Maternal and Child Health June 30, 2014

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 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.

Maternal Mortality Risk of dying as result of pregnancy or childbirth – 1 in in Sweden – 1 in 6 in Afghanistan and Sierra Leone Maternal mortality ratio (# of maternal deaths/ live births) – US - 17 – Haiti – Malawi UNICEF, 2004

Maternal Mortality MM R 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

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 For the first time ever, no measles deaths were reported in 1999.

What can be done $1.20 Tetanus 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.