Health Services Research, Education, and Community Service in Reproductive Health and Perinatal Care - PowerPoint PPT Presentation

1 / 85
About This Presentation
Title:

Health Services Research, Education, and Community Service in Reproductive Health and Perinatal Care

Description:

... than 50% of the infant deaths annually occur during the ... Infant Care ... Infant Care. Interventions: Parenting Skill Education. Child Health Supervision ... – PowerPoint PPT presentation

Number of Views:346
Avg rating:3.0/5.0
Slides: 86
Provided by: rear
Category:

less

Transcript and Presenter's Notes

Title: Health Services Research, Education, and Community Service in Reproductive Health and Perinatal Care


1
World Health Organization
Collaborating Center in Reproductive Health
Emory University Woodruff Health Sciences Center
The National Centers for Disease Control and
Prevention (CDC) Georgia Department of Human Re
sources Division of Public Health
Alfred W. Brann, Jr., MD, Director
Woodruff Health Sciences Center
Emory University
Brian McCarthy, MD, Principal Investigator
The National Centers for Disease Control
and Prevention
2
Collaborating Center in Reproductive Health
Vision

Every woman should have the opportunity, if she
desires, to experience a wanted pregnancy that
results in a full-term normal baby, and following
childbirth that she is alive and healthy and her
infant is healthy and safe in the context of
family and community.
3
Womens Health
  • Education
  • Gender Issues
  • Religion
  • Culture/Society/Family

4
Womens Health
  • Political Stability
  • Economy/Financial Security
  • Health Care System
  • Government Structure

5
NEED
  • More than 50 of the infant deaths annually occur
    during the first week after birth.
  • This is largely a consequence of a poorly
    functioning health care delivery system that
    results in the poor health of women, and poorly
    managed pregnancies and births.

6
NEED
  • Knowledge and skills exist today that can reduce
    by some 50 the excessive rates of both maternal
    and infant mortality.
  • This is possible if there are appropriate
    attitudes and if there is a functioning modern
    maternal and perinatal health care delivery
    system.

7
Collaborating Center in Reproductive Health
Mission
to serve the people who serve the people...
by enabling health professionals in ministries of
health, departments of health, or universities to
build a foundation of sustainable knowledge and
skills in health services research through
education using a state or country-specific
health project at the level of the Health
District.
8
The Balashikha Project
  • MISSION
  • To dramatically improve U.S.-Russia relations
    through a public/private initiative addressing
    the most acute problem facing Russia its
    declining population
  • (V. Putin, 2001).

9
The Balashikha Project
  • WHY
  • Russias new births are not at replacement
    levels. Outmigration, decreasing adult lifespan
    (less than 59 years) and high infant mortality
    all contribute to its declining population.

10
The Balashikha Project
  • WHAT
  • Create a sustainable reduction in population
    decline by decreasing infant mortality by 50 in
    a significant sized health region in Russia.

11
The Balashikha Project
  • WHERE
  • City of Balashikha and the Moscow Oblast, Russia

12
The Balashikha Project
  • HOW
  • Establish a maternal and perinatal health care
    delivery system (using an internationally
    integrated set of health strategies) in the
    Moscow Oblast to significantly reduce infant
    mortality, and serve as a model for the Russian
    Federation.

13
Levels of the Health Care Delivery System (HCDS)
Informal
Skill Knowledge Attitude Resources Management
Manpower Materials Money
Formal
Inter- sectoral
14
The Balashikha Project
  • Components of a Maternal and Perinatal Health
    Care Delivery System
  • The Moscow Region Perinatal Center
  • Evidence-based Perinatal Guidelines
  • Modern Perinatal Surveillance System

15
The Balashikha Project
  • Components of a Maternal and Perinatal Health
    Care Delivery System
  • Continuous Quality Improvement Program
  • International Public Health Practice
  • Postgraduate Education-Distance Learning
  • Public Policy and Legal Assistance

16
The Balashikha Project
  • Microsoft Health Care
  • Application Software Vertical Health Initiatives
  • such as Word, Excel, etc. such as HIV/AIDS,
    Polio, etc.
  • Operating Systems Health Care Delivery
    System
  • on which all Application on which all
    Vertical Health
  • Software is placed Initiatives are placed.

