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Patricia Lima Pereira Student of Master in Social and Health Protection Institute of Public HealthJagiellonian University ...
<ul><li>World infant mortality rate </li></ul><ul><li>Different sources  to measure child mortality </li></ul><ul><li>Dive...
175 100 50 10 Population Reference Bureau 2008
Conception 28 weeks gestation Live birth One week after birth 28 days after birth One year Miscarriage Fetal mortality Per...
 
v
 
<ul><li>Vital registration </li></ul><ul><li>Population census  and surveys (the Brass method and model life tables):  ind...
Rajaratnam, Julie. Child Mortality. Research Methods for Developing Countries. University of Washington  
 
Estimated  (from data of census 2002): 153.000 births  Reported: 111.436 Occurred that year:  49.879 Dirección General de ...
 
 
Reported  infant death: 492 Estimated  infant death ( IMR = 33,8 x 1.000 birth alive) ≈  Between 3752 - 5171 Dirección Gen...
Reported infant, neonatal and postneonatal mortality.  Paraguay 1960 - 2005 Organización Panamericana de la Salud, Unidad ...
 
SOCIOECONOMIC DETERMINANTS Maternal factors Age Parity Birth interval Environmental Contamination Air / food / water Insec...
Mendieta, E 2001 WHO. 2004
1995 -1999 53 % Neonatal 35 % Birth injuries Mendieta 2000 1999 - 2003 60% Neonatal 39% Birth injuries PAHO 2009
<ul><li>In 1995, in 37% of reported infant deaths, the child had not received medical attention.  </li></ul>Health Situati...
<ul><li>Communicable diseases  </li></ul><ul><li>(48%) </li></ul><ul><li>especially pneumonia, diarrheal disease, and sept...
 
 
 
 
<ul><li>Strategies to prevent high-risk pregnancies </li></ul><ul><li>Prenatal care  </li></ul><ul><li>Professional care d...
Handler  2007; Donoso 2005 Strategies to prevent high-risk pregnancies <ul><ul><li>Comprehensive Sexual Health Education <...
Handler  2007; Donoso 2005 Prenatal care  Smoking cessation Screening for variety of medical risks (e.g., hypertension, di...
Handler  2007; Donoso 2005 Professional care during childbirth <ul><ul><li>Regionalization of perinatal care/Neonatal Inte...
Handler  2007; Donoso 2005 Child care <ul><ul><li>Kangaroo Care- skin to skin contact between mother and newborn </li></ul...
<ul><li>Not comprehensive </li></ul><ul><li>Highly fragmented </li></ul><ul><li>Lacks coordination among the various level...
WHO. Health statistics and health information systems. 2004
<ul><li>Progressive implementation of care services without charge </li></ul><ul><li>Strengthening decentralization proces...
Arden Handler. New Approaches for Improving the Health of Mothers and Infants.   Behm-Rosas H . Child survival: magnitude ...
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Infant Mortality in Paraguay

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Transcript of "Infant Mortality in Paraguay"

