MCH IndicatorsMCH Indicators

MCH status is assessed throughMCH status is assessed through::

Mortality indicatorsMortality indicators

Morbidity indicatorsMorbidity indicators

Growth and development.Growth and development.

Mortality indicatorsMortality indicators::

Maternal mortality rateMaternal mortality rate

Mortality in infancy and childhoodMortality in infancy and childhood1.1. Perinatal mortality ratePerinatal mortality rate2.2. Neonatal mortality rateNeonatal mortality rate3.3. Post-neonatal mortality ratePost-neonatal mortality rate4.4. Infant mortality rateInfant mortality rate5.5. 1-4 years mortality rate1-4 years mortality rate6.6. Under 5 mortality rateUnder 5 mortality rate

Maternal Mortality Maternal Mortality RateRate

OverviewOverview::

Africa has the highest maternal mortality Africa has the highest maternal mortality rate in the world Expertsrate in the world Experts

Only 42% of births in the African region Only 42% of births in the African region are attended by skilled personnel.are attended by skilled personnel.

African governments' health budgets are African governments' health budgets are inadequate to deal with obstetric cases. inadequate to deal with obstetric cases.

13% of all maternal deaths occur in 13% of all maternal deaths occur in adolescents adolescents

The Millennium Development Goals call The Millennium Development Goals call for a 75% reduction in maternal mortality for a 75% reduction in maternal mortality by in the African Region within the next by in the African Region within the next decadedecade. .

OverviewOverview::

If nothing is done to arrest the trend it is If nothing is done to arrest the trend it is estimated thatestimated that

2.5 million maternal deaths,2.5 million maternal deaths, 2.5 million child deaths and2.5 million child deaths and 49 million maternal disabilities in the region 49 million maternal disabilities in the region

over the next 10 years over the next 10 years

indicated that 70% of deliveries take place in indicated that 70% of deliveries take place in the community where maternal and newborn the community where maternal and newborn births are usually not recordedbirths are usually not recorded. .

OverviewOverview::

Maternal mortality rateMaternal mortality rate

DefinitionDefinition The death of a woman while pregnant or The death of a woman while pregnant or

within 42 days of termination of pregnancy within 42 days of termination of pregnancy irrespective of the duration and site of irrespective of the duration and site of pregnancy ,from any cause related to or pregnancy ,from any cause related to or aggravated by the pregnancy or its aggravated by the pregnancy or its management but not from accidental or management but not from accidental or incidental causes.incidental causes.

MMRMMR==

Total number of female death, due toTotal number of female death, due to complication of pregnancy ,childbirthcomplication of pregnancy ,childbirth or within 42 days of deliveryor within 42 days of delivery from puerperal causes in an areafrom puerperal causes in an area during a given yearduring a given year X1000X1000 Total number of live births in the Total number of live births in the same area and yearsame area and year

Other definitionsOther definitions

Late maternal deathLate maternal death

Death of a woman from direct or indirect Death of a woman from direct or indirect obstetric causes more than 42 days but obstetric causes more than 42 days but less than one year after termination of less than one year after termination of pregnancypregnancy

Pregnancy –related death:Pregnancy –related death:

Death of a woman while pregnant or within Death of a woman while pregnant or within 42 days of termination of pregnancy 42 days of termination of pregnancy irrespective of the cause of deathirrespective of the cause of death

Other definitionsOther definitions

Classification of maternal deathClassification of maternal death::

Direct obstetric deaths:Direct obstetric deaths: Deaths resulting from obstetric complications of Deaths resulting from obstetric complications of

the pregnant .the pregnant .

