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MATERNAL AND CHILD HEALTH

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					MATERNAL AND CHILD HEALTH




          Jay H. Mayefsky, MD, MPH
GOALS

   HEALTHY MOTHERS AND CHILDREN
MCH

   MEDICAL SERVICES
   ENVIRONMENTAL ISSUES
   PSYCHOSOCIAL STRESSES
   INCOME
FACTORS FOR EMERGENCE

   HIGH INFANT MORTALITY RATE
   HIGH MATERNAL MORTALITY RATE
   REFORM MOVEMENT
   CHILD LABOR CONCERNS
   INCREASED GOVERNMENT INVOLVEMENT
FACTORS FOR EMERGENCE

   THE SHEPPARD-TOWNER ACT (1921-9)

   THE SOCIAL SECURITY ACT (1935)
 MATERNAL AND CHILD HEALTH
         BUREAU

Vision
A future America in which the right to grow to one's full
potential is universally assured through attention to the
comprehensive physical, psychological and social
needs of the maternal and child health population. We
strive for a society where children are wanted and born
with optimal health, receive quality care and are
nurtured lovingly and sensitively as they mature into
healthy, productive adults. MCHB seeks a nation where
there is equal access for all to quality health care in a
supportive, culturally competent, family and community
setting.
    MATERNAL AND CHILD HEALTH
       BUREAU - OBJECTIVES

   Woman and infants
    –   Eliminate barriers and health disparities
   Child health and safety
    –   Reduce illness and injury
    –   Promote health care and healthy environments
   Children with special health care needs
    –   Support coordinated care systems
   Adolescents
    –   Support comprehensive care
    MATERNAL AND CHILD HEALTH
       BUREAU - OBJECTIVES

   Health Promotion and Disease Prevention
   Genetics
    –   Newborn screening and increase knowledge
   ACCOMPLISHED BY
    –   Funding – care and research
    –   Training
    –   Resource centers
    –   Guidelines and tips
MATERNAL SERVICES – GOALS

   HEALTHY WOMEN – PRE AND POST
    PARTUM
   BIRTH OF HEALTHY BABIES WITH NO
    COMPLICATIONS FOR MOTHERS
   BONDING
MATERNAL HEALTH SERVICES


   AGE OF FIRST SEXUAL ACTIVITY
    THROUGH OLD AGE
PAP SMEARS

   START WITHIN 3 YEARS OF ONSET OF
    VAGINAL INTERCOURSE
   NO LATER THAN 21
   <30 - YEARLY
   >30 – EVERY THREE YEARS AFTER 2-3
    NORMALS
   IN HIGH RISK – YEARLY
   WOMEN >70 WITH 3 NORMALS AND NO
    ABNORMALS IN 10 YEARS MAY STOP
PELVIC EXAMINATION

   HEALTH ASSESSMENT

   EDUCATION
BREAST EXAMINATION

   HEALTH ASSESSMENT

   EDUCATION
DISEASE PREVENTION

   ABSTINENCE

   SAFER SEX
IMMUNIZATIONS

   RUBELLA
   VARICELLA
   HEPATITIS B
PREGNANCY PLANNING

   ALL PREGNANCIES SHOULD BE PLANNED
    TO REDUCE MEDICAL AND
    PSYCHOSOCIAL RISK FACTORS
BIRTH CONTROL

   CONDOMS PLUS ANOTHER METHOD
FOLIC ACID FOR REDUCTION OF
NEURAL TUBE DEFECTS

   ALL WOMAN OF CHILDBEARING AGE WHO
    ARE CAPABLE OF BECOMING PREGNANT
    –   0.4mg OF FOLIC ACID DAILY
PRENATAL CARE

   START EARLY IN PREGNANCY
   SCREEN FOR MATERNAL RISK FACTORS
   EVALUATE MATERNAL PHYSICAL AND
    PSYCHOLOGICAL HEALTH
   EVALUATE RISK FOR DOMESTIC
    VIOLENCE
PRENATAL CARE

   MONITOR GROWTH AND DEVELOPMENT
    OF FETUS
   PRENATAL DIAGNOSIS
    –   TRIPLE SCREEN
    –   ULTRASOUND
    –   AMNIOCENTESIS
    –   CHORIONIC VILLUS SAMPLING
PRENATAL CARE

   EDUCATION
    –   PREGNANCY
    –   CHILDBIRTH
    –   BREAST FEEDING
    –   PARENTING
POSTPARTUM CARE

   POST PARTUM PHYSICAL EXAMINATION
   ASSESSMENT OF MOTHERING
   SCREEN FOR POSTPARTUM DEPRESSION
WELL WOMEN

   GENERAL STATE OF HEALTH
   CANCER SCREENING
   MENSTRUAL CYCLE ISSUES
   FOLATE
   PREVENTION OF OSTEOPOROSIS
MAMMOGRAMS

   LOW RISK
    –   BASELINE AT AGE 40
    –   REPEAT EVERY 2-3 YEARS
    –   YEARLY AFTER AGE 50
   HIGH RISK
    –   BASELINE AT AGE OF CANCER IN RELATIVE
    –   YEARLY
MENOPAUSAL WOMEN

   MENOPAUSE SYMPTOMS
   OSTEOPOROSIS PREVENTION AND
    TREATMENT
   CONTINUED CANCER SCREENING
CHILDREN’S HEALTH SERVICES
CHILDREN’S HEALTH SERVICES -
GOALS

   REDUCE PREMATURITY AND CONGENITAL
    ABNORMALITIES
   PREVENT MAJOR CAUSES OF DEATH AND
    DISEASE
   PROVIDE SPECIALIZED TREATMENT
   ENSURE ACCESS TO CARE
   PREPARE CHILDREN TO BE HEALTHY
    ADULTS
PRENATAL

