Maternal and Child Health Practice Questions

Q: Which one of the following is an indicator for evaluation of impact of family planning?

Family size. ***Family size*** - This is a true **impact indicator** that measures the long-term effect of family planning programs on demographic outcomes. - A reduction in **average family size** over time directly reflects the program's effectiveness in helping individuals and couples achieve their desired number of children and birth spacing. - Impact indicators measure the ultimate goal of a program, and family size is one of the most important metrics alongside birth rate, fertility rate, and population growth rate. *Community needs assessment* - This is a **planning tool** used to **identify health needs and priorities** of a community, typically conducted *before* implementing a program. - It serves as a baseline for program design rather than an indicator of the *impact* of an already implemented family planning program. - This is part of the initial assessment phase, not an evaluation metric. *Number of postpartum services availed* - This is an **output/utilization indicator** that measures **service delivery** rather than program impact. - While important for monitoring service uptake, it does not directly evaluate the overall impact or effectiveness of family planning on birth rates or family size decisions. - Output indicators measure what was done, not the effect achieved. *Change in behaviour of people* - While behavioral changes (e.g., increased contraceptive use) are important, this option is too **broad and vague** to serve as a specific measurable indicator. - This could be considered a **process or intermediate outcome indicator** but is not a direct measure of program impact. - Changes in family size are a more concrete and quantifiable outcome reflecting the combined effect of behavioral changes.

Q: How many postnatal visits should be made by the ANM to the house of a low birth weight baby?

4. ***4*** - For a **low birth weight (LBW) baby**, as per traditional guidelines, an **Auxiliary Nurse Midwife (ANM)** makes postnatal home visits on **day 1, day 3, day 7, and day 14** after birth = **4 visits**. - This represents the **minimum essential visits** during the critical first two weeks for monitoring growth, feeding, and identifying complications. - **Note**: Current HBNC guidelines recommend at least 6 visits (adding day 28 and 42) for all newborns, with more intensive follow-up for LBW babies. *8* - Eight visits are **not the standard recommendation** for a low birth weight baby's postnatal care by an ANM. - While more frequent follow-ups may be clinically indicated in some complex cases, it is not the general guideline for all LBW babies. *2* - Two postnatal visits are **insufficient** for proper monitoring of a **low birth weight baby**, who is at higher risk for health issues. - This number of visits would miss critical periods for identifying complications or providing essential care. *6* - Six postnatal visits represent the **current HBNC (Home Based Newborn Care) guideline** for all newborns (days 1, 3, 7, 14, 28, 42). - However, the answer key for this UPSC-CMS 2018 question indicates **4 visits** as the expected answer, likely reflecting guidelines at that time.

Q: Consider the following in respect of Navjyot Shishu Suraksha Karyakram (NSSK): 1. It is a programme aimed to train health personnel in basic newborn care and resuscitation 2. It addresses care at birth issues (i.e. prevention of hypothermia, prevention of infection, early initiation of breastfeeding and basic newborn resuscitation) 3. The objective is to have a trained health person in basic newborn care and resuscitation at every delivery point Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - The **Navjyot Shishu Suraksha Karyakram (NSSK)** focuses on training healthcare personnel in **basic newborn care and resuscitation** to reduce neonatal mortality. - It addresses critical **care at birth issues**, including preventing **hypothermia**, preventing **infections**, promoting **early breastfeeding initiation**, and providing **basic newborn resuscitation**. The overarching objective is to ensure that a trained health person is available at **every delivery point** to provide essential newborn care. *1 and 2 only* - This option incorrectly excludes the third statement regarding the objective of having a trained health person at every delivery point. - The target of ensuring trained personnel at every birth is a core component and objective of the NSSK. *2 and 3 only* - This option incorrectly excludes the first statement, which details the primary function of training health personnel. - The NSSK is fundamentally a training program designed to equip healthcare providers with the necessary skills. *1 and 3 only* - This option incorrectly excludes the second statement, which outlines the specific care at birth issues addressed by the program. - The identified issues such as preventing hypothermia, infection, and promoting breastfeeding are central to the effectiveness of the NSSK.

Q: Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Janani Suraksha Scheme. ***Janani Suraksha Yojana (JSY)*** - This is the **flagship national scheme** launched in 2005 under the National Rural Health Mission (now National Health Mission). - It provides **cash incentives** to pregnant women for choosing to deliver in health facilities and to ASHA workers for promoting institutional deliveries. - Its primary objective is to reduce **maternal and neonatal mortality** by increasing institutional deliveries and ensuring access to essential obstetric care. *Ayushman Bharat Scheme* - This is a national health protection scheme (Pradhan Mantri Jan Arogya Yojana) that provides **health insurance coverage** up to ₹5 lakhs per family for secondary and tertiary care hospitalization. - While it contributes to overall health including maternal health, its primary focus is **broader healthcare access** rather than specifically promoting safe motherhood or reducing maternal mortality through institutional delivery incentives. *Mamta Scheme* - While several state-level maternal and child health programs exist under similar names (e.g., Bihar's MAMTA scheme), there is no widely recognized **national scheme** called "Mamta Scheme" that serves as the primary program for safe motherhood. - The **Janani Suraksha Yojana** remains the principal national initiative for this objective. *Vande Mataram Scheme* - This refers to voluntary initiatives encouraging private practitioners to provide maternal health services. - While supportive of safe motherhood, it is **not the primary comprehensive national scheme** with structured financial incentives and widespread implementation for reducing maternal mortality like JSY.

