Maharashtra CHO - High Yield Topics (MCW Focus)

Exam Pattern at a Glance

• Online CBT, 2 hours, no negative marking, qualifying marks: 45

SECTION 1: MCW - MATERNAL HEALTH (Highest Weightage - Start Here)

Antenatal Care (ANC) - Very High Yield

• ANC visits schedule: Minimum 4 visits (as per WHO/PMSMA) - 1st trimester (before 12 wks), 14-16 wks, 28-32 wks, 36+ wks
• PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan): 9th of every month, free ANC for 3rd trimester women
• Investigations in ANC: Hb, urine protein/sugar, blood group & Rh, VDRL, HIV, BP, weight, fundal height
• Iron-Folic Acid (IFA) supplementation: 100mg iron + 500mcg folic acid daily from 1st trimester; 180 tablets total
• TT vaccination schedule: TT1 at first contact, TT2 after 4 weeks; TT booster if previously vaccinated
• Danger signs in pregnancy: Severe headache, blurred vision, reduced fetal movement, vaginal bleeding, convulsions

Postnatal Care (PNC) - High Yield

• PNC visits: Within 48 hrs of delivery, at 3-7 days, at 6 weeks
• Postpartum hemorrhage (PPH): Most common cause = uterine atony; prevention with oxytocin 10 IU IM after delivery
• Breastfeeding initiation: Within 1 hour of birth (golden hour)
• Colostrum: First milk, rich in IgA and nutrients - do NOT discard
• Exclusive breastfeeding: For first 6 months; complementary feeding starts at 6 months

Complications in Pregnancy

• Pre-eclampsia: BP >140/90 + proteinuria after 20 weeks; Magnesium sulphate for prevention of eclampsia
• Gestational Diabetes: Screening with GCT at 24-28 weeks
• Anemia in pregnancy: Hb <11g/dL (mild: 10-10.9, moderate: 7-9.9, severe: <7) - biggest cause of maternal mortality in India
• Malaria in pregnancy: High risk of preterm, LBW, maternal death; chloroquine-sensitive in pregnancy (no primaquine)
• HIV in pregnancy (PPTCT): All pregnant women tested; NVP regimen for mother and newborn

Maternal Mortality & Safe Motherhood

• MMR in India: ~97/100,000 live births (2018-20); Maharashtra target: reduction under SDG
• 3 delays model: Delay in decision, delay in reaching facility, delay in receiving care
• Janani Suraksha Yojana (JSY): Cash incentive for institutional delivery - rural: Rs.1400, urban: Rs.1000
• Janani Shishu Suraksha Karyakram (JSSK): Free drugs, diagnostics, blood, diet, transport for pregnant women

SECTION 2: MCW - CHILD HEALTH (High Yield)

Newborn Care

• APGAR score: Assessed at 1 and 5 minutes; 0-3 (severe), 4-6 (moderate), 7-10 (normal)
• KMC (Kangaroo Mother Care): For LBW babies <2000g; skin-to-skin contact; reduces hypothermia, promotes breastfeeding
• Normal birth weight: >2500g; Low Birth Weight (LBW): <2500g; VLBW: <1500g
• Essential Newborn Care (ENC): Warmth, breathing, cord care, breastfeeding, eye care

Immunization Schedule (Most Frequently Asked)

• Cold chain: Vaccine storage - BCG/MMR/OPV: -15°C to -25°C; DPT/Penta/Hep B: +2°C to +8°C
• VVM (Vaccine Vial Monitor): Do NOT use vaccine if inner square is darker than outer circle

Child Nutrition

• SAM (Severe Acute Malnutrition): Weight-for-height <-3 SD or MUAC <11.5 cm or bilateral pitting edema
• MAM (Moderate Acute Malnutrition): MUAC 11.5-12.5 cm
• MUAC measurement: Mid-upper arm circumference - red <11.5cm, yellow 11.5-12.5cm, green >12.5cm
• Vitamin A supplementation: 6 months to 5 years, every 6 months; dose: 1 lakh IU (6-11 months), 2 lakh IU (>1 year)

IMNCI / IMCI (Very High Yield for CHO)

