provision of anti-helminthic medicines
- Provision of oral health services including oral health assessment
- Counselling on proper handwashing, environmental sanitation and personal hygiene
- Counselling on nutrition, smoking cessation and adoption of healthy lifestyle practices
PRE-PREGNANT SERVICES
- Philippine Health Insurance Corporation (PhilHealth) enrollment and linkages to facility and community-based health and nutrition workers and volunteers.
- Social welfare support to improve health and nutrition services
- Maternity protection during pregnancy
- Counselling and support to parents and caregivers on parent ‘caregiver-infant/child interaction for responsive care and early stimulation for early childhood development
- Provision of counselling and psychological support to parents and caregivers
PRE-PREGNANT SERVICES
- ANTENATAL CORTICOSTEROIDS
- ESSENTIAL INTRAPARTAL NEWBORN CARE (EINC) (DOH, 2011)
INTRAPARTAL SERVICES:
Maternal-Newborn Health
Birthing Centers capable of providing BEmONC; ideally from homes
30 MINS
Referral hospitals capable of proving CEmONC, ideally ___ from each BEmONC capable facility
1 hour
Medications given to all pregnant women who are at risk for pre-term delivery (labor within 24-34 weeks (AOG) or has any of the following prior to term:
a. Antenatal hemorrhage or bleeding
b. Hypertension
c. Preterm rupture of membranes
ANTENATAL CORTICOSTEROIDS
a. Betamethasone 12mg IM q12h for 2 doses
b. Dexamethasone 6mg (1.50ml) q12h for 4 doses
Two corticosteroids given
12mg IM q12h for 2 doses
Betamethasone
6mg (1.50ml) q12h for 4 doses
Dexamethasone
The partograph (sometimes called portogram) is a labor monitoring tool that is used in countries
worldwide to enable early detection of complications, so that referral, action or closer observations can ensue.
PARTOGRAPH
- Antepartum hemorrhage
- Severe preeclampsia and eclampsia
- Fetal distress
- Previous cesarean section
- Multiple pregnancy
- Malpresentation
- Very premature baby
- Obvious obstructed labor
CONDITION THAT DOES NOT NEED THE USE
OF PARTOGRAPHS
A. DILATATION STAGE
B. FETAL EXPULSION STAGE
C. PLACENTAL EXPULSION STAGE
D. IMMEDIATE POSTPARTUM OR RECOVERY PERIOD
E. IMMEDIATE ESSENTIAL CARE OF THE NEWBORN
ESSENTIAL INTRAPARTAL NEWBORN CARE (EINC) (DOH, 2011)
- Give oxytocin within 1 min. after delivery of the baby
- Controlled cord traction with countertraction on uterus
- Uterine massage after placenta is delivered
Active Management of Third Stage of Labor (AMTSL)
- Immediate and thorough drying
- Skin-to-skin contact
- Properly timed cord clamping
- Non separation of newborn from mother for early breastfeeding
IMMEDIATE ESSENTIAL CARE OF THE NEWBORN FOUR CORE STEPS
- Eye ointment
- Stethoscope (to symbolize Physical Examination)
- Vitamin K
- Hepatitis B Vaccine
- BCG Vaccine (plus cotton balls)
administered to newborn after first full breastfeeding: