this work describes current interventions in maternal and child health in Ghana

1. MATERNAL AND CHILD HEALTH
INTERVENTIONS IN GHANA
DR BAYO YUSUF ADENUGA

2. • Mothers and children constitute a priority group
• they constitute about 70% of the total population.
• They are thus the major consumers of health
services
• special risk group because of the following:
• There are risks associated with child bearing in
women
• There are risks associated with growth,
development and survival in children
• The health of the mother and child therefore
constitute one of the most serious problems
affecting our community.

4. Some statistics on health in Ghana
Percentage of women with no education- 21.2%
Total fertility rate 4.0
Percentage of teenagers who have begun child bearing 13.3%
Percentage of married women currently using any method of family planning
23.5%
Median age at 1st
marriage for women 19.8 years
Median age at 1st
sex for women age 25-49-17.7 years
Percentage of married women with unmet need for family planning- 35.3%
Percentage of live birth delivered at a health facility- 57.1%
Percentage of live birth receiving assistance at delivery from a trained health
professional -58.7%
Percentage of children fully immunized at 59 months-79.0%
Percentage of children with fever taken to a health facility-60.4%
Median exclusive breastfeeding duration in months -5.3 months
Infant mortality rate per thousand live birth- 50.3(compare with Singapore-2)
Under 5 mortality rate per 1000- 80.0
Maternal mortality ratio per 100,000 live birth-150 (2009)

5. Maternal and Child Health (MCH)
• Definition
• This refers to the health promotive,
preventive, curative and rehabilitative health
care for mothers and children. It include sub
areas of maternal health, child health, family
planning, school health, care of the
handicapped children, adolescence health,
care of children in special setting like day
cares.

6. Specific objectives of MCH
• Reduction of maternal, perinatal, infant and
childhood mortality and morbidity.
• Promotion of reproductive health.
• Promotion of the physical and psychological
development of children and adolescent in
the family.
• With ultimate objective of life- long health for
mothers and children.

7. MCH Problems
The main problems of MCH revolve around the triad
of:
• Malnutrition
• Infection
• Consequences of unregulated fertility
• This is further associated with scarcity of health
and other social services and poor socio economic
condition (poverty).

8. Malnutrition Effects
Malnutrition in mothers leads to:
• maternal depletion
• low birth weight babies,
• anaemia,
• toxemia of pregnancy,
• post partum haemorrhage

9. Malnutrition in children leads to:
• low body weight, stunting and kwashiorkor;
with inability to survive,
• susceptibility to infection,
• severity of illness also leading to deaths

10. Infection Effects
In mothers, infection can lead to
• foetal growth retardation,
• low birth weight,
• embryopathy, abortion and puerperal sepsis
•
• There are higher risks of infection during
pregnancy in poor developing countries
compared to developed countries. (Associated
with poverty).
•

11. `Infection in babies can lead to
• diarrhoea,
• respiratory and skin infections
• neonatal tetanus
• worsen by malaria and Tb

12. Uncontrolled Reproduction
• Empirical evidence has shown that it leads to:
• High Low Birth Weight babies,
• severe anaemia,
• abortion,
• ante-partum haemorrhage,
• high maternal and perinatal mortality
• It is also associated with high infant and under 5
mortality rates. All these effects of uncontrolled
reproduction increase more after pregnancy no
4.

13. Direct Root Causes of MCH burden
• 1. Poor personal and environmental hygiene
• 2. Poor nutrition consisting of saturated fats, sugar and salt
leading to obesity and its attendant consequences of
Hypertension, Diabetes etc.
• 3. Poor physical exercise and rest
• 4. Over-working women in households and on the fields
• 5. Bad eating habits. E.g. late eating at night
• 6. Delay in providing prompt medical services in health
institutions
• 7. Poor attitudes of health staff towards clients/patients
• 8. Sub-standard quality of health services
• 9. Eating contaminated food
• 10. Drinking unsafe water
• 11. Poor Health-seeking Behaviours
• 12. Exclusion of the vulnerable from decisions directly affecting
their health

14. Indirect Root Causes:
1. Harmful traditional beliefs, practices and misconceptions:
• Self medication and misuse of medicines
• Belief and revering obesity as sign of affluence
• Adoring certain skin color, tempting women into skin bleaching and its
attendant hazards of bad odors, skin cancers, kidney diseases,
• Food taboos that refuse women and children eating certain types of foods
• The practice of certain rituals and rites such as Puberty, Widowhood, Female
Genital Cuttings etc
• Communal Hair shaving, communal use of enema cans etc.
2. Poverty
3. Victim-blaming by health professionals
4. Reckless lifestyles;
• Indiscriminate sex,
• Alcoholism,
• Exposure to secondhand smoke etc
5. Lack of enforcement of laws on road and occupational safety
6. Bad roads and indiscipline on our roads

15. Solutions to Malnutrition
• Direct intervention: supplementary feeding programmes,
distribution of iron and folic acid tablets, fortification and
enrichment of foods, nutrition education etc
• Nutritional surveillance
• Indirect interventions: not specifically related to
malnutrition but have significant consequences, include:-
Control of communicable diseases through immunization,
improvement of environmental sanitation, provision of
clean drinking water, Family Planning services, food
hygiene, education, Primary Health Care….

