Strategies for promoting child health.

In India maternal and child deaths account for 60% of total mortality. Reductions in maternal mortality require the identification of all pregnant women in the community prenatal care the early detection of medical problems and pregnancy-related complications tetanus toxoid immunization identification of the most appropriate setting for delivery prevention of maternal malnutrition and motivation to practice breastfeeding and birth spacing in the postpartum period. To reduce child mortality infants should be breastfed immunization against common infectious diseases should be provided and growth should be monitored at regular check-ups. As part of the village health workers regular household visits pregnant women should be motivated to seek prenatal care. Ideally there should be a prenatal visit monthly for the 1st 7 months of pregnancy once every 2 weeks until 36 weeks and weekly thereafter. If long distance from a medical facility or the loss of wages make this impossible there should be at least 4-5 visits at the 10th 20th 30th 35th and 35th weeks of gestation. Care should be taken to identify the major factors in high-risk pregnancies: moderate to severe toxemia chronic hypertension significant rental or heart disease hydramnios or oligohydramnios and uterine rupture. In areas where financial and human resources in the primary health care sector are limited inputs should be targeted to high-risk groups and activities of preventive and therapeutic value that are most cost- effective. All interventions should be based on a thorough analysis of the major determinants of mortality the incidence of specific diseases the responsiveness of diseases to available technologies the communitys nutritional status and the cultural milieu. Rather than create new schemes and categories of workers existing health facilities should be fully utilized.