Health index Characteristics of maternal indicators Commonly used maternal health indicators Maternal mortality rate Fertility rate Perinatal mortality rate Neonatal mortality rate Postneonatal mortality rate Infant mortality rate Health index also called health indicators depending on the measure, a health indicators may be defined for a specific population, place, or geographic area. Indicators are defined as “variable which help to measure changes

1. HEALTH INDEX IN CONTRAST OF
MATERNAL HEALTH
Submitted to-:
Mrs pushpa kerketta
Subject coordinator
College of nursing rims
Submitted by-:
Shainy bhadra
Roll no. 34
Basic bsc nursing 4th year
College of nursing, rims
Submitted on-:13-04-21

2. INDEX
1. Health index
2. Characteristics of maternal indicators
3. Commonly used maternal health indicators
• Maternal mortality rate
• Fertility rate
• Perinatal mortality rate
• Neonatal mortality rate
• Postneonatal mortality rate
• Infant mortality rate

3. HEALTH INDEX
•Health index also called health indicators
depending on the measure, a health
indicators may be defined for a specific
population, place, or geographic area.
•Indicators are defined as “variable which help
to measure changes”

4. CHARACTERISTICS OF
MATERNAL INDICATORS
• Should be valid, i.e, they should actually measure what they are supported to
measure.
• Should be reliable and objective, i.e the answer should be same if measure by
different people in similar circumstances.
• Should be sensitive, i.e they should be sensitive to change in the situation
concerned.
• Should be specific i.e, they should reflect changes oy in the situation
concerned.
• Should be feasible, i.e, they should have the ability to obtain data needed

5. COMMONLY USED MATERNAL
HEALTH INDICATORS
1. Maternal mortality rate
2. Fertility rate
3. Mortality in infancy and childhood.
• Perinatal mortality rate (PMR)
• Neonatal mortality rate(NMR)
4. Post neonatal mortality rate(PNMR)
5. Infant mortality rate(IMR)

6. MATERNAL DEATHS
•Death of a woman while pregnant or
within 42 days of the termination of
pregnancy irrespective of the duration
and the site of pregnancy, from any
cause related to or aggravated by the
pregnancy or its management but not
from accidental or incidental causes.

7. MATERNAL MORTALITY
RATIO(MMR)
•The MMR is expressed in terms of such maternal
deaths per 100,000 live births.
•In most of the developed countries, the MMR
varies from 4-40 per 100,000 live births.
•In the developing countries, it varies from 100-
700 with india having about 254 per 100,000 live
births.

8. MATERNAL MORTALITY RATE
• It indicates the number of maternal deaths divided by the
number of women of reproductive age (15-49). It is expressed
per 100,000 women of reproductive age per year. In india, it is
about 120 as compared to 0.5 of united states.
• The term reproductive mortality is used currently to include
maternal mortality and mortality from the use of contraceptives.

12. CLASSIFICATION OF
MATERNAL MORTALITY
• Direct obstetric death (75%) -:are those resulting from complications
of pregnancy, delivery or their management. Such conditions are
abortion, ectopic gestation, preclampsia-eclampsia, antepartum and
postpartum hemorrhage and puerperal sepsis.
• Indirect deaths(25%) –:include condition present before or developed
during pregnancy but aggravated by the physiological effects of
pregnancy and strain of labour. These are anemia, cardiac disease,
diabetes etc.
• Non obstetric of fortuitous deaths-:Accidents, typhoid and other
infectious diseases.

15. FACTORS ASSOCIATED WITH MATERNAL
MORTALITY
1. Age-:In the young adolescents, pregnancy carries a highest risk due to preclampsia,
cephalopelvic disproportion and uterine inertia. In women aged 35yrs or above the risk is 3-4
times higher.
2. Parity-:The risk is slightly more in primigravida bit it is 3 times greater in para, 5 or above
where postpartum hemorrhage, malpresentation and rupture utreus are more common. The
risk is low in second pregnancy.
3. Socioeconomic strata-:Mortality ratios are higher in women belonging to low socioeconomic
strata as these women are likely to be less privileged in the fields of nutrition, housing,
education and antenatal care.
4. Antenatal care-:unfortunately, the women who have the highest mortality, like grand
multipara or the patients of lower socioeconomic status are the women who often donot
avail the benefits of antenatal care.
5. Substandard care-:when the care provided is below the generally accepted level, shortage of
resources (staff) or back up facilities (laboratory) is also included.

16. ACTIONS FOR SAFE MOTHERHOOD
1. Health sector actions-:
• Basic antenatal, intranatal and postnatal care. Risk assessment is a continued
procedure throughout and is not once only.
• A skilled attendant should be present at every birth. Functioning referral
system is essential for integration of domiciliary and institutional services.
• Emergency obstetric care is to be provided either by a field staff at the door
step of a pregnant woman or preferably at the first referral unit.
• Good quality obstetric services at the referral centres are to be ensured.
• Prevention of unwanted pregnancy and unsafe abortion. All couples and
individual should have access to effective, client oriented and confidential
family planning services.

