1.
By
Heba Moustafa
Assistant lecturer of family
medicine
faculty of medicine Suez Canal
University
Dr_hebamoustafa@yahoo.com

2.
While dr Ali – who is a member of family
medicine post graduate group – facing a
pregnant woman in the final clinical exam, his
professor asked him the following question:
What is the latest maternal mortality ratio in
Egypt?

3. Women health
profile
Definitions
Women Health Indicators
in
Egypt
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Profile (indicators)
criteria
Method of
calculation
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4. • A Health indicator is a characteristic of an individual,
population, or environment which is subject to
measurement (directly or indirectly)
• Health indicators can be used to define public health
problems at a particular point in time, to indicate change
over time
Definition of health indicator

5. Criteria of indicators
• Measurable
• Monitored over time
• Accessible for country
• Accuracy (reliable , valid)
• Sensitive to changes and specific

6. Method of calculation
Cause-specific mortality and morbidity
• Maternal mortality ratio (per 100 000 live births)
Number of maternal deaths per 100 000 live births during a
specified time period, usually one year.
= Number of maternal deaths x100 000
Number of live births in the year

7. Maternal mortality ratio in Egypt
• 1990 220
• 2000 110
• 2008 82

8. Health service coverage
Antenatal care coverage(%)
Percentage of women who utilized
antenatal care provided by skilled
health personnel as a percentage of
Live births in a given time period.

9. Antenatal care coverage in Egypt
From 2000- 2010
• At least one visit 74%
• At least 4 visits 66%

10. Births attended by skilled health personnel
(%)
• Percentage of live births attended by skilled health
personnel in a given period of time.
• In Egypt
From 2000- 2010
Births attended by skilled health personnel
79%

11. Institutional delivery coverage (%)
• IN Egypt
• 2005-2009 72% (UNICEF)

12. Births by caesarean section (%)
• Percentage of births by caesarean section among all live
births in a given time period.
• In Egypt
From 2000- 2010
Births by caesarean section 27.6% (WHO)
28% (UNICEF)

13. Neonates protected at birth against
neonatal tetanus (%)
• In Egypt
• 1990 74%
• 2000 80%
• 2009 85%

14. Contraceptive prevalence (%)
• In Egypt
• 2005-2009 60% (UNICEF)

15. Demographic and socioeconomic
• Total fertility rate (per woman)
Live birth for a woman in reproductive age
• In Egypt
• 1990 4.6
• 2000 3.3
• 2009 2.3 (WHO)
2.8 (UNICEF)

16. What is the latest maternal mortality ratio in
Egypt?

18. • During the clinical exam of dr Ali the pregnant woman
gave a family history of breast cancer in her grand
mother so his professor asked him the following
question:
• What are the recommendations of breast cancer
screening?

19. Women health
profile
Breast
cancer
Endometrial
cancer
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profile
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Cervical
cancer
Ovarian
Cancer
Women health
Profile (indicators)
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Cancer screening
In women

20. Screening for Breast Cancer
U.S. Preventive Services Task Force
recommendations
• start regular, biennial screening mammography before
the age of 50 years should be an individual one and take
into account patient context, including the patient’s
values regarding specific benefits and harms. (Grade C
recommendation)

21. • The USPSTF recommends biennial screening
mammography for women between the ages of 50 and
74 years. (Grade B recommendation)
• The USPSTF concludes that the current evidence is
insufficient to assess the additional benefits and harms
of screening mammography in women 75 years or older.
(I statement)
• The USPSTF concludes that the current evidence is
insufficient to assess the additional benefits and harms
of clinical breast examination beyond screening
mammography in women 40 years or older.(I statement)

22. • The USPSTF recommends against clinicians teaching
women how to perform breast self-examination. (Grade
D recommendation)
• The USPSTF concludes that the current evidence is
insufficient to assess additional benefits and harms of
either digital mammography or magnetic resonance
imaging instead of film mammography as screening
modalities for breast cancer. (I statement)

23. Genetic Risk Assessment and BRCA Mutation
Testing for Breast and Ovarian Cancer
Susceptibility
• The U.S. Preventive Services Task Force (USPSTF)
recommends against routine referral for genetic
counseling or routine breast cancer susceptibility gene
(BRCA) testing for women whose family history is not
associated with an increased risk for deleterious
mutations in breast cancer susceptibility gene 1(BRCA1)
or breast cancer susceptibility gene 2 (BRCA2). Grade:
D Recommendation.

