FAMILY, ANTENATAL CARE, IMMUNIZATION AND FERTILITY

FAMILY
1)What you understand with the term family ?
A family is a group of individuals united by bonds of blood /marriage. The group lives together and
consumes food from a common kitchen.
2) Discuss the family structures ( in Malaysia)
Type of family
1) Nuclear / conjugal family -consist of a single couple and their children
-strength= promoting economic dependence,
female emancipation,responsible procreation
-weakness=fragile unity.erosions of values and
limited leisure
2) Extended / consanguine/joint family -consists of a number of married couples and
their children who live together in the same
household.
- All the men are related by blood and the
women of the household are their
wives,unmarried girls ,& widows of the family
kinsmen
-strength=preservation of social values ,providing
opportunity for leisure
-weakness-retarded development, lack of
freedom,irresponsible procreation



3) 3 generation family /vertically extended
family
-A household where there are representatives of
three generations ( grandparent-parent-children)
4) Blended / step family - families with mixed parents: one or both parents
remarried, bringing children of the former family
into the new family
5) Single parent family -due to death, divorce or desertion
6) Augmented family -family group where extended families and /or
nonrelatives live with and provide significant
care to the child
7) Multigenerational family -individuals who reside in the same household
regardless of the number of generations
8) Kin-network -those members of family who are not
biologically related nor related to family but feel
and function like family.

3)Is there any changes in age at 1
st
marriage I Malaysia ? what is the legal age at marriage in
Malaysia?
-No any changes. Under Syariah Law, minimum age to get married is 18 for males and 16 for
females ( with parental consent). Under Law Reform ( Marriage and Divorce) Act, minimum age of
marriage for non muslims is 18 for both males and females( with parental consent). If both parties are
21 of age and above, no consents of parents/guardian required for marriage.
ANTENATAL CARE, POSTNATAL CARE
1. Define antenatal care
The care that a women receive during pregnancy,helps to assure healthy outcome for
women newborns.Antenatal care is a key entry point for a pregnant women to receive a broad
range of health promotion and preventive health services. It is also an opportunity to
promote the benefits of skilled attendance at birth and to encourage women to seek
postpartum care for themselves and newborns.
2. What are objectives of providing antenatal care?
To promote,protect, and maintain health of the mother
To detect at risk cases and provide necessary care
To provide advise on self care during pregnancy
To educate women on warning signals,child care, family planning
To prepare the women for labour and lactation
To allay anxiety associated with pregnancy and childbirth
To provide early diagnosis and treatment of any medical condition/ complication of
pregnancy
To plan for birth and emergencies/ complications (where,how, by
whom,transport,blood)
To provide care to any child accompanying the mother

3. What are the health services provided by at antenatal care ? where and by whom ?

Rountine antenatal check-up with services such as ultrasonography and abdominal
examination .
Preventive care like Immunization ( ATT ) and nutritional supplements ( such as iron
supplement )
Prevention , detection and treatment of existing complicating disease such as TB ,
malaria , STDs , AIDS and etc .
Skilled birth attendants to ensure safe and uncomplicated deliveries and encourage
postpartum care .
Postpartum care .
These services are readily available in any hospital and it is provided by doctors ,
nurse and midwifes .

4. How do you understand by the term high risk approach.
Risk approach in antenatal care aims at identifying the high rick antenatal cases so as
to provide specialized care and appropriate level of care for others.
High cases should be identified as early as possible to prevent development of
compications.
Risk approach also involves utilization of non conventional resources like-traditional
birth attendants, womans groups, community health workers.

5. List the high-risk pregnancies.
Maternal Fetal
- age (younger than age 15, older than age 35)
- weight (pre-pregnancy weight under 100 lb or
obesity)
- height (under five feet)
- history of complications during previous
pregnancies (including stillbirth, fetal loss,
preterm labor and/or delivery, small-for-
gestational age baby, large baby, pre-eclampsia
or eclampsia)
- more than five previous pregnancies
- bleeding during the third trimester
- abnormalities of the reproductive tract
- uterine fibroids
- hypertension
- Rh incompatability
- gestational diabetes
- infections of the vagina and/or cervix
- kidney infection
- fever
- acute surgical emergency (appendicitis,
gallbladder disease, bowel obstruction)
- post-term pregnancy
- pre-existing chronic illness (such as asthma,
autoimmune disease, cancer, sickle cell anemia,
tuberculosis, herpes, AIDS, heart disease, kidney
disease, Crohn's disease, ulcerative colitis,
diabetes)
- exposure to infection (especially herpes
simplex, viral hepatitis, mumps, rubella, varicella,
syphilis, toxoplasmosis, and infections caused by
coxsackievirus)
- exposure to damaging medications (especially
phenytoin, folic acid antagonists, lithium,
streptomycin, tetracycline, thalidomide, and
warfarin)
- exposure to addictive substances (cigarette
smoking, alcohol intake, and illicit or abused
drugs)
- when prenatal tests indicate that the baby has
a serious health problem (for example, a heart
defect)

