Transcript Document 7376003

MOTHERHOOD & CHILDHOOD
MAIN PROBLEMS & STRATEGIES
ELENA A. ABUMUSLIMOVA
PH.D., ASSOCIATE PROFESSOR
Department of Public Health and Health Care,
Northern-West State Medical University named after I.I. Mechnikov, Saint-Petersburg
The United Nations
Millennium Development Goals
UNAIDS/G. Pirozzi
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The United Nations Millennium Development Goals are eight
goals that all 191 UN Member States have agreed to try to
achieve by the year 2015.
The United Nations Millennium Declaration, signed in
September 2000 commits world leaders to combat poverty,
hunger, disease, illiteracy, environmental degradation, and
discrimination against women.
8 Millennium Development Goals
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Eradicate extreme poverty and hunger (MDG 1)
Achieve universal primary education (MDG 2)
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG6)
Ensure environmental sustainability – safe drinking water and
sanitation (MDG 7)
Develop a global partnership for development (MDG 8)
MDG 1: Eradicate extreme poverty and hunger
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Poverty contributes to unintended pregnancies and pregnancyrelated mortality and morbidity in adolescent girls and women,
and under-nutrition and other nutrition-related factors contribute
to 35% of deaths of children under five year, while also
affecting women’s health.
Charging people less for health services reduces poverty and
makes women and children more willing to seek care.
Further efforts at the community level must make nutritional
interventions (such as exclusive breastfeeding for six months, use
of micronutrient supplements and deworming) a routine part of
care
MDG 2: Achieve universal primary education
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Gender parity in education is still to be achieved. It is essential
because educated girls and women improve prospects for the
whole family, helping to break the cycle of poverty. In Africa, for
example, children whose mothers have been educated for at least
five years are 40% more likely to live beyond the age of five.
Schools can serve as a point of contact for women and children,
allowing health-related information to be shared, services offered
and health literacy promoted.
MDG 3:
Promote gender equality and empower women
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Empowerment and gender equality improve the health of women
and children by increasing reproductive choices, reducing child
marriages and tackling discrimination and gender-based violence.
Partners should look for opportunities to coordinate their
advocacy and educational programs (including those for men and
boys) with organizations focusing on gender equality.
Shared programs might include family-planning services, health
education services, and systems to identify women at risk of
domestic violence.
MDG 4: Reduce child mortality
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Reaching the MDG on reducing child mortality will require
universal coverage with key effective, affordable interventions:
care for newborns and their mothers; infant and young child
feeding; vaccines; prevention and case management of
pneumonia, diarrhoea and sepsis; malaria control; and prevention
and care of HIV/AIDS. In countries with high mortality, these
interventions could reduce the number of deaths by more than
half.
MDG 5: Improve maternal health
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Women died during pregnancy and childbirth because they had no
access to skilled routine and emergency care.
In developing countries the risk of maternal death is very high at
1 in 39, unlike in the developed world where a woman's life time
risk of dying during or following pregnancy is 1 in 3800.
Increasing numbers of women are now seeking care during
childbirth in health facilities and therefore it is important to ensure
that quality of care provided is optimal.
Globally, over 10% of all women do not have access to or are
not using an effective method of contraception. It is estimated
that satisfying the unmet need for family planning alone could cut
the number of maternal deaths by almost a third.
MDG6:
Combat HIV/AIDS, malaria and other diseases
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Many women and children die needlessly from diseases that we
have the tools to prevent and treat. In Africa, reductions in
maternal and childhood mortality have been achieved by
effectively treating HIV/AIDS, preventing mother-to-child
transmission (PMTCT) of HIV and preventing and treating malaria.
We should coordinate efforts on such interventions by, for
example, integrating PMTCT into maternal and child health
services and ensuring that mothers who bring children for
immunization are offered other essential interventions.
MDG 7: Ensure environmental sustainability – safe
drinking water and sanitation
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Dirty water and inadequate sanitation cause diseases such as
diarrhea, typhoid, cholera and dysentery, especially among
pregnant women, so sustainable access to safe drinking water and
adequate sanitation is critical. Community-based health efforts
must educate women and children about sanitation and must
improve access to safe drinking water.
