Nasa hukay ang isang paa ng manganganakPresentation Transcript
Overview ofCommunity-Managed Maternal and Newborn 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 Mortality1/10 Filipino mothers die everydayfrom complications related topregnancy and childbirth14 % of deaths among women aged15-49 are due to maternal deaths172 Filipino mothers die for every100,000 live births
Health Care During Pregnancy,Childbirth and After Delivery Percentage of Antenatal Care Provider88% of women No one , 5.6receive prenatalcare from health TBA, 6.5professionals Doctor , 38.1 Nurse/Midwife , 49.5
3/10 women do not get at least 4 visits for prenatal care 50% of women from among those who received prenatal care were informed of danger signs of pregnancySource: www.iccdrb.org 57% of women were not informed to go to a specific facility in case of complications
Percent distribution of women by number of TT injections during pregnancy Two or more None , 27.9 injections, 37.3 One injection, 33.428% of women didn’t receive any tetanus toxoidinjections during pregnancy37% of mothers reported to have TT2 coverage
Percent distribution of live births by place of delivery govt hospital , 22.8 govt health center, 1.4hom e , 61.4 private sector , 13.7 61% of births are delivered at home
Percent distribution of live births by person providing assistance during delivery relative/friend , 2.4 doctor , 33.6 TBA, 37.1 nurse, 1.1 midwife, 25.160% of deliveries are attended by health professionals
6 /10 deliveries are attended by atraditional birth attendant at home3/10 deliveries are attended by amidwife at home1/3 women who delivered outside ahealth facility receive post natalcheck up within 2 days afterdelivery
Child Survival 17/ 1,000 babies die within their first 28 days of life 29/ 1,000 babies die under 12 months 40/ 1,000 children die under the age of five
Family Planning 49 % of married women use a contraceptive method (either traditional or modern)Source: www.scienceclarified.com 33 % use modern methods 16% use traditional methods Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)
Why integrate maternal andnewborn care? • Intrauterine life as the foundation for child survivalSource: www.scienceclarified.com
Reasons why children die dueto maternal factors Mother’s age at Biodemographic differentials birth Neonatal Infant Child mortality mortality mortalityHigh mortality at < 20 28 42 15young agesLow mortality at 20-29 16 26 9middle ages 30-39 15 28 15High at old ages 40-49 32 66 24
Early childhood mortality ratesby birth orderBirth Order Neonatal mortality Infant mortality Child mortality 1 19 29 7 2-3 14 23 8 4-6 14 29 16 7+ 31 56 29 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 ratesby previous birth intervalPrevious birth Neonatal Infant mortality Child mortalityinterval mortality <2 23 39 20 2 years 10 26 13 3 years 10 19 11 4 + years 15 25 6 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.
Early childhood mortality ratesby birth size Birth weight Neonatal Infant Child mortality mortality mortality Small/ very 29 52 na small Average or 11 20 na larger * No available data
Perinatal Mortality Rate bymother’s age at birth Age No. of Still No. of early Perinatal mortality births neonatal deaths rate <20 9 15 38 20-29 30 39 18 30-39 24 27 23 40-49 13 11 68 * 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 Previouspregnancy interval in monthsInterval in months No. of still No. of early Perinatal births neonatal mortality* 1st pregnancy 16 26 23 <15 9 16 35 15-26 15 15 18 27-38 18 13 28 39 + 19 22 24 * The sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, multiplied by 1000
Why are mothers and childrendying? •Not just biological reasons, but also because of economic, socio- cultural, political and environmental factors. •Disparities exist Geographic – rural vs. urban, etc Economic – rich vs. poor Socio-cultural – women vs. men, indigenous peoples, level of educationSources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)
Socio-economic differentials inPerinatal Mortality Socio-demographic factor Still births Early neonatal Perinatal mortality Residence Urban 33 39 21 Rural 43 53 27 Education No education 2 4 45 Elementary 25 35 29 High School 32 38 23 College or higher 17 15 17 Wealth index quintile Lowest 18 28 25 Second 17 23 25 Middle 22 13 26 Fourth 14 20 29 Highest 4 7 11 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.
Socio-economic differentials inchildhood mortality Factor Neonatal Mortality Infant mortality Child mortality Residence Urban 14 24 7 Rural 21 36 17 Education No education 33 65 42 Elementary 22 43 20 High School 18 26 9 College or higher 9 15 3 Wealth index quintile Lowest 21 42 25 Second 19 32 15 Middle 15 26 6 Fourth 15 22 4 Highest 13 19 1 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
The Three Delays 1. Delay in deciding to seek medical care 2. Delay in identifying and reaching the appropriate health facility; and 3. Delay in receiving appropriate and adequate care at the health facility.
What is our role? • Save the lives of mothers and newborns • Combat the Three Delays through provision of Emergency Obstetric Care (EmOC)
Emergency Obstetric Care • Part of Emergency Obstetric Care which includes pre- and postnatal care, clean and safe delivery, neonatal care and family planning (4 pillars of safe motherhood) • Assurance of a skilled birth attendantHow 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 PrimaryHealth 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 ensurethat women and newborns enjoy theirrights? At the National Level • Health Sector Reform Program ( Fourmula One) • Women’s Health and Development Programs • Safe Motherhood Policy • Family Planning Policy
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 mortality ratio. • Alma Ata Declaration