neonatal public health policy - … · neonatal public health policy fossari, marcio ......
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NEONATAL PUBLIC HEALTHPOLICYFossari, MarcioMolinari, SilvanaDos Santos, RobertaReiser, Karina
City of Itajaí - BRA
THE CITYWe have 205.271 habitants
A average of 2.991 live births/year
About 2.400 in the Public Maternity
It´s a port town City
It has a human development index of0,795 3rd in the province
We have about 76% of the City total Areacover by the Family Health Strategy anddivided in the micro-areas.
The Family Health team has at least onenurse, one medical doctor and acommunity health worker (variable aboutthe number of people)
http://cod.ibge.gov.br/232T9
http://dab.saúde.gov.br
CHILD < 1Y MORTALITY 2010-2013
dez-10 dez-11 dez-12 dez-13
Early Neonatal 18 19 22 22
Late Neonatal 3 13 7 11
After Neonatal 9 12 10 19
[VALOR]19
22 22
0
5
10
15
20
25
CHILD < 1Y MORTALITY 2010-2013
[VALOR]
1922
22
3
13
7
11
9 12 1019
Early Neonatal Late Neonatal After Neonatal
2011 2012 20132010
30
44
39
52
2700 2900 310
Total live births
DEATHS
2011
2012
2013
2010
CHILD < 1Y MORTALITY 2010-2013
CHILD MORTALITY < 1YEAR 2013
The second highest rate of child mortality from theprovince
One of the largest number of child death from the province
A fickle line of child mortality
The oscilatory curve demonstrates increase and decreasein mortality rate by chance, and not associated to anefficient Public Health Policy
It`s a surprise ?
RESOURCERESULTS
SURVEILLANCE
Public health surveillance is the continuous, systematic collection, analysis an
interpretation of health-related data needed for the planning, implementation, an
evaluation of public health practice. (WHO)
We have a systematic collection of data (a lot of manual work), but We were n
efficient at analysis and interpretation.
We were not anticipating the healthcare processes. (Very Important !!).
http://www.who.int/topics/public_health_surveillance/en
CARE
kind of care We?
Home visit based care
The Mother care and baby care
Breastfeeding empowerment
No more than 7 days to do the visit
Better if the community health worker
don’t go alone � have to be with the
nurse or the community doctor or both.
WHO technical consultation on newborn health indicators: Every Newborn Ac
Plan Metrics
SUPPORT
PrimaryLevel
IntermediateLevel
AdvancedLevel
We have to support our teams
We must be prepared for the needsthat We have and support them
We need to evaluate and think aboutthe strategy often
We have to give conditons for theproperly work of our teams
Preventive Care in all Levels
We began talk with the largest working
group in the public health, the community
health worker, and the nurses, most of
then are the supervisors from the health
facilities at primary care.
Total about 300 people.
We talk with all comumunity medical
doctors about the numbers of mortality.
Action
Re-evaluateAction
Evaluate
do We Start ?
ATTENTIVE CAREX
THERAPEUTICCARE
Mother/Baby
Breastfeeding
Desnutrition
Jaundice
Screeningtests
We were worried about a attentive care,
more about the visit at home for the
mother and the baby and less about a
medical appointment.
We tried thinking about a integrative
care and more of it, a care with
responsability, like to care about the
mother and the baby.
25.14
23.2
1.2 1.1
26.7
28.2
2013 2014
Features
Mother Age Number of Children Weeks at Birth
When We look for the very briefprofile from the mothers in 2013,
don’t found a socialdeterminant for the number ofneonatal death.
need to measure andevaluate the expected results,
tried to antecipated them.
say ?
A CARE MOVEMENT
Prenatal Care
BreastfeedingEmpowerment
Diabetes
Maternal Nutrition
Maternal Hypertension
Urinary tract Infection
Syphilis
Intrapartum care
• Attendant skilled healthstaff
• The Golden hour
• The father together orsomeone from theFamily
• Newborn measuresand physicalexamination after 1 hour
Home care
• Start at the Hospital
• No more than 7 days
• Look for some riskfactor
• Child log book
• Nurse or Medical Visi(same of prenatal care)
A CARE MOVEMENTIN THE CITY ??
World breastfeeding week (40%)
World Health day
First walk of breastfeeding
A municipal “law” for support breastfeeding actions
Better information (computers in all health facility)
CHILD <1Y MORTALITY 2013-2014
22
19
11
2
19
12
0
5
10
15
20
25
som 52 som 33
< 7 days 7- 27days 28 - 1year
2013 2014
CHILD < 1Y MORTALITY 2010-2014
dez-10 dez-11 dez-12 dez-13 dez-14
Early Neonatal 18 19 22 22 19
Late Neonatal 3 13 7 11 2
After Neonatal 9 12 10 19 12
[VALOR]19
22 22
19
0
5
10
15
20
25
13.3
10.9
15.2
12.8
17.3
10
2009 2010 2011 2012 2013 201
Mortality Rate
CHILD < 1Y MORTALITY 2010-2014
30
44
39
52
33
2700 2800 2900 3000 3100 3200 3300 340
Total live births
DEATHS
2011
2012
2014
2013
2010
CHILD < 1Y MORTALITY 2010-2014
WE MUST CONTINUE !!
• We believe that the set of all actions and not just one or the other has beenessential for improved results.
• We need to get a better result for the neonatal early deaths
• We have to improved a lot our prenatal assistance
• We must to continue all the actions and have more patterns for help
• Invest in education for all !!