Godda Maternal Deaths

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MDR by Soumik- April 2011 to March 2012

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  • Subramanian SV, Davey Smith G, Subramanyam M: Indigenous Health and Socioeconomic Status in India. PLoS Medicine 2006,3(1794)Indigenous person experience 1.2 times excess mortality than a non-indigenous person with the same standard of living
  • Godda Maternal Deaths

    1. 1. Lives lost to State Apathy 1
    2. 2. One of the most backwardregions in JharkhandHome to Santhals (ST)and Paharias (PTG )More than 50% hills &forestsSubsistence farmingHard to reach areaMalaria endemic 2
    3. 3. Indicators Sundarpahari block JharkhandBody Mass Index below 70% of pregnant women 42.45% (NFHS 2005-06)normal (< 18.5 kg/m2)Haemoglobin below 78% of pregnant women 69.55% (NFHS 2005-06)normal (11.5- 15g/dl) have Hb between 7-9 g/dlUnderweight (0-3 years) 56% underweight 54.6% underweightchildren 21% severely underweight (NFHS 2005-06)Mean weight gain duringpregnancy (10 -12 kgs 3 kgsnormal)Low birth weight babies 46% Diet of rice and potato Source: Pradan–UNICEF project 2011, NFHS 2005-06 3
    4. 4.  For a period of 1 year: April 2011 – March 2012 Covering 2 Blocks: Sundarpahari and parts of Poreyahat Total population 1,26,659 – 48% scheduled tribes 4
    5. 5.  Tools used were [1]Primary Informer format and [2]Maternal death review format – prescribed by SRS Firstly, all deaths of women in the age group of 15-49 years were tracked using tool [1]  Filled by trained community volunteers e.g. ASHA Within these maternal deaths were culled out  Upto 42 days after birth  Death related to  Pregnancy  Medical termination of pregnancy  Not accidental PRADAN staff with trained volunteers collected information at the household level using tool [2] Interviews were conducted with family member present with the woman at the time of seeking care or closest relative with requisite information or neighbours 5
    6. 6. 4 3 3 3 3 21 1 1 1 1 0 6
    7. 7.  Recorded 23 dead women in 3150 births At 730, MMR is 3 times the State figure of 278/1,00,000 live births (Annual Health Survey, 2011) 7
    8. 8. 9% 30%22% Eclampsia Fever-Malaria ? Heamorrhage 22% 17% Others Sepsis 8
    9. 9.  Of the 23 cases only 3 children survived Survived Still birth Died Unborn 9
    10. 10.  Socio-economically weaker sections and vulnerable groups 74% from indigenous communities (Santhals) Demography of the maternal 85% do not have formal education deaths 18 16 61% in 18-22 age group 14 12 10 8 6 43% had their first pregnancy 4 2 0 ST OBC General 10
    11. 11. 13Reaching health facility (of 14 cases) 14 Obtaining care (of 14 cases) 18 Deciding to seek care (of 23 cases) 0 2 4 6 8 10 12 14 16 18 11
    12. 12. Indicators PercentageNo medical care 13%First point of care local practitioners/quacks 65%ANC – Tetanus injection only 43%No prior information regarding own 87%condition/birth planningAntepartum deaths 30%Intrapartum deaths 22%Postpartum deaths 48% Point of care 12
    13. 13. Government PHC Local practitioner SelfFamily Midwife Private hospitalGovernment - CHC Government District hospital 4% 13% 4%4%13% 50% 8% 4% 13
    14. 14. Bihar District hospitalBihar Community Health Centre Primary Health Centre Community Health Centre Private hospital Bihar FRU District hospital Local practitioner/quacks 0 2 4 6 8 10 12 14 16 18 14
    15. 15. 10 9 8 7 6 5 4 3 2 1 0 District hospital Community Health Primary Health Centre Centre Total no. of cases referred 8 out of 14 multiple referral cases 15
    16. 16. 1. Blood transfusion2. Complicated labourAs per Operational Guidelines on Maternal & Newborn Health 2010: Community health centre – Basic emergency obstetric care District hospital - comprehensive emergency obstetric care 16
    17. 17.  80% of the villages are relatively well connected by roads Mean distance from functional (first) facility - 18 kms (shortest 1km to PHC, longest 40 kms to CHC) Mean time taken to reach the nearest functional facility from home after appearance of symptoms - 7.5 hours Mean time taken for referral between CHC to DH to Bhagalpur - 7 hours Nearest functional FRU - Jawaharlal Nehru Medical College & Hospital-Bhagalpur (Bihar) - 70 km from District headquarters 48% deaths occurred at home, 35% at hospital and the rest in transit 17
    18. 18. 23 pregnant women 9 died at home 14 reached the 1st facility 3 returned home & died 3 died enroute 2nd facility 8 reached 2nd facility 4 died at the 2nd facility 4 reached 3rd facility 3 died at 3rd facility 1 reached & died at the 4th facilityFacilities include private hospitals/clinics and government facilities - CHC, DH, FRU 18
    19. 19. Intrapartum deaths Anterpartum deaths Postpartum deaths 5 4 3 3 2 2 21 1Facility In transit Return from facility Home 19
    20. 20. Jawaharlal Nehru Medical College & hospital, Bhagalpur Referred from Godda District Hospital to FRU in 70 kms Bhagalpur Reached Godda District Hospital at 11 am Simaldhab villageDied enroutearound 6 pm 30 kms Called private vehicle at 3 am, arrived at 9 am Arranged private vehicle at 5pm 20
    21. 21.  Mean out of pocket expenses –Rs 4478 (range 400-6,000) Vehicle Quacks Pvt Clinic Govt. Facility600050004000300020001000 0 1 2 3 4 5 6 7 8 9 10 21
    22. 22.  Move to the verandah I have to close the ward---ANM to pregnant woman suffering convulsions at CHC Do not step in my vehicle if you don’t have money---Driver of Mamta Vahan to husband of pregnant woman DIGNITY?! Why have you come here, nothing can be done, take the woman to Bhagalpur----Doctor to woman’s family arrived for delivery at District Hospital Pay up! Throw the baby in the ditch and get lost---Nurse yelling at a woman who had a still birth Then you call the person whom you gave money and let her do the delivery--- ANM to family members asking them to pay her after they had paid Rs 300 to the ANM on duty before her You illiterate woman, pay up else we will thrash you---Nurse to woman after she had a still birth 22
    23. 23.  Accessible and functional FRU, EMOC RESIDENT ANMs COMPLETE ANC & PNC FREE TREATMENT & DRUGS ENTITLEMENTS 23
    24. 24. 7 Yrs of NRHM…and women continue to die Lost rights are never regained by appeals to theconscience of the usurpers, but by relentless struggle... ~ Ambedkar 24
    25. 25. 25

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