Increasing Awareness  and  Empowering Communities Maternal and Perinatal  Death Inquiry and Response MAPEDIR
MAPEDIR’s purpose <ul><li>Increase awareness of maternal and perinatal deaths </li></ul><ul><ul><li>MAPEDIR brings the dea...
MAPEDIR’s purpose <ul><li>Empower the community </li></ul><ul><ul><li>Demystifies the causes of maternal and perinatal dea...
MAPEDIR’s purpose <ul><li>Inform the health system </li></ul><ul><ul><li>Community death inquiries identify access issues ...
MAPEDIR’s context in India: The RCH II Program <ul><li>RCH II priorities (implemented by the NRHM) </li></ul><ul><ul><li>I...
The MAPEDIR process <ul><li>1a) Sensitize the community </li></ul><ul><ul><li>Partner with NGOs </li></ul></ul><ul><ul><li...
The MAPEDIR process <ul><li>1b) Engage health officials </li></ul><ul><ul><li>Create a facilitating environment </li></ul>...
The MAPEDIR process <ul><li>2) Identify maternal deaths </li></ul><ul><ul><li>Block: expect 10-25 deaths / year </li></ul>...
The MAPEDIR process <ul><li>3) Investigate the deaths (with verbal autopsy interviews) </li></ul><ul><ul><li>Biological ca...
The MAPEDIR process <ul><li>4) Analyze and interpret the data </li></ul><ul><ul><li>Quantitative analysis – indicator leve...
The MAPEDIR process <ul><li>5) Share the data with the community </li></ul><ul><ul><li>Share the analyses </li></ul></ul><...
The MAPEDIR process <ul><li>6) Monitor interventions </li></ul><ul><ul><li>Continue investigating maternal deaths </li></u...
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Mapedir trainer slides session1.1 introduction_01_july07_pp95-2003

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  • Notes : Maternal mortality : Global: Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA 529,000 maternal deaths/year (400/100,000) = 132,250,000 births/year India: 25 births/1,000 population x 1,000,000,000 = 25,000,000 births/year x 407/100,000 births = 101,750 deaths/year Rajasthan: 1,713,600 births/year x 700/100,000 = 11,995 deaths/year Perinatal mortality : Global: 10,000,000 child deaths/year x .70 (for infants) x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 5,040,000 deaths/year DIV 132,250,000 births/year = 38.1/1,000 births India: 25,000,000 births/year x 64/1000 IMR = 1,600,000 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 1,152,000 deaths/year DIV 25,000,000 births = 46.1/1,000 births Rajasthan: 56,000,000 population x 30.6 births/1,000 population = 1,713,600 births/year x 78/1,000 IMR = 133,661 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 96,236 deaths/year / 1,713,600 births = 56.2/1,000 births
  • Notes : Maternal mortality : Global: Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA 529,000 maternal deaths/year (400/100,000) = 132,250,000 births/year India: 25 births/1,000 population x 1,000,000,000 = 25,000,000 births/year x 407/100,000 births = 101,750 deaths/year Rajasthan: 1,713,600 births/year x 700/100,000 = 11,995 deaths/year Perinatal mortality : Global: 10,000,000 child deaths/year x .70 (for infants) x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 5,040,000 deaths/year DIV 132,250,000 births/year = 38.1/1,000 births India: 25,000,000 births/year x 64/1000 IMR = 1,600,000 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 1,152,000 deaths/year DIV 25,000,000 births = 46.1/1,000 births Rajasthan: 56,000,000 population x 30.6 births/1,000 population = 1,713,600 births/year x 78/1,000 IMR = 133,661 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 96,236 deaths/year / 1,713,600 births = 56.2/1,000 births
  • Notes : Maternal mortality : Global: Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA 529,000 maternal deaths/year (400/100,000) = 132,250,000 births/year India: 25 births/1,000 population x 1,000,000,000 = 25,000,000 births/year x 407/100,000 births = 101,750 deaths/year Rajasthan: 1,713,600 births/year x 700/100,000 = 11,995 deaths/year Perinatal mortality : Global: 10,000,000 child deaths/year x .70 (for infants) x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 5,040,000 deaths/year DIV 132,250,000 births/year = 38.1/1,000 births India: 25,000,000 births/year x 64/1000 IMR = 1,600,000 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 1,152,000 deaths/year DIV 25,000,000 births = 46.1/1,000 births Rajasthan: 56,000,000 population x 30.6 births/1,000 population = 1,713,600 births/year x 78/1,000 IMR = 133,661 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 96,236 deaths/year / 1,713,600 births = 56.2/1,000 births
  • Notes : Maternal mortality : Global: Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA 529,000 maternal deaths/year (400/100,000) = 132,250,000 births/year India: 25 births/1,000 population x 1,000,000,000 = 25,000,000 births/year x 407/100,000 births = 101,750 deaths/year Rajasthan: 1,713,600 births/year x 700/100,000 = 11,995 deaths/year Perinatal mortality : Global: 10,000,000 child deaths/year x .70 (for infants) x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 5,040,000 deaths/year DIV 132,250,000 births/year = 38.1/1,000 births India: 25,000,000 births/year x 64/1000 IMR = 1,600,000 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 1,152,000 deaths/year DIV 25,000,000 births = 46.1/1,000 births Rajasthan: 56,000,000 population x 30.6 births/1,000 population = 1,713,600 births/year x 78/1,000 IMR = 133,661 infant deaths x .60 (for neonates) x .60 (for early neonates) x 2 (for stillbirths) = 96,236 deaths/year / 1,713,600 births = 56.2/1,000 births
  • Mapedir trainer slides session1.1 introduction_01_july07_pp95-2003

