Women and men's Health

4th year

Objectives
Identify key demographic characteristics of women and men
throughout the adult lifespan.
Discuss the major chronic illnesses found in adult women and men
Compare and contrast the manifestations of chronic illnesses in adult
women and men.

Objectives
Identify desirable primary, secondary, and tertiary health promotion
activities designed to improve the health of women and men.
Describe the role of the community health nurse in promoting the
health of adult women and men across the lifespan.

Introduction
Health care needs of women and men have
differed more often than they have been alike.
Many health promotion and health protection
programs are designed specifically for women or
for men.
Mammography screening programs are designed
for womans while prostate cancer screening are
health promotion programs for men.

Adult women and men

Adult is defined as anyone 18 years of age or
older. There are differences in health profiles
and health care needs as people age.
As adults enter their middle years (3565), they
experience many normal physiologic changes.
However, some changes are the result of disease,
environment, or lifestyle and can be slowed
through behavior change.

Demographics of men and women

* Mortality statistics are considered the most reliable indicator of
the health status of a population.
10 leading causes of death for all people in rank order included

10 leading causes of death for all people in

rank order included
1. Diseases of the heart

2. Malignant neoplasms

3. Cerebrovascular diseases
4. Chronic lower respiratory diseases
5. Unintentional injuries
6. Diabetes mellitus

7. Alzheimers

8. Influenza and pneumonia

9. Nephritis, nephritic syndrome and nephrosis
10. Septicemia

Life expectancy
is the average number of years that an
individual member of a specific cohort is
projected to live. In the United States, women
survive an average of 6 years longer than men

PHYSICAL PROFILE OF MIDDLE-AGED ADULTS

BY BODY SYSTEM
Body System

Physical Characteristic

Endocrine and reproductive

system

- Menses stops
- Synthesis of estrogen decreases
- Tissues of the reproductive system
(e.g., cervix and uterus) gradually
atrophy
- Uterine changes make pregnancy less
likely
- Intercourse may be more painful due
to diminishing natural lubrication

PHYSICAL PROFILE OF MIDDLE-AGED ADULTS

BY BODY SYSTEM
Body System

Physical Characteristic

Skeletal system

Intervertebral disks flatten over

time

Integumentary system

* Decreased secretions by sebaceous

glands leads to drier skin
* Sweat glands diminish in size and
number
* Skin loses elasticity and is more
prone to wrinkles
* Hair bulbs lose melanin usually
resulting in gray hair by age 50

PHYSICAL PROFILE OF MIDDLE-AGED ADULTS

BY BODY SYSTEM
Muscular system

- Muscle fibers decrease by

approximately 10%
- Lean body mass is replaced by adipose
tissue
- Decreased grip strength occurs at this
age

Neurologic system

- Nerve impulses are conducted 5%

slower
- Cognition is unaffected, although there
is a gradual loss of neurons
- Eyesight is poorer due to loss of
elasticity in the lens
- Auditory discrimination of certain
tones and consonants gradually

PHYSICAL PROFILE OF MIDDLE-AGED ADULTS

BY BODY SYSTEM
Cardiovascular system

- By age 50, the hearts

efficiency may be only 80%
- Elasticity of heart and blood
vessels decreases
- Cardiac output decreases

Respiratory system

- Elasticity of lungs decreases

- Breathing capacity decreases
to 75% due to diminished
strength of chest wall muscles

PHYSICAL PROFILE OF MIDDLE-AGED ADULTS

BY BODY SYSTEM
Urinary system:
Loss of bladder tone and tissue atrophy may lead to
incontinence or possibly prolapse
In men, an enlarged prostate may result in nocturia or
dribbling

Definition of Reproductive health

It is a state of complete physical, mental and
social well-being (not merely the absence of
disease or infirmity) in all matters related to
the reproductive system and to its functions
and processes.

Definition of Reproductive health care

the constellation of methods, techniques and
services that contribute to reproductive health
and well-being through preventing and solving
reproductive health problems. It also includes
sexual health

purpose of Reproductive health care

Enhancement of life and personal relations,
And not merely counseling and care related to
reproduction and sexually transmitted diseases.