MDG 8: Develop a global partnership for
development
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Global partnership and the sufficient and effective provision of
aid and financing are essential. In addition, collaboration with
pharmaceutical companies and the private sector must continue
to provide access to affordable, essential drugs as well as to bring
the benefits of new technologies and knowledge to those who
need them most.
EVERY WOMAN
EVERY CHILD
Key facts (1)
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Worldwide, 800 women die
every day due to complications
during pregnancy and childbirth
- about 287 000 women in
2010.
In developing countries, conditions related to
pregnancy and childbirth constitute the second
leading causes (after HIV/AIDS) of death among
women of reproductive age.
Key facts (2)
The four main killers are:
 severe bleeding,
 infections,
 unsafe abortion,
 and hypertensive disorders (pre-eclampsia and eclampsia).
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Bleeding after delivery can kill even a healthy woman, if
unattended, within two hours. Most of these deaths are
preventable.
Key facts (3)
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More than 136 million women give birth a year.
About 20 million of them experience pregnancy-related
illness after childbirth. The list of morbidities is long and
diverse, and includes fever, anemia, fistula, incontinence,
infertility and depression.
Key facts (4)
About 16 million girls aged between 15 and 19 give birth
each year, accounting for more than 10% of all births. In
the developing world, about 90% of the births to
adolescents occur in marriage.
In low- and middle-income
countries, complications
from pregnancy and
childbirth are the leading
cause of death among girls
15-19.
Key facts (5)
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The state of maternal health mirrors the gap between the
rich and the poor.
Less than 1% of maternal deaths occur in high-income
countries.
A woman's lifetime risk of dying from complications in
childbirth or pregnancy is an average of one in 150 in
developing countries and compared to one in 3800 in
developed countries.
Also, maternal mortality is higher in rural areas and among
poorer and less educated communities. Of the 800 women
who die every day, 440 live in sub-Saharan Africa, 230 in
Southern Asia and five in high-income countries.
Key facts (6)
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Most maternal deaths can be
prevented through skilled care at
childbirth and access to emergency
obstetric care.
In sub-Saharan Africa, where
maternal mortality ratios are the
highest, less than 50% of women
are attended by a trained midwife,
nurse or doctor during childbirth.
Key facts (7)
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In developing countries, the percentage of women who
have at least four antenatal care visits during pregnancy
ranges from 56% for rural women to 72% for urban
women.
 Women who do not receive the
necessary check-ups miss the
opportunity to detect problems
and receive appropriate care and
treatment. This also includes
immunization and prevention of
mother-to-child-transmission of
HIV/AIDS.
Key facts (8)
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About 21 million unsafe
abortions are carried out,
mostly in developing
countries every year, resulting
in 47 000 maternal deaths.
Many of these deaths could
be prevented if information
on family planning and
contraceptives were available
and put into practice.
Key facts (9)
•One target of the Millennium
Development Goals (MDGs) is to
reduce the maternal mortality
ratio by three quarters between
1990 and 2015. So far, progress
has been slow.

Since 1990 the global maternal mortality ratio has declined
by only 3.1 % annually instead of the 5.5% needed to
achieve MDG 5, aimed at improving maternal health.
Key facts (10)
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The main obstacle to progress towards better health for
mothers is the lack of skilled care. This is aggravated by a
global shortage of qualified health workers.
MDG 5: Improve maternal health
WHO key working areas
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Strengthening health systems and promoting interventions focusing
on policies and strategies that work, are pro-poor and cost-effective.
Monitoring and evaluating the burden of maternal and newborn illhealth and its impact on societies and their socio-economic
development.
Building effective partnerships in order to make best use of scarce
resources and minimize duplication in efforts to improve maternal
and newborn health.
Advocating for investment in maternal and newborn health by
highlighting the social and economic benefits and by emphasizing
maternal mortality as human rights and equity issue.
Coordinating research, with wide-scale application, that focuses on
improving maternal health in pregnancy and during and after
childbirth.
