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Indicators of mch care

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Indicators of mch care

  1. 1. Indicators of MCH care Dr Nishant Kumar Assistant Professor Department of Community Medicine Madhubani Medical College , Madhubani , Bihar
  2. 2. MCH Indicator Classification Mortality indicators Morbidity indicators Growth and development.
  3. 3. Indicators MCH Indicator Maternal Indicators Maternal mortality ratio and rate Late Maternal death Pregnancy related death Indicator during Infancy Perinatal mortality rate, Neonatal mortality rate Post Neonatal mortality rate Infant mortality rate Indicators during childhood 1 to 4 year mortality rate Under 5 mortality rate
  4. 4. Maternal mortality Ratio • Ratio- A ratio is quotient in which the numerator is not a part of denominator • Maternal Death : A maternal death (as cited in International Classification of Disease or ICD-10, [WHO, 1992]) is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, and can stem from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
  5. 5. Maternal Mortality Ratio Total number of female death, due to complication of pregnancy , child birth or within 42 days of delivery from puerperal causes an area during a given year. Total number of live births in the same area and year 1000
  6. 6. Maternal Mortality Ratio • Live Birth : It refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
  7. 7. Maternal Mortality Rate • Rate : A rate is a quotient in which the numerator is a part of denominator. Total number of female death, due to complication of pregnancy , child birth or within 42 days of delivery from puerperal causes an area during a given year. Number of women in reproductive age group during the same period 1000
  8. 8. Other Maternal Mortality Indicators • 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 • Pregnancy –related death :Death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the cause of death
  9. 9. Causes of Maternal MortalityMaternalmortality Direct Cause Obstetric complications of the pregnant state interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Toxemias of pregnancy, Hemorrhage Infection, Obstructed labour, Abortion, Indirect Causes Previous existing disease or disease that developed during pregnancy, and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy Anaemia, Associated diseases e.g cardiac, renal ,Infectious, Malignany
  10. 10. Social Determinants of Maternal Mortality 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
  11. 11. Burden of Problem • Every day in 2015, about 830 women died due to complications of pregnancy and child birth. • The MMR in India has dropped from 212 per 100,000 live births in the period 2007-09 to 167 per 100,000 live births in the period 2011-13, as per the latest report of the registrar general of India, sample registration system (RGI-SRS). "India's rate of decline of MMR between 2007-09 and 2011-13 is 5.7 per cent. • Highest in Assam (300) and lowest in Kerala (61)
  12. 12. Indicators during Infancy • A stillbirth is the death of a fetus weighing 1000g or more, or of 28-weeks gestation or more if weight is unavailable. SBR Foetal death weighting over 1000 gm at birth during the year Total Birth( total live birth+ still births weighting over 1000gram 1000
  13. 13. Indicator During Infancy and Childhood 7 days 28 days 1 year 5 year  ENMR  NMR  IMR  U5MR Expressed as per 1000 live birth
  14. 14. Indicator During Infancy • Perinatal Mortality rate ‘Number of stillbirths and deaths in the first week of life per 1,000 total births, the perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth’. • It measures the wastage of pregnancy both before and after delivery PMR No of Still births + No of early neonatal death weight over 1000 g at birth Total number of live birth , weighting over 1000 grams 1000
  15. 15. Perinatal Mortality Rate • The PMR is a key outcome indicator for newborn care and directly reflects prenatal, intrapartum, and newborn care • Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths
  16. 16. Indicator During Infancy • Post Neonatal Mortality rate Number of Death of infants between 29 days and up to one year of age in a given year Total number of Live birth in the same year 1000
  17. 17. Current Situation Week 1 73% Week2 13% Week 3-4 14% Figure : Distribution of neonatal Death by time since birth 50% 10% 14% 9% 7% 5% 5% Figure :Propotion of infants dying in first week of life Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
  18. 18. • 46% of Maternal deaths • 40% of Neonatal Death • 40% of Still birth Day of Birth is Most dangerous for Mother and Newborn Intervention targeting day of birth – Triple benefit
  19. 19. Current Situation Preterm 35% Sepsis 15% Pneumonia 16% Birth asphyxia 20% Malformation 9% Diarrhea 2% Others 3% Figure : Causes of Neonatal Mortality in India Source :Liu et al , Lancet 2012 Statistical Report
  20. 20. Causes of Post neonatal Mortality • Diarrheal diseases • ARI • Communicable diseases • Malnutrition • Congenital anomalies • Accidents.
  21. 21. Current Situation Trends of Child Mortality Rates.
  22. 22. Current Situation Difference between rural & urban NMR of major states.
  23. 23. Current Situation 64 63 63 62 59 58 58 57 56 56 54 54 54 53 49 39 0 10 20 30 40 50 60 70 Contribution of Neonatal deaths to Under Five Mortality (%) Data source – SRS 2012
  24. 24. Indicators During Childhood Child death rate (1-4 year mortality rate) Number of deaths of children aged 1-4 years during a year Total number of children aged 1-4 years at the middle of the year 1000
  25. 25. Child Survival Index • This indicator is calculated by subtracting the Under Five Mortality from 1000 and dividing this figure by 10 • It is a measure of social development and attention given to the care of under-five children • This Index is much better in developed countries as compared to developing country like India • India 49.7% in 2013 while Japan 99.6% in the same year
  26. 26. Causes of Under 5 Mortality • Acute Respiratory infections • Measles • Diphtheria • Pertussis • Acute diarrhoeal diseases
  27. 27. Summary Birth 7 days 28 Days 1 year28 weeks Still Birth Neonatal Death Early neonatal death Perinatal Death Late neonatal death Post Neonatal Death Infant Death
  28. 28. Thank You

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