Community sheet # 6 - BY:Nataliya Komashynska

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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com 6.docx

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بسم الله الرحمن الرحيم


The services that the maternal-child health should contain are divided into maternal services and infant and child services.

Maternal health
Maternal health care divides into many stages.
1. Premarital (before marriage)
We covered it in previous lecture.
2. Preconceptional (before pregnancy)
There are some diseases we have to control before women go to
physiological stress of pregnancy such as diabetes, hypertension, epilepsy, bronchial asthma and other chronic diseases.
We also should control some nonmedical problems (physiological
problems) like obesity because it is a risk factor for Eclampsia that is the major cause of maternal death in Jordan.
-When we talk about maternal death, we talk about the death that happens during pregnancy or delivery or 6 weeks after delivery.
Another important nonmedical risk factor is the age of pregnant women. If a woman gets pregnant before 20 or after 35, the risk factor increases.
-The best age for delivery is 25 years.
-The average age of marriage in Jordan becomes 24 years.
-Teens pregnancy is a high-risk pregnancy. It is rare in Jordan but in some developing countries, it is still seeing.

3. Conceptional (care during pregnancies)
**ANC (antenatal clinics)
Preventive services are the most important in ANC, because pregnant women aren't patients. But we have to diagnose and monitor any complication as early as possible. If any complication is treated there will be no problem, otherwise it may cause severe complications on baby and on mother.
- (An infant is more sensitive to any complications than the mother ).
-A Pregnant women should visit ANC at least 6 times during pregnancy.

-A period of pregnancy is 40 weeks. Any delivery less than 35 weeks is called premature and more than 42 weeks is called post mature.
Premature and post mature are high risks.
During antenatal care, many things are measured routinely, like blood pressure, level of sugar in the blood, growth of body, heart rate by ultrasound and so on.

4. Delivery care
Some deaths may happen during delivery. It is important where the delivery happens (home, car, hospital, primary health care center)
-In Jordan 99% of deliveries happen in hospital under medical care.
So where and who is attending during delivery is very important.
Sometimes postpartum hemorrhage may happen, so if a woman is in hospital , she can have blood transfusion which may save her life ,but when she is at home shock and death my happen.

5. Post natal care (6 months after delivery)
The most important is family planning services.

Infant and child care divide into many stages.
- Prenatal care of infant
If a baby is premature, there will be high risk of death, Respiratory distress syndrome, or an infection.
Prematurity is number one in causing infant mortality.
Congenital abnormalities, birth injuries and good nurseries have direct effect on an infant.

After delivery there is something called Well Baby Clinic (WBC). This clinics monitor:
1. Growth and development of the child
2. Physical examination (scheduled visits)
3. Vaccination
4. Nutrition
5. Health education

-Day care of children outside the home, good childcare services are primary needs.
-Health of school age child (school health)

-Care of adolescents (youth clinics)
This stage starts at the age of 11 and ends at the age of 19
Risk factor on this group include: psychological problem,
smoking, drug addiction, contraception.
-In Jordan schools health covers the health problems of the youth.

-Handicapped children (physically or mentally) should not be ignored, but they should take their care and health services.

There are many indicators for maternal health such as, number of the pregnant women that visit clinic, take vaccine, but the most sensitive one is a maternal mortality.

Maternal mortality is the death of women while pregnant. It isn't only at time of pregnancy but any time during pregnancy or within 42 days (6
weeks) after the delivery.

-child mortality rate equals number of death per 1000 birth.
-maternal mortality rate equals number of death per 100000 birth.

-Maternal mortality rate as a ratio is the most common indicator to describe the maternal mortality but you must note that the maternal morbidity is much higher.
(Maternal morbidity= Maternal mortality x 16)

-Another maternal indicator is Average Age at first birth. As we said, optimal age for delivery is 25.
-Contraceptive prevalence rate is another good indicator (family planning)
-Birth interval between each child.
-Proportion of child births to women under 20 years and over 35 years.
All these are general indicators, but the most important one is the maternal mortality.

Causes of maternal mortality:

Nearly three quarter of maternal death is due to direct complications of pregnancy such as:
1. Severe bleeding
2. Infection
3. Unsafe abortion
4. Eclempsia ( hypertension disorders)
5. Obstructed labor.

-Eclempsia is the number 4 in the world in causing maternal mortality. In Jordan, it is the major cause of maternal mortality.
Women also die of indirect causes, aggravated by pregnancy such as Malaria, Diabetes, Hepatitis, Anemia, Cancers.

Gestational diabetes is considered as a direct cause, but if she was diabetic before she became pregnant, it is considered as indirect case.

Maternal Mortality by regions.
940 in Sub-Saharan Africa
560 in South Asia
220 Middle East/ Africa
13 More developed countries
Over 99% of maternal death occurs in developing countries.
While high quality, accessible health care has made maternal death a rare event in more developed countries.
Sweden has zero-1percentage maternal mortality.






Causes of Maternal Mortality in Jordan.

• Direct causes (are listed according to their danger)
- Toxemia
- Anesthesia complications(in caesareans)
- Severe hemorrhage postpartum
- Toxic shock
- Cardio or renal failure

• Indirect causes
- Risky pregnancy (age, party, number of pregnant)
- Malnutrition
- Poor ANC
- Cancer

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Community
DONE BY:Nataliya Komashynska
27/2/2011
LEC #:6