MDG 5 and beyond using multiple methods/approaches to identify maternal deaths and the steps needed to prevent them: Lessons Learnt in LAC - PowerPoint PPT Presentation

Loading...

PPT – MDG 5 and beyond using multiple methods/approaches to identify maternal deaths and the steps needed to prevent them: Lessons Learnt in LAC PowerPoint presentation | free to download - id: 18129a-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

MDG 5 and beyond using multiple methods/approaches to identify maternal deaths and the steps needed to prevent them: Lessons Learnt in LAC

Description:

... of cause (accidental and co-incidental deaths excluded from MMR) late maternal deaths ... Accidental and co-incidental causes should be included as a priority ... – PowerPoint PPT presentation

Number of Views:76
Avg rating:3.0/5.0
Slides: 20
Provided by: cama8
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: MDG 5 and beyond using multiple methods/approaches to identify maternal deaths and the steps needed to prevent them: Lessons Learnt in LAC


1
MDG 5 and beyond using multiple
methods/approaches to identify maternal deaths
and the steps needed to prevent them Lessons
Learnt in LAC
  • London, 18-20 October, 2007
  • Dr Joaquín Guillermo Gómez-Dávila, MD, MHS, U. of
    Antioquia, Colombia
  • Dr. Jorge Cruz González, MD, MPH Ministry of
    Health, El Salvador
  • María Celia Hernandez, R.N. Ministry of Health,
    El Salvador
  • Dr. Affette McCawBinns, PhD, University of West
    Indies, Jamaica
  • Dr. Alma Virginia Camacho, MD, MPH, Maternal
    Mortality Reduction Regional Initiative, Advisor,
    PAHO/WHO

2
(No Transcript)
3
Socio-demographic Indicators
Country Population Area GDP (US)
Colombia - Antioquia - Medellín 42,090,502 5,724,492 2,246,190 1,141,814 Km2 63,612 Km2 382 Km2 1,810
El Salvador 6,237,662 20,221 Km2. 3,071
Jamaica 2,735,520 11,224 Km2 2,980
4
Reproductive health status
Country Contraceptive prevalence Total Fertility Rate ANC coverage Skilled attendance at birth
Colombia - Antioquia - Medellín 76.9 2.5 1.9 1.7 93.5 96.3 96.6 94.5
El Salvador 67.3 2.9 66 69
Jamaica 69.1 (Modern Methods 66.7) 2.4 96 95
5
Maternal and Infant Mortality 2003-2006
Maternal deaths X 100,000 l.b
IMR X 1000 l.b
6
The surveillance cycle
WHO, Beyond the Numbers, Figure 3.1
7
Maternal Mortality Surveillance System 3
selected countries
Country Maternal Mortality Surveillance System Coverage Primary Source Notifiable event Estimation of MMR and assessment of underreporting Type
Colombia/Antioquía 2006 100 Institutional notification SIVIGILA Death Cert Prospective
El Salvador 2005-2006 100 Death Certificate Institutional reporting Prospective
Jamaica Initiated in 1998 By 2003 84 of deaths reported 100 ( 20 hospitals) Institutional notification independent case verification Prospective with Retrospective verification
8
Countries/ methodology Identification of cases/Case definition Instruments for data collection Analysis Recommendations/ plan of action evaluation
Colombia/ Antioquia All deaths of women 10-50 years old during pregnancy and after 42 days of post partum irrespective of cause (accidental and incidental deaths are not included) Clinical Audit Verbal autopsy Individual case analysis Aggregated (Institutional and municipal Committees, and departamental) Based on findings Quality of care improvement model based on standards/audits Evidence based protocols in PPH and treatment of hemorrhage ( red code) developed
El Salvador All women 10-54 years old, including suicides and HIV/AIDS cases and late maternal deaths Filter form Social Questionnaire Clinical review CLAP form Verbal Autopsy Individual Aggregated Regional Committees and National Committee Birthing plan Educational materials for community health promoters Maternity waiting homes Midwifery training Up to date training for MD Strengthen referral systems
Jamaica All women 10-50 years (pregnancy ? 1 year post partum irrespective of cause (accidental and co-incidental deaths excluded from MMR) late maternal deaths Clinical audit Verbal autopsy (home visit to relatives) Post mortem Regional committees review cases, report to national committee independent retrospective case validation ? Access to referral care for high risk women Midwifery training Development of clinical guidelines for leading complications Addition of check box to medical certificates (2006)
9
El Salvador Analysis and findings
Source of preventable problems HDP HEM INF OTH Total
Within the community (Delays 1 or 2)          
Identification of pregnancy complications 13 5 3 2 23
No/inadequate prenatal care 6 1 0 0 7
No skilled birth attendant 1 9 0 0 10
Inadequate transport/limted access to health facility 4 6 1 0 11
Within health system (Delay 3)
Lack of confidence in the health care institutions 1 4 2 1 8
Inadequate management (pregnancy, labor, delivery, and postpartum care 2 8 4 6 20
Insufficient supplies (blood, drugs, equipment) 2 5 0 2 7
Inappropriate level of care 1 4 1 1 7
Weak coordination among the health care team (between doctors and health care facilities) 0 0 0 1 1
10
Antioquia/Colombia
  HDP HEM HEM INF PMC PMC OTH OTH Total
Community Community Community Community Community Community Community Community Community Community
Did not recognize risks 4 2 2 1 4 4 0 0 11
Cultural practices 0 1 1 0 4 4 0 0 5
Negative attitude towards family planning 1 7 7 1 2 2 0 0 11
Unfamiliar with rights to health care 0 1 1 3 3 3 1 1 8
Delayed decision making 1 0 0 2 2 2 0 0 5
Economic barriers accessing services 1 3 3 0 3 3 0 0 7
Road infrastructure 2 2 2 0 1 1 0 0 5
Health Systems Health Systems Health Systems Health Systems Health Systems Health Systems Health Systems Health Systems Health Systems Health Systems
Administrative barriers to health care services 1 1 3 0 4 2 2 10 10
Poor of quality of family planning services 1 1 3 3 7 1 1 15 15
Poor quality of obstetric care 2 2 8 0 5 0 0 15 15
Deficiencies in blood supply 3 3 13 3 0 0 0 19 19
Transport b/w institutions deficient 1 1 6 1 2 2 2 12 12
Inappropiate management and treatment 6 6 17 4 12 2 2 41 41
Inadequate coordination among the health team 2 2 8 2 6 2 2 20 20
11
Major findings
Countries Number of Maternal Deaths (42 days/late maternal deaths) MMR Estimates Under-reporting Direct Causes Indirect Causes Mode of termination of pregnancy Major Causes
Antioquia 59 59/100,000 (2006) 15 67.2 32.8 Hemorrhage Pre-eclampsia
El Salvador 100 71.2/100,000(2005-06) 42 50 32 53 C- Section 47 normal delivery Pre-eclampsia Hemorrhage Suicide
Jamaica 121 (2001-03) Late 14 (2001-03) 94.8/100,000 (2001-3) 16 65.8 (ratio) (69.4) 29.0 (ratio) (30.6) Undelivered 31 Vaginal delivery 40 C-section 15.5 Abortion 3.5 Other/NK 10 Pre-eclampsia Embolism Hemorrhage HIV/AIDS
12
Factors associated with non-reporting of maternal
deaths Jamaica 1998-2003
  • Region of residence
  • 2 regions whose maternal mortality surveillance
    systems not well developed
  • No one clearly responsible for case finding
  • No post mortem examination
  • Death in the first trimester
  • abortion, ectopic pregnancy
  • Increasing interval between delivery and death
  • Undelivered 1.00 (reference)
  • lt24 hours 0.67 (0.11-4.13)
  • 1-6 days 3.54 (1.08-11.57)
  • 7-41 days 6.05 (1.80-20.37)
  • 42-364 days 10.69 (3.04-37.63)

