Multiple myeloma

2. Module content
COMMUNITY MIDWIFERY:
Domiciliary Midwifery.
Introduction to Midwifery Care study.
Vital statistics and Documentation.
Maternal and perinatal death surveillance and response
(MPDSR).
Male involvement in safe motherhood.

4. DOMICILIARY MIDWIFERY CARE
DESCRIPTION:
 It’s the care given to a pregnant woman by a midwife at
her home environment, embracing prenatal, Intranatal
and postpartum management.

5. REQUIREMENTS
REQUIREMENTS.
 Refers to items (articles) which comprise the home visiting kit. They include:-
 Sphygmomanometer (BP machine).
 Stethoscope.
 Thermometer.
 Tape measure/ Ruler.
 Spirit swabs.
 Clean gauze and wool swabs.
 Piece of soap and towel.
 Recording charts- both mother /neonate.
 Baby’s weighing scale-carried along post-natally on alternate days.

7. Preamble
These guidelines are meant to guide the student in follow
up and compilation of Midwifery care study reports.
Every student is expected to follow up ONE expectant
mother:
With an abnormal pregnancy case; condition warranting
specific intervention(s).

8. Definition of home visit
 A purposeful and planned visit by a health worker to a
client’s home with the sole aim of teaching the principles
of healthy living prenatally and post-partumly and
Counseling all members of the family.
 It is a professional contact between the health worker and
the expectant client.

9. Principles of home visiting
Home visits should be planned with a purpose and should be beneficial to
clients
The purpose of the visit should be clear and must meet the needs of the
patients.
Home visits should be regular and flexible according to the needs of the
patient.
Home visits should be educative i.e. Gives excellent opportunities for
health education

10. Home visits should give opportunities for nurses to demonstrate
hygienic principles.
Home visit should be convenient and acceptable by the client
The nurse should make an attempt to include each family
member while using the nursing process.
The nurse and the family must develop positive interpersonal
relationship in their work to achieve the goal.
The nurse must be flexible and must respect the patient’s rights
to accept or reject care, and to participate in goal-setting and
goal achievement.
Visits must be recorded in the diary and family folder.

11. objectives
To identify special needs of every individual in the expectant
woman’s family set-up.
To get to know the client’s way of living and identify factors that may
lead to ill health during her pregnancy.
To identify positive attributes in the family that can be used to
promote safe pregnancy and childbirth.
To establish a friendly relationship with the expectant client in her
home environment for the purpose of giving health messages. I.E.
Relaxed informal relationship between the expectant client and the
health worker.

12. Objectives ct’
To link the client’s home with the health facility.
To identify client’s problems early enough and help to
correct before complications set in e.g.
Malnutrition in pregnancy
Anaemia in pregnancy
Bleeding disorders in pregnancy e.t.c.

13. Indications for Home Visiting
Antenatal mothers with a risk factor (s) or abnormal pregnancy case
e.g.
Expectant mothers with Bad obstetric history(BOH). E.g. Recurrent
spontaneous abortions, Hx of still births e.t.c
APH
The mothers with a medical condition(s) such as:
o Cardiac disease
o Diabetes mellitus
o Hypertensive disorders in pregnancy
o TB in pregnancy etc.
The mothers who do not attend the antenatal clinic as scheduled.
Handicapped expectant clients.

14. COMPONENTS OF HOME VISITING:
1 Initiation phase
The Nurse clarifies the purpose of the visit and also
share information on reason /purpose for home visit
with the family. The nurse introduces herself/himself to
the family and establishes nurse-client relationship.

15. 2 pre-visit activities
 The nurse needs prior information regarding the home
and the family which includes location of the house and
distance.
The nurse initiates contact with the family , determines
family willingness for home visit and review the family
health record. This is part of assessment of the family
health education needs.

16. 3 Activities during the home visit
 The interpersonal relationship starts when nurse enters
Into the expectant woman’s house .
The nurse takes a variety of roles when intervening for
client care e.g. Role of a collaborator, consultant,
coordinator, preventer of diseases through modification
of environment, promoter of health in the family through
health education.

17. 4 Termination phase of the Midwifery
home visiting
 Termination occurs when :
i. Nurse-patient goals are reached
ii. A patient changes her residence or leaves the home
iii. The nurse transfers the patient care to another nurse or other
members of the health team( recommend future care of the
family)
NOTE: Termination should occur when the client is in the
puerperium period, having been followed up throughout
(prenatally, intrapartumly and post-natally).