17
The Balashikha Project
  • WHO
  • The following partners have brought about the
    Balashikha Project.

18
The Balashikha Project
  • WHO
  • Future of Russia Foundation (2,000,000 in seed
    capital)
  • Rotary Club of Atlanta (20,000)
  • Rotary Club of Stowe, VT (20,000)
  • Elfin Society of General Electric Company
    (estimated 2,000,000 in Russia)

19
The Balashikha Project
  • Moscow Oblast Ministry of Health (Governor
    Gromov committed 3,000,000)
  • USAID (500,000 Global Development Alliance)
  • World Health Organization Collaborating Center in
    Reproductive Health (intellectual capital)

20
The Balashikha Project
  • WHY SHOULD AMERICANS HELP RUSSIA?
  • Good health is a bedrock issue for building a
    democratic society and is essential for economic
    development.
  • Russia, with an educated and aspiring domestic
    workforce, can become one of our most important
    trading partners.
  • Russia is a strong ally of the U.S. in the war on
    terrorism.
  • Our support creates another level of mutual trust
    and respect.

21
The Balashikha Project
  • I think nothing our generation
  • could do is more important
  • than getting Russia into
  • the fold of successful countries,
  • and nothing worse could happen
  • than to lose it.
  • Dr. Howard Mette, Rotarian and CCI/PEP Volunteer,
    Youngstown, Ohio, 2000

22
(No Transcript)
23
NEED
  • The status of the health of the infant
  • is dependent on
  • the status of health of the woman and the
    pregnant woman.

24
NEED
  • The vast majority of men and women wish to have
    children.
  • All societies depend on their next generation for
    their survival, well being, success and social
    security.

25
NEED
  • Pregnancy and childbirth are the only normal
    physiologic processes associated with a risk of
    death.
  • Women (unlike men) are exposed to this risk of
    death during pregnancy and childbirth.

26
NEED
  • Finally, the health care system supporting
    pregnancy and childbirth is the one through
    which we must all pass, whether it is a good or
    bad system.

27
NEED
  • Problems in reproductive health affect many lives
    and families.
  • The morbidity and disability in both mother and
    child who receive suboptimal health care have
    devastating and permanent consequences.
  • These individual consequences further adversely
    impact society and its ability to not just
    survive but thrive.

28
Collaborating Center in Reproductive Health Focus
The CCRH addresses one of the four top health
problems facing the state of Georgia and the
World - the complex health problems of
reproductive-age women, pregnant women, and
infants during the perinatal period of life.
29
Health Services Research- The systematic study of
whether current medical and other relevant
knowledge is effectively used to improve the
health of a community under an existing set of
conditions.
30
DATA...
INFORMATION...
INTERVENTION
31
Interventions for Reducing Mortality
  • Womens and Maternal Health
  • Maternal and Fetal Care
  • Neonatal Care
  • Infant Care

32
The Opportunity Gap- The potential for
reduction in excessive mortality based on a
comparison between rates already achieved by one
sub-population in a defined geographical area
with those experienced by the remaining
population.
33
NEED
  • The problems leading to high rates of mortality
    and morbidity are not randomly distributed
    women who are economically and intellectually
    disadvantaged have, along with their infants, the
    highest mortality rates, regardless of whether
    they live in a third-world country or in
    third-world conditions in a developed country.

34
NEED
  • Any further significant reduction in infant
    mortality will need to focus on improving the
    health of the woman.
  • This will involve (1) changing the frequency of
    premature infant births, and (2) decreasing
    neonatal deaths, with a particular focus on the
    early neonatal period (1st week).

35
Georgias Six Perinatal Regions
Hospital Perinatal Center
36
Management - a process for planning,
implementing, and evaluating an organized
response to a defined problem.
37
Management Process
Performance Assessment
Problem Definition
Monitoring Evaluation
Intervention
Are we doing the right thing? Are we doing things
right?
38
The Management Cycle in Maternal and Child Health
Care
PROBLEM DEFINITION
A Standard
  • High Risk vs. Lower Risk
  • Problem Description
  • Identification of Risk Factors
  • Identification of High Risk Groups

39
The Management Cycle in Maternal and Child Health
Care
Performance Evaluation
Guidelines
  • Four Essential Questions to Be Asked
  • What is supposed to happen?
  • What do people think is happening?
  • What do people say is happening?
  • What is really happening?

