Transcript Ms. Mariyam Nazviya Ministry of Health & Family Republic of Maldives ESA/STAT/AC.219/21 Background Information on Maldives Definitions MMR Trends Measurement of MMR Sources Methodology Maternal Death Review process Progress towards.

Ms. Mariyam Nazviya
Ministry of Health & Family
Republic of Maldives
ESA/STAT/AC.219/21
Background Information on Maldives
Definitions
MMR Trends
Measurement of MMR
Sources
Methodology
Maternal Death Review process
Progress towards achieving MDG Goal 5
Issues & Challenges
Consist of 1190 tiny coral Islands
Spread over 90,000sq km of the
Indian ocean.
Inhabited 200 islands
Islands grouped to 20 atolls
The total population of the country is
31,4542
Small dispersed populations with difficult
and expensive transport system cause
delays in timely exchange of information.
However development in
telecommunication has brought about
positive changes
WHO standard definitions are followed in the country:
Maternal Death:
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
cause related to or aggravated by the pregnancy or its management but not
from accidental or incidental causes.
Direct Obstetric cause:
Those resulting from obstetric complications of the pregnant state
(pregnancy, labour and puerperium) from interventions, omissions, incorrect
treatment or from a chain of events resulting from any of the above
Indirect Obstetric cause:
Those resulting from previous existing disease or disease that developed
during pregnancy and which was not due to direct obstetric causes, but
which was aggravated by physiologic effects of pregnancy
Year
No. of deaths
MMR per 100,000 live births
1997
16
258
1998
9
158
1999
6
115
2000
4
75
2001
7
143
2002
8
160
2003
5
97
2004
5
96
2005
4
72
2006
4
69
2007
3
46
2008
4
57
2009
6
81
Central level
(MOHF)
investigation
Methods
Institutional level
(Facility)
investigation
Coverage
National All maternal deaths are reviewed
Started
1997
Maternal Death Review
committee 1999
Reporting through death forms - VRS
Death
Reporting
Notification of death mandatory within
24 hrs of occurrence
Detailed information (within 7-14 days)
Analysis
of case
Institutional
(facility) level
Case Review
(MOHF)
Maternal and Perinatal
Morbidity and Mortality
Committee
Maternal Death Review Committee
Reviews forms/ questionnaires
/ Patient Medical Record / Past
Records
Analysis
of case
Directs to additional
investigation /information
Confirms cause of death /
identifies faults/ factors
Recommends preventive
actions
Source of
information
Information
analysis &
reporting
Medical records
Nursing care records
ANC/PNC records
Prescription records
Interviews with attending staff
ANC records
Other health care records
Interviews - health workers
Interviews - family members
Maternal Death Review
Committee
Review & analyze the
information
Ministry of Health, Health
Information and Research
Section
Prepares a case report of
each death;
Compiles an annual report
Every Five Years, a
Synthesis Report is
compiled
Reduce maternal mortality ratio by three quarters, between
1990 and 2015
1990
2000
500/
100000lb
75/
100000lb
2009
81/
100000lb
2015
125/
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
Child health services
 Strengthening of essential obstetric care
 Ensure quality of care
 Proper supervision and monitoring of services
 Implementation of target oriented awareness
programmes
Population size very small
Statistically brings a large variation to MMR with just one or
two deaths
Over 90 Percent of Institutional deliveries
However, not all hospitals in atolls are equipped with
Emergency Obstetric / Neonatal care
Service Delivery and timely referral a challenge
due to geographical dispersed nature of islands
Establishing a public transport mechanism – one of
the priorities of the current government
Quality of Care needs to be improved
Limitation of capacity (institutional / HR)
Maldives has made significant achievements in reduction of
Maternal Mortality since 1990 and currently the country's
MMR stands at 81 / 100,000 live births in the year 2009.
Maternal death reviews are conducted for all Maternal deaths
More than one source of reporting (through VRS as well as
Maternal Death Review Process)
Due to the small population, an increase or decrease in just one
maternal death brings a significant change to the MMR. As
such, the trends over the past few years is seen to fluctuate,
although generally it can be said that country is on track to
achieving MDG Goal 5.