Today was our first day in Family Health Unit. We visited to Klinik Kesihatan Bandar Rata and was given briefing on Family Health by Matron Roshadah. Although Family Health is a Unit which comes under Pejabat Kesihtan Kota Setar, it runs separately in KK Bakar Rata.
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| Matron Roshadah |
Matron Roshadah discussed with us on few aspects of Family Health in relation to community in Kota Setar . Details of today`s discussion are as below:
The scope of family health comprises of :
(a)Antenatal care
(b) Delivery
(c) Post natal care
(d) Family Planning Unit
(e) Pre- Pregnancy Care
(f) Child and School health
(g)Geriatric
(h)Nutrition
(A) Antenatal Care
-A lady is expected to come for antenatal care once she misses her period
- Upon confirmation of pregnancy by urine pregnancy test ( or USG if needed) the pregnancy is recorded in Registration Book-KIB 101.
-Furthermore, `Buku Merah` will be issued. There are two copies of this book namely : KIKI/ B96(A):mothers retain card and KIKI / B96 (B) : Clinic`s retain card. Both book has almost similar information about pregnant mothers antenatal care except that Mothers Retain Card has portion for Foetal Movement Chart which is important to monitor fetal well being.
-Besides this, Colour Tagging is done for pregnant mothers based on risk assessment The colour coding are as below:
WHITE : no associated risk factor
GREEN : low risk pregnancy
YELLOW: Cases that need to be managed by medical officer.This includes:
- HIV positive
- Rh factor –ve
- Hep.B +ve
- BP>140/90
- H/o retained placenta
- anemia - Hb<11g
- Weight gain more than 2kg within a week
- Fundal Height not corresponding to expected date of delivery
- Abnormal presentation
- ü Eclampsia
- ü Severe Pre-Eclampsia
- ü Heart disease
- ü Uncontrolled DM
- ü Leaking liquor
-ATT(anti tetanus toxoid) vaccine is also given as part of antenatal care. The first dose is given after fetal movement is felt and the second dose is administered 1 month later.
(B) Delivery
Most pregnant mothers deliver in hospitals whereby 24 hours after being discharge from hospital , the MCH unit nurses will make home visit to ensure the good health of the mother and the child. As for last year only 0.01% pregnant mothers delivered at home. In cases of precipitate labour and subsequent delivery at home , the mother and child will be first reffered to hospital before the post- natal care being initiated at MCH level.
Each birth is recorded in registration book -KIB 103
(c)Family Planning
Methods recommended for pregnant mother`s in Kota Setar are:
- OCP pills –high dose & low dose pills (preferred in breast feeding mother)
- Injection method
- Intrauterine contraception device-very rare
*However, methods recommended are based on the mothers health and socioeconomic status.This is done by using WHO medical Eligibility Criteria Wheel.
All females under Family Planning Programmes requested to come for routine check up 6 monthly and assessment is done to monitor blood pressure , weight and to detect varicose vein and jaundice..
According, to Matron sterilization is rarely done ; However it is preferred in case of grandmultipara where cases will be referred to specialist in Hospital Sultanah Bahiyah.
Statistics
In Kota Setar district almost 6000 pregnancies were registered last year. Out of that, almost 85% underwent proper follow up with total of 6to8visit. Out of this almost 100% of them underwent proper post natal care. Moreover, according to Matron Roshadah, almost 89% from total number of high risk pregnant mothers underwent family planning care.
(d) child health(from birth to pre-school)
- Immunisation is given at birth , 1st month , 2nd month ,3rd month , 5th month , and 6 month ,1 year and 18 months.
- Child health as far as MCH unit is concerned, it focuses on growth and development, nutritional assessment and plotting weight of the child on Anthropometric chart.
- Exclusive breast feeding for fist 6months after delivery is strongly recommended for optimum growth of the child. This is Followed by gradual weaning. Therefore, pregnant mothers are given counselling on breast feeding at least 10times during antenatal period.
(e) School Health
Vaccination is given priority under this care.
- .Standard 1 :Measles , DA(double antigen) , Polio and Optional BCG with pin point scar
- .Standard 6 : -none
- .Form 1: HPV vaccine (started last year)-3 doses given –
3rd dose-6month after the 1st dose
(f) Geriatric Health
Kelab Warga Emas which is a social club under Klinik Kesihatan Batu Rata for those above 65 years old in Kotar Setar District. They have meeting once a week and plan activities which helps to promote both mental and physical health. Moreover, patients with underlying medical illness monitored closely to ensure optimum health. They are referred to special units such as Diabetic clinic, Nutrionist, Ophthalmologist ..etc
(g) Nutritional Assessment Skills
- - As for pregnant mothers Anemia is being an important concern. Anemia is classified clinically according to its severity:
- <8gm: severe
- 9-11gm : moderate
- >11gm : normal
- As for child health , the weight of the child is plot on Anthropometric chart and the growth is closely monitored. Appropriate management is initiated according to growth of the child.
- As for geriatric age group the weight and general health status is monitored under geriatric care to ensure no nutritional deficit.
Ministry of Health
1.Millenium Development Goal is the latest policy of Ministry Of Health which focuses on few issues as below:
- Child health
- Dead of child <5years
- Handicap children- will be registered under Jabatan Kebajikan Masyarakt and will be referred to Pusat Didikan Kanak –Kanak khas. There are total of 3 Handicap Centre in Kota Setar District.
- To reduce maternal mortality and morbidity
- To ensure proper antenatal care
- Ensure proper pre-pregnancy counselling
- to prevent high risk pregnancies
- Pregnancy in unmarried mothers
2. 22. At the level of KLINIK KESIHATAN risk assessment form is administered to adult male, adult female and geriatric group for general health assessment. The purpose of this forms are :
· to assess risk for a particular disease
· to prevent a particular disease or
· treat patient with particular medical illness or
· to guide patient on rehabilitation method
· to direct patient to appropriate specialty
Job Responsibilities and Infrastructure In Kota Setar
- Pejabat Kesihatan – 1
- Klinik Kesihatan – 10- provides MCH care , Geriatric Health Care and Outpatient Department Services
- Klinki Desa – 20 – run by Jururawat Masyarakat- services include MCH care but no geriatric care unit
- Klinik Satu Malaysia – 3 in Kota Setar- Staffs include 1 medical assistant , i staff nurse and 1 assistant pharmacy.
After briefing on Family Health we were brought for tour around the MCH unit of KK Batu Rata. Matron explained to us the various department within that unit and job responsibilities of each staff nurse under that unit.
We highly appreciate Matron Roshadah for her time and effort for explaining the important aspects of Family Health Unit.Her talk today, was very informative and beneficial to all of us.
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