18. Post-visit activities
 Post-visit activities include recording and reporting . i.e. The
nurse records the visit and plans for the next e.g. Formulating a
lesson plan.
 The Nurse should have a lesson plan marked by the respective
supervisor prior to the next visit i.e. before he/she teaches the
lesson.

19. Advantages of home visit
Home visit provides an excellent opportunity to implement the
nursing process.
Provides the opportunity to study the home and family situation
Provides an opportunity to render service to the family members
at their own surroundings.
Prompt and proper home visits create a good understanding
between the client and the midwife hence builds good image for
the nurses.

20. Advantages ct’
Home visits clarify doubts raised by the family members
Help to observe practices and progress of care given by nurses
and other players.
Help the nurses and family members to modify the ways of their
care.
Convenient for the patient and facilitates patient’s control of the
setting
Home visits provide natural environment for the discussion of
concerns and needs.

21. Qualities/Conduct/Attributes of a Health
Worker
 Be a guest and wait to be received. One should not force his/her way in.
The health worker should observe the customs of the area with respect.
Introduces self and mission to avoid misconceptions.
 Be approachable, a willing teacher, a family health advocate, a counselor
and a consultant.
 Do not expect hospitality such as food, drinks or gifts from the Client .
Some of the families visited are usually poor.
 Respect people and have a genuine desire to help them.
 Be natural in the home e.g. Avoid false smile.
 Be tactful . Avoid anything that may jeopardize your relationship with the
family.

22. Attributes ct’
 Be observant. Avoid asking what you can see (the obvious)
 Use indirect approach in asking questions.
 Maintain confidentiality on family matters
 Teach by demonstration and ask for a return demonstration
 Choose convenient time for the visit
 Include the head of the household in the health discussions
 Be patient. Allow family members to ask questions and leave
them satisfied with the learning session.

23. Procedure of home visiting
 Identify an expectant client with an indication for follow-up as
discussed above.
 Approach the client, introduce yourself and explain the purpose of
the home visit follow up.
 Seek consent, and get residential address. Make an appointment
I.E. Date and time of the visit as per the client’s availability and
wish.
NOTE: Do NOT force a client into accepting home visiting follow up
services against her wish.

24. First visit
This is the most important visit (1st impression).
Objectives:
Familiarization
 To familiarize and introduce self to the family members
Home assessment
 To assess or find out the actual and potential health problems of the
family members hence plan strategies to deal with them.

25. Analysis of the data collected
Set priorities e.g. The problems that require immediate
action
Organize a plan of action e.g. Health messages, referral etc
Set objectives for each visit
Make a lesson plan, make regular visits
Evaluate the progress of your teaching.
Terminate your home care ( trainer’s visit ). write
recommendations for future care of the family.

26. Constraints/disadvantages/problems of
home visiting
Time factor
Home interruptions or unforeseen events
Family apathy in implementation
Misconceptions
Non-acceptance e.g. Cultural differences

27. Home visiting records
 They are records about the client visited, and records of work
done during the visit i.e.
Identification data i.e. Name, residential address, Parity,
Gestation etc.
Problem(s) identified
Progress made so far
Termination or referral
 Note: There should be a family file to keep information/details
about that family in the hospital health records.

28. Home visiting activity (Training requirement)
 Step 1
History taking and physical examination
 Steps 2
Home assessment
 Step 3
Teaching lessons and evaluation of the progress made
 Step 4
Organize for trainer’s visit (termination)
Note: (These lessons should be spread throughout i.e. prenatally,
intrapartumly and post-natally)

29. Note:
In case of a specific condition e.g. Caesarean section or Diabetes mellitus e.t.c.,
the following points should be discussed:
a) Definition of diagnosis
b) Aetiology
c) Indications
d) Investigations
e) Observations
f) Medical care
g) Nursing care (to include also the nursing care plan)
h) Complications
i) Social implications
j) Prognosis
Should any of the above sub-headings be irrelevant, leave it out. Do not fill
what has not happened.
***

30. VITAL STATISTICS IN
MIDWIFERY

31. VITAL STATISTICS
DEFINITION.
Refers to the systematic collection of numerical
figures, related to life and death events then they are
summarized and studied.
SPECIFIC OBSTETRICAL STATISTICS.
Refers to those of special interest in obstetric, they
include:-

32. 1. BIRTH RATE.
 Rate: - Refers to relation of the collected figures to a specific number
within the population. The specific no. is generally 1,000 newborn
infants, so birth rate is calculated as:
Number of births i.e. live &dead
× 1,000
Number of women in child bearing age
 Therefore, accurate records of birth notifications and registration are
important tools for correct birth rate.
 The findings help to estimate the population growth together with
other relevant statistics.

