EPIDEMIOLOGICAL ASPECTS OF

MATERNAL AND CHILD HEALTH

Presented by

Mrs. Sinmayee Devi

Asst professor
L.J.M College of nursing
Bhubaneswar
DEFINITION
Epidemiology
“The study of the distribution and determinants
of health related status or events in specified
population and the application of this study to
the control and prevention of health problems.”
By- M. Last (1988)

This includes study of health services used by

the population and to measure the impact . It is
more concern about society then individual.
Definition:
Maternal and Child Health
“Maternal and child health refers to the
promotive, preventive, curative and
rehabilitative health care for mothers and
children.”
By- Park K. (2007)
AREAS OF MATERNAL AND CHILD
HEALTH
 Maternal health,
 Child health,
 Family planning,
 School health,
 Handicapped children,
 Adolescence health
 Health aspects of care of children in special
settings such as day care.
Mother and child one unit ?
• During antenatal period foetus is an integral part
of mother
• Health of the mother and child are interrelated

• Mother can transmit certain diseases to the child

during pregnancy
• Breast feeding is a regulatory process during
early child hood
• Mother initiated primary socialization to the
child
Epidemiological Aspects of
Maternal and Child Health
The study of the distribution and
determinants of health related status or events
in mothers and children and the application of
this study to the control and prevention of
health problems related to mother and child.

It follows systematic assessment of the health

of the women in reproductive age and children
in the community including timely collection of
data , analysis , interpretation, dissemination
and use of MCH related data.
The Problems in Women
• Early age of marriage—teenage pregnancies
• Unsafe abortion
• Unwanted fertility and infertility
• High fertility rate and rising population
• Unacceptably high mortality rate amongst women in
reproductive age group
• Poor nutritional status—high level of anaemia
• Reproductive tract infections, sexually transmitted
diseases and emerging problem of
• HIV/AIDS
• Unfavorable sex ratio—gender discrimination
• Low level of literacy amongst females
• Low status of women and heavy work load and violence
against women
Problems in Children &
Adolescent
Children
• Low birth weights
• Unacceptably high mortality rate during early childhood period
• Poor nutritional status—high level of anaemia
• Acute respiratory tract infections
• Diarrhoeal diseases
• High level of school dropouts
• Child labour and abuse
• Social problems of adolescents—Drug Abuse and Sexual
problems
• Disabled children—Physical, Mental and also behavioural
problems in street children
Adolescent
• Problem of adolescent girl –Teen age pregnancy, depression,
malnutrition
Epidemiological Tried Related to
Mother and Child
Agent: Child
Foetal Life –Nutrition, change in hormonal level,
growth and development
Childhood – Nutrition ,physical care , growth and
development, socialization & care during illness

Host: Mother
Nutrition, physical health, genetic inheritance &
social status
Environment:
Physical, Biological and psychosocial.
MCH Problems
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Maternal Mortality Rates (Per 1000 live
births)

Place MMR

World
4.0

Developed country
1.3

India
2.9
 WHO review of maternal conditions most frequently reported (97-
02)
Morbidity Number of studies (%)

Hypertensive disorders of pregnancy 885 (14.9)

Stillbirth 828 (13.9)
Preterm delivery 489 (8.2)
Induced abortion 400 (6.7)
Haemorrhage (antepartum, intrapartum, postpartum) 365 (6.2)
Anaemia 267 (4.5)
Placenta anomalies (pravia, abruptio, etc.) 245 (4.1)
Spontaneous abortion 235 (4.0)
Gestational diabetes 224 (3.8)
Ectopic pregnancy 146 (2.5)
Premature rupture of membranes 140 (2.4)
Perineal laceration 139 (2.3)
Uterine rupture 116 (2.0)
Obstructed labour 102 (1.7)
Depression (postpartum, during pregnancy) 96 (1.6)
Puerperal infection 86 (1.5)
Violence during pregnancy 77 (1.3)
Other conditions 1093 (18.4)
Overall 5933
Pie diagram:- Showing the percentage wise distribution
of major causes of maternal mortality, World wide
(2001)
Causes of maternal mortality in Asia (1997-
02)
Morbidity Percentage
Haemorrhage 30.8
Anaemia 12.8
Other indirect causes of deaths 12.5
Sepsis/infection 11.6
Obstructed labour 9.4
Hypertensive disorders 9.1
Unclassified deaths 6.1
Abortion 5.7
Other direct causes of deaths 1.6
Embolism 0.4
Ectopic pregnancy 0.1
HIV/AIDS 0.0
Pie diagram:- Showing the percentage wise distribution
of causes of maternal mortality in India(2002)
Child related statistics(Per 1000 live births)

