Maternal and Child Health Practice Questions

Q: Under the Anaemia Mukt Bharath initiative, mild to moderate anaemia in pregnant women <34 weeks of gestation is treated using:

1-2 IFA tablets daily (depending on severity). ***1-2 IFA tablets daily (depending on severity)*** - The **Anaemia Mukt Bharat (AMB)** guidelines recommend **oral iron and folic acid (IFA)** supplementation as the primary treatment for mild to moderate anaemia in pregnant women <34 weeks gestation. - **Mild anaemia (Hb 10-10.9 g/dL):** 1 IFA tablet daily (100 mg elemental iron + 500 mcg folic acid) - **Moderate anaemia (Hb 7-9.9 g/dL):** 2 IFA tablets twice daily (total 200 mg elemental iron per day) - Oral IFA is safe, cost-effective, and addresses the underlying nutritional deficiency. *IM ferric carboxy maltose (FCM)* - **Intramuscular (IM) iron** formulations like FCM are generally reserved for cases of severe anaemia, malabsorption, or intolerance to oral iron. - For mild to moderate anaemia, IM iron is not the **first-line treatment** under AMB guidelines due to potential injection site reactions and the effectiveness of oral alternatives. *IV iron sucrose for non-compliance with oral tablets* - **Intravenous (IV) iron sucrose** is indicated for specific situations such as severe anaemia (Hb <7 g/dL), significant malabsorption, documented intolerance, or persistent non-compliance with oral iron. - However, for mild to moderate anaemia, efforts are made to ensure compliance with oral treatment before resorting to **parenteral iron**, particularly given its higher cost and need for administration in a healthcare setting. *2 iron and folic acid tablets OD+IV iron sucrose* - Combining **oral iron tablets with IV iron sucrose** is not recommended for mild to moderate anaemia under AMB guidelines. - This approach would be considered **overtreatment** for mild to moderate anaemia in the absence of severe anaemia or documented failure of oral therapy despite good compliance.

Q: A resource-limited setting shows high rates of congenital syphilis despite antenatal screening programs. Lab records show stock-outs and delayed results. Which integrated approach is most cost-effective?

Implementation of point-of-care testing with same-day treatment. ***Implementation of point-of-care testing with same-day treatment*** - This approach directly addresses **stock-outs** and **delayed results** by providing immediate diagnosis and treatment, significantly reducing the window for mother-to-child transmission. - **Point-of-care testing (POCT)** eliminates the need for complex lab infrastructure and transport, making it highly cost-effective and efficient in resource-limited settings. *Enhanced partner notification only* - While important for controlling syphilis spread, **partner notification alone** does not solve the fundamental issues of delayed diagnosis and treatment for the pregnant woman. - It would not prevent congenital syphilis in cases where the mother's infection is already established and untreated due to diagnostic delays. *Universal prophylactic treatment* - Administering **universal prophylactic treatment** without a confirmed diagnosis is not cost-effective due to unnecessary drug use, potential for antibiotic resistance, and wastage of resources. - It would also not address the underlying systemic issues of screening program failures, only providing a broad, untargeted intervention. *Increased lab capacity with result tracking system* - This option addresses **delayed results** and **stock-outs** but requires significant financial investment in infrastructure, equipment, and personnel, which may not be feasible or as rapid in implementation as POCT. - Even with increased capacity, transport of samples and results can still introduce delays, and the cost-benefit might be lower compared to immediate POCT.

Q: 'Cafeteria approach' is related with:

Contraception. ***Contraception*** - The **cafeteria approach** in contraception refers to offering a wide variety of **contraceptive methods** to individuals, allowing them to choose the option that best suits their needs, preferences, and circumstances. - This approach promotes **informed choice** and adherence by recognizing that no single contraceptive method is ideal for everyone. *Diet program* - While diet programs involve choices, the term **cafeteria approach** is not specifically or exclusively associated with the methodology of diet selection. - Diet programs typically focus on dietary guidelines or meal plans rather than a broad offering of methods. *National vector borne disease control programme* - This program focuses on managing and preventing **vector-borne diseases** through public health interventions, which does not involve individual "choices" in a cafeteria-style manner. - Its strategies include surveillance, vector control, and case management, without a direct "cafeteria approach" element. *Child and maternal health* - This broad field encompasses various health interventions, but the **cafeteria approach** is not a specific methodology used to describe comprehensive child and maternal health services. - While choices are involved in healthcare, this term is not standard in this context.

Q: What is a target couple?