33. 2. STILLBIRTH RATE.
 Calculated through accounting for total number of stillbirths
i.e. both fresh and macerated in a year. Compared to the
number of total births/deliveries (live &dead) relate to a group
of 1,000 of those births.
 NB: - Birth/ delivery is that which occurs as from 24th week of
pregnancy.
 FORMULA:
Total number of stillbirths (fresh & macerated)
× 1,000
Total number of deliveries (live & still)

34. 3. PERINATAL DEATH RATE
 Around birth period &1st week after birth.
Definition of Perinatal Death
 The definition of a perinatal death is: “The definition of a
foetus weighing at least 500 grams (or 22 weeks gestation),
plus the number of early neonatal deaths (up to 7 days)
 It’s a good indicator of the country’s socio-economic status,
quality of perinatal care and extent to which patients/clients
use these services (perinatal services- prenatal & delivery)
 Perinatal death refers to both stillbirths and early neonatal
death.

35.  Its significance is to evaluate the performance of relevant disciplines i.e.
midwives and obstetrician as well as the responsibility of the mother i.e.
whether has played her role accurately.
 However, others, such as socio-economic factors have to be considered as
well.
 Mortality rate is expressed as number of stillbirth and early neonatal
deaths per 1,000 total birth (live & still)
 FORMULA:
No. of stillbirths + Early neonatal deaths
× 1,000
Total no. of births (live & still)
 The perinatal mortality rate is currently at 29 deaths per 1,000 total
births (KDHS, 2014)

36. 4. NEONATAL DEATH RATE.
 It’s expressed as total number of both early and late neonatal
deaths per 1,000 live births.
 FORMULA:
Early +Late neonatal death
(no. of deaths among babies below 28 days)
× 1,000
Total no. of live births/delivery

37. NEONATAL DEATH:
 It’s demise of newborn within the first 28days of extra-uterine life OR
Death of a baby during the neonatal period.
CLASSIFICATION.
 Early neonatal death: Demise that occurs to a neonate within the
first week or 0-7days of birth.
 Late neonatal death: Demise occurring after the first week, but
within the neonatal period OR Death of a baby that occurs as from
the 8th- 28th day after birth.
 Neonatal mortality rate is currently at 22 deaths per
1,000 live births (KDHS, 2014).

38. 5. POST NEONATAL DEATH RATE.
 Expressed as number of deaths after the neonatal period per 1,000 live
births.
 FORMULA:
No. of post neonatal deaths i.e. before 1year old
× 1,000
Total No. of live births
 Post-neonatal death refers to demise of a baby after the neonatal stage
but within the first year after birth or before the first birthday
anniversally.

39. 6. INFANT DEATH(MORTALITY) RATE(IMR)
 It’s expressed as total number of neonatal and post-neonatal deaths
per 1,000 live births.
 FORMULA:
Neonatal + Post neonatal deaths
(same year)
× 1000
Total No. of live births
 The result (rate) is among the best tools of evaluating the nation’s
health hence helps in estimating the future population with certainty.

40.  Currently IMR is on the increase due to multiple factors such as,
HIV/AIDS Pandemic, vector borne disease and low socio-economic
and westernization status among others.
 Therefore the respective health care disciplines have to protect the
fetus prenatally, intrapartumly and the infant postnatally in
collaboration with other key sectors (stakeholders), if our future
population is to be healthy.
 The specific aim is to lay down a firm foundation for the baby’s health.

42. Definition
• Maternal & Perinatal Death Surveillance & Response
(MPDSR) is continuous cycle of identification,
notification and review of maternal & perinatal deaths
followed by actions to improve quality of care and
prevent future deaths.

43. Purpose
To improve the participants’ knowledge and skills in MPDSR with a
focus on the M&E (monitoring & evaluation) aspects, including
death notification and review, data aggregation, analysis and
reporting as stipulated in the National MPDSR Guidelines.
 The module is designed to complement other pre-service and in-
service training on MPDSR

44. Learning outcomes
 By the end of the session, you should:
Acquire knowledge and practical skills to support the roll out of the National
Guidelines on MPDSR at the county, sub-county and facility levels.
Appreciate the importance of MPDSR processes, particularly the need for
smooth bi-directional flow of information between different levels of the
system
Be able to correctly undertake the M&E aspects of MPDSR including use of
various tools to gather, record, analyze, report and use data for decision
making.
Demonstrate improved capability to support rollout and institutionalization of
MPDSR in the Sub counties.

