INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
- Integrated childhood management which focus on preventive and curative which involves family and community
- Aim to reduce mortality, illness and disability among under-five years old
Domains of IMCI (Continuum of Care)
- Home
- Growth Promotion & Development
- Breastfeeding, micronutrient, mental and psychosocial development
- Home Management
- Feeding, water, prevent injury, home treatment
- Disease Prevention
- Prevent HIV, insecticide treated net, proper sanitation
- Care Seeking & Compliance
- Responsible fatherhood, immunization, seek medical care
- Health Facilities
- Improve skills and equipment as well as facilities
- Community
- Vaccination outreach delivery
- ORS for diarrhea
- Insecticide net
- Routine postnatal care
- Promotion of breastfeeding and complimentary feeding
Strategies
- Policies, Strategy, Planning, and Partnership
- Health support system and management
- Focus on continuum of care
- Monitoring and evaluation
TOTAL FERTILITY RATE
Definition: The average number of children per women that would be born to the group of women given the ASFR if she survives until 50 years old
Expressed per women
Single measure that is independent of age
Period
- Synthetic, measuring a synthetic cohort of women
Cohort
- Actual TFR, must be followed till 50 years old
(Sum of ASFR / 1000) x 5
ASFR = (no of child birth at age X / mid-year pop. of women age X) x 1000
MATERNAL DEPLETION CYCLE
- Cycle that explains the effects of maternal malnutrition, infection and other risk factor on women
- Start when a pregnant mother were exposed to malnutrition, anemia, smoking, and frequent infection (lifestyle, environment and individual factor)
- Leads to increase number of low birth weight babies (10% less than 2.5 kg)
- Due to that, the newborn infant were vulnerable to more infection and death up till four years old
- Those who manage to survive will continue to be under nutrition thus creating more backward female children
- This children later show poor growth and later on being a stunted adult female
- Which in the end produce more stunted female
AGE OF MARRIAGE AND ITS EFFECT ON FERTILITY
- Fertility is the actual reproductive performance, the opposite of childless
- Marriage is a legal / religious union between men and women
How age of marriage affects fertility
- Low fertility
- Marriage at later age
- Later age & loss in time of fertility, more risk
- Less child
- High fertility
- Marriage at early age
- More time for fertility
- Thus more child
SAFE MOTHERHOOD
Definition: The ability of women to have safe and healthy pregnancy and childbirth
- Safe motherhood initiative launched in 1987 targeted to achieve reduction of maternal death by half before year 2000
- Aim to reduce death, illness among women and children
- Clean and Safe Delivery
- TBA, clean and sterile equipment
- ANC
- Proper nutrition, monitoring of mother and child, detect problems early -> plan intervention
- Responsible Parenthood
- Focus on father, supportive during pregnancy and birth as well as looking after child
- Emergency Obstetric Care
- Transportation, specialized care, obstetric emergency – PE, PPH, etc
- Family Planning
- Prevent maternal depletion, reduce risk - LSCS
IMPORTANCE OF POST-NATAL CARE
- Post-natal Period
- Start from birth till 42 days post partum
- Period where the changes that occur during pregnancy revert to non-pregnant state
- Physiological changes
o Cardiovascular revert to normal
o Reduction in size of uterus
o Reduce swollen of anal and vaginal wall
o Lochia
- Problems
o PPH (first 24h)
o Post-natal Psychosis
o Puerperal Pyrexia (first 14 days)
Post-natal Care
- Aim to promote safety and health of mother and child
- To provide parents information about sign and symptoms of potential life threatening condition of mother and child
- Encourage breastfeeding
- Provide and encourage parents to know when too seek medical care and
GENDER INEQUITY ON HEALTH
Equal: Equal distribution to all level
Equity: Distribution based on the need / performance
Definition
- Gender is a social perception on how male or female should behave
- In health
o Women known to be more vulnerable than men
o Women has more risk to develop CVD
o More risk to develop HIV/AIDS
o Women receive treatment later than men (women seek late treatment)
GENDER BIAS
- Unequal relation between men and women in family, workplace and society
- Usually referred to women as men were placed in higher position compared to women
- Example
o Family
§ Men as a leader, strong, women weak, need to obey
o Community
§ Man made decision, women need to adhere, all facilities based on men, men as the benchmark
o Workplace
§
o Health
PERINATAL MORTALITY
Perinatal Period: A period start from 22 weeks of gestation till the 1st week of life
Mortality: The extreme outcome of health, also known as death.