Stages of rendering of the preventive and
medical aid for women (by WHO)
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rendering assistance to the woman before pregnant;
prenatal protection of foetus and pregnant women;
intranatal protection of foetus and rational medical aid of
deliveries;
health protection of newborn, the organization of correct
feeding, creation of optimum conditions for physical
development;
health protection child health during the preschool period,
maintenance of conditions for optimum physical
development, creation of the necessary immunologic status;
health protection of school-age-children.
The basic establishments of medical services for
women
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Maternity hospital,
Female consultation,
Maternity and gynecologic developments of the general
hospitals,
Obstetrics-gynecological clinics of medical institutes and
institutes of improvement of doctors,
Scientific research institute of obstetrics and gynecology,
Centre of protection of motherhood and the childhood.
Dynamic supervision over woman health (1)
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During the organization of medical aid to pregnant women
it is important to register them on time (till 3 months).
During normal pregnancy the woman is recommended:
to visit consultation in 7-10 days after the first visit,
come back to the doctor once a month in first half of
pregnancy,
after 20 weeks of pregnancy visit a doctor 2 times a month,
after 32 weeks - 3-4 times a month.
Dynamic supervision over woman health (2)
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During the pregnancy each woman has to be examined:
by the therapist - 2 times,
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by the stomatologist - under indications;
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the clinical analysis of blood (2 - 3 times),
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the analysis urine (at each visiting),
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bacteriological research separated of a vagina, definition of group of
blood, the Rh-factor (if Rhesus factor - negative additional inspection of
the husband should be done),
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the analysis of blood on Wassermann reaction (2 times),
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the analysis of blood on a HIV.
MDG 5: Improve maternal health
Indicators
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Maternal mortality ratio
Proportion of deliveries attended by skilled health
personnel
Contraceptive prevalence rate
Adolescent birth rate
Antenatal care coverage
Maternal death definition
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The death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and
site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not
from accidental or incidental causes.
International statistical classification of diseases and related health problems, 10th
revision (ICD-10)
Direct or indirect maternal death
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Direct maternal deaths are those resulting from obstetric complications of
the pregnant state (pregnancy, delivery and postpartum), interventions,
omissions, incorrect treatment, or a chain of events resulting from any
of the above. Deaths due to, for example, obstetric haemorrhage or
hypertensive disorders in pregnancy, or those due to complications of
anaesthesia or caesarean section are classified as direct maternal
deaths.
Indirect maternal deaths are those resulting from previously existing
diseases, or from diseases that developed during pregnancy and that
were not due to direct obstetric causes but aggravated by physiological
effects of pregnancy. For example, deaths due to aggravation of an
existing cardiac or renal disease are considered indirect maternal
deaths.
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Pregnancy-related death
The death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the cause of
death.
Late maternal death
The death of a woman from direct or indirect obstetric
causes, more than 42 days, but less than 1 year after
termination of pregnancy.
Statistical measures of maternal mortality
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Maternal mortality ratio (MMR)
Number of maternal deaths during a given time period per 100 000 live
births during the same time period.
Maternal mortality rate (MMRate)
Number of maternal deaths in a given period per 100 000 women of
reproductive age during the same time period.
Adult lifetime risk of maternal death
The probability that a 15-year-old women will die eventually from a
maternal cause.
The proportion of maternal deaths among deaths of women of reproductive
age (PM)
The number of maternal deaths in a given time period divided by the
total deaths among women aged 15–49 years.
Maternal mortality ratio (MMR), by WHO, 2010
(maternal death per 100 000 live birth)
Region
2010
1990
% change in
MMR
between 1990
& 2010
MMR
Number of
maternal
deaths
MMR
Number of
maternal
deaths
World
210
287 000
400
543 000
- 47
Developed regions
(Russia)
16
2200
26
4 000
- 39
Developing regions
240
284 000
440
539 000
- 47
Southern Asia
(India)
220
83 000
590
233 000
- 64
Southern Asia
excluding India
240
28 000
590
70 000
- 59
Caucasus and
Central Asia
(Azerbaijan)
46
750
71
1400
- 35
Western Asia
(Saudi Arabia)
71
3500
170
7000
- 57
EVERY WOMAN
EVERY CHILD
MDG 4: reduce child mortality
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6.6 million children under five died in 2012.
