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TRIPURA INSTITUTE OF PARAMEDICAL SCIENCE

NURSING SECTION
SUBJECT:-ADVANCE NURSING PRACTICE
An observational report on mch services at madhupur phc

SUBMITTED TO: SUBMITTED BY: -

Mrs.Sangita Paul Tanmoy Das
Assistant Professor. M.SC. Nursing ,1ST
Comunity Health Nursing. Semestar..Roll No:-14
TIPS (Nursing Section) Roll No-14

DATE OF SUBMISSION:-

An observational report on MCH services at Madhupur PHC

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Introduction:-

The term community health gained wide acceptance. Community health implies in a
broad sense,integration of preventive,curative and promotive health services.community health
nursing is the field of nursing in which the family and community are the patients/clients.it is the
synthesis of nursing theory and community health theory applied to prevent ,promote and
preserve the health of the population.as a part of my community posting in advance nursing
practice subject ,I have visited the MCH clinic of Madhupur PHC on 14/10/2023 to 16/10/2023.

Maternal and Child Health(MCH):-

Mother and child health is an important dimension

of community health nursing. The term "maternal
andchild health services" refers to a "package" of
integrated health services designed to promote the
health andnutritional status of mothers and children,
and ensurethe birth of a healthy infant to every expectant mother. MCH was first initiated in the
early 1900s, when maternity services were improved and rural midwives and birth attendants
received training. MCH was voluntary work coordinated by the Maternal and Child Welfare
Bureau under the Indian Red Cross Society.

Aims of Maternal and Child Health Services:-

 Reducing maternal mortality rate, infant mortality rate and maternal and child morbidity
rate.
 Child survival.
 Promoting reproductive health or safe motherhood.
 Checking malnutrition in children and mothers..
 Protecting mothers and children from infectious diseases.
 Early diagnosis and treatment of the health problems of mothers and children.
 Ensuring physical and mental growth and development of children and adolescents.
 Improving the health levels of mothers and children.
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Components of MCH:-
 Maternal health
 Child Health
 Family planning
 School health
 Handicapped Children

Factors Affecting MCH:-

 Education level
 Knowledge of one's own right
 Sociocultural practices
 Cultural taboos
 Early marriage and pregnancy
 Gender based violence
 Women's internalization of patriarchal values
 Social services
 Provision of clean water and sanitation
 Health care access and utilization
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 Health care quality

 Income/Employment
 Illiterate women's economic activity
 Water, food and sanitation
 Unbalanced diet
 Family health
 Poor health status of family members
 Lack of accessibility family planning services

Importance Of MCH:-
 It ensures a healthy pregnancy and good health care.
 It aids in the delivery of a healthy baby by providing immunization services, guaranteeing
a balanced diet, and maintaining sanitation.
 It safeguards reproductive rights and promotes a happy life.
 It ensures the health of both mother and child.
 It helps to reduce the preventable deaths among women and children.

Indicators Of MCH:-
Maternal and child health can be evaluated on the basis of the following indicators:-
 Maternal mortality rate
 Infant mortality rate
 Neonatal mortality rate
 1-4 years child mortality rateChild survival rate.

Common Health problems of Mother and Child:-

1. Infection
Maternal infection can cause:
a) Growth retardation
b) Abortion
c) Low birth weight
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d) Puerperal sepsis
Infection among children can cause
a) Diarrhea
b) Respiratory tract infection
c) Chronic infection like Malaria, Tuberculosis (TB)
2. Uncontrolled fertility
Consequences of uncontrolled fertility:
Increase prevalence of LBW
Anemia
Abortion
Malnutrition

Challenges in Ensuring Maternal and Child Health:-

 Universalization of services
 Existing rural-urban differentiation
 Poor status of women in society
 Political and administrative will in this sector.

Emerging Issues in Maternal and Child Health:-

 Issues like emergence of new viruses like Zika virus, Corona virus as pandemic can result
in overall decrease in coverage across all maternal and child health interventions like in
number of institutional deliveries, antenatal care services, immunization services

 Increase in infertility due to various reasons can potentially affect various aspects of
women's quality of life such as physical health, mental health, social health and the total
quality of life significantly

 Adoption of sedentary lifestyle by many pregnant women reduces metabolism and impair
the body's ability to control blood sugar levels, regulate blood pressure, and break down
fat
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 Consumption of junk food is in trend among younger children. This has certain short and
long term consequences like lethargy, bloating, indigestion, obesity, dental problems etc.
in children as well as adults
 Acceptance of this issue as a social priority
Organizational Activities of MCH Services:-
Maternal and child health services are an important part of primary health care. Traditional
activity areas of these services are:
 Complete health check-up and care of the child and mother from conception to birth.
 Studying health problems of mothers and children.
 Providing health education to parents for taking care of children.
 Training to professionals and assistant workers.
Today, maternal and child health services have been further strengthened by adding services like,
reproductive and child health, immunization, family planning, protecting mother and child
against anemia, preventing blindness, creating postnatal units in big hospitals and training
programmes for SBA (Trained Birth Attendants, like MO,Nurse).

