Maternal and Child Health Practice Questions

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: A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

67. ***67*** - **Correct calculation for ANM pregnancy registration**: - Annual births = (25/1000) × 5000 = **125 births per year** - Monthly births = 125 ÷ 12 = **10.42 births per month** - **Active pregnancy follow-up period** = 6.5 months (from early second trimester until delivery) - Expected pregnancies registered = (125 ÷ 12) × 6.5 = 10.42 × 6.5 = **67.7 ≈ 67** - **Rationale**: The ANM (Auxiliary Nurse Midwife) typically provides active antenatal care from the second trimester (around 3-4 months) through delivery. This represents approximately 6.5 months of the 9-month pregnancy period. The calculation accounts for the number of women currently under active ANC supervision at any given time. - **Key formula**: Number of pregnancies = (Annual births ÷ 12) × Active follow-up months *Incorrect Option 69* - Would imply 6.6 months of active follow-up: 69 ÷ 10.42 = 6.62 months - This overestimates the standard ANC registration period *Incorrect Option 66* - Would imply 6.3 months of active follow-up: 66 ÷ 10.42 = 6.33 months - This underestimates the expected ANC registration period *Incorrect Option 68* - Would imply 6.53 months of active follow-up: 68 ÷ 10.42 = 6.53 months - Close to the standard calculation but less precise than 67 when using the 6.5-month follow-up period

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.

Q: In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?

570. ***570*** - First, calculate the total number of **eligible couples**: 19% of 5000 = (19/100) * 5000 = **950 couples**. - To achieve a **Couple Protection Rate (CPR) of 60%**, calculate 60% of the eligible couples: 60% of 950 = (60/100) * 950 = **570 couples**. *550* - This option indicates a protection rate of approximately **57.9%** (550/950 * 100), which is less than the target of 60%. - It does not meet the specified target for **Couple Protection Rate**. *530* - This option would result in a protection rate of approximately **55.8%** (530/950 * 100), which is significantly lower than the desired 60%. - This value is an underestimation of the number of couples needed to achieve the target CPR. *590* - This option indicates a protection rate of approximately **62.1%** (590/950 * 100), which exceeds the target of 60%. - While protecting more couples is generally good, the question asks for how many *should* be covered to achieve *60%* specifically, making 570 the exact answer.

Q: The incidence of diarrhoea is highest among infants in the age group of 6–11 months due to all of the following reasons EXCEPT:

Eruption of teeth. ***Eruption of teeth*** - While teething can cause discomfort and sometimes lead to mild, temporary changes in bowel movements, it is **not a direct cause of diarrhea** and does not significantly increase the incidence of diarrheal diseases in this age group. - The physiological process of tooth eruption itself doesn't introduce pathogens that cause diarrheal illness or significantly compromise immune defenses in a way that leads to increased diarrhea. *Introduction of foods which may be contaminated* - This is a significant factor as infants begin complementary feeding, introducing them to **foods prepared with unhygienic practices** or contaminated water. - Exposure to new pathogens through solid foods increases the risk of **gastrointestinal infections**. *Declining level of maternal antibodies* - Maternal antibodies provided through breast milk decline significantly around 6 months, reducing the infant's **passive immunity** and making them more susceptible to infections, including those causing diarrhea. - This immunological gap coincides with the period when infants are more exposed to environmental pathogens. *Direct contact with human or animal faeces* - As infants become more mobile and explore their environment by crawling and putting objects in their mouths, their risk of exposure to **fecal-oral pathogens** from contaminated surfaces or hands increases. - Poor hygiene practices in handling infant waste or animal contact can lead to increased transmission of diarrheal causing agents.

Q: How much of Zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?

10 mg per day for 10–14 days. **10 mg per day for 10–14 days** - For infants less than 6 months of age, **WHO and UNICEF** recommend **10 mg of elemental zinc per day** for 10-14 days following an acute diarrheal episode. - This dosage helps to reduce the severity and duration of the current diarrheal episode and prevents future episodes for several months. *20 mg per day for 10–14 days* - This dosage is recommended for **children 6 months of age and older**, not for infants under 6 months. - Providing 20 mg elemental zinc to infants under 6 months could lead to **zinc toxicity** or other adverse effects. *6 mg per day for 7 days* - This recommendation is below the **standard therapeutic dose** for infants, which may not be sufficient to achieve the desired clinical benefit. - The duration of **7 days** is also shorter than the generally recommended 10-14 days. *5 mg per day for 7 days* - Similar to 6 mg, this dose is **insufficient** for effective treatment of acute diarrhea in infants. - The shortened duration of 7 days further reduces its potential therapeutic impact, increasing the risk of **recurrence or prolonged symptoms**.

