Transcript lec 6MCH indicators

MCH Indicators
MCH status is assessed through:
Mortality indicators
Morbidity indicators
Growth and development.
Mortality indicators:
Maternal mortality rate
1.
2.
3.
4.
5.
6.
Mortality in infancy and childhood
Perinatal mortality rate
Neonatal mortality rate
Post-neonatal mortality rate
Infant mortality rate
1-4 years mortality rate
Under 5 mortality rate
Maternal Mortality
Rate
Overview:
Africa has the highest maternal mortality
rate in the world Experts
Only 42% of births in the African region
are attended by skilled personnel.
African governments' health budgets are
inadequate to deal with obstetric cases.
Overview:
13% of all maternal deaths occur in
adolescents
The Millennium Development Goals call
for a 75% reduction in maternal mortality
by in the African Region within the next
decade.
Overview:
If nothing is done to arrest the trend it is
estimated that
2.5 million maternal deaths,
2.5 million child deaths and
49 million maternal disabilities in the region
over the next 10 years
indicated that 70% of deliveries take place in
the community where maternal and newborn
births are usually not recorded.
Maternal mortality rate
Definition
The death of a woman while pregnant or
within 42 days of termination of pregnancy
irrespective of the duration and site of
pregnancy ,from any cause related to or
aggravated by the pregnancy or its
management but not from accidental or
incidental causes.
MMR=
Total number of female death, due to
complication of pregnancy ,childbirth
or within 42 days of delivery
from puerperal causes in an area
during a given year
X1000
Total number of live births in the
same area and year
Other definitions
Late maternal death
Death of a woman from direct or indirect
obstetric causes more than 42 days but
less than one year after termination of
pregnancy
Other definitions
Pregnancy –related death:
Death of a woman while pregnant or within
42 days of termination of pregnancy
irrespective of the cause of death
Classification of maternal death:
Direct obstetric deaths:
Deaths resulting from obstetric complications of
the pregnant .
Indirect obstetric deaths:
Deaths resulting from previous existing disease
or disease that developed during pregnancy and
aggravated by physiologic effects of pregnancy
Causes of MM:
1.
2.
3.
4.
5.
Obstetric causes:
Toxemias of
pregnancy
Hemorrhage
Infection
Obstructed labour
Abortion
Non –obstetric causes:
1. Anaemia
2. Associated diseases e.g
cardiac, renal ,infectious
3. Malignancy
4. accidents
Social factors of MM:
Age at child birth
Shortage of health
manpower
Delivery by untrained
midwives
Poor environmental
sanitation
Poor communications
Social customs…
Parity
Too close
pregnancies
Family size
Malnutrition
Poverty
Illiteracy
Ignorance
Lack of maternity
services
MM prevention:
Early registration of pregnancy
Identification of high risk group
(risk approach)
At least 3 antenatal visits
Dietary supplementation
Prevention of infection and he
Prevention of complications
Treatment of medical conditions
MM prevention:
Antimalarial prophylaxis in high transmission areas
Tetanus toxoid vaccination
Clean delivery practices
Delivery by trained midwives
Institutional deliveries for high risk group
Promotion of family planning
Identification of maternal deaths and searching the
cause.
Socioeconomic development
Initiatives to reduce MM:
Two major initiatives launched in the past two decades :
1- The Safe Motherhood Initiative launched in 1987
drew attention to the multifaceted nature of the problem :
human rights,
empowerment of women,
education,
socio-economic development and
the improvement of health systems.
2- The Making Pregnancy Safer Initiative, launched in
2000, focused on
The health sector and its crucial role in accelerating
maternal maternity reduction.
Aim:
to ensure that women and their newborns have access
to the care they need through
- the strengthening of health systems and
- appropriate community-level actions
Mortality In Infancy
And Childhood
Mortality in infancy and childhood
Fetal death
Is death prior to the complete expulsion or
extraction from its mother of a product of
conception irrespective of the duration of
pregnancy; the death is indicated by the fact that
after such separation the foetus does not
breathe or show any evidence of life such as
beating of the heart ,pulsation of the umbilical
cord or definite movement of the voluntary
muscles.
Still birth rate=
foetal deaths weighing
over 1000 g at birth
Total live+ still births
weighing over 1000g at birth
X1000
Perinatal mortality rate=
Late foetal deaths and
Early neonatal deaths
Weighing over 1000g
At birth
Total Live births weighing over
1000g at birth
X1000
At - risk factors for PM:
Low socioeconomic status
High maternal age
Low maternal age
High parity
Heavy smoking
Short stature
Poor past obstetric history
Malnutrition
Multiple pregnancy.
Causes of PM:
Anta natal causes
Intranatal causes
Postnatal causes
Unknown causes.
Interventions to reduce PM:
Birth spacing
Advice to mothers
Tetanus toxoid
Anaemia control
Early treatment of complications
Institutional delivery for high risk mothers
Good referral system
Clean delivery practices
Newborn care
Resuscitation of newborn.
Neonatal mortality rate:
Number of deaths of children
under 28 days of age in a year
Total live births in the same year
X1000
Post neonatal mortality rate:
Number of deaths of children
between 28 days and one
year of age in a given year
Total live births in the same year
X1000
Causes:
Neonatal mortality:
Endogenous factors
Post-neonatal mortality
Exogenous causes
Infant mortality rate
IMR=
Number of deaths of children
less than one year of age in
an a year
X1000
Number of live births in the same year
What are the
causes?
Medical causes of infant mortality:
1- neonatal mortality
LBW
Birth injury
Congenital anomalies
Hemolytic disease of newborn
Conditions of placenta and cord
Diarroheal diseases
ARI
tetanus
2- post-neonatal mortality:
Diarrheal diseases
ARI
Communicable diseases
Malnutrition
Congenital anomalies
Accidents.
Factors affecting IM:
1-biological factors:
Birth weight
Age of mother
Birth order
Birth spacing
Multiple births
Family size
High fertility
other factors:
2- economic factors
3- cultural and social factors
breast feeding
customs
early marriage
quality of mothering
maternal education
quality of health care
broken families
illegitimate babies
untrained midwives
bad environmental sanitation.
measures to reduce IM:
prenatal feeding
prevention of infection
breast feeding
growth monitoring
family planning
sanitation
provision of PHC
socioeconomic development
education
child death rate
(1-4 year mortality rate):
= number of deaths of
children aged 1-4 years
during a year
X1000
total number of children
aged 1-4 years at the middle
of the year
child mortality rate
(under 5 mortality rate) =
number of deaths of children
less than 5years of age in
a given year
X1000
number of live births in the same year
Thank you