40
The Management Cycle in Maternal and Child Health
Care
INTERVENTION
  • What are they doing? vs What should they do?
  • Coverage
  • Referral Pattern
  • Matching Skill
  • Altering Risk Factors
  • Training/Education
  • Planning/Policy
  • The five Rs
  • The right person
  • At the right place
  • At the right time
  • Doing the right thing
  • Doing it right

41
The Management Cycle in Maternal and Child Health
Care
MONITORING EVALUATION
A Standard
  • Evaluation Measurement Comparison
  • Outcome
  • Process
  • Community Education
  • Training
  • Use of Appropriate Technology

42
Surveillance- a dynamic process
which collects, analyzes, and responds to data on
the occurrence and distribution of events in a
defined population within a geographical area.
43
Data Surveillance System
System of Data Analysis
System of Data Collection
A - Adaptable R - Responsive C - Cost Effective
S - Simple
System of Response
44
You can not manage...
What you do not measure.
45
We are data rich
But information poor.
46
DATA...
INFORMATION...
INTERVENTION
47
Total Cohort Accountability
  • Every pregnancy counts
  • so account for every pregnancy.
  • Every newborn has weight
  • so weigh every newborn.

48
Perinatal Health Care Surveillance System
Integrated Management
Performance Assessment
Problem Definition
System of Data Analysis
System of Data Collection
A - Adaptable R - Responsive C - Cost Effective
S - Simple
System of Response
Intervention
Monitoring Evaluation
Are we doing the right things? Are we doing
things right?
49
Conceptual Framework for Action
Trigger Symbols
  • Model for the HCDS
  • Perinatal Surveillance Principles
  • Management Process

50
NEED
  • The World Bank (in a 1993 publication ?Investing
    in Health) described
  • GOOD HEALTH as essential for economic
    development throughout the world and made two
    major recommendations.

51
NEED
  • THESE ARE
  • To pursue policies to reduce poverty and expand
    education, especially for girls
  • To invest in the most cost-effective public
    health initiatives and essential clinical
    services. These are in the field of womens
    health during the reproductive years and in child
    health.

52
  • Spontaneous Experiences in Social Change
  • COSTA RICA
  • A senior general decided that a standing army was
    not needed and government funds were put into
    education and health.

53
  • Spontaneous Experiences in Social Change
  • CUBA
  • A revolution occurred with government funds and
    programs going to improve services and access to
    education, health care and social services.

54
  • Spontaneous Experiences in Social Change
  • Karela, INDIA
  • The state in India with the lowest infant
    mortality that has matriarchal passage of wealth
    and an intermittent elected communist government
    that has strongly facilitated literacy,
    accomplished land reform, and tolerated religious
    diversity.

55
  • Spontaneous Experiences in Social Change
  • ROMANEO
  • An Eastern Block Country that mandated that each
    woman have five children in order to have workers
    for economic development.

56
Reproductive HealthComparative Issues Around
the World
  • A.W. Brann, Jr., M.D.
  • World Health Organization Collaborating Center
  • in Reproductive Health
  • Atlanta, Georgia
  • Vanderbilt University
  • World Health Week 2005

57
NEED
  • Therefore, the health care system dealing with
    childbirth might naturally be viewed as a very
    important need a need of the highest priority.
  • Yet the following facts state otherwise

58
NEED
  • Women are the poorest, least educated, and least
    healthy segment (approximately one half) of the
    worlds population.
  • Women earn significantly less than men while
    working approximately 25 hours longer.

59
NEED
  • The literacy rate for women in developing
    countries is approximately 75 of the male rate.
  • Maternal mortality rates are unconscionably high
    over half a million (585,000) women die in
    childbirth each year.

