MCH Indicators

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MCH Indicators
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MCH status is assessed through

• Mortality indicators
• Morbidity indicators
• Growth and development.

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Mortality indicators

• Maternal mortality rate
• Mortality in infancy and childhood
• Perinatal mortality rate
• Neonatal mortality rate
• Post-neonatal mortality rate
• Infant mortality rate
• 1-4 years mortality rate
• Under 5 mortality rate

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• Maternal Mortality Rate

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Overview

• Africa has the highest maternal mortality rate in
  the world Experts
• Only 42 of births in the African region are
  attended by skilled personnel.
• African governments' health budgets are
  inadequate to deal with obstetric cases.

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Overview

• 13 of all maternal deaths occur in adolescents
• The Millennium Development Goals call for a 75
  reduction in maternal mortality by in the African
  Region within the next decade.

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Overview

• If nothing is done to arrest the trend it is
  estimated that
• 2.5 million maternal deaths,
• 2.5 million child deaths and
• 49 million maternal disabilities in the
  region over the next 10 years
• indicated that 70 of deliveries take place in
  the community where maternal and newborn births
  are usually not recorded.

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Maternal mortality rate

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

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MMR

• Total number of female death, due to
• complication of pregnancy ,childbirth
• or within 42 days of delivery
• from puerperal causes in an area
• during a given year
• 
  X1000
• Total number of live births in the
• same area and year

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Other definitions

• Late maternal death
• Death of a woman from direct or indirect
  obstetric causes more than 42 days but less than
  one year after termination of pregnancy

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Other definitions

• Pregnancy related death
• Death of a woman while pregnant or within 42
  days of termination of pregnancy irrespective of
  the cause of death

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Classification of maternal death

• Direct obstetric deaths
• Deaths resulting from obstetric complications
  of the pregnant .
• Indirect obstetric deaths
• Deaths resulting from previous existing
  disease or disease that developed during
  pregnancy and aggravated by physiologic effects
  of pregnancy

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Causes of MM

• Obstetric causes
• Toxemias of pregnancy
• Hemorrhage
• Infection
• Obstructed labour
• Abortion

• Non obstetric causes
• Anaemia
• Associated diseases e.g cardiac, renal
  ,infectious
• Malignancy
• accidents

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Social factors of MM

• Age at child birth
• Shortage of health manpower
• Delivery by untrained midwives
• Poor environmental sanitation
• Poor communications
• Social customs

• Parity
• Too close pregnancies
• Family size
• Malnutrition
• Poverty
• Illiteracy
• Ignorance
• Lack of maternity services

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MM prevention

• Early registration of pregnancy
• Identification of high risk group
• (risk approach)
• At least 3 antenatal visits
• Dietary supplementation
• Prevention of infection and he
• Prevention of complications
• Treatment of medical conditions

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MM prevention

• Antimalarial prophylaxis in high transmission
  areas
• Tetanus toxoid vaccination
• Clean delivery practices
• Delivery by trained midwives
• Institutional deliveries for high risk group
• Promotion of family planning
• Identification of maternal deaths and searching
  the cause.
• Socioeconomic development

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Initiatives to reduce MM

• Two major initiatives launched in the past two
  decades
• 1- The Safe Motherhood Initiative launched in
  1987
• drew attention to the multifaceted nature of the
  problem
• human rights,
• empowerment of women,
• education,
• socio-economic development and
• the improvement of health systems.

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2- The Making Pregnancy Safer Initiative,
launched in 2000, focused on

• The health sector and its crucial role in
  accelerating maternal maternity reduction.
• Aim
• to ensure that women and their newborns have
  access to the care they need through
• - the strengthening of
  health systems and
• - appropriate
  community-level actions

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• Mortality In Infancy And Childhood

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Mortality in infancy and childhood

• Fetal death
• Is death prior to the complete expulsion or
  extraction from its mother of a product of
  conception irrespective of the duration of
  pregnancy the death is indicated by the fact
  that after such separation the foetus does not
  breathe or show any evidence of life such as
  beating of the heart ,pulsation of the umbilical
  cord or definite movement of the voluntary
  muscles.

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Still birth rate

• foetal deaths weighing
• over 1000 g at birth
  X1000
• Total live still births
• weighing over 1000g at birth

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Perinatal mortality rate

• Late foetal deaths and
• Early neonatal deaths
• Weighing over 1000g
• At birth
  X1000
• Total Live births weighing over
• 1000g at birth

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At - risk factors for PM

• Low socioeconomic status
• High maternal age
• Low maternal age
• High parity
• Heavy smoking
• Short stature
• Poor past obstetric history
• Malnutrition
• Multiple pregnancy.

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Causes of PM

• Anta natal causes
• Intranatal causes
• Postnatal causes
• Unknown causes.

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Interventions to reduce PM

• Birth spacing
• Advice to mothers
• Tetanus toxoid
• Anaemia control
• Early treatment of complications
• Institutional delivery for high risk mothers
• Good referral system
• Clean delivery practices
• Newborn care
• Resuscitation of newborn.

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Neonatal mortality rate

• Number of deaths of children
• under 28 days of age in a year X1000
• Total live births in the same year

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Post neonatal mortality rate

• Number of deaths of children
• between 28 days and one
• year of age in a given year X1000
• Total live births in the same year

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Causes

• Neonatal mortality
• Endogenous factors
• Post-neonatal mortality
• Exogenous causes

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Infant mortality rate

• IMR
• Number of deaths of children
• less than one year of age in
• an a year
• 
  X1000
• Number of live births in the same year

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• What are the causes?

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Medical causes of infant mortality

• 1- neonatal mortality
• LBW
• Birth injury
• Congenital anomalies
• Hemolytic disease of newborn
• Conditions of placenta and cord
• Diarroheal diseases
• ARI
• tetanus

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2- post-neonatal mortality

• Diarrheal diseases
• ARI
• Communicable diseases
• Malnutrition
• Congenital anomalies
• Accidents.

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Factors affecting IM

• 1-biological factors
• Birth weight
• Age of mother
• Birth order
• Birth spacing
• Multiple births
• Family size
• High fertility

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other factors

• 2- economic factors
• 3- cultural and social factors
• breast feeding
• customs
• early marriage
• quality of mothering
• maternal education
• quality of health care
• broken families
• illegitimate babies
• untrained midwives
• bad environmental sanitation.

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measures to reduce IM

• prenatal feeding
• prevention of infection
• breast feeding
• growth monitoring
• family planning
• sanitation
• provision of PHC
• socioeconomic development
• education

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child death rate(1-4 year mortality rate)

• number of deaths of
• children aged 1-4 years
• during a year
• 
  X1000
• total number of children
• aged 1-4 years at the middle
• of the year

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child mortality rate(under 5 mortality rate)

• number of deaths of children
• less than 5years of age in
• a given year
• 
  X1000
• number of live births in the same year

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• Thank you

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