Transcript Tamil Nadu’s initiatives to reduce MMR

Tamil Nadu’s initiatives to
reduce MMR
POPULATION
India
1027 Mn
Tamil Nadu
62.24 Mn
Demographic Profile
VITAL EVENTS
INDIA
TAMILNADU
53
(SRS 2008)
31
(SRS 2008)
254
(SRS 2004-06)
79
(State HMIS2008-09)
2.7
(SRS 2007)
1.6
(SRS 2007)
Institutional Deliveries
40.7
(NFHS 3)
90.4
(NFHS 3)
Maternal Anaemia
57.8
(NFHS 3)
53.3
(NFHS 3)
50.7
(NFHS 3)
97.6
(NFHS 3)
Infant Mortality Rate
Maternal Mortality Ratio
TFR
Mothers who had at least 3
antenatal care visits for their last
birth (%)
Trend in Maternal Mortality RateTamil Nadu
160
MMR
140
127
120
100
80
60
110
123 126
126
114
133
145
123 114
AMTSL,
LSAS
training,
Hiring of
Specialists
40
20
0
Before RCH
RCH
Source DPH & PM
YEAR
109 94
95
Blood
storage
facility,
AN
protocol,
etc
91
79
EMRI
NRHM
Improved utilization of PHCs
1.
Positioning 3 staff nurses in each PHC to provide 24x7
delivery care and training to these nurses in SBA skills
2.
Filling vacancies of medical officers and equipping the
PHCs to provide BEmONC services.
3.
Using untied funds and Patient Welfare Society funds
to improve ambience and user friendliness of PHCs
4.
Building bridges between PHC and community using
innovative IEC techniques
CONTRIBUTION IN DELIVERIES
(%)
100%
5.7
4.4
3.4
1.7
0.5
0.2
34.6
32.5
Domi.
90%
80%
70%
42.8
42.5
42.7
38.2
PVT
60%
50%
40%
30%
42.1
42.5
43.3
41.2
39.7
0%
GH
PHC
20%
10%
39.3
7.8
7.4
7.9
7.2
7.9
6.1
2004-05
2005-06
2006-07
13.1
22.9
26.9
5.8
2.3
2008-09
0.97
2009-10
Up to Dec.
2007-08
HSC
Baby warmers at PHC
Privacy assured during the
stay at PHC
RO , Solar water
heater
X-Ray Unit in PHC
Communication
Clean and Neat environment
Making Emergency Obstetric
Care available
Hiring private anaesthetists
and obstetricians to carry out
caesarian operations
Total caesarians done in
secondary institutions in
2006-07-40878
Increased to 45966 (upto
Jan2010)
Training MBBS doctors in
short term course in Life
Saving Anaesthesia Skills
and Emergency Obstetric
Care.
So far 177 doctors trained
No of LSCS done by trained
anesthetists - 12780
Making Emergency Obstetric
Care available (contd)
Emergency Referral Services (Toll free no 108)
introduced
AN mothers transported in Jan 2010 - 11152
 Cases of inter facility transfer
- 3401
Cause for concern!
Direct Cause
2006(%)
2008(%)
Post partum
haemorrhage
30
25.4
Pregnancy induced
Hypertension
6.5
6.5
Postpartum sepsis
3.5
3.2
Septic abortion
3.5
3.2
Indirect Cause
Anaemia in pregnancy
5.4
4.5
No major change in causes of maternal death!!
Analysis of Maternal death
(2006 & 2008) - A comparison
Place of Maternal death
2006(%)
2008(%)
Place of Maternal death
Teaching Hospital
31
39
Transit
22
19
Private Hospital
16
18
Head quarters Hospital
15
7
Home
12
12
Marginal reduction in transit… increase in
teaching hospital…no change in home deaths!
Analysis of period of Maternal
Death- 2008(%)
Out of 73 % of PN death
Antenatal
22
Intranatal
5
Post natal
73
8-42
Days,
29%
0 - 24
Hrs,
35%
1-7
Days,
36%
In spite of 99% institutional deliveries, 35% of the deaths
are still within 24 hrs!
Haemorrhage-Direct Cause
Interventions
• AMTSL training for the whole state-NASG of
Pathfinders International also being introduced
• Focus on training of all nurses including
secondary and tertiary institutions
• Ensuring safe blood availability – blood storage
centres and logistics of how to use them in
resource poor settings
PIH-Direct Cause
Interventions
• Retraining to all VHNs in ante natal care
protocols and skills including basic BP
measurement
• Use of electronic BP apparatus as a validating
device
• Model blocks to introduce calcium
supplementation for antenatal women
• Reemphasising the use of magnesium sulphate
in management of eclampsia
Sepsis-Direct cause
Interventions
• Post natal care visits- emphasis of danger signs
in home based care training
• IEC/ BCC messages to new mothers on danger
signs and to overcome cultural taboos of leaving
home before one week
• Ensuring forty eight hour stay in PHCs with
clear discharge guidelines to be checked by the
medical officer
• Hospital side- infection management practices
in labour rooms and post natal wards- training
programmes to be put in place
Obstructed /Prolonged labour
(Direct cause)
Interventions
• Training on use of partogram
• Emphasis on prompt referral
• Building district level quality control circles
using the obstetricians and nurse trainers
to improve delivery skills of nurses
• Ensuring availability of emergency
services at the CEmONC centres through
better networking
Anaemia management
(Indirect cause)
Interventions
• Anaemia management protocol for normal, moderate
and severe anaemia cases including mandatory
deworming in view of the high worm load
• Use of iron sucrose for severe anaemia
• Supplementation with Vit C and B-12 in view of the
deficiencies in diet
• Ensuring proper measurement of haemoglobin levels
• IEC strategy for changing diet and lifestyle of women
(using slippers..)
• Adolescent Anaemia Control programme - long term
effect on haemoglobin and ferritin levels
Other initiatives
Interventions
• Pregnancy cohort monitoring- focus on women
at risk
• Verbal community death autopsy conducted by
the district collector
• Continued focus on reduction of higher order
births- strong IUD campaign for those women
unwilling to accept sterilization
• Policy for safe abortion and ensuring availability
of MVA services at least at the block level.