REDUCING MATERNAL AND NEWBORN DEATHS in Viet Nam

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REDUCING MATERNAL AND NEWBORN DEATHS in Viet Nam
Photo Theresa Shaver
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Presentation

• Magnitude of maternal and newborn mortality in
  Viet Nam
• Human and economic consequences
• Priority interventions
• Economic benefits of action

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Human Development Index
108 / 176 countries
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Socio-Economic Indicators

• Per capita income 377
• Allocation to health 5
• Access to potable water 52
• School attendance 91

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Characteristics of the Population

• Total Population 78 million
• Women of
  
  reproductive Age 21.2 million
• Total Fertility Rate 2.25

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Place of Delivery

• Health Facility
• 49.6 rural
• 90 urban

Photo Mary Kroeger
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Place of Delivery

• In certain mountainous and remote areas, over
  90 of women deliver at home

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Maternal mortality is the death of a woman
Year 2000 MMR estimate 95 / 100,000

• while pregnant
• during delivery
• or within 42 days after the end of
  pregnancy
• WHO, 1992

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Maternal Mortality Mountainous and Remote Areas

• 1991
• MMR estimate
• 418 / 100,000

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Causes of Maternal Death Viet Nam

• Source MCH/FP, 2000

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Emergency Obstetric Care

• Major causes of maternal mortality cannot be
  predicted but can be treated through emergency
  obstetric care (EmOC).
  (J.Smith, Columbia University,
  2001)
• Accessing these services in a timely manner is
  key the Three Delays model.

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The First Delay

• Lack of information about danger signs of
  pregnancy and labor
• Cultural customs among minorities
  delay care-seeking
• Family members, especially men, have an
  important role to play

53 delay in decision to seek care
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The Second Delay
Delays in reaching health facilities

• Poor roads
• Lack money
• No access to transport
• Lack awareness about danger signs

Photo Theresa Shaver
Delay in referral 60
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The Third Delay

• Delay between arriving and receiving quality care
  at the health facility

• Delay in treatment 63
• Wrong treatment 37
• Lack equipment 11
• Lack health staff 12
• Lack medicine 20 (Source MOH Survey 2000)

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• Nutritional factors
• contribute to
• maternal mortality
• and disabilities

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Severe Anemia

• 47 of maternal deaths in Viet Nam are due to
  hemorrhage
• Severe anemia is an underlying factor, making
  the consequences of hemorrhage more serious
• Iron and folate help to prevent anemia

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Micronutrient deficiencies
Cobalt
Zinc
Vitamin D
Riboflavin
Iodine
Thiamin
Vitamin E
Vitamin B6
Magnesium
Iron
Manganese
Selenium
Vitamin B12
Niacin
Folate
Vitamin A
Vitamin K
Phosphorus
Vitamin C
Cobalamin
Chromium
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Maternal iodine deficiency will lower the IQ of
infants and children (2001-2010)

• 45,000 children will suffer from
  cretinism
• 135,000 children will be severely
  retarded
• About 1 million children will be mildly to
  moderately affected

Permanent
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Maternal Care
Newborn Care

Newborn health and survival
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Perinatal and neonatal mortality
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Death in the First Year of Life Viet Nam, 2000
Infant Mortality 37
Neonatal Mortality 18
Source Viet Nam MCH/FP, 2000
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Perinatal and Neonatal Mortality Viet Nam, 2000
Late neonatal mortality
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Early neonatal mortality (deaths in first week)
12
Perinatal mortality 30 / 1000 total births
Stillbirths and late pregnancy losses
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Based on State of the Worlds Newborns 2001
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Causes of Neonatal Mortality
Other 5
Congenital anomalies 10
Prematurity 24
Sepsis, tetanus, other infections 32
Birth asphyxia and injuries 29
Source WHO, 2001
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Death rates vary by weight categories at birth
Birth weight Incidence Mortality lt 1500 g 1 - 3
50 - 80 1500 - 1999 g 1 - 8 20 - 30 2000
- 2499 g 4 - 34 5
13 of Vietnamese children are born weighing less
than 2500 g
Global information
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Photo Theresa Shaver
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Global Newborn Deaths from Asphyxia

• 1 infant dies
• 4 infants suffer long-
• term impairment

SourceSommerfelt,E.
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Infection

• Accounts for approximately 1/3 of neonatal
  deaths
• Infections can be prevented by
• TT immunization for pregnant women
• use of clean delivery practices equipment
• clean cord care
• immediate and exclusive breastfeeding

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To avert deaths from neonatal infection

• Families and health workers
• Early recognition of danger signs
• Families
• Knowledge of where to seek care
• Health workers
• Prompt and appropriate illness management

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Timely investments and interventions

Photo Mary Kroeger
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REDUCE/ALIVE Maternal and Newborn Health and
Survival Models
Data
Team Analysis
Newborn and maternal health linkages
Estimated benefits of interventions
Lives saved
Economic losses reduced
Disabilities prevented
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Data Sources