Currently married couple where the wife is in reproductive age (15-49 years). ***Currently married couple where the wife is in reproductive age (15-49 years)*** - This is the **official definition** of a target couple according to the **National Family Welfare Programme** of India. - A target couple is specifically defined as a **currently married couple** in which the wife is in the **reproductive age group (15-49 years)**. - This operational definition is used for **planning, monitoring, and evaluation** of family planning services in India. - It forms the basis for calculating **couple protection rate (CPR)** and other family planning indicators. *Couple that is eligible for practicing family planning* - While this is conceptually broad and inclusive, it is **not the standard operational definition** used in Indian public health programs. - The official definition is more specific and includes marital status and age criteria for program planning purposes. *Couple using contraception* - This describes a **protected couple** or **couple currently using contraception**, not a target couple. - Target couples include both those using and not using contraception, as they represent the denominator for family planning coverage. *Couple with 3 children* - The number of children is **not a defining criterion** for a target couple. - Target couples are defined by marital status and reproductive age, regardless of parity (number of children).

Q: Highest Contraceptive failure is reported in

Spermicidal methods. ***Spermicidal methods*** - **Spermicides** have a significantly higher failure rate compared to other contraceptive methods because their effectiveness relies heavily on **correct and consistent application** before each act of intercourse. - Their efficacy is often compromised by improper use, short duration of action, or failure to adequately kill sperm, leading to a higher chance of **unintended pregnancy**. *Implant* - Contraceptive **implants** (e.g., etonogestrel implant) are among the most effective contraceptive methods, with a very low failure rate due to **continuous hormone release**. - They offer **long-acting reversible contraception (LARC)**, eliminating user error upon insertion. *IUD* - **Intrauterine devices (IUDs)**, both hormonal and copper, are highly effective LARC methods with very low failure rates. - Their effectiveness is independent of user adherence after insertion, making them **highly reliable**. *Oral contraceptive pills* - **Oral contraceptive pills** are effective when used perfectly, but their typical use effectiveness is lower than implants or IUDs due to the possibility of **user error**, such as missing pills. - **Adherence** to a daily regimen is crucial for their efficacy.

Q: IMCI approach developed by WHO encompasses the following childhood illnesses Except

Chicken pox. ***Chicken pox*** - The **Integrated Management of Childhood Illness (IMCI)** strategy focuses on major causes of childhood morbidity and mortality in developing countries. - **Chickenpox** is generally a self-limiting viral illness in otherwise healthy children and is not a primary focus of the IMCI guidelines for acute management. *Measles* - **Measles** is a highly contagious and potentially severe childhood illness that is explicitly covered in the IMCI guidelines. - Due to its high morbidity and mortality rates, especially in malnourished children, IMCI includes guidance on its recognition, classification, and management. *Malaria* - **Malaria** is a leading cause of childhood death in many endemic regions and is a core component of the IMCI strategy. - IMCI provides clear algorithms for the assessment, classification, and treatment of malaria, particularly in children under five. *Diarrhoea* - **Diarrhoea** is one of the most common causes of illness and death in young children, making it a critical disease addressed by the IMCI approach. - IMCI includes detailed protocols for assessing dehydration, classifying the severity of diarrhoea, and guiding treatment.

Q: Under HBNC (Home-Based Newborn Care), which is NOT a remuneration activity for ASHA workers?

Institutional delivery. ***Institutional delivery*** - Under the Home-Based Newborn Care (HBNC) program, ASHA workers receive remuneration specifically for **home-based newborn care activities** during the first 42 days after birth. - **Institutional delivery incentives are provided separately under JSY (Janani Suraksha Yojana)**, not under HBNC remuneration. - While ASHAs promote institutional deliveries, this is compensated through a different program, making it the correct answer to this EXCEPT question. *Recording of birth weight* - ASHAs are remunerated for recording birth weight during home visits, especially for home births. - This is a crucial HBNC activity for identifying low birth weight babies and at-risk newborns requiring special care. *Counseling mothers on newborn care practices* - ASHAs receive remuneration for conducting home visits (up to 6 visits in 42 days) where they counsel mothers on breastfeeding, thermal care, hygiene, and danger signs. - This counseling is a core component of HBNC and is directly compensated. *Registration of birth* - ASHAs are incentivized under HBNC to facilitate birth registration of all newborns. - This ensures complete documentation and access to health services for all newborns in the community.

Q: Test done at sub-centre during pregnancy:

Haemoglobin. ***Haemoglobin*** - **Haemoglobin testing** is a routine and essential screening measure performed at the subcenter level during pregnancy, primarily to detect and monitor **anaemia**. - Its simplicity, cost-effectiveness, and direct impact on maternal and fetal health make it suitable for primary healthcare settings. *Triple test* - The **triple test** (or multiple marker screen) is a prenatal diagnostic test for chromosomal abnormalities and neural tube defects, typically performed between weeks 15 and 20 of pregnancy. - This test requires specialized laboratory facilities and interpretation, which are usually not available or routinely performed at the subcenter level. *USG* - **Ultrasonography (USG)** is a vital imaging technique used to monitor fetal growth, development, and maternal health during pregnancy. - While crucial, USG requires specialized equipment and trained personnel (sonographers or radiologists) and is generally conducted in higher-level healthcare facilities, not routinely at a subcenter. *OGTT* - An **Oral Glucose Tolerance Test (OGTT)** is used to screen for **gestational diabetes mellitus**. - While it is a routine test in pregnancy, performing a full OGTT (which involves multiple blood draws over several hours after glucose ingestion) is often logistically challenging for routine performance at a subcenter; usually, only initial screening (like random blood sugar or fasting glucose) or a single-step glucose challenge test might be done at a primary level before referral.