Perinatal Mortality
1. Any death occurring between the periods of 22 weeks of life till the 1st week of life.
GROWTH MONITORING
Growth: The increase in size of organism that includes increase in cell size and cell number
Monitoring of Growth
- Aim to measure the current and past nutritional status of child
- Regular weight and height measurements and plotting aim to monitor child growth
- Method -> Growth Chart
o Tool for monitoring growth and development
o Used to detect early growth deviation
o Assist in diagnosis of childhood diseases
o For prevention and curative care
o Age at X-Axis
o Consists of reference line -> to compare between normal and acceptable growth
Weight to Height - Indicator for current nutrition status
Height to Age – Indicator for previous nutrition status
UNIVERSAL CHILDHOOD IMMUNIZATION
Expanded Program on Immunization
- Created by WHO 1974 due to low number of immunized children (less than 5%)
- Objective to reduce morbidity and mortality from immunization preventable disease such as diphtheria, pertussis, tuberculosis and measles
- Making immunization available by 1990
SCREENING OF CONGENITAL ABNORMALITIES
Congenital Anomalies: Any fetal abnormalities that arises during antenatal period
Screening: A method for early detection of abnormalities / diseases
Aim:
To detect congenital abnormalities of fetal at earlier stage so that decision can be made whether to continue pregnancy / to prepare for the care of the babies
How (e.g. down syndrome)
1. Ultrasound Scan during 1st trimester to detect down syndrome
2. Amnion synthesis
3. Maternal Serum Screening
CONTRACEPTIVE PREVALANCE RATE
- (No of women with contraceptive / no of women in age group 15 – 49) x 100
- Percentage of women that use contraceptive in a particular time
EARLY CHILDHOOD DEVELOPMENT
Development: A biological, psychosocial, and emotional changes that occur between birth and end adolescence
IQ: Score derived from one of several test to assess human intelligence
- The process of development of a child which covers developmental changes start from birth till end of adolescence
- Disorder
o Dyslexia – difficult to read and write
o ADHD
o Autism – Spectrum of psychological condition characterized by abnormalities in social interaction and communications
VIOLENCE AGAINST WOMEN
- Intentional use of force or power to threatened that may cause harm to the other parties physically, psychologically, and sexually
- Violence against women can be divided into;
o Physical
§ Hitting, kicking, use of intentional force
o Sexual
§ Forced sex, unconsented oral sex, ass grabbing, unwanted sexual talk
o Psychological
§ No right to talk, give opinion, mental torture
- Why
o Because women socially accepted as the lowest hierarchy, lack of power, have no right, men more superior
o Cultural belief
- How to prevent
o Call center
o Community support group
o Education to women about their rights
HARMFULL TRADITIONAL PRACTICE DURING ANC
ANC: Care received during the pregnancy period
What
- Consumption of traditional herbs which may contain toxic, steroid that may cause harm to mother and child
- Antenatal massage, which may cause abortion / bleeding due to pressure at abdomen
- Salt bathing of mother, can introduce infection to baby
How To Control
- Proper antenatal care at professional health care / antenatal clinic
- Health education to future mothers as well as mothers
TEENAGE PREGNANCY
Definition: Pregnancy under the age of 20 at the time of pregnancy ends
Why
- Increase and early sexual exposure from friends, mass media, internet
- Lack of knowledge about contraceptive, sexual relationship
- Lack of monitoring from parents
What Problems
- Maternal death
- Low birth weight baby
- Unsafe abortion
- Disposal of babies
How To Control
- Sexual education
- Parental control
- Contraceptive knowledge
- Supportive community (rumah pengasih)
FEMALE GENITAL MUTILATION
Definition: Known as female genital cutting / female circumcision which was done traditionally to remove some part of the female genital
What Type
1. Normal
2. Type 1 – Prepuce removal / prepuce + part of clitoris removal
3. Type 2 – Clitoris removal plus part of labia minora
4. Type 3 – Removal all labia minora and labia majora opposed leaving only the urethra and small hole for menses
Complication
- Painful period, urinary retention, infertility, pain during intercourse, infection
INDICES OF INFANT MORTALITY
Infant Mortality = No of infant death (age less than 1 year) x 100
No of life birth in a same year
Infant = Age less than 1 year (indices life birth)
Neonatal = Age under 28 days (indices life birth)
Post-Neonatal = Age 28 days to 1 year (indices life birth)
Perinatal = 22 weeks of gestation till 1st week of life (indices stillbirth n life birth)
Still Birth = Death at 22 weeks of gestation or more (indices stillbirth n life birth)
Toddler = Age 1 to 4 years (indices bahagi mid-year population)
Under-5 = Age less than 5 years old indices bahagi mid-year pop)
BABY FRIENDLY HOSPITAL INITIATIVE
WELL-BABY CLINIC
BIRTH WEIGHT / LOW BIRTH WEIGHT
EARLY INVESTIGATION PROGRAM FOR DISABLED CHILDREN
CHID ABUSE AND NEGLECT
- Type of violence towards child
- Divided into
o Physical
o Sexual
o Psychological
- Neglect
POPULATION DYNAMIC
Total Dependency Ratio
Kalau Aged ambil >65 over pop 15-64
Kalau Child ambil 0-14 over pop 15-64
Doubling time = No of years needed for a population to double its size