Roles and Responsibilities of Community Health Nurse in MCH:-

Responsibilities of community health nurse in maternal health services can be presented under
following headings:
Direct Care:-
Antenatal Care:-
 Contact: Contacting every pregnant mother in the primary stage of pregnancy.
 History: Taking history of general health; family environment, social conditions. previous
childbirths pregnancy. and present
 Antenatal examination: Conducting general examination, physical examination and
obstetric examination, laboratory examinations etc.
 Calculating the expected date of delivery and informing mothers.
 Conducting antenatal clinics.
 Identifying high-risk mothers. • Providing counselling and health education.
 Helping mother and other family members in planning the delivery.
Intranatal Care:-
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 Preparing the place for delivery. Arranging necessary equipments and their
 sterilization.
 Giving mental support to mother.
 Preparing mother for delivery.

 Examining position of fetus, dilation of cervix, and heart of fetus, observing the position
of bladder and uterine contractions.
 Noting general condition of the pregnant mother, process of pains and time of membrane
rupture.
 Ensuring safe delivery, examining umbilical cord and noting abnormalities. . If
necessary, taking help of doctor or
 referring patient to a specialist. Taking care of the mother and newborn
 baby after the delivery.
 Maintaining through asepsis during delivery.
 Should be ready to handle complications like bleeding, malpresentation, cord prolapse
etc.
 Noting the correct time of childbirth.
Postnatal Care:-
The week immediately after the childbirth is called postnatal period. Given below are the duties
of community health nurse during this period:
 Observing the blood pressure, temperature and pulse of mother immediately after the
delivery and then during the following period.
 Collecting information about the general condition of mother, food, sleep, pain and
elimination etc. and, accordingly providing the nursing care.
 Observing fundus, perineum, lochia, bladder etc.
 Observing breasts and nipples.
 Protecting the mother from complications like puerperal sepsis, breast inflammation,
postpartum hemorrhage, urinary incontinence, urinary retention and thrombophlebitis and
providing required treatment.
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Neonatal Care:-
 Observing the respiration of newborn, immediately after birth and if necessary providing
resuscitation.
 Taking care of the umbilical cord cutting the cord and tying it using proper Taking care
techniques.
 Taking notice of abnormalities congenital defects and informing the or relatives.
 Assessing the physical condition of the newborn by his Apgar score (9 or 10 is ideal
score). Cleaning the newborn child (giving bath to the newborn has become less popular
Follow the doctor's order or hospital policy).
 Taking care of the newborn's skin and eyes.Keeping the newborn child on safe bed and
providing breast-feeding to baby at the earliest.
 Maintaining normal body temperature of the newborn. Give kangaroo care.
 Observe the crying, intestinal activity. urination, sleep and feeding pattern of the newborn
child and accordingly giving the treatment or nursing care.

Functions Related to Maternal Clinics:-

In maternal services, community health nurse has to assume the responsibilities of conducting
antenatal and postnatal clinics also.
Home Visits:-
Home visits are the backbone of maternal and community health services. In maternal services
home visits can be antenatal, postnatal or regarding home delivery. Home visits increase the
utility of maternal and child health services, and reduce the mortality and morbidity rate in both
the segments. During home visits, community health nurse should try to focus the attention of
mother on following points:
 Antenatal checkup and its importance.
 Anatomy, physiology, and psychology of pregnancy.
 Diet during pregnancy
 Plans of delivery.
 Neonatal care
 Family planning
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Managerial Functions:-
 Organizing and managing the nursing homes.
 Playing the role of liaison officer under referral system, for sending the mother to
hospital for safe delivery.
 Taking part in community activities. Explaining the importance of reproductive and child
health in community.
 Supervising the work of TBAs, midwives and female health workers and giving them
appropriate suggestions.
 Organizing and managing maternal clinics.
 Coordinating between the doctor, family and patients.
 Storing and maintaining the records of maternal and child health services.
 Evaluating the maternal and child welfare services on the basis of interviews and other
standards/check-list.
 Assisting the research work in the field of maternal and child health services.

Educational Functions:-
 Providing health education to TBAS, mothers and family either individually or in the
group.
 Educating (using demonstrations) pregnant mothers and relatives about maternal nursing.
 Community health nurse should discuss following topics with pregnant mothers:
 Importance of regular antenatal checkup. Utility of rest, sleep and exercise.
 Personal hygiene and proper diet.
 Clean environment (including mental environment).
 Importance of hospital delivery or delivery by trained worker.
 Utility of maternal clinics.
 Plans of delivery.
 Cutting (severing) and tying the umbilical cord.
 Taking care of infant.

