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Overview of Maternal and Child Health Epidemiology

Overview of Maternal and Child Health Epidemiology. GCC/RH Morelos, January 28, 2013. Objectives. COUNT 2X2 tables DIVIDE: Ratios, proportions, rates Maternal Mortality Ratio (MMR) Infant Mortality Rate (IMR) Birth weight specific mortality rate (BWSMR) Proportionate Mortality

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Overview of Maternal and Child Health Epidemiology

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  1. Overview of Maternal and Child Health Epidemiology GCC/RH Morelos, January 28, 2013

  2. Objectives • COUNT • 2X2 tables • DIVIDE: Ratios, proportions, rates • Maternal Mortality Ratio (MMR) • Infant Mortality Rate (IMR) • Birth weight specific mortality rate (BWSMR) • Proportionate Mortality • Birth weight proportionate mortality rate (BWPMR) • Intervention package proportionate mortality rate (IPPMR) • COMPARE: Opportunity Gap

  3. Cycle of Epidemiology Divide Count Compare

  4. Counts Definition: The absolute number of cases or events related to a health outcome (maternal deaths, neonatal deaths, total number of patients seen, etc.)

  5. Numerator/ Denominator Numerator Denominator • Both are counts • Choice of denominator primarily determines the meaning of the calculation

  6. 2 X 2 Table Outcome

  7. 2 X 2 Table Outcome=deaths

  8. 3 X 3 TableOutcome=DEATHS

  9. Cycle of Epidemiology Divide Count Compare

  10. Ratios– Proportion and Rates Basic Formula: x/y x 10n Ratio: X and Y can be independent of each other or x may be included in y (male to female ratio, maternal mortality ratio=maternal deaths/live births) Proportion: a type of ratio, x is always included in y (low birth weight proportion) Rate: (often) a type of proportion; the occurrence of an event in a population over time (neonatal mortality rate, infant mortality rate, birth weight specific mortality rate, etc.)

  11. Incidence vs. Prevalence • Both rates • Incidence – number of new cases of a disease in a defined population, during a particular time; rate of “infection” • Prevalence – the total number of cases of a disease in a population at a given time.; total burden of disease

  12. Maternal Mortality Ratio x/y x 10n X = # deaths of women caused by pregnancy related causes Y = # live births during the same time interval N = 5 (10n= 100,000)

  13. Infant Mortality Rate Definition: The proportion of deaths among live born infants during a given time period X = number of infant deaths Y = total number of infants N = 3 (10n = 1,000)

  14. Birth Weight Specific Mortality Rate (BWSMR) Definition: The proportion of infants who died and weighed a given birth weight among all infants of that birth weight X = number of infants who died and weighed a given birth weight Y = total number of infants who weighed a given birth weight N = varies

  15. Birth Weight Specific Mortality Rate YES NO

  16. Proportionate Mortality Rate x/y x 10n X = deaths linked to a particular cause or risk factor Y = deaths related to all causes or risk factors N = varies

  17. Birth Weight Proportionate Mortality Rate (BWPMR) Definition: The proportion of infants of a given birth weight who died among all infants who died X = number of deaths among infants of a given birth weight Y = total number of births N = varies

  18. Birth Weight Proportionate Mortality Rate

  19. Intervention Package Proportionate Mortality Rate (IPPMR) Definition: Proportion of deaths among infants whose birth weight(s) and period(s) of death are associated with a given intervention package X = number of deaths in an intervention package cell grouping Y = total number of births N = varies

  20. Intervention Package Proportionate Mortality Rate

  21. Intervention Package Proportionate Mortality Rate (IPPMR)

  22. Intervention Package Proportionate Mortality Rate

  23. The OpportunityGap

  24. The Opportunity Gap Definition: The potential for reduction in excessive mortality based on a comparison between rates already achieved by one population with those experienced by different population

  25. How to Calculate the Opportunity Gap • Plot raw data for targeted subpopulation into the BABIES matrix

  26. How to Calculate the Opportunity Gap 2. Calculate intervention package proportionate mortality rates

  27. 9 2 How to Calculate the Opportunity Gap 3. Select a standard for comparison 4. Subtract the rate for the targeted subpopulation from standard population - 2 7 = 1,9 4,8 1 1 0,8 1,2 1 3 1 5 3,5 4 6 Moldova Georgia, USA The opportunity gap

  28. Opportunity Gap 7 Pre pregnancy interventions 3 Care During pregnancy interventions 5 Early neonatal care interventions 1 Intrapartum care interventions The opportunity gap

  29. Selecting a Standard

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