• Classify sick children under 5 into: Danger signs, then classify pneumonia, diarrhea, fever, malnutrition, anemia
• Pneumonia: Fast breathing (≥60 bpm <2 months; ≥50 bpm 2-12 months; ≥40 bpm 1-5 yrs) - Cotrimoxazole
• Severe pneumonia: Chest indrawing, stridor - refer + amoxicillin + oxygen
• Diarrhea with dehydration: ORS + zinc (20mg for 14 days for children >6 months)
• RUTF (Ready to Use Therapeutic Food): Plumpy'Nut for SAM children

Child Development & Milestones (Developmental Screening)

• 1 month: Social smile
• 3 months: Head control, cooing
• 6 months: Sits without support, babbling
• 9 months: Pincer grasp, stranger anxiety
• 12 months: First words, walks with support
• 18 months: 10 words, walks independently
• 2 years: 2-word sentences, runs

RBSK (Rashtriya Bal Swasthya Karyakram)

• Screening children 0-18 yrs for 4D's: Defects at birth, Deficiencies, Diseases, Developmental delays
• Mobile Health Teams screen children at AWC and schools

SECTION 3: FAMILY PLANNING (Medium-High Yield)

• IUCD (Cu-T 380A): Most effective non-hormonal; valid for 10 years; inserted within 48 hrs (post-partum) or after 6 weeks
• OCP: Pearl index ~0.3; take daily; contraindicated in breastfeeding mothers in first 6 weeks
• Emergency contraception: i-pill within 72 hours of unprotected intercourse
• NSV (No-Scalpel Vasectomy): Safest, OPD procedure, no stitches, failure rate 0.1%
• Female sterilization (tubectomy): Minilap/laparoscopy; ideal timing: post-partum, post-abortal, interval
• DMPA (Depo-Provera): 150mg IM every 3 months; no estrogen-related side effects

SECTION 4: NHM PROGRAMS (20 Marks - Do Not Skip)

Key National Programs for MCW

ASHA's Role (Frequently Asked)

• Facilitates institutional deliveries under JSY
• Ensures immunization coverage
• Distributes IFA, ORS, condoms, OCP
• Escorts pregnant women for ANC, delivery, PNC
• ASHA incentive: Rs.600 for JSY (rural)

SECTION 5: COMMUNICABLE DISEASES (Medium Yield)

• Tuberculosis (RNTCP/NIKSHAY): DOTS, ATT regimen (2HRZE/4HR); Nikshay Poshan Yojana Rs.500/month
• Malaria: Plasmodium vivax (most common in India) vs P. falciparum (more dangerous); RDT for diagnosis; ACT treatment
• Dengue: NS1 antigen (early), IgM ELISA (later); platelet transfusion if <10,000 or bleeding
• COVID-19 protocols: Still relevant for CHO practice
• Diarrheal diseases: ORS formula - 1L water + 6 tsp sugar + 0.5 tsp salt; zinc supplementation

SECTION 6: NUTRITION (10 Marks)

• Protein Energy Malnutrition: Kwashiorkor (protein deficiency - edema, moon face) vs Marasmus (calorie deficiency - "old man" appearance)
• Vitamin A deficiency: Night blindness → Bitot spots → Keratomalacia (corneal ulceration)
• Iron deficiency anemia: Most common nutritional deficiency; IFA supplementation, dietary sources
• Iodine deficiency: Goiter, cretinism; iodized salt mandatory
• Vitamin D deficiency: Rickets in children; fortified food + sunlight

SECTION 7: GK & CURRENT AFFAIRS (20 Marks)

• Maharashtra-specific health statistics (IMR, MMR, TFR)
• WHO/UNICEF programs and goals
• SDG 3 targets (health-related)
• Current Health Ministers (state and central)
• Recent NHM Maharashtra notifications/circulars

Quick Revision - Most Frequently Asked MCQ Topics

1. ANC visit schedule and PMSMA date
2. Immunization schedule (age vs vaccine)
3. Cold chain temperatures
4. APGAR score components
5. Breastfeeding - initiation, exclusive duration
6. JSY/JSSK cash amounts and eligibility
7. MUAC cut-offs for SAM/MAM
8. ORS formula
9. Danger signs in pregnancy
10. Vitamin A dose and schedule
11. ASHA role and incentives
12. Pre-eclampsia diagnosis and management (Mag Sulphate)
13. Family planning - Pearl index, IUCD timing
14. IMNCI classification of pneumonia
15. MMR in India and Maharashtra