Q: Steroidal contraceptives available in the basket of contraceptive choice from Ministry of Health & Family Welfare, Government of India are

Monophasic. ***Monophasic*** - **Monophasic oral contraceptive pills** are the formulation type available in India's National Family Planning Programme basket of contraceptive choices. - The Ministry of Health & Family Welfare provides **Mala-N** (Levonorgestrel 0.15mg + Ethinyl estradiol 0.03mg) and **Mala-D** (Desogestrel + Ethinyl estradiol) - both are monophasic formulations. - Monophasic pills contain a **fixed dose of estrogen and progestin** throughout the 21 active pill cycle, making them simpler to use and ensuring better compliance. *Biphasic* - **Biphasic pills** contain two different doses of hormones during the active pill cycle. - These are **not included** in the Government of India's national family planning programme basket of contraceptive choices. - Less commonly used compared to monophasic formulations. *Estrogen only pills* - **Estrogen-only pills** are not used as contraceptives due to the risk of **endometrial hyperplasia** and cancer if not balanced with progestin. - These are used for hormone replacement therapy or specific medical conditions, **not for contraception**. *Triphasic* - **Triphasic pills** contain three different dosages of hormones throughout the active pill cycle to mimic the natural menstrual cycle. - These are **not included** in the Government of India's national family planning programme basket. - Their varied dosing schedule is more complex and not preferred for widespread public health distribution.

Q: The most important single determinant of infant mortality is:

Birth weight. ***Birth weight*** - **Low birth weight** (less than 2500 grams) is the single most important predictor of **infant mortality** and morbidity. - Infants with low birth weight are at a significantly higher risk for **respiratory distress syndrome**, infections, and developmental problems. *Interval between births* - While **short birth intervals** (less than 18-24 months) are associated with increased risks for both mother and child, their impact on infant mortality is secondary to birth weight. - Short intervals can lead to **maternal depletion** and prematurity, but birth weight remains the most direct determinant. *Order of birth* - **High birth order** (e.g., 5th child or more) can be associated with increased infant mortality in some contexts, often linked to socioeconomic factors or maternal depletion. - However, it does not have the same direct and powerful statistical correlation with infant survival as birth weight. *Age of the mother* - **Maternal age extremes** (very young or advanced maternal age) are associated with increased risks of adverse pregnancy outcomes, including preterm birth and low birth weight. - The impact of maternal age on infant mortality is largely mediated through its influence on conditions like birth weight, making birth weight the more immediate determinant.

Q: The most sensitive indicator of the health status of a community is the:

Infant mortality rate. ***Infant mortality rate*** - The **infant mortality rate (IMR)** is widely considered the most sensitive indicator of a community's health status, reflecting the overall living conditions, public health interventions, and access to quality healthcare. - A high IMR often points to underlying issues such as **poor maternal health**, **inadequate nutrition**, **infectious diseases**, and limited access to healthcare. *Crude death rate* - The crude death rate includes all deaths in a population, making it less sensitive to specific health challenges or disparities that affect vulnerable groups. - It can be influenced by the **age structure** of a population; an older population will naturally have a higher crude death rate, even if its healthcare system is excellent. *Maternal mortality rate* - While an important indicator of the health of women and the quality of obstetric care, the maternal mortality rate focuses solely on deaths related to pregnancy and childbirth. - It does not encompass the broader spectrum of health issues affecting the entire population, including children, men, and non-reproductive women. *Child mortality rate* - The child mortality rate (deaths between 1 and 5 years of age) is a valuable indicator, but it is less sensitive than the infant mortality rate. - Many of the factors contributing to child mortality are also reflected in infant mortality, but the neonatal period and early infancy are particularly vulnerable and responsive to public health interventions.

