Indicators of MCH care Dr Pracheth R Department

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Indicators of MCH care Dr. Pracheth R, Department of Community Medicine, Yenepoya Medical College.

Indicators of MCH care Dr. Pracheth R, Department of Community Medicine, Yenepoya Medical College.

Outline • Maternal mortality rate • Perinatal mortality rate • Post-neonatal mortality rate •

Outline • Maternal mortality rate • Perinatal mortality rate • Post-neonatal mortality rate • Infant mortality rate • Under five mortality rate • Child survival rate

Maternal mortality rate • Death : woman- pregnant/ 42 days, site, duration, cause: related/

Maternal mortality rate • Death : woman- pregnant/ 42 days, site, duration, cause: related/ aggravated, management • Not accidental/ incidental causes • Late maternal deaths: six weeks to one year • Pregnancy related death: while pregnant/ within 42 days

Contd… • Direct obstetric deaths • Indirect obstetric deaths • Measure maternal mortality: ü

Contd… • Direct obstetric deaths • Indirect obstetric deaths • Measure maternal mortality: ü Civil registration systems üHousehold surveys üSisterhood methods üVerbal autopsy üReproductive age mortality studies

Incidence: World • 287, 000 maternal deaths • 2 countries: third : India, Nigeria

Incidence: World • 287, 000 maternal deaths • 2 countries: third : India, Nigeria • India: 212/ lac live birth rates • Karnataka: 178 • 56, 000 deaths: India

Causes • Obstetric: üToxaemias üHaemorrhage üInfection üObstructed labour • Non-obstetric: anaemia, associated diseases

Causes • Obstetric: üToxaemias üHaemorrhage üInfection üObstructed labour • Non-obstetric: anaemia, associated diseases

Social factors • Age at child birth • Parity • Too close pregnancies •

Social factors • Age at child birth • Parity • Too close pregnancies • Family size • Malnutrition • Poverty, illiteracy, ignorance • Social customs • Lack of maternity services

Preventive and social measures • Early registration • Antenatal check-ups • Dietary supplementation •

Preventive and social measures • Early registration • Antenatal check-ups • Dietary supplementation • Prevent infection, haemorrhage • Prevent complications • Treat medical conditions • Clean delivery practices

Contd… • Train local dais, female health workers • Institutional deliveries • Identify every

Contd… • Train local dais, female health workers • Institutional deliveries • Identify every maternal deaths • Safe abortion services

Foetal death • Death after 28 th or 20 th week • Stillbirth rate:

Foetal death • Death after 28 th or 20 th week • Stillbirth rate: foetus born dead, weighing >500 g, gestation: 22 weeks.

Perinatal mortality rate • Late foetal deaths (stillbirths) and early neonatal deaths • 28

Perinatal mortality rate • Late foetal deaths (stillbirths) and early neonatal deaths • 28 th week – 7 th day after birth • (Late foetal+postnatal deaths/ Live births in year)X 1000 • International comparison: weighing 1000 g or above

Why perinatal mortality rate? • Stillbirths, deaths under first week: factors similar • Proportion

Why perinatal mortality rate? • Stillbirths, deaths under first week: factors similar • Proportion of deaths: occur after birth: incorrectly registered as stillbirths: inflates stillbirth rate • Perinatal period: 0. 5% lifespan: many deaths • Good indication of pregnancy wastage, quality and quantity of health care

Incidence • 90% of all infant, foetal mortality • India: hardly registered • 32/1000

Incidence • 90% of all infant, foetal mortality • India: hardly registered • 32/1000 live births and stillbirths • 35: rural areas, 22: urban areas

Social and biological factors • Low SES • High maternal age • Low maternal

Social and biological factors • Low SES • High maternal age • Low maternal age • High parity • Heavy smoking • Maternal height: short stature • Poor past obstetric history • Malnutrition, severe anaemia • Multiple pregnancy

Causes • 2/3 rd of deaths: <2500 g birth weight • Main causes: üIntrauterine,

Causes • 2/3 rd of deaths: <2500 g birth weight • Main causes: üIntrauterine, birth asphyxia üLow birth weight üBirth trauma üIntrauterine/ neonatal infections

