Transcript Overview of Maternal health scenario in India and Introduction to

SBA - Presentation 3 (b)
Antenatal Care:
Interventions
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
Antenatal Care: Interventions
Interventions
• Iron-folic acid (IFA) supplementation
• Injection tetanus toxoid (Inj.TT) administration
• Malaria prophylaxis and treatment
• Folic acid supplementation (400 µg) upto 12 weeks of
pregnancy to prevent neural tube defects
• Regular consumption of iodised salt
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Interventions
Why is IFA supplementation needed?
To meet the increased demand of iron and
folic acid during pregnancy
Additionally
• Ensure regular intake of IFA tablet
• Counsel for increase in dietary intake of iron
rich food : green leafy vegetables, jaggery,
whole pulses, meat, fish, chicken, eggs,
groundnuts etc
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Interventions
What is the prophylactic dose of IFA?
Dose :
1 tablet of IFA (100mg elemental iron+0.5 mg of folic acid)
Duration :
At least 100 days starting at 14-16 weeks
Continue for 3 months postpartum
Given for preventing anemia even if Hb>11gm/dl
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Interventions
What is the therapeutic dose of
IFA if Hb < 11 gm/dl?
Dose :
1 tablet twice a day of IFA
(100mg elemental iron+0.5 mg of folic acid)
Duration :
At least 100 days during pregnancy
Continue for 3-6 months in postpartum period
Follow up
Repeat Hb after 1 mth : If increased, continue the same treatment
If no increase refer to MO for further investigations
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Interventions
What are the indications for referral
in women with anemia?
• Women with severe anemia, that is, Hb < 7 gm%
• Anemic women with breathlessness and or
tachycardia HR > 100 beats / min
Start with therapeutic dose of IFA and
REFER the woman immediately to MO at FRU
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Prescribing IFA tablets: Counseling
• Tablets to be taken regularly preferably early morning on
an empty stomach
• If nausea or pain abdomen, it may be taken after meals
or at night
• Stools will be dark in color while on tablets
• May have constipation, relieved by taking plenty of
fluids and roughage
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Prescribing IFA tablets: Counseling
• Absorption of iron is interfered if taken with tea, coffee or
foods rich in fluoride
• Enhanced if taken with lemon water or orange juice
• Encourage her to take plenty of fruits and vegetables like
mango, guava, orange, amla etc containing vitamin C
• Emphasize the importance of high protein diet like black
gram, ground nuts, whole grains, milk, eggs etc
• Give advice not to stop the medication on her own
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Injection tetanus toxoid administration
Importance
For preventing maternal and neonatal tetanus
Dosage schedule :
Two doses 0.5 ml I/M in upper arm
First dose
Second dose
- As soon as woman registers for ANC
- 4 weeks after the first dose even if it is after delivery
If previously fully vaccinated within 3 years,
give only one dose as early as possible
Inform that there may be slight swelling,
stiffness or pain at the injection site or in the arm
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Malaria prophylaxis and treatment
All clinically suspected cases should be investigated for malaria
by Microscopy or Rapid Diagnostic Kit (RDK)
•
No prophylaxis in pregnant women
•
In non endemic areas :
All clinically suspected cases should
be investigated by RDK
•
In highly endemic areas :
All pregnant women are routinely
tested for malaria at 1st AN visit and
then every month
If positive, the woman is referred to PHC for treatment
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Thank you
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