Reproductive Health Services

Reproductive and sexual health services should
be integrated within a system that offers
primary health care and referrals for more
specialized needs.

A full sexual and reproductive health

package
Family planning/birth spacing services
Antenatal care, skilled attendance at delivery, and
postnatal care
Management of obstetric and neonatal complications
and emergencies
Prevention of abortion and management of
complications resulting from unsafe abortion

A full sexual and reproductive health

package
Prevention and treatment of reproductive tract
infections and sexually transmitted infections
including HIV/AIDS
Early diagnosis and treatment for breast and
cervical cancer
Promotion, education and support for exclusive
breast feeding

A full sexual and reproductive health

package
Prevention and appropriate treatment of infertility
Active discouragement of harmful practices such as
female genital cutting
Adolescent sexual and reproductive health
Prevention
violence

and

management

of

gender-based

Definition of women health

Women's
health
focused
primarily
on
reproduction and women's role as mothers . It
include
biological,
social,
psychological,
cultural, political, and economic factors

Objectives Relevant to Women's Health

From US Department of Health and Human
Services: Healthy People 2010. understanding
and improving health (The Mellennium
Development Goals )

Objectives Relevant to Women's Health

Access to quality health services
1-1 Increase the proportion of persons with health
insurance to 100%
2. Arthritis, Osteoporosis, And Chronic Back Conditions
2-9 Reduce the overall number of cases of osteoporosis
among adults ages 50 years and older from 10% to 8%

Objectives Relevant to Women's Health

3. Cancer
3-3 Reduce the death rate of breast cancer
3-4 Reduce death rate from uterine cervical cancer
from 30deaths per 100,000 to 20 deaths per 100,000
3-5 Reduce the colorectal cancer death rate
3-6 Reduce the rate of melanoma cancer deaths

Objectives Relevant to Women's Health

Increase the number of women who receive a Pap test
Increase the proportion of women ages 40 years and
older who have received a mammogram within the pre
ceding 2 years from 67% to 70%

Objectives Relevant to Women's Health

Family Planning
Increase the proportion of intended pregnancies from
51 % to 70%
Increase the proportion of health care providers who
provide emergency contraception

Factors affecting womens health

Age

Young age at pregnancy teen age pregnancy

affect the womens health.

Menopausal period is risk of gynecological cancer and

malnutrition

Factors affecting womens health

Socio economic
Poverty and other economic factors
Level of education

Factors affecting womens health

Cultural factors
Gender issue
The high value placed on sons in some regions leads to
serious physical and psychological consequences for
girls and women e.g., education, feeding.

Factors affecting womens health

Medical
Some diseases are Associated with womens
reproductive biology:
More risk of cervical cancer and breast cancer.
More risk for exposure to infection by STDs.
Higher susceptibility to anemia due to menstrual
period.

Factors affecting womens health

Lack of utilization of health care and poor quality of
maternity care
Behavioral determinants
Poor personal hygiene exposes women to infection
especially STDs and urinary tract infection.

Health status indicators for women health

Health status indicators are a set of data that has been
analyzed in a way that permits assessment of the
health status of the population so that public health
priorities and actions can be appropriately identified.

Health status indicators for women health

Mortality
Morbidity

Morbidity
Arthritis,
Depression,
Orthopedic problems,
Diabetes,
Chronic obstructive pulmonary disease (COPD),
Hemorrhoids.
Hypertension,
Chronic bronchitis, asthma, and chronic sinusitis.

Maternal Morbidity
Maternal morbidity refers to morbidity from any cause
related to or aggravated by the pregnancy or its
managements

Maternal morbidity classification

Direct

Indirect

Psychological

Maternal morbidity classification

Direct obstetric morbidity resulting from obstetric
complication of the:
pregnancy e.g. gestational diabetes
labor e.g. hemorrhage and
the puerperium e.g. puerperal sepsis

Maternal morbidity classification

Indirect obstetric morbidity resulting from diseases such
as:
anemia,
malaria,
hepatitis
and TB,
aggravated by the physiological effects of pregnancy

Maternal morbidity classification

Psychological obstetric morbidity:
post partum psychoses or depression and
other mental health problems related to pregnancy
and childbirth

Maternal mortality
Deaths of women while pregnant or within 42 day of
termination of pregnancy, related to any cause or
aggravated by pregnancy or its management but not
from accidental cause e.g. rood traffic accident,
burns, suicides, poisoning.