16. Solutions to Infection
• Prevention and treatment of prevalent infections
is important.
• Immunization of children against 9 infections-Tb,
diphtheria, pertusis, tetanus, polio, heamophilus
influenza type B, hepatitis B, measles, yellow
fever
• Tetanus toxoid vaccination for pregnant women
• Expanded Program on Immunization as part of
MCH
• Education of women in emergency treatment
measure such as Oral Rehydration Therapy and
management of fever, knowledge and practices
of personal hygiene, appropriate, sanitation in
and around homes

17. Solutions to Uncontrolled Fertility
• Family Planning integration into MCH
• Introduction of new easier and safer techniques
of FP
• Safer abortion practices which is comprehensive
in nature
• Family life education in schools
• Use of Traditional Birth Attendants and
community health workers to extend FP into
community
• Importantly to improve the economical status of
women

18. Maternal and Child Health Services
• Antenatal care
• Prenatal advice
• Specific health protection
• Intra-natal care (child birth)
• Post natal care
• Care of children

19. • Ante Natal Care
• Refers to the care provided for women
before, during and after pregnancy. The aim is
to achieve a healthy mother and baby.
• The following programmes of health care are
carried out:

20. 1. Antenatal Care Visit
• Ideally should be once a month during the
first 7 months of pregnancy; twice during the
next (8th
) month and thereafter once a week if
all is well till delivery.
• However due to economic and other
implications; a minimum of 3 visits are
required: 1st
visit at 20 weeks; 2nd
visit at 32
weeks and 3rd
visit at 36 weeks. Plus a home
visit by a health worker.

21. What Is Done At The Ante Natal Visit?
1. Physical Examination
• Physical examination of mother
• Monitoring of baby’s growth, ultra sound
uterus scanning
• Blood examination for haemoglobin, sickle
cell, HIV antibodies, Syphilis, blood group
antigen, Rhesus factors etc
• Urine examination for proteins etc

22. 2. Prenatal Advice
• Dietary advice: to eat adequate and balanced diet as frequently as possible to meet the
needs of pregnancy and lactation.
• Personal and environmental hygiene: bathe daily; wear clean clothes; clean environment
• Rest and sleep: 8 hrs sleep minimum and 2 hrs of rest after midday meals;
• Bowels: to avoid constipation by eating regularly green leafy vegetables, fruits, extra fluids
• Exercise: to do light exercise around the house, avoid strenuous manual labour
• Smoking: advised not to smoke because it causes low birth weight babies (LBW); mortality is
10-40% higher in babies of smokers.
• Alcohol: to avoid consumption of alcohol especially the local brews; as this can lead to
abortion and Fetal Alcohol Syndrome disease;
• Dental care: advised on regular dental care and checkups;
• Sexual intercourse: restrict sex especially in the last trimester (last 3 months)
• Drugs: stop the use of non essential drugs; avoid over the counter medicines. Some drugs
like Thalidomide, LSD, Streptomycin, Iodine, Steroids, and Pethidine etc should be avoided in
pregnancy.
• Radiation: to avoid exposure to radiation; as it can damage the foetus; use x-rays only when
necessary and at minimum exposure.
• Warning signs: mother should be made aware of warning signs including swelling of feet, fits
and headaches, blurring of vision, bleeding or discharge per vagina, any other unusual
symptoms.
• Child care; advised on nutritional education, child hygiene, cooking, breast feeding, FP
education etc

23. 3. Specific Health Protection measures to includes:
• Treatment for anaemia; Iron and folic acid tablets intake daily
• Vitamin A, Iodine, Vitamin D, and Protein: Capsules of Vitamins A&D are
given; fresh or skimmed milk is given in some clinics.
• Albendazole tablets are given for the treatment of worms
• SP (Sulphadoxine Pyremethamine) tablets are also given for malaria
prevention
• Management of Toxemia of Pregnancy: early detection and
management is important; signs include; presence of albumin in urine
and high blood pressure.
• Tetanus toxoid injection is given: minimum 2 doses at 16-20 wks and 20-
24 wks minimum interval of 1 month between doses.
• Protection against Syphilis: Syphilis may lead to abortion, neurological
damage to baby if untreated. The blood is tested for syphilis at 1st
visit; if
present 10 doses of procaine penicillin is given to treat the infection.
• Protection against Rubella: by vaccinations of young girls and
adolescents
• Rhesus Grouping (RH) of blood is required to guard against later effects
on babies.