45. MATERNAL DEATH (MATERNAL MORTALITY)
Definition
 Maternal mortality refers to the Death of a woman while pregnant or
within 42 days (6weeks) of termination of pregnancy, irrespective of the
duration and site of pregnancy, from any cause related to/or worsened by
the pregnancy or its management but not from accidental or incidental
causes.
 Maternal deaths account for 14% of all deaths to women age 15-49 Years
 According to KDHS (2008/2009), MMR was at 488/100,000 live births.
 The target was to reduce this rate to 200 deaths per 100,000 live births by
2030
 KDHS (2013/2014) reports of maternal mortality ratio of 362 deaths per
100,000 live births

46. Maternal death
Direct obstetric death: Maternal death resulting from complications
in pregnancy, labour or postpartum/puerperium or from interventions,
omissions, incorrect treatment, or from a chain of events resulting
from any of the above.
Indirect obstetric death: Maternal death resulting from previously
existing disease that developed before pregnancy, which was not due
to direct obstetric causes, but was aggravated by the physiologic
effects of pregnancy or its management. Or newly developed medical
conditions aggravated by the physiologic effects of pregnancy or its
management.
NB: Deaths from unrelated causes which happen to occur during pregnancy or
postpartum period (Coincidental maternal death) are not included in MPDSR.

47. Maternal death
Maternal “near-miss” case: This is a woman who nearly died but survived a life-
threatening complication during pregnancy, childbirth or within 42 days of end of the
pregnancy.

48. Maternal Mortality Ratio (MMR)
• The maternal mortality ratio represents the risk associated
with each pregnancy, i.e. the obstetric risk.
• The MMR is defined as the number of maternal deaths
during a given time period per 100,000 live births during
the same time period.

49. FORMULA OF DETERMINING THE MATERNAL
MORTALITY RATE:
Prenatal+ Intrapartum+ Puerperium deaths
× 100,000
Total no. of live births

50. Perinatal death
Perinatal death constitutes pregnancy losses occurring after
seven completed months of gestation (stillbirths) plus deaths to
live births within the first seven days of life (early neonatal
deaths).
Related definitions:
 Neonatal death: This is death of an infant occurring during the
first four weeks after birth.
 Early neonatal death: This is death of an infant within the first
seven (7) days of life.
 Still birth: birth of a baby with no signs of life at: >24 weeks
gestation.

51. The Three-Delay Model
The model proposes that pregnancy-related mortality is overwhelmingly due to
delays in: (1) deciding to seek appropriate medical help for an obstetric emergency;
(2) reaching an appropriate obstetric facility; and (3) receiving adequate care when
a facility is reached.

52. Contributing factors to maternal deaths
COMMUNITY-BASED FACTORS HEALTH SERVICE FACTORS
Lack of awareness of danger signs of illness No health service available or nearby
Delay in seeking care due to lack of family
agreement
No staff available when care was sought
Geographical isolation Medicine not available at the hospital;
dependence on family to provide it
Lack of transportation or money to pay for it Lack of clinical care guidelines
Other family or household responsibilities Woman not treated immediately after arriving
at the facility
Cultural barriers, such as prohibitions on mother
leaving the house
Lack of necessary supplies or equipment at the facility
Lack of money to pay for care Lack of staff knowledge/skills to diagnose and treat
the mother
Belief in use of traditional remedies Long waiting time before qualified staff could see the
mother
Belief in fate controlling outcome No transport available to reach referral hospital
Dislike of or bad experiences with health-care
system
Poor staff attitude

53. Modifiable factor
Circumstances that may have prevented a death if a different course
of action was taken (missed opportunity). Using “modifiable” instead
of “avoidable” or “substandard” helps limit opportunities for blame
and presents potential for positive change.
Can you give examples of modifiable
factors in a case of maternal death
due to postpartum haemorrhage?

54. Introduction to MPDSR
 It is a qualitative in-depth
investigation into the causes
and circumstances surrounding
maternal and perinatal deaths
and identification of avoidable
or modifiable factors and clear
response plan to prevent future
similar deaths.
What is MPDSR?
 MPDSR consists of six steps
that starts with a death
notification.