Causes of maternal deaths

Women health promotion across the lifespan

A.Young Adult Women (18 to 35

Years)
B.Adult Women (35 to 65 Years)

Young Adult Women (18 to 35 Years)

Two main concerns of women in this group
Making career choices.
Establishing relationships that may lead
to marriage and pregnancy .

Young Adult Women (18 to 35 Years)

Needs
Preconception care
Safe motherhood
Post abortion care
Family planning
Nutrition

Pre-conception care
Definition
Objectives of Pre-conception care
Components of preconception care

Pre-conception care
Objectives of Pre-conception care
Improve the knowledge and attitudes and behaviors
of women related to preconception health.
Evaluating physical readiness;
Helping women to evaluate their psychological
readiness;

Pre-conception care
Components of preconception care
1- Health education.
2- Nutritional counseling.
3- Testing for RH blood group.
4- Rubella vaccination .
5-Birth planning .

Safe motherhood
Definition of safe motherhood
Means that the mother will be safe all over the
pregnancy and deliver healthy baby.

Objectives of safe motherhood

Provide maternal care for all pregnant women.
Reduce maternal mortality- Promote, protect, support exclusive breast
feeding.
Reduce infant mortality, and eliminate neonatal
tetanus.

Safe motherhood principles

Family planning- 1
Antenatal care- 2
Clean labor and delivery- 3
Essential obstetric care for high-risk pregnancies and - 4
.complications

Basic services for safe motherhood intervention

Education on safe motherhood.

Promotion of maternal nutrition.
Provision of micronutrient supplementation and
tetanus toxoid, where appropriate.

Basic services for safe motherhood intervention

Prenatal care and counseling.
Adequate delivery assistance, in all cases by a skilled
person, without excessive. recourse to caesarean sections.
Neonatal care, including exclusive breast-feeding for six
months.

Basic services for safe motherhood intervention

Care for obstetric emergencies, including referral
for
pregnancy,
childbirth,
and
abortion
complications.
Postnatal care
Antibiotic combat infection
Blood bank combat bleeding

Basic services for safe motherhood intervention

Abortion-related care, including counseling and
reliable information for women who have unwanted
pregnancies, and treatment for women who have had
recourse to abortion.
Family planning counseling, information and services,
and promotion of longer intervals between births.

Post abortion care (PAC)

is the strategy to reduce death and suffering from
the complications of unsafe and spontaneous
abortion.

The elements of PAC

1-Emergency management of incomplete abortion
and potentially life-threatening Complications.
2-Family planning counseling and services.
3-Making links between post-abortion emergency
services and other RH care services.
4-Comprehensive post-abortion care services should
include both medical and preventive health care.

Post abortion care (PAC)

The following steps should be taken to manage postabortion complications:
1) Education
2) Counseling
3) Family planning and contraceptive services
4) Treatment

Post abortion care (PAC)

Education to:
- increase family planning and contraceptive use
- thus preventing unwanted pregnancies,
- assisting women with birth spacing and
- planning healthy pregnancies,
- and reducing the need for unsafe abortion

Post abortion care (PAC)

Education about:
the risks and consequences of unsafe abortion.
the signs and symptoms of obstetric emergencies such as postabortion complications to promote appropriate care-seeking
behaviors.
Participation by community members in decisions about which
reproductive health services are offered, when, where, by
whom, for whom and at what cost.