17. 2. Community, society and family Actions-:These are essential to safe motherhood.
Wide range of groups, health care professionals, religious leaders and safe
motherhood committee can help the woman to obtain the essential obstetric care.
3.Health planners/Policy makers actions-:
To organize Community education, motivation and formation of safe motherhood
committee at the local level.
To strengthen the referral system for obstetric emergencies.
To develop written management protocols for obstetric emergencies in the hospital.
Periodic audit of the existing health care delivery system and to implement changes
as needed.

19. FERTILITY RATE
• Fertility depends several factors. The higher fertility in india is
attributed to lower fertility in india is attributed to lower age of
marriage, low level of literacy, poor level of living etc.
• Birth rate-:
BR=no.of live births during year ×1000
Mid year population
General fertility Rate-:
GFR=no.of live birth in an area during yr ×1000
Mid year female population aged 15-45 in same area and year.

20. PERINATAL MORTALITY
• Perinatal mortality is defined as the number of fetal
deaths past 22 (or 28) completed weeks of pregnancy
plus the number of deaths among live-born children up
to 7 completed days of life, per 1000 total births.

22. PREDISPOSING FACTORS OF
PERINATAL MORTALITY
1. Epidemiological-:Age over 35 yrs, teenegers, parity above 5,low
socioeconomic conditions, poor maternal nutritional status.
2. Medical Disorder-:Anemia, hypertensive disorder of pregnancy, diabetes
mellitus, syphilis, acute fever (malaria) and infection are often associated.
3. Obstetric complications-:a) Antepartum Hemorrhage particularly abruptio
placenta is responsible for about 10% of perinatal deaths due to severe
hypoxia, b) preclampsia-eclampsia c) Rh isoimmunization d) cervical
incompetence.
4. Complication labor-:Dystocia from dispropotion, malpresentation, abnormal
uterine action, amninitis .
5. Fetoplacental factors-:multiple pregnancy, congenital malformation, lBW,
preterm labor.

23. PREVENTION OF PERINATAL
MORTALITY
1. Prepregnancy health care and counseling
2. Genetic counseling in high –risk cases and prenatal diagnosis to detect genetic,
chromosomal or structural abnormalities are essential
3. Regular antenatal care with advice regarding health, diet, and rest.
4. Detection and management of medical disorders in pregnancy-:Anemia,
diabetes, infection and preclsmpsia-eclampsia.
5. Screening of high –risk patients those of poor socioeconomic status or high
parity, extreme of age, and twins etc.
6. Careful monitoring in labour to detect hypoxia early and avoidance of traumatic
vaginal delivery.
7. Skilled birth attendant- To minimize sepsis, at least three clean are to be
maintained.

24. NEONATAL DEATHS
•Neonatal death is the death of the infant
within 28 days after birth. Neonatal mortality
rate is thr number of such deaths per 10000
live births
•Majority of the deaths occur within 48 hrs of
birth.

26. HOW TO REDUCE THE RISK OF
NEONATAL MORTALITY
•
• Preventing Birth Defects
• Addressing Preterm Birth, Low Birth Weight, and Their
Outcomes
• Getting Pre-Pregnancy and Prenatal Care
• Creating a Safe Infant Sleep Environment
• Using Newborn Screening to Detect Hidden Conditions

27. STILLBIRTHS
•A stillbirths is the birth of a newborn after 28th
completed week (weighing 1000 g or more) when
the baby does not breathe or show any sign of life
after delivery.
•Still birth is the number of such deaths per 1000
total births (live and stillbirth).

29. REDUCE THE RISK OF STILLBIRTHS
• Go to all your antenatal appointments
• Eat healthily and keep active
• Stop smoking
• Avoid alcohol in pregnancy
• Go to sleep on your side
• Tell your midwife about any drug use
• Avoid people who are ill
• Wash your hands
• Prepare and store food safely

30. POSTNEONATAL MORTALITY RATE
• 1. Definition:
• POSTNEONATAL MORTALITY RATE is the number of resident newborns
dying between 28 and 364 days of age in a specified geographic area
(country, state, county, etc.) divided by the number of resident live births
for the same geographic area (for a specified time period, usually a
calendar year) and multiplied by 1,000.
• Calculation:
(Number of resident postneonatal deaths/Number of resident live births) x
1,000

31. INFANT MORTALITY RATE
• 1. Definition:
INFANT MORTALITY RATE is the number of resident newborns in a
specified geographic area (country, state, county, etc.) dying
under one year of age divided by the number of resident live
births for the same geographic area (for a specified time period,
usually a calendar year) and multiplied by 1,000.
2. Calculation:
(Number of resident infant deaths/Number of resident live births)
x 1,000

32. EVALUATION
• How do you classify maternal mortality?
• What are the major causes of maternal mortality rate?
• What factors influence perinatal mortality rate?