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Learning Objectives: After studying the material in this unit, the students will be able to describe: - Safe mother hood in relation to child health - Age and disease patterns - Health priorities in children 1.1 Introduction Throughout the world, poor women and children are the most vulnerable and the least served. In the less developed areas of the world, disease and death take the highest toll among mothers and children who make up over two-thirds of the population. Perinatal mortality may be as much as ten times higher than that of infants born in industrialized countries; the infant mortality rate may be six to twenty times greater than that the industrialized regions of Europe and North America; the death rate among pre-school children is also up to ten times high. Furthermore, in underdeveloped countries, half of the total mortality may occur in children under 5 years of age compared to only 5% in countries such as United Kingdom Pediatric Nursing and child health care 2 and Sweden. In technically advanced countries, the child survival rate is over 97% while in less developed countries over 50% of total deaths are of children under the age of 5, and the average life span is about 35 years. In scientifically advanced countries, only 5% of the total mortality occurs among the under 5; and the average life span is over 70 years. Before the advent of scientific medicine, it was taken for granted that a large proportion of children born alive would die in childhood, and the parents felt it necessary to have many children in the hope that some would survive, that few of them paid much attention to childhood diseases 1.2. Safe mother hood in relation to child health High Neonatal Mortality Rates are preventable Proven, simple, low cost solutions exist; up to 70% of neonatal deaths could be prevented through intervention for the mother. Impact of mother baby package interventions on neonatal death (WHO mother –baby package 1994). A. Antenatal Care: In the first visit • History taking • Physical examination Pediatric Nursing and child health care 3 • Laboratory examination (Blood for RH, anemia, urine for albumine..) • Treatment of minor ailment • In the second and subsequent visit • Measuring BP, fundal height, weight • Maternal immunization with tetanus toxoid • Nutritional support including iron/ folate supplementation • Birth planning • Counseling on breast feeding • Presumptive malaria treatment where appropriate • Syphilis screening and treatment where appropriate • Voluntary counseling and testing for HIV, where appropriate • Recognition of danger signs; treatment & referral as needed. Detecting for high risk pregnancy: • Age 35 years • Primigravida • Previous Cesarean section (C/S) • Instrumental deliveries (vacuum, forceps) • Destructive deliveries • Previous prenatal death • Previous still birth • Previous ante partum hemorrhage (APH) • Previous post partum hemorrhage (PPH) Pediatric Nursing and child health care 4 • Grand multiparty • Preeclamsia, eclampsia • Cardiac disease • Renal disease • Diabetes mellitus • Multiple pregnancy B. Labor and delivery Care: Trained health worker during labor and delivery should attend Mother and baby. Delivery should be conducted under hygienic condition. Clean hand, delivery surface, clean cordcutting and tying, clean environment, and clean perineum. Skilled attendant at delivery. Recognition of danger signs (mother and baby); treatment and referral as needed. Age and disease patterns: C. Essential Newborn Care: Immediate assessment Care of the new-born baby should be guided by the following principles Dry the new-born as soon as possible Wrap the new-born in a dry towel to prevent heat loss from the body Place the new-born next to the mother to get the breast and warmth (rooming in). Cut the cord when it becomes thin and white. Apply Pediatric
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