Almost 75% of all child deaths are attributable to
just six conditions: neonatal causes, pneumonia,
diarrhoea, malaria, measles, and HIV/AIDS. The
aim is to further cut child mortality by two thirds by
2015 from the 1990 level.
Target: Reduce child mortality by two-thirds,
between 1990 and 2015, the under-five mortality
rate

A child's risk of dying is highest in
the first month of life
In the first month of life safe childbirth and effective
neonatal care are essential. Preterm birth, birth asphyxia
and infections cause most newborn deaths. Once children
have reached one month of age, and up until the age of
five years, the main causes of loss of life are pneumonia,
diarrhoea, and malaria. Malnutrition contributes to almost
one half of all child deaths.
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Nearly three million children died in
2011 within a month of their birth
Newborn life is fragile. Health risks to
newborns are minimized by:
1) quality care during pregnancy;
2) safe delivery by a skilled birth
attendant;
3) essential neonatal care after birth:
immediate attention to breathing and
warmth, hygienic cord and skin care,
and exclusive breastfeeding.
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Pneumonia is the largest single
cause of death in children under
five years of age
In 2011, it killed an estimated 1.2 million children under the
age of five years, accounting for 17% of all deaths of children
under five years old worldwide. Addressing the major risk
factors for pneumonia through immunization, exclusive
breastfeeding, reduction in household air pollution and
adequate nutrition is essential for prevention. Antibiotics and
oxygen are vital treatment tools.
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Diarrhoeal diseases are a leading cause
of sickness and death among children in
developing countries
Exclusive breastfeeding and proper
sanitation and hygiene, and immunization
help prevent diarrhoea among young
children.
Treatment for sick children with Oral
Rehydration Salts (ORS) and zinc
supplements is safe, cost-effective and
saves lives. The lives of more than 50
million children have been saved in the last
25 years as a result of ORS.
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Every minute a child dies from malaria
It is one of the leading causes of death among children underfive. Sleeping under insecticide-treated nets prevents
transmission and increase child survival. Early testing and
treatment with effective anti-malarial medication saves lives.
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Over 90% of children with HIV are infected through motherto-child transmission
This is preventable with the use of antiretrovirals, as well as
safer delivery and feeding practices. An estimated two million
children under 15 years of age are living with HIV, and every
day more than 1000 are newly infected.
Without intervention, more than half of all HIV-infected
children die before their
second birthday.
Early testing and treatment with
antiretroviral therapy for all
HIV-infected children greatly
improves survival and quality of life.
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In 2012, about 17 million children
suffered from severe wasting
Almost half of the under-five child
deaths are associated malnutrition.
Severe acute malnutrition leaves children
more vulnerable to serious illness and
high probability of dying.
Most children can be successfully treated
at home with ready-to-use therapeutic
foods (RUTF). Globally, in 2012, an
estimated 162 million children below 5
years of age, were stunted and 99
million were underweight.
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Some 80% of the world’s under-five deaths in 2012
occurred in only 25 countries, and about half in only five
countries
Under-five deaths are increasingly concentrated in subSaharan Africa and Southern Asia. Child survival rates differ
significantly around the world. Within countries, child mortality
is higher in rural areas, and among poorer and less educated
families.
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About two-thirds of child deaths are preventable
They are preventable through access to practical, low-cost
interventions, and effective primary care up to five years of
age. Child health is improving, but serious challenges remain to
achieve global goals to reduce deaths. Stronger health systems
are crucial for improving access to care and prevention.
MDG 4: reduce child mortality
WHO strategies
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Appropriate home care and timely treatment of
complications for newborns;
Integrated management of childhood illness for all children
under five years old;
Expanded programme on immunization;
Infant and young child feeding.
These child health strategies are complemented by
interventions for maternal health, in particular, skilled care
during pregnancy and childbirth.
