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01.2. Phase II

iii. Reproductive Health – (Lectures - 25 hours + Tutorials - 3 hours)

Learning Objectives

Content

Activity

Time

Describe Reproductive Health concepts

Definition of RH/ Components of RH

Family health program in Sri Lanka

– objectives and strategies

Safe motherhood

Mother Baby package

Life cycle approach

Lecture

1

Describe pre-natal, natal and post-natal care

The need for provision of field maternal and child care        

The role of MOH, PHN and PHM in the provision of maternal care, Pre conceptual counseling, Antenatal care

Objectives of home visits

Clinic activities – health education, Anthropometric measurements, Investigations, Vitamin, Mineral and Food supplementation, Immunization, Proper maintenance of records and returns

Screening for high risk conditions and referral

Lecture /

Clerkship

1

 

Natal care

Importance of hospital delivery

The need for trained assistance for home deliveries

Hospital delivery: Infection control at the labour room

Post natal Visits

Objectives of home visits for mother and neonates

Early identification of puerperal complications and referral, Nutrition during lactation

   

Describe child health services

Child health services – Institutional and Field

Role of public health staff in delivery of child health services.

Clerkship

 

Describe activities of the CWC

Organization

Facilities available

Clerkship

 

Describe Infant feeding practices

Breast feeding: Composition of breast milk, Advantages – mother & infant, Contraindications,

Assessment of adequacy

Formula feeding: Concepts of formulae I,II,& III

Special formulae, Advantages & Disadvantages

Absolute indications

Complementary feeding: Concepts of complementary feeding, Planning to complementary feeding,

Value of different complementary foods (CF),

Conjee, Fruit juices, homemade CF, Commercial CF

Composition / Constitution, Frequency

Errors/ Misconceptions

 Lecture

2

Describe feeding during second year

Appetite during this period

Disadvantages of force feeding

Self selection of diet

Self feeding/ Independence of a child eating habits

Lecture

½

Describe Nutritional assessment methods

At national and individual level

Anthropometric, Biochemical, Bio physical

Clinical, Dietary assessment

Advantages and disadvantages of each method

Lecture

Clerkship

1

Interpret nutritional status using different classifications

Gomez’s classification

Waterlow classification

Welcome classification

Lecture

½

Describe the Child Health Development Record (CHDR)

Content of CHDR

Growth monitoring

Early detection of PCM / Growth faltering, Underweight, Wasting and Stunting

Management of PCM

Advantages and limitations of the CHDR

Lecture

Clerkship

1

Describe failure to thrive (FTT)

Definition

Causes: Nutritional deprivation

Pathological conditions

Investigation of FTT

Principles of management

Lecture

1 ½

Describe the nutritional status

Epidemiology of malnutrition:

Under nutrition, Obesity

Sri Lankan situation with regard to Protein Energy Malnutrition (PEM )

Kwashiorkor & Marasmus:

Clinical picture/ Investigations

Management principles

Diet formulation/ Feeding methods

Nutritional advice/ Follow up

Childhood obesity:

Identification/ Management

Complications

Lecture

1

Describe nutritional anaemia

Definition

Prevalence – global and National, Aetiology

Importance as a public health problem

Prevention

Lecture

1

Describe IDD

Classification (WHO)

Prevalence – global and national        

Aetiology

Importance as a public health problem

Prevention

Lecture

½

Describe vitamin A deficiency

Classification (WHO)

Prevalence               

Aetiology

Importance as a public health problem

Prevention

Lecture

½

Describe community approach in preventing nutritional

deficiencies

Food related programs

Health related programs

Nutritional education

Lecture

1

Describe the current EPI programme

EPI program Cold chain

Management of ‘missed immunisation’ and absence of BCG scar

Contraindications -absolute, relative, false

Adverse Events Following Immunisation and management

Non EPI vaccines and their advantages

Vaccination coverage

Lecture/

Clerkship

1

Describe mental health promotion in childhood

Concepts of ECCD

Life skills

Parenting skills

Services available

Lecture/

Clerkship

1

Describe the school health services

School health programme:

Objectives

Components

Deficiencies

Lecture/

Clerkship

1

Describe adolescent health           

Importance

Health problems – social and mental

Nutrition, Future changes        

Lecture

1

Describe methods of minimizing childhood

mortality

Millennium Development Goals (MDG)

Childhood mortality rates:

Still birth rate

Perinatal mortality rate (PMR)

Neonatal mortality rate (NMR)

Infant mortality rate (IMR)

Child mortality rate

Main causes of childhood mortality

Methods / strategies to minimize childhood mortality

Lecture

1 ½ 

Describe different family planning methods available in SL

Benefits, Classification of FP methods

Each method to be described in terms of

Mode of action, Indications and contraindications

Eligibility criteria, Effectiveness, effective period & return of fertility, Side effects and management, Relevant Advice, Follow up

Counseling – “GATHER”

Emergency contraception

Lecture/

Clerkship

3

Describe the fertility control policy in Sri Lanka

Measures of fertility – CBR, GFR,ASSR, ASFR, TFR, GRR, NRR,

Replacement level fertility

Goals, targets and objectives

Contraceptive prevalence and FP indicators

Incentives offered

Unmet need of FP

Lecture

1

Describe measures of preventing maternal deaths

Definition of maternal death

Epidemiology

The need for investigation

Lecture

1

Describe gender issues

Equity, Gender discrimination

Violence against women

Issues of human rights

Lecture

1

Describe activities of Well Woman Clinic

Objectives

Activities

Lecture/

Clerkship

½

Describe monitoring and evaluation of maternal and child health services

Importance of monitoring and evaluation

Indicators – ante and post natal and outcome indicators

Lecture

½

RECOMMENDED READING MATERIAL

  • Park, K 2007, ‘Nutrition and Health : Assessment of Nutritional Status’, in Park’s Text Book of Preventive and Social Medicine pp. 515- 518, Banarsidas Bhanot Publishers, Jabalpur, India

  • Park, K 2007, ‘Nutrition and Health : Nutritional Problems in Public Health’, in Park’s Text Book of Preventive and Social Medicine pp. 506- 512, Banarsidas Bhanot Publishers, Jabalpur, India

  • Epidemiological Unit 2002, ‘Immunization Handbook’, Ministry of Health, Nutrition and Welfare, Colombo.

  • Duty list of PHM

  • Conducting Antenatal Clinic, General circular no. 01-24/2004, Ministry of Health, Sri Lanka.

  • Conducting Postnatal Clinic, General Circular no. 01-27/2004, Ministry of Health, Sri Lanka.

  • Guidelines on Infant and Young Child Feeding, Circular Letter. FHB/FD/WHO/01-P, Ministry of Health, Sri Lanka.

  • Vitamin A Mega-dose Supplementation- Revised schedule, Circular no. 01/05/2009.

  • School Health Programme, General Circular no. 01/37/2007, Ministry of health.

  • National Maternal and Child Health Policy

  • WHO Medical Eligibility Criteria for starting Contraceptive Methods. http://www.familyhealth.gov.lk/downloads.php?catid=41

  • Family Health Bureau, 2009, Overview of Maternal Mortality Reduction in Sri Lanka FHB Circular on Definition of maternal deaths http://www.familyhealth.gov.lk/downloads.php?catid=43

NEWS AND EVENTS

Dr. B. Kumerendran assumed duties as a Senior Lecturer at Faculty of Medicine ,University of Jaffna from 01-01-2019

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