Indirect obstetric deaths:Indirect obstetric deaths: Deaths resulting from previous existing disease Deaths resulting from previous existing disease

or disease that developed during pregnancy and or disease that developed during pregnancy and aggravated by physiologic effects of pregnancyaggravated by physiologic effects of pregnancy

Causes of MMCauses of MM::

Obstetric causes:Obstetric causes:

1.1. Toxemias of Toxemias of pregnancypregnancy

2.2. HemorrhageHemorrhage

3.3. InfectionInfection

4.4. Obstructed labourObstructed labour

5.5. AbortionAbortion

Non –obstetric causes:Non –obstetric causes:

1.1. AnaemiaAnaemia

2.2. Associated diseases e.g Associated diseases e.g cardiac, renal ,infectiouscardiac, renal ,infectious

3.3. MalignancyMalignancy

4.4. accidentsaccidents

Social factors of MMSocial factors of MM::

Age at child birthAge at child birthShortage of health Shortage of health manpowermanpowerDelivery by untrained Delivery by untrained midwivesmidwivesPoor environmental Poor environmental sanitationsanitationPoor communicationsPoor communicationsSocial customs…Social customs…

ParityParityToo close Too close pregnanciespregnanciesFamily sizeFamily sizeMalnutritionMalnutritionPovertyPovertyIlliteracyIlliteracyIgnoranceIgnoranceLack of maternity Lack of maternity servicesservices

MM preventionMM prevention::

Early registration of pregnancyEarly registration of pregnancy

Identification of high risk groupIdentification of high risk group

(risk approach)(risk approach)

At least 3 antenatal visitsAt least 3 antenatal visits

Dietary supplementationDietary supplementation

Prevention of infection and hePrevention of infection and he

Prevention of complicationsPrevention of complications

Treatment of medical conditionsTreatment of medical conditions

Antimalarial prophylaxis in high transmission areasAntimalarial prophylaxis in high transmission areasTetanus toxoid vaccinationTetanus toxoid vaccinationClean delivery practicesClean delivery practicesDelivery by trained midwivesDelivery by trained midwivesInstitutional deliveries for high risk groupInstitutional deliveries for high risk groupPromotion of family planningPromotion of family planningIdentification of maternal deaths and searching the Identification of maternal deaths and searching the cause.cause.Socioeconomic developmentSocioeconomic development

MM preventionMM prevention::

Initiatives to reduce MMInitiatives to reduce MM::

Two major initiatives launched in the past two decades :Two major initiatives launched in the past two decades :

1- The Safe Motherhood Initiative launched in 19871- The Safe Motherhood Initiative launched in 1987 drew attention to the multifaceted nature of the problem drew attention to the multifaceted nature of the problem ::

human rights,human rights, empowerment of women,empowerment of women, education,education, sociosocio--economic development andeconomic development and the improvement of health systemsthe improvement of health systems..

22 - -The Making Pregnancy Safer Initiative, launched in The Making Pregnancy Safer Initiative, launched in 2000, focused on2000, focused on

The health sector and its crucial role in accelerating The health sector and its crucial role in accelerating maternal maternity reductionmaternal maternity reduction..

Aim:Aim: to ensure that women and their newborns have access to ensure that women and their newborns have access

to the care they need through to the care they need through - the strengthening of health systems and- the strengthening of health systems and - appropriate community- appropriate community--level actionslevel actions

Mortality In Infancy Mortality In Infancy And ChildhoodAnd Childhood

Mortality in infancy and childhoodMortality in infancy and childhood

Fetal deathFetal death Is death prior to the complete expulsion or Is death prior to the complete expulsion or

extraction from its mother of a product of extraction from its mother of a product of conception irrespective of the duration of conception irrespective of the duration of pregnancy; the death is indicated by the fact that pregnancy; the death is indicated by the fact that after such separation the foetus does not after such separation the foetus does not breathe or show any evidence of life such as breathe or show any evidence of life such as beating of the heart ,pulsation of the umbilical beating of the heart ,pulsation of the umbilical cord or definite movement of the voluntary cord or definite movement of the voluntary muscles.muscles.

Still birth rateStill birth rate==

foetal deaths weighing foetal deaths weighing

over 1000 g at birth X1000over 1000 g at birth X1000

Total live+ still birthsTotal live+ still births

weighing over 1000g at birthweighing over 1000g at birth

Perinatal mortality rate=Perinatal mortality rate=

Late foetal deaths andLate foetal deaths andEarly neonatal deathsEarly neonatal deathsWeighing over 1000gWeighing over 1000gAt birth X1000At birth X1000

Total Live births weighing overTotal Live births weighing over1000g at birth1000g at birth

At - risk factors for PM: At - risk factors for PM:

Low socioeconomic statusLow socioeconomic statusHigh maternal ageHigh maternal ageLow maternal ageLow maternal ageHigh parityHigh parityHeavy smokingHeavy smokingShort statureShort staturePoor past obstetric historyPoor past obstetric historyMalnutritionMalnutritionMultiple pregnancy.Multiple pregnancy.

