1. MCH Indicators

2. MCH status is assessed through:
Mortality indicators
Morbidity indicators
Growth and development.

3. Mortality indicators:
Maternal mortality rate
Mortality in infancy and childhood
Perinatal mortality rate
Neonatal mortality rate
Post-neonatal mortality rate
Infant mortality rate
1-4 years mortality rate
Under 5 mortality rate

4. Maternal Mortality Rate

5. Overview:
Africa has the highest maternal mortality rate in the world Experts
Only 42% of births in the African region are attended by skilled personnel.
African governments' health budgets are inadequate to deal with obstetric cases.

6. Overview: 13% of all maternal deaths occur in adolescents
The Millennium Development Goals call for a 75% reduction in maternal mortality by in the African Region within the next decade.

7. 49 million maternal disabilities in the region over the next 10 years
Overview:
If nothing is done to arrest the trend it is estimated that
2.5 million maternal deaths,
2.5 million child deaths and
49 million maternal disabilities in the region over the next 10 years
indicated that 70% of deliveries take place in the community where maternal and newborn births are usually not recorded.

8. Maternal mortality rate
Definition
The death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy ,from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

9. MMR= Total number of female death, due to
complication of pregnancy ,childbirth
or within 42 days of delivery
from puerperal causes in an area
during a given year
X1000
Total number of live births in the
same area and year

10. Other definitions Late maternal death
Death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy

11. Other definitions Pregnancy –related death:
Death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the cause of death

12. Classification of maternal death:
Direct obstetric deaths:
Deaths resulting from obstetric complications of the pregnant .
Indirect obstetric deaths:
Deaths resulting from previous existing disease or disease that developed during pregnancy and aggravated by physiologic effects of pregnancy

13. Causes of MM: Obstetric causes: Toxemias of pregnancy Hemorrhage
Infection
Obstructed labour
Abortion
Non –obstetric causes:
Anaemia
Associated diseases e.g cardiac, renal ,infectious
Malignancy
accidents

14. Social factors of MM: Age at child birth Parity
Shortage of health manpower
Delivery by untrained midwives
Poor environmental sanitation
Poor communications
Social customs…
Parity
Too close pregnancies
Family size
Malnutrition
Poverty
Illiteracy
Ignorance
Lack of maternity services

15. MM prevention: Early registration of pregnancy
Identification of high risk group
(risk approach)
At least 3 antenatal visits
Dietary supplementation
Prevention of infection and he
Prevention of complications
Treatment of medical conditions

16. MM prevention: Antimalarial prophylaxis in high transmission areas
Tetanus toxoid vaccination
Clean delivery practices
Delivery by trained midwives
Institutional deliveries for high risk group
Promotion of family planning
Identification of maternal deaths and searching the cause.
Socioeconomic development

17. Initiatives to reduce MM:
Two major initiatives launched in the past two decades :
1- The Safe Motherhood Initiative launched in 1987
drew attention to the multifaceted nature of the problem :
human rights,
empowerment of women,
education,
socio-economic development and
the improvement of health systems.

18. 2- The Making Pregnancy Safer Initiative, launched in 2000, focused on
The health sector and its crucial role in accelerating maternal maternity reduction.
Aim:
to ensure that women and their newborns have access to the care they need through
- the strengthening of health systems and
- appropriate community-level actions

19. Mortality In Infancy And Childhood

20. Mortality in infancy and childhood
Fetal death
Is death prior to the complete expulsion or extraction from its mother of a product of conception irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the foetus does not breathe or show any evidence of life such as beating of the heart ,pulsation of the umbilical cord or definite movement of the voluntary muscles.

21. Still birth rate= foetal deaths weighing over 1000 g at birth X1000
Total live+ still births
weighing over 1000g at birth

22. Perinatal mortality rate=
Late foetal deaths and
Early neonatal deaths
Weighing over 1000g
At birth X1000
Total Live births weighing over
1000g at birth

23. At - risk factors for PM:
Low socioeconomic status
High maternal age
Low maternal age
High parity
Heavy smoking
Short stature
Poor past obstetric history
Malnutrition
Multiple pregnancy.

24. Causes of PM: Anta natal causes Intranatal causes Postnatal causes
Unknown causes.

25. Interventions to reduce PM:
Birth spacing
Advice to mothers
Tetanus toxoid
Anaemia control
Early treatment of complications
Institutional delivery for high risk mothers
Good referral system
Clean delivery practices
Newborn care
Resuscitation of newborn.

26. Neonatal mortality rate:
Number of deaths of children
under 28 days of age in a year X1000
Total live births in the same year

27. Post neonatal mortality rate:
Number of deaths of children
between 28 days and one
year of age in a given year X1000
Total live births in the same year

28. Causes: Neonatal mortality: Endogenous factors Post-neonatal mortality
Exogenous causes

29. Infant mortality rate IMR= Number of deaths of children
less than one year of age in
an a year
X1000
Number of live births in the same year

30. What are the causes?

31. Medical causes of infant mortality:
1- neonatal mortality
LBW
Birth injury
Congenital anomalies
Hemolytic disease of newborn
Conditions of placenta and cord
Diarroheal diseases
ARI
tetanus

32. 2- post-neonatal mortality:
Diarrheal diseases
ARI
Communicable diseases
Malnutrition
Congenital anomalies
Accidents.

33. Factors affecting IM: 1-biological factors: Birth weight Age of mother
Birth order
Birth spacing
Multiple births
Family size
High fertility

34. other factors: 2- economic factors 3- cultural and social factors
breast feeding
customs
early marriage
quality of mothering
maternal education
quality of health care
broken families
illegitimate babies
untrained midwives
bad environmental sanitation.

35. measures to reduce IM: prenatal feeding prevention of infection
breast feeding
growth monitoring
family planning
sanitation
provision of PHC
socioeconomic development
education

36. child death rate (1-4 year mortality rate):
= number of deaths of
children aged 1-4 years
during a year
X1000
total number of children
aged 1-4 years at the middle
of the year

37. child mortality rate (under 5 mortality rate) =
number of deaths of children
less than 5years of age in
a given year
X1000
number of live births in the same year

38. Thank you