55.  The main purpose of MPDSR is to provide essential information to
stimulate and guide actions to prevent future maternal and perinatal
deaths
 It helps to answer the question: Why are mothers/babies dying? What
needs to be done to stop the deaths?
Rationale for MPDSR

56. Specific objectives of MPDSR
 To document the burden of maternal and perinatal deaths.
 To gain understanding of the health system failures that led to the
maternal/ perinatal death or complication.
 To raise awareness among health professionals, administrators,
programme managers, policy makers and community members
about those factors in the facilities and the communities which, if
avoided, the death may not have occurred (the avoidable factors).
 To stimulate action to address the avoidable factors thereby
prevent future maternal and perinatal deaths.

57.  Death reviews focus on health systems not individuals.
 MPDSR meeting is primarily an educational experience for all participants. It
should be multidisciplinary.
 No blame policy.
 Death audit data are anonymized and cannot be used for disciplinary
purposes.
 In MPDSR programs, a zero-reporting principle is adopted, meaning that
reports are made regularly even if no death has occurred.
 The death reviews are incomplete without response to prevent avoidable
factors in the future.
 The response mechanism involves a multi-sectorial approach.
 Documentation of patient case notes is the main source for information in the
MPDSR process.
Guiding principles of MPDSR

58. MPDSR strategies
• Community-based maternal & perinatal death reviews (verbal autopsies):
Method of finding out the medical causes of death and ascertaining the
personal, family or community factors that may have contributed to the
deaths occurring outside of a medical facility.
• Facility-based maternal & perinatal deaths review: This is a qualitative,
in-depth investigation of the causes of and circumstances surrounding
maternal and perinatal deaths occurring at health facilities.
• Confidential enquiries into maternal deaths (CEMD): This is a systematic
multi-disciplinary anonymous investigation of all or a representative
sample of maternal deaths occurring at regional or national level.
• Near miss review: review of women who survived severe complications
during pregnancy and within 42 days of delivery.

59. The no-blame principle
Participants exercise:
“The lack of autonomy, privacy, anonymity and immunity of patients, families,
health professionals and review committees threaten the environment for a
MPDSR system.”
• What is your understanding of this statement?
 What is the meaning of autonomy, privacy, anonymity, and immunity in the
context of MPDSR?
 No-blame does not mean no-accountability: do you agree or disagree?

60. No-blame Principle
The principle of no name, no blame within MPDSR, amongst health staff and
reviewers should be established, supported and reiterated.
How to Establish a No-blame Culture
•Sensitise health professionals, that the MPDSR system seeks to identify
improvements in the health care delivery system and not to provide the basis
for litigating or punitive action.
•Establish immunity and legal protection for committee members, witness and
others providing information from personal liability
•Engage stakeholders within the planning and set-up process and educate on
the ‘no-blame’ process and atmosphere.
•Hospital management should value and integrate the process, through
providing leadership and human or financial resources.

61. APPROACHES OF MATERNAL AUDIT
(MPDSR)
 Community based maternal and perinatal death reviews verbal
autopsy.
 Facility based maternal and perinatal death reviews.
 Confidential enquiries into maternal deaths
 Near miss reviews

62. 1. Community Based
 Finding out the medical causes of death and ascertaining the
personal, family community factors contributing to death in
women.
 Inside a health facility
 Outside a health facility

63. 1.It must be ascertained that diseased woman was pregnant
2.Questions asked about major symptoms:
• Any haemorrhage
• Hypertension Direct causes of death
• Abortions etc
•Direct causes of death
3.Indirect causes are also enquired about e.g Accident
4.Cause of death is established (Identified) and usually assigned following
INTERNATIONAL CLASSIFICATION OF DISEASES 10 (ICD10) -data
aggregated to county or National level.
5.Efforts made to identify causes of delay in accessing MNH service.

64. 2. FACILITY BASED MPDSR
64
 Qualitative in depth investigations dne causes and circumstances
surrounding maternal/perinatal death occurring in Health Facility.
 Concerned with women who died in health care system and within the
facility
 Identify any avoidable remediable factors that could be changed to
prevent them occurring in the future
 Identify combination of factors at facility that may have led to delay in
receiving quality MNH services i.e(3rd delay factor)…..occur in facility.
 Identify delays in community contributing to death and which ones
were avoidable (1st, 2nd delay factors)

65. 3 CONFIDENTIAL ENQUIRIES INTO MPD
65
Define: Confidential enquiry into maternal deaths is a
systematic multidisciplinary anonymous investigation of all
representative of maternal death occurring at an area, sub-
county , county or national level.
Identifies:
Number
Causes and avoidables
Remedial factors associated with them

66.  Fresh interviews done on:
Persons involved in the care of a woman at time of death
Her family and health providers
 Fresh assessments of source documents including patients
notes by independent assessors and discussion to reach
consensus on cause of death enquired into.

