1. Primary health care Maternal and child health care MCH

2. Specific objectives At the end of the lecture you will be able to 1.Describe the demographic profile of Iraqi population by the use of population pyramid. 2.Describe the health profile in Iraq in relation to mothers and their children. 3.Identify the need for MCH services. 4.Define maternal death. 5.Enumerate causes of maternal death. 6.Define maternal mortality rate, ratio and lifetime risk of maternal death.

3. 7. Define PHC. 8. Enumerate components of PHC. 9. State the objectives and justification of providing MCH services.

4. Population Profile The population of Iraq during 2013 was estimated to be 35,000,000 with an urban:rural ratio of 67:33. Ninevah governorate: 3,335,200 The age distribution of the population in Iraq is typical of high fertility.

5. Population Profile The population is young as more than half are <20 years and about 5% are 60+. The proportion of infants to population 3.9% and that of the <5s is 16.9%. The proportion of < 15s is 44%. The proportion of women in childbearing age is 25%. consequently, 69% of Iraqi population is women in child bearing age and their children.

6. Population Profile The sex ratio is balanced at the younger age group. There is a sever male deficit in (40- 54). Specific marital status shows that women married younger than men.

8. Health Profile Maternal mortality ratio was 294 per 100,000 live births, in 2002. Maternal mortality ratio was 84 per 100,000 live births, in 2006. It was 24 per 100, 000 live births, in 2009. Became 26 per 100, 000 live births in 2011 And it dropped down to 20 per 100,000 live births in 2012 (Nineveh figure)

9. The health Profile for Iraq Abortion rate is 9.7 per 100 pregnancy (2006). Still birth is 0.9 per 100 pregnancy (2006). The estimated lifetime risk of maternal death for women in Iraq is 1 in 57*. *(Local survey)

10. Health Profile Almost 17% of women in child bearing age in Mosul have collective high fertility behaviors  66.44% of deliveries took place at hospitals (Ninevah governorate) in 2012  18% are attended by TBA and  39% by licensed midwives and nurse.  Only 43% of Mosuli women in child bearing age use contraceptive methods &  only 29% of them use the modern of contraception.

11. Health Profile for Iraq Child mortality rate (U5) It was 58.9 per 1000 live birth(2003-2005), it dropped to 29.5 per 1000 live births in 2009 and 22 per 1000 live births in 2010 and to 21.4 in 2012

12. Health Profile Infant mortality rate It was 42 per 1000 live birth(2003- 2005) and it dropped to 24 per 1000 live births in 2009, to be 19 in 2010. Neonatal mortality rate It was 23 per 1000 live births in 2006 Incidence of low birth weight is 6.5% in 2011 and 2012.

13. Why we need MCH services? Annually 200,000,000 women become preg. 15%need skilled obst.care 580,000 women develop fatal complications of preg. &childbirth Infants born alive 8,100.000 (die during the 1 st year) 4,000,000 (die during the 1 st month) 2,800,000(die during the 1 st week) Another 2,800,000 lost because of abortion &stillbirths 1 st -6 th wks after pregnancy

14. What is maternal death? It is the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of site or duration of pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes.

15. Direct obstetric deaths result from obstetric complications occurs during pregnancy, Labor, or at the post partum period.

16. Direct obstetric deaths They are usually due to one of five major causes:  Hemorrhages (usually post partum)  Sepsis  Eclampsia  Obstructed labour

17. Direct obstetric deaths  Complications of unsafe abortion  as well as intervention, omissions, incorrect treatment, or events resulting from any of these.

18. Indirect obstetric deaths Result from previously exiting diseases or from diseases arising during pregnancy (but without direct obstetric causes), which were aggravated by the physiological effects of pregnancy.

19. Pregnancy related death The death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. ICD10

20. Lecture question Define pregnancy related death as it was stated in the ICD-10.

21. More than 80 percent of maternal deaths worldwide are due to five direct causes :

22. Maternal Mortality Ratio Represents the risk associated with each pregnancy,i.e the obstetrical risk. It is the number of maternal deaths during a given year per 100,000 live births during the same period.Although the measure has traditionally been referred to as a rate it is actually a ratio.

23. Maternal Mortality Rate Measures both the obstetric risk &the frequency with which women exposed to this risk. It is the number of maternal deaths in a given period per 100 000 women of reproductive age (usually 15-49years).

24. Life Time Risk of Maternal Death Takes into account both the probability of becoming pregnant & the probability of dying as the result of the pregnancy cumulated across woman’s reproductive years. Maternal mortality rate х 35

25. Women’s risk of dying from pregnancy & childbirth Risk of dyingRegion 1 in 48All developing countries 1 in 16Africa 1 in 65Asia 1 in 1300Latin America &Caribbean 1 in 1800All developed countries 1 in 1400Europe 1 in 3700North America

26. Primary Health Care Is essential health care based on practical,scientifically sound &socially acceptable methods &technology,made universally accessible to individuals & families in the community through their full participation &at a cost the community &country can afford to maintain at every stage of their development in the spirit to self-reliance &self determination.

27. Main elements of PHC program 1.Health Education 2.Proper Nutrition 3.Immunization 4.Maternal & Child Health Care (MHC) &Family Planning (FP) 5.Provision of Safe Water Supply & Sanitation 6.Control of Endemic Diseases 7.Treatment of Common Diseases 8.Provision of Essential Drugs Promotion of Mental Health School Health Services

28. Justification to provide MCH services 1.Mothers & children form majority of the population in developing countries 2.Deaths of mothers & children is major determinant of mortality in developing countries 3.Many of health problems encountered by mothers & children are preventable.

29. Justification to provide MCH services 4. Stress of pregnancy, lactation, growth & development 5. Mother & children represent the least powerful sector of the community.

30. Objectives of MCH service  Every pregnant woman maintains good health, is prepared both physically & mentally to look after her child, goes through normal & safe delivery & bears healthy child.

31. Objectives of MCH service  Every child grows up in healthy surrounding receives proper nutrition & adequate protection of diseases.

32. Objectives of MCH service  Communicable diseases are controlled by taking adequate preventive measures & by health education.

33. Objectives of MCH service  All pregnancies are wanted & planned by couples who are in good physical, mental & socio–economic circumstances for rearing children.

34. Objectives of MCH service  Sickness is detected & treated before it becomes serious & chronic.

35. Conclusion MCH services is an important components of primary health care. It is essential since almost two thirds of the Iraqi population is formed from children and their mothers.