Indicators of MCH care Dr Pracheth R Department
- Slides: 32
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 • Infant mortality rate • Under five mortality rate • Child survival rate
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 Civil registration systems üHousehold surveys üSisterhood methods üVerbal autopsy üReproductive age mortality studies
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
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 • Prevent infection, haemorrhage • Prevent complications • Treat medical conditions • Clean delivery practices
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: foetus born dead, weighing >500 g, gestation: 22 weeks.
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 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 live births and stillbirths • 35: rural areas, 22: urban areas
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, birth asphyxia üLow birth weight üBirth trauma üIntrauterine/ neonatal infections
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 üRespiratory distress üRespiratory, alimentary infections üCongenital anomalies
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 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, diarrhoea, respiratory infections • Increases with birth order • Girls > boys: neglect
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: 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: 13 • Better: literacy, primary health care
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
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 marriage ü Sex of child üQuality of mothering
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 • Breast feeding • Growth monitoring • Family planning • Sanitation
• Primary health care • Socio-economic development • Education
Summary
Thanks
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