67. 4. NEAR MISS MORBIDITY REVIEWS MATERNAL
NEAR MIS (MNM)
• Identification and assessment of cases in which pregnant
woman survive obstetric complications.
 A woman who nearly died but survived a complication that
occurred during pregnancy, childbirth or within 42 days of
termination of pregnancy.
 This strategy has been adopted as a routine part of MPDSR
 It yields results that inform policy decision for improving the
quality of maternal Health Care in individual care facilities.

68. LEVELS OF MATERNAL DEATH RESPONSE IN KENYA
1.COMMUNITY LEVEL
 Entails feedback to community.
 Partnering to alleviate multiple cause of first delay in
accessing care(e.g In community dialogue days, baraza)
 Development of locally relevant community based transport
networks.

69. 2. FACILITY LEVEL
 Addressing causes of 3rd delay
 Continuous quality improvement programs
 Clinical audit

70. 3. SUB-COUNTY LEVEL
 Entails aggregating community facility data
 Addressing broad and common avoidable factors that
affect multiple communities/facilities
 Escalate response to county level if common avoidable
factors affect several sub counties.

71. 4. COUNTY LEVEL
ENCOMPASSES:
 Monitoring MPDSR activities countywide.
Addressing countrywide avoidable cause of death (sub-
counties, facilities, communities).
 Reviewing relevant county specific multisectral framework.
Aligning them to achievement of MPDSR goals
Allocating necessary resources to support response as
guided by county MPDSR report.

72. 5. NATIONAL LEVEL
There should be National oversight.
 Close monitoring of MPDSR indicators to identify high
burden counties as a basis of resource allocation, for
focused response and technical support.
 Review of relevant legislation and resource
mobilization to address National avoidable factors
where the needs is greatest is a critical response
parameter at this level.

73. Role of the Midwife in Maternal Death Audit
 Reporting Maternal deaths – Death notification
 Collecting and documenting evidence in order to notify the
health team
 Processing and preparing evidence for the audit meeting
 Participates in audit meetings
 Helps in formulating recommendations as a part of the audit
team
 Disseminating, implementing and monitoring the
recommendations of the audit report.

74. Role of the Community Health worker in
prevention of maternal and Perinatal mortality.
1.Monitoring mothers in labour ward to diagnose early
complications on Baby/ Mother and prevent death (using
partograph)
2.Proper delivery methods to prevent perinatal deaths by
shoulder dystocia, aspiration and sudden delivery of head
leading to intracranial injury- death.
3.Educating mothers on diet exercises, clinic attendance
4.Educating mothers on malaria prevention (use ITNS)
5.Deworming of antinatals to prevent malaria- placental
insufficiency and PPH ( Maternal and Fatal death).

75. 6. Physical exam and pelvic assessment to prevent CPD that can lead to
fetal and maternal death.
7. Monitoring of vital signs in ANC to detect high BP early and prevent
death of both mother and fetus from increase BP related
complications.
8. Educating mothers on birth preparedness and signs of labour as well
as danger signs thus prevent BBA and death of babies from
Hypothermia, injuries and sepsis and death of mothers from PPH.
9. Attending maternal death Audits so as to know the preventable causes
of death and Act on the recommendations.
Ct’ …Role of the Community Health worker in
prevention of maternal and Perinatal mortality

76. MALE INVOLVEMENT IN SAFE
MOTHERHOOD

78. Source: Drennan, Popul Rep 1998;J(46).
L. Rigsby

79. Source: Drennan, Popul Rep 1998;J(46).
US Agency for International Development

80. United Nations
Mexfam

82. CONCLUSION.
 The rates have generally decreased currently compared to 20-30 years ago.
 This is due to;-
 Great advancement in the field of medicine in terms of chemotherapeutic
agents, specialized personnel and life support machines/facilities.
 Better standards of living- hygiene, housing and means of communication.
 Increase of literally rate- Has helped communities to modify or even
abandon, certain beliefs and practices that are not maternal/neonatal
health friendly.
 Male involvement in RH services/care.
 Availability of health facilities within reach.
 However there is still room for improvement since HIV/AIDS menace and low
socio-economic status are contributory to rise in various death rates.

83. 83
THE END! Questions