  1. 1. Patricia Lima Pereira Student of Master in Social and Health Protection Institute of Public HealthJagiellonian University Medical College January 2009
  2. 2. <ul><li>World infant mortality rate </li></ul><ul><li>Different sources to measure child mortality </li></ul><ul><li>Divergent data in Paraguay </li></ul><ul><li>Causes of neonatal death </li></ul><ul><li>Inequity </li></ul><ul><li>  Response of health sector </li></ul>
  3. 3. 175 100 50 10 Population Reference Bureau 2008
  4. 4. Conception 28 weeks gestation Live birth One week after birth 28 days after birth One year Miscarriage Fetal mortality Perinatal mortality Infant mortality Post neonatal mortality Stillbirth Neonatal mortality Five years Child mortality Rajaratnam, Julie. Child Mortality. Research Methods for Developing Countries. University of Washington
  5. 6. v
  6. 8. <ul><li>Vital registration </li></ul><ul><li>Population census and surveys (the Brass method and model life tables): indirect methods </li></ul><ul><li>Surveys based on birth history: direct method </li></ul>
  7. 9. Rajaratnam, Julie. Child Mortality. Research Methods for Developing Countries. University of Washington  
  8. 11. Estimated (from data of census 2002): 153.000 births Reported: 111.436 Occurred that year: 49.879 Dirección General de Estadísticas Encuestas y Censos. Estadísticas Vitales 2007.
  9. 14. Reported infant death: 492 Estimated infant death ( IMR = 33,8 x 1.000 birth alive) ≈ Between 3752 - 5171 Dirección General de Estadísticas Encuestas y Censos. Estadísticas Vitales 2007. Paho 2009
  10. 15. Reported infant, neonatal and postneonatal mortality. Paraguay 1960 - 2005 Organización Panamericana de la Salud, Unidad de Análisis de Salud y Estadísticas . Iniciativa Regional de Datos Básicos en Salud; Sistema de Información Técnica en Salud. Washington DC, 2007.
  11. 17. SOCIOECONOMIC DETERMINANTS Maternal factors Age Parity Birth interval Environmental Contamination Air / food / water Insect vector Nutrient deficiency Calories / Protein micronutrients Injury Accidental Intentional Personal illness control Healthy Sick Growth faltering Mortality Personal preventive measures Medical Treatment
  12. 18. Mendieta, E 2001 WHO. 2004
  13. 19. 1995 -1999 53 % Neonatal 35 % Birth injuries Mendieta 2000 1999 - 2003 60% Neonatal 39% Birth injuries PAHO 2009
  14. 20. <ul><li>In 1995, in 37% of reported infant deaths, the child had not received medical attention. </li></ul>Health Situation Analysis and Trends Summary. Country Chapter Summary from Health in the Americas, 1998 .
  15. 21. <ul><li>Communicable diseases </li></ul><ul><li>(48%) </li></ul><ul><li>especially pneumonia, diarrheal disease, and septicemia </li></ul><ul><li>External causes </li></ul><ul><li>(12.4%) </li></ul><ul><li>Pan American Health Organization “Health Systems Profi le Paraguay” Washington, D.C.: PAHO, © 2009 </li></ul>
  16. 26. <ul><li>Strategies to prevent high-risk pregnancies </li></ul><ul><li>Prenatal care </li></ul><ul><li>Professional care during childbirth </li></ul><ul><li>Child care </li></ul>Handler 2007; Donoso 2005
  17. 27. Handler 2007; Donoso 2005 Strategies to prevent high-risk pregnancies <ul><ul><li>Comprehensive Sexual Health Education </li></ul></ul><ul><ul><li>Well-women care </li></ul></ul><ul><ul><li>Family Planning </li></ul></ul><ul><ul><li>Prepregnancy nutrition </li></ul></ul><ul><ul><li>Adolescent Pregnancy Prevention Programs </li></ul></ul>10.9% of adolescents 15–19 years old said they had had one or more pregnancies
  18. 28. Handler 2007; Donoso 2005 Prenatal care Smoking cessation Screening for variety of medical risks (e.g., hypertension, diabetes, STDS, HIV) Management of high-risk pregnancies Immunization against tetanus, diphteria, rubeola Nutritional supplementation Preterm birth prevention programs- (e.g., awareness of signs and symptoms of preterm labor, uterine monitoring programs) Average incidence of neonatal tetanus: 1-2 cases per year 36.8% of youths 13–15 years old in Asunción smoked. Girls smoke as much as boys Maternal mortality rate (1999):114.4 per 100,000 live births Vaccination coverage in women of reproductive age: 78% 32.5% pregnant women were underweight 94.2% of mothers received prenatal care at least once 68.6%, during the first trimester