13
Lessons learned
  • The use of RAMOS methodology has allowed
    countries to better understand the underlying
    causes of maternal death
  • There is a need to include late maternal death
    into case definition
  • Use of multiple sources of information critical
    for case identification
  • Verbal autopsy has limitations when ascertaining
    indirect causes

14
Lessons learned (2)
  • The three countries have used the information and
    decision making processes have improved
  • International collaboration is key to
  • development of new methodologies
  • transfer of skills and competencies
  • Monitoring maternal deaths has increased the
    awareness of health care providers and policy
    makers
  • Jamaica Poor case ascertainment from death
    registration (only 26) ? addition (in 2006) of a
    check box to the medical certificate in an effort
    to improve the identification of maternal deaths
    from the death certificate (ELS and Colombia as
    well).
  • El Salvador active case identification
    increased maternal death reporting in 42
  • Involving civil registries in MMSS has been
    critical in system strengthening
  • Colombia/Antioquia
  • MMSS recognized as a public health function
  • Development of maternal morbidity surveillance
    system and quality assurance programs

15
Lessons learned (3)
  • Health teams have demonstrated a willingness to
    monitor and review their maternal deaths, but
    have indicated the need for
  • technical assistance in interpreting their
    findings
  • developing interventions to address the
    deficiencies identified
  • Some interventions have policy implications which
    require national leadership, e.g.
  • Budget allocation for effective interventions
  • Development of clinical guidelines/clinical
    training
  • Health promotion interventions
  • MMSS institutionalized

16
Lessons learned (4)
  • Preventing direct deaths
  • Still a challenge for health system strengthening
    e.g.
  • allocation and deployment of human resources 24/7
  • functioning of referral systems among others
  • enabling environment (drugs, blood, supplies)
  • access to health services (economic, cultural,
    geographic)
  • improvement of quality of care
  • strengthening/development of empowerment of
    individual families and communities strategies

17
Lessons learned (5)
  • Preventing indirect deaths new challenge
  • Multi-factorial etiology
  • (e.g. diet, exercise, sexual behavior)
  • Obstetric team needs to develop and test new
    strategies to better service women with chronic
    diseases who want children
  • Pre -conceptional care
  • Post partum care (many late deaths are indirect
    deaths)
  • Strengthening family planning programs
    (counseling and availability of FP methods) e.g.
    adolescent groups
  • Accidental and co-incidental causes should be
    included as a priority
  • violence is a public health problem in the 3
    countries

18
Summary
  • New challenges, (e.g. increasing indirect
    mortality), reinforces the need for active
    surveillance and dynamic problem solving to
    reduce womens risk of death associated with
    child bearing
  • Multi-source methods are needed to triangulate
    multiple streams of information on maternal
    health risks
  • Qualitative studies needed to support
    surveillance data to improve our understanding of
    the social challenges women face in accessing care

19
Summary
  • Surveillance systems have improved awareness
    among health teams, however they are only useful
    if we are empowered to act on our findings
  • Continued efforts are needed to develop evidence
    based methods to make pregnancy safer in Latin
    America and the Caribbean and the rest of the
    developing world
About PowerShow.com