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Initiatives for Mother, Infant and Young Child Care Nutrition (MIYCN)

"A woman's body is a miracle. Respect it, enjoy it, and celebrate it during pregnancy." - Christine Northrup.



There are several awareness programs available for pregnant women in India, such as


Pradhan Mantri Matru Vandana Yojana (#PMMVY) - A Scheme that provides financial assistance for pregnant women to support their first live birth. It provides a monetary benefit of INR 5000 in three instalments.


Mother and Child Tracking System (#MCTS) - An Online Tool that records and tracks the health of pregnant women and their children until they turn 5 years old. It helps in improved Antenatal care and post-pregnancy care.


Anemia Mukt Bharat (#AMB) - A scheme launched by the Ministry of Health and Family Welfare(MoHFW) in order to track the presence of Anaemia in Pregnant women and children. Its goal is to provide nutritional counselling, Iron Folic Acid(IFA) supplementation and deworming.


Apart from these, there are several other initiatives by the government such as Maternal Mortality Reduction Program (#MMRP), that provide knowledge and assistance to pregnant women in India.


It is essential to know the factors that pose nutritional risks, in order to understand the preventive measures taken for #MIYCN in Antenatal Care Out Patient Department(ANC OPD).



Who is at nutritional risk?

  • With age < 20 years

  • Has height< 145 cm

  • Is thin < 20 weeks of pregnancy with Body Mass Index(BMI) < 18.5 kg/m.sq

  • Has Mid-upper arm circumference(MUAC) < 23 cm

  • Is overweight and obese with BMI > 23 Kg/m.sq

  • Has anaemia with its haemoglobin gradient < 11g/dl, mild or severe, with severe being a gradient< 7g/dl

  • Has Weight gain of less than 1 kg/month and more than 3 Kg/month from the second trimester onwards

  • Has signs of night blindness, visible goitre and skeletal fluorosis in endemic zones

  • Has medical complications and associated infections like Malaria, HIV and TB


MIYCN implementation in ANC OPD:

A pregnant woman receives a series of services until the child turns 2 years old. It creates an opportunity to educate pregnant women, their husbands and other family members to improve maternal nutrition.


They have different contact points for the1000-days period. The “1000-day” window is further divided into two parts

270 days from conception until the discharge of the mother and baby after labour and

• 730 days from discharge until the baby reaches 2 years




The first contact point - ANC OPD:

In Antenatal Care Outpatient Department (ANC OPD), the pregnant woman’s husband and other family members are provided counselling on the mother’s nutrition, consumption of Iron- Folic acid (IFA), Calcium (Ca) tablets and breastfeeding preparation. It is provided during every ANC OPD visit, which happens at least four times.


Recommended Nutritional Services - Overview:

First service - Assess, measure, and Identify (AMI):

  • Pregnant women are Assessed and Measured to Identify nutritional requirements

  • Anthropometric measurements such as Height and Weight are assessed

  • Calculation of BMI is done to identify underweight or overweight women

  • Screening is done for anaemia, any visible sign of goitre, Vitamin A deficiency

  • An oral glucose tolerance test is taken

  • Signs/symptoms of any underlying medical complications are examined


Second service - Counsel/Prescribe:

  • Counselling is an integral feature recommended by the Government of India and the World Health Organisation(WHO)

  • It is provided to women, husbands and families on diet diversity and adequacy

  • Advise is provided on malaria prevention in endemic areas

  • The use of Iodized salt is emphasized

  • For appropriate measurement of Anaemia, a Positive glucose tolerance test is recommended

  • All pregnant women are advised to consume at least 5 food groups from 10 recommended food groups

  • 400 mcg of Folic acid is advised to prevent neural tube defects

For 2nd and 3rd trimester:

  • Weight is checked. Weight gain calculation and tracking is done. Counselling on optimal weight gain is provided

  • Hb levels are checked. Advice on Prophylactic IFA(60 mg Iron and 500 mcg folic acid/day) is provided for all women, starting from 2nd trimester for 180 days. A prescription is given for a therapeutic dose of 2 IFA tablets for mild to moderate anaemia patients and necessary follow-up is ensured

  • Appropriate management of severe Anaemia is done with measures such as blood transfusion

  • Calcium(1g/day) supplementation is prescribed, starting from 14th week for 180 days

