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INDICATORS OF MATERNAL AND CHILD HEALTH CARE

INDICATORS OF MATERNAL AND CHILD HEALTH CARE. Dr. Rekha Dutt. Maternal and child health status is assessed through mortality, morbidity and growth and development. Commonly used mortality indicators are : Maternal mortality rate Mortality in infancy and childhood: Perinatal mortality rate

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INDICATORS OF MATERNAL AND CHILD HEALTH CARE

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  1. INDICATORS OF MATERNAL AND CHILD HEALTH CARE Dr. Rekha Dutt

  2. Maternal and child health status is assessed through mortality, morbidity and growth and development. Commonly used mortality indicators are : • Maternal mortality rate • Mortality in infancy and childhood: • Perinatal mortality rate • Neonatal mortality rate • Post neonatal mortality rate • Infant mortality rate • 1-4 mortality rate • Under 5 mortality rate • Child survival rate

  3. Maternal mortality rate • Death of a female while pregnant or with in 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes / number of live births • In developed countries MMR has declined significantly .

  4. Direct obstetric causes Pregnancy Labor Postnatal period Incorrect treatment Indirect obstetric causes Resulting from previous existing disease Or disease that developed during pregnancy Maternal deaths are segregated into 2 groups

  5. Incidence • GLOBAL: 400/100,000 LB • INDIA: 301/100,000 LB CAUSES : • Hemorrhage 38% • Sepsis 11% • Hypertension 5% • Obstructed labor 5% • Abortions 8% Anemia is the leading cause of death and also aggravating factor in sepsis, hemorrhage and toxemia.

  6. Obstetric causes Toxemia Hemorrhage Infection Obstructive labor Unsafe abortion Non obstetric causes Anemia Associated diseases: cardiac, renal,metabolic, infection Malignancy accidents Medical causes

  7. Social causes • Age at child birth • Parity • Too close pregnancy • Family size • Malnutrition • Poverty • Illiteracy • Ignorance • Delivery by untrained dais • Poor communication and transport facility • Social customs • Poor environmental sanitation

  8. Preventive and social measures to reduce MMR: • Early registration of pregnancy • At least 3 antenatal checkups • Dietary supplements: iron folic acid • Prevention of infection and hemorrhage during labor • Prevention of complications eg. Eclampsia,malformation and ruptured uterus • Treatment of medical conditions • Tetanus prophylaxis • Clean delivery practices • Training to local dais • Promotion of institutional delivery • Promotion of family planning • Identification of every maternal death and searching for its cause

  9. Mortality in infancy and childhood Infant death Neonatal death Post neonatal death Early neonatal death Late neonatal death Perinatal death Still birth 28 weeks birth 7 days 1 year 28 days

  10. Fetal death : death prior to complete expulsion or extraction from its mother of a product of conception , irrespective of duration of pregnancy. Signs : fetus does not breath , heartbeat or pulsation of umbilical cord is absent • Still birth rate :death of fetus weighing 1000 gm( which is equal to 28 weeks of gestation ) or more,occuring during one year in 1000 total births (live + dead ). India – 9/1000 total births Prevention : • Detection and treatment of infection • High B.P. control • RH incompatibility • Diabetes • Premature rupture of membranes

  11. Perinatal mortality rate • Includes late fetal deaths(28 weeks gestation or more) and early neonatal deaths(7 days) in one year / live births. • Babies minimum birth weight should be 1000 gm or body length crown to heal of at least 35 cm. • India – 33/ 1000 births • Risk factors: • Maternal age > 35 or <16 • High parity (with short intervals between pregnancies) • Heavy smoking • Malnutrition – severe anemia • Infections

  12. Causes: • Intrauterine and birth asphyxia • Low birth weight • Birth trauma • Intrauterine and neonatal infection Antenatal causes: • Maternal diseases • Pelvic diseases: uterine myomas, endometriosis, ovarian tumor • Anatomical defects – uterine anomalies, incompetent cervix • Endocrine imbalance • Blood incompatibilities • Malnutrition • Toxemia of pregnancy • Ante partum hemorrhage • Congenital defects • Advanced maternal age Intranatal causes • Birth injuries • Asphyxia • Obstetric complications Postnatal causes: • Prematurity • Respiratory distress syndrome • Infection • Congenital anomalies

  13. Neonatal mortality rate • Number of deaths of children < 28 days of age in a year/total number of live births in same year Causes: • Low birth weight • Birth asphyxia • Atelectasis • Birth injuries • Congenital malformation • Infections ( tetanus , diarrhea) • NMR is more in boys as they are biologically more fragile than girls • NMR in India – 37 /1000 live births

  14. Post neonatal mortality rate • Number of deaths of children between 28 days to 1 year of age in a year/total number of live births in same year. • Exogenous factors are responsible. • Girls die more frequently than boys because of neglect of female children in terms of nutrition and health care. • India – 23 /1000 live births

  15. Infant mortality rate • Number of deaths of children < 1 year / total number of live births. Indicates : • Health status of community • Level of living • Effectiveness of MCH services It is given a separate treatment because: • It is largest single age category of mortality • Deaths are due to peculiar set of disease and conditions • It is affected quickly by special health programme.

  16. IMR in developed countries -10/1000 LB • Reasons of low IMR in developed countries : • Improved quality of life • Improved perinatal care • Better control of communicable diseases • Advances in chemotherapy • Better nutrition , emphasis on breast feeding • Family planning

  17. IMR in India – 58/1000 LB • Variation in different states, M P. -79 /1000 LB Kerala – 12 /1000 LB Orrisa, MP,Assam, Bihar,UP,Haryana and Rajasthan have IMR above national level • Mortality patterns: Age – 60% of total deaths in infants occur in first month, of these 40% die in first week. Sex – female die more than males

  18. Neonatal mortality LBW and prematurity Birth injury and difficult labor Sepsis Congenital anomalies Hemolytic disease of newborn Conditions of placenta and cord Diarrhea, ARI,tetanus Postneonatal mortality Diarrhea ARI Malnutrition Congenital anomalies accidents Medical causes of Infant Mortality

  19. Factors affecting infant mortality BIOLOGICAL FACTORS • Birth weight • Age of mother • Birth order • Birth spacing • Multiple births • Family size • High fertility Economic factors

  20. Cultural and social factors Breast feeding Early marriage Sex of child Quality of mothering Maternal education Quality of health care Broken families Illegitimacy Brutal habits and customs Untrained dais Bad sanitation

  21. Preventive and social measures Multipronged approach • Prenatal nutrition • Prevention of infection – EPI • Breast feeding • Growth monitoring • Family planning • Sanitation • PHC- high risk approach • Socioeconomic development • education

  22. 1-4 years mortality rate • Number of deaths of children aged 1-4 years in a year / total number of children aged 1-4 years in the middle of year • It is more refined indicator of social situation of country than IMR.It reflects environmental health hazards. In developing countries – 30 In developed countries - 1

  23. Developing countries Diarrhea ARI Malnutrition Infectious diseases accidents Developed countries Accidents Congenital anomalies Malignancies Influenza Pneumonia 1-4 years mortality rate - causes

  24. Under 5 mortality rate • Annual number of deaths of children under 5 years expressed as a rate / 1000 LB • UNICEF considers this as best single indicator of social development and well being as it reflects income, nutrition, health care and basic education. • Developed countries – 7 /1000 LB • Developing countries – 90 /1000 LB • India – 93 /1000 LB • CHILD SURVIVAL INDEX • 1000 – Under 5 mortality rate /10 • CSI of India = 1000-93 / 10 = 90.7 %

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