Immunization Of Mother and child_ as MCH Service tool:-

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Immunization plays a vital role in MCH affecting directly the maternal and infant morbidity and
mortality rate by means of prevention of infection.immunizations programmes proves
prophylaxis to the mother and child agains some specific diseases through specially made
substances,that is called vaccines.
Objectives of Immunization:-
 Reducing Infant Mortality Rate:
This objective can be achieved by giving vaccines against tetanus, polio. diphtheria,
whooping cough, TB and measles (six killer diseases of children).
 Reducing Maternal Mortality Rate:
By immunizing the pregnant mothers, number of maternal deaths can be reduced to a
large extent.Controlling the infections of diseases and their carriers.
 Increasing the health level and life expectancy of citizens:
by generating prophylaxis against diseases and Developing sufficient capacity and
technique to manufacture vaccines.

National Immunization Programme:

Immunization programme is one of the most important national health programmes to protect
pregnant women and children from serious diseases such as tetanus, diphtheria, pertussis,
poliomyelitis, tuberculosis, measles, typhoid and hepatitis. Immunization is recommended by the
ministry of health and family welfare, Govt. of India to protect the pregnant women and children
from such diseases. Government of india has taken various initiative to ensure sent percent
vaccination with various national health programmes such as intensified mission indradhanush.

Immunization Immunization of Healthy child

of mother newborn and
MCH
during ANC infancy
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(Picture:- Front view of Madhupur PHC)

MCH clinic Of Madhupur PHC at a glance:-

Name of the PHC :- Madhupur PHC.
State :- Tripura
District :-Sepahijala
Block :-Bishalgarh RD Bock
Ownership :-State Government
Name Of the Incharge Medical officer :-Dr.Paramita Biswas.
Address :-Madhupur,Kamalasagar,
Bishalgarh,Sepahijala,Tripura.
Population Covered :- 35188.
Pregnant women :-510
Infant :-441
Under five :-2205
Male :-18613
Female :-16575
Subcentre Covered :- 10 nos.
Gao sabha covered :-13nos.
Staffing pattern :-MPW:-02Nos,MPS:-07 Nos.
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(Pic:- Floor map of Madhupur PHC)

(Pic- Floor Map Of MCH Clinic of Madhupur PHC)

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(Pic:- Floor plan of PHC)

Administrative structure of Madhupur PHC

Madhupur PHC is serving the people under state government of Tripura rules and regulations
following the said authority provided guidelines.the administrative channel of communication
is_

Ministry, health and family welfare,

Secretary ,health and family welfare,

Director of family welfare and preventive medicine,

Chief medical officer,Sepahijala,District,

Subdivisional Medical Officer,bishalgarh,

Medical Officer in charge,Madhupur PHC.

Services offered in MCH Clinic:-

Operataing Time:- 9.00am to 4.30pm.

At MCH clinic,madhupur PHC, services are being offered as per the government of india
adopted reproductive,maternal,new-borne,child and adolescent health (RMNC+A)
framework.service offered here are:-

Routine immunization services,

Antenatal clinic on every wednessday
JSSK and JSY benefits
Anti rabies clinic
Family planning services
Conducting school health programme comprising school health team including one medical
officer,pharmacist and MPW
implentation of various national health programme
conducting surveys at specific areas communicable disease prone zone
conducting non communicable disease clinic under national programme for non communicable
disease band palliative care,
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Atal Bihari Bajpayee pradhan mantri jan arogya yojna_ayushman bharat scheme card
generation
maintaining of cold chain for vaccine storage
conducting mass education and awareness programme on various health habits and control
measures of various prevalent disease .
conducting meeting among health care employees viz, ASHA, anganwadi worker etc,
conducting meeting inviting local PRI members with preplanned agendas on health related
issues
Reporting of activities done to higher authorities in specific formats
maintaining quality in service following standard operating procedures of state government,
department of health and family welfare.
implementing the national family welfare health programmes
Counselling and appropriate referral for safe abortion service(MTP)
Promotion of sanitation including use of toilet and appropriate garbage disposal
water quality monitoring

Present endemic scenario:-

Recently before around 2 month back sudeen outbreak of dengue fever took place in kaiyadhepa
area under this PHCand malaria outbreak took place in pathariyadhar gao sabha area, health care
worjers have visited those areas and conducted mass health screening and awareness camps.the
MCH clinic and the nearby area beyond and within the boundaries of hospital, necessary
information education and communication material eg., posters, display board, handouts are
pasted for the purpose of community awareness.

Conclusion:-
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As a part of my PHC posting I have been posted in MCH clinic of Madhupur PHC, where I
gained experience in various MCH functions,organization,planning,process ,roles of MCH staffs,
Objective of MCH activities.the MCH clinic is well equipped with the facilities like growth
charts,new born baby health screeing,maternal health screening,antenatal clinic,ARSH
clinic,counseling on family planning,ORS/Zinc Counter, Family planning counter,etc.

Reference,

1.Keshav Swarnkar.Community Health Nursing.second edition.indore.N R Brothers.2007

2.K Park.Essentials Of Community Health Nursing.Fourth edition.M/S Banrsidas Bhanot

publishers.2004.

3.bijayalakshmi Dash.A comprehensive Text Book Of Community Health Nursing.second

Edition.new delhi.Jaypee jaypee brothers.2004.

4.VariousRecords and Reports of MCH clinic,Madhupur PHC,e.g., HMIS Report.