THE RELATIONSHIP BETWEEN MATERNAL AND CHILD HEALTH SERVICES WITH THE PREVALENCE OF STUNTING BASED ON THE BASIC HEALTH RESEARCH IN INDONESIA

ABSTRACTStunting is a linear growth disorder considered as a serious health problem in Indonesia, where its prevalence is related to maternal and child health (MCH) services. This study aimed to compare the coverage of maternal and child health services between two surveys and analyze how they relate to the prevalence of stunting. The study used aggregate data from the 2013 and 2018 Basic Health Research Reports using a cross-sectional approach. The research sample spanned to 34 provinces in Indonesia. Stunting prevalence was taken as aggregate data from individuals based on height-for-age z-scores (HAZ). The independent variable was the achievement of MCH service indicators. Data analysis used variance measures, correlations, simple linear regression, and paired T-tests. The results found variations in the prevalence of stunting, with 25.4% in 2013 and 25.1% in 2018. There was a 7.4% decrease in severe stunting prevalence between 2013 and 2018, but the decrease was not significant (p = 0.506). The analysis results of the 2013 Basic Health Research showed that MCH service indicators related to stunting prevalence were coverage of antenatal care, iron consumption, delivery by health personnel, delivery in health facilities, postpartum maternal health services, low birth weight (LBW) prevalence, neonatal examination, complete immunization, health card ownership, and growth monitoring. The analysis results of the 2018 Basic Health Research showed that MCH indicators were related to the prevalence of antenatal care coverage, delivery by health personnel, and delivery in health facilities, postpartum maternal health services, LBW prevalence, neonatal examination, and complete immunization. There was a significant increase in the coverage of MCH services from 2013 and 2018 (p < 0.0001), except for the coverage of Fe tablet consumption, the prevalence of stunted birth babies, ownership of health cards, provision of vitamin A, and provision of colostrum. The better the coverage of MCH services, the lower the stunting prevalence. Efforts to improve the MCH service programs are required to reduce the prevalence of stunting for Indonesian children. Keywords: stunting, children under five years old, coverage of maternal and child health services

History and examination

This chapter discusses history and examination, including basic history and examination, recording your clerking, cardiovascular medicine, respiratory medicine, gastrointestinal medicine, neurological medicine, endocrine medicine, skin, oncological/haematological medicine, breast surgery, eye surgery, head and neck surgery, musculoskeletal surgery, urological surgery, the female reproductive system, obstetric medicine, psychiatric medicine, neonatal examination, and paediatrics.

Impact of Pulse Oximetry Screening on the Detection of Duct Dependent Critical Congenital Heart Disease in Neonate

Background: Screening for congenital heart diseases (CHD) in newborn babies aid in early recognition, with the prospect of improved outcome. Currently there is no effective screening protocol for this condition. Pulse oximetry is highly specific for detection of critical CHD with moderate sensitivity that meets criteria for universal screening.Objective: To evaluate the use of pulse oximetry as a screening tool in early detection of critical CHD specially duct dependent critical CHD in asymptomatic newborn babies.Methodology: A cross sectional study conducted in Dhaka Shishu (Children) Hospital from October 2014 to June 2015. Newborns attended outpatient department or admitted in different wards with having gestational age >35 weeks and age between 24-48 hours were included and pulse oximetry screening was done. Oxygen saturation measurement <90%, or oxygen saturation measurements <95% in both extremities on three consecutive measurements separated by one hour, or a >3% absolute difference in oxygen saturation between the right hand & foot on three consecutive measurements was considered as pulse oximetry screening positive. Routine neonatal examination was done and clinical evidence of CHD was noted. Echocardiogram was done to rule out CHD. Data were analyzed by using SPSS and sensitivity, specificity and predictive values were calculated.Result: Total 510 neonate were screened during the data collection period. Mean age at screening was 34.99±8.4 hours, male were 322(63.1%) and female were 188(36.9%). Among the neonates 28(5.49%) were found pulse oximetry screening positive and 25(4.90%) were suspected as CHD by routine neonatal examination. Critical CHD were found in 21 cases out of 28 screening positive cases among them duct dependent critical CHD was found in 11 cases. Sensitivity of pulse oximetry to identify critical CHD was 77.77% and specificity was 98.55%. Sensitivity of pulse oximetry to identify duct dependent critical CHD was 78.57% and specificity 96.57%.Conclusion: Pulse oximetry is a good screening test for early identification of duct dependent critical CHD for those who have no obvious feature. So in resource poor country like Bangladesh if all neonatal health setup use pulse oximetry screening within 24-48 hours of life, it will increase early identification of duct dependent critical CHD.Bangladesh J Child Health 2016; VOL 40 (2) :85-91

Immediate care of the newborn

This chapter covers the immediate care of the newborn following birth. The Apgar score and a structured initial neonatal examination are described in detail. Skin-to-skin contact and bonding between the mother and neonate are covered. This aspect of care is covered in more depth in later chapters.