maternal and child health
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Maternal and Child Health. August 1, 2011. Maternal Child Health. Different from Women’s Health and Child’s Health “Maternal” Health of mothers and children highly inter-related: pregnancy, nutrition, lactation, primary care provision, health seeking, advocacy for education etc - PowerPoint PPT PresentationTRANSCRIPT
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Maternal and Child Health
August 1, 2011
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Maternal Child Health
• Different from Women’s Health and Child’s Health– “Maternal”– Health of mothers and
children highly inter-related: pregnancy, nutrition, lactation, primary care provision, health seeking, advocacy for education etc
– Maternal educational status consistent predictor of infant survival
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Leading Causes of Under Five M & M in Developing World
• Infectious Diseases leading cause of death among children (about half)
• Undernutrition – Potentiating effects on infectious diseases– Related to poor learning and cognitive function
• Perinatal (extreme prematurity, stillbirth etc)
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Infectious Diseases in Under 5’s
• Many vaccine preventable– Expanded Program of Immunization (EPI) established 1974– Has significantly reduced polio, neonatal tetanus, and measles
• Parasitic diseases-treatment available for almost all– Malaria major killer in sub-saharan Africa (1 million per year) and
extensive morbidity extensive ---> severe anemia, undernutrition– Helminth infections ---> anemia, undernutrition, cognitive
• HIV/AIDS• Acute lower respiratory tract infections (number 1)• Diarrheal illnesses - highlight precarious state of children
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• The assets of the top 3 billionaires are more than the combined GDP of all of the least developed countries and their 600 million people
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• At least 1/5 of the world’s population (1.2 billion people) live in absolute poverty, surviving on US$1 or less a day, and a total of 50%, half of the world’s population, live on US$2 or less a day
• 70% of people living in absolute poverty are women.
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• Every minute 20 children under 5 years old die, leading to over 10.6 million deaths a year.
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• 53% of childhood deaths are associated with malnutrition, as a direct or indirect cause.
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• 66% of child deaths each year are caused by diarrhea, acute respiratory infections, measles, malaria and perinatal illnesses.
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Sources: For cause-specific mortality: EIP/WHO. Caulfield LE, de Onis M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr. 2004 Jul.; 80 (1): 193-8
Diarrhoea12%
Other29%
Perinatal22% HIV/AIDS
4%
Measles5%
Malaria8%
Pneumonia20%
Deaths associated
with undernutrition
60%
Major causes of death among children under five, world, 2000
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0
20
40
60
80
100
1983 1999 1983 1999
Post-neonatal mortality
Late neonatal mortality
Early neonatal mortality
Developing Regions
Developed Regions
Source: RHR/WHO, 2001
Infant Mortality, what are the factors?
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Maternal Mortality
• Risk of dying as result of pregnancy or childbirth
– 1 in 30 000 in Sweden– 1 in 6 in Afghanistan and Sierra Leone
• Maternal mortality ratio (# of maternal deaths/100 000 live births)
– US - 17– Haiti - 680– Malawi - 1800
UNICEF, 2004
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0
200
400
600
800
1000
1200
1400
1600
1800
US
Haiti
Malawi
Maternal Mortality
MMR
UNICEF, 2004
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More Disparities• Urban vs Rural
– Afghanistan: • MMR 418 in Kabul • MMR 6507 in rural Ragh
• Wealthy vs Impoverished– Peru
• Richest quintile – MMR 130• Poorest – MMR >800
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4
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10
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14
16
18
20
US Maternal Mortality Ratios
White, non-Hispanic
African-American
Disparities at home
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What can be done
26¢Measles vaccine Per dose
Malawi boosted immunization coverage to 90 percent in 2002 from 50 percent in 1980. For the first time ever, no measles deaths were reported in 1999.
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What can be done
$1.20Tetanus vaccine 3 doses for mother
Bangladesh increased coverage for mothers to 86 percent in 1998 from 5 percent in 1986; during the same period, the death rate fell to 4 per 1,000 live births from 41.
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What can be done
33¢Oral rehydration salts Per dose
In Mexico, since the introduction of oral rehydration therapy in 1984, mortality rates for diarrheal diseases fell by 60 percent in less than a decade.