  19. 29. Handler 2007; Donoso 2005 Professional care during childbirth <ul><ul><li>Regionalization of perinatal care/Neonatal Intensive Care Units </li></ul></ul><ul><ul><li>Use of antenatal corticosteroids to accelerate fetal lung maturation for women at risk of preterm birth (reduce respiratory distress syndrome) </li></ul></ul><ul><ul><li>Treatments for VLBW infants (e.g., surfactant to improve respiratory status of preterm infants) </li></ul></ul>Percentage of institutional births : 74.1% in 2004. Less than 50% of the hospitals have the necessary infrastructure and equipment required to provide basic neonatal care. (ENOC 2005) 65% of public services provide incomplete coverage of neonatal care.
  20. 30. Handler 2007; Donoso 2005 Child care <ul><ul><li>Kangaroo Care- skin to skin contact between mother and newborn </li></ul></ul><ul><ul><li>SIDS Initiatives (Back to sleep campaign) </li></ul></ul><ul><ul><li>Access to well-child care and immunizations </li></ul></ul><ul><ul><li>Postnatal home visiting </li></ul></ul><ul><ul><li>Provision of social support </li></ul></ul><ul><ul><li>Breastfeeding </li></ul></ul>Average coverage of immunization < 90%
  21. 31. <ul><li>Not comprehensive </li></ul><ul><li>Highly fragmented </li></ul><ul><li>Lacks coordination among the various levels </li></ul><ul><li>Has suffered from a deficiency of decision making at the first level. </li></ul><ul><li>Only 2 of 10 people has medical insurance (27% in the urban areas and 7% in the rural areas) . 81.6% have no medical insurance </li></ul>Pan American Health Organization “Health Systems Profile Paraguay” Washington, D.C.: PAHO, © 2009
  22. 32. WHO. Health statistics and health information systems. 2004
  23. 33. <ul><li>Progressive implementation of care services without charge </li></ul><ul><li>Strengthening decentralization process: communitarian participation </li></ul>Ministerio de Salud Pública y Bienestar Social. CALIDAD DE VIDA Y SALUD EN PARAGUAY. “Plan de Contingencia en Salud” Setiembre 2008 a marzo 2009 http://www.mspbs.gov.py/ver_noticia.php?id=2032 . Retrieved on 27 Dec 2009. 15:20.
  24. 34. Arden Handler. New Approaches for Improving the Health of Mothers and Infants.   Behm-Rosas H . Child survival: magnitude of the problem in Latin America. Salud Publica Mex.  1988 May-Jun;30(3):289-311.   Bulletin of the Pan American Health Organization.  1981;15(1):73-6. Infant mortality in the Americas. [No authors listed] Cirera Suárez L. , Martínez López C. , Salmerón Martínez D. and Navarro Sánchez C. Perinatal mortality underreporting in obstetrics and neonatology. Anales de Pediatria 2008 69:2 (129-133) Del Popolo F., Oyarce A.M. y Ribotta B. Indígenas urbanos en América Latina: algunos resultados censales y su relación con los Objetivos de Desarrollo del Milenio. Notas de población N ° 8 6. C E PAL   Donoso Siña, Enrique. Mortalidad perinatal en las Américas. Revista Chilena de Obstetricia y Ginecología 2005; 70(5) Health Situation Analysis and Trends Summary. Country Chapter Summary from Health in the Americas, 1998. Mendieta, E; Battaglia, V; Villalba, B. Mortalidad Neonatal en el Paraguay: Análisis de los indicadores. Revista de la Sociedad Paraguaya de Pediatría 2001 28: 1 Ministerio de Salud Pública y Bienestar Social. CALIDAD DE VIDA Y SALUD EN PARAGUAY. “Plan de Contingencia en Salud” Setiembre 2008 a marzo 2009 http://www.mspbs.gov.py/ver_noticia.php?id=2032 . Retrieved on 27 Dec 2009. 15:20.   Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. Population and Development Review, 1984, 10 (Supplement): 25–45.   Pan American Health Organization “Health Systems Profile Paraguay” Washington, D.C.: PAHO, 2009   Rajaratnam, Julie. Child Mortality. Research Methods for Countries. University of Washington (ppt file) Rutstein SO . Mortality trends of young children in developing countries. IPPF Medical Bulletin. 1983 Dec;17(6):2-4. United Nations. Department of International Economic and Social Affairs. Population Division ;  United Nations Fund for Population Activities UNFPA . Population Policy Compendium.  1982 May:1-7. University of Illinois School of Public Health. Maternal and Infant Mortality Summit. October 24, 2007. (Ppt file)   Wegman, Myron E.,Infant mortality: Some international comparisons. Pediatrics, Dec96 Part 1 of 2, Vol. 98, Issue 6 Monitoring of the availability and use of health services with Essential Neonatal and Obstetric Care (ENOC) in Paraguayan health establishments, 2005.
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