الفهرس 
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Abstract
Multiparity is in it self a risk factor, as child mortality and morbidity is closely linked with maternal multiparity and the numbers of children in the family, Mothers must encouraged to use family planning with adequate spacing between pregnancies to improve maternal and child health (Lynea, 2015).
Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity. Early childhood includes the period from infancy until eight years of age characterized by rapid and complex growth (Karen & Robret, 2015).
Worldwide, an estimated about 210 million pregnancies occur annually, nearly 80 million are unintended and end in abortion, still birth and live birth. In developing countries, it was estimated that about 76 million unintended pregnancies occur annually, of which about 34 million result in unplanned births and the remaining are interrupted by abortion and miscarriage (WHO, 2016).
Community health nurse (CHN) should assess and incorporate into the prenatal program for multiparity mothers, also she should have skills to design programs that meet needs for prenatal multiparity women. The roles of the CHN are important when work in family medicine centers program. These roles include: direct care giver, health educator, coordinator, and liaison for community resources, counselor, advocator, facilitator, evaluator, and administrator (Judith and Spradley, 2013).
Significance of the study:
Child, maternal, and infant health, outcomes, linked to Women who have a greater number of children. Childhood growth depends on nutritional, health, and environmental conditions. Changes in any of these influences affect how well a child grows and develops (Vicky & Cindy, 2016).
In EYGPT according to WHO statistics; Mother’s mean age at first birth was between 25-29 Yrs. total infant mortality rate was 19.7 deaths per 1000 live births. Maternal mortality rate: 33 deaths per 100, 000 live births. Total fertility rate was 3.53 children born/woman., under five mortality now accounts for 52% of all deaths. Mortality rate under five years old 23.92 Per 1, 000 Births (WHO, 2017).
Aim of the study:
The aim of this study is to assess the effect of multiparity on the children health condition .
Research Questions:
- Is there a relation between mothers knowledge&practice and their children healh condition?
-Is there a relation between multiparity and occurance of health problems in the children ?
Subject and methods
Research design:
Descriptive study design was used
Research Setting:
The study was carried out in three family medical centers at EL-SALAM city, Cairo governorate (El-Salam Awal, El-Salam Thany, El-Delta).
Sampling:
Type: A purposive sample was used.
Size: the sample composed of two hundred and seventeen (217) mothers with their children chosen randomly as they represent all multiparity mothers and their children attending mentioned three family medical centers at El-Salam city at the time of data collection (three days / week for three months).
Sampling technique:
The technique of the sample was be carried out as follows:
All the subjects who will meet the set of inclusive criteria and attending, the pre-mentioned family medical centers at EL-SALAM city, Cairo governorate will only be involved in this works the researcher will complete the data collection format from subject after explaining the aim of this study and once completed go to the next one till the end of the working day.
Technical design
The following tools were used for data collection of study:
• First tool:
-Part one: Socio-demographic characteristic for the multiparity mothers as age, gender, educational level, occupation, marital status and monthly income.
- Part two: the past and present history for mothers and children such as: reproductive status including duration of marriage, number of children, family planning method, , parity status, maternal health before & during pregnancy, family health history, ……etc.
-Part three: Assess Mother’s knowledge toward multiparity.
- Part four: Assess Mother’s practices toward multiparity &family planning utilization.
• Second tool:
Family medical record to assess child health condition and include the follwing:
- Part one: physical examination for child include general child appearance, child body measurement.
- Partwo: Assess children health problems and complains frequency.suchas(malnurition, bronchitis, gasteroentritis, anemia, …….etc).
- Part three: Assess child development data from family medical record such as, smiling, playing, name persons, grasping, drawing, towering cubes, turn to voice, syllables, combining words movements, walking, jumping……..etc.
Results& findings:
Findings of the current study can be summarized as:
• There were half (50.5%) of the multiparity mothers their age are between 30-35 years. AS regard mothers education the result shows that 45.4% ofmultiparity mothers are primary education. Also shows that 96.3% of the multiparity mothers are married.
• There were (77%) of multiparity mothers have poor knowledge of About multiparity&utilization of family planning methods while 13% of them have average and 10% have good respectively.
• Total level of practice for the study sample towards multiparty and the use of family planning method was average for 56%of them.While 26% of themhave poor regarding their Total level of practice towards multiparty and the use of family planning methods.
• As regards Infectious diseases that multiparity mothers children have, the intestinal parasites were the more frequent disease with 87.5%, then Viral hepatitis c in the second grade with 70.9% and then Measles in the third grade with 69.6%.
• As regards Exposure to malnutrition diseases, There were the Severe anaemia are the more frequent disease with 64.1%, and then Thinness disease in the second grade with 53.9%
• there were a significant relation between total level of mother knowledge and their total level of mother practice about utilization of family planning methods and multiparity.
• there were a significant relation between total level of poor mother knowledge about utilization of family planning methods and their Children health problems as infectious diseases that child have.
Recommendations:
In the light of the study findings, the following recommendations were suggested:
• planning and Developing a health educational program for multiparity mothers who should informed about all aspects regarding family planning utilization, spacing between pregnancies, prevention and care of their children through family medical centres counseling.
• An Arabic self learning package as a part of educational program is needed to be developed for raising awareness of multiparity mothers and correct their knowledge and practice toward family planning utilization and their children health condition.
• Improving the multiparity mothers knowledge and practice toward utilization of family planning and caring their children through mass media such as posters, booklets, television and newspapers.
• Further studies should be conducted to improve the multiparity mothers knowledge and practices for proper caring their large number of children and for proper utilization of family planning methods