  • A single dose of Albendazole(deworming) is prescribed in 2nd trimester

  • Diet practices, adequacy and diversity of diet are assessed

  • Appropriate management of gestational diabetes mellitus is ensured

  • Advise on rest and limiting hard work is provided

  • For 3rd trimester women, mother and family members are explained on importance/benefits of breastfeeding especially early initiation of breastfeeding

Iron- Folic acid (IFA) tablet watchfulness:

  • To consume IFA with lemon water

  • Not to take IFA and Calcium tablets together

  • Not to take IFA tablets with tea, coffee and milk




ANC OPD Entry:

  • Check if it’s the first or follow-up visit

  • If it's the first visit, registration is done. Mother Child Tracking System(MCTS) ID is generated(Sometimes called RCH ID Reproductive Child Health ID number), MCPC(Mother Child Protection Card) is provided

  • Weight & Height (other measurements as per AMC guidelines) are measured

  • Calculation of BMI (red mark<18.5 or >24.9) and MUAC (MUAC < 19 cm or >=33cm) are done. Blood pressure is checked

  • Lab Tests are done for basic investigations- Hb and Glucose Tolerance Test etc.,

  • Family history is recorded


The next step is an examination by Gynaecologist or Post Graduate Resident, during which, the pregnant women's details are documented in the "Mother and Child Protection Card(MCPC)". This card helps in ensuring safe pregnancies and deliveries in India. The MCPC is provided free of cost to pregnant women to record all their data.


Gynaecologists or Post Graduate Residents:

  • A complete physical examination is done to see if danger signs are present

  • If danger signs are present, they are managed

  • Reviews of BMI and 24-hour diet history are done

  • The required number of meals is specified

  • Tea/Coffee intake is regulated

  • Insecticide-treated bed for malaria is prescribed

  • Tetanus toxoid(TT) injection recommendation is done

  • If required, references for specific tests are provided

  • Reference is done to Nurse and Counsellor, who repeats all key messages

ANC Exit:


Nurse:

  • Advice on rest, diet, weight gain, micronutrients and follow-up is repeated

  • TT injection is administered and updation is done on the #MCPC

Counsellor:


Reinforce all key messages such as

  • Benefits of healthy eating - adequate quantity and diversity in diet, using locally available, specific nutrient food items

  • Importance of weight gain

  • Dosage and benefits of IFA and Ca consumption

  • How to consume IFA and Ca supplements (What to do and What not to do)

  • Management of side effects of IFA supplements


Follow-up visits:

  • A nurse checks whether its a first or follow-up visit

  • Confirms in MCTS ID

  • Measures Weight. Compares with previous weight (red flag or warning signal:<1kg in one month or >3 Kg in one month)

After this, the pregnant woman is sent to the Physical examination room. There, a gynaecologist or Post Graduate Resident will examine her.



Gynaecologists or Post Graduate Residents:

  • Enquiry of current complaints or difficulty in following the advice of IFA or Ca or any other complaint is done. A complete physical examination is done.

  • Danger signs are screened and if present, the danger signs are managed

  • Nutritional status is assessed by reviewing Weight gain, 24 hr dietary recall, and Hb level. If weight gain is optimal and no anaemia is found, then the pregnant woman and her family members are appreciated with advice on continuing the same practices

  • Supplements of IFA, Ca and nutritional and adequate diet practices are advised

  • If weight gain is not optimal, possible reasons are analysed

  • The second dose of (TT)Tetanus toxoid injection is prescribed and deworming if they are in 2nd trimester

  • In the third trimester of pregnancy, she is advised on practices such as early initiation, exclusive breastfeeding, birth preparedness and family planning,

Nurse:

  • Repeats advice on diet, rest, weight gain, and micronutrients

  • Reminds about follow-up

  • Gives guidance in immunization OPD for 2nd dose TT, medical store for IFA and Ca supplements and provides treatment with albendazole

  • Documents in the MCPC

Counsellors:


Reinforces

  • benefits of healthy eating

  • importance of weight gain, IFA and Ca supplements

  • how to consume IFA and Ca

  • managing side effects of IFA and Ca

  • remind about a follow-up visit

  • early initiation of breastfeeding for the third trimester etc.,


Key takeaways

Awareness and corrective measures during pregnancy are important to avoid the consequences of negligence. The Antenatal care and Postnatal care measures taken by the government must be consciously recognized by everyone. Adequate assistance must be provided to pregnant women to improve their mental health and physical health. Maternal health improves the child's health in each and every family. It is important for everyone to realise the significance of women's health, and involve themselves in remedial measures.



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