6. Complication of postpartum
Worldwide Malaysia

1. Postpartum hemorrhage
2. Uterine atony
3. Puerperal infection
4. Mastitis
5. Postpartum depression
6. Postpartum or baby blues
7. Thromboembolic disease
8. Lacerations
9. Retained placental fragments
10. Inversion of uterus
1. postpartum haemorrhage
2. Puerperal infection
3.thromboembolic disease
4.Puerperal psychiatric disorder



7. What are the postnatal care services?
Ministry of Health, Malaysia (MOH) has taken a stand to promote safe practices in the Malay
postpartum care and also provide information to discourage any potentially harmful beliefs that may
affect the morbidity and mortality of new mothers.
The T&CM unit will implement the manipulative component of Malay postnatal care. The services
consist of :
a) Wellness Postnatal Massage

The objectives of wellness postnatal massage are :-
To relief muscle cramps/fatigue which occurred after labor.
To give awareness and promote safe practices of traditional postnatal care.
To promote compliance in breastfeeding program.

b) Midwifery Care

The objectives of midwifery care are :-
Early detection of postpartum complications.
To promote a safe and good practice of Malay postnatal care.
To give awareness of the safe usage of herbal concoction during confinement period.

The practice midwifery care in T&CM unit consists of whole body massage, hot iron compression and
body wrapping/binding. It usually begins after 3-7 days post normal delivery.

8) What are the major causes of maternal mortality in Malaysia?
Hemorrhage(PPH)
Sepsis (15%)
Eclampsia(12%)
Obstructed labour (8%)
Unsafe abortion
Anemia
Other indirect causes are malaria, hepatitis, heart diseases, HIV/AIDS

9) Why do women die in childbirth in developing countries?

Childbirth in developing countries are carried out by their own without the help of
professionals or skilled attendants
Less number of skilled attendants
A delay in recognizing childbirth complications ( severe bleeding, infections, increased
blood pressure in pre-eclampsia & eclampsia, unsafe abortion)
A delay in reaching a medical facility
A delay in receiving good quality care
The age of women giving birth ( younger ages like 15 years of age are more prone to
maternal death)
Living place far from health facilities (rural areas)
Socioeconomic status (poor)
inadequate health services in a particular country
Lack of proper information on maternal health & child health


10.who are skilled birth attendants?
A)midwives
B)nurses with midwifery skills
C)doctor with midwifery skills
D)obstetricians
A birth attendant, also known as "skilled birth attendant" ("SBA"), who provides basic and
emergency health care services to women and their newborns during pregnancy, childbirth and the
postpartum period. Birth attendants are trained to be present at ("attend") childbirth, whether the
delivery takes place in a health care institution or at home, to recognize and respond appropriately to
medical complications, and to implement interventions to help prevent them in the first place
including through prenatal care.
11) What are the indicators for assessing maternal health? antenatal, intranatal and
postnatal
12.) Indicators of maternal health in Malaysia


IMMUNISATION
1.Immunization schedule of Malaysia
2. Indicators of immunization services
3. What is AEFI and how was AEFI classified?

FERTILITY

1)What is meant by the term fertility?
- Natural human capabilities of producing offspring

2)What are the factors affecting the human fertility?

Marriage & Marital Disruption
Sterility
Postpartum Infecundability
Fecundability
Spontaneous Intrauterine Mortality
Contraception
Induced Abortion

3)How can fertility be regulated?

Age at marriage: Early marriage is a long established custom in India The disadvantages of
early marriage are
a) Population growth due to increased child birth
b) adverse effect on the health of women.
Duration of married life: Maximum child birth occurs in the first 15 years of married life. So
efforts for family planning must be concentrated only during these early years of married life.
Spacing of children: Spacing between births reduces fertility rates.
. Education: Educated women give birth to lesser number of children when compared to
illiterates.
. Economic status: Fertility decreases with an increase in per capita income. Therefore
economic development is considered to be the best contraceptive.
Caste and Religion Muslims show higher fertility than Hindus. Among Hindus, fertility is
high in lower castes.
. Nutrition: It has an indirect effect. Well fed societies show lower fertility rate.
Family planning: It is an important factor which can lower fertility.
Other factors: Cultural and social factors like i) position of women in society ii) value of
children iii) customs and beliefs iv) widow remarriage v) industrialization vi) urbanization
etc. can affect fertility.

4) Describe the different methods of fertility regulation.
-Hormanal methods(PILLS,IMPLANT,VAGINAL RINGS/INJECTABLES
-New IUD

5)What are the indicators of fertility? Fertility indicators of Malaysia?
The Major Indicators:
Changes in cervical mucus.
Changes in basal body temperature (BBT).
Changes in the cervix itself.

The Minor Indicators:
An example of a minor index is ovulation pain (mittleschmerz), or the calendar calculation.