Causes of PMCauses of PM::

Anta natal causesAnta natal causes

Intranatal causesIntranatal causes

Postnatal causesPostnatal causes

Unknown causes.Unknown causes.

Interventions to reduce PMInterventions to reduce PM::

Birth spacingBirth spacingAdvice to mothers Advice to mothers Tetanus toxoidTetanus toxoidAnaemia controlAnaemia controlEarly treatment of complicationsEarly treatment of complicationsInstitutional delivery for high risk mothersInstitutional delivery for high risk mothersGood referral systemGood referral systemClean delivery practicesClean delivery practicesNewborn careNewborn careResuscitation of newborn.Resuscitation of newborn.

Neonatal mortality rateNeonatal mortality rate::

Number of deaths of childrenNumber of deaths of children

under 28 days of age in a year X1000under 28 days of age in a year X1000

Total live births in the same yearTotal live births in the same year

Post neonatal mortality ratePost neonatal mortality rate::

Number of deaths of children Number of deaths of children

between 28 days and onebetween 28 days and one

year of age in a given year X1000year of age in a given year X1000

Total live births in the same yearTotal live births in the same year

CausesCauses::

Neonatal mortality:Neonatal mortality:

Endogenous factorsEndogenous factors

Post-neonatal mortalityPost-neonatal mortality

Exogenous causesExogenous causes

Infant mortality rateInfant mortality rate

IMR=IMR=

Number of deaths of childrenNumber of deaths of children

less than one year of age inless than one year of age in

an a year an a year

X1000X1000

Number of live births in the same yearNumber of live births in the same year

What are the What are the causes?causes?

Medical causes of infant mortalityMedical causes of infant mortality::

1- neonatal mortality1- neonatal mortalityLBWLBWBirth injuryBirth injuryCongenital anomaliesCongenital anomaliesHemolytic disease of newbornHemolytic disease of newbornConditions of placenta and cordConditions of placenta and cordDiarroheal diseasesDiarroheal diseasesARIARItetanustetanus

22 - -post-neonatal mortalitypost-neonatal mortality::

Diarrheal diseasesDiarrheal diseases

ARIARI

Communicable diseasesCommunicable diseases

MalnutritionMalnutrition

Congenital anomaliesCongenital anomalies

Accidents.Accidents.

Factors affecting IMFactors affecting IM::

1-biological factors:1-biological factors:Birth weightBirth weightAge of motherAge of motherBirth orderBirth orderBirth spacingBirth spacingMultiple birthsMultiple birthsFamily sizeFamily sizeHigh fertilityHigh fertility

other factors:other factors:

2- economic factors2- economic factors3- cultural and social factors3- cultural and social factors

breast feedingbreast feedingcustomscustomsearly marriageearly marriagequality of motheringquality of motheringmaternal educationmaternal educationquality of health carequality of health carebroken familiesbroken familiesillegitimate babiesillegitimate babiesuntrained midwivesuntrained midwivesbad environmental sanitation.bad environmental sanitation.

measures to reduce IMmeasures to reduce IM::

prenatal feedingprenatal feedingprevention of infectionprevention of infectionbreast feedingbreast feedinggrowth monitoringgrowth monitoringfamily planningfamily planningsanitationsanitationprovision of PHCprovision of PHCsocioeconomic developmentsocioeconomic developmenteducationeducation

child death ratechild death rate(1-4 year mortality rate)(1-4 year mortality rate)::

= number of deaths of= number of deaths of

children aged 1-4 years children aged 1-4 years

during a yearduring a year

X1000X1000

total number of childrentotal number of children

aged 1-4 years at the middle aged 1-4 years at the middle

of the yearof the year

child mortality ratechild mortality rate(under 5 mortality rate)(under 5 mortality rate)= =

number of deaths of childrennumber of deaths of children

less than 5years of age inless than 5years of age in

a given yeara given year

X1000X1000

number of live births in the same yearnumber of live births in the same year

Thank youThank you