Post abortion care (PAC)

2) Counseling
The aims of counseling for post-abortion women is to solicit and
affirm women's feelings and provide emotional support
throughout the entire post-abortion care visit.
3) Family planning and contraceptive services
Help women practice birth-spacing or prevent an unwanted
pregnancy

Post abortion care (PAC)

Treatment: Talk to the woman about her condition.
Complete clinical assessment.
Management of pain and complications.
Rest: in case of light to moderate bleeding.
Replacement of fluids.
surgery and uterine evacuation.
Antibiotics: for infection or septic shock.
Prevention of tetanus: A tetanus vaccination should be given

Family planning
Definition of Family planning
the practice that help individuals couples to attain certain
objectives:
To avoid unwanted births and bring about wanted births.
To regulate intervals between pregnancies.
To control the time at which births occur in relation to age of the
parents.
To determine the number of children in the family

Family planning
Family planning methods
Hormonal methods: Pills, Injection Norplant
Mechanic al barrier: IUD, Condom male and female
Cervical cup
Chemical: Spermicide, Foams, cream,
Surgical: Tubal legation, Vasectomy

Nutrition
Women's nutrition affects a wide range of health and
social issues, including:
Pregnancy outcomes,
Family care,
Household food security,
and local and national economic development

Nutrition
Malnutrition is the most widespread problem among
women in the developing countries,
Anemia is the most common form of malnutrition,
afflicting an estimated 47 percent of women
worldwide,
Anemia in pregnancy is one of the leading causes of
maternal death.

Nutrition
Nutritional education programs
Iron and folic acid supplements have to be
provided through the MCH program.

Problems
Eating disorder
are complex, chronic illnesses primarily affecting
young women. The cause is not clear; however,
the incidence is on the rise. The three most
common are
anorexia nervosa,
bulimia nervosa,
and binge eating

Problems
Anorexia nervosa
is an eating disorder that is marked by:
Weight loss, emaciation,
A disturbance in body image, and a fear of weight gain.
Persons affected lose weight either by:
excessive dieting or by purging themselves of ingested
calories.

Problems
Bulimia nervosa
is marked by recurrent episodes of binge eating,
self-induced vomiting and diarrhea, excessive
exercise,
strict
dieting
or
fasting, and an
exaggerated concern about body shape and weight.
In many ways, anorexia and bulimia are similar
except, women with anorexia nervosa rarely binge
eat.

Problems
Binge eating
It is the newest clinically recognized eating
disorder characterized by repeated episodes of
uncontrolled eating and starts following significant
weight loss from dieting.
However, many binge eaters are obese because
they do not induce vomiting and diarrhea or
engage in excessive exercise.

Problems
Characteristics of individuals with this disorder:
eat quickly,
eat until they are uncomfortably full,
eat when they are not hungry,
eat large amounts of food alone,
have difficulty expressing their feelings, and feel depressed

Problems
Eating disorder also puts the women at increased
risk for:
type 2 diabetes,
high cholesterol,
gallbladder disease,
depression,
heart disease, and some cancers

Reproductive tract infections (RTIs)

(RTIs) include three types of infection that affect women and men

1- Sexually transmitted infections (STIs) caused by

viruses, bacteria, or parasitic organisms that are
passed through sexual activity with an infected
partner. More than 40 have been identified, including
Chlamydia, gonorrhea, hepatitis B , herpes, human
papillomavirus, syphilis, and HIV.

Reproductive tract infections (RTIs)

2.Infections that result from an overgrowth of
organisms normally present in the vagina (endogenous
infections). These infections are not usually sexually
transmitted, and include bacterial vaginitis and
candidiasis.

Reproductive tract infections (RTIs)

3. Infections introduced into the reproductive tract
by a medical procedure such as induced abortion,
IUD insertion, or childbirth.

Reproductive tract infections (RTIs)

Causes:
Surgical instruments used in the procedure are
not properly sterilized,
Infection already present in the lower
reproductive tract is pushed through the cervix
into the upper reproductive tract.

Reproductive tract infections (RTIs)

Prevention and treatment
Educating patients at risk for STDs about safer sexual behaviors
Detecting asymptomatic or symptomatic patients who are unlikely to seek
treatment;
Providing effective diagnosis and treatment of those with STDs;
Identification of patients at risk for transmitting or acquiring STDs.
Evaluating, treating and counseling the sexual partners of those with STDs;
Immunizing patients who are at risk for STDs that are preventable by
vaccination.

Infertility
Definition of female Sterility

Is restricted to inability to ovulate.

Approximately 40% of reported cases of infertility are
due to problems in the male;
another 40% to problems in the female;
the remaining 20% are of unknown cause or due to
problems in both the male and female.