• Figures on Social Development, 2000
• Health statistics yearbook, 2000
• MCH/FP report, 2001
• UN World Population Prospects, revised 2000
• Global Burden of Disease, 1996-98 (WHO)
• Human Development Report, 2001
• Studies from research institutions in Viet Nam

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Photo Theresa Shaver
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Maternal Deaths over 10 Year Period
No change in level of intervention
12,000 maternal deaths
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Maternal Deaths due to Hemorrhage over
10 Year Period
No change in management of hemorrhage
5,700 maternal deaths
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Economic losses from maternal deaths
(2001-2010)
The loss of productivity due to all maternal
deaths will be about 14,000,000
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Economic losses from maternal deaths due to
hemorrhage (2001-2010)
The loss of productivity due to maternal deaths
caused by hemorrhage will be about 6,500,000
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Maternal Disabilities
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Maternal Disabilities

• 1 maternal death
• 20 - 40 maternal
• disabilities

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Maternal Disabilities (2001-2010)

• Chronic anemia (including anemia from hemorrhage)
• Stress incontinence
• Fistulae
• Uterine prolapse
• Emotional depression
• Maternal exhaustion

660,000,000 from lost productivity
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Newborn Deaths and Disabilities
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Neonatal Mortality2001-2010
No change in interventions for newborns
300,000 children will die
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Newborn Disabilities

• Mental retardation and cretinism due to IDD
• Mental retardation due to birth asphyxia and
  injury
• LBW can lead to lower IQ and chronic ill health
  in adulthood

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Commitment to Reducing Maternal and Newborn Deaths
Viet Nams Goal by 2010

• To reduce
• MMR from 95 to 70 / 100,000 live births
• IMR from 37 to 25 / 1,000 live births
• PNMR from 30 to 18 / 1,000 total births
• LBW from 13 to 6
• (Vietnams National Strategy on RH Care)

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Economic Gains2001-2010

• Interventions

198 million saved or gained
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Moving from Information to Action
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Priority Program Interventions

• To reduce maternal deaths and disabilities from
  hemorrhage
• Iron and folate supplementation
• Presumptive malaria treatment where
  appropriate
• Active management of the third stage of labor
• Access to EmOC including safe blood transfusion

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Priority Program Interventionsfor Newborns

• Every infant needs a
• skilled attendant who will
• ensure clean delivery practices
• ensure the baby is
• dried and wrapped immediately
• kept with the mother
• breastfed immediately

Photo Mary Kroeger
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Priority Program Interventionsfor Newborns

• appropriate resuscitation
  for asphyxiated babies
• early recognition prompt treatment
  of sick infants
• extra attention to low birth weight babies -
  Kangaroo Care
• iodized salt for mothers in high risk areas

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If we act now
2,000 womens lives saved
321,000 disabilities averted
52,000 childrens lives saved
198 million in productivity gains
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Photo Theresa Shaver
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Conditions Needed

• Strong political commitment to maternal and
  newborn survival
• Special focus on the newborn within the framework
  of existing safe motherhood program
• Appropriate investment for these interventions
• Implementation of
• functional health information system
• clearly defined supervision
• monitoring evaluation mechanisms

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• Vietnamese women and children have the right to
  health and life
  -------------------------
• They need quality maternal and newborn care and
  services

Photo Mary Kroeger
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Developed by MOH/Viet Nam, Save the
Children/Viet Nam, Saving Newborn Lives, NGO
Networks for Health, and Collaborating
Organizations with technical assistance
fromAcademy for Educational Development
(AED)ALIVE/REDUCE teamApril 2002
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The REDUCE / ALIVE Viet Nam Team

• 1. Dinh Thuan An MD MCH/FP - MOH
• 2. Duong Hai Ngoc MD MCH/FP - MOH
• 3. Nguyen Thi Thang Health Strategy and Policy
  Institute, MOH
• 4. Ha Anh Duc MD Cabinet Office, MOH
• 5. Le Ngoc Anh Hanoi Medical University
• 6. Vo Minh Tuan MD MPH HCMC University of
  Medicine
• 7. Huynh Thanh Hai MD Tu Du Hospital
• 8. Bui Thi Diep Vietnam Women's Union
• 9. Le Minh Thi MD School of Public Health
• 10. Nguyen Quang Phuong General Statistics Office
• 11. Nguyen Ngoc Thang Research Center for Rural
  Population and Health
• 12. Nguyen Thi Phuc MD SC/US
• 13. Nguyen Thi Huong MD Health Statistics
  Information Division, MOH
• 14. Nguyen Duc Tien MD Department of Treatment,
  MOH
• 15. Vu Ngoc Khanh MD MCH/FP, MOH
• 16. Pham Duc Duc MD MA Institute of Protection
  for Mothers Newborn
• 17. Vu Kim Hoa MD Vietnam CPCC
• 18. Dang Kim Khanh Ly Social Institute
• 19. Nguyen Bich Van MD Institute of Protection
  Child Health