Session 1 - Maternal and Child Health

Question 1

What is public health concerned with, focused on and what does it consider?

Answer 1

It is concerned with the health of populations.
It focuses on promoting wellbeing and prevention.
It considers the wider determinants of health.

Question 2

What are the 3 domains of public health? State what the domains are underpinned by.

Answer 2

Health improvement.
Health protection.
Healthcare public health.

They are underpinned by epidemiology, health economics, sociology and psychology.

Question 3

What factors affect the birth experience of a woman?

Answer 3

Their general health.
Access to healthcare and the skill of the people involved in the birth.
Socioeconomic status.
Empowerment.
Family and peer support.
Advocacy.
Health literacy.

Question 4

What is maternal health?

Answer 4

The health of a woman during pregnancy, childbirth and the postpartum period, encompassing family planning, pre-conception, prenatal and postnatal care to ensure a positive and fulfilling experience, reducing maternal morbidity and mortality.

Question 5

What is good sexual and reproductive health?

Answer 5

A state of complete physical, mental and social well-being relating to the reproductive system.
People are able to have a satisfying and safe sex life, with the capability to reproduce, if and when they want to do so.

Question 6

What are some pre-conception and antenatal screening programmes?

Answer 6

Pre-conception:
- Women with diabetes mellitus are offered diabetic eye screening annually.
- Folic acid is commenced.

Antenatal:
- Sickle cell anaemia and thalassaemia.
- Blood borne viruses screening.

Question 7

What is the maternal mortality ratio?

Answer 7

[ (All maternal deaths occurring within a period / (Total number of live births occurring within that period) ] x 100,000

Question 8

What are the positives of the maternal mortality ratio?

Answer 8

Positives:
- Good indicator of general population health, and the status of health services.
- Advocacy purposes; able to help show the results to gain support.
- Methods are available to gain the missing data.

Question 9

What are the negatives of the maternal mortality ratio?

Answer 9

Negatives:
- Only gives information about live births, no stillbirths or miscarriages.
- It is difficult to gain the required data.
- Does not detail the causes of mortality.
- In countries where mortality is rare, it can be difficult to interpret change.

Question 10

Define the term maternal death.

Answer 10

Death of a woman while pregnant or within 42 days (6 weeks) of the end of the pregnancy (excluding accidental or incidental causes).

Question 11

What is the difference between direct and indirect maternal death?

Answer 11

Direct - a death associated with the process of pregnancy and childbirth, such as bleeding and pre-eclampsia.

Indirect - a death due to pregnancy or childbirth exacerbating other conditions, such as a heart defect.

Question 12

What is late maternal death?

Answer 12

A direct or indirect cause of maternal death greater than 42 days but less than 1 year post pregnancy.

Question 13

What are the causes of maternal mortality worldwide?

Answer 13

Question 14

What is the most common cause of late maternal death?

Answer 14

Maternal suicide.

Question 15

What are the differences between maternal death in the following groups, compared to white women:
- Black ethnic.
- Asian ethnic.
- Deprived.

Answer 15

A black woman is 4x more likely to die in pregnancy.
An Asian woman is twice as likely to die in pregnancy.
Deprived women are twice as likely to die in pregnancy.

Question 16

What are the 3 phases of delay, outlines by the ‘too far to walk’ paper, regarding reasons for maternal death?

Answer 16

Phase 1 - a delay in deciding to seek care.
Phase 2 - a delay in reaching adequate health care facilities.
Phase 3 - a delay in receiving adequate care at a facility.

Question 17

What are the 3 causes of inequalities seen in maternal deaths?

Answer 17

Multi-factorial.
Intersectionality (social categorisation) of multiple disadvantages - ethnicity, deprivation, language barriers, etc.
Systemic problems with race and unconscious bias.

Question 18

How can we reduce maternal deaths?

Answer 18

Start with a population.
Understand and address the causes of maternal deaths.
Supporting prevention.
Use of data and evidence based medicine.
Working in partnership with organisations and communities.

Question 19

What is the neonatal mortality rate?

Answer 19

The number of deaths in the first 28 days of life per 1000 live births.

Question 20

What proportion of neonatal deaths occur in the first day of life?

Answer 20

50%.

Question 21

How can neonatal mortality be reduced?

Answer 21

Safe birthing techniques.
Resuscitation training and adequate equipment is provided.
Challenging traditional practices that increase risk.

Question 22

What are some risk factors for premature delivery?

Answer 22

Intra-uterine growth restriction.
Infection in the womb/ membranes.
Waters breaking early.
Cervical or uterine abnormalities.
Pre-eclampsia.
Lifestyle factors - smoking, illicit drug use, etc.
Multiple pregnancy.
Diabetes in pregnancy.

Question 23

What are some causes of neonatal death?

Answer 23

Prematurity.
Intra-partum related complications, such as asphyxiation.
Neonatal sepsis.
Congenital abnormalities.
Pneumonia.
Neonatal tetanus.

Question 24

What is equity amongst children’s health?

Answer 24

All mothers and babies will achieve outcomes that are as good as the groups with the best health outcomes.

Question 25

What is proportionate universalism?

Answer 25

Universal services delivered at a scale and intensity proportionate to the need.

Question 26

What is the first 1001 days programme?

Answer 26

A programme from conception to 2 years old aimed at improving health outcomes and reducing inequalities throughout childhood. It aims to effect:
- Wellbeing.
- Educational achievement.
- Economic status.

Question 27

What are the stated requirements for the ‘best outcomes’ for mother and baby?

Answer 27

Not socio-economically disadvantaged.
In a supportive relationship.
Well-balanced diet.
Managing stress or anxiety.
Not smoking, consuming alcohol or misusing illegal substances.
Not in poor physical, mental or emotional health.

Question 28

What does the looked after children (LAC) health needs assessment (HNA) tell us?

Answer 28

LAC are a vulnerable group, at risk of poor physical and emotional health.

LAC have an expected poorer health throughout their life and reduced life expectancy.

Question 29

What is Evidence Based Medicine?

Answer 29

The use of current best evidence in making decisions about the care of individual patients.

Question 30

What are the roles of a doctor with respect to medical research?

Answer 30

Interpreter - communication research to a patient.
Consumer - using the evidence as a practitioner.
Contributor - researching.

Question 31

What are the 5 A’s, for steps using evidence-based medicine?

Answer 31