   ESTABLISH RAPPORT
   ASSESS RISK FACTORS
   GENETIC COUNSELING
   INFANT CARE
   FAMILY ADJUSTMENT
   BREAST FEEDING
   SAFETY
NEWBORNS

   PHYSICAL EXAMINATION
   ANTICIPATORY GUIDANCE
   IMMUNIZATION
   BACK TO SLEEP
NEWBORNS – SCREENING TESTS

   PKU
   Congenital hypothyroidism
   Congenital adrenal hyperplasia (CAH)
   Biotinidase deficiency
   Maple syrup urine disease
   Galactosemia
   Homocystinuria
   Sickle cell anemia
   Medium chain acyl-CoA dehydrogenase deficiency
    (MCAD)
   Hearing loss
INFANTS AND CHILDREN

   THE NEW MORBIDITY
INFANTS AND CHILDREN

   ANTICIPATORY GUIDANCE
   PHYSICAL EXAMINATION
   SCREENING TESTS
   IMMUNIZATIONS
SCREENING TESTS

   HEARING          LEAD
   VISION           PPD
   DEVELOPMENT      URINALYSIS
   CBC              CHOLESTEROL
ROUTINE IMMUNIZATIONS

   HEPATITIS B          MEASLES
   DIPHTHERIA           MUMPS
   TETANUS              RUBELLA
   PERTUSSIS            VARICELLA
   POLIO                PNEUMOCOCCUS
   H. INFLUENZAE B      (HEPATITIS A)
                         (INFLUENZA)
              Recommended Childhood and Adolescent Immunization
                 Schedule — United States, January – June 2004
                                Range of Recommended Ages                              Catch-up Immunization                   Preadolescent Assessment

                  Age        Birth       1 mo           2 mo             4 mo   6 mo     12 mo    15 mo        18 mo   24 mo       4-6 y     11-12 y
Vaccine

                            HepB #1         only if mother HBsAg ( - )
    Hepatitis B1                                                                                                                    HepB series
                                                     HepB #2                                HepB #3

Diphtheria, Tetanus,
                                                       DTaP              DTaP   DTaP                    DTaP                       DTaP          Td    Td
    Pertussis2

    Haemophilus
                                                         Hib             Hib    Hib3           Hib
 influenzae Type b3

Inactivated Poliovirus                                   IPV             IPV                   IPV                                  IPV

 Measles, Mumps,
                                                                                             MMR #1                               MMR #2          MMR #2
    Rubella4

     Varicella5                                                                                  Varicella                            Varicella


  Pneumococcal6                                         PCV              PCV    PCV           PCV                           PCV            PPV
                   Vaccines below this line are for selected populations
    Hepatitis A7                                                                                                                  Hepatitis A series


     Influenza8                                                                                              Influenza (yearly)
ADOLESCENTS

   ANTICIPATORY         ADOLESCENT ISSUES
    GUIDANCE              –   PUBERTY / SEX
   PHYSICAL EXAM         –   SUBSTANCE ABUSE
                          –   RISK TAKING
   SCREENING TESTS
                          –   PEER PRESSURE
   IMMUNIZATIONS
                          –   FUTURE PLANS
OTHER CHILDREN’S PROGRAMS

   HEAD START          WELFARE
   FACILITY            WIC
    REGULATIONS         CHILD ABUSE
   PROGRAM FOR          SERVICES
    CHILDREN WITH       PL94-142
    SPECIAL HEALTH      PL99-457
    CARE NEEDS
HOW WELL ARE WE DOING?
WHAT’S MISSING?




    FATHERS
HOW WELL ARE WE DOING?

   11 MILLION CHILDREN LIVE BELOW THE
    POVERTY LEVEL
    –   INCOME <$17,603/YEAR FOR A FAMILY OF 4
   Improvement but still 71% higher than adults
HOW WELL ARE WE DOING?

   56% OF CHILDREN LIVING IN POVERTY
    ARE IN HOUSEHOLDS HEADED BY A
    SINGLE FEMALE
   64% OF ALL MOTHERS OF PRESCHOOL
    CHILDREN ARE IN THE LABOR FORCE
   11.6% OF CHILDREN HAVE NO HEALTH
    INSURANCE
HOW WELL ARE WE DOING?

   In 2000, 879,000 children were victims of
    abuse or neglect (12/1000 children)
   79% of perpetrators were the parents
HOW WELL ARE WE DOING?

   3% OF HEALTH EXPENDITURES ARE
    ALLOCATED FOR PREVENTION
HOW WELL ARE WE DOING?

   HIGH SCHOOL STUDENTS
    –   NEVER WORE SEAT BELTS         19%
    –   NEVER WORE BIKE HELMETS       88%
    –   RIDDEN WITH ALCOHOL DRINKER   37%
    –   DRIVEN AFTER DRINKING         17%
    –   CARRIED A WEAPON              18%
    –   SMOKED                        37%
    –   CONSIDERED SUICIDE            20%
    –   ATTEMPTED SUICIDE             8%
HOW WELL ARE WE DOING?


                            1997    Y2K GOAL

UNINTENDED PREGNANCY       34-50%    30%


PRENATAL CARE AFTER 3 MO   17-31%    10%


SMOKING IN 3RD TRIMESTER   11-24%    10%


BREAST FEEDING             48-87%    75%
HOW WELL ARE WE DOING?

   20 COUNTRIES HAVE LOWER MATERNAL

    MORTALITY RATES THAN THE UNITED

    STATES

				
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posted:8/27/2011
language:English
pages:60