60
Number of Feto-Infant Deaths Data Rich, Informati
on Poor
Total Deaths 3936
61
Perinatal Surveillance System
  • Foundation Birthweight by Age at Death
  • Action Interventions for Reducing Mortality
  • Opportunity Gap Excessive Mortality Rates

62
Number of Feto-Infant Deaths Data Rich, Informati
on Poor
Age at Death
Total Deaths 3936
Birth Weight
63
Birthweight and Age at Death
Late Fetal Death (28 wks)
Early Neontal Death (
Late Neonatal Death (7-27days)
Post Neonatal Death (28 days)
1
2
3
4
VVLBW (0-999gms)
5
6
7
8
VLBW (999-1499 gms)
9
10
12
11
IBW (1499-2499 gms)
13
14
15
16
NBW (2500 gms)
64
Perinatal Surveillance System
  • Foundation Birthweight by Age at Death
  • Action Interventions for Reducing Mortality
  • Opportunity Gap Excessive Mortality Rates

65
Interventions for Reducing Mortality
  • Womens and Maternal Health
  • Maternal and Fetal Care
  • Neonatal Care
  • Infant Care

66
Birthweight and Age at Death
Late Fetal Death (28 wks)
Early Neontal Death (
Late Neonatal Death (7-27days)
Post Neonatal Death (28 days)
W M Health 1
W M Health 2
W M Health 3
W M Health 4
VVLBW (0-999gms)
W M Health 5
W M Health 6
W M Health 7
W M Health 8
VLBW (999-1499 gms)
M F Care 9
Newborn Care 10
Infant Care 12
Newborn Care 11
IBW (1499-2499 gms)
M F Care 13
Newborn Care 14
Infant Care 15
Infant Care 16
NBW (2500 gms)
67
Summary of Perinatal Health Care Interventions
  • Family Planning
  • Nutrition
  • Micronutrients
  • STDs
  • Substance Abuse
  • Anticipatory Guidance
  • Preconception Care
  • Pregnancy Identification

Womens Maternal Health Interventions
Infant Care Interventions
  • Pregnancy Identification
  • Prenatal Surveillance Care
  • Anticipatory Guidance
  • Intrapartum Monitoring
  • ART for complications
  • Surgical Services
  • High Risk Maternal
  • Followup

Maternal Fetal Care Interventions
Newborn Care Interventions
  • Parenting Skill Education
  • Child Health Supervision
  • Breastfeeding/nutrition
  • Immunization
  • Growth/Development Monitoring
  • Anticipatory Guidance
  • A.R.I.
  • D.D.
  • Injury Control
  • ART for the At-Risk-Infant
  • Community Services
  • Clean Delivery
  • Resuscitation
  • Thermal Control
  • Breast Feeding
  • ART for the At-Risk-Infant
  • Baby Friendly Concept
  • Parenting Skill Education

68
Perinatal Surveillance System
  • Foundation Birthweight by Age at Death
  • Action Interventions for Reducing Mortality
  • Opportunity Gap Excessive Mortality Rates

69
The Opportunity Gap- The potential for
reduction in excessive mortality based on a
comparison between rates already achieved by one
sub-population in a defined geographical area
with those experienced by the remaining
population.
70
Planning for Change
1. Measure and Compare 2. Standard against which
to compare
71
Analysis of Sociodemographic Risks
Deaths per 1,000 live births
Death Rate
Excess Rate
Education
Sub-group
Age
White Group 1 20 13 years
5.7 .7 White Group 2
20 4.1 White Group 3 19 ears 13.3 8.3
Black Group 1 20 13 years
14.0 9.0 Black Group 2
20 14.0 Black Group 3 19 rs 19.6 14.6
72
Calculating The Opportunity Gap Excess Morta
lity
Excess Mortality BWPR
- BWPR
TARGET POPULATION
STANDARD
Birthweight Proportionate Rate (BWPR)
Number of deaths in a given weight group
Total Number of births in all weight groups
BWPR
x 1000
OR
Maternal Health of Deaths
( in cells)
x 1000
( in entire table)
73
Total Feto-Infant Deaths 3936
Excessive Feto-Infant Deaths 2314
74
Feto-Infant Mortality Rate White Group I, Atlanta
Region
2.1
0.8
0.9
1.2
Total 5.0
75
What do Current Data Show?
  • Gaps in fetal and infant mortality exist
    between
  • groups of women as defined by race age, level
    of
  • education and residence.
  • One in seven women (standard woman) 14
    5/1000
  • White, 20 yrs., 13 yrs. Education
  • Atlanta Perinatal Region (APR)
  • Six in seven women
    86 14.7/1000
  • Black (including college educated)
  • White(even the standard group living outside
    APR)