    1. 1. Increasing Awareness and Empowering Communities Maternal and Perinatal Death Inquiry and Response MAPEDIR
    2. 2. MAPEDIR’s purpose <ul><li>Increase awareness of maternal and perinatal deaths </li></ul><ul><ul><li>MAPEDIR brings the deaths to light </li></ul></ul><ul><ul><ul><li>Mobilizes communities to take local action </li></ul></ul></ul><ul><ul><ul><li>Stimulates policy makers to improve health services </li></ul></ul></ul><ul><ul><li>MAPEDIR provides useful information </li></ul></ul><ul><ul><ul><li>What caused local deaths </li></ul></ul></ul><ul><ul><ul><li>Suggests ways to prevent similar deaths </li></ul></ul></ul>
    3. 3. MAPEDIR’s purpose <ul><li>Empower the community </li></ul><ul><ul><li>Demystifies the causes of maternal and perinatal deaths and how to prevent them </li></ul></ul><ul><ul><li>Helps people understand they can take action to prevent deaths </li></ul></ul><ul><ul><li>Provides information to the community: </li></ul></ul><ul><ul><ul><li>To take effective local action </li></ul></ul></ul><ul><ul><ul><li>To advocate for improved services </li></ul></ul></ul>
    4. 4. MAPEDIR’s purpose <ul><li>Inform the health system </li></ul><ul><ul><li>Community death inquiries identify access issues and some quality of care problems </li></ul></ul><ul><ul><ul><li>Encourage community–health system partnerships </li></ul></ul></ul><ul><ul><li>Facility-based death inquiries can identify more quality of care problems </li></ul></ul>
    5. 5. MAPEDIR’s context in India: The RCH II Program <ul><li>RCH II priorities (implemented by the NRHM) </li></ul><ul><ul><li>Increase community (PRI, etc.) participation in and demand for quality RCH services </li></ul></ul><ul><ul><ul><li>Evidence-based planning, resource allocation and action to improve system quality and responsiveness </li></ul></ul></ul><ul><ul><li>Strengthen the health system </li></ul></ul><ul><ul><ul><li>Institutional awareness, responsiveness and accountability to improve RCH services </li></ul></ul></ul>
    6. 6. The MAPEDIR process <ul><li>1a) Sensitize the community </li></ul><ul><ul><li>Partner with NGOs </li></ul></ul><ul><ul><li>Mobilize the PRI, VHCs, SHGs, etc. </li></ul></ul><ul><ul><li>Sensitize the community to maternal and perinatal health issues: </li></ul></ul><ul><ul><ul><li>Birth preparedness / complication readiness </li></ul></ul></ul><ul><ul><ul><li>Project purpose, and need to report maternal deaths and conduct death inquiries </li></ul></ul></ul><ul><ul><ul><li>Non-blaming, non-punitive approach </li></ul></ul></ul>
    7. 7. The MAPEDIR process <ul><li>1b) Engage health officials </li></ul><ul><ul><li>Create a facilitating environment </li></ul></ul><ul><ul><ul><li>Non-blaming, non-punitive </li></ul></ul></ul><ul><ul><li>Develop facility-based MAPEDIR </li></ul></ul>
    8. 8. The MAPEDIR process <ul><li>2) Identify maternal deaths </li></ul><ul><ul><li>Block: expect 10-25 deaths / year </li></ul></ul><ul><ul><li>Currently – most deaths not reported </li></ul></ul><ul><li>Ways to increase death reporting </li></ul><ul><ul><li>Sensitize the community to increase awareness </li></ul></ul><ul><ul><li>Key informants (AWWs, TBAs, others) </li></ul></ul><ul><ul><li>Health facility reports of deaths </li></ul></ul><ul><ul><li>Pregnancy registration and monitoring </li></ul></ul>
    9. 9. The MAPEDIR process <ul><li>3) Investigate the deaths (with verbal autopsy interviews) </li></ul><ul><ul><li>Biological causes </li></ul></ul><ul><ul><li>Social causes (careseeking delays and reasons for the delays) </li></ul></ul>
    10. 10. The MAPEDIR process <ul><li>4) Analyze and interpret the data </li></ul><ul><ul><li>Quantitative analysis – indicator levels </li></ul></ul><ul><ul><ul><li>e.g., the percent of maternal deaths that did not seek any formal care </li></ul></ul></ul><ul><ul><li>Qualitative analysis – the complete story of individual maternal deaths </li></ul></ul><ul><ul><li>Interpret – understand what are the most important causes and possible solutions </li></ul></ul>
    11. 11. The MAPEDIR process <ul><li>5) Share the data with the community </li></ul><ul><ul><li>Share the analyses </li></ul></ul><ul><ul><li>Interpret the data with the community </li></ul></ul><ul><ul><li>Help the community: </li></ul></ul><ul><ul><ul><li>Develop effective local interventions </li></ul></ul></ul><ul><ul><ul><li>Advocate for improved services </li></ul></ul></ul>
    12. 12. The MAPEDIR process <ul><li>6) Monitor interventions </li></ul><ul><ul><li>Continue investigating maternal deaths </li></ul></ul><ul><ul><ul><li>Are the interventions working? </li></ul></ul></ul><ul><ul><ul><li>Are some women not being reached? </li></ul></ul></ul><ul><ul><li>Modify the interventions as needed </li></ul></ul><ul><ul><li>Develop new interventions if needed </li></ul></ul>

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