Developed
Problems India World
country
IMR 6.86 56 56.29
Underfives mortality 87 74
Early Neonatal mortality 33
Post neonatal mortality 24
Total neonatal mortality 39
Birth rate 24
Malnutrition 470
Acute respiratory infection 150-300
Others (Sexual harassment,
adolescent pregnancy, abuse)
Exact statistics not available
Pie diagram:- Showing the percentage wise distribution
of important causes of Perinatal mortality in India
(2004)
Achievements related to Family planning
programme in India (2007-08)

Achievement
Family planning methods
(in %)
Sterilization
71

IUD
69

Oral pills
72

Couple protection rate

47.8
Achievements of National Immunization Programme
(2004)

Achievement
Vaccine
(in %)
Measles 56

DPT 64

Polio 70

BCG 73

TT 80
National Health Indicators, Achievements &
Strategies
Indicators Achievement Strategies
(2004) (2015)
MMR 2.9/1000 0.75/1000
IMR 56/1000 35/1000
Delivery by skill birth attendant 43% 90%
Access to reproductive health 100%
Gender equity
Poverty Reduction
Population growth Reduction
Antenatal Coverage 60% 100%
Couple protection rate 47% 100%
Total fertility rate 3.2% <2%
Aim & Purposes of epidemiology
Aim
Prevention and control of diseases among
women and children
Purpose
(a)Identify
 trends and emerging threats to the health of
women on reproductive age and child
 local impacts on the prevention strategies
(b)Targeting effective implementation
(c)Appropriate coordination with other
agencies
Importance of epidemiology
related to MCH
(A) World
 Mother and child constitute around two third of
the total population
 Most of the maternal and child hood mortality
are due to preventable causes
 They are pillars of any of the developing or
developed nation
 Though various strategies are made since many
decades the progress seems to be very slow
 They are vulnerable /special risk groups
Importance of epidemiology for
MCH
India
 Mother and child constitute 70% of total
population of which women between 15 -44 yrs of
age is 19% and 40% are children
 Slow progress in the national MCH related
programmes
 Newly emerging problems
 Un utilized funds
 Poor distribution system of skilled services and
transport s
 Unmet needs of contraceptions
Major Elements of PHC Related to
MCH
 MCH including family planning;
 immunization against major infectious diseases;
and
 education of the community about health and
nutrition

These have direct bearing on the outcome of

the Maternal and Child Health related goals and
objectives.
Challenges in Collecting and Monitoring Data
Data Related Information Data Community
Systems Capability Readiness
 Data access  Creating and  Recruitment and  Community
maintaining retention of skilled awareness
 Data availability information staff
systems Community
 Quality of data Lack of analytic interest
Availability of capability
 Timeliness of data user-friendly  Political will
hardware/software  Lack of data
 Problems with and manuals management skills  Communication
data collection
 Lack of  Collaboration
interpretation skills
 Agency’s
 Need for readiness to change
additional staff

Training
Epidemiological Approach
Epidemiology deals with interaction of agent host
and environment which if operating in
combination determine the –
WHAT ?
WHEN ?
WHERE ?
WHO ?
WHY ?
 HOW TO PREVENT AND CONTROL THE
PROBLEM?
 Epidemiological
methods

Observational Experimental

Correlational Randomized
controlled trials
Prevalence
Field trials

Case-control
Community trials

Cohort
 CONCLUSION
Mother and child are one unit and most vulnerable to
the morbidity and mortality. Hence it is essential to
protect them through appropriate action at each
level. MCH epidemiology programme emphasizes
the analytical skills to address the health problems
of the mothers and children through surveillance,
assessment, planning, implementation ,monitoring
and evaluation. Nurse as team member of the
health can contribute her skill for the promotion of
health of mother and children
THANK YOU