24. • The USPSTF recommends that women whose family
history is associated with an increased risk for
deleterious mutations in BRCA1 or BRCA2 genes be
referred for genetic counseling and evaluation for BRCA
testing. Grade: B Recommendation.

25. American Cancer Society Guidelines
• Yearly mammograms are recommended starting at age
40 and continuing for as long as a woman is in good
health
• Clinical breast exam (CBE) about every 3 years for
women in their 20s and 30s and every year for women
40 and over
• Breast self-exam (BSE) is an option for women starting
in their 20s.

26. Screening for Cervical Cancer
U.S. Preventive Services Task Force recommendations
• The U.S. Preventive Services Task Force (USPSTF) strongly
recommends screening for cervical cancer in women who have
been sexually active and have a cervix. Grade: A Recommendation.
• The USPSTF recommends against routinely screening women older
than age 65 for cervical cancer if they have had adequate recent
screening with normal Pap smears and are not otherwise at high
risk for cervical cancer. Grade: D Recommendation

27. • The USPSTF recommends against routine Pap smear
screening in women who have had a total hysterectomy
for benign disease. Grade: D Recommendation.
• The USPSTF concludes that the evidence is insufficient
to recommend for or against the routine use of new
technologies to screen for cervical cancer. Grade: I
Statement.
• The USPSTF concludes that the evidence is insufficient
to recommend for or against the routine use of human
papillomavirus (HPV) testing as a primary screening test
for cervical cancer. Grade: I Statement.

28. American Cancer Society Guidelines
• All women should begin cervical cancer screening about
3 years after they begin having vaginal intercourse, but
no later than 21 years old. Screening should be done
every year with the regular Pap test or every 2 years
using the newer liquid-based Pap test.
• Beginning at age 30, women who have had 3 normal
Pap test results in a row may get screened every 2 to 3
years. Women older than 30 may also get screened
every 3 years with either the conventional or liquid-based
Pap test, plus the human papilloma virus (HPV) test.

29. • Women 70 years of age or older who have had 3 or
more normal Pap tests in a row and no abnormal Pap
test results in the last 10 years may choose to stop
having Pap tests.
• Women who have had a total hysterectomy may also
choose to stop having Pap tests, unless the surgery was
done as a treatment for cervical cancer or pre-cancer.
Women who have had a hysterectomy without removal
of the cervix should continue to have Pap tests.

30. Screening for Ovarian Cancer
• The U.S. Preventive Services Task Force (USPSTF)
recommends against routine screening for ovarian
cancer. Grade: D Recommendation.

31. Endometrial cancer
• American Cancer Society Guidelines
• The American Cancer Society recommends that at the
time of menopause, all women should be informed about
the risks and symptoms of endometrial cancer.

32. USPSTF Grade Definitions
• A Strongly Recommended: The USPSTF strongly
recommends that clinicians provide [the service] to
eligible patients.
• B Recommended: The USPSTF recommends that
clinicians provide [the service] to eligible patients
• C No Recommendation: The USPSTF makes no
recommendation for or against routine provision of [the
service].

33. • D Not Recommended: The USPSTF recommends
against routinely providing [the service] to asymptomatic
patients.
• I Insufficient Evidence to Make a Recommendation:
The USPSTF concludes that the evidence is insufficient
to recommend for or against routinely providing [the
service].

34. Heba Moustafa
Assistant lecturer of family medicine
faculty of medicine Suez Canal University
Dr_hebamoustafa@yahoo.com