also korogwe 2009 causes of maternal and neonatal deaths why mothers and newborns die
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ALSO Korogwe 2009
Causes of Maternal and Neonatal Deaths
Why mothers and newborns die
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The aim of maternal health care
to prevent death and disability of women, related to pregnancy and birth
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The decades of irresponsible commitments
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The decades of irresponsible commitments
”Maternal mortality will be reduced by 50% by the year 2000”
World Summit for children, New York, 1990
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The decades of irresponsible commitments
”Maternal mortality will be reduced by 50% by the year
2000”
ICPD, Cairo, 1994
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The decades of irresponsible commitments
”Maternal mortality will be reduced by 50% by the year
2000”
Women’s Conference, Beijing, 1995
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The decades of irresponsible commitments
”Maternal mortality will be reduced by 50% by the year
2000”
World Summit for Social Development, Copenhagen, 1995
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So, what happened by the year 2000?
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Maternal mortality
1995
Maternal deaths
MMR(Maternal deaths per 100.000 live births)
WORLDWIDE
WESTEN
LOWINCOME
Africa
Asia
Latin America
515.000
2.800
512.000
273.000
217.000
22.000
400
21
440
1.000
280
190
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Maternal mortality
1995 2000
Maternal deaths
MMR(Maternal deaths per 100.000 live births)
Maternal deaths
MMR
Maternal deaths per 100.000 live births)
WORLDWIDE
WESTEN
LOWINCOME
Africa
Asia
Latin America
515.000
2.800
512.000
273.000
217.000
22.000
400
21
440
1.000
280
190
529.000
2.500
527.000
251.000
253.000
22.000
400
20
440
830
330
190
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UN Millenium Development Goal 5
by 2015
75% reduction of maternal deaths90% skilled delivery attendance
Tanzania:MMR 950/100,000 live birthsincreased from 1996 to 2004
46% deliveries in health facilities
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The cause of maternal deaths Poverty• More than ½ million women die every year in
relation to pregnancy and delivery. • That is one every minute. • In Denmark one out of 17.000 women die in
relation to childbearing.• In Subsaharan Africa one out of 15.• In Afghanistan one out of six.• Ninety nine percent of all maternal deaths occur
in low income countries reflecting the greatest disparity between rich and poor countries of any health indicator
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Developing countries that reduced MMR
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Kigoma Region, Tanzania
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Clinical causes of maternal deaths
Direct obstetric causes: 75%• Haemorrhage 21%• Abortion 14%• Eclampsia 13%• Obstructed labor 8%• Infection 8%Indirect obstetric causes 25%Malaria, anemia, hepatitis, HIV/AIDSCauses vary from place to place
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Components of Maternal health care
• Ante natal care
• Post partum care
• Traditional birth attendants
• Skilled delivery attendance
• Emergency obstetric care
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Ante natal careScreening for mother and child morbidity and risc, f.ex:• Obstetric history • Hypertension• Anemia• Number, position and growth of fetus(es)Preventive administering of drugs, f.ex:• Iron, folic acid, antimalaria-drugs, tetanus-immunizationTreatment or referral of certain complications, f.ex:• Malposition• Preeclampsia• Infection (including malaria)• Ante partum bleedingPlanning of delivery
Ante natal care has not been able to reduce maternal morbidity and mortality significantly as most complications occur unexpected during or after birth
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Post partum care
A significant share of maternal deaths happen in the postpartum period (the 6 weeks after birth) – bleeding, infection, eclampsia
The majority of delivered women don’t get postpartum care.
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Training of traditional birth attendants
Training of Traditional birth attendants in safe delivery and referral at complications has been tried
It has proven difficult to align western and traditional
health concepts; results have been disappointing and the strategy has largely been abandoned
Training of TBAs has been criticized for not
respecting the skills of traditional birth attendants and not considering that most TBAs are illiterate
Women’s satisfaction of maternal care by TBAs is
higher than by modern health services
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Skilled delivery attendants
The main strategy for the last ten years to reduce maternal mortality:
90% of all births by skilled delivery attendants A skilled attendant is trained in midwifery skills (2 yrs.+)Problems:• Human and economical ressources - Brain drain• Skilled attendants are not necessarily able to treat
obstetric complications due to lack of training or supplies• Many women don’t recognize the importance of skilled
attendants and prefer to deliver at home
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Skilled delivery attendants
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Skilled delivery attendants – doctors
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Skilled delivery attendants - midwives
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Emergency obstetric care 1
• Most complications occur unexpected and sudden in low risk pregnant women
• 75% of complications occur around the time of birth
• Skilled delivery attendants must be able to perform adequate life saving emergency obstetric care at all deliveries
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Emergency obstetric care 2
UN signal functionsBasic emergency obstetric care (2 hrs)1. Administration of parenteral antibiotics Infection, abortion2. Administration of parenteral oxytocic drugs Bleeding3. Administration of anticonvulsant drugs Eclampsia4. Manual removal of placenta Bleeding, infection,
abortion
5. Removal of retained products Bleeding, infection, abortion
6. Assisted vaginal delivery Obstructed labour
Comprehensive emergency obstetric care (12 hrs)7. Cesarean section Obstructed labour8. Blood transfusion Bleeding
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Emergency obstetric care 3
Delays in receiving life saving treatment
• 1st Delay: Delay in deciding to seek medical assistance
• 2nd Delay: Delay in reaching health facility
• 3rd Delay: Delay in receiving adequate treatment once at the health facility
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Emergency obstetric care 3
Delays in receiving life saving treatment
• 1st Delay: Delay in deciding to seek medical assistance
• 2nd Delay: Delay in reaching health facility
• 3rd Delay: Delay in receiving adequate treatment once at the health facility
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The National Road Map Strategic Plan To Accelerate The Reduction of
Maternal and Newborn Deaths In Tanzania (2006 -2010)Tanzanian Ministry of Health
By 2010
Reduce MMR from 578 to 265
Increase deliveries by skilled attendantsfrom 46% in 2004 to 80%
The road map EmOC objective• Basic EmOC at all Health Facilities by 2010• Comprehensive EmOC at half Health Centres and all
Hospitals
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Newborns
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Under five mortality
• Each year 11 million children under the age of 5 years die
• 4 million die within the first month
• 3 million within the first week
• 1 million within the first day
The UN MDG 4 is to reduce under five mortality by 2/3 by 2015
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Neonatal mortality
World Africa E. AfricaTanzania
Live births 133 mio. 30.3 mio. 10.6 mio. 1423000
Stillbirths 3.3 mio. 1.0 mio. 0.3 mio. 56000
Neonatal deaths 4.0 mio. 1.24 mio 0.44 mio. 113000
NMR (/1000 LB) 30 41 42 62
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Neonatal mortality
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Neonatal mortality
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A home-based study on neonatal mortality in Gadchiroli, India
NMR was reduced 70%
by
Asphyxia management
Supportive care in LBW
Sepsis management
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ALSO in Kagera
Impact on neonatal mortality
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Before: No=577 After: No=565
Stillborn15 2,5% 15 2,7%
Assisted ventilation17 3,0% 13 2,4%Cardio-Pulmonary Resuscitation 7 1,2% 6 1,1%With mother <10 minutes:32 5,8% 394 72,0%
Born alive Apgar 4-10 but died before discharge 6/528 1,1% 0/521 0,0%