11. There have been recent reports of pregnancy related deaths in Coochbehar district in increased number. Define maternal mortality. Enlist the common causes of maternal deaths. Mention the systemic and community level factors that may contribute to the problem. Write down the steps that may be taken by district health administration. (2+4+4+5=15) [MJNMCH] 12. Define maternal and child health (MCH) and discuss the national programs in place to reduce the Maternal Mortality Rate (MMR) in India. How do these programs contribute to improving maternal and child health? (2 + 7 + 6) [NBMCH] 13. A 9-month-old child was brought to a Primary Health Centre for routine immunization and received Measles-Rubella (MR) vaccine. Within 30 minutes of vaccination, the child developed difficulty in breathing, generalized rash, and became unconscious. The child was immediately referred to the district hospital. On the same day, four other children vaccinated from the same session site developed mild fever and local swelling at the injection site. a. What is the most probable diagnosis in the first child? Justify your answer. b. How will you investigate this case at the field level? c. What preventive measures can be taken to avoid such events in future immunization sessions? d. Enumerate different types of reactions observed following immunization. (2 + 6 + 4 + 3 = 15) [JMNMCH] 14. Enumerate the package of services under RMNCAH+N. Outline of the services a postnatal mother with her newborn is expected to receive from subcentre and ASHA from the birth up to five years of age? (6 + 4 + 5 = 15) [JIMSH] 15. A 20-year-old woman delivered a baby boy of birthweight 1.9 kg by normal vaginal delivery at a District Hospital. Define LBW and classify. Enumerate the causes of LBW in India. What are the measures that can be adopted to reduce the prevalence of LBW? What are the danger signs that should be looked for in this low birth weight newborn baby? (2 + 2 + 4 + 4 + 3) [JIMSH] 16. Define IMR. What are the common causes of infant mortality in our country? Briefly describe the prevention and control strategy for reduction of high infant mortality in our country as per the National Guideline. Why IMR is considered as an important community health indicator? (2+4+7+2=15) [DMGMCH] 17. A 15-month-old male child is brought to a Primary Health Centre with complaints of frequent loose stools for the last 2 days. The mother reports that the child has passed about 8 watery stools in the last 24 hours. There is no blood in the stool. The child is irritable and thirsty and drinks eagerly when offered water. The mother states that the child has vomited twice since yesterday. On examination: Weight 9 kg, Temperature: 37.5°C, Eyes: Sunken, Skin pinch goes back slowly. Child is restless and irritable, no signs of severe malnutrition, no other danger signs are present. • Classify the dehydration status of the child according to IMNCI guidelines. Justify your answer. (3 Marks) • What treatment plan should be followed in this child according to IMNCI? (1 Mark) • Describe the management of this child under the recommended treatment plan. (3 Marks) • What advice should be given regarding feeding during diarrhoea? (1 Marks) • What danger signs should the mother be advised to watch for and return immediately to the ER? (2 Marks) [DHGMCH] 18. Briefly outline with suitable examples the three-delay model to review the maternal death in India. Define delay-4 as per World Health Organization. The Maternal mortality ratio of West Bengal is higher than the national average as per the latest report.Outline the measures to address this issue.(6 + 2 + 7) [CMSDH] 19. A fifteen month old child has been brought in the OPD with cough and cold for last 3 days. The child is having a respiratory rate of 64/minute with no signs of chest indrawing. The child is calm. Classify the disease as per IMNCI guideline. Describe the management of this child according to the guideline. Enumerate the danger signs to be explained to the mother.(3 + 8 + 4 = 15) [BSMCH] 20. A 39 weeks pregnant mother came to the antenatal clinic with convulsion. Describe the steps of management for this case. Discuss the components of Essential obstetric care. What are the differences basic emergency obstetric care and comprehensive emergency obstetric care?( 8 + 4 + 3 = 15) [BSMCH] 21. Define Perinatal mortality rate. Enlist the factors associated with perinatal mortality in India. Outline the goals and intervention strategies of India Newborn Action Plan (INAP). (2+5+8=15) [BGMCH] 22. A 27-year-old primigravida from a rural area comes to a health centre at 34 weeks of pregnancy with severe headache, swelling of feet and BP 160/110 mmHg. She has not received regular antenatal check-ups. • Identify the problems in this case. • Discuss the objectives and components of antenatal care. • Discuss in brief the national programmes and schemes to reduce maternal mortality in India (1+2+2+10 = 15) [IQCITY] 23. A 7-month-old infant is brought to the pediatric OPD with complaints of fast breathing and chest indrawing for 2 days. The mother reports no history of convulsions, inability to feed, or lethargy. On examination, the infant is alert, feeding well, but has a respiratory rate of 58/min and visible chest indrawing. No stridor or wheeze is noted. How will you assess and classify the case as per IMNCI? Outline the management steps for this infant as per IMNCI. What advice will you give to the mother regarding home care and danger signs? (4+3+5+3 = 15) [RGMCH] 24. A 25-year-old pregnant woman in her 2nd trimester presents to the ANC clinic with complaints of fatigue and breathlessness. On examination, she is pale, and her haemoglobin level is 8.5 g/dL. She admits irregular intake of IFA tablets. What is the most likely diagnosis? Mention the cut-off value of haemoglobin to diagnose the disease among pregnant women. Describe the risk factors and consequences of a low haemoglobin level in pregnancy. Outline its preventive and control measures under the national health programme. (2+1+6+6 = 15) [RGMCH] 25. a) What are the components of RMNCAH+N strategy? b) Briefly discuss the package of services for newborns under this strategy. c) Mention the two goals of India Newborn Action Plan (INAP). (7 + 6 + 2 = 15) [ESIC JOKA]