24. Intra-Natal Care
The objectives of intra-natal care are:
• Aseptic delivery
• Delivery with minimum injury to mother and
baby
• Resuscitation of baby, care of umbilical cord
etc
• Readiness to deal with complications such as
prolonged labour, ante partum haemorrhage,
convulsion, prolapse of cords etc
• Care of the baby at delivery

25. Post-Natal Care
The objectives of post natal care:
• 1. To prevent complications
• 2. Restore mother to optimum health
• 3. Family planning services provision
• 4. Health education to mother and family etc

26. Care of Children
• The care of children during these periods:
• Infancy period: day 0-1 year
• Neonatal period: the first 28 days of life
• Post neonatal- from the 28th
day – 1 year
• Pre-school age: 1-4 years
• School age: 5-14 years

27. During these periods, the cares for the children
include:
• Adequate and balanced nutrition
• Growth monitoring
• Integrated Management of Childhood Illness
• Immunization
• Vitamin A
• School Health programs etc

28. • The Safe Motherhood Initiative
• This is one of the initiatives organized by the World
Health Organization to tackle maternal mortality
(deaths). Member states are to implement these
initiatives and integrate them into their health
care.
• The Goal of the Safe Motherhood Initiative
• The goal of the Safe Motherhood Programme is to
improve women’s health in general and especially,
to reduce maternal morbidity and mortality and to
contribute to reducing infant morbidity and
mortality.

29. • Safe Motherhood services comprise
• Antenatal Care services
• Supervised Delivery
• Post Natal Care Services
• Comprehensive Abortion Care services
• Other areas separated for Program Purposes
are:-
• -Breast feeding program (Baby Friendly
initiative)
• -Prevention of Mother-to-Child
Transmission of HIV. (PMTCT)

30. Child Health
Deaths in Under-Fives children - Global
• About 10.6 million children below the age of 5 years die
every year. Majority of these deaths are in developing
countries.
• Also majority of the deaths are from preventable causes.
Deaths in Under Fives children - Ghana
• 1 in 10 children dies before their fifth birthday (U5MR -
80/1000 live births)
• 2/3 of these deaths occur within the first year (IMR –
50.3/1000live births)
• 2/3 of infants die before they are 1month old (NMR –
43/1000live births)

31. Causes of Death in under fives (70%)
1. Malaria
2. Acute Respiratory Infections (Pneumonia)
3. Diarrhoea
4. Measles
5. Malnutrition (linked to >50% deaths)

32. Causes of deaths in children under five in Ghana

33. Priority Areas for Improving Child Health
• Neonatal Health
• Prevention and control of growth and
nutritional problems
• Prevention and control of infectious diseases
and injuries
• Clinical care of the sick and injured child
• Health related interventions
• Prevention and Control of infectious diseases

34. Immunization
• Vaccinations against 9 disease entities(Tb,
diphtheria, Pertusis, tetanus, hepatitis B,
haemophilus B, polio, measles, yellow fever)

35. Malaria Control
• The control of malaria in children efforts are
targeted towards:
• Distribution and use of Insecticide Treated Bed-
Nets
• Prompt and effective case management of
malaria
• Availability of an anti malaria vaccine
•
• There is an integrated campaign providing
Measles/Polio/Vitamin A combined with the
distribution of ITN

36. Prevention of Mother-to-Child-
Transmission of HIV/AIDS (PMTCT)
• Without treatment, 15–30 per cent of babies
born to mothers with HIV will themselves get
the virus. Around one in two infants who get
HIV from their mothers and do not receive
treatment die before their second birthday.
Many pregnant women are still missing out on
treatment.

37. Family Planning
• Women in Africa have the highest number of
children:
• on average, about five children each, compared
with nearly seven children 30 years ago.
• Women in more developed countries have the
fewest children, with an average birth rate of 1.6
now compared with 2.4 in the late 1960s.
• This low level of childbearing, combined with an
older population, accounts for population declines
in many European countries.

38. • Evidence has shown that higher levels of
contraceptives use are associated with lower
levels of childbearing.
• The high infant mortality in this part of the
world may be both a cause and an effect of
high levels of childbearing.
• In Africa, where infant mortality is high (88
infants die per 1,000 live births), on average
women have over five children each.

