women health profile (indicators)

By

Heba MoustafaAssistant lecturer of family

medicine faculty of medicine Suez Canal

[email protected]

While dr Ali – who is a member of family medicine post graduate group – facing a pregnant woman in the final clinical exam, his professor asked him the following question:

What is the latest maternal mortality ratio in Egypt?

Women health profile

DefinitionsWomen Health Indicators

in Egypt









Women health Profile (indicators)

criteriaMethod of calculation














• A Health indicator is a characteristic of an individual, population, or environment which is subject to measurement (directly or indirectly)

• Health indicators can be used to define public health problems at a particular point in time, to indicate change over time

Definition of health indicator

Criteria of indicators

• Measurable• Monitored over time• Accessible for country• Accuracy (reliable , valid)• Sensitive to changes and specific

Method of calculation

Cause-specific mortality and morbidity

• Maternal mortality ratio (per 100 000 live births)

Number of maternal deaths per 100 000 live births during a specified time period, usually one year.

= Number of maternal deaths x100 000

Number of live births in the year

Maternal mortality ratio in Egypt

• 1990 220

• 2000 110

• 2008 82

Health service coverage

Antenatal care coverage(%)

Percentage of women who utilized

antenatal care provided by skilled

health personnel as a percentage of

Live births in a given time period.

Antenatal care coverage in Egypt

From 2000- 2010

• At least one visit 74%

• At least 4 visits 66%

Births attended by skilled health personnel (%)

• Percentage of live births attended by skilled health personnel in a given period of time.

• In Egypt

From 2000- 2010

Births attended by skilled health personnel

79%

Institutional delivery coverage (%)

• IN Egypt

• 2005-2009 72% (UNICEF)

Births by caesarean section (%)

• Percentage of births by caesarean section among all live births in a given time period.

• In Egypt

From 2000- 2010

Births by caesarean section 27.6% (WHO)

28% (UNICEF)

Neonates protected at birth against neonatal tetanus (%)

• In Egypt

• 1990 74%

• 2000 80%

• 2009 85%

Contraceptive prevalence (%)

• In Egypt

• 2005-2009 60% (UNICEF)

Demographic and socioeconomic

• Total fertility rate (per woman)

Live birth for a woman in reproductive age

• In Egypt

• 1990 4.6

• 2000 3.3

• 2009 2.3 (WHO) 2.8 (UNICEF)

What is the latest maternal mortality ratio in Egypt?

• During the clinical exam of dr Ali the pregnant woman gave a family history of breast cancer in her grand mother so his professor asked him the following question:

• What are the recommendations of breast cancer screening?


Breast cancer

Endometrial cancer










Cervical cancer

Ovarian Cancer











Women health Profile (indicators)Cancer screening

In women

Screening for Breast Cancer

U.S. Preventive Services Task Force recommendations

• start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms. (Grade C recommendation)

• The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older.(I statement)

• The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)

Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility

• The U.S. Preventive Services Task Force (USPSTF) recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1(BRCA1) or breast cancer susceptibility gene 2 (BRCA2). Grade: D Recommendation.

• The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. Grade: B Recommendation.

American Cancer Society Guidelines

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health

• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over

• Breast self-exam (BSE) is an option for women starting in their 20s.

Screening for Cervical Cancer

U.S. Preventive Services Task Force recommendations

• The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. Grade: A Recommendation.

• The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. Grade: D Recommendation

• The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease. Grade: D Recommendation.

• The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. Grade: I Statement.

• The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer. Grade: I Statement.

American Cancer Society Guidelines

• All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.

• Beginning at age 30, women who have had 3 normal

Pap test results in a row may get screened every 2 to 3 years. Women older than 30 may also get screened every 3 years with either the conventional or liquid-based Pap test, plus the human papilloma virus (HPV) test.

• Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.

• Women who have had a total hysterectomy may also choose to stop having Pap tests, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to have Pap tests.

Screening for Ovarian Cancer

• The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer. Grade: D Recommendation.

Endometrial cancer

• American Cancer Society Guidelines

• The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer.

USPSTF Grade Definitions

• A Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients.

• B Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients

• C No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service].

• D Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients.

• I Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service].

Heba MoustafaAssistant lecturer of family medicine

faculty of medicine Suez Canal [email protected]

women health profile (indicators)

Health & Medicine

skilled health personnel

public health problems

percentage of births

percentage of live births

number of live births

percentage oflive births

given time period

given period of time