76
What do Current Data Show?
  • Excess fetal and infant death rates occur in all
    six perinatal regions, with the highest death
    rate in the Macon region followed by
    Albany, Savannah, Augusta, Columbus and
    Atlanta.
  • The standard woman has excess fetal and infant
    mortality when compared to the same woman who
    lives in Connecticut.

77
Areas of Concentration
Area
Potential for Improvement
LOW HIGH
WOMENS MATERNAL HEALTH
60 Maternal Fetal Care
10 Neonatal Intensive
Care 9
POSTNATAL CARE
21
  • All four areas contribute independently to
    affect infant mortality.
  • High-risk neonatal and maternal/fetal care has
    reduced infant deaths.
  • Low birth weight and preterm births are directly
    related to womens
  • health and account for 60 of preventable
    deaths.
  • Term infants who die after discharge account for
    21 of preventable deaths.
  • Womens maternal health and postnatal care are
    community issues.

78
Central Nervous System Morbidity
  • There has been an increase in the number of
    cases of cerebral palsy in children who were high
    risk neonates.
  • Infants less than 1000 gm. (from the Neonatal
    Research Network- NICHD) survive with significant
    handicapping conditions, including
  • Cerebral Palsy 17
  • Mental Retardation 50
  • Blindness / Hearing Loss 10
  • Learning Disabilities 50
  • The average cost of the INITIAL HOSPITALIZATION
    of a VLBW is 49,000.
  • The average cost for supporting an infant who
    survives with CEREBRAL PALSY is 500,000 over
    their lifetime.

1
2
3
4
79
VLBW Infants
  • 50 of Georgias infant mortality is from only
    2 of the births- 1500 gm.
  • We cannot identify the woman with a pregnancy
    that will end in her first
  • preterm birth.
  • The frequency of recurrence of a VLBW infant to
    a woman whose first
  • pregnancy ended with a VLBW infant is
  • - 8 for white women
  • - 13 for black women
  • - 2x for teenage girls
  • Of 2500 women who deliver VLBW infants
    (500-1500gm) each year
  • - 1700 are live births
  • - 800 are still births

80
Interconception Care
  • Child Spacing 18-24 months
  • Bonding with Infant
  • Treatment of Chronic Medical Conditions
  • Nutritional Assessment
  • Modify Adverse Lifestyle Practices
  • Treatment of STD
  • Intendedness of Pregnancy

81
Where in the World is Carmen Sandiego?
Birthweight Proportionate Mortality Rates
White Atlanta
Black Atlanta
Jiaxing
2.1
12.5
1.9
0.8
1.8
8.2
0.9
3.6
9.2
1.2
4.1
3.4
5.0
22.0
22.7
Cali
West Bank
Malawi
10.6
2.5
12.3
26.4
9.5
8.9
12.6
16.2
12.3
80.2
30.8
7.3e
43.8
55.4
131.2
82
Where in the World is Carmen Sandiego?
Birthweight Proportionate Mortality Rates
2.1
12.5
1.9
0.8
1.8
8.2
0.9
3.6
9.2
1.2
4.1
3.4
5.0
22.0
22.7
10.6
2.5
12.3
26.4
9.5
8.9
12.6
16.2
12.3
80.2
30.8
7.3e
43.8
55.4
131.2
83
Georgia Resident Births 1994-1998
Birth Weight 1500gm. or less
84
Number of Live Births less than 1500 gm.
by Census Tract 1994-1998 Georgia and Public Heal
th Districts
85
Number of Live Births less than 1500 gm.
by Census Tract Neighborhood view in Fulton Count
y
Write a Comment
User Comments (0)
About PowerShow.com