Q: Which of the following contraceptives provides the best protection against sexually transmitted diseases?

Barrier method. ***Barrier method*** - **Condoms** (male and female) are the only contraceptive methods that provide effective protection against the transmission of sexually transmitted diseases (STDs) by creating a **physical barrier** between partners. - They prevent the exchange of **bodily fluids** and direct skin-to-skin contact in areas covered by the condom, which are common routes for STD transmission. *IUCD* - **Intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs or hormonal IUCDs, are highly effective methods of contraception but offer **no protection** against STDs. - They do not create a physical barrier to prevent the transmission of infections during sexual activity. *OCP* - **Oral contraceptive pills (OCPs)**, while highly effective in preventing pregnancy, offer **no protection** against STDs. - They work by altering hormonal levels to prevent ovulation and fertilization but do not form a physical barrier against pathogen transmission. *Minipill* - The **minipill** (progestin-only pill) is a hormonal contraceptive that prevents pregnancy, but it provides **no protection** against STDs. - Similar to combined OCPs, its mechanism of action is hormonal and does not involve a physical barrier or antimicrobial properties.

Q: The MTP Act was introduced in:

1971. ***1971*** - The **Medical Termination of Pregnancy (MTP) Act** was enacted in **1971** in India. - This legislation was a significant step towards legalizing and regulating abortion services in the country under specific conditions. - The Act came into force on **April 1, 1972**. *1961* - This year is not associated with the introduction of the MTP Act. - Other significant legislative changes may have occurred, but not related to medical termination of pregnancy. *1975* - The year **1975** is incorrect as the MTP Act was already in effect from 1971. - This year marked a different period in India's legal and social history. *1974* - The year **1974** is also incorrect; the MTP Act was passed and came into force before this date. - No major amendments to the MTP Act were introduced in 1974.

Question 1

Under the Anaemia Mukt Bharath initiative, mild to moderate anaemia in pregnant women <34 weeks of gestation is treated using:

Accepted Answer

1-2 IFA tablets daily (depending on severity)

Answer

IM ferric carboxy maltose (FCM)

Answer

IV iron sucrose for non-compliance with oral tablets

Answer

2 iron and folic acid tablets OD+IV iron sucrose

Question 2

A resource-limited setting shows high rates of congenital syphilis despite antenatal screening programs. Lab records show stock-outs and delayed results. Which integrated approach is most cost-effective?

Accepted Answer

Implementation of point-of-care testing with same-day treatment

Answer

Enhanced partner notification only

Answer

Universal prophylactic treatment

Answer

Increased lab capacity with result tracking system

Question 3

'Cafeteria approach' is related with:

Accepted Answer

Contraception

Answer

Diet program

Answer

National vector borne disease control programme

Answer

Child and maternal health

Question 4

What is a target couple?

Accepted Answer

Currently married couple where the wife is in reproductive age (15-49 years)

Answer

Couple using contraception

Answer

Couple with 3 children

Answer

Couple that is eligible for practicing family planning

Question 5

Highest Contraceptive failure is reported in

Accepted Answer

Spermicidal methods

Answer

Implant

Answer

IUD

Answer

Oral contraceptive pills

Question 6

IMCI approach developed by WHO encompasses the following childhood illnesses Except

Accepted Answer

Chicken pox

Answer

Measles

Answer

Malaria

Answer

Diarrhoea

Question 7

Under HBNC (Home-Based Newborn Care), which is NOT a remuneration activity for ASHA workers?

Accepted Answer

Institutional delivery

Answer

Recording of birth weight

Answer

Counseling mothers on newborn care practices

Answer

Registration of birth

Question 8

Test done at sub-centre during pregnancy:

Accepted Answer

Haemoglobin

Answer

Triple test

Answer

USG

Answer

OGTT

Question 9

Which of the following contraceptives provides the best protection against sexually transmitted diseases?

Accepted Answer

Barrier method

Answer

IUCD

Answer

OCP

Answer

Minipill

Question 10

The MTP Act was introduced in:

Accepted Answer

1971

Answer

1961

Answer

1975

Answer

1974

Maternal and Child Health — MCQs

Maternal and Child Health — MCQs

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