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• The main purpose of the antenatal care is to identifying the ‘high – risk’ cases among a large antenatal population, and at the earliest possible
• These high risk cases can be provided skilled care while the routine appropriate care is provided to all the remaining
• The ‘high – risk’ antenatal women are:
o Elderly primi (primi ≥ 30 yr.)
o Short statured primi (≤ 140 cm)
o Mal-presentations like breech, transverse lie
o Antepartum hemorrhage, threatened abortion
o Pre – eclampsia and eclampsia
o Anemia
o Twins, hydramnios

Interventions and Counselling
• Iron and folic acid supplementation
– One tablet of IFA (100 mg elemental iron and 0.5 mg folic acid) every day for at least 100 days.
– This is the prophylactic dose of IFA.
– If a woman is anemic (Hb <11 g/dl or she has pallor), give her two tablets of IFA per day for three months.
– This means a woman with anemia in pregnancy needs to take at least 200 tablets of IFA.
– This is the therapeutic dose of IFA.

Antenatal care is the systemic supervision of women during pregnancy to monitor the progress of foetal growth and to ascertain the well-being of the mother and the foetus.
A proper antenatal check-up provides necessary care to the mother and helps identify any complications of pregnancy such as anaemia, pre-eclampsia and hypertension etc. in the mother and slow/inadequate growth of the foetus.
Antenatal care allows for the timely management of complications through referral to an appropriate facility for further treatment.

Bio- Medical Waste Management Rules, 2016 – Major Changes
DEFINITION of Bio Medical Waste
• “Bio-medical waste" means any waste, which is generated during the
• diagnosis,
• treatment or
• Immunization of human beings or
• Animals or research activities pertaining thereto or
• In the production or testing of biological or
• In health camps, including the categories mentioned in Schedule I appended to these rules
The New Rules are more comprehensive in nature
It contains important features of BMW (M & H) Rules, 1998

Introduction:
• Three major clinical types
– Anterior nasal
– Faucial and
– Laryngeal
• Rarely, other body parts may be affected
– Skin
– Conjunctiva
– Vulva etc.
• The bacilli multiply locally (mostly this site is the throat) and elaborate a powerful exotoxin which causes the following:
1. Formation of a greyish or yellowish membrane commonly over the
• tonsils,
• pharynx or
• Larynx or
• At the site of implantation
– This is a false membrane with
• Well defined edges and

Contacts merit special attention
1. They should be throat swabbed
2. Determine the immunization status and take further action accordingly (shown below)
3. Contacts need to be placed under medical surveillance
– Examined daily for evidence of diphtheria for one week
– Bacteriological surveillance weekly for several weeks (weekly swabbing)

Control of Diphtheria
1. Treatment of
– Cases and
– Carriers
– Management of the ‘Contacts’ and
3. At the community level
– Increasing coverage of immunization with diphtheria toxoid
Treatment of Cases and Carriers
Early detection
• An active search for cases and carriers should start immediately amongst family and school contacts
• Carriers can be detected ONLY by culture
• Swabs should be taken from both the nose and throat
• Examined by culture for diphtheria bacilli

The aim of post–exposure prophylaxis is to neutralize the inoculated virus BEFORE it can enter the nervous system
• Every instance of human exposure should be treated as a medical emergency
• The components of prophylactic treatment are:
1. Local treatment of wound
2. Antibiotics and anti-tetanus measures
3. Active immunization against rabies – if indicated
4. Passive immunization with rabies immunoglobulin – if indicated
5. Observe the animal for 10 days from the day of bite:

In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals (MDGs) to be achieved by 2015.

Vaccines under UIP, India, 2016
Brief History of the Immunization Program in India
• May 1974:
– Expanded Programme on Immunization (EPI); Launched by WHO
– Included immunization against 6 Vaccine Preventable Diseases (VPD’s)
• Diphtheria,
• Pertussis,
• Tetanus,
• TB,
• Measles and
• Polio
– Later renamed as ‘Universal Child Immunization, 1990
• Jan 1978: EPI launched in India

• Nov 1985: EPI replaced in India by the ‘Universal Immunization Programme (UIP)