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Maternal and Child Health. July 29 , 2013. 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 Presentation
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Maternal and Child Health
July 29, 2013
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
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)
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
• 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
• 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.
• Every minute 20 children under 5 years old die, leading to over 10.6 million deaths a year.
• 53% of childhood deaths are associated with malnutrition, as a direct or indirect cause.
• 66% of child deaths each year are caused by diarrhea, acute respiratory infections, measles, malaria and perinatal illnesses.
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
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?
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
0
200
400
600
800
1000
1200
1400
1600
1800
USHaitiMalawi
Maternal Mortality
MMR
UNICEF, 2004
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
0
2
4
6
8
10
12
14
16
18
20
US Maternal Mortality Ratios
White, non-HispanicAfrican-American
Disparities at home
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.
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.
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.