Q: The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Complications during ANC, PNC are not covered. ***Complications during ANC, PNC are not covered*** - The **Janani Shishu Suraksha Karyakram (JSSK)** aims to eliminate out-of-pocket expenses for pregnant women, including those arising from **complications during ANC (Antenatal Care)** and **PNC (Postnatal Care)**. - Therefore, this statement is incorrect as JSSK *does* cover such complications to ensure comprehensive care. *Free diet up to 3 days during normal delivery* - The JSSK scheme provides **free diet** for mothers up to **3 days** for normal deliveries and **7 days** for C-sections, while they are admitted in public health institutions. - This benefit aims to reduce financial burden and ensure adequate nutrition post-delivery. *All pregnant women delivery in public health institution to have absolutely free and no expense delivery including cesarean section* - A core component of JSSK is to ensure **absolutely free and no-expense delivery** for all pregnant women delivering in public health institutions, regardless of whether it's a normal delivery or a **cesarean section**. - This includes free drugs, consumables, diagnostics, and blood. *Free diagnosis and free blood whenever required* - The JSSK programme includes provisions for **free diagnostics** (e.g., blood tests, ultrasound) and **free blood transfusions** whenever required during pregnancy and delivery. - This is crucial to manage complications and ensure the safety of both the mother and the newborn.

Q: Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Zinc deficiency. ***Zinc deficiency*** - **Rashtriya Bal Swasthya Karyakram (RBSK)** under the 4Ds framework (Defects, Deficiencies, Diseases, Development delays) screens for specific nutritional deficiencies, but **zinc deficiency is NOT included** in the standard screening protocol. - RBSK focuses on identifying **severe acute malnutrition, vitamin A deficiency, and anemia (iron deficiency)** as priority nutritional deficiencies. - While zinc supplementation may be provided during diarrhea management, routine zinc deficiency screening is not part of RBSK. *Vitamin D deficiency* - **Vitamin D deficiency screening is NOT explicitly part of RBSK protocol**, though clinical manifestations like **rickets** may be identified during general examination. - RBSK does not conduct routine biochemical screening for vitamin D levels in the 0-18 years age group. - However, some sources may consider rickets under skeletal abnormalities, making this option potentially debatable. *Severe acute malnutrition* - **Severe acute malnutrition (SAM)** is a **major screening target** under RBSK's deficiency category. - Children are screened using **mid-upper arm circumference (MUAC), weight-for-height Z-scores**, and clinical signs of malnutrition. - Identified SAM cases are referred to **Nutrition Rehabilitation Centers (NRCs)** for management. *Vitamin A deficiency* - **Vitamin A deficiency** is a **key screening target** under RBSK, particularly to identify **xerophthalmia** and prevent childhood blindness. - RBSK teams screen for clinical signs including **Bitot's spots, night blindness**, and corneal involvement. - This aligns with national programs for vitamin A supplementation and prevention of nutritional blindness.

Question 1

Features of Janani Suraksha Yojana are the following except:

Accepted Answer

Cash assistance is given to mothers for high and low performing states

Answer

100% Centrally sponsored scheme

Answer

ASHA is a link between woman and Government

Answer

It promotes institutional deliveries

Question 2

Which one of the following is an indicator for evaluation of impact of family planning?

Accepted Answer

Family size

Answer

Community needs assessment

Answer

Number of postpartum services availed

Answer

Change in behaviour of people

Question 3

How many postnatal visits should be made by the ANM to the house of a low birth weight baby?

Accepted Answer

4

Answer

8

Answer

2

Answer

6

Question 4

Consider the following in respect of Navjyot Shishu Suraksha Karyakram (NSSK):

1. It is a programme aimed to train health personnel in basic newborn care and resuscitation
2. It addresses care at birth issues (i.e. prevention of hypothermia, prevention of infection, early initiation of breastfeeding and basic newborn resuscitation)
3. The objective is to have a trained health person in basic newborn care and resuscitation at every delivery point

Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 5

Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Accepted Answer

Janani Suraksha Scheme

Answer

Ayushman Bharat Scheme

Answer

Mamta Scheme

Answer

Vande Mataram Scheme

Question 6

Steroidal contraceptives available in the basket of contraceptive choice from Ministry of Health & Family Welfare, Government of India are

Accepted Answer

Monophasic

Answer

Biphasic

Answer

Estrogen only pills

Answer

Triphasic

Question 7

The most important single determinant of infant mortality is:

Accepted Answer

Birth weight

Answer

Interval between births

Answer

Order of birth

Answer

Age of the mother

Question 8

The most sensitive indicator of the health status of a community is the:

Accepted Answer

Infant mortality rate

Answer

Crude death rate

Answer

Maternal mortality rate

Answer

Child mortality rate

Question 9

The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Accepted Answer

Complications during ANC, PNC are not covered

Answer

Free diet up to 3 days during normal delivery

Answer

Free diagnosis and free blood whenever required

Answer

All pregnant women delivering in public health institution to have absolutely free and no expense delivery including cesarean section

Question 10

Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Accepted Answer

Zinc deficiency

Answer

Vitamin D deficiency

Answer

Severe acute malnutrition

Answer

Vitamin A deficiency

Maternal and Child Health — MCQs

Maternal and Child Health — MCQs

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