Transcript Management and Administration

Prof. Laila kamel
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Premarital Care &
Counseling
(PMCC)
Prof. Laila Kamel
Professor of Public Health &
Community Medicine
Cairo University
Prof. Laila kamel
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Some references
• MOHP (2007); “Practice Guidelines for Family
Physicians; Vol. 3
• Premarital screening & Counseling
 http://www.easternbiotech.com/resource_Pre%20marital
%20Screening.php
 http://www.moh.gov.sa/en/HealthAwareness/Beforemarri
age/Pages/default.aspx
 https://www.haad.ae/haad/tabid/1042/Default.aspx
 http://www.mayoclinic.org/tests-procedures/premaritalcounseling/basics/definition/prc-20013242
Prof. Laila kamel
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Overview
Premarital care and counseling (PMCC) is a
health promotion activity directed to each of
the future couples to establish a healthy
family raising a healthy future generation
(Healthy marriage).
This is also an opportunity to meet with a
physician who can address any other health
concerns before marriage.
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Health is a state of complete physical,
mental, social and spiritual wellbeing not just
the absence of disease or infirmity
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Healthy Marriage
• Healthy marriage is defined as state of
agreement and harmony between the
marriage partners with regard to the
healthy, psychological, sexual, social, and
legislative aspects, aiming at making a
sound family and begetting healthy, happy
children.
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Overview (Cont.)
• PMCC would prevent reproductive health
hazards, sexual dysfunction, marital distress,
divorce & family breakdown and it will allow
people to enjoy life.
• PMCC can help ensure that future couples have
a strong, healthy relationship and a better
chance for a stable and satisfying marriage.
• Premarital counseling can help identifying
weaknesses that could become bigger problems
during marriage.
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Overview (Cont.)
• In some countries premarital counseling is
provided by licensed therapists known as
marriage and family therapists. In Egypt
Family Physicians is the key provider
• Religious leaders can play an important
role
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Background information
On 12 June 2008, a presidential decree
regarding the Child Law was issued. The
decree included two main articles,
increasing the minimum age of marriage for
males and females to 18 years, and the
establishment of premarital testing and
counseling as a precondition to issue a
marriage certificate
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Background information (Cont.)
• UNFPA was involved through supporting a
steering committee on premarital examination.
• The role of the committee was to come up with a
draft of the components to be included in the
premarital testing and counseling.
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Background information (Cont.)
• the committee recommended the
following:
• Obligatory tests should include a complete
blood picture, RH factor in the blood and
urine analysis, whereas additional tests
could be requested based on history
taking, counseling and consent of the
couple.
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Background information (Cont.)
• Necessary vaccinations and supplementation
should be taken by the couple, including
Hepatitis B vaccine, Rubella vaccine and folic
acid pills for the female.
• Premarital counseling, to include counseling on
such topics as nutrition, harmful behavior and
misconceptions regarding sexual and
reproductive health, married life and
responsibilities of the married couple, intimate
relations and budgeting for the family.
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By the end of this session we should
have covered the following:
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Value of premarital care
Premarital care package
Premarital counseling
Timing of PMCC
Components of premarital counseling
At-risk approach in PMCC
Genetic counseling
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Value of premarital care
• Establish a healthy family
• Prevent several medical and psychological
problems
• Prevention of genetic disorders and
congenital anomalies
• Promotion of a healthy life style for each of
the couples, early detection and
management of any health problems.
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Timing of PMCC
• Conceptually premarital care extends from birth,
throughout the premarital period. It is also
affected by the health of the grandparents in a
spiral life cycle continuum. By caring for the
health of the present children and adolescents
we are actually starting to provide care for the
future generation.
• In practice the specific service provided is the
premarital examination which is now required by
law.
•
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Timing (cont.)
• School years: Mainly secondary school
(May be late preparatory)
• Just before marriage
Premarital care should be an essential part
of primary and preventive care rather than
an isolated visit.
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Who provides PMCC
• As premarital care extends from birth,
throughout the premarital period, the
Primary Health Care / family physician is
the main provider
• Immediate pre-marriage mandatory
examination to obtain the certificate
required to register marriage is done in
specified hospitals
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Premarital care package
• Examination: clinical and basic
investigations, referral as needed.
• Vaccination and supplementation
• Health education and counseling
• Genetic counseling
The at-risk approach
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Premarital examination
Although the main concern in premarital
examination is to diagnose and manage
health problems related to marriage and
reproduction, yet, it is a chance to provide
full clinical assessment and to care for the
individual in a total person approach.
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Premarital examination (Cont.)
Medical examination includes
• Personal medical history / any specific
concerns
• Family history / consanguinity
• Family pedigree
• General and systematic examination
• Laboratory investigations
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Laboratory investigations
• Routine investigations
– complete blood picture,
– Rh factor in the blood
– urine analysis
• Additional tests could be requested based
on history taking, counseling and consent
of the couple. These may include VDRL,
HIV, etc. Examination for thalassemia is
now under consideration.
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Vaccination and supplementation
• Rubella
• HBV
• Folic acid for females (to prevent neural
tubal defect)
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Premarital counseling
Health education and counseling are key
components of PMCC
What is the difference between HE and
counseling?
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Health Education
HE messages include
- Healthy life style
- family life and reproductive health in general
- Appropriate time for the first pregnancy and
contraception
- Importance of antenatal care visit early in
pregnancy
- Precautions to be taken in pregnancy e.g., to
avoid taking any drugs or be exposed to other
teratogens
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Healthy life style
Lifestyle is a way of living based on
identifiable patterns of behaviour which
are determined by the interplay between
an individual's personal characteristics,
social interactions, and socioeconomic
and environmental living conditions
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Healthy life style
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Healthy surroundings and housing
Personal hygiene
Adequate diet and good nutrition
Physical exercise
Coping with stress
Avoid harmful practices as smoking, alcohol,
violence, etc.
• Accident and injury prevention
• Preventive practices: immunization, early
detection of disease, etc.
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Adequate diet and good nutrition
- Premarital education is a good chance to
improve the feeding habits for the future
family
- Good nutrition education takes into
consideration the socioeconomic level of
the future couple
- Food exchange lists should be discussed
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Premarital counseling
• Counseling is geared to specific needs of
individuals
• It is directed to specific health problems,
either related to the health of the individual
him/herself, or to the expected offspring.
• Genetic counseling is an important form
of premarital counseling
Counseling should end with an informed
decision
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Genetic counseling
A specific form of counseling to advise the parents
about the probabilities of having a congenital or
hereditary disease. It is done either in the
premarital period, or during inter-conceptual care,
usually after having such a problem with the
previous child.
Genetic counseling include study of the pedigree
(through family history for both partners), and
chromosomal studies for cases that could be
discovered through this technique.
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‫شكرا‬
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‫إعداد أ‪.‬د‪ .‬ليلى محمود كامل‬
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‫‪Prof. Laila kamel‬‬