Typical establishments
rendering medical - prophylaxis to
children
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city and regional pediatric hospitals,
the specialized children's hospitals (infectious, psychiatric,
tubercular, orthopedic-surgical, regenerative treatment clinic),
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children's city polyclinics,
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children's stomatological polyclinics,
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establishments on protection of motherhood and the childhood
(children's homes, maternity hospitals, dairy cuisines),
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children's balneal clinics,
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the sanatorium,
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the specialized sanatorium establishments for all-the-year action,
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children's department in hospitals and polyclinics of the general
structure.
The children's city polyclinic provides:
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the organization and carrying out a complex of preventive
actions (dynamic medical supervision over healthy children,
routine inspections, prophylactic medical examination,
preventive vaccination);
medical consultation by home visiting service and in
polyclinic (including the specialized medical aid), directing
children for treatment in hospitals;
treatment-and-prophylactic work in preschool
establishments and schools;
carrying out antiepidemic actions together with territorial
establishments sanitary epidemic service.
Work load of the local pediatrician
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In an area under specifications there should be 750-800
children up to 17 years old inclusive, including 40-60
children of the first year of life.
Work load of the local pediatrician is: 5 people on 1
reception hour in a polyclinic (7 - at routine inspections) and
2 - under service at-home.
Under-five mortality rate
(probability of dying by age 5 per 1000 live births)
Years Azerbaidjan
India
Russia
Saudi
Arabia
Finland
2012 35 (24-50)
56 (51-62)
10 (10-11)
9 (8-10)
3 (3-3)
2010 39 (29-51)
61 (57-66)
12 (11-12)
10 (9-11)
3 (3-3)
2005 51 (43-60)
75 (72-79)
17 (16-17)
15 (14-17)
4 (4-4)
2000 72 (64-81)
92 (88-95)
23 (23-24)
22 (20-25)
4 (4-4)
1995 90
(81-100)
109
(105-113)
26 (26-27)
31 (27-37)
5 (5-5)
1990 93
(84-103)
126
(122-130)
26 (26-27)
47 (39-56)
7 (7-7)
The 11 indicators of maternal, newborn
and child health (by WHO)
1
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maternal mortality ratio (deaths per 100 000 live births);
underfive child mortality, with the proportion of newborn deaths
(deaths per 1000 live births);
children under five who are stunted (percentage of children under
five years of age whose height-for-age is below minus two
standard deviations from the median of the WHO Child Growth
Standards).
These three health status indicators are essential for monitoring MDGs.
Stunting, a nutrition indicator, is important for understanding not only
outcomes, but also determinants of maternal and child health. Nutrition
is also a useful proxy indicator for development more broadly.
The 11 indicators of maternal, newborn
and child health (by WHO)
2
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met need for contraception; (proportion of women aged 15-49
years who are married or in union and who have met their need
for family planning, i.e. who do not want any more children or
want to wait at least two years before having a baby,
and are using contraception);
antenatal care coverage (percentage of women aged 15–49 with
a live birth who received antenatal care by a skilled health
provider at least four times during pregnancy);
antiretroviral prophylaxis among HIV-positive pregnant women
to prevent vertical transmission of HIV, and antiretroviral therapy
for women who are treatment-eligible;
skilled attendant at birth (percentage of live births attended by
skilled health personnel);
The 11 indicators of maternal, newborn
and child health (by WHO)
3
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postnatal care for mothers and babies (percentage of
mothers and babies who received postnatal care visit
within two days of childbirth);
exclusive breastfeeding for six months (percentage of
infants aged 0–5 months who are exclusively breastfed);
three doses of the combined diphtheria, pertussis and
tetanus vaccine (percentage of infants aged 12–23 months
who received three doses of diphtheria/pertussis/tetanus
vaccine);
antibiotic treatment for pneumonia (percentage of children
aged 0–59 months with suspected pneumonia receiving
antibiotics).
Indicators of maternal, newborn and
child health (by WHO)
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4
These eight coverage indicators have been selected
because they are strategic and significant: each one
represents a part of the continuum of care and
each one is connected with other dimensions of
health and health systems.
The global consensus for Maternal, newborn
and child health