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Measurement of Maternal Mortality in Maldives. Ms. Mariyam Nazviya Ministry of Health & Family Republic of Maldives ESA/STAT/AC.219/21. Contents. Background Information on Maldives Definitions MMR Trends Measurement of MMR Sources Methodology Maternal Death Review process - PowerPoint PPT Presentation
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Ms. Mariyam NazviyaMs. Mariyam NazviyaMinistry of Health & FamilyMinistry of Health & FamilyRepublic of MaldivesRepublic of Maldives
ESA/STAT/AC.219/21ESA/STAT/AC.219/21
Background Information on MaldivesBackground Information on MaldivesDefinitionsDefinitionsMMR TrendsMMR TrendsMeasurement of MMRMeasurement of MMR
Sources Sources MethodologyMethodology
Maternal Death Review processMaternal Death Review processProgress towards achieving MDG Goal 5Progress towards achieving MDG Goal 5Issues & ChallengesIssues & Challenges
Consist of 1190 tiny coral IslandsConsist of 1190 tiny coral IslandsSpread over 90,000sq km of the Spread over 90,000sq km of the Indian ocean. Indian ocean. Inhabited 200 islandsInhabited 200 islandsIslands grouped to 20 atollsIslands grouped to 20 atollsThe total population of the country is The total population of the country is 31,454231,4542Small dispersed populations with difficult Small dispersed populations with difficult and expensive transport system cause and expensive transport system cause delays in timely exchange of information.delays in timely exchange of information.
However development in However development in telecommunication has brought about telecommunication has brought about positive changespositive changes
WHO standard definitions are followed in the country:WHO standard definitions are followed in the country:
Maternal DeathMaternal Death::The death of a woman while pregnant or within 42 days of termination of The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.not from accidental or incidental causes.
Direct Obstetric cause:Direct Obstetric cause:Those resulting from obstetric complications of the pregnant state Those resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium) from interventions, omissions, (pregnancy, labour and puerperium) from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the incorrect treatment or from a chain of events resulting from any of the aboveabove
Indirect Obstetric cause:Indirect Obstetric cause:Those resulting from previous existing disease or disease that developed Those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancywhich was aggravated by physiologic effects of pregnancy
Institutional level (Facility)
investigation
Central level (MOHF)
investigationMethods
Coverage National - All maternal deaths are reviewed
1997Started Maternal Death Review committee 1999
Death Reporting
Notification of death mandatory within 24 hrs of occurrence
Reporting through death forms - VRS
Institutional (facility) level
Case Review (MOHF)
Maternal and Perinatal Maternal and Perinatal Morbidity and Mortality Morbidity and Mortality
CommitteeCommittee
Analysis of case
Detailed information (within 7-14 days)
Reviews forms/ questionnaires / Patient
Medical Record / Past Records
Maternal Death Review Committee
Analysis of case
Confirms cause of death / identifies faults/ factors
Directs to additional investigation /information
Recommends preventive actions
Source of information
Medical recordsNursing care recordsANC/PNC recordsPrescription recordsInterviews with attending staff
ANC recordsOther health care recordsInterviews - health workersInterviews - family members
Information analysis & reporting
Maternal Death Review Committee
Ministry of Health, Health Information and Research Section
Review & analyze the information
Prepares a case report of each death; Compiles an annual report
Every Five Years, a Synthesis Report is
compiled
200075/
100000lb
200981/
100000lb
2015125/
100000lb
Reduce maternal mortality ratio by three quarters, between 1990 and 2015
1990500/
100000lb
FLUCTUATING TREND … On Track
Improvement in health care services
Expansion of obstetric/gynecological
services
Improved antenatal care services
High proportion of institutional deliveries
High proportion of skilled attendance at birth
With the decline
in mortality,
direct causes are declining
Strengthening and expansion of Maternal and Strengthening and expansion of Maternal and Child health servicesChild health services
Strengthening of essential obstetric careStrengthening of essential obstetric care
Ensure quality of careEnsure quality of care
Proper supervision and monitoring of servicesProper supervision and monitoring of services
Implementation of target oriented awareness Implementation of target oriented awareness programmesprogrammes
Population size very small Population size very small Statistically brings a large variation to MMR with just one or Statistically brings a large variation to MMR with just one or two deathstwo deaths
Over 90 Percent of Institutional deliveriesOver 90 Percent of Institutional deliveriesHowever, not all hospitals in atolls are equipped with However, not all hospitals in atolls are equipped with Emergency Obstetric / Neonatal care Emergency Obstetric / Neonatal care
Service Delivery and timely referral a challenge Service Delivery and timely referral a challenge due to geographical dispersed nature of islandsdue to geographical dispersed nature of islands
Establishing a public transport mechanism – one of Establishing a public transport mechanism – one of the priorities of the current governmentthe priorities of the current government
Quality of Care needs to be improvedQuality of Care needs to be improved
Limitation of capacity (institutional / HR)Limitation of capacity (institutional / HR)
Maldives has made significant achievements in reduction of Maldives has made significant achievements in reduction of Maternal Mortality since 1990 and currently the country's Maternal Mortality since 1990 and currently the country's MMR stands at 81 / 100,000 live births in the year 2009. MMR stands at 81 / 100,000 live births in the year 2009.
Maternal death reviews are conducted for all Maternal deathsMaternal death reviews are conducted for all Maternal deaths
More than one source of reporting (through VRS as well as More than one source of reporting (through VRS as well as Maternal Death Review Process)Maternal Death Review Process)
Due to the small population, an increase or decrease in just one Due to the small population, an increase or decrease in just one maternal death brings a significant change to the MMR. As maternal death brings a significant change to the MMR. As such, the trends over the past few years is seen to fluctuate, such, the trends over the past few years is seen to fluctuate, although generally it can be said that country is on track to although generally it can be said that country is on track to achieving MDG Goal 5. achieving MDG Goal 5.