39. • In contrast, in more developed regions, where infant
mortality is low (6 infants die per 1,000 live births), women
have fewer than two children on average.
• Analysis of pregnancy outcomes worldwide shows that as
much as 22% of pregnancies are induced to abort indicating
that these were initially unwanted pregnancies. This figure is
even higher in the developing countries.
• Overall, 14 percent of births in Ghana are unwanted, while
23 percent are mistimed (wanted later).
• The most commonly used modern method of contraception
among married women is injectable (6 percent), followed by
the pill (5 percent). Male condoms and female sterilization
are used by 2 percent each, while implants are used by 1
percent of married women.
• The most commonly used traditional method of
contraception is rhythm, which is used by 5 percent of
married women.

40. • Consequences of these statistics are:
• Population explosion with all the attendant
socio- economic effects e.g. slums, migration,
poverty etc
• High infant and child mortality
• Unsafe abortion practices with consequent
danger of maternal mortality
• This has necessitated the need for scaling up
of effective family planning services.

41. Definition of Family Planning
• A way of thinking and living that is adopted
voluntarily upon the basis of knowledge,
attitudes and responsible decision by
individuals and couples in order to promote
the health and welfare of the family group
and thus contribute effectively to the social
development of a country. - WHO

42. • Another WHO expert committee defined FP as:
• Practices that help individual or couple to:
• -Avoid unwanted births
• -Regulate the interval between pregnancies
• -Control the time at which births occur in relation to
the ages of the parent and determine the number
of children in the family
• The United Nation has declared FP as a
fundamental human right

43. Scope of FP services:
It is more than just birth control and consists of the
following:
1.The proper spacing and limitations of births
2.Advice on sterility
3.Education for parenthood
4.Sex education
5.Screening for pathological conditions related to
the reproductive system e.g. cervical cancer
6.Premarital consultation and examination
7.Carrying out pregnancy tests
8.Marriage counseling

44. 9.Preparation of couple for the arrival of their
first child
10.Providing services for unmarried mothers
11.Teaching home economics and nutrition
12.Providing adoption services

45. Methods of Contraception:
Divided into Traditional and Modern
• Traditional Methods:
• These are practices, beliefs or customs that
have been used for birth control for many
years and are handed down from one
generation to the other. The few remaining
traditional methods in use are as follows:

46. • Abstinence: Avoidance of sexual intercourse by
personal choice or culturally and religiously enforced.
• Douching: Hot water with or without concentrated
solutions of salt, alum, vinegar, lemon etc are put into
the vagina immediately after sex to prevent
conception. This is a very dangerous method.
• Withdrawal (Coitus interruptus): This involves the man
withdrawing his penis from the vagina during
intercourse and just before ejaculation so that sperm is
prevented from being discharged into the vagina.
• Safe period: A natural method of birth control that
involves the couple abstaining from sexual intercourse
during the fertile period of the woman. Proponents
sometimes refer to this method as a modern method
of family planning

47. Three techniques of safe period are commonly used:
• Calendar method: Educated couples use the
calendar to determine their fertile period and
abstain from sexual intercourse for this period. The
Bead Method is similar to this method
• Temperature method: This involves determining the
ovulation period using the body temperature chart
to determine the probable time of ovulation
• Cervical Mucus Method: This also involves
determining the time of ovulation by observing the
changes that occur in the cervical mucus during
ovulation.

48. Modern Methods:
• Barrier Methods: These are mechanical
barriers that are placed to prevent the sperm
from entering the cervix. They include the
condoms and diaphragms.

49. • Spermicides: Chemical substances deposited
into the vaginal cavity before sexual
intercourse to block the cervix and kill the
sperm. Examples include the foaming tablets,
the cream and jellies.
• Intrauterine Device (IUD): A plastic or stainless
steel object inserted into the uterus by a
trained health worker to prevent pregnancy.
Types include the Lippes’s Loop (coil), the
Copper T etc.

50. Hormonal Methods:
• These methods involve administering either estrogen or
progesterone hormones or both into the woman so as to
temporarily alter her hormonal constitution and prevent
pregnancy in various ways. They include the following:
• 1. Oral Pills: One tablet is taken daily by the woman
throughout the month to prevent pregnancy within that
month.
• 2. Injectables: Long acting hormones given by injection to
prevent pregnancy over one, two or three month(s)
depending on the type given.
• 3. Implant: A deposit of a very long acting preparation of
progesterone in the form of an elastic capsule implanted
in the upper arm of a woman to prevent pregnancy for a
long duration. Norplant, as an example, could prevent
pregnancy for a period of 5 years.

51. • Surgical Methods (Sterilization): A surgery
performed on either the woman or the man
to permanently prevent pregnancy. They
include Tubal Ligation for the woman and
Vasectomy for the man.