Antenatal causes • Maternal diseases: hypertension, cardiovascular, diabetes, tuberculosis • Pelvic diseases: uterine myomas,

Antenatal causes • Maternal diseases: hypertension, cardiovascular, diabetes, tuberculosis • Pelvic diseases: uterine myomas, endometriosis • Anatomical defects: uterine anomalies, incompetent cervix • Endocrine imbalance • Blood incompatibilities • Malnutrition

Intranatal causes • Birth injuries • Asphyxia • Obstetric complications • Postnatal causes: üPrematurity

Intranatal causes • Birth injuries • Asphyxia • Obstetric complications • Postnatal causes: üPrematurity üRespiratory distress üRespiratory, alimentary infections üCongenital anomalies

Neonatal mortality rate • 28 days • Causes: üLow birth weight üAsphyxia üBirth injuries

Neonatal mortality rate • 28 days • Causes: üLow birth weight üAsphyxia üBirth injuries üCongenital malformations üEndogenous

Incidence • 2. 9 million newborns die every year <4 weeks • Half of

Incidence • 2. 9 million newborns die every year <4 weeks • Half of them die in 24 hours • Newborn deaths : 40% of all deaths • India: 25/1000 live births • Kerala : 5, Madhya Pradesh: 34

Post neonatal mortality rate • 28 days- 1 year • Exogenous: environmental, social factors,

Post neonatal mortality rate • 28 days- 1 year • Exogenous: environmental, social factors, diarrhoea, respiratory infections • Increases with birth order • Girls > boys: neglect

Infant mortality rate • Definition • Effectiveness of MCH care • Single largest age

Infant mortality rate • Definition • Effectiveness of MCH care • Single largest age category of mortality • Deaths due to peculiar causes • Affected quickly by specific health programmes

International • 37/1000 live births • 5/1000: developed, 69/1000 developing • Reflect socio-economic development:

International • 37/1000 live births • 5/1000: developed, 69/1000 developing • Reflect socio-economic development: country • Decline: improved ANC, quality of life, better control –diseases, family planning, nutrition

India • 47/1000 live births • 129: 1970, `114: 1980 • MP: 62, Kerala:

India • 47/1000 live births • 129: 1970, `114: 1980 • MP: 62, Kerala: 13 • Better: literacy, primary health care

Medical causes • Neonatal: ü low birth weight üBirth injury üSepsis üCongenital anomalies üHaemolytic

Medical causes • Neonatal: ü low birth weight üBirth injury üSepsis üCongenital anomalies üHaemolytic disease of newborn üDiarrhoeal diseases üARI üTetanus

 • Post-neonatal: ü Diarrhoeal üARI üMalnutrition üCongenital anomalies üAccidents

• Post-neonatal: ü Diarrhoeal üARI üMalnutrition üCongenital anomalies üAccidents

Factors affecting • Biological: üBirth weight üAge of mother üBirth order üBirth spacing üMultiple

Factors affecting • Biological: üBirth weight üAge of mother üBirth order üBirth spacing üMultiple births üFamily size

 • Economic causes: • Cultural and social: ü Breast feeding üReligion, caste üEarly

• Economic causes: • Cultural and social: ü Breast feeding üReligion, caste üEarly marriage ü Sex of child üQuality of mothering

üMaternal education üQuality: health care üBroken families üIllegitimacy üBad habits, customs üIndigenous dais üBad

üMaternal education üQuality: health care üBroken families üIllegitimacy üBad habits, customs üIndigenous dais üBad environment

Preventive and social measures v. Multifactorial- multipronged approach • Prenatal nutrition: • Prevent infection

Preventive and social measures v. Multifactorial- multipronged approach • Prenatal nutrition: • Prevent infection • Breast feeding • Growth monitoring • Family planning • Sanitation

 • Primary health care • Socio-economic development • Education

• Primary health care • Socio-economic development • Education

Summary

Summary

Thanks

Thanks