Q: The net effect of antenatal care has been the following EXCEPT:

Reduction in the incidence of institutional delivery. ***Reduction in the incidence of institutional delivery*** - Antenatal care aims to increase awareness of safe delivery practices and encourage women to deliver in health facilities, thereby **increasing institutional deliveries**, not reducing them. - Improved access to and understanding of obstetric care through ANC promotes safer childbirth environments. *Reduction in maternal morbidity* - Antenatal care plays a crucial role in the early detection and management of **pregnancy-related complications** such as pre-eclampsia, gestational diabetes, and infections. - This proactive management minimizes the severity and impact of these conditions on maternal health. *Reduction in perinatal mortality* - Regular antenatal visits allow for monitoring of fetal growth and well-being, identification of **fetal distress**, and intervention for conditions like intrauterine growth restriction. - Early detection and management of issues affecting the fetus significantly improve perinatal outcomes and reduce **stillbirths** and **neonatal deaths**. *Reduction in maternal mortality* - ANC provides essential health education, nutritional advice, and timely vaccinations, which are vital for a healthy pregnancy. - It also facilitates preparedness for childbirth and potential complications, thereby **reducing the risk of maternal death** from preventable causes.

Q: Which one of the following is the most commonly used surgical method/technique of female sterilization as recommended by Government of India?

Pomeroy's method. ***Pomeroy's method*** - **Pomeroy's method** involves creating a loop of the fallopian tube, ligating its base, and excising the looped segment, which is a highly effective and widely used surgical sterilization technique. - This method is the **most commonly recommended by the Government of India** for female sterilization under the national family planning program, typically performed via minilaparotomy (minilap) approach. - It is preferred due to its **simplicity, high efficacy, and low complication rates**, making it particularly suitable for resource-constrained settings and large-scale implementation in India. *Madlener technique* - The **Madlener technique** involves crushing and ligating a loop of the fallopian tube without excising any segment, making it less robust and potentially leading to higher recanalization rates. - This method is generally considered less effective compared to techniques that involve segment excision or destruction, hence it is not the most commonly recommended. *Uchida technique* - The **Uchida technique** involves injecting a sclerosing solution into the fallopian tube and then excising a portion of the tube, aiming to induce extensive fibrosis and prevent recanalization. - While effective, it is a more complex procedure than Pomeroy's method, requiring specialized training and materials, making it less suitable for widespread adoption as a primary method in national programs. *Irving method* - The **Irving method** involves ligating and transecting the fallopian tube, then burying the proximal stump into the broad ligament and the distal stump under the serosa, creating multiple barriers to recanalization. - This technique is highly effective but is considered more technically demanding and time-consuming than Pomeroy's method, which limits its widespread use as the go-to sterilization method in public health programs.

Question 1

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 2

A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

Accepted Answer

67

Answer

69

Answer

66

Answer

68

Question 3

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 4

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

Question 5

The specific goals for 2025 under the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) are all of the following EXCEPT:

Accepted Answer

Reduce the incidence of severe pneumonia by 90 % in children less than 5 years of age compared to 2010 levels

Answer

Reduce incidence of severe diarrhea by 75 % in children less than 5 years of age compared to 2010 levels

Answer

Reduce mortality from pneumonia in children less than 5 years of age to fewer than 3 per 1000 live births

Answer

Reduce mortality from diarrhea in children less than 5 years of age to fewer than 1 per 1000 live births

Question 6

In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?

Accepted Answer

570

Answer

550

Answer

530

Answer

590

Question 7

The incidence of diarrhoea is highest among infants in the age group of 6–11 months due to all of the following reasons EXCEPT:

Accepted Answer

Eruption of teeth

Answer

Introduction of foods which may be contaminated

Answer

Declining level of maternal antibodies

Answer

Direct contact with human or animal faeces

Question 8

How much of Zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?

Accepted Answer

10 mg per day for 10–14 days

Answer

20 mg per day for 10–14 days

Answer

6 mg per day for 7 days

Answer

5 mg per day for 7 days

Question 9

The net effect of antenatal care has been the following EXCEPT:

Accepted Answer

Reduction in the incidence of institutional delivery

Answer

Reduction in maternal morbidity

Answer

Reduction in perinatal mortality

Answer

Reduction in maternal mortality

Question 10

Which one of the following is the most commonly used surgical method/technique of female sterilization as recommended by Government of India?

Accepted Answer

Pomeroy's method

Answer

Madlener technique

Answer

Uchida technique

Answer

Irving method

Maternal and Child Health — MCQs

Maternal and Child Health — MCQs

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