Overview of Community-Managed Maternal and Newborn Care · “Nasa hukay ang isang paa ng isang...
Transcript of Overview of Community-Managed Maternal and Newborn Care · “Nasa hukay ang isang paa ng isang...
Overview of Overview of CommunityCommunity--Managed Managed
Maternal and Maternal and Newborn CareNewborn Care
PPT 1
“Nasa hukay ang isang paang isang manganganak”
photo courtesy of: BEMOC: A Trainers’ Guide (DOH) 2004.Photo Courtesy of BEmOC: A Trainer’s Guide (2004)
Maternal Mortality
1/10 Filipino mothers die everyday from complications related to pregnancy and childbirth
14 % of deaths among women aged 15-49 are due to maternal deaths
172 Filipino mothers die for every 100,000 live births
Health Care During Pregnancy, Childbirth and After Delivery
88% of women receive prenatal care from health professionals
Percentage of Antenatal Care Provider
Nurse/Midwife , 49.5
Doctor , 38.1
No one , 5.6
TBA, 6.5
3/10 women do not get at least 4 visits for prenatal care
Source: www.iccdrb.org
50% of women from among those who received prenatal care were informed of danger signs of pregnancy
57% of women were not informed to go to a specific facility in case of complications
28% of women didn’t receive any tetanus toxoidinjections during pregnancy
37% of mothers reported to have TT2 coverage
Percent distribution of women by number of TT injections during pregnancy
One injection, 33.4
None , 27.9Two or more injections, 37.3
61% of births are delivered at home
Percent distribution of live births by place of delivery
private sector , 13.7
govt health center, 1.4
govt hospital , 22.8
home , 61.4
60% of deliveries are attended by health professionals
Percent distribution of live births by person providing assistance during delivery
midwife, 25.1
nurse, 1.1
doctor , 33.6
relative/friend, 2.4
TBA, 37.1
6 /10 deliveries are attended by a traditional birth attendant at home
3/10 deliveries are attended by a midwife at home
1/3 women who delivered outside a health facility receive post natal check up within 2 days after delivery
17/ 1,000 babies die within their first 28 days of life
Child Survival
40/ 1,000 children die under the age of five
29/ 1,000 babies die under 12 months
49 % of married women use a contraceptive method (either traditional or modern)
Source: www.scienceclarified.com
Family Planning
33 % use modern methods
16% use traditional methods
Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)
• Intrauterine life as the foundation for child survival
Source: www.scienceclarified.com
Why integrate maternal and newborn care?
Reasons why children die due to maternal factors
24663240-49High at old ages
15281530-39
9261620-29Low mortality at middle ages
154228< 20High mortality at young ages
Child mortality
Infant mortality
Neonatal mortality
Biodemographic differentialsMother’s age at birth
Early childhood mortality rates by birth order
2956317+
1629144-6
823142-3
729191
Child mortalityInfant mortalityNeonatal mortalityBirth Order
Note:Clear positive association between birth order and probability of dying between ages one and five. Higher birth order have higher mortality ratio.
Early childhood mortality rates by previous birth interval
Note: Childhood mortality rates decline as the birth interval increases. Children born 3 years after a preceding birth have the best chance of surviving infancy, with IMR of 19 deaths/1,000 live birth.
625154 + years
1119103 years
1326102 years
203923<2
Child mortalityInfant mortalityNeonatal mortality
Previous birth interval
Early childhood mortality rates by birth size
na2011Average or larger
na5229Small/ very small
Child mortality
Infant mortality
Neonatal mortality
Birth weight
* No available data
Perinatal Mortality Rate by mother’s age at birth
68111340-49
23272430-39
18393020-29
38159<20
Perinatal mortality rate
No. of early neonatal deaths
No. of Still births
Age
* The sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, multiplied by 1000
Perinatal Mortality Rate by Previous pregnancy interval in months
24221939 +28131827-3818151515-2635169<152326161st pregnancy
Perinatalmortality*
No. of early neonatal
No. of still births
Interval in months
* The sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, multiplied by 1000
•Not just biological reasons, but also because of economic, socio-cultural, political and environmental factors.
Why are mothers and children dying?
Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)
•Disparities existGeographic – rural vs. urban, etcEconomic – rich vs. poor Socio-cultural – women vs. men,
indigenous peoples,level of education
Socio-economic differentials in Perinatal Mortality
Note: Perinatal mortality is slightly higher in rural than in urban areas; highest among pregnancies with preceding birth interval or less than 15 months. Wealthiest groups have the least perinatal mortality rate.
1174Highest292014Fourth 261322Middle 252317Second 252818Lowest
Wealth index quintile 171517College or higher 233832High School293525Elementary 4542No education
Education 275343Rural 213933Urban
Residence Perinatal mortality Early neonatal Still births Socio-demographic factor
Socio-economic differentials in childhood mortality
Notes: - mortality rates in urban areas are much lower than in rural areas; inversely related to mortality education level and wealth status
- regional differences should be used with caution due to large sampling errors
11913Highest42215Fourth 62615Middle 153219Second 254221Lowest
Wealth index quintile 3159College or higher 92618High School204322Elementary 426533No education
Education 173621Rural
72414UrbanResidence
Child mortalityInfant mortalityNeonatal MortalityFactor
1. Delay in deciding to seek medical care
The Three Delays
2. Delay in identifying and reaching the appropriate health facility; and
3. Delay in receiving appropriate and adequate care at the health facility.
• Save the lives of mothers and newborns
What is our role?
• Combat the Three Delays through provision of Emergency Obstetric Care (EmOC)
• Assurance of a skilled birth attendant
Emergency Obstetric Care• Part of Emergency Obstetric Care which includes pre- and
postnatal care, clean and safe delivery, neonatal care andfamily planning (4 pillars of safe motherhood)
How can we help save?
• Be equipped with essential skills both clinical and non-clinical to deliver maternal and newborn health services effectively
• Health is the responsibility of everyone
The Right to Health
• Every woman has a right to a safe pregnancy and childbirth
MCH in the Principle of Primary Health Care • Address MCH problems by
providing promotive, preventive, curative and rehabilitative services in communities
• Participation of people individually and collectively in the planning, implementation and evaluation of their health care
• “Health in the hands of the people”
What are the current efforts to ensure that women and newborns enjoy their rights?
• Health Sector Reform Program( Fourmula One)
• Women’s Health and Development Programs• Safe Motherhood Policy• Family Planning Policy
At the National Level
International Covenants• Beijing Platform of Action
• Convention on the Elimination of All- Forms of Violence Against Women
• Convention on the Rights of the Child
• Millennium Development Goals, meet the following goals by 2015 • Goal number 4: Reduce the
mortality rate among children under five by two thirds.
• Goal number 5: Reduce by three quarters the maternal mortalityratio.
• Alma Ata Declaration